Lafayette, LA (KPEL News) - Sixteen doctors in specialties dealing with orthopedics practice together under the umbrella of Louisiana Orthopaedic Specialists in Lafayette. If a patient has a joint or bone ailment of any kind, LOS has a physician on staff to treat them.
Now, a pending merger will expand the care services of the prominent Lafayette group to include more medical minds to minister to patients across south Louisiana.
Louisiana Orthopaedic Specialists has its physical home on Rue Louis XIV. In January, the rapidly-growing medical group broke ground on a new Ambulatory Surgery Center (ASC) that will house six operating rooms and two procedure rooms for minor patient treatments. The new facility will be located at 300 E. Bluebird Drive in Lafayette, Louisiana, behind the Rouses on Camellia Boulevard.
In addition to its clinic and Ambulatory Surgery Center, LOS operates two urgent care orthopedic facilities, one in Scott and the other in Lafayette.
In a recent joint news release, LOC and Baton Rouge Orthopaedic Clinic (BROC) announced that they will become the founding members of a new practice to be called Gulf South Orthopedic Partners. The release states:
The partnership represents a significant milestone, combining the expertise and resources of two esteemed orthopedic practices to enhance patient care and treatment outcomes, accessibility, and to preserve and protect the independent practice of Orthopedic Surgery during these dynamic times of consolidation and change.
Medical care across Louisiana and the country has changed dramatically over the last decade, and providers are working to treat patients effectively within insurance and economic constraints. The merger will allow each physician group to operate within their own geographic footprint, while allowing them to collaborate and offer more expertise to their patients.
Gulf South Orthopedic Partners will have 54 board-certified doctors and will offer a range of services related to musculoskeletal health, including:
sports medicine.
joint replacement.
spine surgery.
hand surgery.
foot and ankle surgery.
orthopedic oncology.
orthopedic trauma.
pediatric orthopedics.
rehabilitation.
These COVID Symptoms May Lead to Hospitalizations
Health officials say folks should be on a close lookout for a number of Omicron symptoms that likely mean you need urgent medical care.
A new M Health Fairview clinic is confronting an exhausting disorder that has afflicted more children since the pandemic and caused alarming spikes in heart rate, blood pressure and breathing.
Dr. Matthew Ambrose said it is disheartening to see so many more cases of the condition known as POTS. But the increase at least spurred awareness, and accelerated plans for a clinic in Minneapolis that can better diagnose and treat children who in the past were dismissed.
"Sometimes they're being told outright that they are making it up, that it's all in their head," said Ambrose, a U pediatric cardiologist and the clinic's director. "It's really dispiriting to hear. They can't even be at school because they are too tired."
POTS emerged prior to the pandemic in about one in 500 children and young adults, usually after infectious diseases triggered overly aggressive responses by their immune systems. So doctors weren't shocked when POTS became more of a problem during the pandemic. An estimated 96% of Minnesota children had been infected by the end of 2022 with the coronavirus that causes COVID-19, based on a federal review of pediatric blood samples, creating a huge risk pool for the development of the disorder.
The condition bears similarities to long COVID, the lingering cognitive and physical problems that people experience after coronavirus infections, but with at least one distinguishing characteristic. POTS is short for postural orthostatic tachycardia syndrome, and it is defined by a severe and immediate increase in heart rate whenever people switch positions by sitting or standing up.
Anna Burt, 14, was a bubbly dancer, skier and cheerleader from Sioux Falls, S.D., when she was diagnosed with COVID-19 in October 2020. The resulting exhaustion left her struggling to walk, and often was marked by a pounding heartbeat that raced up to 160 beats per minute.
"Its like a big drum," the girl said.
Burt's mother, Jody, said she felt fortunate to eventually connect with Ambrose, who had observed cases of POTS prior to the pandemic and had taken a clinical and research interest in the condition. Mayo Clinic in Rochester also has specialists who treat POTS, but they didn't have appointments when Anna got sick. Her daughter had developed stomach problems and couldn't sit up, even to ride in the car to the doctor's office, along with episodes of dizziness and pain.
"She really was trapped in the house," her mother said.
Depression and anxiety often occur alongside POTS, so much that they are often mistaken as the causes of children's lethargy, research has shown. Just finding a clinician that believed Anna and her family was vital, her mother said. "We weren't getting that. Most of the time, we were getting, 'its just constipation.'"
Drinking water can reduce POTS flareups, and regular exercise and physical therapy can help patients regain function, Ambrose said. But patients often need poorly understood and even controversial medication regimens. Naltrexone treats opioid addiction but appears to reduce POTS-related fatigue. Steroids regulate water and sodium levels and can prevent or reduce attacks.
Paradoxically, beta blocker drugs that lower blood pressure were thought to worsen POTS, but studies show they help. POTS is related to the autonomic nervous system, or the portion of the nervous system that controls subconscious functions such as heart rate and body temperature.
The drugs temper the body's reaction to signals from that system, Ambrose said. "It's like being at a rock concert but wearing hearing protection."
The clinic's goal is to package together treatments that patients and families often struggled to access separately, and to keep tabs on patients through online check-ups and counseling. By following patients over time, the clinic also hopes to prove which treatments work best and how much progress children with POTS can expect to make.
"When I tell people I think we can get them to a place where they are fully functional, I mean it," Ambrose said. "But it does take work and time and trial and error ... and an Avengers Team of physical therapists."
The clinic sometimes looks for little successes, Ambrose added, giving fluid infusions to one recent patient so she had the energy just to go to prom.
Anna Burt has progressed from a wheelchair to braces to walking on her own, but she still can't run without exhaustion. She has replaced her old pursuits for now with swimming and archery. As a fidgety girl with sensitive skin, she has invented a non-irritating slime toy that she plans to sell under the brand Rainbow Slime.
She said her pain and other symptoms are under better control now, as long as she keeps up with therapy exercises and remembers her medication. She rides a recumbent bicycle at home for exercise and has returned to school for her English and writing classes. Changes day to day are imperceptible, but Anna said she has made long-term improvements and dreams of getting back to old activities.
"Sometimes I get sad. I'm just tired of doing this over and over and over again, but I wouldn't change the experience I had," she said. "Definitely a lot of parts suck, like most of it, 99% sucks. But I wouldn't be who I am now without it."
Research by Cardiff University shows that over-the-counter cold and flu treatments are safe and effective for managing mild covid-19 symptoms at home and could help alleviate the burden on hospitals during high incidence of the illness in the population.
The study, led by Ron Eccles, Emeritus Professor in the School of Biosciences, found that medicines used to treat cold and flu symptoms - such as pain relief, fever reducers, decongestants and cough suppressants – can also be used to manage mild covid-19 infection at home despite not being licensed for such.
Professor Eccles, said: "The covid-19 pandemic has resulted in the deaths of over 6 million people. Currently, with increased exposure of the world population to covid-19 virus and mass vaccination programmes, this serious disease, in the majority of the population, is now considered to have evolved into a much milder disease resembling a common cold or flu-like illness that can be treated at home.
"Over-the-counter (OTC) treatments for cold, flu and upper respiratory tract infections can help alleviate symptoms such as fever, muscle aches, cough, runny nose, sore throat and nasal congestion – many of the symptoms associated with mild covid-19 infections. But currently, over-the-counter medicines are only licensed for treatment of common cold and flu symptoms and not for treatment of the same symptoms associated with covid-19."
The team - comprised of experts in respiratory viruses from Cardiff University, Université Laval in Quebec, University of Hong Kong, University of Utah and the University of Missouri School of Medicine - undertook a literature review and examined their own databases to understand whether over-the-counter cold and flu treatments are t safe and effective treatments for the same symptoms associated with covid-19.
They found that cold and flu-like symptoms associated with covid-19 could be relieved by OTC medicines, and that it is reasonable for these medicines to be licensed by the regulatory authorities to treat these symptoms, regardless of the virus causing them.
Professor Eccles added: "The success of the mass covid-19 vaccination programmes and exposure to the virus means that most people will experience covid-19 as a mild infection that can be managed at home, it's important that people know how best to manage their symptoms at home, safely and effectively.
"However, there has been some speculation that over-the-counter treatments such as ibuprofen used to treat fever may worsen the outcome of covid-19."The data we analysed doesn't appear to support ibuprofen worsening covid-19 outcomes, and more recent studies indicate that treatment with ibuprofen may improve the outcome by suppressing the inflammatory response."
"Our research confirms that over-the-counter common cold and flu treatments can be used for mild symptoms of covid-19, so we can ensure people reach for the correct treatments when recovering from covid-19 infection at home."
/Public Release. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).View in full here.
Four years after hospitals in New York City overflowed with Covid patients, emergency physician Dr. Sonya Stokes remains shaken by how unprepared and misguided the American health system was.
Hospital leadership instructed health workers to forgo protective N95 masks in the early months of 2020, as covid cases mounted. “We were watching patients die,” Stokes said, “and being told we didn’t need a high level of protection from people who were not taking these risks.”
Droves of front-line workers fell sick as they tried to save lives without proper face masks and other protective measures. More than 3,600 died in the first year. “Nurses were going home to their elderly parents, transmitting Covid to their families,” Stokes recalled. “It was awful.”
Across the country, hospital leadership cited advice from the Centers for Disease Control and Prevention on the limits of airborne transmission. The agency’s early statements backed employers’ insistence that N95 masks, or respirators, were needed only during certain medical procedures conducted at extremely close distances.
Such policies were at odds with doctors’ observations, and they conflicted with advice from scientists who study airborne viral transmission. Their research suggested that people could get Covid after inhaling SARS-CoV-2 viruses suspended in teeny-tiny droplets in the air as infected patients breathed.
Ignoring this body of research was convenient at a time when N95s masks were in short supply and expensive, said Peg Seminario, an occupational health expert, and a former director at the American Federation of Labor and Congress of Industrial Organizations, which represents some 12 million workers.
Now, she and many others worry that the CDC is repeating past mistakes as it develops a crucial set of guidelines that hospitals, nursing homes, prisons, and other facilities that provide health care will apply to control the spread of infectious diseases. The guidelines update those established nearly two decades ago. They will be used to establish protocols and procedures for years to come.
“This is the foundational document,” Seminario said. “It becomes gospel for dealing with infectious pathogens.”
“If we applied these draft guidelines at the start of this pandemic, there would have been even less protection than there is now — and it’s pretty bad now,” Seminario said.
In an unusual move in January, the CDC acknowledged the outcry and returned the controversial draft to its committee so that it could clarify points on airborne transmission. The director of the CDC’s National Institute for Occupational Safety and Health asked the group to “make sure that a draft set of recommendations cannot be misread to suggest equivalency between facemasks and NIOSH Approved respirators, which is not scientifically correct.”
The CDC also announced it would expand the range of experts informing their process. Critics had complained that most members of last year’s Healthcare Infection Control Practices Advisory Committee represent large hospital systems. And about a third of them had published editorials arguing against masks in various circumstances. For example, committee member Dr. Erica Shenoy, the infection control director at Massachusetts General Hospital, wrote in May 2020, “We know that wearing a mask outside health care facilities offers little, if any, protection from infection.”
Although critics are glad to see last year’s draft reconsidered, they remain concerned. “The CDC needs to make sure that this guidance doesn’t give employers leeway to prioritize profits over protection,” said Jane Thomason, the lead industrial hygienist at the union National Nurses United.
She’s part of a growing coalition of experts from unions, the American Public Health Association, and other organizations putting together an outside statement on elements that ought to be included in the CDC’s guidelines, such as the importance of air filtration and N95 masks.
But that input may not be taken into consideration.
The CDC has not publicly announced the names of experts it added this year. It also hasn’t said whether those experts will be able to vote on the committee’s next draft — or merely provide advice. The group has met this year, but members are barred from discussing the proceedings. The CDC did not respond to questions and interview requests from KFF Health News.
A key point of contention in the draft guidance is that it recommends different approaches for airborne viruses that “spread predominantly over short distances” versus those that “spread efficiently over long distances.” In 2020, this logic allowed employers to withhold protective gear from many workers.
For example, medical assistants at a large hospital system in California, Sutter Health, weren’t given N95 masks when they accompanied patients who appeared to have Covid through clinics. After receiving a citation from California’s occupational safety and health agency, Sutter appealed by pointing to the CDC’s statements suggesting that the virus spreads mainly over short distances.
A distinction based on distance reflects a lack of scientific understanding, explained Dr. Don Milton, a University of Maryland researcher who specializes in the aerobiology of respiratory viruses. In general, people may be infected by viruses contained in someone’s saliva, snot, or sweat — within droplets too heavy to go far. But people can also inhale viruses riding on teeny-tiny, lighter droplets that travel farther through the air. What matters is which route most often infects people, the concentration of virus-laden droplets, and the consequences of getting exposed to them, Milton said. “By focusing on distance, the CDC will obscure what is known and make bad decisions.”
Front-line workers were acutely aware they were being exposed to high levels of the coronavirus in hospitals and nursing homes. Some have since filed lawsuits, alleging that employers caused illness, distress, and death by failing to provide personal protective equipment.
One class-action suit brought by staff was against Soldiers’ Home, a state-owned veterans’ center in Holyoke, Massachusetts, where at least 76 veterans died from Covid and 83 employees were sickened by the coronavirus in early 2020.
“Even at the end of March, when the Home was averaging five deaths a day, the Soldiers’ Home Defendants were still discouraging employees from wearing PPE,” according to the complaint.
It details the experiences of staff members, including a nursing assistant who said six veterans died in her arms. “She remembers that during this time in late March, she always smelled like death. When she went home, she would vomit continuously.”
Researchers have repeatedly criticized the CDC for its reluctance to address airborne transmission during the pandemic. According to a new analysis, “The CDC has only used the words ‘COVID’ and ‘airborne’ together in one tweet, in October 2020, which mentioned the potential for airborne spread.’”
It’s unclear why infection control specialists on the CDC’s committee take a less cautious position on airborne transmission than other experts, industrial hygienist Deborah Gold said. “I think these may be honest beliefs,” she suggested, “reinforced by the fact that respirators triple in price whenever they’re needed.”
Critics fear that if the final guidelines don’t clearly state a need for N95 masks, hospitals won’t adequately stockpile them, paving the way for shortages in a future health emergency. And if the document isn’t revised to emphasize ventilation and air filtration, health facilities won’t invest in upgrades.
