Hand-held Monitor Research Articles

AMS measurements of 14C, 36Cl, and 239/240Pu samples taken in a ‘small facility’

The release of nuclear facilities from regulatory control is commonly addressed by demonstrating that contaminations are below ‘clearance values’. AMS is commonly too laborious for a large number of samples, especially if nuclide vectors have been established, but it might be of interest for the release of a so-called ‘small facility’. For this case study, a radiochemistry laboratory in Cologne, Germany was chosen. It was known that 14C, 36Cl as well as 240Pu had been handled openly in this lab. There were no apparent contaminations, i.e., no alpha/beta contaminations that could be detected using a hand-held radiation monitor. Elevated values of 14C were measured in three, increased values of 36Cl in all and 239Pu in only one of the examined samples. All measured activities are well below the release values, but it can be proven that the elements 14C, 36Cl, 239Pu were handled openly in the ‘small facility’.

Assessment and mapping of total suspended particulate and soil quality around brick kilns and occupational health issues among brick kilns workers in Pakistan.

Brick kilns constitute one of the major sources of environmental degradation in Pakistan. The present study was conducted to determine the soil quality and total suspended particulates (TSPs) around the brick kilns and assess the health effects on brick kiln workers. Four brick kilns were selected, two each at Sheikhupura and Pattoki city. The soil quality was assessed by analyzing pH, electrical conductivity, moisture content, nitrogen, phosphorus, potassium content, and heavy metal concentration while TSPs were measured by hand-held Microdust Pro Real time monitor. Average TSP concentration around brick kilns at Sheikhupura and Pattoki ranged between 1100 and 1200µg/m3 and between 550 and 600µg/m3 respectively which exceeded the Punjab Ambient Air Standards. The soil was slightly acidic (Sheikhupura: average pH = 6.41; Pattoki: average pH = 6.6) while all other analyzed parameters, except heavy metals, were lower than the required FAO Standards for good quality agriculture soil. Heavy metal accumulation in soil samples followed the general order zinc (Zn) > chromium (Cr) > nickel (Ni) > manganese (Mn) > cadmium (Cd) > copper (Cu). For assessment of occupational health and safety issues, all 440 brick kiln workers from the study areas were interviewed. Mostly, brick kiln workers suffered from chronic back pain (84%), skin issues (80.5%), dry cough (72.9%), common cold (46.1%), and shortness of breath (17.1%). The vulnerability risk varied with the nature of the work as workers engaged in brick baking were more vulnerable to respiratory issues than were those in molding task. The study concludes that brick kilns are a source of increased TSP, deteriorated surrounding soil quality, and impaired worker health. It is necessary to regulate these activities and implement requisite health and safety measures.

Development of a new hand-held type thyroid monitor using multiple GAGG detectors for young children following a nuclear accident

One of the most important lessons learned from the Fukushima Daiichi Nuclear Power Plant accident is that direct (in vivo) measurements of thyroid exposure to radioiodine (mainly, 131I) in the affected populations should be initiated in a timely manner. Furthermore, the existing commercial detectors are not necessarily suitable for the measurement of young children, who are especially vulnerable to radiation exposure and therefore important to screen. This paper presents the development of a new thyroid monitor for such measurements and the results from phantom-based experiments. The monitor has two unique probes having multiple high-energy-resolution type Gd3(Al,Ga)5O12(Ce) (GAGG) detectors that can be placed directly on the young subject's anterior neck. The crystal size of the GAGG detector is 1 cm3, and a probe consisting of a 4 × 1 or 4 × 2 detector array can be selected depending on the subject's body size. The thickness of the 4 × 1 array probe is 24 mm, which is less than that for a conventional NaI(Tl) survey meter having a crystal 1 inch in diameter and 1 inch long (38 mm). Experimental and computational calibrations of the new monitor using existing and virtual phantoms allowed us to determine the full energy peak efficiency for the 131I thyroid contents of different age groups from 3-mo-old to 10-yr-old and minimum detectable activity (MDA) values under various conditions. As a result, the attainable MDA for subjects age ≤5 years under a normal background level (∼0.05 μSv h−1) was found to be ∼30 Bq, which was low enough to identify children with thyroid-equivalent doses over 10 mSv up to about 25 days after the 131I intake. Our new monitor would be useful in direct thyroid measurements for vulnerable young children following a large nuclear accident.

Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial.

Introduction: Mobility impairments are among the main causes of falls in older adults and patients with neurological diseases, leading to functional dependence and substantial health care costs. Feedback-based interventions applied in controlled, laboratory environments have shown promising results for mobility rehabilitation, enhancing the benefits of standard therapy. However, the effectiveness of sensor-based feedback to improve gait in actual outpatient physical therapy settings is unknown. The proposed trial examines the effectiveness of a physical therapist-assisted, visual feedback system using wearable inertial sensors, Mobility Rehab, for mobility training in older adults with gait disturbances in an outpatient clinic.Methods: The study is a single site, pragmatic clinical trial in older adults with gait disturbances. Two hundred patients undergoing their outpatient rehabilitation program are assigned, by an independent assistant, for screening by one of four therapists, and assigned to either a standard physical therapy or therapist-assisted feedback therapy. Both groups train twice a week for 6 weeks. Four physical therapists were randomized and stratified by years of experience to deliver standard therapy or therapist-assisted feedback rehabilitation. Each session is 45 min long. Gait is trained for 30 min. The additional 15 min include exercises for endurance, strength, and static and dynamic balance in functional tasks. Mobility Rehab uses unobtrusive, inertial sensors on the feet and belt with real-time algorithms to provide real-time feedback on gait metrics (i.e., gait speed, double support time, foot clearance, angle at foot strike, and arm swing), which are displayed on a hand-held monitor. Blinded assessments are carried out before and after the intervention. The primary outcome measure is subjects' perception of balance as measured by the Activities-specific Balance Confidence scale. Gait speed, as measured with wearable inertial sensors during walking, is the secondary outcome measure.Discussion: We hypothesize that therapist-assisted feedback rehabilitation will be more effective than standard rehabilitation for gait. Feedback of motor performance plays a crucial role in rehabilitation and objective characterization of gait impairments by Mobility Rehab has the potential to improve the accuracy of patient-specific gait feedback.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03869879.

Evaluation of direct reading photoionization detector performance under various operational parameters

Background: A hand-held portable direct-reading monitor, including photoionization detector (PID) is renowned for its good sensitivity, considerable dynamic range, and nondestructive vapor detection ability in comparison to the tardy response of the PID in gas chromatography (GC), which its application has been restricted. In this study, the performance of a PID system (MultiRAE Lite) was evaluated as a replacement of GC in the measurement of toluene in a dynamic adsorption system. Methods: The test was done at different relative humidity levels (30%, 50%, and 80%), temperatures (21, 30, 40° C), and toluene concentrations (20, 100, 200, and 400 ppm). Results: The PID achieved 48% of all measurements meeting the comparison criterion. The results showed that the performance of the PID could be altered by the variables. The best performance of the PID was at temperature of 21° C, the relative humidity of 50%, and concentration of 200 ppm with the percentage of readings achieving the criterion of comparison to 58%, 54%, and 52%, respectively. The averages of the PID readings (mean ± SD at 200 ppm= 207.9 ± 8.7) were higher than the reference method measurements averages (mean ± SD at 200 ppm= 203.5 ± 5.8). The regression analysis of the toluene results from the PID and the reference method results indicated that the measurements were significantly correlated (r2 = 0.93). Conclusion: According to the results, the device response is linear. Therefore, the findings are acceptable in adsorption studies. In this way, the measurement of the sample concentration should be performed using the same instrument before and after the reactor in order to calculate the adsorption efficiency.

Prediction of Paroxysmal Atrial Fibrillation From Complexity Analysis of the Sinus Rhythm ECG: A Retrospective Case/Control Pilot Study.

Paroxysmal atrial fibrillation (PAF) is the most common cardiac arrhythmia, conveying a stroke risk comparable to persistent AF. It poses a significant diagnostic challenge given its intermittency and potential brevity, and absence of symptoms in most patients. This pilot study introduces a novel biomarker for early PAF detection, based upon analysis of sinus rhythm ECG waveform complexity. Sinus rhythm ECG recordings were made from 52 patients with (n = 28) or without (n = 24) a subsequent diagnosis of PAF. Subjects used a handheld ECG monitor to record 28-second periods, twice-daily for at least 3 weeks. Two independent ECG complexity indices were calculated using a Lempel-Ziv algorithm: R-wave interval variability (beat detection, BD) and complexity of the entire ECG waveform (threshold crossing, TC). TC, but not BD, complexity scores were significantly greater in PAF patients, but TC complexity alone did not identify satisfactorily individual PAF cases. However, a composite complexity score (h-score) based on within-patient BD and TC variability scores was devised. The h-score allowed correct identification of PAF patients with 85% sensitivity and 83% specificity. This powerful but simple approach to identify PAF sufferers from analysis of brief periods of sinus-rhythm ECGs using hand-held monitors should enable easy and low-cost screening for PAF with the potential to reduce stroke occurrence.

