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Objective: To compare the effectiveness of an antishear mattress overlay (ASMO) with a standard ambulance stretcher surface in reducing pressure and shear and increasing patient comfort., Methods: In this randomized, crossover design, adults in three body mass index categories served as their own controls. Pressure/shear sensors were applied to the sacrum, ischial tuberosity, and heel. The stretcher was placed in sequential 0°, 15°, and 30° head-of-bed elevations with and without an ASMO. The ambulance traveled a closed course, achieving 30 mph, with five stops at each head-of-bed elevation. Participants rated discomfort after each series of five runs., Results: Thirty individuals participated. Each participant had 30 runs (15 with an ASMO, 15 without), for a total of 900 trial runs. The peak-to-peak shear difference between support surfaces was -0.03 N, indicating that after adjustment for elevation, sensor location, and body mass index, peak shear levels at baseline (starting pause) were 0.03 N lower for the ASMO than for the standard surface ( P = .02). The peak-to-peak pressure difference between surfaces was -0.16 mm Hg, indicating that prerun peak-to-peak pressure was 0.16 mm Hg lower with the ASMO versus standard surface ( P = .002). The heel received the most pressure and shear. Discomfort score distributions differed between surfaces at 0° ( P = .004) and 30° ( P = .01); the overall score across all elevations was significantly higher with the standard surface than with the ASMO ( P = .046)., Conclusions: The ASMO reduced shear, pressure, and discomfort. During transport, the ambulance team should provide additional heel offloading., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To identify sociodemographic, health condition, and organizational/process factors associated with pressure injury (PI) incidence during older adults' emergency transitions from long-term care (LTC) to the ED., Methods: Emergency transitions were tracked for older adults within included LTC facilities to participating EDs in two urban centers located in provinces in Canada. Binary logistic regression was used to examine the influence of sociodemographic, service use, and client health and function factors on the incidence of PIs during transitions from LTC facilities to EDs., Results: Having a mobility issue (odds ratio [OR], 4.318; 95% CI, 1.344-13.870), transitioning from a publicly owned versus a nonprofit volunteer LTC facility (OR, 4.886; 95% CI, 1.157-20.634), and time from ED arrival to return to LTC being 7 to 9 days (OR, 41.327; 95% CI, 2.691-634.574) or greater than 9 days (OR, 77.639; 95% CI, 5.727-1,052.485) significantly increased the odds of experiencing a new skin injury upon return to LTC. A higher number of reported reasons for emergency transition (up to 4) significantly decreased the odds of a new PI upon return to LTC (OR, 0.315; 95% CI, 0.113-0.880)., Conclusions: The study findings can be used to identify LTC residents at increased risk for developing new skin injuries during an emergency transition, namely, those with mobility impairment, those requiring inpatient care for 6 or more days, and those transitioning from publicly owned LTC facilities. Evaluating the uptake and effectiveness of single-pronged and multipronged interventions such as visual cues for patient turning through online monitoring, consistent risk assessments, and improved nutrition in all care settings are vital next steps in preventing skin injuries in this population., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The author declares no conflicts of interest.

