Karen J. Klingman

Monitoring for Opioid- Induced Advancing Sedation and Respiratory Depression: ASPMN Membership Survey of Current Practice

Adverse events secondary to opioid-induced advancing sedation and respiratory depression continue to occur during hospitalizations despite efforts to increase awareness and clinical practice guidelines to address prevention strategies. In 2009, ASPMN surveyed membership on current practices surrounding this topic. ASPMN clinical practice guidelines were then published in 2011. In winter of 2013, ASPMN membership was again surveyed to assess progress in preventing adverse events. This is a report of the follow-up membership survey. In general, monitoring practices are slowly improving over time, but there are many facilities that have not instituted best practices for avoiding adverse events.

Validation of the Behavioral Risk Factor Surveillance System Sleep Questions.

STUDY OBJECTIVES leep problems may constitute a risk for health problems, including cardiovascular disease, depression, diabetes, poor work performance, and motor vehicle accidents. The primary purpose of this study was to assess the validity of the current Behavioral Risk Factor Surveillance System (BRFSS) sleep questions by establishing the sensitivity and specificity for detection of sleep/ wake disturbance. METHODS Repeated cross-sectional assessment of 300 community dwelling adults over the age of 18 who did not wear CPAP or oxygen during sleep. Reliability and validity testing of the BRFSS sleep questions was performed comparing to BFRSS responses to data from home sleep study, actigraphy for 14 days, Insomnia Severity Index, Epworth Sleepiness Scale, and PROMIS-57. RESULTS Only two of the five BRFSS sleep questions were found valid and reliable in determining total sleep time and excessive daytime sleepiness. CONCLUSIONS Refinement of the BRFSS questions is recommended.

Validation of Capturing Sleep Diary Data via a Wrist-Worn Device.

Paper sleep diaries are the gold standard for assessment of sleep continuity variables in clinical practice as well as research. Unfortunately, paper diaries can be filled out weekly instead of daily, lost, illegible or destroyed; and are considered out of date according to the newer technology savvy generations. In this study, we assessed the reliability and validity of using a wrist-worn electronic sleep diary. Design. A prospective design was used to compare capturing 14 days of sleep continuity data via paper to a wrist-worn electronic device that also captured actigraphy data. Results. Thirty-five healthy community dwelling adults with mean (sd) age of 36 (15), 80% Caucasians, and 74% females were enrolled. All sleep continuity variables via electronic and paper diary capture methods were significantly correlated with moderate, positive relationships. Assessment of validity revealed that electronic data capture had a significant relationship with objective measure of sleep continuity variables as measured by actigraphy. Paper diary variables were not significantly associated with objective measures. Conclusions. The use of a wrist-worn device to capture daily sleep diary data is as accurate as and for some variables more accurate than using paper diaries.

Design of epitaxial CVD reactors: I. Theoretical relationships for mass and heat transfer

Abstract Theoretical relationships are derived for the mass and heat transfer coefficients applicable to horizontal reactors with tilted susceptor and non-rotating barrel and vertical reactors based on the boundary layer equations for momentum, heat, and mass transport. These relationships give the mass and heat transfer coefficients in terms of a group representing the effect of susceptor tilting. Schmidt and Prandtl numbers, and a modified Reynolds number including the effect of tilting. The results are given for two different cases: one in which the outer flow is free and the other in which the outer flow rate changes with the susceptor coordinate. The effects of buoyancy on concentration, thermal, and velocity boundary layer equations are discussed in the context of stable boundary layer. The results are applicable only to stable boundary layers.

A Review of Worldwide Patents: Innovations in Peak Flow Meters for Asthma.

BackgroundContemporary healthcare nurses increasingly rely on innovative technology for assessment, treatment, and patient self-management. Funding opportunities as well are increasingly steering toward technology development and innovation. Health researchers, including nursing scientists, who are engaged in medical device innovation need to assess the state of the art of current technology. This requires an intellectual property analysis, or patent search, which is not covered by the types of literature reviews customarily used in health science research. PurposeThe purposes of this article are to illustrate a methodical review of worldwide patents and to show how those results can be used to identify possible products available for use. ApproachAn application of peak flow meters for use by patients with asthma is used to illustrate the process. The Derwent Innovations Index interface with keyword searching is illustrated, as is the use of Google Patents. From the 14 patent document results, six possible technologies were identified. The patent search revealed innovations in asthma peak flow meters for use in future research and identified future directions for device development. DiscussionThese results support the claim that patent literature must be included in reviews that seek to identify technology state-of-the-art healthcare applications and that advances in the nursing research paradigm should include patents as background and scholarly products.

Hitting home with technology development for asthma.

102 www.thelancet.com/respiratory Vol 4 February 2016 Technology solutions for asthma self care are particularly timely and imperative as asthma poses a substantial public health problem. Asthma is associated with approximately 2 million annual emergency department visits and costs an estimated US

Revisions to the Behavioral Risk Factor Surveillance System Sleep Questions.