Monitoring Hospitalized Dialysis Patients With COVID-19: Repurposing Baby Monitors for Patient and Staff Safety

Monitoring Hospitalized Dialysis Patients With COVID-19: Repurposing Baby Monitors for Patient and Staff Safety

AAOS Clinical Practice Guideline: Management of Acute Compartment Syndrome.

AAOS Clinical Practice Guideline: Management of Acute Compartment Syndrome.

First-In-Human Experience With Integration of Wireless Intracranial Pressure Monitoring Device Within a Customized Cranial Implant.

BACKGROUNDDecompressive craniectomy is a lifesaving treatment for intractable intracranial hypertension. For patients who survive, a second surgery for cranial reconstruction (cranioplasty) is required. The effect of cranioplasty on intracranial pressure (ICP) is unknown.OBJECTIVETo integrate the recently Food and Drug Administration-approved, fully implantable, noninvasive ICP sensor within a customized cranial implant (CCI) for postoperative monitoring in patients at high risk for intracranial hypertension.METHODSA 16-yr-old female presented for cranioplasty 4-mo after decompressive hemicraniectomy for craniocerebral gunshot wound. Given the persistent transcranial herniation with concomitant subdural hygroma, there was concern for intracranial hypertension following cranioplasty. Thus, cranial reconstruction was performed utilizing a CCI with an integrated wireless ICP sensor, and noninvasive postoperative monitoring was performed.RESULTSIntermittent ICP measurements were obtained twice daily using a wireless, handheld monitor. The ICP ranged from 2 to 10 mmHg in the supine position and from −5 to 4 mmHg in the sitting position. Interestingly, an average of 7 mmHg difference was consistently noted between the sitting and supine measurements.CONCLUSIONThis first-in-human experience demonstrates several notable findings, including (1) newfound safety and efficacy of integrating a wireless ICP sensor within a CCI for perioperative neuromonitoring; (2) proven restoration of normal ICP postcranioplasty despite severe preoperative transcranial herniation; and (3) proven restoration of postural ICP adaptations following cranioplasty. To the best of our knowledge, this is the first case demonstrating these intriguing findings with the potential to fundamentally alter the paradigm of cranial reconstruction.

Retrofitting an environmental monitor with a silicon photomultiplier sensor

We report on the retrofitting of a standard DP2 environmental radiation monitor replacing the photomultiplier tube with a silicon photomultiplier (SiPM). The use of a SiPM has several advantages for a hand-held radiation monitor, including convenient low-voltage operation and physical robustness. We report the detection efficiency and alpha/beta discrimination performance of the modified probe compared with an unmodified version.

Experimental Study on Burning Characteristics of the Large-Scale Transformer Oil Pool Fire with Different Extinguishing Methods

In this study, a 100 m2 steel tank was used to simulate transformer oil fires, with an aim of investigating the burning characteristics of a large-scale pool fire. To recover a real thermal state of transformer oil in operation, a heating system was employed to raise the initial fuel temperature. In total, three fire-extinguishing tests were performed using two delivery methods, i.e., a hand-held fire water branch (FWB) and fire water monitor (FWM) to understand their performance in fighting large-scale pool fires. The extinguishing activities using the FWB method were conducted by four trained firefighters, and the FWM was operated by a trained firefighter. Also, a sequence of bench-scale tests was conducted to investigate the impact of initial fuel temperature on the mass burning rate of transformer oil pool fires. This part is a supplement to the large-scale tests. The results demonstrated that the temperatures adjacent to the tank border were reduced as the vertical height increased. The growth rate of the flame height was enhanced in the development stage when the initial fuel temperature was pre-heated to a higher value. Meanwhile, it was found that the burning rate of transformer oil pool fire occurred a slight increase with the initial fuel temperature was grown according to the bench-scale data, while the impact of initial temperature was limited within the tested temperature range. In addition, it was shown that the FWB and FWM were both effective for fighting a large-scale transformer oil pool fire. However, their efficiency was influenced significantly by the concentration of the extinguishing agents and the application density of delivery. In contrast, the FWM might be a good choice when considering the safety of firefighters, because its delivery range is greater and extinguishing time is shorter as compared to the FWB. Here, it shall be noted that the FWM has also its flipsides. Sometimes, the application of a single FWM is not well to extinguish the corner fire or other fire types, in such cases, the FWM strategy should be to use two or more fire trucks in order to cover the whole accident pool.

