1
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O'Donnell C, Brownlee K, Martin E, Suyama J, Albert S, Anderson S, Bhatte S, Bonner K, Burton C, Corn M, Eng H, Flage B, Frerotte J, Balasubramani GK, Haggerty C, Haight J, Harrison LH, Hartman A, Hitter T, King WC, Ledger K, Marsh JW, McDonald MC, Miga B, Moses K, Newman A, Ringler M, Roberts M, Sax T, Shekhar A, Sterne M, Tenney T, Vanek M, Wells A, Wenzel S, Williams J. SARS-CoV-2 control on a large urban college campus without mass testing. J Am Coll Health 2023:1-9. [PMID: 36595575 DOI: 10.1080/07448481.2022.2153600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/22/2022] [Accepted: 09/19/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE A small percentage of universities and colleges conducted mass SARS-CoV-2 testing. However, universal testing is resource-intensive, strains national testing capacity, and false negative tests can encourage unsafe behaviors. PARTICIPANTS A large urban university campus. METHODS Virus control centered on three pillars: mitigation, containment, and communication, with testing of symptomatic and a random subset of asymptomatic students. RESULTS Random surveillance testing demonstrated a prevalence among asymptomatic students of 0.4% throughout the term. There were two surges in cases that were contained by enhanced mitigation and communication combined with targeted testing. Cumulative cases totaled 445 for the term, most resulting from unsafe undergraduate student behavior and among students living off-campus. A case rate of 232/10,000 undergraduates equaled or surpassed several peer institutions that conducted mass testing. CONCLUSIONS An emphasis on behavioral mitigation and communication can control virus transmission on a large urban campus combined with a limited and targeted testing strategy.
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Affiliation(s)
- Christopher O'Donnell
- Department of Medicine, University of Pittsburgh School of Medicine (UPSOM), Pittsburgh, Pennsylvania, USA
| | | | - Elise Martin
- Department of Medicine, University of Pittsburgh School of Medicine (UPSOM), Pittsburgh, Pennsylvania, USA
| | - Joe Suyama
- Department of Emergency Medicine, UPSOM, Pittsburgh, Pennsylvania, USA
| | - Steve Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health (GSPH), Pittsburgh, Pennsylvania, USA
| | - Steven Anderson
- Office of the Dean, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sai Bhatte
- Kenneth P. Dietrich School of Arts & Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenyon Bonner
- Office of the Dean, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chad Burton
- University of Pittsburgh Information Technology, Pittsburgh, Pennsylvania, USA
| | - Micaela Corn
- Office of University Communications & Marketing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Heather Eng
- Department of Epidemiology, GSPH, Pittsburgh, Pennsylvania, USA
| | - Bethany Flage
- Department of Infectious Disease and Microbiology, GSPH, Pittsburgh, Pennsylvania, USA
| | - Jay Frerotte
- Environmental Health and Safety, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Joel Haight
- Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lee H Harrison
- Department of Medicine, University of Pittsburgh School of Medicine (UPSOM), Pittsburgh, Pennsylvania, USA
| | - Amy Hartman
- Department of Infectious Disease and Microbiology, GSPH, Pittsburgh, Pennsylvania, USA
| | - Thomas Hitter
- Office of Policy Development and Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Wendy C King
- Department of Epidemiology, GSPH, Pittsburgh, Pennsylvania, USA
| | - Kate Ledger
- Office of University Communications & Marketing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jane W Marsh
- Department of Medicine, University of Pittsburgh School of Medicine (UPSOM), Pittsburgh, Pennsylvania, USA
| | | | - Bethany Miga
- Office of the Chancellor, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kimberly Moses
- Office of University Counsel, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne Newman
- Department of Epidemiology, GSPH, Pittsburgh, Pennsylvania, USA
| | - Meg Ringler
- Office of University Communications & Marketing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark Roberts
- Department of Health Policy and Management, GSPH, Pittsburgh, Pennsylvania, USA
| | - Theresa Sax
- Department of Epidemiology, GSPH, Pittsburgh, Pennsylvania, USA
| | | | - Matthew Sterne
- Office of Business and Auxiliary Services, GSPH, Pittsburgh, Pennsylvania, USA
| | - Tyler Tenney
- Office of Policy Development and Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marian Vanek
- Office of the Dean, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alan Wells
- Department of Pathology, UPSOM, Pittsburgh, Pennsylvania, USA
| | - Sally Wenzel
- Department of Environmental and Occupational Health, GSPH, Pittsburgh, Pennsylvania, USA
| | - John Williams
- Department of Pediatrics, UPSOM, Pittsburgh, Pennsylvania, USA
- Institute for Infection, Inflammation, and Immunity in Children, Pittsburgh, Pennsylvania, USA
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2
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Zimmerman RK, Balasubramani GK, D'Agostino HEA, Clarke L, Yassin M, Middleton DB, Silveira FP, Wheeler ND, Landis J, Peterson A, Suyama J, Weissman A, Nowalk MP. Population-based hospitalization burden estimates for respiratory viruses, 2015-2019. Influenza Other Respir Viruses 2022; 16:1133-1140. [PMID: 35996836 PMCID: PMC9530548 DOI: 10.1111/irv.13040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Acute respiratory infections (ARIs) result in millions of illnesses and hundreds of thousands of hospitalizations annually in the United States. The responsible viruses include influenza, parainfluenza, human metapneumovirus, coronaviruses, respiratory syncytial virus (RSV), and human rhinoviruses. This study estimated the population-based hospitalization burden of those respiratory viruses (RVs) over 4 years, from July 1, 2015 to June 30, 2019, among adults ≥18 years of age for Allegheny County (Pittsburgh), Pennsylvania. METHODS We used population-based statewide hospital discharge data, health system electronic medical record (EMR) data for RV tests, census data, and a published method to calculate burden. RESULTS Among 26,211 eligible RV tests, 67.6% were negative for any virus. The viruses detected were rhinovirus/enterovirus (2552; 30.1%), influenza A (2,299; 27.1%), RSV (1082; 12.7%), human metapneumovirus (832; 9.8%), parainfluenza (601; 7.1%), influenza B (565; 6.7%), non-SARS-CoV-2 coronavirus (420; 4.9% 1.5 years of data available), and adenovirus (136; 1.6%). Most tests were among female (58%) and White (71%) patients with 60% of patients ≥65 years, 24% 50-64 years, and 16% 18-49 years. The annual burden ranged from 137-174/100,000 population for rhinovirus/enterovirus; 99-182/100,000 for influenza A; and 56-81/100,000 for RSV. Among adults <65 years, rhinovirus/enterovirus hospitalization burden was higher than influenza A; whereas the reverse was true for adults ≥65 years. RV hospitalization burden increased with increasing age. CONCLUSIONS These virus-specific ARI population-based hospital burden estimates showed significant non-influenza burden. These estimates can serve as the basis for several areas of research that are essential for setting funding priorities and guiding public health policy.
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Affiliation(s)
- Richard K. Zimmerman
- Department of Family MedicineUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - G. K. Balasubramani
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPAUSA
| | - Helen E. A. D'Agostino
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPAUSA
| | - Lloyd Clarke
- Department of Pharmacy, Division of Infectious Diseases/Pharmacy DepartmentUPMC Health SystemPittsburghPAUSA
| | - Mohamed Yassin
- Infection Control DepartmentUPMC Mercy HospitalPittsburghPAUSA
| | | | - Fernanda P. Silveira
- Department of Medicine, Division of Infectious DiseasesUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Nicole D. Wheeler
- Department of Emergency MedicineUPMC Passavant HospitalPittsburghPAUSA
| | - Jonathan Landis
- Department of Emergency MedicineUPMC Passavant HospitalPittsburghPAUSA
| | - Alanna Peterson
- Department of Emergency MedicineUPMC Shadyside HospitalPittsburghPAUSA
| | - Joe Suyama
- Department of Emergency MedicineUPMC Magee‐Women's HospitalPittsburghPAUSA
| | - Alexandra Weissman
- Department of Emergency MedicineUPMC Magee‐Women's HospitalPittsburghPAUSA
| | - Mary Patricia Nowalk
- Department of Family MedicineUniversity of Pittsburgh School of MedicinePittsburghPAUSA
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3
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Carpenter CR, Leggett J, Bellolio F, Betz M, Carnahan RM, Carr D, Doering M, Hansen JC, Isaacs ED, Jobe D, Kelly K, Morrow-Howell N, Prusaczyk B, Savage B, Suyama J, Vann AS, Rising KL, Hwang U, Shah MN. Emergency Department Communication in Persons Living With Dementia and Care Partners: A Scoping Review. J Am Med Dir Assoc 2022; 23:1313.e15-1313.e46. [PMID: 35940681 PMCID: PMC10802113 DOI: 10.1016/j.jamda.2022.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To synthesize published research exploring emergency department (ED) communication strategies and decision-making with persons living with dementia (PLWD) and their care partners as the basis for a multistakeholder consensus conference to prioritize future research. DESIGN Systematic scoping review. SETTINGS AND PARTICIPANTS PLWD and their care partners in the ED setting. METHODS Informed by 2 Patient-Intervention-Comparison-Outcome (PICO) questions, we conducted systematic electronic searches of medical research databases for relevant publications following standardized methodological guidelines. The results were presented to interdisciplinary stakeholders, including dementia researchers, clinicians, PLWD, care partners, and advocacy organizations. The PICO questions included: How does communication differ for PLWD compared with persons without dementia? Are there specific communication strategies that improve the outcomes of ED care? Future research areas were prioritized. RESULTS From 5451 studies identified for PICO-1, 21 were abstracted. From 2687 studies identified for PICO-2, 3 were abstracted. None of the included studies directly evaluated communication differences between PLWD and other populations, nor the effectiveness of specific communication strategies. General themes emerging from the scoping review included perceptions by PLWD/care partners of rushed ED communication, often exacerbated by inconsistent messages between providers. Care partners consistently reported limited engagement in medical decision-making. In order, the research priorities identified included: (1) Barriers/facilitators of effective communication; (2) valid outcome measures of effective communication; (3) best practices for care partner engagement; (4) defining how individual-, provider-, and system-level factors influence communication; and (5) understanding how each member of ED team can ensure high-quality communication. CONCLUSIONS AND IMPLICATIONS Research exploring ED communication with PLWD is sparse and does not directly evaluate specific communication strategies. Defining barriers and facilitators of effective communication was the highest-ranked research priority, followed by validating outcome measures associated with improved information exchange.
