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As autoinjector requirements become increasingly diverse and pharma companies look for quicker routes to market, with lower costs and improved sustainability, there is an increasing trend towards devices with a reusable element. The flexibility in reusable elements can be beneficial for pharma companies with access to these platforms, allowing a relatively rapid transition between different drug combinations. However, it can also lead to devices designed to cover a wide range of requirements which are over designed for their actual more limited end use. The challenge of creating both a cost and sustainability optimised platform device is significantly harder than if developing a single use device with a specific purpose in mind. This paper looks at the range of reusable products on the market, examining some of the assertions around the cost and sustainability benefits of these devices as well as where there are trade-offs relative to current single use format devices., (© PDA, Inc. 2024.)

Surgical masks have become critical for protecting human health against the COVID-19 pandemic, even though their environmental burden is a matter of ongoing debate. This study aimed at shedding light on the environmental impacts of single-use (i.e., MD-Type I) versus reusable (i.e., MD-Type IIR) face masks via a comparative life cycle assessment with a cradle-to-grave system boundary. We adopted a two-level analysis using the ReCiPe (H) method, considering both midpoint and endpoint categories. The results showed that reusable face masks created fewer impacts for most midpoint categories. At the endpoint level, reusable face masks were superior to single-use masks, producing scores of 16.16 and 84.20 MPt, respectively. The main environmental impacts of single-use masks were linked to raw material consumption, energy requirements and waste disposal, while the use phase and raw material consumption made the most significant contribution for reusable type. However, our results showed that lower environmental impacts of reusable face masks strongly depend on the use phase since reusable face masks lost their superior performance when the hand wash scenario was tested. Improvement of mask eco-design emerged as another key factor such as using more sustainable raw materials and designing better waste disposal scenarios could significantly lower the environmental impacts., (© 2022. The Author(s).)

Ureteroscopy is the most common surgical modality for stone treatment. Reusable flexible ureteroscopes are delicate instruments that require expensive maintenance and repairs. Multiple single use ureteroscopes have been developed recently to combat the expensive and time-intensive sterilization and repair of ureteroscopes. Although multiple studies have looked at different aspects of reusable and single use ureteroscopes, there is significant heterogeneity in performance measures and cost between the 2 categories, and neither has a clear advantage. Both can be used successfully, and individual and institution level factors should be considered when deciding which ureteroscope to use., Competing Interests: Disclosure The authors have no direct or indirect commercial financial incentive associated with publishing this article, and there was no extra-institutional funding., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types., Design: Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare., Data Sources: Websites of international standards organisations, Medline and Embase, hand-searching of references and citations., Study Selection: Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use., Results: We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators., Conclusion: A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care., Competing Interests: Competing interests: SS recently retired from a scientific research position at a major manufacturer of respiratory protective equipment., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: An accuracy test method is proposed to reduce the amount of reagents used in the test and reduce the cost of spot checks and self-tests., Methods: According to the requirements of dose accuracy test in standard atmospheric conditions in ISO 11608-1:2014, dose accuracy test is carried out for the same batch of reusable pen injector samples by using the test method proposed in this paper and the test method in relevant foreign research, and the data measured by the two methods are processed., Results: After experimental testing and analysis, the data measured by the two methods did not exceed the dose accuracy limit specified in the ISO standard. There was no significant difference between the two methods when the dose of 60 U and 30 U were tested, but there was significant difference when the dose of 1 U was tested., Conclusions: Both methods can be used to evaluate dose accuracy, however, the method proposed in this paper can reduce the usage of drugs by 2/3, so it can reduce cost of supervised test.

Objective: Arterial catheterization is a commonly performed procedure in intensive care units to guide the management of critically ill patients who require precise hemodynamic monitoring; however, this technology is not always available in the transport setting because of cumbersome and expensive equipment requirements. We compared the accuracy and reliability of a disposable vascular pressure device (DVPD) with the gold standard (ie, the transducer pressure bag invasive arterial monitoring system) used in intensive care units to determine if the DVPD can be reliably used in place of the traditional pressure transducer setup., Methods: This study was a single-center, prospective, observational study performed in the adult intensive care unit of a large academic university hospital. A convenience cohort of hemodynamically stable, adult critically ill patients with femoral, brachial, or radial arterial catheters was recruited for this study. The Compass pressure device (Centurion Medical Products, Williamston, MI) is a disposable vascular pressure-sensing device used to assure venous access versus inadvertent arterial access during central line placement. The DVPD was attached to an in situ arterial catheter and measures the mean intravascular pressure via an embedded sensor and displays the pressure via the integrated LCD screen. Using a 3-way stopcock, the DVPD was compared with the standard arterial setup. We compared the mean arterial pressure (MAP) in the standard setup with the DVPD using Bland-Altman plots and methods that accounted for repeated measures in the same subject., Results: Data were collected on 14 of the 15 subjects enrolled. Five measurements were obtained on each patient comparing the DVPD with the standard arterial setup at 1-minute intervals over the course of 5 minutes. A total of 70 observations were made. Among the 15 subjects, most (10 [67%]) were radial or brachial sites. The average MAP scores and standard deviation values obtained by the standard setup were 83.5 mm Hg (14.8) and 81.1 mm Hg (19.3) using the DVPD. Just over half (51.4%) of the measurements were within a ± 5-mm Hg difference. Using Bland-Altman plotting methods, standard arterial measurements were 2.4 mm Hg higher (95% confidence interval, 0.60-4.1) than with the DVPD. Differences between the 2 devices varied significantly across MAP values. The standard arterial line measurements were significantly higher than the DVPD at low MAP values, whereas the DVPD measurements were significantly higher than the standard arterial line at high MAP values., Conclusion: The DVPD provides a reasonable estimate of MAP and may be suitable for arterial pressure monitoring in settings where standard monitoring setups are not available. The DVPD appears to provide "worst-case" values because it underestimates low arterial blood pressure and overestimates high arterial blood pressure. Future trials should investigate the DVPD under different physiological conditions (eg, hypotensive patients, patients with ventricular assist devices, and patients on extracorporeal membrane oxygenation), different patient populations (such as pediatric patients), and in different environments (prehospital, air medical transport, and austere locations)., (Copyright © 2020 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Rationale and Objectives: The use of chest computed tomography (CT) in the era of the COVID-19 pandemic raises concern regarding the transmission risks to patients and staff caused by CT room contamination. Meanwhile the Center for Disease Control guidance for air exchange in between patients may heavily impact workflows. To design a portable custom isolation device to reduce imaging equipment contamination during a pandemic., Materials and Methods: Center for Disease Control air exchange guidelines and requirements were reviewed. Device functional requirements were outlined and designed. Engineering requirements were reviewed. Methods of practice and risk mitigation plans were outlined including donning and doffing procedures and failure modes. Cost impact was assessed in terms of CT patient throughput., Results: CT air exchange solutions and alternatives were reviewed. Multiple isolation bag device designs were considered. Several designs were custom fabricated, prototyped and reduced to practice. A final design was tested on volunteers for comfort, test-fit, air seal, and breathability. Less than 14 times enhanced patient throughput was estimated, in an ideal setting, which could more than counterbalance the cost of the device itself., Conclusion: A novel isolation bag device is feasible for use in CT and might facilitate containment and reduce contamination in radiology departments during the COVID Pandemic., (Published by Elsevier Inc.)