Exposure to metalworking fluid has been shown to cause health problems among workers. The aim of this study was to compare health outcomes and levels of exposure among workers exposed to metalworking fluid before and after the implementation of preventive measures. The frequencies of self-reported symptoms, as well as the concentrations of measured substances were lower after the implementation of preventive measures. Logistic regression showed statistically significant differences in the report of irritations, a stuffy or runny nose, eye irritation, a hoarse or dry throat, and a cough with odds ratios of 0.31 (95% confidence interval [CI] 0.21 to 0.47), 0.12 (95% CI 0.05 to 0.29), 0.13 (95% CI 0.06 to 0.28), and 0.24 (95% CI 0.12 to 0.46), respectively. This confirms the efficiency of the performed intervention and highlights the importance of eliminating the recirculation of contaminated air., Competing Interests: Declaration of interest: The authors declare that they have no conflict of interest, whether commercial or non-commercial. E.N. and H.J. work in companies that uses metalworking fluids in their production, but do not produce or sell metalworking fluids., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Results from large-scale randomized clinical trials support the application of prophylactic dressings to provide protection from body-weight force-induced deformations known to damage skin and underlying tissues, which often result in pressure injuries (pressure ulcers). This laboratory study using a new method for aging dressings in simulated use followed by tensile testing was conducted to further understand the protective effect of sacral prophylactic dressings (SPDs) in alleviating tissue deformations in the sacral region through the course of typical application. Specifically, four SPDs were exposed to a simulation of the clinical environment incorporating saline solution absorption, mechanical loading, and repetitive sliding-induced shear. After aging, the protective endurance of the SPDs was measured through tensile testing to determine their effectiveness against tissue-damaging forces over time.This study uses the concepts of axial stiffness, protective endurance, and elastic limit to describe more accurately the protective aspects of SPDs under dry and moist conditions and how they interact with the skin and underlying tissues over the life of the dressing. The authors propose two primary features in SPD effectiveness in preventing pressure injuries: high conformability (ie, low flexural stiffness) and protective endurance (the dressing's capacity to maintain biomechanical performance when moist).

Aims: Heart failure patients show impaired left ventricular rotation and twist. In patients undergoing cardiac resynchronization therapy (CRT) significance of preimplant left ventricular rotational timing between different ventricular regions is unknown. We thoroughly evaluated, in patients eligible for CRT, baseline left ventricular rotational mechanics, also assessing segmental rotational timing, and investigated whether the presence of rotational dyssynchrony may be associated with echocardiographic response., Methods: By two-dimensional speckle-tracking echocardiography, baseline peak apical and basal rotation, peak twist, and time-related parameters, such as delays between opposite segments at base and apex, were assessed in 55 CRT patients and 11 healthy participants., Results: At 6 months, 30 (54%) patients were echocardiographic responders. Left ventricular rotation and twist had no association with response. All time-related parameters were significantly altered in CRT patients. Maximum basal and apical segments delay, and anteroseptal-posterior delays at base and apex, were longer in responders than in nonresponders (P < 0.05 for all), regardless of the presence of left bundle branch block (LBBB) and QRS duration. At multivariable analysis, apical anteroseptal-posterior delay resulted as independently associated with response [odds ratio (OR): 1.022 (1.007-1.038); P = 0.004]. A cut-off value of 97.5 ms for apical anteroseptal-posterior delay predicted response with 96% specificity and 57% sensitivity (AUC = 0.83). Magnitude of left ventricular reverse remodeling was significantly related to apical anteroseptal-posterior delay (P = 0.001)., Conclusion: In heart failure patients eligible for CRT, left ventricular rotational timing is altered. Dyssynchrony in rotational mechanics shows a specific pattern in responders regardless of the presence of LBBB. Apical anteroseptal-posterior rotational delay is independently associated with left ventricular reverse remodeling.

Administrators at Rush University Medical Center have made a commitment to diversity, including accommodating disabilities in the workplace and for students. This article explains extensive multilevel accommodations instituted by Rush University Medical Center that promote organizational growth and a healthier work environment and improve patient care.

Doulas are sometimes sought to provide support to women during childbirth. Communication between nurses and doulas is essential to work together effectively and promote the best outcomes for the mother and baby. An understanding of the training and certification of doulas and potential roles and benefits of a doula-assisted birth can be the foundation for developing strategies to improve communication and collaboration between doulas and nurses.

