IMPLEMENTATION OF A DYNAMIC AND EXTENSIBLE MECHANICAL VENTILATOR MODEL FOR REAL-TIME PHYSIOLOGICAL SIMULATION.

We have designed and implemented a generic virtual mechanical ventilator model into the open-source Pulse Physiology Engine for real-time medical simulation. The universal data model is uniquely designed to apply all modes of ventilation and allow for modification of the fluid mechanics circuit parameters. The ventilator methodology provides a connection to the existing Pulse respiratory system for spontaneous breathing and gas/aerosol substance transport. The existing Pulse Explorer application was extended to include a new ventilator monitor screen with variable modes and settings and a dynamic output display. Proper functionality was validated by simulating the same patient pathophysiology and ventilator settings virtually in Pulse as a physical lung simulator and ventilator setup.

Computational simulation to assess patient safety of uncompensated COVID-19 two-patient ventilator sharing using the Pulse Physiology Engine.

BACKGROUND: The COVID-19 pandemic is stretching medical resources internationally, sometimes creating ventilator shortages that complicate clinical and ethical situations. The possibility of needing to ventilate multiple patients with a single ventilator raises patient health and safety concerns in addition to clinical conditions needing treatment. Wherever ventilators are employed, additional tubing and splitting adaptors may be available. Adjustable flow-compensating resistance for differences in lung compliance on individual limbs may not be readily implementable. By exploring a number and range of possible contributing factors using computational simulation without risk of patient harm, this paper attempts to define useful bounds for ventilation parameters when compensatory resistance in limbs of a shared breathing circuit is not possible. This desperate approach to shared ventilation support would be a last resort when alternatives have been exhausted. METHODS: A whole-body computational physiology model (using lumped parameters) was used to simulate each patient being ventilated. The primary model of a single patient with a dedicated ventilator was augmented to model two patients sharing a single ventilator. In addition to lung mechanics or estimation of CO2 and pH expected for set ventilation parameters (considerations of lung physiology alone), full physiological simulation provides estimates of additional values for oxyhemoglobin saturation, arterial oxygen tension, and other patient parameters. A range of ventilator settings and patient characteristics were simulated for paired patients. FINDINGS: To be useful for clinicians, attention has been directed to clinically available parameters. These simulations show patient outcome during multi-patient ventilation is most closely correlated to lung compliance, oxygenation index, oxygen saturation index, and end-tidal carbon dioxide of individual patients. The simulated patient outcome metrics were satisfactory when the lung compliance difference between two patients was less than 12 mL/cmH2O, and the oxygen saturation index difference was less than 2 mmHg. INTERPRETATION: In resource-limited regions of the world, the COVID-19 pandemic will result in equipment shortages. While single-patient ventilation is preferable, if that option is unavailable and ventilator sharing using limbs without flow resistance compensation is the only available alternative, these simulations provide a conceptual framework and guidelines for clinical patient selection.

Parameterization of Respiratory Physiology and Pathophysiology for Real-Time Simulation.

We have refactored the Pulse Physiology Engine respiratory software with enhanced parameterization for improved simulation functionality and results. Realistic patient variability can be applied using discretized lumped-parameters that define lung volumes, compliances, and resistances. A new sigmoid compliance waveform helps meet validation of compartment pressures, flows, volumes, and substance values. Further parameterization and enhanced logic for the application of pathophysiology allows for more accurate modeling of both restrictive and obstructive diseases for mild, moderate, and severe cases.Clinical Relevance- This free and open model provides a well-validated respiratory system for integration with medical simulations and research. It improves the Pulse modeling software and allows for new, low-cost training and in silico testing use-cases. Applications include virtual/augmented environments, manikin-based simulations, and clinical explorations.

Pharmacokinetic and pharmacodynamic modeling in BioGears.

Pharmacokinetics/pharmacodynamics models were designed and integrated into the BioGears® physiology engine to address the need for real time drug effects for varying patients and injury profiles. Ten drugs were validated using experimental and subject matter expert data. The plasma concentration curves had a good fit with experimental data and 48 of 50 physiologic parameters displayed a less than 10% error compared to the validation data.

A DNA barcode library for North American Ephemeroptera: progress and prospects.

DNA barcoding of aquatic macroinvertebrates holds much promise as a tool for taxonomic research and for providing the reliable identifications needed for water quality assessment programs. A prerequisite for identification using barcodes is a reliable reference library. We gathered 4165 sequences from the barcode region of the mitochondrial cytochrome c oxidase subunit I gene representing 264 nominal and 90 provisional species of mayflies (Insecta: Ephemeroptera) from Canada, Mexico, and the United States. No species shared barcode sequences and all can be identified with barcodes with the possible exception of some Caenis. Minimum interspecific distances ranged from 0.3-24.7% (mean: 12.5%), while the average intraspecific divergence was 1.97%. The latter value was inflated by the presence of very high divergences in some taxa. In fact, nearly 20% of the species included two or three haplotype clusters showing greater than 5.0% sequence divergence and some values are as high as 26.7%. Many of the species with high divergences are polyphyletic and likely represent species complexes. Indeed, many of these polyphyletic species have numerous synonyms and individuals in some barcode clusters show morphological attributes characteristic of the synonymized species. In light of our findings, it is imperative that type or topotype specimens be sequenced to correctly associate barcode clusters with morphological species concepts and to determine the status of currently synonymized species.