The recent SARS-CoV-2 outbreak has placed immense pressure on supply chains, including shortages in nasopharyngeal (NP) swabs. Here, we report our experience of using 3D-printing to rapidly develop and deploy custom-made NP swabs to address supply shortages at our healthcare institution., (© American Society for Clinical Pathology 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose of Review: Single-use flexible ureteroscopes (su-fURS) aim at overcoming the main limitations of conventional reusable ureteroscopes in terms of acquisition and maintenance costs, breakages, and reprocessing. However, little data exist to date regarding the superiority of su-fURS at this regard. We aimed to perform a systematic literature review on available su-fURS performance with a focus on clinical data for all articles in the last 10 years., Recent Findings: To date, more than 10 different su-fURS are available on the market, with different characteristics and performance. Some of these devices have top-level features, almost catching up with those observed in reusable flexible ureteroscopes. Clinical evidence is mainly available only for two models, LithoVue and Uscope PU3022, and to date it is not strong enough to support routine adoption and use of su-fURS, with a consequent lack of consensus of specific clinical indications. Cost-effectiveness analyses seem to indicate an economic disadvantage in the routine adoption of su-fURS. Environmental issues related to the use of su-fURS also remain to be inquired and addressed., Summary: Since their introduction, su-fURS have gained widespread popularity. Despite their ability at addressing reusable ureteroscope limitations, high-cost and a substantial lack of evidence are still limiting their routine adoption.

Background and Aims: Multidrug-resistant infectious outbreaks associated with duodenoscope reuse have been documented internationally. A single-use endoscope could eliminate exogenous patient-to-patient infection associated with ERCP., Methods: We conducted a comparative bench simulation study of a new single-use and 3 models of reusable duodenoscopes on a synthetic anatomic bench model. Four ERCP tasks were performed: guidewire locking (single-use and 1 reusable duodenoscope only), plastic stent placement and removal, metal stent placement and removal, and basket sweeping. The study schedule included block randomization by 4 duodenoscopes, 4 tasks, and 2 anatomic model ERCP stations. Ability to complete tasks, task completion times, and subjective ratings of overall performance, navigation/pushability, tip control, and image quality on a scale of 1 (worst) to 10 (best) were compared among duodenoscopes., Results: All 4 ERCP tasks (total 14 subtasks) were completed by 6 expert endoscopists using all 4 duodenoscopes, with similar task completion times (median, 1.5-8.0 minutes per task) and overall performance ratings by task (median, 8.0-10.0). Navigation/pushability ratings were lower for the single-use duodenoscope than for the 3 reusable duodenoscopes (median, 8.0, 10.0, 9.0, and 9.0, respectively; P < .01). Tip control ratings were similar among all the duodenoscopes (median, 9.0-10.0; P = .77). Image quality ratings were lower for 1 reusable duodenoscope compared with the single-use and other 2 reusable duodenoscopes (median, 8.0, 9.0, 9.0, and 9.0, respectively; P < .01)., Conclusions: A new single-use duodenoscope was used to simulate 4 ERCP tasks in an anatomic model, with performance ratings and completion times comparable with 3 models of reusable duodenoscopes., (Copyright © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

One-fourth of all operating room (OR) waste is attributed to anesthesia-related material. The goal of this project was to reduce the waste and increase cost savings of opened and unused endotracheal (ET) tubes and disposable laryngoscope handles and blades in 2 separate OR environments. The production of these unused anesthesia supplies was assessed weekly in each of 2 OR environments for 8 weeks before an educational intervention, and for 8 weeks following the intervention. The average weekly waste production was summarized for each study period, compared between periods (preintervention vs postintervention), and analyzed per 100 surgeries using the 2-sample t test. The overall average weekly waste for ET tubes was significantly reduced from 26.7 ± 10.7 to 10.0 ± 6.1 from pre to post intervention (P = < .001), representing a 62.6% reduction. A similar significant reduction in waste was observed for laryngoscope handles (15.9 ± 8.1 vs 7.2 ± 3.1; P = .004; a 54.7% reduction) and laryngoscope blades (21.5 ± 11.0 vs 9.9 ± 4.4; P = .004; a 54.0% reduction). These results highlight the significance and feasibility of an educational intervention in reducing the environmental and economic waste produced by anesthetic practices in the OR., Competing Interests: This project was in part supported by the Department of Surgical Services, Mayo Clinic, and by the Mayo Clinic School of Health Sciences, Rochester, Minnesota. The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

The aim of this study was to develop a new container for cryopreservation of a limited number of spermatozoa. To evaluate the efficacy and safety of this new container, we performed preclinical evaluations using human sperm or mouse oocytes and sperm. First, using human sperm that was frozen and then thawed, we demonstrated that the sperm recovery rate using the new container was 96.7% (58/60), which was significantly higher (P < 0.05) than the recovery rate of 21.2% (11/52) when using the Cryotop ® . Sperm motility rates were 19.2% (10/52) using the Cryotop ® and 35.0% (21/60) using the new container. Second, murine epididymal spermatozoa were divided into three groups: fresh spermatozoa, spermatozoa frozen using a straw, and spermatozoa frozen using the new container. Sperm motility, sperm membrane and DNA integrity, in vitro development of fertilized eggs, and offspring development after embryo transfer were assessed. The motility of freeze-thawed sperm was lower in spermatozoa that were frozen using the new container than in fresh spermatozoa or those that were frozen using a straw. After intracytoplasmic sperm injection, the survival rate was 96.7% (145/150), the 2-cell development rate was 90.3% (131/145), and the blastocyst development rate was 77.2% (112/145), when using the new container. There were no differences in the sperm membrane, DNA integrity, or in the embryo development rates to the blastocyst stage among the different frozen groups. Six offspring were derived from spermatozoa freeze-thawed in the new container, and they developed normally. Thus, the new container allows easy handling of a small number of sperms and minimizes sperm loss during cryopreservation.

