Comparison of expiratory pressures generated by four different EPAP devices in a laboratory bench setting.

OBJECTIVE/BACKGROUND: Expiratory positive airway pressure (EPAP) has been a treatment option for patients with obstructive sleep apnea (OSA). ULTepap is a new FDA-cleared EPAP device that seals the nares with a nasal pillow interface. Comparisons of expiratory pressures generated by ULTepap and other EPAP devices like Provent, Bongo Rx, and Theravent are not available. We aimed to compare the backpressures created by these devices in an in vitro laboratory bench setting. METHODS: A test rig was designed and fabricated to test the expiratory pressures generated by ULTepap, Provent, Bongo Rx, and Theravent. Airflow was generated by a linear actuator-driven piston in a syringe, and a range of flow rates was provided by varying the voltage input to the actuator. The resulting expiratory and inspiratory pressures were measured and resistances were calculated. RESULTS: The backpressures generated by ULTepap and Provent were comparable at all flow rates. For flow rates at 99/142/212 ml/s, the expiratory pressures were 3.5/7.5/13.8 cmH2O for ULTepap and 4.5/8.5/14.5 cmH2O for Provent. Bongo Rx and Theravent devices produced substantially lower backpressures compared to ULTepap devices (0.8/1.8/3.5 cmH2O for Bongo Rx and 0.9/2.2/5.3 cmH2O for Theravent at flow rates of 99/142/212 ml/s). All four devices presented very low inspiratory flow resistance, with all generating 0.5 cmH2O or less at all flow rates. CONCLUSION: Not all FDA-cleared EPAP devices produce similar expiratory pressure profiles. ULTepap generated backpressures closest to that of Provent. Clinical trials comparing the efficacy, tolerance, and adherence of these EPAP devices in patients with OSA are warranted.

Mechanical Blood-Immersed Bearings in Continuous-Flow Rotary Blood Pumps.

Mechanical blood-immersed bearings have been used in many continuous-flow rotary blood pumps to reduce friction between relatively moving parts, but their use has been associated with a significant incidence of pump thrombosis. As newer cardiac assist devices with more advanced bearings become available, the rate of pump thrombosis will likely decrease. Nevertheless, it is important to understand the design limitations of mechanical bearings as pumps utilizing them are still in use as chronic support devices and especially in the acute setting for temporary support devices. A properly designed journal bearing should support the spinning rotor with no surface-to-surface contact between the bearing and journal surfaces. The journal continuously undergoes orbital motion within the bearing, which can be "stable" or "unstable." Unstable orbital motion causes the journal to move progressively off-center until it collides with the bearing, and even minor variations in manufacturing can create off-design operation and dynamic instability of the journal. Since blood is the lubricant in most clinically-used rotary blood pumps, lubricant viscosity can vary abruptly in response to changes in hematocrit or plasma protein concentration. Additionally, shear stress from the high-speed rotor can cause hemolysis and plasma protein denaturation. We reviewed theoretical design and operating principles of mechanical bearings and discuss why the phenomenon of mechanical bearing thrombosis may be an inherent design issue dependent on variables that are beyond the control of clinicians.

Characteristics and health effects of BTEX in a hot spot for urban pollution.

This study reports a spatiotemporal characterization of toluene, benzene, ethylbenzene, and xylenes concentrations (BTEX) in an urban hot spot in Iran, specifically at an bus terminal region in Shiraz. Sampling was carried out according to NIOSH Compendium Method 1501. The inverse distance weighting (IDW) method was applied for spatial mapping. The Monte Carlo simulation technique was applied to evaluate carcinogenic and non-carcinogenic risk owing to BTEX exposure. The highest average BTEX concentrations were observed for benzene in the morning (at 7:00-9:00 A.M. local time) (26.15 ±â€¯17.65 µg/m3) and evening (at 6:00-8:00 P.M. local time) (34.44 ±â€¯15.63 µg/m3). The benzene to toluene ratios in the morning and evening were 2.02 and 3.07, respectively. The main sources of BTEX were gas stations and a municipal solid waste transfer station. The inhalation lifetime cancer risk (LTCR) for benzene in the morning and evening were 1.96 × 10-4 and 2.49 × 10-4, respectively, which exceeds the recommended value by US EPA and WHO. The hazard quotient (HQ) of all these pollutants was less than 1. The results of this work have implications for public health near 'hot spots' such as IKBT where large populations are exposed to carcinogenic emissions.