Electrospinning of urea clathrate polymerized polyacrylonitrile (PAN) with isotacticity 25% and 52% was achieved in N,N-dimethylformamide (DMF) at room temperature. Although the molecular weights of the 25% and 52% were found to be comparable by size exclusion chromatography, creation of uniform nanofibers with comparable diameters (average of~450 nm) required concentrations of 5 % w/v and 3.5% w/v, respectively. X-ray diffraction (XRD) analysis demonstrated that the polymer retained semicrystalline structure and suggested that crystallinity was correlated with increasing isotacticity. Fourier transform infrared spectroscopy (FTIR) also confirmed increased crystallinity as compared to commercially purchased free-radical polymerized PAN due to a shift in the~1250 cm −1 methine peak. Periodic semistatic normal load piezoelectric testing of the electrospun isotactic PAN samples also exhibited an average of~30% of the piezoelectric response of electrospun (65:35) poly(vinylidene fluoride-trifluoroethylene) (PVDF-TrFE), a current gold standard for piezoelectric polymers, whereas commercially purchased free-radical polymerized PAN exhibited no observable piezoelectric response. Figure 8. Representative voltage response for electrospun polyethylene oxide, commercial PAN, 25% isotactic PAN, 52% isotactic PAN and PVDF-TrFE. In addition, a comparison of calculated d 33,eff means for each sample composition is presented. Error bars represent standard deviation. ARTICLEWILEYONLINELIBRARY.COM/APP

Technological advancements have transformed healthcare. System delays in transferring patients with ST- segment elevation myocardial infarction (STEMI) to a primary percutaneous coronary intervention (PCI) center are associated with worse clinical outcomes. Our aim was to design and develop a secure mobile application, STEMIcathAID, streamlining communication and coordination between the STEMI care teams to reduce ischemia time and improve patient outcomes. The app was designed for transfer of patients with STEMI to a cardiac catheterization laboratory (CCL) from an emergency department (ED) of either a PCI capable or a non-PCI capable hospital. When a suspected STEMI arrives to a non-PCI hospital ED, the ED physician uploads the EKG and relevant patient information. An instant notification is simultaneously sent to the on-call CCL attending and transfer center. The attending reviews the information, makes a video call and decides to either accept or reject the transfer. If accepted, on-call CCL team members receive an immediate push notification and begin communicating with the ED team via a HIPPA compliant chat. The app provides live GPS tracking of the ambulance and frequent clinical status updates of the patient. In addition, it allows for screening of STEMI patients in cardiogenic shock. Prior to discharge important data elements have to be entered to close the case. In conclusion, we developed a novel mobile app to optimize care for STEMI patients and facilitate electronic extraction of relevant performance metrics to improve allocation of resources and reduction of costs.

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Background In an effort to improve outcomes of STEMI patients, we developed a secure mobile application (app) to streamline real-time communication and coordination between multiple teams taking care of STEMI patients in a large health care system. The app includes multi-level alarm and notification systems, instant EKG transmission for quick interpretation, activation of the cardiac catheterization laboratory (CCL) after expert case review, secure video chat among team members facilitating clinical discussion, continuous updates on patients' clinical status and ambulance location tracking. Purpose One of the major shortcomings in STEMI system of care has been long delays in transfer of patients from non-PCI capable hospitals to a receiving center for primary PCI. To address the challenges of interhospital transfer, we designed a pilot project employing the app for STEMI transfer from a first contact hospital to our CCL. This report assesses the effect of the app on door-to-device time by comparing the key metric for STEMI transfer before (historic) and after app launch. Methods The pilot project involved key leadership stakeholders from Emergency Medicine and Nursing Departments at the referring hospital, CCL and our transfer center. During pilot period (July 2021 to January 2022) the referring center activated STEMI alarms using app activation in parallel with the previously established STEMI activation process via traditional phone calls to the transfer center. The built-in workflow redundancy was introduced to ensure the rapid and efficient, and at the same time, safe and reliable response to STEMI alert. In preparation for the pilot, more than 250 people were provisioned accounts, trained on their user-specific roles and scheduled in the app according to their schedules. Results A total of 40 suspected STEMIs were activated through the app during the pilot study; among them 30 cases were accepted for transfer and 10 rejected. After excluding patients who expired during transfer, were intubated, or had normal coronaries, final study population included 13 STEMI cases activated through the app. These cases were compared with 43 STEMIs activated through the traditional pathway from January 2019 to July 2021 before app launch. After implementing the app, the mean door-to-device time for STEMI transfer decreased from 120.3±48.3 to 91.8±15.4 min (P=0.002) (Figure 1). The significant improvement, 29 min (24%), of the key metric for interhospital transfer resulted in all STEMI cases meeting AHA goal of door-to-device time ≤120 minutes after the app launch. The respective percent of STEMI cases meeting the goal before app was 71% (Figure 2). Conclusions Implementation of a mobile app into STEMI workflow of a large urban healthcare system had a significant impact on the quality of care for transfer of STEMI patients, which has also helped bring our clinical practice closer to the AHA guidelines pertaining to the first door-to-device time. Funding Acknowledgement Type of funding sources: None.

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