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Contactless vital signs (VS) measurement with video photoplethysmography (vPPG), motion analysis (MA), and passive infrared thermometry (pIR) has shown promise.To compare conventional (contact-based) and experimental contactless VS measurement approaches for emergency department (ED) walk-in triage in pandemic conditions.Patients' heart rates (HR), respiratory rates (RR), and temperatures were measured with cardiorespiratory monitor and vPPG, manual count and MA, and contact thermometers and pIR, respectively.There were 475 walk-in ED patients studied (95% of eligible). Subjects were 35.2 ± 20.8 years old (range 4 days‒95 years); 52% female, 0.2% transgender; had Fitzpatrick skin type of 2.3 ± 1.4 (range 1‒6), Emergency Severity Index of 3.0 ± 0.6 (range 2‒5), and contact temperature of 36.83°C (range 35.89-39.4°C) (98.3°F [96.6‒103°F]). Pediatric HR and RR data were excluded from analysis due to research challenges associated with pandemic workflow. For a 30-s, unprimed "Triage" window in 377 adult patients, vPPG-MA acquired 377 (100%) HR measurements featuring a mean difference with cardiorespiratory monitor HR of 5.9 ± 12.8 beats/min (R = 0.6833) and 252 (66.8%) RR measurements featuring a mean difference with manual RR of -0.4 ± 2.6 beats/min (R = 0.8128). Subjects' Emergency Severity Index components based on conventional VS and contactless VS matched for 83.8% (HR) and 89.3% (RR). Filtering out vPPG-MA measurements with low algorithmic confidence reduced VS acquired while improving correlation with conventional measurements. The mean difference between contact and pIR temperatures was 0.83 ± 0.67°C (range -1.16-3.5°C) (1.5 ± 1.2°F [range -2.1-6.3°F]); pIR fever detection improved with post hoc adjustment for mean bias.Contactless VS acquisition demonstrated good agreement with contact methods during adult walk-in ED patient triage in pandemic conditions; clinical applications will need further study.

Background: Little has been written about the geographic basis of emergency department (ED) visits. Objective: The objective of this study is to describe the impact of geography on ED visits. Methods: A retrospective analysis was conducted of ED visits during a 1-year period at a single institution using spatial interaction analysis that models the pattern of flow between a series of origins (census block groups) and a destination (ED). Patients were assigned to census block groups based upon their verified home address. The study hospital is the only Level I trauma, pediatric, and tertiary referral center in the area. There are 11 other hospitals with EDs within a 40-mile radius. Each patient visit within this radius, including repeat visits, was included. Patients with an invalid home address, a post office box address, or those who lived outside a 40-mile radius were excluded. ED visits per 100 population were calculated for each census block group. Results: There were 98,584 (95%) visits by 63,524 patients that met study inclusion criteria. Visit rates decreased with increasing distance from the ED (p < 0.0001). Nineteen percent of patients lived within 2 miles, 48% within 4 miles, and 92% within 12 miles of the ED. The Connecticut border, 7 miles south of the ED (p < 0.0001), the Connecticut River, 1 mile west of the ED (p < 0.0001), and the presence of a competing ED within 1 mile (p < 0.0001) negatively impacted block group ED visit rates. Travel distance was related to the percentage of visits that were high acuity (p < 0.0001), daytime (p < 0.01), or resulted in admission (p < 0.0001). Conclusions: Geography and travel distance significantly impact ED visits.

A staged pattern of cathepsin B cleavage of MHC class II alpha, beta-bound invariant (Ii) chain and release of fragments was defined. Charge-loss mutations in the Ii chain were created in three clusters of cathepsin B putative cleavage sites R78K80K83K86, K137K143, and R151K154. Products of HLA-DR1 alpha, beta and wild type (WT) or mutant Ii genes, co-transfected into COS1 cells, were cleaved by cathepsin B and immunoprecipitated by antibodies either to MHC class II chains or to different Ii epitopes. In WT Ii, cathepsin B digestion generated two forms of p21 Ii fragments: a p21 recognized by anti-C-terminus antibodies and a p21 recognized by an antibody to a determinant near the N-terminus. C-terminal p21 was released from MHC class II alpha, beta chains upon its formation while N-terminal p21 remained associated with MHC class II alpha, beta chains. Mutations at K137K143 inhibited the generation of N-terminal p21 by cathepsin B. Mutation at R78K80K83K86 led to an accumulation of MHC class II-bound N-terminal p21 without the appearance of MHC class II-bound p14, p10, and p6 fragments after cathepsin B digestion. These results indicate that cathepsin B cleaves wild type Ii first about K137K143 to produce a MHC class II-associated N-terminal p21, which is then cleaved about R78K80K83K86 to generate p14, p10 and finally p6 which still associates with MHC class II alpha, beta chains. This pattern of staged cleavage and release of Ii might be related to a concerted mechanism regulating the binding of antigenic peptides to MHC class II molecules.