Intravascular device administration sets: Replacement after standard versus prolonged use in hospitalised patients--a study protocol for a randomised controlled trial (The RSVP Trial)

Introduction Vascular access devices (VADs), such as peripheral or central venous catheters, are vital across all medical and surgical specialties. To allow therapy or haemodynamic monitoring, VADs frequently require administration sets (AS) composed of infusion tubing, fluid containers, pressure-monitoring transducers and/or burettes. While VADs are replaced only when necessary, AS are routinely replaced every 3–4 days in the belief that this reduces infectious complications. Strong evidence supports AS use up to 4 days, but there is less evidence for AS use beyond 4 days. AS replacement twice weekly increases hospital costs and workload. Methods and analysis This is a pragmatic, multicentre, randomised controlled trial (RCT) of equivalence design comparing AS replacement at 4 (control) versus 7 (experimental) days. Randomisation is stratified by site and device, centrally allocated and concealed until enrolment. 6554 adult/paediatric patients with a central venous catheter, peripherally inserted central catheter or peripheral arterial catheter will be enrolled over 4 years. The primary outcome is VAD-related bloodstream infection (BSI) and secondary outcomes are VAD colonisation, AS colonisation, all-cause BSI, all-cause mortality, number of AS per patient, VAD time in situ and costs. Relative incidence rates of VAD-BSI per 100 devices and hazard rates per 1000 device days (95% CIs) will summarise the impact of 7-day relative to 4-day AS use and test equivalence. Kaplan-Meier survival curves (with log rank Mantel-Cox test) will compare VAD-BSI over time. Appropriate parametric or non-parametric techniques will be used to compare secondary end points. p Values of <0.05 will be considered significant.

The standard you walk past is the standard you accept

In his 2013 three-minute speech on unacceptable behaviour in the workplace, Lieutenant General David Morrison makes the above insightful statement. While the context of the speech is the defence force, the meaning of the powerful message holds true for perioperative nursing. Perioperative nurses are part of a profession. Professions Australia, a national organisation of professional associations which aims to advance and promote professionalism for the benefit of the community, provides us with a definition of a profession2 and perioperative nurses meet this definition. Perioperative nurses possess special knowledge and skills grounded in a widely recognised body of discipline knowledge derived from research, education and high-level training. We control and regulate our own boundaries of work. We adhere to ethical and professional standards and values. Specialty professional practice standards define perioperative nurses as a community of professionals — assisting perioperative nurses when advocating for consistency in quality patient care3. It is an imperative for every professional perioperative nurse to model practice underpinned by the ACORN Standards throughout their workplace. Hence, Lieutenant General Morrison’s profound statement is a mantra each perioperative nurse could readily adopt and model in their practice environment...

Self-reported bruxism : Associated factors among media personnel with or without irregular shift work