Flexible endoscopes are exposed to blood, mucus, and other secretions during procedures. Single-use sheaths are designed to prevent contact between contaminants and reusable endoscope components. This systematic review examined findings from 22 studies that assessed endoscopic sheath use during urologic, gastrointestinal, or respiratory procedures. The evidence showed that sheaths were durable and yielded faster endoscope turnover times because their reusable components did not require high-level disinfection or sterilization. After a brief learning period, health care providers successfully assembled and maneuvered sheathed endoscopes. Patients generally did not experience greater discomfort during procedures in which sheaths were used. Microbial cultures of sheathed endoscopes were negative or similar to unsheathed endoscopes. More research is needed to evaluate the potential effect of disposable sheaths on infection risks. The evidence suggests that sheaths are a viable option for reliably providing a barrier between endoscopes and patients without affecting the quality of endoscopic procedures., (© AORN, Inc, 2019.)

Reprocessing single-use surgical supplies and devices is an option for hospitals and ambulatory surgery centers (ASCs). The US Federal Government has recognized the practice since 2000, and regulatory oversight has increased dramatically since that time. Reprocessing single-use devices is safe when personnel use approved methods, and health care facilities can experience significant cost savings by participating in this type of initiative. This article explores reprocessing and its benefits in ASCs, including a review of the oversight that the US Food and Drug Administration currently has for reprocessing and a discussion of the results of studies pertaining to this practice. The article also describes some issues that ASC leaders need to be aware of when considering the implementation of a reprocessing program. Single-use device reprocessing can be an effective tool for ASC leaders to conserve and manage resources., (© AORN, Inc, 2019.)

Background: Research and history have largely shown the covert billion-dollar global market of single-use medical device (SUD) reprocessing and reuse to be a safe endeavor, but awareness and perceptions of the practice both within and outside of healthcare have received limited attention., Methods: Responses for patients, physicians, and medical practitioners were attained on both online and article-based surveys, in which attitudes and perceptions of SUD reprocessing and reuse were expressed in an assortment of closed-ended questions and partially closed-ended questions., Results: Of the 214 participants, a collective 77% were unaware that the Food and Drug Administration allows SUD reprocessing and reuse. This included 65% of physicians and 84% of patients, which were significantly different proportions (P = 0.005). A significantly greater proportion of patients than physicians (92 vs. 68%) also felt that hospitals bear the responsibility of informing patients of the practice as part of their care (P < 0.001)., Conclusion: There is a profound lack of awareness of SUD reprocessing and reuse among all relevant stakeholders. In addition, the overwhelming desire for transparency among patients further forces the debate of whether current, covert methods should be altered, in addition to the question of who bears this responsibility. Despite research and history having shown the practice to be safe, apprehension and misconceptions remain. Survey results suggest that education may be able to subdue such patient concerns.

Background: The American College of Surgeons guidelines indicate that skull caps are acceptable, and the Association of Perioperative Registered Nurses recommends bouffant caps. However, no scientific evidence has shown a significant advantage in surgical site infection (SSI) reduction with either cap. The objective of this study was to determine the influence of surgical cap choice on SSIs., Study Design: Data from a previously published prospective randomized trial on the impact of hair clipping on SSIs were analyzed. Patients were grouped by the attending surgeons' preferred cap choice into either bouffant or skull cap groups., Results: Overall, 1,543 patients were included in the trial. Attending surgeons wore bouffant caps in 39% and skull caps in 61% of cases. Prevalence of diabetes and tobacco use were similar between the groups. Bouffant caps were used in 71% of colon/intestinal cases, 42% of hernia/other cases, 40% of biliary cases, and only 1% of foregut cases. Overall, SSIs occurred in 8% and 5% of cases with a bouffant and skull cap, respectively (p = 0.016); with 6% vs 4% classified as superficial (p = 0.041), 0.8% vs 0.2% classified as deep (p = 0.12), and 1% vs 0.9% classified as organ space (p = 0.79); however, when adjusting for the type of operation, no significant differences in SSI rates were observed for skull caps vs bouffant caps., Conclusions: Attending surgeon preference for bouffant vs skull cap does not significantly impact SSI rates after accounting for surgical procedure type. Future guidelines should consider these clinical outcomes data and surgeon preference should dictate operating room headwear., (Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Average costs associated with common procedures can vary by surgeon without a corresponding variation in outcome or case complexity., Methods: De-identified cost and equipment utilization data were collected from our hospital for elective laparoscopic cholecystectomy performed by 17 different surgeons over a 6-month period. A group of surgeons used this data to design a standardized equipment pick list that became optional (not mandated) for laparoscopic cholecystectomy. Cost and consumable surgical supply utilization data were collected for six months prior to and following the creation of the standardized pick-list., Results: 280 elective laparoscopic cholecystectomies were performed during the study interval. In the 6 months after standardized pick list creation, the cost of disposable supplies utilized per case decreased by 32%., Conclusions: Surgical cost savings can be achieved with standardized procedure pick lists and attention to the cost of consumable surgical supplies., (Copyright © 2017 Elsevier Inc. All rights reserved.)

