Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit : a literature review

BACKGROUND: Studies have shown that nurse staffing levels, among many other factors in the hospital setting, contribute to adverse patient outcomes. Concerns about patient safety and quality of care have resulted in numerous studies being conducted to examine the relationship between nurse staffing levels and the incidence of adverse patient events in both general wards and intensive care units. AIM: The aim of this paper is to review literature published in the previous 10 years which examines the relationship between nurse staffing levels and the incidence of mortality and morbidity in adult intensive care unit patients. METHODS: A literature search from 2002 to 2011 using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Australian digital thesis databases was undertaken. The keywords used were: intensive care; critical care; staffing; nurse staffing; understaffing; nurse-patient ratios; adverse outcomes; mortality; ventilator-associated pneumonia; ventilator-acquired pneumonia; infection; length of stay; pressure ulcer/injury; unplanned extubation; medication error; readmission; myocardial infarction; and renal failure. A total of 19 articles were included in the review. Outcomes of interest are patient mortality and morbidity, particularly infection and pressure ulcers. RESULTS: Most of the studies were observational in nature with variables obtained retrospectively from large hospital databases. Nurse staffing measures and patient outcomes varied widely across the studies. While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies concluded that a trend exists between increased nurse staffing levels and decreased adverse events. CONCLUSION: While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies demonstrated a trend between increased nurse staffing levels and decreased adverse patient outcomes in the intensive care unit which is consistent with previous literature. While further more robust research methodologies need to be tested in order to more confidently demonstrate this association and decrease the influence of the many other confounders to patient outcomes; this would be difficult to achieve in this field of research.

Continuum mechanics modelling of microfilament networks with different architectures based on molecular investigation of single F-actin

The actin microfilament plays a critical role in many cellular processes including embryonic development, wound healing, immune response, and tissue development. It is commonly organized in the form of networks whose mechanical properties change with changes in their architecture due to cell evolution processes. This paper presents a new nonlinear continuum mechanics model of single filamentous actin (F-actin) that is based on nanoscale molecular simulations. Following this continuum model of the single F-actin, mechanical properties of differently architected lamellipodia are studied. The results provide insight that can contribute to the understanding of the cell edge motions of living cells.

Behavioral biometrics for persistent single sign-on

Driven by the rapid development of ubiquitous and pervasive computing, personalized services and applications are deployed to support our lives. Accordingly, the number of interfaces and devices (smartphone, tablet computer, etc.) provided to access and consume these services is growing continuously. To simplify the complexity of managing many accounts with different credentials, Single Sign-On (SSO) solutions have been introduced. However, a single password for many accounts represents a single-point-of-failure. Furthermore, once initiated SSO session is a high potential risk when the working station is left unlocked and unattended. In this paper, we present a conception of a Persistent Single Sign-On (PSSO) for ubiquitous home environments by involving the capabilities of Behavioral Biometrics to check the identity of the user continuously in an unobtrusive manner.

Peer assisted learning, skills development and Generation Y : a case study of a first year undergraduate law unit

The majority of current first year university students belong to Generation Y. Consequently, research suggests that, in order to more effectively engage them, their particular learning preferences should be acknowledged in the organisation of their learning environments and in the support provided. These preferences are reflected in the Torts Student Peer Mentor Program, which, as part of the undergraduate law degree at the Queensland University of Technology, utilises active learning, structured sessions and teamwork to supplement student understanding of the substantive law of Torts with the development of life-long skills. This article outlines the Program, and its relevance to the learning styles and experiences of Generation Y first year law students transitioning to university, in order to investigate student perceptions of its effectiveness – both generally and, more specifically, in terms of the Program’s capacity to assist students to develop academic and work-related skills.

