Bio-Compatible Sensor for Middle Ear Pressure Monitoring on a Bio-Degradable Substrate

Hypotension in the middle ear can cause serious diseases and hearing disorders. Until now, pressure in the middle ear is measured indirectly by using the impedance of the tympanic membrane (tympanometry). Direct methods are just described in scientific studies and would be harmful in clinical routine. Here, we demonstrate a bio-compatible pressure sensor, which can resolve pressure changes in the range of −7.5 kPa up to +7.5 kPa, and due to its compact design (area of 2 × 4 mm2), can be directly implanted in the human middle ear. Furthermore, the read-out of the pressure sensor can be conveniently done using wireless data communication technologies employing a plate capacitor with an elastic dielectric for pressure monitoring and a planar coil. Thus, our sensor allows for direct pressure measurements in the middle ear, avoiding additional surgeries after device implantation.

Student Perspectives on Implementing Stop the Bleed Training into Medical School Curriculum

Background Following the Hartford Consensus guidelines and recommendations, third-year medical students from a single institution were offered an optional Stop the Bleed (STB) training course in August 2018. The aim of this study was to assess medical students’ confidence in performing bleeding control techniques and teaching others after completing the STB course. The secondary goal was to assess student perception on integrating mandatory STB training into the medical school curriculum. Materials and Methods A 24-question survey using a 4-point Likert scale was administered to all medical students who completed STB training. Students were anonymously asked to self-report their confidence in performing bleeding control techniques, training others after STB training, and their perception on integrating STB training into medical school curriculum. Results After completing the STB course, 95% of students were comfortable applying a tourniquet, 92% of students were confident in packing wounds, and 99% of students could apply direct pressure to wounds to stop bleeding. Overall, 94% of students reported that STB training would be helpful for their clinical rotations. Conclusion These results demonstrate that medical students are positively impacted by Stop the Bleed courses and validate that the implementation of mandatory STB courses into medical school curriculum will improve medical students’ knowledge and skills for hemorrhage control.

Noninvasive detection of elevated ICP using spontaneous tympanic membrane pulsation

Neurological conditions such as traumatic brain injury (TBI) and hydrocephalus may lead to intracranial pressure (ICP) elevation. Current diagnosis methods rely on direct pressure measurement, while CT, MRI and other expensive imaging may be used. However, these invasive or expensive testing methods are often delayed because symptoms of elevated ICP are non-specific. Invasive methods, such as intraventricular catheter, subdural screw, epidural sensor, lumbar puncture, are associated with an increased risk of infection and hemorrhage. On the other hand, noninvasive, low-cost, accurate methods of ICP monitoring can help avoid risks and reduce costs while expediting diagnosis and treatment. The current study proposes and evaluates a novel method for noninvasive ICP monitoring using tympanic membrane pulsation (TMp). These signals are believed to be transmitted from ICP to the auditory system through the cochlear aqueduct. Fifteen healthy subjects were recruited and TMp signals were acquired noninvasively while the subjects performed maneuvers that are known to change ICP. A custom made system utilizing a stethoscope headset and a pressure transducer was used to perform these measurements. Maneuvers included head-up-tilt, head-down-tilt and hyperventilation. When elevated ICP was induced, significant TMp waveform morphological changes were observed in each subject (p < 0.01). These changes include certain waveform slopes and high frequency wave features. The observed changes were reversed by the maneuvers that decreased ICP (p < .01). The study results suggest that TMp waveform measurement and analysis may offer an inexpensive, noninvasive, accurate tool for detection and monitoring of ICP elevations. Further studies are warranted to validate this technique in patients with pathologically elevated ICP.