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Affiliation(s)
- Christopher R Carpenter
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, Emergency Care Research Core, St. Louis, MO, USA.
| | - Jesseca Leggett
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, Emergency Care Research Core, St. Louis, MO, USA
| | | | - Marian Betz
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Ryan M Carnahan
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - David Carr
- Department of Medicine and Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Michelle Doering
- Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Eric D Isaacs
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah Jobe
- Person Living with Dementia, 2021-2022 Alzheimer's Association National Early Stage Advisory Group, St. Louis MO, USA
| | | | - Nancy Morrow-Howell
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Beth Prusaczyk
- Department of Medicine, Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Bob Savage
- Person Living with Dementia, LiveWell Alliance, Plantsville, CT, USA
| | - Joe Suyama
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
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4
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Gettel CJ, Voils CI, Bristol AA, Richardson LD, Hogan TM, Brody AA, Gladney MN, Suyama J, Ragsdale LC, Binkley CL, Morano CL, Seidenfeld J, Hammouda N, Ko KJ, Hwang U, Hastings SN, Bellolio MF, Biese K, Binkley C, Bott N, Brody A, Carpenter C, Clark S, Dresden MS, Forrester S, Gerson L, Gettel C, Goldberg E, Greenberg A, Hammouda N, Han J, Hastings SN, Hogan T, Hung W, Hwang U, Kayser J, Kennedy M, Ko K, Lesser A, Linton E, Liu S, Malsch A, Matlock D, McFarland F, Melady D, Morano C, Morrow‐Howell N, Nassisi D, Nerbonne L, Nyamu S, Ohuabunwa U, Platts‐Mills T, Ragsdale L, Richardson L, Ringer T, Rosen A, Rosenberg M, Shah M, Skains R, Skees S, Souffront K, Stabler L, Sullivan C, Suyama J, Vargas S, Camille Vaughan E, Voils C, Wei D, Wexler N. Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement. Acad Emerg Med 2021; 28:1430-1439. [PMID: 34328674 DOI: 10.1111/acem.14360] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, particularly addressing social needs, and prioritize future research questions. METHODS GEAR engaged 49 interdisciplinary stakeholders, derived clinical questions, and conducted searches of electronic databases to identify ED discharge care transition interventions in older adult populations. Informed by the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) framework, data extraction and synthesis of included studies included the degree that intervention components addressed social needs and their association with patient outcomes. GEAR convened a consensus conference to identify topics of highest priority for future care transitions research. RESULTS Our search identified 248 unique articles addressing care transition interventions in older adult populations. Of these, 17 individual care transition intervention studies were included in the current literature synthesis. Overall, common care transition interventions included coordination efforts, comprehensive geriatric assessments, discharge planning, and telephone or in-person follow-up. Fourteen of the 17 care transition intervention studies in older adults specifically addressed at least one social need within the PRAPARE framework, most commonly related to access to food, medicine, or health care. No care transition intervention addressing social needs in older adult populations consistently reduced subsequent health care utilization or other patient-centered outcomes. GEAR stakeholders identified that determining optimal outcome measures for ED-home transition interventions was the highest priority area for future care transitions research. CONCLUSIONS ED care transition intervention studies in older adults frequently address at least one social need component and exhibit variation in the degree of success on a wide array of health care utilization outcomes.
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Affiliation(s)
- Cameron J. Gettel
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- National Clinician Scholars Program Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA
| | - Corrine I. Voils
- William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Lynne D. Richardson
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
- Department of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York New York USA
- Institute for Health Equity Research Icahn School of Medicine at Mount Sinai New York New York USA
| | - Teresita M. Hogan
- Department of Medicine Section of Emergency Medicine The University of Chicago School of Medicine Chicago Illinois USA
| | - Abraham A. Brody
- Hartford Institute for Geriatric Nursing New York University Rory Meyers College of Nursing New York New York USA
| | - Micaela N. Gladney
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
| | - Joe Suyama
- Department of Emergency Medicine University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Luna C. Ragsdale
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
- Department of Emergency Medicine Durham VA Health Care System Durham North Carolina USA
| | - Christine L. Binkley
- Department of Emergency Medicine University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Carmen L. Morano
- School of Social Welfare University at AlbanyState University of New York Albany New York USA
| | - Justine Seidenfeld
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
| | - Nada Hammouda
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Kelly J. Ko
- West Health Institute La Jolla California USA
| | - Ula Hwang
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- Geriatrics Research, Education, and Clinical Center James J. Peters VAMC Bronx New York USA
| | - Susan N. Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
- Department of Medicine Duke University School of Medicine Durham NC USA
- Geriatric Research, Education, and Clinical Center Durham VA Health Care System Durham North Carolina USA
- Center for the Study of Human Aging and Development Duke University School of Medicine Durham North Carolina USA
- Department of Population Health Sciences Duke University School of Medicine Durham North Carolina USA
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5
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Mitchell SL, Orris S, Freeman T, Freeman MC, Adam M, Axe M, Gribschaw J, Suyama J, Hoberman A, Wells A. Performance of SARS-CoV-2 antigen testing in symptomatic and asymptomatic adults: a single-center evaluation. BMC Infect Dis 2021. [PMID: 34663212 DOI: 10.1186/s12879-021-06716-1/tables/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Antigen testing offers rapid and inexpensive testing for SARS-CoV-2 but concerns regarding performance, especially sensitivity, remain. Limited data exists for use of antigen testing in asymptomatic patients; thus, performance and reliability of antigen testing remains unclear. METHODS 148 symptomatic and 144 asymptomatic adults were included. A nasal swab was collected for testing by Quidel Sofia SARS IFA (Sofia) as point of care. A nasopharyngeal swab was also collected and transported to the laboratory for testing by Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV RT-PCR (Cepheid). RESULTS Overall, Sofia had good agreement with Cepheid (> 95%) in adults, however was less sensitive. Sofia had a sensitivity of 87.8% and 33.3% for symptomatic and asymptomatic patients, respectively. Among symptomatic patients, testing > 5 days post symptom onset resulted in lower sensitivity (82%) when compared with testing within 5 days of symptom onset (90%). Of the four Sofia false-negative results in the asymptomatic cohort, 50% went on to develop COVID-19 disease within 5 days of testing. Specificity in both symptomatic and asymptomatic cohorts was 100%. CONCLUSIONS Sofia has acceptable performance in symptomatic adults when tested < 5 days of symptom onset. Caution should be taken when testing patients with ≥ 5 days of symptoms. The combination of low prevalence and reduced sensitivity results in relatively poor performance of in asymptomatic patients. NAAT-based diagnostic assays should be considered in when antigen testing is unreliable, particularly in symptomatic patients with > 5 days of symptom onset and asymptomatic patients.
