Equipment Familiarity Research Articles

Multisource Data Fusion Analysis of Maintainability for Overlapping Degree High Performance Computing

With the continuous development of social economy, industry has become the main industry that contributes to the economy. In the process of industrial development, human operation is gradually replaced by machine operation, and the replacement of machines is followed. Over the years, machines have become more and more important in industry. However, although the machine liberates manpower, over time, it has experienced external pressures such as the environment and personnel and is internally affected by the technical level, experience, equipment familiarity, and physical and mental state of the maintenance personnel. Industrial machines tend to cause all sorts of problems when they run for too long. Therefore, it is ensured that the efficient operation and long-term operation of the machine are crucial issues. In view of the current situation and problems, this paper combines different equipment maintenance test data, adopts the method of high-performance computing overlap, establishes corresponding multisource data for data conversion and processing, and then uses the Bayesian method to analyze the multisource data. Parameter fusion and overfitting are performed, and finally the device is tested for prior data fusion using the overlap data model. The simulation results of this paper show that the high-performance overlap calculation method is effective and can effectively support the fusion analysis of maintainable multisource data.

An Introduction to Cystoscopy for OB/GYN Residents.

IntroductionOB/GYN residents' preparedness to perform cystoscopy after residency may vary as the ACGME requires only 10 cystoscopic cases to be performed during training. Given residents' potentially limited exposure to cystoscopy, supplemental educational activities centered around increasing familiarity with the procedure may be useful. The objective of this workshop was to provide an opportunity for OB/GYN residents to become more comfortable with cystoscopic equipment and performing cystoscopy.MethodsWe showed a video of common pathology seen on cystoscopy and then progressed through two hands-on stations. One station focused on equipment familiarity, with learners identifying equipment and then practicing assembling and disassembling the cystoscope. The other station allowed for simulated cystoscopy utilizing a pig bladder. We used a checklist assessment and pre- and postcourse surveys to evaluate familiarity with equipment and anxiety surrounding performing cystoscopy.ResultsTwenty residents ranging from PGY 1s to PGY 4s who participated in this workshop over the past 2 years completed both pre- and postcourse evaluations. There was statistically significant improvement in ratings of familiarity with equipment and anxiety surrounding the procedure. All participants whom we assessed showed improvement in identifying and assembling equipment as well as in performing the steps of the procedure independently.DiscussionThis workshop provided OB/GYN residents with an opportunity for hands-on cystoscopic experience. Through direct assessment and evaluation forms, the workshop was shown to be a beneficial activity for improving cystoscopic knowledge.

Safe Practice of Total Intravenous Anesthesia With Target-Controlled Infusion in Taiwan: A Recommendation.

There have been immense advances in the safety and variety of intravenous anesthetic delivery systems including drug cost reduction, development of more effective opioids, and improvement in depth of anesthesia monitoring in the last 20 years. Propofol-based total intravenous anesthesia (TIVA) with target-controlled infusion (TCI) is relatively easy to practice. While this technique promotes a higher overall anesthesia quality and patient survival, especially for cancer patients, there are deficiencies in training and education of the technique. Therefore, the Society for Intravenous Anesthesia and the Association of Anesthetists (United Kingdom) have laid out guidelines in an attempt to highlight multiple important TIVA-related safety issues to help clinicians feel more confident. In the present article, we discuss five recommendations and four special clinical situations. Preparation, equipment familiarity, and safe delivery techniques are extremely important for the proper employment of this method. Herein, we emphasize the importance of proper education, and the clinical practice experience of the TIVA technique. Additionally, we suggest a modified connection method to set up a safely administered line. We highlight the advantages of using processed electroencephalogram monitoring (such as bispectral index or Entropy) to prevent awareness during TIVA administration in difficult clinical situations. These situations may include triple low patients (e.g., low blood pressure, low maintained effect-site concentration of propofol, and low body weight ≤ 18), obese patients, and patients with difficult infusion site monitoring or use of neuromuscular blocking agents. Due to a limited consensus among Taiwanese medical professionals, this document is intended to act as a safe practice reference for the use of TIVA with TCI. Additionally, two pithy formula codes, 4321 for propofol with fentanyl/alfentanil and 42222111 for propofol with remifentanil, are provided for the general population and one pithy formula code, 4321 for propofol with fentanyl, is provided for pediatric patients.

