Utilization of non-pneumatic anti-shock garment for treating obstetric hemorrhage and associated factors among obstetric care providers in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: The non-pneumatic anti-shock garment (NASG) is a life-saving device that can help to avoid delays and prevent further complications in the case of obstetric hemorrhage. Although there are many fragmented primary studies on the NASG utilization in Ethiopia, the pooled utilization rate is unknown. In addition, a disagreement was observed among those studies while reporting the associated factors. Therefore, this study was intended to determine the pooled level of NASG utilization and its associated factors among obstetric care providers in Ethiopia. METHODS: A total of 51 studies were retrieved from PubMed, Google Scholar, the African Journal of Online, direct open-access journals, and Ethiopian universities' institutional repositories. This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The quality of studies was evaluated using the modified Newcastle-Ottawa quality assessment tool. The data were extracted by two authors independently using Microsoft Excel and analyzed by Stata version 11. A random-effects model was applied to calculate the pooled level of NASG utilization and its associated factors. The PROSPERO registration number for the review is CRD42023414043. RESULT: A total of 8 studies comprising 2,575 study participants were involved in this meta-analysis. The pooled utilization rate of NASG was found to be 39.56%. Having NASG training (pooled odds ratio (OR) = 3.99, 95%CI = 2.35, 6.77), good knowledge about NASG (OR = 2.92, 95%CI = 2.04, 4.17), a positive attitude towards NASG (OR = 3.17, 95%CI = 2.10, 4.79), and having ≥ 2 NASGs in the health facility (OR = 10.59, 95%CI = 6.59, 17.01) were significantly associated with NASG utilization. CONCLUSION: Utilization of NASG for the treatment of obstetric hemorrhage was low in Ethiopia. To increase its utilization, Ministry of Health should improve the accessibility of NASG at each health facility and increase the Health professionals' knowledge and attitude through in-service and pre-service training.

Effects of single and multiple sessions of lower body diastole-synchronized compressions using a pulsating pneumatic suit on endothelium function and metabolic parameters in patients with type 2 diabetes: two controlled cross-over studies.

BACKGROUND: Endothelium function is often impaired in patients with type 2 diabetes. We hypothesized that by improving endothelial function using diastole-synchronized compressions/decompressions (DSCD) to the lower body may improve the metabolic profile. The objective of this research was to evaluate the effects of single and multiple DSCD sessions on microcirculation, endothelium function and metabolic parameters of patients with type 2 diabetes. METHODS: Two monocentric, controlled, randomized cross-over studies (Study 1 and Study 2) were performed. In Study 1, 16 patients received one 20 min DSCD and one simulated (control) session at 2 week intervals; continuous glucose monitoring and cutaneous blood flow were recorded continuously before, during and after DSCD or Control session; other vascular assessments were performed before and after DSCD and control sessions. In Study 2, 38 patients received 60 min DSCD sessions three times/week for three months followed by a 4-6 week washout and 3 month control period (without simulated sessions); vascular, metabolic, body composition, physical activity and quality of life assessments were performed before and after 3 months. RESULTS: Both studies showed significant, multiplex effects of DSCD sessions. In Study 1, cutaneous blood flow and endothelium function increased, and plasma and interstitial glucose levels after a standard breakfast decreased after DSCD sessions. In Study 2, cutaneous endothelium function improved, LDL-cholesterol and non-HDL cholesterol decreased, extra-cell water decreased and SF-36 Vitality score increased after 3 months of DSCD sessions. CONCLUSIONS: Our findings support the beneficial effect of DSCD on the endothelium and show concomitant beneficial metabolic and vitality effects. Future clinical trials need to test whether DSCD use translates into a preventive measure against microvascular diabetic complications and its progression. Trial registration ClinicalTrials.gov identifiers: NCT02293135 and NCT02359461.

Pilot Study: Pneumatic Compression Garment Therapy for Postradiotherapy Laryngopharyngeal Edema.

