Aid Of Tools Research Articles

Screening for elder mistreatment in a Swiss emergency department: a prospective cohort study.

The mistreatment of older adults is a global and complex problem with varying prevalence. As there are no data on the prevalence of elder mistreatment in European emergency department populations, we aimed to translate and culturally adapt the Emergency Department Senior Abuse Identification (ED Senior AID) tool for German use, assess the positive screen rate for elder mistreatment with the German version, and compare characteristics of patients who screened positive and negative. To assess the prevalence of elder mistreatment, we created a German version of the ED Senior AID tool. This tool identifies intentional or negligent actions by a caregiver or trusted person that cause harm or risk to an older adult. Then, the German ED Senior AID tool was applied to all consecutively presenting patients aged ≥65 years at our academic emergency department in the Northwest of Switzerland from 25 April to 30 May 2022. Usability was defined as the percentage of patients with completed assessments using the German ED Senior AID tool. We included 1010 patients aged ≥65 years, of whom 29 (2.9%) screened positive with the ED Senior AID tool. The patients who screened positive were older, more severely cognitively impaired, hospitalised more frequently, and presented with higher frailty scores than those who screened negative. Mortality up to 100 days after presentation was comparable in all patients (p = 0.861), regardless of their screening result. The tool showed good usability, with 73% of assessments completed. This is the first prospective investigation on the prevalence of elder mistreatment in a European emergency department setting. Overall, 2.9% of patients screened positive using a validated screening tool translated into German. This study was registered with the National Institute of Health on ClinicalTrials.gov with the registration number NCT05400707.

Curbing the Opioid Crisis: Optimal Dynamic Policies for Preventive and Mitigating Interventions

Problem statement: This paper addresses the challenge of effectively responding to the opioid epidemic stemming from prescription pills through a public health lens. It centers on the strategic distribution of resources across diverse interventions aimed at preventing and mitigating the consequences of opioid use disorder (OUD) and overdose occurrences. Methodology: This paper proposes a decision aid tool built on the expected utility theory that leverages a Susceptible-Infected-Removed compartmental model to simulate the dynamics of the epidemic in a population. This model then feeds into a Markov Decision Process (MDP) model to generate optimal policies upon the current state of the epidemic. The optimal policies allocate the intervention budget to primary preventive and mitigating interventions in each decision period by minimizing the cost of fatal overdoses relative to the population’s number of individuals with OUD, considering the impact magnitude of each intervention, based on the current state of the epidemic. A 10-year simulation of the epidemic’s progression is conducted to assess the dynamic efficacy of the proposed decision tool. Results: The findings reveal an average reduction of 29% in total costs compared to the scenario without interventions and a decrease of 12% in total costs on average compared to the scenario with a 50-50 allocation. The extensive sensitivity analysis of key parameters validates the decision aid tool. We observe that it is optimal to allocate a significant portion of the budget to prevention when the rate of opioid pill acquisition rises. Even with a heightened rate of fatal overdoses, it remains optimal to mostly invest in preventive interventions, as long as fatal overdose rates are lower than opioid access rates. Practical implications: This study provides practitioners with a tool to effectively address the opioid epidemic and enhance public health by deciding how to allocate their budget to various levels of intervention.

Development of a web-based patient decision aid for myopia laser correction method

