Nursing Home Residents' Use of Radiography in New Brunswick: A Case for Mobile Radiography?

Introduction: Identifying ways to eliminate unnecessary transfer of nursing home (NH) residents to hospitals provides an opportunity to improve outcomes and use scarce healthcare resources more efficiently. This study's goal was to better understand where NH residents access X-ray (XR) and computed tomography (CT) scans and to determine if there was a case for mobile radiography policies in New Brunswick. Methods: A retrospective analysis of all the visits to the emergency department (ED) and outpatient imaging departments in two hospitals in Saint John, New Brunswick, in 2020, that involved XR or CT investigations was conducted. Results: There were 521 visits by 311 unique NH residents and 920 investigations (688 XR and 232 CT scans). Most investigations were ordered in the ED (696 of 920; 75.6%; confidence interval: 72.8-78.3%). Of the NH residents who visited the ED and received either an XR or a CT scan, 33.2% received only XR imaging and were discharged back to the NH after a mean ED stay of 5.15 hours. Discussion: The pattern of NH residents' use of the ED for their imaging needs supports the creation of mobile XR policies to deliver more safe and efficient care in a Canadian medium population urban centre.

Comparing the First-Pass Success Rate of the King LTS-D and the i-gel Airway Devices in Out-of-Hospital Cardiac Arrest.

OBJECTIVES:  Significant heterogeneity exists internationally in the airway devices used in the pre-hospital setting during cardiac arrest. This study evaluated the first-pass success (FPS) rate of two supraglottic airways (SGAs) used by paramedics during out-of-hospital cardiac arrest: the King LTS-D and the i-gel. METHODS:  By examining 2,680 patient care records compiled by Ambulance New Brunswick between 2015 and 2020, we evaluated the FPS rate of the two SGAs using a 2x2 Pearson chi-square test for association, and a Mann-Whitney U test, to determine whether there were significant differences in FPS rates. RESULTS:  Our study demonstrated a statistically significant association between airway devices and FPS favoring the i-gel with an FPS of 90.6% compared to a 76.6% FPS with the King LTS-D; X 2(1) = 96.01, p < 0.001. The odds of successfully inserting the airway on the first attempt were 2.94 times higher if paramedics used the i-gel than if they used the King LTS-D with a 95% CI [2.32, 3.60]. Mann-Whitney's U test for SGA differences favored the i-gel in fewer attempts for successful insertion (z = -4.357, p < 0.001, d = 0.15). CONCLUSIONS:  Among patients in New Brunswick with out-of-hospital cardiac arrest, paramedics had a higher FPS rate with the i-gel compared to the King LTS-D. Our study also found a statistically significant difference between the King LTS-D and i-gel, favoring the i-gel in fewer attempts. Our findings suggest that the i-gel provides a more consistent FPS rate compared to the King LTS-D within our study populations; however, further research is necessary to determine the clinical implications of this. While multiple attempts at tracheal intubation are associated with negative clinical outcomes, no such evidence exists for SGAs.

NanoMi: An open source electron microscope hardware and software platform.

We outline a public license (open source) electron microscopy platform, referred to as NanoMi. NanoMi offers a modular, flexible electron microscope platform that can be utilized for a variety of applications, such as microscopy education and development of proof-of-principle experiments, and can be used to complement an existing experimental apparatus. All components are ultra-high vacuum compatible and the electron optics elements are independent from the vacuum envelope. The individual optical components are mounted on a 127 mm (5-inch) diameter half-pipe, allowing customizing of electron optics for a variety of purposes. The target capabilities include SEM, TEM, scanning TEM (STEM), and electron diffraction (ED) at up to 50 keV incident electron energy. The intended image resolution in SEM, TEM and STEM modes is ≈ 10 nm. We describe the existing components and the interfaces among components that ensure their compatibility and interchangeability. The paper provides a resource for those who consider building or utilizing their own NanoMi.

The role of grain boundary character in solute segregation and thermal stability of nanocrystalline Pt-Au.

