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Novel Negative Pressure Procedural Tent Reduces Aerosolized Particles in a Simulated Prehospital Setting
- Nathaniel Hunt, Spencer Masiewicz, Logan Herbert, Benjamin Bassin, Christine Brent, Nathan L. Haas, Mohamad Hakam Tiba, Jon Lillemoen, Mark J. Lowell, Isabel Lott, Matthew Basinger, Graham Smith, Kevin R. Ward
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- Journal:
- Prehospital and Disaster Medicine / Volume 37 / Issue 3 / June 2022
- Published online by Cambridge University Press:
- 05 April 2022, pp. 383-389
- Print publication:
- June 2022
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Background/Objective:
The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of Emergency Medical Services (EMS) providers to maintain personal safety during the treatment and transport of patients potentially infected. Increased rates of COVID-19 infection in EMS providers after patient care exposure, and notably after performing aerosol-generating procedures (AGPs), have been reported. With an already strained workforce seeing rising call volumes and increased risk for AGP-requiring patient presentations, development of novel devices for the protection of EMS providers is of great importance.
Based on the concept of a negative pressure room, the AerosolVE BioDome is designed to encapsulate the patient and contain aerosolized infectious particles produced during AGPs, making the cabin of an EMS vehicle safer for providers. The objective of this study was to determine the efficacy and safety of the tent in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization.
Methods:Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, an aeromedical-configured helicopter, and an aeromedical-configured jet. Sodium chloride particles were used to simulate infectious particles and particle counts were obtained in numerous locations close to the tent and around the patient compartment. Counts near the tent were compared to ambient air with and without use of AGPs (non-rebreather mask, continuous positive airway pressure [CPAP] mask, and high-flow nasal cannula [HFNC]).
Results:For all transport platforms, with the tent fan off, the particle generator alone, and with all AGPs produced particle counts inside the tent significantly higher than ambient particle counts (P <.0001). With the tent fan powered on, particle counts near the tent, where EMS providers are expected to be located, showed no significant elevation compared to baseline ambient particle counts during the use of the particle generator alone or with use of any of the AGPs across all transport platforms.
Conclusion:Development of devices to improve safety for EMS providers to allow for use of all available therapies to treat patients while reducing risk of communicable respiratory disease transmission is of paramount importance. The AerosolVE BioDome demonstrated efficacy in creating a negative pressure environment and workspace around the patient and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.
Novel Negative Pressure Helmet Reduces Aerosolized Particles in a Simulated Prehospital Setting
- Part of
- Nathaniel Hunt, Spencer Masiewicz, Logan Herbert, Benjamin Bassin, Christine Brent, Nathan L. Haas, Mohamad Hakam Tiba, Jon Lillemoen, Mark J. Lowell, Isabel Lott, Matthew Basinger, Graham Smith, Kevin R. Ward
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- Journal:
- Prehospital and Disaster Medicine / Volume 37 / Issue 1 / February 2022
- Published online by Cambridge University Press:
- 31 January 2022, pp. 33-38
- Print publication:
- February 2022
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Background/Objective:
The coronavirus disease 2019 (COVID-19) pandemic has created challenges in maintaining the safety of prehospital providers caring for patients. Reports have shown increased rates of Emergency Medical Services (EMS) provider infection with COVID-19 after patient care exposure, especially while utilizing aerosol-generating procedures (AGPs). Given the increased risk and rising call volumes for AGP-necessitating complaints, development of novel devices for the protection of EMS clinicians is of great importance.
Drawn from the concept of the powered air purifying respirator (PAPR), the AerosolVE helmet creates a personal negative pressure space to contain aerosolized infectious particles produced by patients, making the cabin of an EMS vehicle safer for providers. The helmet was developed initially for use in hospitals and could be of significant use in the prehospital setting. The objective of this study was to determine the efficacy and safety of the helmet in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization.
Methods:Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, a medical helicopter, and a medical jet. Sodium chloride particles were used to simulate infectious particles, and particle counts were obtained in numerous locations close to the helmet and around the patient compartment. Counts near the helmet were compared to ambient air with and without use of AGPs (non-rebreather mask [NRB], continuous positive airway pressure mask [CPAP], and high-flow nasal cannula [HFNC]).
