Search

Background: Drug inhalation is common mode of treatment for chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the efficiency of aerosol devices in a simulated COPD adult lung model using five commercially available hand-held mesh nebulizers. Materials and Methods: Five nebulizers (PARI VELOX®, Omron NE-U22, Aeroneb® Go, APEX PY001, and Pocket Air®) were tested with a unit dose of 5.0 mg/2.5 mL salbutamol. An in vitro lung model (compliance: 0.06 L/cm H2O, resistance: 20 cm H2O/L/sec) was constructed to simulate parameters (tidal volume of 500 mL, respiratory rate of 15 breaths/min, inspiratory time of 1 second) of an adult patient with COPD. A bacterial filter was attached at the bronchi level for drug collection, referring as inhaled mass. After nebulization, the inhaled mass (%), dose remaining on each component (%), particle size characteristics, and nebulizer performances were analyzed. Particle size characteristics were analyzed using an 8-stage Anderson Cascade Impactor. The salbutamol particles deposited were eluted and analyzed using a spectrophotometer at 276 nm. The inhaled mass (%), dose remaining on each component (%), particle size distribution, and nebulizer performance were statistically analyzed using analysis of variance (ANOVA) with Sheffee post hoc tests. Results: Pocket Air and APEX PY001 showed the greatest inhaled mass and the lowest dose in the mouthpiece connection. The largest and smallest mass median aerodynamic diameters were found with Omron NE-U22 and PARI VELOX, respectively. In addition, the output rate and inhaled aerosol rate (IAR) of PARI VELOX were higher than those of other nebulizers. Conclusions: This study showed that the performance of commercially available mesh nebulizers varied. Aerosol particles deposited on different auxiliary equipment directly influenced the output rate and IAR of the mesh nebulizer. Clinical validation of the drug IAR is necessary to avoid overdose and reduce drug wastage.

Expiratory tasks may facilitate transversus abdominis (TrA) activity for spinal stabilization. The purpose of this study was to verify whether a combination of pursed-lip breathing (PLB) and use of an expiratory threshold loading (ETL) device to increase expiratory resistance would promote TrA contraction comparable to that for a stabilization exercise.Twenty healthy men performed expiratory tasks or an abdominal drawing-in maneuver (ADIM). Expiratory tasks comprised combinations of ETL settings with 0%, 5%, or 15% of maximum expiratory pressure, and mouthpieces with a normal shape or pursed-lip shape. B-mode ultrasound imaging of the TrA, internal oblique, and external oblique muscles was performed to determine percentage changes in muscle thickness. Percentage changes among tasks were statistically compared for each muscle.TrA thickness increased with normal lips at 15% ETL, with PLB with 5% ETL, and with ADIM (p 0.01 each). Internal oblique thickness increased under all PLB conditions (p 0.01 each). No significant differences in external oblique thickness were seen for any tasks. The total thickness of the lateral abdominal muscles was significantly increased not only for 15% ETL tasks and ADIM, but also for PLB with 5% ETL (p 0.02 each).These results indicated that PLB with 5% ETL could facilitate the same level of TrA activity as the ADIM. PLB with 5% ETL was the only task that simultaneously increased overall lateral abdominal muscles, including the internal obliques, and might be readily applicable in clinical situations.

Introduction: Fugitive aerosol concentrations generated by different nebulizers and interfaces in vivo, and mitigation of aerosol dispersion into the environment with various commercially available devices are not known. Methods: Nine healthy volunteers were given 3 mL saline with a small volume nebulizer (SVN) or vibrating mesh nebulizer (VMN) with a mouthpiece, a mouthpiece with an exhalation filter, an aerosol mask with open ports for SVN and a valved facemask for VMN, and a facemask with a scavenger (Exhalo) in random order. Five of the participants received treatments using a face tent scavenger (Vapotherm) and a mask with exhalation filter with SVN and VMN in a random order. Treatments were performed in an ICU room, with 2 particle counters positioned 1 and 3 feet from participants measuring aerosol concentrations at sizes of 0.3-10 µm at baseline, before, during and after each treatment. The Ethics Committee at Rush University approved this study. Results: Fugitive aerosol concentrations were higher with SVN than VMN and higher with a facemask than a mouthpiece. Adding an exhalation filter to a mouthpiece reduced aerosol concentrations of 0.3-1.0 µm in size for VMN and 0.3-3.0 µm for SVN (all p

Introduction New training devices have been introduced to help in inhaler counseling by addressing the inspiratory flow through the metered-dose inhaler (MDI), which is the most important problem of the MDI inhalation technique. This study aims to compare the effects of MDI traditional verbal counseling and advanced counseling using training devices with a smartphone application in pediatric asthmatic patients. Methods A total of 201 pediatric asthmatic subjects (8–18 years) were divided into two groups: a verbal counseling group, who received only MDI verbal counseling training (n = 101), and an advanced counseling group who received counseling using a training device (Flo-Tone with Trainhaler smartphone application) in addition to the traditional MDI verbal counseling (n = 100). Every patient in the two groups attended three counseling visits, 1 month apart. At each visit, pulmonary functions [peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV1) as % of predicted] were measured. Also, patients were asked to perform their normal inhalation technique using their MDI, and mistakes were detected and recorded by the investigator. Then, patients were trained on the correct steps of the MDI inhalation technique using either verbal counseling or advanced counseling depending on their study group. In the advanced group, the Flo-Tone was connected to the mouthpiece of the MDI to blow a whistle while the patient inhaled from the MDI. That whistle was detected by the Trainhaler smartphone application and the duration of inhalation determined by the application was recorded. Results Both groups showed a gradual significant decrease (p

Purpose We investigated the immobilization accuracy of a new type of thermoplastic mask—the Double Shell Positioning System (DSPS)—in terms of geometry and dose delivery. Methods Thirty‐one consecutive patients with 1–5 brain metastases treated with stereotactic radiotherapy (SRT) were selected and divided into two groups. Patients were divided into two groups. One group of patients was immobilized by the DSPS (n = 9). Another group of patients was immobilized by a combination of the DSPS and a mouthpiece (n = 22). Patient repositioning was performed with cone beam computed tomography (CBCT) and six‐degree of freedom couch. Additionally, CBCT images were acquired before and after treatment. Registration errors were analyzed with off‐line review. The inter‐ and intrafractional setup errors, and planning target volume (PTV) margin were also calculated. Delivered doses were calculated by shifting the isocenter according to inter‐ and intrafractional setup errors. Dose differences of GTV D99% were compared between planned and delivered doses against the modified PTV margin of 1 mm. Results Interfractional setup errors associated with the mouthpiece group were significantly smaller than the translation errors in another group (p = 0.03). Intrafractional setup errors for the two groups were almost the same in all directions. PTV margins were 0.89 mm, 0.75 mm, and 0.90 mm for the DSPS combined with the mouthpiece in lateral, vertical, and longitudinal directions, respectively. Similarly, PTV margins were 1.20 mm, 0.72 mm, and 1.37 mm for the DSPS in the lateral, vertical, and longitudinal directions, respectively. Dose differences between planned and delivered doses were small enough to be within 1% for both groups. Conclusions The geometric and dosimetric assessments revealed that the DSPS provides sufficient immobilization accuracy. Higher accuracy can be expected when the immobilization is combined with the use of a mouthpiece.

