Vergleich von Antibeschlagmethoden in der Endoskopie: Was wirklich hilft

Zusammenfassung: Hintergrund und Fragestellung: Endoskopische Verfahren, wie die fiberoptische Intubation, haben sich als Standard in der Anästhesie etabliert. Obwohl allgemein bekannt ist, dass zur sicheren Anwendung von Endoskopen eine Antibeschlagmethode unerlässlich ist, fehlen Studien zum Vergleich der Wirksamkeit verschiedener Antibeschlagmethoden. Ziel dieser Studie war es, die Wirksamkeit von 7Antibeschlagmethoden im Einsatz mit einem flexiblen und einem starren Endoskop zu untersuchen. Material und Methoden: Die Wirksamkeit von je 2Antibeschlaglösungen und -tüchern, einem induktiven Endoskopvorwärmer, sowie kontinuierlichem Sauerstofffluss über den Arbeitskanal der Optik wurde in einem Atemwegsmodell mithilfe eines flexiblen und eines starren Endoskops getestet sowie verblindet beurteilt. Ergebnisse: Insgesamt wurden 300Testbilder aufgezeichnet und analysiert. Sowohl in der Gruppe mit dem flexiblen als auch in der Gruppe mit dem starren Endoskop erzielten je eine Antibeschlaglösung und ein -tuch die besten Ergebnisse. Flexible Endoskopie: Anti-Fog (Versagerquote: 3%), Lina Clear (4%). Starre Endoskopie: Ultrastop (5%), Lina Clear (3,5%). Der Endoskopvorwärmer mit 2-maliger Anwendung zeigte in beiden Gruppen sehr gute Ergebnisse (6% und 10%). Keinen positiven Effekt gegen das Beschlagen eines Endoskops ergab die Verwendung des Sauerstoffflusses (93,5%). Schlussfolgerungen: Die Studie konnte aufzeigen, dass es Unterschiede in der Effektivität von Antibeschlagtüchern und -lösungen gibt. Der klinische Einsatz ist aber auch von weiteren Faktoren wie Endoskoptyp und Häufigkeit der Verwendung, Kosten- und Hygieneaspekten abhängig. Der induktive Endoskopvorwärmer kann trotz hoher Anschaffungskosten eine Alternative darstellen. Jedoch fehlen bislang klare Sicherheitshinweise zur mehrfachen Anwendung durch den Hersteller. Der kontinuierliche Sauerstofffluss über den Arbeitskanal einer flexiblen Optik kann nicht als Antibeschlagmethode empfohlen werde

Tracheal fluid leakage in benchtop trials: comparison of static versus dynamic ventilation model with and without lubrication

Purpose: Longitudinal folds in tracheal tube (TT) cuffs cause leakage of pooled secretions past the tube cuff, and the most common in vitro method to test the efficacy of a new tube is a benchtop model using an artificial rigid trachea. This study compared the potential of a static and dynamic ventilation benchtop model and cuff lubrication in testing the tracheal sealing properties of a given TT cuff. Methods: Static trial Six brands of 7.5mm internal diameter (ID) cuffed TT (n=8) with high volume-low pressure cuffs were inflated in an artificial trachea (18mm ID) without and with lubrication. Dynamic trial The same tube cuffs, without lubrication, were subjected to positive pressure ventilation (PPV)+positive end-expiratory pressure (PEEP) of 5cmH2O or to PPV alone (without PEEP) or to PEEP alone (without PPV). Clear water (5ml) was placed above the tube cuff, and fluid leakage (ml) was measured up to 60min. Results: Gel lubrication, PEEP alone and PPV+PEEP completely prevented fluid leakage across the tube cuffs in all six TT brands tested within 60min when compared to the static unlubricated model (0% leak versus 100% leak; P<0.01). Fluid leakage in the static unlubricated model and the PPV group was 1.38-4.76ml and 0.23-4.47ml, respectively. Conclusion: Gel lubrication, PEEP alone, and PPV+PEEP in the benchtop model had a much stronger protective effect than PPV alone on fluid leakage. Studies testing the fluid sealing efficiency of tube cuffs might be more conclusive in a static benchtop model without lubrication than in a dynamic mode

Einsatz der intraossären Infusion im pädiatrischen Notarztdienst: Analyse von Notarzteinsätzen 1990-2009