Cerebrospinal fluid lactate in dogs with inflammatory central nervous system disorders.

BackgroundCerebrospinal fluid (CSF) lactate is frequently used as a biomarker in humans with inflammatory central nervous system (CNS) disorders including bacterial meningitis and autoimmune disorders such as multiple sclerosis.HypothesisCerebrospinal fluid lactate concentrations are increased in a subset of dogs with inflammatory CNS disorders.AnimalsOne hundred two client‐owned dogs diagnosed with inflammatory CNS disease.MethodsCase series. Cases were identified both prospectively at the time of diagnosis and retrospectively by review of a CSF biorepository. Cerebrospinal fluid lactate was analyzed with a commercially available, handheld lactate monitor. Subcategories of inflammatory disease were created for comparison (eg, steroid‐responsive meningitis arteritis, meningoencephalitis of unknown etiology).ResultsCerebrospinal fluid lactate concentrations were above reference range in 47% of dogs (median, 2.5 mmol/L; range, 1.0‐11.7 mmol/L). There was no significant difference in lactate concentrations between disease subcategories (P = .48). Significant but weak correlations were noted between CSF lactate concentration and nucleated cell count (r = .33, P < .001), absolute large mononuclear cell count (r = .44, P < .001), absolute small mononuclear cell count (r = .39, P < .001), absolute neutrophil cell count (r = .24, P = .01), and protein (r = .44, P < .001). No correlation was found between CSF lactate concentration and CSF red blood cell count (P = .58). There was no significant association of CSF lactate concentration with survival (P = .27).Conclusions and Clinical ImportanceCerebrospinal fluid lactate concentrations could serve as a rapid biomarker of inflammatory CNS disease in dogs.

Validity and reliability of a handheld blood glucose monitor during exercise and an oral glucose tolerance test

The purpose of the present study was to examine the validity and reliability of the handheld Nova Max Plus blood glucose monitor during an oral glucose tolerance test and 60-minute bout of exercise. Thirty subjects (mean age±SD=22.3±1.9 years; body mass=77.6±14.2 kg) volunteered for an oral glucose tolerance test or 60-minute treadmill test. Blood glucose concentrations were measured from the fingertip at six time points during both tests. The reference method of blood glucose analysis was the Yellow Springs Instruments (YSI) 2300. Our results indicated that the blood glucose values provided by the Nova Max Plus were significantly (p&amp;lt;.05) greater than the YSI 2300 at all-time points of the oral glucose tolerance test and treadmill test. In addition, the Nova Max Plus exhibited an overall mean absolute relative deviation (±SD) of 9.0 (±7.0) and did not meet the 95% accuracy requirements of ISO 15197:2013. The Bland-Altman plot for constant error (YSI 2300 – Nova Max Plus) versus the reference method (YSI 2300) indicated an average negative bias (-8.2 mg·dL-1) that increased (r=-0.23) at higher blood glucose values. Intra-device reliability analyses for the Nova Max Plus demonstrated the ICC was R=0.99 and CV=3.0%, with no mean differences between the test and retest values. These findings suggested that the Nova Max Plus provided highly reliable, yet inaccurate blood glucose values compared to the YSI 2300 during the dynamic conditions associated with an oral glucose tolerance test and exercise.

