9 results
A Change from a Spinal Immobilization to a Spinal Motion Restriction Protocol was Not Associated with an Increase in Disabling Spinal Cord Injuries
- Brian M. Clemency, Peter Natalzia, Johanna Innes, Sharon Guarino, Jacob V. Welch, Arsalan Haghdel, Ekaterina Noyes, Jeffery Jordan, Heather A. Lindstrom, E. Brooke Lerner
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- Journal:
- Prehospital and Disaster Medicine / Volume 36 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 03 November 2021, pp. 708-712
- Print publication:
- December 2021
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Background:
Over the past decade, Emergency Medical Service (EMS) systems decreased backboard use as they transition from spinal immobilization (SI) protocols to spinal motion restriction (SMR) protocols. Since this change, no study has examined its effect on the neurologic outcomes of patients with spine injuries.
Objectives:The object of this study is to determine if a state-wide protocol change from an SI to an SMR protocol had an effect on the incidence of disabling spinal cord injuries.
Methods:This was a retrospective review of patients in a single Level I trauma center before and after a change in spinal injury protocols. A two-step review of the record was used to classify spinal cord injuries as disabling or not disabling. A binary logistic regression was used to determine the effects of protocol, gender, age, level of injury, and mechanism of injury (MOI) on the incidence of significant disability from a spinal cord injury.
Results:A total of 549 patients in the SI period and 623 patients in the SMR period were included in the analysis. In the logistic regression, the change from an SI protocol to an SMR protocol did not demonstrate a significant effect on the incidence of disabling spinal injuries (OR: 0.78; 95% CI, 0.44 - 1.36).
Conclusion:This study did not demonstrate an increase in disabling spinal cord injuries after a shift from an SI protocol to an SMR protocol. This finding, in addition to existing literature, supports the introduction of SMR protocols and the decreased use of the backboard.
Avoid the Goose! Paramedic Identification of Esophageal Intubation by Ultrasound
- Penelope C. Lema, Michael O’Brien, Juliana Wilson, Erika St. James, Heather Lindstrom, John DeAngelis, Jennifer Caldwell, Paul May, Brian Clemency
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 4 / August 2018
- Published online by Cambridge University Press:
- 21 August 2018, pp. 406-410
- Print publication:
- August 2018
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Objectives
Rapid identification of esophageal intubations is critical to avoid patient morbidity and mortality. Continuous waveform capnography remains the gold standard for endotracheal tube (ETT) confirmation, but it has limitations. Point-of-care ultrasound (POCUS) may be a useful alternative for confirming ETT placement. The objective of this study was to determine the accuracy of paramedic-performed POCUS identification of esophageal intubations with and without ETT manipulation.
MethodsA prospective, observational study using a cadaver model was conducted. Local paramedics were recruited as subjects and each completed a survey of their demographics, employment history, intubation experience, and prior POCUS training. Subjects participated in a didactic session in which they learned POCUS identification of ETT location. During each study session, investigators randomly placed an ETT in either the trachea or esophagus of four cadavers, confirmed with direct laryngoscopy. Subjects then attempted to determine position using POCUS both without and with manipulation of the ETT. Manipulation of the tube was performed by twisting the tube. Descriptive statistics and logistic regression were used to assess the results and the effects of previous paramedic experience.
ResultsDuring 12 study sessions, from March 2014 through December 2015, 57 subjects participated, evaluating a total of 228 intubations: 113 tracheal and 115 esophageal. Subjects were 84.0% male, mean age of 39 years (range: 22 - 62 years), with median experience of seven years (range: 0.6 - 39 years). Paramedics correctly identified ETT location in 158 (69.3%) cases without and 194 (85.1%) with ETT manipulation. The sensitivity and specificity of identifying esophageal location without ETT manipulation increased from 52.2% (95% confidence interval [CI], 43.0-61.0) and 86.7% (95% CI, 81.0-93.0) to 87.0% (95% CI, 81.0-93.0) and 83.2% (95% CI, 0.76-0.90) after manipulation (P<.0001), without affecting specificity (P=.45). Subjects correctly identified 41 previously incorrectly identified esophageal intubations. Paramedic experience, previous intubations, and POCUS experience did not correlate with ability to identify tube location.
Conclusion:Paramedics can accurately identify esophageal intubations with POCUS, and manipulation improves identification. Further studies of paramedic use of dynamic POCUS to identify inadvertent esophageal intubations are needed.
