C9orf72 poly(PR) mediated neurodegeneration is associated with nucleolar stress.

The ALS/FTD-linked intronic hexanucleotide repeat expansion in the C9orf72 gene is aberrantly translated in the sense and antisense directions into dipeptide repeat proteins, among which poly proline-arginine (PR) displays the most aggressive neurotoxicity in-vitro and in-vivo. PR partitions to the nucleus when heterologously expressed in neurons and other cell types. We show that by lessening the nuclear accumulation of PR, we can drastically reduce its neurotoxicity. PR strongly accumulates in the nucleolus, a nuclear structure critical in regulating the cell stress response. We determined that, in neurons, PR caused nucleolar stress and increased levels of the transcription factor p53. Downregulating p53 levels also prevented PR-mediated neurotoxicity both in in-vitro and in-vivo models. We investigated if PR could induce the senescence phenotype in neurons. However, we did not observe any indications of such an effect. Instead, we found evidence for the induction of programmed cell death via caspase-3 activation.

Unveiling the Impact of COVID-19 Vaccines: A Meta-Analysis of Survival Rates Among Patients in the United States Based on Vaccination Status.

The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a significant number of cases and deaths worldwide. Vaccination is the most effective preventive measure against the disease. This study aimed to assess the mortality rates of COVID-19 patients in the United States and the effectiveness of Pfizer (Pfizer, NY, USA), Moderna (Moderna, MA, USA), and Janssen (Johnson & Johnson, NJ, USA) vaccines in preventing mortality. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-2020) guidelines. Eligible studies reporting on the effectiveness of COVID-19 vaccines on patient outcomes were included. The search was performed in PubMed, Cochrane, and Google Scholar databases. The data were extracted, and risk ratios (RR) were calculated for mortality outcomes. The analysis was performed using Review Manager software, and bias assessments were conducted using the Joanna Briggs Institute (JBI) Meta-Analysis tools. A total of seven studies with 21,618,297 COVID-19 patients were included in the meta-analysis. The odds ratio (OR) for mortality among unvaccinated patients compared to vaccinated patients was 2.46 (95% CI: 1.71-3.53), indicating that unvaccinated patients were 2.46 times more likely to die from COVID-19. The findings of this study support the effectiveness of COVID-19 vaccination in reducing mortality among infected individuals. Unvaccinated patients had a significantly higher risk of mortality compared to vaccinated patients. Vaccination remains a crucial strategy to mitigate the severity of the disease and reduce mortality rates. Efforts should be made to address vaccine hesitancy and ensure widespread vaccine coverage.

Observation of the effect of gravity on the motion of antimatter.

Einstein's general theory of relativity from 19151 remains the most successful description of gravitation. From the 1919 solar eclipse2 to the observation of gravitational waves3, the theory has passed many crucial experimental tests. However, the evolving concepts of dark matter and dark energy illustrate that there is much to be learned about the gravitating content of the universe. Singularities in the general theory of relativity and the lack of a quantum theory of gravity suggest that our picture is incomplete. It is thus prudent to explore gravity in exotic physical systems. Antimatter was unknown to Einstein in 1915. Dirac's theory4 appeared in 1928; the positron was observed5 in 1932. There has since been much speculation about gravity and antimatter. The theoretical consensus is that any laboratory mass must be attracted6 by the Earth, although some authors have considered the cosmological consequences if antimatter should be repelled by matter7-10. In the general theory of relativity, the weak equivalence principle (WEP) requires that all masses react identically to gravity, independent of their internal structure. Here we show that antihydrogen atoms, released from magnetic confinement in the ALPHA-g apparatus, behave in a way consistent with gravitational attraction to the Earth. Repulsive 'antigravity' is ruled out in this case. This experiment paves the way for precision studies of the magnitude of the gravitational acceleration between anti-atoms and the Earth to test the WEP.

Stability and Cooling of the C_{7}

We have studied the stability of the smallest long-lived all carbon molecular dianion (C_{7}^{2-}) in new time domains and with a single ion at a time using a cryogenic electrostatic ion-beam storage ring. We observe spontaneous electron emission from internally excited dianions on millisecond timescales and monitor the survival of single colder C_{7}^{2-} molecules on much longer timescales. We find that their intrinsic lifetime exceeds several minutes-6 orders of magnitude longer than established from earlier experiments on C_{7}^{2-}. This is consistent with our calculations of vertical electron detachment energies predicting one inherently stable isomer and one isomer which is stable or effectively stable behind a large Coulomb barrier for C_{7}^{2-}→C_{7}^{-}+e^{-} separation.