OBJECTIVES: Pneumatic compression garment therapy (PCGT) has been established as treatment for postradiotherapy lymphedema, and its use in head and neck patients is becoming more common. Although effects on interstitial edema of the cervical soft tissues have been studied, effects on internal laryngopharyngeal edema, as well as associated symptoms of dysphagia and dysphonia, have yet to be published. METHODS: We surveyed 7 patients treated with radiation for head and neck cancer (HNC) who had also been prescribed PCGT for cervical lymphedema. Patients were asked about subjective experience with the device, and also administered the Eating Assessment Tool-10 (EAT-10) and Voice Handicap Index-10 (VHI-10) surveys regarding their symptoms after using PCGT. Laryngoscopy videos from these same periods were also reviewed and scored using a validated tool for assessing laryngopharyngeal edema. RESULTS: 85% of patients reported at least some improvement in dysphagia and dysphonia following PCGT. Average EAT-10 score after PCGT was 11.4 and average VHI-10 score after PCGT was 8.7. These compare more favorably to historical scores for the same questionnaires in similar patient populations. Laryngeal edema scores on endoscopic examination were not significantly different after at least 3 months of therapy (pre: 20.15, post: 20.21, P = .975); however, the utility of this result is limited by a low inter-rater reliability (Krippendorff α = .513). CONCLUSIONS: While we are unable to show any difference in objective assessment of laryngopharyngeal edema on endoscopic examination in this small pilot study, patients report substantial subjective improvement in postradiotherapy dysphagia and dysphonia following cervical PCGT that warrants more formal investigation.

Utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management among obstetric care providers in public health facilities of southern Ethiopia, 2020.

BACKGROUND: Delays in care have been recognized as a significant contributor to maternal mortality in low-resource settings. The non-pneumatic antishock garment is a low-cost first-aid device that can help women with obstetric haemorrhage survive these delays without long-term adverse effects. Extending professionals skills and the establishment of new technologies in basic healthcare facilities could harvest the enhancements in maternal outcomes necessary to meet the sustainable development goals. Thus, this study aims to assess utilization of non-pneumatic anti-shock garment to control complications of post-partum hemorrhage and associated factors among obstetric care providers in public health institutions of Southern Ethiopia, 2020. METHODS: A facility-based cross-sectional study was conducted among 412 obstetric health care providers from March 15 -June 30, 2020. A simple random sampling method was used to select the study participants. The data were collected through a pre-tested interviewer-administered questionnaire. A binary logistic regression model was used to identify determinants for the utilization of non-pneumatic antishock garment. STATA version 16 was used for data analysis. A P-value of < 0.05 was used to declare statistical significance. RESULTS: Overall, 48.5% (95%CI: 43.73, 53.48%) of the obstetric care providers had utilized Non pneumatic antishock garment for management of complications from postpartum hemorrhage. Training on Non pneumatic antishock garment (AOR = 2.92; 95% CI: 1.74, 4.92), working at hospital (AOR = 1.81; 95% CI: 1.04, 3.16), good knowledge about NASG (AOR = 1.997; 95%CI: 1.16, 3.42) and disagreed and neutral attitude on Non pneumatic antishock garment (AOR = 0.41; 95%CI: 0.24, 0.68), and (AOR = 0.39; 95% CI: 0.21, 0.73), respectively were significantly associated with obstetric care provider's utilization of Non-pneumatic antishock garment. CONCLUSIONS: In the current study, roughly half of the providers are using Non-pneumatic antishock garment for preventing complications from postpartum hemorrhage. Strategies and program initiatives should focus on strengthening in-service and continuous professional development training, thereby filling the knowledge and attitude gap among obstetric care providers. Health centers should be targeted in future programs for accessibility and utilization of non-pneumatic antishock garment.

Suit therapy versus whole-body vibration on bone mineral density in children with spastic diplegia.

OBJECTIVES: Osteoporosis because of physical inactivity is one of the major complications associated with neuromuscular disorders. The study aimed to compare using Suit therapy and whole-body vibration in addition to selected physical therapy program to improve Bone Mineral Density in children with cerebral palsy of spastic diplegia. METHODS: Forty-six patients were classified randomly into two equal groups. Patients in the group (A) engaged in a selected physical therapy program, also besides, suit therapy training program while those in the group (B) received the same selected physical therapy program received by group (A) in addition to the whole-body vibration training program. The treatment programs were conducted three times per week for twelve successive weeks. Measurements obtained included bone mineral density at the lumbar spine as well as at the femoral neck. These measures were recorded pre- and post-treatment. RESULTS: There was a significant improvement in favor of the whole-body Vibration group. Bone mineral density improved significantly at both the lumbar spine (P=.038) and the femoral neck (P=.005) in the WBV group as compared to the Suit therapy group. CONCLUSIONS: Whole-body vibration is effective in improving Bone Mineral Density rather than Suit therapy in children with cerebral palsy of spastic diplegia.