“If the CDC doesn’t prioritize the safety of health providers, health systems will err on the side of doing less, especially in an economic downturn,” Stokes said. “The people in charge of these decisions should be the ones forced to take those risks.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
MONDAY, March 18, 2024 (HealthDay News) -- Breathing and relaxation techniques may offer relief to some patients battling Long COVID.
In a new, small study of 20 patients, biofeedback therapy relieved both the physical and psychological symptoms of Long COVID, researchers said. Many participants had been dealing with symptoms for more than a year.
"Our biggest hope is that we've identified a way to alleviate chronic physical symptoms that are not successfully treated by standard biomedical approaches, and that we did so with a short-term, non-pharmacological model that is easily scalable," said lead author Natacha Emerson, an assistant clinical professor of psychiatry and behavioral sciences at the University of California, Los Angeles (UCLA).
Biofeedback therapy pairs breathing and relaxation techniques with visual feedback to teach people how to regulate their body temperature, heart rate and other body processes.
After six weeks of treatment, patients in this study reported they were sleeping better and had significant improvements in physical, depression and anxiety symptoms.
Three months later, they were still seeing the benefit, using fewer prescription medicines and having fewer doctor visits, researchers said.
Worldwide, an estimated 65 million people have Long COVID — persistent symptoms that linger long past the actual infection. This constellation of symptoms include depression, anxiety, sleep issues, brain fog, dizziness and heart palpitations.
"It is important to underscore that while this behavioral intervention may help symptoms, patients with Long COVID are not in control of their symptoms and are not faking or exaggerating what they report to their doctors," Emerson said in a UCLA news release.
"Whether it is a racing heart, chronic cough or fatigue, these are real symptoms, just not rooted in a disease process," she added. "Instead, we think the autonomic nervous system is off balance and signaling fight-or-flight mechanisms, similarly to what we see in panic attacks."
Emerson did note that some patients were also receiving other treatments such as acupuncture or psychotherapy, which may have contributed to the observed improvements.
Her team hopes to see similar findings from a randomized, controlled trial. They want to compare biofeedback to other treatments such as psychotherapy or pulmonary rehabilitation.
“What is exciting is that we are restoring hope in people who feared they would be disabled long-term," Emerson said. "And if this tool works, it is one they can practice long term and might apply to future periods of stress.”
More information
The U.S. Centers for Disease Control and Prevention has more about Long COVID.
SOURCE: UCLA Health Sciences, news release, March 13, 2024
Breathing and relaxation techniques may offer relief to some patients battling Long COVID.
In a new, small study of 20 patients, biofeedback therapy relieved both the physical and psychological symptoms of Long COVID, researchers said. Many participants had been dealing with symptoms for more than a year.
"Our biggest hope is that we've identified a way to alleviate chronic physical symptoms that are not successfully treated by standard biomedical approaches, and that we did so with a short-term, non-pharmacological model that is easily scalable," said lead author Natacha Emerson, an assistant clinical professor of psychiatry and behavioral sciences at the University of California, Los Angeles (UCLA).
Biofeedback therapy pairs breathing and relaxation techniques with visual feedback to teach people how to regulate their body temperature, heart rate and other body processes.
After six weeks of treatment, patients in this study reported they were sleeping better and had significant improvements in physical, depression and anxiety symptoms.
Three months later, they were still seeing the benefit, using fewer prescription medicines and having fewer doctor visits, researchers said.
Worldwide, an estimated 65 million people have Long COVID — persistent symptoms that linger long past the actual infection. This constellation of symptoms include depression, anxiety, sleep issues, brain fog, dizziness and heart palpitations.
"It is important to underscore that while this behavioral intervention may help symptoms, patients with Long COVID are not in control of their symptoms and are not faking or exaggerating what they report to their doctors," Emerson said in a UCLA news release.
"Whether it is a racing heart, chronic cough or fatigue, these are real symptoms, just not rooted in a disease process," she added. "Instead, we think the autonomic nervous system is off balance and signaling fight-or-flight mechanisms, similarly to what we see in panic attacks."
Emerson did note that some patients were also receiving other treatments such as acupuncture or psychotherapy, which may have contributed to the observed improvements.
Her team hopes to see similar findings from a randomized, controlled trial. They want to compare biofeedback to other treatments such as psychotherapy or pulmonary rehabilitation.
“What is exciting is that we are restoring hope in people who feared they would be disabled long-term," Emerson said. "And if this tool works, it is one they can practice long term and might apply to future periods of stress.”
The global digital therapeutic devices market size was USD 5.56 Billion in 2022 and is likely to reach USD 29.97 Billion by 2031, expanding at a CAGR of 22.8% during 2023–2031.
Growth Market Reports, a leading Market research firm, introduces its latest research report on the Digital Therapeutic Devices Market, offering a detailed guide to understanding various factors crucial for growth progression. This report amalgamates detailed Market overviews based on segmentations, applications, trends, opportunities, mergers and acquisitions, drivers, and restraints. It showcases current and forthcoming technical and financial details of the Digital Therapeutic Devices Market.
The report delves into the impact of the ongoing global crisis, COVID-19, on the Digital Therapeutic Devices Market, providing insights into how the future is expected to unfold for the global market. Thorough research by Growth Market Reports analysts explores the effects of the pandemic on the global economy, addressing disruptions in production, demand and supply chains. The report computes the financial impact on firms and financial markets, providing clients with data and strategies to navigate Market challenges during and after the COVID-19 pandemic.
To analyze the Market with simplicity, it is fragmented into the following regions:
- North America
- Europe
- Asia Pacific
- Middle East & Africa
- Latin America
Segmenting the Market into smaller components helps in analyzing Market dynamics with more clarity. The report also includes a regional analysis to assess the global presence of the Digital Therapeutic Devices Market.
Table of Contents:
1. Executive Summary
2. Assumptions and Acronyms Used
3. Research Methodology
4. Digital Therapeutic Devices Market Overview
5. Digital Therapeutic Devices Market Analysis and Forecast by Segments
6. North America Digital Therapeutic Devices Market Analysis and Forecast
7. Latin America Digital Therapeutic Devices Market Analysis and Forecast
8. Europe Digital Therapeutic Devices Market Analysis and Forecast
9. Asia Pacific Digital Therapeutic Devices Market Size and Volume Forecast by Application
10. Middle East & Africa Digital Therapeutic Devices Market Analysis and Forecast
Growth Market Reports specializes in crafting customized Market research reports across various industry verticals. With a focus on complete client satisfaction, the team covers in-depth Market analysis, formulating lucrative business strategies, especially for new entrants and emerging players. Rigorous primary and secondary research, interviews, and consumer surveys ensure the highest standards in report quality.
The Business Research Company has updated its global market reports, featuring the latest data for 2024 and projections up to 2084
The Business Research Company offers in-depth market insights through Bronchodilators Global Market Report 2024, providing businesses with a competitive advantage by thoroughly analyzing the market structure, including estimates for numerous segments and sub-segments.
Market Size And Growth Forecast:
The bronchodilators market size has grown strongly in recent years. It will grow from $30.43 billion in 2023 to $32.93 billion in 2024 at a compound annual growth rate (CAGR) of 8.2%. The growth in the historic period can be attributed to growing geriatric population, rising incidence of asthma, growing funding by government organizations, increase in ageing population, and increasing air pollution across the globe.The bronchodilators market size is expected to see strong growth in the next few years. It will grow to $43.25 billion in 2028 at a compound annual growth rate (CAGR) of 7.0%. The growth in the forecast period can be attributed to increasing prevalence of COPD, rising awareness about lung diseases treatment aided with escalating research and development efforts, increase in prevalence of pulmonary disorders, the rise in disposable income, and increasing smoking rates. Major trends in the forecast period include advanced clinical research and innovative strategies, growing technological advancements, high prevalence of lung diseases such as COPD and asthma, new product launches, and rising number of patients with acute respiratory infections.
The bronchodilators market covered in this report is segmented -
1) By Type: Beta-Adrenergic Bronchodilators, Anticholinergic Bronchodilators, Xanthine Derivatives, Other Types
2) By Route of Administration: Oral, Nasal (Inhalation), Injectable
3) By Indication: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Allergic Reactions, Breathing Problem, Other Indications
4) By End-User: Hospitals, Specialty Clinics, Other End Users
Major Driver - Rising COPD Prevalence Fuels Growth In Bronchodilator Market
The increasing prevalence of chronic obstructive pulmonary disease (COPD) is expected to propel the growth of the bronchodilator market going forward. Chronic obstructive pulmonary disease is a progressive lung disease characterized by chronic inflammation of the airways and obstruction or limitation of airflow. Bronchodilators are used in chronic obstructive pulmonary disease (COPD) to relax the muscles around the airways, which helps to open the airways and make it easier to breathe. For instance, in March 2023, according to a report by the Scottish Public Health Observatory, led by Public Health Scotland, a UK-based Population Health Centre, COPD rates started to increase as the impact of COVID-19 eased. The rate in males increased from 83.2 to 97.6 cases per 100,000, and for females, the increase was from 72.6 to 97.3. Therefore, the increasing prevalence of chronic obstructive pulmonary disease (COPD) is driving the growth of the bronchodilator market.
Competitive Landscape:
Major companies operating in the bronchodilators market report are Pfizer Inc. , Johnson & Johnson Services Inc., F. Hoffmann-La Roche Ltd., Bayer AG, Novartis AG, Thermo Fisher Scientific, Abbott Laboratories , Sanofi S.A., GlaxoSmithKline plc, Siemens Healthcare GmbH, Merck & Co. Inc., AstraZeneca plc, Teva Pharmaceuticals Industries Ltd., Mylan N.V., Quest Diagnostics Incorporated., Boehringer Ingelheim International GmbH, Aurobindo Pharma Limited, Bio-Rad Laboratories Inc., Cipla Limited, Hikma Pharmaceutical plc, Amneal Pharmaceuticals LLC, Glenmark Pharmaceuticals Limited, Vectura Group Limited, Foundation Medicine Inc., Sun Pharmaceutical Industries Ltd., Amgen Inc., Kissei Pharmaceutical Co.Ltd., Mitsubishi Tanabe Pharma, Theron Pharmaceuticals, Viatris Inc.
Top Trend - Lupin Introduces DIFIZMA A Groundbreaking Fixed-Dose Triple Drug Combination
Major companies operating in the bronchodilator market are developing innovative products such as fixed-dose triple-drug combinations to better serve patients. A fixed-dose triple drug combination is a medication that contains three active ingredients in a single formulation, with each ingredient having a predetermined dose. For instance, in January 2023, Lupin, an India-based pharmaceutical firm, launched DIFIZMA, a fixed-dose triple-drug bronchodilator with a combination of indacaterol, glycopyrronium, and mometasone for managing asthma. DIFIZMA is offered as a dry powder inhalation. DIFIZMA is the only fixed-dose combination that has been approved by the Drug Controller General of India (DCGI) for the treatment of inadequately controlled asthma by improving lung function, providing better symptom control, and reducing exacerbations.
The Table Of Content For The Market Report Include:
The Business Research Company (www.thebusinessresearchcompany.com) is a market intelligence firm that pioneers in company, market, and consumer research. Located globally, TBRC's consultants specialize in various industries including manufacturing, healthcare, financial services, chemicals, and technology. The firm has offices located in the UK, the US, and India, along with a network of proficient researchers in 28 countries.
Winnebago County Health Department Director/Health Officer Doug Gieryn confirmed the news in an interview with the Northwestern while describing the current influenza activity as “pretty stable.”
“Influenza A and Influenza B are still present, but we would consider flu activity in the state to be moderate,” said Gieryn.
“RSV has dropped a bit, too, although it is still present, so our recommendation is always that people with respiratory illnesses contact a medical provider.
“We’re definitely still in flu season, but we’re continuing to see a decline,” he added.
The report does show high levels of influenza-like illness activity in the north and central regions of Wisconsin, but the entire Fox Valley area shows moderate levels.
And while influenza activity is increasing in school-age children, those numbers are falling with regards to COVID-19 and RSV.
“Specific to COVID, our wastewater monitoring in the Oshkosh area is showing more moderate levels and statewide we are continuing to trend downward on COVID hospitalizations,” Gieryn stated.
“In the 12 hospitals across the Fox Valley region, we currently have 11 patients hospitalized with COVID and that’s a reduction of three over the past week.
“I don’t want us to get complacent as there’s always time to vaccinate, but we’re continuing to see a decline, although we’re definitely still in respiratory illness season,” he added.
The news is extremely encouraging considering less than three months ago the same wastewater concentration data were categorized as "very high."
At that time, Gieryn was reporting more than a 10% increase in the number of hospitalized COVID patients across the state during a certain seven-day span in December.
The numbers were such that health officials were warning members of the community they could be facing a significant spike in COVID cases in Oshkosh.
ThedaCare recently updated its guidelines for visiting a patient in isolation, particularly those being treated for COVID-19.
The healthcare facility issued a news release saying there should only be two visitors at a time, and those visitors should go directly to the patient’s room and remain there during the visit.
Have a story tip or public interest concern?Contact Justin Marville at [email protected].
Germaine Gooden-Patterson has lived in Clairton, Pennsylvania, for more than 15 years, but it wasn’t until she began a job as a community health worker in 2019 that she understood how much air pollution was affecting her neighbors’ lives—and her own.
Gooden-Patterson’s work for the Pittsburgh-based nonprofit Women for a Healthy Environment required her to visit homes in Clairton and the nearby towns of Duquesne and McKeesport, conducting surveys and interviews about air quality. As she spoke with families about air filters, lead and mold exposure, she realized that the large number of people she knew with asthma and other respiratory conditions may not be coincidental.
Clairton is home to the Clairton Coke Works, which was named the most toxic air polluter in Allegheny County in a 2021 report by PennEnvironment, an advocacy group focused on climate change issues in Pennsylvania.
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The Coke Works is one of the world’s largest producers of coke, a coal derivative used to forge steel. Manufacturing coke leads to the emission of a raft of chemicals, including benzene, mercury, lead, toluene, styrene, sulfur dioxide and hydrogen sulfide, a colorless, flammable gas with a pungent, rotten odor.
