Perioperative comparison of the agreement between a portable fingertip pulse oximeter vs. a conventional bedside pulse oximeter in adult patients (COMFORT trial)

Background: Low-cost, portable fingertip pulse oximeters are widely available to health professionals and the public. They are often not tested to ISO standards, or only undergo accuracy studies in healthy volunteers under ideal laboratory conditions. This study aims to pragmatically evaluate the agreement between one such device and a conventional bedside pulse oximeter in a clinical setting, in patients with varied comorbidities and skin pigmentations. Methods: A single-centre equipment comparison study was conducted. Simultaneous measurements were obtained in 220 patients with both a Contec CMS50D Fingertip Pulse Oximeter and a Nihon Kohden Life Scope MU-631 RK conventional bedside monitor. Peripheral oxygen saturations (SpO₂) and pulse rates were documented, and patient skin tone was recorded using the Fitzpatrick scale. Data was assessed using a Bland-Altman analysis with bias, precision and limits of agreement (LOA) calculated with 95% confidence intervals. A priori acceptability for LOA was determined to be 3%, in keeping with international standards. Results: Mean difference (therefore bias) between the conventional and fingertip oximeters for all data was -0,55% (95% CI -0,73 to -0,36%). Upper and lower limits of agreement (95% CI) were 2,16 (1,84 to 2,47) and -3,25 (-3,56 to -2,94) %. Regression analysis demonstrated worsening agreement with decreasing SpO₂. When samples were separated into “normal” (SpO₂ ≥ 93%) and “hypoxaemic” (SpO₂ < 93%) groups, the normal range displayed acceptable agreement between the two oximeters (bias -0,20 with LOA 2,20 to -2,27%), while the hypoxaemic group fell outside the study’s a priori limits. Heart rate measurements had mean difference (LOA) of -0,43 (-5,61 to 4,76) beats per minute. The study was not powered to detect difference among the skin tones, but demonstrated no trend for this parameter to alter the SpO₂ measurements. Conclusions: During normoxia, portable fingertip pulse oximeters are reliable indicators of SpO₂ and pulse rates in patients with various comorbidities in a pragmatic clinical context. However, they display worsening agreement with conventional pulse oximeters during hypoxaemia. Skin tones do not appear to adversely affect measurements

Bandwidth reconfigurable metamaterial arrays

Metamaterial structures provide innovative ways to manipulate electromagnetic wave responses to realize new applications. This paper presents a conformal wideband metamaterial array that achieves as much as 10: 1 continuous bandwidth. This was done by using interelement coupling to concurrently achieve significant wave slow-down and cancel the inductance stemming from the ground plane. The corresponding equivalent circuit of the resulting array is the same as that of classic metamaterial structures. In this paper, we present a wideband Marchand-type balun with validation measurements demonstrating the metamaterial (MTM) array\u27s bandwidth from 280 MHz to 2800 MHz. Bandwidth reconfiguration of this class of array is then demonstrated achieving a variety of band-pass or band-rejection responses within its original bandwidth. In contrast with previous bandwidth and frequency response reconfigurations, our approach does not change the aperture\u27s or ground plane\u27s geometry, nor does it introduce external filtering structures. Instead, the new responses are realized by making simple circuit changes into the balanced feed integrated with the wideband MTM array. A variety of circuit changes can be employed using MEMS switches or variable lumped loads within the feed and 5 example band-pass and band-rejection responses are presented. These demonstrate the potential of the MTM array\u27s reconfiguration to address a variety of responses. © 2014 Nathanael J. Smith et al

Anomalous light propagation and continuous lasing without inversion in an open driven VV-system

We explore a driven three-level $V$-system coupled to an environment with dynamics governed by the Lindblad master equation. We perform a transformation into superoperator space, which brings the Lindblad equation into a Schr\"{o}dinger-like, thus allowing us to obtain an exact analytical solution for the time-dependence of the density matrix in a closed form. We demonstrate a regime for continuous lasing without inversion for driving with a continuous wave laser. We show a mechanism for achieving superluminal, negative, and vanishing light pulse group velocities and provide a range of physical parameters for realizing these regimes experimentally