Tutkimuksen kohderyhmänä oli mediatyöntekijöitä, joiden toimenkuva on viime vuosina muuttunut yhä kuormittavammaksi epäsäännöllisen vuorotyön sekä jatkuvien teknisten, organisatoristen ja taloudellisten tekijöiden ristipaineessa. Väitöskirjatutkimus on osa laajempaa tutkimushanketta, joka suunniteltiin selvittämään epäsäännöllisen vuorotyön mahdollisia haittoja. Tutkimusta tukivat taloudellisesti Työsuojelurahasto ja Suomen Hammaslääkäriseura Apollonia sekä resurssipanostuksin Hammaslääketieteen laitos (HY), Työterveyslaitos ja Yleisradio Oy. Bruksismi on tahdosta riippumatonta hampaiden narskuttelua tai yhteenpuristamista. Hampaiden narskuttelu on rytmistä jaksoittain toistuvaa puremalihasten toimintaa, joka esiintyy nukkuessa -tavallisimmin kevyen unen ja havahtumisjaksojen yhteydessä. Valveilla ollessa bruksismi on terveillä ihmisillä lähinnä hampaiden yhteenpuristamista. Yleisen käsityksen mukaan toistuvaa unibruksismia esiintyy noin 10 %:lla ja valveilla tapahtuvaa hampaiden yhteenpuristamista noin 20 %:lla. Aiemmin bruksismi kuului kansainvälisen unihäiriöluokituksen (ICSD 1997) mukaan unen erityishäiriöihin, mutta tuorein luokitus (ICSD 2005) listaa sen unen liikehäiriöihin. Väitöstutkimuksen yleisenä tavoitteena oli kartoittaa koetun bruksismin ja uni- valvehäiriöiden yhteyttä. Tutkimus oli poikittainen vertailututkimus epäsäännöllistä vuorotyötä ja säännöllisiä päivävuoroja tekevien välillä. Mielenkiinto kohdistui myös bruksismin ja kasvojen alueen kivun mahdolliseen yhteyteen. Lisäksi tutkimuksessa selvitettiin joidenkin tunnetusti unen laatua huonontavien psykososiaalisten, neurologisten ja fysiologisten tekijöiden yhteyttä koettuun bruksismiin. Tutkimuksen kohderyhmän muodosti 750 Yleisradion epäsäännöllistä vuorotyötä tekevää työntekijää. Vertailuryhmänä käytettiin samansuuruista satunnaistetusti valittua kaltaistettua Yleisradion työntekijäjoukkoa, joka tekee samankaltaista työtä, mutta säännöllisenä päivätyönä. Kohderyhmälle lähetettiin kyselylomakkeet, jotka kartoittivat koetun bruksismin lisäksi mm. tutkittavien taustatiedot, yleisen terveydentilan, yleisiä koettuja stressioireita ja tuntemuksia, kipuoireita, sekä unen laatua. Lisäksi esitettiin jaksamista ja työympäristöä koskevia kysymyksiä. Kyselyyn vastasi kaikkiaan 874 henkilöä. Kokonaisvastausprosentti oli 58,3 % (53,7 % miehiä). Epäsäännöllistä vuorotyötä tekevien vastausprosentti oli 82,3 % ja säännöllistä päivätyötä tekevien ryhmässä 34,3 %. Työtehtävät sisälsivät ohjelmien toimitus- ja tuottamistyötä, teknistä tuotanto- ja tukityötä, sekä esimies- ja hallintotyötä. Miesten keski-ikä vuorotyöryhmässä oli 45,0 (± 10,6) vuotta ja naisten keski-ikä 42,6 (± 10,7) vuotta, vastaavat luvut päivätyötä tekeville olivat 47,4 (± 9,7) ja 45,5 (± 10,1) vuotta. Vuorotyötä tekevistä oli miehiä 56,6 %, päivätyöryhmässä miehien osuus oli 46,7 %. Usein koettua bruksismia havaittiin koko tutkimusjoukossa 10,6 %:lla. Bruksismin esiintyvyydessä ei ollut merkitsevää eroa epäsäännöllistä vuorotyötä ja päivätyötä tekevien välillä. Kun bruksismia ja stressiä arvioitiin suhteessa tyytyväisyyteen nykyiseen työaikamuotoon, molemmat olivat merkitsevästi vallitsevimpia niillä, jotka halusivat vaihtaa nykyistä työaikamuotoaan. Epäsäännöllistä vuorotyötä tekevät lisäksi ilmoittivat kokevansa enemmän stressiä kuin päivätyötä tekevät sekä olivat tyytymättömämpiä työaikamuotoonsa. Tutkittavista henkilöistä katkonaista unta esiintyi 43,6 %:lla sekä 36,2 % koki unensa virkistämättömäksi. Kasvokipua esiintyi 19,6 %:lla. Usein toistuva bruksaus sekä tyytymättömyys työaikamuotoon olivat erittäin merkitsevästi yhteydessä unihäiriöiden sekä riittämättömän unen oireiden kanssa. Bruksismi ja katkonainen uni osoittautuivat myös kasvokivun taustatekijöiksi. Tutkimus osoitti, että koetulla bruksismilla oli merkitsevä yhteys unihäiriöihin, kasvokipuun, koettuun stressiin ja ahdistuneisuuteen, nuorempaan ikään, runsaampiin hammaslääkäri- ja lääkärikäynteihin sekä siihen että oli tyytymätön työaikamuotoonsa (itse työaikamuoto ei ollut merkitsevä tekijä). Tutkimuksen yhtenä johtopäätöksenä todettiin, että koettu bruksismi voi terveillä työikäisillä henkilöillä olla osa stressaavaa tilannetta ja siihen liittyvää käyttäytymistä. Tämän tiedostaminen terveydenhuollossa voisi olla hyödyllistä.