A Meta-Analysis To Ascertain the Effectiveness of COVID-19 Vaccines on Clinical Outcomes in Patients With COVID-19 Infection in North America.

The challenges in controlling the pandemic have been exacerbated by the disease's morbidity and the emergence of additional COVID-19 variants. The use of emergency vaccines to circumvent these challenges has sparked mixed opinions on their effectiveness. Therefore, we conducted a meta-analysis to assess the efficacy of COVID-19 vaccines on clinical outcomes such as incidence, hospitalization, and ventilation rates in both vaccinated and unvaccinated patients. PubMed, Google Scholar, and Cochrane Central Register of Clinical Trials were searched on April 21, 2022, to extract published articles comparing vaccinated COVID-19 patients versus unvaccinated COVID-19 patients and their clinical outcomes. The clinical outcomes studied were incidence rate, intensive care unit (ICU) admission, mechanical ventilation, and hospitalization rates. The analysis was performed with Review Manager (RevMan) software. Random-effect models were used to calculate pooled odds ratio and corresponding 95% confidence interval (CI). In our meta-analysis, we have identified a total of 250 published findings, encompassing 15 studies that involved a cumulative count of 24,164,227 individuals diagnosed with COVID-19. Being unvaccinated had a significant association with severe clinical outcomes in patients infected with COVID-19. Unvaccinated individuals were 2.36 times more likely to be infected, with a 95% CI ranging from 1.13 to 4.94 (p = 0.02). Unvaccinated subjects with COVID-19 infection were 6.93 times more likely to be admitted to the ICU than their vaccinated counterparts, with a 95% CI ranging from 3.57 to 13.46 (p < 0.0001). The hospitalization rate was 3.37 higher among the unvaccinated compared to those vaccinated, with a 95% CI ranging from 1.92 to 5.93 (p < 0.0001). In addition, patients with COVID-19 infection who are unvaccinated were 6.44 times more likely to be mechanically ventilated than those vaccinated, with a 95% CI ranging from 3.13 to 13.23 (p < 0.0001). Overall, our study revealed that vaccination against COVID-19 disease is beneficial and effective in mitigating the spread of the infection and associated clinical outcomes. However, more awareness and proper education must be made to increase vaccine acceptance. We, therefore, recommend and urge all stakeholders involved in COVID-19 prevention, management, and control to strengthen awareness and educate the people on the effectiveness of COVID-19 vaccination.

C9orf72 poly(PR) mediated neurodegeneration is associated with nucleolar stress.

The ALS/FTD-linked intronic hexanucleotide repeat expansion in the C9orf72 gene is translated into dipeptide repeat proteins, among which poly-proline-arginine (PR) displays the most aggressive neurotoxicity in-vitro and in-vivo . PR partitions to the nucleus when expressed in neurons and other cell types. Using drosophila and primary rat cortical neurons as model systems, we show that by lessening the nuclear accumulation of PR, we can drastically reduce its neurotoxicity. PR accumulates in the nucleolus, a site of ribosome biogenesis that regulates the cell stress response. We examined the effect of nucleolar PR accumulation and its impact on nucleolar function and determined that PR caused nucleolar stress and increased levels of the transcription factor p53. Downregulating p53 levels, either genetically or by increasing its degradation, also prevented PR-mediated neurotoxic phenotypes both in in-vitro and in-vivo models. We also investigated whether PR could cause the senescence phenotype in neurons but observed none. Instead, we found induction of apoptosis via caspase-3 activation. In summary, we uncovered the central role of nucleolar dysfunction upon PR expression in the context of C9-ALS/FTD.

Partner bereavement when parenting dependent children: What factors influence adjustment?

Little is known about those who are widowed while raising dependent children. This study aimed to explore the factors which influence adjustment to partner death. Seven fathers and five mothers were interviewed, and constructivist grounded theory was used. Three interrelated themes were identified: Interpersonal influences, Intrapersonal influences, and Contextual influences. Dependent children meant sole responsibility and increased demands, yet ultimately provided widowed parents a purpose. Participants highlighted the need for increased awareness of young widowhood at a systemic and cultural level, to improve communication around death and young widowhood. Implications included social, financial and therapeutic interventions.