Home Monitoring for Fetal Heart Rhythm During Anti-Ro Pregnancies

BackgroundFetal atrioventricular block (AVB) occurs in 2% to 4% of anti-Ro antibody–positive pregnancies and can develop in <24 h. Only rarely has standard fetal heart rate surveillance detected AVB in time for effective treatment. ObjectivesOutcome of anti-Ro pregnancies was surveilled with twice-daily home fetal heart rate and rhythm monitoring (FHRM) and surveillance echocardiography. MethodsAnti-Ro pregnant women were recruited from 16 international centers in a prospective observational study. Between 18 and 26 weeks’ gestation, mothers checked FHRM twice daily with a commercially available Doppler monitor and underwent weekly or biweekly surveillance fetal echocardiograms. If FHRM was abnormal, a diagnostic echocardiogram was performed. Cardiac cycle length and atrioventricular interval were measured, and cardiac function was assessed on all echocardiograms. After 26 weeks, home FHRM and echocardiograms were discontinued, and mothers were monitored during routine obstetrical visits. Postnatal electrocardiograms were performed. ResultsMost mothers (273 of 315, 87%) completed the monitoring protocol, generating 1,752 fetal echocardiograms. Abnormal FHRM was detected in 21 mothers (6.7%) who sought medical attention >12 h (n = 7), 3 to 12 h (n = 9), or <3 h (n = 5) after abnormal FHRM. Eighteen fetuses had benign rhythms, and 3 had second- or third-degree AVB. Treatment of second-degree AVB <12 h after abnormal FHRM restored sinus rhythm. Four fetuses had first-degree AVB diagnosed by echocardiography; none progressed to second-degree AVB. No AVB was missed by home FHRM or developed after FHRM. ConclusionsHome FHRM confirms the rapid progression of normal rhythm to AVB and can define a window of time for successful therapy. (Prospective Maternal Surveillance of SSA [Sjögren Syndrome A] Positive Pregnancies Using a Hand-held Fetal Heart Rate Monitor; NCT02920346)

Voice Disorders after Intubation: The Importance of Intra-Operative Monitoring and Controlling of Endo-Tracheal Tube Cuff Pressure in Reducing Intubation-Related Complications

AbstractBackground: The importance of monitoring and controlling endotracheal tube cuff (ETTc) pressure in reducing larynge-otracheal injuries and intubation-related respiratory compli-cations has been previously investigated by several authors. However, little is known about the role of controlling ETT cuff pressure in minimizing transient voice changes following endotracheal intubation.Aim of the Study: The aim of this study was to investigate the importance of monitoring and controlling ETTc pressure in reducing voice disorders after endotracheal intubation.Patients and Methods: Fifty patients in the age between 18-50 years, undergoing middle ear surgery were enrolled into the study. Patients were randomized by means of individ-ually prepared envelopes to either the control group (n=25), without measuring ETTc pressure, or the study group (n=25), with ETTc pressure measurement. All patients were examined pre-operatively to determine baseline values, 24 hours after surgery and 1 week post-operatively. Phoniatric examination included auditory perceptual assessment, videolaryngoscopy and acoustic analysis of voice. Statistical analysis included the arithmetic mean, Standard Deviation (SD), standard error, hypothesis student's t and Spearman's rank-order correlation tests. p-values <0.05 were chosen as the level of significance.Results: Auditory perceptual assessment of voice per-formed one day after extubation indicated the presence of post-intubation dysphonia which was of a mild to moderate grade, an irregular quality, a low pitch and fluctuating loudness. These changes were more pronounced and occurred more frequently in patients of the control group in whom the cuff pressure was adjusted by pilot balloon palpation according to the experience of the anaesthesiologist. One week after surgery, all patients belonging to the study group, in whom a hand-held cuff pressure monitor was used to adjust the cuff pressure, showed improvement in all the perceived parameters, whereas persistent dysphonia was still perceived in two patients of the control group. Videolaryngoscopy performed before intubation showed that all patients were free from any laryngeal lesions. One day after extubation, there was evidence of traumatic laryngeal lesions in the form of vocal fold congestion in 5 patients (20%) of the control group and 3 patients (12%) of the study group. One week after extubation, residual lesions were still present in 3 patients (12%) of the control group in the form of mild vocal fold edema in one patient and vocal fold congestion in two other patients. Acoustic analysis of voice performed 24 hours after extubation showed a highly significant increase in fundamental frequency F0 in both male and female patients of the control group. These changes were accompanied by a significant increase in jitter in only the female patients. By contrast, acoustic analysis of voice recorded both 24 hours and one week after extubation in patients belonging to the study group did not show any significant changes in any of the measured parameters when compared to their corresponding baseline values. An inter-group com-parison of the post-operative parameters recorded by acoustic analysis of voice one day after extubation showed a statistically highly significant (p=0.013) reduction in fundamental fre-quency F0 by 75% among male patients, and a statistically significant (p=0.05) reduction in jitter by 74% in females belonging to the study group when compared to those of the control group. Shimmer and NHR increased to 78% and 47%, respectively, in male patients belonging to the study group, and decreased in females, but these changes were statistically not significant.Correlation performed between the changes in parameters obtained by acoustic analysis of voice and the duration of intubation showed a statistically significant (p-value=0.023) positive correlation between the changes in fundamental frequency F0 and the duration of intubation. Likewise, a significant (p-value=0.016) positive correlation was found between the changes in jitter and the duration of intubation.Conclusion and Future Recommendations: General an-aesthesia has multisystem effects, some of which can disturb the fine harmony necessary for voice production. Even short-term intubation is usually followed by a period of dysphonia that may extend after extubation anywhere from 12 hours to more than five days. Proper control of endotracheal tube cuff (ETTc) pressure by a manometer helps reduce ETT-related postprocedural complications. Acoustic analysis may be used to identify and monitor even minor laryngeal trauma resulting from the procedure. Jitter and shimmer are the best indicators of post-intubation phonation changes. For medicolegal reasons, patients scheduled for general anesthesia should be informed about the possible post-operative voice changes that could last longer than one day. We further recommend routine intraoperative monitoring of endotracheal tube cuff pressure, in additition to post-operative phoniatric assessment and follow-up of the patients for early post-operative diagnosis and treatment of dysphonia.

