Development of Interdisciplinary Communication Tools to Improve Handoffs for Emergent Airway Management

Project goal Improve response time from airway alert to intubation while ensuring pertinent critical patient information is communicated to the airway team to reduce negative patient outcomes and better mobilize anesthesia resources

Physical Activity and Stroke Risk: A Meta-Analysis

Background and Purpose - Whether physical activity reduces stroke risk remains controversial. We used a meta-analysis to examine the overall association between physical activity or cardiorespiratory fitness and stroke incidence or mortality. Methods - We searched MEDLINE from 1966 to 2002 and identified 23 studies (18 cohort and 5 case-control) that met inclusion criteria. We estimated the overall relative risk (RR) of stroke incidence or mortality for highly and moderately active individuals versus individuals with low levels of activity using the general variance-based method. Results - The meta-analysis documented that there was a reduction in stroke risk for active or fit individuals compared with inactive or unfit persons in cohort, case-control, and both study types combined. For cohort studies, highly active individuals had a 25% lower risk of stroke incidence or mortality (RR=0.75; 95% CI, 0.69 to 0.82) compared with low-active individuals. For case-control studies, highly active individuals had a 64% lower risk of stroke incidence (RR=0.36; 95% CI, 0.25 to 0.52) than their low-active counterparts. When we combined both the cohort and case-control studies, highly active individuals had a 27% lower risk of stroke incidence or mortality (RR=0.73; 95% CI, 0.67 to 0.79) than did low-active individuals. We observed similar results in moderately active individuals compared with inactive persons (RRs were 0.83 for cohort, 0.52 for case-control, and 0.80 for both combined). Furthermore, moderately and highly active individuals had lower risk of both ischemic and hemorrhagic strokes than low-active individuals. Conclusions - We conclude that moderate and high levels of physical activity are associated with reduced risk of total, ischemic, and hemorrhagic strokes

Prospects for measuring supermassive black hole masses with future extremely large telescopes

The next generation of giant-segmented mirror telescopes ($>$ 20 m) will enable us to observe galactic nuclei at much higher angular resolution and sensitivity than ever before. These capabilities will introduce a revolutionary shift in our understanding of the origin and evolution of supermassive black holes by enabling more precise black hole mass measurements in a mass range that is unreachable today. We present simulations and predictions of the observations of nuclei that will be made with the Thirty Meter Telescope (TMT) and the adaptive optics assisted integral-field spectrograph IRIS, which is capable of diffraction-limited spectroscopy from $Z$ band (0.9 $\mu$m) to $K$ band (2.2 $\mu$m). These simulations, for the first time, use realistic values for the sky, telescope, adaptive optics system, and instrument, to determine the expected signal-to-noise ratio of a range of possible targets spanning intermediate mass black holes of $\sim10^4$ \msun to the most massive black holes known today of $>10^{10}$ $M_\odot$. We find that IRIS will be able to observe Milky Way-mass black holes out the distance of the Virgo cluster, and will allow us to observe many more brightest cluster galaxies where the most massive black holes are thought to reside. We also evaluate how well the kinematic moments of the velocity distributions can be constrained at the different spectral resolutions and plate scales designed for IRIS. We find that a spectral resolution of $\sim8000$ will be necessary to measure the masses of intermediate mass black holes. By simulating the observations of galaxies found in SDSS DR7, we find that over $10^5$ massive black holes will be observable at distances between $0.005 < z < 0.18$ with the estimated sensitivity and angular resolution provided by access to $Z$-band (0.9 $\mu$m) spectroscopy from IRIS and the TMT adaptive optics system. (Abridged)Comment: 19 pages, 20 figures, accepted to A

Electrochemical immunosensing of low-density lipoprotein based on sol-gel encapsulation