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Affiliation(s)
- Stephanie L Mitchell
- Department of Pathology, University of Pittsburgh, 3477 Euler Way, Clinical Laboratory Building-6th Floor, Pittsburgh, PA, 15213, USA.
| | - Steven Orris
- Division of General Internal Medicine, Center for Research On Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tanner Freeman
- Department of Pathology, University of Pittsburgh, 3477 Euler Way, Clinical Laboratory Building-6th Floor, Pittsburgh, PA, 15213, USA
| | - Megan C Freeman
- Department of Pediatrics, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Michelle Adam
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Meredith Axe
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jamie Gribschaw
- Clinical Microbiology Laboratory, UPMC Hospital System, Pittsburgh, PA, 15261, USA
| | - Joe Suyama
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Alejandro Hoberman
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Alan Wells
- Department of Pathology, University of Pittsburgh, 3477 Euler Way, Clinical Laboratory Building-6th Floor, Pittsburgh, PA, 15213, USA
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6
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Mitchell SL, Orris S, Freeman T, Freeman MC, Adam M, Axe M, Gribschaw J, Suyama J, Hoberman A, Wells A. Performance of SARS-CoV-2 antigen testing in symptomatic and asymptomatic adults: a single-center evaluation. BMC Infect Dis 2021; 21:1071. [PMID: 34663212 PMCID: PMC8521263 DOI: 10.1186/s12879-021-06716-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background Antigen testing offers rapid and inexpensive testing for SARS-CoV-2 but concerns regarding performance, especially sensitivity, remain. Limited data exists for use of antigen testing in asymptomatic patients; thus, performance and reliability of antigen testing remains unclear. Methods 148 symptomatic and 144 asymptomatic adults were included. A nasal swab was collected for testing by Quidel Sofia SARS IFA (Sofia) as point of care. A nasopharyngeal swab was also collected and transported to the laboratory for testing by Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV RT-PCR (Cepheid). Results Overall, Sofia had good agreement with Cepheid (> 95%) in adults, however was less sensitive. Sofia had a sensitivity of 87.8% and 33.3% for symptomatic and asymptomatic patients, respectively. Among symptomatic patients, testing > 5 days post symptom onset resulted in lower sensitivity (82%) when compared with testing within 5 days of symptom onset (90%). Of the four Sofia false-negative results in the asymptomatic cohort, 50% went on to develop COVID-19 disease within 5 days of testing. Specificity in both symptomatic and asymptomatic cohorts was 100%. Conclusions Sofia has acceptable performance in symptomatic adults when tested < 5 days of symptom onset. Caution should be taken when testing patients with ≥ 5 days of symptoms. The combination of low prevalence and reduced sensitivity results in relatively poor performance of in asymptomatic patients. NAAT-based diagnostic assays should be considered in when antigen testing is unreliable, particularly in symptomatic patients with > 5 days of symptom onset and asymptomatic patients.
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Affiliation(s)
- Stephanie L Mitchell
- Department of Pathology, University of Pittsburgh, 3477 Euler Way, Clinical Laboratory Building-6th Floor, Pittsburgh, PA, 15213, USA.
| | - Steven Orris
- Division of General Internal Medicine, Center for Research On Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tanner Freeman
- Department of Pathology, University of Pittsburgh, 3477 Euler Way, Clinical Laboratory Building-6th Floor, Pittsburgh, PA, 15213, USA
| | - Megan C Freeman
- Department of Pediatrics, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Michelle Adam
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Meredith Axe
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jamie Gribschaw
- Clinical Microbiology Laboratory, UPMC Hospital System, Pittsburgh, PA, 15261, USA
| | - Joe Suyama
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Alejandro Hoberman
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Alan Wells
- Department of Pathology, University of Pittsburgh, 3477 Euler Way, Clinical Laboratory Building-6th Floor, Pittsburgh, PA, 15213, USA
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7
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Dawood FS, Varner M, Munoz F, Stockwell MS, Suyama J, Li DK, Tita A, Mathias L, Shakib JH, Piedra PA, Gyamfi-Bannerman C, Weissman A, Ferber J, Battarbee AN, Wesley MG, Vorwaller K, Powers E, Gibson M, Bond N, Santarcangelo P, Avadhanula V, Newes-Adeyi G, Hunt DR, Subramaniam A, Sanusi A, Boone A, Ogokeh C, Macio I, Odouli R, Thind P, Vargas CY, Almonte C, Galang R, Shapiro-Mendoza C, Campbell AP. Respiratory Viral Infections and Infection Prevention Practices among Women with Acute Respiratory Illness during Delivery Hospitalizations during the 2019-2020 Influenza Season. J Infect Dis 2021; 225:50-54. [PMID: 34037764 DOI: 10.1093/infdis/jiab292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/21/2021] [Indexed: 11/12/2022] Open
Abstract
We conducted a cross-sectional study of pregnant women with acute respiratory illness during delivery hospitalizations in influenza season to describe clinical testing for respiratory viruses and infection prevention practices. Women had nasal swabs tested for influenza and other respiratory viruses. Among 91 enrolled women, 22 (24%) had clinical testing for influenza. Based on clinical and study testing combined, 41/91 (45%) women had samples positive for respiratory viruses. The most common virus was influenza (17/91, 19%); 53% (9/17) of influenza virus infections were identified through study testing alone. Only 16% of women were on droplet precautions. Peripartum respiratory infections may be underrecognized.
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Affiliation(s)
- Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Flor Munoz
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA.,New York-Presbyterian Hospital, New York, NY, USA
| | - Joe Suyama
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - De-Kun Li
- Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, CA, USA
| | - Alan Tita
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Julie H Shakib
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Pedro A Piedra
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Cynthia Gyamfi-Bannerman
- New York-Presbyterian Hospital, New York, NY, USA.,Department of OBGYN, Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, USA
| | - Alexandra Weissman
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeannette Ferber
- Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, CA, USA
| | - Ashley N Battarbee
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kelly Vorwaller
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Emily Powers
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Marie Gibson
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Nanette Bond
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Patricia Santarcangelo
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Vasanthi Avadhanula
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Akila Subramaniam
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ayodeji Sanusi
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy Boone
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Constance Ogokeh
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ingrid Macio
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Roxana Odouli
- Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, CA, USA
| | - Priyam Thind
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Celibell Y Vargas
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Casandra Almonte
- Department of OBGYN, Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, USA
| | - Romeo Galang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carrie Shapiro-Mendoza
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela P Campbell
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
ABSTRACT Bautz, J, Hostler, D, Khorana, P, and Suyama, J. Cardiovascular effects of compression garments during uncompensable heat stress. J Strength Cond Res 35(4): 1058-1065, 2021-This study examined the potential hemodynamic benefits of wearing lower extremity compression garments (CGs) beneath thermal protective clothing (TPC) worn by wildland firefighters, while exercising in a heated environment. Using in a counterbalanced design, 10 male subjects ([mean ± SD] age 27 ± 6 years, height 1.78 ± 0.09 m, body mass 74.8 ± 7.0 kg, body fat 10.6 ± 4.2%, and V̇o2max 57.8 ± 9.3 ml·kg-1·min-1) completed control (no CG) and experimental (CG) conditions in randomly assigned order. Protocols were separated by a minimum of 3 days. Subjects exercised for 90 minutes (three, 30-minute segments) on a treadmill while wearing wilderness firefighter TPC and helmet in a heated room. Venous blood was drawn before and after exercise to measure hemoglobin (Hgb), hematocrit (Hct), serum osmolarity (OSM), and serum creatine phosphokinase (CPK). Vital signs and perceptual measures of exertion and thermal comfort were recorded during the protocol. Data were analyzed by the paired t-test. There were no differences in the change in heart rate (84 ± 27 vs. 85 ± 14 b·min-1, p = 0.9), core temperature rise (1.8 ± 0.6 vs. 1.9 ± 0.5° C, p = 0.39), or body mass lost (-1.72 ± 0.78 vs. -1.77 ± 0.58 kg, p = 0.7) between the conditions. There were no differences in the change in Hgb (0.49 ± 0.66 vs. 0.33 ± 1.11 g·dl-1, p = 0.7), Hct (1.22 ± 1.92 vs. 1.11 ± 3.62%, p = 0.9), OSM (1.67 ± 6.34 vs. 6.22 ± 11.39 mOsm·kg-1, p = 0.3), or CPK (22.2 ± 30.2 vs. 29.8 ± 19.4 IU·L-1, p = 0.5). Total distance walked (3.9 ± 0.5 vs. 4.0 ± 0.5 miles, p = 0.2), exercise interval (88.6 ± 3.5 vs. 88.4 ± 3.6 minutes, p = 0.8), and perceptual measures were similar between conditions. Compression garments worn beneath TPC did not acutely alter the physiologic response to exertion in TPC. With greater use in the general public related to endurance activities, the data neither encourage nor discourage CG use during uncompensable heat stress.