Exponential integrators and a dual-scale model for wood drying

For the timber industry, the ability to simulate the drying of wood is invaluable for manufacturing high quality wood products. Mathematically, however, modelling the drying of a wet porous material, such as wood, is a diffcult task due to its heterogeneous and anisotropic nature, and the complex geometry of the underlying pore structure. The well{ developed macroscopic modelling approach involves writing down classical conservation equations at a length scale where physical quantities (e.g., porosity) can be interpreted as averaged values over a small volume (typically containing hundreds or thousands of pores). This averaging procedure produces balance equations that resemble those of a continuum with the exception that effective coeffcients appear in their deffnitions. Exponential integrators are numerical schemes for initial value problems involving a system of ordinary differential equations. These methods differ from popular Newton{Krylov implicit methods (i.e., those based on the backward differentiation formulae (BDF)) in that they do not require the solution of a system of nonlinear equations at each time step but rather they require computation of matrix{vector products involving the exponential of the Jacobian matrix. Although originally appearing in the 1960s, exponential integrators have recently experienced a resurgence in interest due to a greater undertaking of research in Krylov subspace methods for matrix function approximation. One of the simplest examples of an exponential integrator is the exponential Euler method (EEM), which requires, at each time step, approximation of φ(A)b, where φ(z) = (ez - 1)/z, A E Rnxn and b E Rn. For drying in porous media, the most comprehensive macroscopic formulation is TransPore [Perre and Turner, Chem. Eng. J., 86: 117-131, 2002], which features three coupled, nonlinear partial differential equations. The focus of the first part of this thesis is the use of the exponential Euler method (EEM) for performing the time integration of the macroscopic set of equations featured in TransPore. In particular, a new variable{ stepsize algorithm for EEM is presented within a Krylov subspace framework, which allows control of the error during the integration process. The performance of the new algorithm highlights the great potential of exponential integrators not only for drying applications but across all disciplines of transport phenomena. For example, when applied to well{ known benchmark problems involving single{phase liquid ow in heterogeneous soils, the proposed algorithm requires half the number of function evaluations than that required for an equivalent (sophisticated) Newton{Krylov BDF implementation. Furthermore for all drying configurations tested, the new algorithm always produces, in less computational time, a solution of higher accuracy than the existing backward Euler module featured in TransPore. Some new results relating to Krylov subspace approximation of '(A)b are also developed in this thesis. Most notably, an alternative derivation of the approximation error estimate of Hochbruck, Lubich and Selhofer [SIAM J. Sci. Comput., 19(5): 1552{1574, 1998] is provided, which reveals why it performs well in the error control procedure. Two of the main drawbacks of the macroscopic approach outlined above include the effective coefficients must be supplied to the model, and it fails for some drying configurations, where typical dual{scale mechanisms occur. In the second part of this thesis, a new dual{scale approach for simulating wood drying is proposed that couples the porous medium (macroscale) with the underlying pore structure (microscale). The proposed model is applied to the convective drying of softwood at low temperatures and is valid in the so{called hygroscopic range, where hygroscopically held liquid water is present in the solid phase and water exits only as vapour in the pores. Coupling between scales is achieved by imposing the macroscopic gradient on the microscopic field using suitably defined periodic boundary conditions, which allows the macroscopic ux to be defined as an average of the microscopic ux over the unit cell. This formulation provides a first step for moving from the macroscopic formulation featured in TransPore to a comprehensive dual{scale formulation capable of addressing any drying configuration. Simulation results reported for a sample of spruce highlight the potential and flexibility of the new dual{scale approach. In particular, for a given unit cell configuration it is not necessary to supply the effective coefficients prior to each simulation.

