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15,526,600 | has already went and investigated it lol.
Is my baby the only one who can't sleep through a marching band?!? | [
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15,526,601 | Seems like the janitor process is taking much longer then anticipated. Apart from removing redacted messages form the database (normally they are still stored for no good reason), we are removing traces of empty rooms (those are stored in the database too). We havent done it in a while so we are dealing with a lot of forgotten rooms. We hope janitor will finish its tasks soon so we can put the matrix back online and start purging public rooms history, while you guys can continue chatting. | [
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15,526,602 | To Cite: Lotfi N, Shokohi T, Nouranibaladezaei S Z, Nasrolahi Omran A, Kondori N. High Recovery Rate of Non-albicans Candida Species Isolated From Burn Patients With Candidemia in Iran, Jundishapur J Microbiol. 2015 ; 8(10):e22929. doi: 10.5812/jjm.22929.
Background: Blood stream infections (BSIs) are major causes of morbidity and mortality in burn patients. Microorganisms responsible for BSI are generally bacteria; however, Candida spp. are the infection agents in as many as 8% of all cases. Burn wound colonization and infections are generally the first steps to systemic infection. Candidemia in burn patients has been associated with high mortality and a prolonged hospital stay.
Objectives: Candidemia in burn patients has been defined as a preterminal event, leading to high morbidity and mortality rates among these patients. The aim of this study was to establish the incidence of candidemia in burn patients in Iran.
Patients and Methods: We consecutively collected 405 blood samples from 113 burn patients. The yeast isolates were identified to the species level using conventional procedures. In vitro antifungal susceptibility of the Candida isolates to amphotericin B, fluconazole, voriconazole and caspofungin was performed using the Etest.
Results: Twenty-seven samples (6.7%) of the blood cultures from 13 patients (12%) were positive for Candida species. Candidaparapsilosis (38%) and C. tropicalis (38%) were the most commonly found Candida species, followed by C. albicans (15%) and C. guilliermondii (15%) in the patients. The incidence of candidemia was significantly correlated with increased duration of hospitalization, increased time of stay in the intensive care unit, and higher mortality. The antifungal susceptibility tests demonstrated that amphotericin B and voriconazole had the lowest minimum inhibitory concentrations (MICs) against Candida spp.
Conclusions: Non-albicans Candida should be considered as significant pathogens in burned patients with candidemia.
Blood Stream Infections (BSI) are major causes of morbidity and mortality in burn patients (1). Microorganisms responsible | [
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15,526,603 | for BSI are generally bacteria; however, Candida spp. are the infection agents in as many as 8% of all cases (2). Burn wound colonization and infections are generally the first steps to systemic infection (1). Candidemia in burn patients has been associated with high mortality and a prolonged hospital stay (3, 4). Disruption of skin barrier in burn is a major risk factor for invading fungi. The necrotic tissue resulting burn injury is an excellent medium for colonizing and growing various microorganism including fungi. Administration of broad-spectrum antibiotics, glucocorticosteroid treatment, mechanical ventilation, parenteral nutrition, trachstomy tubing, burn-induced hyperglycemia, renal failure, persistent neutropenia, immune dysfunction, multiple sites of colonization, and hemodialysis and prolonged hospital stay are also thought to be predisposing factors for candidemia (5-7).
Candidaalbicans has been described as the most common cause of candidemia. However, the number of non-albicans species has increased during recent decades, and C. glabrata has emerged as the second most common cause, followed by C.parapsilosis, C. tropicalis and C. krusei (8). The latest study about candidemia in Iran unexpectedly revealed the higher rate of C. parapsilosis (34.4%), followed by C. glabrata (28.1%) and C. albicans (25%). The predisposing factor in these patients was surgery, cancer, hematological malignancy, diabetes, renal filature, premature birth and pancreatitis. Voriconazole was the most active drug and fluconazole was associated with high Minimum Inhibitory Concentration (MIC) results (9). Reduced susceptibility of non-albicans Candida species to antifungal agents has been reported (10, 11). It is known that C. glabrata exhibits intrinsically low susceptibility to azoles and develops resistance after exposure to these drugs (12). Inherent and emerging resistance to antifungal agents represents a major challenge for empirical therapeutic and prophylactic strategies (13).