Reviewing fair subject selection considerations for the unique case of post sequelae COVID-19 translational studies.

Fair inclusion of research subjects is necessary to ensure that post-acute sequelae COVID-19 (PASC) research results benefit all members of society. Scientists should conduct research on a broad sample of individuals who represent clinically relevant factors influencing a disease. Without demographic diversity and sociological and environmental variability, research outputs are less likely to apply to different populations and would thus increase health disparities. The goal of this narrative literature review and ethical analysis is to apply fair selection criteria to PASC research studies. We briefly highlight the importance of fair subject selection in translational research and then identify features of PASC, as well as PASC research, that hinder fair inclusion of research participants. We will demonstrate that determining an adequate and representative sample is not simply a matter of ensuring greater diversity; rather, fairness requires a broader evaluation of risks, burdens, and benefits specific to underrepresented populations. We provide recommendations to ensure fair subject selection in PASC research and promote translation toward positive health outcomes for all individuals, including the most vulnerable.

Model-based evaluation of the COVID-19 epidemiological impact on international visitors during Expo 2020.

The impact of the COVID-19 pandemic on large events has been substantial. In this work, an evaluation of the potential impact of international arrivals due to Expo 2020 in terms of potential COVID-19 infections from October 1st, 2021, until the end of April 2022 in the United Arab Emirates is presented. Our simulation results indicate that: (i) the vaccination status of the visitors appears to have a small impact on cases, this is expected as the small numbers of temporary visitors with respect to the total population contribute little to the herd immunity status; and (ii) the number of infected arrivals is the major factor of impact potentially causing a surge in cases countrywide with the subsequent hospitalisations and fatalities. These results indicate that the prevention of infected arrivals should take all precedence priority to mitigate the impact of international visitors with their vaccination status being of less relevance.

Ray Amputation in a Traumatic Diabetic Foot.

Diabetic foot is a complex syndrome that is co-morbid with other diabetic complications such as peripheral arterial disease (PAD) and peripheral neuropathy. Patients with the diabetic foot are increasingly prone to diabetic foot ulcers (DFUs) due to a high infection susceptibility and poor wound healing possibly prompting the need for minor or major amputations. We herein highlight the case of a 47-year-old male with a traumatic diabetic foot who necessitated a Ray amputation (RA). The notable aspects of this case are the late presentation of a patient with uncontrolled diabetes who could have avoided this complication if he went to seek help earlier and how diabetic foot is controlled and managed in a low-income resource setting. This case also highlights how physicians can better diagnose and treat diabetic foot complications with a scoring metric.

A retrospective analysis comparing set up errors from standard versus customised headrests for head and neck radiotherapy.

INTRODUCTION: In response to advice from The National Institute for Health and Care Excellence (1) to reduce hospital visits during COVID-19, standard headrests were introduced for head and neck radiotherapy within Northern Centre for Cancer Care (NCCC). The standard headrest requires one mould room appointment compared to 3 appointments with customised headrests. METHODS: Two groups of 10 patients treated between December 2019 and June 2020 were retrospectively analysed by 1 observer. Groups were stratified according to age, sex and tumour site. One group had customised headrest and the other had standard headrest. Five hundred and forty seven cone beam computed tomography images were reviewed. A 6 Degree of Freedom match was performed then chin, shoulder and spine position were assessed using dosimetrist drawn structures. Structures out of the tolerance were recorded. A chi-squared test was used for statistical analysis. RESULTS: The out of tolerance chin position count recorded was 21 for customised headrest and 36 for standard headrest, p-value 0.046. The shoulder position count was 13 for customised headrest and 77 for standard headrest p-value <0.001. The spine position count was 3 for CHR and 21 for standard headrest, p-value <0.001. This means the headrests compared are not equivalent in terms of set up reproducibility. Overall the standard headrest group had 10 set-up re-scans and no set up re-scans were recorded in the customised headrest group. CONCLUSION: Fewer hospital visits with SHR reduce patient exposure to COVID-19. However, CHR provided a more reliable level of immobilisation in this study. IMPLICATIONS FOR PRACTICE: The radiotherapy service will be reviewed in line with these findings.

