Evaluation of a Point-of-Use Kiosk for Improving the Fit of N95/P2 Respirators in Healthcare Settings: A Randomized Controlled Trial.

INTRODUCTION: Verifying the fit of disposable N95/P2 half-face respirators is critical. There are currently no objective ways to evaluate the implementation when used. Previously, we showed that only 26% of healthcare workers achieve appropriate fit at the point of use. METHODS: 657 quantitative fit tests were conducted on 166 subjects, using four different respirator styles. Randomization was performed; controls employing standard 'fit-check' and intervention using a custom built infra-red video kiosk. Primary outcome was passing rates of quantitative fit, with secondary outcomes of respirator type, gender, race, and previous experience. RESULTS: Intervention demonstrated significantly higher pass rate (50.6%) compared to controls (30.8%). The odds of passing with IR Kiosk compared to control was 2.3 (OR 2.3 95%CI 1.8 to 2.9, p<0.001). Duckbill style improved the greatest (OR 4.1 95%CI 2.1 to 7.9, p<0.001), and Tri-fold also showing substantial benefit (OR 2.66 95%CI 1.4 to 5.2, p<0.001). Gender and race did not influence the outcomes when using the kiosk, nor did previous experience. CONCLUSION: A custom point of use kiosk improved the odds of achieving a satisfactory fit of common respirator styles, independent of participant demographics. These findings open the door to addressing a critical gap in respiratory protection programs by providing individual assessment and interventions that improve worker safety at the time of highest risk. DATA AVAILABILITY STATEMENT: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Power-law properties of nocturnal arrhythmia avalanches: a novel marker for incident cardiovascular events.

BACKGROUND: Bursting non-sustained cardiac arrhythmia events, are a common observation during sleep. OBJECTIVES: We hypothesized nocturnal arrhythmia episode durations could follow a power-law, whose exponent could predict long-term clinical outcomes. METHODS: We defined 'nocturnal arrhythmia avalanche' (NAA) as any instance of a drop in electrocardiogram (ECG) template-matched R-R intervals ≥30% of R-R baseline, followed by a return to 90% of the baseline. We studied NAA in ECG recordings obtained from the Sleep Heart Health Study (SHHS), the Osteoporotic Fractures in Men Study (MrOS) Sleep and Multi-Ethnic Study of Atherosclerosis (MESA) studies. The association of the nocturnal arrhythmia durations with a power-law distribution was evaluated, and the association of derived power-law exponents (α) with major adverse cardiovascular events and mortality assessed with multivariable Cox regression. RESULTS: n=9176 participants were studied. NAA episodes distribution was with a consistent power-law versus comparator distributions in all datasets studied (Positive log likelihood ratio of power-law vs. exponential in MESA: 83%; SHHS: 69%; MrOS: 81%; power-law vs. log-normal in MESA: 95%; SHHS: 35% and MrOS: 64%). The NAA power law exponent (α) showed a significant association of with adverse CV outcomes (Association with CV mortality: SHHS (HR = 1.39[1.07-1.79], p=0.012); MrOS (HR = 1.42[1.02-1.94], p=0.039; Association with CV events: MESA (HR = 3.46[1.46-8.21], p=0.005)) in multivariable Cox regression, after adjusting for conventional CV risk factors and nocturnal ectopic rate. CONCLUSION: The NAA power-law exponent is a reproducible, predictive marker for incident cardiovascular events and mortality.

Outcomes of bent ab interno needle goniectomy with phacoemulsification in moderate to severe primary open angle glaucoma.

