West Chester University

Introduction: NIV is beneficial for many forms of ventilatory failure. NIV benefits may be realized in austere environments and during transport by use of a PV with NIV capabilities. We evaluated the ASI of 4 PVs set to provide NIV with varying Leak (Lk), Pressure Support (PS), and physiologic conditions. Methods: Four PVs (Sparrow Robust, Inovytec; 731 EMV+, Zoll; T1, Hamilton; V60, Philips) were set to deliver NIV to an ASL5000 simulator (Ingmar) at 192 conditions based on physiology (normal (C=60, R=5) and COPD (C=70, Ri=20, Re=35), inspiratory effort (Insp) (Low=-3, Norm=-7, High=-15), Lk, and PS (5 and 10) at a rate of 15, Ti 1.0, and PEEP of 5. Each PV used default settings for trigger, rise time, and exp cycle. Lk conditions were characterized by Lk flow at P of 5 and 15 cmH2O: Lk0=no additional Lk, Lk1=constant Lk (14.4, 27.9), L3=Lk during inspiration only >7.5 via water column (< 1,17.0), and L2=both L1+L3 (14.6, e14.6/i46.11). Each PV used a recommended circuit, and data/waveforms were collected for 2 min after 30 sec stabilization. ASI was determined by analysis of waveforms of 25 breaths at each condition by 2 raters. Five AS types were defined: Missed Trigger (MT) = no breath delivery during Ti, Delayed Trigger (DT) = breath initiated > 300ms following start of effort (SOE), Auto Trigger (AT)= any breath initiated prior to SOE + breaths initiated during Ti without visible evidence of trigger, Premature Cycle (PC) and Delayed Cycle (DC) = vent cycle off > 300ms prior to or following end of Insp effort, respectively. ASI for each PV was compared for all conditions and specific to conditions related to physiology, Insp effort, Lk setting, and PSV level. Results: Conditions with 0% ASI for each PV were: V60 68 (35%), T1 64 (33%), 731 44 (23%), Sparrow 20 (10%). The ASI for all 192 conditions [ASI (COPD ASI, NORM ASI)] for each PV was: T1 37% (64%, 11%); V60 39% (65%, 13%); 731 68% (79%, 58%); Sparrow 69%, (88%, 49%). The most common ASI type for each PV was: V60 DT (24%), T1 DT (24%), 731 AT (34%), Sparrow MT (44%). COPD, low effort, and Lk2 conditions had the highest ASI; PS had minimal effect on ASI. Conclusions: NIV performance varies greatly among PVs. T1 and V60 had the lowest ASI. The 731 and Sparrow had high ASI, and their NIV use should be limited with COPD, low Insp effort, and high Lk.

ABSTRACT During lunge feeding, rorquals depress their lower jaw to fill the buccal pouch, which can produce a downward pitch on the body from a drag force below the center of mass. It is hypothesized that without flippers the raised upper jaw could produce a counteracting lift to trim the body. Upper jaws of the blue whale and humpback whale have triangular shapes that resemble delta wings. Such wings generate lift without stalling at high angles of attack. To test whether the upper jaw is acting like a delta wing, planform shapes of jaws were tested with multiaxis force transducer in a flow tank at angles of attack. These 2‐dimensional models performed like delta wings without stalling. A CFD model of an inflated buccal pouch indicated that pouch drag could be modeled as a flat plate. Comparison of flume and CFD data, on the other hand, showed pouch lift as more dependent on its degree of streamlining. Three‐dimensional models of whale bodies with the lower jaw angled down at 90 o and the upper jaw angled at 0 o , 15 o , and 30 o were tested in a flow tank. Without the flippers, increasing the angle of the raised upper jaw acted as a delta wing that produces most of the lift needed to negate downward pitching due to the drag of the depressed lower jaw and inflated buccal pouch.

