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2. Use of Locally Produced Novel Low-Cost 3D Printed Respiratory Muscle Strength Trainer Device (RMSTD) for Long COVID-Rehabilitation: An Innovative Case Report

Author

Dipendra Kandel, Arjan J. Knulst, Joshua Riggsbee, Sarah O. Riggsbee, Suman Tamang, Himal Bikram Bhattarai, and Mitesh Karn

Subjects
Medicine
Abstract

Introduction. This article details the development and use of a low-cost, custom RMST device for a patient with long COVID who had received positive airway flow support during ICU treatment. By sharing our successful management of respiratory muscle weakness in a severe COVID-19 patient, we aim to contribute to the broader conversation around effective long COVID management. Case Description. A patient with respiratory muscle weakness used a hospital-made RMST device. The training involved ten short forced exhalations per cycle for five cycles, followed by five long forced exhalations held for five seconds. Additionally, the patient learned lower abdominal and box breathing techniques. The patient showed significant improvement, using the RMST device without supplemental oxygen within 24 hours and completely weaned off by day 5. By discharge, the patient could complete the RMST exercise regime and achieved 290 meters in the 6MWT. After six weeks of outpatient therapy, the patient used the RMST device at 80 cm H2O and increased their 6MWT distance to 390 meters. Device Description. The RMST device was designed for in-house production with a 3D-printed PETG cap, base, and plunger, and a standard pen spring. Its design mimicked a standard PEEP valve with a different geometry. The spring closed the valve until a pressure threshold was reached, allowing airflow. The adjustable pressure threshold ranged from −40 to +40 cm H2O, calibrated in 10 cm H2O increments by measuring displaced water column height. Discussion and Limitation. COVID-19 can cause long-term respiratory issues needing proper management and rehabilitation. Inspiratory muscle training benefits those recovering from severe COVID-19 who were weaned from mechanical ventilation. However, the device’s design and production method are unsuitable for large-scale and commercial production. Rehabilitation centers should prepare for postintensive care syndrome in post-COVID-19 individuals, with interprofessional teams addressing various recovery aspects. Early medical attention and therapy can improve patients’ quality of life.

Published
2024
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3. The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement

Author

Miller, Marissa A., Taddei-Peters, Wendy C., Jeffries, Neal O., Buxton, Dennis, Geller, Nancy L., Gordon, David, Burke, Catherine, Lee, Albert, Smith, Tyrone, Moy, Claudia S., Gombos, Ilana Kogan, Weisel, Richard, Gardner, Timothy J., O'Gara, Patrick T., Rose, Eric A., Gelijns, Annetine C., Parides, Michael K., Ascheim, Deborah D., Moskowitz, Alan J., Bagiella, Emilia, Moquete, Ellen, Shah, Kinjal, Overbey, Jessica R., Pan, Stephanie, Chang, Helena, Chase, Melissa, Goldfarb, Seth, Gupta, Lopa, Kirkwood, Katherine, Dobrev, Edlira, Levitan, Ron, O'Sullivan, Karen, Santos, Milerva, Ye, Xia, Mack, Michael, Winkle, Rachelle, Boswell, Haley, Fenlon, Amanda, Johnson, Melissa, Jones, Jessica, Kolb, Megan, Lam, Sarah, Miranda, Lucy, Ward, Jackie, Whitman, Renessa, Zingler, Brittany, Ryan, William, Smith, Robert L., Grayburn, Paul, Nosnik, Pedro, Gillinov, A. Marc, Blackstone, Eugene H., Moazami, Nader, Starling, Randall C., Barzilai, Benico, Grimm, Richard A., Soltesz, Edward G., Katzan, Irene, Strippy, Brian, Smith, Shoi, Garcia, Michelle, Alice bowman, Mary, Geither, Carrie, Wang, Robert, Argenziano, Michael, Borger, Michael, Takayama, Hiroo, Leon, Martin B., Goldsmith, Lyn, Schwartz, Allan, Sookraj, Nadia, McCright-Gill, Talaya, Sreekanth, Sowmya, McCullough, Jock N., Iribarne, Alexander, DeSimone, Joseph P., DiScipio, Anthony W., Stokes, Henry, Ivany, Amanda St., Petty, Gaylin, Smith, Peter K., Alexander, John H., Milano, Carmelo A., Glower, Donald D., Huber, Joel, Morganlander, Joel, Mathew, Joseph P., Welsh, Stacey, Casalinova, Sarah, Johnson, Victoria, Lane, Kathleen, Smith, Derek, Tipton, Greg, Berry, Mark F., Williams, Judson B., Englum, Brian, Hartwig, Matthew, Thourani, Vinod H., Guyton, Robert, Lattouf, Omar, Chen, Edward, Vega, J. David, Baer, Jefferson, Nguyen, Duc, Halkos, Michael, Baio, Kim, Prince, Tamara, Cook, Natascha, Neill, Alexis A., Voisine, Pierre, Senechal, Mario, Dagenais, François, Laforce, Robert, Jr., O'Connor, Kim, Dussault, Gladys, Caouette, Manon, Tremblay, Hugo, Gagne, Nathalie, Dumont, Julie, Landry, Patricia, Groh, Mark A., Trichon, Benjamin H., Binns, Oliver A., Ely, Stephen W., Johnson, Alan M., Hansen, Todd H., Short, John G., Taylor, Reid D., Mangusan, Ralph, Nanney, Tracy, Aubart, Holly, Cross, Kristin, McPeters, Leslie, Riggsbee, Christina, Rixey, Lucy, Michler, Robert E., DeRose, Joseph J., Jr., Goldstein, Daniel J., Bello, Ricardo A., Taub, Cynthia, Spevack, Daniel, Kirchoff, Kathryn, Meli, Rebecca, Garcia, Juan, Goldenberg, Jon, Kealy, Lauren, Perrault, Louis P., Bouchard, Denis, Tanguay, Jean François, O'Meara, Eileen, Lacharité, Jonathan, Robichaud, Sophie, Horvath, Keith A., Corcoran, Philip C., Siegenthaler, Michael P., Murphy, Mandy, Iraola, Margaret, Greenberg, Ann, Kumkumian, Greg, Milner, Mark, Nadareishvili, Zurab, Whitson, Bryan A., Hasan, Ayesha, McDavid, Asia, Fadorsen, Denise, Ouzounian, Maral, Yau, Terry, Farkouh, Michael, Woo, Anna, Cusimano, Robert James, David, Tirone, Feindel, Christopher, Fumakia, Nishit, Christie, Shakira, Mullen, John C., Bissonauth, Asvina, Hripko, Alexandra, Gammie, James S., Noor, Zahid, Mackowick, Kristen, Deasey, Stephanie, Al-Suqi, Manal, Collins, Julia, Acker, Michael A., Messé, Steven, Kirkpatrick, James, Mayer, Mary Lou, McDonald, Caitlin, Fok, Holley, Maffei, Breanna, Cresse, Stephen, Gepty, Christine, Bowdish, Michael, Starnes, Vaughn A., Shavalle, David, Heck, Christi, Hackmann, Amy, Baker, Craig, Fleischman, Fernando, Cunningham, Mark, Lozano, Edward, Hernandez, Michelle, Ailawadi, Gorav, Kron, Irving L., Johnston, Karen, Ghanta, Ravi K., Dent, John M., Kern, John, Yarboro, Leora, Ragosta, Michael, Annex, Brian, Bergin, Jim, Burks, Sandra, Cosner, Mike, Green, China, Loya, Samantha, Kim, Hye Ryun, Bull, David A., Desvigne-Nickens, Patrice, Dixon, Dennis O., Gottesman, Rebecca, Haigney, Mark, Holubkov, Richard, Iadecola, Constantino, Jacobs, Alice, Meslin, Eric M., Murkin, John M., Spertus, John A., Sellke, Frank, McDonald, Cheryl L., Canty, John, Dickert, Neal, Ikonomidis, John S., Kim, KyungMann, Williams, David O., Yancy, Clyde W., Chaturvedi, Seemant, Chimowitz, Marc, Fang, James C., Richenbacher, Wayne, Rao, Vivek, Furie, Karen L., Miller, Rachel, Cook, Jennifer, D'Alessandro, David, Han, Frederick, Pinney, Sean, Walsh, Mary N., Greer, David, Ishida, Koto, Stapf, Christian, Hung, Judy, Zeng, Xin, Hung, David, Satitthummanid, Sudarat, Billelo, Michel, Davatzikos, Christos, Erus, Guray, Karpf, Lauren, Desiderio, Lisa, Browndyke, Jeffrey N., James, Michael L., Toulgoat-Dubois, Yanne, Brassard, Rachele, Virmanu, Renu, Romero, Maria E., Braumann, Ryan, Messé, Steven R., Mack, Michael J., Southerland, Andrew M., Moy, Claudia Scala, and Bowdish, Michael E.