BackgroundIn the context of healthcare centered on the patient, Patient Decision Aids (PtDAs) acts as an essential instrument, promoting shared decision-making (SDM). Considering the prevalent occurrence of myopia, the objective of this study is to furnish exhaustive and easily comprehensible information to assist patients in making well-informed decisions about their options for myopia laser correction.MethodThe research team developed a decision guide for myopia patients considering laser correction, aiming to facilitate informed decisions. The study followed the first four stages of the IPDAS process model: “scope/scoping,” “design,” “prototype development,” and “alpha testing.” Ten semi-structured interviews with patients (n = 6) and corneal specialist ophthalmologists (n = 4) were conducted to understand the challenges in selecting a laser correction method. Online meetings with 4 corneal specialists were held to discuss challenging cases. A comparison table of harms and benefits was created. The initial prototype was developed and uploaded on the internet portal. User feedback on software and text aspects was incorporated into the final web software, which was reviewed by a health education expert for user-friendliness and effectiveness.ResultEducational needs assessment revealed concerns such as pain, daily life activities, return to work, the potential need for glasses (‘number return’), eye prescription stability, and possible complications. These shaped the decision aid tool’s content. Expert consensus was achieved in several areas, with some items added or extended. In areas lacking consensus, comments were added for clarity. Five clients assessed the web app (PDAIN), rating it 46/50 in user-centricity, 47/50 in usability, and 45/50 in accuracy and reliability, totaling 138/150. Post-piloting, software errors were documented and rectified. During the trial phase, five myopic users interacted with the software, leading to modifications. User feedback indicated the tool effectively enhanced understanding and influenced decision-making.ConclusionPDAIN, serves as a facilitative tool in the process of selecting a corneal laser correction method for myopic patients. It enabling Nearsighted patients to make informed decisions.

CSP2023: 237 - Enabling Shared Decision Making - Torbay Charts (TC) Patient Decision Aids (PDA) tool in management of hip and knee arthritis

CSP2023: 237 - Enabling Shared Decision Making - Torbay Charts (TC) Patient Decision Aids (PDA) tool in management of hip and knee arthritis

Implementation of machine learning models for invasive Breast cancer classification – towards early diagnosis

Invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) are the most common forms of breast cancer and leading causes of death among women globally. Early detection of these subtypes with the aid of routinely collected demographic and clinical data is a feasible strategy and facilitates cancer routine care. Due to its widespread use, it could potentially benefit from the use of machine learning models to aid clinicians in their diagnosis workflow. Thus, we aimed to develop ML models using data retrieved from electronic health records corresponding to 1021 patients to accurately predict and classify these subtypes. Of note, prediction models were built using decision trees, naïve bayes, logistic regression, random forest and support vector machine. The classifiers' performances were assessed using accuracy, precision, recall and area under the curve. It is worth noting that the SVM model outperformed the ILC and IDC diagnostic response with an overall accuracy of 83% (AUC score 85%, precision 88% and recall 30%) than the other models. These findings highlight that it is feasible to develop a precise prognostic model by fusing various clinical and demographic data. The positive outcomes show the promise of using machine models as diagnostic aid tools for pathologists in clinical practice.

Minimum viable product “Ailey Robot Improves Verbal Skills” for the development of preschool children

This paper specifically examines MVP “Ailey Robot Improves Verbal Skills” as a tool for preschool aged children’s verbal skills development. Initial project aims to develop competent verbal skills as an aid tool for simple verbal correction in native (Russian) language and the associative object thinking improvement for children aged 3 years old, as well as is objected to increase the vocabulary of older children (up to seven aged ones). One of most significant activities for preschoolers is a role-playing game with a plot helping children to orient in social relations and estimate human activity’ values and motives through the acceptance of a certain role. With technological development, online platforms and applications are becoming the most accessible and increasingly popular method of teaching children from 3 to 7 years old. The content of thematic levels in the application covers various areas of daily life, which helps the child develop important situational and social skills, while the game format increases internal motivation to learn. The “Ailey Robot Improves Verbal Skills” service uses artificial intelligence models to create an exciting and effective learning environment for children and serves as an informative auxiliary tool for parents and speech specialists. In this paper we aimed to review this online application’s main features, analyze its performance, and identify its pros & cons.

Geometrization of the Huygens–Fresnel principle: Applications to Fraunhofer diffraction

