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Researchers have shown in laboratory studies that different types of fabrics were associated with changes in skin moisture, friction, shear, and temperature that may predispose patients to pressure injury. There was an association between type of fiber used in hospital linens and pressure injury development in previous clinical studies. We examined if bed linens made from a newly developed synthetic fiber fabric affected occurrence rate, time to development, and severity of unit-acquired pressure injury in critically ill adult inpatients. DESIGN: Cluster randomized controlled trial. SETTING: Five adult medical ICUs within one quaternary care center in the Midwest United States. PATIENTS: Patients were assigned to a unit based on bed availability. In total, there were 3,332 patients in the study. INTERVENTIONS: Participating medical ICUs were randomly assigned to cotton fiber or synthetic fiber linens for the first 6 months of the study period, and assignment reversed after a 14-day washout period for the final 6 months. MEASUREMENTS AND MAIN RESULTS: Unit-acquired pressure injury occurrence rate, time to first unit-acquired pressure injury, and severity were evaluated using generalized mixed effect models with patient as a random effect, and a marginal Cox proportional hazards model with repeated admissions from the same patient accounted for by use of a sandwich estimator of the variance. There were 1,706 patients on cotton fiber linens and 1,626 patients on synthetic fiber linens. Groups were similar on demographics except race and admitting diagnosis groupings. Occurrence rate (p = 0.99), time to development (p = 0.99), and maximum severity of unit-acquired pressure (p = 0.86) were similar between groups before and after controlling for race and admitting diagnosis groupings. CONCLUSIONS: Linen type did not affect unit-acquired pressure injury occurrence rate, severity, or timing. Standard unit-acquired pressure injury prevention efforts may be more cost-effective than investment in synthetic fiber linens.

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OBJECTIVE: The purpose of this study was to evaluate the comfort and the electromyographic (EMG) activity of the neck and mid-upper back of asymptomatic adults using foam pillows of 3 different heights. METHODS: Twenty-one asymptomatic adults used foam pillows of 3 different heights (1: 5 cm, 2: 10 cm, and 3: 14 cm). Comfort was assessed using a 100-mm visual analog scale. Electromyographic activity was assessed in the lateral position. We calculated the root mean square (RMS) in 500-millisecond windows of bilateral EMG activity of the sternocleidomastoid and upper and middle trapezius, normalized by maximal isometric contraction of each individual. The RMS of the EMG signals was compared among pillow heights using repeated-measures analysis of variance (P < .05). RESULTS: The middle trapezius muscle of the down-side showed the highest RMS in height 1 when compared with heights 2 (P = .0163) and 3 (P = .0313), with no statistical significance between pillow heights 2 and 3 for this muscle. There were no statistical differences between pillows 2 and 3 in any muscle activity. Height 2 was considered the most comfortable (P < .001) compared with heights 1 and 3, and height 1 the least comfortable (P < .001) compared with the other heights. CONCLUSION: For the participants in this study, there was an association among pillow height, myoelectric activity, and comfort.

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BACKGROUND: Cervical pillow height is an important factor that affects the perception of pillow comfort. However, few studies have addressed methods for predicting a patient's preferred cervical pillow size. We studied the effect of pillow size preference on the strength and electromyographic (EMG) signals of the upper extremity muscle. If the response of the upper extremity muscle is affected by pillow size preference, this would aid in devising an alternate strategy for selecting the optimal pillow size. METHODS: Twenty-nine healthy individuals (mean age: 28.6 years, range: 24-55 years) participated in this study. The participants performed isometric maximal finger extension in the supine position with their heads supported on four different size preferences of cervical pillow (the most comfortable, next most comfortable, worst, and next worst). Maximal contraction force and peak-to-peak EMG amplitude of the extensor digitorum communis (EDC) during contraction were measured. One-way repeated-measures analysis of variance was used to evaluate the effect of pillow size preference. We also explored the relationship between anthropometric parameters and the individual's cervical pillow height preference. RESULTS: The two most comfortable pillows were associated with significantly larger maximal EDC force than the two worst pillows. However, no significant differences in EMG were observed between pillows. No statistically significant correlation was found between anthropometric parameters and pillow height preference. CONCLUSION: The results suggest that anatomical body measurements are not good predictors of optimal pillow height. As EDC muscle strength is affected by pillow height preference, maximal EDC muscle strength may be a useful complement for selecting the optimal pillow size.

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OBJECTIVES: Term infants in resource-poor settings frequently develop hypothermia during the first hours after birth. Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in preterm and low birth weight infants that may also be effective in term infants. Our objective was to test the hypothesis that placement of term neonates in plastic bags at birth reduces hypothermia at 1 hour after birth in a resource-poor hospital. METHODS: This parallel-group randomized controlled trial was conducted at University Teaching Hospital, the tertiary referral center in Zambia. Inborn neonates with both a gestational age ≥37 weeks and a birth weight ≥2500 g were randomized 1:1 to either a standard thermoregulation protocol or to a standard thermoregulation protocol with placement of the torso and lower extremities inside a plastic bag within 10 minutes after birth. The primary outcome was hypothermia (<36.5°C axillary temperature) at 1 hour after birth. RESULTS: Neonates randomized to plastic bag (n = 135) or to standard thermoregulation care (n = 136) had similar baseline characteristics (birth weight, gestational age, gender, and baseline temperature). Neonates in the plastic bag group had a lower rate of hypothermia (60% vs 73%, risk ratio 0.76, confidence interval 0.60-0.96, P = .026) and a higher axillary temperature (36.4 ± 0.5°C vs 36.2 ± 0.7°C, P < .001) at 1 hour after birth compared with infants receiving standard care. CONCLUSIONS: Placement in a plastic bag at birth reduced the incidence of hypothermia at 1 hour after birth in term neonates born in a resource-poor setting, but most neonates remained hypothermic.

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OBJECTIVE: Few studies have analyzed the shapes of pillows. The purpose of this study was to investigate the relationship between the pillow shape design and subjective comfort level for asymptomatic subjects. METHODS: Four basic pillow designs factors were selected on the basis of literature review and recombined into 8 configurations for testing the rank of degrees of comfort. The data were analyzed by the analytic hierarchy process method to determine the most comfortable pillow. RESULTS: Pillow number 4 was the most comfortable pillow in terms of head, neck, shoulder, height, and overall comfort. The design factors of pillow number 4 were using a combination of standard, cervical, and shoulder pillows. A prototype of this pillow was developed on the basis of the study results for designing future pillow shapes. CONCLUSIONS: This study investigated the comfort level of particular users and redesign features of a pillow. A deconstruction analysis would simplify the process of determining the most comfortable pillow design and aid designers in designing pillows for groups.

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This study of cutaneous leishmaniasis in Jericho city and the adjacent Aqbat-Jaber refugee camp investigated the seroprevalance of Leishmania major and the risk factors associated with acquiring the disease. Clinical and parasitology identification of cases showed children and young men were more affected, with the head most affected in children. Enzyme-linked immunosorbent assay [ELISA] was used to test sera from 190 individuals. The overall seroprevalence of cutaneous leishmaniasis was 26.3%. A case-control study of 247 individual in 37 households showed that a higher level of education of the head of the household and having children sleep under bed nets were significantly related to a lower incidence of cutaneous leishmaniasis

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