Severe Hyperthermia in Mountaineering: Coincidence of Heat Stroke and Infection.

Heat illness is a condition that is sometimes seen in those undertaking physical activities. This case report focuses on a female hiker who developed heat stroke during a trek in the Dachstein region of Upper Austria. The patient's presentation was initially unclear and could only be confirmed by the use of a thermometer. This had a significant impact on the medical decision-making process during a complex rescue operation.

Thermoelectric-Feedback Nanocomposite Hydrogel for Temperature-Synchronized Monitoring and Regulation in Accurate Photothermal Therapy.

Photothermal therapy (PTT) is a promising approach for tumor ablation and cancer treatment. However, controlling the therapeutic temperature during treatment remains challenging, and imprecise thermal regulation can harm adjacent healthy tissues, reduce therapeutic accuracy, and promote the thermotolerance of cellular phenotypes, potentially leading to tumor invasion and recurrence. Although existing methods provide basic temperature control by adjusting irradiation power and photothermal agent dosing, they lack real-time temperature monitoring and feedback control capabilities, underscoring the urgent need for more integrated and precise PTT systems. In this context, an innovative photothermoelectric (PTE) cobalt-infused chitosan (CS) nanocomposite hydrogel (PTE-Co@CS) is developed for precise temperature-regulated PTT, exhibiting desirable mechanical properties and exceptional biocompatibility. Enhanced by embedded nanoparticles, PTE-Co@CS demonstrates superior photothermal conversion efficiency compared with existing methods, while also featuring thermoelectric responsiveness and increased sensitivity to photostimuli. Its advantageous PTE response characteristics ensure a linear correlation between temperature shifts and resistance changes (e.g., R2 = 0.99919 at 0.5 W cm⁻2), enabling synchronized qualitative and quantitative control of PTT temperature through electrical signal monitoring. This allows for real-time monitoring and regulation during PTT, effectively addressing the issue of uncontrollable temperatures and improving therapeutic efficacy.

Integrated Firefighting Textile with Temperature and Pressure Monitoring for Personal Defense.

Although electronic textiles that can detect external stimuli show great promise for fire rescue, existing firefighting clothing is still scarce for simultaneously integrating reliable early fire warning and real-time motion sensing, hardly providing intelligent personal protection under complex high-temperature conditions. Herein, we introduce an "all-in-one" hierarchically sandwiched fabric (HSF) sensor with a simultaneous temperature and pressure stimulus response for developing intelligent personal protection. A cross-arranged structure design has been proposed to tackle the serious mutual interference challenge during multimode sensing using two separate sets of core-sheath composite yarns and arrayed graphene-coated aerogels. The functional design of the HSF sensor not only possesses wide-range temperature sensing from 25 to 400 °C without pressure disturbance but also enables highly sensitive pressure response with good thermal adaptability (up to 400 °C) and wide pressure detection range (up to 120 kPa). As a proof of concept, we integrate large-scalable HSF sensors onto conventional firefighting clothing for passive/active fire warning and also detecting spatial pressure and temperature distribution when a firefighter is exposed to high-temperature flames, which may provide a useful design strategy for the application of intelligent firefighting protective clothing.

Clinical utility of oesophageal temperature monitoring in AF ablation: An updated meta-analysis and review of literature.

BACKGROUND: Atrial fibrillation (AF) ablation can lead to oesophageal thermal injuries (ETI). These are thought to be the precursor of the much rarer but frequently fatal atrio-oesophageal fistulas. Many centers performing AF ablation routinely use oesophageal temperature monitoring (ETM). This meta-analysis aims to determine the utility of ETM in preventing ETI in the context of radiofrequency catheter ablation of AF. METHODS: A systematic search of PubMed, Embase databases and Cochrane registry was performed comparing ETI between ETM and non-ETM strategies in AF ablation. Data on endoscopically determined ETI, AF recurrence, procedure time and ablation time were extracted. Statistical analyses including subgroup and covariate analyses were performed using random effect model in R platform. RESULTS: ETI were similar in both ETM (n = 864) and non- ETM groups (n = 639) (RR 1.04, 95 % CI 0.34-3.23) across 12 studies. AF recurrence was statistically similar in both groups (IRR 0.92, 95 % CI 0.73-1.17) but showed a lower trend in non-ETM group. Ablation time was numerically lower in the ETM group and procedure time was numerically higher trend in the ETM group; but they were not statistically significant. Covariate analysis found that posterior wall ablation power setting, additional linear ablation, BMI, use of GA or prophylactic PPI after ablation had no significant correlation in the incidence of ETI. CONCLUSION: ETM was not associated with a reduced incidence of ETI during AF ablation. Evidence supporting the routine use of ETM to reduce the risk of ETI or atrio-oesophageal fistulas is lacking.

