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Timing for Invasive Measurement to Detect Anemia During Surgery

Masimo  (NASDAQ: MASI) announced today the results of a study published in BMC Anesthesiology in which clinicians at Peking Union Medical College in Beijing evaluated the ability of noninvasive and continuous hemoglobin monitoring with Masimo SpHb ® to help clincians estimate when to conduct invasive hemoglobin measurement to detect possible anemia in patients undergoing spine or cytoreductive surgery. 1

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20190520005244/en/

Masimo Radical-7® with SpHb® (Photo: Business Wire)

Noting that because of the “invasive, time-consuming and intermittent” nature of invasive blood sampling, clincians often forgo these “objective indications” when making transfusion decisions during surgery, Dr. Tang and colleagues sought to determine whether noninvasive, continuous hemoglobin monitoring could aid clinicians in estimating when it might be appropriate to perform an invasive measurement. They enrolled 69 adult patients scheduled for spine surgery or cytoreductive surgery for whom estimated blood loss was more than 15% of total blood volume. The patients were randomly divided into an SpHb group (32 patients) and a standard care group (37 patients). In the SpHb group, diagnostic blood samples were drawn when a patient’s SpHb, measured using a Masimo Radical-7 ® Pulse CO-Oximeter ®, decreased by 1 g/dL. In the standard care group, they were drawn at the clinicians’ discretion. Blood gas analysis was performed using a Radiometer ABL800. The researchers determined the positive predictive value (PPV) of SpHb for the SpHb group and clinician perception in the standard care group in detecting a decrease in lab hemoglobin of more than 1 g/dL or lab hemoglobin of less than 10 g/dL.

The researchers found that the incidence of unnecessary hemoglobin measurement was lower in the SpHb group than the standard care group. For a decrease of greater than 1 g/dL in lab hemoglobin, SpHb had a PPV of 93.3%, compared to 54.5% for clinical perception (p = 0.002). For hemoglobin lower than 10 g/dL, SpHb had a PPV of 86.7%, compared to 50.0% for clinical perception (p = 0.015). In the SpHb group, lab hemoglobin was never less than 7 g/dL. In addition, using Bland-Altman analysis, the researchers calculated that, compared to lab hemoglobin, SpHb had bias and precision of -0.29 +/- 1.03 g/dL, with limits of agreement of -2.30 and 1.72 g/dL. No difference was observed in transfusion units or postoperative hemoglobin concentrations between the two groups.

The researchers concluded, “The SpHb trend tracked changes in hemoglobin satisfactorily during surgery and more accurately estimated the appropriate timing for invasive hemoglobin measurements than the clinicians.” They also noted that “This study was the first diagnostic randomized controlled trial to explore the triage role of Pulse CO-Oximetry in the intraoperative detection of anemia. We found that the trend in SpHb could detect a decrease in Hb in dynamic situations and indicate the appropriate timing for further Hb measurements.”

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New Study Evaluates Ability of Masimo SpHb

Masimo  (NASDAQ: MASI) announced today the results of a study published in BMC Anesthesiology in which clinicians at Peking Union Medical College in Beijing evaluated the ability of noninvasive and continuous hemoglobin monitoring with Masimo SpHb ® to help clincians estimate when to conduct invasive hemoglobin measurement to detect possible anemia in patients undergoing spine or cytoreductive surgery. 1

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20190520005244/en/

Masimo Radical-7® with SpHb® (Photo: Business Wire)

Noting that because of the “invasive, time-consuming and intermittent” nature of invasive blood sampling, clincians often forgo these “objective indications” when making transfusion decisions during surgery, Dr. Tang and colleagues sought to determine whether noninvasive, continuous hemoglobin monitoring could aid clinicians in estimating when it might be appropriate to perform an invasive measurement. They enrolled 69 adult patients scheduled for spine surgery or cytoreductive surgery for whom estimated blood loss was more than 15% of total blood volume. The patients were randomly divided into an SpHb group (32 patients) and a standard care group (37 patients). In the SpHb group, diagnostic blood samples were drawn when a patient’s SpHb, measured using a Masimo Radical-7 ® Pulse CO-Oximeter ®, decreased by 1 g/dL. In the standard care group, they were drawn at the clinicians’ discretion. Blood gas analysis was performed using a Radiometer ABL800. The researchers determined the positive predictive value (PPV) of SpHb for the SpHb group and clinician perception in the standard care group in detecting a decrease in lab hemoglobin of more than 1 g/dL or lab hemoglobin of less than 10 g/dL.