Objective: Deep tissue injury (DTI) is caused by prolonged mechanical loading that disrupts blood flow and metabolic clearance. A patient simulator that mimics the biomechanical aspects of DTI initiation, stress and strain in deep muscle tissue, would be potentially useful as a training tool for pressure-relief techniques and testing platform for pressure-mitigating products. As a step toward this goal, this study evaluates the ability of silicone materials to mimic the distribution of stress in muscle tissue under concentrated loading., Methods: To quantify the mechanical properties of candidate silicone materials, unconfined compression experiments were conducted on 3 silicone formulations (Ecoflex 0030, Ecoflex 0010, and Dragon Skin; Smooth-On, Inc, Easton, Pennsylvania). Results were fit to an Ogden hyperelastic material model, and the resulting shear moduli (G) were compared with published values for biological tissues. Indentation tests were then conducted on Ecoflex 0030 and porcine muscle to investigate silicone's ability to mimic the nonuniform stress distribution muscle demonstrates under concentrated loading. Finite element models were created to quantify stresses throughout tissue depth. Finally, a preliminary patient simulator prototype was constructed, and both deep and superficial "tissue" pressures were recorded to examine stress distribution., Results: Indentation tests showed similar stress distribution trends in muscle and Ecoflex 0030, but stress magnitudes were higher in Ecoflex 0030 than in porcine muscle. All 3 silicone formulations demonstrated shear moduli within the range of published values for biological tissue. For the experimental conditions reported in this work, Ecoflex 0030 exhibited greater stiffness than porcine muscle., Conclusion: Indentation tests and the prototype patient simulator trial demonstrated similar trends with high pressures closest to the bony prominence with decreasing magnitude toward the interfacial surface. Qualitatively, silicone mimicked the phenomenon observed in muscle of nonuniform stress under concentrated loading. Although shear moduli were within biological ranges, stress and stiffness values exceeded those of porcine muscle. This research represents a first step toward development of a preclinical model simulating the biomechanical conditions of stress and strain in deep muscle, since local biomechanical factors are acknowledged to play a role in DTI initiation. Future research is needed to refine the capacity of preclinical models to simulate biomechanical parameters in successive tissue layers of muscle, fat, dermis, and epidermis typically intervening between bone and support surfaces, for body regions at risk for DTI.

Objective: Pulmonary arterial hypertension (PAH) is a progressive, fatal disease with average survival of less than 3 years if left untreated. It is most common in patients infected with HIV. Although the pathogenesis in this population is not fully understood, it is thought that HIV infection, through the immune response and release of different inflammatory mediators such as endothelin-1, may contribute directly to endothelial damage. Our objective was to quantify endothelin-1 levels in HIV-infected patients and determine whether or not there is an association between this marker and PAH., Design: A case-control study in patients attending an infectious diseases clinic., Methods: The sample was composed of 79 patients divided into three groups: 23 HIV patients with PAH (HIV+/PAH+), 45 HIV patients without PAH (HIV+/PAH-) and a control group of 11 healthy individuals. The ratio between the HIV+/PAH- and HIV+/PAH+ groups was 2 : 1. Patients were matched by age, sex, risk group and viral load; the control group by age and sex. All patients had blood taken for endothelin-1 plasma quantification., Results: We found lower endothelin-1 levels in the controls than in the HIV+/PAH- group [0.71 pg/ml (interquartile range, IQR 0.54-0.94) vs. 1.13 pg/ml (IQR 0.87-1.38); P = 0.005] and the HIV+/PAH+ cohort [1.16 pg/ml (IQR 0.86-2.37); P = 0.003]. Patients with severe PAH had higher endothelin-1 levels [2.94 pg/ml (IQR 1.81-6.33)] than patients with mild and moderate PAH., Conclusion: Plasma endothelin-1 levels are higher in HIV patients with PAH than in the HIV-noninfected population and levels increase with the severity of the PAH.

Management of radiological risks typically encountered in environmental and occupational settings is challenging because of uncertainties in the magnitude of the risks and the benefits of risk reduction. In practice, radiation dose instead of risk is measured. However, the relationship between dose and risk is not straightforward because cancer (the major health effect of concern at low doses) is a disease of complexity. Risks at small doses (defined as less than 100 mSv) can never be known exactly because of the inherent uncertainties in cancer as a complex disease. Tumors are complex because of the nonlinear interactions that occur among tumor cells and between the tumor and its local tissue environment. This commentary reviews evidence for cancer complexity and what complexity means for radiation protection. A complexity view of cancer does not mean we must abandon our current system of protection. What it does mean is that complexity requires new ways of thinking about control of cancer-the ideas that cancers can occur without cause, cancers behave unpredictably, and calculated cancer risks following small doses of radiation are highly uncertain.