Flexible Thermoelectric Device Based on Protrusion-Structured Liquid Metal Elastomer for Gravity Heat Pipe.

Monitoring the temperature of the coal gangue mountains is fundamental to preventing their spontaneous combustion. However, the existing temperature monitoring systems fail to achieve stable, pollution-free temperature monitoring without affecting vegetation growth in these mountains. To address this issue, this work proposes a flexible thermoelectric device (FTD) based on a protrusion-structured liquid metal elastomer (LME). Utilizing a high-thermal-conductivity LME, the FTD adheres closely to the surface of the gravity heat pipe (GHP), ensuring compatibility between FTD and the curved surface of the GHP. Simultaneously, employing a low-thermal-conductivity elastomer helps concentrate heat onto FTD, thereby enhancing thermoelectric power generation efficiency. Additionally, the impact of the shape, size, and height of the protrusion structure at the cold end of the GHP on its efficiency was also investigated. The practical application of FTD on GHP was demonstrated.

Infrared Thermography Shows That a Temperature Difference of 2.2°C (4°F) or Greater Between Corresponding Sites of Neuropathic Feet Does Not Always Lead to a Diabetic Foot Ulcer.

BACKGROUND: There is emerging interest in the application of foot temperature monitoring as means of diabetic foot ulcer (DFU) prevention. However, the variability in temperature readings of neuropathic feet remains unknown. The aim of this study was to analyze the long-term consistency of foot thermograms of diabetic feet at the risk of DFU. METHODS: A post-hoc analysis of thermal images of 15 participants who remained ulcer-free during a 12-month follow-up were unblinded at the end of the trial. Skin foot temperatures of 12 plantar, 15 dorsal, 3 lateral, and 3 medial regions of interests (ROIs) were derived on monthly thermograms. The temperature differences (∆Ts) of corresponding ROIs of both feet were calculated. RESULTS: Over the 12-month study period, out of the total 2026 plantar data points, 20.3% ROIs were rated as abnormal (absolute ∆T ≥ 2.2°C). There was a significant between-visit variability in the proportion of plantar ROIs with ∆T ≥ 2.2°C (range 7.6%-30.8%, chi-square test, P = .001). The proportion of patients presenting with hotspots (ROIs with ∆T ≥ 2.2°C), abnormal plantar foot temperature (mean ∆T of 12 plantar ROIs ≥ 2.2°C), and abnormal whole foot temperature (mean ∆T of 33 ROIs ≥ 2.2°C) varied between visits and showed no pattern (P > .05 for all comparisons). This variability was not related to the season of assessment. CONCLUSIONS: Despite the high rate of hotspots on monthly thermograms, all feet remained intact. This study underscores a significant between-visit inconsistency in thermal images of neuropathic feet which should be considered when planning DFU-prevention programs for self-testing and behavior modification.

A Multi-Faceted Digital Health Solution for Monitoring and Managing Diabetic Foot Ulcer Risk: A Case Series.