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Affiliation(s)
- Joshua Bautz
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - David Hostler
- Center for Research and Education in Special Environments, Exercise and Nutrition Sciences, SUNY University at Buffalo, Buffalo, New York
| | - Priya Khorana
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Joe Suyama
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
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Eisaman D, Geyer S, McFarland J, Fleming C, Suyama J. 60 The Value of an Integrated Sexual Assault Nurse Examiner Program at Trauma Centers: Comparing the Quality of Documentation. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Balasubramani GK, Nowalk MP, Sax TM, Suyama J, Bobyock E, Rinaldo CR, Martin ET, Monto AS, Jackson ML, Gaglani MJ, Flannery B, Chung JR, Zimmerman RK. Influenza vaccine effectiveness among outpatients in the US Influenza Vaccine Effectiveness Network by study site 2011-2016. Influenza Other Respir Viruses 2020; 14:380-390. [PMID: 32298048 PMCID: PMC7298285 DOI: 10.1111/irv.12741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Influenza vaccination is recommended for all US residents aged ≥6 months. Vaccine effectiveness (VE) varies by age, circulating influenza strains, and the presence of high‐risk medical conditions. We examined site‐specific VE in the US Influenza VE Network, which evaluates annual influenza VE at ambulatory clinics in geographically diverse sites. Methods Analyses were conducted on 27 180 outpatients ≥6 months old presenting with an acute respiratory infection (ARI) with cough of ≤7‐day duration during the 2011‐2016 influenza seasons. A test‐negative design was used with vaccination status defined as receipt of ≥1 dose of any influenza vaccine according to medical records, registries, and/or self‐report. Influenza infection was determined by reverse‐transcription polymerase chain reaction. VE estimates were calculated using odds ratios from multivariable logistic regression models adjusted for age, sex, race/ethnicity, time from illness onset to enrollment, high‐risk conditions, calendar time, and vaccination status‐site interaction. Results For all sites combined, VE was statistically significant every season against all influenza and against the predominant circulating strains (VE = 19%‐50%) Few differences among four sites in the US Flu VE Network were evident in five seasons. However, in 2015‐16, overall VE in one site was 24% (95% CI = −4%‐44%), while VE in two other sites was significantly higher (61%, 95% CI = 49%‐71%; P = .002, and 53%, 95% CI = 33,67; P = .034). Conclusion With few exceptions, site‐specific VE estimates aligned with each other and overall VE estimates. Observed VE may reflect inherent differences in community characteristics of the sites and highlights the importance of diverse settings for studying influenza vaccine effectiveness.
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Affiliation(s)
- Goundappa K Balasubramani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Patricia Nowalk
- Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theresa M Sax
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joe Suyama
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily Bobyock
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles R Rinaldo
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Arnold S Monto
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Manjusha J Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, TX, USA
| | | | - Jessie R Chung
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard K Zimmerman
- Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Suyama J, Yang F, Soriano A, Rao H, Arya L. 25: Mechanisms underlying nocturia in women with bladder pain syndrome/interstitial cystitis. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Approximately 35% to 37% of older emergency department (ED) patients will have delirium or dementia, which can negatively affect safe and appropriate clinical care. This article describes the epidemiology of delirium and dementia in the ED and how it affects clinical care and patient outcomes. Screening for delirium and dementia in the context of the busy ED environment, as well as their diagnostic evaluation and management, is discussed.
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Affiliation(s)
- Jin H Han
- Department of Emergency Medicine, Center for Quality Aging, Vanderbilt University Medical Center, 311 Oxford House, Nashville, TN 37232, USA.
| | - Joe Suyama
- Department of Emergency Medicine, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, 3600 Forbes Tower, Pittsburgh, PA 15213, USA
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Suyama J, McEntire SJ, Rittenberger JC, Rosalky D, Reis SE, Hostler D. Pilot Study Examining the Effects of Atropine on Performance during Uncompensable Heat Stress. PREHOSP EMERG CARE 2015; 20:283-91. [PMID: 26528941 DOI: 10.3109/10903127.2015.1076092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED In many operational scenarios, hypohydration can be corrected with oral rehydration following the work interval. Although rare, there are potential situations that require extended intervals of uncompensable heat stress exposure while working in personal protective equipment (PPE). Under these conditions, retention of body water may be valuable to preserve work capacity and reduce cardiovascular strain. We conducted a pilot study comparing intramuscular atropine sulfate versus saline placebo to establish the safety profile of the protocol and to provide pilot data for future investigations. Five, healthy, heat-acclimated subjects completed this crossover design laboratory study. Each subject performed up to one hour of exertion in a hot environment while wearing a chemical resistant coverall. Atropine sulfate (0.02 mg/kg) or an equivalent volume of sterile saline was administered by intramuscular injection. Core temperature, heart rate, perceptual measures, and changes in body mass were measured. All five subjects completed the acclimation period and both protocols. No adverse events occurred, and no pharmacologically induced delirium was identified. Change in body mass was less following exercise influenced by atropine sulfate (p = 0.002). Exertion time tended to be longer in the atropine sulfate arm (p = 0.08). Other measures appeared similar between groups. Intramuscular atropine sulfate reduced sweating and tended to increase the work interval under uncompensable heat stress when compared to saline placebo. Heart rate and temperature changes during exertion were similar in both conditions suggesting that the influence of an anticholinergic agent on thermoregulation may be minimal during uncompensable heat stress. KEY WORDS thermoregulation; cholinolytic; anticholinergic; reaction time.
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Dickson R, Kim JO, Huq MS, Bednarz G, Suyama J, Yealy DM, Wang H, Greenberger JS. A Mobile Alert System for Preparing the Delivery of Radiation Mitigators. In Vivo 2015; 29:505-513. [PMID: 26359406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND/AIM A mobile system allowing hospital medical personnel to prepare for the administration of radiation mitigators prior to receiving casualties is desirable. MATERIALS AND METHODS We evaluated a portable spectroscopic personal radiation detector for use as an ambulance-based unit for early detection and identification of gamma radiation. We tested the sensitivity, time-to-identification, and radionuclide identification accuracy rates, change in detector response to vehicle operation, interference from cardiac equipment, and internal versus external radiation source location. RESULTS We detected radiation sources in each of 119 trials using a humanoid phantom in a moving ambulance with a primary radionuclide identification accuracy of 96%. Typical identification time was around two minutes (149±95 s). CONCLUSION Our observations suggest this mobile system is a potential pre-hospital arrival tool allowing for rapid preparation of radiation mitigators.
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Affiliation(s)
- Ryan Dickson
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, U.S.A
| | - Jong Oh Kim
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, U.S.A
| | - Mohammed Saiful Huq
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, U.S.A
| | - Greg Bednarz
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, U.S.A
| | - Joe Suyama
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, U.S.A
| | - Donald M Yealy
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, U.S.A
| | - Hong Wang
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, U.S.A
| | - Joel S Greenberger
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, U.S.A.
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Stoler GB, Johnston JR, Stevenson JA, Suyama J. Preparing emergency personnel in dialysis: a just-in-time training program for additional staffing during disasters. Disaster Med Public Health Prep 2014; 7:272-7. [PMID: 21527642 DOI: 10.1001/dmp.2011.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND There are 341 000 patients in the United States who are dependent on routine dialysis for survival. Recent large-scale disasters have emphasized the importance of disaster preparedness, including supporting dialysis units, for people with chronic disease. Contingency plans for staffing are important for providing continuity of care for a technically challenging procedure such as dialysis. PReparing Emergency Personnel in Dialysis (PREP-D) is a just-in-time training program designed to train individuals having minimum familiarity with the basic steps of dialysis to support routine dialysis staff during a disaster. METHODS A 5-module educational program was developed through a collaborative, multidisciplinary effort. A pilot study testing the program was performed using 20 nontechnician dialysis facility employees and 20 clinical-year medical students as subjects. RESULTS When comparing pretest and posttest scores, the entire study population showed a mean improvement of 28.9%, with dialysis facility employees and medical students showing improvements of 21.8% and 36.4%, respectively (P < .05 for all comparisons). CONCLUSIONS PREP-D participants were able to demonstrate improved tests scores when taught in a just-in-time training format. The knowledge gained by using the PREP-D program during a staffing shortage may allow for continuity of care for critical services such as dialysis during a disaster.
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Abstract
PURPOSE To investigate the effect of ice slurry ingestion precooling on body core temperature (Tc) during exertion in wildland firefighting garments in uncompensable heat stress. METHODS On two separate trials, 10 males ingested 7.5 g·kg(-1) of either an ice slurry (0.1°C) or control beverage (20°C) during seated rest for 30 minutes prior to simulating the U.S. Forest Service Pack Test on a treadmill in wildland firefighting garments in a hot environment (38.8 ± 1.2°C, 17.5 ± 1.4% relative humidity). Deep gastric temperature, mean skin temperature (Tsk), and heart rate (HR) were recorded. Ratings of perceived exertion, thermal sensation, comfort, and sweating were assessed. RESULTS Compared with ingestion of a temperate beverage, precooling with ice slurry before exertion in a hot environment reduced Tc during the first 30 minutes of the exercise bout. Exercise time and distance completed were not different between treatments. Skin temperature, heart rate, and perceptual responses rose in both conditions during exercise but did not differ by condition. CONCLUSION Pretreatment with ice slurry prior to exertion in wildland firefighting garments results in a modest reduction in Tc during the first 30 minutes of exercise when compared to pretreatment with control beverage but the ice slurry precooling advantage did not persist throughout the 45-minute exercise protocol.
