Best practice in stabilisation of oral endotracheal tubes : a systematic review

Mechanical ventilation of patients in intensive care units is common practice. Artificial airways are utilised to facilitate ventilation and the endotracheal tube (ETT) is most commonly used for this purpose. The ETT must be stabilised to optimise ventilation and avoid displacement or unplanned extubation. Tube movement is a major factor in causing airway trauma. A destabilised tube can cause fatal complications. A systematic review was conducted to identify and analyse the best available evidence on ETT stabilisation to determine which stabilisation method resulted in reduced tube displacement and the least amount of unplanned or accidental extubations. The types of stabilisations included one or a combination of the following methods: twill or cotton tape, adhesive tape, gauze, or a manufactured device. All relevant randomised controlled and quasi-experimental studies of ETT stabilisation practices, identified through electronic and hand searching, were assessed for inclusion in the study. One published randomised controlled trial and six published quasi-experimental studies met the inclusion and exclusion criteria and were retrieved. Data were extracted independently by two reviewers. Results of the systematic review showed that no single method of ETT stabilisation could be identified as superior for minimising tube displacement and unplanned or accidental extubations. Rigorous randomised controlled trials with clearly identified and described ETT stabilisation methods are required to establish best practice. In addition, comparative research to evaluate cost effectiveness and nursing time requirements would also be of significant benefit to critical care nursing practice.

The stabilisation of ego identifications in psychosis

The paper discusses the stabilisation of psychotic fragmentation which can occur in psychoanalytic treatments of patients with psychosis. The paper examines the writing practice of James Joyce with reference to its construction of Joyce as the artist and the manner in which he uses his continuous writing practice to inscribe himself and his name into literary history. The clinical significance of this practice is examined according to the theory of writing as a stabilising symptom, drawing on the work of Jacques Lacan in his later seminars.

In situ stabilisation of pavements using cementitious binders

An extensive study was made of the physical properties of a range of cementitiously stabilised materials to determine their suitability for use in in situ pavement construction. This process for recycling existing pavements has considerable environmental and cost benefits. Pavement models incorporating these materials were analysed to determine their structural behaviour.

Stabilisation of brown coal fly ash using geopolymers

This research explores geopolymer technology as a means of stabilising fly ash from power stations. By controlling the synthesis process, geopolymeric materials incorporating fly ash were synthesised. Successful stabilisation of strontium and barium was achieved, though attributed to side reactions. The geopolymer did not contribute significantly to stabilisation of fly ash.

Surface coverage of filter medium in deep bed filtration : mathematical modelling and experiments

This paper highlights the importance of surface coverage in modeling the removal of particles in deep bed filtration. A model that considers the saturation of sites on which particle deposition occurs is used. Experimental results obtained with monodispersed suspensions of 0.46 and 0.816 μm latex particles at different influent concentrations and ionic strengths were used to calculate the fraction of filter grain surface (β1) on which actual particle deposition occurs. This will be useful in evaluating the filter performance in terms of the utilization of available surface area of the filter medium. Further, the level of dendrite formation of particles on filter grains during filtration is expressed in terms of β1 and the specific surface coverage, θT (the fraction of a filter grain surface that is covered by particles at time T, assuming that the filter grain is covered by a monolayer of particles). This can be used to compare the contribution of deposited particles in the removal efficiency of deep bed filtration for suspensions with different physical and chemical characteristics.

Mathematical modelling of downflow floating medium filter (DFF) with in-line flocculation arrangement

A laboratory-scale set-up consisting of rapid mixing device and floating medium filter was used to study the use of a downflow floating medium filter (DFF) with an in-line flocculation arrangement as a static flocculator and a prefilter. The semi-empirical mathematical model formulated incorporates flocculation within the filter, particle/floc attachment onto the filter and the detachment of flocs from the medium. The mathematical model for filtration takes into account the expansion of the filter bed. The removal efficiency of DFF and headless development were successfully simulated for different conditions of filtration velocity, filter depth and influent suspended solids (SS). The values of attachment coefficient a(p)β and headless coefficient β1 were found to be independent of filtration velocity, filter depth and influent SS concentration.

High technology nanocomposite fibres: Development of melt spun semi-aromatic polyamide nanocomposite fibres

Novel polyamide nanocomposite fibres have been produced by compounding semi aromatic Poly (m-xylene adipamide) (MXD6) and organophilic Montmorillonite (MMT). Partially orientated fibres (POF) of MXD6 nanocomposite were obtained by melt spinning on a multifilament fibre extrusion system at three different speeds. The effect of the drawing velocity
on the mechanical properties of the filaments has been determined. Tensile measurements indicated that the introduction of the nanoparticies by melt intercalation improves the tenacity and toughness of the resulting polyamide fibres. The microstructure of the nanocomposites was examined by X-ray diffraction and Transmission Electron Microscope (TEM) and shown to
be an exfoliated disordered structure. The thermal stability of MXD6 nanocomposites was analysed by thermo gravimetric analysis (TGA) suggesting stabilisation of the clay and the polymer systems above 450°C.