Lipoprotein monitoring is desirable in the management of medical conditions such as atherosclerotic cardiovascular disease and coronary artery disease, in which controlling the concentration of these chylomicrons is crucial. Current clinical methods are complex and present poor reproducibility between laboratories. For these reasons, recent guidelines discard the assessment of low-density lipoprotein cholesterol (LDL-C) as a routine analysis during lipid-lowering therapies. Concerning the importance of monitoring this parameter, the authors present an electrochemical immunosensor constructed from a simple and easy-to-reproduce platform that allows detecting and quantifying LDL nanoparticles directly from human serum samples. The performance of the biosensor was studied by scanning electron microscopy, cyclic voltammetry, and electrochemical impedance spectroscopy. The biosensing platform displays good stability and linearity between 30 mg dL-1&nbsp;and 135 mg dL-1&nbsp;with a detection limit of 20 mg dL-1. The proposed biosensor can be easily employed for monitoring LDL concentration in clinical treatments

Comparison of Airway Intubation Devices When Using a Biohazard Suit: A Feasibility Study

OBJECTIVES: We set out to compare emergency medicine residents\u27 intubating times and success rates for direct laryngoscopy (DL), GlideScope-assisted intubation (GS), and the Supraglottic Airway Laryngopharyngeal Tube (SALT) airway with and without biohazard gear. METHODS: Each resident passed through 2 sets of 3 testing stations (DL, GS, SALT) in succession, intubating Laerdal mannequin heads with the 3 modalities after randomization to start with or without biohazard gear. RESULTS: Thirty-seven residents participated, and 27 were male (73%); 14 (37.8%) had prior experience intubating in biohazard suits. There was a statistically significant difference in those who had prior intubation experience between DL (37, 100%), GS (32, 86.5%), and SALT (12, 32.4%) (P \u3c .001) and in median time to intubation (48 seconds, no suit; 57 seconds, with suits) (P = .03). There was no statistically significant difference between the overall times to intubate for the 3 devices. First-pass success was highest for DL (91.2%, no suit; 83.7%, suit) followed by GS (89%, no suit; 78.3%, suit) and SALT (51%, no suit; 67.6%, suit). CONCLUSION: A minority of participants had prior experience intubating in biohazard suits. Use of biohazard suits extends time to successful intubation. There was no difference in time to intubation for the 3 devices, but first-pass success was highest for DL (with or without biohazard gear)

Probing the Soft X-ray Properties and Multi-Wavelength Variability of SN2023ixf and its Progenitor

We present a detailed analysis of nearly two decades of optical/UV and X-ray data to study the multi-wavelength pre-explosion properties and post-explosion X-ray properties of nearby SN2023ixf located in M101. We find no evidence of precursor activity in the optical to UV down to a luminosity of $\lesssim 7\times10^{4}\, \rm L_{\odot}$, while X-ray observations covering nearly 18 years prior to explosion show no evidence of luminous precursor X-ray emission down to an absorbed 0.3 - 10.0 keV X-ray luminosity of $\sim6\times10^{36}$ erg s$^{-1}$. Extensive Swift observations taken post-explosion did not detect soft X-ray emission from SN2023ixf within the first $\sim$3.3 days after first light, which suggests a mass-loss rate for the progenitor of $\lesssim5\times10^{-4}\,\rm M_{\odot}$ yr$^{-1}$ or a radius of $\lesssim4\times10^{15}$ cm for the circumstellar material. Our analysis also suggests that if the progenitor underwent a mass-loss episode, this had to occur $>$ 0.5 - 1.5 years prior to explosion, consistent with previous estimates. Swift detected soft X-rays from SN2023ixf $\sim4.25$ days after first light, and it rose to a peak luminosity of $\sim10^{39}$ erg s$^{-1}$ after 10 days and has maintained this luminosity for nearly 50 days post first light. This peak luminosity is lower than expected, given the evidence that SN2023ixf is interacting with dense material. However, this might be a natural consequence of an asymmetric circumstellar medium. X-ray spectra derived from merging all Swift observations over the first 50 days are best described by a two-component bremsstrahlung model consisting of a heavily absorbed and hotter component similar to that found using NuSTAR, and a less-absorbed, cooler component. We suggest that this soft component arises from cooling of the forward shock similar to that found in Type IIn SN2010jl.Comment: 27 pages, 13 figure