The Role of Pharmacists in Primary Care Settings

Introduction: The profession of pharmacy has evolved from a dispensing role to an interdisciplinary clinical role in patient care. One area of patient care expertise is Medication Therapy Management Services (MTM), which includes services such as pharmacotherapy, medication therapy reviews, disease management, immunizations and other clinical services. Various studies have shown that pharmacists conducting MTM improve patient outcomes in some clinical settings. Amidst the valuable services all healthcare professionals are providing, increasing medical costs and a lack of primary care physicians have become overwhelming, potentially leading to negative patient outcomes. Gaps in communication between hospital, primary care clinics and community pharmacies also contribute to negative patient outcomes. Pharmacists can help bridge the gap in miscommunication and help improve patient outcomes by working in primary care settings. Objective: To determine if the addition of pharmacists providing clinical services (i.e. MTM) in a primary care setting can support the prescribers’ patient care demands. Methods: The study is an observational, exploratory study. All Federally Qualified Health Centers (FQHCs) in Ohio will be invited to participate. FQHCs are identified from the HRSA Office of Pharmacy Affairs as Consolidated Health Center Programs. IRB approval will be acquired. A Qualtrics survey will be administered via email to the participants which will include a consent form, information about the study and a link to the survey. The survey will include demographic, open-ended and 5-point Likert-type scale (1=strongly agree, 5=strongly disagree) questions. Reliability and validity of the survey will be established by a thorough search of the literature and expert review. Results: Upon approval from the IRB, data will be collected from summer 2014 to summer 2015. Submitted surveys will be analyzed with the appropriate statistical tests in SPSS. Data will be presented in spring of 2016

SAE Baja Data Acquisition System

The Olivet Nazarene University SAE Baja team designs a custom off-road vehicle every year to compete against teams from other schools at competitions throughout the year. The current car that the Baja team is working on needs some improvements, but they need some help gathering data to see where to make these improvements. In previous years, the Baja team would not have any feedback besides what they observed while driving, so this year they have tasked the SAE Baja Data Acquisition design group with the project of creating a sensor system and a data logging program to gather information that will be useful to them

Bandwidth Reconfigurable Metamaterial Arrays

Metamaterial structures provide innovative ways to manipulate electromagnetic wave responses to realize new applications. This paper presents a conformal wideband metamaterial array that achieves as much as 10 : 1 continuous bandwidth. This was done by using interelement coupling to concurrently achieve significant wave slow-down and cancel the inductance stemming from the ground plane. The corresponding equivalent circuit of the resulting array is the same as that of classic metamaterial structures. In this paper, we present a wideband Marchand-type balun with validation measurements demonstrating the metamaterial (MTM) array’s bandwidth from 280 MHz to 2800 MHz. Bandwidth reconfiguration of this class of array is then demonstrated achieving a variety of band-pass or band-rejection responses within its original bandwidth. In contrast with previous bandwidth and frequency response reconfigurations, our approach does not change the aperture’s or ground plane’s geometry, nor does it introduce external filtering structures. Instead, the new responses are realized by making simple circuit changes into the balanced feed integrated with the wideband MTM array. A variety of circuit changes can be employed using MEMS switches or variable lumped loads within the feed and 5 example band-pass and band-rejection responses are presented. These demonstrate the potential of the MTM array’s reconfiguration to address a variety of responses

SAE Baja Data Acquisition System

The Olivet Nazarene University SAE Baja team designs a custom off-road vehicle every year to compete against teams from other schools at competitions throughout the year. The current car that the Baja team is working on needs some improvements, but they need some help gathering data to see where to make these improvements. In previous years, the Baja team would not have any feedback besides what they observed while driving, so this year they have tasked the SAE Baja Data Acquisition design group with the project of creating a sensor system and a data logging program to gather information that will be useful to them

The Pivotal Role of the Pharmacist in a Primary Care Office

Abstract The profession of pharmacy has evolved from a dispensing role to an interdisciplinary clinical role in patient care. One area of patient care expertise is Medication Therapy Management (MTM), which includes services such as pharmacotherapy, medication therapy reviews, disease management, immunizations and other clinical services. In various studies, pharmacists conducting MTM have shown improved patient outcomes in community pharmacy and hospital settings. Amidst the valuable services all healthcare professionals are providing, increasing medical costs and consequences have become overwhelming, leading to negative patient outcomes. A lack of primary care physicians (PCPs) may contribute to these distressing facts. Gaps in communication between hospital, PCPs and community pharmacies also contribute to negative patient outcomes. Pharmacists can bridge the gap in miscommunication and help improve patient outcomes. Thus far in practice, pharmacists have had a limited role in primary care settings. The objective of this study is to determine if the addition of pharmacists providing clinical services (i.e. MTM) in a primary care setting can support the prescribers’ patient care demands. For this observational, exploratory research, the primary care settings under study will be all Federally Qualified Health Centers (FQHCs) in Ohio. IRB approval will be acquired before contact is made with participants. The contact person from each FQHC has been identified from the HRSA Office of Pharmacy Affairs. A script will be used to gather email addresses for the manager, physician, nurse and pharmacist, if available, from the contact person. A Qualtrics survey will be administered to these participants via email. The purpose of this study is to establish components of patient care in a primary care office, specifically FQHCs, that other medical professionals identify as lacking, which pharmacists can provide. A consent form, information about the study and a link to the survey will be provided in an email. The survey will include demographic, open-ended and 5-point Likert-type scale (1=strongly agree, 5=strongly disagree) questions. Reliability and validity of the survey will be established by a thorough search of the literature and expert review. Submitted answers will be analyzed with the appropriate statistical tests