Zusammenfassung: Hintergrund: Ziel der Studie war es, den Einfluss der Einführung des intraossären Zugangs (IOZ) auf die Art der Medikamentenapplikation im Rahmen der Primärversorgung schwer kranker oder verletzter Kinder [National-Advisory-Committee-for-Aeronautics- (NACA-)Index V-VII] in einem zentrumgebundenen Kindernotarztdienst zu evaluieren. Methode: Hinsichtlich des Vorhandenseins und der Art des Gefäßzugangs im Rahmen der Primärversorgung wurden 5279 pädiatrische Kindernotarztprotokolle aus den Jahren 1990-2009 retrospektiv analysiert. Von primärem Interesse waren die Häufigkeit der IOZ-Anlage, die Häufigkeit alternativer Applikationswege für Medikamente sowie Primärversorgungen ohne Gefäßzugang. Ergebnisse: Als NACA-Index V-VII wurden 401Patienten (7,6%) klassifiziert. Am Einsatzort wurde 299-mal (75%) eine periphere Venenverweilkanüle (PVK) und 3-mal (0,7%) ein zentraler Venenkatheter (ZVK) angelegt. In 77Fällen (19%) wurde eine intraossäre Nadel (IOZ) gesetzt. Bei 22Patienten (5,4%) konnte bis zur Klinikeinlieferung kein Gefäßzugang angelegt werden. Bei 48Patienten (12%) wurden Medikamente endobronchial oder alternativ appliziert. Im Beobachtungszeitraum kam der IOZ stetig häufiger zum Einsatz; dagegen wurden fehlende oder alternative Applikationswege seltener. Innerhalb der letzten 3Jahre wurde keine endobronchiale Medikamentengabe mehr berichtet. Schlussfolgerung: Die Einführung der intraossären Infusionstechnik in der präklinischen Kindernotfallmedizin hat die Zahl kritisch kranker oder schwer verletzter Kinder ohne Gefäßzugang oder mit unzuverlässigen alternativen Medikamentenapplikationswegen in den letzten 20Jahren deutlich reduzier

Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study

Background This study compared the fluid leakage in the new ‘tapered' shaped against the classic ‘cylindrical' shaped tracheal tube cuffs when placed in different sized tracheas. Methods The 7.5 mm internal diameter (ID) tracheal tube cuffs—Tapered Seal Guard (TSG), Standard Seal Guard (SSG), Hi-Lo, Microcuff, Ruesch, and Portex Profile—were compared in an in vitro apparatus. Vertical artificial tracheas with 16, 20, and 22 mm ID were intubated, 5 ml clear water was applied above the unlubricated tube cuffs, and fluid leakage was measured up to 60 min. Data of tapered vs non-tapered tube cuffs (16 observations) were compared for each tracheal diameter using the Mann-Whitney test. Results Median (range) fluid leakage (ml) at 60 min was 2.14 (0.05-4.88), 1.14 (0.00-4.84), and 0.13 (0.00-1.32), respectively, for 16, 20, and 22 mm tracheas in the TSG tube studies when compared with 4.58 (0.44-4.88), 2.21 (0.00-4.81), and 0.00 (0.00-4.81) in the SSG tube and 4.54 (1.54-4.82), 0.90 (0.00-4.49), and 4.85 (4.40-4.99) in the Microcuff tube studies. Leakage in all polyvinylchloride (PVC) tube cuffs was almost complete (5 ml) within 5 min (P<0.001). Conclusions The tapered PU tube cuff was as effective as the cylindrical PU cuffs in smaller tracheal diameters and was more efficient than the cylindrical Microcuff PU tube cuff in larger tracheal diameter in preventing subglottic fluid leakage across the tube cuff tested in this in vitro study. PVC tube cuffs leaked much more and faster than PU cuff

Pathways to Care of Maine Youth with Psychosis

Study clinicians conducted semi-structured interviews to identify the timing and steps of each person’s Pathway to Care (PtC).https://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1028/thumbnail.jp

Imaging the molecular gas in a submm galaxy at z = 4.05: cold mode accretion or a major merger?

We present a high resolution (down to 0.18"), multi-transition imaging study of the molecular gas in the z = 4.05 submillimeter galaxy GN20. GN20 is one of the most luminous starburst galaxy known at z > 4, and is a member of a rich proto-cluster of galaxies at z = 4.05 in GOODS-North. We have observed the CO 1-0 and 2-1 emission with the VLA, the CO 6-5 emission with the PdBI Interferometer, and the 5-4 emission with CARMA. The H_2 mass derived from the CO 1-0 emission is 1.3 \times 10^{11} (\alpha/0.8) Mo. High resolution imaging of CO 2-1 shows emission distributed over a large area, appearing as partial ring, or disk, of ~ 10kpc diameter. The integrated CO excitation is higher than found in the inner disk of the Milky Way, but lower than that seen in high redshift quasar host galaxies and low redshift starburst nuclei. The VLA CO 2-1 image at 0.2" resolution shows resolved, clumpy structure, with a few brighter clumps with intrinsic sizes ~ 2 kpc. The velocity field determined from the CO 6-5 emission is consistent with a rotating disk with a rotation velocity of ~ 570 km s^{-1} (using an inclination angle of 45^o), from which we derive a dynamical mass of 3 \times 10^{11} \msun within about 4 kpc radius. The star formation distribution, as derived from imaging of the radio synchrotron and dust continuum, is on a similar scale as the molecular gas distribution. The molecular gas and star formation are offset by ~ 1" from the HST I-band emission, implying that the regions of most intense star formation are highly dust-obscured on a scale of ~ 10 kpc. The large spatial extent and ordered rotation of this object suggests that this is not a major merger, but rather a clumpy disk accreting gas rapidly in minor mergers or smoothly from the proto-intracluster medium. ABSTRACT TRUNCATEDComment: 33 pages, 8 figures, submitted to the ApJ, aas latex forma