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18
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Hostler D, Suyama J, Guyette FX, Moore CG, Pryor RR, Khorana P, McEntire SJ, Comer D, Reis SE. A Randomized Controlled Trial of Aspirin and Exertional Heat Stress Activation of Platelets in Firefighters during Exertion in Thermal Protective Clothing. PREHOSP EMERG CARE 2014; 18:359-67. [DOI: 10.3109/10903127.2013.869644] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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19
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Patterson PD, Suyama J, Reis SE, Weaver MD, Hostler D. What does it cost to prevent on-duty firefighter cardiac events? A content valid method for calculating costs. Adv Prev Med 2013; 2013:972724. [PMID: 24455288 PMCID: PMC3881339 DOI: 10.1155/2013/972724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/29/2013] [Indexed: 11/17/2022] Open
Abstract
Cardiac arrest is a leading cause of mortality among firefighters. We sought to develop a valid method for determining the costs of a workplace prevention program for firefighters. In 2012, we developed a draft framework using human resource accounting and in-depth interviews with experts in the firefighting and insurance industries. The interviews produced a draft cost model with 6 components and 26 subcomponents. In 2013, we randomly sampled 100 fire chiefs out of >7,400 affiliated with the International Association of Fire Chiefs. We used the Content Validity Index (CVI) to identify the content valid components of the draft cost model. This was accomplished by having fire chiefs rate the relevancy of cost components using a 4-point Likert scale (highly relevant to not relevant). We received complete survey data from 65 fire chiefs (65% response rate). We retained 5 components and 21 subcomponents based on CVI scores ≥0.70. The five main components include, (1) investment costs, (2) orientation and training costs, (3) medical and pharmaceutical costs, (4) education and continuing education costs, and (5) maintenance costs. Data from a diverse sample of fire chiefs has produced a content valid method for calculating the cost of a prevention program among firefighters.
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Affiliation(s)
- P. Daniel Patterson
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, 3600 Forbes Avenue, Suite 400A, Pittsburgh, PA 15261, USA
| | - Joe Suyama
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, 3600 Forbes Avenue, Suite 400A, Pittsburgh, PA 15261, USA
| | - Steven E. Reis
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, 3600 Forbes Avenue, Suite 400A, Pittsburgh, PA 15261, USA
| | - Matthew D. Weaver
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, 3600 Forbes Avenue, Suite 400A, Pittsburgh, PA 15261, USA
| | - David Hostler
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, 3600 Forbes Avenue, Suite 400A, Pittsburgh, PA 15261, USA
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Abstract
University of Pittsburgh Medical Center (UPMC) installed an Emergency Department Notification System (EDNS) in one of its hospitals. The system, manufactured by Thermo Fisher Scientific (Thermo Fisher Scientific, Inc., 81 Wyman Street, Waltham, MA 02454), consists of four NaI(Tl) scintillation detectors, a 2.5 L PVT gamma counter, a 512 channels multi-channel analyzer, a system controller, and a database-monitoring server. We evaluated a portable Interceptor Interceptor™ hand-held detector (Thermo Fisher Scientific, Inc., 81 Wyman Street, Waltham, MA 02454) as part of the system for potential ambulancebased early detection and warning unit. We present the minimum detectable activity, distance, and isotope identification success rates along with the change in detector response to various radioisotope sources placed in a Rando® humanoid phantom. (The Phantom Laboratory. P.O. Box 511, Salem, NY 12865-0511 USA). The present paper reports these results.
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Affiliation(s)
- Ryan Dickson
- *University of Pittsburgh, Cancer Institute, 5150 Center Avenue, Pittsburgh PA 15232
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21
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Goss FL, Robertson RJ, Gallagher M, Haile L, Morley J, Suyama J, Hostler D. VALIDATION OF THE OMNI SCALE OF THERMAL SENSATIONS 1,2. Percept Mot Skills 2013. [DOI: 10.2466/27.29.pms.116.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Abstract
Concurrent and construct validation of the OMNI Scale of Thermal Sensations was examined in a sample of 16 adult men and 5 adult women. Concurrent validity was established by regressing OMNI ratings of thermal sensation against core and skin temperatures obtained during treadmill walking while wearing firefighter thermal-protective clothing in temperatures between 33 and 35°C. Construct validity was established by regressing the OMNI scale against a construct-specific visual analogue scale. OMNI scale responses accounted for statistically significant variance in both skin temperature and core temperature (48% and 51%, respectively) and visual analogue scale responses (84%). Concurrent and construct validity were established for the OMNI Scale of Thermal Sensations in healthy adults performing treadmill walking while wearing fire fighter thermal protective clothing.
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Affiliation(s)
- Fredric L. Goss
- Center for Exercise and Health-Fitness Research, University of Pittsburgh
- Emergency Responder Human Performance Lab, Department of Emergency Medicine, University of Pittsburgh Medical Center
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Liu TY, Sanders JL, Tsui FC, Espino JU, Dato VM, Suyama J. Association of over-the-counter pharmaceutical sales with influenza-like-illnesses to patient volume in an urgent care setting. PLoS One 2013; 8:e59273. [PMID: 23555647 PMCID: PMC3605458 DOI: 10.1371/journal.pone.0059273] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/13/2013] [Indexed: 12/03/2022] Open
Abstract
We studied the association between OTC pharmaceutical sales and volume of patients with influenza-like-illnesses (ILI) at an urgent care center over one year. OTC pharmaceutical sales explain 36% of the variance in the patient volume, and each standard deviation increase is associated with 4.7 more patient visits to the urgent care center (p<0.0001). Cross-correlation function analysis demonstrated that OTC pharmaceutical sales are significantly associated with patient volume during non-flu season (p<0.0001), but only the sales of cough and cold (p<0.0001) and thermometer (p<0.0001) categories were significant during flu season with a lag of two and one days, respectively. Our study is the first study to demonstrate and measure the relationship between OTC pharmaceutical sales and urgent care center patient volume, and presents strong evidence that OTC sales predict urgent care center patient volume year round.
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Affiliation(s)
- Timothy Y. Liu
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jason L. Sanders
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Fu-Chiang Tsui
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Real-time Outbreak and Disease Surveillance Laboratory, Pittsburgh, Pennsylvania, United States of America
| | - Jeremy U. Espino
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Real-time Outbreak and Disease Surveillance Laboratory, Pittsburgh, Pennsylvania, United States of America
| | - Virginia M. Dato
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Pennsylvania Department of Health, Harrisburg, Pennsylvania, United States of America
| | - Joe Suyama
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- University of Pittsburgh Medical Center Urgent Care at Shadyside, Pittsburgh, Pennsylvania, United States of America
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McEntire SJ, Suyama J, Hostler D. Mitigation and Prevention of Exertional Heat Stress in Firefighters: A Review of Cooling Strategies for Structural Firefighting and Hazardous Materials Responders. PREHOSP EMERG CARE 2013; 17:241-60. [DOI: 10.3109/10903127.2012.749965] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Serina J. McEntire
- From the Department of Emergency Medicine, Emergency Responder Human Performance Laboratory, University of Pittsburgh,
Pittsburgh, Pennsylvania
| | - Joe Suyama
- From the Department of Emergency Medicine, Emergency Responder Human Performance Laboratory, University of Pittsburgh,
Pittsburgh, Pennsylvania
| | - David Hostler
- From the Department of Emergency Medicine, Emergency Responder Human Performance Laboratory, University of Pittsburgh,
Pittsburgh, Pennsylvania
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Abstract
OBJECTIVE To compare and contrast three different training modalities for fit testing N-95 respirator face masks. DESIGN Block randomized interventional study. SETTING Urban university. PARTICIPANTS Two hundred eighty-nine medical students. INTERVENTIONS Students were randomly assigned to video, lecture, or slide show to evaluate the effectiveness of the methods for fit testing large groups of people. MAIN OUTCOME MEASURES Ease of fit and success of fit for each instructional technique. RESULTS Mask 1 was a Kimberly-Clark duckbill N-95 respirator mask, and mask 2 was a 3M™ carpenters N-95 respirator mask. "Ease of fit" was defined as the ability to successfully don a mask in less than 30 seconds. "Success of fit" was defined as the ability to correctly don a mask in one try. There were no statistical differences by training modality for either mask regarding ease of fit or success of fit. CONCLUSION There were no differences among video presentation, small group demonstration, and self-directed slide show just-in-time training modalities for ease of fit or success of fit N-95 respirator mask fitting. Further study is needed to explore more effective fit training modalities.