A vibrational spectroscopic study of the phosphate mineral cyrilovite Na(Fe3+)3(PO4)2(OH)4·2(H2O) and in comparison with wardite

Vibrational spectroscopy enables subtle details of the molecular structure of cyrilovite to be determined. Single crystals of a pure phase from a Brazilian pegmatite were used. Cyrilovite is the Fe3+ member of the wardite group. The infrared and Raman spectroscopy were applied to compare the structure of cyrilovite with that of wardite. The Raman spectrum of cyrilovite in the 800–1400 cm−1 spectral range shows two intense bands at 992 and 1055 cm−1 assigned to the ν1View the MathML source symmetric stretching vibrations. A series of low intensity bands at 1105, 1136, 1177 and 1184 cm−1 are assigned to the ν3View the MathML source antisymmetric stretching modes. The infrared spectrum of cyrilovite in the 500–1300 cm−1 shows much greater complexity than the Raman spectrum. Strong infrared bands are found at 970 and 1007 cm−1 and are attributed to the ν1View the MathML source symmetric stretching mode. Raman bands are observed at 612 and 631 cm−1 and are assigned to the ν4 out of plane bending modes of the View the MathML source unit. In the 2600–3800 cm−1 spectral range, intense Raman bands for cyrilovite are found at 3328 and 3452 cm−1 with a broad shoulder at 3194 cm−1 and are assigned to OH stretching vibrations. Sharp infrared bands are observed at 3485 and 3538 cm−1. Raman spectroscopy complimented with infrared spectroscopy has enabled the structure of cyrilovite to be ascertained and compared with that of wardite.

C-BN Single-Walled Nanotubes from Hybrid Connection of BN/C Nanoribbons: Prediction by ab initio Density Functional Calculations

We demonstrated for the first time by ab initio density functional calculation and molecular dynamics simulation that C0.5(BN)0.5 armchair single-walled nanotubes (NT) are gapless semiconductors and can be spontaneously formed via the hybrid connection of graphene/BN Nanoribbons (GNR/BNNR) at room temperature. The direct synthesis of armchair C0.5(BN)0.5 via the hybrid connection of GNR/BNNR is predicted to be both thermodynamically and dynamically stable. Such novel armchair C0.5(BN)0.5 NTs possess enhanced conductance as that observed in GNRs. Additionally, the zigzag C0.5(BN)0.5 SWNTs are narrow band gap semiconductors, which may have potential application for light emission. In light of recent experimental progress and the enhanced degree of control in the synthesis of GNRs and BNNR, our results highlight an interesting avenue for synthesizing a novel specific type of C0.5(BN)0.5 nanotube (gapless or narrow direct gap semiconductor), with potentially important applications in BNC-based nanodevices.

Formation of single-walled carbon nanotube via the interaction of graphene nanoribbons : ab initio density functional calculations

The interaction of bare graphene nanoribbons (GNRs) was investigated by ab initio density functional theory calculations with both the local density approximation (LDA) and the generalized gradient approximation (GGA). Remarkably, two bare 8-GNRs with zigzag-shaped edges are predicted to form an (8, 8) armchair single-wall carbon nanotube (SWCNT) without any obvious activation barrier. The formation of a (10, 0) zigzag SWCNT from two bare 10-GNRs with armchair-shaped edges has activation barriers of 0.23 and 0.61 eV for using the LDA and the revised PBE exchange correlation functional, respectively, Our results suggest a possible route to control the growth of specific types SWCNT via the interaction of GNRs.

Distributed data acquisition unit with microsecond-accurate wireless clock synchronisation

This paper describes the implementation of the first portable, embedded data acquisition unit (BabelFuse) that is able to acquire and timestamp generic sensor data and trigger General Purpose I/O (GPIO) events against a microsecond-accurate wirelessly-distributed ‘global’ clock. A significant issue encountered when fusing data received from multiple sensors is the accuracy of the timestamp associated with each piece of data. This is particularly important in applications such as Simultaneous Localisation and Mapping (SLAM) where vehicle velocity forms an important part of the mapping algorithms; on fast-moving vehicles, even millisecond inconsistencies in data timestamping can produce errors which need to be compensated for. The timestamping problem is compounded in a robot swarm environment especially if non-deterministic communication hardware (such as IEEE-802.11-based wireless) and inaccurate clock synchronisation protocols are used. The issue of differing timebases makes correlation of data difficult and prevents the units from reliably performing synchronised operations or manoeuvres. By utilising hardware-assisted timestamping, clock synchronisation protocols based on industry standards and firmware designed to minimise indeterminism, an embedded data acquisition unit capable of microsecond-level clock synchronisation is presented.

