Browsing by Subject "Respiratory Tract Diseases"
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Item A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas(2007-05-01) Miller, Thaddeus L.; Scott McNabb; Peter Hilsenrath; Jotam PasipanodyaMiller, Thaddeus L. A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas. Doctor of Public Health (Health Management and Policy), May 2007, 232 pp., 29 tables, 2 illustrations, bibliography, 274 titles. Tuberculosis cost has been incompletely described as the cost arising from acute illness and treatment. The societal cost of tuberculosis arises from infection, suspicion of infection, acute and preventive responses, the sequalae of illness (including acute morbidity, drug induced hepatitis, mortality, and disability), and the compounding effects of transmission. This societal cost in unknown however the variable portion of this cost is equivalent to the savings made possible by averting tuberculosis, This study measured the societal cost of tuberculosis in Tarrant County, Texas, for the year 2002. Societal costs were estimated as the sum of known or estimated expenditures and health losses related to tuberculosis and discounted at 3%. Current and future costs will accrue to an estimated net $33.9 2002 USD million for the year 2002 in Tarrant County, Texas. An average of 1.4 QALYs net of 3% social discount were lost per incident case. The greatest burdens of tuberculosis, when analyzed by either cost or health quality, can be averted only by case prevention. Forty-three and 44% of societal cost was generate by secondary transmission and chronic impairment associated with pulmonary tuberculosis. Neither factor is routinely considered in discussions of tuberculosis cost. Acute treatment, hospitalization and direct medical care account for only 2.4% of societal cost. Any intervention that prevents one tuberculosis case will prevent at least a net $295,182 (2002 USD) and individual health quality losses averaging 1.4 net QALYs.Item A Study of the Effectiveness and Tolerability of Weekly Rifapentine/Isoniazid for Three Months Versus Daily Isoniazid for Nine Months for the Treatment of Latent Tuberculosis Infection(2004-11-01) Lemp, Jessie; Patricia Gwirtz; Walter McConathy; Richard EasomLemp, Jessie M. A Study of the Effectiveness and Tolerability of Weekly Rifapentine/Isoniazid for Three Months Versus Daily Isoniazid for Nine Months for the Treatment of Latent Tuberculosis Infection. Master of Science, November, 2004, 107 pp., 4 tables, 4 figures, references, 29 titles. The standard treatment for latent tuberculosis infection, nine months of daily isoniazid, is effective at preventing active tuberculosis; however, its full benefits are limited by non-adherence. A shorter intermittent regimen of rifapentine plus isoniazid once weekly for three months is equally effective as the standard regimen in animal models. This regimen facilitates the use of directly observed therapy, a method that significantly improves adherence. The Center for Disease Control is sponsoring Study 26 to test the effectiveness and tolerability the three-month rifapentine based regimen in latently infected persons with risk factors for progression to active tuberculosis. This thesis will describe the background rationale and methods for the clinical trial, and the internship experience.Item Association Between Breastfeeding and Asthma: A Cross-Sectional Study(2003-08-01) Trombley, Ann M.; Manuel Bayona; Raghbir SandhuTrombley, Ann M., Association Between Breastfeeding and Asthma: A Cross-Sectional Study. Master of Public Health (Epidemiology), August 2003, 17 pp., 12 tables, bibliography, 54 titles. Controversy has surrounded the topic of breastfeeding and if it provides a protective effect against childhood asthma. The objective of this study was to assess whether a relationship exists between breastfeeding and childhood asthma. This study also examined several significant predictors of childhood asthma. A cross-sectional study was conducted using NHANES 1999-2000 data to identify and assess the crude and multivariate associations between the above mentioned variables and asthma and the effect that breastfeeding has on these relationships. Prevalence of asthma in this study was 12.5 per 100. Mexican Americans were found to have a protective association with the development of asthma. A strong protective association was found for those who were breastfed and the development of childhood asthma (OR=0.693, p-value=0.014).Item Association of Leukemia and Other Selected Diseases with Occupational Exposure to Welding(2003-05-01) Mendoza, Hilda OraliaMENDOZA, HILDA ORALIA. ASSOCIATION OF LEUKEMIA AND OTHER SELECTED DISEASES WITH OCCUPATIONAL EXPOSURE TO WELDING. Master of Public Health (Epidemiology). May, 2003. Exposure to carcinogens is an established risk factor for cancer development. Welders are chronically exposed to cardinogens. In this study, the relationship between occupational exposure to welding and mortality from leukemia, lymphoma, Hodgkin’s disease, melanoma, lung cancer, or myocardial infarcation was