Publications by Type: Journal Article

Background: Pelvic organ prolapse (POP) refers to symptomatic descent of the vaginal wall. To reduce surgical failure rates, surgical correction can be augmented with the insertion of polypropylene mesh. This benefit is offset by the risk of mesh complication, predominantly mesh exposure through the vaginal wall. If mesh placement is under consideration as part of prolapse repair, patient selection and counseling would benefit from the prediction of mesh exposure; yet, no such reliable preoperative method currently exists. Past studies indicate that inflammation and associated cytokine release is correlated with mesh complication. While some degree of mesh-induced cytokine response accompanies implantation, excessive or persistent cytokine responses may elicit inflammation and implant rejection.

Objective: Here, we explore the levels of biomaterial-induced blood cytokines from patients who have undergone POP repair surgery to (1) identify correlations among cytokine expression and (2) predict postsurgical mesh exposure through the vaginal wall.

Methods: Blood samples from 20 female patients who previously underwent surgical intervention with transvaginal placement of polypropylene mesh to correct POP were collected for the study. These included 10 who experienced postsurgical mesh exposure through the vaginal wall and 10 who did not. Blood samples incubated with inflammatory agent lipopolysaccharide, with sterile polypropylene mesh, or alone were analyzed for plasma levels of 13 proinflammatory and anti-inflammatory cytokines using multiplex assay. Data were analyzed by principal component analysis (PCA) to uncover associations among cytokines and identify cytokine patterns that correlate with postsurgical mesh exposure through the vaginal wall. Supervised machine learning models were created to predict the presence or absence of mesh exposure and probe the number of cytokine measurements required for effective predictions.

Results: PCA revealed that proinflammatory cytokines interferon gamma, interleukin 12p70, and interleukin 2 are the largest contributors to the variance explained in PC 1, while anti-inflammatory cytokines interleukins 10, 4, and 6 are the largest contributors to the variance explained in PC 2. Additionally, PCA distinguished cytokine correlations that implicate prospective therapies to improve postsurgical outcomes. Among machine learning models trained with all 13 cytokines, the artificial neural network, the highest performing model, predicted POP surgical outcomes with 83% (15/18) accuracy; the same model predicted POP surgical outcomes with 78% (14/18) accuracy when trained with just 7 cytokines, demonstrating retention of predictive capability using a smaller cytokine group.

Conclusions: This preliminary study, incorporating a sample size of just 20 participants, identified correlations among cytokines and demonstrated the potential of this novel approach to predict mesh exposure through the vaginal wall following transvaginal POP repair surgery. Further study with a larger sample size will be pursued to confirm these results. If corroborated, this method could provide a personalized medicine approach to assist surgeons in their recommendation of POP repair surgeries with minimal potential for adverse outcomes.

JMIR Perioper Med 2023;6:e40402

The emissivity of nylon, cotton, polyester and acrylic fabrics coated with dried rat blood have been determined in the thermographic infrared region (~8–12 µm wavelength) at 40 °C and at the lowest humidity we could attain in the laboratory. Results show the emissivity of known nylon (ε = 0.87), cotton (ε = 0.88) and polyester (ε = 0.88) fabrics in our laboratory increase by 0.01, 0.01 and 0.03 respectively when coated with dried blood at a concentration of 100 µL of whole blood per 0.9 cm2 of fabric. An acrylic fabric (ε = 0.82) shows an increase in emissivity of 0.05 under the same conditions. We also investigated the change in emissivity of an acrylic fabric sample coated heavily with whole rat blood 8 years previously as a function of humidity and report that its emissivity increases from 0.90 at low humidity to nearly 0.94 at 90% humidity.

The effectiveness of material to emit energy as thermal radiation is important in determining the apparent temperature in infrared thermographic measurements. For this reason, a number of measurements of the thermal emissivity in the mid-infrared thermographic (8–12 µm) region have been reported for fabrics. However, many fabrics adsorb moisture from the air, and condensed water has a relatively high thermal emissivity. In this manuscript, we report measurements of adsorption isotherms and mid-infrared thermal emissivity for nylon, cotton, polyester, and acrylic as a function of their moisture content in weight percent at temperatures just above ambient. We find that the order of water mass percentage gain for the fabrics in high humidity conditions are polyester < acrylic < nylon < cotton. The thermal emissivity is ∼0.88 independent of moisture content for the fabrics polyester, cotton, and nylon, while acrylic shows a pronounced increase in thermal emissivity as moisture content increases, ranging from ɛ ∼ 0.81 at low humidity conditions to ɛ ∼ 0.88 under high humidity conditions. In this work, emissivity measurements are made by imaging through a novel infrared window made from household cling wrap and interpreted with equations that are independent of window transmittance and sample temperature.