,Lema PC ,O’Brien M ,Wilson J ,St. James E ,Lindstrom H ,DeAngelis J ,Caldwell J ,May P Clemency B. Avoid the Goose! Paramedic Identification of Esophageal Intubation by Ultrasound . Prehosp Disaster Med.2018 ;33 (4 ):406 –410
Prehospital Naloxone Administration as a Public Health Surveillance Tool: A Retrospective Validation Study
- Heather A. Lindstrom, Brian M. Clemency, Ryan Snyder, Joseph D. Consiglio, Paul R. May, Ronald M. Moscati
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 4 / August 2015
- Published online by Cambridge University Press:
- 10 June 2015, pp. 385-389
- Print publication:
- August 2015
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Background
Abuse or unintended overdose (OD) of opiates and heroin may result in prehospital and emergency department (ED) care. Prehospital naloxone use has been suggested as a surrogate marker of community opiate ODs. The study objective was to verify externally whether prehospital naloxone use is a surrogate marker of community opiate ODs by comparing Emergency Medical Services (EMS) naloxone administration records to an independent database of ED visits for opiate and heroin ODs in the same community.
MethodsA retrospective chart review of prehospital and ED data from July 2009 through June 2013 was conducted. Prehospital naloxone administration data obtained from the electronic medical records (EMRs) of a large private EMS provider serving a metropolitan area were considered a surrogate marker for suspected opiate OD. Comparison data were obtained from the regional trauma/psychiatric ED that receives the majority of the OD patients. The ED maintains a de-identified database of narcotic-related visits for surveillance of narcotic use in the metropolitan area. The ED database was queried for ODs associated with opiates or heroin. Cross-correlation analysis was used to test if prehospital naloxone administration was independent of ED visits for opiate/heroin ODs.
ResultsNaloxone was administered during 1,812 prehospital patient encounters, and 1,294 ED visits for opiate/heroin ODs were identified. The distribution of patients in the prehospital and ED datasets did not differ by gender, but it did differ by race and age. The frequency of naloxone administration by prehospital providers varied directly with the frequency of ED visits for opiate/heroin ODs. A monthly increase of two ED visits for opiate-related ODs was associated with an increase in one prehospital naloxone administration (cross-correlation coefficient [CCF]=0.44; P=.0021). A monthly increase of 100 ED visits for heroin-related ODs was associated with an increase in 94 prehospital naloxone administrations (CCF=0.46; P=.0012).
ConclusionsFrequency of naloxone administration by EMS providers in the prehospital setting varied directly with frequency of opiate/heroin OD-related ED visits. The data correlated both for short-term frequency and longer term trends of use. However, there was a marked difference in demographic data suggesting neither data source alone should be relied upon to determine which populations are at risk within the community.
,Lindstrom HA ,Clemency BM ,Snyder R ,Consiglio JD ,May PR .Moscati RM Prehospital Naloxone Administration as a Public Health Surveillance Tool: A Retrospective Validation Study . Prehosp Disaster Med.2015 ;30 (4 ):1 –5 .
Sufficient Catheter Length for Pneumothorax Needle Decompression: A Meta-Analysis
- Brian M. Clemency, Christopher T. Tanski, Michael Rosenberg, Paul R. May, Joseph D. Consiglio, Heather A. Lindstrom
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 3 / June 2015
- Published online by Cambridge University Press:
- 10 April 2015, pp. 249-253
- Print publication:
- June 2015
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Introduction
Needle thoracostomy is the prehospital treatment for tension pneumothorax. Sufficient catheter length is necessary for procedural success. The authors of this study determined minimum catheter length needed for procedural success on a percentile basis.
MethodsA meta-analysis of existing studies was conducted. A Medline search was performed using the search terms: needle decompression, needle thoracentesis, chest decompression, pneumothorax decompression, needle thoracostomy, and tension pneumothorax. Studies were included if they published a sample size, mean chest wall thickness, and a standard deviation or confidence interval. A PubMed search was performed in a similar fashion. Sample size, mean chest wall thickness, and standard deviation were found or calculated for each study. Data were combined to create a pooled dataset. Normal distribution of data was assumed. Procedural success was defined as catheter length being equal to or greater than the chest wall thickness.
ResultsThe Medline and PubMed searches yielded 773 unique studies; all study abstracts were reviewed for possible inclusion. Eighteen papers were identified for full manuscript review. Thirteen studies met all inclusion criteria and were included in the analysis. Pooled sample statistics were: n=2,558; mean=4.19 cm; and SD=1.37 cm. Minimum catheter length needed for success at the 95th percentile for chest wall size was found to be 6.44 cm.
DiscussionA catheter of at least 6.44 cm in length would be required to ensure that 95% of the patients in this pooled sample would have penetration of the pleural space at the site of needle decompression, and therefore, a successful procedure. These findings represent Level III evidence.
