Implementation and impact of a point of care electroencephalography platform in a community hospital: a cohort study.

Objective: To determine the clinical and financial feasibility of implementing a poc-EEG system in a community hospital. Design: Data from a prospective cohort displaying abnormal mentation concerning for NCSE or rhythmic movements due to potential underlying seizure necessitating EEG was collected and compared to a control group containing patient data from 2020. Setting: A teaching community hospital with limited EEG support. Patients: The study group consisted of patients requiring emergent EEG during hours when conventional EEG was unavailable. Control group is made up of patients who were emergently transferred for EEG during the historical period. Interventions: Application and interpretation of Ceribell®, a poc-EEG system. Measurement and main results: 88 patients were eligible with indications for poc-EEG including hyperkinetic movements post-cardiac arrest (19%), abnormal mentation after possible seizure (46%), and unresponsive patients with concern for NCSE (35%). 21% had seizure burden on poc-EEG and 4.5% had seizure activity on follow-up EEG. A mean of 1.1 patients per month required transfer to a tertiary care center for continuous EEG. For the control period, a total of 22 patients or a mean of 2 patients per month were transferred for emergent EEG. Annually, we observed a decrease in the number of transferred patients in the post-implementation period by 10.8 (95% CI: -2.17-23.64, p = 0.1). Financial analysis of the control found the hospital system incurred a loss of $3,463.11 per patient transferred for an annual loss of $83,114.64. In the study group, this would compute to an annual loss of $45,713.05 for an overall decrease in amount lost of $37,401.59. We compared amount lost per patient between historical controls and study patients. Implementation of poc-EEG resulted in an overall decrease in annual amount lost of $37,401.59 by avoidance of transfer fees. We calculated the amount gained per patient in the study group to be $13,936.44. To cover the cost of the poc-EEG system, 8.59 patients would need to avoid transfer annually. Conclusion: A poc-EEG system can be safely implemented in a community hospital leading to an absolute decrease in transfers to tertiary hospital. This decrease in patient transfers can cover the cost of implementing the poc-EEG system. The additional benefits from transfer avoidance include clinical benefits such as rapid appropriate treatment of seizures and avoidance of unnecessary treatment as well as negating transfer risk and keeping the patient at their local hospital.

Basic Modes of Mechanical Ventilation.

Acute respiratory failure requiring invasive mechanical ventilation is a common presentation in the emergency department. Providers can further improve care for these patients by understanding common modes of mechanical ventilation, recognizing changes in respiratory mechanics, and tailoring ventilator settings and therapies accordingly.

Energetics and Biomechanics of Uphill, Downhill and Level Running in Highly-Cushioned Carbon Fiber Midsole Plated Shoes.

Road-racing shoes recently experienced major changes. In the recent past, lightweight, thin midsole shoes were thought to help runners maximize their performance. But, in 2017, Nike released the Vaporfly shoe which transformed the thinking about racing shoe design. Incorporating a curved carbon fiber plate embedded in a thick, compliant and resilient midsole resulted in a reduced metabolic cost across a range of running speeds. We hypothesized the new style of shoes would be less effective uphill than downhill due to the larger ground reaction forces and hence greater elastic energy storage in the shoe during downhill running. Eighteen runners completed two days of testing, each comprising two trials of two shoe models (Saucony Endorphin Pro (EP) and Type A) and three grade conditions (uphill, level and downhill), i.e. 12 trials per day. Oxygen uptake, ground reaction forces, and lower-body kinematics were captured during each condition. Comparisons of the percent metabolic benefit were made between shoes for each grade. Stride rate, ground time, peak vertical force, and flight time were regressed with the percent metabolic benefit of the EP over the Type A shoe across grades. Metabolic benefits of the Endorphin Pro were similar across the three grade conditions (p = 0.778). No significant correlations were observed between how much benefit one runner got over another specific to grade. The new style of road-racing shoes effectively decreases metabolic cost equally across grades. Differences in running mechanics between runners did not explain greater individual metabolic benefits between shoe conditions during uphill or downhill running.

Running economy, mechanics, and marathon racing shoes.