Safe Practice of Total Intravenous Anesthesia With Target-Controlled Infusion in Taiwan: A Recommendation.

There have been immense advances in the safety and variety of intravenous anesthetic delivery systems including drug cost reduction, development of more effective opioids, and improvement in depth of anesthesia monitoring in the last 20 years. Propofol-based total intravenous anesthesia (TIVA) with target-controlled infusion (TCI) is relatively easy to practice. While this technique promotes a higher overall anesthesia quality and patient survival, especially for cancer patients, there are deficiencies in training and education of the technique. Therefore, the Society for Intravenous Anesthesia and the Association of Anesthetists (United Kingdom) have laid out guidelines in an attempt to highlight multiple important TIVA-related safety issues to help clinicians feel more confident. In the present article, we discuss five recommendations and four special clinical situations. Preparation, equipment familiarity, and safe delivery techniques are extremely important for the proper employment of this method. Herein, we emphasize the importance of proper education, and the clinical practice experience of the TIVA technique. Additionally, we suggest a modified connection method to set up a safely administered line. We highlight the advantages of using processed electroencephalogram monitoring (such as bispectral index or Entropy) to prevent awareness during TIVA administration in difficult clinical situations. These situations may include triple low patients (e.g., low blood pressure, low maintained effect-site concentration of propofol, and low body weight ≤ 18), obese patients, and patients with difficult infusion site monitoring or use of neuromuscular blocking agents. Due to a limited consensus among Taiwanese medical professionals, this document is intended to act as a safe practice reference for the use of TIVA with TCI. Additionally, two pithy formula codes, 4321 for propofol with fentanyl/alfentanil and 42222111 for propofol with remifentanil, are provided for the general population and one pithy formula code, 4321 for propofol with fentanyl, is provided for pediatric patients.

Therapeutic Endoscopic Procedures on a Human Cadaver—A Pilot Feasibility Study

Abstract Introduction The traditional apprentice model of teaching therapeutic endoscopic skills is inadequate due to unpredictable frequency and high stakes for patient outcome. Simulation had gained widespread acceptance for training modules. But all the procedures cannot be trained on simulator. We designed a novel human cadaver hands-on training module for practicing percutaneous endoscopic gastrostomy (PEG), endoscopic variceal band ligation (EVL), endoscopic injection (EI), snare polypectomy (SP), thermal cautery (TC), and endoscopic clip (EC) placement. Methods A single preserved pre-coronavirus disease 2019 human cadaver was used as a training model. Twelve trainees (6 teams) used the module to acquire and practice new skills of PEG, EVL, EI, SP, and EC using standard endoscope and regular endoscopic accessories. All the trainees completed the course evaluation using a 5-point Likert scale (5= strongly agree). Results The training resulted in a self-reported increase in equipment familiarity and all the trainees felt uniformly that they are better prepared for performing the procedures on real patients. They strongly agreed that this exhaustive hands-on exercise has more educational value than attending lectures. Conclusion Human cadaver can be used for trainees to hone therapeutic endoscopic skills by teaching modules with predefined learning objectives.

Does Experiencing an Injury Claim Impact Small Construction Company Leaders' Participation in a Fall Protection Survey?

Workers in small and medium residential construction companies (≤50 employees) have a high risk of fall-related fatality or disability. However, little is known about effective ways to engage with this subsector for research and training. We tested whether insurance-documented fall-related claims during the past 12 months and lower familiarity with equipment motivated companies' representatives to engage with a fall protection survey. Oregon's largest workers compensation insurer drew a random anonymous sample of small and medium residential construction that did (n = 197) and did not (n = 195) have a recent fall-related claim. Samples were stratified by size, trade, and region. Company representatives were emailed a 34-item questionnaire about equipment familiarity to enter a raffle to win fall-prevention equipment. We coded survey engagement binarily, indicating whether a participant completed at least half of the survey. Familiarity with 10 pieces of equipment was measured with a scale from 0 (never seen it) to 3 (use it frequently) points. The survey was initiated by 88 out of 392 representatives (22.4% response rate). Of those, 63 representatives provided the company identifier which was needed to establish claim status. Survey engagement was higher among representatives from companies with claims compared with those without (57.6 versus 42.4%, P = 0.16). Equipment familiarity was lower among company representatives with lower survey engagement (1.15 versus 1.56, P < 0.05). The survey had a relatively encouraging response rate for a hard-to-reach sector. The large but not statistically significant difference in survey engagement rates suggests that adverse events motivate companies to engage with fall protection research. Low equipment familiarity in the sample substantiates the need to identify effective engagement methods for fall protection practices.

