Respiratory monitoring practices during procedural sedation and analgesia in the cardiac catheterisation laboratory could be improved by using capnography to assess ventilation

Background: Procedural sedation and analgesia (PSA) administered by nurses in the cardiac catheterisation laboratory (CCL) is unlikely to yield serious complications. However, the safety of this practice is dependent on timely identification and treatment of depressed respiratory function. Aim: Describe respiratory monitoring in the CCL. Methods: Retrospective medical record audit of adult patients who underwent a procedure in the CCLs of one private hospital in Brisbane during May and June 2010. An electronic database was used to identify subjects and an audit tool ensured data collection was standardised. Results: Nurses administered PSA during 172/473 (37%) procedures including coronary angiographies, percutaneous coronary interventions, electrophysiology studies, radiofrequency ablations, cardiac pacemakers, implantable cardioverter defibrillators, temporary pacing leads and peripheral vascular interventions. Oxygen saturations were recorded during 160/172 (23%) procedures, respiration rate was recorded during 17/172 (10%) procedures, use of oxygen supplementation was recorded during 40/172 (23%) procedures and 13/172 (7.5%; 95% CI=3.59–11.41%) patients experienced oxygen desaturation. Conclusion: Although oxygen saturation was routinely documented, nurses did not regularly record respiration observations. It is likely that surgical draping and the requirement to minimise radiation exposure interfered with nurses’ ability to observe respiration. Capnography could overcome these barriers to respiration assessment as its accurate measurement of exhaled carbon dioxide coupled with the easily interpretable waveform output it produces, which displays a breath-by-breath account of ventilation, enables identification of respiratory depression in real-time. Results of this audit emphasise the need to ascertain the clinical benefits associated with using capnography to assess ventilation during PSA in the CCL.

Ateljeevaatteen valmistuksen työtavat Salon Kaarlo Forsmanin tuotannossa

The objective of the present study was to increase knowledge about the atelier culture of recent history, especially about the ways in which atelier clothes were made. I look at the ways of dress-making in the production of a renowned atelier, Salon Kaarlo Forsman. I also give a general outline of the atelier. The studying method I used was triangulation, which is a typical approach in case studies of recent history. My data include 23 dresses by the Salon Forsman, theme interviews of four of the Salon workers and one mannequin, data from my research work, as well as press material and archives. The basis of the analysis of these materials was a theme frame that I had put together with the help of pre-understanding. I then completed and defined the theme frame on the basis of the analysis of the data. I also analyzed the dresses in the fashion photos in the press material. Salon Kaarlo Forsman represents a certain cultural period, the years 1937-1986, and a place where a woman could have individual clothes made for her, from hats to fur coats. The atelier was particularly known for embroidery with beads, draping, and fantastic cuttings designed by the owner, fashion designer Kaarlo Forsman. I draw an outline of the work and practices of the atelier, but also that of Kaarlo Forsman’s life work, as he had a great influence on the sewing methods atelier clothes. Mr. Forsman was able to stretch the first period of modern fashion well into the third period by refusing new, labor-saving methods and sticking to individually designer clothes to the end of his enterprise. The crucial practices in the atelier that I present in this study are fitting, designing, finishing and sewing, as well as beading and the decoration of dresses. I compare the activity, practices and dress-making methods in the Forsman atelier to that of Haute Couture in Paris, which served as model for Finnish fashion houses. I point out the similarities and differences.