examined. Files from ORISEWDS, Comprehensive Epidemiologic Data Resource, U.S. Department of Energy were utilized to develop a working file including 416,686 records from employees of one or more Oak Ridge, nuclear plant facilities. Neither welding exposure length, radiation exposure, nor smoking were included in this study. Results show higher adjusted ratios (OR) for leukemia, lymphoma, and Hodgkin’s disease for employees occupationally exposed to welding as compared to employees on-occupationally exposed to welding. OR’s for lung cancer and myocardial infarction were also higher for welders than non-welders.Item Asthma Mortality and Toxic Release in Texas - An Ecological Study 1980-2001(2004-05-01) Maddipatla, Sreeram; Manuel BayonaMaddipatla, S., Asthma Mortality and Toxic Release in Texas - An Ecological Study 1980-2001. Master of Public Health (Environmental Health) April 2004, 97 pp., 4 tables, bibliography, 94 titles. There is a lack of literature examining how the spatiotemporal trend of asthma may have impacted different ethnic/racial compositions of Texans. The present study sought to evaluate the geographic-temporal variations in asthma mortality in Texans over a 22-year period, retrospectively, and examine whether the trend of environmental Toxic Release Inventory (TRI) concentrations and their spatiotemporal persistence might place an uneven burden on particular racial groups. The study concentrates on the time period between 1980-2001 and first evaluates geographic excess of asthma mortality in different racial groups at the county level and characterizes the excess burden by spatiotemporal variations. After this assessment, the impact of TRI on asthma mortality over this period of time is analyzed. Based on these two analyses, this would identify which racial/ethnic groups in which Texas regions might have been affected the most by regarding mortality over time, and suggested priority geographic areas for policy intervention. At the end of this study, it could be said that there might be an association between the TRI release and increased asthma mortality in the Black male population.Item Cardiovascular Fitness and Lung Function of Adult Men and Women in the United States: NHANES 1999-2002.(2008-12-01) Jackson, HannahThere is a distinct disparity between adult males and females in lung function and cardiovascular fitness in the United States. This study utilizes a nationally representative sample in order to determine predictors of lung function between men and women. Simple means analysis, logistic and linear regressions were utilized in order to determine predictors of lung function between genders. Continuous analyses of lung function reveal that sex and BMI are the most important predictors of VO2 max. However, analyses of clinical cut-points of cardiovascular fitness indicate that gender was not a significant predictor.Item Characterization of MRSA Infection at Childrens Medical Center, Dallas, January 2005-June 2005(2006-05-01) Okoro, Ngozi M.; Raghbir Sandhu; Claudia S. Coggin; Sejong BaeOkoro, Ngozi M., Characterization of MRSA infection at Childrens Medical Center, Dallas, January 2005-June 2005. Master of Public Health (Epidemiology), May 2006, 33p., 14 tables, 10 illustrations, bibliography, 13 titles. MRSA infection is increasingly emerging in patients without the established risk factors hence the term CAMRSA. This study is a descriptive secondary data analysis from an ongoing study at UTSM/CMCD and describes the CMCD patients with MRSA infection. Data analysis showed a consistent increase in the incidence rate of the infection with slight female preponderance. Race distribution showed that blacks were the majority. Most children were less than 2years, used Medicaid, had superficial infections and community-acquired infections. All (100%) isolates were susceptible to Vancomycin and Linezolid while many (92.2%) were resistant to Erythromycin. The increasing incidence in CAMRSA infection remains a challenge for public health professionals and the resistant pattern a potential problem to the pharmaceuticals.Item Clinical Diagnosis(W.B. Saunders Company, 1981-01-01) Todd, JamesItem COPD Handout materials(2008-01-01)Item Disability-Adjusted Life Years Lost Due to Adult Pulmonary Tuberculosis in Tarrant County, 2005-2006: An Analysis of the Role of Post Tuberculosis Impairment(2008-05-01) Pasipanodya, Jotam Garaimunashe; Sejong Bae; Kristine Lykens; Peter HilsenrathPasipanodya, Jotam G. Disability-Adjusted Life Years lost due to adult pulmonary tuberculosis in Tarrant County, 2005-2006: An analysis of the role of post tuberculosis impairment. Doctor of Public Health (Health Management and Policy), May 2008. 