,Clemency BM ,Tanski CT ,Rosenberg M ,May PR ,Consiglio JD .Lindstrom HA Sufficient Catheter Length for Pneumothorax Needle Decompression: A Meta-Analysis . Prehosp Disaster Med.2015 ;30 (3 ):1 5
Frequency of Manuscript Publication Following Presentation of EMS Abstracts at National Meetings
- Brian M. Clemency, Jeffrey J. Thompson, Heather A. Lindstrom, Steven Gurien, Berly A. Jaison, Alexis A. Grates-Sciarrino
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- Journal:
- Prehospital and Disaster Medicine / Volume 29 / Issue 3 / June 2014
- Published online by Cambridge University Press:
- 15 April 2014, pp. 294-298
- Print publication:
- June 2014
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Introduction
Specialized knowledge and a scientific body of literature are the foundation of the recognition of Emergency Medical Services (EMS) as a subspecialty within emergency medicine (EM). Emergency Medical Services research often is presented at national meetings and published in abstract form, but full publication occurs less frequently.
ProblemThe primary goal of the study was to determine the rate at which EMS-related research presented at selected conferences went on to manuscript publication. A secondary goal was the determination of the time to manuscript publication.
MethodsA cross-sectional study of published abstracts from the 2003-2005 national meetings of the American College of Emergency Physicians (ACEP), Society for Academic Emergency Medicine (SAEM), National Association of EMS Physicians (NAEMSP), Association of Air Medical Services (AAMS), and the National Association of EMS Educators (NAEMSE) was conducted to identify EMS-related abstracts. PubMed (National Center for Biotechnology Information, Bethesda, Maryland USA) was searched using abstract title keywords and authors’ names to determine if the study had been published in a PubMed-indexed journal in the time since presentation and abstract publication.
ResultsAbstracts for the five conferences were reviewed for 2003-2005. Six hundred and thirty-five EMS-related abstracts met the inclusion criteria. The total number of EMS abstracts presented and the percent subsequently published as a manuscript were: SAEM 135, 53.3%; ACEP 128, 48.4%; NAEMSP 282, 42.9%; AAMS 66, 33.3%; and NAEMSE 24, 16.7%. The overall rate of publication was 44.3%. The average time to publication was 22.2 months (SD = 16.5 months, range = 0-94 months).
ConclusionLess than half of EMS abstracts go on to manuscript publication. This may represent missed opportunities for the growth of EMS as a subspecialty.
,Clemency BM ,Thompson JJ ,Lindstrom HA ,Gurien S ,Jaison BA .Grates-Sciarrino AA Frequency of Manuscript Publication Following Presentation of EMS Abstracts at National Meetings . Prehosp Disaster Med.2014 ;29 (3 ):1 -5 .
Prehospital High-dose Sublingual Nitroglycerin Rarely Causes Hypotension
- Brian M. Clemency, Jeffrey J. Thompson, Gina N. Tundo, Heather A. Lindstrom
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- Journal:
- Prehospital and Disaster Medicine / Volume 28 / Issue 5 / October 2013
- Published online by Cambridge University Press:
- 21 August 2013, pp. 477-481
- Print publication:
- October 2013
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Introduction
High-dose intravenous nitroglycerin is a common in-hospital treatment for respiratory distress due to congestive heart failure (CHF) with hypertension. Intravenous (IV) nitroglycerin administration is impractical in the prehospital setting. In 2011, a new regional Emergency Medical Services (EMS) protocol was introduced allowing advanced providers to treat CHF with high-dose oral nitroglycerin. The protocol calls for patients to be treated with two sublingual tabs (0.8 mg) when systolic blood pressure (SBP) was >160 mm Hg, or three sublingual tabs (1.2 mg) when SBP was >200 mm Hg, every five minutes as needed.
Hypothesis/ProblemTo assess the protocol's safety, the incidence of hypotension following prehospital administration of multiple simultaneous nitroglycerin (MSN) tabs by EMS providers was studied.
MethodsThis study was a retrospective cohort study of patients from a single commercial EMS agency over a 6-month period. Records from patients with at least one administration of MSN were reviewed. For each administration, the first documented vital signs pre- and post-administration were compared. Administrations were excluded if pre- or post-administration vital signs were missing.
ResultsOne hundred case-patients had at least one MSN administration by an advanced provider during the study period. Twenty-five case-patients were excluded due to incomplete vital signs. Seventy-five case-patients with 95 individual MSN administrations were included for analysis. There were 65 administrations of two tabs, 29 administrations of three tabs, and one administration of four tabs. The mean change in SBP following MSN was -14.7 mm Hg (SD = 30.7; range, +59 to -132). Three administrations had documented systolic hypotension in the post-administration vital signs (97/71, 78/50 and 66/47). All three patients were over 65 years old, were administered two tabs, had documented improved respiratory status, and had repeat SBP of at least 100. The incidence of hypotension following MSN administration was 3.2%.