Background: Timely evaluation and treatment are essential to optimizing outcomes in ischemic and hemorrhagic stroke. National guidelines emphasize rapid provider response and multidisciplinary coordination. In complex settings such as inpatient units, delays in decision-making and care coordination can hinder time-sensitive interventions, including thrombolysis and thrombectomy. Purpose: As part of a broader institutional focus on continuous quality and process improvement (QI/PI) in stroke care, this project evaluated treatment time trends following integration of Advanced Practice Providers (APPs) into the acute stroke response workflow at a Comprehensive Stroke Center (CSC). The analysis focused on door-to-needle (DTN) and door-to-device (DTD) times for stroke alerts in inpatient units and the Emergency Department (ED). Methods: In Fiscal Year (FY) 2021, eight APPs were incorporated into the hospital-wide stroke response team. APPs were trained in acute stroke protocols and began responding in real time to stroke alerts across all hospital settings, assisting with rapid triage, examination, imaging review, and coordination with interventional teams. In FY24, three additional APPs joined the inpatient team, increasing coverage from 64% to 86%. Time metrics for ED and inpatient stroke activations were compared pre- and post-APP integration and monitored annually as the APP team expanded. Descriptive statistics were used to evaluate changes in treatment intervals. Results: Among inpatients, median DTN for thrombolysis decreased by 33 minutes and median DTD for thrombectomy by 37 minutes. For ED patients, median DTN decreased by 4 minutes and DTD by 34 minutes. Adherence to Get With The Guidelines (GWTG) target stroke measures also improved across all settings. The most significant improvements were seen in inpatient cases, where delays were historically greatest. Conclusions: As part of broader institutional efforts to enhance stroke care quality and efficiency, integration of APPs into the acute stroke response workflow was associated with improved key treatment time metrics. While not the sole intervention, APP integration did not extend and may contribute to reduced time to evaluation and treatment, particularly in complex inpatient settings. This experience provides valuable insights for health systems seeking to enhance multidisciplinary stroke care through scalable, team-based innovations.

ABSTRACTDuring closed mitosis inS. pombe, the nuclear envelope and mitotic spindle must work together mechanically and biochemically to ensure successful nuclear division. Previous work has demonstrated that mechanical force from the nuclear envelope, transmitted through spindle pole bodies, can re-shape the spindle. However, it remains unclear how force might alter spindle biochemistry. Here, we investigate how force reprograms the spindle with two approaches: chronically increasing nuclear envelope tension via the lipid synthesis inhibitor cerulenin, and acutely applying force through an optical trap. Both perturbations slow elongation dynamics and reduce microtubule number. Despite this reduction, key spindle proteins Ase1 and Klp5 increase their density at the spindle midzone, indicating inward force from the nuclear envelope can alter spindle biochemistry. We find that while motor proteins Klp5 and Klp6 only minimally affect the spindle’s response to increased nuclear envelope force, the combination of removing Ase1 and increasing nuclear envelope force together rescue spindle stability. Together, our findings reveal that nuclear force on the spindle does not merely alter its shape, but is key in regulating its biochemistry to maintain force balance.

Trauma therapists must make clinical judgments about what order to target memories for treatment. Study 1, of 146 self-identified trauma therapists, found a variety of reported strategies for deciding which trauma memory to treat first, including letting the client choose, treating the memory that caused the symptoms, or working in chronological order. Study 2a, of 159 therapists in eye movement desensitization and reprocessing (EMDR) or progressive counting workshops, examined the impact on the distress level of a later memory after treating an earlier related memory. Study 2b, of 114 therapists in EMDR or progressive counting workshops, examined the impact on the distress level of an earlier memory after treating a later related memory. In each condition, the distress of the untreated memory was reduced; the effect was greater when treating the earlier memory. In study 3, 3 therapy clients rated the distress level of each trauma memory at the beginning of each session, as the trauma memories were being resolved in chronological order. The distress level of many (but not all) later memories did go down following the resolution of earlier memories, and this effect persisted over time. These findings suggest that treating trauma memories can reduce the distress level of related memories, with a greater effect when treating earlier memories.