Effective therapeutic management of patients with candidemia requires early identification of the infecting agent. Appropriate antifungal therapy guided by antifungal susceptibility testing improves the outcome for severely injured burn victims susceptible to fungal infection. In Iran | [
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15,526,604 | , there is a lack of extensive studies regarding candidemia in burn and the antifungal susceptibility patterns of the isolated Candida strains.
The aim of this study was to identify the Candida species involved in candidemia in burn patients, and determine the susceptibility patterns of the isolated Candida species to the antifungal agents including amphotericin B, fluconazole, voriconazole and caspofungin.
A cross-sectional study was conducted from June 2011 to March 2012 at the Burn Center of Zare Hospital in Sari, Iran. Post-burn reconstructive surgery and debridement were carried out for patients based on the depth of the injury. The study protocol was approved by the medical research ethics committee of the Mazandaran University of Medical Sciences (ethical no. 92-3-8 90-159) and a written informed consent was obtained from the patients. The patients who were not willing to participate were excluded from the study.
Demographic and clinical data included age, gender, percentage of the Total Body Surface Area affected by the burn (TBSA; Lund-Browder charts were used to estimate burn sizes), duration of the hospital and Intensive Care Unit (ICU) stay, the number of items prescribed as antibiotic treatment (for > 7 days), necessity for Total Parenteral Nutrition (TPN), and Central Venous Catheter (CVC), or mechanical ventilation, and outcomes of surgical procedures collected.
Samples from peripheral blood were obtained aseptically when the persistent fever refractory to broad-spectrum antibiotics was present for more than 96 hours or sepsis was clinically suspected.
The blood samples were inoculated onto biphasic fungal blood culture media containing Brain heart infusion (BHI) broth and BHI Agar (Kusha Faravar Giti, Karaj, Iran) and incubated for 10 days at 37°C. The blood culture bottles vented with a needle and incubated in a shaking incubator for the first day and the agar slants were washed with the broth mixture once each day for 5 days (14). All blood cultures including positive and negative ones were subcultured onto Sabouraud’s dextrose agar (Scharlau Chemie, Barcelona, Spain) medium with chloramphenicol and CHROM agar Candida (bioMérieux, Marcy l’Etoile | [
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] |
15,526,605 | , France).
More than two blood culture sets obtained over a 24-hour period were included for detecting low level candidemia and increasing the sensitivity. Episodes of candidemia were counted once, irrespective of the number of sets of blood cultures that were positive, with the same organism within 14 days for the same patient. If the same species was grown more than 14 days later it was regarded as a new episode. Candidemia was defined as at least 1 set of positive blood cultures for Candida species in patients with compatible clinical signs and symptoms of infection (15). The yeasts isolates were identified to the species level using conventional procedures; i.e. morphological examination on a cornmeal agar plate (CMA, BBL Sparks, Maryland, USA ), germ tube formation, and carbon-nitrogen assimilation test using the API 20C yeast identification system (bioMerieux, Marcy l’Etoile, France).
In vitro antifungal susceptibility of the Candida isolates to amphotericin B, fluconazole, voriconazole and caspofungin was performed using Etest (bioMerieux, Marcy l'Etoile, France) according to the manufacturer’s instructions. The Etest strips for amphotericin B, voriconazole, and caspofungin contained concentration gradients of 32 - 0.002 µg/mL of the respective drug. The fluconazole strips contained gradients of 256 - 0.016 µg/mL. The yeast inocula were adjusted by spectrophotometer to 1 × 106 to 5 × 106 which matched an optical density of 0.5 McFarland in saline. An agar medium containing RPMI-1640 (GIBCO/Life Technologies, Grand Island, NY) with 2% glucose was flooded with the cell suspension (16).
