End-expiratory lung volume recovers more slowly after closed endotracheal suctioning than after open suctioning : a randomized crossover study

Purpose Endotracheal suctioning causes significant lung derecruitment. Closed suction (CS) minimizes lung volume loss during suction, and therefore, volumes are presumed to recover more quickly postsuctioning. Conflicting evidence exists regarding this. We examined the effects of open suction (OS) and CS on lung volume loss during suctioning, and recovery of end-expiratory lung volume (EELV) up to 30 minutes postsuction. Material and Methods Randomized crossover study examining 20 patients postcardiac surgery. CS and OS were performed in random order, 30 minutes apart. Lung impedance was measured during suction, and end-expiratory lung impedance was measured at baseline and postsuctioning using electrical impedance tomography. Oximetry, partial pressure of oxygen in the alveoli/fraction of inspired oxygen ratio and compliance were collected. Results Reductions in lung impedance during suctioning were less for CS than for OS (mean difference, − 905 impedance units; 95% confidence interval [CI], − 1234 to –587; P < .001). However, at all points postsuctioning, EELV recovered more slowly after CS than after OS. There were no statistically significant differences in the other respiratory parameters. Conclusions Closed suctioning minimized lung volume loss during suctioning but, counterintuitively, resulted in slower recovery of EELV postsuction compared with OS. Therefore, the use of CS cannot be assumed to be protective of lung volumes postsuctioning. Consideration should be given to restoring EELV after either suction method via a recruitment maneuver.

End-of-life care in the intensive care setting : a descriptive exploratory qualitative study of nurses' beliefs and practices

Background: End-of-life care is a significant component of work in intensive care. Limited research has been undertaken on the provision of end-of-life care by nurses in the intensive care setting. The purpose of this study was to explore the end-of-life care beliefs and practices of intensive care nurses. Methods: A descriptive exploratory qualitative research approach was used to invite a convenience sample of five intensive care nurses from one hospital to participate in a semi-structured interview. Interview transcripts were analysed using an inductive coding approach. Findings: Three major categories emerged from analysis of the interviews: beliefs about end-of-life care, end-of-life care in the intensive care context and facilitating end-of-life care. The first two categories incorporated factors contributing to the end-of-life care experiences and practices of intensive care nurses. The third category captured the nurses’ end-of-life care practices. Conclusions: Despite the uncertainty and ambiguity surrounding end-of-life care in this practice context, the intensive care setting presents unique opportunities for nurses to facilitate positive end-of-life experiences and nurses valued their participation in the provision of end-of-life care. Care of the family was at the core of nurses’ end-of-life care work and nurses play a pivotal role in supporting the patient and their family to have positive and meaningful experiences at the end-of-life.Variation in personal beliefs and organisational support may influence nurses’ experiences and the care provided to patients and their families. Strategies to promote an organisational culture supportive of quality end-of-life care practices, and to mentor and support nurses in the provision of this care are needed.

Exo1 plays a major role in DNA end resection in humans and influences double-strand break repair and damage signaling decisions

The resection of DNA double-strand breaks (DSBs) to generate ssDNA tails is a pivotal event in the cellular response to these breaks. In the two-step model of resection, primarily elucidated in yeast, initial resection by Mre11-CtIP is followed by extensive resection by two distinct pathways involving Exo1 or BLM/WRN-Dna2. However, resection pathways and their exact contributions in humans in vivo are not as clearly worked out as in yeast. Here, we examined the contribution of Exo1 to DNA end resection in humans in vivo in response to ionizing radiation (IR) and its relationship with other resection pathways (Mre11-CtIP or BLM/WRN). We find that Exo1 plays a predominant role in resection in human cells along with an alternate pathway dependent on WRN. While Mre11 and CtIP stimulate resection in human cells, they are not absolutely required for this process and Exo1 can function in resection even in the absence of Mre11-CtIP. Interestingly, the recruitment of Exo1 to DNA breaks appears to be inhibited by the NHEJ protein Ku80, and the higher level of resection that occurs upon siRNA-mediated depletion of Ku80 is dependent on Exo1. In addition, Exo1 may be regulated by 53BP1 and Brca1, and the restoration of resection in BRCA1-deficient cells upon depletion of 53BP1 is dependent on Exo1. Finally, we find that Exo1-mediated resection facilitates a transition from ATM- to ATR-mediated cell cycle checkpoint signaling. Our results identify Exo1 as a key mediator of DNA end resection and DSB repair and damage signaling decisions in human cells.

