Reservoir Cannulas for Pediatric Oxygen Therapy: A Proof-of-Concept Study

Hypoxemia is a complication of pneumonia—the leading infectious cause of death in children worldwide. Treatment generally requires oxygen-enriched air, but access in low-resource settings is expensive and unreliable. We explored use of reservoir cannulas (RCs), which yield oxygen savings in adults but have not been examined in children. Toddler, small child, and adolescent breathing profiles were simulated with artificial lung and airway models. An oxygen concentrator provided flow rates of 0 to 5 L/min via a standard nasal cannula (NC) or RC, and delivered oxygen fraction (FdO2) was measured. The oxygen savings ratio (SR) and absolute flow savings (AFS) were calculated, comparing NC and RC. We demonstrated proof-of-concept that pendant RCs could conserve oxygen during pediatric therapy. SR mean and standard deviation were 1.1±0.2 to 1.4±0.4, 1.1±0.1 to 1.7±0.3, and 1.3±0.1 to 2.4±0.3 for toddler, small child, and adolescent models, respectively. Maximum AFS observed were 0.3±0.3, 0.2±0.1, and 1.4±0.3 L/min for the same models. RCs have the potential to reduce oxygen consumption during treatment of hypoxemia in children; however, further evaluation of products is needed, followed by clinical analysis in patients

Immigrant Occupational Attainment: Assimilation and Mobility over Time.

This article compares immigrant and native-born male occupational distributions in Canada in the 1980s. Three questions are addressed: (1) how do immigrant and native-born occupational distributions differ?; (2) are immigrants more occupationally mobile?; and (3) how do immigrant occupations and mobility relate to characteristics used in immigrant selection? Results indicate that immigrants are more skilled but this declines across successive cohorts. Immigrants are more occupationally mobile even long after arrival, indicating immigration may contribute to a more flexible labor force. Immigrants who are not assessed on their skills or are not fluent at arrival are less occupationally mobile. Copyright 1999 by University of Chicago Press.

Comprehension and Selective Visual Attention in Play-calling Signage in NCAA Division 1 Football: A Comprehensive Literature Review

Background: The huddle in American college football has been replaced by hand-signals, play-cards, and other forms of nonverbal communication to deliver information from the sidelines to the field. These communication methods serve a dual-purpose of capturing the student-athletes’ attention while perplexing the opposition. Objective: The purpose of this study is to apply cognitive engineering concepts toward the improvement of signage and play-calling such that coaches can more effectively transmit information to players on the field during competitions. Methods: This comprehensive literature review investigates strategies for successful visual play-calling systems in sports communication. Collaboration occurred with a National Collegiate Athletic Association (NCAA) Division 1 football coaching staff to understand communication processes on field. Existing literature related to visual language processing, selective attention, and signal comprehension were compiled for recommendations. Results: Research findings suggest positive correlations between speed, clarity, and simplicity of signage in addition to effective sideline communication. The results of this review can be used to develop guidelines that increase the accuracy and speed of play-calling during games, such as clearly designed imagery and simplified play calls; coaches may establish strategies that are consistently understood by student-athletes. Conclusion: In addition to the findings, this study also identifies visual communication methods and mediums that can be used in any sport or work field where transmitting and comprehending information from a distance is critical for task completion

Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: A qualitative study

Background: Pneumonia and possible serious bacterial infection (PSBI) are leading causes of death among under-five children. The World Health Organization (WHO) issued global recommendations for the case management of childhood pneumonia and PSBI when referral is not feasible with oral amoxicillin. However, few governments to date have incorporated child-friendly amoxicillin dispersible tablets (DT) into their national treatment guidelines and policies. We aimed to understand the key drivers to the implementation of WHO recommendations for childhood pneumonia and PSBI using amoxicillin DT in Bangladesh. Methods: A qualitative study was conducted from October 2017 to March 2018 in two districts of Bangladesh. Interviews were completed with 67 participants consisting of government officials and key stakeholders, international development agencies, health service providers (HSPs), and caregivers of young children diagnosed and treated with amoxicillin for pneumonia or PSBI. Data were analyzed thematically. Results: Policies and operational planning emerged as paramount to ensuring access to essential medicines for childhood pneumonia and PSBI. Though amoxicillin DT is included for National Newborn Health Programme and Integrated Management of Childhood Illnesses in the Operational Plan of the Directorate General of Health Services, inclusion in Community-Based Healthcare Project and Directorate General of Family Planning policies is imperative to securing national supply, access, and uptake. At the sub-national level, training on the use of amoxicillin DT as a first line intervention is lacking, resulting in inadequate management of childhood pneumonia by HSPs. Advocacy activities are needed to create community-wide demand among key stakeholders, HSPs, and caregivers not yet convinced that amoxicillin DT is the preferred formulation for the management of childhood pneumonia and PSBI. Conclusion: Challenges in policy and supply at the national level and HSP preparedness at the sub-national levels contribute to the slow adoption of WHO recommendations for amoxicillin DT in Bangladesh. A consultation meeting to disseminate study findings was instrumental in driving the development of recommendations by key stakeholders to address these challenges. A comprehensive and inclusive evidence-based strategy involving all divisions of the Ministry of Health and Family Welfare will be required to achieve national adoption of WHO recommendations and country-wide introduction of amoxicillin DT in Bangladesh. 2020 The Author(s).This study was funded by GlaxoSmithKline (GSK) through PATH, Seattle, USA under the grant number GR-0154

