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.

Nanobiotechnology as a novel paradigm for enzyme immobilisation and stabilisation with potential applications in biodiesel production

Nanobiotechnology is emerging as a new frontier of biotechnology. The potential applications of nanobiotechnology in bioenergy and biosensors have encouraged researchers in recent years to investigate new novel nanoscaffolds to build robust nanobiocatalyt

Global finite-time stabilisation for a class of stochastic nonlinear systems by output feedback

In this paper, the problem of global finite-time stabilisation by output feedback is considered for a class of stochastic nonlinear systems. First, based on homogeneous systems theory and the adding a power integrator technique, a homogeneous reduced order observer and control law are constructed in a recursive manner for the nominal system. Then, the homogeneous domination approach is used to deal with the nonlinearities in drift and diffusion terms; it is shown that the proposed output-feedback control law can guarantee that the closed-loop system is global finite-time stable in probability. Finally, simulation examples are carried out to demonstrate the effectiveness of the proposed control scheme.

Environmental Assessment of Rammed Earth Construction Systems

Present concerns for sustainable development have led to a revival of traditional building practices using natural or recycled resources. There is a perception that buildings constructed from such materials are environmentally benign. This perception is questionable, as often no evaluation is undertaken to assess the associated environmental impacts. Rammed earth is one such construction technology that has seen renewed interest in recent years. The energy required to manufacture materials (i.e. embodied energy) is a significant component of the life cycle energy associated with buildings. This paper assesses the embodied energy of rammed earth construction relative to brick veneer and cavity brick construction. Rammed earth was found to have significantly less embodied energy than cavity brick construction (to which it is closer in thermal performance), but was approximately equivalent to brick veneer construction. Topics of further research identified include thermal performance and strategies for reducing the embodied energy of cement used for earth stabilisation.

Reduction of metal leaching in brown coal fly ash using geopolymers

Current regulations classify fly ash as a prescribed waste and prohibit its disposal in regular landfill. Treatment of the fly ash can reduce the leach rate of metals, and allow it to be disposed in less prescribed landfill. A geopolymer matrix was investigated as a potential stabilisation method for brown coal fly ash. Precipitator fly ash was obtained from electrostatic precipitators and leached fly ash was collected from ash disposal ponds, and leaching tests were conducted on both types of geopolymer stabilised fly ashes. The ratio of fly ash to geopolymer was varied to determine the effects of different compositions on leaching rates.

Using inorganic polymer to reduce leach rates of metals from brown coal fly ash

The burning of brown coal for electricity generation produces thousands of tonnes of fly ash each year. Treatment of the fly ash can reduce leach rates of metals and allow it to be disposed in less prescribed landfill. A geopolymer matrix was investigated as a potential stabilisation method for fly ash obtained from electrostatic precipitators and ash disposal ponds. The ratio of fly ash and geopolymer was varied to determine the effects of different compositions on leaching rates. The major element leachate concentrations obtained from pond ash were lower than that of precipitator fly ash. Conversely, precipitator ash-geopolymers were better for trace heavy metal stabilisation. Effective reduction of elemental concentrations in the leachate has been achieved, particularly for calcium, arsenic, selenium, strontium and barium. Scanning electron microscopy revealed the distribution of metals originated from fly ash and from added geopolymer material. It also showed that some elements are leached from ash particles to the geopolymer phase and others remained as undissolved particles. Qualitative analysis showed that fly ash particles interacted with the geopolymers phase through surface reactions.

Using geopolymer to minimise metals leaching from brown coal fly ash

Fly ash is generated from combustion of brown coal in power stations. The majority of fly ash is removed by electrostatic precipitators (ESP) and finally disposed into the landfill as prescribed wastes. A method was studied to add clay materials to the brown coal fly ash in order to form the so-called geopolymer network, which is effective at stopping the metal contents from leaching, and have minimum impact to the environment. The experiments were conducted parallel on leached fly ash and dry precipitator fly ash. The ratios of fly ash and added clay materials were varied to determine the effects of different compositions on leaching rates. Both X-ray diffraction analysis and scanning electron microscopy images showed that as the percentage of fly ash was increased, the formation of geopolymer is reduced. Eighteen metals and heavy metals were targeted during the leaching tests and the leachate samples were analysed using ICP-AES and ICP-MS. It was found that the reduction of metal leaching was achieved by adding up to 60% of fly ash to form the geopolymer like structure. Significant reductions were observed for calcium, strontium and barium. Leached fly ash achieved better stabilisation than dry precipitator fly ash for major elements. It's hard to quantify its effects on trace metals leaching due to their ultra low concentration in the fly ash. The samples spiked with trace metals of lead, zinc, mercury and barium showed remarkable reduction in leaching.

Prevalence of the thioamide {···H-N-C=S}2 synthon-solid-state (X-ray crystallography), solution (NMR) and gas-phase (theoretical) structures of O-methyl-N-aryl-thiocarbamides

Structural investigations, i.e. solid-state (X-ray), solution (¹H NMR) and gas-phase (theoretical), on molecules with the general formula MeOC(S)N(H)C₆H₄-4-Y: Y = H (1), NO₂ (2), C(O)Me (3), Cl (4) have shown a general preference for the adoption of an E-conformation about the central C–N bond. Such a conformation allows for the formation of a dimeric hydrogen-bonded {H–N–C=S}₂ synthon as the building block. In the cases of 1–3, additional C–H^...O interactions give rise to the formation of tapes of varying topology. A theoretical analysis shows that the preference for the E-conformation is about the same as the crystal packing stabilisation energy and consistent with this, the compound with Y = C(O)OMe, (5), adopts a Z-conformation in the solid-state that facilitates the formation of N–H^...O, C–H^...O and C–H^...S interactions, leading to a layer structure. Global crystal packing considerations are shown to be imperative in dictating the conformational form of molecules 1–5.