Published
2024
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5. Use of Locally Produced Novel Low‐Cost 3D Printed Respiratory Muscle Strength Trainer Device (RMSTD) for Long COVID‐Rehabilitation: An Innovative Case Report.

Author

Kandel, Dipendra, Knulst, Arjan J., Riggsbee, Joshua, Riggsbee, Sarah O., Tamang, Suman, Bhattarai, Himal Bikram, Karn, Mitesh, and Conese, Massimo

Subjects
PATIENT education, OUTPATIENT services in hospitals, POST-acute COVID-19 syndrome, RESPIRATION, PRODUCT design, NEW product development, DISCHARGE planning, BREATHING exercises, MUSCLE weakness, COMMERCIAL product evaluation, ARTIFICIAL respiration, THREE-dimensional printing, VENTILATOR weaning, RESPIRATORY muscles
Abstract

Introduction. This article details the development and use of a low‐cost, custom RMST device for a patient with long COVID who had received positive airway flow support during ICU treatment. By sharing our successful management of respiratory muscle weakness in a severe COVID‐19 patient, we aim to contribute to the broader conversation around effective long COVID management. Case Description. A patient with respiratory muscle weakness used a hospital‐made RMST device. The training involved ten short forced exhalations per cycle for five cycles, followed by five long forced exhalations held for five seconds. Additionally, the patient learned lower abdominal and box breathing techniques. The patient showed significant improvement, using the RMST device without supplemental oxygen within 24 hours and completely weaned off by day 5. By discharge, the patient could complete the RMST exercise regime and achieved 290 meters in the 6MWT. After six weeks of outpatient therapy, the patient used the RMST device at 80 cm H2O and increased their 6MWT distance to 390 meters. Device Description. The RMST device was designed for in‐house production with a 3D‐printed PETG cap, base, and plunger, and a standard pen spring. Its design mimicked a standard PEEP valve with a different geometry. The spring closed the valve until a pressure threshold was reached, allowing airflow. The adjustable pressure threshold ranged from −40 to +40 cm H2O, calibrated in 10 cm H2O increments by measuring displaced water column height. Discussion and Limitation. COVID‐19 can cause long‐term respiratory issues needing proper management and rehabilitation. Inspiratory muscle training benefits those recovering from severe COVID‐19 who were weaned from mechanical ventilation. However, the device's design and production method are unsuitable for large‐scale and commercial production. Rehabilitation centers should prepare for postintensive care syndrome in post‐COVID‐19 individuals, with interprofessional teams addressing various recovery aspects. Early medical attention and therapy can improve patients' quality of life. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Evaluation of the safety of piperacillin‐tazobactam extended infusion in pediatric cystic fibrosis patients

Author

Daniel Riggsbee, Samantha Engdahl, and Rebecca S. Pettit

Subjects
Pulmonary and Respiratory Medicine, Pediatrics, Perinatology and Child Health
Abstract