In the biopharmaceutical industry, pre-packed columns are the standard for process development, but they must be qualified before use in experimental studies to confirm the required performance of the packed bed. Column qualification is commonly done by pulse response experiments and depends highly on the experimental testing conditions. Additionally, the peak analysis method, the variation in the 3D packing structure of the bed, and the measurement precision of the workstation influence the outcome of qualification runs. While a full body of literature on these factors is available for HPLC columns, no comparable studies exist for preparative columns for protein chromatography. We quantified the influence of these parameters for commercially available pre-packed and self-packed columns of disposable and non-disposable design. Pulse response experiments were performed on 105 preparative chromatography columns with volumes of 0.2-20ml. The analyte acetone was studied at six different superficial velocities (30, 60, 100, 150, 250 and 500cm/h). The column-to-column packing variation between disposable pre-packed columns of different diameter-length combinations varied by 10-15%, which was acceptable for the intended use. The column-to-column variation cannot be explained by the packing density, but is interpreted as a difference in particle arrangement in the column. Since it was possible to determine differences in the column-to-column performance, we concluded that the columns were well-packed. The measurement precision of the chromatography workstation was independent of the column volume and was in a range of±0.01ml for the first peak moment and±0.007 ml 2 for the second moment. The measurement precision must be considered for small columns in the range of 2ml or less. The efficiency of disposable pre-packed columns was equal or better than that of self-packed columns., (Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.)

Due to the high prevalence of incontinence among skilled nursing facility (SNF) residents, incontinence-associated derma- titis (IAD) is a common occurrence. In addition, facility staff may mistakenly identify IAD as a pressure injury. A prospective, descriptive, multicenter study was conducted in 3 Connecticut facilities to evaluate the effect of substituting a disposable, high- uid capacity underpad for nonpermeable disposable and reusable containment products on the rate of IADs. Residents with and without IAD but with high IAD risk scores who were bed- or chairbound or ambulatory and used disposable nonpermeable briefs and underpads or reusable, laundered containment products when in bed longer than 2 hours were randomly enrolled and observed for a 4-week period. Facility staff were trained on the importance of differentiating between IAD and pressure injury; they substituted the study product (a disposable, high- uid capacity underpad) for all previously used containment products. Patient risk for IAD and skin condition were assessed using the Perineal Assessment Tool (PAT) and the Skin Condition Assessment Tool (SAT), respectively, at 5 time points: baseline, week 1, week 2, week 3, and week 4. The PAT is a 4-item instrument based conceptually on the 4 determinants in perineal skin breakdown; subscales are rated from 1 (least risk) to 3 (most risk), with a total score range of 4 to 12. The SAT is used to evaluate IAD speci cally, generating a cumulative severity score ranging from 0 to 3 on area of skin affected, degree of redness, and depth of ero- sion. Final data analysis was conducted on 40 residents: 25 had IAD present at enrollment and 15 were deemed high risk for developing IAD. Mean SAT scores in the 25 participants with IAD decreased with signi cance at week 1 (P = .0016), week 2 (P = .0023), week 3 (P = .0005), and week 4 (P <.0001). Baseline IAD severity scores averaged 3.3 ± 1.7. Overall IAD average severity scores in this group decreased from baseline mean of 3.3 ± 1.7 to 0.7 ± 1.4 at week 4 (P <.001). The 15 participants with intact, nondamaged skin at enrollment did not develop IAD from baseline to week 4, and PAT score risk levels decreased from high (7 or greater) to low (6 or less) as a result of a speci c reduction in the duration of irritant exposure category for 11 (73%) of this group of participants by week 4. PAT risk level scores for both IAD and non-IAD participants at baseline averaged 8.1 ± 1.4; after 4 weeks, they averaged 7.0 ± 1.5). Although change was not significant, results suggest the use of a disposable, high- uid capacity underpad improved SAT scores over time. IAD rates increased in each facility, but pressure injury incidence rates decreased for the study duration. Replacing a nonpermeable, reusable containment product with a disposable, high- uid capacity underpad when SNF residents are in bed longer than 2 hours may impact the severity of IAD and reduce its incidence. The inverse impact reported on IAD and pressure injury incidence rates 1 month after training suggest study educational efforts had a short-lasting effect. Future research is indicated to determine the most effective method to improve nurses' ability to identify and distinguish IAD from pressure injury in the SNF setting.

Introduction: Single-use ureteroscopes have been gaining popularity in recent years. We compare the optics, deflection, and irrigation flow of two novel single-use flexible ureteroscopes-the YC-FR-A and the NeoFlex-with contemporary reusable and single-use flexible ureteroscopes., Methods: Five flexible ureteroscopes, YC-FR-A (YouCare Tech, China), NeoFlex (Neoscope, Inc., USA), LithoVue (Boston Scientific, USA), Flex-Xc (Karl Storz, Germany), and Cobra (Richard Wolf, Germany), were assessed in vitro for image resolution, distortion, field of view, depth of field, color representation, and grayscale imaging. Ureteroscope deflection and irrigation were also compared., Results: The YC-FR-A showed a resolution of 5.04 lines/mm and 4.3% image distortion. NeoFlex showed a resolution of 17.9 lines/mm and 14.0% image distortion. No substantial difference was demonstrated regarding the other optic characteristics between the two. Across all tested ureteroscopes, single-use or reusable, the digital scopes performed best with regard to optics. The YC-FR-A had the greatest deflection at baseline, but lacks two-way deflection. The NeoFlex had comparable deflection at baseline to reusable devices. Both ureteroscopes had substantial loss of deflection with instruments in the working channel. The YC-FR-A had the greatest irrigation rate. The NeoFlex has comparable irrigation to contemporary ureteroscopes., Conclusions: The YouCare single-use fiberoptic flexible ureteroscope and NeoFlex single-use digital flexible ureteroscope perform comparably to current reusable ureteroscopes, possibly making each a viable alternative in the future. Newer YouCare single-use flexible ureteroscopes with a digital platform and two-way deflection may be more competitive, while the NeoFlex devices are undergoing rapid improvement as well. Further testing is necessary to validate the clinical performance and utility of these ureteroscopes, given the wide variety of single-use devices under development.

