Barriers to point-of-care ultrasound utilization during cardiac arrest in the emergency department: a regional survey of emergency physicians.

INTRODUCTION: Though point-of-care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic intervention during cardiac arrest (CA), critics advise caution. The purpose of this survey study was to determine the barriers to POCUS during CA in the Emergency Department (ED). METHODS: Two survey instruments were distributed to emergency medicine (EM) attending and resident physicians at three academic centers in the South Florida. The surveys assessed demographics, experience, proficiency, attitudes and barriers. Descriptive and inferential statistics along with Item Response Theory Logistic Model and the Friedman Test with Wilcoxon Signed Rank tests were used to profile responses and rank barriers. RESULTS: 206 EM physicians were invited to participate in the survey, and 187 (91%) responded. 59% of attending physicians and 47% of resident physicians reported that POCUS is performed in all their cases of CA. 5% of attending physicians and 0% of resident physicians reported never performing POCUS during CA. The top-ranked departmental barrier for attending physicians was "No structured curriculum to educate physicians on POCUS." The top-ranked personal barriers were "I do not feel comfortable with my POCUS skills" and "I do not have sufficient time to dedicate to learning POCUS." The top-ranked barriers for resident physicians were "Time to retrieve and operate the machine" and "Chaotic milieu." CONCLUSIONS: While our study demonstrates that most attending and resident physicians utilize POCUS in CA, barriers to high-quality implementation exist. Top attending physician barriers relate to POCUS education, while the top resident physician barriers relate to logistics and the machines. Interventions to overcome these barriers might lead to optimization of POCUS performance during CA in the ED.

Ultrasound Assisted Extraction of Phenolic Compounds from Peaches and Pumpkins.

The ultrasound-assisted extraction (UAE) method was used to optimize the extraction of phenolic compounds from pumpkins and peaches. The response surface methodology (RSM) was used to study the effects of three independent variables each with three treatments. They included extraction temperatures (30, 40 and 50°C), ultrasonic power levels (30, 50 and 70%) and extraction times (10, 20 and 30 min). The optimal conditions for extractions of total phenolics from pumpkins were inferred to be a temperature of 41.45°C, a power of 44.60% and a time of 25.67 min. However, an extraction temperature of 40.99°C, power of 56.01% and time of 25.71 min was optimal for recovery of free radical scavenging activity (measured by 1, 1-diphenyl-2-picrylhydrazyl (DPPH) reduction). The optimal conditions for peach extracts were an extraction temperature of 41.53°C, power of 43.99% and time of 27.86 min for total phenolics. However, an extraction temperature of 41.60°C, power of 44.88% and time of 27.49 min was optimal for free radical scavenging activity (judged by from DPPH reduction). Further, the UAE processes were significantly better than solvent extractions without ultrasound. By electron microscopy it was concluded that ultrasonic processing caused damage in cells for all treated samples (pumpkin, peach). However, the FTIR spectra did not show any significant changes in chemical structures caused by either ultrasonic processing or solvent extraction.

Engineering of a hybrid polymer-lipid nanocarrier for the nasal delivery of tenofovir disoproxil fumarate: physicochemical, molecular, microstructural, and stability evaluation.

PURPOSE: To engineer a hybrid nanocarrier system based on lipid and polymer for the nasal delivery of tenofovir disoproxil fumarate (TDF), and further to investigate its physicochemical, molecular, microstructural, and stability aspects. METHODS: Nanoparticles were prepared by melt emulsification-probe sonication technique. A 3(2) factorial design was used to identify key formulation variables influencing the characteristics of drug-loaded carrier. FT-IR, mass spectroscopy (MS) and (1)H NMR was used to probe molecular interactions among the components of the system, while the surface morphology was imagined through electron microscopy (TEM and SEM). Thermal analysis and powder X-ray diffraction (PXRD) was used to explore melting and crystallization behavior of drug and the carrier lipid. PLN-9 GEL was studied for its rheology, drug release, ex-vivo permeation, histopathology, and stability. RESULTS: Batch PLN-9 had size of 239 nm, drug encapsulation of 87.14% and revealed spherical morphology. MS, FT-IR and (1)H NMR established compatibility between the drug (TDF) and the carrier lipid (Lauric acid), while, a strong H-bonding was identified between the amino (-NH2) group of drug and the carboxyl (-COOH) group of pemulen polymer. Thermal analysis confirmed an amorphous TDF within the carrier matrix. PXRD analysis indicated substantial change in the molecular packing and subcell structure of carrier lipid during the PLN processing. PLN-9 GEL had shear thinning rheology, an anomalous type (n>0.5) of drug release and possessed potential to transport TDF across the nasal mucosa with an average flux of 135.36 µg/cm(2)/h. CONCLUSION: The designed carrier can encapsulate TDF and accentuates its transnasal flux, thus could be used as a carrier for an effective nasal delivery of TDF.

Investigating photoinduced charge transfer in carbon nanotube-perylene-quantum dot hybrid nanocomposites.

In this study, we investigate photophysical and photoinduced current responses of a nanocomposite which consists of multiwalled carbon nanotubes (CNTs), thiol derivative perylene compound (ETPTCDI), and cadmium selenide quantum dots (QDs). These QDs as well as the ETPTCDI harvest photons and transfer their excited electrons or holes to CNTs to complete the circuit. Both QDs and ETPTCDI contribute charges to the carbon nanotubes, which increased the overall photon harvest efficiency of the nanocomposite. Herein, we investigate through a series of photophysical photoluminescence quenching studies the charge transfer between donors (QDs and ETPTCDI) and acceptor (CNTs). The incorporation of ETPTCDI into the nanocomposite significantly increases the adhesion between QDs and CNTs through bonding between QDs and thiol groups on ETPTCDI and π-π interactions between ETPTCDI and CNTs. Thus, ETPTCDI acted as a molecular linker between QDs and CNTs. Furthermore, a significant increase (>5 times) in the Stern-Volmer constant, K(sv), for QD emission after addition of ETPTCDI-tagged CNTs clearly indicates a large enhancement in the adhesion between CNTs and QDs. The nanocomposite shows a ∼2-4-fold increase in the photoconductivity when exposed to AM1.5 solar-simulated light. The damage to the nanocomposite from the intensity of the solar-simulated light is also investigated. The proposed nanocomposite has the potential for photovoltaic applications such as being the active component in a hybrid bulk heterojunction solar cell.

Influence of habits on masons' blood cholesterol.

Plasma total cholesterol, HDL cholesterol, glucose and total protein were estimated in (male) masons without any habits (normal masons) and masons with habits (cigarette smoking, alcohol consumption and betel-quid cum tobacco chewing) and compared with normal subjects. Masons had less total cholesterol and more HDL cholesterol when compared with normal subjects, which may be due to their occupational physical activities. Among masons, cigarette-smoking masons alone had more total cholesterol and less HDL cholesterol. Blood glucose also decreased in masons and more so in betel-quid cum tobacco chewing masons when compared with normal subjects while total protein content showed no variation.

Effect of occupation on lipid peroxidation and antioxidants' status in masons.

Effect of occupation on haematological factors, lipid peroxidation and antioxidants' status was studied in masons and compared with normal subjects. Red blood corpuscles (RBC), haemoglobin (Hb), Vitamin C, Vitamin E, beta-carotene levels and glutathione peroxidase (GSHPx), superoxide dismutase (SOD) and catalase (CAT) activities decreased. Thiobarbituric acid reacting substances (TBARS) level increased. Occupational exposure to cement increased lipid peroxidation but decreased antioxidants' levels in masons. Increased lipid peroxidation seems to be responsible for the reduction in RBC and Hb.