Clinical data were analysed using GraphPad Prism version 5.00 (GraphPad Software, San Diego) for the Mann-Whitney U test. P < 0.05 was considered statistically significant.
Clinical data characterizing the 13 patients with candidemia are summarized in Table 1. Statistical analysis of these data revealed that the incidence of candidemia was significantly correlated with an increased duration of hospitalization, a longer stay in the ICU and higher mortality (Table 2).
a All patients had TPN administration and | [
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] |
15,526,606 | CVC.
b Abbreviations: DOS, duration of stay; ICU, intensive care unit; TBSA, total body surface area; y, years; d, days.
a Abbreviations: CVC, central venous catheter; DOS, duration of stay; ICU, intensive care unit; TBSA, total body surface area; TPN, total parenteral nutrition; y, years; d, days.
During the study period a total of 405 blood samples were collected from 113 burn patients who had persistent fever refractory to broad-spectrum antibiotics for more than 96 hours or were clinically suspected to have sepsis. The median age of the patients was 34 years (range 1 - 88 years). Twenty-seven (6.7%) of the blood cultures from 13 (12%) patients were positive for yeasts. Identification of the isolated yeasts revealed that patients were infected with C. parapsilosis 38% (n = 5), C. tropicalis 38% (n = 5), C. albicans 15% (n = 2), and C. guilliermondii 15% (n = 2). One patient (patient 8) was infected with two Candida species (C. tropicalis and C. parapsilosis (Table 1). The mean duration of hospital and ICU stay in patients with candidemia were 41 and 37 days, respectively which were greater than those without candidemia (23 and 16 days respectively). In addition, higher mortality rate among patients with candidemia (69%) was observed (Table 2).
The isolated Candida species grew well on the RPMI agar plates, with detectable Etest endpoints. The MIC ranges and geometric means are summarized in Table 3. Amphotericin B and voriconazole exhibited the lowest MICs followed by fluconazole. Caspofungin appeared to have poor antifungal activity against all C. parapsilosis isolates and two isolates of C. guilliermondii (Table 3).
a Abbreviation: MIC, minimal inhibitory concentration.
Bloodstream infections are among the most common complications occurring in severe burn patients. In fact, most burn-related deaths in modern burn units occur because of septic shock and organ dysfunction rather than osmotic shock and hypovolemia (17). Candida albicans have been described as the fourth most | [
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15,526,607 | common pathogen isolated from blood in ICU patients (18, 19). The incidence of infections caused by Candida spp. other than C. albicans has increased markedly during recent years (9, 20-22). In this study, we found that non-albicans Candida was the most common yeast isolated from burn patients. The high incidence of non-albicans Candida in patients with candidemia has been reported before (9, 21). Ghahri et al. reported C. parapsilosis as the most common Candida species isolated from blood of patients with candidemia in Iran (9).
Miranda et al. have suggested that C. parapsilosis candidemia is more likely to be from an exogenous source than from the patients themselves and highly associated with medical device such as CVC, TPN, mechanical ventilation, and urine catheter (23). These aggressive procedures and prolonged broad-spectrum antibiotics increase the risk of candidemia in burn patients (23, 24). Candida parapsilosis has been reported as a frequent colonizer fungal species of the hands of hospital personnel and that may be a predisposing condition for nosocomial infections transmitted with the hands of hospital personnel (25). Education of hospital personnel for regular hand washing practice may prevent Candida colonization and nosocomial transmission of fungemia.
The incidence of candidemia in our study was 12% in burn patients, which was higher than those reported before (1- 5 %) (26); these differences might be due to the population size and duration of the study, or differences in the underlying disease. We found that the incidence of candidemia in burn patients was significantly associated with increased duration of hospitalization and time of stay in the ICU. This is in agreement with previous studies that have shown a high incidence of systemic Candida infections in ICU patients (27). In our study, the mortality rate among burn patients with candidemia was significantly higher than in other patients, which is in agreement with previous studies (6). Moore et al. have reported that mortality among burn patients with candidemia is almost four times higher than in those without candidemia (15).