Background and study aim  Our aim was to evaluate the first use in humans of a new, single-use, digital, single-operator intraductal cholangiopancreatoscopy system (IDCP). Patients and methods  Data were collected retrospectively from four US institutions between February 2015 and April 2015. The visual impression of neoplasia or benign findings with IDCP was determined by the performing endoscopist. High grade dysplasia, intraductal papillary mucinous neoplasm, neuroendocrine tumor, and malignancy were categorized as neoplasia. Benign disease was defined as the absence of neoplasia during ≥ 6 months of follow-up. Results  Patients (n = 108) with indeterminate strictures, dilatation, or difficult stones underwent IDCP. Of 74 patients with indeterminate stricture or dilatation, 29 (39 %) had neoplasia, of which 25 were confirmed by miniature biopsy forceps, 2 by surgical pathology, and 2 by the presence of metastatic disease on follow-up imaging. In patients with benign disease, 15 had concentric stenosis or normal/erythematous changes, 5 had low papillary mucosal projections, 6 had coarse granular mucosa, and 4 had nodular mucosa. Findings in patients with neoplastic disease included dilated, tortuous vessels ("tumor vessels"; n = 13), irregular margins with partial occlusion of the lumen (infiltrative stricture, n = 12), villous or nodular mass (n = 9), and finger-like villiform projections (n = 5). Operating characteristics for indeterminate stricture or dilatation were: 97 % sensitivity, 93 % specificity, 90 % positive predictive value, 98 % negative predictive value. Targeted biopsy yielded 86 % sensitivity and 100 % specificity. Stone clearance was noted in all cases. Adverse events occurred in 3 %. Conclusion  The new IDCP system provides enhanced image resolution, and may improve the ability to target difficult stones and diagnose indeterminate strictures., Competing Interests: Competing interests: Drs. Shah, Raijman, Brauer, Gumustop, and Pleskow are consultants for Boston Scientific, Inc., (© Georg Thieme Verlag KG Stuttgart · New York.)

Circulating tumour cells (CTCs) are an emerging resource for monitoring cancer biomarkers. New technologies for CTC isolation and biomarker detection are increasingly sensitive, however, the ideal blood storage conditions to preserve CTC-specific mRNA biomarkers remains undetermined. Here we tested the preservation of tumour cells and CTC-mRNA over time in common anticoagulant ethylene-diamine-tetra-acetic acid (EDTA) and acid citrate dextrose solution B (Citrate) blood tubes compared to preservative-containing blood tubes. Blood samples spiked with prostate cancer cells were processed after 0, 24, 30, and 48 h storage at room temperature. The tumour cell isolation efficiency and the mRNA levels of the prostate cancer biomarkers androgen receptor variant 7 (AR-V7) and total AR, as well as epithelial cell adhesion molecule (EpCAM) were measured. Spiked cells were recovered across all storage tube types and times. Surprisingly, tumour mRNA biomarkers were readily detectable after 48 h storage in EDTA and Citrate tubes, but not in preservative-containing tubes. Notably, AR-V7 expression was detected in prostate cancer patient blood samples after 48 h storage in EDTA tubes at room temperature. This important finding presents opportunities for measuring AR-V7 expression from clinical trial patient samples processed within 48 h-a much more feasible timeframe compared to previous recommendations.

Inexpensive cloth masks are widely used in developing countries to protect from particulate pollution albeit limited data on their efficacy exists. This study examined the efficiency of four types of masks (three types of cloth masks and one type of surgical mask) commonly worn in the developing world. Five monodispersed aerosol sphere size (30, 100, and 500 nm, and 1 and 2.5 μm) and diluted whole diesel exhaust was used to assess facemask performance. Among the three cloth mask types, a cloth mask with an exhaust valve performed best with filtration efficiency of 80-90% for the measured polystyrene latex (PSL) particle sizes. Two styles of commercially available fabric masks were the least effective with a filtration efficiency of 39-65% for PSL particles, and they performed better as the particle size increased. When the cloth masks were tested against lab-generated whole diesel particles, the filtration efficiency for three particle sizes (30, 100, and 500 nm) ranged from 15% to 57%. Standard N95 mask performance was used as a control to compare the results with cloth masks, and our results suggest that cloth masks are only marginally beneficial in protecting individuals from particles<2.5 μm. Compared with cloth masks, disposable surgical masks are more effective in reducing particulate exposure.

Reuse of medical device is accepted worldwide. Benefits of reuse include not only cost saving but a favorable impact on environment. However, certain requirements should be met for reuse to be safe and effective. The devices, which can be reused, should be clearly defined, a meticulous process for dis-infection and sterilization followed and its functionality ascertained before use. Further, an appropriate consent should be obtained where necessary and the cost saving entailed should be directly passed on to the patient., (Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Background: Single-use plastic blades (SUPB) and single-use metal blades (SUMB) for direct laryngoscopy and tracheal intubation have not yet been compared with reusable metal blades (RUMB) in difficult airway scenarios., Objective: The purpose of our manikin study was to compare the effectiveness of these different laryngoscope blades in a difficult airway scenario, as well as in a difficult airway scenario with simulated severe inhalation injury., Methods: Thirty anesthetists performed tracheal intubation (TI) with each of the three laryngoscope blades in the two scenario manikins., Results: In the inhalation injury scenario, SUPB were associated with prolonged intubation times when compared with the metal blades. In the inhalation injury scenario, both metal laryngoscope blades provided a quicker, easier, and safer TI. In the difficult airway scenario, intubation times were significantly prolonged in the SUPB group in comparison to the RUMB group, but there were no significant differences between the SUPB and the SUMB. In this scenario, the RUMB demonstrated the shortest intubation times and seems to be the most effective device., Conclusions: Generally, results are in line with previous studies showing significant disadvantages of SUPB in both manikin scenarios. Therefore, metal blades might be beneficial, especially in the airway management of patients with inhalation injury., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the levels of agreement between the standard reusable prism and a disposable prism, and to examine the agreement between ophthalmologists, nursing and technical staff when measuring intraocular pressure (IOP) using the Goldmann applanation tonometer., Methods: Three hundred eyes of 300 patients were recruited. IOP measurements were made in a randomised order by three observer groups consisting of ophthalmologists and ophthalmic technicians/nurses taken from a pool of clinicians working within a busy outpatient clinic. Agreement was calculated by Bland-Altman analysis, showing the mean difference and 95% limits of agreement (LoA) of measurements., Results: The mean difference between the reusable and disposable prism IOP measurements was <0.5 mm Hg. The LoA ranged from ±3.1 to ±4.9 mm Hg, depending on the observer group. The interobserver variability was <1 mm Hg across all observer groups; the LoA was slightly higher for observers using the reusable prism (range between ±4.3 and ±5.6 mm Hg) compared with using the disposable prism (range between ±3.7 and ±5.4 mm Hg) across observer groups., Conclusions: There is an acceptable agreement between IOP measurements made with the reusable Goldmann tonometer prism and the disposable Tonosafe prism. Interobserver variability in IOP measurements within an outpatient setting is larger than that found within a research setting, and may be of a level that impacts on clinical decision-making., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Although they play an important role in infection prevention and control, textile materials and personal protective equipment (PPE) used in health care settings are known to be one of the sources of cross-infection. Gowns are recommended to prevent transmission of infectious diseases in certain settings; however, laboratory and field studies have produced mixed results of their efficacy. PPE used in health care is regulated as either class I (low risk) or class II (intermediate risk) devices in the United States. Many organizations have published guidelines for the use of PPE, including isolation gowns, in health care settings. In addition, the Association for the Advancement of Medical Instrumentation published a guidance document on the selection of gowns and a classification standard on liquid barrier performance for both surgical and isolation gowns. However, there is currently no existing standard specific to isolation gowns that considers not only the barrier resistance but also a wide array of end user desired attributes. As a result, infection preventionists and purchasing agents face several difficulties in the selection process, and end users have limited or no information on the levels of protection provided by isolation gowns. Lack of knowledge about the performance of protective clothing used in health care became more apparent during the 2014 Ebola epidemic. This article reviews laboratory studies, regulations, guidelines and standards pertaining to isolation gowns, characterization problems, and other potential barriers of isolation gown selection and use., (Published by Elsevier Inc.)