The classical wave theory can trace its historical origins to the seminal works of Christian Huygens, Thomas Young, and Augustin Fresnel. To explain some of light’s observed properties, such as rectilinear propagation, reflection, and refraction, Huygens proposed a simple geometrical construction of secondary spherical wavelets with centers of disturbance located on a primary wavefront. More than a century later, Young formulated the law of interference to both predict the formation of fringes in his now famous double slit experiment and also to estimate the wavelengths associated with different colors. A decade after that, Fresnel combined Huygens’ construction with Young’s interference law to qualitatively and quantitatively describe diffraction, which is the bending of light upon encountering an obstacle or an aperture. This grand synthesis, called the Huygens–Fresnel principle, acts as a powerful pictorial aid and conceptual tool that can describe a wide variety of complicated optical phenomena. However, the applications of the principle and its later developments, such as the Kirchhoff–Fresnel integral, are strewn with several simplifying assumptions and approximations that are aimed at minimizing the mathematical challenges involved. Consequently, two distinct formalisms are necessary to account for diffraction effects when the source of light or observation screen is placed nearby and far away from the aperture or obstacle. Recently, a hyperbola framework for analyzing wave interference at a multi-slit barrier was shown to successfully circumvent all conventionally imposed ad hoc conditions. The method commences directly from the Huygens–Fresnel principle and the ensuing predictions pertaining to the distribution of fringe characteristics, namely, positions, widths, and intensities on a detection screen can, therefore, justifiably claim accuracy in both the near field (Fresnel regime) and the far field (Fraunhofer regime). In this paper, the analysis that was previously carried out for the special case of slits of negligible widths is further extended to encompass slits of finite widths as well.

Physician preferences for an electronic lung cancer screening decision aid.

To present primary care physician (PCP) suggestions for design and implementation of a decision aid (DA) tool to support patient-provider shared decision-making on lung cancer screening (LCS). Semistructured interviews were conducted with 15 PCPs at an academic medical center. The deidentified transcripts were independently coded by 2 study interviewers and jointly reviewed every 5 interviews until we determined that data saturation had been achieved. We then identified themes in the data and selected illustrative quotes. Three main themes were identified: (1) make it brief and familiar (make the tool user-friendly and implement a similar format to other widely used DAs); (2) bring me to automation station (limit busywork; focus on the patient and on the decision); and (3) involve the patient (facilitate patient involvement in the DA with simple language, visual aids, and bullet-point takeaways). Findings contain concrete suggestions by PCPs to inform usable and acceptable LCS DA tool design and implementation. For an LCS DA to be most successful, PCPs emphasized that the tool must be easy to use and incorporate autopopulation functions to limit redundant patient charting.

The impact of decision tools during oncological consultation with lung cancer patients: A systematic review within the I3LUNG project.

To date, lung cancer is one of the most lethal diagnoses worldwide. A variety of lung cancer treatments and modalities are available, which are generally presented during the patient and doctor consultation. The implementation of decision tools to facilitate patient's decision-making and the management of their healthcare process during medical consultation is fundamental. Studies have demonstrated that decision tools are helpful to promote health management and decision-making of lung cancer patients during consultations. The main aim of the present work within the I3LUNG project is to systematically review the implementation of decision tools to facilitate medical consultation about oncological treatments for lung cancer patients. In the present study, we conducted a systematic review following the PRISMA guidelines. We used an electronic computer-based search involving three databases, as follows: Embase, PubMed, and Scopus. 10 articles met the inclusion criteria and were included. They explicitly refer to decision tools in the oncological context, with lung cancer patients. The discussion highlights the most encouraging results about the positive role of decision aids during medical consultations about oncological treatments, especially regarding anxiety, decision-making, and patient knowledge. However, no one main decision aid tool emerged as essential. Opting for a more recent timeframe to select eligible articles might shed light on the current array of decision aid tools available. Future review efforts could utilize alternative search strategies to explore other lung cancer-specific outcomes during medical consultations for treatment decisions and the implementation of decision aid tools. Engaging with experts in the fields of oncology, patient decision-making, or health communication could provide valuable insights and recommendations for relevant literature or research directions that may not be readily accessible through traditional search methods. The development of guidelines for future research were provided with the aim to promote decision aids focused on patients' needs.