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Affiliation(s)
- David Jones
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Genevieve Stoler
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joe Suyama
- Associate Professor, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Kong PW, Suyama J, Cham R, Hostler D. The relationship between physical activity and thermal protective clothing on functional balance in firefighters. Res Q Exerc Sport 2012; 83:546-52. [PMID: 23367817 PMCID: PMC4895198 DOI: 10.1080/02701367.2012.10599144] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We investigated the relationship between baseline physical training and the use of firefighting thermal protective clothing (TPC) with breathing apparatus on functional balance. Twenty-three male firefighters performed a functional balance test under four gear/clothing conditions. Participants were divided into groups by physical training status, and task performance was analyzed. There was an effect of equipment and training status on performance with the group reporting both aerobic and resistance training performing better than the group reporting no physical training. In conclusion, firefighters walk more slowly as a strategy to maintain balance when wearing TPC, which may be suboptimal given the emergent nature of fire suppression. This result was most prominent in the group reporting no physical training.
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Affiliation(s)
- Pui W Kong
- Department of Emergency Medicine, University of Pittsburgh, PA 15261, USA
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Guyette F, Suyama J, Rosen J, Allswede M. Prevalence of Radioactive Signals from Surveillance of an Emergency Department. Prehosp Disaster Med 2012; 21:276-81. [PMID: 17076430 DOI: 10.1017/s1049023x00003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:Since the 11 September 2001 terrorist attacks in the United States, concerns have been raised regarding the threat of a radiological terrorist weapon. Although the probability of the employment of a nuclear device is remote, the potential of a radiological dispersal device (RDD) or “dirty bomb” is of concern. While it is unlikely that such a device would produce massive numbers of casualties, it is far more likely that it would result in pub- lic panic and perhaps even disable the local healthcare system. The utility of surveillance with radiation detectors in the healthcare setting has not been fully evaluated.Objective:The objective of this study was to characterize the prevalence of radioactive sources entering an urban emergency department (ED).Methods:A retrospective review of data obtained from a radiation detector positioned to detect radioactive people entering an ED of an urban academic hospital that serves 45,000 patients/year was performed. Graphical outputs of radioactivity were recorded in Microsoft ExcelTM (Microsoft, Redmond, WA, US) spreadsheets in microREM/hour. Data were collected continuous-ly from 22 December 2003 to 22 January 2004. An event was defined as any elevation in radiation levels >95% confidence interval from the mean level of background radiation over 72 hours (h).Results:A total of 215 events were observed over a 28-day period, with a mean value of 7.7 events/day, and a maximum of 15 events/day. During the 28-day period, the baseline mean level of background radiation was 2–4 microREM/h. Readings ranged from 2,148.28–17,292.25 microREM/h with a maximum sustained detector exposure of 684.37 microREM. Distinct signal patterns were seen at both detectors including tonic, phasic, dual, and short duration spikes.Conclusion:The number of radioactive signals detected from persons entering the ED was much higher than expected. While the vast majority of these signals pose no health threat, they may make routine screening for a radiological terrorist event difficult.Further study is needed to determine this correlation.
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Affiliation(s)
- Frank Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Abstract
Special Weapons and Tactics (SWAT) operators are specialized law enforcement officers who traditionally perform their duties with higher anticipated workloads because of additional body armor, weapons, and equipment used for enhanced operations and protection. This elevated workload increases the need for SWAT operators to improve or maintain their physical fitness to consistently perform routine operations. Typical tasks require trunk rotation, overhead upper extremity use, upper and lower body strength use, and long waiting periods followed by explosive movements while wearing additional equipment. Eleven male SWAT operators from 1 SWAT team performed flexibility, strength, power, and aerobic capacity tests and a variety of job-related tasks. Data were compared with age- and gender-based normative data. Fitness testing revealed that officers ranked high on tests of muscular strength (leg strength, 90th percentile; bench press, 85th percentile); however, body composition (55th percentile), core body strength, and flexibility ranked lower. Furthermore, aerobic capacity and muscular power had a wide range of scores and were also not ideal to support maximal performance during routine operations. These data can assist exercise specialists choose fitness programs specifically for job-related tasks of SWAT operators when creating fitness programs. Fitness programming for law enforcement should focus on improving aerobic fitness, flexibility, core strength, and muscular power while maintaining muscular strength to meet the needs of these specialized officers.
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Affiliation(s)
- Riana R Pryor
- Department of Emergency Medicine, Emergency Responder Human, Performance Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Bourlai T, Pryor RR, Suyama J, Reis SE, Hostler D. Use of thermal imagery for estimation of core body temperature during precooling, exertion, and recovery in wildland firefighter protective clothing. PREHOSP EMERG CARE 2012; 16:390-9. [PMID: 22510022 DOI: 10.3109/10903127.2012.670689] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Monitoring core body temperature to identify heat stress in first responders and in individuals participating in mass gatherings (e.g., marathons) is difficult. OBJECTIVE This study utilized high-sensitivity thermal imaging technology to predict the core temperature of human subjects at a distance while performing simulated field operations wearing thermal protective garments. METHODS Six male subjects participating in a study of precooling prior to exertion in wildland firefighter thermal protective clothing had thermal images of the face captured with a high-resolution thermal imaging camera concomitant with measures of core and skin temperature before, during, and after treadmill exercise in a heated room. Correlations and measures of agreement between core temperature and thermal imaging-based temperature were performed. RESULTS The subjects walked an average (± standard deviation) of 42.6 (±5.9) minutes and a distance of 4.2 (±0.6) km on the treadmill. Mean heart rate at the end of exercise was 152 (±33) bpm and core body temperature at the end of exercise was 38.3°C (±0.7°C). A visual relationship and a strong correlation between core temperature and thermal imaging of the face were identified in all subjects, with the closest relationship and best agreement occurring during exercise. The Bland-Altman test of agreement during exercise revealed the majority of measurement pairs to be within two standard deviations of the measured temperature. CONCLUSIONS High-resolution thermal imaging in the middle-wave infrared spectrum (3-5 μm) can be used to accurately estimate core body temperature during exertion in a hot room while participants are wearing wildland firefighting garments. Although this technology is promising, it must be refined. Using alternative measurement sites such as the skin over the carotid artery, using multiple measurement sites, or adding pulse detection may improve the estimation of body temperature by thermal imagery.
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Affiliation(s)
- Thirimachos Bourlai
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, West Virginia, USA
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Pryor RR, Seitz JR, Morley J, Suyama J, Guyette FX, Reis SE, Hostler D. Estimating Core Temperature with External Devices After Exertional Heat Stress in Thermal Protective Clothing. PREHOSP EMERG CARE 2012; 16:136-41. [DOI: 10.3109/10903127.2011.614047] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Machi MS, Staum M, Callaway CW, Moore C, Jeong K, Suyama J, Patterson PD, Hostler D. The relationship between shift work, sleep, and cognition in career emergency physicians. Acad Emerg Med 2012; 19:85-91. [PMID: 22221346 DOI: 10.1111/j.1553-2712.2011.01254.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The 24-hour physician coverage of the emergency department (ED) requires shift work, which can result in desynchronosis and cognitive decline. We measured changes in cognition and sleep disturbance in attending emergency physicians (EPs) before and after day and overnight shifts. METHODS Thirteen EPs were tested before and after day and overnight shifts using the Paced Auditory Serial Addition Test (PASAT), the University of Southern California Repeatable Episodic Memory Test (REMT), the Trail Making Test (TMT), and the Stroop Color-Word Test. Sleep quality and fatigue were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Chalder Fatigue Questionnaire (CFQ). Saliva samples were collected from each physician immediately before and after day shifts and night shifts for neurohormonal assays. RESULTS Significantly fewer words were recalled on the REMT after both day (-2.4, 95% confidence interval [CI] = -4.4 to -0.4) and overnight shifts (-4.6, 95% CI = -6.4 to -2.8). There was a significant postshift increase in words recalled from the last third of the REMT list after overnight shifts (6.6, 95% CI = 2.8 to 10.4). Sleep quality was worse in EPs (mean PSQI = 4.8, SD ± 2.5) compared to the normal population, with 31% of subjects reporting poor sleep quality. Postshift fatigue was correlated with the perceived difficulty of the shift. Salivary cortisol and melatonin demonstrated diurnal variation consistent with normal circadian rhythms. Morning cortisol peak was decreased or delayed in samples from physicians after a night shift. CONCLUSIONS These data indicate that short-term memory appears to decline after day and overnight shifts and confirms the high incidence of disturbed sleep in this population.
