The source, cost and prevention of central venous catheter-related infection

Central venous catheters have become an integral part of patient management however they are associated with many complications including infection. Despite efforts being made to reduce the incidence of such infect ions the problem continues to increase and has resource implications for the Health Service. Studies relating to the source of microorganisms causing CVC-associated infection, the cost of such infections and the efficacy of an antimicrobial catheter have been undertaken. Thirty patients who required a CVC as part of their medical management and underwent cardiac surgery had the distal tips of their catheters sampled whilst in situ. Sampling took place within 1 h of catheter placement. Bacteria were isolated from 16% of the catheter distal tips sampled in situ. The guidewires used to insert the devices were also contaminated (50%). When CVC were inserted via a protective sheath, avoiding contact with the skin. the incidence of microbial contamination was reduced. These findings suggest that despite rigorous skin disinfection and strict aseptic technique, viable microorganisms are impacted onto the distal tip of CVC during the insertion procedure. Needleless intravascular access devices have been introduced in order to reduce the incidence of need1estick injury. However, it was unclear whether such connectors would act as a portal of entry for microorganisms to CVC. The efficacy of these devices was investigated. Within the controlled laboratory environment it was demonstrated that needleless devices, when challenged with microorganisms, did not allow the passage of microbes when flu id was injected. This therefore suggested that the devices should not increase the risk of catheter colonisation. When used in clinical practice however microbial contamination of the needleless connectors was 55 % in comparison to the routinely used luer connectors (23%). The cost of infections associated with CVC was determined. Twenty patients catheterised with a CVC designed for long term use who were admitted to hospital with a presumptive diagnosis of catheter-related infection were studied. The treatment given specifically for this infection was costed. The mean cost of such an infection was £ 1781.81. Throughout the UK this may amount to £1.565.906 per annum. The cost of infections associated with CVC designed for short term use was estimated to be between 5 and 7 million pounds per annum in the UK. In an attempt to reduce both the incidence and cost of catheter- related infection antimicrobial CVC have been developed. The efficacy of a novel polyurethane CVC impregnated on both the internal and external catheter surface with the quaternary ammonium compound benzalkonium chloride was investigated. Eighty eight patients received an antimicrobial catheter and 78 patients a conventional polyurethane CVC. The anti-microbial CVC resulted in a reduction in microbial colonisation of the external and internal polymer surfaces as compared to the control device. The observed reduction in microbial colonisation with the anti-microbial CVC may decrease the likelihood of subsequent infection offering a useful approach to the prevention of catheter-related infections.

Cost and time control of construction projects: a survey of contractors and consultants in the UK

Numerous techniques have been developed to control cost and time of construction projects. However, there is limited research on issues surrounding the practical usage of these techniques. To address this, a survey was conducted on the top 150 construction companies and 100 construction consultancies in the UK aimed at identifying common project control practices and factors inhibiting effective project control in practice. It found that despite the vast application of control techniques a high proportion of respondents still experienced cost and time overruns on a significant proportion of their projects. Analysis of the survey results concluded that more effort should be geared at the management of the identified top project control inhibiting factors. This paper has outlined some measures for mitigating these inhibiting factors so that the outcome of project time and cost control can be improved in practice.

Recent advances in fundamentals and applications of random fiber lasers

Random fiber lasers blend together attractive features of traditional random lasers, such as low cost and simplicity of fabrication, with high-performance characteristics of conventional fiber lasers, such as good directionality and high efficiency. Low coherence of random lasers is important for speckle-free imaging applications. The random fiber laser with distributed feedback proposed in 2010 led to a quickly developing class of light sources that utilize inherent optical fiber disorder in the form of the Rayleigh scattering and distributed Raman gain. The random fiber laser is an interesting and practically important example of a photonic device based on exploitation of optical medium disorder. We provide an overview of recent advances in this field, including high-power and high-efficiency generation, spectral and statistical properties of random fiber lasers, nonlinear kinetic theory of such systems, and emerging applications in telecommunications and distributed sensing.

Comparison of cost- and energy-efficient signal modulations for next generation passive optical networks

Extensive numerical investigations are undertaken to analyze and compare, for the first time, the performance, techno-economy, and power consumption of three-level electrical Duobinary, optical Duobinary, and PAM-4 modulation formats as candidates for high-speed next-generation PONs supporting downstream 40 Gb/s per wavelength signal transmission over standard SMFs in C-band. Optimization of transceiver bandwidths are undertaken to show the feasibility of utilizing low-cost and band-limited components to support next-generation PON transmissions. The effect of electro-absorption modulator chirp is examined for electrical Duobinary and PAM-4. Electrical Duobinary and optical Duobinary are powerefficient schemes for smaller transmission distances of 10 km SMFs and optical Duobinary offers the best receiver sensitivity albeit with a relatively high transceiver cost. PAM-4 shows the best power budget and costefficiency for larger distances of around 20 km, although it consumes more power. Electrical Duobinary shows the best trade-off between performance, cost and power dissipation.