Around the time she moved to Clairton and gave birth to her third child, she said, she started to experience heart palpitations. Before, she attributed this symptom to being an older mom. “But once I started to learn about the effects that air pollution has on the cardio system, I put two and two together,” said Gooden-Patterson, 60.
Gooden-Patterson had commuted out of town for her previous job, but now she was spending much more of her time in Clairton, and she began to notice symptoms that she hadn’t before. During the COVID-19 pandemic, about a year into the job, she was diagnosed with environmental allergies. She said that smells from the Coke Works sometimes wake her up in the middle of the night, and the odors come with throat irritation, inflammation in her eyes and a burning in her nose.
“I can feel it on bad days,” she said, even though she has installed air filters in her home. “And I know that it’s connected.”
While lower pollution levels in communities across the nation have largely been attributed to the successful enforcement of the Clean Air Act, passed in 1970, researchers have found that some of the most persistently harmful air in America is present in communities that are predominantly made up of people of color or those with low incomes.
In Clairton, which is about 15 miles south of Pittsburgh on the Monongahela River, 40 percent of the population is African American and 23 percent live below the poverty line. The Coke Works, PennEnvironment found, was “in violation of the Clean Air Act in every quarter of the three years ending in March 2023” and has been fined more than $10 million since 2018. While Allegheny County’s overall air quality has improved since the days of killer smog and afternoon skies blackened with soot, in places like Clairton, progress still feels a long way off.
After analyzing 40 years of data about changes in pollution in emissions, scientists at Columbia University found that “racial/ethnic and socioeconomic inequities in air pollution exposure persist across the US despite the nationwide downward trend in air pollution indicating inequities in air pollution emissions reductions.”
The findings, published in a peer-reviewed study in the journal Nature Communications, examined emissions data from 1970 to 2010 involving six major sources of air pollution, including the manufacturing industry, energy producers, farming and agriculture, and transportation. Commercial, and residential sources of pollution were also considered.
“We wanted to answer the question of whether decreases in emissions have been equitable across demographic groups,” said Yanelli Núñez, an environmental health scientist at Columbia University’s Mailman School of Public Health, who was the lead author of the study. “We found that the changes in emissions were influenced by a county’s socio-economic characteristics. We found racial, ethnic and economic disparities in the decreases of air pollution emissions.”
One of the researchers’ major findings, Núñez said, concerned the role of income as a factor in lower emissions. For example, she said, counties where the median income level increased from the national average of $49,000 to $100,000 saw a 100 percentage point decrease in the emissions of sulfur dioxide, which are given off when fuels containing sulfur are burned. The median household income in Clairton between 2018 and 2021 was $41,301.
“We found that the median household income plays a major role in the decrease of emissions for all pollution sectors, except agriculture,” said Núñez, who is also a scientist at PSE Healthy Energy, a nonprofit research institute. “The higher that income the larger the decrease in emissions.”
The study also noted differences in emissions as the racial and demographic make-up of various communities changed. An increase in the percentage of American Indian, Asian or Hispanic population in American communities typically resulted in an increase in the emission of NOx, or nitrogen oxides, which are commonly produced by vehicles and power plants.
“When I can really smell it, I know it’s really bad.”
“For instance,” the researchers wrote, “an increase in the Hispanic population percentage from the national average of 4.4% to 75% resulted in a 50 [percentage point] increase in the relative change of energy NOx emissions; and a decrease in county White percentage from the national average of 87% to 25% led to 12.5 [percentage point] increase in the relative emissions change.”
Núñez said that she and her colleagues hope their research illustrates the importance of ensuring that policies like the Clean Air Act are implemented evenly across racial and socio-economic lines.
She added: “The results show that policies, although they benefit everyone, don’t necessarily benefit everyone equitably.”
One of Gooden-Patterson’s neighbors, Art Thomas, doesn’t need to be reminded of the importance of equity. Thomas, 79, has lived in Clairton for his entire life, and worked for U.S. Steel for decades.
Thomas said that many Clairton residents have gotten used to the smells from the plant after years of breathing polluted air. “You see the commercial on TV where a woman walks into her son’s room and it stinks, and he can’t smell nothing,” he said. “I think a lot of people in Clairton are nose blind.”
“When I can really smell it, I know it’s really bad,” he said. “There’s a movie called “The Deer Hunter” that was made in Duquesne and Clairton. And in that movie, they call Clairton, ‘the armpit of the universe.’ And that’s how I feel.”
Six years ago, when a fire broke out at the Coke Works, shutting down the plant’s pollution controls for months and leading to spiking emissions of chemicals like sulfur dioxide, Thomas said he didn’t find out about it until three weeks later, when he happened to see a news report on television.
“You realize you’re having trouble breathing, sleeping,” he said in a recent phone interview. “Here I am, living in the middle of what might as well be called a war zone, and I can’t find out that my life is in danger, my wife’s life is in danger from breathing this stuff, until three weeks after breathing it. It’s ridiculous.”
U.S. Steel recently reached a $42 million settlement with Allegheny County, PennEnvironment and the Clean Air Council after a lawsuit was filed under the Clean Air Act following the 2018 fire. As part of the agreement, U.S. Steel must pay a $5 million penalty, which PennEnvironment called “by far the largest in a Clean Air Act citizen enforcement suit in Pennsylvania history” and one of the largest nationally as well. A 2021 study found that asthma symptoms were exacerbated for people living near the Coke Works in the weeks after the fire, and another study found that for Clairton residents, emergency and outpatient visits for asthma doubled after the fire.
In a previous statement to Inside Climate News about the Coke Works, U.S. Steel said that the company has “a compliance rate over 99 percent and attainment with all National Ambient Air Quality Standards.”
“More than 3,000 Mon Valley Works employees strive each day to ensure their role in the steelmaking process is done in the safest and most environmentally responsible manner,” a spokesperson said.
Thomas, whose wife has been diagnosed with sarcoidosis—a disease marked by enlarged lymph nodes and lumps of inflammatory cells throughout the body, most often in the lungs—sees a relationship between his wife’s illness and the Coke Works as well as elevated rates of cancer and respiratory diseases that he’s observed in his hometown.
“When I go to a class reunion, there will be more people there from out of town, out of state, than there are from Clairton,” he said. That’s in part because so many of his peers who stayed in town have died, he said. The estimated lifetime cancer risk for Clairton residents is 2.3 times the EPA’s acceptable limit, according to the investigative news site ProPublica, which attributes that excess risk primarily to industrial emissions from the Coke Works.
Many of the stores in downtown Clairton have gone out of business. Credit: Scott Goldsmith/Inside Climate News
“We’re in the top 1 percent for cancer in the United States. Our children have three times as much asthma as other people do in the United States. There’s a reason for it,” said Thomas, who is African American. “I think somebody needs to face up to the reason and get Clairton Coke Works and the rest of these industrial plants to live up to what they’re supposed to be doing.”
Public health studies on Clairton and the effects of exposure to pollution from coke manufacturing bear out Thomas’ experiences.
Advocates say the impact on children in Clairton is especially dire. “We know that children in particular are vulnerable and susceptible to the impacts of pollution in the air,” said Aimee VanCleave, director of advocacy for the American Lung Association in Pennsylvania. The ALA recently released a new report showing that the transition to electric vehicles and a renewable-powered electric grid would prevent 148,000 pediatric asthma attacks in Pennsylvania alone. “[Children] are at a greater risk anytime that air quality dips, just because they’re breathing in at a faster rate than adults are.”
And children are also experiencing greater harms from climate change, said Laura Kate Bender, a national vice president at the lung association who focuses on healthy air.
“Kids are not only more vulnerable to the impacts of air pollution from vehicles, but also to the impacts of climate change,” she said. “I think over the past year basically everyone we know has had a personal experience with the climate impact, whether it was wildfire smoke or an extreme storm or a heat wave. We know that’s especially harmful for kids.”
A study led by Deborah Gentile, the medical director of Community Partners in Asthma Care, based in Southwestern Pennsylvania, found that nearly 24 percent of children living near the Coke Works had been diagnosed with asthma. Another 12 to 15 percent likely had asthma but hadn’t been officially diagnosed, Gentile said. Those rates are significantly higher than the rates of children’s asthma for Pennsylvania and for the U.S. as a whole.
The study looked at stress levels and controlled for other factors like socioeconomic status and secondhand smoke. But that’s not what appeared to be behind the increased numbers. “What was driving it was their exposure to pollution, how close they live to the plant and whether they were in the wind direction of the plant,” Gentile said.
There is evidence that air pollution not only exacerbates asthma in people who are already afflicted with the condition; it can also cause asthma to develop in the first place.
“These particles are real small, and when you inhale, they go deep into your lungs,” Gentile said, causing inflammation and swelling and leading to permanent damage in some people. For children exposed to air pollution, this reaction, when it occurs, can have lifelong consequences. “In a child, their lungs are still developing. If they are exposed to something that causes inflammation, and they have scarring, that’s never going to be reversed,” Gentile said. “They are not going to achieve their full expected lung function.”
For families dealing with pediatric asthma, like Germaine Gooden-Patterson’s clients in Clairton, the ramifications can be compounding, Gentile said.
“The kids are missing school, the parents are missing work,” she said. “Parents run out of leave, and kids fall behind in school.” Asthma worsens at night, so children’s sleep also suffers. If their symptoms are not well-controlled, children with asthma often don’t participate in sports or get enough exercise, which puts them at risk for obesity and diabetes. When bad air days happen, children can’t play outside because exercising in an environment with poor air quality is especially dangerous for them, Gentile said.
“That’s a great move in the right direction,” Gentile said of the new soot standard. “We’re still not there. We really have to be stricter with enforcing regulation. We have to do a better job at alerting residents.” The 2018 fire is one dramatic example of this failure; Gentile said Thomas’ complaint about the lack of communication after that event is widespread.
Gooden-Patterson wants the plant to halt production on days when an inversion occurs, trapping pollution closer to the ground. Even when residents are warned about the air quality, they don’t always have the option to stay inside. “Some of us have to go outside. We have to work. Children have to go to school,” she said. Clairton Elementary School is less than a mile from the Coke Works.
A recent Harvard University study found that children who were exposed to air pollution during the first three years of life had an increased risk of developing asthma. The researchers believe that being exposed to PM 2.5 or NO2 during their early years may play a role, according to the study that was published on Feb. 28 in the peer-reviewed journal JAMA Network Open.
“For NO2 we found a 25 percent increase in asthma by age four and a 22 percent increase in asthma by age 11, and for PM 2.5, it was like 30 percent in asthma by age four and around 23 percent in asthma by age 11,” said Antonella Zanobetti, a principal research scientist at Harvard’s T.H. Chan School of Public Health. “These are high percentages. These were really surprising.”
Zanobetti said she and her fellow researchers found that Black children were at higher risk of developing asthma than white children. And they also examined neighborhood characteristics and found that children living in more densely populated areas with less resources were also at higher risk.
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“Clinicians need to look out for these children and try to understand and to help them and realize that if they live in certain areas of the city, they might have a risk,” she said.
“You cannot just say, ‘oh, look, you need to move out of the area,’” Zanobetti added. “But it is important that families understand that air pollution is not good for you. And there are other risk factors that are worsening the risk. And so just the warning of the risk may be a step towards risk reduction.”
Gentile agreed. “These communities are just devastated. They’re falling apart,” she said.“They can’t afford to move because their house isn’t worth anything anymore because of the proximity to the sources of pollution. They’re really just stuck there.”
The impact of air pollution is not confined by city limits, Gooden-Patterson said, even if residents could afford to move elsewhere. “It’s not just this community that has been affected,” she said, though Clairton and its neighbors have shouldered a disproportionate burden. “It’s affecting you, too.”
Despite gains in the region over the past forty years, in the American Lung Association’s 2023 State of the Air report, Allegheny County as a whole still received an F for 24-hour particle pollution and a C for ozone days.
“We all have a right to breathe clean air,” she said. “It’s our God-given right.”
Kiley Bense covers climate change and the environment with a focus on Pennsylvania, politics, energy, and public health. She has reported on the effects of the fracking boom in Pennsylvania, the expansion of the American plastics industry, and the intersection of climate change and culture. Her previous work has appeared in the New York Times, the Atlantic, Smithsonian Magazine, the Believer, and Sierra Magazine, and she holds master’s degrees in journalism and creative writing from Columbia University. She is based in Pennsylvania.
Victoria St. Martin covers health and environmental justice at Inside Climate News. During a 20-year career in journalism, she has worked in a half dozen newsrooms, including The Washington Post where she served as a breaking news and general assignment reporter. Besides The Post, St. Martin has also worked at The Star-Ledger of Newark, N.J., The Times-Picayune of New Orleans, The Trentonian, The South Bend Tribune and WNIT, the PBS-member station serving north central Indiana. In addition to her newsroom experience, St. Martin is also a journalism educator who spent four years as a distinguished visiting journalist with the Gallivan Program in Journalism, Ethics, and Democracy at the University of Notre Dame. She is a co-director of the Dow Jones News Fund summer internship training workshop at Temple University. St. Martin is a graduate of Rutgers University and holds a master’s degree from American University’s School of Communication. She was diagnosed with breast cancer in 2011 and has written extensively about the prevalence of breast cancer in young women. In her work, St. Martin is particularly interested in health care disparities affecting Black women.
A seven-year-old girl has been credited with saving her mother’s life when she suffered a severe asthma attack.
Katherine Holifield, 37, was driving home on August 12 after a day kayaking with friends when she began to struggle for breath.
She pulled over into a layby on the A449 in Monmouthshire and called 999 for help, but due to heavy wheezing was unable to speak and give the call handler her location.
As Ms Holifield, who suffers from brittle asthma, found her breathing worsening, her daughter Isla took over the call.
The seven-year-old calmly told the call handler to look out for a red car with a kayak on the roof.
The Welsh Ambulance Service call handler used the global addressing technology what3words to pinpoint Ms Holifield’s exact location and organise help.
A schoolgirl has been credited for saving her mum’s life by talking to 999 as her mum had an asthma attack at the wheel. In this extraordinary call, Isla Holifield calmly directs paramedics to a red car with a kayak as mum Katherine struggles to breathe ???? t.co/IKQ0namScmpic.twitter.com/3XofoTDVeO
Ms Holifield, of Cardiff said: “We’d spent the day kayaking in Monmouth with friends. I felt a bit tight-chested when we got off the water but just put it down to the fact we’d been doing quite a bit of strenuous activity.