Performance comparison of four power system stabilizer

The well-known power system stabilizer (PSS) is used to generate supplementary control signals for the excitation system of a generator so as to damp low frequency oscillations in the power system concerned. Up to now, various kinds of PSS design methods have been proposed and some of them applied in actual power systems with different degrees. Given this background, the small-disturbance eigenvalue analysis and large-disturbance dynamic simulations in the time domain are carried out to evaluate the performances of four different PSS design methods, including the Conventional PSS (CPSS), Single-Neuron PSS (SNPSS), Adaptive PSS (APSS) and Multi-band PSS (MBPSS). To make the comparisons equitable, the parameters of the four kinds of PSSs are all determined by the steepest descent method. Finally, an 8-unit 24-bus power system is employed to demonstrate the performances of the four kinds of PSSs by the well-established eigenvalue analysis as well as numerous digital simulations, and some useful conclusions obtained.

A prospective observational study of patient positioning in a Saudi intensive care unit

Aim: To describe the positioning of patients managed in an intensive care unit (ICU); assess how frequently these patients were repositioned; and determine if any specific factors influenced how, why or when patients were repositioned in the ICU. Background: Alterations in body position of ICU patients are important for patient comfort and are believed to prevent and/or treat pressure ulcers, improve respiratory function and combat the adverse effects of immobility. There is a paucity of research on the positioning of critically ill patients in Saudi Arabian ICUs. Design and Methods: A prospective observational study was undertaken. Participant demographic data were collected as were clinical factors (i.e. ventilation status, primary diagnosis, co-morbidities and Ramsay sedation score) and organizational factors (i.e. time of day, type of mattress or beds used, nurse/patient ratio and the patient's position). Clinical and some organization data were recorded over a continuous 48 hour period. Result: Twenty-eight participants were recruited to the study. No participant was managed in either a flat or prone position. Obese participants were most likely to be managed in a supine position. The mean time between turns was two hours. There was no significant association between the mean time between turns and the recorded variables related to patients' demographic and organizational considerations. Conclusion: Results indicate that patient positioning in the ICU was a direct result of unit policy - it appeared that patients were not repositioned based upon evaluation of their clinical condition but rather according to a two-hour ICU timetable

Pressure ulcers in the adult intensive care unit : a literature review of patient risk factors and risk assessment scales

Background: Critically ill patients are at high risk for pressure ulcer (PrU) development due to their high acuity and the invasive nature of the multiple interventions and therapies they receive. With reported incidence rates of PrU development in the adult critical care population as high as 56%, the identification of patients at high risk of PrU development is essential. This paper will explore the association between PrU development and risk factors. It will also explore PrU development and the use of risk assessment scales for critically ill patients in adult intensive care units. Method: A literature search from 2000 to 2012 using the CINHAL, Cochrane Library, EBSCOHost, Medline (via EBSCOHost), PubMed, ProQuest and Google Scholar databases was conducted. Key words used were: pressure ulcer/s; pressure sore/s; decubitus ulcer/s; bed sore/s; critical care; intensive care; critical illness; prevalence; incidence; prevention; management; risk factor; risk assessment scale. Results: Nineteen articles were included in this review; eight studies addressing PrU risk factors, eight studies addressing risk assessment scales and three studies overlapping both. Results from the studies reviewed identified 28 intrinsic and extrinsic risk factors which may lead to PrU development. Development of a risk factor prediction model in this patient population, although beneficial, appears problematic due to many issues such as diverse diagnoses and subsequent patient needs. Additionally, several risk assessment instruments have been developed for early screening of patients at higher risk of developing PrU in the ICU. No existing risk assessment scales are valid for identification high risk critically ill patient,with the majority of scales potentially over-predicting patients at risk for PrU development. Conclusion: Research studies to inform the risk factors for potential pressure ulcer development are inconsistent. Additionally, there is no consistent or clear evidence which demonstrates any scale to better or more effective than another when used to identify the patients at risk for PrU development. Furthermore robust research is needed to identify the risk factors and develop valid scales for measuring the risk of PrU development in ICU.