Quality of life after early enteral feeding versus standard care for proven or suspected advanced epithelial ovarian cancer: Results from a randomised trial

Background Malnutrition is common in patients with advanced epithelial ovarian cancer (EOC), and is associated with impaired quality of life (QoL), longer hospital stay and higher risk of treatment-related adverse events. This phase III multi-centre randomised clinical trial tested early enteral feeding versus standard care on postoperative QoL. Methods From 2009 to 2013, 109 patients requiring surgery for suspected advanced EOC, moderately to severely malnourished were enrolled at five sites across Queensland and randomised to intervention (n = 53) or control (n = 56) groups. Intervention involved intraoperative nasojejunal tube placement and enteral feeding until adequate oral intake could be maintained. Despite being randomised to intervention, 20 patients did not receive feeds (13 did not receive the feeding tube; 7 had it removed early). Control involved postoperative diet as tolerated. QoL was measured at baseline, 6 weeks postoperatively and 30 days after the third cycle of chemotherapy. The primary outcome measure was the difference in QoL between the intervention and the control group. Secondary endpoints included treatment-related adverse event occurrence, length of stay, postoperative services use, and nutritional status. Results Baseline characteristics were comparable between treatment groups. No significant difference in QoL was found between the groups at any time point. There was a trend towards better nutritional status in patients who received the intervention but the differences did not reach statistical significance except for the intention-to-treat analysis at 7 days postoperatively (11.8 intervention vs. 13.8 control, p 0.04). Conclusion Early enteral feeding did not significantly improve patients' QoL compared to standard of care but may improve nutritional status.

Stress and strain-driven algorithmic formulations for finite strain viscoplasticity for hybrid and standard finite elements

This work deals with the formulation and implementation of finite deformation viscoplasticity within the framework of stress-based hybrid finite element methods. Hybrid elements, which are based on a two-field variational formulation, are much less susceptible to locking than conventional displacement-based elements. The conventional return-mapping scheme cannot be used in the context of hybrid stress methods since the stress is known, and the strain and the internal plastic variables have to be recovered using this known stress field.We discuss the formulation and implementation of the consistent tangent tensor, and the return-mapping algorithm within the context of the hybrid method. We demonstrate the efficacy of the algorithm on a wide range of problems.

Reconstructing the properties of dark energy using standard sirens

Future space-based gravity wave (GW) experiments such as the Big Bang Observatory (BBO), with their excellent projected, one sigma angular resolution, will measure the luminosity distance to a large number of GW sources to high precision, and the redshift of the single galaxies in the narrow solid angles towards the sources will provide the redshifts of the gravity wave sources. One sigma BBO beams contain the actual source in only 68% of the cases; the beams that do not contain the source may contain a spurious single galaxy, leading to misidentification. To increase the probability of the source falling within the beam, larger beams have to be considered, decreasing the chances of finding single galaxies in the beams. Saini et al. T.D. Saini, S.K. Sethi, and V. Sahni, Phys. Rev. D 81, 103009 (2010)] argued, largely analytically, that identifying even a small number of GW source galaxies furnishes a rough distance-redshift relation, which could be used to further resolve sources that have multiple objects in the angular beam. In this work we further develop this idea by introducing a self-calibrating iterative scheme which works in conjunction with Monte Carlo simulations to determine the luminosity distance to GW sources with progressively greater accuracy. This iterative scheme allows one to determine the equation of state of dark energy to within an accuracy of a few percent for a gravity wave experiment possessing a beam width an order of magnitude larger than BBO (and therefore having a far poorer angular resolution). This is achieved with no prior information about the nature of dark energy from other data sets such as type Ia supernovae, baryon acoustic oscillations, cosmic microwave background, etc. DOI:10.1103/PhysRevD.87.083001