Cost and performance analysis of new wood-fuelled power plant concepts

The objective of the thesis was to analyse several process configurations for the production of electricity from biomass. Process simulation models using AspenPlus aimed at calculating the industrial performance of power plant concepts were built, tested, and used for analysis. The criteria used in analysis were performance and cost. All of the advanced systems appear to have higher efficiencies than the commercial reference, the Rankine cycle. However, advanced systems typically have a higher cost of electricity (COE) than the Rankine power plant. High efficiencies do not reduce fuel costs enough to compensate for the high capital costs of advanced concepts. The successful reduction of capital costs would appear to be the key to the introduction of the new systems. Capital costs account for a considerable, often dominant, part of the cost of electricity in these concepts. All of the systems have higher specific investment costs than the conventional industrial alternative, i.e. the Rankine power plant; Combined beat and power production (CUP) is currently the only industrial area of application in which bio-power costs can be considerably reduced to make them competitive. Based on the results of this work, AsperiPlus is an appropriate simulation platform. How-ever, the usefulness of the models could be improved if a number of unit operations were modelled in greater detail. The dryer, gasifier, fast pyrolysis, gas engine and gas turbine models could be improved.

The appraisal and management of multi-storey dwelling blocks using large concrete panel systems

This exploratory study is concerned with the integrated appraisal of multi-storey dwelling blocks which incorporate large concrete panel systems (LPS). The first step was to look at U.K. multi-storey dwelling stock in general, and under the management of Birmingham City Council in particular. The information has been taken from the databases of three departments in the City of Birmingham, and rearranged in a new database using a suite of PC software called `PROXIMA' for clarity and analysis. One hundred of their stock were built large concrete panel system. Thirteen LPS blocks were chosen for the purpose of this study as case-studies depending mainly on the height and age factors of the block. A new integrated appraisal technique has been created for the LPS dwelling blocks, which takes into account the most physical and social factors affecting the condition and acceptability of these blocks. This appraisal technique is built up in a hierarchical form moving from the general approach to particular elements (a tree model). It comprises two main approaches; physical and social. In the physical approach, the building is viewed as a series of manageable elements and sub-elements to cover every single physical or environmental factor of the block, in which the condition of the block is analysed. A quality score system has been developed which depends mainly on the qualitative and quantitative conditions of each category in the appraisal tree model, and leads to physical ranking order of the study blocks. In the social appraisal approach, the residents' satisfaction and attitude toward their multi-storey dwelling block was analysed in relation to: a. biographical and housing related characteristics; and b. social, physical and environmental factors associated with this sort of dwelling, block and estate in general.The random sample consisted of 268 residents living in the 13 case study blocks. Data collected was analysed using frequency counts, percentages, means, standard deviations, Kendall's tue, r-correlation coefficients, t-test, analysis of variance (ANOVA) and multiple regression analysis. The analysis showed a marginally positive satisfaction and attitude towards living in the block. The five most significant factors associated with the residents' satisfaction and attitude in descending order were: the estate, in general; the service categories in the block, including heating system and lift services; vandalism; the neighbours; and the security system of the block. An important attribute of this method, is that it is relatively inexpensive to implement, especially when compared to alternatives adopted by some local authorities and the BRE. It is designed to save time, money and effort, to aid decision making, and to provide ranked priority to the multi-storey dwelling stock, in addition to many other advantages. A series of solution options to the problems of the block was sought for selection and testing before implementation. The traditional solutions have usually resulted in either demolition or costly physical maintenance and social improvement of the blocks. However, a new solution has now emerged, which is particularly suited to structurally sound units. The solution of `re-cycling' might incorporate the reuse of an entire block or part of it, by removing panels, slabs and so forth from the upper floors in order to reconstruct them as low-rise accommodations.

Cost and time control of construction project: inhibiting factors and mitigating measures in practice

Despite the availability of various control techniques and project control software many construction projects still do not achieve their cost and time objectives. Research in this area so far has mainly been devoted to identifying causes of cost and time overruns. There is limited research geared towards studying factors inhibiting the ability of practitioners to effectively control their projects. To fill this gap, a survey was conducted on 250 construction project organizations in the UK, which was followed by face-to-face interviews with experienced practitioners from 15 of these organizations. The common factors that inhibit both time and cost control during construction projects were first identified. Subsequently 90 mitigating measures have been developed for the top five leading inhibiting factors—design changes, risks/uncertainties, inaccurate evaluation of project time/duration, complexities and non-performance of subcontractors were recommended. These mitigating measures were classified as: preventive, predictive, corrective and organizational measures. They can be used as a checklist of good practice and help project managers to improve the effectiveness of control of their projects.