Personal preferences for end-of-life care among Taiwanese community city dwellers : an inductive approach for qualitative data

Background: As an increasing number of Taiwanese people live out the final stages of their lives with chronic and complex conditions. Care decisions at the end of life can also be complex, overwhelming and stressful for an individual, family and health professionals. Understanding individuals’ wishes for end-of-life care and factors which influence individuals' decisions is important so that the provision of quality end-of-life care for all can be promoted and ensured.

Pt/Nanostructured RuO2/SiC Schottky Diode based hydrogen gas sensors

In this paper, we report the development of novel Pt/nanostructured RuO2/SiC Schottky diode based sensors for hydrogen gas applications. The nanostructured ruthenium oxide thin films were deposited on SiC substrates using radio frequency sputtering technique. Scanning electron microscopy revealed the sputtered RuO2 layer consists of nano-cubular structures with dimensions ranging between 10 and 50 nm. X-ray diffraction confirmed the presence of tetragonal ruthenium (IV) oxide, with preferred orientation along the (101) lattice plane. The current-voltage characteristics of the sensors were investigated towards hydrogen gas in synthetic air at different temperatures from 25 °C to 240 °C. The dynamic responses of the sensors were studied at an optimum temperature of 240 °C and a voltage shift of 304 mV was recorded toward 1% hydrogen gas.

Pt/Nanograined ZnO/SiC Schottky diode based hydrogen and propene sensor

A nanostructured Schottky diode was fabricated to sense hydrogen and propene gases in the concentration range of 0.06% to 1%. The ZnO sensitive layer was deposited on SiC substrate by pulse laser deposition technique. Scanning electron microscopy and X-ray diffraction characterisations revealed presence of wurtzite structured ZnO nanograins grown in the direction of (002) and (004). The nanostructured diode was investigated at optimum operating temperature of 260 °C. At a constant reverse current of 1 mA, the voltage shifts towards 1% hydrogen and 1% propene were measured as 173.3 mV and 191.8 mV, respectively.

Hydrogen sensing properties of Pt/Lanthanum oxide- molybdenum oxide nanoplatelet/SiC based Schottky diode

An investigation of the electrical and hydrogen sensing properties of a novel Schottky diode based on a nanostructured lanthanum oxide-molybdenum oxide compound is presented herein. Molybdenum oxide (MoO3) nanoplatelets were grown on SiC substrates via thermal evaporation which was then subsequently coated with lanthanum oxide (La2O3) by RF sputtering. The current-voltage characteristics and hydrogen sensing performance (change in barrier height and sensitivity as well as the dynamic response) were examined from 25 to 300°C. At 180°C, a voltage shift of 2.23V was measured from the sensor while exposed to 1% hydrogen gas under a 100 μA constant reverse bias current. The results indicate that the presence of a La2O3 thin layer substantially improves the hydrogen sensitivity of the MoO3 nanoplatelets.

Hydrogen gas sensors based on thermally evaporated nanostructured MoO3 Schottky diode : a comparative study

In this paper, a comparative study of Pt/nanostructured MoO3/SiC Schottky diode based hydrogen gas sensors is presented. MoO3 nanostructured films with three different morphologies (nanoplatelets, nanoplateletsnanowires and nano-flowers) were deposited on SiC by thermal evaporation. We compare the current-voltage characteristics and the dynamic response of these sensors as they are exposed to hydrogen gas at temperatures up to 250°C. Results indicate that the sensor based on MoO3 nanoflowers exhibited the highest sensitivity (in terms of a 5.79V voltage shift) towards 1% hydrogen; while the sensor based on MoO3 nanoplatelets showed the quickest response (t90%- 40s).