Background Intrapulmonary percussive ventilation (IPV) facilitates the mobilization and clearance of bronchial secretions. Cricothyroidotomy using a Mini-Trach II device is a minimally invasive method used for secretion clearance. To our knowledge, there are no previous reports regarding IPV combined with Mini-Trach II. Case presentation An 82-year-old man underwent controlled mechanical ventilation and IPV via an endotracheal tube to treat atelectasis following emergency surgical repair of a traumatic diaphragm laceration. He underwent cricothyroidotomy using Mini-Trach II for ensuring airway management after extubation. On resumption, IPV through a mouthpiece or face mask was unsuccessful owing to air leakage from his mouth. However, IPV via the already inserted Mini-Trach II could deliver the percussion flow and led to a marked improvement in his condition. Conclusion This experience indicates that Mini-Trach II is beneficial as a minimally invasive interface for IPV that can deliver percussion flow efficiently.

Several case studies and anecdotal reports have shown assorted motor and quality of life benefits from use of a dental mouthpiece among people with Parkinson disease (PD). A larger exploratory study is necessary to assess potential efficacy and feasibility of this treatment strategy. If shown to be effective and feasible in a larger sample of people with PD, mechanistic studies may be warranted to examine a potential relationship between orofacial sensory input and motor function in people with PD.This study was registered on clinicaltrials.gov (NCT: 04082663). Twenty people with PD, Hoehn and Yahr stages I-III, participated in this study. Each participant completed various baseline motor and quality of life assessments before being fitted with a custom mouthpiece. Motor assessments were completed a second time after 25 min of mouthpiece wear. Participants were asked to wear the mouthpiece for 1 month before completing follow-up quality of life assessments and providing feedback about the mouthpiece. Wilcoxon signed-rank tests were used to compare results across conditions.Gait velocity and cadence showed significant (These results do not provide adequate evidence to pursue further this type of mouthpiece as a treatment strategy for motor signs and symptoms or quality of life in people with PD.

What is the delivered dose with jet and mesh nebulisers during spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV) using an adult lung model with exhaled humidity (EH)? The delivery of salbutamol sulfate (2.5 mg per 3 mL) with jet (Mistymax10) and mesh nebulisers (Aerogen Solo) was compared during SB, NIV, and MV using breathing parameters (tidal volume 450 mL, respiratory rate 20 breaths per min, inspiratory:expiratory ratio 1:3) with three lung models simulating exhaled humidity. A manikin was attached to a sinusoidal pump via a filter at the bronchi to simulate an adult with SB. A ventilator (V60) was attached via a facemask to a manikin with a filter at the bronchi connected to a test lung to simulate an adult receiving NIV. A ventilator-dependent adult was simulated through a ventilator (Servo-i) operated with a heated humidifier (Fisher & Paykel) attached to an endotracheal tube (ETT) with a heated-wire circuit. The ETT was inserted into a filter (Respirgard II). A heated humidifier was placed between the filter and test lung to simulate exhaled humidity (35±2°C, 100% relative humidity). Nebulisers were placed at the Y-piece of the inspiratory limb during MV and positioned between the facemask and the leak-port during NIV. A mouthpiece was used during SB. The delivered dose was collected in an absolute filter that was attached to the bronchi of the mannequin during each aerosol treatment and measured with spectrophotometry. Drug delivery during MV was significantly greater than during NIV and SB with a mesh nebuliser (p=0.0001) but not with a jet nebuliser (p=0.384). Delivery efficiency of the mesh nebuliser was greater than the jet nebuliser during MV (p=0.0001), NIV (p=0.0001), and SB (p=0.0001). Aerosol deposition obtained with a mesh nebuliser was greater and differed between MV, NIV, and SB, while deposition was low with a jet nebuliser and similar between the modes of ventilation tested., Delivered dose distal to the trachea of an adult lung model is similar or greater with MV than NIV and SB, suggesting that the artificial airway may provide a similar or better pathway for medical aerosols to the lung https://bit.ly/3gAk7nd

Our aim was to synthesize the published literature on factors that potentially affect the delivery of bronchodilators using valved holding chambers (VHC) in preschool children. We also aimed to identify those attributes that are not yet incorporated or clearly stated in the guidelines and those topics that are still lacking sufficient data. There is strong evidence supporting several recommendations in current guidelines. Based on present knowledge, bronchodilators should be delivered by VHC administering each puff separately. Face mask should be omitted as soon as the child can hold the mouthpiece of the VHC tightly between the lips and teeth. Based on the review, we suggest adding a specific note to current guidelines about the effect of chamber volume and the impact of co-operation during drug administration. Calming the child and securing a tight face-to-mask seal is critical for successful drug delivery. There is not enough evidence to make specific recommendations on the most reliable VHC and face mask for children. There is an urgent need for studies that evaluate and compare the effectiveness of VHCs in various clinical settings in wide age-groups and respiratory patterns. In addition, there is insufficient data on ideal chamber volume, material, and effective antistatic treatment. What is Known:• Valved holding chambers (VHC) should not be considered interchangeable when used with pressurized metered dose inhalers (pMDI).• Drug delivery is influenced by VHC volume, aerodynamic and electrostatic properties; mask fit; respiratory pattern and co-operation during inhalation; and the number of puffs actuated.What is New:• The impact of co-operation, VHC volume, and good mask-to-face fit during drug inhalation is not stressed enough in the guidelines.• Studies are urgently needed to evaluate the effectiveness of different VHCs in various clinical settings focusing on VHC electrostatic properties, respiratory patters, face masks, and ideal pMDI+VHC combinations.

BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy has been broadly used. However, no consensus has been achieved on the practical implementation of HFNC and how to provide aerosol delivery during HFNC therapy in adult patients. METHODS: An online anonymous questionnaire survey endorsed by 4 academic societies from America, Europe, mainland China, and Taiwan was administered from May to December 2019. Clinicians who had worked in adult ICUs for > 1 year and had used HFNC to treat patients within 30 days were included. RESULTS: A total of 2,279 participants clicked on the survey link, 1,358 respondents completed the HFNC section of the questionnaire, whereas 1,014 completed the whole survey. Postextubation hypoxemia and moderate hypoxemia were major indications for HFNC. The initial flow was mainly set at 40–50 L/min. Aerosol delivery via HFNC was used by 24% of the participants (248/1,014), 30% (74/248) of whom reported reducing flow during aerosol delivery. For the patients who required aerosol treatment during HFNC therapy, 40% of the participants (403/1,014) reported placing a nebulizer with a mask or mouthpiece while pursuing HFNC (a method shown to reduce inhaled dose), whereas 33% (331/1,014) discontinued HFNC to use conventional aerosol devices. A vibrating mesh nebulizer was the most commonly used nebulizer (40%) and was mainly placed at the inlet of the humidifier. CONCLUSIONS: The clinical utilization of HFNC was variable, as were indications, flow settings, and criteria for adjustment. Many practices associated with concomitant aerosol therapy were not consistent with available evidence for optimal use. More efforts are warranted to close the knowledge gap.

