Patient comfort in the intensive care unit : a multicentre, binational point prevalence study of analgesia, sedation and delirium management

Objective: To measure the prevalence of assessment and management practices for analgesia, sedation and delirium in patients in Australian and New Zealand intensive care units.
Materials and Methods: We developed survey items from a modified Delphi panel and included them in a binational, point prevalence study. We used a standard case report form to capture retrospective patient data on management of analgesia, sedation and delirium at the end of a 4-hour period on the study day. Other data were collected during independent assessment of patient status and medication requirements.
Results: Data were collected on 569 patients in 41 ICUs. Pain assessment was documented in the 4 hours before study observation in 46% of patients. Of 319 assessable patients, 16% had moderate pain and 6% had severe pain. Routine sedation assessment using a scale was recorded in 63% of intubated and ventilated patients. When assessed, 38% were alert and calm, or drowsy and rousable, 22% were lightly to moderately sedated, 31% were deeply sedated (66% of these had a documented indication), and 9% were agitated or restless. Sedatives were titrated to a target level in 42% of patients. Routine assessment of delirium occurred in 3%, and at study assessment 9% had delirium. Wrist or arm restraints were used for 7% of patients.
Conclusions: Only two-thirds of sedated patients had their sedation levels formally assessed, half had pain assessed and very few had formal assessment of delirium. Our description of current practices, and other observational data, may help in planning further research in this area.

Comparative study of mental model research methods : relationships among ACSMM, SMD, MITOCAR & deep methodologies

Measuring and assessing mental models of individuals and teams requires the capturing and analysis of key latent variables. This paper presents and compares four different research methods (ACSMM, SMD, MITOCAR and DEEP) that capture and create a conceptual representation of individual and team mental models. These methods use qualitative and quantitative techniques to investigate a single comparison of different groups or individuals' mental models with another group's mental model or to investigate the comparison of a group or individuals' mental model with themselves at a later time

A review of sedation scales for the cardiac catheterization laboratory.

Sedation scales have the potential to facilitate effective procedural sedation and analgesia in the cardiac catheterization laboratory (CCL). For this potential to become realized, a scale that is suitable for use in the CCL either needs to be identified or developed.

RF rectifiers for EM power harvesting in a deep brain stimulating device

A passive deep brain stimulation (DBS) device can be equipped with a rectenna, consisting of an antenna and a rectifier, to harvest energy from electromagnetic fields for its operation. This paper presents optimization of radio frequency rectifier circuits for wireless energy harvesting in a passive head-mountable DBS device. The aim is to achieve a compact size, high conversion efficiency, and high output voltage rectifier. Four different rectifiers based on the Delon doubler, Greinacher voltage tripler, Delon voltage quadrupler, and 2-stage charge pumped architectures are designed, simulated, fabricated, and evaluated. The design and simulation are conducted using Agilent Genesys at operating frequency of 915 MHz. A dielectric substrate of FR-4 with thickness of 1.6 mm, and surface mount devices (SMD) components are used to fabricate the designed rectifiers. The performance of the fabricated rectifiers is evaluated using a 915 MHz radio frequency (RF) energy source. The maximum measured conversion efficiency of the Delon doubler, Greinacher tripler, Delon quadrupler, and 2-stage charge pumped rectifiers are 78, 75, 73, and 76 % at -5 dBm input power and for load resistances of 5-15 kΩ. The conversion efficiency of the rectifiers decreases significantly with the increase in the input power level. The Delon doubler rectifier provides the highest efficiency at both -5 and 5 dBm input power levels, whereas the Delon quadrupler rectifier gives the lowest efficiency for the same inputs. By considering both efficiency and DC output voltage, the charge pump rectifier outperforms the other three rectifiers. Accordingly, the optimised 2-stage charge pumped rectifier is used together with an antenna to harvest energy in our DBS device.

Rigs-to-reefs: Will the deep sea benefit from artificial habitat?

As a peak in the global number of offshore oil rigs requiring decommissioning approaches, there is growing pressure for the implementation of a "rigs-to-reefs" program in the deep sea, whereby obsolete rigs are converted into artificial reefs. Such decommissioned rigs could enhance biological productivity, improve ecological connectivity, and facilitate conservation/restoration of deep-sea benthos (eg cold-water corals) by restricting access to fishing trawlers. Preliminary evidence indicates that decommissioned rigs in shallower waters can also help rebuild declining fish stocks. Conversely, potential negative impacts include physical damage to existing benthic habitats within the "drop zone", undesired changes in marine food webs, facilitation of the spread of invasive species, and release of contaminants as rigs corrode. We discuss key areas for future research and suggest alternatives to offset or minimize negative impacts. Overall, a rigs-to-reefs program may be a valid option for deep-sea benthic conservation. © The Ecological Society of America.

Closed loop deep brain stimulation: an evolving technology

Deep brain stimulation is an effective and safe medical treatment for a variety of neurological and psychiatric disorders including Parkinson's disease, essential tremor, dystonia, and treatment resistant obsessive compulsive disorder. A closed loop deep brain stimulation (CLDBS) system automatically adjusts stimulation parameters by the brain response in real time. The CLDBS continues to evolve due to the advancement in the brain stimulation technologies. This paper provides a study on the existing systems developed for CLDBS. It highlights the issues associated with CLDBS systems including feedback signal recording and processing, stimulation parameters setting, control algorithm, wireless telemetry, size, and power consumption. The benefits and limitations of the existing CLDBS systems are also presented. Whilst robust clinical proof of the benefits of the technology remains to be achieved, it has the potential to offer several advantages over open loop DBS. The CLDBS can improve efficiency and efficacy of therapy, eliminate lengthy start-up period for programming and adjustment, provide a personalized treatment, and make parameters setting automatic and adaptive.

Refinement of retained austenite in super-bainitic steel by a deep cryogenic treatment

The effect of a deep cryogenic treatment on the microstructure of a super-bainitic steel was investigated. It was shown that quenching the super-bainitc steel in -196°C liquid nitrogen resulted in the transformation of retained austenite to two phases: ~20 nm thick martensite films and some nano carbides with a ~25 nm diameter. Some refinement of the retained austenite occurred, due to formation of fine martensite laths within the retained austenite. The evolution of these new phases resulted in an increase in the average hardness of the super-bainitic steel from 641 to ~670 HV1. © 2014 ISIJ.