Characterisation of Ni–Ti thin films produced by filtered arc deposition

Ti–49.5 at%Ni thin films have been formed by deposition onto Si and glass substrates using a filtered arc deposition system (FADS). The films deposited on glass were composed of nanocrystalline parent phase grains contained within an amorphous matrix. The films deposited onto silicon were crystalline, and were largely parent phase whereas a bulk alloy of the same composition would be expected to be martensite. The stabilisation of the parent phase is proposed to be a grain size effect, with the critical grain size for parent phase stabilisation being about 30 nm.

Investigations into the analytical applications and fundamental chemistry of the chemiluminescent reactions of Tris(2,2'-bipyridyl)ruthenium(III) with certain Papaver Somniferum alkaloids and other related compounds

The reaction of tris(2,2’-bipyridyl)ruthenium(III) (Ru(bipy) ₃³⁺) with various analytes to generate chemiluminescence has been well documented. This investigation sought to undertake a chemiluminometic study of the reactions of Ru(bipy) ₃³⁺ with selected Papaver Somniferum alkaloids and specifically synthesised phenethylamines. The investigation, based on a kinetic study, primarily addressed the effect of varying reaction conditions (pH) on Ru(bipy) ₃³⁺ chemiluminescence production. To monitor these reactions, a batch chemiluminometer was specifically designed, fabricated and automated to conduct an extensive study on the selected compounds of interest. The instrumentation incorporated a custom built reaction cell and comprised an ‘on-line’ sample preparation system with which calibration standards could be automatically prepared. The instrumentation provided both time-independent (peak area) and time-dependent (kinetic profile) information. A novel approach to the stabilisation of Ru(bipy) ₃³⁺ as a chemiluminescencent reagent was also investigated and a recirculating system was employed with the batch chemiluminometer to provide a stable supply of Ru(bipy) ₃³⁺. Codeine, thebaine and 6-methoxy-codeine were the Papaver Somniferum alkaloids selected for this study and several N-methylated and N,N-dimethylated phenethylamines and methoxy-substituted phenetheylamines were also synthesised to investigate the affect of pH on the chemiluminescence emission efficiency. The versatility of the batch chemiluminometer facilitated the kinetic study of numerous analytes over a broad pH range. The exemplary performance of the chemiluminometer as an analytical instrument, was demonstrated by the calibration functions, based on peak area data, which exhibited excellent linearity and sensitivity. The estimated detection limits (3s) for the selected alkaloids were in the range 2 x 10^-9 M to 7 x 10^-9 at pH 5.0 and above, which compared favourably to detection limits for the same compounds determined using FIA. Relative standard deviations (n=5) for peak areas ranged between 1% to 5% with a mean of 3.1% for all calibration standards above 2.5 x 10^-8 M. Correlation between concentration and peak area, irrespective of pH and analyte was excellent, with all but two calibration functions having r-squared values greater than 0.990. The analytical figures of merit exemplified the precision and robustness of the reagent delivery and ‘on-line’ sample preparation, as well as the sensitivity of the system. The employment of the chemiluminometer for the measurement of total chemiluminescence emission (peak area) was in itself a feasible analytical technique, which generated highly reproducible and consistent data. Excellent analytical figures of merit, based on peak area, were similarly achieved for the phenethylamines. The effects of analyte structure on chemiluminescence activity was also investigated for the alkaloids and the phenethylamines. Subtle structural variations between the three alkaloids resulted in either a moderately reduced or enhanced total emission that was two or three fold difference only. A significant difference in reaction kinetics was observed between thebaine and codeine/6-methoxy-codeine, which was dependent upon pH. The time-dependent data, namely the observed rate constants for the initial rise in intensity and for the subsequent decay rate, were obtained by fitting a mathematical function (based on the postulated reaction mechanism) to the raw data. The determination of these rate constants for chemiluminescence reactions highlighted the feasibility for utilising such measurements for quantitative analytical applications. The kinetic data were used to discriminate between analyte responses in order to determine the concentrations of individual analytes in a binary mixture. A preliminary, multi-component investigation performed on a binary mixture of codeine and 6-methoxy-codeine (1:1) successfully determined the concentrations of these individual components using such rate constant measurements. Consequently, variations in kinetics resulted in a significant difference between the relative chemiluminescence response based on peak area measurements and the relative response base on peak height measurements obtained using FIA. With regards to the observed reactivity of secondary amines and tertiary amines, chemiluminescence peak area determinations confirmed the vital role of pH on reaction efficiency, which was governed by structural features and kinetics. The tertiary amines investigated generally produced a greater emission under acidic conditions than the corresponding secondary amines. However, the measured chemiluminescence responses were highly dependent upon pH, with similar peak areas obtained for both amine groups under slightly alkaline conditions.

Optimisation of the microencapsulation of tuna oil in gelatin-sodium hexametaphosphate using complex coacervation.