“We’d started to make the journey home but I wasn’t getting any better, I was getting worse.
“Recognising it was an asthma attack, I pulled into a layby and got my nebuliser out to try and help.
“I’ve had brittle asthma since I was a month old and have managed it my entire life with inhalers and nebulisers, but this one was especially bad.
“In the end I couldn’t speak at all and Isla said, ‘Mummy, is this when I need to call 999?’”
Call handler Madison Vickery, who is based at the trust’s clinical contact centre in Carmarthenshire, said: “I could tell straight away that Katherine was really struggling to breathe.
Isla was very sweet and was holding her mum’s hand throughout
Paramedic Will Jones
“She was physically unable to describe their location, so I sent her a text message containing a link to the what3words website so we could try and find them.
“The three words – configure, audio, plodding – put them on the A449 just outside Llandenny in Monmouthshire, so we were then able to organise help.”
As Ms Holifield’s condition deteriorated, quick-thinking Isla took over the call.
Ms Holifield, a service co-ordinator at Cardiff-based Haven Home Care, added: “Isla was so calm and concise when she was giving information to the call handler.
“She was upset but she was just on a mission with it. She did all of this with our Jack Russell, Roly, in the car too.
“There are periods when my asthma is very good and periods where it goes completely off the rails.
“On average, I have an asthma attack every two to three months, and usually have to call for an ambulance around twice a year when they’re that severe.
“I had Covid-19 last April which just seems to have exacerbated the problem.”
Paramedics Harriett Thomas and Will Jones arrived to help Ms Holifield and took her to the Grange University Hospital in Cwmbran.
Mr Jones said: “It was clear when we got there that Katherine was in massive respiratory distress.
“For us, it was about trying to stabilise her breathing enough to get her in the back of the ambulance – all while traffic was hurtling past us in the next lane.
“Isla was very sweet and was holding her mum’s hand throughout.”
This week, Ms Holifield, Isla and Roly met call handler Ms Vickery in person to say thank you and were also reunited with the two paramedics.
Isla was presented with a certificate of commendation by trust chief executive Jason Killens.
The global economy seems to have come to a halt. Per International Monetary Fund (IMF) chief Kristalina Georgieva “we have entered a recession", which might be worse than 2009. However, on a brighter note, global economic growth can significantly rebound in 2021, provided the spread of the deadly virus is contained and companies can address the current liquidity and solvency issues.
COVID-19 has now affected199 countries. and impacted the United States deeply, infecting nearly 142,900 people and taking 2,489 lives. Globally, about 723,997 have been infected so far, with highest fatalities in Italy and Spain.
With no drug or vaccination yet, researchers are at present working overtime to find a cure and are making advancement in technology to diagnose infected patients and prevent the infection from spreading further. The need for personal protective equipment has pushed car makers and other various manufacturers to retooltheir factoriesto make respirator ventilators, which are the need of the hour for treatinginfected people, globally.
Ventilators in Demand
Coronavirus is a highly infectious respiratory disease that affects the lungs, resulting in breathing difficulty. Mechanical breathing devices offer gentle breathing assistance to patients whose lungs have been attacked by the virus
Per the World Health Organization (WHO), one in six coronavirus infected patients becomes seriously ill and can develop breathing difficulties. According to the Johns Hopkins Center for Health Security, at present America has 160,000 ventilators available but given the spike in cases, 740,000 could be needed.
Ventilator shortage is a concern and has put governments across the globe in distress. The crisis has brought many automakers onto the forefront who have teamed up with existing ventilator makers to help them ramp up production.
Many of them are exploring ways to retool their factories to make ventilators. For instance, on Mar 27, General Motors Company GM announced that it will be working with Ventec Life Systems to help increase production. General Motors will help ramp up production of Ventec to achieve a target of at least 10,000 units a month or more.
Additionally, Tesla, Inc. TSLA and SpaceX Chief Elon Musk has offered to start manufacturing ventilators for coronavirus patients, as both the companies’ plants are well suited to make ventilators. Tesla and SpaceX both had prior expertise in manufacturing ventilator and life support systems. Tesla's cars do have ventilators, while SpaceX had developed a life-support system for the company's Crew Dragon astronaut taxi. With President Donald Trump’s official confirmation to produce ventilators, the companies are looking forward to revamp and help in the time of crisis.
Mask Makers in Limelight
American mask manufacturing giants like 3M Company MMM and DuPont de Nemours, Inc. DD are failing to meet demand. DuPont that makes personal protective equipment (like masks and protective body suits) needed by first responders has increased production capacity three times. In fact, N95 respirators manufacturer 3M has increased production since the outbreak in Wuhan.
The American Hospital Association believes that hospitals treating coronavirus patients will need up to nine times the protective equipment compared to normal flu. Per Health and Human Services Secretary Alex Azar, the United States only has about 1% of the 3.5 billion masks it needs to combat a serious outbreak. With a steep rise in cases, the government had to import carrying 80 tons of gloves, masks, gowns and other medical supplies from Shanghai on Mar 29.
At the time of crisis, many factories are retooling to make mask instead of hoodies and other clothing. Designers and manufacturers have taken up manufacturing of surgical face masks and other protective gear. Notable among them is Dov Charney who believes his 150,000-square-foot American Apparel factory can produce nearly 300,000 masks and 50,000 gowns in a week.
3 Must-Buy Stocks
Given that demand for ventilators and personal protective equipment has increased amid the coronavirus outbreak, investing in the following three companies seems prudent.
Cardinal Health, Inc. CAH provides customized solutions for hospitals, healthcare systems, pharmacies, ambulatory surgery centers, clinical laboratories, and physician offices. The company is ramping up production of masks, gloves and face shields.
The company’s expected earnings growth rate for the current year is 1.1%. The Zacks Consensus Estimate for the company’s current-year earnings has been revised 5.5% upward over the past 60 days.Cardinal Health sports a Zacks Rank #1 (Strong Buy). You can see the complete list of today’s Zacks #1 Rank stocks here.
Next we have, ResMed Inc. RMD, which makes three models of ventilators. Its Astral model supports both invasive and non-invasive use. The company is plans to double or even triple production of hospital ventilators.
ResMed’s expected earnings growth rate for the current year is 16.5%. The Zacks Consensus Estimate for the company’s current-year earnings has been revised 0.5% upward over the past 60 days. ResMed carries a Zacks Rank #2 (Buy).
Last one on our list is Medtronic plc MDT. The company makes high-performance ventilators for critically ill patients in high-acuity settings. Medtronic has plans to operate factories round-the-clock to ramp production.
ThisZacks Rank #2 company’s expected earnings growth rate for the current year is 8.1%. The Zacks Consensus Estimate for the company’s current-year earnings has been revised 0.7% upward over the past 60 days.
(We are reissuing this article to correct a mistake. The original article, issued on March 30, 2020, should no longer be relied upon.)
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An Illinois mother is pushing for pregnant women to get a COVID-19 vaccination after she came close to death because of the virus and had to deliver her son seven weeks early.
Samantha Kelly recently met her newborn son, Holden, for the first time since contracting COVID-19 while pregnant — and being placed in a medically-induced coma after giving birth — according to a GoFundMe set up to benefit her family.
"She is extremely weak and will have a long road to recovery but we can finally see the light after being in this dark place," Kelly's mom, Amy, wrote in an update on the donation page on Sept. 19. "Next step for her to meet Holden we are blessed to have everyone of you in our lives. I believe in the power of kindness and prayer."
Two days later, a picture of Kelly holding her son was shared on the GoFundMe, which has raised more than $16,000 as of Wednesday afternoon.
In an interview with WLS-TV, Kelly — who has two other children ages 3 and 5 with her husband, Donnell — said she "was almost dead," adding that there were a "couple of scary times I heard I was close to not making it."
According to the outlet, Kelly was just over seven months pregnant when she and her family contracted the virus. Kelly soon experienced difficulty breathing and a fever, her husband recalled. She had planned to get her first of two vaccine shots later that week.
"A lot of decisions being thrown at you, you try as [a] mom [to] make the best one," she told WLS-TV. "I unfortunately made the wrong one, should've gotten the vaccine."
RELATED VIDEO: FDA Grants Full Approval to Pfizer's COVID Vaccine
The Centers for Disease Control and Prevention has recommended the COVID-19 vaccine for everyone age 12 and older, including women who are pregnant (or want to become pregnant).
Today, Kelly no longer needs to be intubated, but she cannot yet see her two other children.
"I cannot wait until I can see my kids again. I wish I would've gotten vaccinated, I really wish I would've," she told WLS-TV. "I hope every pregnant woman gets it. It's so much better than near death."
As of Wednesday afternoon, 55 percent of people in the United States have been fully vaccinated against COVID-19, and 64 percent have had at least one dose, according to the New York Times.
As information about the coronavirus pandemic rapidly changes, PEOPLE is committed to providing the most recent data in our coverage. Some of the information in this story may have changed after publication. For the latest on COVID-19, readers are encouraged to use online resources from the CDC, WHO and local public health departments.PEOPLE has partnered with GoFundMe to raise money for the COVID-19 Relief Fund, a GoFundMe.org fundraiser to support everything from frontline responders to families in need, as well as organizations helping communities. For more information or to donate, click here.
Long COVID may be no different to other post-viral syndromes, suggests latest research led by Queensland’s Chief Health Officer Dr John Gerrard.
People who tested positive for COVID-19 a year ago were no more likely to report moderate-to-severe functional limitations than people who had influenza, the research found.
Gerrard suggests it is time to stop using terms like “long COVID” as it wrongly implies there is something unique and exceptional about longer-term symptoms associated with the virus. “This terminology can cause unnecessary fear, and in some cases, hypervigilance to longer symptoms that can impede recovery,” Gerrard said.
The study by Queensland Health researchers suggests that in the highly vaccinated population of Queensland exposed to the Omicron variant[1], long COVID’s impact on the health system is likely to stem from the sheer number of people infected with SARS-CoV-2 within a short period of time, rather than the severity of long COVID symptoms or functional impairment.
Symptoms reported with the illness include fatigue, brain fog, cough, shortness of breath, change to smell and taste, dizziness and rapid or irregular heartbeat.
COVID-19 and influenza
The research, to be presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024) in Barcelona, Spain (27–30 April), adds to previous research by the same authors and published in BMJ Public Health which found no difference in ongoing symptoms and functional impairment when COVID-19 was compared with influenza,12 weeks post-infection[2].
To understand more about the impact of long COVID on the Australian state of Queensland, researchers surveyed 5112 symptomatic individuals aged 18 years and older, comprising those with PCR-confirmed infection for COVID-19 (2399 adults) and those who were PCR negative for COVID-19 (2713 adults: 995 influenza positive and 1718 PCR negative for both but symptomatic with a respiratory illness) between 29 May and 25 June 2022.
Laboratory reporting for COVID-19 and influenza is mandated upon PCR test request under Queensland’s public health legislation, with the results recorded in the state’s Department of Health’s Notifiable Conditions System. A year after their PCR test, in May and June 2023, participants were asked about ongoing symptoms and the degree of functional impairment using a questionnaire delivered by SMS link.
Overall, 16% (834/5112) of all respondents reported ongoing symptoms a year later and 3.6% (184) reported moderate-to-severe functional impairment in their activities of daily life.
After controlling for influential factors including age, sex and First Nation status, the analysis found no evidence that COVID-19-positive adults were more likely to have moderate-to-severe functional limitations a year after their diagnosis than symptomatic adults who were negative for COVID-19 (3.0% vs 4.1%).
Moreover, results were similar when compared with the 995 symptomatic adults who had influenza (3.0% vs 3.4%).
Physiological data
Jeremy Nicholson, Professor of Medicine and Director of the Australian National Phenome Center at Murdoch University, said the research reports a year follow-up on 5112 symptomatic adult COVID-19 patients (omicron sub-variant of the SARS CoV-2) and 995 post-influenza patients from Queensland Australia. “The study indicates that 3–4% of people have significant symptoms a year after either COVID-19 or influenza, hence the authors argue that they are effectively the same.”
“Unfortunately, this question cannot be simply answered in this work. The study is observational, based on reported symptoms with no physiological or detailed functional follow-up data. Without laboratory pathophysiological assessment of individual patients, it is impossible to say that this is indistinguishable from flu-related or any other post-viral syndrome,” Nicholson said.
“Also, there are many long-term effects of COVID-19 that do not have significant early-stage symptoms eg, heart disease, atherosclerosis and diabetes. These conditions do, however, have associated metabolic signatures which were not measured in the current study.
“The absence of evidence is different from evidence of absence, so the authors’ assertion that long COVID is the same as flu-related post viral syndrome is not proven, even if long COVID is indeed a post-viral syndrome (which it is),” Nicholson said.
Physician training programs
Marie-Claire Seeley from the Australian Dysautonomia and Arrhythmia Research Collaborative at the University of Adelaide and CEO of The Australian POTS Foundation said, “This abstract reveals a significant finding: approximately 4% of individuals, irrespective of the virus they contracted, may experience persistent health issues post-infection, resulting in chronic incapacitation. This implies that long COVID is not a standalone condition but rather part of a broader spectrum of post-viral syndromes.
“These findings align with previous Australian research published in the American Journal of Medicine in 2023. Adelaide researchers objectively demonstrated that 79% of long COVID patients met the criteria for postural orthostatic tachycardia syndrome (POTS), an autonomic nervous system disorder. Considering that POTS typically emerges following viral infection, this correlation is not unexpected. However, it’s concerning because POTS significantly impairs quality of life and functional capabilities, particularly affecting women during their childbearing years.
“Of further concern is the absence of specialised public autonomic physician training programs in Australia, unlike in the USA. This leaves us ill equipped to manage the increasing burden of post-COVID chronic autonomic disorders.”
Further research needed
Interestingly, the Queensland Health analysis also found that those who were more likely to report moderate-to-severe functional impairment were those aged 50 years or older, and those who had symptoms of dizziness, muscle pain, shortness of breath, post-exertional malaise and fatigue.
