Nasal versus oronasal mask in home mechanical ventilation: the preference of patients as a strategy for choosing the interface.

INTRODUCTION: In home mechanical ventilation (HMV), the mask is a key factor for patient comfort and therapeutic adherence. There is no evidence on the best strategy for choosing the mask in HMV. OBJECTIVE: To explore patient preference when prescribing the mask for HMV treatment and assess its relationship with effectiveness. METHODS: A prospective study with repeated measures in stable patients receiving home nocturnal ventilation. Alternating oronasal mask (ONM) and nasal mask (NM) were tested in day and overnight sessions, with arterial blood gas measured and S(pO(2)) monitored. At the end of each evening session, patients rated interface comfort using a visual analog scale. At 3 months we evaluated adherence and effectiveness of the treatment. RESULTS: Twenty-nine subjects (mean ± SD age 65 ± 13 y, 44% male) completed the study. Initial functional values were P(CO(2)) 57.4 ± 5.2 mm Hg and time with S(pO(2)) < 90% (T90) 81.5 ± 9.5%. Both ONM and NM significantly decreased P(CO(2)) and T90. Over a third (38%) of our subjects preferred ONM, while NM was deemed more comfortable in general. At 3 months, effectiveness and adherence showed no differences between those treated with NM or ONM. CONCLUSIONS: Patient choice is an effective criterion for selecting the interface in HMV treatment.

Assembling the Dead, Gathering the Living: Radiocarbon Dating and Bayesian Modelling for Copper Age Valencina de la Concepción (Seville, Spain).

The great site of Valencina de la Concepción, near Seville in the lower Guadalquivir valley of southwest Spain, is presented in the context of debate about the nature of Copper Age society in southern Iberia as a whole. Many aspects of the layout, use, character and development of Valencina remain unclear, just as there are major unresolved questions about the kind of society represented there and in southern Iberia, from the late fourth to the late third millennium cal BC. This paper discusses 178 radiocarbon dates, from 17 excavated sectors within the c. 450 ha site, making it the best dated in later Iberian prehistory as a whole. Dates are modelled in a Bayesian statistical framework. The resulting formal date estimates provide the basis for both a new epistemological approach to the site and a much more detailed narrative of its development than previously available. Beginning in the 32nd century cal BC, a long-lasting tradition of simple, mainly collective and often successive burial was established at the site. Mud-vaulted tholoi appear to belong to the 29th or 28th centuries cal BC; large stone-vaulted tholoi such as La Pastora appear to date later in the sequence. There is plenty of evidence for a wide range of other activity, but no clear sign of permanent, large-scale residence or public buildings or spaces. Results in general support a model of increasingly competitive but ultimately unstable social relations, through various phases of emergence, social competition, display and hierarchisation, and eventual decline, over a period of c. 900 years.