When Direct Pressure Is Not Enough: An Educational Technique for Teaching Wound Packing in Athletic Training Education

Context Uncontrolled hemorrhage is a major cause of preventable death. Wound care and managing external hemorrhage are important skills for athletic trainers. Objective Describe a laboratory activity used to allow students to practice managing uncontrolled external hemorrhage and wound packing. Background The prevalence of active shooter and other mass casualty events has grown, and a trend to move military-based emergency skills into civilian casualty care has emerged. Athletic trainers are uniquely positioned to respond to catastrophic events at the time of injury. Controlling hemorrhage and rapidly applying a tourniquet or administering wound packing have a great effect in preventing death due to severe hemorrhage. Description An educational technique using a pork shoulder was implemented to provide students with experience in wound packing. Clinical Advantage(s) Students describe this activity as a beneficial way to gain experience on an important skill not often seen in the clinical education setting. Conclusion(s) Faculty may consider implementing wound packing using a pork shoulder as a laboratory activity when teaching wound care and external hemorrhage management.

The Soviet Union and the Post-World War II Foreign Policy of Czechoslovakia as Assessed by American Diplomacy

This article examines how American diplomats and international relations experts perceived Czechoslovak foreign policy priorities between the end of World War II and the consolidation of communist power in the ČSR in 1948. The purpose of the work is to identify the Soviet factor in US policy towards Czechoslovakia, the peculiarities of the perception of the country in the general context of Soviet-American relations and the genesis of the Cold War. The research is based on documentary sources from different archives: the US National Archives, the Archive of the Ministry of Foreign Affairs of the Czech Republic, and the archive of Ambassador L. A. Steinhardt at the Library of Congress. Archival documents are supplemented by articles from the American press. The author concludes that during this period, the perception of Czechoslovakia by the Americans was ambivalent and controversial. On the one hand, the existence of a democratic multi-party system made it possible to consider the ČSR part of the West, but, on the other hand, its pro-Soviet foreign policy forced the Americans to regard it as being behind the Iron Curtain. The real foreign activities of the Czechoslovak government led by communist K. Gottwald directly demonstrated Czechoslovakia’s orientation toward close relations with the USSR and its loyalty to the Kremlin. Because of this, the degree of Prague’s dependence on Moscow was a subject of serious discussion and reflection among American experts in international relations. Some of them unconditionally placed the ČSR among the Soviet satellites, while others considered it the last outpost of democracy in Eastern Europe. A turning point in the perception of Czechoslovakia was its refusal to participate in the Marshall Plan under the direct pressure of the Soviet government. After that, Prague’s inability to resist Soviet pressure and its dependence on Moscow became apparent to the Americans.

Modeling tilt noise caused by atmospheric processes at long periods for several horizontal seismometers at BFO - a reprise

Summary Tilting of the ground due to loading by the variable atmosphere is known to corrupt very long-period horizontal seismic records (below 10 mHz) even at the quietest stations. At BFO (Black Forest Observatory, SW-Germany) the opportunity arose to study these disturbances on a variety of simultaneously operated state-of-the-art broadband sensors. A series of time windows with clear atmospherically caused effects was selected and attempts were made to model these “signals” in a deterministic way. This was done by simultaneously least squares fitting the locally recorded barometric pressure and its Hilbert transform to the ground accelerations in a bandpass between 100 and 3600 s periods. Variance reductions of up to 97 per cent were obtained. We show our results by combining the “specific pressure induced accelerations” for the two horizontal components of the same sensor as vectors on a horizontal plane, one for direct pressure and one for its Hilbert transform. It turned out that at BFO the direct pressure effects are large, strongly position dependent, and largely independent of atmospheric events for instruments installed on piers, while three posthole sensors are only slightly affected. The infamous “cavity effects” are invoked to be responsible for these large effects on the pier sensors. On the other hand, in the majority of cases all sensors showed very similar magnitudes and directions for the vectors obtained for the regression with the Hilbert transform, but highly variable from event to event especially in direction. Therefore this direction most certainly has to do with the gradient of the pressure field moving over the station which causes a larger scale deformation of the crust. The observations are very consistent with these two fundamental mechanisms of how fluctuations of atmospheric surface pressure causes tilt noise. The results provide a sound basis for further improvements of the models for these mechanisms. The methods used here can already help to reduce atmospherically induced noise in long period horizontal seismic records .