PURPOSE: To assess the safety and efficacy of bent ab interno needle goniectomy (BANG) in moderate to severe primary open angle glaucoma (POAG) eyes undergoing phacoemulsification (phaco). DESIGN: Single-arm, prospective, interventional study. METHODS: POAG patients with medically uncontrolled intraocular pressure (IOP), >15 mmHg for moderate and >12 mmHg for severe POAG, with visually significant cataract were recruited. All patients underwent BANG using a 26-gauge needle to excise 30° of the trabecular meshwork, along with phaco. Primary outcome was IOP. Secondary outcomes were success rate, percentage reduction in IOP/antiglaucoma medications (AGMs), and intraoperative complications. Success at 12 months was defined as: criterion A: IOP <15 mmHg for moderate glaucoma or <12 mm Hg for severe glaucoma with or without AGMs OR criterion B reduction in number of AGMs by >1. RESULTS: Thirty-two eyes of 32 patients underwent BANG + phaco. Mean age of the participants was 62.7 ± 8.4 years and there were 25 males and seven females. At 12 months, a significant decrease was noted in both IOP (from 17.6 ± 3.6 to 12 ± 1.6 mmHg, 31.8%; P < 0.001) and AGMs (from 3.7 ± 0.9 to 2.8 ± 0.8, 24.3%; P < 0.001). Twenty percent or more reduction in IOP was achieved in 62.5% (20/32) of eyes. Overall success (meeting either of the criteria A or B) at 12 months was achieved in 87.5% eyes. Mild postoperative hyphema was noted in 10 (31.2%) eyes, and two eyes (6.2%) required additional filtration surgery at 7 months. CONCLUSION: A 30-degree BANG with phaco in patients of POAG appears to be a safe, effective and affordable MIGS for developing countries.

Modeling the atmospheric refractive index structure parameter using macrometeorological observations.

The dynamic fluctuations in the atmospheric refractive index, commonly referred to as optical turbulence, cause phase distortions of the electromagnetic waves propagating through the atmosphere. The consequent scintillations have large implications for free-space optical communication, laser remote sensing, and directed energy applications. The refractive index structure parameter (C n2), quantifying the strength of these fluctuations, is usually estimated using high-frequency micrometeorological measurements, employing sonic anemometer-thermometers or scintillometers. Despite providing highly accurate information, these systems are immensely complex and costly, especially for frequent field applications and remote locations. In this study, we have developed an empirical multinomial model for estimating C n2 using three-year macrometeorological data and validated it against collocated and concurrent micrometeorological measurements, from a tropical semi-arid location. This simpler model would be handy for applications in remote locations having weather station measurements alone.

A comprehensive study on engineering and sustainability characteristics with emphasizing on 3R's approach in building construction.

The study assesses the mechanical efficiency, long-lasting characteristics, microstructure, and sustainability of sustainable concrete (SC) samples through several optimization methods, emphasizing the significance of the 3Rs (recycle, reuse, reduce) approach in the construction sector. The study uses advanced techniques like the Taguchi method, grey relational analysis (GRA), analysis of variance (ANOVA), and signal-noise ratio (SNR) to optimize parameters affecting the performance of SC. In this study, the properties of SC are assessed by considering various parameters. These parameters include the use of 10 %, 20 %, and 30 % of ground granulated blast furnace slag (GGBFS) as a replacement for fly ash (FA). Additionally, six different binder contents ranging from 300 kg/m3 to 600 kg/m3 are examined. The study also investigates three different molarities of sodium hydroxide (NaOH) (8 M, 12 M, and 16 M), three different ratios of alkaline activators (AA) (1.5, 2.0, and 2.5), three different AA to-binder ratios (0.30, 0.35, and 0.40), and curing temperature (CT) of 30 °C, 60 °C, and 90 °C. The study includes fresh properties such as fresh density (FD) and slump, mechanical properties such as tensile strength (TS), flexural strength (FS), modulus of elasticity (MOE), and compressive strength (CS), and durability studies such as dry density (DD), impact strength, water absorption (WA), and sorptivity. The blended proportions were obtained using the Taguchi method. The study shows that GGBFS accelerates geopolymerization in FA-based concrete, reducing setting time and early-age CS. FA is crucial for setting time, workability, and CS enhancement. GGBFS increases the densities of fresh and hardened concrete, with a highly correlated increase, allowing accurate hardened density prediction with a coefficient of 0.9057. The CS of the cube SC surpassed 40 MPa, irrespective of variables such as the AA ratio, CT, and NaOH molarity. The trail mix with a binder concentration of 600 kg/m3, 30 % GGBFS content, 12 M NaOH molarity, 1.5 AA ratio, 0.35 AA to binder ratio, and 90 °C CT exhibited the greatest strength. Mixtures containing 10 % GGBFS can attain a CS above 30 MPa after 28 days, making them suitable for structural purposes. The T18 mix exhibited a compact Calcium (alumino) silicate hydrate (C-A-S-H) and N-A-S-H gel, whereas the T3 mix displayed a varied and permeable structure. The study used GRA, ANOVA, and SNR methods to analyze properties varying by six variables, finding GGBFS content as the most influencing parameter. The study found that the SC had a lower sustainability score than the OPC mix, but had better energy efficiency.

