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The aim of this systematic review is to evaluate the impact of personal protective equipment (PPE) on medical device use during public health emergency responses. We conducted a systematic literature search of peer-reviewed journals in PubMed, Web of Science, and EBSCO databases. Twenty-nine of 92 articles published between 1984 and 2015 met the inclusion criteria for the review. Although many medical device use impacts were reported, they predominantly fell into 3 categories: airway management, drug administration, and diagnostics and monitoring. Chemical, biological, radiological, and nuclear (CBRN)-PPE increased completion times for emergency clinical procedures by as much as 130% and first attempt failure rates by 35% (anesthetist) versus 55% (non-anesthetist). Effects of CBRN-PPE use depend on device, CBRN-PPE level, and clinician experience and training. Continuous clinical training of responders in CBRN-PPE and device modifications can improve safety and effectiveness of medical device use during public health emergency response.
Osteoblast (the bone-forming cells) and smooth muscle cell adhesion was investigated on carbon nanofiber formulations of various diameters (specifically, from 60 to 200 nm) and surface energies (from 25 to 140 mJ/m2) in the present in vitro study. Results provided the first evidence that osteoblast adhesion increased with decreased carbon nanofiber diameter after 1 hour. In contrast, smooth muscle cell adhesion was not dependent on carbon nanofiber diameter. Moreover, the present study demonstrated that smooth muscle cell adhesion decreased with increased carbon nanofiber surface energy after 1 hour. Alternatively, osteoblast adhesion was not affected by carbon nanofiber surface energy. Since adhesion is a crucial prerequisite for subsequent functions of cells (such as the deposition of bone by osteoblasts), the present results of controlled adhesion of both osteoblasts and a competitive cell line (i.e., smooth muscle cells) demonstrate that carbon nanofibers with small diameters and high surface energies may become the next-generation of orthopedic implant materials to enhance new bone synthesis. These criteria may prove critical in the clinical success of bone prostheses.