“These findings underscore the importance of comparing post-COVID-19 outcomes with those following other respiratory infections, and of further research into post-viral syndromes,” Gerrard said.
The authors caution that the findings are associations and do not represent prevalence. They point to several limitations, including that participants who were hospitalised or had pre-existing illness were not identifiable within the cohort. They also note that the risk of long COVID has been lower during the Omicron wave compared with other SARS-CoV-2 variants, and because 90% of people in Queensland were vaccinated when Omicron emerged, the lower severity of long COVID could be due to vaccination and/or the variant.
[1] More than 90% of the population of Queensland had been vaccinated against COVID-19 before the community first experienced transmission of the Omicron variant in 2022.
Paul Alexander, who was known as “the man in the iron lung,” has died at the age of 78 not long after contracting Covid-19.
Alexander had lived with the machine known as “the iron lung” since 1952 when he contracted polio at just six years old. Within days, the disease left him paralyzed from the neck down and unable to breathe independently. The iron lung is a metal, horizontal cylinder that stimulates breathing in patients who are unable to use their respiratory muscles.
When he first woke up in the hospital, a young boy unable to move or speak due to a tracheotomy, he was likely terrified. He stayed in the hospital for 18 months.
“I was just a kid like everybody else,” he said in a video from Gizmodo. “I began to feel a little bit ill. When Mom saw my face, she knew. She put me immediately to bed. Over the next five days, I lost everything – couldn’t move, couldn’t walk. And finally, the last day, I couldn’t breathe. My diaphragm was gone, destroyed. My body muscles were gone, destroyed. Which left me in the iron lung for the rest of my life.”
The iron lung has since been replaced by ventilators, but Alexander chose to keep his iron lung, saying he was used to it.
Though he was not expected to survive for very long, Alexander lived in his iron lung for 72 years.
He told Catholic Online, “The early part was very, very scary, but I’m an Alexander. My parents taught me to have a lot of pride and self-respect, and God taught me to believe I could do anything I dreamed of – and I did. So instead of letting Polio break me or kill me, I fought hard. The more it would knock me down, the angrier I would get. That anger, I’ve often said, is what kept me alive.”
In fact, Alexander graduated from high school, went off to college at age 25, and earned three degrees. He became a lawyer, running his own practice. He was even able to teach himself how to breathe, allowing him short amounts of time outside of the iron lung.
“It was years and years and years before I developed another way of breathing,” he told Catholic Online. “It’s a task that requires a lot of energy. But I was challenged to do it, I did it, and it took me a year to get up to three minutes.
“What I do is I use my throat to gulp. I gulp in breaths and swallow them into my lungs.”
Alexander overcame challenges with the support of friends and family. When the power would go out, there were people willing to hand pump a generator to keep him alive. And when his iron lung would break, he found Brady Richards, a mechanic who had an old iron lung in his garage, and used parts from it to fix Alexander’s iron lung.
Alexander even traveled the world with his iron lung and wrote his autobiography, “Three Minutes for a Dog,” by using a rod to type out words on a keyboard. He said, “I never thought of myself as a cripple. That’s the word I choose to use because I think it covers the ground in most people’s perceptions.”
“I’m crippled in most people’s minds, except mine. I’m Paul Alexander, human being.”
Alexander spent his final days with his brother Philip, sharing pints of ice cream. Though he was hospitalized with Covid-19 in February, Alexander had been released but had trouble eating and drinking.
“It was an honor to be with him in his last moments,” said Philip. He called his brother “an incredible role model.”
“He was just a normal brother to me,” he added. “We fought, we played, we loved, we partied, we went to concerts together — he was just a normal brother, I never thought about it.”
Here is Dr Andrew Miller’s weekly medical and news commentary during the WAMN News Sunday broadcast.
“Alright, thanks for your time, you can probably tell I’ve been to the doctor this week to have some skin biopsies done one up here and one of my nose as a result of too much sun burn.
“When I was a kid, reminder that not only do we need to protect ourselves in Australia’s harsh sun conditions, but that health problems can evolve over a very long period of time.
“Last week, a study came out of Queensland that was suggesting we should stop calling the long term symptoms from COVID, long COVID because it’s really, according to this survey that was done.
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“Not a lot different to what happens after things like influenza, and other respiratory viruses.
“This is of course, ignoring the fact that the long term damage of COVID is much greater in our population because far more people have suffered from it, and will continue to suffer from it.
“Unfortunately, neither the infection nor the vaccines that we have at the moment can prevent us from getting infected over and over again.
“So it’s still worthwhile doing what you can to avoid catching it so that we don’t get those cumulative health effects that people like Professor Jeremy Nicholson, from Murdoch University, say, are very important and much more likely to occur after this virus than it would with something like influenza or a simple cold.
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“So what do we need to do? Well, we need to keep encouraging our governments to take the problem seriously, and we need to continue to seek out clean air whenever we can.
“In Europe, they bring in indoor clean air regulations so that people have a right to breathe clean air when they’re in public spaces, and also in America and many other countries. They’re vaccinating children.
“I think that that’s something that we should really be pushing hard for in our country because now we’re no longer able to access the vaccine for our for our children.
“Whereas in other countries, they can get them from six months of age and up and given that they’re the ones who have the longest term to worry about.
“I think that’s a population that’s worth fighting for. Thanks for your time.”
Medical life-saving techniques include mechanical ventilation. During the COVID-19 epidemic, the lack of inexpensive, precise, and accessible mechanical ventilation equipment was the biggest challenge. The global need exploded, especially in developing nations. Global researchers and engineers are developing inexpensive, portable medical ventilators. A simpler mechanical ventilator system with a realistic lungs model is simulated in this work. A systematic ventilation study is done using the dynamic simulation of the model. Simulation findings of various medical disorders are compared to standard data. The maximum lung pressure (Pmax) was 15.78 cmH2O for healthy lungs, 17.72 for cardiogenic pulmonary edema, 16.05 for pneumonia, 19.74 for acute respiratory distress syndrome (ARDS), 17.1 for AECOPD, 19.64 for asthma, and 15.09 for acute intracranial illnesses and head traumas. All were below 30 cmH2O, the average maximum pressure. The computed maximum tidal volume (TDVmax) is 0.5849 l, substantially lower than that of the healthy lungs (0.700 l). The pneumonia measurement was 0.4256 l, substantially lower than the typical 0.798 l. TDVmax was 0.3333 l for ARDS, lower than the usual 0.497 l. The computed TDVmax for AECOPD was 0.6084 l, lower than the normal 0.700 l. Asthma had a TDVmax of 0.4729 l, lower than the typical 0.798 l. In individuals with acute cerebral diseases and head traumas, TDVmax is 0.3511 l, lower than the typical 0.700 l. The results show the viability of the model as it performs accurately to the presented medical condition parameters. Further clinical trials are needed to assess the safety and reliability of the simulation model.
Patients who are diagnosed with COVID-19 suffer from a major drop in blood oxygen saturation and face difficulty breathing. Mechanical ventilation is a crucial procedure for providing respiratory support to individuals facing inconveniences in breathing by assisting the breathing or controlling the respiration.1 In severe COVID-19 individuals, thromboembolic consequences, such as deep venous thrombosis, pulmonary embolism (PE), and acute mesenteric ischemia (AMI), have been observed. Lung illness can cause respiratory failure in many ways. Depending on immunity, COVID-19 might induce mild to severe breathing issues. The virus enters the human body through the nose, mouth, and eyes. COVID-19 causes bilateral pneumonia. Fluid in the lungs limits oxygen intake and causes shortness of breath, which can lead to acute respiratory distress syndrome (ARDS) and sepsis. Mechanical ventilation can help with breathing problems.2
Modern hospital ventilators are highly functional and technologically advanced, but in resource-limited health systems, they are very expensive.3 Severe Acute Respiratory Syndrome (SARS) caused by microcirculation thrombotic events promotes severe hypoxemia and multiple-organ dysfunction in patients with this disease.4 Mechanical ventilators are life support devices for patients in intensive care units (ICUs) who need assistance with ventilation diseases, trauma, congenital malformations, drug interactions, or surgical emergencies. However, the current need for respiratory mechanical ventilation due to COVID-19 outweighs the ability of health systems worldwide to obtain and deliver mechanical ventilators.5
Mechanical ventilation through modern mechanical ventilators is carried out in different modes. Modes of mechanical ventilation are widely discussed in Refs. 6 and 7. The present study is mainly focused on controlled modes, which can be divided into VCV (volume-controlled ventilation) and PCV (pressure-controlled ventilation). The most important advantage of minute-based ventilation is that it keeps the waveforms stable. VCV mode requires setting tidal volume, minute respiratory rate, inspiration-to-expiration (I/E) ratio, positive end-expiratory pressure (PEEP), and FiO2. PCV mode requires setting PiO2, minute respiratory rate, I/E ratio, PEEP, and FiO2. A VCV breath is a tidal volume delivered to the lungs. After a set tidal volume, the ventilator cycles. Flow rate determines inspiratory time. Lung pressures—peak inspiratory pressures (PIPs) and end-inspiratory alveolar pressures—depend on respiratory system resistance, compliance, and tidal volume. Controlling tidal volume and minute ventilation is the main benefit of VC, but in cases of impaired respiratory system compliance, it may cause dangerously high airway pressures and barotrauma. PCV uses airway pressure to expand the lungs for a set time. The clinician sets the inspiratory pressure, while dynamic lung compliance and airway resistance determine the delivered tidal volume and flow rate. After an inspiratory time, the ventilator stops delivering pressure. Controlling lung pressure prevents barotrauma. In intubated patients with high respiratory drive, PCV may improve ventilator synchrony because inspiratory flow is not fixed. PCV’s inability to guarantee or limit tidal volume due to acute lung compliance changes is a major drawback.8
In this uncertain situation, many researchers and engineers are actively participating to design a ventilator that can be produced by any suitable manufacturing facility. A plastic air tank, two wooden or plastic circles, a bendable wire, two check valves, a DC motor, and a guide cylinder were used in El Majid et al.’s9 design. The motor bends the wire and pulls the bottom circle up, squeezing the tank’s air. Through the check valve, the compressed air enters pipes. This is the inspiration stage of breathing. Since the patient’s lungs have a higher pressure than the air tank, the device will draw air from them. This is the expiration state. Low-cost embedded boards, such as Arduinos or ESP32s, will control the components. Although still in development, this concept offers a promising and affordable alternative to mechanical ventilation.
The RapidVent group and Northwell Health have figured out a way to transform a non-invasive BiPAP machine into an invasive ventilator for COVID patients.10 The researchers also invented a low-cost Brazilian emergency mechanical ventilator called 10D-EMV.11 The simulation model in this study was inspired by “Manshema,” a doctor-scientist-developed emergency ventilation machine. The model was based on MathWorks® “Medical Ventilator with Lung Model” and altered to classify the mechanical ventilator design, control method, and autonomously breathing patients. The Manshema Ventilator helps autonomously breathing patients maintain PEEP and blood oxygen saturation.12 A compact mechanical ventilator was created by automating bag-valve-mask (BVM) ventilation. Those projects used cam mechanisms, mechanical arms, and servo motors to move the BVM. Barotrauma from this cheap and easy design may damage the patient’s lungs. Robotic mechanisms squeeze and release the Ambu bag, but they cannot accurately control inspiration pressure.13,14
Researchers attempted cost savings in similar ways. Modifying the bag-valve-mask (BVM) with a ventilation rate alarm system and comparing it to conventional BVMs maximized minute ventilation volume delivery.15 In a simulation model, Culbreth and Gardenhire examined RT manual ventilation performance. Ninety-eight respiratory therapists were taught to ventilate a BVM manikin for 18 breaths. Therapists with more confidence provided higher peak pressures and flow rates. Thus, BVM ventilation may injure the patient’s lungs, emphasizing the need for an intervention to just provide safe and effective manual ventilation.16 Many emergency mechanical ventilator designs were also proposed based on mechanism, shape, cost, accessibility, novel sensors, and actuators.17–20 Complex ventilator designs were also manufactured by some researchers using 3-D printing technology.21,22
Guler et al. created a closed-loop intelligent mechanical ventilator using LabVIEW® to monitor and maintain respiratory variables to reduce clinician’s burden. The performance of device was tested with eight female Wistar albino rats using pressure-controlled ventilation.23,24 The present study standardized the mechanical ventilator design using these studies.23,24 To improve student learning, Guler and Ata created an instructional mechanical ventilator set. The training dataset controls inspiration and expiration valves and evaluates pressure sensors.25 Kato et al. studied trait–respiratory variable relationships. They examined silent breathing patterns.26
In volume control ventilation, preliminary ventilator configurations involve tidal volume, method of ventilation, plateau pressure, peak inspiratory pressure, and set inspiratory pressure. In pressure control ventilation, input parameters include set respiration rate, actual respirations, PEEP, and FiO2.27 Volume-targeted ventilation and pressure-targeted ventilation are used for patients on volume control and pressure-release volume control.
A recent article reviewed gas exchange monitoring during artificial ventilation.28 Avoiding volutrauma and barotrauma from uncorrected ventilation is crucial. Thus, flow meters are essential for accurately measuring patient gas exchange volumes. Accurate monitoring of flow rate and volume exchanges is also essential to minimize ventilator-induced lung injury (VILI). Mechanical ventilators use flowmeters to estimate patient gas delivery using the flow signal as input to adjust gas delivery. Flow meters must meet strict static or dynamic criteria because of their importance.29 Thus, mechanical ventilators use linear pneumotachographs, variable and fixed cost orifice meters, hot wire anemometers, and ultrasonic flow meters. Micromachined and fiber optic flow meter research is growing.30 Some studies have shown that flowmeters with high sensitivity, low pneumatic resistance, compact size, bi-directional features, and immunity from electromagnetic interference can give more accurate results and lead to concise choices.31
Mechanical ventilation requires many simultaneous operations and is delicate. Proper planning and monitoring of all operating parameters is essential. Mechanical ventilator mismanagement during initial ventilation can also harm patients. Tidal volume, ventilation rate, IE ratio, and PEEP are simultaneously adjusted to manage oxygenation. VILI occurs in 2.9% of artificially ventilated patients and usually causes pneumonia, lifelong lung bruising, and organ failure.32 To decrease VILI risk and ensure arterial oxygen supply and acid–base balance, these ventilator settings must be optimized.33 Mathematical simulation can help us understand organ and organism-level procedures and translate scattered knowledge into medically applicable effective treatments.