Cultural Adaptation of the Functional External Memory Aid Tool for Use in the United Kingdom and Australia

Purpose: The Functional External Memory Aid Tool (FEMAT) is a performance-based measure of applied cognitive-linguistic abilities and attempted use of compensatory aids and strategies (e.g., using a calendar to recall an appointment) through completion of simulated everyday living tasks. The FEMAT was originally developed in the United States (US), and a need arose from clinicians to adapt the FEMAT for use in other countries. The aim of this study is to describe the cultural adaptation process that resulted in the United Kingdom (UK) and Australian (AU) versions of the FEMAT via international clinical research partnerships. Method: The FEMAT was adapted into UK and AU cultures using established guidelines for cultural and linguistic adaptation. The adaptation was completed by researchers and clinicians from the US, UK, and AU, and we followed a six-step process: (a) preparation, (b) forward translation, (c) back translation, (d) committee review, (e) field testing, and (f) finalization. Results: The FEMAT items and materials were successfully adapted from the source culture (i.e., English-US) to the target cultures (i.e., English-UK, English-AU). Through the adaptation process, the FEMAT items were determined to be conceptually appropriate for each culture and minimal modifications were made to the FEMAT materials (e.g., voicemail recordings recorded in target dialect). The finalized FEMAT-English-UK and the FEMAT-English-AU versions are available for free on the FEMAT website. Conclusions: Through successful international clinical research collaborations, the FEMAT was successfully adapted for use in other English-speaking cultures. This work provides guidance to streamline future FEMAT cultural adaptations. Supplemental Material: https://doi.org/10.23641/asha.25564461

Methodology to develop a writing and translating aid tool to transfer dried-meat product cards from Spanish into English

La traducción y la redacción del español al inglés en el sector agroalimentario y el desarrollo de aplicaciones y herramientas que asistan durante este proceso se ha convertido en un campo prioritario para los Estudios de Traducción. A partir de la compilación de un corpus virtual comparable español-inglés compuesto por fichas descriptivas de producto describimos la metodología empleada para desarrollar GEFEM (GEnerador de Fichas de EMbutidos). Determinamos el prototipo de estructura retórica en cada lengua con la ayuda del Etiquetador Retórico© desarrollado por el grupo ACTRES. A continuación, con el Visor de Corpus Comparables© identificamos las líneas modelo, los principales patrones léxico‑gramaticales, la terminología y la fraseología. Con la información lingüística se desarrolla el software, que da como resultado una herramienta que asiste a la redacción de fichas descriptivas de embutidos del español al inglés, que contiene un menú en el que se selecciona la macroestructura del texto y se corresponde con la estructura retórica y, a continuación, varias alternativas para desarrollar el contenido de cada apartado.

Dysregulation of Porphyromonas gingivalis Agmatine Deiminase Expression in Alzheimer's Disease.

Alzheimer's disease (AD) is the most prevalent neurodegenerative disorder, with a significant burden on global health. AD is characterized by a progressive cognitive decline and memory loss. Emerging research suggests a potential link between periodontitis, specifically the presence of oral bacteria such as Porphyromonas gingivalis (P. gingivalis), and AD progression. P. gingivalis produces an enzyme, Agmatine deiminase (AgD), which converts agmatine to N-carbamoyl putrescine (NCP), serving as a precursor to essential polyamines. Recent studies have confirmed the correlation between disruptions in polyamine metabolism and cognitive impairment. This study aims to investigate the dysregulation of P. gingivalis Agmatine deiminase (PgAgD) in the context of AD. Saliva samples were collected from a total of 54 individuals, including 27 AD patients and 27 healthy controls. The expression of the PgAgD gene was analyzed using quantitative Real-- Time PCR. The results showed a significant decrease in PgAgD gene expression in the saliva samples of AD patients compared to healthy controls. This downregulation was found in AD patients with advanced stages of periodontitis. Additionally, a correlation was observed between the decrease in PgAgD expression and the 30-item Mini-Mental State Examination (MMSE) score. These findings suggest that measuring PgAgD expression in saliva could be a noninvasive tool for monitoring AD progression and aid in the early diagnosis of patients with periodontitis. Further research is needed to validate our results and explore the underlying mechanisms linking periodontitis, PgAgD expression, and AD pathophysiology.

Staining Pattern of Alcian Blue in Endometrial Cytology: Utility in Distinguishing Grade 1-Endometrial Endometrioid Carcinoma from Endometrial Glandular Stromal Breakdown.