A comparative study of point-of-care protection from N95 filtering face-piece respirators in a Residential Aged Care Facility and a Tertiary Hospital-Respiratory protection challenges remain amidst long-term impacts of COVID-19.

This study compared the effectiveness of N95 FFRs in providing respiratory protection for healthcare staff in a residential aged care facility (RACF) and tertiary teaching hospital (TTH) who had previously passed their occupational respiratory protection program fit test. A total of 126 healthcare workers who were regularly using N95 FFRs and who had previously passed a fit test participated in this comparative study. In this study, participants were again fit tested with the PortaCount machine, and their self-assessed tolerability of wearing an N95 FFR was assessed using a standardized questionnaire. The main outcome measures included the pass rate of the fit test and the assessment of tolerability and comfort of the N95 FFR. Across all participants, the fit test pass rate was low (27%), indicating persistent gaps in respiratory protection programs for healthcare workers during the ongoing COVID-19 pandemic. Hospital workers were 3.7 times more likely to pass the test compared to their counterparts in RACFs (p < 0.001). It was also found that workers in RACFs reported higher levels of discomfort and overall dissatisfaction with N95 FFRs compared to hospital staff. These findings highlight the need for targeted interventions and improvements in respiratory protection practices beyond annual fit testing, particularly in RACFs, to ensure the safety of healthcare workers and the vulnerable population they serve.

Observable Atrial and Ventricular Fibrillation Episode Durations Are Conformant With a Power Law Based on System Size and Spatial Synchronization.

BACKGROUND: Atrial fibrillation (AF) and ventricular fibrillation (VF) episodes exhibit varying durations, with some spontaneously ending quickly while others persist. A quantitative framework to explain episode durations remains elusive. We hypothesized that observable self-terminating AF and VF episode lengths, whereby durations are known, would conform with a power law based on the ratio of system size and correlation length ([Formula: see text]. METHODS: Using data from computer simulations (2-dimensional sheet and 3-dimensional left-atrial), human ischemic VF recordings (256-electrode sock, n=12 patients), and human AF recordings (64-electrode basket-catheter, n=9 patients; 16-electrode high definition-grid catheter, n=42 patients), conformance with a power law was assessed using the Akaike information criterion, Bayesian information criterion, coefficient of determination (R2, significance=P<0.05) and maximum likelihood estimation. We analyzed fibrillatory episode durations and [Formula: see text], computed by taking the ratio between system size ([Formula: see text], chamber/simulation size) and correlation length (xi, estimated from pairwise correlation coefficients over electrode/node distance). RESULTS: In all computer models, the relationship between episode durations and [Formula: see text] was conformant with a power law (Aliev-Panfilov R2: 0.90, P<0.001; Courtemanche R2: 0.91, P<0.001; Luo-Rudy R2: 0.61, P<0.001). Observable clinical AF/VF durations were also conformant with a power law relationship (VF R2: 0.86, P<0.001; AF basket R2: 0.91, P<0.001; AF grid R2: 0.92, P<0.001). [Formula: see text] also differentiated between self-terminating and sustained episodes of AF and VF (P<0.001; all systems), as well as paroxysmal versus persistent AF (P<0.001). In comparison, other electrogram metrics showed no statistically significant differences (dominant frequency, Shannon Entropy, mean voltage, peak-peak voltage; P>0.05). CONCLUSIONS: Observable fibrillation episode durations are conformant with a power law based on system size and correlation length.