Management of Acute Contrast Reactions—Understanding Radiologists' Preparedness and the Efficacy of Simulation-Based Training in Canada

PurposeAcute radiologic emergencies, primarily severe contrast reactions, are rare but life-threatening events. Given a generalized paucity of formalized or mandated training, studies have shown that radiologists and trainees perform poorly when acutely managing such events. Moreover, skill base, knowledge, and comfort levels precipitously decline over time given the infrequent occurrence of these events during one's daily practice.The primary aim of this study was to assess radiologists' preparedness for managing acute radiologic emergencies and to determine the efficacy of a high-fidelity simulation based training model in an effort to provide a rationale for similar programs to be implemented on a provincial or national level. MethodsThis was a prospective, observational study of radiology residents and attending radiologists throughout the province who were recruited to attend a full-day simulation-based course presenting various cases of acute radiologic emergencies. Participant demographics were collected at the time of commencement of the workshop. Course materials were disseminated 4 weeks prior to the workshop, and a 17-question knowledge quiz was administered before and after the workshop. Likert-type questionnaires were also distributed to survey comfort levels and equipment familiarity. The knowledge quiz and questionnaire were redistributed at 3- and 6-month intervals for acquisition of follow-up data. ResultsA total of 14 attending radiologists and 7 residents attended the workshop, with all participants completing the preworkshop questionnaire and 90.5% (19 of 21) completing the post-workshop questionnaire. Participants' principle locations of practice were as follows: academic institutions (50%), community hospitals (36.9%), and private clinics (13.1%). A significant increase in knowledge was demonstrated, with average scores of 10 out of 17 (59%) and 14.5 out of 17 (85%) (P < .001) before and after the workshop, respectively. A significant increase in participants' comfort levels in recognizing acute anaphylactic reactions (3.5; 4.7, P < .001), commencing initial management for acute radiologic emergencies (3.3; 5.0, P < .001), and administering the correct dose for anaphylactic reactions (2.5; 4.8, P < .001) was also demonstrated. Moreover, participants became increasingly familiar with the contents and equipment found within contrast reaction kits (2.8; 3.8, P < .01). Repeat evaluations at 3 and 6 months found an average knowledge test score of 13.8 out of 17 (81%) and 10.8 out of 17 (64%), respectively. Comfort levels were also reassessed in recognizing acute anaphylactic reactions (4.5; 4.1), commencing initial management (4.0; 3.9) and administering the correct dose of medication (4.0; 3.7) at 3- and 6-month intervals. ConclusionsAcute radiologic emergencies are rare but life-threatening events that require rapid diagnosis and treatment to mitigate associated morbidity and mortality. Simulation-based workshops are a highly efficacious training model to increase knowledge, comfort levels, and equipment familiarity for radiologists and trainees alike; however, retraining at regular intervals is required.

MP15: Innovative use of simulation to consolidate pediatric didactic curriculum. A pilot in emergency department continuing medical education