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Affiliation(s)
- Mari S Machi
- Department of Emergency Medicine, Emergency Responder Human Performance Lab, University of Pittsburgh, Pittsburgh, PA, USA
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Morley J, Beauchamp G, Suyama J, Guyette FX, Reis SE, Callaway CW, Hostler D. Cognitive function following treadmill exercise in thermal protective clothing. Eur J Appl Physiol 2011; 112:1733-40. [PMID: 21892644 DOI: 10.1007/s00421-011-2144-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 08/18/2011] [Indexed: 11/25/2022]
Abstract
Occupational injuries are common among firefighters who perform strenuous physical exertion in extreme heat. The thermal protective clothing (TPC) worn by firefighters inhibits normal thermoregulation, placing the firefighter at risk of hypohydration and hyperthermia that may result in cognitive decline. We tested whether cognitive function changes after treadmill exercise in TPC. In an initial study (Cog 1), ten healthy volunteers performed up to 50 min of treadmill exercise while wearing TPC in a heated room. A battery of neurocognitive tests evaluating short-term memory, sustained and divided attention, and reaction time was administered immediately before and after exercise. In a follow-up study (Cog 2), 19 healthy volunteers performed a similar exercise protocol with the battery of cognitive tests administered pre-exercise, immediately post-exercise, and serially up to 120 min after exercise. Subjects performed 46.4 ± 4.6 and 48.1 ± 3.6 min of exercise in the Cog 1 and Cog 2, respectively. In both studies heart rate approached age predicted maximum, body mass was reduced 1.0-1.5 kg, and body core temperature increased to levels similar to what is seen after fire suppression. Neurocognitive test scores did not change immediately after exercise. Recall on a memory test was reduced 60 and 120 min after exercise. The mean of the 10 slowest reaction times increased in the 120 min after exercise. Fifty minutes of treadmill exercise in TPC resulted in near maximal physiologic strain but alterations in neurocognitive performance were not noted until an hour or more following exercise in TPC.
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Affiliation(s)
- Julia Morley
- Department of Emergency Medicine, Emergency Responder Human Performance Lab, University of Pittsburgh, 3600 Forbes Ave, Suite 400A, Pittsburgh, PA 15213, USA
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Goss FL, Robertson RJ, Gallagher M, Haile L, Morley J, Suyama J, Hostler D. Validation Of The OMNI Thermal Sensation Scale. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000401884.69567.ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Colburn D, Suyama J, Reis SE, Morley JL, Goss FL, Chen YF, Moore CG, Hostler D. A comparison of cooling techniques in firefighters after a live burn evolution. PREHOSP EMERG CARE 2011; 15:226-32. [PMID: 21294631 DOI: 10.3109/10903127.2010.545482] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We compared the use of two active cooling devices with passive cooling in a moderate-temperature (≈ 22 °C) environment on heart rate (HR) and core temperature (T(c)) recovery when applied to firefighters following 20 minutes of fire suppression. METHODS Firefighters (23 men, two women) performed 20 minutes of fire suppression at a live-fire evolution. Immediately following the evolution, the subjects removed their thermal protective clothing and were randomized to receive forearm immersion (FI), ice water perfused cooling vest (CV), or passive (P) cooling in an air-conditioned medical trailer for 30 minutes. Heart rate and deep gastric temperature were monitored every 5 minutes during recovery. RESULTS A single 20-minute bout of fire suppression resulted in near-maximal mean ± standard deviation HR (175 ± 13 b min(-1), P; 172 ± 20 b·min(-1), FI; 177 ± 12 b·min(-1), CV) when compared with baseline (p < 0.001), a rapid and substantial rise in T(c) (38.2° ± 0.7°, P; 38.3° ± 0.4°, FI; 38.3° ± 0.3°, CV) compared with baseline (p < 0.001), and body mass lost from sweating of nearly 1 kilogram. Cooling rates (°C·min) differed (p = 0.036) by device, with FI (0.05 ± 0.04) providing higher rates than P (0.03 ± 0.02) or CV (0.03 ± 0.04), although differences over 30 minutes were small and recovery of body temperature was incomplete in all groups. CONCLUSIONS During 30 minutes of recovery following a 20-minute bout of fire suppression in a training academy setting, there is a slightly higher cooling rate for FI and no apparent benefit to CV when compared with P cooling in a moderate temperature environment.
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Affiliation(s)
- Deanna Colburn
- Center for Exercise and Health?Fitness Research, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA
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Hostler D, Reis SE, Bednez JC, Kerin S, Suyama J. Comparison of active cooling devices with passive cooling for rehabilitation of firefighters performing exercise in thermal protective clothing: a report from the Fireground Rehab Evaluation (FIRE) trial. PREHOSP EMERG CARE 2010; 14:300-9. [PMID: 20397868 DOI: 10.3109/10903121003770654] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thermal protective clothing (TPC) worn by firefighters provides considerable protection from the external environment during structural fire suppression. However, TPC is associated with physiologic derangements that may have adverse cardiovascular consequences. These derangements should be treated during on-scene rehabilitation periods. OBJECTIVE To examine heart rate and core temperature responses during the application of four active cooling devices, currently being marketed to the fire service for on-scene rehabilitation, and compare them with passive cooling in a moderate temperature (approximately 24 degrees C) and with an infusion of cold (4 degrees C) saline. METHODS Subjects exercised while they were wearing TPC in a heated room. Following an initial exercise period (bout 1), the subjects exited the room, removed the TPC, and for 20 minutes cooled passively at room temperature, received an infusion of cold normal saline, or were cooled by one of four devices (fan, forearm immersion in water, hand cooling, or water-perfused cooling vest). After cooling, the subjects donned the TPC and entered the heated room for another 50-minute exercise period (bout 2). RESULTS The subjects were not able to fully recover core temperature during a 20-minute rehabilitation period when provided rehydration and the opportunity to completely remove the TPC. Exercise durations were shorter during bout 2 when compared with bout 1 but did not differ by cooling intervention. The overall magnitudes and rates of cooling and heart rate recovery did not differ by intervention. CONCLUSIONS No clear advantage was identified when active cooling devices and cold intravenous saline were compared with passive cooling in a moderate temperature after treadmill exercise in TPC.
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Affiliation(s)
- David Hostler
- Department of Emergency Medicine, Emergency Responder Human Performance Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Hostler D, Bednez JC, Kerin S, Reis SE, Kong PW, Morley J, Gallagher M, Suyama J. Comparison of rehydration regimens for rehabilitation of firefighters performing heavy exercise in thermal protective clothing: a report from the fireground rehab evaluation (FIRE) trial. PREHOSP EMERG CARE 2010; 14:194-201. [PMID: 20095824 DOI: 10.3109/10903120903524963] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Performing fire suppression activities results in cardiovascular stress, hyperthermia, and hypohydration. Fireground rehabilitation (rehab) is recommended to blunt the deleterious effects of these conditions. OBJECTIVE We tested the hypothesis that three rehydration fluids provided after exercise while wearing thermal protective clothing (TPC) would produce different heart rate or core temperature responses during a second bout of exercise in TPC. METHODS On three occasions, 18 euhydrated firefighters (16 men, two women) wearing TPC completed a standardized, 50-minute bout of upper and lower body exercise in a hot room that mimicked the National Fire Protection Association (NFPA) rehabilitation guidelines of "two cylinders before rehab" (20 minutes of work, 10 minutes of recovery, 20 minutes of work). After an initial bout of exercise (bout 1), subjects were randomly assigned water, sport drink, or an intravenous (IV) infusion of normal saline equal to the amount of body mass lost during exercise. After rehydration, the subject performed a second bout of exercise (bout 2). Heart rates, core and skin temperatures, and exercise durations were compared with a two-way analysis of variance (ANOVA). RESULTS Subjects were firefighters with a mean (+/- standard deviation [SD]) age of 28.2 +/- 11.3 years and a mean peak oxygen consumption (VO(2peak)) of 37.4 +/- 3.4 mL/kg/min. The mean amount of fluid provided during the rehabilitation period was 527 +/- 302 mL. No subject could complete either the pre- or postrehydration 50-minute bout of exercise. The mean (+/-SD) times to exhaustion were longer (p < 0.001) in bout 1 (25.9 +/- 12.9 min, water; 28.0 +/- 14.1 min, sport drink; 27.4 +/- 13.8 min, IV) compared with bout 2 (15.6 +/- 9.6 min, water; 14.7 +/- 8.6 min, sport drink; 15.7 +/- 8.0 min, IV) for all groups but did not differ by intervention. All subjects approached their age-predicted maximum heart rate at the end of bout 1 (180 +/- 11 bpm) and bout 2 (176 +/- 13 bpm). Core temperature rose 1.1 degrees C +/- 0.7 degrees C during bout 1 and 0.5 degrees C +/- 0.4 degrees C during bout 2. Core temperatures, heart rates, and exercise times during bout 2 did not differ between the rehydration fluids. CONCLUSIONS Performances during a second bout of exercise in TPC did not differ when firefighters were rehydrated with water, sport drink, or IV normal saline when full rehydration was provided. Of concern was the inability of all subjects to complete two consecutive periods of heavy exercise in TPC, suggesting that the NFPA's "two cylinders before rehab" guideline may not be appropriate in continuous heavy work scenarios.