Results:Without the helmet fan on, the particle generator alone and with all AGPs produced particle counts inside the helmet significantly higher than ambient particle counts. With the fan on, there was no significant difference in particle counts around the helmet compared to baseline ambient particle counts. Particle counts at the filter exit averaged less than one despite markedly higher particle counts inside the helmet.
Conclusion:Given the risk to EMS providers by communicable respiratory diseases, development of devices to improve safety while still enabling use of respiratory therapies is of paramount importance. The AerosolVE helmet demonstrated efficacy in creating a negative pressure environment and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.
A distributed geospatial approach to describe community characteristics for multisite studies
- Patrick H. Ryan, Cole Brokamp, Jeff Blossom, Nathan Lothrop, Rachel L. Miller, Paloma I. Beamer, Cynthia M. Visness, Antonella Zanobetti, Howard Andrews, Leonard B. Bacharier, Tina Hartert, Christine C. Johnson, Dennis Ownby, Robert F. Lemanske, Heike Gibson, Weeberb Requia, Brent Coull, Edward M. Zoratti, Anne L. Wright, Fernando D. Martinez, Christine M. Seroogy, James E. Gern, Diane R. Gold
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- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue 1 / 2021
- Published online by Cambridge University Press:
- 05 February 2021, e86
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Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
A Descriptive Analysis of Care Provided by Law Enforcement Prior to EMS Arrival in the United States
- Aaron B. Klassen, S. Brent Core, Christine M. Lohse, Matthew D. Sztajnkrycer
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 2 / April 2018
- Published online by Cambridge University Press:
- 13 March 2018, pp. 165-170
- Print publication:
- April 2018
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Study Objectives
Law enforcement is increasingly viewed as a key component in the out-of-hospital chain of survival, with expanded roles in cardiac arrest, narcotic overdose, and traumatic bleeding. Little is known about the nature of care provided by law enforcement prior to the arrival of Emergency Medical Services (EMS) assets. The purpose of the current study was to perform a descriptive analysis of events reported to a national EMS database.
MethodsThis study was a descriptive analysis of the 2014 National Emergency Medical Services Information System (NEMSIS) public release research data set, containing EMS emergency response data from 41 states. Code E09_02 1200 specifically identifies care provided by law enforcement prior to EMS arrival.
ResultsA total of 25,835,729 unique events were reported. Of events in which pre-arrival care was documented, 2.0% received prior aid by law enforcement. Patients receiving law enforcement care prior to EMS arrival were more likely to be younger (52.8 [SD=23.3] years versus 58.7 [SD=23.3] years), male (54.8% versus 46.7%), and white (80.3% versus 77.5%). Basic Life Support (BLS) EMS response was twice as likely in patients receiving prior aid by law enforcement. Multiple-casualty incidents were five times more likely with prior aid by law enforcement. Compared with prior aid by other services, law enforcement pre-arrival care was more likely with motor vehicle accidents, firearm assaults, knife assaults, blunt assaults, and drug overdoses, and less likely at falls and childbirths. Cardiac arrest was significantly more common in patients receiving prior aid by law enforcement (16.5% versus 2.6%). Tourniquet application and naloxone administration were more common in the law enforcement prior aid group.
ConclusionWhere noted, law enforcement pre-arrival care occurs in 2.0% of EMS patient encounters. The majority of cases involve cardiac arrest, motor vehicle accidents, and assaults. Better understanding of the nature of law enforcement care is required in order to identify potential barriers to care and to develop appropriate training and policy recommendations.
,Klassen AB ,Core SB ,Lohse CM .Sztajnkrycer MD A Descriptive Analysis of Care Provided by Law Enforcement Prior to EMS Arrival in the United States . Prehosp Disaster Med.2018 ;33 (2 ):165 –170 .