145 pages, 18 tables, 11 illustrations, 135 references. Pulmonary impairment after tuberculosis treatment (PIAT) is not yet incorporated in assessing burden of tuberculosis. Previous global and national TB burden estimates therefore did not fully reflect the consequences of surviving tuberculosis disease. This study was conducted to assess burden of TB in Tarrant County, Texas, using Disability-Adjusted Life Years (DALY). DALY is a composite measure of premature mortality and disability that equates years of healthy life lost. DALY, stratified by gender and race were calculated for 118 adult TB subjects seen between July 2005 and October 2006. Years of Life Lost (YLL) were calculated from the difference between standard life expectancy and age at death from TB, summed across county population. Years Lived with Disability (YLD) were derived from age and gender-specific disease incidence weight-adjusted for impairment levels; using disability weights obtained from literature. Three percent discount rate per year was used. One hundred and eighteen subjects lost 444.25 DALY during the study period. Years of life lost to premature mortality (YLL) contributed 159.62 (36%) and years of life lived with disability (YLD) contributed majority of total DALY. Pulmonary impairment after tuberculosis (YLD PIAT) contributed 234.6 (53%), while YLD Acute contributed only 50.03 (11 %) of total DALYS. Contrary to previous estimates; disability contributes more than mortality to TB burden in areas with low TB adult and child mortality. PIA T contributes significantly to TB burden, but was previously unrecognized. These findings suggest that the greatest health savings will be achieved through strategies to prevent tuberculosis from developing rather than strategies to shorten treatment once it has developed.Item Epidemiology and Diagnostic Testing of Tuberculosis (Mycobacterium bovis) Infection in Ungulates in a Texas Zoo(1998-06-01) Hodges, Connie M.; Bidaut-Russell, Michelle; Licciardone, John C.; Murnane, ThomasTuberculosis infection among ungulates with Mycobacterium bovis (M. bovis) in a Texas zoo resulted in epidemiological assessment and testing of 161ungulates because of concerns about the validity of tuberculosis infection in the zoo. Three intradermal tests and one serological test were used to assess M.bovis infection : 1)the comparative cervical tuberculin test (CCT) consisting of biologically balanced bovine purified protein derivative (PPD) and avian PPD; 2) the single cervical bovine PPD tuberculin (BPDD); 3) the Tuberculin-Mammalian (MOT) intradermal tuberculin; and 4) the serological blood tuberculosis test (BTB). All four tests were evaluated. Validity (i.e. sensitivity and specificity), positive predictive value (PPV), and negative predictive value (NPV) were measured. The MOT followed by the BPPD were the most sensitive tests, correctly identifying 100% and 67%, respectively of tuberculosis infected/exposed ungulates. The BTB test was the third order of recommendation followed by the combined CCT and BTB (CCT+BTB) tests, where a positive result in either test denoted a positive response. The CCT test ranked last, as this test had the lowest sensitivity and would have allowed tuberculosis infection to remain in the zoo.Item For Better or for Worse: The Influence of NK Cells, IFN-y and IL-4 on the Development of Protective Adaptive Immunity in Mycoplasma Respiratory Disease(2008-08-01) Bodhankar, Sheetal; Porunelloor A. Mathew; Stephen R. Grant; Rance E. BergSheetal Bodhankar, For better or for worse: The influence of NK cells, IFN-y and IL-4 on the generation of protective adaptive immunity in mycoplasma respiratory disease, Doctor of Philosophy (Microbiology and Immunology) August 2008, 136 pp., 13 illustrations, 3 tables, bibliography, 176 titles. The purpose of these studies was to evaluate the contribution of NK cells and the polarizing cytokines, IFN-y and IL-4, in the generation of protective adaptive immunity against mycoplasma infection. Presence of NK cells during the generation of adaptive immunity resulted in detrimental immune responses. However, upon depletion of NK cells, prior to nasal-pulmonary immunizations, mice demonstrated better clearance of mycoplasma from the respiratory tracts. That the NK cells hindered with the beneficial development of adaptive immune responses via lymphoid cells was demonstrated, since no protection was demonstrated in SCID mice. Furthermore, purified pulmonary T and B lymphocytes primed in a NK cell depleted environment as opposed to one’s primed in a versus non-depleted environment could transfer protection to naïve mice. Interestingly, this is the first time that a favorable role of functional CD4 T cells in mediating protection in mycoplasma respiratory disease was demonstrated. The presence of NK cells at the time of nasal-pulmonary immunization also modulated mycoplasma-specific IFN-y and IL-4 responses in lungs and lower respiratory nodes. In evaluating the roles of IFN-y and IL-4, it was demonstrated that the absence of a single cytokine alters a vast array of chemokines and cytokines produced in response to mycoplasma infection. Corresponding to the higher numbers of mycoplasma and severity in disease due to the loss of IFN-y, altered cytokine and chemokine responses in the lungs to mycoplasma infection were demonstrated. Nasal-pulmonary immunization of IFN-y mice exacerbated, rather than reduced, mycoplasma disease and infection, whereas immunization of IL-4 mice significantly