The researchers found that the incidence of unnecessary hemoglobin measurement was lower in the SpHb group than the standard care group. For a decrease of greater than 1 g/dL in lab hemoglobin, SpHb had a PPV of 93.3%, compared to 54.5% for clinical perception (p = 0.002). For hemoglobin lower than 10 g/dL, SpHb had a PPV of 86.7%, compared to 50.0% for clinical perception (p = 0.015). In the SpHb group, lab hemoglobin was never less than 7 g/dL. In addition, using Bland-Altman analysis, the researchers calculated that, compared to lab hemoglobin, SpHb had bias and precision of -0.29 +/- 1.03 g/dL, with limits of agreement of -2.30 and 1.72 g/dL. No difference was observed in transfusion units or postoperative hemoglobin concentrations between the two groups.

The researchers concluded, “The SpHb trend tracked changes in hemoglobin satisfactorily during surgery and more accurately estimated the appropriate timing for invasive hemoglobin measurements than the clinicians.” They also noted that “This study was the first diagnostic randomized controlled trial to explore the triage role of Pulse CO-Oximetry in the intraoperative detection of anemia. We found that the trend in SpHb could detect a decrease in Hb in dynamic situations and indicate the appropriate timing for further Hb measurements.”

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IDF medical innovation: Battlefield surgery of the future

Imagine this: You are a soldier behind enemy lines. A firefight has broken out between your squad and terrorists in the Gaza Strip, and your best friend is hit by gunfire. The paramedic whips out his VR glasses and, with the help of a doctor in Beersheba’s Soroka-University Medical Center, he saves his life.

While that scenario might seem fantastical, the reality is that it might not be so far away for the Israel Defense Forces.Established less than a year ago, the IDF’s Medical Innovation Branch has been working on several projects to improve the innovative spirit of the military’s Medical Corps.

“Where is the future of combat medicine going?” Lt.-Col. Ariel Furer, chief medical innovation officer at the IDF Medical Corps, explained to The Jerusalem Post at his base in the center of the country. “We need to be faster, more agile. We have to work much faster, plan faster and treat faster. And make the relevant changes much faster.”

The Medical Corps is one of the largest health organizations in the country and faces unique challenges, providing it with opportunities not available elsewhere.

The main purpose of Furer’s unit is not only to create new and innovative medical technology, but to promote a spirit among troops to collaborate with key players such as health organizations, government agencies and academic institutions both in Israel and abroad.

Israel is known as the Start-Up Nation, and “the military is just one segment of Israel’s innovative community,” Furer said. “We firmly believe that the digital era will enable us to get closer to our patients and bring forward innovative ideas and solutions to the most challenging environments.”

Furer said he believes his unit will “revolutionize healthcare in the country” with the best and brightest caregivers in the country, and he doesn’t want the answers but the challenges. “Medical innovations are very hot right now. There’s a lot of buzz surrounding them,” Furer said.

One such project is to use virtual reality glasses like Microsoft’s HoloLens. It allows for paramedics treating wounded soldiers on the battlefield to get guided treatment from a doctor in a hospital who does not have to deal with all of the sounds of battle in the background.

According to Furer, a trial with the HoloLens glasses showed that paramedics had more self-confidence while providing treatment. But with a cost per unit of $3,500, “the technology is challenging,” Furer admitted.

In July, IDF troops took an opportunity to try another innovative technique to drastically reduce the time that a wounded patient’s data gets to the doctors in hospitals.

“We had a problem that, from the time when we get to injured people and begin to treat them, to the time that their information gets to the relevant authorities down the chain of treatment, it takes time. And it takes time for them to physically arrive,” Furer explained.

His unit then came up with the idea of placing a bar code on the injured individual and develop a smartphone application where the paramedic in the field can place all of the patient’s relevant medical information.

