Results of a Quality Improvement Initiative to Increase the Completion Rate of Electronic Health Records for Patient Encounters at a Large Urban Fire-Based Non-Transporting EMS Agency.

Introduction: Documentation of patient care is essential for both out-of-hospital and in-hospital clinical management. Secondarily, documentation is key for monitoring and improving quality; however, in some EMS systems initial care is often provided by non-transporting agencies whose personnel may not routinely complete patient care reports. Limited data exist describing effective methods for increasing complete patient care documentation among non-transporting agencies.

Increased weight in patients with time-sensitive diagnosis is associated with longer prehospital on-scene times.

Background: Obesity is a growing epidemic associated with higher rates of metabolic disease, heart disease and all-cause mortality. Heavier patients may require more advanced resources and specialized equipment. We hypothesize that increasing patient weight will be associated with longer prehospital on-scene times.

Two-tone frequency-modulation stimulated Rayleigh spectroscopy.

We have demonstrated two-tone frequency-modulation (FM) stimulated Rayleigh spectroscopy. This method can provide high spectral resolution (∼1  MHz), excellent pump/probe detuning accuracy, and near-shot-noise-limited signal-to-noise ratios using a single narrowband laser as the master oscillator. Pump/probe detuning and FM sideband generation are produced with an electro-optic modulator.

Microdroplet temperature calibration via thermal dissociation of quenched DNA oligomers.

The development of microscale analytical techniques has created an increasing demand for reliable and accurate heating at the microscale. Here, we present a novel method for calibrating the temperature of microdroplets using quenched, fluorescently labeled DNA oligomers. Upon melting, the 3' fluorophore of the reporter oligomer separates from the 5' quencher of its reverse complement, creating a fluorescent signal recorded as a melting curve.

Droplet shape analysis and permeability studies in droplet lipid bilayers.

We apply optical manipulation to prepare lipid bilayers between pairs of water droplets immersed in an oil matrix. These droplet pairs have a well-defined geometry allowing the use of droplet shape analysis to perform quantitative studies of the dynamics during bilayer formation and to determine time-dependent values for the droplet volumes, bilayer radius, bilayer contact angle, and droplet center-line approach velocity. During bilayer formation, the contact angle rises steadily to an equilibrium value determined by the bilayer adhesion energy.

Cell assay using a two-photon-excited europium chelate.

We report application of two-photon excitation of europium chelates to immunolabeling of epidermal growth factor receptor (EGFR) cell surface proteins on A431 cancer cells. The europium chelates are excited with two photons of infrared light and emit in the visible. Europium chelates are conjugated to antibodies for EGFR.

High-speed camera with real time processing for frequency domain imaging.

We describe a high-speed camera system for frequency domain imaging suitable for applications such as in vivo diffuse optical imaging and fluorescence lifetime imaging. 14-bit images are acquired at 2 gigapixels per second and analyzed with real-time pipeline processing using field programmable gate arrays (FPGAs). Performance of the camera system has been tested both for RF-modulated laser imaging in combination with a gain-modulated image intensifier and a simpler system based upon an LED light source.

Near infrared transillumination imaging of breast cancer with vasoactive inhalation contrast.

Inhalation of vasoactive gases such as carbon dioxide and oxygen can provide strong changes in tissue hemodynamics. In this report, we present a preliminary clinical study aimed at assessing the feasibility of inhalation-based contrast with near infrared continuous wave transillumination for breast imaging. We describe a method for fitting the transient absorbance that provides the wavelength dependence of the optical pathlength as parametrized by tissue oxygenation and scatter power as well as the differential changes in oxy- and deoxy-hemoglobin.

Wound healing monitoring using near infrared fluorescent fibrinogen.

We demonstrate a method for imaging the wound healing process with near infrared fluorescent fibrinogen. Wound healing studies were performed on a rat punch biopsy model. Fibrinogen was conjugated with a near infrared fluorescent dye and injected into the tail vein.

Light-driven formation and rupture of droplet bilayers.

We demonstrate the optical manipulation of nanoliter aqueous droplets containing surfactant or lipid molecules and immersed in an organic liquid using near-infrared light. The resulting emulsion droplets are manipulated using both the thermocapillary effect and convective fluid motion. Droplet-pair interactions induced in the emulsion upon optical initiation and control provide direct observations of the coalescence steps in intricate detail.

Frequency domain measurements on turbid media with strong absorption using the PN approximation.

We have applied the frequency-domain technique to measurement of the optical properties of turbid media with strong absorption in the infinite medium limit. Absorption coefficients up to 2.3 cm(-1) for a modified scattering coefficient of 4.

Petri dish PCR: laser-heated reactions in nanoliter droplet arrays.

We report high-speed real-time PCR performed on an unmodified disposable polystyrene Petri dish. The reaction cycle relies solely on an infrared laser for heating; no conventional heater is required. Nanoliter droplets of PCR mixture as water-in-oil emulsions printed in an array format served as individual PCR microreactors.