Mechanical ventilation in ARDS patients is risky. A poorly set mechanical breath can worsen ARDS-related lung injury, causing supplementary ventilator-induced lung injury. Mechanical ventilation reduces VILI and ARDS mortality.34 PEEP could be adapted to physiologic variables, usually oxygenation. Dead space, lung stress, lung compliance, and strain; ventilation trends using Computed Tomography (CT) or Electrical impedance tomography (EIT); inflection marks on the pressure/volume curve (P/V); and the expiratory flow curve slope utilizing airway pressure release ventilation (APRV) have, indeed, been tested to personalize PEEP.35 Personalizing PEEP helps ventilator settings match lungs’ pathophysiology. Novel PEEP personalization uses the expiratory flow trend during APRV.36 Expiratory duration adjusts with acute lung injury. Intrinsic PEEP stabilizes the lungs during short expiration.37
Guideline-based ventilator weaning reduces ventilator-associated pneumonia (VAP) and ICU length of stay. VAP is usually diagnosed by infection control specialists. Guideline-based weaning lessens mechanical ventilation and VAP risk. Complications drop significantly in wounded and general surgical patients, but ICU length depends on medical system resources. Because of the prolonged respiratory care, ICU discharge of the patient was often delayed. VAP and impromptu reintubation are reduced along with mechanical ventilation use. Injury and general surgery patients benefit the most from the implementation of this procedure.38,39 Mechanical ventilator simulation and mathematical modeling research by Refs. 40–42 was also perceived.
Using MATLAB®, SimscapeTM, and Simulink® tools, this study attempts to develop a physiological simulation model that describes the allocation of airflow and oxygenation in the lungs of healthy individuals and medically ill patients with ventilation issues. A simple clinical ventilator system with a real-world lungs model and patient–ventilator synchronization is simulated in this study. Mathematical modeling is used to present a system using just a mathematical concept. Computational software packages, such as MATLAB, Simscape, and LabVIEW, make it easy to study mathematical models and simulate them under varying conditions.
Biomedical engineering relies on modeling and simulation, especially respiratory system models, which save lives. This study successfully simulated a pressure-controlled ventilator. The simulations were carried out for different test cases, which include healthy human lungs (normal lungs model); hypoxemic respiratory failure, including cardiogenic pulmonary edema (CPE), pneumonia (without ARDS), and ARDS; hypercapnic respiratory failure for obstructive lung disease, including acute exacerbation of COPD (AECOPD) and asthma; and hypercapnic respiratory failure for acute intracranial disorders and head injuries with elevated intracranial pressure (ICP). The process for creating the mechanical ventilation model is covered in detail in Sec. II, Methodology. In Sec. III, results and discussion, the simulation parameter settings, model output for various test cases, and correlation with standard data are reviewed. A computational model of a medical ventilator and a patient's respiratory system is used in Sec. IV, or the conclusion, to demonstrate the importance of mathematical modeling in biomedical research.
In the present study, MathWorks MATLAB and Simulink Simscape are used to create the simulation model for the mechanical ventilator. The software aids in developing a system-design platform to predict the outcome of the project with a better visualization and accuracy without bringing the prototype into actual existence and helps in avoiding the risk of a patient’s life for experimental purposes. Simulink has a vast collection of tools on Simscape to create the simulation model in domains such as electrical, gas, hydraulics, and moist air. This model is created in the moist air domain. A reservoir block is used as a source of oxygen and air. A pulse generator block is used for performing the breathing cycles. To monitor the system, sensor blocks, such as volumetric flow rate sensors, pressure and temperature sensors, and ideal translational motion sensors, are used. The scope block is used to plot the data measured by sensors. Furthermore, to control pressure, volume, flow, etc., tools such as controlled pressure sources, controlled volumetric flow rate sources, and local restrictions are used.
Figure 2 shows the Simulink model of a mechanical ventilator in Pressure Controlled Ventilation (PCV) mode. It is based on the schematic diagram shown in Fig. 1. The model comprises a lungs model, which is a replication of the actual lungs of the patient. The model of the lungs is created in the mechanical domain to make the system more realistic. A translational mechanical converter, spring, damper, and force source model the lungs. The force source simulates muscle-induced pressure,43 and the spring and damper model the lungs’ mechanical compliance and resistance.44 Fresnel et al.43 described exponential functions for muscle contraction and relaxation pressure, Pmuscle,
where T1 is the muscle contraction time and Ttot is the breathing cycle length. Pmax is the maximum muscle-induced pressure, and τc and τr are the contraction and relaxation time constants.
While developing the MathWorks MATLAB and Simulink Simscape mechanical ventilation simulation model, several assumptions and limitations were taken into account. The first assumption was that all the sensors, actuators, and controllers are ideal components in MATLAB. However, in real, these components are not ideal and possess some degree of error or limitation. The second supposition is that the Simulink model might take steady-state circumstances for granted and ignore the transient effects that occur when the mechanical ventilation system starts and stops. This may have an effect on how well the ventilation system operates. In addition, the model may disregard the real-time variation of temperature, humidity, and density in the atmosphere by assuming that these parameters are constant. Whenever there is a relationship between the environment and the ventilation model components, this was mostly taken into consideration when constructing the model. The model may also imply that, unlike other electrical systems, it functions as an isolated system and does not interact with external disturbances.
The simulation model for the mechanical ventilation system will have certain limitations because it is based on assumptions. There may be differences between the system conditions that are modeled and the actual system conditions since the correctness of the model is dependent on the underlying mathematical equations and assumptions. In addition, the model will fall short in capturing the nonlinearities and delays that are inherent in the response of sensors and actuators. The performance and response time of the system may be impacted by this. Model simplification is frequently done to increase computational efficiency, but it can have an adverse effect on accuracy by leaving out important aspects of the physical phenomenon. In certain instances, it is possible that the model oversimplified control methods rather than accurately capturing the intricacies of actual control systems. It is possible that any parameter variability was omitted, which could have an impact on the model’s performance. Although all safety precautions were taken, such as fail-safe valves and real-time gas exit to the atmosphere or reservoir, the model may not fully account for all real-world scenarios that could arise during actual operation. Therefore, additional testing of the model in real-world scenarios is necessary to avoid these limitations and close any gaps.
For simulation purposes, the predicted body weight (PBW) and tidal volume of the patient are taken from the NHLBI ARDS Network (available at www.ardsnet.org/). The PBW is taken as 70 kg, and the corresponding tidal volumes are referred to for the validation of the model.
ARDS is a serious lung injury with several causes. It is commonly linked to sepsis and multi-organ failure, and it is associated with increased mortality. ARDS induces diffuse alveolar injury, pulmonary micro-vascular thrombus formation, inflammatory cell collation, and blood flow stagnation. Hypoxemia and increased respiratory work typify ARDS. PEEP, high FiO2, and lowered breathing work alter hypoxemia. Often, these ARDS issues require MV. MV has been detrimental for five decades. Ventilators were adjusted to stabilize blood gas values in the late 1960s. Healthcare professionals used a TDV of 12–15 ml/kg of body weight.60 In serious ARDS, 90% of deaths occurred from pneumothorax, pneumomediastinum, and pneumoperitoneum.61 Amato and colleagues62 and the ARDSNet (Acute Respiratory Distress Syndrome Network)63 trial conducted in the year 2000 indicated that low TDV ventilation [4–6 ml/kg Ideal Body Weight (IBW)] seemed to be better than higher TDV ventilation (10–12 ml/kg IBW). IBW anticipates lung capacity better than weight. Recent progress in the VILI investigation has rekindled interest in lung protective ventilation strategies (LPVS).64 Recent evidence indicates that reducing the tidal volume in patients without ARDS could be beneficial.65–68
Four main theories describe ventilator-induced lung injury: barotrauma, volutrauma, atelectrauma, and biotrauma.65 High airway pressure causes lung barotrauma (i.e., pneumothorax or pneumomediastinum). High-TV-induced volutrauma produces alveoli overdistribution. Atelectrauma is caused by shear and strain of retractable lung units opening and closing, and biotrauma is caused by proinflammatory cytokines and immune-mediated damage from unphysiologic stress or strain.64 LPVS focus on limiting tidal volume, end-inspiratory plateau pressure (Pplat), PEEP, and FiO2.68 MV patients without ARDS have no optimal TDV.68–70 Mammalian TDV is 6.3 ml/kg.71 ARDSNet63 and other trials65–67 imply that TDV exceeding 10 ml/kg IBW is injurious. In cardiac surgery patients, a TDV less than 10 ml/kg IBW reduced organ failure and ICU length of stay (LOS), according to Lellouche and colleagues.65 A reduced intra-operative TDV (6–8 ml/kg IBW) after abdominal surgery lowered postoperative ventilatory support, pneumonia, and hospital LOS in the IMPROVE66 study group. LPVS and low TDV require high RR to retain Vm. By taking the above data into account, the input parameters provided to the model are listed in Table VII. The output obtained from the model simulation is listed in Table VIII.
TABLE VII.
Input parameters for the model.
Ventilation strategies
.
Disease/condition
.
RR
.
P01
.
PEEP
.
IPAP
.
EPAP
.
Breaths/min
cmH2O
cmH2O
cmH2O
cmH2O
Hypoxemic respiratory failure
ARDS
27
4.5
12
15
8
Ventilation strategies
.
Disease/condition
.
RR
.
P01
.
PEEP
.
IPAP
.
EPAP
.
Breaths/min
cmH2O
cmH2O
cmH2O
cmH2O
Hypoxemic respiratory failure
ARDS
27
4.5
12
15
8
TABLE VIII.
Output parameters obtained from the model.
Ventilation strategies
.
Disease/condition
.
Pmax
.
Vmax
.
Fmax
.
TDVmax
.
cmH2O
l
l/min
l
Hypoxemic respiratory failure
ARDS
19.74
3.995
32.21
0.3333
Ventilation strategies
.
Disease/condition
.
Pmax
.
Vmax
.
Fmax
.
TDVmax
.
cmH2O
l
l/min
l
Hypoxemic respiratory failure
ARDS
19.74
3.995
32.21
0.3333
LPVS limit airway pressure to avoid barotrauma. Pplat estimates alveolar pressure throughout inspiration. Preventing airflow after inspiration achieves this. No Pplat is safe. Pplat must be under 30 cmH2O in ARDS. Hager and colleagues72 found that lower Pplat values improved ARDSNet outcomes. PEEP configuration and selection methods are debated.73,74 The validated and easy-to-use ARDSNet PEEP table75 is recommended for ED management.73 So, PEEP and FiO2 are provided to the model according to these data. An Fmax of 32.21 l/min is obtained during the simulation, which can be observed in Fig. 15. The pressure variation is shown in Fig. 16, where a Pmax of 19.74 cmH2O is obtained, which is less than the Pplat pressure limit for an ARDS patient. From Fig. 17, a TDVmax of 0.3333 l is obtained, which is a low tidal volume and specifically suitable for ARDS patients.
In Fig. 18, the variation of the overall flow rate, lung pressure, and lung volume during the total simulation time is presented. A gradual increase in pressure and variation of the built-up volume as per the flow rate can be predominantly observed in the figure.
FIG. 18.
Flow (l/min), pressure (cmH2O), and volume (l) vs simulation time (s).
FIG. 18.
Flow (l/min), pressure (cmH2O), and volume (l) vs simulation time (s).
COPD patients’ airway function and respiratory symptoms worsen suddenly during acute exacerbations (AECOPD). Such exacerbations could, indeed, range from self-limiting diseases to florid respiratory failure, mandating mechanical ventilation. The average COPD patient has two such episodes per year, which use a myriad of medical resources.76 Viral diseases and environmental factors can also cause AECOPD. AECOPD episodes can be sparked or complicated by other comorbid conditions, such as cardiovascular disease, other lung diseases (e.g., pulmonary emboli, aspiration, pneumothorax), or systemic processes. In most patients, antibiotics, corticosteroids, and bronchodilators are prescribed. Certain patients may benefit from oxygen, physical therapy, mucolytics, and airway clearance devices.77
Non-invasive positive pressure ventilation may delay endotracheal intubation in hypercapnic respiratory failure. Invasive mechanical ventilation should avoid ventilator-induced lung injury and reduce inherent positive end-expiratory pressure. For these instances, restrict breathing by limiting the ventilation and allow hypercapnia. Mild AECOPD is usually reversible, but serious breathing failure is linked to high mortality and long-term impairment.78 PCV or VCV can be used. Setting rate and inspiratory time makes PCV better than pressure support ventilation (PSV). PCV’s patient-demand-driven flow is an advantage. PCV reduces tidal volume with increased auto-PEEP. With VCV, tidal volume does not decrease with increased auto-PEEP, but there is a risk of increased plateau pressure and overdistention. By taking the above data into consideration, the input parameters for the model are derived and tabulated in Table IX. The resulting output from the model is listed in Table X.
TABLE IX.
Input parameters for the model.
Ventilation strategies
.
Disease/condition
.
RR
.
P01
.
PEEP
.
IPAP
.
EPAP
.
Breaths/min
cmH2O
cmH2O
cmH2O
cmH2O
Hypercapnic
Obstructive lung disease
12
4.1
6
14.3
6
respiratory failure
(acute exacerbation of COPD)
Ventilation strategies
.
Disease/condition
.
RR
.
P01
.
PEEP
.
IPAP
.
EPAP
.
Breaths/min
cmH2O
cmH2O
cmH2O
cmH2O
Hypercapnic
Obstructive lung disease
12
4.1
6
14.3
6
respiratory failure
(acute exacerbation of COPD)
TABLE X.
Output parameters obtained from the model.
Ventilation strategies
.
Disease/condition
.
Pmax
.
Vmax
.
Fmax
.
TDVmax
.
cmH2O
l
l/min
l
Hypercapnic respiratory
Obstructive lung disease
17.1
3.841
32.11
0.6084
failure
(acute exacerbation of COPD)
Ventilation strategies
.
Disease/condition
.
Pmax
.
Vmax
.
Fmax
.
