Early warnings of heart rate deterioration

Hospitals can experience difficulty in detecting and responding to early signs of patient deterioration leading to late intensive care referrals, excess mortality and morbidity, and increased hospital costs. Our study aims to explore potential indicators of physiological deterioration by the analysis of vital-signs. The dataset used comprises heart rate (HR) measurements from MIMIC II waveform database, taken from six patients admitted to the Intensive Care Unit (ICU) and diagnosed with severe sepsis. Different indicators were considered: 1) generic early warning indicators used in ecosystems analysis (autocorrelation at-1-lag (ACF1), standard deviation (SD), skewness, kurtosis and heteroskedasticity) and 2) entropy analysis (kernel entropy and multi scale entropy). Our preliminary findings suggest that when a critical transition is approaching, the equilibrium state changes what is visible in the ACF1 and SD values, but also by the analysis of the entropy. Entropy allows to characterize the complexity of the time series during the hospital stay and can be used as an indicator of regime shifts in a patient’s condition. One of the main problems is its dependency of the scale used. Our results demonstrate that different entropy scales should be used depending of the level of entropy verified.

Enforceability of leasehold covenants and the landlord and tenant (Covenants) Act 1995

Describes the impact of the English Landlord and Tenant (Covenants) Act 1995, reforming liability in the context of new leases, extending the 'touching and concerning' requirement so all covenants 'run with the land' (with some exceptions), and abolishing the enduring liability of the original tenants and landlords. Explains that landlords will have more freedom to prescribe in advance the circumstances in which they consent to an assignment, referring also to changes in default notices requiring an 'early warning' to defaulters, and overriding leases, with a remedy for former tenants. Expects future leases to be shorter as landlords realize they cannot hold original tenants liable any more.

Measuring water activity of aviation fuel using a polymer optical fiber Bragg grating

Poly(methyl methacrylate) (PMMA) based polymer optical fiber Bragg gratings have been used for measuring water activity of aviation fuel. Jet A-1 samples with water content ranging from 100% ERH (wet fuel) to 10 ppm (dried fuel), have been conditioned and calibrated for measurement. The PMMA based optical fiber grating exhibits consistent response and a good sensitivity of 59±3pm/ppm (water content in mass). This water activity measurement allows PMMA based optical fiber gratings to detect very tiny amounts of water in fuels that have a low water saturation point, potentially giving early warning of unsafe operation of a fuel system. © 2014 SPIE.

Reviewing the evidence base for the Children and Young People Safety Thermometer (CYPST):a mixed studies review

The objective was to identify evidence to support use of specific harms for the development of a children and young people's safety thermometer (CYPST). We searched PubMed, Web of Knowledge, and Cochrane Library post-1999 for studies in pediatric settings about pain, skin integrity, extravasation injury, and use of pediatric early warning scores (PEWS). Following screening, nine relevant articles were included. Convergent synthesis methods were used drawing on thematic analysis to combine findings from studies using a range of methods (qualitative, quantitative, and mixed methods). A review of PEWS was identified so other studies on this issue were excluded. No relevant studies about extravasation injury were identified. The synthesized results therefore focused on pain and skin integrity. Measurement and perception of pain were complex and not always carried out according to best practice. Skin abrasions were common and mostly associated with device related injuries. The findings demonstrate a need for further work on perceptions of pain and effective communication of concerns about pain between parents and nursing staff. Strategies for reducing device-related injuries warrant further research focusing on prevention. Together with the review of PEWS, these synthesized findings support the inclusion of pain, skin integrity, and PEWS in the CYPST.