INTRODUCTION: Diabetic foot ulcers (DFU) are a devastating complication of diabetes. There are numerous challenges with preventing diabetic foot complications and barriers to achieving the care processes suggested in established foot care guidelines. Multi-faceted digital health solutions, which combine multimodal sensing, patient-facing biofeedback, and remote patient monitoring (RPM), show promise in improving our ability to understand, prevent, and manage DFUs. METHODS: Patients with a history of diabetic plantar foot ulcers were enrolled in a prospective cohort study and equipped with custom sensory insoles to track plantar pressure, plantar temperature, step count, and adherence data. Sensory insole data enabled patient-facing biofeedback to cue active plantar offloading in response to sustained high plantar pressures, and RPM assessments in response to data trends of concern in plantar pressure, plantar temperature, or sensory insole adherence. Three non-consecutive case participants that ultimately presented with pre-ulcerative lesions (a callus and/or erythematous area on the plantar surface of the foot) during the study were selected for this case series. RESULTS: Across three illustrative patients, continuous plantar pressure monitoring demonstrated promise for empowering both the patient and provider with information for data-driven management of pressure offloading treatments. CONCLUSION: Multi-faceted digital health solutions can naturally enable and reinforce the integrative foot care guidelines. Multi-modal sensing across multiple physiologic domains supports the monitoring of foot health at various stages along the DFU pathogenesis pathway. Furthermore, digital health solutions equipped with remote patient monitoring unlock new opportunities for personalizing treatments, providing periodic self-care reinforcement, and encouraging patient engagement-key tools for improving patient adherence to their diabetic foot care plan.

Agreement between three noninvasive temperature monitoring devices during spinal anaesthesia for caesarean delivery: a prospective observational study.

Hypothermia during obstetric spinal anaesthesia is a common and important problem, yet temperature monitoring is often not performed due to the lack of a suitable, cost-effective monitor. This study aimed to compare a noninvasive core temperature monitor with two readily available peripheral temperature monitors during obstetric spinal anaesthesia. We undertook a prospective observational study including elective and emergency caesarean deliveries, to determine the agreement between affordable reusable surface temperature monitors (Welch Allyn SureTemp® Plus oral thermometer and the Braun 3-in-1 No Touch infrared thermometer) and the Dräger T-core© (using dual-sensor heat flux technology), in detecting thermoregulatory changes during obstetric spinal anaesthesia. Predetermined clinically relevant limits of agreement (LOA) were set at ± 0.5 °C. We included 166 patients in our analysis. Hypothermia (heat flux temperature < 36 °C) occurred in 67% (95% CI 49 to 78%). There was poor agreement between devices. In the Bland-Altman analysis, LOA for the heat flux monitor vs. oral thermometer were 1.8 °C (CI 1.7 to 2.0 °C; bias 0.5 °C), for heat flux monitor vs. infrared thermometer LOA were 2.3 °C (CI 2.1 to 2.4 °C; bias 0.4 °C) and for infrared vs. oral thermometer, LOA were 2.0 °C (CI 1.9 to 2.2 °C; bias 0.1 °C). Error grid analysis highlighted a large amount of clinical disagreement between methods. While monitoring of core temperature during obstetric spinal anaesthesia is clinically important, agreement between monitors was below clinically acceptable limits. Future research with gold-standard temperature monitors and exploration of causes of sensor divergence is needed.

Internet of Things (IoT)-enabled framework for a sustainable Vaccine cold chain management system.

Vaccines are a unique category of drugs sensitive to temperature and humidity and whose effectiveness directly impacts public health. There has been an increase in vaccine-related adverse events worldwide, particularly in developing countries, attributed to suboptimal temperatures during transport and storage. At the same time, the Internet of Things (IoT) has ushered in a paradigm shift in vaccine information and storage monitoring, enabling continuous 24/7 tracking. This further reduces the dependence on limited human resources and significantly reduces the associated errors and losses. This paper presents an IoT-driven framework that aims to improve the sustainability of medical cold chain management. The framework promotes trust and transparency in vaccine surveillance data by accessing and authenticating IoT devices. The proposed system aims to improve the safety and sustainability of vaccine management. Moreover, we provide detailed insights into the design and hardware components of the proposed framework. In addition, the specific use of the framework in a particular province is highlighted, covering the design of the software platform and the analysis of the hardware equipment.

MXene/TPU Hybrid Fabrics Enable Smart Wound Management and Thermoresponsive Drug Delivery.