Cost-effective upgrade of WDM all-optical networks using overlay fibres and hop reduction links

Fibre overlay is a cost-effective technique to alleviate wavelength blocking in some links of a wavelength-routed optical network by increasing the number of wavelengths in those links. In this letter, we investigate the effects of overlaying fibre in an all-optical network (AON) based on GÉANT2 topology. The constraint-based routing and wavelength assignment (CB-RWA) algorithm locates where cost-efficient upgrades should be implemented. Through numerical examples, we demonstrate that the network capacity improves by 25 per cent by overlaying fibre on 10 per cent of the links, and by 12 per cent by providing hop reduction links comprising 2 per cent of the links. For the upgraded network, we also show the impact of dynamic traffic allocation on the blocking probability. Copyright © 2010 John Wiley & Sons, Ltd.

Fabrication and characterisation of 45º and Ex 45º:tilted fibre gratings and their applications in fibre lasers and sensors

In this thesis, I present the studies on fabrication, spectral and polarisation characterisation of fibre gratings with tilted structures at 45º and > 45º (namely 45º- TFGs and ex 45º-TFGs throughout this thesis) and a range of novel applications with these two types of grating. One of the major contributions made in this thesis is the systematic investigation of the grating structures, inscription analysis and spectral and polarisation properties of both types of TFGs. I have inscribed 45º-TFGs in standard telecom and polarisation maintaining (PM) fibres. Two wavelength regions of interest have been explored including 1.55 µm and 1.06 µm. Detailed analysis on fabrication and characterisation of 45º-TFGs on PM fibres have also been carried out for the first time. For ex 45º- TFGs, fabrication has been investigated only on low-cost standard telecom fibre. Furthermore, thermal responses have been measured and analysed showing that both types of TFG have low responsivity to temperature change. More importantly, their refractive index (RI) responses have been characterised to verify the high responsivity to surrounding medium. Based on the unique polarisation properties, both types of TFG have been applied in fibre laser systems to improve the laser performance, which forms another major contribution of the research presented in this thesis. The integration of a 45º-TFG to the Erbium doped fibre laser (EDFL) enables single polarisation laser output at a single wavelength. When combing with ex 45º-TFGs, the EDFL can be transformed to a multi-wavelength switchable laser with single polarisation output. Furthermore, by utilising the polarisation property of the TFGs, a 45º-TFG based mode locked fibre laser is implemented. This laser can produce laser pulses at femtosecond scale and is the first application of TFG in the field of nonlinear optics. Another important contribution from the studies is the development of TFG based passive and active optical sensor systems. An ex 45º-TFG has been successfully developed into a liquid level sensor showing high sensitivity to water based solvents. Strain and twist sensors have been demonstrated via a fibre laser system using both 45°- and ex 45º-TFG with capability identifying not just the twist rate but also the direction. The sensor systems have shown the added advantage of low cost signal demodulation. In addition, load sensor applications have been demonstrated using the 45º-TFG based single polarisation EDFL and the experimental results show good agreement with the theoretical simulation.

Risk-benefit and cost-effectiveness assessments of the statins

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Cost-effective upgrade of WDM all-optical networks using overlay fibres and hop reduction links

Fibre overlay is a cost-effective technique to alleviate wavelength blocking in some links of a wavelength-routed optical network by increasing the number of wavelengths in those links. In this letter, we investigate the effects of overlaying fibre in an all-optical network (AON) based on GÉANT2 topology. The constraint-based routing and wavelength assignment (CB-RWA) algorithm locates where cost-efficient upgrades should be implemented. Through numerical examples, we demonstrate that the network capacity improves by 25 per cent by overlaying fibre on 10 per cent of the links, and by 12 per cent by providing hop reduction links comprising 2 per cent of the links. For the upgraded network, we also show the impact of dynamic traffic allocation on the blocking probability. Copyright © 2010 John Wiley & Sons, Ltd.

Analysis and representation of statistical performance of JPEG2000 encoded image over wireless channels

JPEG2000 is a new coming image standard. In this paper we analyze the performance of error resilience tools in JPEG2000, and present an analytical model to estimate the quality of JPEG2000 encoded image transmitted over wireless channels. The effectiveness of the analytical model is validated by simulation results. Furthermore, analytical model is utilized by the base station to design efficient unequally error protection schemes for JPEG2000 transmission. In the design, a utility function is denned to make a tradeoff between the image quality and the cost for transmitting the image over wireless channel. © 2002 IEEE.