Reimagining IRB review to incorporate a clear and convincing standard of evidence.

This commentary is a critical response to the article written by David Resnik regarding the use of a standard of evidence for Institutional Review Board (IRB) decision making. Resnik suggests that IRBs should not only base decisions on evidence, but that this evidence should be sufficient to ensure a "clear and convincing" standard similar to that used by juries for legal proceedings. We agree that the increased use of evidence to meet this standard would be ideal since this provides clear guidance and could allow for a more transparent IRB review. However, to effectively meet this standard, significant modification would be required for researchers as well as for IRBs' processes. First, researchers would be required to identify, understand and include appropriate scientific and ethics evidence in support of their protocol. IRB members and IRB professionals would need to discuss the importance, value, and significance of evidence in order to come to a collective decision regarding each protocol. Such responsibilities are justifiable and could bring much needed rigor and transparency to the system but they would require time, training, research, and education. While Resnik's suggestion seems to incorporate a small change with respect to a standard, in application it would actually require a novel system.

Anatomic Neuroimaging Characteristics of Posterior Fossa Type A Ependymoma Subgroups.

BACKGROUND AND PURPOSE: Posterior fossa type A (PFA) ependymomas have 2 molecular subgroups (PFA-1 and PFA-2) and 9 subtypes. Gene expression profiling suggests that PFA-1 and PFA-2 tumors have distinct developmental origins at different rostrocaudal levels of the brainstem. We, therefore, tested the hypothesis that PFA-1 and PFA-2 ependymomas have different anatomic MR imaging characteristics at presentation. MATERIALS AND METHODS: Two neuroradiologists reviewed the preoperative MR imaging examinations of 122 patients with PFA ependymomas and identified several anatomic characteristics, including extension through the fourth ventricular foramina and encasement of major arteries and tumor type (midfloor, roof, or lateral). Deoxyribonucleic acid methylation profiling assigned ependymomas to PFA-1 or PFA-2. Information on PFA subtype from an earlier study was also available for a subset of tumors. Associations between imaging variables and subgroup or subtype were evaluated. RESULTS: No anatomic imaging variable was significantly associated with the PFA subgroup, but 5 PFA-2c subtype ependymomas in the cohort had a more circumscribed appearance and showed less tendency to extend through the fourth ventricular foramina or encase blood vessels, compared with other PFA subtypes. CONCLUSIONS: PFA-1 and PFA-2 ependymomas did not have different anatomic MR imaging characteristics, and these results do not support the hypothesis that they have distinct anatomic origins. PFA-2c ependymomas appear to have a more anatomically circumscribed MR imaging appearance than the other PFA subtypes; however, this needs to be confirmed in a larger study.

Reflection on the proposed changes to dose quantities-an industrial perspective.

In 2021, the ICRP initiated the revision of the general recommendations of the system of radiation protection, and part of it will focus on dose quantities. The recently published ICRP Publication 147 and ICRU Report 95 have described the extent of the proposed modifications and paved the way for the strategy to be adopted. These revisions would seek to simplify, improve the accuracy and extend the field of use of dose quantities. While the Radiological Protection Working Group of the World Nuclear Association recognises the notable improvement in the estimation of the protection quantities and the usefulness of such changes for the medical and research sector, the benefits of the proposed new system seem very limited for the nuclear industry and industries involving naturally occurring radioactive materials. The complexity associated with changing a long-standing and robust system and the risk incurred by the human factor seem unjustified, bearing in mind the likely cost.

Implementation of child mental health service improvement plans in four low- and middle-income countries: stakeholders' perspectives.

Children in low- and middle-income countries (LMIC) have high levels of unmet mental health needs, especially in disadvantaged communities. To address this gap, we developed a child mental health service improvement programme. This was co-facilitated using interprofessional principles and values in four countries, South Africa, Kenya, Turkey and Brazil. Eighteen stakeholders from different professions were interviewed after six months on their perspectives on enabling factors and challenges they faced in implementing service plans. Participants valued the holistic case management approach and scaled service model that underpinned the service plans. Emerging themes on participants' priorities related to service user participation, integrated care, and different levels of capacity-building. We propose that an integrated care model in LMIC contexts can maximize available resources, engage families and mobilize communities. Implementation requires concurrent actions at micro-, meso- and macro-level.