Introduction: Our emergency department (ED) sees a low volume of high acuity pediatric cases. A needs assessment revealed that 68% of our Emergency Physicians (EP) manage pediatric patients in less than 25% of their shifts. The same percentage of EPs as well as ED nurses indicated they were uncomfortable managing a critically unwell neonate. Thus, an interprofessional curriculum focused on pediatric emergencies for ED staff was developed. In-situ simulation education was chosen as the most appropriate method to consolidate each didactic block of curriculum, and uncover important system gaps. Methods: Needs assessment conducted, and emerging themes informed IPE curriculum objectives. A committee of experts in simulation, pediatric emergencies and nursing education designed a full-day, RCPSC accredited, interprofessional in-situ simulation program. Results: Progressive segmental strategy maximized learning outcomes. The initial phase (2 hrs) comprised an” early recognition of sepsis” seminar and 4 rotating skills stations (equipment familiarity, sedating the child, IV starts, and mixing IV medication). This deliberate, adaptive, customized practice was enhanced by expert facilitation at each station, directly engaging participants and providing real-time feedback. The second phase allowed interprofessional teams of MDs, RNs and Physician Assistants to apply knowledge gained from the didactic and skills stations to in-situ simulated emergencies. Each group participated in two pediatric emergency scenarios. Scenarios ran 20 minutes, followed by a 40 minute debrief. Each scenario had a trained debriefer and content expert. The day concluded with a final debrief, attended by all participants. Formalized checklists assessed participants knowledge translation during simulation exercises. Participants assessed facilitators and evaluated the simulation day and curriculum via anonymous feedback forms. Debriefing sessions were scribed and knowledge gaps and system errors were recorded. Results were distributed to ED leaders and responsibilities assigned to key stakeholders to ensure accountability and improvement in system errors. Results All participants reported the experience to be relevant and helpful in their learning. All participants requested more frequent simulation days. System gaps identified included: use of metric vs imperial measurements, non-compatible laryngoscope equipment, inadequate identification of team personnel. As a result, the above-mentioned equipment has been replaced, and we are developing resuscitation room ID stickers for all team roles. Conclusion: Simulation as a culmination to a didactic curriculum provides a safe environment to translate acquired knowledge, increasing ED staff comfort and familiarity with rare pediatric cases. Additionally, is an excellent tool to reveal system gaps and allow us to fill these gaps to improve departmental functioning and safety.

Simulation in urological training: Where are we in 2017?

Traditional Halstedian principles are no longer compatible with modern day urological training. Changing patterns of healthcare provision and the advanced nature of minimally invasive urological surgery have resulted in trainees receiving reduced exposure to independent operative experience. The drive towards consultant-delivered care, coupled with the introduction of the European working time directive, necessitate the urology trainee to meet end-of-training competencies with fewer learning opportunities compared with previous generations. Simulation provides an opportunity to compensate for reduced operative experience by augmenting both technical and non-technical skills development. A variety of simulation models can be used from cadaveric, synthetic and animal models to advanced virtual reality to aid surgical training. Whilst simulation is not without limitations, it has the potential to significantly enhance procedural competency and non-technical skills in a risk-free environment. Clear benefits, including equipment familiarity and trainee confidence have been demonstrated. However, direct transferability of these benefits to an operating-theatre is not clearly evident. Whilst not a substitute for clinical practice, simulation is likely to prove itself as a valuable adjunct to urological training. In this narrative review, we examine the current literature on simulation training in relation to urological surgery.

Familiarization Protocol Influences Reproducibility of 20-km Cycling Time-Trial Performance in Novice Participants.

Introduction: Exercise performance is reproducible in experienced athletes; however, less trained participants exhibit greater variability in performance and pacing. To reduce variability, it is common practice to complete a familiarization prior to experimental testing. However, there are no clear guidelines for familiarizing novice participants to a cycling time-trial (TT), and research findings from novice populations may still be influenced by learning effects. Accordingly, the aims of this study were to establish the variability between TTs after administering differing familiarization protocols (duration or type) and to establish the number of familiarization trials required to limit variability over multiple trials.Methods: Thirty recreationally active participants, with no prior experience of a TT, performed a 20-km cycling TT on five separate occasions, after completing either a full (FF, 20-km TT, n = 10), a half (HF, 10-km TT, n = 10) or an equipment familiarization (EF, 5-min cycling, n = 10).Results: Variability of TT duration across five TTs was the lowest after completing FF (P = 0.69, ηp2 = 0.05) compared to HF (P = 0.08, ηp2 = 0.26) and EF (P = 0.07, ηp2 = 0.21). In the FF group after TT2, the effect size for changes in TT duration was small (d < 0.49). There were large differences between later TTs in HF (d = 1.02, TT3-TT4) and EF (d = 1.12, TT4-TT5). The variability in mean power output profiles between trials was lowest within FF, with a similar pacing profile reproduced between TT3-TT5.Discussion: Familiarization of the exercise protocol influenced reproducibility of pacing and performance over multiple, maximal TTs, with best results obtained after a full experience of the exercise compared to HF and EF. The difference of TT1 to later TTs indicates that one familiarization is not adequate in reducing the variability of performance for novice participants. After the FF and an additional TT, performance changes between TTs were small, however, a reproducible pacing profile was not developed until after the FF and two additional TTs. These findings indicate that a minimum of three full familiarizations are necessary for novice participants to limit systematic error before experimental testing.