Thermoresponsive wound dressings with real-time monitoring and on-demand drug delivery have gained significant attention recently. However, such smart systems with stable temperature adjustment and drug release control are still lacking. Here, a novel smart fabric is designed for wound management with thermoresponsive drug delivery and simultaneously temperature monitoring. The triple layers of the fabrics are composed of the drug-loaded thermoresponsive nanofiber film, the MXene-optimized joule heating film, and the FPCB control chip. The precise and stable temperature stimulation can be easily achieved by applying a low voltage (0-4 V) to the heating film, achieving the temperature control ranging from 25 to 130 °C. And the temperature of the wound region can be monitored and adjusted in real time, demonstrating an accurate and low-voltage joule heating capability. Based on that, the drug-loaded film achieved precise thermoresponsive drug release and obtained significant antibacterial effects in vitro. The in vivo experiments also proved the hybrid fabric system with a notable antibacterial effect and accelerated wound healing process (about 30% faster than the conventional gauze group).

Ratiometric Fluorescence Optical Fiber Enabling Operando Temperature Monitoring in Pouch-Type Battery.

Thermal characteristics are essential for improving the performance and monitoring the status of Li-ion batteries (LIBs). However, it is a challenge to design efficient and facile sensing materials for the detection of the in situ temperature of a working LIB. Herein, a ratiometric fluorescence optical fiber is developed and real-time temperature monitoring is performed with a measurement accuracy of 0.12 °C, and the feasibility based on this polymer optical fiber composed of NaLaTi2O6:Yb/Er phosphors is verified in a pouch-type battery. During the charging and discharging cycles, the in situ temperature is instantaneously conveyed, revealing the internal situation of LIBs. This article further dwells on the thermal characteristics in constant current (CC)/constant voltage charging and CC discharging processes at different C-rates and the battery failure when operated at low temperatures (0 °C). This work demonstrates an innovative strategy for operando solitary temperature monitoring conducted by ratiometric fluorescence optical fiber.

Continuous monitoring of body temperature for objective detection of health and safety risks in construction sites: An analysis of the accuracy and comfort of off-the-shelf wearable sensors.

Recent studies have shown the potential of wearable sensors for objective detection of health and safety risks in construction workers through their collected physiological data. Body temperature, as the focus of the current study, is one of the most important physiological parameters that can help to detect various health and safety risks such as heat stress, physical fatigue, and infectious diseases. This study aims to assess the applicability and performance of off-the-shelf wearable sensor devices to monitor workers' body temperature in construction sites by evaluating the accuracy of temperature measurements as well as the comfort of the devices. A total of nine off-the-shelf wearable sensor devices available on the market were initially trialed in the laboratory, and three devices were shortlisted considering a set of selection criteria for further assessment. Over three weeks, the shortlisted wearable sensors were tested on 26 workers in two large construction sites in Australia. The reliability/validity of the selected wearable sensors in measuring body temperature was investigated using Bland-Altman analysis. Human factors were also investigated in terms of the comfort of the devices, their impact on workers' performance, and the acceptability of being worn for an extended period (i.e., 8 h or more). It was found that all selected devices measured body temperature with a bias of less than one indicating a slight difference in measurements compared to the reference hospital-grade thermometers. Two devices out of the three were also comfortable. The achieved results indicate that it is feasible to develop a continuous temperature monitoring platform using off-the-shelf wearable sensors to detect a range of significant health and safety risks in construction sites objectively. Considering the rapid advancements in manufacturing wearable sensors, future research can adopt a similar approach to include the newly introduced off-the-shelf temperature sensors and select the most appropriate device.

Harness High-Temperature Thermal Energy via Elastic Thermoelectric Aerogels.

