Translational design for limited resource settings as demonstrated by Vent-Lock, a 3D-printed ventilator multiplexer

BACKGROUND: Mechanical ventilators are essential to patients who become critically ill with acute respiratory distress syndrome (ARDS), and shortages have been reported due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We utilized 3D printing (3DP) technology to rapidly prototype and test critical components for a novel ventilator multiplexer system, Vent-Lock, to split one ventilator or anesthesia gas machine between two patients. FloRest, a novel 3DP flow restrictor, provides clinicians control of tidal volumes and positive end expiratory pressure (PEEP), using the 3DP manometer adaptor to monitor pressures. We tested the ventilator splitter circuit in simulation centers between artificial lungs and used an anesthesia gas machine to successfully ventilate two swine. RESULTS: As one of the first studies to demonstrate splitting one anesthesia gas machine between two swine, we present proof-of-concept of a de novo, closed, multiplexing system, with flow restriction for potential individualized patient therapy. CONCLUSIONS: While possible, due to the complexity, need for experienced operators, and associated risks, ventilator multiplexing should only be reserved for urgent situations with no other alternatives. Our report underscores the initial design and engineering considerations required for rapid medical device prototyping via 3D printing in limited resource environments, including considerations for design, material selection, production, and distribution. We note that optimization of engineering may minimize 3D printing production risks but may not address the inherent risks of the device or change its indications. Thus, our case report provides insights to inform future rapid prototyping of medical devices

Dark Energy Survey identification of a low-mass active galactic nucleus at redshift 0.823 from optical variability

We report the identification of a low-mass active galactic nucleus (AGN), DES J0218-0430, in a redshift z = 0.823 galaxy in the Dark Energy Survey (DES) Supernova field. We select DES J0218-0430 as an AGN candidate by characterizing its long-term optical variability alone based on DES optical broad-band light curves spanning over 6 yr. An archival optical spectrum from the fourth phase of the Sloan Digital Sky Survey shows both broad MgII and broad Hβ lines, confirming its nature as a broad-line AGN. Archival XMM-Newton X-ray observations suggest an intrinsic hard X-ray luminosity of L2-12 keV ≈ 7.6 ± 0.4 × 1043 erg s-1, which exceeds those of the most X-ray luminous starburst galaxies, in support of an AGN driving the optical variability. Based on the broad Hβ from SDSS spectrum, we estimate a virial black hole (BH) mass of M• ≈ 106.43-106.72M_(with the error denoting the systematic uncertainty from different calibrations), consistent with the estimation from OzDES, making it the lowest mass AGN with redshift > 0.4 detected in optical. We estimate the host galaxy stellarmass to beM* ≈1010.5 ± 0.3M_based on modelling the multiwavelength spectral energy distribution. DES J0218-0430 extends theM•-M* relation observed in luminous AGNs at z ∼ 1 to masses lower than being probed by previous work. Our work demonstrates the feasibility of using optical variability to identify low-mass AGNs at higher redshift in deeper synoptic surveys with direct implications for the upcoming Legacy Survey of Space and Time at Vera C. Rubin Observatory. © 2020 Oxford University Press. All rights reserved

The Curious Case of PHL 293B: A Long-lived Transient in a Metal-poor Blue Compact Dwarf Galaxy

We report on small-amplitude optical variability and recent dissipation of the unusually persistent broad emission lines in the blue compact dwarf galaxy PHL 293B. The galaxy's unusual spectral features (P Cygni-like profiles with ∼800 km s-1 blueshifted absorption lines) have resulted in conflicting interpretations of the nature of this source in the literature. However, analysis of new Gemini spectroscopy reveals the broad emission has begun to fade after being persistent for over a decade prior. Precise difference imaging light curves constructed with the Sloan Digital Sky Survey and the Dark Energy Survey reveal small-amplitude optical variability of ∼0.1 mag in the g band offset by 100 21 pc from the brightest pixel of the host. The light curve is well-described by an active galactic nuclei (AGN)-like damped random walk process. However, we conclude that the origin of the optical variability and spectral features of PHL 293B is due to a long-lived stellar transient, likely a Type IIn supernova or nonterminal outburst, mimicking long-term AGN-like variability. This work highlights the challenges of discriminating between scenarios in such extreme environments, relevant to searches for AGNs in dwarf galaxies. This is the second long-lived transient discovered in a blue compact dwarf, after SDSS1133. Our result implies such long-lived stellar transients may be more common in metal-deficient galaxies. Systematic searches for low-level variability in dwarf galaxies will be possible with the upcoming Legacy Survey of Space and Time at the Vera C. Rubin Observatory. © 2020. The American Astronomical Society. All rights reserved.