The in vitro antifungal susceptibility testing revealed that amphotericin and voriconazole were the most active agents against isolated Candida species. This is in agreement with the results of a study by Aydin et al., who reported that isolates of C | [
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15,526,608 | . albicans, C. parapsilosis, C. tropicalis and C. guilliermondii were susceptible to amphotericin B, voriconazole and fluconazole (28). We found that caspofungin had poor antifungal activity against C. parapsilosis. The activity of caspofungin and other echinocandins (anidulafungin and micafungin) against C. parapsilosis was also found to be unsatisfactory in vivo in a study by Canton et al. (29).
In conclusion, C. parapsilosis is the most common Candida species isolated from blood of burned patients with candidemia in north part of Iran. Transmission through the hands of healthcare workers may play an important role in the spread of C. parapsilosis, contributing to the high isolation rate of this fungus. Identification and antifungal susceptibility testing of yeasts isolated from blood cultures is crucial, since the echinocandins are less active against C. parapsilosis.
We are grateful to the vice chancellor of research at the Mazandaran University of Medical Sciences for their financial support. We also would like to thank the technical assistance of Elham Mosayebi.
Authors’ Contributions: Tahereh Shokohi: designed and managed the research, analyzed and interpreted the data, wrote the main manuscript; Seyed Zahra Nouranibaladezaei: acquisition of clinical data; Nazanin Lotfi: acquisition of clinical data, performing all tests, and drafting of the manuscript; Nahid Kondori: analysis and interpretation of data and critical revision of the manuscript; Ayatollah Nasrolahi Omran: set up some tests and managed the research. All authors reviewed the manuscript.
Funding/Support: The present article is based on a research done in partial fulfillment of the requirements for the thesis by Nazanin Lotfi, and was financially supported by Mazandaran University of Medical Sciences (grant no. 90-159). | [
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15,526,609 | Alan Weedon is a publisher and photographer. His work has been published in VICE, i-D, and The Quietus, among others.
Currently he's a journalist in the ABC Asia Pacific newsroom, and the Creative Director of Swampland—a print publication devoted to longform Australian music journalism and photography.
Call me, beep me, if you wanna reach me, etc. | [
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15,526,610 | CEDAR RAPIDS, IA. – The Welty Way softball team may be the world’s second best, but it got a reception befitting the champions as the squad arrived here from the Philippines Tuesday evening.
Three city council members, some 250 fans and the El Kahir Shrine band welcomed the team as Manager Jim Caviness, 15 players and 10 wives stepped off the plane and onto a red carpet.
“We came back losers,” said a sad-faced Caviness as he shook hands with Roger Welty, president of Welty Way Products, Inc.
OKLAHOMA CITY – USA Softball, the National Governing Body of Softball in the United States, announced today 19 coaches who have been selected to the 2017-2020 USA Softball Men’s National Team Coaching Pool.
FINDLAY, Ohio – The International Softball Congress continues its outreach to university, college and high school baseball coaches across the United States with a second recruiting video to attract new players into men’s fastpitch softball.
The new video is now available on the ISC website at www.iscfastpitch.com as well as on the ISC Facebook page www.facebook.com/isc.fastpitch.
“By our unofficial count, there’s nearly 1,300 men’s fastpitch softball teams across North America, so there’s an opportunity out there for those that want to play,” says Fisher.
Tapping into the baseball past of several players on the highly-ranked New York Gremlins team, the video features several top players as well as USA Softball President Warren Jones, who speaks about the opportunities for younger players to be identified for the U.S.A. U19 junior men’s national team.
“We want to let these young kids know that there’s another game out there that they can play,” says Jones.
Among the Gremlins, Matt Palazzo talks about the quick pace of play, the ability for one hit to be a big difference in the game and the success he’s had in recruiting athletes in the Des Moines, Iowa area to take up the game.
Aimed at high school and college seniors, the video commentary notes that men’s fastpitch softball offers baseball players the opportunity to utilize all | [
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15,526,611 | of the skills they’ve developed over a lifetime of playing, and will give them the chance to create 20+ years of new memories.