Decompression Sickness Treatment Using a Pressure Suit After Loss of Spacecraft Atmosphere.

BACKGROUND: Loss of spacecraft atmosphere (LOA) during Earth-Moon transit may require up to 144 h of pressure suit operations. This work investigates the feasibility of DCS treatment in this paradigm and discusses the operational and engineering implications.METHODS: Three scenarios of LOA-induced DCS were considered: a permanent LOA secondary to a 0.25-in (0.64 cm) hole (unrecoverable cabin leak), a transient LOA, and a permanent LOA with early suit over-pressurization (beyond suit specification). Each was simulated in the context of the current Orion spacecraft operational concept with regards to atmosphere and anticipated cabin depress profile. Probability of DCS symptom resolution (P(SR)) was estimated using the previously derived Hypobaric DCS Treatment Model, with ΔP calculated from a Three Region Well-Stirred Tissue (3RWT) bubble dynamics model. Analysis was conducted and analogies drawn from experiences with the development and testing of the Orion Crew Survival System (OCSS).RESULTS: Maintaining 8 psia at 100% Fio2 following LOA resulted in an eventual halt and regression of bubble growth with a P(SR) of 87% (at 8 h, time to symptom onset (Ts) = 105 min, with ambulation). If cabin atmosphere was not restored and psia dropped to 4.3, bubble growth returned, but again eventually slowed and regressed over time (P(SR) = 75% at 21 h). If the leak is repaired within the 8-h period, 8 psid (psia = 22.7) resulted in P(SR) of greater than 95%. Similarly, if the suit was over-pressurized (12 psid/psia) within 3 h after LOA, P(SR) exceeded 95%.DISCUSSION: A launch/entry pressure suit represents a contingency option for DCS management in the event of LOA.Greene MR, Jacobs SE. Decompression sickness treatment using a pressure suit after loss of spacecraft atmosphere. Aerosp Med Hum Perform. 2020; 91(7):571-577.

Dynamic Countermeasure Fabrics for Post-Spaceflight Orthostatic Intolerance.

INTRODUCTION: Aerospace orthostatic intolerance garments (OIG) have historically been pneumatic (e.g., NASA's antigravity suit), an approach that inhibits mobility and requires connection to an air supply. Elastic compression garments, an alternative technology, are difficult to don/doff and cannot be worn in a noncompressive state, resulting in discomfort and usability challenges. This research evaluates a novel technology-contractile shape memory alloy (SMA) knitted actuators-that can enable low-profile, dynamic compression for an aerospace OIG.METHODS: To characterize the functional capabilities of SMA knitted actuators, displacement control testing was conducted on 10 actuator samples with a range of geometric design parameters. Inactive (FI) and actuated forces (FA) were observed by repeatedly thermally cycling each sample at 0%, 15%, 30%, and 45% structural strain. Compression capabilities were approximated using medical compression hosiery standards and anthropometric data from a representative aerospace population (ANSUR 2012).RESULTS: Dynamic compression predictions reached 52 mmHg (single layer fabric) and 105 mmHg (double layer fabric) at the ankle. Low, inactive pressures (p < 20 mmHg) demonstrate that compression is controllable and can be dynamically increased upon actuation up to 33 mmHg in a single layer system and up to 67 mmHg in a double layer system.DISCUSSION: The results highlight the potential of SMA knitted actuators to enable low-profile, dynamic compression garments that can reach medically therapeutic pressures on an aerospace population to counteract OI symptoms. In addition to astronautic applications, this technology demonstrates widespread terrestrial medical and high-performance aircraft applicability.Granberry RM, Eschen KP, Ross AJ, Abel JM, Holschuh BT. Dynamic countermeasure fabrics for post-spaceflight orthostatic intolerance. Aerosp Med Hum Perform. 2020; 91(6):525-531.

Utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management among health care professionals' in public hospitals of Jimma zone, south-West Ethiopia, 2019.