Pt/MoO3 nano-flower/SiC Schottky diode based hydrogen gas sensor

In this paper, we report the development of a novel Pt/MoO3 nano-flower/SiC Schottky diode based device for hydrogen gas sensing applications. The MoO3 nanostructured thin films were deposited on SiC substrates via thermal evaporation. Morphological characterization of the nanostructured MoO3 by scanning electron microscopy revealed randomly orientated thin nanoplatelets in a densely packed formation of nano-flowers with dimensions ranging from 250 nm to 1 μm. Current-voltage characteristics of the sensor were measured at temperatures from 25°C to 250°C. The sensor showed greater sensitivity in a reverse bias condition than in forward bias. Dynamic response of the sensor was investigated towards different concentrations of hydrogen gas in a synthetic air mixture at 250°C and a large voltage shift of 5.7 V was recorded upon exposure to 1% hydrogen.

A comparison of forward and reverse bias operation in a Pt/nanostructured ZnO Schottky diode based hydrogen sensor

A hydrogen gas sensor based on Pt/nanostructured ZnO Schottky diode has been developed. Our proposed theoretical model allows for the explanation of superior dynamic performance of the reverse biased diode when compared to the forward bias operation. The sensor was evaluated with low concentration H2 gas exposures over a temperature range of 280°C to 430°C. Upon exposure to H2 gas, the effective change in free carrier concentration at the Pt/structured ZnO interface is amplified by an enhancement factor, effectively lowering the reverse barrier, producing a large voltage shift. The lowering of the reverse barrier permits a faster response in reverse bias operation, than in forward bias operation.

Water end use consumption analysis study into Gold Coast dual reticulated households : pilot study

Australia is the driest inhabited continent in the world and persisting droughts have triggered a move toward sensible and sustainable water consumption. Understanding how and where water is consumed in households enables streamlined development of demand management programs and efficient engineering of water infrastructure. End use water consumption analysis is required to gain necessary empirical data of how and where water is consumed. Several end use water consumption studies have been conducted within Australia and around the world with varying results produced. This pilot study paper provides preliminary data from the Gold Coast Watersaver End Use Project which is currently underway. Specifically, the paper includes water end use category volumetric and percentage break downs for 18 single and 32 dual reticulated homes on the Gold Coast (i.e. 50 in total). Moreover, a comparitive analysis between each of the individual households water end use levels is discussed along with other national studies previously completed. The paper finishes with an overview of the greater 200 home end use study conducted on the Gold Coast and its key deliverables and research outcomes.

Control of dc capacitor voltages in diode-clamped multilevel inverter using bidirectional buck-boost choppers

The dc capacitors voltage unbalancing is the main technical drawback of a diode-clamped multilevel inverter (DCMLI), with more than three levels. A voltage-balancing circuit based on buck–boost chopper connected to the dc link of DCMLI is a reliable and robust solution to this problem. This study presents four different schemes for controlling the chopper circuit to achieve the capacitor voltages equalisation. These can be broadly categorised as single-pulse, multi-pulse and hysteresis band current control schemes. The single-pulse scheme does not involve faster switching actions but need the chopper devices to be rated for higher current. The chopper devices current rating can be kept limited by using the multi-pulse scheme but it involves faster switching actions and slower response. The hysteresis band current control scheme offers faster dynamics, lower current rating of the chopper devices and can nullify the initial voltage imbalance as well. However, it involves much faster switching actions which may not be feasible for some of its applications. Therefore depending on the system requirements and ratings, one of these schemes may be used. The performance and validity of the proposed schemes are confirmed through both simulation and experimental investigations on a prototype five-level diode-clamped inverter.

Teaching end-user remote online searching

The Queensland University of Technology (QUT) Library bas recently commenced teaching higher degree students to search online systems such as BRS, ORBIT and STN. The emphasis is on education rather than training. with students being required to familiarise themselves with system commands and database structures whilst receiving necessarily limited tutorial help. The teaching strategies used and problems encountered in the program are outlined. Student responses to the experience of learning to online search are discussed.

Towards better end-of-life care : a major opportunity for nurses to contribute to the debate

Integrated care pathways are documents which outline the essential steps of multidisciplinary care in addressing a specific clinical problem (Rotter et al., 2010). They can be used to introduce clinical guidelines and systematic audits of clinical practice, and to ensure that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. The Liverpool Care Pathway (LCP) is an example of an integrated care pathway, designed in the 1990s to guide care for people who are in their last days of life (Ellershaw et al., 1997, Ellershaw and Ward, 2003)...