Developing a Local Anesthetic Systemic Toxicity Protocol in a Mississippi Hospital

Local anesthetic systemic toxicity (LAST) is a rare complication of administering local anesthetic medications. However, this complication is potentially deadly, especially without prompt and correct treatment. Due to the rarity of LAST and the fact that its treatment differs from the conventional treatment of cardiac arrest, the authors sought a best practice recommendation to guide its treatment. While the most effective treatment for LAST has been well established, a thorough review of literature and survey of clinical preceptors demonstrated that most providers have not encountered LAST in clinical practice. Additionally, lipid emulsion therapy is a somewhat controversial treatment among some providers, even though its effectiveness is well documented. This doctoral project sought to develop a best practice recommendation to guide the treatment of LAST events and increase the confidence of providers in their ability to recognize and treat LAST. The recommendation was developed after a thorough review of the literature. The information was used to create a report of findings that were presented to a panel of experts. Feedback from the expert panel revealed that the respondents have not encountered a LAST event in their clinical practice. They all agreed that this practice recommendation would potentially help to guide the correct treatment of LAST. Their feedback, along with the report of findings was subsequently used to develop an executive review that was sent to a hospital affiliated with the Nurse Anesthesia Program at The University of Southern Mississippi in which the evaluation was performed. The executive summary also included an education module for the anesthesia staff

Proposed Framework for Determining Added Mass of Orion Drogue Parachutes

The Crew Exploration Vehicle (CEV) Parachute Assembly System (CPAS) project is executing a program to qualify a parachute system for a next generation human spacecraft. Part of the qualification process involves predicting parachute riser tension during system descent with flight simulations. Human rating the CPAS hardware requires a high degree of confidence in the simulation models used to predict parachute loads. However, uncertainty exists in the heritage added mass models used for loads predictions due to a lack of supporting documentation and data. Even though CPAS anchors flight simulation loads predictions to flight tests, extrapolation of these models outside the test regime carries the risk of producing non-bounding loads. A set of equations based on empirically derived functions of skirt radius is recommended as the simplest and most viable method to test and derive an enhanced added mass model for an inflating parachute. This will increase confidence in the capability to predict parachute loads. The selected equations are based on those published in A Simplified Dynamic Model of Parachute Inflation by Dean Wolf. An Ames 80x120 wind tunnel test campaign is recommended to acquire the reefing line tension and canopy photogrammetric data needed to quantify the terms in the Wolf equations and reduce uncertainties in parachute loads predictions. Once the campaign is completed, the Wolf equations can be used to predict loads in a typical CPAS Drogue Flight test. Comprehensive descriptions of added mass test techniques from the Apollo Era to the current CPAS project are included for reference

Sports Utility Vehicles: A Public Health Model of Their Climate and Air Pollution Impacts in the United Kingdom

The emission benefits of shifting towards battery electric vehicles have so far been hampered by a trend towards sports utility vehicles (SUVs). This study assesses the current and future emissions from SUVs and their potential impact on public health and climate targets. We modelled five scenarios of varying SUV sales and electrification rates, and projected associated carbon dioxide (CO2) and nitrogen oxide (NOx) emissions. Multiple linear regression was used to determine the relationship between vehicle characteristics and emissions. Cumulative CO2 emissions were valued using the social cost of carbon approach. Life table analyses were used to project and value life years saved from NOx emission reductions. Larger SUVs were disproportionately high emitters of CO2 and NOx. Replacing these with small SUVs achieved significant benefits, saving 702 MtCO2e by 2050 and 1.8 million life years from NO2 reductions. The largest benefits were achieved when combined with electrification, saving 1181 MtCO2e and gaining 3.7 million life years, with a societal value in the range of GBP 10-100s billion(s). Downsizing SUVs could be associated with major public health benefits from reduced CO2 and NOx emissions, in addition to the benefits of electrification. This could be achieved by demand-side mass-based vehicle taxation and supply-side changes to regulations, by tying emission limits to a vehicle's footprint rather than its mass

Microneedle delivery of autoantigen for immunotherapy in type 1 diabetes

Antigen specific immunotherapy mediated via the sustained generation of regulatory T cells arguably represents the ideal therapeutic approach to preventing beta cell destruction in type 1 diabetes. However, there is a need to enhance the efficacy of this approach to achieve disease modification in man. Previous studies suggest that prolonged expression of self-antigen in skin in a non-inflammatory context is beneficial for tolerance induction. We therefore sought to develop a dry-coated microneedle (MN) delivery system and combine it with topical steroid to minimise local inflammation and promote prolonged antigen presentation in the skin. Here we show that a combination of surface-modified MNs coated with appropriate solvent systems can deliver therapeutically relevant quantities of peptide to mouse and human skin even with hydrophobic peptides. Compared to conventional “wet” intradermal (ID) administration, “dry” peptide delivered via MNs was retained for longer in the skin and whilst topical hydration of the skin with vehicle or steroid accelerated loss of ID-delivered peptide from the skin, MN delivery of peptide was unaffected. Furthermore, MN delivery resulted in enhanced presentation of antigen to T cells in skin draining lymph nodes (LNs) both 3 and 10 days after administration. Repeated administration of islet antigen peptide via MN was effective at reducing antigen-specific T cell proliferation in the pancreatic LN, although topical steroid therapy did not enhance this. Taken together, these data show auto-antigenic peptide delivery into skin using coated MNs results in prolonged retention and enhanced antigen presentation compared to conventional ID delivery and this approach may have potential in individuals identified as being at a high risk of developing type 1 diabetes and other autoimmune diseases

Ritchie Argue

The effectiveness of interaction with mobile devices can be impacted by handedness; however, support for handedness in the interface is rarely provided. The goal of this article is to demonstrate that handedness is a significant interface consideration that should not be overlooked. Four studies were conducted to explore left-handed user interaction with right- or left-aligned scrollbars on personal digital assistants. Analysis of the data shows that left-handed users are able to select targets significantly faster using a left-aligned scrollbar when compared to a right-aligned scrollbar. User feedback also indicated that a left-aligned scrollbar was preferred by left-handed users and provided more natural interaction. 1