enhanced protection along the respiratory tract particularly in the lungs. Prominent Th-2 type immune responses in the lungs of IFN-y mice corresponded to the severe immunopathologic reactions developed after mycoplasma infection and immunization. These studies demonstrated diverse but crucial functions for NK cells, IFN-y and IL-4 vital towards the development of protective adaptive immune responses against mycoplasma respiratory infection that will have a significant impact on future studies on respiratory immunology.Item Geospatial and Molecular Clustering of Mycobacterium tuberculosis, Tarrant County, TX, 1993-2000(2002-05-01) Moonan, Patrick Kevin; Manuel Bayona; Teresa N. Quituga; Joseph OppongMolecularly clustered cases are assumed to be the result of recent transmission of those in the cluster. An intervention that targets clustered cases with recent transmission, such as identifying contacts of active cases, could be effective as a programmatic control measure. The purpose of this study is to identify areas of recent transmission, whereby determining the contribution of geospatial and molecular clustering to the local tuberculosis morbidity. Tuberculosis cases due to recent transmission have important implications for tuberculosis control programs. They suggest that current methods of case-finding, investigations of susceptible contacts, and the provision of preventive therapy are ineffective in interrupting some transmission. This study utilized molecular strain characteristics and GIS technology to uncover geographical links to on-going transmission, where tradition public health surveillance methods are failing. Risk behaviors such as illicit drug use, crack-cocaine use, jail experience, and sexual relations with a prostitute were strongly associated with on-going transmission. Place factors, specifically where patients reside, was also found to be significantly associated for certain zip codes in Tarrant County. Cases in urban zip codes 76102 [OR=3.954; 95% CI=1.803, 8.671] and 76105 [OR=3.135; CI=1.254, 7.835] were strongly associated to infection with a clustered strain when compared to the rest of the county. The use of Geographical Informational Systems (GIS) technology and molecular strain typing provides a proactive approach that may be used to initiate traditional surveillance investigations. As an application utility, this project will be used to develop more effective means of tuberculosis control within Tarrant County.Item Immune and Inflammatory Responses Differ Between the Upper and Lower Respiratory Tract(2001-05-01) Hodge, Lisa M.; Simecka, Jerry; Goldfarb, Ronald H.; Mathew, Porunelloor A.The purpose of these studies was to evaluate the role of upper and lower respiratory immune responses during immunization against respiratory disease antigens, and to characterize which immune responses during immunization against respiratory disease antigens, and to characterize which immune responses contribute to protection in the respiratory tract during infection. After nasal immunization, antigen-specific IgA antibody forming cells dominated throughout the respiratory tract. However, IgG responses were significant in lungs, but not in nasal passages. Furthermore, parental immunization did not enhance humoral immunity in the upper respiratory tract even after a nasal challenge, whereas extrapulmonary lymphoid responses enhanced responses in the lung. After nasal immunization, inflammatory reactions developed within the lungs of mice, but not in nasal passages. Lowering dosages of CT reduced, but did not eliminate, these adverse reactions without compromising immunogenicity. Serum IgE responses were also enhanced in a dose dependent manner by inclusion of CT. During infection, mRNA expression for IL-4 was greater in the nasal passages, while both mRNAs for IL-4 and IFN-y were increased in the lungs. As well, we found increased mycoplasma organisms in the lungs of IFN-y-/- mice, suggesting a protective role for cell-mediated immunity in the lung. In contrast, IL-4-/- mice had greater mycoplasma organisms in the nasal passages, indicating IL-4 responses are crucial for upper respiratory tract protection. Consistent with antigen deposition, nasal inoculation with 10 μl volume of antigen plus CT resulted in significant IgA responses in the nasal passages compared to mice given 24 μl immunizations; however, lower respiratory tract immunizations generated antibody responses in both nasal passages and lungs. In addition, both immunizations resulted in equivalent serum antibody responses. Upper and total respiratory tract immunizations provided protection in the nasal passages when CT was added. However, in the lung, all immunizations resulted in protection against mycoplasma infection, regardless of the inclusion of CT, suggesting a different role for CT as an adjuvant in upper and lower respiratory tract immune protection. In conclusion, we found immune responses generated during immunization and infection are different between the upper and lower respiratory tracts, and the contribution of these responses to clearance