Biologics manufacturing technology has made great progress in the last decade. One of the most promising new technologies is the single-use system, which has improved the efficiency of biologics manufacturing processes. To ensure safety of biologics when employing such single-use systems in the manufacturing process, various issues need to be considered including possible extractables/leachables and particles arising from the components used in single-use systems. Japanese pharmaceutical manufacturers, together with single-use suppliers, members of the academia and regulatory authorities have discussed the risks of using single-use systems and established control strategies for the quality assurance of biologics. In this study, we describe approaches for quality risk management when employing single-use systems in the manufacturing of biologics. We consider the potential impact of impurities related to single-use components on drug safety and the potential impact of the single-use system on other critical quality attributes as well as the stable supply of biologics. We also suggest a risk-mitigating strategy combining multiple control methods which includes the selection of appropriate single-use components, their inspections upon receipt and before releasing for use and qualification of single-use systems. Communication between suppliers of single-use systems and the users, as well as change controls in the facilities both of suppliers and users, are also important in risk-mitigating strategies. Implementing these control strategies can mitigate the risks attributed to the use of single-use systems. This study will be useful in promoting the development of biologics as well as in ensuring their safety, quality and stable supply.

Background: To deliver insulin glargine 300 U/mL (Gla-300), the widely used SoloSTAR(®) pen has been modified to allow for accurate and precise delivery of required insulin units in one-third of the volume compared with insulin glargine 100 U/mL, while improving usability. Here we compare the accuracy and injection force of 3 disposable insulin pens: Gla-300 SoloSTAR(®), FlexPen(®), and KwikPen™., Methods: For the accuracy assessment, 60 of each of the 3 tested devices were used for the delivery of 3 different doses (1 U, half-maximal dose, and maximal dose), which were measured gravimetrically. For the injection force assessment, 20 pens of each of the 3 types were tested twice at half-maximal and once at maximal dose, at an injection speed of 6 U/s., Results: All tested pens met the International Organization for Standardization (ISO) requirements for dosing accuracy, with Gla-300 SoloSTAR showing the lowest between-dose variation (greatest reproducibility) at all dose levels. Mean injection force was significantly lower for Gla-300 SoloSTAR than for the other 2 pens at both half maximal and maximal doses (P < .0271)., Conclusion: All tested pens were accurate according to ISO criteria, and the Gla-300 SoloSTAR pen displayed the greatest reproducibility and lowest injection force of any of the 3 tested devices., (© 2015 Diabetes Technology Society.)

Objective: The aim was to compare 2 disposable insulin pens, FlexTouch® (Novo Nordisk, insulin aspart) and SoloSTAR® (Sanofi, insulin glulisine), according to new ISO 11608-1:2012 requirements for dosing accuracy., Methods: Sixty pens of each type were tested at 1, 40, and 80 U doses. Following the new ISO requirements, each dose was delivered from the front, middle, and rear one-third of the pen. Statistical analysis was performed using Student's t test., Results: Both pens delivered all doses within ISO limits. The difference between the average measured dose and the target dose was significantly smaller for SoloSTAR than FlexTouch at 40 U (P = .009) and 80 U (P = .008), but not at 1 U (P = .417)., Conclusion: Both insulin pens fulfilled the dosing accuracy requirements defined by ISO 11608-1:2012 at all 3 dosage levels., (© 2015 Diabetes Technology Society.)

The emergence of consolidated nighttime sleep and the formation and maintenance of parent-infant relationships are 2 primary developmental achievements of the infancy period. Despite the development of a transactional model that links parenting behaviors to infant sleep, limited attention has been devoted to examining experimental manipulations of infant sleep that may impact the discrete parent-infant interactions that may form the foundation for emerging attachment relationships. In the present study, infants were randomly assigned to wear high-absorbency disposable diapers or to continue using traditional low-absorbency cloth diapers that necessitate frequent changes and associated disruptions of nighttime sleep. Parents reported on infant sleep before and during the 6-week experimental manipulation; a subset of infants also wore actigraphs. Parents and infants also participated in a parent-infant interaction task both before and near the end of the experimental manipulation. Infants who wore cloth diapers experienced more frequent sleep disruptions overall as well as a greater number of disruptions that did and did not wake the infant from sleep. Infants who wore disposable diapers were rated as experiencing more engagement and positive affect near the end of the intervention relative to infants who wore cloth diapers; mothers of infants who wore disposable diapers were rated as more engaged and sensitive near the end of the intervention relative to mothers of infants who wore cloth diapers. These findings suggest that the disposable diaper manipulation was causally related to characteristics of mother-infant interactions that may form the foundation for emerging attachment relationships., ((c) 2015 APA, all rights reserved).)