Ebola Virus Disease Simulation Case Series: Patient With Ebola Virus Disease in the Prodromal Phase of Illness (Scenario 1), the "Wet" Gastrointestinal Phase of Illness (Scenario 2), and the Late, Critically Ill Phase of Disease (Scenario 3).

As part of an international response to the Ebola virus disease (EVD) outbreak, the US Department of Defense has deployed thousands of personnel to help train and augment international health care workers. The transmission risk of this deadly virus to health care workers has been extreme, demonstrating the importance of safe practices while caring for these patients. Medical simulation training is well recognized as an integral component for disease outbreak preparedness. Therefore, the US Government created a program of instruction that outlines a formalized EVD training program, using high-fidelity simulation, which projects both an understanding of the disease and its transmission risks. Two 5-day training courses were established to provide training to the 65-member Department of Defense Ebola Response Team, which would be activated during a stateside Ebola outbreak. This training consisted of Ebola-specific protocols, personal protective equipment familiarization, and scenario-based certification for physicians, nurses, and public health trainers. Simulation was used to replicate the work environment inside an Ebola treatment unit. Three comprehensive clinical scenarios covering a wide spectrum of EVD presentations were designed around details of published cases to provide the most realistic and relevant EVD training available. The authors conducted 10 iterations of the 3 EVD clinical scenarios totaling more than 1100 hours of simulation training. Quality practical exercises to include specialized task performance and collective teamwork training relied heavily on dedicated facilities and realistic medical simulation resulting in valuable lessons learned. In future iterations, these characteristics would be imperative to a successful training course.

The Effects of Office Equipment Familiarity in Reducing Human Errors and Accidents

Although the advancement of technology can provide a better and safer working environment to people, sometimes, overconfidence in technology can lead to unavoidable accidents and human errors in the workplace. This study aims to determine the effects of familiarity with office equipment on human errors and accidents in the workplace. A total of 150 surveys were collected and analysed with correlations analysis usingSPSS software version 19.0. The results show that although familiarity can reduce the occurrence of human errors, it cannot reduce the occurrence of accidents in the workplace. While it is now understood that improving one's familiarity with office equipment can potentially reduce their mistakes at work, companies should still be observant of other factors that can potentially reduce accidents in the workplace. This study sheds light on potential possibilities to improve the occupational safety, health and environment of organizations.

What is the Potential for False Positive Results in Ankle Brachial Index Measurements Performed by Emergency Providers?

Introduction: The Ankle-Brachial Index measurement (ABI) is an easily performed bedside test used to screen for lower extremity arterial injury. It is possible that the ABI is not always correctly performed in the acute setting, depending on available equipment and provider familiarity with validated measurement techniques. We sought to determine the potential for false positive ABI results in healthy subjects if the ABI is performed incorrectly. We also sought to identify the method most likely to minimize false positive results. Materials and methods: Healthy volunteers and low acuity emergency department patients were enrolled. Exclusion criteria included a known history of documented peripheral arterial disease or extremity trauma. Subjects were examined by two investigators. “Most Accurate” (MA) ABI measurements used the higher of the two ankle readings and the higher of the two brachial readings to calculate the result. “Least Accurate” (LA) measurements used the lower of the two ankle readings and the higher of the two brachial readings. Results: 118 study subjects were enrolled: mean age 32.8 years (range 19 to 49), 50% female, none with known peripheral vascular disease or extremity trauma, and none with documented femoral artery bruit at the time of the study. When a single provider performed LA ABI’s, the false positive rate was 29%, while single provider MA ABI’s lowered the false positive rate to 2%. For two provider ABI’s, these rates were 4% and 0%, respectively. Conclusions: We identified an unacceptably high rate of false positive ABI results if the test is performed incorrectly. We recommend strict adherence to standardized ABI measurement protocols to minimize this error. Ideally, an ABI measurement of less than 0.9 in a patient with lower extremity trauma should be confirmed by a second provider in order to minimize the risk of inappropriately implementing invasive diagnostic procedures.