International stars Zenon Winters and Bryan Abrey also talk about the opportunities and experiences they’ve enjoyed.
Abrey, who is a member of the defending World Champion Canadian men’s national team, played junior college baseball in California before transferring to an NAIA school in Idaho. Abrey talks about the speed of the game and the adjustments that baseball players will need to make.
Winters notes that he’s been playing fastpitch softball for 27 years, starting as a six-year-old in his native Australia, and has been able to travel the world because of the game and highlights the opportunity for American players to do the same thing.
“We think that if baseball players give fastpitch softball a chance, we’re confident that they’re going to fall in love with the game just like Matt Palazzo talks about,” said Larry Fisher, ISC Executive Director.
OKLAHOMA CITY – Christina Drumm of USA Softball of Southern California has been appointed as one of the newest members of the World Baseball Softball Confederation (WBSC) Regional Softball Umpire Coordinator Committee, the WBSC announced today.
The new composition of the nine-member, gender-balanced committee covers the five Olympic continents — Africa, Asia, America, Europe and Oceania.
Christina Drumm received her WBSC certification in 2003 and has umpired in six softball World Championships and the World Cup of Softball. She has also served as an Assistant UIC for WBSC Junior Women’s and Women’s Softball World Championships. Drumm was named to the USA Softball National Umpiring Staff in 2015. | [
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15,526,612 | Want to create a friendly URL for your Google+ page? Leverage a simple plugin and your Wordpress blog to easily make your Google Plus URL easier to remember!
In preparation for my blog Spring cleaning, I thought I’d put together a checklist of things that I want to do that would positively impact my SEO and I figured I’d share it in hopes that might help you out.
Driving user adoption is one of the key challenges for any Intranet portal, but one of the most effective ways to ensure that your users are getting the most of your Intranet functionality is to ask them how they want to use it, observe how they actually use it, and either add/modify functionality to meet their needs or train them to use the portal better.
In case you hadn’t noticed, Facebook pulled another…well…”Facebook” today by rolling out changes to their GUI without telling anyone. As usually, they rolled out a poorly tested piece of functionality that works as well as if…well…a 25 year old drunk grad student coded it. | [
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15,526,613 | Pitchfork: How long had you been doing the ad copy writing? That's quite different from lyric writing.
Alasdair: For about four years. I used to do books before that. I worked for a book publisher, and actually attempted to turn down Harry Potter. The first Harry Potter title came in, and we had an editorial meeting about it, and I said, "This is just absolute rubbish. There are so many better children's books that aren't being published." And I was overruled. So, they published the book, and all my bridges are burned. I was a bit harsh on it at first. I wanted them to do a biography on Arthur Lee, and everyone said, "Who's Arthur Lee?" So I was never happy in that job.
Pitchfork: Have you read the 33 1/3 Series' book on Forever Changes?
Alasdair: It's pretty interesting actually, but it's kind of a grad student view. They talk about the American tradition of prophecy, and how it leads into Arthur Lee's heroes, and kind of the disjointedness of the music, and they link it together with quotes from Henry Thoreau and Ralph Waldo Emerson and people like that, Walt Whitman. So it's pretty interesting.
You can read the whole interview here. And if you're interested in the book itself, I'm sure that Amazon can help you out. | [
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15,526,614 | A system for detecting physiological data from a patient and, more particularly, a system for detecting electrocardiograph (ECG) information from a patient and transmitting the information to a central monitoring station via telemetry.
The application is a continuation-in-part of and claims the benefit of the filing date pursuant to 35 U.S.C. § 120 of application Ser. No. 09/998,733, for a WIRELESS ECG SYSTEM, filed Nov. 30, 2001 (Attorney Docket No. 05123.00004), the disclosure and content of which is hereby incorporated by reference in its entirety. In addition, the application claims priority to provisional U.S. Application Serial No. 60/350,840, which was filed on Jan. 22, 2002, the disclosure and content of which is hereby incorporated by reference in its entirety.