The aim of this study was to compare the estimated public medical care cost of measures to address metallic dental restorations (MDRs) for head and neck radiotherapy using high-energy mega-voltage X-rays. This was considered a first step to clarify which MDR measure was more cost-effective. We estimated the medical care cost of radiotherapy for two representative MDR measures: (i) with MDR removal or (ii) without MDR removal (non-MDR removal) using magnetic resonance imaging and a spacer. A total of 5520 patients received head and neck radiation therapy in 2018. The mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. Therefore, the difference in total public medical care cost between MDR removal and non-MDR removal was estimated to be 303 268 800 yen. Our results suggested that non-MDR removal would be more cost-effective than MDR removal for head and neck radiotherapy. In the future, a national survey and cost-effectiveness analysis via a multicenter study are necessary; these investigations should include various outcomes such as the rate of local control, status of oral mucositis, frequency of hospital visits and efforts of the medical professionals.

Le document qui suit est la traduction intégrale du compte rendu établi à l’occasion du 252eatelier international ENMC consacré, du 6 ou 8 mars 2020, au « Développement de recommandations pour l’utilisation de la ventilation par embout buccal dans les maladies neuromusculaires », et publié très récemment dans la revueNeuromuscular Disorders(M. Chatwin, M. Gonçalves, J. Gonzalez-Bermejo, M. Toussaint, et al. 252ndENMC international workshop: Developing best practice guidelines for management of mouthpiece ventilation in neuromuscular disorders. March 6thto 8th2020, Amsterdam, the Netherlands.Neuromuscular Disorders2020 ; 30 : 772–81.https://doi.org/10.1016/j.nmd.2020.07.008).

Chronic obstructive pulmonary disease (COPD) is a disease whose prevalence tends to increase annually, with the World Health Organization (WHO) data predicting in 2020 the disease is the cause of the third-highest mortality worldwide. The assessment of the recurrence of COPD patients is very important, as it will accelerate the decline of lung function and health status. The purpose of this research is to design a spirometer by utilizing the MPXV7002DP sensor and equipped with a graphical display as well as lung health status on the Nextion TFT LCD. A portable Spirometer design has been done using the MPXV7002DP pressure sensor out as a transducer with a display on the Nextion TFT LCD. The design aims to determine the health of lung function by knowing the volume of lung Forced Vital Capacity (FVC), Forced Expired Volume in one second (FEV1), and Vital Capacity (VC). The working principle of this tool is to process the pressure from the results of the user blowing to the sensor through a mouthpiece which is designed based on Venturimeter law, the data will be processed by the Arduino microcontroller 2560 to be displayed on the LCD TFT and Nextion stored in SD card memory. The result of module validation data against a Spirometer 3L calibrator Benchmarking tool was obtained 1.58% VC error. The value is still below the 5% error tolerance limit so that the VC parameters in the secure module is used.

Background Fluid Resistant Surgical Masks have been implemented in UK personal protective equipment (PPE) guidelines for COVID-19 for all care sites that do not include aerosol-generating procedures (AGPs). FFP3 masks are used in AGP areas. Concerns from the ENT and plastic surgery communities out with intensive care units have questioned this policy. Emerging evidence on cough clouds and health care worker deaths has suggested that a review is required. Aims To test the efficacy of Fluid Resistant Surgical Mask with and without adaptions for respiratory protection. To test the efficacy of FFP and FFP3 regarding fit testing and usage. Methods A smoke chamber test of 5 min to model an 8-h working shift of exposure while wearing UK guideline PPE using an inspiratory breathing mouthpiece under the mask. Photographic data were used for comparison. Results The Fluid Resistant Surgical Mask gave no protection to inhaled smoke particles. Modifications with tape and three mask layers gave slight benefit but were not considered practical. FFP3 gave complete protection to inhaled smoke but strap tension needs to be ‘just right’ to prevent facial trauma. Facial barrier creams are an infection risk. Conclusions Surgical masks give no protection to respirable particles. Emerging evidence on cough clouds and health care worker deaths suggests the implementation of a precautionary policy of FFP3 for all locations exposed to symptomatic or diagnosed COVID-19 patients. PPE fit testing and usage policy need to improve to include daily buddy checks for FFP3 users

Purpose This study aimed to reduce radiation doses to the tongue, a patient-specific semi-customized tongue immobilization device (SCTID) was developed using a 3D printer for helical tomotherapy (HT) of nasopharyngeal cancer (NPCa). Dosimetric characteristics and setup stability of the SCTID were compared with those of a standard mouthpiece (SMP).Materials and Methods For displacement and robust immobilization of the tongue, the SCTID consists of four parts: upper and lower tooth stoppers, tongue guider, tongue-tip position guide bar, and connectors. With the SCTID and SMP, two sets of planning computed tomography and HT plans were obtained for 10 NPCa patients. Dosimetric and geometric characteristics were compared. Position reproducibility of the tongue with SCTID was evaluated by comparing with planned dose and adaptive accumulated dose of the tongue and base of the tongue based on daily setup mega-voltage computed tomography.Results Using the SCTID, the tongue was effectively displaced from the planning target volume compared to the SMP. The median mucosa of the tongue (M-tongue) dose was significantly reduced (20.7 Gy vs. 27.8 Gy). The volumes of the M-tongue receiving a dose of 15 Gy, 30 Gy, and 45 Gy and the volumes of the mucosa of oral cavity and oropharynx (M-OC/OP) receiving a dose of 45 Gy and 60 Gy were significantly lower than using the SMP. No significant differences was observed between the planned dose and the accumulated adaptive dose in any dosimetric characteristics of the tongue and base of tongue.Conclusion SCTID can not only reduce the dose to the M-tongue and M-OC/OP dramatically, when compared to SMP, but also provide excellent reproducibility and easy visual verification.

Highlights • Pre workshop international survey on MPV • Best practice guidline on the provision of MPV in NMD's by reviewing and recommend the most appropriate monitoring, mode, settings and equipment required for MPV. • Best practice algorithm on MPV for daytime ventilatory support (see Figure 1 ).Figure 1Figure 1 shows the best practice algorithm for the initiation of mouthpiece ventilation (MPV) in the long-term setting. For each stage of the algorithm there is a description to assist in the provision of this service.Figure 1 • Future studies in MPV.

PURPOSE: This study was intended to determine the effect of skin cooling on breath-hold duration and predicted emergency air supply duration during immersion.METHODS: While wearing a helicopter transport suit with a dive mask, 12 subjects (29 ± 10 yr, 78 ± 14 kg, 177 ± 7 cm, 2 women) were studied in 8 and 20°C water. Subjects performed a maximum breath-hold, then breathed for 90 s (through a mouthpiece connected to room air) in five skin-exposure conditions. The first trial was out of water for Control (suit zipped, hood on, mask off). Four submersion conditions included exposure of the: Partial Face (hood and mask on); Face (hood on, mask off); Head (hood and mask off); and Whole Body (suit unzipped, hood and mask off).RESULTS: Decreasing temperature and increasing skin exposure reduced breath-hold time (to as low as 10 ± 4 s), generally increased minute ventilation (up to 40 ± 15 L · min−1), and decreased predicted endurance time (PET) of a 55-L helicopter underwater emergency breathing apparatus. In 8°C water, PET decreased from 2 min 39 s (Partial Face) to 1 min 11 s (Whole Body).CONCLUSION: The most significant factor increasing breath-hold and predicted survival time was zipping up the suit. Face masks and suit hoods increased thermal comfort. Therefore, wearing the suits zipped with hoods on and, if possible, donning the dive mask prior to crashing, may increase survivability. The results have important applications for the education and preparation of helicopter occupants. Thermal protective suits and dive masks should be provided.Madu VC, Carnahan H, Brown R, Ennis K-A, Tymko KS, Hurrie DMG, McDonald GK, Cornish SM, Giesbrecht GG. Skin cooling on breath-hold duration and predicted emergency air supply duration during immersion. Aerosp Med Hum Perform. 2020; 91(7):578–585.