“You take a picture of the bar code, open the application, fill in the fields, and the moment you press send, all of the information is shared with the entire chain of treatment in real time,” he said.

Furer explained to the Post that he had paramedics attach the bar code to wounded Syrians who came to Israel for medical treatment as part of the IDF’s Operation Good Neighbor, and saw that they were able to transfer all relevant medical information to doctors at Nahariya’s Galilee Medical Center .

“We had a paramedic try the system on injured Syrians, and the doctors in Nahariya were able to plan ahead to receive the patients, an hour and a half before they arrived.”

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Colorado teen wins top international science fair

The 16-year-old was awarded the top prize over the weekend at the Intel International Science and Engineering Fair, considered the “largest international pre-college science competition”. The prize includes the prestigious Gordon E. Moore Award and $75,000.

“This is such an incredible prestige and it happened to me and I haven’t fully comprehended everything yet,” Ramesh told FOX31.

Ramesh says he enjoys listening to music, solving Rubik’s cubes, competing with his school’s speech and debate team, experimenting with his flight simulator and playing Just Dance. He says the video game, which uses motion sensing technology, inspired his winning science project.

“My project started because I was trying to like five star Shakira’s ‘Hips Don’t Lie’ on Just Dance, so learning how the motion tracking system worked was ultimately how I predicted spine behavior,” he said.

Ramesh spent about nine months researching for his project. He learned how to interpret medical imaging, collaborated with medical professionals and developed algorithms for using augmented reality, machine learning and computer vision.

“Essentially what I did was try to eliminate fluoroscopy from surgery,” he said.

Fluoroscopy is a medical imaging procedure in which doctors can see x-rays in real time, like an x-ray movie. It allows surgeons to see where they need to place screws in the spine.

“Patients saw productive coughing, vomiting and acute vertebral disc degeneration” during fluoroscopy procedures, according to Ramesh.

“I thought if we could just get one preoperative MRI or CT scan, I can predict the spine biomechanics or how the spine actually behaves and then optimize the surgical approach and then guide the surgeon in real time,” he said.

In theory, Ramesh says surgeons would wear an augmented reality headset which produces a hologram with data from the previous scans, which would direct doctors where to place the pedical screws without the need for real-time x-rays.

According to Intel, Ramesh’s project “has the potential to decrease operating time by at least 30 minutes, reduce physical therapy recovery time by four weeks, and diminish the negative effects associated with traditional medical imaging.”

“Robotic surgery is really one of the next frontiers in medicine and biomedical engineering so I’m hoping all the research that I’ve done with this will definitely help further that,” Ramesh said.

According to Ramesh, 25 students from Colorado were invited to participate in the 2019 ISEF. Ramesh was one of three students representing Cherry Creek High School.

He also was awarded a regional first place award at ISEF in 2018 for a project that attempted to use mechanical learning to help the wings of  aircraft compensate for turbulence.

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Ranking every item on the Wegmans hot food bar from 1-40

Walking into Wegmans brings with it the scent of possibilities. The size and scope of the store’s hot foods and salad bars are unparalleled among its competitors and is a big reason the regional powerhouse has such a loyal following. The selections run the full gamut from traditional faire to Asian offerings, a salad bar, soups and more.

The number of Wegmans’ hot foods is more expansive than any other grocery store chain in the area and is generally done at a higher level. The tradeoff, of course, is that the price per pound skews higher — hot foods tip the scales at $9.49 per pounds — and costs can escalate quickly. Wise eaters weigh the opportunity cost of every item on their plates.

That’s where we are trying to help.

We sampled everything and ranked the items from least to most edible. Almost everything available was very good, but the rankings had to start and end somewhere. The whole idea was to come up with a listing that helps inform choices for the casual diner looking to sort through the 50-plus options.

So, which items are worth the weight?

The rankings below are limited to self-serve hot foods and did not include the salad bar, soups, pizza, subs, sushi or other cold items.

Here we go …

40. Steamed fish

The lemon flavor and fresh diced peppers and scallions helped mask the fact that the fish itself doesn’t bring much to the table. Hard pass.

39. Meatloaf

This dish doesn’t look like much in the pan, and doesn’t taste like much on your plate. Sometimes you really can judge a book by its cover.