BACKGROUND: Non- pneumatic anti-shock garment is a unique, life -saving first -aid device made of neoprene and velcro, which is used for treatment of women with postpartum hemorrhage. Maternal mortality in the world still very high and postpartum hemorrhage is the leading cause of maternal mortality worldwide. OBJECTIVE: This study was aimed to assess the utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management. METHODS: Facility based cross-sectional studies design both quantitative and qualitative data collection methods were employed among 210 health care professionals and 10 key informants respectively. Bivariable and multivariable logistic regression was done to identify factors associated with non-pneumatic anti-shock garment utilization. Qualitative data was transcribed, translated and triangulated with quantitative findings. RESULTS: Seventy six (36.2%) of the respondents used non-pneumatic anti-shock garment in their hospitals for management of post-partum hemorrhage. Having good knowledge [(AOR = 3.96, 95% CI: (1.67, 9.407)], having positive attitude [(AOR = 3.54, 95% CI: (1.37, 9.13)], attending training [AOR = 13.156, 95% CI: (4.81, 36.00], having two and above non-pneumatic anti-shock garment at their hospitals [AOR = 8.7, 95% CI: (2.89, 26.20)] were significantly associated with utilization of non-pneumatic anti-shock garment. … "I didn't use non-pneumatic anti-shock garment for the management of postpartum hemorrhage complication before because I have no training and experience how to use it." CONCLUSION: The utilization of non-pneumatic anti-shock garment for the management of postpartum hemorrhage was low. Having positive attitude, having good knowledge and training on non-pneumatic anti-shock garment were statically associated with its use. The health care professionals that involved in the maternity service should be trained on how to use this important garment in the management of postpartum hemorrhage.

Mobile Lower Body Negative Pressure Suit as an Integrative Countermeasure for Spaceflight.

BACKGROUND: Persistent headward fluid shift and mechanical unloading cause neuro-ocular, cardiovascular, and musculoskeletal deconditioning during long-term spaceflight. Lower body negative pressure (LBNP) reintroduces footward fluid shift and mechanical loading.METHODS: We designed, built, and tested a wearable, mobile, and flexible LBNP device (GravitySuit) consisting of pressurized trousers with built-in shoes to support ground reaction forces (GRF) and a thoracic vest to distribute load to the entire axial length of the body. In eight healthy subjects we recorded GRF under the feet and over the shoulders (Tekscan) while assessing cardiovascular response (Nexfin) and footward fluid shift from internal jugular venous cross-sectional area (IJVa) using ultrasound (Terason).RESULTS: Relative to normal bodyweight (BW) when standing upright, increments of 10 mmHg LBNP from 0 to 40 mmHg while supine induced axial loading corresponding to 0%, 13 ± 3%, 41 ± 5%, 75 ± 11%, and 125 ± 22% BW, respectively. Furthermore, LBNP reduced IJVa from 1.12 ± 0.3 cm² to 0.67 ± 0.2, 0.50 ± 0.1, 0.35 ± 0.1, and 0.31 ± 0.1 cm², respectively. LBNP of 30 and 40 mmHg reduced cardiac stroke volume and increased heart rate while cardiac output and mean arterial pressure were unaffected. During 2 h of supine rest at 20 mmHg LBNP, temperature and humidity inside the suit were unchanged (23 ± 1°C; 47 ± 3%, respectively).DISCUSSION: The flexible GravitySuit at 20 mmHg LBNP comfortably induced mechanical loading and desired fluid displacement while maintaining the mobility of hips and knee joints. The GravitySuit may provide a feasible method to apply low-level, long-term LBNP without interfering with daily activity during spaceflight to provide an integrative countermeasure.Petersen LG, Hargens A, Bird EM, Ashari N, Saalfeld J, Petersen JCG. Mobile lower body negative pressure suit as an integrative countermeasure for spaceflight. Aerosp Med Hum Perform. 2019; 90(12):993-999.

Hemodynamic Responses and G Protection Afforded by Three Different Anti-G Systems.