Objectives: Now, a lot of researchers have tried to make recycled rigid materials from the sludge cake produced in paper mill industries for the purpose of decreasing its volume. In this study, the researchers tried to make economically a disposable bin and to examine whether it is toxic or not to the outside environment., Methods: To make a disposable bin, the researchers used the sludge cake, a plastic basket, as a fixed mold, white cloth or newspaper, as a removable supporter for wrapping around the mold, and latex or plaster, as a binder. The strength of the samples was measured by tensile-stress testing. The water absorption was evaluated by Cobb test. As toxicological tests, leaching test and seed germination test were selected., Results: It was possible to form the disposal bin from the cleaned sludge cake. They seemed safe to carry garbage in the industry judging from the results of tensile-stress testing. Some of them showed less water absorptiveness (higher water resistance) in the results of Cobb test. The results of leaching test showed small values of three heavy metals, lead, nickel and copper, in the leachate. The seed germination test suggested no adverse effects of the bins in the clay and sand on the tomato growth., Conclusions: The results of these tests suggest that the bins have good strength, sufficient water resistance and no toxicological effect on the environment. This new recycled bin has the possibility to solve the environmental and health problems at disposing the sludge cake.

Purpose: To compare leak point volumes and cost-effectiveness of a variety of adult incontinence products., Methods: Adult incontinence products were purchased from local retail stores and categorized into moderate absorbency pads, moderate absorbency briefs, maximum absorbency pads, and maximum absorbent briefs. The leak point for each product was determined by applying fluid to the pad until the first drop of leakage from the pad or brief occurred. Cost-effectiveness was calculated by dividing the cost per product by the amount of fluid absorbed prior to the leak point. The leak points and cost-effectiveness of incontinence products were compared within and between categories., Results: Significant differences in leak point volumes were present within all product categories except moderate absorbency pads. When comparing product categories, moderate absorbency pads were the least cost-effective, followed by maximum absorbency pads and absorbent briefs (P < .01)., Conclusions: As a group, absorbent briefs are more cost-effective than incontinence pads, although products of similar absorbency category and design demonstrated varying leak points and cost-effectiveness. These findings may influence physician assessment of urinary incontinence as well as patient selection of incontinence products.

An effective GC method was established for contents determination of the residual solvent of cyclohexanone in infusion sets for single use. The cyclohexanone in infusion sets for single use products were extracted with circular pump, using ethylalcohol as the extraction solven, then the extract followed by analysis of gas chromatography-tandem mass spectrometry. The method was simple, rapid, sensitive and accurate, Cyclohexanone showed good linearity in the range of (5.5-190.9) μg/mL, the correlation coefficient was 0.999 0, the detection limit (S/N = 3) was 0.133 μg/mL and limits of quantitation (S/N = 10) was 1.33 μg/mL. The spiked average recoveries ranged from 98% to 99%. The relative standard deviations (RSDs) of the method ranged from 1.03% to 1.98%. The method was simple, fast, sensitive and accurate, and may serve as a mass control method for residual cyclohexanone in disposable infusion sets for single use.

Purpose: The purpose of this study was to compare contamination of the immediate environment with Clostridium difficile spores and vegetative cells from 2 stool management systems over a period of 30 days in a controlled laboratory setting., Design: In vitro, comparison trial., Methods: Two stool management systems were compared over a 30-day period in a controlled laboratory setting. Sixteen systems were filled with sterile loose canine stool inoculated with 10 colony-forming units (CFUs) per milliliter of C difficile; specially prepared culture media were used to detect C difficile contamination on various surfaces of the device and in the immediate environment. Containment bags were changed daily and devices were refilled with inoculated stool to more closely imitate use in the clinical setting. A dichotomous outcome variable (growth vs no growth) was used to analyze contamination on a daily basis via the generalized estimating equation; devices were also compared on days 3, 10, 20, and 30 by measuring CFUs per device surface. Logistic regression analysis was used to analyze growth over time. When observations showed no growth, the Cochran-Mantel Haenszel test was used to compare study devices., Results: Analysis revealed that 20.8% of anterior surfaces of the collection bags for device 1 were contaminated versus 83.9% of collection bags for device 2 (P < .001). Comparison of the tubing/hub interface resulted in similar findings; 20.8% of device 1 group were contaminated versus 86.3% of device 2 group (P < .001). Analysis of an absorbent pad placed under the device during daily changes found that 0.5% of device 1 were contaminated versus 38.1% of pads placed under device 2 (P < .001)., Conclusions: Findings from this in vitro study show that stool management systems can limit or prevent environmental contamination of C difficile. Results also reveal significant differences in the 2 systems tested; we hypothesize that these differences are attributable to the interface between the tubing and collection bag, the point at which these systems are most often disconnected as collection bags become filled with fecal material. Further clinical studies are required to confirm the clinical relevance of the data presented in this in vitro study.