56 billion annually in lost productivity and healthcare. As the prevalence and negative impacts of asthma increases, an estimated 13% of those with asthma have symptoms every day, 37% had active symptoms in the past 30 days, 24% had symptoms with diffi culty staying asleep, and 25% missed work or their usual activities because of their asthma. Self management of asthma is not simple. Care of this chronic disease at home is a complex, multistep, decision-making process that involves identifying and avoiding triggers, altering the environment, remembering both routine and rescue medications, recognising symptoms indicative of changes in underlying physiology, adjusting medical therapy, and determining appropriate times to contact a health-care provider. Additionally, many individuals do not properly execute the steps in taking medication or measuring lung function without errors. Asthma selfmanagement, which can be error-prone, is a worsening public health problem ripe for novel approaches that engage multiple perspectives. Technological innovations are revolutionising healthcare. According to Moore’s law, computer processing speed and power will double roughly every 18 months, rendering more effi cient and cost-eff ective technology systems every year. It is conceivable that innovations in the next 20 years will fundamentally change every process in health-care delivery. For example, sensors and microprocessors might become so aff ordable and ubiquitous that health monitoring will become a passive process, requiring minimum eff ort on the part of the individual, and integrated into smart homes that have more computing capacity than modern day hospitals. One example of innovation is occurring at the University of Buff alo’s Home-BASE Center (Center for Excellence in Home Health and Well-Being through Adaptive Smart Environments). The centre uses both transdisciplinary and transcommunity (including lay and industry team members) approaches to ensure relevant and meaningful designs in these potentially groundbreaking technologies. Home-BASE researchers are engaged in research and educational activities dedicated to home health and wellness. The Breathe Smart Team in Home-BASE started as a collaboration between Nursing and Biomedical Engineering and has since expanded to include eff orts from disciplines of geography, mechanical engineering, business, industrial and systems engineering, computer science, epidemiology, biostatistics, architecture and planning, rehabilitation science, and medicine. Affi liated researchers have produced innovations such as smart shirts (for wearable breathing measures), smart radios (for non-contact breathing detection), smart necklaces (for breathing sound sensing), and others that promise to change the manner in which respiratory disease is prevented, monitored, and managed in the future. By tapping into the ubiquity of smart devices, we can develop new devices for patients to monitor and control their asthma. For example, the MobiSpiro is a microphone-based spirometry device for an unmodifi ed smartphone. With a set of built-in sensor calibration models and machine learning algorithms, we are exploring the possibility of using the smartphone for the analysis of common lung function tests (fi gure 1). Another device uses a smartphone coupled with a custom 3D printed “smart” spirometer that enables an asthma patient to monitor and record their conditions as needed (fi gure 2). A smartphone rehabilitation game application is also in development that trains and guides breathing exercises for those with asthma. The goal for this application (fi gure 3) is to motivate the user and promote exercise compliance through gamifi cation and eff ective, timely feedback. It is important to engage researchers, clinicians, and the public in technology innovations, and Home-BASE works closely with the local Asthma Coalition, affiliated with the American Lung Association and the New York State Department of Health to ensure their approach moves beyond the walls of academia and traditional clinical settings. Specific activities in which health-care providers and health discipline researchers engaged in Hitting home with technology development for asthma

A model for catalytic reactions in packed beds based on alternating flow model

STUDY OBJECTIVES To revise and enhance the current Behavioral Risk Factor Surveillance System (BRFSS) sleep questions for detection of sleep/wake disorders that contribute to health burden. METHODS A descriptive qualitative design was used to guide the investigation. The three methods were (1) a review of the current evidence on sleep related screening questions (including the results from the parent study validating the current BRFSS questions), (2) interviews with sleep experts about the questions they use in their clinical practice to screen for sleep problems, and (3) interviews with lay people to discuss contextual meanings, feelings, and beliefs about sufficient and restful sleep and not feeling rested. RESULTS Recommendations for revisions of the current BRFSS questions. CONCLUSIONS The current BRFSS questions should be refined to better screen for sleep disorders.

Ink set for ink jet printing

Abstract A description of catalytic reactions in packed beds based on alternating flow model (AFM) is presented. It is based on the model developed earlier for mass and heat dispersion in packed beds and as such involves only the parameters pertinent to the reaction. Although the model is applicable to any packed bed and reaction, emphasis is placed on highly exothermic reactions that are typically carried out in a bed with a small tube to pellet diameter ratio. Comparison between the AFM and the traditional Fickian approach shows some drastic differences in the reactor behavior for the highly exothermic reactions. These differences can be attributed to the way the radial voidage distribution and the corresponding flow distribution are accounted for in the two models. The results point to the inadequacy of the Fickian model for highly exothermic reactions.