Patients with cystic fibrosis (CF) may be treated with piperacillin-tazobactam (PZT) for acute pulmonary exacerbations. Extending the infusion of PZT is one strategy to increase efficacy. Direct comparison, with respect to incidence of acute kidney injury (AKI), between these two strategies has not been evaluated in pediatric patients with CF. The primary objective of this study was to compare the incidence of AKI in pediatric CF patients receiving extended infusion (EI) PZT versus traditional infusion (TI).This IRB-approved, retrospective analysis included patients ages 30 days to 18 years that received PZT for at least 48 hours between 01/01/2008 and 01/01/2020. PZT was infused over thirty minutes (TI group) or four hours (EI group).204 patients were included (TI:109, EI: 95). Median age was 8 years (4-13) and 7 years (3-12) in the TI and EI groups (p=0.15). The groups did not differ significantly in their baseline characteristics. There were 12 (11%) AKIs in the TI group and 8 (8.4%) in the EI group (p=0.53). There was 1 occurrence of serum sickness in the TI group and none in the EI group. The incidence of thrombocytopenia was similar between the two groups. Median treatment duration was 8 days (5-11) and 9 days (5-13) for the TI and EI groups respectively (p=0.24).There was no significant increase in AKI in pediatric patients with CF receiving PZT by EI compared to TI. EI may be utilized to optimize the pharmacokinetics of PZT in pediatric CF patients. This article is protected by copyright. All rights reserved.

Published
2023
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10. Nutrition Education in Food Pantries: Perceptions of Pantry Personnel towards Implementation

Author

Chelsea Allison, Christopher Sneed, Marissa McElrone, Kristin Riggsbee, and Janie Burney

Subjects
Education
Abstract

Extension programming can be effective at delivering nutrition education to food pantry clients. This study aimed to understand the perceptions of food pantry personnel towards nutrition education. A mixed methods survey was administered to food pantry personnel (n=53). Most (62.3%) reported their food pantry was church-affiliated, and few (22.6%) reported any Extension collaboration. Qualitative themes included perceptions that nutrition education was resource intensive, clients were not interested in nutrition education, and differing attitudes towards nutrition education. When working with food pantries, Extension should educate personnel about the importance of nutrition education, offer resources, and facilitate programming.

Published
2022
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14. The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement

Author

Messé, Steven R., primary, Overbey, Jessica R., additional, Thourani, Vinod H., additional, Moskowitz, Alan J., additional, Gelijns, Annetine C., additional, Groh, Mark A., additional, Mack, Michael J., additional, Ailawadi, Gorav, additional, Furie, Karen L., additional, Southerland, Andrew M., additional, James, Michael L., additional, Moy, Claudia Scala, additional, Gupta, Lopa, additional, Voisine, Pierre, additional, Perrault, Louis P., additional, Bowdish, Michael E., additional, Gillinov, A. Marc, additional, O'Gara, Patrick T., additional, Ouzounian, Maral, additional, Whitson, Bryan A., additional, Mullen, John C., additional, Miller, Marissa A., additional, Gammie, James S., additional, Pan, Stephanie, additional, Erus, Guray, additional, Browndyke, Jeffrey N., additional, Taddei-Peters, Wendy C., additional, Jeffries, Neal O., additional, Buxton, Dennis, additional, Geller, Nancy L., additional, Gordon, David, additional, Burke, Catherine, additional, Lee, Albert, additional, Smith, Tyrone, additional, Moy, Claudia S., additional, Gombos, Ilana Kogan, additional, Weisel, Richard, additional, Gardner, Timothy J., additional, Rose, Eric A., additional, Parides, Michael K., additional, Ascheim, Deborah D., additional, Bagiella, Emilia, additional, Moquete, Ellen, additional, Shah, Kinjal, additional, Chang, Helena, additional, Chase, Melissa, additional, Goldfarb, Seth, additional, Kirkwood, Katherine, additional, Dobrev, Edlira, additional, Levitan, Ron, additional, O'Sullivan, Karen, additional, Santos, Milerva, additional, Ye, Xia, additional, Mack, Michael, additional, Winkle, Rachelle, additional, Boswell, Haley, additional, Fenlon, Amanda, additional, Johnson, Melissa, additional, Jones, Jessica, additional, Kolb, Megan, additional, Lam, Sarah, additional, Miranda, Lucy, additional, Ward, Jackie, additional, Whitman, Renessa, additional, Zingler, Brittany, additional, Ryan, William, additional, Smith, Robert L., additional, Grayburn, Paul, additional, Nosnik, Pedro, additional, Blackstone, Eugene H., additional, Moazami, Nader, additional, Starling, Randall C., additional, Barzilai, Benico, additional, Grimm, Richard A., additional, Soltesz, Edward G., additional, Katzan, Irene, additional, Strippy, Brian, additional, Smith, Shoi, additional, Garcia, Michelle, additional, Alice bowman, Mary, additional, Geither, Carrie, additional, Wang, Robert, additional, Argenziano, Michael, additional, Borger, Michael, additional, Takayama, Hiroo, additional, Leon, Martin B., additional, Goldsmith, Lyn, additional, Schwartz, Allan, additional, Sookraj, Nadia, additional, McCright-Gill, Talaya, additional, Sreekanth, Sowmya, additional, McCullough, Jock N., additional, Iribarne, Alexander, additional, DeSimone, Joseph P., additional, DiScipio, Anthony W., additional, Stokes, Henry, additional, Ivany, Amanda St., additional, Petty, Gaylin, additional, Smith, Peter K., additional, Alexander, John H., additional, Milano, Carmelo A., additional, Glower, Donald D., additional, Huber, Joel, additional, Morganlander, Joel, additional, Mathew, Joseph P., additional, Welsh, Stacey, additional, Casalinova, Sarah, additional, Johnson, Victoria, additional, Lane, Kathleen, additional, Smith, Derek, additional, Tipton, Greg, additional, Berry, Mark F., additional, Williams, Judson B., additional, Englum, Brian, additional, Hartwig, Matthew, additional, Guyton, Robert, additional, Lattouf, Omar, additional, Chen, Edward, additional, Vega, J. David, additional, Baer, Jefferson, additional, Nguyen, Duc, additional, Halkos, Michael, additional, Baio, Kim, additional, Prince, Tamara, additional, Cook, Natascha, additional, Neill, Alexis A., additional, Senechal, Mario, additional, Dagenais, François, additional, Laforce, Robert, additional, O'Connor, Kim, additional, Dussault, Gladys, additional, Caouette, Manon, additional, Tremblay, Hugo, additional, Gagne, Nathalie, additional, Dumont, Julie, additional, Landry, Patricia, additional, Trichon, Benjamin H., additional, Binns, Oliver A., additional, Ely, Stephen W., additional, Johnson, Alan M., additional, Hansen, Todd H., additional, Short, John G., additional, Taylor, Reid D., additional, Mangusan, Ralph, additional, Nanney, Tracy, additional, Aubart, Holly, additional, Cross, Kristin, additional, McPeters, Leslie, additional, Riggsbee, Christina, additional, Rixey, Lucy, additional, Michler, Robert E., additional, DeRose, Joseph J., additional, Goldstein, Daniel J., additional, Bello, Ricardo