Functional cerebral distance and the effect of emotional music on spatial rotation scores in undergraduate women and men.

The influence of listening to music on subsequent spatial rotation scores has a controversial history. The effect is unreliable, seeming to depend on several as yet unexplored factors. Using a large sample (167 women, 160 men; M age = 18.9 yr.), two related variables were investigated: participants' sex and the emotion conveyed by the music. Participants listened to 90 sec. of music that portrayed emotions of approach (happiness), or withdrawal (anger), or heard no music at all. They then performed a two-dimensional spatial rotation task. No significant difference was found in spatial rotation scores between groups exposed to music and those who were not. However, a significant interaction was found based on the sex of the participants and the emotion portrayed in the music they heard. Women's scores increased (relative to a no-music condition) only after hearing withdrawal-based music, while men's scores increased only after listening to the approach-based music. These changes were explained using the theory of functional cerebral distance.

MRSA prevention and control in county correctional facilities in Southwestern Ohio.

The number of methicillin-resistant Staphylococcus aureus (MRSA) infections in correctional facilities around the country has been increasing. Considering the potential health impact of MRSA, it is important that correctional facilities have prevention and control protocols in place. The study results summarize the prevention and control preparedness activities of county jails in the Greater Dayton area of Ohio. Protocols and control measures were in place for environmental control (95.4%), MRSA screening (88.4%), standard precautions (84.3%), treatment (83.6%), personal hygiene (80.6%), and education (80.4%). Statistical analysis found no significant difference between rural and urban county jails in their handling of MRSA issues. The findings suggest significant compliance with MRSA prevention and control protocols among county jails in the Greater Dayton area.

Henoch-Schönlein purpura associated with Helicobacter pylori infection in a child.

Henoch-Schönlein purpura is an acute leukocytoclastic vasculitis that primarily affects children. Henoch-Schönlein purpura is often associated with an infection, and a wide variety of infectious agents have been implicated in the pathogenesis. We report a child with Henoch-Schönlein purpura associated with Helicobacter pylori infection. Treatment of the Helicobacter pylori infection was accompanied by prompt resolution of the Henoch-Schönlein purpura.

Pressure-induced polymerization of diiodobutadiyne in assembled cocrystals.

Diiodobutadiyne forms cocrystals with bis(pyridyl)oxalamides in which the diyne alignment is near the ideal parameters for topochemical polymerization to the ordered conjugated polymer, poly(diiododiacetylene) (PIDA). Nonetheless, previous efforts to induce polymerization in these samples via heat or irradiation were unsuccessful. We report here the successful ordered polymerization of diiodobutadiyne in these cocrystals, by subjecting them to high external pressure (0.3-10 GPa). At the lower end of the pressure range, the samples contain primarily monomer, as demonstrated by X-ray diffraction studies, but some polymerization does occur, leading to a pronounced color change from colorless to blue and to the development of intense Raman peaks at 962, 1394, and 2055 cm-1, corresponding to the poly(diacetylene). At higher pressures, the samples turn black and contain primarily polymer, as determined by solid-state NMR and Raman spectroscopy. Both density functional theory calculations (B3LYP/LanL2DZ) and comparisons to authentic samples of PIDA have confirmed the data analysis.

Designed cocrystals based on the pyridine-iodoalkyne halogen bond.

Diiodobutadiyne (1) and diiodohexatriyne (2) form cocrystals with bispyridyl oxalamides and ureas, based on the halogen bond between the alkynyl iodine and pyridine nitrogen. In each cocrystal, the oxalamide or urea host forms one-dimensional hydrogen-bonded networks, aligning the diiodopolyyne for potential topochemical polymerization with a repeat distance matching the host repeat.

Tetrabromobutatriene: completing the perhalocumulene series.

[structure: see text] Tetrabromobutatriene, C(4)Br(4), can be prepared directly from dibromobutadiyne by reaction with Br(2) at -25 degrees C in concentrated hexanes solution. The cumulene precipitates out of the reaction mixture as a yellow powder. Under palladium-catalyzed coupling conditions, C(4)Br(4) can undergo allylic rearrangement, giving a mixture of products, including some with butenyne backbones. However, in furan solution, C(4)Br(4) reacts cleanly at its central double bond to give the furan Diels-Alder adduct. Under Suzuki conditions, this adduct reacts at the furan double bond rather than at bromide.

Experimental studies of the 13C NMR of iodoalkynes in Lewis-basic solvents.

The (13)C NMR spectra of two different iodoalkynes, 1-iodo-1-hexyne (1) and diiodoethyne (2), exhibit a strong solvent dependence. Comparisons of the data with several common empirical models, including Gutmann's Donor numbers, Reichardt's E(N)(T), and Taft and Kamlet's beta and pi, demonstrate that this solvent effect arises from a specific acid-base interaction. Solvent basicity measures such as Donor numbers and beta values correlate well with the alpha-carbon chemical shift of 1, but polarity measures such as E(N)(T) and pi do not correlate. The similarity of the solvent effect for 1 and 2 suggests that carbon-carbon bond polarization may not play a role in the change in chemical shift, as previously hypothesized.