Topics in LIGO-related physics: interferometric speed meters and tidal work

In the quest to develop viable designs for third-generation optical interferometric gravitational-wave detectors, one strategy is to monitor the relative momentum or speed of the test-mass mirrors, rather than monitoring their relative position. The most straightforward design for a speed-meter interferometer that accomplishes this is described and analyzed in Chapter 2. This design (due to Braginsky, Gorodetsky, Khalili, and Thorne) is analogous to a microwave-cavity speed meter conceived by Braginsky and Khalili. A mathematical mapping between the microwave speed meter and the optical interferometric speed meter is developed and used to show (in accord with the speed being a quantum nondemolition observable) that in principle the interferometric speed meter can beat the gravitational-wave standard quantum limit (SQL) by an arbitrarily large amount, over an arbitrarily wide range of frequencies . However, in practice, to reach or beat the SQL, this specific speed meter requires exorbitantly high input light power. The physical reason for this is explored, along with other issues such as constraints on performance due to optical dissipation.

Chapter 3 proposes a more sophisticated version of a speed meter. This new design requires only a modest input power and appears to be a fully practical candidate for third-generation LIGO. It can beat the SQL (the approximate sensitivity of second-generation LIGO interferometers) over a broad range of frequencies (~ 10 to 100 Hz in practice) by a factor h/h_SQL ~ √W^(SQL)_(circ)/W_circ. Here W_circ is the light power circulating in the interferometer arms and W_SQL ≃ 800 kW is the circulating power required to beat the SQL at 100 Hz (the LIGO-II power). If squeezed vacuum (with a power-squeeze factor e^-2R) is injected into the interferometer's output port, the SQL can be beat with a much reduced laser power: h/h_SQL ~ √W^(SQL)_(circ)/W_circe^-2R. For realistic parameters (e^-2R ≃ 10 and W_circ ≃ 800 to 2000 kW), the SQL can be beat by a factor ~ 3 to 4 from 10 to 100 Hz. [However, as the power increases in these expressions, the speed meter becomes more narrow band; additional power and re-optimization of some parameters are required to maintain the wide band.] By performing frequency-dependent homodyne detection on the output (with the aid of two kilometer-scale filter cavities), one can markedly improve the interferometer's sensitivity at frequencies above 100 Hz.

Chapters 2 and 3 are part of an ongoing effort to develop a practical variant of an interferometric speed meter and to combine the speed meter concept with other ideas to yield a promising third- generation interferometric gravitational-wave detector that entails low laser power.

Chapter 4 is a contribution to the foundations for analyzing sources of gravitational waves for LIGO. Specifically, it presents an analysis of the tidal work done on a self-gravitating body (e.g., a neutron star or black hole) in an external tidal field (e.g., that of a binary companion). The change in the mass-energy of the body as a result of the tidal work, or "tidal heating," is analyzed using the Landau-Lifshitz pseudotensor and the local asymptotic rest frame of the body. It is shown that the work done on the body is gauge invariant, while the body-tidal-field interaction energy contained within the body's local asymptotic rest frame is gauge dependent. This is analogous to Newtonian theory, where the interaction energy is shown to depend on how one localizes gravitational energy, but the work done on the body is independent of that localization. These conclusions play a role in analyses, by others, of the dynamics and stability of the inspiraling neutron-star binaries whose gravitational waves are likely to be seen and studied by LIGO.

Towards a standard methodology to evaluate internal cluster validity indices

The evaluation and comparison of internal cluster validity indices is a critical problem in the clustering area. The methodology used in most of the evaluations assumes that the clustering algorithms work correctly. We propose an alternative methodology that does not make this often false assumption. We compared 7 internal cluster validity indices with both methodologies and concluded that the results obtained with the proposed methodology are more representative of the actual capabilities of the compared indices.

Density-potential mapping in the standard and quantum electrodynamical time-dependent density functional theory

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Gold Standard and Reforms of The International Monetary System

This academic work is based on the study of the gold standard, its evolution over the years, their periods of boom and crisis. We will also discuss the arguments that some economists back the return to this monetary system.