O-Band Subwavelength Grating Filters in a Monolithic Photonics Technology

The data communications industry has begun transitioning from electrical to optical interconnects in datacenters in order to overcome performance bottlenecks and meet consumer needs. To mitigate the costs associated with this change and achieve performance for 5G and beyond, it is crucial to explore advanced photonic devices that can enable high-bandwidth interconnects via wavelength-division multiplexing (WDM) in photonic integrated circuits. Subwavelength grating (SWG) filters have shown great promise for WDM applications. However, the small feature sizes necessary to implement these structures have prohibited them from penetrating into industrial applications. To explore the manufacturability and performance of SWG filters in an industrial setting, we fabricate and characterize O-band subwavelength grating filters using the monolithic photonics technology at GLOBALFOUNDRIES (GF). We demonstrate a low drop channel loss of -1.2 dB with a flat-top response, a high extinction ratio of -30 dB, a 3 dB channel width of 5 nm and single-source thermal tunability without shape distortion. This filter structure was designed using elements from the product design kit provided by GF and functions in a compact footprint of 0.002 mm2 with a minimum feature size of 150 nm.Comment: 4 pages, 3 figure

City of Newport News, Virginia Shoreline Inventory Report Methods and Guidelines

This shoreline inventory is developed as a tool for assessing conditions along the tidal shoreline in the City of Newport News. Field data were collected during July and September 2002, and data were updated using VBMP 2006/2007 imagery. Conditions are reported for three zones within the immediate riparian river area: riparian land use, bank and buffers, and the shoreline. A series of maps and tabular data are published to illustrate and quantify results of an extensive shoreline survey. Shorelines of the James River, Skiffes Creek, Warwick River and Deep Creek, including small tributaries, were surveyed. Some sections were coded using remote sensing techniques because the shoreline was inaccessible by boat

City of Chesapeake, Virginia Shoreline Inventory Report Methods and Guidelines

This shoreline inventory is developed as a tool for assessing conditions along the tidal shoreline in the City of Chesapeake. Field data were collected between June and July 2002. Conditions are reported for three zones within the immediate riparian river area: riparian land use, bank and buffers, and the shoreline. A series of maps and tabular data are published to illustrate and quantify results of an extensive shoreline survey. Shorelines of the western, southern and eastern branches of the Elizabeth River including small tributaries were surveyed for this inventory. Small sections were coded using remote sensing techniques because the shoreline segment was inaccessible by boat

Total- and Monomethyl-Mercury and Major Ions in Coastal California Fog Water: Results from Two Years of Sampling on Land and at Sea

Marine fog water samples were collected over two summers (2014–2015) with active strand collectors (CASCC) at eight coastal sites from Humboldt to Monterey counties in California, USA, and on four ocean cruises along the California coastline in order to investigate mercury (Hg) cycling at the ocean-atmosphere-land interface. The mean concentration of monomethylmercury (MMHg) in fog water across terrestrial sites for both years was 1.6 ± 1.9 ng L-1 (\u3c0.01–10.4 ng L-1, N = 149), which corresponds to 5.7% (2.0–10.8%) of total Hg (HgT) in fog. Rain water samples from three sites had mean MMHg concentrations of 0.20 ± 0.12 ng L-1 (N = 5) corresponding to 1.4% of HgT. Fog water samples collected at sea had MMHg concentrations of 0.08 ± 0.15 ng L-1 (N = 14) corresponding to 0.4% of HgT. Significantly higher MMHg concentrations in fog were observed at terrestrial sites next to the ocean relative to a site 40 kilometers inland, and the mean difference was 1.6 ng L-1. Using a rate constant for photo-demethylation of MMHg of -0.022 h-1 based on previous demethylation experiments and a coastal-inland fog transport time of 12 hours, a mean difference of only 0.5 ng L-1 of MMHg was predicted between coastal and inland sites, indicating other unknown source and/or sink pathways are important for MMHg in fog. Fog water deposition to a standard passive 1.00 m2 fog collector at six terrestrial sites averaged 0.10 ± 0.07 L m-2 d-1, which was ∼2% of typical rainwater deposition in this area. Mean air-surface fog water fluxes of MMHg and HgT were then calculated to be 34 ± 40 ng m-2 y-1 and 546 ± 581 ng m-2 y-1, respectively. These correspond to 33% and 13% of the rain fluxes, respectively