of respiratory infection differs.Item Investigating the Role of Stress in a Murine Model of Asthma(2008-07-01) Deshmukh, Aniket; Harlan Jones; P. Mathew; Jerry SimeckaThe mechanisms by which stress can exacerbate asthma are still unknown. The purpose of this study was to examine the immunological links between stress controllability and asthma pathogenesis. Our studies reveal specificity of stress control and immune activation resulting in hyper-inflammatory reactions in response to allergic airway challenge. We anticipate that these studies can serve as a translational piece to facilitate clinical studies of stress and asthma prevalence. The purpose of this project was to establish a murine model of stress controllability and demonstrate the impact of stress on the development of immune allergic airway hypersensitivity as a major feature of asthma. I hypothesized that given the ability to control the degree of stress would translate into less severe allergic airway hypersensitivity. We also hypothesized that distinct changes in immune responses generated in response to uncontrolled stress would reflect the extent of airway hypersensitivity. Mice were exposed to daily regimen of uncontrollable stress, controllable stress or no stress concurrently with allergen exposure. Behavioral disposition to stress was monitored in conjunction with evaluation of severity of asthma and immune status. Our results demonstrate that exerting control over stress conditions leads to distinct changes in immunological status corresponding with positive behavioral responses and less disease severity. We anticipate that our studies will facilitate application of stress management in control of immune status as a biomarker for asthma progression.Item Lethality of Staphylococcus in Murine Pneumonia is Due to Alpha-Toxin and Other Secreted Factors Regulated by AGR and SAR(2003-08-01) Overheim, Katie A.; Dan Dimitrijevich; Glenn Dillon; James CaffreyOverheim, Katie A., Lethality of Staphlococcus aureus in Murine Pneumonia is Due to Alpha-Toxin and Other Secreted Factors Regulated by agr and sar. Doctor of Philosophy (Biomedical Sciences), August, 2003, 91 pp, 6 Tables, 9 illustrations, bibliography, 106. The purpose of these studies was to determine if the S. aureus global regulators agr and sar play a role in staphylococcal pneumonia and if the virulence factors regulated by them contributed to the severity of staphylococcal pneumonia. To determine this, we established a pneumonia model in mice in order to identify if S. aureus global regulators agr and sar play a role in the pathogenesis of staphylococcal pneumonia. As well, we took steps to identify the extracellular factors responsible for the lethality in a murine model of staphylococcal pneumonia and determine if these factors involved in disease process could be used as targets for immune therapy. My work revealed that lethal pneumonia in a mouse model is dependent on the S. aureus global regulators agr and sar. This study also revealed that the lethality associated with our model is due to secreted factors, regulated by S. aureus global regulators agr and sar. Further investigation demonstrated the alpha-toxin is a major virulence factor involved in the lethality in our model. By generating an alpha-toxin deficient strain in S. aureus RN6390, we show a reduced virulence in our disease model. As well, antiserum to alpha-toxin, when administered with a lethal dose of S. aureus RN6390, we show a reduced virulence in our disease model. As well, antiserum to alpha-toxin, when administered a lethal dose of S. aureus RN6390, we show a reduced virulence in our disease model. As well, antiserum to alpha-toxin, when administered with a lethal dose of S. aureus RN6390 protected animals from death. By evaluating the role of alpha-toxin’s ability to contribute to lethality, we assessed numerous strains of S. aureus in our pneumonia model. We discovered that there was a correlation to alpha-toxin production levels and lethality in our pneumonia model. However, our study also demonstrated that alpha-toxin is not the only factor involved in the disease process.Item Lung Cancer Risk Among Workers in Poultry Slaughtering and Processing Plants: A Pilot Study(2008-05-01) Preacely, Nykiconia D.; Ramphal-Naley, Lilly; Cardarelli, Kathryn; Qualls-Hampton, RaquelPreacely, Nykiconia D., Lung Cancer Risk Among Workers in Poultry Slaughtering and Processing Plants: A Pilot Study. Doctor of Public Health (Epidemiology), May 2008, 104 pp., 21 tables, 4 figures, bibliography, 50 titles. Poultry workers are at a great risk of exposure to potentially harmful transmissible agents which can cause cancer in poultry; yet there are few epidemiological studies that examine the association of occupation and illnesses experienced by these workers. Workers in poultry slaughtering and processing plants are well suited to investigate the effects of exposure to poultry oncogenic agents because they have one of the highest human exposure to carcinogenic chemicals formed during the packaging and preparation of poultry. The preparations