Nebulized Tranexamic Acid in Secondary Post-Tonsillectomy Hemorrhage: Case Series and Review of the Literature

Introduction: Post-tonsillectomy hemorrhage is a serious postoperative complication, and its acute management can present a challenge for the emergency provider. Although various strategies have been proposed, guidance on the best approach for management of this condition in the emergency department (ED) setting remains limited. Anecdotal reports of the use of nebulized tranexamic acid (TXA) for management of tonsillar bleeding have emerged over the past two years. Two recently published case reports describe the successful use of nebulized TXA for stabilization of post-tonsillectomy hemorrhage in an adult and a pediatric patient. Case Series: Eight patients who presented to our ED with secondary post-tonsillectomy hemorrhage received nebulized TXA for hemostatic management. The most common TXA dose used was 500 milligrams, and all but one patient received a single dose of the medication in the ED. Hemostatic benefit was observed in six patients, with complete bleeding cessation observed in five cases. Interventions prior to nebulized TXA administration were attempted in three of the six patients and included ice water gargle, direct pressure with TXA-soaked gauze, and nebulized racemic epinephrine. All but one of the patients were taken to the operating room for definitive management after initial stabilization in the ED. Conclusion: Nebulized TXA may offer a hemostatic benefit and aid in stabilization of tonsillectomy hemorrhage in the acute care setting, prior to definitive surgical intervention. Consideration of general principles of nebulization and aerosol particle size may be an important factor for drug delivery to the target tissue site.

Linguistic and Psycholinguistic Aspects of Silence: A Structural Model of Communication

Introduction. This work examines the role of silence along the lines of the theoretical considerations suggested by L. Wittgenstein and M. Heidegger. It also focuses on the role of communicative silence in each of the six functions of language in the structural model of communication put forward by Roman Jacobson. Other important types of functions are considered.Methodology and sources. Firstly, various philosophical and linguistic approaches towards the definition of silence are studied. Non-communicative silence, being outside the language domain, is differentiated from silence as part of communication, which is treated as a zero speech act in its own right. Finally, the paper analyzes the roles of communicative silence in the communicative model developed by Jacobson. Aesthetic function of silence is given special attention to. The poststructuralist view of silence is discussed.Results and discussion. Silence, acting as a linguistic sign, could convey information in the referential function; it could express emotions and personal experiences while performing the emotive function. As far as the conative function is concerned, silence serves to exert direct pressure on the addressee. Regarding the phatic function, silence acts as a means of establishing or discontinuing communication. Poetic silence focuses on the message for its own sake and manifests itself in repeating elements, such as syntactic pauses of various lengths and in differing contexts. Aesthetic function of silence is studied in a broader sense and involves the implementation of the motif of silence or “quietness” in a work of art. Silence becomes an important tool to study the acoustic, rhythmical potential of prosaic and poetic texts. With regard to silence in the metalinguistic function, it focuses primarily on the code of communication, i. e. on the language and its structure. The view of silence in psychoanalytical practice is also taken into account.Conclusion. The study of the phenomenon of silence allows to see a different number of functions it performs in situations when the speaker is either in a particular opposition to the speaker; or the situation is associated with a sense of respect, grief, humility. Silence could also accompany a number of emotive states, and perform a major role in prosaic and poetic texts when it stands out against the sounds that the main character hears around him allowing texts to bring out its acoustic properties. Psycho-analytical perspective allows to reveal more functions of silence.