Despite notable progress in thermoelectric (TE) materials and devices, developing TE aerogels with high-temperature resistance, superior TE performance and excellent elasticity to enable self-powered high-temperature monitoring/warning in industrial and wearable applications remains a great challenge. Herein, a highly elastic, flame-retardant and high-temperature-resistant TE aerogel, made of poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate)/single-walled carbon nanotube (PEDOT:PSS/SWCNT) composites, has been fabricated, displaying attractive compression-induced power factor enhancement. The as-fabricated sensors with the aerogel can achieve accurately pressure stimuli detection and wide temperature range monitoring. Subsequently, a flexible TE generator is assembled, consisting of 25 aerogels connected in series, capable of delivering a maximum output power of 400 µW when subjected to a temperature difference of 300 K. This demonstrates its outstanding high-temperature heat harvesting capability and promising application prospects for real-time temperature monitoring on industrial high-temperature pipelines. Moreover, the designed self-powered wearable sensing glove can realize precise wide-range temperature detection, high-temperature warning and accurate recognition of human hand gestures. The aerogel-based intelligent wearable sensing system developed for firefighters demonstrates the desired self-powered and highly sensitive high-temperature fire warning capability. Benefitting from these desirable properties, the elastic and high-temperature-resistant aerogels present various promising applications including self-powered high-temperature monitoring, industrial overheat warning, waste heat energy recycling and even wearable healthcare.

Full-Color "Off-On" Thermochromic Fluorescent Fibers for Customizable Smart Wearable Displays in Personal Health Monitoring.

Responsive thermochromic fiber materials capable of miniaturization and integrating comfortably and compliantly onto the soft and dynamically deforming human body are promising materials for visualized personal health monitoring. However, their development is hindered by monotonous colors, low-contrast color changes, and poor reversibility. Herein, full-color "off-on" thermochromic fluorescent fibers are prepared based on self-crystallinity phase change and Förster resonance energy transfer for long-term and passive body-temperature monitoring, especially for various personalized customization purposes. The off-on switching luminescence characteristic is derived from the reversible conversion of the dispersion state and fluorescent emission by fluorophores and quencher molecules, which are embedded in the matrix of a phase-change material, during the crystallizing/melting processes. The achievement of full-color fluorescence is attributed to the large modulation range of fluorescence colors according to primary color additive theory. These thermochromic fluorescent fibers exhibit good mechanical properties, fluorescent emission contrast, and reversibility, showing their great potential in flexible smart display devices. Moreover, the response temperature of the thermochromic fibers is controllable by adjusting the phase-change material, enabling body-temperature-triggered luminescence; this property highlights their potential for human body-temperature monitoring and personalized customization. This work presents a new strategy for designing and exploring flexible sensors with higher comprehensive performances.

Robust Fiber-Shaped Flexible Temperature Sensors for Safety Monitoring with Ultrahigh Sensitivity.

Flexible temperature sensors capable of detecting and transmitting temperature data from the human body, environment, and electronic devices hold significant potential for applications in electronic skins, human-machine interactions, and disaster prevention systems. Nonetheless, fabricating flexible temperature sensors with exceptional sensing performance remains a formidable task, primarily due to the intricate process of constructing an intrinsically flexible sensing element with high sensitivity. In this study, a facile in situ two-step synthetic method is introduced for fabricating flexible fiber-shaped NiO/carbon nanotube fiber (CNTF) composites. The resulting NiO/CNTF flexible temperature sensors demonstrate outstanding deformability and temperature sensing characteristics, encompassing a broad working range (-15 to 60 °C) and high sensitivity (maximum TCR of -20.2% °C-1 and B value of 3332 K). Importantly, the mechanical and thermal behaviors of the sensor in various application conditions are thoroughly examined using finite element analysis simulations. Moreover, the temperature sensors can effectively capture diverse thermal signals in wearable applications. Notably, a temperature monitoring and warning system is developed to prevent fire accidents resulting from abnormal thermal runaway in electronic devices.

High-Performance Flexible Temperature Sensors Based on Laser-Irradiated Ag-MWCNTs/PEDOT:PSS.