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Affiliation(s)
- David Hostler
- Department of Emergency Medicine, Emergency Responder Human Performance Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Colburn D, Reis SE, Suyama J, Morley J, Goss FL, Hostler D. A Comparison of Cooling Techniques in Firefighters After a Live Burn Evolution. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000386311.64785.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gallagher M, Robertson RJ, Nagle EF, Goss FL, Schafer MA, Hostler D, Suyama J. Development of a Perceptual Hyperthermia Index to Evaluate Heat Strain during Treadmill Exercise. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000385870.76923.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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40
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Kong PW, Beauchamp G, Suyama J, Hostler D. Effect of fatigue and hypohydration on gait characteristics during treadmill exercise in the heat while wearing firefighter thermal protective clothing. Gait Posture 2010; 31:284-8. [PMID: 19962897 DOI: 10.1016/j.gaitpost.2009.11.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 10/29/2009] [Accepted: 11/06/2009] [Indexed: 02/02/2023]
Abstract
This study compared the gait characteristics of individuals walking in heat while wearing firefighting equipment in fatigued and non-fatigued states. Nineteen subjects performed a 50-min treadmill protocol in a heated room while gait patterns were recorded using a digital video camcorder. Forty gait cycles were analyzed near the beginning (9 min) and at the end (39-49 min) of exercise. Spatio-temporal gait variables including step frequency, step length, swing time, stance time, cycle time and double-support time were determined. Gait variability was quantified by the standard deviation (SD) and coefficient of variation (CV) of each variable. Left-right symmetry was calculated using the symmetry index (SI) and symmetry angle (SA). Paired t-tests (alpha = 0.05) were performed to identify difference between the beginning and the end of the protocol for each measured variable. Spatio-temporal gait characteristics did not differ between the beginning and the end of exercise. Gait variability of the double-support time increased at the end as measured by both SD (P = 0.037) and CV (P = 0.030) but no change was observed for other variables. Left-right symmetry measured using either SI or SA did not differ between sessions. In summary, spatio-temporal gait characteristics and symmetry while wearing firefighting equipment are insensitive to physiological fatigue. Prolonged walking in heat while wearing firefighting equipment may increase gait variability and therefore the likelihood of a fall. Future studies are needed to confirm the potential relationship between fatigue and gait variability and to investigate the possible influence of individual variation.
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Affiliation(s)
- Pui W Kong
- Emergency Responder Human Performance Lab, Department of Emergency Medicine, University of Pittsburgh, Iroquois Building Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA 15261, USA
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Abstract
INTRODUCTION During normal operations, public safety personnel may become injured, leading them to seek medical care and possible time off. Examining the nature and patterns of injury may help to identify preventive health measures for all public safety personnel and address specific needs of each discipline based on actual risk. Objective. To determine the types and severity of injuries encountered by public safety personnel during routine work conditions within a single urban population. METHODS De-identified workers' compensation data for emergency medical services (EMS), fire, and police providers from one urban center between January 1, 2005, and May 31, 2007, were examined. Data included type of injury, severity of injury, and date of event. Severity was categorized as follows: lost time (type 1), medical evaluation (type 2), report only (type 3), restricted duty (type 4), and not reported (type 5). Analysis of variance (ANOVA) and a pairwise t-test between groups with a Bonferroni correction was performed to determine the relative risk of injuries between groups. RESULTS During the 29-month interval, an average workforce of 850 firefighters, 194 EMS providers, and 850 police officers were employed. A total of 1,295 workers' compensation events were documented, with 243 (18%) reported from EMS, 477 (36%) from fire, and 608 (46%) from police. Type 1 injuries were more common in fire (39%) and police (38%) than EMS (23%). EMS had higher rates of lost work (type 1) and medical evaluations (type 2) than both fire and police. Workers' compensation events common to all bureaus were minor trauma (76%) and exposures to blood-borne pathogens (12%). Minor traumatic injuries, mostly associated with axial musculoskeletal strains and extremity injuries, were responsible for the majority of injuries resulting in missed work. Injuries more common in a specific bureau included motor vehicle crashes and gunshot wounds (police) and cardiovascular disease, burns, and heat illness (fire). CONCLUSION Public safety personnel are affected by both profession-specific and non-profession-specific injuries. Overall, EMS has higher rates of missed time and medical evaluations than both fire and police. These data highlight the need to make direct comparisons of various public safety personnel bureaus using a common time interval and locale in order to rationally plan interventions and apply resources.
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Affiliation(s)
- Joe Suyama
- Department of Emergency Medicine, Emergency Responder Human Performance Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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Machi M, Suyama J, Rittenberger J, Guyette F, Moore C, Jeong K, Callaway C, Hoslter D. 419: Work-Induced Memory Decline in Emergency Medicine Attending Physicians. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hostler D, Gardner K, Pinchalk M, Northington WE, Suyama J. Characterization of the Atmosphere within Vapor-Resistant Encapsulating Personal Protective Equipment during Treadmill Exercise. PREHOSP EMERG CARE 2009; 13:379-83. [DOI: 10.1080/10903120902935249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hostler D, Kerin S, Bednez JC, Suyama J. Temperature Monitoring In Firefighters During And Following Exercise In Thermal Protective Clothing. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000356218.29198.4a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kong PW, Hostler D, Suyama J, Cham R. Effect Of Wearing Thermal Protective Clothing On Functional Balance In Male Firefighters. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000356217.29198.ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gallagher M, Bednez JC, Kerin S, Suyama J, Hostler D, Goss FL, Robertson RJ. The Relation Between Mood And Perceived Exertion Following Exercise In Thermal Protective Clothing. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000353730.46861.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sanders RW, Katz KD, Suyama J, Akhtar J, O'Toole KS, Corll D, Ladenburger RN. Seizure during hyperbaric oxygen therapy for carbon monoxide toxicity: a case series and five-year experience. J Emerg Med 2009; 42:e69-72. [PMID: 19372022 DOI: 10.1016/j.jemermed.2008.12.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2007] [Revised: 11/24/2008] [Accepted: 12/16/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hyperbaric oxygen (HBO) therapy is recommended to reduce the delayed neurologic sequelae resulting from carbon monoxide (CO) toxicity. Although HBO is generally well tolerated, there exists a risk of seizure in all patients that may be increased in patients with predisposing factors including: fever, hypothermia, prior seizure, or brain injury. CASE REPORT We present two cases of patients without known risk factors who experienced seizures associated with HBO therapy during treatment for CO toxicity. CONCLUSION This facility's 5-year experience and a review of the germane literature are also presented to elucidate the risk factors and incidence of seizures in patients treated with HBO for CO toxicity.
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Affiliation(s)
- Robert W Sanders
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA, USA
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Hostler D, Gallagher M, Goss FL, Seitz JR, Reis SE, Robertson RJ, Northington WE, Suyama J. The effect of hyperhydration on physiological and perceived strain during treadmill exercise in personal protective equipment. Eur J Appl Physiol 2008; 105:607-13. [PMID: 19037655 DOI: 10.1007/s00421-008-0940-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2008] [Indexed: 11/25/2022]
Abstract
Work in personal protective equipment (PPE) impairs thermoregulation causing cardiovascular stress, increased core body temperature, and hypohydration. We examined the effect of pretreating first responders performing treadmill exercise in PPE with an infusion of normal saline on physiological and perceptual strain. Ten (eight males, two females) euhydrated subjects performed treadmill exercise on two occasions wearing a chemical resistant coverall, air purifying respirator, butyl gloves, and heavy boots. During the hyperhydration session, normal saline was rapidly infused through an arm vein prior to donning PPE. Exercise duration and maximum core temperature did not differ between euhydrated and hyperhydrated conditions. Perceptual strain index (PeSI) was higher than physiological strain index (PhSI) in the euhydrated condition (P = 0.002) but neither index differed between the control and experimental conditions. Intravenous hyperhydration did not reduce physiological stress, increase exercise, or influence perceptual strain time when compared to the euhydrated condition in moderately fit individuals.
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Affiliation(s)
- David Hostler
- Emergency Responder Human Performance Lab, Department of Emergency Medicine, University of Pittsburgh, 230 McKee Place, Suite 400, Pittsburgh, PA 15213, USA.
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Hostler D, Gallagher M, Seitz JR, Goss FL, Reis SE, Northington WE, Suyama J. The Effect of Hyperhydration on CV Function and Core Temperature on Treadmill Exercise in Personal Protective Equipment. Med Sci Sports Exerc 2008. [DOI: 10.1249/01.mss.0000322282.78298.a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gallagher M, Seitz JR, Goss FL, Robertson RJ, Suyama J, Reis SE, Northington W, Hostler D. The Effect of Hyper-Hydration on Perceptual and Physiological Heat Strain in Personal Protective Equipment. Med Sci Sports Exerc 2008. [DOI: 10.1249/01.mss.0000321771.39488.c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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