A model for oxygen conservation associated with titration during pediatric oxygen therapy

<div><p>Background</p><p>Continuous oxygen treatment is essential for managing children with hypoxemia, but access to oxygen in low-resource countries remains problematic. Given the high burden of pneumonia in these countries and the fact that flow can be gradually reduced as therapy progresses, oxygen conservation through routine titration warrants exploration.</p><p>Aim</p><p>To determine the amount of oxygen saved via titration during oxygen therapy for children with hypoxemic pneumonia.</p><p>Methods</p><p>Based on published clinical data, we developed a model of oxygen flow rates needed to manage hypoxemia, assuming recommended flow rate at start of therapy, and comparing total oxygen used with routine titration every 3 minutes or once every 24 hours versus no titration.</p><p>Results</p><p>Titration every 3 minutes or every 24 hours provided oxygen savings estimated at 11.7% ± 5.1% and 8.1% ± 5.1% (average ± standard error of the mean, n = 3), respectively. For every 100 patients, 44 or 30 kiloliters would be saved—equivalent to 733 or 500 hours at 1 liter per minute.</p><p>Conclusions</p><p>Ongoing titration can conserve oxygen, even performed once-daily. While clinical validation is necessary, these findings could provide incentive for the routine use of pulse oximeters for patient management, as well as further development of automated systems.</p></div

Two oxygen need profiles (Profile A and B, or v_a(t) and v_b(t), respectively) assumed to reflect patient oxygen requirements in order to maintain SpO2 > 90%.

<p>Two oxygen need profiles (Profile A and B, or v_a(t) and v_b(t), respectively) assumed to reflect patient oxygen requirements in order to maintain SpO2 > 90%.</p

Overview of model and simulation used to estimate the oxygen usage and savings associated with routine titration during oxygen therapy of hypoxic children with pneumonia.

<p>Overview of model and simulation used to estimate the oxygen usage and savings associated with routine titration during oxygen therapy of hypoxic children with pneumonia.</p

Cumulative oxygen usage for 100 patients, in scenarios with three different titration intervals.

<p>Δt is the titration interval.</p

mPneumonia: Development of an Innovative mHealth Application for Diagnosing and Treating Childhood Pneumonia and Other Childhood Illnesses in Low-Resource Settings

<div><p>Pneumonia is the leading infectious cause of death in children worldwide. Each year, pneumonia kills an estimated 935,000 children under five years of age, with most of these deaths occurring in developing countries. The current approach for pneumonia diagnosis in low-resource settings—using the World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and relying on a health care provider’s ability to manually count respiratory rate—has proven inadequate. Furthermore, hypoxemia—a diagnostic indicator of the presence and severity of pneumonia often associated with an increased risk of death—is not assessed because pulse oximetry is frequently not available in low-resource settings. In an effort to address childhood pneumonia mortality and improve frontline health care providers’ ability to diagnose, classify, and manage pneumonia and other childhood illnesses, PATH collaborated with the University of Washington to develop “mPneumonia,” an innovative mobile health application using an Android tablet. mPneumonia integrates a digital version of the IMCI algorithm with a software-based breath counter and a pediatric pulse oximeter. We conducted a design-stage usability field test of mPneumonia in Ghana, with the goal of creating a user-friendly diagnostic and management tool for childhood pneumonia and other childhood illnesses that would improve diagnostic accuracy and facilitate adherence by health care providers to established guidelines in low-resource settings. The results of the field test provided valuable information for understanding the usability and acceptability of mPneumonia among health care providers, and identifying approaches to iterate and improve. This critical feedback helped ascertain the common failure modes related to the user interface design, navigation, and accessibility of mPneumonia and the modifications required to improve user experience and create a tool aimed at decreasing mortality from pneumonia and other childhood illnesses in low-resource settings.</p></div