The Effects of Aerobic Exercise Timing on Sleep Architecture

It is well known that the quality of sleep has direct effects on the manifestations of disease. Further, exercise has been shown to enhance the quality of sleep, yet little is known regarding how exercise effects sleep stages. Our laboratory has shown that the timing of exercise is important for cardiovascular benefits which may be derived from the improved quality of sleep. Therefore, the purpose of this study was to investigate the effects of aerobic exercise timing on sleep architecture. Thirteen subjects, with no self-reported sleep disorders and not on any medications participated in this study. Visit one consisted of informed consent and a graded exercise test to exhaustion (VO2peak) and equipment familiarization. During visits 2-4 subjects reported for 3 pre-determined exercise times at 7am, 1pm, and 7pm in a random counterbalanced order to perform a 30 minute treadmill protocol at 65% of their predetermined VO2peak. A Zeo™ ambulatory sleep EEG monitoring headband was worn during sleep. This system transmitted brainwave data to a receiver which was analyzed for sleep stage time and quality of sleep. Aerobic exercise at 7am invoked significantly greater time spent in light and deep sleep and the greatest frequency of sleep cycles compared to exercise in the afternoon or evening. However, exercise at 7pm showed less time in Rapid Eye Movement sleep compared to 7am and 1pm exercise times. These data show that engaging in aerobic exercise during the early morning hours may be the most beneficial epoch of time for greater quality of sleep.

A Novel Approach for Augmenting Percutaneous Endoscopic Gastrostomy Tube Placement Training

Surgical trainees routinely participate in percutaneous endoscopic gastrostomy (PEG) tube placement. Although simulation has gained widespread acceptance, novice trainees continue learning this procedure on real patients. We designed a novel hands-on training model for practicing PEG tube placement with minimal monetary investment (cost<$10). Our portable low-fidelity bench model has a simulated upper gastrointestinal construct made of foam. Seventeen trainees used our model to acquire and practice skills necessary to perform PEG tube placement, for setting up and troubleshooting upper gastrointestinal endoscope, and for using endoscopic instruments in the state-of-the-art simulated operative room. Thirteen trainees completed the course evaluation, using a 5-point Likert scale (5=strongly agree). The training resulted in a self-reported increase in equipment familiarity (4.23±0.73) and troubleshooting real endoscope (4.69±0.48), and trainees felt better prepared (4.23±0.93) for performing PEG tube placement on real patients. Trainees agreed that this exercise has more educational value than using virtual reality simulator alone (4.38±0.52). Procedural training for PEG tube placement using a simple bench training model is perceived as valuable by trainees. Cost and commercial availability can be overcome by innovation in surgical simulation.

Teaching Lifesaving Procedures: The Impact of Model Fidelity on Acquisition and Transfer of Cricothyrotomy Skills to Performance on Cadavers

To the Editor: Using high- and low-fidelity simulators, Friedman et al.1 describe teaching cricothyrotomy using the Seldinger technique of the Melker set (Cook, Bloomington, IN). The authors demonstrate, as do others,2 that this method is slow (pretest 240 s and 260 s in the low- and high-fidelity training groups, respectively, posttest 140 s and 120 s).1 The new Melker kit, with preloaded dilator, may improve performance, but we believe that trainees should also be taught surgical cricothyrotomy, which with instruction can be achievable in as little as 30 s.3 The authors acknowledge the lack of a control group, without which it is difficult to ascribe improvement to practice on manikins. Improvements may have resulted from exposure to an instructional video, equipment familiarity, or advance preparation for a posttest. Having used the SimMan (Laerdal, Kent, UK) to teach cricothyrotomy, we would argue with the assigned “high fidelity” characteristics. Perhaps, the distinction between the two manikins in Friedman’s study is not so much one of fidelity but more one of expense. Arguably, a better high-fidelity comparison would have been with cadavers. Charlotte R. Soulsby Gareth Kessell, MBChB, MRCP, FRCA Department of Anaesthesia James Cook University Hospital Middlesbrough, UK [email protected]