Development of a transillumination infrared modality for differential vasoactive optical imaging.

We present the development and implementation of a new near infrared transillumination imaging modality for tissue imaging. Exogenous inhaled hyperoxic and hypercarbic gases are used as "vasoactive contrast agents" via the production of changes in concentration of the endogenous HbO(2) and Hb in blood. This vasoactive differential imaging method is employed to acquire data and for subsequent image analysis.

Nanodroplet real-time PCR system with laser assisted heating.

We report the successful application of low-power (approximately 30 mW) laser radiation as an optical heating source for high-speed real-time polymerase chain reaction (PCR) amplification of DNA in nanoliter droplets dispersed in an oil phase. Light provides the heating, temperature measurement, and Taqman real-time readout in nanoliter droplets on a disposable plastic substrate. A selective heating scheme using an infrared laser appears ideal for driving PCR because it heats only the droplet, not the oil or plastic substrate, providing fast heating and completing the 40 cycles of PCR in 370 seconds.

Inspiratory contrast for in vivo optical imaging.

We demonstrate the use of inspired oxygen and carbon dioxide as a possible route to increase contrast in optical imaging of cancerous tissue. Differential imaging in human xenograft rodent models of cancer exhibits significant variation in signal between normal and cancerous tissue. This differential cancer-specific contrast is stronger and more consistent than the conventional static contrast.

Strategy for photostable proximity bioassays using lanthanides.

We report initial findings for research aimed at creating photostable lanthanide chelate reporters for proximity assays. These reporters take advantage of the nanometer-scale distance dependence of fluorescence enhancement for molecules in the vicinity of noble metal nanoparticles and also capitalize on some unique properties of lanthanide chelates. This approach promises to lead to proximity assays that do not suffer from photobleaching and offer very high on/off enhancement ratios.

Polyethylene sterilization and production affects wear in total hip arthroplasties.

Production and package sterilization techniques for the polyethylene used in acetabular components for total hip arthroplasties are known to affect wear. We considered three combinations of techniques: sterilization by radiation in inert gas with isostatically molded polyethylene, in inert gas and ram-extruded polyethylene, and in air with extruded polyethylene. The intent of this study was to confirm that molded polyethylene and polyethylene radiated in inert environments reduce wear rates in vivo, to determine the combination of methods with the least wear, and to determine how much variance in wear is attributable to these methods.

Upconversion from aqueous phase lanthanide chelates.

We have prepared and characterized several lanthanide ion complexes of multidentate ligands or chelates in an effort to develop new upconverting luminescent labels that can be immune to autofluorescence and photobleaching. This study has involved the characterization of various chelates of Nd, Er, and Tm with respect to relative luminescent efficiency and excited-state lifetimes and explored various two-photon stepwise excitation mechanisms. Using peak laser powers near 100 kW, the upconversion emissions of Nd in Nd(EDTA)2(5-) at 386 nm, Er in Er(DPA)3(3-) at 550 nm, and Tm in Tm(DPA)3(3-) at 480 nm, at levels of approximately 10(-12) moles can be detected.

Optically addressed droplet-based protein assay.

We demonstrate a new method for performing protein assays with very small volumes ( approximately 1.7 muL to 14 pL). Using a laser to modify local surface energy, we manipulate, fuse, and mix droplets containing horseradish peroxidase and its substrates.

P(N) approximation for frequency-domain measurements in scattering media.

Presented here are expressions for the P(N) approximation for light propagation in scattering media in the frequency domain. To elucidate parametric dependencies, the derivation uses normalization of the resulting expressions to either the total interaction coefficient or the reduced total interaction coefficient. For the latter case, a set of reduced phase function coefficients are introduced.

Tibial component failure mechanisms in total knee arthroplasty.

The purpose of this study was to examine the failure mechanisms and factors associated with failure of a nonmodular metal backed cemented tibial component. Out of 3152 total knee replacements done for osteoarthritis, 41 tibial components had been revised (1.3%).

Total knee arthroplasty in patients with angular varus or valgus deformities of > or = 20 degrees.

Of 8,014 surgeries between January 1986 and August 2000, 82 primary total knee arthroplasties (TKAs) were performed on 75 patients with severe preoperative varus or valgus deformity of greater than or equal to 20 degrees with a minimum 2-year follow-up time and a posterior cruciate retaining prosthesis. This study was designed to determine whether these patients (group A) could be as successful, using a Knee Society score (KSS) and alignment, as a matched control group (group B). There was no statistical difference in knee score, alignment, or revision.

Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life.

The goal of this study was to evaluate the complications and efficacy of total joint arthroplasty in the extremely elderly and compare the survival with the normal age-matched population. One hundred one joint arthroplasties (45 total knee arthroplasties [TKAs], 56 total hip arthroplasties [THAs]) were performed in 83 patients 89 years old and older. Over an average follow-up period of 2.