The microencapsulation of tuna oil in gelatin-sodium hexametaphosphate (SHMP) using complex coacervation was optimised for the stabilisation of omega-3 oils, for use as a functional food ingredient. Firstly, oil stability was optimised by comparing the accelerated stability of tuna oil in the presence of various commercial antioxidants, using a Rancimat™. Then zeta-potential (mV), turbidity and coacervate yield (%) were measured and optimised for complex coacervation. The highest yield of complex coacervate was obtained at pH 4.7 and at a gelatin to SHMP ratio of 15:1. Multi-core microcapsules were formed when the mixed microencapsulation system was cooled to 5 °C at a rate of 12 °C/h. Crosslinking with transglutaminase followed by freeze drying resulted in a dried powder with an encapsulation efficiency of 99.82% and a payload of 52.56%. Some 98.56% of the oil was successfully microencapsulated and accelerated stability using a Rancimat™ showed stability more than double that of non-encapsulated oil.

An embedded two-layer feature selection approach for microarray data analysis

Feature selection is an important technique in dealing with application problems with large number of variables and limited training samples, such as image processing, combinatorial chemistry, and microarray analysis. Commonly employed feature selection strategies can be divided into filter and wrapper. In this study, we propose an embedded two-layer feature selection approach to combining the advantages of filter and wrapper algorithms while avoiding their drawbacks. The hybrid algorithm, called GAEF (Genetic Algorithm with embedded filter), divides the feature selection process into two stages. In the first stage, Genetic Algorithm (GA) is employed to pre-select features while in the second stage a filter selector is used to further identify a small feature subset for accurate sample classification. Three benchmark microarray datasets are used to evaluate the proposed algorithm. The experimental results suggest that this embedded two-layer feature selection strategy is able to improve the stability of the selection results as well as the sample classification accuracy.

Resistive vibration exercise during bed-rest reduces motor control changes in the lumbo-pelvic musculature

To understand the effects of a resistive vibration exercise (RVE) countermeasure on changes in lumbo-pelvic muscle motor control during prolonged bed-rest, 20 male subjects took part in the Berlin Bed-Rest Study (in 2003-2005) and were randomised to a RVE group or an inactive control group. Surface electromyographic signals recorded from five superficial lumbo-pelvic muscles during a repetitive knee movement task. The task, which required stabilisation of the lumbo-pelvic region, was performed at multiple movement speeds and at multiple time points during and after bed-rest. After excluding effects that could be attributed to increases in subcutaneous fat changes and improvements in movement skill, we found that the RVE intervention ameliorated the generalised increases in activity ratios between movement speeds (p⩽0.012), reductions in lumbo-pelvic extensor and flexor co-contraction (p=0.058) and increases in root-mean-square electromyographic amplitude (p=0.001) of the lumbar erector spinae muscles. Effects of RVE on preventing increases in amplitude-modulation (p=0.23) of the lumbar erector spinae muscles were not significant. Few significant changes in activation-timing were seen. The RVE intervention during bed-rest, with indirect loading of the spine during exercise, was capable of reducing some, but not all, motor control changes in the lumbo-pelvic musculature during and after bed-rest.

Identifying Heel Contact and Toe-Off Using Forceplate Thresholds With a Range of Digital-Filter Cutoff Frequencies

Analysis of human gait requires accurate measurement of foot-ground contact, often determined using either foot-ground reaction force thresholds or kinematic data. This study examined the differences in calculating event times across five vertical force thresholds and validated a vertical acceleration-based algorithm as a measure of heel contact and toe-off.

Drifting or walking? colonisation routes used by different instars and species of lotic, macroinvertebrate filter feeders

Many views of stream invertebrate populations centre on drift as the major route of larval dispersal, but few studies have presented unambiguous information about the role of drift. We present the results from an experiment designed to determine whether the major route of colonisation of substrata by hydropsychid larvae (commonly found in the drift) is by drifting directly onto substrata or by walking along the stream bottom. The experimental design contained four treatments: substrata open to drifters and walkers; fenced substrata open to drifters only; and two treatments open to drifters and walkers that provided forms of fence controls. Fifteen replicates of each treatment were set out at random locations within a riffle at each of three sites, with each site on a different river (the Little River, the Steavenson River and the Acheron River) in the Acheron River catchment. The experiment was run twice, once during autumn (April 1999) and once during early summer (January 2000). Both experiments were colonised by three species of hydropsychids, Asmicridea sp. AV1, and Smicrophylax sp. AV1 and AV2. We found that 2nd/3rd instars of Asmicridea sp. AV1 walked as well as drifted, whereas all others primarily drifted. No relation between numbers of recruits and water speed was found when substrata were open only to drifters, whereas substrata open also to walkers gained more recruits in faster flows. Additionally, larvae more frequently abandoned nets in slow than fast flows, indicating that drifting into unfavourable flow environments may result in mortality or redispersal of larvae. These findings demonstrate that, although drift is important, it is not necessarily the only method used by hydropsychids to colonise substrata. Larvae may have more capacity to choose substrata in fast flows when they colonise substrata by walking. Spot measures of hydropsychid distribution cannot distinguish between these explanations. The finding that walkers can sometimes comprise significant numbers of recruits raises the prospect that hydropsychids can be sourced locally and have not inevitably drifted in from upstream locations.