BACKGROUND: UK Royal Air Force fast jet aircrew use three different anti-G systems, however, little objective comparison of the G protection they provide exists. The G-protection afforded by each system and associated hemodynamic responses were investigated.METHODS: Ten subjects performed centrifuge acceleration exposures using Mk-10 (S1) and Mk-4 (S2) five-bladder anti-G trousers (AGT) and full coverage AGT plus pressure breathing for G-protection (PBG; S3). Measurements of relaxed G tolerance (RGT), eye-level blood pressure (BPeye), lower body blood volume (LBV), stroke volume (SV) and total peripheral resistance (TPR) were made during gradual onset runs (GOR) and rapid onset runs (ROR). The subjective effort required to maintain clear vision at +7 and +8 Gz provided an indication of the protection provided by the system.RESULTS: All systems moderated decreases in SV and BPeye and increases in LBV under increased +Gz. S3 provided the greatest mean RGT during GOR (+6.2 Gz) and ROR (+6 Gz), reduced the effort required to maintain clear vision at up to +8 Gz, prevented venous pooling and afforded the greatest rise in TPR. The majority of indices revealed no difference between S1 and S2 although RGT during the ROR was greater with S2 (+0.25 Gz).DISCUSSION: S3 effectively prevented pooling of blood in the lower limbs under +Gz, despite the use of PBG, and offers an advantage over five-bladder AGT. Given the similarities of S1 and S2, it was unsurprising that the majority of indices measured were similar. The objective measurement of hemodynamic parameters provides useful information for comparing the G-protection provided by anti-G systems.Pollock RD, Firth RV, Storey JA, Phillips KE, Connolly DM, Green NDC, Stevenson AT. Hemodynamic responses and G protection afforded by three different anti-G systems. Aerosp Med Hum Perform. 2019; 90(11):925-933.

Scaling up interventions: findings and lessons learned from an external evaluation of Niger's National Initiative to reduce postpartum hemorrhage.

BACKGROUND: Niger has one of the highest maternal mortality ratios in Sub Saharan Africa, of which postpartum hemorrhage is the leading cause. In 2014, Health and Development International and the Ministry of Health of Niger launched an initiative to introduce and scale-up three PPH interventions in health facilities nationwide: misoprostol, uterine balloon tamponade, and the non-pneumatic anti-shock garment. METHODS: A two-phase mixed-methods evaluation was conducted to assess implementation of the initiative. Health facility assessments, provider interviews, and household surveys were conducted in May 2016 and November 2017. RESULTS: All evaluation facilities received misoprostol prevention doses. However, shortages in misoprostol treatment doses, UBT kits, and NASG stock were documented. Health provider training increased while knowledge of each PPH intervention varied. Near-universal uterotonic coverage for PPH prevention and treatment was achieved and sustained throughout the evaluation period. Use of UBT and NASG to manage PPH was rare and differed by health facility type. Among community deliveries, fewer than 22% of women received misoprostol at antenatal care for self-administered prophylaxis. Among those who did, almost all reported taking the drugs for PPH prevention in each phase. CONCLUSIONS: This study is the first external evaluation of a comprehensive PPH program taking misoprostol, UBT, and NASG to national scale in a low resource setting. Although gaps in service delivery were identified, results demonstrate the complexities of training, managing stock, and implementing system-wide interventions to reach women in varying contexts. The experience provides important lessons for other countries as they develop and expand evidence-based programs for PPH care.

Experience of combined use of a Bakri uterine balloon and a non-pneumatic anti-shock garment in a university hospital in Colombia.

OBJECTIVE: To compare the outcomes of women with postpartum hemorrhage (PPH) refractory to initial management and in a state of hypoperfusion between management with a non-pneumatic anti-shock garment (NASG) and Bakri balloon and management with other surgical interventions. METHODS: A retrospective observational descriptive study of women with PPH and hemorrhagic shock who were treated at a high complexity obstetric unit in Columbia between 2011 and 2017. Clinical records were reviewed and women were divided in two groups by clinical management. Group 1 women were managed with surgical interventions; group 2 women were managed with NASG plus a Bakri balloon. RESULTS: Overall, 142 women were treated for PPH, with 69 in group 1 and 73 in group 2). There were differences between group 1 and group 2 in the degree of hypovolemic shock (shock index: 1.1 vs 0.9, P=0.02), indicators associated with hypoperfusion (lactic acid, 2.9 vs 1.9 mmol/L, P=0.001), and frequency of transfusion of blood components (68% vs 44%, P<0.05). CONCLUSIONS: The joint use of NASG and Bakri balloon in PPH management seemed to improve hypoperfusion-related markers such as lactic acid and shock index, and reduce the frequency of additional blood transfusion.

Pulmonary Effects from a Simulated Long-Duration Mission in a Confined Cockpit.