Breathing tracking is critical for the assessment of lung functions, exercise physiologies, and energy expenditure. Conventional methods require using a face mask or mouthpiece that is connected to a stationary equipment through a tube, restricting the location, movement, or even the posture. To obtain accurate breathing physiology parameters that represent the true state of the patient during different scenarios, a wearable technology that has less intervention to patient’s activities in free-living conditions is highly preferred. Here, we propose a miniaturized, reliable, and wide-dynamic ranged flow sensing technology that is immune to orientation, movement, and noise. As far as we know, this is the first work of introducing a fully integrated mask device focusing on breath tracking in free-living conditions. There are two key challenges for achieving this goal: miniaturized flow sensing and motion-induced artifacts elimination. To address these challenges, we come up with two technical innovations: 1) in hardware wise, we have designed an integrated flow sensing technique based on differential pressure Pneumotach approach and motion sensing; 2) in software wise, we have developed comprehensive algorithms based baseline tracking and orientation and motion compensation. The effectiveness of the proposed technology has been proven by the experiments. Experimental results from simulator and real breath conditions show high correlation (R(2) = 0.9994 and 0.9964 respectively) and mean error within 2.5% for Minute Volume (VE), when compared to values computed from reference methods. These results show that the proposed method is accurate and reliable to track the key breath parameters in free-living conditions.

Background: Thelarynx is an inevitable mouthpiece of the human body which has to execute very associated assignment like protection, respiration, and phonation. To fulfill this mission, the larynx should be accommodated, integrated, and sensible. The vocal cord is the concern of larynx, which served all-purpose. If any occurrence due to iatrogenic, idiopathic, or any other causes shut down the vocal cord mobility, the patient is facing miserable complexity in their life. Methods: It is a cohort retrospective study of 67 cases in the department of otolaryngology and Head-Neck Surgery, Bangladesh, from 01 July 2016 to 31 June 2019. Results: Incidence among outpatient was 0.06%, inpatient was 0.37%, and total laryngeal disorder, and thyroid operation was 6.51%. Of them unilateral was 64(95.52%) in which both right and left were equal 32(50%) bilateral were 3(2.99%), male were 28(41.79%), and females were 39(58.21%). Amidst them 00-18 years were 2(2.99%), 19-40 years were 21(31.34), 41-60 years 36(53.73%) and above 60 years 8(11.94%), smokers were 34(50.74%), betel leaf chewer 26(38.81%), diabetic were 27(40.30%), hypertensive were 19(28.36%), iatrogenic were 33(49.25%), idiopathic 20(29.85%) and others 14(20.90%), 61(91.05%) treated conservatively, 5(7.46%) surgical, and 1(1.49%) denied the repeated surgery.

Background: Dry powder inhalers (DPIs) offer a number of advantages, such as rapid delivery of high-dose inhaled medications; however, DPI use in children is often avoided due to low lung delivery efficiency and difficulty in operating the device. The objective of this study was to develop a high-efficiency inline DPI for administering aerosol therapy to children with the option of using either an oral or trans-nasal approach. Methods: An inline DPI was developed that consisted of hollow inlet and outlet capillaries, a powder chamber, and a nasal or oral interface. A ventilation bag or compressed air was used to actuate the device and simultaneously provide a full deep inspiration consistent with a 5-year-old child. The powder chamber was partially filled with a model spray-dried excipient enhanced growth powder formulation with a mass of 10 mg. Device aerosolization was characterized with cascade impaction, and aerosol transmissions through oral and nasal in vitro models were assessed. Results: Best device performance was achieved when all actuation air passed through the powder chamber (no bypass flow) resulting in an aerosol mean mass median aerodynamic diameter (MMAD)

PURPOSE: Motion artifact limits the clinical translation of high-field MR. We present an optical prospective motion correction system for 7 Tesla MRI using a custom-built, within-coil camera to track an optical marker mounted on a subject. METHODS: The camera was constructed to fit between the transmit-receive coils with direct line of sight to a forehead-mounted marker, improving upon prior mouthpiece work at 7 Tesla MRI. We validated the system by acquiring a 3D-IR-FSPGR on a phantom with deliberate motion applied. The same 3D-IR-FSPGR and a 2D gradient echo were then acquired on 7 volunteers, with/without deliberate motion and with/without motion correction. Three neuroradiologists blindly assessed image quality. In 1 subject, an ultrahigh-resolution 2D gradient echo with 4 averages was acquired with motion correction. Four single-average acquisitions were then acquired serially, with the subject allowed to move between acquisitions. A fifth single-average 2D gradient echo was acquired following subject removal and reentry. RESULTS: In both the phantom and human subjects, deliberate and involuntary motion were well corrected. Despite marked levels of motion, high-quality images were produced without spurious artifacts. The quantitative ratings confirmed significant improvements in image quality in the absence and presence of deliberate motion across both acquisitions (P < .001). The system enabled ultrahigh-resolution visualization of the hippocampus during a long scan and robust alignment of serially acquired scans with interspersed movement. CONCLUSION: We demonstrate the use of a within-coil camera to perform optical prospective motion correction and ultrahigh-resolution imaging at 7 Tesla MRI. The setup does not require a mouthpiece, which could improve accessibility of motion correction during 7 Tesla MRI exams.

Metachronous cancer rate in the pharynx is high before and after the treatment of esophageal cancer. Endoscopic observation is difficult in the pharynx especially in the postcricoid area. Pharyngeal cancer in the postcricoid area has been often found in advanced stage. Valsalva maneuver has been reported to improve the visibility. From May 2017 we introduced a dedicated mouthpiece to conduct Valsalva maneuver. One hundred consecutive patients who had been observed throughout the pharynx by one endoscopist were enrolled. A total of 200 image files before and after introduction were made and reviewed by three endoscopists. We retrospectively evaluated the utility and safety of Valsalva maneuver. The visibility before introduction was Good in three cases, Moderate in 12 cases and Poor in 85 cases. Meanwhile, the visibility after introduction was Good in 58 cases, Moderate in 23 cases, and Poor in 19 cases (P

A 66-year-old man had been intubated for 21 days for severe COVID-19 infection. He then underwent tracheotomy, retained the tube for 2 months, then was discharged home on 10 L/O2/min breathing via a tracheostomy collar. We were consulted for tracheostomy tube decannulation. Mechanical insufflation exsufffation was used via the tracheostomy tube to clear secretions, increase vital capacity, and normalize O2 saturation. He practiced nasal and mouthpiece noninvasive ventilatory support (NVS) once a capped fenestrated cuffless tracheostomy tube was placed although he did not need NVS after decannulation. He was decannulated despite O2 dependence. While he required antibiotics for almost 3 months prior to decannulation and after it, he had no further episodes of lung infection for at least the next 4 months from the point of decannulation.

