Respiratory monitoring practices during procedural sedation and analgesia in the cardiac catheterisation laboratory could be improved by using capnography to assess ventilation

Background: Procedural sedation and analgesia (PSA) administered by nurses in the cardiac catheterisation laboratory (CCL) is unlikely to yield serious complications. However, the safety of this practice is dependent on timely identification and treatment of depressed respiratory function. Aim: Describe respiratory monitoring in the CCL. Methods: Retrospective medical record audit of adult patients who underwent a procedure in the CCLs of one private hospital in Brisbane during May and June 2010. An electronic database was used to identify subjects and an audit tool ensured data collection was standardised. Results: Nurses administered PSA during 172/473 (37%) procedures including coronary angiographies, percutaneous coronary interventions, electrophysiology studies, radiofrequency ablations, cardiac pacemakers, implantable cardioverter defibrillators, temporary pacing leads and peripheral vascular interventions. Oxygen saturations were recorded during 160/172 (23%) procedures, respiration rate was recorded during 17/172 (10%) procedures, use of oxygen supplementation was recorded during 40/172 (23%) procedures and 13/172 (7.5%; 95% CI=3.59–11.41%) patients experienced oxygen desaturation. Conclusion: Although oxygen saturation was routinely documented, nurses did not regularly record respiration observations. It is likely that surgical draping and the requirement to minimise radiation exposure interfered with nurses’ ability to observe respiration. Capnography could overcome these barriers to respiration assessment as its accurate measurement of exhaled carbon dioxide coupled with the easily interpretable waveform output it produces, which displays a breath-by-breath account of ventilation, enables identification of respiratory depression in real-time. Results of this audit emphasise the need to ascertain the clinical benefits associated with using capnography to assess ventilation during PSA in the CCL.

Acute illness is a risk factor for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory

Impaired respiratory function (IRF) during procedural sedation and analgesia (PSA) poses considerable risk to patient safety as it can lead to inadequate oxygenation and ventilation. Risk factors that can be screened prior to the procedure have not been identified for the cardiac catheterization laboratory (CCL).

Utility of dexmedetomidine in sedation for radiofrequency ablation of atrial fibrillation.

[Letter to the Editor] I read with great interest the article recently published in the Journal of PeriAnesthesia Nursing that examined the utility of using dexmedetomidine (DEX) as an adjunct to midazolam and fentanyl for procedural sedation and analgesia during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF).1 With the view toward advancing knowledge about more effective medications for sedation in this challenging context, I offer the following insights for readers to consider regarding this study...

Robust scale initialization for long-range stereo visual odometry

Achieving a robust, accurately scaled pose estimate in long-range stereo presents significant challenges. For large scene depths, triangulation from a single stereo pair is inadequate and noisy. Additionally, vibration and flexible rigs in airborne applications mean accurate calibrations are often compromised. This paper presents a technique for accurately initializing a long-range stereo VO algorithm at large scene depth, with accurate scale, without explicitly computing structure from rigidly fixed camera pairs. By performing a monocular pose estimate over a window of frames from a single camera, followed by adding the secondary camera frames in a modified bundle adjustment, an accurate, metrically scaled pose estimate can be found. To achieve this the scale of the stereo pair is included in the optimization as an additional parameter. Results are presented both on simulated and field gathered data from a fixed-wing UAV flying at significant altitude, where the epipolar geometry is inaccurate due to structural deformation and triangulation from a single pair is insufficient. Comparisons are made with more conventional VO techniques where the scale is not explicitly optimized, and demonstrated over repeated trials to indicate robustness.

The Cube : a very large-scale interactive engagement space

“The Cube” is a unique facility that combines 48 large multi-touch screens and very large-scale projection surfaces to form one of the world’s largest interactive learning and engagement spaces. The Cube facility is part of the Queensland University of Technology’s (QUT) newly established Science and Engineering Centre, designed to showcase QUT’s teaching and research capabilities in the STEM (Science, Technology, Engineering, and Mathematics) disciplines. In this application paper we describe, the Cube, its technical capabilities, design rationale and practical day-to-day operations, supporting up to 70,000 visitors per week. Essential to the Cube’s operation are five interactive applications designed and developed in tandem with the Cube’s technical infrastructure. Each of the Cube’s launch applications was designed and delivered by an independent team, while the overall vision of the Cube was shepherded by a small executive team. The diversity of design, implementation and integration approaches pursued by these five teams provides some insight into the challenges, and opportunities, presented when working with large distributed interaction technologies. We describe each of these applications in order to discuss the different challenges and user needs they address, which types of interactions they support and how they utilise the capabilities of the Cube facility.

CubIT : Large-scale multi-user presentation and collaboration

CubIT is a multi-user, large-scale presentation and collaboration framework installed at the Queensland University of Technology’s (QUT) Cube facility, an interactive facility made up 48 multi-touch screens and very large projected display screens. CubIT was built to make the Cube facility accessible to QUT’s academic and student population. The system allows users to upload, interact with and share media content on the Cube’s very large display surfaces. CubIT implements a unique combination of features including RFID authentication, content management through multiple interfaces, multi-user shared workspace support, drag and drop upload and sharing, dynamic state control between different parts of the system and execution and synchronisation of the system across multiple computing nodes.