INTRODUCTION: A recent U-2 fatigue study, in which 10 subjects completed 2 simulated long-duration missions breathing either 100% oxygen or air in a hypobaric chamber, offered an opportunity to compare subjects' pulmonary function before and after remaining seated in a confined cockpit for 12 h. METHODS: In one U-2 mission configuration, the subject wore a full pressure suit and breathed aviator's breathing oxygen while chamber pressure was maintained at 4572 m (15,000 ft) above mean sea level. In the second mission configuration, subjects wore standard aircrew flight equipment and breathed air while chamber pressure was maintained at 2438 m (8000 ft) above mean sea level. Subjects' pulmonary function was assessed before and after the mission using four metrics: forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and forced expiratory volume in 1 s/forced vital capacity ratio. RESULTS: Subjects showed significant declines for all four pulmonary metrics (2.7%, 6.4%, 13.9%, and 3.5%, respectively) after 12 h seated in the cockpit in both full pressure suit and aircrew flight equipment conditions. DISCUSSION: While the declines at both altitudes amounted to modest percentages of subjects' total pulmonary capacities, they emerged after a single, acute sedentary exposure and appear to be unrelated to the percentage of oxygen in the breathing gas. This might have operational implications in confined mission environments where physiological demands are interspersed with long periods of inactivity.Beer J, Dart TS, Fischer J, Kisner J. Pulmonary effects from a simulated long-duration mission in a confined cockpit. Aerosp Med Hum Perform. 2017; 88(10):952-957.

Mechanical and physiological effect of partial pressure suit: Experiment and numerical study.

BACKGROUND: During high-altitude flight, the protection of the pilot is vital. A partial pressure suit may affect human physiology, especially circulatory physiology. OBJECTIVE: The purpose of this study was to investigate how a partial pressure suit works. METHOD: Ten subjects took part in the flight simulation experiments. Counter pressure at the chest, abdomen, thigh and shank were detected, together with physiological parameters such as heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR). A numerical model was also established to simulate hemo-physiological effects of the partial pressure suit. RESULTS: The experiment's results show the non-uniform counter pressure distribution in different parts of the body. There is a linear, proportional relation between TPR and the pressurizing level. HR and MAP increase along with that of the pressure level. SV and CO decrease with the increase of the pressure level. The numerical model simulated the physiological effect of a partial pressure suit. The results were verified by experiment data. The simulation estimated the change of blood flow with the pressure level. CONCLUSIONS: The numerical model provides a potential way to improve the protection of pilots.

Experience in the use of non-pneumatic anti-shock garment (NASG) in the management of postpartum haemorrhage with hypovolemic shock in the Fundación Valle Del Lili, Cali, Colombia.

BACKGROUND: The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals. METHODS: Descriptive case series of 77 women that received NASG in the management of PPH with severe hypovolemic shock from June 2014 to December 2015. Vital signs, shock index (SI), the lactic acid value and the base deficit were compared before and after NASG application. RESULTS: Fifty-six (77%) women had an SI > 1.1 at the time shock management was initiated; 96% had uterine atony. All women received standard does of uterotonics. The average time between the birth and NASG applications was 20 min. Forty-eight percent of women recovered haemodynamic variables in the first hour and 100% within the first 6 h; 100% had a SI < 1.0 in the first hour. The NASG was not removed until definitive control of bleeding was achieved, with an average time of use of 24 h. There were no mortalities. CONCLUSIONS: In this case series of women in severe shock, the NASG was an effective management device for the control of severe hypovolemic shock. It should be considered a first-line option for shock management.

Influence of a Full-Body Compression Suit on Trunk Positioning and Knee Joint Mechanics During Lateral Movements.

Trunk positioning has been shown to be associated with knee joint loading during athletic tasks, especially changes of direction. The purpose of the present study was to test whether a full-body compression suit (FBCS) would improve trunk positioning and knee joint control during lateral movements. Twelve female athletes performed lateral reactive jumps (LRJ) and unanticipated cuttings with and without the customized FBCS, while 3D kinematics and kinetics were measured. FBCS did not influence trunk positioning during LRJ and led to increased trunk lateral lean during cuttings (P < .001). However, while wearing FBCS, knee joint abduction and internal rotation angles were reduced during LRJ (P < .001 and P = .013, respectively), whereas knee joint moments were comparable during cuttings. FBCS cannot support the trunk segment during unanticipated dynamic movements. But, increased trunk lateral lean during cutting maneuvers was not high enough to elicit increased knee joint moments. On the contrary, knee joint abduction and internal rotation were reduced during LRJ, speaking for a better knee joint alignment with FBCS. Athletes seeking to improve trunk positioning may not benefit from a FBCS.

Vibrotactile perception assessment for a haptic interface on an antigravity suit.