Background: Aerosol delivery via high-flow nasal cannula (HFNC) has attracted clinical interests in recent years. However, both HFNC and nebulization are categorized as aerosol generating procedures (AGPs). In-vitro studies raised concerns that AGPs had high transmission risk. Very few in-vivo studies examined fugitive aerosols with HFNC and nebulization via HFNC, and effective methods to mitigate aerosol dispersion are unknown.Method: Two HFNC devices (Airvo2 and Vapotherm) with or without a vibrating mesh nebulizer (VMN) were compared; HFNC alone, surgical mask over HFNC interface, and HFNC with face tent scavenger were used in a random order for nine healthy volunteers. Fugitive aerosol concentrations at sizes of 0.3-10 µm were continuously measured by particle sizers placed at one and three feet from participants. On a different day, six of the nine participants received six additional nebulizer treatments via VMN or small volume nebulizer (SVN) with mouthpiece with/without an expiratory filter or facemask. In-vitro simulation was employed to quantify inhaled dose with VMN via Airvo2 and Vapotherm.Results: Compared to baseline, neither HFNC device generated higher aerosol concentrations. Compared to HFNC alone, VMN via Airvo2 generated higher 0.3-1.0 µm particles (all p

Purpose: To investigate how the materials of mouthpieces used for proton therapy of head and neck cancer affect the dose distribution in surrounding normal tissue by focusing on the CT values of the materials.Methods: Six dental materials were used to measure CT values: temporary relining resin, tissue conditioner, vinyl polysiloxane, thermoplastic ethylene vinyl acetate copolymer splint, silicone rubber impression material, and a composite impression material. Among these materials, three of the dental materials were investigated further: one material with the CT value closest to water, and the materials with the highest and lowest CT values. Based on these results, we investigated the effect of the CT value of the mouthpiece on the dose distribution in 17 cases in which a mouthpiece was used during proton therapy for head and neck cancers, the treatment plans were recalculated by changing the CT values of the mouthpiece to that of the three identified dental materials. For each cancer case, the irradiation dose to normal tissue was calculated for the treatment plans. The evaluation indices were set to the mandible max dose (GyE), the mandible mean dose (GyE), the volume of the mandible irradiated above 60 GyE (mandible V-60GyE), the parotid affected side mean dose (GyE), the parotid unaffected side mean dose (GyE), and the oral mean dose (GyE). The Wilcoxon’s rank sum test was used to analyze the significance of the differences between treatment plans.Results: The temporary relining resin with the CT value closest to water was 36.9 HU, the vinyl polysiloxane with the highest CT value was 985 HU, and the thermoplastic ethylene vinyl acetate copolymer splint with the lowest CT value was -89.7 HU. The maximum absolute difference among the treatment plans per case was 4.18 GyE for the oral mean dose. The radiation dose for the evaluation indices did not differ significantly among the treatment plans. Conclusion: In the range of CT values from -89.7 HU to 985.0 HU covered in this study, the effect of the CT value of the mouthpiece on the dose distribution may be considered to have no clinical impact.

Incentive spirometer (IS) is a popular choice for chest physiotherapy. It is used to optimize preoperative respiratory status and prevent postoperative pulmonary complications. However, the use of conventional forms of IS pose a challenging task in children due to the lack of cooperation, compliance, and submaximal effort on the part of pediatric patients. To tackle this problem, we describe an innovative and fascinating technique of spirometry. It employs a toy as a better acceptable incentive spirometry device in pediatric population. This toy has a mouthpiece and a long inflatable plastic strip at the other end. As the child blows into the mouthpiece, a captivating sound from the toy keeps buzzing progressively till the air is being blown during exhalation and is accompanied with inflation of the strip in an elongated fashion. Hence, this device incorporates the two best enjoyed incentives for children, namely, visual and audio to ensure patient compliance and participation.

Ice hockey has one of the highest concussion rates among youth sports. Sensor technology has been implemented in contact and collision sports to inform the frequency and severity of head impacts experienced on-ice. However, existing studies have utilized helmet-mounted sensors with limited accuracy. The objective of this study was to characterize head kinematics of contact events in a sample of youth boys' hockey players using a validated instrumented mouthpiece with improved accuracy. Head kinematics from 892 video-verified events were recorded from 18 athletes across 127 sessions. Median peak resultant linear acceleration, rotational velocity, and rotational acceleration of video-verified events were 7.4 g, 7.7 rad/s, and 576 rad/s2, respectively. Contact events occurred at a higher rate in games (2.48 per game) than practices (1.30 per practice). Scenarios involving head contact had higher peak kinematics than those without head contact. This study improves our understanding of head kinematics in boys' youth hockey.

OBJECTIVE This study aimed to assess if a color scale in the endotracheal tube (ETT) can help operators to correctly select the size and depth of placement of the ETT and decrease the time required to complete the procedure and compared with the usual numeric ETT scale in a mannequin model. STUDY DESIGN The study was conducted in eight centers. Each size of the ETT was identified with a different color. The experimental ETTs had two different colored areas, one for the mouthpiece and another to identify where the ETT should be taped above the lip (an area of 1 cm. The operators were trained as part of the protocol using an instructional video. Four clinical scenarios requiring endotracheal intubation were designed and randomly assigned. Each operator had to select the size and depth of ETT based on the birth weight (BW), and then had to perform four intubations. RESULTS A total of 108 operators performed 432 intubations. No differences were found in the correct placement and selection of the ETT. Median time (in seconds) required for intubation using numeric versus experimental tube was: for ETT O NRP (Neonatal Resuscitation Program) 2.5, 11.5 versus 8 (p

Background New training devices were introduced to help in the inhaler counseling by addressing the inspiratory flow through the metered-dose inhaler (MDI), which is the most important problem of the MDI inhalation technique. This study aimed to compare the effects of MDI traditional verbal counseling and advanced counseling using training devices with a smartphone application in pediatric asthmatic patients. Methods A total of 201 pediatric asthmatic subjects (8-18 years) were divided into 2 groups: a verbal counseling group, who received only MDI verbal counseling training (n=101), and an advanced counseling group who received counseling using a training device (Flo-Tone with Trainhaler smartphone application) in addition to the traditional MDI verbal counseling (n=100). Every patient in the 2 groups attended three counseling visits, one month apart. At each visit pulmonary functions [peak expiratory flow (PEF), forced expiratory volume in one second (FEV1 ) as % of predicted] were measured. Also, patients were asked to perform their normal inhalation technique using their MDI, and mistakes were detected and recorded by the investigator, then patients were trained on the correct steps of the MDI inhalation technique using either verbal counseling or advanced counseling depending on their study group. In the advanced group, the Flo-Tone was connected to the mouthpiece of the MDI to blow a whistle while the patient inhaling from MDI. That whistle was detected by the Trainhaler smartphone application and the duration of inhalation determined by the application was recorded. Results Both groups showed a gradual significant decrease (p Conclusion The addition of training devices and smartphone applications to traditional verbal counseling of MDI inhalation technique in asthmatic children resulted in significant improvements in lung functions, and duration of inhalation, and progressive decreases in the average number of MDI inhalation techniques errors compared to the verbal counseling group.

he standard treatment for patients with neuromuscular respiratory failure is non-invasive ventilation (NIV) as non-invasive ventilation support-setting (NVS). NVS is administered through a nasal or face mask and/or mouthpiece with the potential to cause nasal ulcers, discomfort, and/or aesthetic issues, resulting in poor compliance. We reported the observation of a 45-year-old woman with limb-girdle muscular dystrophy (LGMD), secondary to Dysferlin deficiency, who was on NVS since 2017 for nocturnal hypoventilation. In 2018, despite nocturnal ventilation, due to weight gain and daytime hypoventilation, a nasal mask was introduced. We initiated daytime intermittent abdominal pressure ventilation (IAPV) to mitigate cosmetic problems, improving in pO2 and decreasing in pCO2 versus baseline (52>84 mmHg, 46>33 mmHg respectively) at 6 (85 mmHg, 42 mmHg) and 18 months (93 mmHg, 38 mmHg), respectively. IAPV was effective, safe, and well-tolerated in our patients who did not tolerate standard daytime NVS with the known interface.