DiscussionHigh-dose oral nitroglycerin administration is a practical alternative to IV nitroglycerin in the prehospital setting when administered by advanced providers. The prehospital protocol for high dose oral nitroglycerin was demonstrated to be safe in the cohort of patients studied. Limitations of the study include the relatively small sample size and the inability to identify hypotension that may have occurred following the cessation of data collection in the field.
ConclusionHypotension was rare and self-limited in prehospital patients receiving MSN.
,Clemency B ,Thompson J ,Tundo G .Lindstrom H Prehospital High-dose Sublingual Nitroglycerin Rarely Causes Hypotension . Prehosp Disaster Med.2013 ;28 (5 ):1 -4 .
Use of vitamin D supplements during infancy in an international feeding trial
- Eveliina Lehtonen, Anne Ormisson, Anita Nucci, David Cuthbertson, Susa Sorkio, Mila Hyytinen, Kirsi Alahuhta, Carol Berseth, Marja Salonen, Shayne Taback, Margaret Franciscus, Teba González-Frutos, Tuuli E Korhonen, Margaret L Lawson, Dorothy J Becker, Jeffrey P Krischer, Mikael Knip, Suvi M Virtanen, , Thomas Mandrup-Poulsen, Elias Arjas, Åke Lernmark, Barbara Schmidt, Jeffrey P. Krischer, Hans K. Åkerblom, Mila Hyytinen, Mikael Knip, Katriina Koski, Matti Koski, Eeva Pajakkala, Marja Salonen, David Cuthbertson, Jeffrey P. Krischer, Linda Shanker, Brenda Bradley, Hans-Michael Dosch, John Dupré, William Fraser, Margaret Lawson, Jeffrey L. Mahon, Mathew Sermer, Shayne P. Taback, Dorothy Becker, Margaret Franciscus, Anita Nucci, Jerry Palmer, Minna Pekkala, Suvi M. Virtanen, Jacki Catteau, Neville Howard, Patricia Crock, Maria Craig, Cheril L. Clarson, Lynda Bere, David Thompson, Daniel Metzger, Colleen Marshall, Jennifer Kwan, David K. Stephure, Daniele Pacaud, Wendy Schwarz, Rose Girgis, Marilyn Thompson, Shayne P. Taback, Daniel Catte, Margaret L. Lawson, Brenda Bradley, Denis Daneman, Mathew Sermer, Mary-Jean Martin, Valérie Morin, Lyne Frenette, Suzanne Ferland, Susan Sanderson, Kathy Heath, Céline Huot, Monique Gonthier, Maryse Thibeault, Laurent Legault, Diane Laforte, Elizabeth A. Cummings, Karen Scott, Tracey Bridger, Cheryl Crummell, Robyn Houlden, Adriana Breen, George Carson, Sheila Kelly, Koravangattu Sankaran, Marie Penner, Richard A. White, Nancy King, James Popkin, Laurie Robson, Eva Al Taji, Irena Aldhoon, Pavla Mendlova, Jan Vavrinec, Jan Vosahlo, Ludmila Brazdova, Jitrenka Venhacova, Petra Venhacova, Adam Cipra, Zdenka Tomsikova, Petra Krckova, Pavla Gogelova, Ülle Einberg, Mall-Anne Riikjärv, Anne Ormisson, Vallo Tillmann, Päivi Kleemola, Anna Parkkola, Heli Suomalainen, Anna-Liisa Järvenpää, Anu-Maaria Hämälainen, Hannu Haavisto, Sirpa Tenhola, Pentti Lautala, Pia Salonen, Susanna Aspholm, Heli Siljander, Carita Holm, Samuli Ylitalo, Raisa Lounamaa, Anja Nuuja, Timo Talvitie, Kaija Lindström, Hanna Huopio, Jouni Pesola, Riitta Veijola, Päivi Tapanainen, Abram Alar, Paavo Korpela, Marja-Liisa Käär, Taina Mustila, Ritva Virransalo, Päivi Nykänen, Bärbel Aschemeier, Thomas Danne, Olga Kordonouri, Dóra Krikovszky, László Madácsy, Yeganeh Manon Khazrai, Ernesto Maddaloni, Paolo Pozzilli, Carla Mannu, Marco Songini, Carine de Beaufort, Ulrike Schierloh, Jan Bruining, Margriet Bisschoff, Aleksander Basiak, Renata Wasikowa, Marta Ciechanowska, Grazyna Deja, Przemyslawa Jarosz-Chobot, Agnieszka Szadkowska, Katarzyna Cypryk, Malgorzata Zawodniak-Szalapska, Luis Castano, Teba Gonzalez Frutos, Mirentxu Oyarzabal, Manuel Serrano-Ríos, María Teresa Martínez-Larrad, Federico Gustavo Hawkins, Dolores Rodriguez Arnau, Johnny Ludvigsson, Malgorzata Smolinska Konefal, Ragnar Hanas, Bengt Lindblad, Nils-Osten Nilsson, Hans Fors, Maria Nordwall, Agne Lindh, Hans Edenwall, Jan Aman, Calle Johansson, Margrit Gadient, Eugen Schoenle, Dorothy Becker, Ashi Daftary, Margaret Franciscus, Carol Gilmour, Jerry Palmer, Rachel Taculad, Marilyn Tanner-Blasiar, Neil White, Uday Devaskar, Heather Horowitz, Lisa Rogers, Roxana Colon, Teresa Frazer, Jose Torres, Robin Goland, Ellen Greenberg, Maudene Nelson, Holly Schachner, Barney Softness, Jorma Ilonen, Massimo Trucco, Lynn Nichol, Erkki Savilahti, Taina Härkönen, Mikael Knip, Outi Vaarala, Kristiina Luopajärvi, Hans-Michael Dosch