of poultry via smoking, and frying are additional exposures that release carcinogens which may be involved in lung cancer risk among poultry workers. Union records from several unions belonging to the United Food & Commercial Workers International Union for the years 1949-1989 were used to identify a cohort of workers once employed in poultry slaughtering and processing plants. The current research investigated whether certain occupational exposures were associated with lung cancer mortality among these workers. The research employed a case cohort design that provided individual level occupational and lifestyle data for workers who died with lung cancer between 1990 and 2003 compared to a sub-cohort of individuals randomly sampled from the entire cohort. It is anticipated that by identifying potentially harmful exposures in this industry, future research may focus on developing methods to alleviate them among poultry workers. The results of this study will provide public health professionals and the poultry industry with new information on the occupational exposures not previously explored in relation to lung cancer mortality among poultry slaughtering/processing plant workers.Item Measurement of Health Care Professional Concordance with the National Asthma Education and Prevention Program Guidelines for the Management of Asthma(2007-05-01) Oshitoye, Jeannette AdetokunboAsthma is a widely prevalent chronic disease affecting children in the United States. Prior studies show that blacks are more likely to die from asthma than other racial groups. Despite this fact, blacks are less likely to receive the recommended medication to appropriately treat their asthma. Because of the disparity in treatment, this study was conducted to determine if minorities were receiving information recommended by the NAEPP Guidelines. Logistic regression was used to determine the receipt of instructional information. Results show that males are less likely; and those below the age of 17 are more likely to receive the information.Item Mechanisms of Post-Apneic Symathoinhibition in Humans(2002-08-01) Swift, Nicolette Muenter; Michael Smith; David Barker; John R BurkMuenter Swift, Nicolette, Mechanisms of Post-Apneic Sympathoinhibition in Humans. Doctor of Philosophy (Biomedical Sciences), August, 2002, 110 pp., 14 figures, references. Apnea is accompanied by a concomitant rise in arterial pressure and muscle sympathetic nerve activity (MSNA), the latter primarily due to chemoreflex stimulation and possibly the lack of sympathoinhibitory input from pulmonary stretch receptors. The progressive sympathoexcitation during apnea suggests a possible overriding of arterial baroreflex sympathoinhibitory input to sympathoregulatory centers by apnea-induced sympathoexcitatory mechanisms. Nevertheless, it is unknown whether apnea attenuates baroreflex control of MSNA. Apnea termination is accompanied by a profound and immediate sympathoinhibition, the mechanisms of which are unclear; however, potential mediators include normalization of blood gases (i.e. chemoreflex unloading), the lung inflation reflex, and arterial baroreflex stimulation. Therefore, the purpose of the current studies was to: i) determine the contribution of chemoreflex unloading to post-apneic sympathoinhibition, ii) determine the contribution of the lung inflation reflex to post-apneic sympathoinhibition, and iii) determine whether carotid baroreflex control of MSNA is altered by apnea and its termination. The first study compared MSNA during post-apneic administration of room air versus a gas mixture designed to maintain the subjects’ end-apneic alveolar gas levels. Regardless of post-apneic gas administration, post-apneic MSNA was at or below baseline pre-apneic levels; thus; chemoreflex unloading does not contribute to post-apneic sympathoinhibition. Furthermore, quantification of post-apneic MSNA associated only with the low lung volume phase of respiration, when sympathoinhibitory input from the lung inflation reflex is minimal, demonstrated that post-apneic sympathoinhibition persists even during the low lung volume phase of respiration, when sympathoinhibitory input from the lung inflation reflex is minimal, demonstrated that post-apneic sympathoinhibition persists even during the low lung volume phase of respiration. Therefore, the lung inflation reflex does not appear to be the primary mediator of post-apneic sympathoinhibition. The second study utilized neck suction (NS) and neck pressure (NP) to assess carotid baroreflex function during and following sleep apnea. The sympathoinhibitory response to -60 Torr NS was maintained throughout apnea; conversely, the sympathoexcitatory response to +30 Torr NP was attenuated for nearly one minute post-apnea. Thus, carotid baroreflex control of MSNA is not altered by apnea but is transiently attenuated by apnea termination. We propose that the carotid baroreflex-MSNA function curve resets rightward and upward during apnea. Return of the function curve to baseline upon apnea termination may partly explain the reduced MSNA response to NP post-apnea.