FIG. 15 depicts an exemplary embodiment of the telemetry system.
For a better understanding of the present invention, reference may be had to the following detailed description taken in conjunction with the appended claims and accompanying drawings. Briefly, the present invention relates to a wireless, portable ECG system. Referring to FIG. 1, the ECG system 10 comprises a chest assembly 12, a body electronics unit 14, and a base station 16.
The chest assembly 12 is a one-piece flexible circuit that connects a plurality of electrode connectors 18. Referring to FIG. 3, the electrode connectors are individually labeled 18 a, 18 b, 18 c 18 d, and 18 e. The electrode connectors 18 have releasable connections that connect to electrodes or sensors 20. Preferably, the electrode connectors 18 have snap terminals that connect to electrodes 20 having snap terminals. Each electrode connector 18 connects to an electrically conductive element or trace for transmitting electrical signals. The electrically conductive elements or traces run along the chest assembly 12 and connect to a chest assembly connector 21.
Referring to FIG. 2, the chest assembly 12 has outer layers 22, 24 that are constructed of a lightweight and reasonably moisture resistant material, such as DuPont Sontara® or other suitable fabric. Adhesive layers 26, 28 secure insulating layers 30, 32 to the outer layers 22, 24 respectively. Insulating layers 30, 32 are constructed of Mylar® (polyester) film or other suitable insulating material. Adhesive layers 34, 36 secure the insulating layers 30, 32 | [
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15,526,615 | to a base layer 38. The base layer 38 is preferably constructed of Mylar film and has a first side 40 and a second side 42. The electrically conductive elements or traces that connect to the electrode connectors 18 are located on the first side 40 of the base layer 38. One such conductive element or trace is shown at 39. A shielding layer 44 for reducing any external inferences or radio frequency noise with the chest assembly 12 is located on the second side 42 of the base layer 38. The shielding layer 44 may be constructed of single or multiple layers of dielectric, or electrically or magnetically conductive material. The back of the electrode connector 18 may also be covered with Mylar to further insulate the chest assembly 12 and prevent an externally applied electric potential from entering the ECG system. The shielding layer preferably comprises an X-patterned grid.
Referring back to FIG. 1, the chest assembly 12 attaches to five electrodes 20 and provides a means for generally positioning the electrodes on the patient, thereby providing up to a “7 lead” analysis of the electrical activity of the heart. The electrode connectors 18 are preferably labeled and color-coded to ensure that the chest assembly 12 is properly positioned on the patient and connected to the appropriate electrodes or sensors 20. For instance, referring back to FIG. 3, the electrode connectors 18 a, 18 b, 18 c, 18 d, 18 e are labeled RL, LA, LL, RA, and V, respectively. The chest assembly 12 is constructed such that the RA electrode connector is connected to an electrode positioned on the right side of the patient's chest about level of the first and second intercostal space, the LA electrode connector is connected to an electrode positioned on the left side of the patient's chest about level of the first and second intercostal space, the RL and LL electrode connectors are connected to electrodes positioned on the left side of the patient's torso, and the V electrode connector is connected to an electrode positioned in the middle of the patient's chest about level of the fourth and fifth intercostal space. The chest assembly 12 is designed such that it is centered on the chest below the patient's clavicle.
Referring to FIG. 3, the chest assembly 12 is configured to provide flexible positioning of the chest assembly 12 on the patient. FIG. 3 is for illustrative purposes only, and thus, the chest assembly 12, as depicted in FIG. 3 | [
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] |
15,526,616 | , is not limited to any particular shape or configuration. The chest assembly 12 has a linear section or tail 46 extending from the chest assembly connector 21. Referring back to FIG. 1, the tail 46 has a securing means 46 a that allows the tail 46 to extend to either side of the patient. This securing means 46 a may be any suitable mechanical device although adhesive or a clip is most preferred. Referring back to FIG. 3, the tail 46 flows into an electrode retaining section 47. The electrode retaining section 47 has an arcuate section 48. A first expandable arm 50 attaches to the arcuate section 48. The RA electrode connector attaches to the first expandable arm 50. The arcuate section 48 flows into a transition section 52. The LA electrode connector attaches to the transition section 52. The transition section 52 flows into a linear run 54. The RL electrode connector attaches to the linear run 54. A second expandable arm 56 and an extension arm 58 attach to the linear run 54. The V electrode connector attaches to the second extension arm 58 and the LL electrode connector attaches to the second expandable arm 56.