A great amount of research looks at whether information about lung mechanics can be obtained using spirometry, as these mechanics give clinically useful information about lung condition and disease progression. This study uses a time-varying elastance, single compartment lung model to calculate lung mechanics of 15 tidally breathing healthy subjects. A plethysmograph with a built-in shutter was used to induce an exponentially decaying airflow. Lung elastance and respiratory system resistance were separated from the decay rate of flow caused by the shutter. Occlusion resistance was calculated at shutter closure. To simulate upper airway obstruction, progressively larger resistances were added to the plethysmograph mouthpiece. Decay rates measured ranged from 5-42, with large intra-subject variation associated with muscular breathing effort. Measured lung elastance ranged from 3.9-21.2 cmH2O/L and often remained constant as resistance was increased. Resistance calculated from the decay rate was very small, ranging from 0.15-1.95 cmH2Os/L. The low resistance is due to the airflow measured originating from low resistance areas in the centre of airways. Occlusion resistance measurements were as expected for healthy subjects, and followed the expected resistance trend as resistance was increased.

BACKGROUND AND AIM Discomfort associated with the gag reflex during transoral endoscopy can be troublesome. To overcome this problem during esophagogastroduodenoscopy (EGD), we recently developed a novel mouthpiece. The aim of the present study was to compare acceptance and tolerability of transoral EGD with conventional and new mouthpieces in unsedated patients and analyze the effects of the new mouthpiece. METHODS This study consisted of two phases of cephalometric and EGD examinations to analyze the effects of the new mouthpiece. Cephalometry was carried out in six subjects to evaluate differences in the size of the pharynx (anteroposterior diameter of the oropharynx and longitudinal diameter of the oral cavity) when subjects held the conventional mouthpiece (MAJ674) or the new mouthpiece in their mouths. EGD was done in 10 subjects using the conventional or new mouthpiece to evaluate the number of times the gag reflex occurred, examinee discomfort, and endoscope operability during EGD using a visual analogue scale (VAS). RESULTS Anteroposterior diameter of the oropharynx and longitudinal diameter of the oral cavity were significantly larger with the new mouthpiece than with the conventional mouthpiece (oropharynx: P = 0.03; oral cavity: P = 0.03). With the new mouthpiece during EGD, subjects had significantly fewer instances of the gag reflex (P = 0.01); VAS score for discomfort was significantly lower (P

Purpose To reduce radiation doses to the tongue, a patient-specific semi-customized tongue displacement device (SCTDD) was developed using a 3D printer (3DP) for head and neck (H&N) radiation therapy (RT). Dosimetric characteristics of the SCTDD were compared with those of a standard mouthpiece (SMP). Materials and methods The SCTDD consists of three parts: a mouthpiece, connector with an immobilization mask, and tongue displacer, which can displace the tongue to the contralateral side of the planning target volume. Semi-customization was enabled by changing the thickness and length of the SCTDD. The instrument was printed using a 3DP with a biocompatible material. With the SCTDD and SMP, two sets of planning computed tomography (CT) and tomotherapy plans were obtained for seven H&N cancer patients. Dosimetric and geometric characteristics were compared. Results Using the SCTDD, the tongue was effectively displaced from the planning target volume without significant tongue volume change compared to the SMP. The median tongue dose was significantly reduced (29.6 Gy vs. 34.3 Gy). The volumes of the tongue receiving a dose of 15 Gy, 30 Gy, 35 Gy, 45 Gy, and 60 Gy were significantly lower than using the SMP. Conclusion The SCTDD significantly decreased the radiation dose to the tongue compared to the SMP, which may potentially reduce RT-related tongue toxicity.

OBJECTIVE The aim of the study was to evaluate the efficacy of noninvasive ventilatory assistance/support via mouthpiece to improve performance in 6-min walk tests for individuals with severe restrictive ventilatory disorders. DESIGN Each subject performed the 6-min walk test breathing spontaneously and again while using mouthpiece noninvasive ventilatory assistance/support at full ventilatory support. Oxyhemoglobin saturation (O2 sat), heart rate, Borg scale, distance walked, and ambulation duration were recorded. RESULTS Eighteen patients using nocturnal nasal noninvasive ventilatory assistance/support, median (interquartile range) age of 58.5 (20) yrs, were studied. Their median baseline forced vital capacity and PaCO2 were 940 (385) ml and 54.1 (6) mm Hg, respectively. All used noninvasive ventilatory assistance/support for at least overnight hours for 36 (111) mos. Because of the progression of ventilatory impairment and hypercapnia, daytime mouthpiece noninvasive ventilatory assistance/support was initiated. All the 6-min walk test parameters improved significantly by using noninvasive ventilatory assistance/support. Both initial and final values of O2 saturation significantly increased (92% [6] vs 96% [2], P < 0.001) and (80% [19] vs 85.50% [13], P = 0.001), respectively. The median distance walked increased by 43% with noninvasive ventilatory assistance/support (175 [218] m vs 250 [113] m, P = 0.017), and the total ambulation time also increased with noninvasive ventilatory assistance/support (5.45 [3] mins vs. 6 [0] mins, P = 0.008). CONCLUSIONS The exercise tolerance of patients with severe ventilatory impairment can improve by using noninvasive ventilatory support.

In 2018, the Medical Panel of the NATO Underwater Diving Working Group (UDWG) discussed the question of the rescue and management of a submerged unresponsive compressed-gas diver. The Panel reviewed the 2012 recommendation by the UHMS Diving Committee with respect to the specific recommendation in a convulsing diver using a half-face mask and separate mouthpiece, to delay surfacing until the clonic phase had subsided if the mouthpiece was in place. There is a paucity of scientific, epidemiological, experimental and observational human studies to substantiate this guidance. Experimental animal studies suggest that the likelihood of a complete airway obstruction during an ongoing seizure is low and that there is a high likelihood of surviving pulmonary barotrauma caused by complete airway closure. Airway management and control is an essential step in the management of the unresponsive diver and would be challenging to achieve in the underwater environment. Even in the military setting, it will be difficult to provide sufficient training to enable divers to handle such a situation. In this very rare scenario it is considered that emergency guidelines should be clear, concise and easy to follow. The UDWG therefore recommends that all unconscious military divers in this situation should be rescued to surface without waiting for clonic seizures to subside. Training organizations for recreational and occupational divers should consider whether this guidance should be applied for civilian divers as well.