Recently, flexible temperature sensors have attracted significant interest due to their wide-ranging applications in areas such as biomedical monitoring, environmental monitoring, electronic skin, and intelligent robots. However, a combination of high sensitivity and high resolution remains a critical challenge. These properties depend on the synthesis techniques of the sensitive materials. In this work, we use a laser irradiation method to prepare a silver nanoparticle-modified carbon nanotube (Ag-MWCNT) which is further mixed with poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT:PSS). The developed temperature sensor exhibited a high sensitivity of -0.45% °C-1 and linearity with an R2 value of 0.998 in the temperature range of 25-80 °C. Additionally, the sensor demonstrated remarkable repeatability, making it suitable for real-time temperature monitoring of the human body and environment. This temperature sensor is successfully demonstrated in practical applications such as monitoring the temperature of various parts of the human body and sensing the spatial temperature. These demonstrations highlight their significant potential in electronic skin and other related fields.

Optimizing Sensor Placement for Temperature Mapping during Ablation Procedures.

Accurately mapping the temperature during ablation is crucial for improving clinical outcomes. While various sensor configurations have been suggested in the literature, depending on the sensors' type, number, and size, a comprehensive understanding of optimizing these parameters for precise temperature reconstruction is still lacking. This study addresses this gap by introducing a tool based on a theoretical model to optimize the placement of fiber Bragg grating sensors (FBG) within the organ undergoing ablation. The theoretical model serves as a general framework, allowing for adaptation to various situations. In practical application, the model provides a foundational structure, with the flexibility to tailor specific optimal solutions by adjusting problem-specific data. We propose a nonlinear and nonconvex (and, thus, only solvable in an approximated manner) optimization formulation to determine the optimal distribution and three-dimensional placement of FBG arrays. The optimization aims to find a trade-off among two objectives: maximizing the variance of the expected temperatures measured by the sensors, which can be obtained from a predictive simulation that considers both the type of applicator used and the specific organ involved, and maximizing the squared sum of the distances between the sensor pairs. The proposed approach provides a trade-off between collecting diverse temperatures and not having all the sensors concentrated in a single area. We address the optimization problem through the utilization of approximation schemes in programming. We then substantiate the efficacy of this approach through simulations. This study tackles optimizing the FBGs' sensor placement for precise temperature monitoring during tumor ablation. Optimizing the FBG placement enhances temperature mapping, aiding in tumor cell eradication while minimizing damage to surrounding tissues.

Effectiveness of a Continuous Remote Temperature Monitoring Program to Reduce Foot Ulcers and Amputations: Multicenter Postmarket Registry Study.

BACKGROUND: Neuropathic foot ulcers are the leading cause of nontraumatic foot amputations, particularly among patients with diabetes. Traditional methods of monitoring and managing these patients are periodic in-person clinic visits, which are passive and may be insufficient for preventing neuropathic foot ulcers and amputations. Continuous remote temperature monitoring has the potential to capture the critical period before the foot ulcers develop and to improve outcomes by providing real-time data and early interventions. For the first time, the effectiveness of such a strategy to prevent neuropathic foot ulcers and related complications among high-risk patients in a real-world commercial setting is reported. OBJECTIVE: This study aims to evaluate the effectiveness of a real-world continuous remote temperature monitoring program in preventing neuropathic foot ulcers and amputations in patients with diabetes. METHODS: In this retrospective analysis of a real-world continuous remote temperature monitoring program, 115 high-risk patients identified by clinical providers from 15 geographically diverse private podiatry offices were analyzed. Patients received continuous remote monitoring socks as part of the program. The enrollment was based on medical necessity as decided by their managing physician. We evaluated data from up to 2 years before enrollment and up to 3 years during the program. The primary outcome was the rate of wound development. Secondary outcomes included amputation rate, the severity of the foot ulcers, and the number of visits to an outpatient podiatry clinic after enrolling in the program. RESULTS: We observed significantly lower rates of foot ulceration (relative risk reduction [RRR] 0.68; 95% CI 0.52-0.79; number needed to treat [NNT] 5.0; P<.001), less moderate to severe ulcers (RRR 0.86; 95% CI 0.70-0.93; NNT 16.2; P<.001), less amputations (RRR 0.83; 95% CI 0.39-0.95; NNT 41.7; P=.006), and less hospitalizations (RRR 0.63; 95% CI 0.33-0.80; NNT 5.7; P<.002). We found a decrease in outpatient podiatry office visits during the program (RRR 0.31; 95% CI 0.24-0.37; NNT 0.46; P<.001). CONCLUSIONS: Our findings suggested that a real-world continuous remote temperature monitoring program was an effective strategy to prevent foot ulcer development and nontraumatic foot amputation among high-risk patients.