In order to answer statutory requirements and to anticipate the future needs and standards, the EFS is committed, since a few years, in a process of harmonization of its metrology function. In particular, the institution has opted for the skills development by internalizing the metrological traceability of the main critical quantities (temperature, volumetric) measurements. The development of metrology so resulted in a significant increase in calibration and testing activities. Methods are homogenized and improved through accreditations. The investment strategies are based on more and more demanding specifications. The performance of the equipments is better known and mastered. Technical expertise and maturity of the national metrology function today are assets to review in more informed ways the appropriateness of the applied periodicities. Analysis of numerous information and data in the calibration and testing reports could be pooled and operated on behalf of the unique establishment. The objective of this article is to illustrate these reflections with a few examples from of a feedback of the EFS Pyrénées Méditerranée. The analysis of some methods of qualification, the exploitation of the historical metrology in order to quantify the risk of non-compliance, and to adapt the control strategy, analysis of the criticality of an instrument in a measurement process, risk analyses are tools that deserve to be more widely exploited for that discipline wins in efficiency at the national level., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Dose accuracy and injection force, representing key parameters of insulin pens, were determined for three pens delivering insulin glargine-based copies, Pen Royale (WR) and DispoPen (WD) for Glaritus® (Wockhardt) and GanLee Pen (GL) for Basalin® (Gan & Lee), compared with pens of the originator, ClikSTAR® (CS) and SoloSTAR® (SS) for Lantus® (Sanofi)., Methods: Using the weighing procedure recommended by DIN EN ISO 11608-1:2000, dose accuracy was evaluated based on nonrandomized delivery of low (5 U), mid (30 U), and high (60 U) dosage levels. Injection force was measured by dispensing the maximum dose of insulin (60 U for the GL, WR, and WD; 80 U for the SS and CS) at dose speeds of 6 and 10 U/s., Results: All tested pens delivered comparable average doses within the DIN EN ISO 11608-1:2000 limits at all dosage levels. The GL revealed a higher coefficient of variation (CV) at 5 U, and the WR and WD had higher CVs at all dosage levels compared with the CS and SS. Injection force was higher for the WR, WD, and GL compared with the CS and SS at both dose speeds. In contrast to the CS and SS with an end-of-content feature, doses exceeding the remaining insulin could be dialed with the WR, GL, and WD and, apparently, dispensed with the WD., Conclusions: All pens fulfilled the dose accuracy requirements defined by DIN EN ISO 11608-1:2000 standards at all three dosage levels, with the WR, WD, and GL showing higher dosage variability and injection force compared with the SS and CS. Thus, the devices that deliver insulin glargine copies show different performance characteristics compared with the originator., (© 2013 Diabetes Technology Society.)

Purpose: To quantify the optical quality of various daily disposable contact lenses in vivo and to ascertain its variation in terms of wearing time by means of objective non-invasive determination of wavefront patterns., Methods: The crx1 adaptive-optics system was used to measure the wavefront aberrations in 15 myopic eyes before and at 2-h intervals after contact lens fitting, over a 12-h wearing period. Seven types of contact lenses having different material, water content and lens design were evaluated in this study: Dailies Total1, Dailies AquaComfort Plus, Proclear 1 Day, 1-Day Acuvue TruEye, 1-Day Acuvue moist, SofLens daily disposable and Clariti 1-Day. The aberration data were analysed by fitting Zernike polynomials up to the 5th-order for 3 and 5-mm pupils. The optical quality under each condition and at each point in time was described by means of the Root-Mean-Square (RMS) value of wavefront aberration, Modulation Transfer Function (MTF), Point Spread Function and cut-off spatial frequency., Results: A RMS increase was observed after contact lens fitting as well as over time, both for a 3-mm and a 5-mm pupil. Each type of lens induced a different amount of wavefront aberrations, which vary over time also in a different manner. Dailies Total1 showed the lowest RMS values both at baseline and at the end of the day. In addition, Dailies Total1 provided the best MTF out of all the contact lenses that were assessed. These observations were reflected in higher cut-off spatial frequencies and visual resolution both at baseline and after 12 h of wearing time., Conclusions: Aberrometry makes it possible to analyse accurately and in vivo the optical quality of contact lenses and to assess how lenses having different characteristics - such as material or water content - behave for different wearing times. These variations across contact lenses may result in differences in visual performance., (© 2013 The Authors Ophthalmic & Physiological Optics © 2013 The College of Optometrists.)

Objectives: To systematically assess (i) the effects and safety and (ii) the acceptability of using lay health workers (LHWs) to deliver vaccines and medicines to mothers and children through compact pre-filled autodisable devices (CPADs)., Methods: We searched electronic databases and grey literature. For the systematic review of effects and safety, we sought randomised and non-randomised controlled trials, controlled before-after studies and interrupted time series studies. For the systematic review of acceptability, we sought qualitative studies. Two researchers independently carried out data extraction, study quality assessment and thematic analysis of the qualitative data., Results: No studies met our criteria for the review exploring the effects and safety of using LHWs to deliver CPADs. For the acceptability review, six qualitative studies assessed the acceptability of using LHWs to deliver hepatitis B vaccine, tetanus toxoid vaccine, gentamicin or oxytocin using Uniject™ devices. All studies took place in low- or middle-income countries and explored the perceptions of community members, LHWs, supervisors, health professionals or programme managers. Most of the studies were of low quality. Recipients generally accepted the intervention. Most health professionals were confident that LHWs could deliver the intervention with sufficient training and supervision, but some had problems delivering supervision. The LHWs perceived Uniject™ as effective and important and were motivated by positive responses from the community. However, some LHWs feared the consequences if harm should come to recipients., Conclusions: Evidence of the effects and safety of using CPADs delivered by LHWs is lacking. Evidence regarding acceptability suggests that this intervention may be acceptable although LHWs may feel vulnerable to blame., (© 2013 John Wiley & Sons Ltd.)

Background: The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nursing Association have developed consensus guidelines for pediatric emergency department policies, procedures, supplies, and equipment. Kentucky received funding from the Health Resources and Services Administration through the Emergency Medical Services for Children program to pilot test the guidelines with the state's hospitals. In addition to providing baseline data regarding institutional alignment with the guidelines, the survey supported development of grant funding to procure missing items., Methods: Survey administration was undertaken by staff and members of the Kentucky Board of Emergency Medical Services Emergency Medical Services for Children work group and faculty and staff of the University of Kentucky College of Public Health and the University of Louisville School of Medicine. Responses were solicited primarily online with repeated reminders and offers of assistance., Results: Seventy respondents completed the survey section on supplies and equipment either online or by fax. Results identified items unavailable at 20% or more of responding facilities, primarily the smallest sizes of equipment. The survey section addressing policy and procedure received only 16 responses., Conclusions: Kentucky facilities were reasonably well equipped by national standards, but rural facilities and small hospitals did not stock the smallest equipment sizes because of low reported volume of pediatric emergency department cases. Thus, a centralized procurement process that gives them access to an adequate range of pediatric supplies and equipment would support capacity building for the care of children across the entire state. Grant proposals were received from 28 facilities in the first 3 months of funding availability.