An optimized online secondary path modeling method for single-channel feedback ANC systems

This paper proposes a new method for online secondary path modeling in feedback active noise control (ANC) systems. In practical cases, the secondary path is usually time varying. For these cases, online modeling of secondary path is required to ensure convergence of the system. In literature the secondary path estimation is usually performed offline, prior to online modeling, where in the proposed system there is no need for using offline estimation. The proposed method consists of two steps: a noise controller which is based on an FxLMS algorithm, and a variable step size (VSS) LMS algorithm which is used to adapt the modeling filter with the secondary path. In order to increase performance of the algorithm in a faster convergence and accurate performance, we stop the VSS-LMS algorithm at the optimum point. The results of computer simulation shown in this paper indicate effectiveness of the proposed method.

Nutritional analysis of gastric contents and body condition score at a single time point in feral horses in Australia

Objective: To determine the impact of a free-choice diet on nutritional intake and body condition of feral horses. Animals: Cadavers of 41 feral horses from 5 Australian locations. Procedures: Body condition score (BCS) was determined (scale of 1 to 9), and the stomach was removed from horses during postmortem examination. Stomach contents were analyzed for nutritional variables and macroelement and microelement concentrations. Data were compared among the locations and also compared with recommended daily intakes for horses. Results: Mean BCS varied by location; all horses were judged to be moderately thin. The BCS for males was 1 to 3 points higher than that of females. Amount of protein in the stomach contents varied from 4.3% to 14.9% and was significantly associated with BCS. Amounts of water-soluble carbohydrate and ethanol-soluble carbohydrate in stomach contents of feral horses from all 5 locations were higher than those expected for horses eating high-quality forage. Some macroelement and microelement concentrations were grossly excessive, whereas others were grossly deficient. There was no evidence of ill health among the horses. Conclusions and Clinical Relevance: Results suggested that the diet for several populations of feral horses in Australia appeared less than optimal. However, neither low BCS nor trace mineral deficiency appeared to affect survival of the horses. Additional studies on food sources in these regions, including analysis of water-soluble carbohydrate, ethanol-soluble carbohydrate, and mineral concentrations, are warranted to determine the provenance of such rich sources of nutrients. Determination of the optimal diet for horses may need revision.

How similar are two-unit bicycle and motorcycle crashes?

This paper explores the similarities and differences between bicycle and motorcycle crashes with other motor vehicles. If similar treatments can be effective for both bicycle and motorcycle crashes, then greater benefits in terms crash costs saved may be possible for the same investment in treatments. To reduce the biases associated with under-reporting of these crashes to police, property damage and minor injury crashes were excluded. The most common crash type for both bicycles (31.1%) and motorcycles (24.5%) was intersection from adjacent approaches. Drivers of other vehicles were coded most at fault in the majority of two-unit bicycle (57.0%) and motorcycle crashes (62.7%). The crash types, patterns of fault and factors affecting fault were generally similar for bicycle and motorcycle crashes. This confirms the need to combat the factors contributing to failure of other drivers to yield right of way to two-wheelers, and suggest that some of these actions should prove beneficial to the safety of both motorized and non-motorized two-wheelers. In contrast, child bicyclists were more often at fault, particularly in crashes involving a vehicle leaving the driveway or footpath. The greater reporting of violations by riders and drivers in motorcycle crashes also deserves further investigation.