TDVmax
.
cmH2O
l
l/min
l
Hypercapnic respiratory
Obstructive lung disease
17.1
3.841
32.11
0.6084
failure
(acute exacerbation of COPD)
From Fig. 19, it is observed that the flow rate particularly drops when the outlet valve opens and rises at the start of the inhalation process. From Fig. 20, a lung peak pressure, Pmax, of 17.1 cmH2O is observed, which is particularly safe as it is less than the safe limit of ≤30 cmH2O.79 A TDVmax value of 0.6084 l is obtained from the model as shown in Fig. 21. By making the PEEP higher, the tidal volume can be cut down even more.
The variation of the overall flow rate, lung pressure, and lung volume during the total simulation time is presented in Fig. 22. A gradual increase in pressure and variation of the built-up volume as per the flow rate can be predominantly observed in the figure.
FIG. 22.
Flow (l/min), pressure (cmH2O), and volume (l) vs simulation time (s).
FIG. 22.
Flow (l/min), pressure (cmH2O), and volume (l) vs simulation time (s).
A person is said to have hypercapnic respiratory failure if their PaCO2 is higher than 45 mmHg and their PaO2 is lower than 60 mmHg. With asthma, it can be hard to tell when regular treatment has not worked and extra help with breathing is needed. Many people with severe asthma are young and fit otherwise, and they can still breathe even though they have to work much harder to do so.80–82 These people can keep their PaCO2 below or equal to 40 mmHg until they have been completely worn out. When CO2 is kept inside the body, serious hypercapnia and acidosis can happen quickly. So, mechanical ventilation can be used when PaCO2 is higher than 40 mmHg, or sooner if the patient shows signs of being tired. At this point, the patient is growing tired, and waiting longer to start ventilation causes even less air to get into the lungs.82 Auto-positive end-expiratory pressure and air trapping happen in individuals with serious acute asthma (auto-PEEP). The air gets stuck because bronchospasm, inflammation, and secretions make the airways less flexible. The large changes in intrathoracic pressure during the breathing cycle are caused by the auto-PEEP and the increased resistive load. This is called pulsus paradoxus. Either VCV or PCV can be used, but at the start of respiratory support, VCV is often needed. Due to the high resistance in the airways, people with very acute asthma need a high driving pressure to get the tidal volume.83,84
Once the asthma severity improves, the patient can be transitioned to PCV per the clinician’s bias. With PCV, changes in the delivered tidal volume at a fixed pressure are a reflection of changes in resistance and air trapping. As the severity of the asthma improves, the delivery of TDV with PCV increases. To minimize the development of auto-PEEP, a small TDV (4–6 ml/kg) should be used. The tidal volume must be selected so that the pressure at the plateau is less than 30 cmH2O. The threshold of pulmonary congestion and auto-PEEP should be used to decide how fast a person should breathe. In theory, a lower rate makes air trapping less likely. However, in some asthma patients, the rate can be raised to 15–20 breaths per min without the need for a big change in auto-PEEP. CO2 stays in the body when the tidal volume is low and the rate is slow. Most of the time, it is enough to keep the pH at 7.20 or higher. Even a lower pH may be fine for young asthmatics who are otherwise healthy. Most of the time, the risk of auto-PEEP, lung damage, and low blood pressure is higher than the risk of acidosis.84 Whether or not PEEP should be used to treat asthma is a point of debate. In asthma, auto-PEEP is not usually caused by a lack of airflow as it is in COPD. If flow is not limited, adding PEEP may not be able to counterbalance auto-PEEP, but it may instead raise alveolar pressure.85 In addition, the advantage of PEEP in the case of auto-PEEP might be brought into question if the patient is getting full ventilation and is not trying to wake up the machine. When PEEP is used, lung units that do not make their own auto-PEEP may be recruited and stabilized, which could make the way air moves through the body better. Patients with acute asthma should not be given PEEP if it leads to a rise in plateau pressure and total PEEP.86 If PEEP is used in this situation, gas exchange, auto-PEEP, plateau pressure, and the way the heart works must be watched. Taking the above things into consideration, the input parameters for simulating the model are presented in Table XI. The output from the simulation model is shown in Table XII.
TABLE XI.
Input parameters for the model.
Ventilation strategies
.
Disease/condition
.
RR
.
P01
.
PEEP
.
IPAP
.
EPAP
.
Breaths/min
cmH2O
cmH2O
cmH2O
cmH2O
Hypercapnic respiratory
Obstructive lung
17
4.8
11
14.3
5
failure
disease (asthma)
Ventilation strategies
.
Disease/condition
.
RR
.
P01
.
PEEP
.
IPAP
.
EPAP
.
Breaths/min
cmH2O
cmH2O
cmH2O
cmH2O
Hypercapnic respiratory
Obstructive lung
17
4.8
11
14.3
5
failure
disease (asthma)
TABLE XII.
Output parameters obtained from the model.
Ventilation strategies
.
Disease/condition
.
Pmax
.
Vmax
.
Fmax
.
TDVmax
.
cmH2O
l
l/min
l
Hypercapnic respiratory
Obstructive lung disease
19.64
4.051
32.52
0.4729
failure
(asthma)
Ventilation strategies
.
Disease/condition
.
Pmax
.
Vmax
.
Fmax
.
TDVmax
.
cmH2O
l
l/min
l
Hypercapnic respiratory
Obstructive lung disease
19.64
4.051
32.52
0.4729
failure
(asthma)
The flow rate variation is shown in Fig. 23. From the figure, it is observed that the flow rate is low as per the respiratory rate of the patient and is suitable for the said respiratory condition, as discussed previously. From Fig. 24, a Pmax of 19.64 cmH2O is observed, which is sufficiently less than the recommended safe pressure for acute asthmatic patients. The plateau pressure is also within the safe ≤30 cmH2O limit.86 The PCV mode is utilized here to simulate the model. The tidal volume variation obtained from the model, as shown in Fig. 25, can be utilized by the clinician as one of the parameters for determining the severity of the patient. A TDVmax of 0.4729 l is obtained, which is suitable as per the input parameters provided to the patient.86
In Fig. 26, the variation of the overall flow rate, lung pressure, and lung volume during the total simulation time is presented. A gradual increase in pressure and variation of the built-up volume as per the flow rate can be predominantly observed in the figure.
FIG. 26.
Flow (l/min), pressure (cmH2O), and volume (l) vs simulation time (s).
FIG. 26.
Flow (l/min), pressure (cmH2O), and volume (l) vs simulation time (s).
Most of the time, central respiratory depression causes people with head injuries to need mechanical ventilation. ICP goes up when the amount of fluid in the brain goes up because the skull is rigid. Even though a slight increase in the intracranial volume does not cause ICP to rise, ICP goes up a lot when the intracranial volume goes up a lot. This rise in ICP cuts off blood flow to the brain, which leads to a lack of oxygen in the brain. When the ICP goes up a lot, the brain starts to swell and pushes through the tentorium. This puts pressure on the brain stem. Controlling ICP is a big part of how head injuries are treated. The difference between the mean arterial pressure (MAP) and the intracranial pressure (ICP) is called the cerebral perfusion pressure (CPP): CPP = MAP − ICP.
The normal CPP is greater than 80 mmHg because ICP is less than 10 mmHg and MAP is equal to 90 mmHg. The goal CPP is between 50 and 70 mmHg. CPP should not be less than 50 mm Hg. When someone has a head injury, the ICP is often measured. Either a drop in MAP or a rise in ICP will cause CPP to go down. Because of the higher intrathoracic pressure that comes with mechanical ventilation, ICP can go up and CPP can go down. PEEP could cause MAP and venous return to go down. When venous return goes down, ICP goes up, and when MAP goes down, CPP goes down. Acute head injuries need both blood flow management and breathing management. Caution shall be exercised to avoid a high MAP, which can hurt CPP by lowering venous return (which causes ICP to rise) and lowering cardiac output (resulting in a decrease in MAP). When a patient has an ICP that is too high, the goal of ventilation is to get their oxygen levels and acid–base balance back to normal. When the pressure in the lungs goes up, the veins do not get as much blood back and the heart does not pump as much blood out.87
Most of the time, such patients need to be ventilated because the primary injury has caused their central breathing to slow down. In these cases, the lung function could be close to normal, and it is easy to use mechanical ventilation. When a person has a traumatic injury, they might have injuries to their chest, abdomen, or spine, meaning that they require mechanical ventilation. Because of neurogenic pulmonary edema, it may also be necessary to use positive pressure ventilation. Finally, some treatments for a severe head injury, such as barbiturates, sedation, and paralysis, slow down the central respiratory system. This makes mechanical ventilation necessary.88,Table XIII shows recommendations for the first settings of the ventilator for patients with head injuries. Oxygenation is probably not necessary for people with head injuries since their lungs usually work pretty well. At first, 100% oxygen is given to these patients, but pulse oximetry makes it easy to reduce the amount of oxygen quickly. Most of the time, a PEEP level of 5 cmH2O is a good starting point. Even though there are worries about how PEEP affects ICP, it usually does not hurt ICP at levels less than or equal to 10 cmH2O. Oxygenation is treated the same way for neurogenic pulmonary edema as for other types of ARDS, but caution must be exercised to prevent the effects of a high MAP on ICP. When a patient needs high levels of PEEP, the head of the bed must be lifted to lessen the effects of the enhanced intrathoracic pressure, and ICP should be watched carefully.89,90
TABLE XIII.
Input parameters for the model.
Ventilation strategies
.
Disease/condition
.
RR
.
P01
.
PEEP
.
IPAP
.
EPAP
.
Breaths/min
cmH2O
cmH2O
cmH2O
cmH2O
Permissive
Acute intracranial disorders
18
4
5
12
5
hypercapnia
and head injuries
Ventilation strategies
.
Disease/condition
.
RR
.
P01
.
PEEP
.
IPAP
.
EPAP
.
Breaths/min
cmH2O
cmH2O
cmH2O
cmH2O
Permissive
Acute intracranial disorders
18
4
5
12
5
hypercapnia
and head injuries
The clinician’s personal preference determines whether volume-controlled ventilation or pressure-controlled ventilation is used. If the plateau pressure is kept below 30 cmH2O, a tidal volume of 6–8 ml/kg of ideal body weight can be used. Most of the time, this is not an issue since these patients have almost normal lung and chest wall compliance. If the patient has both short-term and long-term respiratory problems, the tidal volume is set lower. The right breathing rate must be selected to keep the acid–base balance in the body normal. Most of the time, this can be done by taking 15–25 breaths per min. The input parameters presented to the model based on the above data and the output from the model are listed in Tables XIII and XIV, respectively.
TABLE XIV.
Output parameters obtained from the model.
Ventilation strategies
.
Disease/condition
.
Pmax
.
Vmax
.
Fmax
.
TDVmax
.
cmH2O
l
l/min
l
Permissive
Acute intracranial disorders
15.09
3.533
32.12
0.3511
hypercapnia
and head injuries
Ventilation strategies
.
Disease/condition
.
Pmax
.
Vmax
.
Fmax
.
TDVmax
.
cmH2O
l
l/min
l
Permissive
Acute intracranial disorders
15.09
3.533
32.12
0.3511
hypercapnia
and head injuries
The flow rate during the inhalation and exhalation processes of the patient is shown in Fig. 27. From the figure, it is observed that the flow rate is accurately following the breathing pattern of the patient. As recommended from the previous studies, the plateau pressure should be maintained below 30 cmH2O. Here, from Fig. 28, a maximum lung pressure (Pmax) of 15.09 cmH2O is observed, and the plateau pressure is well within the limit.91
The maximum tidal volume (TDVmax) from Fig. 29 is observed to be 0.3511 l, which is considered a low tidal volume and generally recommended for elevated ICP patients. The tidal volume curve shows no significant deflection from the ideal TDV curve.
FIG. 29.
Tidal volume (l) vs time (s).
In Fig. 30, the variation of the overall flow rate, lung pressure, and lung volume during the total simulation time is shown. As visible from the figure, at the onset of breathing, the solenoid valve opens, and due to the high flow rate, a corresponding pressure drop and an increase in volume are observed.
FIG. 30.
Flow (l/min), pressure (cmH2O), and volume (l) vs simulation time (s).
FIG. 30.
Flow (l/min), pressure (cmH2O), and volume (l) vs simulation time (s).
In the present study, a simulation model is presented for the bulk of the individually built ventilators developed globally in response to the COVID‐19 issue. MATLAB/Simulink, a program for computational modeling, is used to develop a simulation model of mechanical ventilation systems. An examination of the operation of a mechanical ventilator can be conducted using the suggested simulation model. Through the Simulink interface, all model parameters can be monitored, and the data plots may be utilized to examine appropriate ventilation details. The model is used to test various medical conditions that require mechanical ventilation, such as hypoxemic respiratory failures, including cardiogenic pulmonary edema (CPE), pneumonia (without ARDS), and ARDS; hypercapnic respiratory failure due to obstructive lung diseases, including acute exacerbation of COPD (AECOPD) and asthma; and hypercapnic respiratory failure for acute intracranial disorders and head injuries with elevated intracranial pressure (ICP), and the simulation results showed a high degree of agreement with the commonly accessible data. Pmax was calculated to be 15.78 cmH2O for the healthy lungs case, which is much lower than the standard maximum value of 30 cmH2O. TDVmax was calculated to be 0.5849 l, which is much lower than the typical value of 0.700 l. In the case of cardiogenic pulmonary edema (CPE), a maximum pressure of 17.72 cmH2O is measured, which is lower than the typical maximum pressure of 30 cmH2O. The TDVmax of 0.5053 l is lower than the average TDVmax, which is 0.798 l. In the case of pneumonia, Pmax is calculated to be 16.05 cmH2O, which is significantly lower than the Pmax that is typical, which is 30 cmH2O. TDVmax was calculated to be 0.4256 l, which is much lower than the usual value of 0.798 l. The Pmax for the case of ARDS was determined to be 19.74 cmH2O, which is lower than the usual Pmax of 30 cmH2O. The value of 0.3333 l that was achieved for TDVmax is lower than the value of 0.497 l that is typically used for TDVmax. In the case of AECOPD, the maximum pressure measured was 17.1 cmH2O, which is lower than the typical maximum pressure of 30 cmH2O. In addition, the TDVmax that was calculated came out to be 0.6084 l, which is lower than the usual TDVmax value of 0.700 l. In the case of asthma, the maximum pressure measured was 19.64 cmH2O, which is lower than the typical maximum pressure of 30 cmH2O. In addition, the TDVmax that was calculated came out to be 0.4729 l, which is lower than the usual value of 0.798 l. The Pmax that was measured in patients with acute intracranial disorders and head injuries was 15.09 cmH2O, which is lower than the Pmax that is typically measured, which is 30 cmH2O. In addition, the TDVmax is lower than the normal value of 0.700 l, coming in at 0.3511 l. This validates the accuracy of the simulation model. Through the use of a realistic lung model and human response comparison, the simulation model provides an opportunity to assess the level of quality between the developed devices and the digital twin model. By better visualizing and accurately forecasting the results, this simulation model can aid in the prototype building of the real mechanical ventilator.