In endometrial cytology, differentiating endometrial glandular stromal breakdown (EGBD) from endometrial endometrioid carcinoma (G1-EEC) is often difficult. In this study, we provided a new focus on chondroitin sulfate (CS), a major substrate component of the endometrial stroma, and assessed the diagnostic utility of Alcian Blue (AB) staining in the differential diagnosis in liquid-based cytological (LBC) samples. LBC specimens from 19 patients with a proliferative endometrium, 36 with EGBD, and 30 with G1-EEC who underwent endometrial cytology were stained with AB (pH 1.0), and their reactivity was observed. In addition, immunocytochemical staining of CS and CD31 was performed for five cases each to evaluate their interrelationship with blood vessels. Regarding the 30 G1-EEC cases, at least one of the three representative staining patterns was observed by AB staining: dot-like, microtubular, and finely branched linear patterns. Moreover, the inner portion of the tubular material observed by AB staining expressed CD31. Conversely, in the 36 EGBD cases, only five metaplastic clusters with irregular protrusions and condensed stromal clusters (CSCs) showed a dot-like positive pattern, and background CSCs did not show reactivity to AB staining in any of the cases. Furthermore, the vascular structure expressing CD31 in cell clusters was also unclear. We demonstrated that AB staining shows different staining patterns in G1-EEC and EGBD, reflecting their different tissue structures. Our data provide new insights into endometrial cell diagnosis changes and demonstrate that AB staining is a potential new diagnostic aid tool for the differentiation of G1-EEC from EGBD.

Qualitative user experience evaluation of the MS trust's online treatment decision aid tool's accommodation of planning pregnancy.

Decision-making about treatment when planning a pregnancy (family planning) is complex for women living with multiple sclerosis (MS). Decision tools can help this process, in 2016 MS Trust launched their online digital treatment decision tool to support people with MS. To evaluate user-experience of this tool by exploring women's opinions about its content, interface, and usefulness in the context of family planning; and to synthesize recommendations to improve the tool. Thirty participants qualitatively evaluated the tool using Think Aloud methodology. Sessions were conducted online using Microsoft Teams and were video recorded. Transcription was automated and data were thematically analyzed. Women's first impression was that the tool presented a lot of information at once, which was difficult to take in, and they found it difficult to navigate. Although the tool was helpful in allowing them to compare treatment options, the filters were confusing, and the information related to pregnancy sometimes contradicted advice from their healthcare practitioners. They suggested rewording the pregnancy recommendations and filters, updating some content, and making some changes to the interface to meet users' cognitive needs. The MS Trust treatment decision tool is excellent in helping women with treatment choices at initial diagnosis. However, it is not currently as useful when considering family plans. Recommendations were conveyed to MS Trust where some are now applied to the new live version and the rest are to be considered for future updating projects.

Automatic left ventricle volume and mass quantification from 2D cine-MRI: Investigating papillary muscle influence

ObjectiveEarly detection of cardiovascular diseases is based on accurate quantification of the left ventricle (LV) function parameters. In this paper, we propose a fully automatic framework for LV volume and mass quantification from 2D-cine MR images already segmented using U-Net. MethodsThe general framework consists of three main steps: Data preparation including automatic LV localization using a convolution neural network (CNN) and application of morphological operations to exclude papillary muscles from the LV cavity. The second step consists in automatically extracting the LV contours using U-Net architecture. Finally, by integrating temporal information which is manifested by a spatial motion of myocytes as a third dimension, we calculated LV volume, LV ejection fraction (LVEF) and left ventricle mass (LVM). Based on these parameters, we detected and quantified cardiac contraction abnormalities using Python software. ResultsCNN was trained with 35 patients and tested on 15 patients from the ACDC database with an accuracy of 99,15 %. U-Net architecture was trained using ACDC database and evaluated using local dataset with a Dice similarity coefficient (DSC) of 99,78 % and a Hausdorff Distance (HD) of 4.468 mm (p < 0,001). Quantification results showed a strong correlation with physiological measures with a Pearson correlation coefficient (PCC) of 0,991 for LV volume, 0.962 for LVEF, 0.98 for stroke volume (SV) and 0.923 for LVM after pillars’ elimination. Clinically, our method allows regional and accurate identification of pathological myocardial segments and can serve as a diagnostic aid tool of cardiac contraction abnormalities. ConclusionExperimental results prove the usefulness of the proposed method for LV volume and function quantification and verify its potential clinical applicability.