Contributors
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- By Alberto Albanese, Karine Auré, Selim R. Benbadis, Jose Biller, Matthew Bower, Francisco Cardoso, Kelvin L. Chou, Rima M. Dafer, Praveen Dayalu, Michelle M. Dompenciel, Eissa Ibrahim Al Eissa, Alberto J. Espay, Hubert H. Fernandez, Brent L. Fogel, Steven Frucht, Victor S. C. Fung, Néstor Gálvez-Jiménez, David Grabli, Era Hanspal, Claire Henchcliffe, Nelson Hwynn, Kurt A. Jellinger, Julia Johnson, Danita Jones, Daniel Kantor, Ninith Kartha, Jan Kassubek, Taranum Khan, Samuel Kim, Christine Klein, Neeraj Kumar, Roger Kurlan, Corneliu Luca, Ramon Lugo, Roneil Malkani, Giacomo Della Marca, Marcelo Merello, Henry Moore, Sarkis Morales-Vidal, Santiago Perez-Lloret, Susan Perlman, Elmar H. Pinkhardt, David E. Riley, Emmanuel Roze, Daniel S. Sa, Virgilio D. Salanga, Michael J. Schneck, Susanne A. Schneider, David Shprecher, Carlos Singer, Mark Stacy, Sylvia Stemberger, Pichet Termsarasab, Paul J. Tuite, Marie Vidailhet, Mary Vo, Ruth H. Walker, Gregor K. Wenning, Cindy Zadikoff
- Edited by Néstor Gálvez-Jiménez, Paul Tuite, University of Minnesota
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- Book:
- Uncommon Causes of Movement Disorders
- Published online:
- 05 August 2011
- Print publication:
- 12 May 2011, pp ix-xii
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- By Jane E. Adcock, Yahya Aghakhani, A. Anand, Eva Andermann, Frederick Andermann, Alexis Arzimanoglou, Sandrine Aubert, Nadia Bahi-Buisson, Carman Barba, Agatino Battaglia, Geneviève Bernard, Nadir E. Bharucha, Laurence A. Bindoff, William Bingaman, Francesca Bisulli, Thomas P. Bleck, Stewart G. Boyd, Andreas Brunklaus, Harry Bulstrode, Jorge G. Burneo, Laura Canafoglia, Laura Cantonetti, Roberto H. Caraballo, Fernando Cendes, Kevin E. Chapman, Patrick Chauvel, Richard F. M. Chin, H. T. Chong, Fahmida A. Chowdhury, Catherine J. Chu-Shore, Rolando Cimaz, Andrew J. Cole, Bernard Dan, Geoffrey Dean, Alessio De Ciantis, Fernando De Paolis, Rolando F. Del Maestro, Irissa M. Devine, Carlo Di Bonaventura, Concezio Di Rocco, Henry B. Dinsdale, Maria Alice Donati, François Dubeau, Michael Duchowny, Olivier Dulac, Monika Eisermann, Brent Elliott, Bernt A. Engelsen, Kevin Farrell, Natalio Fejerman, Rosalie E. Ferner, Silvana Franceschetti, Robert Friedlander, Antonio Gambardella, Hector H. Garcia, Serena Gasperini, Lorenzo Genitori, Gioia Gioi, Flavio Giordano, Leif Gjerstad, Daniel G. Glaze, Howard P. Goodkin, Sidney M. Gospe, Andrea Grassi, William P. Gray, Renzo Guerrini, Marie-Christine Guiot, William Harkness, Andrew G. Herzog, Linda Huh, Margaret J. Jackson, Thomas S. Jacques, Anna C. Jansen, Sigmund Jenssen, Michael R. Johnson, Dorothy Jones-Davis, Reetta Kälviäinen, Peter W. Kaplan, John F. Kerrigan, Autumn Marie Klein, Matthias Koepp, Edwin H. Kolodny, Kandan Kulandaivel, Ruben I. Kuzniecky, Ahmed Lary, Yolanda Lau, Anna-Elina Lehesjoki, Maria K. Lehtinen, Holger Lerche, Michael P. T. Lunn, Snezana Maljevic, Mark R. Manford, Carla Marini, Bindu Menon, Giulia Milioli, Eli M. Mizrahi, Manish Modi, Márcia Elisabete Morita, Manuel Murie-Fernandez, Vivek Nambiar, Lina Nashef, Vincent Navarro, Aidan Neligan, Ruth E. Nemire, Charles R. J. C. Newton, John O'Donavan, Hirokazu Oguni, Teiichi Onuma, Andre Palmini, Eleni Panagiotakaki, Pasquale Parisi, Elena Parrini, Liborio Parrino, Ignacio Pascual-Castroviejo, M. Scott Perry, Perrine Plouin, Charles E. Polkey, Suresh S. Pujar, Karthik Rajasekaran, R. Eugene Ramsey, Rahul Rathakrishnan, Roberta