Rate of Diabetes in Maricopa County, AZ

The prevalence of type 2 diabetes mellitus (T2DM) is well documented at the national, state, and even county level. Results are captured in the Behavior Risk Factor Surveillance System (BRFSS), a U.S. survey that collects data on disease rates and health-related risk behavior. The 2015 BRFSS audit revealed Arizona has an overall adult T2DM prevalence of 9.1%. Further, in Maricopa County, the region which includes the greater Phoenix area, the T2DM prevalence is higher at 10.8%. Conversely, there is limited data available on prediabetes rates in Maricopa County; therefore, we examined the rate of diabetes and prediabetes during community-partnered events as part of an educational “A1C initiative.” Basic demographic data as well as a fingerstick blood sample were obtained. HbA1c was measured with a hand-held monitor. 794 participants (272 men) were screened at 15 events from April 2016 to Sept 2017. The majority of participants were of Hispanic descent (54%). HbA1c results were categorized according to the ADA guidelines; normal (&amp;lt; 5.7%), prediabetes (5.7-6.4%) and diabetes (≥6.5%) ranges. Mean HbA1c for all participants was 6.0% +1.2%, with 16% and 35% falling in the diabetes and prediabetes ranges respectively. Diabetes and prediabetes rates for males and females were similar. By ethnicity, prediabetes was highest among African Americans (AA) (41%), followed by white non-Hispanics (35%) then Hispanics (33%). Despite AA having a higher diabetes rate at 21%, HbA1c was significantly higher in Hispanics vs. AA diabetes only subjects (8.6% +2.0 vs. 7.4% +1.4, p&amp;lt;0.001), suggesting worse glycemic control for the Hispanic group. In line with the national average of prediabetes prevalence at 33.9%, the overall rate we observed was similar, yet higher in certain groups. Notably, the diabetes rate was nearly double than that of the BRFSS report. The initiative provided vital (pre)diabetes awareness to Maricopa County residents. These findings were shared with our community partners, to aid in developing strategies to best assist those at risk of developing T2DM. Disclosure S.H. Jaycox: None. S. Paglialunga: Employee; Self; Celerion.

A Rapid, Handheld Device to Assess Respiratory Resistance: Clinical and Normative Evidence.