A., additional, Taub, Cynthia, additional, Spevack, Daniel, additional, Kirchoff, Kathryn, additional, Meli, Rebecca, additional, Garcia, Juan, additional, Goldenberg, Jon, additional, Kealy, Lauren, additional, Bouchard, Denis, additional, Tanguay, Jean François, additional, O'Meara, Eileen, additional, Lacharité, Jonathan, additional, Robichaud, Sophie, additional, Horvath, Keith A., additional, Corcoran, Philip C., additional, Siegenthaler, Michael P., additional, Murphy, Mandy, additional, Iraola, Margaret, additional, Greenberg, Ann, additional, Kumkumian, Greg, additional, Milner, Mark, additional, Nadareishvili, Zurab, additional, Hasan, Ayesha, additional, McDavid, Asia, additional, Fadorsen, Denise, additional, Yau, Terry, additional, Farkouh, Michael, additional, Woo, Anna, additional, Cusimano, Robert James, additional, David, Tirone, additional, Feindel, Christopher, additional, Fumakia, Nishit, additional, Christie, Shakira, additional, Bissonauth, Asvina, additional, Hripko, Alexandra, additional, Noor, Zahid, additional, Mackowick, Kristen, additional, Deasey, Stephanie, additional, Al-Suqi, Manal, additional, Collins, Julia, additional, Acker, Michael A., additional, Messé, Steven, additional, Kirkpatrick, James, additional, Mayer, Mary Lou, additional, McDonald, Caitlin, additional, Fok, Holley, additional, Maffei, Breanna, additional, Cresse, Stephen, additional, Gepty, Christine, additional, Bowdish, Michael, additional, Starnes, Vaughn A., additional, Shavalle, David, additional, Heck, Christi, additional, Hackmann, Amy, additional, Baker, Craig, additional, Fleischman, Fernando, additional, Cunningham, Mark, additional, Lozano, Edward, additional, Hernandez, Michelle, additional, Kron, Irving L., additional, Johnston, Karen, additional, Ghanta, Ravi K., additional, Dent, John M., additional, Kern, John, additional, Yarboro, Leora, additional, Ragosta, Michael, additional, Annex, Brian, additional, Bergin, Jim, additional, Burks, Sandra, additional, Cosner, Mike, additional, Green, China, additional, Loya, Samantha, additional, Kim, Hye Ryun, additional, Bull, David A., additional, Desvigne-Nickens, Patrice, additional, Dixon, Dennis O., additional, Gottesman, Rebecca, additional, Haigney, Mark, additional, Holubkov, Richard, additional, Iadecola, Constantino, additional, Jacobs, Alice, additional, Meslin, Eric M., additional, Murkin, John M., additional, Spertus, John A., additional, Sellke, Frank, additional, McDonald, Cheryl L., additional, Canty, John, additional, Dickert, Neal, additional, Ikonomidis, John S., additional, Kim, KyungMann, additional, Williams, David O., additional, Yancy, Clyde W., additional, Chaturvedi, Seemant, additional, Chimowitz, Marc, additional, Fang, James C., additional, Richenbacher, Wayne, additional, Rao, Vivek, additional, Miller, Rachel, additional, Cook, Jennifer, additional, D'Alessandro, David, additional, Han, Frederick, additional, Pinney, Sean, additional, Walsh, Mary N., additional, Greer, David, additional, Ishida, Koto, additional, Stapf, Christian, additional, Hung, Judy, additional, Zeng, Xin, additional, Hung, David, additional, Satitthummanid, Sudarat, additional, Billelo, Michel, additional, Davatzikos, Christos, additional, Karpf, Lauren, additional, Desiderio, Lisa, additional, Toulgoat-Dubois, Yanne, additional, Brassard, Rachele, additional, Virmanu, Renu, additional, Romero, Maria E., additional, and Braumann, Ryan, additional

Published
2022
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15. Stop Kiss: A Scenic Design

Author

Walters-Riggsbee, Taylor

Subjects
Theatre, Theatre Arts, Scenic Design, Stop Kiss, Diana Son, Scenic, Art and Materials Conservation, Contemporary Art, Illustration, Interactive Arts, Other Theatre and Performance Studies, Painting, Theory and Criticism
Abstract

The purpose of this thesis is to document the design processes of the University of Nebraska Lincoln’s production of Stop Kiss by Diana Son, produced March 1-9, 2023, in partnership with the Nebraska Repertory Theatre. Documented is a complete representation of a scenic design process including discussion of practices and design methodologies, research plates, supporting analytical paperwork, preliminary sketches, digital renderings, and 1/4” scale model photos, a full set of drafting, painter’s elevations and a corresponding props and dressing list. Performance photos follow as an archive of the production process and performance photos. Advisor: Joshua David Madsen

Published
2023

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