Search Results (6)

Background/Objectives: Neonatal intubation is a complex procedure, often associated with low first-pass success rates and a high incidence of complications. Video laryngoscopes provide several advantages, including higher success rates, especially for novice clinicians, a magnified airway view that can be shared with supervisors, and the ability to record still or video images for debriefing and education. However, video laryngoscope devices vary, raising the possibility of differences in usability. Methods: The study used mixed methodology, including observations, semi-structured interviews, think-aloud techniques, high-fidelity simulations, function tests, and questionnaires to assess usability, defined by the clinician satisfaction, efficacy, and efficiency of six video laryngoscope devices; (1) C-MAC^® with Miller blade, (2) GlideScope^® Core^TM with Miller blade, (3) GlideScope^® Core^TM with hyperangle LoPro blade, (4) Koala^® Vision Ultra with Miller blade, (5) Koala^® Handheld with Miller blade, and (6) Parker Neonatal with Miller blade. Clinician satisfaction was determined by the System Usability Scale (SUS), National Aeronautics and Space Administration Task Load Index (NASA-TLX), and clinician preference. Device efficacy was determined by first-pass success, number of attempts, and overall success. Efficiency was assessed by time to successful intubation and function test completion rates. Results: Neonatal video laryngoscopes varied considerably in design, impacting usability. All devices were deemed suitable for neonatal intubation, with the Koala^® Handheld, C-MAC^®, and GlideScope^® Core ^TM Miller demonstrating the highest usability. Conclusions: This simulation-based study highlights substantial variability in neonatal video laryngoscope usability, indicating the need for further research into usability in the clinical setting. Full article

Indented growth rings were found long ago to be experimentally induced in Pinus halepensis Miller by thin parallel axial scratching of the bark up to the vascular cambium with a sharp blade. Here, we show that when the bark and vascular cambium of P. halepensis are wounded by wide and long parallel axial wounds (“windows”) rather than by thin scratches, the induced indented growth rings become dramatically more indented. All ten trees that were wounded by long parallel “windows” responded with very strong growth (especially in the first two years) that resulted in the formation of very conspicuous, extremely indented growth rings in the wood formed in between the long and wide woundings. This is true for both the trunks that were wounded all around their circumference and those that were wounded only in part of their circumference. We also suggest further lines of research. Full article

The primary objective of this study was to demonstrate whether the Miller blade laryngoscope could provide better visualization of the vocal cords in morbidly obese patients than the Macintosh blade laryngoscope. The secondary objective was to identify the patient-measured factors associated with better visualization of the vocal cords when using the Miller vs. Macintosh blade, as well as whether the application of external pressure might improve the visibility of the glottis during intubation. A prospective, observational study encompassing 110 patients with a BMI > 40 undergoing elective bariatric surgery and intubation procedure was performed. The evaluation of the vocal cords was performed according to the Cormack–Lehane scale and POGO scale in the same patient during intubation, performed with a Miller and a Macintosh blade laryngoscope, in a random matter. The following parameters were assessed: body weight, height, BMI, neck circumference, thyromental distance, sternomental distance, mouth opening, and Mallampati scale and their impact on visualization of the vocal cords using the Miller blade without the application of external pressure. The Miller blade provides an improved view of the glottis compared to the Macintosh blade measured with both the Cormac–Lehane scale (45 (40.91%) without external pressure application on the larynx, and 18 (16.36%) with external pressure application on the larynx) and the POGO scale (45 (40.91%) without external pressure application on the larynx, and 19 (17.27%) with external pressure application on the larynx). The application of laryngeal pressure improved the view of the glottis. Among the measured features, a significant improvement in the visibility of the glottis could be found in patients with a BMI over 44.244 kg/m² and a neck circumference over 46 cm. To conclude, the usage of the Miller blade improves the visibility of the glottis compared to the Macintosh blade in morbidly obese patients. The recommendation to use the Miller blade in this group of patients requires further investigation, taking into account the effectiveness of the intubation. Trial Registration: NCT05494463. Full article