The FAST VIP (First Aid for Severe Trauma “Virtual” in-Person) Educational Study

Introduction: Trauma is the leading cause of death for young Americans. Increased school violence, combined with an emphasis on early hemorrhage control, has boosted demand to treat injuries in schools. Meanwhile, coronavirus disease 2019 (COVID-19) has made educating the public about trauma more difficult. A federally funded high school education program in development, called First Aid for Severe Trauma™ (FAST™), will teach students to aid the severely injured. The program will be offered in instructor-led, web-based, and blended formats. We created a program to prepare high school teachers to become FAST instructors via “virtual” in-person (VIP) instruction. We used a webinar followed by VIP skills practice, using supplies shipped to participants’ homes. To our knowledge, no prior studies have evaluated this type of mass, widely distributed, VIP education. Methods: This study is a prospective, single-arm, educational cohort study. We enrolled a convenience sample of all high school teachers attending FAST sessions at the Health Occupations Students of America–Future Health Professionals International Leadership Conference. Half of the participants were randomized to complete the Stop the Bleed Education Assessment Tool (SBEAT) prior to the webinar, and the other completed it afterward; SBEAT is a validated tool to measure learning of bleeding competencies. We then performed 76 VIP video-training sessions from June–August 2020. The FAST instructors assessed each participant’s ability to apply a tourniquet and direct pressure individually, then provided interactive group skills training, and finally re-evaluated each participant’s performance post-training. Results: A total of 190 (96%) participants successfully applied a tourniquet after VIP training, compared to 136 (68%) prior to training (P < 0.001). Participants significantly improved their ability to apply direct pressure: 116 (56%) pre-assessment vs 204 (100%) post-assessment (P < 0.001). The mean score for the SBEAT increased significantly from pre-training to post-training: 2.09 with a standard deviation (SD) of 0.97 to 2.55 post-training with a SD of 0.72 (P < 0.001). Conclusion: This study suggests that a webinar combined with VIP training is effective for teaching tourniquet and direct-pressure application skills, as well as life-threatening bleeding knowledge. VIP education may be useful for creating resuscitative medicine instructors from distributed locations, and to reach learners who cannot attend classroom-based instruction.

FIELDWIDE DYNAMIC PRESSURE SURVEILLANCE WITH FPWD TECHNOLOGY

Reservoir management utilizes time-lapse pressure data that is captured over years in order to monitor reservoir development. Several methods can be used to establish field-wide hydraulic lateral and/or vertical connectivity: well testing, monitoring of permanent downhole gauges, wireline and LWD formation testers. While a typical formation pressure survey provides information about reservoir depletion or charge (production or injection), in a field with several wells it is not clearly understood where the pressure disturbances are coming from, which can hamper further field development decision making in terms of infill well selection and drilling. A novel method is introduced where a Formation Pressure While Drilling (FPWD) tool is run in UKCS wells and used to acquire interference data while drilling. Initially reservoir pressures are acquired as soon as practically possible after drilling. Having established these benchmark pressures, nearby injectors and/or producers can be started or shut in one at a time. Drilling is then resumed and after a certain time has elapsed since the benchmark pressure acquisition (typically at least 12 hours), the pressure measurements are repeated using the FPWD tool to evaluate the influence of the created transients in order to prove or disprove either lateral or vertical hydraulic connectivity across reservoirs. This way, the influence of a single offset well is evaluated in real time over the reservoir being currently drilled. This helps in the determination of interference pattern whereby injector wells can be judged for selective zone injections and producers can be rated in terms of zonal contribution which can help in completion design. These direct pressure measurements can illuminate reservoir pressure complexity seen in mature fields and provide operators with the means to safely and effectively construct wells to develop brownfields. The pressure changes obtained are used not only by reservoir engineers as an additional source of dynamic data into the reservoir simulation model but also help geologists in refining the geological or basin model. Two applications of real-time interference testing using FPWD from a recent drilling campaign are shown. In the first application, communication between wells is tested to reduce the risk of accidentally completing a well in an area of the field that experiences insufficient injection support. In the second application, real-time interference testing is used to identify a specific zone in a multi-layered reservoir sequence in order to enable selective completion.