Nanocrystalline (NC) metals suffer from an intrinsic thermal instability; their crystalline grains undergo rapid coarsening during processing treatments or under service conditions. Grain boundary (GB) solute segregation has been proposed to mitigate grain growth and thermally stabilize the grain structures of NC metals. However, the role of GB character in solute segregation and thermal stability of NC metals remains poorly understood. Herein, we employ high resolution microscopy techniques, atomistic simulations, and theoretical analysis to investigate and characterize the impact of GB character on segregation behavior and thermal stability in a model NC Pt-Au alloy. High resolution electron microscopy along with X-ray energy dispersive spectroscopy and automated crystallographic orientation mapping is used to obtain spatially correlated Pt crystal orientation, GB misorientation, and Au solute concentration data. Atomistic simulations of polycrystalline Pt-Au systems are used to reveal the plethora of GB segregation profiles as a function of GB misorientation and the corresponding impact on grain growth processes. With the aid of theoretical models of interface segregation, the experimental data for GB concentration profiles are used to extract GB segregation energies, which are then used to elucidate the impact of GB character on solute drag effects. Our results highlight the paramount role of GB character in solute segregation behavior. In broad terms, our approach provides future avenues to employ GB segregation as a microstructure design strategy to develop NC metallic alloys with tailored microstructures.

Hierarchical nanotwins in single-crystal-like nickel with high strength and corrosion resistance produced via a hybrid technique.

High-density growth nanotwins enable high-strength and good ductility in metallic materials. However, twinning propensity is greatly reduced in metals with high stacking fault energy. Here we adopted a hybrid technique coupled with template-directed heteroepitaxial growth method to fabricate single-crystal-like, nanotwinned (nt) Ni. The nt Ni primarily contains hierarchical twin structures that consist of coherent and incoherent twin boundary segments with few conventional grain boundaries. In situ compression studies show the nt Ni has a high flow strength of ∼2 GPa and good deformability. Moreover, the nt Ni has superb corrosion behavior due to the unique twin structure in comparison to coarse grained and nanocrystalline counterparts. The hybrid technique opens the door for the fabrication of a wide variety of single-crystal-like nt metals with unique mechanical and chemical properties.

Microgenetic optimization algorithm for optimal wavefront shaping.

One of the main limitations of utilizing optimal wavefront shaping in imaging and authentication applications is the slow speed of the optimization algorithms currently being used. To address this problem we develop a microgenetic optimization algorithm (µGA) for optimal wavefront shaping. We test the abilities of the µGA and make comparisons to previous algorithms (iterative and simple-genetic) by using each algorithm to optimize transmission through an opaque medium. From our experiments we find that the µGA is faster than both the iterative and simple-genetic algorithms and that both genetic algorithms are more resistant to noise and sample decoherence than the iterative algorithm.

Non-assigned Medicare payment increases practice revenue & lowers Medicare costs.

Private practice physicians can increase practice revenue and also save Medicare money. What seems like a paradox is instead a choice. The non-assigned Medicare payment option allows physicians to bill 8% more for their services. This also decreases Medicare payment 5%. Selecting the non-assigned payment method does not require permission from Medicare or any Medicare contractor. This is a physician decision and for 2014 must be made between mid-November and year end 2013.

A new method for the quantification of breathing.

Quantification of the breath flow and nostril dominance reveals internal physiological cycles. There are very few existing methods for unobtrusive monitoring of the breath flow. In this paper we present a new method for the quantification of breath flow and evaluation of the symmetry of breathing through both nostrils. The system utilizes thermal film to visualize the flow of breath and implements image processing techniques to quantify the flow. We present system design and preliminary results from an experiment with 11 subjects. Preliminary results indicate a good correlation between subjective measure of the nostril dominance and two analyzed parameters - ratio of left/right area and average intensity. The proposed method can be used as a diagnostic tool, for stress monitoring, biofeedback techniques, and circadian rhythm analysis.

Photodynamic therapy with verteporfin: observations on the introduction of a new treatment into clinical practice.

OBJECTIVE: To assess adherence to Food and Drug Administration-approved indications and Centers for Medicare & Medicaid Services policy through June 2001 regarding the use of photodynamic therapy in Medicare beneficiaries. DESIGN: Systematic review of pretreatment fluorescein angiograms of 1245 consecutive Medicare patients who received photodynamic therapy from physicians in 3 contiguous Medicare coverage areas (fee-for-service arrangement) and in 136 consecutive patients in a Medicare health maintenance organization. RESULTS: In the 3 Medicare fee-for-service regions, payment denial due to nonconforming fluorescein angiograms ranged from 17% to 29% by region in 1245 beneficiaries. In the health maintenance organization setting, 60 (44%) of 136 submitted angiograms were nonconforming, including 8 in which the photographic quality was too poor to grade the lesion size, composition, or both. CONCLUSIONS: A substantial proportion of the actual or intended clinical application of photodynamic therapy with verteporfin was directed to patients who did not meet concurrent published clinical criteria associated with treatment benefit or national coverage policy. Although this policy has evolved, it still depends on fluorescein angiographic interpretation, suggesting that there is an opportunity to improve the cost-effectiveness of delivery of photodynamic therapy with verteporfin to Medicare beneficiaries.