Piloting delivery of PfSPZ vaccines for malaria through a cryogenic vaccine cold chain to travel and military medicine clinics.

BACKGROUND: PfSPZ vaccines comprising Plasmodium falciparum (Pf) sporozoites (SPZ) have demonstrated > 90% protection against variant Pf malaria infections for at least 12 weeks; they are the only vaccines with the level of efficacy necessary to protect travellers. PfSPZ are eukaryotic cells stabilized by cryopreservation and distributed using a cryogenic (below -150 °C) cold chain. The Ebola vaccine and mRNA vaccines against SARS-CoV-2 pioneered uptake of vaccines requiring non-standard ultra-low temperature cold chains. The cryogenic cold chain using liquid nitrogen (LN2) vapour phase (LNVP) cryoshippers, is simpler, more efficient than -80, -20 or 2-8 °C cold chains, and does not use electricity. This study was conducted to evaluate implementation and integration of a cryogenically distributed vaccine at travel and military immunization clinics. METHODS: We conducted sequential 28-day studies evaluating vaccine shipping, storage, maintenance and accession at two US military and two civilian travel health/immunization clinics. In each clinic, personnel were trained in equipment use, procurement and handling of LN2, temperature monitoring and inventory record keeping by in-person or video instruction. RESULTS: Sites required 2-4 h/person for two persons to assimilate and develop the expertise to manage vaccine storage and LNVP operations. LN2 for recharging cryoshippers was delivered every 1-2 weeks. Vaccine ordering, receipt, storage and inventory control was conducted effectively. Simulated single dose vaccine cryovial retrieval and thawing were performed successfully in different travel clinic settings. Continuous temperature monitoring at each site was maintained with only one short excursion above -150 °C (-145 °C) through shipping, use and reverse logistics. Staff, during and at study conclusion, provided feedback that has been incorporated into our models for cold chain logistics. CONCLUSIONS: These studies demonstrated that the training in delivery, storage, administration and integration of PfSPZ vaccines can be successfully managed in different immunization clinic settings for travellers and military personnel.

Maternal hypothermia during elective caesarean delivery: A prospective observational study.

BACKGROUND: Patients undergoing caesarean delivery are at risk of developing unintended perioperative hypothermia, defined as a core temperature <36.0°C. Most previous studies of core temperature in caesarean delivery patients have not been conducted with accurate measurements for the complete perioperative period. Therefore, we conducted a prospective observational study to identify the incidence and duration of pre- and post-operative maternal hypothermia with a high accuracy continuous temperature monitoring system. METHODS: Women ≥18 years old presenting for elective caesarean delivery under spinal anaesthesia were invited to participate in the study. The primary outcomes were the incidence and duration of perioperative maternal hypothermia (<36.0°C). Maternal core temperatures were measured with the non-invasive zero-heat-flux thermometer (Bair Hugger Temperature Monitoring System, 3M) throughout the perioperative course. RESULTS: A total of 40 participants were recruited to the study. The incidence of perioperative hypothermia was 32.5%, with a duration of 77 ± 40 min (mean ± standard deviation). The hypothermic patients had similar core temperature as the normothermic patients at baseline preoperatively, but significantly lower temperature at operating room arrival and during the remaining study period. Forty percent of all patients reported thermal discomfort and felt cold on admission to post anaesthesia care unit, whereas 33% had shivering. Neither thermal discomfort nor shivering were associated with hypothermia. CONCLUSION: In the present study almost a third of the women undergoing elective caesarean delivery developed perioperative hypothermia with a core temperature <36.0°C. The mean duration of maternal hypothermia was 77 min, lasting well into the postoperative period for many patients. These data should remind healthcare professionals of the importance of measuring core temperature in all phases of the perioperative setting and to consider optimal warming measures to avoid and treat hypothermia.