The choice of marathon racing shoes can greatly affect performance. The purpose of this study is to metabolically and mechanically compare the consumer version of the Nike Vaporfly 4% shoe to two other popular marathon shoes, and determine differences in running economy. Nineteen subjects performed two 5-minute trials at 4.44m/s wearing the Adidas Adios Boost (AB), Nike Zoom Streak (ZS), and Nike Vaporfly 4% (VP) in random order. Oxygen uptake was recorded during minutes 3-5 and averaged across both shoe trials. On a second day, subjects wore reflective markers, and performed a 3-minute trial in each shoe. Motion and force data were collected over the final 30 seconds of each trial. VP oxygen uptake was 2.8% and 1.9% lower than the AB and ZS. Stride length, plantar flexion velocity, and center of mass vertical oscillation were significantly different in the VP. The percent benefit of the VP over AB shoe was predicted by subject ground time. These results indicate that use of the VP shoe results in improved running economy, partially due to differences in running mechanics. Subject variation in running economy improvement is only partially explained by variation in ground time.

Self-optimization of Stride Length Among Experienced and Inexperienced Runners.

Experienced runners appear to naturally select a stride length which is optimal for minimizing oxygen uptake. However, whether this ability is naturally built into the human body or whether it is learned through experience has not been previously tested. This study investigated whether inexperienced runners are as capable as experienced runners of self-optimizing stride length to minimize oxygen uptake. Thirty-three subjects (nineteen experienced and fourteen inexperienced) ran for twenty-minutes while preferred and economical stride lengths were measured. A t-test checked for differences between the experienced and inexperienced groups in the percent increase of oxygen uptake due to not running at the most economical stride length. No difference was found between groups with the increase in oxygen uptake due to not being optimized (p=0.47). The average percent increase in oxygen uptake above the most economical for inexperienced and experienced runners was 1.8% and 1.2% respectively. We concluded that inexperienced and experienced runners are equally capable of matching preferred stride length to economical stride length, thus athletes and coaches do not need to alter runner's stride length when economy is the main concern.

Oral health-related quality of life in children with orofacial clefts.

Objectives : To determine the impact of orofacial clefts on the oral health-related quality of life of affected children and whether the oral health-related quality of life of children with orofacial clefts differs among different age groups. To assess whether the responses of children with orofacial clefts differ from the caregivers' perceptions of their child's oral health-related quality of life and compare with data from a control group. Design : Cross-sectional study. Patients/Setting : A total of 75 subjects with cleft lip and/or cleft palate (mean age, 13.0 years) from the Nationwide Children's Hospital Craniofacial Anomalies Clinic, as well as their caregivers, and 75 control subjects (mean age, 13.9 years). Main Outcome Measure : Self-reported oral health-related quality of life measured with the Child Oral Health Impact Profile, a reliable and valid questionnaire designed for use with children and teenagers. Results : Children with orofacial clefts had statistically significant lower quality of life scores than control subjects had for overall oral health-related quality of life, Functional Well-being, and Social Emotional Well-being. There was a statistically significant difference in the interaction of age group and Social-Emotional Well-being between children with orofacial clefts and control children. No statistically significant differences were found between the responses of children with orofacial clefts and their caregivers' reports. Conclusions : Presence of an orofacial cleft significantly decreases overall oral health-related quality of life, Functional Well-being, and Social-Emotional Well-being in children and adolescents. The negative impact of orofacial clefts on Social-Emotional Well-being is greater in 15- to 18-year-olds than in younger age groups. Children with orofacial clefts and their caregivers had very similar evaluations of the child's oral health-related quality of life.

HJURP is a CENP-A chromatin assembly factor sufficient to form a functional de novo kinetochore.

Centromeres of higher eukaryotes are epigenetically marked by the centromere-specific CENP-A nucleosome. New CENP-A recruitment requires the CENP-A histone chaperone HJURP. In this paper, we show that a LacI (Lac repressor) fusion of HJURP drove the stable recruitment of CENP-A to a LacO (Lac operon) array at a noncentromeric locus. Ectopically targeted CENP-A chromatin at the LacO array was sufficient to direct the assembly of a functional centromere as indicated by the recruitment of the constitutive centromere-associated network proteins, the microtubule-binding protein NDC80, and the formation of stable kinetochore-microtubule attachments. An amino-terminal fragment of HJURP was able to assemble CENP-A nucleosomes in vitro, demonstrating that HJURP is a chromatin assembly factor. Furthermore, HJURP recruitment to endogenous centromeres required the Mis18 complex. Together, these data suggest that the role of the Mis18 complex in CENP-A deposition is to recruit HJURP and that the CENP-A nucleosome assembly activity of HJURP is responsible for centromeric chromatin assembly to maintain the epigenetic mark.