Mass food challenges in a vacant COVID-19 stepdown facility: Exceptional opportunity provides a model for the future.

BACKGROUND: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi-elective procedures. For allergic children in Ireland, already waiting up to 4 years for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative, there were approx 900 children on the Children's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short-term (6 weeks) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive (HSE), Ireland. The aim of this study was to achieve the rapid roll-out of an offsite OFC service, delivering high throughput of long waiting patients, while aligning with existing hospital policies and quality standards, international allergy guidelines and national social distancing standards. METHODS: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant paediatric allergists, consultant paediatricians, trainees and allergy clinical nurse specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, pulse and oxygen saturation) and bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardized food challenge protocols were created. Access to the onsite hotel chef facilitated food preparation. A risk register was established. RESULTS: After 6 weeks of planning, the remote centre became operational on 7/9/2020, with the capacity of 27 OFC/day. 474 challenges were commenced: 465 (98%) were completed and 9 (2%) were inconclusive. 135 (29%) OFCs were positive, with 25 (5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. CONCLUSIONS: Oral food challenges remain a vital tool in the care of allergic children, with their cost saving and quality-of-life benefits negatively affected by a delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy-in-even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID-19 era.

Inter-laboratory comparison of three earplug fit-test systems.

The National Institute for Occupational Safety and Health (NIOSH) sponsored tests of three earplug fit-test systems (NIOSH HPD Well-Fit, Michael & Associates FitCheck, and Honeywell Safety Products VeriPRO). Each system was compared to laboratory-based real-ear attenuation at threshold (REAT) measurements in a sound field according to ANSI/ASA S12.6-2008 at the NIOSH, Honeywell Safety Products, and Michael & Associates testing laboratories. An identical study was conducted independently at the U.S. Army Aeromedical Research Laboratory (USAARL), which provided their data for inclusion in this article. The Howard Leight Airsoft premolded earplug was tested with twenty subjects at each of the four participating laboratories. The occluded fit of the earplug was maintained during testing with a soundfield-based laboratory REAT system as well as all three headphone-based fit-test systems. The Michael & Associates lab had the highest average A-weighted attenuations and smallest standard deviations. The NIOSH lab had the lowest average attenuations and the largest standard deviations. Differences in octave-band attenuations between each fit-test system and the American National Standards Institute (ANSI) sound field method were calculated (Attenfit-test - AttenANSI). A-weighted attenuations measured with FitCheck and HPD Well-Fit systems demonstrated approximately ±2 dB agreement with the ANSI sound field method, but A-weighted attenuations measured with the VeriPRO system underestimated the ANSI laboratory attenuations. For each of the fit-test systems, the average A-weighted attenuation across the four laboratories was not significantly greater than the average of the ANSI sound field method. Standard deviations for residual attenuation differences were about ±2 dB for FitCheck and HPD Well-Fit compared to ±4 dB for VeriPRO. Individual labs exhibited a range of agreement from less than a dB to as much as 9.4 dB difference with ANSI and REAT estimates. Factors such as the experience of study participants and test administrators, and the fit-test psychometric tasks are suggested as possible contributors to the observed results.

A Speech Perception Test in Simulated Reverberation Conditions.

PURPOSE: This study developed new test materials by applying various reverberation treatments to sentences having high and low contextual redundancy. METHOD: The Speech Perception in Noise-Revised (SPIN-R; Bilger, Nuetzel, Rabinowitz, & Rzeczkowski, 1984; Kalikow, Stevens, & Elliott, 1977) sentences were modified (SPIN-Reverb) with reverberation times (RT60) from simulated environments: unprocessed, RevCond 1 (RT60 = 600 ms), RevCond 2 (RT60 = 1200 ms), and RevCond 3 (RT60 = 3600 ms). Phase 1 investigated list equivalency among 75 listeners with normal hearing; Phase 2 examined the utility of SPIN-Reverb for 15 cochlear implant (CI) recipients. RESULTS: Equivalent lists within each reverberation condition (unprocessed, RevCond 1, 2, and 3) were identified using nonparametric bootstrapping. Analysis of variance (Phase 1) demonstrated significant differences across conditions for high predictability and total scores. Listening performance decreased for both high and low predictability as RT60 increased for listeners with normal hearing and CI recipients. Unprocessed, RevCond 1, RevCond 2, and RevCond 3 conditions were significantly different from each other. Within RevCond conditions, high- and low-predictability sentences were significantly different from each other. CONCLUSIONS: RevCond 1 and RevCond 2 may be useful supplements to the current CI battery. The SPIN-Reverb has potential as a set of clinically feasible materials that are graded in difficulty and representative of real-life acoustic challenges for the evaluation of sensory devices.

A case report and brief review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting.

Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION), posterior ischaemic optic neuropathy (PION), and central retinal artery occlusion (CRAO). These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass); general surgery; urology; gynaecology; liposuction; liver transplantation and duration of surgery. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone), alteration of venous drainage of the retina, hypertension, smoking, atherosclerosis, hyperlipidaemia, diabetes, hypercoagulability, hypotension, blood loss and large volume resuscitation. Other important cardiac causes are septic emboli from bacterial endocarditis and emboli caused by atrial myxomata. The majority of AION cases occur during CPB followed by head/neck surgery and prone spine surgery. CPB is used to allow coronary artery bypass grafting on a motionless heart. It has many side-effects and complications associated with its use and we report here a case of bilateral retinal infarction during routine coronary artery bypass grafting in a young male patient with multiple risk factors for developing this complication despite steps to minimise its occurrence.

A tutorial on complex sound fields for audiometric testing.

A fundamental understanding of soundfield characteristics in enclosed spaces is required in order to appreciate and predict the behavior of complex sound fields (i.e., sound fields created with at least two uncorrelated sound sources on different axes) used in auditory tests for evaluating hearing aid performance, especially speech-in-noise tasks. This article is a tutorial starting with idealized definitions of acoustical spaces. Next is an exploration of the interactions between practical sound fields and the enclosures that contain them, based on a synthesis of ideas formed from a review of classical acoustical theory combined with direct observation. Finally, the discussion turns to the application of complex sound fields for speech-in-noise testing in typical audiometric test rooms and a practical realization of such a sound field with consideration given to the limitations imposed by factors covered in the foregoing discussions.

Development of a test environment to evaluate performance of modern hearing aid features.

This article describes a new test environment and materials with the potential to measure performance differences among different hearing aid signal processing methods and features. Normative data suggest a linearly predictable increase in difficulty on a speech-in-noise task as the masker changes from random noise to multiple-talker speech, and the number of talkers increases. Data collected with normal listeners revealed no differences across four test sites for the single loudspeaker (Noise-Front) results and some differences across test sites for the multiple loudspeaker results. Room dimension differences among audiometric test enclosures and diffusion (or lack thereof) of the maskers in the vertical and horizontal dimensions of the sound fields appear to account for performance differences for the multiloudspeaker arrays, confirming the need to limit maskers to aperiodic signals in rooms with controlled ceiling height or to establish norms for each test environment such that results obtained in different enclosures can be compared.