Development of a large scale flexible LED display matrix for the screen industry

This project addresses the viability of lightweight, low power consumption, flexible, large format LED screens. The investigation encompasses all aspects of the electrical and mechanical design, individually and as a system, and achieves a successful full scale prototype. The prototype implements novel techniques to achieve large displacement colour aliasing, a purely passive thermal management solution, a rapid deployment system, individual seven bit LED current control with two way display communication, auto-configuration and complete signal redundancy, all of which are in direct response to industry needs.

Supporting collaboration in large-scale multi-user workspaces

CubIT is a multi-user, large-scale presentation and collaboration framework installed at the Queensland University of Technology’s (QUT) Cube facility, an interactive facility made up 48 multi-touch screens and very large projected display screens. The CubIT system allows users to upload, interact with and share their own content on the Cube’s display surfaces. This paper outlines the collaborative features of CubIT which are implemented via three user interfaces, a large-screen multi-touch interface, a mobile phone and tablet application and a web-based content management system. Each of these applications plays a different role and supports different interaction mechanisms supporting a wide range of collaborative features including multi-user shared workspaces, drag and drop upload and sharing between users, session management and dynamic state control between different parts of the system.

Large-scale association study identifies ICAM gene region as breast and prostate cancer susceptibility locus

We conducted a large-scale association study to identify genes that influence nonfamilial breast cancer risk using a collection of German cases and matched controls and >25,000 single nucleotide polymorphisms located within 16,000 genes. One of the candidate loci identified was located on chromosome 19p13.2 [odds ratio (OR) = 1.5, P = 0.001]. The effect was substantially stronger in the subset of cases with reported family history of breast cancer (OR = 3.4, P = 0.001). The finding was subsequently replicated in two independent collections (combined OR = 1.4, P < 0.001) and was also associated with predisposition to prostate cancer in an independent sample set of prostate cancer cases and matched controls (OR = 1.4, P = 0.002). High-density single nucleotide polymorphism mapping showed that the extent of association spans 20 kb and includes the intercellular adhesion molecule genes ICAM1, ICAM4, and ICAM5. Although genetic variants in ICAM5 showed the strongest association with disease status, ICAM1 is expressed at highest levels in normal and tumor breast tissue. A variant in ICAM5 was also associated with disease progression and prognosis. Because ICAMs are suitable targets for antibodies and small molecules, these findings may not only provide diagnostic and prognostic markers but also new therapeutic opportunities in breast and prostate cancer.

Nonlinear actuator fault detection for small-scale UAS

This paper presents a recursive strategy for online detection of actuator faults on a unmanned aerial system (UAS) subjected to accidental actuator faults. The proposed detection algorithm aims to provide a UAS with the capability of identifying and determining characteristics of actuator faults, offering necessary flight information for the design of fault-tolerant mechanism to compensate for the resultant side-effect when faults occur. The proposed fault detection strategy consists of a bank of unscented Kalman filters (UKFs) with each one detecting a specific type of actuator faults and estimating corresponding velocity and attitude information. Performance of the proposed method is evaluated using a typical nonlinear UAS model and it is demonstrated in simulations that our method is able to detect representative faults with a sufficient accuracy and acceptable time delay, and can be applied to the design of fault-tolerant flight control systems of UASs.

Formative evaluation for improving collaborative planning : a case study at the regional scale

In an earlier paper (Cameron & Johnson 2004) we introduced the idea of formative evaluation (or evaluation for development), the purpose of which is to provide information for improving planning programs and activities. This type of evaluation differs from the two other types: outcome evaluation which aims to judge the success or otherwise of a program; and evaluation for knowledge which seeks to contribute to theoretical work on planning processes and activities. In the earlier paper we also outlined the first stage of formative evaluation in the SEQ 2021 regional planning exercise showing how the process of planning for community engagement was modified in light of the evaluation findings. This current paper details the second stage of formative evaluation in which the collaborative planning component of SEQ 2021 was evaluated, as such it further demonstrates how formative evaluation can be used to improve planning programs. The evaluation findings also provide insights into strategies for more effective collaborative planning. We begin with an overview of collaborative approaches to regional planning, including the SEQ 2021 regional planning program. We then outline formal and informal evaluations of various collaborative regional planning exercises, including the predecessor of SEQ 2021 - SEQ 2001. This sets the scene for discussion of the approach used to evaluate the collaborative component of SEQ 2021. After outlining the main findings from the evaluation and the ways these findings were used to refine the collaborative planning process we conclude with a series of recommendations, relevant not only to SEQ 2021 but to other collaborative planning exercises

Understanding mild acid pretreatment of sugarcane bagasse through particle scale modeling