Early Drainage of Suprachoroidal Hemorrhage Combined with Surgical Correction of Hypotony after Trabeculectomy.

Aims and background: Delayed suprachoroidal hemorrhage (DSCH) is a vision-threatening complication of intraocular surgeries with a higher prevalence in postglaucoma filtering surgeries. Through these case series of trabeculectomy complicated with DSCH, we aim to emphasize that correction of hypotony (inciting factor) is fundamental for complete resolution and prevention of recurrence. Case description: All three glaucoma patients underwent trabeculectomy surgery followed by DSCH on postoperative day 1. Drainage of DSCH using a 23 gauge trocar cannula within 48 hours of onset was performed along with exploration for the cause of hypotony. All three patients had satisfactory visual and anatomical outcomes. Conclusion: Early drainage using 23 gauge trocar cannulas gives good results in DSCH. The cause of hypotony must simultaneously be corrected during the drainage of DSCH. Preventive measures against hypotony should be taken while doing glaucoma filtering surgery. Clinical significance: Surgical exploration for the cause of hypotony must simultaneously be performed during drainage of DSCH. Primary preventive measures against hypotony and bleeding during glaucoma filtering surgeries, like the use of releasable sutures, viscoelastic in the anterior chamber, and discontinuation of anticoagulants, can be done. Early drainage using trocar cannulas gives satisfactory results in DSCH postglaucoma surgeries. How to cite this article: Beri N, Verma S, Bukke AN, et al. Early Drainage of Suprachoroidal Hemorrhage Combined with Surgical Correction of Hypotony after Trabeculectomy. J Curr Glaucoma Pract 2024;18(1):23-27.

Infra-Red Imaging to Detect Respirator Leak in Healthcare Workers During Fit-Testing Clinic.

OBJECTIVE: This study addressed the problem of objectively detecting leaks in P2 respirators at point of use, an essential component for healthcare workers' protection. To achieve this, we explored the use of infra-red (IR) imaging combined with machine learning algorithms on the thermal gradient across the respirator during inhalation. RESULTS: The study achieved high accuracy in predicting pass or fail outcomes of quantitative fit tests for flat-fold P2 FFRs. The IR imaging methods surpassed the limitations of self fit-checking. CONCLUSIONS: The integration of machine learning and IR imaging on the respirator itself demonstrates promise as a more reliable alternative for ensuring the proper fit of P2 respirators. This innovative approach opens new avenues for technology application in occupational hygiene and emphasizes the need for further validation across diverse respirator styles. SIGNIFICANCE STATEMENT: Our novel approach leveraging infra-red imaging and machine learning to detect P2 respirator leaks represents a critical advancement in occupational safety and healthcare workers' protection.

A real-time signal processing software package for the electrophysiology laboratory.

BACKGROUND: Real-time signal processing has to date been difficult to implement in the clinical electrophysiology laboratory. To date, no open access software solutions are available in electrophysiology (EP) laboratories to facilitate real-time intraprocedural signal analysis. We aimed to develop an open access, scalable Python plug-in to allow real-time signal processing during human EP procedures. METHODS AND RESULTS: A Python-based plug in for the widely available EnsiteX mapping system was developed. This plug-in utilized the LiveSync feature of the system to allow real-time signal analysis. An open access library was developed to allow end-users to implement real-time signal analysis using this platform, implemented in the Python programming language https://github.com/anand9176/WaveWatch5000Public. CONCLUSION: We have developed and demonstrated the feasibility of a readily scalable and open-access Python-based plug in to an electroanatomic mapping system (EnSiteX) to allow real-time processing and display of electrogram (EGM) based information for the procedural electrophysiologist to view intraprocedurally in the electrophysiology laboratory. The availability, to the clinician, of traditional and novel EGM-based metrics at the time of intervention, such as atrial fibrillation ablation, allows for key mechanistic insights into critical unresolved questions regarding arrhythmia mechanism.

Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry.

BACKGROUND: Cancer incidence and mortality vary across the globe, with nearly two-thirds of cancer-related deaths occurring in low- and middle-income countries. The rural-urban disparity in socio-demographic, behavioural, and lifestyle-related factors, as well as in access to cancer care, is one of the contributing factors. Population-based cancer registries serve as a measure for understanding the burden of cancer. We aimed to evaluate the rural-urban disparity in cancer burden and care of patients registered by an Indian population-based cancer registry. METHODS: This study collected data from Varanasi, Uttar Pradesh, India, between 2017 and 2019. Sex and site-specific age-standardised rates for incidence and mortality per 100,000 population were calculated. Rural-urban disparities in cancer incidence and mortality were estimated through rate differences and standardised rate ratios (with 95% confidence intervals). Univariable and multivariable regressions were applied to determine any significant differences in socio-demographic and cancer-related variables according to place of residence (rural/urban). Crude and adjusted odds ratios with 95% confidence intervals were calculated. RESULTS: 6721 cancer patients were registered during the study duration. Urban patients were older and had better literacy and socioeconomic levels, while rural patients had higher odds of having unskilled or semi-skilled professions. Diagnostic and clinical confirmation for cancer was significantly higher in urban patients, while verbal autopsy-based confirmation was higher in rural patients. Rural patients were more likely to receive palliative or alternative systems of medicine, and urban patients had higher chances of treatment completion. Significantly higher incidence and mortality were observed for oral cancer among urban men and for cervical cancer among rural women. Despite the higher incidence of breast cancer in urban women, significantly higher mortality was observed in rural women. CONCLUSIONS: Low- and middle-income countries are facing dual challenges for cancer control and prevention. Their urban populations experience unhealthy lifestyles, while their rural populations lack healthcare accessibility. The distinctness in cancer burden and pattern calls for a re-evaluation of cancer control strategies that are tailor-made with an understanding of urban-rural disparities. Context-specific interventional programmes targeting risk-factor modifications, cancer awareness, early detection, and accessibility to diagnosis and care are essential.

Assessing Torque Transfer in Conduction System Pacing: Development and Evaluation of an Ex Vivo Model.

BACKGROUND: Conduction system pacing (CSP) faces challenges in achieving reliable and safe deployments. Complex interactions between tissue and lead tip can result in endocardial entanglement, a drill effect that prevents penetration. No verified ex vivo model exists to quantitatively assess this relationship. OBJECTIVES: The purpose of this study was to quantitatively characterize CSP lead tip to tissue responses for 4 commonly used leads. METHODS: CSP leads (from Medtronic, Biotronik, Boston Scientific, and Abbott) were examined for helix rotation efficiency in ex vivo ovine right ventricular septa. A custom jig was utilized for rotation measurements. Fifteen turns were executed, documenting tissue-interface changes every 90° using high-resolution photography. Response curves (input rotation vs helix rotation) were evaluated using piecewise linear regression, with a focus on output vs input response slopes and torque breakpoint events. RESULTS: We analyzed 3,840 quarter-turn CSP insertions with 4 different lead types. Helix rotations were consistently less than input: Abbott Tendril = 0.21:1, Medtronic 3830 = 0.21:1, Biotronik Solia = 0.47:1, and Boston Scientific Ingevity = 0.56:1. Torque breakpoint events were observed on average 7.22 times per insertion (95% CI: 6.08-8.35; P = NS) across all leads. In 57.8% of insertions (37 of 64), uncontrolled torque breakpoint events occurred, signaling unexpected excess helix rotations. CONCLUSIONS: Using a robust ex vivo model, we revealed a muted helix rotation response compared with input turns on the lead, and frequent torque change events during insertion. This is critical for CSP implanters, emphasizing the potential for unexpected torque breakpoint events, and suggesting the need for novel lead designs or deployment methods to enhance CSP efficiency and safety.