Developing Healthcare Team Observations for Patient Safety (HTOPS): senior medical students capture everyday clinical moments.

BACKGROUND: Aviation has used a real-time observation method to advance anonymised feedback to the front-line and improve safe practice. Using an experiential learning method, this pilot study aimed to develop an observation-based real-time learning tool for final-year medical students with potential wider use in clinical practice. METHODS: Using participatory action research, we collected data on medical students' observations of real-time clinical practice. The observation data was analysed thematically and shared with a steering group of experts to agree a framework for recording observations. A sample of students (observers) and front-line clinical staff (observed) completed one-to-one interviews on their experiences. The interviews were analysed using thematic analysis. RESULTS: Thirty-seven medical students identified 917 issues in wards, theatres and clinics in an acute hospital trust. These issues were grouped into the themes of human influences, work environment and systems. Aviation approaches were adapted to develop an app capable of recording real-time positive and negative clinical incidents. Five students and eleven clinical staff were interviewed and shared their views on the value of a process that helped them learn and has the potential to advance the quality of practice. Concerns were shared about how the observational process is managed. CONCLUSION: The study developed an app (Healthcare Team Observations for Patient Safety-HTOPS), for recording good and poor clinical individual and team behaviour in acute-care practice. The process advanced medical student learning about patient safety. The tool can identify the totality of patient safety practice and illuminate strength and weakness. HTOPS offers the opportunity for collective ownership of safety concerns without blame and has been positively received by all stakeholders. The next steps will further refine the app for use in all clinical areas for capturing light noise.

Reflections on low-dose radiation, the misconceptions, reality and moving forward.

Low dose radiation has been widely accepted by the radiation protection community as presenting a very low risk to human health, if any. Over-conservatism in optimisation principles and regulations have resulted in a disproportionate fear of radiation amongst the general public and government authorities alike, overlooking the great benefits nuclear science and techniques have brought to society as a whole. As such, the World Nuclear Association advocates for a recontextualisation of the radiation hazards with regards to low dose radiation, and a greater awareness as to the absence of any discernible effects associated with it.

Planes, políticas públicas y estrategias de salud bucal en Latinoamérica y el Caribe (1991-2018) / Plans, public policies and strategies of oral health in Latin America and Caribbean (1991-2018)

Introducción: La identificación de políticas públicas y estrategias en salud bucal, así como lo relacionado con sus propósitos, acciones y limitaciones, es un paso importante en la acción intersectorial en salud para alcanzar equidad. Objetivo: Describir las características principales de los documentos relacionados con planes, políticas y estrategias en salud bucal en Latinoamérica y el Caribe. Métodos: Estudio exploratorio mediante el análisis documental de fuentes secundarias de información disponibles en las páginas web de los ministerios de salud de 23 países, y rastreo sistemático en el buscador Google, sin restricción espacio-temporal. Se realizó análisis de contenido cuantitativo y cualitativo. Resultados: Se analizaron 85 documentos. Los países con mayor número de documentos relacionados con el tema propuesto fueron Colombia (n = 14), México (n = 8) y Panamá (n = 7). Una buena parte centran su atención en poblaciones específicas; por ejemplo: gestantes, comunidades vulnerables, escolares, maestros, entre otras. Tienen como propósito la disminución de factores de riesgo para las principales enfermedades bucales, desde enfoques relacionados con los determinantes sociales. El enfoque de género es más tímido y centra su atención en necesidades especiales de las mujeres en embarazo, parto y posparto. Los objetivos de la mayoría de los documentos analizados consistían en una atención integral sobre el estado de salud bucodental, mediante acciones de educación, promoción y actividades clínicas a la población, según sus necesidades. Conclusiones: Se encontró una representación importante de países que tienen documentos relacionados con programas y planes nacionales o locales y con indicadores que reflejan su cumplimiento. También existen guías prácticas de actuación. Aunque en el diseño y construcción de los documentos intervienen profesionales, sobre todo de la estomatología, falta la participación de otras áreas del conocimiento que ayudarían a lograr una visión más amplia hacia la determinación social de la salud(AU)