Background and Objective: Placing the laryngoscope blade directly under the epiglottis (known as the direct view (DV) method) during videolaryngoscopy offers a superior view of the glottis when compared to the indirect method of lifting the epiglottis by positioning the Macintosh blade tip over the vallecula. While there are few studies comparing glottic views using Miller and Macintosh blades in pediatric patients, we have not come across such a study in adults. In this study, we aimed to compare the effectiveness and hemodynamic responses of the Miller laryngoscope and the McGrath-MAC videolaryngoscope (VL) in visualizing the glottic opening using the DV method. Material and Methods: A prospective study was conducted between August and December 2022 at XXX Hospital on 85 patients scheduled for surgical procedures involving endotracheal intubation. Patients were divided into two groups: Miller laryngoscope (Group M) and McGrath-MAC videolaryngoscope (Group VL) and intubated using the direct lifting method of the epiglottis. Hemodynamic responses before and after induction, as well as during laryngoscopy, intubation time, number of attempts, Cormack and Lehane (C&L) score, percentage of glottic opening (POGO), duration of the view of the opening, and need for external laryngeal pressure during intubation were recorded. Results: Both laryngoscopes showed similar effectiveness in terms of POGO and C&L score when used with the direct lifting method of the epiglottis. The median POGO values according to the DV method were 80% in Group M and 70% in Group VL (p = 0.099). Hemodynamic responses, intubation time, number of attempts, duration of view of the glottis opening, and the need for external laryngeal pressure were similar between the groups. Conclusions: Due to its ability to provide effective intubation conditions, we believe that the McGrath-MAC VL, when used with the indirect view method, can also be utilized in anesthesia practices alongside the DV method. Full article

In this study, we propose a consistent and explainable degradation indexing method and a non-destructive-based degradation and creep-life prediction method from extensive destructive test (creep-rupture) data of a nickel-based superalloy (DA-5161 SX), an extreme-environment material. High-temperature components made of nickel-based superalloys that operate in extreme environments (e.g., gas turbine blades) deteriorate over time and shorten the life of the device. To ensure the safety and efficiency of the equipment, it is important to predict the lifetime of high-temperature parts, and a consistent and explanatory degradation index and a reliable predictive model that can predict the degree of degradation and life without destructive testing of high-temperature parts are needed. As the degradation of nickel-based superalloys progresses, degradation indices reflecting the geometrical characteristics are required that focus on the fact that the shape of the gamma-prime phase becomes longer and larger. A representative value of the degradation index was selected through parameter inference based on a Bayesian method, and the high-dimensional degradation index of previous studies was simplified to only one dimension. The robustness of the degradation index quantification model was verified by confirming that the degradation index obtained from 20% of the test images had the lowest change rate of the degradation index obtained from 80% of the training images at 6.9%. The basis for predicting the life of high-temperature parts without destructive testing was established in the degradation index and life prediction model by connecting environmental conditions and degradation indices/the LMP (Larson–Miller parameter) to represent creep life in regression models. Gaussian process regression (GPR) models based on sampling-based Bayesian inference performed well in terms of both RMSE in the degradation index and the LMP prediction model, demonstrating robust behavior in performance variation. This may be used as a key health factor that indicates the soundness of diagnostic solutions in the future, and it is expected to be a foundational technology for decision-making models for maintenance, repair, and disposal. Full article

The Hellenic Air Force (HAF) operates both EMB-145 and EMB-135 LR versions of Embraer aircraft, used in surveillance and civil missions respectively. These aircraft are equipped with the same version of Rolls Royce, AE 3007 turbofan engine. This study aims to quantify and compare the life consumption rate of this engine when installed in each of the two aircraft variants. Two typical missions, one for each variant, were constructed based on mission profile data dictated by the aircraft commanders. For each mission profile segment, corresponding engine data were matched out of the engine recordings archives held by the Hellenic Air Force. The life consumption rate was based on the Low Cycle Fatigue (LCF) and creep cumulative detrimental effect on the rotor blades of the 1st High-Pressure Turbine stage. For the LCF, the rainflow method was used to determine the respective loading cycles, whereas the Larson - Miller parameter method was used to determine the consumed life fractions due to creep. The main conclusion of the study was that the engine when installed in the EMB-145 military variant, is much more loaded. Despite the fact absolute life consumption values could hide a great level of uncertainty, the comparative outcomes wherein errors are, to a certain extent, cancelled out, could be used as a rule of thumb when monitoring engine life consumption rates. Full article