Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children

Background Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion, however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. Objectives To assess the clinical effects (benefits and harms) of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Search Methods The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (Issue 3, 2015). We also searched the reference lists of retrieved trials. Selection criteria Randomised controlled trials that compared the efficacy of normal saline with heparin to prevent occlusion of long term CVCs in infants and children aged up to 18 years of age were included. We excluded temporary CVCs and peripherally inserted central catheters (PICC). Data Collection and Analysis Two review authors independently assessed trial inclusion criteria, trial quality and extracted data. Rate ratios were calculated for two outcome measures - occlusion of the CVC and central line-associated blood stream infection. Other outcome measures included duration of catheter placement, inability to withdraw blood from the catheter, use of urokinase or recombinant tissue plasminogen, incidence of removal or re-insertion of the catheter, or both, and other CVC-related complications such as dislocation of CVCs, other CVC site infections and thrombosis. Main Results Three trials with a total of 245 participants were included in this review. The three trials directly compared the use of normal saline and heparin, however, between studies, all used different protocols for the standard and experimental arms with different concentrations of heparin and different frequency of flushes reported. In addition, not all studies reported on all outcomes. The quality of the evidence ranged from low to very low because there was no blinding, heterogeneity and inconsistency between studies was high and the confidence intervals were wide. CVC occlusion was assessed in all three trials (243 participants). We were able to pool the results of two trials for the outcomes of CVC occlusion and CVC-associated blood stream infection. The estimated rate ratio for CVC occlusion per 1000 catheter days between the normal saline and heparin group was 0.75 (95% CI 0.10 to 5.51, two studies, 229 participants, very low quality evidence). The estimated rate ratio for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37, two studies, 231 participants; low quality evidence). The duration of catheter placement was reported to be similar between the two study arms, in one study (203 participants). Authors' Conclusions The review found that there was not enough evidence to determine the effects of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Ultimately, if this evidence were available, the development of evidenced-based clinical practice guidelines and consistency of practice would be facilitated.

Using Web2.0 applications to close the digital divide in Western Australia

The research reported in this paper documents the use of Web2.0 applications with six Western Australian schools that are considered to be regional and/or remote. With a population of two million people within an area of 2,525,500 square kilometres Western Australia has a number of towns that are classified as regional and remote. Each of the three education systems have set up telecommunications networks to improve learning opportunities for students and administrative services for staff through a virtual private network (VPN) with access from anywhere, anytime and ultimately reduce the feeling of professional and social dislocation experienced by many teachers and students in the isolated communities. By using Web2.0 applications including video conferencing there are enormous opportunities to close the digital divide within the broad directives of the Networking the Nation plan. The Networking the Nation plan aims to connect all Australians regardless of where they are hence closing the digital divide between city and regional living. Email and Internet facilities have greatly improved in rural, regional and remote areas supporting every day school use of the Internet. This study highlights the possibilities and issues for advanced telecommunications usage of Web2.0 applications discussing the research undertaken with these schools. (Contains 1 figure and 3 tables.)

Web 2.0 technology: Social learning tools in higher education in Saudi Arabia

Information and communication technology (ICT) has created opportunities for students' online interaction in higher education throughout the world. Limited research has been done in this area in Saudi Arabia. This study investigated university students' engagement and perceptions of online collaborative learning using Social Learning Tools (SLTs). In addition, it explored the quality of knowledge construction that occurred in this environment. A mixed methods case study approach was adopted, and the data was gathered from undergraduate students (n=43) who were enrolled in a 15-week course at a Saudi university. The results showed that while the students had positive perceptions towards SLTs and their engagement, data gathered from their work also showed little evidence of high levels of knowledge construction.

Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children: A systematic review

Background Around the world, guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) vary greatly. To prevent occlusion, most institutions recommend the use of heparin when the CVC is not in use. However, there is debate regarding the need for heparin and evidence to suggest normal saline may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased costs. Objectives To assess the clinical effects (benefits and harms) of heparin versus normal saline to prevent occlusion in long-term central venous catheters in infants, children and adolescents. Design A Cochrane systematic review of randomised controlled trials was undertaken. - Data sources: The Cochrane Vascular Group Specialised Register (including MEDLINE, CINAHL, EMBASE and AMED) and the Cochrane Register of Studies were searched. Hand searching of relevant journals and reference lists of retrieved articles was also undertaken. - Review Methods: Data were extracted and appraisal undertaken. We included studies that compared the efficacy of normal saline with heparin to prevent occlusion. We excluded temporary CVCs and peripherally inserted central catheters. Rate ratios per 1000 catheter days were calculated for two outcomes, occlusion of the CVC, and CVC-associated blood stream infection. Results Three trials with a total of 245 participants were included in this review. The three trials directly compared the use of normal saline and heparin. However, between studies, all used different protocols with various concentrations of heparin and frequency of flushes. The quality of the evidence ranged from low to very low. The estimated rate ratio for CVC occlusion per 1000 catheter days between the normal saline and heparin group was 0.75 (95% CI 0.10 to 5.51, two studies, 229 participants, very low quality evidence). The estimated rate ratio for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37, two studies, 231 participants; low quality evidence). Conclusions It remains unclear whether heparin is necessary for CVC maintenance. More well-designed studies are required to understand this relatively simple, but clinically important question. Ultimately, if this evidence were available, the development of evidenced-based clinical practice guidelines and consistency of practice would be facilitated.