Following reports of respiratory symptoms among service members returning from deployment to South West Asia (SWA), an expert panel recommended pre-deployment spirometry be used to assess disease burden. Unfortunately, testing with spirometry is high cost and time-consuming. The airflow perturbation device (APD) is a handheld monitor that rapidly measures respiratory resistance (APD-Rr) and has promising but limited clinical data. Its speed and portability make it ideally suited for large volume pre-deployment screening. We conducted a pilot study to assess APD performance characteristics and develop normative values. We prospectively enrolled subjects and derived reference equations for the APD from those without respiratory symptoms, pulmonary disease, or tobacco exposure. APD testing was conducted by medical technicians who received a 10-min in-service on its use. A subset of subjects performed spirometry and impulse oscillometry (iOS), administered by trained respiratory therapists. APD measures were compared with spirometry and iOS. The total study population included 199 subjects (55.8% males, body mass index 27.7 ± 6.0 kg/m2, age 49.9 ± 18.7 yr). Across the three APD trials, mean inspiratory (APD-Ri), expiratory (APD-Re), and average (APD-Ravg) resistances were 3.30 ± 1.0, 3.69 ± 1.2, and 3.50 ± 1.1 cm H2O/L/s. Reference equations were derived from 142 clinically normal volunteers. Height, weight, and body mass index were independently associated with APD-Ri, APD-Re, and APD-Ravg and were combined with age and gender in linear regression models. APD-Ri, APD-Re, and APD-Ravg were significantly inversely correlated with FEV1 (r = -0.39 to -0.42), FVC (r = -0.37 to -0.40), and FEF25-75 (r = -0.31 to -0.35) and positively correlated with R5 (r = 0.61-0.62), R20 (r = 0.50-0.52), X5 (r = -0.57 to -0.59), and FRES (r = 0.42-0.43). Bland-Altman plots showed that the APD-Rr closely approximates iOS when resistance is normal. Rapid testing was achieved with minimal training required, and reference equations were constructed. APD-Rr correlated moderately with iOS and weakly with spirometry. More testing is required to determine whether the APD has value for pre- and post-deployment respiratory assessment.

Evaluation of HbA1c screening during outreach events for prediabetes subject recruitment for clinical research

BackgroundThere are a number of obstacles which may impede the recruitment of underserved populations in clinical research studies; some of these factors include mistrust of medical research, socioeconomic constraints, cultural factors, and language barriers. For chronic metabolic disease indications, these barriers may also include lack of disease awareness. Recently, national organizations such as the American Diabetes Association (ADA) and Centers for Disease Control and Prevention (CDC) have highlighted the need for prediabetes recognition. Therefore the aim of the study was twofold: to raise prediabetes awareness in an under-represented Hispanic community and to engage prediabetes participants in clinical research.MethodsHemoglobin A1c (HbA1c) screening was performed at major outreach events catered to the Hispanic community. All participants signed an ethics review board approved waiver which collected basic demographic information and the HbA1c test was performed with a hand-held monitor and finger-stick blood sample. Participants were given their HbA1c results at the event as well as information on prediabetes and upcoming clinic studies. After the event, participants were contacted by a study participant recruiter to assess interest in participating in clinical research.ResultsThe majority of participants screened fell within a prediabetes HbA1c range. Mean HbA1c was similar among men and women, yet higher in individuals aged 45–65 years compared to adults aged < 45 years (p < 0.05). For recruitment purposes, the highest number of leads came from participants attending a faith-based community event. In all, 17% of individuals contacted expressed interest in participating in clinical research and created a profile within our database to be eligible for future studies.ConclusionsProviding no-cost HbA1c screening is an excellent recruitment tool for clinical research as well as an opportunity to raise prediabetes awareness in a traditionally underserved population.

Proposed Workflow for the Utilisation of a Single-Lead Smartphone-Based Electrocardiogram in Clinical Practice

Background: The AliveCor heart rate monitor (AHM) is a Food and Drug Administration-approved hand-held cardiac rhythm monitor that records a lead-I electrocardiogram (ECG) strip. While the application provides both ECGs and an automated diagnosis, clinician verification is recommended. However, it is unclear whether blinded clinician interpretation offers additive value to the automated machine-learning algorithm.

Causes of ‘Unclassified’ Automated Diagnoses on a Smartphone Based Single-Lead Electrocardiogram Platform

Background: The AliveCor heart rate monitor (AHM) is a Food and Drug Administration-approved hand-held ambulatory cardiac rhythm monitor that records a lead-I electrocardiogram (ECG) strip when paired with a smartphone. On population screening studies, up to one in four tracings are ‘unclassified’ by device algorithms. However, there is a lack of data on the causes of an ‘unclassified’ tracing and the proportion of undetected arrhythmias in this cohort.