While many research efforts have focused on head impact exposure in professional soccer, there have been few studies characterizing exposure at the youth level. The aim of this study is to evaluate a new instrumentation approach and collect some of the first head impact exposure data for youth female soccer players. Athletes were instrumented with custom-fit mouthpieces that measure head impacts. Detailed video analysis was conducted to identify characteristics describing impact source (e.g., kick, header, throw). A total of 763 verified head impacts were collected over 23 practices and 8 games from 7 athletes. The median peak linear accelerations, rotational velocities, and rotational accelerations of all impacts were 9.4 g, 4.1 rad/s, and 689 rad/s2, respectively. Pairwise comparisons resulted in statistically significant differences in kinematics by impact source. Headers following a kicked ball had the highest accelerations and velocity when compared to headers from thrown or another header.

The purpose of the study is to describe experiences of swallowing with two forms of noninvasive positive-pressure ventilation (NPPV): mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP) in people with muscular dystrophy. Ten men (ages 22-42 years; M = 29.3; SD = 7.1) with muscular dystrophy (9 with Duchenne's; 1 with Becker's) completed the Eating Assessment Tool (EAT-10; Ann Otol Rhinol Laryngol 117(12):919-924 [33]) and took part in semi-structured interviews. The interviews were audio recorded, transcribed, and verified. Phenomenological qualitative research methods were used to code (Dedoose.com) and develop themes. All participants affirmed dysphagia symptoms via responses on the EAT-10 (M = 11.3; SD = 6.38; Range = 3-22) and reported eating and drinking with M-NPPV and, to a lesser extent, nasal BPAP. Analysis of interview data revealed three primary themes: (1) M-NPPV improves the eating/drinking experience: Most indicated that using M-NPPV reduced swallowing-related dyspnea. (2) NPPV affects breathing-swallowing coordination: Participants described challenges and compensations in coordinating swallowing with ventilator-delivered inspirations, and that the time needed to chew solid foods between ventilator breaths may lead to dyspnea and fatigue. (3) M-NPPV aids cough effectiveness: Participants described improved cough strength following large M-NPPV delivered inspirations (with or without breath stacking). Although breathing-swallowing coordination is challenging with NPPV, participants reported that eating and drinking is more comfortable than when not using it. Overall, eating and drinking with NPPV delivered via a mouthpiece is preferred and is likely safer for swallowing than with nasal BPAP. M-NPPV (but not nasal BPAP) is reported to improve cough effectiveness, an important pulmonary defense in this population.

BACKGROUND Children suffering from bronchial diseases need assistance from nurses in the use of inhalation devices. PURPOSE We aimed to assess nurses' skills and knowledge concerning drug administration with inhalation devices in hospitalized pediatric patients. METHODS An expert panel defined medication errors in drug administration with inhalation devices in children. We monitored 241 inhalation procedures to investigate nurses' inhalation technique skills. Twenty-nine nurses completed a questionnaire to assess nurses' knowledge. RESULTS Skills: In 93 of 241 (39%) inhalation procedures, the mask/mouthpiece did not fit airtight. In none of the 11 inhalations administering a glucocorticoid, the patient's mouth was thoroughly cleaned afterward. Knowledge: Ten of 29 nurses (34%) thought a distance between mask and the patient's face was acceptable. Only 16 of 29 (55%) knew that it is necessary to thoroughly clean the patient's mouth after the inhalation of budesonide. CONCLUSIONS We found that education on inhalation procedures including practical training is required to increase patient safety.

High-flow nasal oxygen used before and during apnoea prolongs time to desaturation at induction of anaesthesia. It is unclear how much oxygenation before apnoea prolongs this time. We randomly allocated 84 participants to 3 minutes of pre-oxygenation by one of three methods: 15 l.min-1 by facemask; 50 l.min-1 by high-flow nasal cannulae only; or 50 l.min-1 by high-flow nasal cannulae plus 15 l.min-1 by mouthpiece. We then anaesthetised and intubated the trachea of 79 participants and waited for oxygen saturation to fall to 92%. Median (IQR [range]) times to desaturate to 92% after pre-oxygenation with facemask oxygen, high-flow nasal oxygen only and high-flow nasal oxygen with mouthpiece, were: 309 (208-417 [107-544]) s; 344 (250-393 [194-585]) s; and 386 (328-498 [182-852]) s, respectively, p = 0.014. Time to desaturation after facemask pre-oxygenation was shorter than after combined nasal and mouthpiece pre-oxygenation, p = 0.006. We could not statistically distinguish high-flow nasal oxygen without mouthpiece from the other two groups for this outcome. Median (IQR [range]) arterial oxygen partial pressure after 3 minutes of pre-oxygenation by facemask, nasal cannulae and nasal cannulae plus mouthpiece, was: 49 (36-61 [24-66]) kPa; 57 (48-62 [30-69]) kPa; and 61 (55-64 [36-72]) kPa, respectively, p = 0.003. Oxygen partial pressure after 3 minutes of pre-oxygenation with nasal and mouthpiece combination was greater than after facemask pre-oxygenation, p = 0.002, and after high-flow nasal oxygen alone, p = 0.016. We did not reject the null hypothesis for the pairwise comparison of facemask pre-oxygenation and high-flow nasal pre-oxygenation, p = 0.14.

Asthma is one of the most common respiratory diseases in the world. It is caused by the swelling of the airways that result in the narrowness of the lung. Self-record and monitor of lung condition are essential for asthmatic patients to well control the disease. One way to monitor asthma condition is by using a spirometer. In this project, a digital spirometer with a mobile application that can help asthmatic patients to self-monitor and keep track of their lung condition has been developed. The device can be divided into three parts: hardware, mobile application and database. The hardware consists of NodeMCU, a pressure sensor and a mouthpiece. The analog signal from the sensor was converted to digital by the NodeMCU and sent wirelessly using wifi to smartphone and stored in a database. The lung function parameters calculated are displayed using mobile application. One normal subject aged 24 has been recruited to perform three categories of severity test using the mobile application. The categories are normal, moderate and severe, and the result showed the severity correctly according to the category compared to the theory.

The measurement of breathing biomechanics, such as tidal volume, can be used to assess both the breathing performance and the respiratory health of individuals. State-of-the-art methods like spirometry or body plethysmography require a mouthpiece or facemask., which can be uncomfortable to the test person. As an alternative, we propose to use the change of the geometric shape of the subject’s torso while breathing. By acquiring 3D point clouds of the person with a real-time near-infrared (NIR) 3D scanner, we measure those changes in a comfortable, irritation-free, and contact-free manner. Accordingly, two continuously measuring structured light 3D sensors, using a GOBO-based aperiodic sinusoidal pattern projector at a wavelength of 850 nm, simultaneously capture the upper front and side torso of the subject at a frame rate of 200 Hz. Both 3D scanners are calibrated and operated in a sensor network fashion, yielding a unified data stream within a global coordinate system. This results in increased coverage and reduced occlusion of the patient’s body shape, enabling robust measurements even in the presence of loose clothing and varying body figure. We collected data from 16 healthy participants in an upright sitting position, wearing everyday clothing during the measurements. For reference, we simultaneously recorded spirometry readings. An algorithm (“OpTidal”) tracks the volume of the subject’s torso from the 3D data. Comparison whith the reference data shows high correlation and low mean error for the absolute tidal volume readings. As such, our method is a viable, safe, and accurate alternative to spirometry and plethysmography.