Informal Distance Learning as an Aiding Tool in the Teaching-Learning Process at Times of Pandemics

As of late 2019, the emergence of the high speed spreading Corona Virus (Covid-19) which later turned into a pandemic forced everyone to stay home in a seemingly unending quarantine. As a result, a lot of outdoor activities that represented our daily routine had to stop including going to school. However, soon after this new situation occurred, a lot of countries started coping with it by providing what is called distance learning at all educational levels. In the Algerian educational context, the use of the online platform offered by the Ministry of Education actively increased among students, but the lack of live interaction with teachers and the situation where the student is forced to sit and only receive posed many flaws on the process and made it difficult to proceed with this form of learning. To overcome this problem, the excessive use of social media among kids and teenagers was put to use by many teachers. It was an alternative and a way of non-formal learning to make the EFL teaching-learning process very much easier and more flexible and fun. This exploratory study aims at measuring the extent to which teachers in secondary schools use social media and interactive apps in the EFL teaching context during both regular and exceptional times, how they are used and what outcomes are expected, the goals that are achieved and the obstacles that are faced. A mixed method of data gathering and analysis was adopted through distributing a questionnaire to a number of secondary school teachers in El Meghaier, Algeria. The results show that social media platforms are not fully benefited from as informal teaching tools. The reason is not due to teachers’ ignorance of how these tools work, but other concerns on the part of teachers.

Contouring aid tools in radiotherapy. Smoothing: the false friend.

Contouring accuracy is critical in modern radiotherapy. Several tools are available to assist clinicians in this task. This study aims to evaluate the performance of the smoothing tool in the ARIA system to obtain more consistent volumes. Eleven different geometric shapes were delineated in ARIA v15.6 (Sphere, Cube, Square Prism, Six-Pointed Star Prism, Arrow Prism, And Cylinder and the respective volumes at 45° of axis deviation (_45)) in 1, 3, 5, 7, and 10cm side or diameter each. Post-processing drawing tools to smooth those first-generated volumes were applied in different options (2D-ALL vs 3D) and grades (1, 3, 5, 10, 15, and 20). These volumetric transformations were analyzed by comparing different parameters: volume changes, center of mass, and DICE similarity coefficient index. Then we studied how smoothing affected two different volumes in a head and neck cancer patient: a single rounded node and the volume delineating cervical nodal areas. No changes in data were found between 2D-ALL or 3D smoothing. Minimum deviations were found (range from 0 to 0.45cm) in the center of mass. Volumes and the DICE index decreased as the degree of smoothing increased. Some discrepancies were found, especially in figures with cleft and spikes that behave differently. In the clinical case, smoothing should be applied only once throughout the target delineation process, preferably in the largest volume (PTV) to minimize errors. Smoothing is a good tool to reduce artifacts due to the manual delineation of radiotherapy volumes. The resulting volumes must be always carefully reviewed.

Developing a Decision Aid for Clinical Obesity Services in the Real World: the DACOS Nationwide Pilot Study