Haptic technology is used in various fields to transmit information to the user with or without visual and auditory cues. This study aimed to provide preliminary data for use in developing a haptic interface for an antigravity (anti-G) suit. With the structural characteristics of the anti-G suit in mind, we determined five areas on the body (lower back, outer thighs, inner thighs, outer calves, and inner calves) on which to install ten bar-type eccentric rotating mass (ERM) motors as vibration actuators. To determine the design factors of the haptic anti-G suit, we conducted three experiments to find the absolute threshold, moderate intensity, and subjective assessments of vibrotactile stimuli. Twenty-six fighter pilots participated in the experiments, which were conducted in a fixed-based flight simulator. From the results of our study, we recommend 1) absolute thresholds of ∼11.98-15.84 Hz and 102.01-104.06 dB, 2) moderate intensities of 74.36 Hz and 126.98 dB for the lower back and 58.65 Hz and 122.37 dB for either side of the thighs and calves, and 3) subjective assessments of vibrotactile stimuli (displeasure, easy to perceive, and level of comfort). The results of this study will be useful for the design of a haptic anti-G suit.

The Effect of the Gravity Loading Countermeasure Skinsuit Upon Movement and Strength.

Carvil, PA, Attias, J, Evetts, SN, Waldie, JM, and Green, DA. The effect of the gravity loading countermeasure skinsuit upon movement and strength. J Strength Cond Res 31(1): 154-161, 2017-Effective countermeasures against musculoskeletal deconditioning induced by microgravity and disuse are required. A simple alternative to provision of artificial gravity by centrifugation is compressive axial loading. The Russian "Pingvin" suit was the first wearable suit to apply this concept using bungee cords tethered around the shoulders and feet. However, poor loading characteristics and severe thermal and movement discomfort were reported. The gravity loading countermeasure skinsuit (GLCS) uses a bidirectional weave to generate staged axial loading from shoulders to feet, better mimicking how Earth's gravity induces progressive loading head to foot. The Mk III GLCS's loading was evaluated and tolerability assessed during maximal joint motion, ambulation, and selected strength exercises. Eight subjects (5 male and 3 female; 28 ± 3 years; 179 ± 0.1 cm and 74.8 ± 2.9 kg), having given written informed consent, had an Mk III GLCS individually tailored. Axial loading imparted, body height, joint range of motion (ROM), ambulation, and strength tests (12 repetition maximum) were performed in the GLCS and gym attire, with subjective (rating of perceived exertion, thermal comfort, movement discomfort and body control) ratings recorded throughout. Gravity loading countermeasure skinsuit provided significant axial loading when standing but significantly reduced knee (-13°), spinal (-28°) and shoulder flexion/extension ROM (-34°/-13°), in addition to Sit and Reach (-12.8 cm). No thermal issues were reported but there was an increase in subjective discomfort. Gravity loading countermeasure skinsuit did not significantly impede strength exercise, with the exception of shoulder press. The GLCS (Mk III) demonstrates potential as a countermeasure by providing tolerable, static axial loading. Furthermore, it may serve as an elasticlike strength exercise adjunct, which may have utility as a rehabilitation modality after further design refinement.

Preventing deaths due to haemorrhage.

Prevention of deaths from obstetric haemorrhage requires effective health systems including family planning, commodities, personnel, infrastructure and ultimately universal access to comprehensive obstetric care for women giving birth. The main causes of death associated with antepartum haemorrhage are placental abruption, placenta praevia and uterine rupture. Preventive measures include preconceptual folate supplementation, management of hypertensive disorders, early diagnosis of placenta praevia and use of uterine stimulants cautiously, particularly misoprostol. Preventive measures for post-partum haemorrhage include routine active management of the third stage of labour. Treatment involves a cascade of increasingly invasive interventions in rapid sequence until the bleeding is stopped. These interventions include fluid resuscitation, removal of the placenta, bimanual uterine compression, uterotonics, tranexamic acid, suturing of lower genital tract injury, blood product replacement, balloon tamponade, laparotomy, stepwise uterine devascularization, uterine compression sutures and hysterectomy. Emergency temporizing measures include application of the non-pneumatic anti-shock garment, and at laparotomy, aortic compression and uterine tourniquet application. The effectiveness of treatment methods and the optimal dosage of misoprostol are research priorities. Interesting new approaches include transvaginal uterine artery clamping and suction uterine tamponade.