The expandable arms 50, 56 are die cut in a serpentine pattern. The expandable arms 50, 56 comprise polypropylene or polyethylene fabric, Kapton, Mylar, or other flexible, memory-less material. The expandable arms 50, 56 expand, if necessary, by elongating the serpentine pattern. When expanded, a portion or all of the expandable arm is extended. Where only a portion of the expandable arm is extended, another portion remains folded. The expandable arms 50, 56 allow for extension as needed to so that the chest assembly 12 can fit patients of various sizes and also allow for patient movement when the patient is wearing the chest assembly 12. The extension arm 58 allows for flexible positioning of the V electrode connector in the middle of the patient's chest such as placement at electrode position V1, V2 or V3. In some instances, the health care practitioner may desire not to utilize the extension arm 58 for taking electrocardiograph measurements. Thus, to keep the extension arm 58 secured to the linear run 54 and to ensure that the extension arm 58 will not interfere with the placement and positioning of the chest assembly 12, the extension arm 58 is die cut with a perforated seam that connects the extension arm 58 and the linear run 54 along the length of the extension arm 58 | [
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15,526,617 | . If the health care practitioner desires to use the extension arm 58, the perforated seam is unbroken so that the extension arm 58 can be selectively positioned on the patient's chest.
The chest assembly 12 can be used with a precordial assembly 60 to provide a “12-lead” analysis of the electrical activity of the heart. Similar to the chest assembly 12, the precordial assembly 60 is a one-piece flexible circuit that connects a plurality of electrode connectors 62. The electrode connectors 62 have releasable connections that connect to electrodes (not shown). Preferably, the electrode connectors 62 have snap terminals that connect to electrodes having snap terminals. Each electrode connector 62 connects to an electrically conductive element or trace for transmitting electrical signals from a patient's heart. The electrically conductive elements or traces run along the precordial assembly 60 and connect to a precordial assembly connector 66. The precordial assembly 60 has the construction as shown in FIG. 2.
The precordial assembly 60 can attach to six electrodes that are selectively positioned on the abdomen and middle chest of the patient. The electrode connectors 62 of the precordial assembly 60 are preferably labeled and color-coded so as to prevent a health care provider from applying or positioning the precordial assembly onto the patient improperly. For instance, as referring to FIG. 4, the electrode connectors 62 a, 62 b, 62 c, 62 d, 62 e, and 62 f are labeled V1, V2, V3, V4, V5, and V6, respectively. When the precordial assembly 60 is used, the V electrode connector on the chest assembly 12 is removed from its electrode and replaced with an electrode connector on the precordial assembly 60.
In operation, the chest assembly 12 and the precordial assembly 60 detect electrical signals generated by the heart during each beat and transfer these signals to the body electronics unit 14. When the system is operating in “7 lead” mode (i.e. when only the chest assembly 12 is being used) the body electronics unit 14 acquires signals from the RL, RA, LL, LA, and V electrodes. The body electronics unit 14 uses the RL electrode as a ground reference. When the system is operating in the “12 lead” mode (i.e. the chest assembly 12 and the precordial assembly 60 are being used) the body electronics unit 14 acquires signals from the RL, RA | [
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15,526,618 | , LL, and LA electrodes via the chest assembly 12 and acquires signals from the V1, V2, V3, V4, V5, and V6 electrodes via the precordial assembly 60. Alternatively, a various number of electrodes may be monitored by the system. For example, the health care provider or physician may choose to use only two electrodes to monitor the heart, seven electrodes to monitor the heart, or the like. In other words, the present system is not limited to performing a “7 lead” and “12 lead” analysis of the heart. In addition, to detecting electrical signals from the heart, the chest assembly 12 and the precordial assembly 60 may be constructed to detect other vital signs of the patient, for example, pulse, respiration rate, heart rate, temperature EEG signals, and pulse oximeter signals.