Teaching Lifesaving Procedures: The Impact of Model Fidelity on Acquisition and Transfer of Cricothyrotomy Skills to Performance on Cadavers

In Response: We are grateful for the insights offered by Drs. Soulsby and Kessel.1 The tested Melker kit is widely available in North America and currently is the one most residents will encounter. Its obvious advantage is that anesthesiologists are familiar with the Seldinger technique and therefore may be more comfortable with this procedure that they will rarely perform. Although we agree that residents should be taught surgical cricothyrotomy, studies have shown anesthesiologists would prefer a Seldinger technique to an open surgical technique.2 Residents should be familiarized with both options. We agree that our study is limited by the absence of a control group as discussed in our original article.3 However, the potential confounding factors of equipment familiarity and preparation for a posttest would be unlikely to be eliminated by a control group. To prevent an improvement in performance from residents preparing for the posttest, we did not warn them in advance. As for the instructional video, hands-on teaching was shown to be far superior to didactic teaching for procedural skill acquisition.4 The larynx of the Laerdal SimMan is anatomically correct in contrast to the low-fidelity model used and is commonly referred to in the literature as a high-fidelity model. We agree that the issues of cost, availability, and portability are central to the interpretation of our findings as highlighted in our article. Cadavers, although obviously an anatomically perfect model have their own drawbacks, including the stiffness of the tissues and the technical difficulty of aspirating air from the formalin-filled trachea. The main problem with cadavers is of course their scarcity, which was one of the most important reasons we undertook this study. Zeev Friedman, MD Kong E. You-Ten, MD, PhD, FRCPC Matthew D. Bould, MBChB, MRCP, FRCA Viren Naik, MD, MEd, FRCPC Department of Anesthesia Mount Sinai Hospital Toronto, Ontario, Canada Department of Anesthesia St Michael’s Hospital Toronto, Ontario, Canada [email protected]

Comparison Of Vastus Lateralis And Medial Hamstring Electromyographic Activity Across Five Cardiovascular Exercises

Greater emphasis on the value of incorporating cardiovascular training into rehabilitation programs has heightened the need to define normative muscle activation patterns across cardiovascular exercises. This study‘s findings will help guide clinical decision-making regarding selection of appropriate exercises to meet not only the cardiovascular fitness goals but also the muscle strengthening needs of clients recovering from a variety of orthopedic and neurologic disorders. PURPOSE: To compare vastus lateralis (VL) and medial hamstring (MH) muscle activity patterns across five cardiovascular exercises. METHODS: Six males and four females participated (mean age 25±5 yrs). Subjects engaged in three equipment familiarization sessions and then performed each of the following exercises for 5 minutes in random order: treadmill jogging (J), stair stepping (S), elliptical training (E), treadmill walking (W) and recumbent biking (B). Subjects were instructed to perform each at an intensity that could be maintained for 30-min. Kinematic (8 camera), foot-floor contact pattern (footswitches), and VL and MH surface electromyography (EMG) data were recorded simultaneously during the final minute on each device. Cycles were defined using kinematic (B, S, E) and footswitch (W, J) data. For each muscle and exercise, 10 representative cycles were used to calculate the average peak (expressed as % maximum voluntary contraction, % MVC), mean (% MVC) and duration (expressed as % cycle) of EMG activity. Separate 5×1 ANOVAs with repeated measures identified significant differences in EMG activity (peak, mean, duration) across exercises for each muscle. RESULTS: All data expressed as mean ± SD. VL: Peak: J, S> E, W, B (105±52, 95±37 > 51±30, 43±34, 35±25; p<0.001). Mean: S, J> E, W, B (41±13, 40±15 > 26±14, 20±8, 19±9; p<0.001). Duration: E, S > W (61±18, 53±18 > 29±22; p<0.001). MH: Peak: J> B, E, S (56±46 > 15±11, 11±9, 8±5; p<0.001) and W > S (21±11 > 8±5; p<0.001). Mean: J> B, E, S (25±15 > 9±6, 7±5, 5±4; p<0.001) and W > S (13±6 > 5±4; p<0.001). Duration: J > S, E (49±23 > 17±27, 14±14; p<0.001). CONCLUSION: When greater VL activation is warranted, consider S and J. When VL protection is needed (e.g., post-polio overuse), then B and W appear beneficial. J consistently provided the greatest MH activation, while S offered greater MH protection.