“Tongue control system” is basically controlled by Assistive Technology (AT) which is developed for people who has severe physical disability or paralyzed who want to control/access their environment. The Tongue control system consists of four hall sensor modules placed on the Mouthpiece and the Hall Effect magnetic field is created by placing a permanent magnet on the tongue of the victim with the help of tissue adhesive or piercing. These fields with the help of wireless transmitter is sent to the prototype receiver which the victim wants to control; in this way a victim can control his/her environment using the tongue that works on AT. Finally, the design was tested, and the result confirms the design approach for a healthy subject.

Recent guidelines for the prevention of COVID-19 advocate that all the elective procedures should be postponed as these produce aerosols that may affect the staff engaged. Sagami R et al and Neven L et al published the use of a barrier box to prevent the spread of droplets.1, 2 We have done some modifications to this technique. Our endoscopic shield is made of three plastic square walls with a height and width of 50 cm and a length of 40 cm. The wall facing the patient has a hole of 10cm for insertion of the scope. The foot and head sides of the cube are left open. The opening in the head side helps the assistant to keep the patient in proper position, along with the mouth-piece and nasal prong. One may argue that it would lead to the spread of droplets but the previous study has shown that the droplets fall more on the wall facing the patient’s mouth, hence placing the surgical mask over the patient’s face further reduces the head-ward spread of droplets.3 This also helps to facilitate the to and fro movement of the box so that the intubation hole moves away and the intact part of the front wall faces the mouth. A surgical mask with a small hole is placed in a way that the hole is aligned with the mouthpiece hole. The shield is placed over the patient’s head. The scope is passed through the endoscopic port made in the wall of the shield facing the patient and endoscopy is performed. This technique has a few advantages. First, it gives free access to the assistant during the procedure. Second, putting the face mask further reduces the risk of the spread of droplets. Third, an appropriate window for endoscope insertion allows the operator to work at ease, especially during challenging procedures. Continuous....

The use of noninvasive ventilation (NIV) has been associated with improved patient satisfaction and comfort compared to tracheostomy in patients who are ventilator dependent. We present a case of a young man who fell off a platform and sustained a traumatic third and fourth cervical vertebrae (C3/4) fracture dislocation with bilateral facet dislocation, in whom a trial of mouthpiece NIV was attempted. We discuss the issues surrounding this method of ventilation in ventilator-dependent patients.

Objectives: Measurement of electronic cigarette (ECIG) puff topography provides an under- standing of how product characteristics and user behavior affect nicotine delivery. However, mouthpiece-based topography devices may affect natural puffing behavior. This study was designed to compare ECIG topography measured by mouthpiece-based eTop computerized de- vice and mouthpiece-free video recordings. Methods: ECIG-naïve cigarette smokers (N = 18) and ECIG-experienced users (N = 25) puffed on a standardized ECIG via eTop or conventionally; both sessions were videotaped. Following overnight abstinence, participants experienced one directed (10 puffs, 30 sec IPI) and 2 ad libitum puffing bouts. Heart rate and subjective response were measured throughout sessions. Results: No statistically significant differences between methods were observed for topography, heart rate, or abstinence-related subjective effects, and both methods were accurate and reliable. Use of a mouthpiece was perceived to alter aspects of ECIG puffing (eg, "reduce enjoyment). Conclusions: The mouthpiece-based eTop measures ECIG topography precisely as when no mouthpiece is used, and interferes minimally with subjective ECIG experience. Reliable and valid ECIG topography measurement methods are an important regulatory tool, as they can be used to understand the interplay between product design and user behavior to predict toxicant exposure.

Background: The effectiveness of standard chest physiotherapy (CPT) has been confirmed by many studies. Airway CPT is considered the base of physiotherapy and is characterized as “gold standard” of physiotherapy. Chest physiotherapy is a routinely used therapy to prevent post-operative pulmonary complications after abdominal surgery. There are different types of devices used to deliver PEP but one of the most commonly used is Acapella. It has more stable wave form and a wider range of PEP at low air flow. Objective: To find out the effect of hemodynamic response to acapella in abdominal surgery patients. Methodology: Study design is Quasi experimental, study type is pre-test - post-test type, and sampling method is convenient sampling, sample size is 36, study duration of 4 weeks, study setting in SRM medical college hospital research centre, Kattankulathur. Procedure: Acapella device was selected depending upon the patient’s ability to maintain an expiratory flow of 15 litres per minute. Patients were explained with complete procedure prior to examination. Mouthpiece was used during exhalation. Patients were asked to breath from diaphragm taking deep breath. Hold breath for 2-3 seconds. They were asked to Perform 10-20 PEP breaths and then asked to remove the mouthpiece and perform 2-3 ‘huffs’ coughs to raise secretions as needed. This was repeated 3- 4 times. Results: There is no significant improvement by using acapella in systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, arterial oxygen saturation rate. Conclusion: This study concludes that there was an increase in hemodynamic variables during the usage of acapella which return back to normal values in post 30 minutes of training. Thus, acapella is safe, effective to use for airway clearance. Key words: abdominal surgery, acapella, airway clearance, hemodynamics.

Maintaining oral function in older individuals with missing teeth is important for leading a healthy and independent life. This study aimed to evaluate whether simple isometric exercises can maintain and improve the oral function [maximum occlusal force (MOF) and masticatory ability (MA)] and the masticatory muscle properties [masseter muscle thickness (MMT) and echo intensity (MMEI)] in older adults during the maintenance phase of removable prosthetic treatment. Participants were randomly categorized into the intervention and control groups. The mouthpieces were distributed, and participants were instructed to use them for exercising. The intervention group was instructed to perform maximum clenching for 10 s, whereas the control group was instructed to tap the teeth at an arbitrary speed for 10 s. Both were repeated five times at an interval of 5 s between each activity and twice daily for 4 weeks. The outcomes were measured after a month of exercise. The intervention group showed a significant improvement in the MOF, MMT during contraction, MMT at rest and MMEI during contraction. There were no significant differences in the MA and MMEI at rest. In the control group, no improvement was observed in any of the parameters. When the isometric exercises were performed using a mouthpiece, there was an improvement in the oral function and masseter muscle properties in older individuals with Eichner B status who used dentures.

INTRODUCTIONS Improved aerosol delivery of bronchodilators to chronic obstructive pulmonary disease (COPD) subjects is a cornerstone in the treatment approach. Drug delivery and response are improved with the use of accessory devices [spacers and valved holding chambers (VHCs)] with metred-dose inhalers (pMDIs). However, different accessory devices are available in the market with different properties that could affect aerosol delivery. Thus, this study aimed to assess the relative lung deposition and systemic bioavailability and compare bronchodilator response of salbutamol delivered using different accessory devices attached to pMDIs. METHODS Twelve healthy subjects and twelve COPD subjects inhaled 300 μg salbutamol (3 pMDI puffs) using five different accessory devices with either masks or mouthpieces (Able, Aerochamber plus flow Vu, Dolphin chamber, Tipshaler spacer, and modified Drink bottle spacer). Urine samples were collected thirty minutes post-dosing and cumulatively for the next twenty-four hours, to determine and compare the relative lung deposition [0-0.5 hour excretion of urinary salbutamol (USAL0.5)] and systemic bioavailability [0.5-24 hours excretion of urinary salbutamol (USAL24)] of salbutamol from the selected accessory devices. Also, the difference between pre and post-inhalation forced expiratory volume in one second (ΔFEV1 %) of predicted was determined for each accessory device. RESULTS Urinary excretion of salbutamol (both USAL0.5 and USAL24 samples) in COPD subjects was significantly (P