PurposeThe purpose of this study is to develop a decision aid tool using “real-world” data within the Australian health system to predict weight loss after bariatric surgery and non-surgical care.Materials and MethodsWe analyzed patient record data (aged 16+years) from initial review between 2015 and 2020 with 6-month (n=219) and 9-/12-month (n=153) follow-ups at eight clinical obesity services. Primary outcome was percentage total weight loss (%TWL) at 6 months and 9/12 months. Predictors were selected by statistical evidence (p<0.20), effect size (±2%), and clinical judgment. Multiple linear regression and bariatric surgery were used to create simple predictive models. Accuracy was measured using percentage of predictions within 5% of the observed value, and sensitivity and specificity for predicting target weight loss of 5% (non-surgical care) and 15% (bariatric surgery).ResultsObserved %TWL with bariatric surgery vs. non-surgical care was 19% vs. 5% at 6 months and 22% vs. 5% at 9/12 months. Predictors at 6 months with intercept (non-surgical care) of 6% include bariatric surgery (+11%), BMI>60 (–3%), depression (–2%), anxiety (–2%), and eating disorder (–2%). Accuracy, sensitivity, and specificity were 58%, 69%, and 56%. Predictors at 9/12 months with intercept of 5% include bariatric surgery (+15%), type 2 diabetes (+5%), eating disorder (+4%), fatty liver (+2%), atrial fibrillation (–4%), osteoarthritis (–3%), sleep/mental disorders (–2–3%), and ≥10 alcohol drinks/week (–2%). Accuracy, sensitivity, and specificity were 55%, 86%, and 53%.ConclusionClinicians may use DACOS to discuss potential weight loss predictors with patients after surgery or non-surgical care.Graphical

Effects of weights applied to the apex of a bag-valve-mask and pinch strength on tidal volume: a prospective simulation study

A bag-valve-mask (BVM) is a first aid tool that can easily and quickly provide positive-pressure ventilation in patients with breathing difficulties. The most important aspect of BVM bagging is how closely the mask adheres to the patient’s face when the E–C technique is used. In particular, the greater the adhesion force at the apex of the mask, the greater the tidal volume. The purpose of this study was to investigate the effect of various weights applied to the mask’s apex and the pinch strength needed to perform the E–C technique, on tidal volume. In this prospective simulation study, quasi-experimental and equivalent time-series designs were used. A total of 72 undergraduate paramedic student from three universities were recruited using convenience sampling. The tidal volumes according to the weights (0 g, 100 g, 200 g, 300 g) applied to the apical area of the mask, handgrip strength, and pinch strength (tip pinch strength, key pinch strength, and tripod pinch strength) were measured. A linear mixed model analysis was performed. Linear mixed model analyses showed that tidal volume was significantly higher at 200 g (B = 43.38, p = 0.022) and 300 g (B = 38.74, p = 0.017) than at 0 g. Tripod pinch strength (B = 12.88, p = 0.007) had a significant effect on mask adhesion for effective BVM ventilation. Adding weight to the apical area of the mask can help maintain the E–C technique and enable effective ventilation. Future studies are required to develop specific strategies to improve the ventilation skills, which can be an important first-aid activity.

Evaluation of the Canadian approved drug screening equipment cut-off levels for tetrahydrocannabinol (THC).

In 2018, Canada introduced roadside oral fluid (OF) screening devices, called Approved Drug Screening Equipment (ADSE), as an investigative tool in impaired driving investigations to detect tetrahydrocannabinol (THC), cocaine and/or methamphetamine in drivers. In this work, we compare the detection and concentration of THC in blood samples collected from suspected impaired drivers that tested positive at the roadside for THC on an ADSE. The two ADSEs that were utilized were the Dräger DrugTest® 5000 (DDT) and the Abbott SoToxa™ (SoToxa), both configured with a THC OF concentration cut-off concentration of 25 ng/mL. Blood samples were screened for cannabinoids using immunoassay and positive results were followed up by confirmation/quantitation of THC by ultra-performance liquid chromatography with tandem mass spectrometry (UPLC-MS-MS). A total of 230 cases were available where a blood sample was collected from a suspected impaired driver subsequent to a positive THC screen result on an ADSE. The blood samples were taken an average of 1.4 hours (range = 9 minutes to 3.2 hours) after the ADSE test. THC was confirmed in 98% of blood samples with concentrations across all samples ranging from not detected (cut = off 0.5 ng/mL) to greater than 20 ng/mL. Further, 90% of the blood samples had a THC concentration of 2.0 ng/mL (the lower per se limit in Canada) or greater. A positive ADSE test of a suspected impaired driver may predict that the driver has a detectable level of THC in their blood, and there is a high likelihood that the THC blood concentration is 2.0 ng/mL or higher. Hence, ADSE may be a useful tool for law enforcement and aid in the development of grounds to believe that a driver is operating a conveyance with a THC concentration exceeding Canadian per se limits.