Prenatal exposures and exposomics of asthma

This review examines the causal investigation of preclinical development of childhood asthma using exposomic tools. We examine the current state of knowledge regarding early-life exposure to non-biogenic indoor air pollution and the developmental modulation of the immune system. We examine how metabolomics technologies could aid not only in the biomarker identification of a particular asthma phenotype, but also the mechanisms underlying the immunopathologic process. Within such a framework, we propose alternate components of exposomic investigation of asthma in which, the exposome represents a reiterative investigative process of targeted biomarker identification, validation through computational systems biology and physical sampling of environmental medi

Protection levels of N95-level respirator substitutes proposed during the COVID-19 pandemic: Safety concerns and quantitative evaluation procedures

OBJECTIVE: The COVID-19 pandemic has precipitated widespread shortages of filtering facepiece respirators (FFRs) and the creation and sharing of proposed substitutes (novel designs, repurposed materials) with limited testing against regulatory standards. We aimed to categorically test the efficacy and fit of potential N95 respirator substitutes using protocols that can be replicated in university laboratories. SETTING: Academic medical centre with occupational health-supervised fit testing along with laboratory studies. PARTICIPANTS: Seven adult volunteers who passed quantitative fit testing for small-sized (n=2) and regular-sized (n=5) commercial N95 respirators. METHODS: Five open-source potential N95 respirator substitutes were evaluated and compared with commercial National Institute for Occupational Safety and Health (NIOSH)-approved N95 respirators as controls. Fit testing using the 7-minute standardised Occupational Safety and Health Administration fit test was performed. In addition, protocols that can be performed in university laboratories for materials testing (filtration efficiency, air resistance and fluid resistance) were developed to evaluate alternate filtration materials. RESULTS: Among five open-source, improvised substitutes evaluated in this study, only one (which included a commercial elastomeric mask and commercial HEPA filter) passed a standard quantitative fit test. The four alternative materials evaluated for filtration efficiency (67%-89%) failed to meet the 95% threshold at a face velocity (7.6 cm/s) equivalent to that of a NIOSH particle filtration test for the control N95 FFR. In addition, for all but one material, the small surface area of two 3D-printed substitutes resulted in air resistance that was above the maximum in the NIOSH standard. CONCLUSIONS: Testing protocols such as those described here are essential to evaluate proposed improvised respiratory protection substitutes, and our testing platform could be replicated by teams with similar cross-disciplinary research capacity. Healthcare professionals should be cautious of claims associated with improvised respirators when suggested as FFR substitutes

Illness perceptions and explanatory models of viral hepatitis B & C among immigrants and refugees: a narrative systematic review.

© 2015 Owiti et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Hepatitis B and C (HBV, HCV) infections are associated with high morbidity and mortality. Many countries with traditionally low prevalence (such as UK) are now planning interventions (screening, vaccination, and treatment) of high-risk immigrants from countries with high prevalence. This review aimed to synthesise the evidence on immigrants' knowledge of HBV and HCV that might influence the uptake of clinical interventions. The review was also used to inform the design and successful delivery of a randomised controlled trial of targeted screening and treatment. METHODS: Five databases (PubMed, CINHAL, SOCIOFILE, PsycINFO & Web of Science) were systematically searched, supplemented by reference tracking, searches of selected journals, and of relevant websites. We aimed to identify qualitative and quantitative studies that investigated knowledge of HBV and HCV among immigrants from high endemic areas to low endemic areas. Evidence, extracted according to a conceptual framework of Kleinman's explanatory model, was subjected to narrative synthesis. We adapted the PEN-3 model to categorise and analyse themes, and recommend strategies for interventions to influence help-seeking behaviour. RESULTS: We identified 51 publications including quantitative (n = 39), qualitative (n = 11), and mixed methods (n = 1) designs. Most of the quantitative studies included small samples and had heterogeneous methods and outcomes. The studies mainly concentrated on hepatitis B and ethnic groups of South East Asian immigrants residing in USA, Canada, and Australia. Many immigrants lacked adequate knowledge of aetiology, symptoms, transmission risk factors, prevention strategies, and treatment, of hepatitis HBV and HCV. Ethnicity, gender, better education, higher income, and English proficiency influenced variations in levels and forms of knowledge. CONCLUSION: Immigrants are vulnerable to HBV and HCV, and risk life-threatening complications from these infections because of poor knowledge and help-seeking behaviour. Primary studies in this area are extremely diverse and of variable quality precluding meta-analysis. Further research is needed outside North America and Australia

Prolonged Survival in a Patient with Neuroendocrine Tumor of the Cecum and Diffuse Peritoneal Carcinomatosis

Peritoneal carcinomatosis is a well-known factor of poor prognosis in patients with digestive adenocarcinomas. Peritoneal dissemination may also occur in midgut well-differentiated neuroendocrine tumors, but its influence on survival is ill-defined. We report here the history of a 64-year-old woman who had a neuroendocrine tumor of the cecum with multiple synchronous metastases in the liver and diffuse peritoneal carcinomatosis. She underwent surgical resection of the primary tumor and cytoreduction of liver metastases, and received subsequently chemotherapy and somatostatin analogs. In spite of the widespread extension of the disease, she survived for 13 years and died from a carcinoid heart disease. We discuss the natural history and prognostic factors in patients with midgut well-differentiated neuroendocrine tumors, with a focus on the impact of the peritoneal carcinomatosis