A silicon light emitting devices in standard CMOS technology

A silicon light emitting device is designed and simulated. It is fabricated in 0.6 mum standard CMOS technology. The device can give more than 1 muW optical power of visible light under reverse breakdown. The device can be turned on at a bias of 0.88 V and work in a large range of voltage: 1.0-6.0 V The external electrical-optical conversion efficiency is more than 10(-6). The optical spectrum of the device is between 540-650 nm, which have a clear peak near 580 nm. The emission mechanism can be explained by a hot carrier direct recombination model.

A nonmonotonic dependence of standard rate constant on reorganization energy for heterogeneous electron transfer processes on electrode surface

In the present work a nonmonotonic dependence of standard rate constant (k(0)) on reorganization energy (lambda) was discovered qualitatively from electron transfer (Marcus-Hush-Levich) theory for heterogeneous electron transfer processes on electrode surface. It was found that the nonmonotonic dependence of k(0) on lambda is another result, besides the disappearance of the famous Marcus inverted region, coming from the continuum of electronic states in electrode: with the increase of lambda, the states for both Process I and Process II ET processes all vary from nonadiabatic to adiabatic state continuously, and the lambda dependence of k(0) for Process I is monotonic thoroughly, while for Process II on electrode surface the lambda dependence of k(0) could show a nonmonotonicity.

Hidden Gems: systematically searching electronic databases for research publications for social work and social care.

Context: Electronic bibliographic databases are a key source for professional publications about social work and community care more generally. This article describes and evaluates a method of identifying relevant articles as part of a systematic review of research evidence. Decision making about institutional and home care services for older people is used as an example. Method: Four databases (Social Science Citation Index, Medline, CINAHL, and Caredata) that abstract publications relevant to health and social services were searched systematically to identify relevant research studies. The items retrieved were appraised independently using a standard form developed for the purpose. The searches were compared in terms of sensitivity, precision, overlap between databases, and inter-rater reliability. Results: The search retrieved 525 articles, of which 276 were relevant. The four databases retrieved 55%, 41%, 19%, and 1% of the relevant articles respectively, achieving these sensitivities with precision levels of 54%, 48%, 84% and 94%. The databases retrieved 116, 73, 24 and 15 unique relevant articles respectively, showing the need to use a range of databases. Discussion: A general approach to creating a search to retrieve relevant research has been developed. The development of an international, indexed database dedicated to literature relevant to social services is a priority to enable progress in evidence-based policy and practice in social work. Editors and researchers should consider using structured abstracts in order to improve the retrieval and dissemination of research.

What is Irish Standard English?

Standard English need not be a matter of prescriptivism or any attempt to ‘create’ a particular standard, but, rather, can be a matter of observation of actual linguistic behaviour. For Hudson (2000), standard English is the kind of English which is written in published work, which is spoken in situations where published writing is most influential – especially in university level education and so in post-university professions – and which is spoken ‘natively’ at home by the ‘professional class’, i.e. people who are most influenced by published writing. In the papers in Bex and Watts (eds, 1999), it is recurrently claimed that, when speaking English, what the ‘social group with highest degree of power, wealth or prestige’ or more neutrally ‘educated people’ or ‘socially admired people’ speak is the variety known as ‘standard English’. However, ‘standard English’ may also mean that shared aspect of English which makes global communication possible. This latter perspective allows for two meanings of ‘standard’: it may refer both to an idealised set of shared features, and also to different sets of national features, reflecting different demographic and political histories and language influences. The methodology adopted in the International Corpus of English (henceforth ICE – cf. Greenbaum, 1996) enables us to observe and investigate each set of features, showing what everybody shares and also what makes each national variety of English different.

Measuring work and heat in ultracold quantum gases

We propose a feasible experimental scheme to direct measure heat and work in cold atomic setups. The method is based on a recent proposal which shows that work is a positive operator valued measure (POVM). In the present contribution, we demonstrate that the interaction between the atoms and the light polarization of a probe laser allows us to implement such POVM. In this way the work done on or extracted from the atoms after a given process is encoded in the light quadrature that can be measured with a standard homodyne detection. The protocol allows one to verify fluctuation theorems and study properties of the non-unitary dynamics of a given thermodynamic process.