Objective: The testing of informatics tools designed for use during mass casualty incidents presents a unique problem as there is no readily available population of victims or identical exposure setting. The purpose of this article is to describe the process of designing, planning, and executing a functional exercise to accomplish the research objective of validating an informatics tool specifically designed to identify and triage victims of irritant gas syndrome agents. Materials and Methods: During a 3-year time frame, the research team and partners developed the Emergency Department Informatics Computational Tool and planned a functional exercise to test it using medical records data from 298 patients seen in 1 emergency department following a chlorine gas exposure in 2005. Results: The research team learned valuable lessons throughout the planning process that will assist future researchers with developing a functional exercise to test informatics tools. Key considerations for a functional exercise include contributors, venue, and information technology needs (ie, hardware, software, and data collection methods). Discussion: Due to the nature of mass casualty incidents, testing informatics tools and technology for these incidents is challenging. Previous studies have shown a functional exercise as a viable option to test informatics tools developed for use during mass casualty incidents. Conclusion: Utilizing a functional exercise to test new mass casualty management technology and informatics tools involves a painstaking and complex planning process; however, it does allow researchers to address issues inherent in studying informatics tools for mas casualty incidents. Key words: chlorine exposure, disaster, functional exercise, informatics, mass casualty incident

Background:Chemical exposures pose a significant threat to life. A rapid assessment by first responders and emergency nurses is required to reduce death and disability. Currently, no informatics tools exist to process victims of chemical exposures efficiently. The surge of patients into a hospital emergency department during a mass casualty incident creates additional stress on an already overburdened system, potentially placing patients at risk and challenging staff to process patients for appropriate care and treatment efficacy. Traditional emergency department triage models are oversimplified during highly stressed mass casualty incident scenarios in which there is little margin for error. Emerging mobile technology could alleviate the burden placed on nurses by allowing the freedom to move about the emergency department and stay connected to a decision support system.

Objective:This study aims to present and evaluate a new mobile tool for assisting emergency department personnel in patient management and triage during a chemical mass casualty incident.

Methods:Over 500 volunteer nurses, students, and first responders were recruited for a study involving a simulated chemical mass casualty incident. During the exercise, a mobile application was used to collect patient data through a kiosk system. Nurses also received tablets where they could review patient information and choose recommendations from a decision support system. Data collected was analyzed on the efficiency of the app to obtain patient data and on nurse agreement with the decision support system.

Results:Of the 296 participants, 96.3% (288/296) of the patients completed the kiosk system with an average time of 3 minutes, 22 seconds. Average time to complete the entire triage process was 5 minutes, 34 seconds. Analysis of the data also showed strong agreement among nurses regarding the app’s decision support system. Overall, nurses agreed with the system 91.6% (262/286) of the time when it came to choose an exposure level and 84.3% (241/286) of the time when selecting an action.

Conclusions:The app reliably demonstrated the ability to collect patient data through a self-service kiosk system thus reducing the burden on hospital resources. Also, the mobile technology allowed nurses the freedom to triage patients on the go while staying connected to a decision support system in which they felt would give reliable recommendations.

Thermal imaging is not ordinarily a good way to visualize chemical contrast. In recent work, however, we observed strong and reproducible images with chemical contrasts on blood-stained fabrics, especially on more hydrophobic fabrics like acrylic and polyester.

A major type of infrared camera is sensitive to wavelengths in the 8–14 μm band and is mainly used for thermal imaging. Such cameras can also be used for general broadband infrared reflectance imaging when provided with a suitable light source. We report the design and properties of an infrared lamp using a heated alumina emitter suitable for active thermal infrared imaging, as well as comparisons to existing commercial light sources for this purpose. We find that the alumina lamp is a broadband non-blackbody source with a lower out-of-band emission intensity and therefore higher electrical efficiency for this application than existing commercial sources.

Infrared spectroscopy is an appealing technique for application to forensic samples because it offers the benefits of being non-destructive and non-hazardous, fast, reasonably sensitive, and resistant to some of the interferences of many commonly used techniques. Our research team has been focusing on detecting biological fluids on fabrics, which are inherently anisotropic substrates for spectroscopy. The work presented here investigates the effect of azimuthal angle of the sample on the infrared diffuse reflection spectra of fabrics with a goal of removing sampling differences as a source of analytic variation.