Referring to FIG. 5, the chest assembly 12 connects to the body electronics unit 14 via a chest assembly connector 21. Specifically, the chest assembly connector 21 inserts into a chest assembly port 88 located in the body electronics unit 14. Similarly, the precordial assembly 60 connects to the body electronics unit 14 via the precordial assembly connector 66. Specifically, the precordial assembly connector 66 (not shown) inserts into a precordial assembly port 90. Resisters are connected to the chest assembly port 88 and the precordial assembly port 90 to prevent excessive electrical current from entering the body electronics unit 14—thereby ensuring that the body electronics unit 14 continues to operate properly in the presence a strong electrical current caused by a defibrillator (i.e. a 5 kV defibrillation excitation). The chest assembly connector 21 and the precordial assembly connector 66 are specifically keyed or configured to prevent the assembly connectors 21, 66 from being inserted into the assembly ports 88, 90 backwards, misaligned or otherwise improperly. Moreover, the chest assembly connector 21 is keyed or configured such that it is not compatible with the precordial assembly port 90. Likewise, the precordial assembly connector 66 is keyed or configured such that it is not compatible with the chest assembly port 88. Specifically, the chest assembly connector 21 has tongues specifically configured or arranged to fit into corresponding grooves of the chest assembly port 88. Accordingly, the chest assembly connector 21 can only be connected to the chest assembly port 88 in one orientation. For example, if the tongues are not aligned with the grooves, the chest assembly connector | [
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] |
15,526,619 | 21 will not couple to the chest assembly port 88. Likewise, the precordial assembly connector 66 has tongues (not shown) specifically configured or arranged to fit into corresponding grooves (not shown) of the precordial assembly port 90.
As shown in FIG. 6, the chest assembly connector 21 and the precordial assembly connector 66 (not shown) have retaining clips or flanges 92 located on the sides of the connectors 21, 66 for removably securing the connectors 21, 66 into the assembly ports 88, 90. However, other means may be used to removably secure the connectors 21, 66 in the assembly ports 88, 90, such as screws, pins or the like. In addition, the assembly connectors 21, 66 may have spring flanges or clips 94 located at the tip of the connectors 21, 66 for providing a bias or tension against the assembly ports 88, 90. The spring flanges or clips 94 provide the connectors 21, 66 with a secure fit within the assembly ports 88, 90, thereby reducing any play or movement of the connectors 21, 66 within the assembly ports 88, 90. The electrically conductive elements or traces are specifically configured on the connectors 21, 66 so as to ensure that the electrical signals from the heart are properly transmitted to the body electronics unit 14. In other words, the electrically conductive elements or traces must be sufficiently spaced apart or otherwise isolated in some manner to prevent arcing across the electrically conductive elements. In addition, the spacing of the electrically conductive elements or traces permits the chest assembly and the precordial assembly to withstand defibrillation shock. Furthermore, the connectors 21, 66 have ribs 96 for preventing the electrically conductive elements or traces from coming into contact with metal objects or the like when the connectors 21, 66 are not inserted into the assembly ports 88, 90.
The chest assembly connector 21 has a sensor pin or ground pin 98 that completes a circuit within the body electronics unit 14 when the chest assembly connector 21 is plugged into the chest assembly port 88, thereby activating the power and bringing the body electronic unit 14 out of “sleep mode.” The sensor pin has specific tongue that corresponds and fits into a groove located in the chest assembly port 88. The sensor pin 98 serves as a means for the body electronics unit 14 to identify the chest assembly 12 and to prevent the use of other chest assemblies or electrocardiograph wearables that are not designed to be | [
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