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- Journal:
- Public Health Nutrition / Volume 17 / Issue 4 / April 2014
- Published online by Cambridge University Press:
- 24 June 2013, pp. 810-822
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Objective
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
DesignLongitudinal study.
SettingInformation about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
SubjectsInfants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
ResultsDaily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
ConclusionsMost of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
Chapter 9 - Executive functions in learning disorders
- from Section II - Executive Dysfunction in the Neurodevelopmental and Acquired Disorders
- Edited by Scott J. Hunter, University of Chicago, Elizabeth P. Sparrow
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- Book:
- Executive Function and Dysfunction
- Published online:
- 05 October 2012
- Print publication:
- 04 October 2012, pp 131-140
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Summary
Growing evidence supports the involvement of EF in academic performance and, consequently, EdF in learning disorders (commonly known as learning disabilities or LD). Often, the first indicator of LD is low academic achievement in areas of reading, math, or writing. The terminology used to describe different LD conditions varies by field and includes dyslexia and reading disorder/disability, dyscalculia and mathematics disorder/disability, and disorder of written expression/writing disability. Comorbidity among these learning disorders is common, as is the co-occurrence of LD with ADHD.
Recent US data indicate that almost 2.5 million public school students received special education and related services for LD in 2008, and 43% of all public school students receiving special education and related services were identified as having a specific learning disability. Federal guidelines used in educational settings indicate that a child may have a specific LD if, in the absence of any other disability or limiting condition and despite appropriate instruction and experiences, the child does not adequately achieve for age or state standards in one of the following eight academic areas: oral expression, listening comprehension, written expression, basic reading skills, reading fluency skills, reading comprehension, mathematics calculation, or mathematics problem solving. The DSM-IV-TR indicates diagnosis of specific disorders of reading, math, and written expression based on lower than expected performance on standardized tests “given the person’s chronological age, measured intelligence, and age-appropriate education.” The proposed changes for DSM-5 include defining these disorders based on low performance on standardized measures without requiring a significant discrepancy between measured intelligence and achievement.
Characterization of Hydrogen in Concrete by Cold Neutron Prompt Gamma-Ray Activation Analysis and Neutron Incoherent Scattering
- Rick L. Paul, H. Heather Chen-Mayer, Richard M. Lindstrom, Menno Blaauw
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- Journal:
- MRS Online Proceedings Library Archive / Volume 591 / 1999
- Published online by Cambridge University Press:
- 10 February 2011, 175
- Print publication:
- 1999
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A combination of cold neutron prompt gamma-ray activation analysis (PGAA) and neutron incoherent scattering (NIS) has been used for nondestructive characterization of hydrogen as a function of position in slabs of wet concrete of different compositions. Hydrogen was determined by PGAA by scanning each sample across a 5 mm diameter neutron beam in 10 mm increments, and measuring the 2223 keV prompt gamma ray. NIS measurements were performed by scanning the sample across a 5 mm diameter neutron beam at 5 mm increments and detecting scattered neutrons. The measurements demonstrate the feasibility of the techniques for 2D compositional mapping of hydrogen and other elements in materials, and indicate the potential of these methods for monitoring the uniformity of drying concrete.