VIBRANTe 2.0

ARTIST STATEMENT VIBRANTe 2.0 was inspired by a research project for Parkinson’s disease patients aimed at developing a wearable device to collect relevant data for patients and medical health professionals. Vibrante is a Spanish word that translates to vibrant; literally meaning shaking or vibrations. Vibrante also has a dual meaning including vibrancy, energy, activity, and liveliness. Parkinson’s can be a debilitating disease, but it does not mean the person has to lose energy, activeness or vibrancy. As technology moves from being worn to becoming implantable and completely hidden within the body, the very notion of its physicality becomes difficult to grasp. While the human body hides implantable technology, VIBRANTe 2.0 intentionally hides the human body by making it invisible to reveal the technology stitched within. Wires become veins, delivering lifeblood to the technology inside, allowing it to pulsate and exist, while motherboards become networked hubs by which information is transferred through and within the body, performing functions that mirror and often surpass human performance capabilities. Ultimately, VIBRANTe 2.0 seeks to prompt the viewer to reflect on the potential ramifications of the complete immersion of technology into the human body. CONTEXT Technology is increasingly penetrating all aspects of our environment, and the rapid uptake of devices that live near, on or in our bodies is facilitating radical new ways of working, relating and socialising. Such technology, with its capacity to generate previously unimaginable levels of data, offers the potential to provide life-augmenting levels of interactivity. However, the absorption of technology into the very fabric of clothes, accessories and even bodies begins to dilute boundaries between physical, technological and social spheres, generating genuine ethical and privacy concerns and potentially having implications for human evolution. Embedding technology into the fabric of our clothes, accessories, and even the body enable the acquisition of and the connection to vast amounts of data about people and environments in order to provide life-augmenting levels of interactivity. Wearable sensors for example, offer the potential for significant benefits in the future management of our wellbeing. Fitness trackers such as ‘Fitbit’ and ‘Garmen’ provide wearers with the ability to monitor their personal fitness indicators while other wearables provide healthcare professionals with information that improves diagnosis and observation of medical conditions. This exhibition aimed to illustrate this shifting landscape through a selection of experimental wearable and interactive works by local, national and international artists and designers. The exhibition will also provide a platform for broader debate around wearable technology, our mediated future-selves and human interactions in this future landscape. EXHIBITION As part of Artisan’s Wearnext exhibition, the work was on public display from 25 July to 7 November 2015 and received the following media coverage: [Please refer to Additional URLs]

Sinteractivity, proton conductivity and chemical stability of BaZr 0.7In0.3O3-δ for solid oxide fuel cells (SOFCs)

In3+ was used as dopant for BaZrO3 proton conductor and 30 at%-doped BaZrO3 samples (BaZr0.7In 0.3O3-δ, BZI) were prepared as electrolyte materials for proton-conducting solid oxide fuel cells (SOFCs). The BZI material showed a much improved sinteractivity compared with the conventional Y-doped BaZrO 3. The BZI pellets reached almost full density after sintering at 1600 °C for 10 h, whereas the Y-doped BaZrO3 samples still remained porous under the same sintering conditions. The conductivity measurements indicated that BZI pellets showed smaller bulk but improved grain boundary proton conductivity, when compared with Y-doped BaZrO3 samples. A total proton conductivity of 1.7 × 10-3 S cm -1 was obtained for the BZI sample at 700 °C in wet 10% H 2 atmosphere. The BZI electrolyte material also showed adequate chemical stability against CO2 and H2O, which is promising for application in fuel cells.

Techno Teacher Moms: Web 2.0 Connecting Mothers in the Home Education Community

Home education is on the rise in Australia. However, unlike parents who choose mainstream schooling, these parents often lack the support of a wider community to help them on their educational and parenting journey. This support is especially lacking as many people in the wider community find the choice to home education confronting. As such, these parents may feel isolated and alienated in the general population as their choice to home educate is questioned at best, and ridiculed at worst. These parents often find sanctuary online in homeschool groups on Facebook. This chapter explores the ways that Facebook Groups are used by marginalized and disenfranchised families who home educate to meet with others who are likeminded and aligned with their beliefs and philosophies. It is through these groups that parents, in relation to schooling it is especially mothers, are able to ask for advice, to vent, to explore options and find connections that may be lacking in the wider community.