Candy companies want to know: What will make Americans start chewing gum again?
Gum's bubble burst during the pandemic, when masks and social distancing made bad breath less of a worry and fewer people spent on impulse buys. The number of packages of gum sold dropped by nearly a third in the United States in 2020, according to Circana, a market research firm.
Consumer demand has picked up only slightly since then. Last year, U.S. chewing gum sales rose less than 1% to 1.2 billion units, which was still 32% fewer than in 2018. Although sales in dollars are back to pre-pandemic levels, that's mostly due to inflation; the average pack of gum cost $2.71 last year, $1.01 more than it did in 2018, Circana said.
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It's a similar story globally. Worldwide gum sales rose 5% last year to more than $16 billion, according to market researcher Euromonitor. That still was 10% below the 2018 sales figure.
Some manufacturers are responding to the bland demand by leaving the market altogether. In 2022, Mondelez International sold its U.S., Canadian and European gum business, including brands like Trident, Bubblicious, Dentyne and Chiclets, to Amsterdam-based Perfetti Van Melle.
Chicago-based Mondelez, which makes Oreos and Cadbury chocolates, said it wanted to shift resources to brands with higher growth opportunities.
Other American confectioners are cutting slow-selling brands. Ferrera Candy Co., which is headquartered in Forest Park, Illinois, quietly ended production of Fruit Stripe and Super Bubble gums in 2022 after more than 50 years.
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Chewing gum is fighting more than a virus, however, when its comes to regaining its flavor. Lynn Dornblaser, the director of innovation and insight at market research firm Mintel, said a growing number of consumers are trying to limit sugar in their diets and to eat foods with more natural ingredients. That limits the appeal of gum, since even sugar-free varieties often contain artificial sweeteners.
U.S. consumers, like those in Europe and Asia, also may be increasingly concerned about the stubborn litter from used gum, Dornblaser said. Singapore famously banned the sale, import and manufacturing of chewing gum in 1992, blaming the careless disposal of the substance on subways for gumming up service. More recently, the U.K. government persuaded gum manufacturers to pay for a street-cleaning program to help remove gum and gum stains.
Dan Sadler, a principal for client insights at Circana, has noticed generational differences in gum chewing.
Generation X, the cohort born between 1965 and 1980, tends to chew gum more than other age groups, he said. Millennials generally show less interest in gum and candy, while Generation Z consumers are more interested in novelty candies like sour gummies. Nielsen says U.S. unit sales of gummies rose 2.5% over the last year and 4% the year before.
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Mars Inc., which owns the 133-year-old Wrigley brand, thinks it may have an answer: repositioning gum as an instant stress reliever rather than an occasional breath freshener. In January, the company launched a global ad campaign promoting its top-selling Orbit, Extra, Freedent and Yida brands as tools for mental well-being.
Alyona Fedorchenko, vice president for global gum and mints in Mars' snacking division, said the idea stuck in the summer of 2020, when the company was frantically researching ways to revive sales.
Fedorchenko remembered talking to a nurse in a hospital COVID-19 ward who chewed gum to calm herself even though she always wore a mask. The nurse's habit meshed with studies by Mars that showed half of chewers reached for gum to relieve stress or boost concentration.
"That, for us, was the big 'Aha!'" Fedorchenko said. "We've had a century of legacy of fresh breath, and that is still very important. Don't get me wrong. But there is so much more this category can be."
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Emphasizing wellness is part of a multi-year effort to attract 10 million new U.S. chewers by 2030, she said. Mars also is introducing new products like Respawn by 5 gum, which is aimed at gamers. The gum contains green tea and vitamin B, and the company promotes those ingredients as a way to help improve focus. Sold in three flavors, Respawn by 5 could lure customers from smaller brands like Rev Energy Gum, which contains caffeine.
Megan Schwichtenberg, a public relations account director from Minneapolis, buys into the idea of gum as a quick respite. She often chews a piece of fruit-flavored Mentos gum when she's driving or at the gym, and finds that chewing gum stops her from clenching her jaw during the workday.
"If I'm sitting at a desk all day managing a team, I can't get up and go punch a punching bag," Schwichtenberg said. "It's a way to contain some of that in the space you're in."
But not everyone finds gum enhances well-being. Kylie Faildo, a pelvic floor physical therapist in Denver, thinks artificial sweeteners and swallowing air while chewing made her bloating symptoms worse. She gave up gum two years ago and doesn't plan to go back, even though she misses the ease of popping a piece into her mouth before meeting a client.
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"I use mouthwash a lot more now," Faildo said.
Caron Proschan, the founder and CEO of the natural gum brand Simply, said she thinks U.S. gum sales slowed due to a shortage of innovation. Young customers have little disposable income and many distractions, she said, so gum needs to be compelling.
Simply – which makes gum from a type of tree sap called chicle instead of synthetic ingredients – has seen its sales double every year since 2021 without raising prices, Proschan said.
"Consumers today care about ingredients. They care about quality. The chewing gum category was not evolving to meet the needs of this consumer," she said.
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Sadler and Dornblaser say they still see growth ahead for gum, but it needs to adapt to customers' changing tastes and buying habits, including a shift from impulse sales to online shopping.
Some brands, like the U.K.'s Nuud Gum, are offering subscription plans, for example. Other gum makers are experimenting with pop-up ads that remind customers to add gum to their food delivery orders.
Paul Alexander, a Dallas man who’s lived in an iron lung since contracting polio at the age of six, has died at 78, according to a GoFundMe page set up by a friend. An official cause of death was not announced, but Alexander’s TikTok page noted in late February that he’d been hospitalized with Covid-19.
“Paul Alexander, ‘The Man in the Iron Lung’, passed away yesterday,” Alexander’s GoFundMe wrote on Tuesday. “After surviving polio as a child, he lived over 70 years inside of an iron lung. In this time Paul went to college, became a lawyer, and a published author. His story traveled wide and far, positively influencing people around the world. Paul was an incredible role model that will continue to be remembered.”
Gizmodo profiled Alexander in 2017, looking at the difficulties he faced spending so many decades in an iron lung while also exploring the myriad ways he was able to accomplish his goals, like graduating from law school at the University of Texas-Austin and writing his book Three Minutes For a Dog: My Life in an Iron Lung.
“Once you live in an iron lung forever, it seems like, it becomes such a part of your mentality. Like if somebody touches the iron lung—touches it—I can feel that. I can feel the vibration go through the iron lung,” Alexander told Gizmodo at the time.
A friend of Alexander set up a GoFundMe page in 2022 after he’d been “taken advantage of by people who were supposed to care for his best interests.” Alexander’s high health care costs, combined with the lost money, forced him to move into a one-bedroom apartment without a window, according to the GoFundMe. The crowdfunding page raised over $US140,000 while he was still alive, but has been shut down in the wake of his death. The remaining money will help pay for funeral costs, according to his brother.
“I’ve got to tell you that it probably changed my whole life,” Alexander said of the GoFundMe donations in a video from November 2022. “You guys are incredible because the things you said to me touched my heart tremendously. I want you to know I appreciate what you’ve done, but I love you even more.”
Alexander had a TikTok page with the handle @ironlungman where he would give updates on what was happening in his world to over 300,000 followers. Alexander would field questions from TikTok users on a range of topics, including how he became a lawyer.
There were scammers who apparently were tried to impersonate Alexander, according to a TikTok video he posted in early February, but through it all, he was an eternal optimist often talking about his faith in God and the wonderful people who helped him through online donations.
“I want to tell you that God has recognized the problems… we care, all of my life and even though I’ve had some times where I struggle to survive, even my life threatened, God has always been there and that is significant because without that I wouldn’t be here,” Alexander said in 2022.
“Now God’s blessed me with some very caring, very loving and very competent people. I’m most thankful for what he’s done and I’m gonna do my best to move on and move to my next challenge in life and see what I can do. But thank you for your comments. And thank you for being there.”
Paul Alexander as a Young Man
Paul Writing His Book
Scammers Try to Impersonate Paul Alexander
Paul Tells His Story
Paul Expresses His Gratitude for GoFundMe Donations
Worryingly, a new study has revealed that catching the Victorian disease might be easier than previously thought.
The bacterial infection was believed to spread in the air when ill people coughed, laughed, sneezed or sang. However, research, published in the journal The Lancet Infectious Diseases, found that four in five people who tested positive for the killer bug didn't suffer from a cough.
The researchers now think that even people who show no signs of the disease could spread the infection, which can travel to your brain, heart, abdomen, glands, bones and nervous system.
Even those who don't suffer from a cough can carry the infectious disease in their spit, which can be spewed into the air when someone talks or breathes, according to the study.
This means people could contract the infection just by breathing near someone who has tuberculosis but isn't showing any obvious signs.
Study author Professor Frank Cobelens of Global Health at Amsterdam University Medical Center said: “A persistent cough is often the entry point for a diagnosis. But if 80 percent of those with TB don't have one, then it means that a diagnosis will happen later, possibly after the infection has already been transmitted to many others, or not at all.”
The latest study looked at data of more than 600,000 people in 12 countries across Africa and Asia, including tuberculosis patients.
The findings revealed that 82.8 percent of those with the disease had no persistent cough and 62.5 percent had no cough at all. Furthermore, a quarter of those without a cough had high loads of the bacteria in their spit.
Professor Cobelens is now calling for consideration of new ways of diagnosing the disease so cases are not missed.
He said: “When we take all of these factors into account, it becomes clear that we need to really rethink large aspects of how we identify people with TB. It's clear that current practice, especially in the most resource-poor settings, will miss large numbers of patients with TB."
The new research comes as the cases of the Victorian disease are now on the rise. According to the UK Health Security Agency, the number of infections increased by over 10 percent last year.
Globally, 7.5 million people were diagnosed with the killer bug in 2022 - the highest number ever recorded.
Health chiefs are scrambling to "investigate the reasons" behind this sudden infection rise. The World Health Organisation (WHO) previously suggested this could be because many people were unable to get a diagnosis or receive treatment during Covid lockdowns.
Now, anyone suffering from a persistent cough and fever, especially those in groups at a higher risk of catching tuberculosis, is being urged not to dismiss their symptoms as a cold.
Key signs include a cough that lasts for more than three weeks, feeling exhausted, a high temperature, weight loss and loss of appetite.
People are at a higher risk of catching the disease if they are in close contact with an infected person, travel to countries with high rates of tuberculosis, are homeless, are addicted to drugs, have a weakened immune system or are in prison.
There's a vaccine that can protect you against the infection, but vaccination programmes have been scrapped in several countries over the last 20 years. The good news is that most cases of tuberculosis can be successfully treated with antibiotics.
Breathing+ by Breathing Labs has passed peer review in a randomized controlled clinical trial that was recently published in SCI Q2 journal Pediatric Pulmonology. Research done by @bezmialem Full text is available in a link here: https://www.breathinglabs.com/clinical-trials/research-breathing-labs-and-nintendo-clinical-trial-is-published-in-journal-pediatric-pulmonology-sci-q2-impact-factor-3/?fbclid=IwAR2wNhSgurdbrrf3gzOOkHthgiWfXJ1x8RWvnMhkSo6fi33QPZEGzxzd6jM
BREAKING: @breathinglabs and @Nintendo clinical trial is published in journal Pediatric Pulmonology (SCI Q2, Impact Factor > 3), full text: https://breathinglabs.com/Nintendo%20&%20Breathing%20Labs%202022 #telemedicine #telehealth #mhealth
Clinical mouthpieces 10pcs packages are now available at 45€/50USD (shipping cost not included). Learn more: https://www.breathinglabs.com/latest-news/announcement-breathing-mouthpieces-for-clinical-and-professional-use-are-now-available/
BREATHING VR: Lately we are sourcing this VR headset for use in Breathing VR application. It allows easiest installation of both breathing+ headset cable, and USB charging cables, which is essential in professional use: https://www.banggood.com/VR-SHINECON-G5-VR-Glasses-3D-Virtual-Reality-Glasses-VR-Headset-For-iPhone-XS-11Pro-Mi10-p-1679808.html?rmmds=myorder&cur_warehouse=CN
Update: Each purchase of Breathing+ will now include three machine washable mouthpieces. Previous buyers will be supplied with those by their country representatives but will have to cover shipping costs. Please be patient while we arrange distribution. https://www.breathinglabs.com/latest-news/announcement-breathing-mouthpieces-for-clinical-and-professional-use-are-now-available/
Update: We moved servers + relocated all our games to our servers, please be patient while google reviews all that (showing unsafe website atm). Use duckduckgo or non-chromium browsers to reach our pages in the meantime. Everything ok + new product addons coming out in a month!
Registration and all functionalities at http://breathinglabs.com (and in our iOS and Android games) are fixed and fully working. If you find any issues -> [email protected]
We are back in stock with Breathing+, currently searching for VR supplier, and setting up mass production for toys and tens stimulation + in November we will be signing up new erasmus traineeships, research projects, bilateral, FP(eu), and asia-pacific ->[email protected]
BREAKING: Nintendo Co. Ltd (Japan) is implementing Breathing Games by @breathinglabs in FDA approved clinical trial for children with bronchiectasis: https://clinicaltrials.gov/ct2/show/NCT04038892
Notice to b2b partners: we are running late with some minor upgrade-> briefly running out of stock -> retail and b2b sale is closed until early october. To get a list of partners with stock to sell contact us at [email protected] Thanks, we'll go strong again in winter 💪