LOCAL GOVERNMENT AND TRIBAL EQUIPMENT CACHING IN WASHINGTON STATE

ABSTRACT During the 2006 Legislative session, the Washington Department of Ecology received $1.45 million to pre-stage oil spill response equipment throughout the state. In the event of a spill, this equipment can be rapidly mobilized and deployed for spill containment or to protect local resources. Equipment caches are customized for each recipient. Available equipment includes storage trailers, boom vanes, containment boom, anchor systems, navigation lights, adsorbent materials, responder protective clothing, and safety and decontamination equipment. Recipients also receive equipment familiarization training with their mutual aid response agencies. Eligible recipients include local government public agencies, such as Counties, Fire and Police Departments, Port Districts, Public Utility Districts, Emergency Management Departments, and Tribes. Grant are awarded based on: substantial threat of an oil spill, resources that will be protected, recipient'S ability and willingness to deploy the equipment, proximity of nearby response equipment, and partnerships with other agencies. As of March 2007, Ecology and its contractor, Global Diving and Salvage have:Delivered equipment to 36 of 60 recipients.Pre-staged 47 of 97 equipment caches.Pre-staged 32,600’ of 52,600’ of containment boomTrained approximately 400 of 1,000 first responders. Equipment delivery and training will be completed by June 2007. This equipment has been used to avert potentially devastating spills. Examples of successful use of the pre-staged response equipment include:The City of Gig Harbor initiated a spill response by deploying containment boom and adsorbent materials at the Peninsula Yatch Basin Marina when a vessel carrying 200 gallons of diesel caught fire.Tacoma'S Fire and Police Departments deployed adsorbent materials when a vessel sank at the Delin Docks Marina on the Thea Foss Waterway.The San Juan DEM and the Island Oil Spill Association established a protection zone with containment boom during the raising of the sunken F/V Stanley.

Variations in Plantar Pressure Variables across Five Cardiovascular Exercises

To quantify variations in plantar pressure variables in healthy adults across five cardiovascular exercises. Ten young (19-35 yr old) and 10 middle-aged (45-60 yr old) individuals participated. After equipment familiarization, plantar pressure data were recorded during walking, running, elliptical training, stair climbing, and recumbent biking. Separate one-way analyses of variance with repeated measures identified significant differences in pressure variables across exercises and between age groups under the forefoot, arch, and heel. Forefoot: Peak pressures were higher during walking (253 kPa), running (251 kPa), and elliptical training (213 kPa) than stair climbing (130 kPa) and recumbent biking (41 kPa; P < or = 0.001). Biking pressures were lower than all other conditions (P < 0.001). Arch: Pressures were higher during running (144 kPa) compared with all other conditions (P < or = 0.001). Intermediate-level pressures during walking (119 kPa) and elliptical training (102 kPa) exceeded those during stair climbing (80 kPa; P < or = 0.002). Pressures were lowest during recumbent biking (33 kPa; P < 0.001). Heel: Pressures were highest during walking (215 kPa) and running (188 kPa), exceeding those recorded during all other activities (P < 0.001). Moderate elliptical training pressures (94 kPa) surpassed stair climbing values (66 kPa; P = 0.014). Pressures were lowest during recumbent biking (25 kPa; P < 0.001). The only significant difference identified between age groups was a larger arch contact area in the young compared with middle-aged, when averaged across exercises (P = 0.011). When protection of the forefoot is important (e.g., diabetic foot neuropathies), biking and stair climbing offer optimal pressure reductions. If protecting the heel from high pressures and forces is warranted, recumbent biking, stair climbing, and elliptical training provide greater relief.