Introduction: The identification of public policies and strategies in oral health, as well as its purposes, actions and limitations is an important step in intersectoral action in health to achieve equity. Objective: To describe the main characteristics of the documents related to oral health plans, policies and strategies in Latin America en the Caribbean. Methods: An exploratory study was conducted by means of documentary analysis of secondary sources of information available on the websites of the ministries of health of 23 countries, and systematic search in the Google, without spatio-temporal restriction. Quantitative and qualitative content analysis was performed. Results: 85 documents were analyzed. The countries with the highest number of documents related to the research topic were Colombia (n = 14), Mexico (n = 8) and Panama (n = 7). A good part is focused on specific populations, such as pregnant women, socially vulnerable communities, school children, teachers, among others. Their purpose is to reduce risk factors for the main oral diseases, making important advances in approaches related to social determinants. However, the gender approach is more timid by focusing attention on the oral health special needs of women in pregnancy, childbirth and postpartum. The main objectives of most of the documents analyzed consisted of an integral attention on the state of oral health, applying education, promotion and clinical activities to the population, according to their needs. Conclusions: An important representation of countries with documents related to national or local programs and plans were found and they have indicators that reflect their compliance. Also practical action guides were described. Although many professionals, especially in dentistry, intervene in the design and construction of documents, the participation of other areas of knowledge is lacking, what will help to achieve a broader vision towards the social determination of health(AU)

An essential model for leaders to enable integrated working to flourish: a qualitative study examining leaders of Children's Centers.

Today's era of integrated working seeks to bring together different professionals to work in patient-centered teams. As a result leadership perspectives have changed. We now seek leaders who recognize the complexity of moderating across different health, social care and other public and private sector organizations for collective patient/community focussed service. This research focuses on the role of leaders in the UK who were asked to lead a range of practitioners working from Children's Centers. These centers brought together a myriad of practitioners from health, social care, and education to meet the needs of children from wide and diverse backgrounds. We share a qualitative study, exploring the experiences of Children's Center leaders, using critical theory and constructivism. The study explored how leaders enable integrated working to flourish. The research was conducted in two stages: In Stage One, five strategic Children's Center managers were interviewed to illuminate the key ingredients felt to support good leaders. Stage Two brought together 10 Children's Center leaders from across different areas of the UK, to share their experiences using Participatory Action Research. The final synthesis identified four main processes which could help leaders to enable integrated working to flourish. These were: i) Thinking Systematically; ii) Building and re-building relationships; ii) Nourishing self-actualization and; iv) Utilizing alternative approaches to problem solving. Four borderline processes were identified: Interaction, Integrity, Flow and Sensitivity. The final model articulates the skills required to lead integrated services which bring together a wide range of practitioners. The outcomes help leaders to explore new ways of leading and require further testing. The outcomes may apply to other clinical areas of integrated working.

A comparison of gastric gas volumes measured by computed tomography after high-flow nasal oxygen therapy or conventional facemask ventilation.

High-flow nasal oxygen therapy is increasingly used to improve peri-intubation oxygenation. However, it is unknown whether it may cause or exacerbate insufflation of gas into the stomach. High-flow nasal oxygen therapy is now standard practice in our hospital for adult patients undergoing percutaneous thermal ablation of liver cancer under general anaesthesia with tracheal intubation. We compared gastric gas volumes measured from computed tomography images that had been acquired immediately after intubation in two series of patients: 50 received peri-intubation high-flow nasal oxygen therapy and another 50 received conventional facemask pre-oxygenation and ventilation before intubation and before high-flow nasal oxygen therapy became standard practice in our unit. Median (IQR [range]) gastric gas volume was 24.0 (14.2-59.9 [3-167]) cm3 in the high-flow nasal oxygen therapy group and 23.8 (12.6-38.8 [0-185]) cm3 in the facemask group. There was no difference between the two groups in the volume of gastric gas measured by computed tomography imaging (Mann-Whitney U-test, U = 1136, p = 0.432, n1  = n2  = 50). Our results demonstrate that a small volume of gastric gas is commonly present after induction of anaesthesia, but that the use of peri-intubation high-flow nasal oxygen therapy for pre-oxygenation and during apnoea does not increase this volume compared with conventional facemask pre-oxygenation and ventilation. This is clinically relevant, as high-flow nasal oxygen therapy is increasingly being used in a peri-intubation context and in patients at higher risk of aspiration.