Sugarcane bagasse is an abundant and sustainable resource, generated as a by-product of sugarcane milling. The cellulosic material within bagasse can be broken down into glucose molecules and fermented to produce ethanol, making it a promising feedstock for biofuel production. Mild acid pretreatment hydrolyses the hemicellulosic component of biomass, thus allowing enzymes greater access to the cellulosic substrate during saccharification. A particle-scale mathematical model describing the mild acid pretreatment of sugarcane bagasse has been developed, using a volume averaged framework. Discrete population-balance equations are used to characterise the polymer degradation kinetics, and diffusive effects account for mass transport within the cell wall of the bagasse. As the fibrous material hydrolyses over time, variations in the porosity of the cell wall and the downstream effects on the reaction kinetics are accounted for using conservation of volume arguments. Non-dimensionalization of the model equations reduces the number of parameters in the system to a set of four dimensionless ratios that compare the timescales of different reaction and diffusion events. Theoretical yield curves are compared to macroscopic experimental observations from the literature and inferences are made as to constraints on these “unknown” parameters. These results enable connections to be made between experimental data and the underlying thermodynamics of acid pretreatment. Consequently, the results suggest that data-fitting techniques used to obtain kinetic parameters should be carefully applied, with prudent consideration given to the chemical and physiological processes being modeled.

The "caring experience": testing the psychometric properties of the Caring Efficacy Scale

The purpose of the study was to undertake rigorous psychometric testing of the Caring Efficacy Scale in a sample of Registered Nurses. A cross-sectional survey of 2000 registered nurses was undertaken. The Caring Efficacy Scale was utilised to inform the psychometric properties of the selected items of the Caring Efficacy Scale. Cronbach’s Alpha identified reliability of the data. Exploratory Factor Analysis and Confirmatory Factor Analysis were undertaken to validate the factors. Confirmatory factor analysis confirmed the development of two factors; Confidence to Care and Doubts and Concerns. The Caring Efficacy Scale has undergone rigorous psychometric testing, affording evidence of internal consistency and goodness-of-fit indices within satisfactory ranges. The Caring Efficacy Scale is valid for use in an Australian population of registered nurses. The scale can be used as a subscale or total score reflective of self-efficacy in nursing. This scale may assist nursing educators to predict levels of caring efficacy.

Saliva-derived DNA performs well in large-scale, high-density single-nucleotide polymorphism microarray studies

As of June 2009, 361 genome-wide association studies (GWAS) had been referenced by the HuGE database. GWAS require DNA from many thousands of individuals, relying on suitable DNA collections. We recently performed a multiple sclerosis (MS) GWAS where a substantial component of the cases (24%) had DNA derived from saliva. Genotyping was done on the Illumina genotyping platform using the Infinium Hap370CNV DUO microarray. Additionally, we genotyped 10 individuals in duplicate using both saliva- and blood-derived DNA. The performance of blood- versus saliva-derived DNA was compared using genotyping call rate, which reflects both the quantity and quality of genotyping per sample and the “GCScore,” an Illumina genotyping quality score, which is a measure of DNA quality. We also compared genotype calls and GCScores for the 10 sample pairs. Call rates were assessed for each sample individually. For the GWAS samples, we compared data according to source of DNA and center of origin. We observed high concordance in genotyping quality and quantity between the paired samples and minimal loss of quality and quantity of DNA in the saliva samples in the large GWAS sample, with the blood samples showing greater variation between centers of origin. This large data set highlights the usefulness of saliva DNA for genotyping, especially in high-density single-nucleotide polymorphism microarray studies such as GWAS.

A large scale quantitative study of pedestrian railway level crossing behaviour : deliberate violations, errors and deterrence

Every year a number of pedestrians are struck by trains resulting in death and serious injury. While much research has been conducted on train-vehicle collisions, very little is currently known about the aetiology of train-pedestrian collisions. To date, scant research has been undertaken to investigate the demographics of rule breakers, the frequency of deliberate violation versus error making and the influence of the classic deterrence approach on subsequent behaviours. Aim This study aimed to to identify pedestrians’ self-reported reasons for engaging in violations at crossing, the frequency and nature of rule breaking and whether the threat of sanctions influence such events. Method A questionnaire was administered to 511 participants of all ages. Results Analysis revealed that pedestrians (particularly younger groups) were more likely to commit deliberate violations rather than make crossing errors e.g., mistakes. The most frequent reasons given for deliberate violations were participants were running late and did not want to miss their train or participants believed that the gate was taking too long to open so may be malfunctioning. In regards to classical deterrence, an examination of the perceived threat of being apprehended and fined for a crossing violation revealed participants reported the highest mean scores for swiftness of punishment, which suggests they were generally aware that they would receive an “on the spot” fine. However, the overall mean scores for certainty and severity of sanctions (for violating the rules) indicate that the participants did not perceive the certainty and severity of sanctions as very high. This paper will further discuss the research findings in regards to the development of interventions designed to improve pedestrian crossing safety.