H. Raven, Guy M. Rémillard, David Rosenblatt, M. Elizabeth Ross, Abdulrahman Sabbagh, P. Satishchandra, Swati Sathe, Ingrid E. Scheffer, Philip A. Schwartzkroin, Rod C. Scott, Frédéric Sedel, Michelle J. Shapiro, Elliott H. Sherr, Michael Shevell, Simon D. Shorvon, Adrian M. Siegel, Gagandeep Singh, S. Sinha, Barbara Spacca, Waney Squier, Carl E. Stafstrom, Bernhard J. Steinhoff, Andrea Taddio, Gianpiero Tamburrini, C. T. Tan, Raymond Y. L. Tan, Erik Taubøll, Robert W. Teasell, Mario Giovanni Terzano, Federica Teutonico, Suzanne A. Tharin, Elizabeth A. Thiele, Pierre Thomas, Paolo Tinuper, Dorothée Kasteleijn-Nolst Trenité, Sumeet Vadera, Pierangelo Veggiotti, Jean-Pierre Vignal, J. M. Walshe, Elizabeth J. Waterhouse, David Watkins, Ruth E. Williams, Yue-Hua Zhang, Benjamin Zifkin, Sameer M. Zuberi
- Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
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- Book:
- The Causes of Epilepsy
- Published online:
- 05 March 2012
- Print publication:
- 14 April 2011, pp ix-xvi
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- By R. J. Aitken, Gokhan Akkoyunlu, David F. Albertini, Christiani A. Amorim, R. A. Anderson, Baris Ata, Pedro N. Barri, Mohamed A. Bedaiwy, Rosita Bergström, Veronica Bianchi, Montserrat Boada, Paolo Boffetta, Andrea Borini, Karina Braga Ribeiro, Peter R. Brinsden, Ralph L. Brinster, Jason G. Bromer, A. L. Caplan, Chian Ri-Cheng, Ina N. Cholst, A. Ciobanu, Megan Clowse, Ana Cobo, Susannah C. Copland, John K. Critser, B. J. Curry, Giuseppe Del Priore, M. De Vos, Marie-Madeleine Dolmans, Javier Domingo, Jacques Donnez, David H. Edgar, Nanette R. Elster, Carol Fabian, Gregory M. Fahy, Tommaso Falcone, Debra Friedman, Jill P. Ginsberg, Debra A. Gook, Julie R. Gralow, Elizabeth Grill, Sebastien Gouy, Xu Han, Lisa M. Harlan-Williams, Outi Hovatta MD, Wayland Hsiao, Zhongwei Huang, E. Isachenko, V. Isachenko, Roy A. Jensen, I. I. Katkov, S. Samuel Kim, Jennifer Klemp, Larissa A. Korde, R. Kreienberg, Srinivasan Krishnamurthy, Juergen Liebermann, J. Ryan Martin, Elizabeth A. McGee, Marie McLaughlin, P. Mathevet, D. Meirow, Philippe Morice, Steven F. Mullen, Kutluk Oktay, Pasquale Patrizio, Antonio Pellicer, Pinki K. Prasad, Kenny A. Rodriguez-Wallberg, Erin Rohde, Allison B. Rosen, Zev Rosenwaks, María Sánchez, R. Sanchez, Glenn L. Schattman, Peter N. Schlegel, Einat Shalom-Paz, Lonnie D. Shea, Gunapala Shetty, Jill Simmons, Carrie A. Smith, J. Smitz, Miquel Solé, Jean Squifflet, Shane R. Stecklein, Jerome F. Strauss, David J. Tagler, Seang Lin Tan, Evelyn E. Telfer, Sreedhar Thirumala, Michael J. Tucker, Catherine Uzan, Anne Van Langendonckt, Anna Veiga, W. H. B. Wallace, Wenjia Wang, Brent Waters, Dagan Wells, Teresa K. Woodruff, Erik Woods, Christine Wyns
- Edited by Jacques Donnez, Université Catholique de Louvain, Belgium, S. Samuel Kim, University of Kansas
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- Book:
- Principles and Practice of Fertility Preservation
- Published online:
- 04 February 2011
- Print publication:
- 03 February 2011, pp x-xiv
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10 - Hypertension
- Edited by Christine Arenson, Jan Busby-Whitehead, University of North Carolina, Chapel Hill, Kenneth Brummel-Smith, Florida State University, James G. O'Brien, University of Louisville, Kentucky, Mary H. Palmer, University of North Carolina, Chapel Hill, William Reichel, Georgetown University, Washington DC
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- Book:
- Reichel's Care of the Elderly
- Published online:
- 19 May 2010
- Print publication:
- 09 February 2009, pp 96-101
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Summary
INTRODUCTION
Hypertension is the single most common outpatient diagnosis in the United States, and older Americans have the highest prevalence of any age group. Therefore, it is vital for clinicians to be comfortable with the classification, treatment, and circumstances unique to the geriatric patient. Adequately treated hypertension has been well documented to help prevent adverse outcomes such as kidney failure, stroke, myocardial infarction, ventricular hypertrophy, and heart failure. Special consideration in older patients, especially those with multiple comorbid illnesses, and frail elders require individualized therapy.
EPIDEMIOLOGY
More than 65 million American adults have hypertension, creating a large public health burden. The overall prevalence of hypertension in the United States is approximately 25%; however, the prevalence for people 60 years or older is much higher at 66%. The Framingham Heart Study indicated the lifetime risk of developing hypertension in this age group to be 90%. The most recent data indicate for patients 60 years and older, 81% of people with hypertension are aware of their diagnosis and approximately 73% of them were treated. Of those treated, only approximately 50% achieved target blood pressure goals. Framingham calculated the lifetime probability of being on antihypertensive medications for patients aged 55–65 years to be 60%. For all people older than 60 years with hypertension, including those not treated, only 36% were at goal, well short of the Healthy People 2010 goal of 50%. Although these statistics are dire, there has been increasing control of hypertension since 1999. Furthermore, the geriatric population is most likely to be aware of their diagnosis, most likely to be treated, and most likely to be at goal.
Phase Behavior and Shrinking Kinetics of Thermo-Reversible Poly(N-Isopropylacrylamide-2-Hydroxyethyl Methacrylate)
- Christine M Leon, Francisco J Solis, Brent L Vernon
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1190 / 2009
- Published online by Cambridge University Press:
- 31 January 2011, 1190-NN03-09
- Print publication:
- 2009
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We study the thermodynamic properties of solutions of the physically gelling poly(N-isopropylacrylamide-2-hydroxyethyl methacrylate) [poly(NIPPAm-HEMA)]. We construct its phase diagram and characterize its kinetics of phase separation. This material belongs to a class of thermosensitive, “smart” polymers, that exhibit complex phase behavior. The copolymer studied is liquid at low temperatures and undergoes phase separation near 28°C, with negligible dependence on concentration. Above the transition temperature we observe coexistence between a polymer-dilute solution and a gel. We show that, upon quick heating, liquid solutions form a homogeneous gel that phase separates (shrinks) from a dilute polymer solution. We find that the evolution of the gel volume fraction is well described by a double exponential decay, indicating the presence of two shrinking regimes in a close parallel to the behavior of chemically cross-linked gels. The first stage is characterized by quick water ejection. In the second stage, slower shrinking is observed associated with internal reorganization of the polymers that allows the creation of gel-forming contacts.