Novel system for distant assessment of cataract surgical quality in rural China

BACKGROUND: This study aims to assess the quality of various steps of manual small incision cataract surgery and predictors of quality, using video recordings.
DESIGN: This paper applies a retrospective study.
PARTICIPANTS: Fifty-two trainees participated in a hands-on small incision cataract surgery training programme at rural Chinese hospitals.
METHODS: Trainees provided one video each recorded by a tripod-mounted digital recorder after completing a one-week theoretical course and hands-on training monitored by expert trainers. Videos were graded by two different experts, using a 4-point scale developed by the International Council of Ophthalmology for each of 12 surgical steps and six global factors. Grades ranged from 2 (worst) to 5 (best), with a score of 0 if the step was performed by trainers.
MAIN OUTCOME MEASURES: Mean score for the performance of each cataract surgical step rated by trainers.
RESULTS: Videos and data were available for 49/52 trainees (94.2%, median age 38 years, 16.3% women and 77.5% completing > 50 training cases). The majority (53.1%, 26/49) had performed ≤ 50 cataract surgeries prior to training. Kappa was 0.57∼0.98 for the steps (mean 0.85). Poorest-rated steps were draping the surgical field (mean ± standard deviation = 3.27 ± 0.78), hydro-dissection (3.88 ± 1.22) and wound closure (3.92 ± 1.03), and top-rated steps were insertion of viscoelastic (4.96 ± 0.20) and anterior chamber entry (4.69 ± 0.74). In linear regression models, higher total score was associated with younger age (P = 0.015) and having performed >50 independent manual small incision cases (P = 0.039).
CONCLUSIONS: More training should be given to preoperative draping, which is poorly performed and crucial in preventing infection. Surgical experience improves ratings.© 2015 Royal Australian and New Zealand College of Ophthalmologists.

Perceived difficulty of various steps of manual small incision cataract surgery among trainees in rural China

Background: The perceived difficulty of steps of manual small incision cataract surgery among trainees in rural China was assessed. Design: Cohort study. Participants: Fifty-two trainees at the end of a manual small incision cataract surgery training programme. Methods: Participants rated the difficulty of 14 surgical steps using a 5-point scale, 1 (very easy) to 5 (very difficult). Demographic and professional information was recorded for trainees. Main Outcome Measure: Mean ratings for surgical steps. Results: Questionnaires were completed by 49 trainees (94.2%, median age 38 years, 8 [16.3%] women). Twenty six (53.1%) had performed ≤50 independent cataract surgeries prior to training. Trainees rated cortical aspiration (mean score±standard deviation=3.10±1.14) the most difficult step, followed by wound construction (2.76±1.08), nuclear prolapse into the anterior chamber (2.74±1.23) and lens delivery (2.51±1.08). Draping the surgical field (1.06±0.242), anaesthetic block administration (1.14±0.354) and thermal coagulation (1.18±0.441) were rated easiest. In regression models, the score for cortical aspiration was significantly inversely associated with performing >50 independent manual small incision cataract surgery surgeries during training (P=0.01), but not with age, gender, years of experience in an eye department or total number of cataract surgeries performed prior to training. Conclusions: Cortical aspiration, wound construction and nuclear prolapse pose the greatest challenge for trainees learning manual small incision cataract surgery, and should receive emphasis during training. Number of cases performed is the strongest predictor of perceived difficulty of key steps. © 2013 Royal Australian and New Zealand College of Ophthalmologists.

STRUCTURAL ANALYSIS, LAYER THICKNESS MEASUREMENTS AND MINERALOGICAL INVESTIGATION OF THE LARGE INTERIOR LAYERED DEPOSIT WITHIN GANGES CHASMA, VALLES MARINERIS, MARS

The interior layered deposit (ILD) in Ganges Chasma, Valles Marineris, is a 4.25 km high mound that extends approximately 110 km from west to east. The deposition, deformation, and erosion history of the Ganges ILD records aids in identifying the processes that formed and shaped the Chasma. To interpret structural and geomorphic processes acting on the ILD, multiple layer attitudes and layer thickness transects were conducted on the Ganges ILD. Mineralogical data was analyzed to determine correlations between materials and landforms. Layer thickness measurements indicate that the majority of layers are between 0.5 m and 4 m throughout the ILD. Three major benches dominate the Ganges ILD. Layer thicknesses increase at the ILD benches, suggesting that the benches are formed from the gradual thickening of layers. This indicates that the benches are depositional features draping over basement topography. Layer attitudes indicate overall shallow dips generally confined to a North-South direction that locally appear to follow bench topography. Layering is disrupted on a scale of 40 m to 150 m in 12 separate locations throughout the ILD. In all locations, underlying layering is disturbed by overlying folded layers in a trough-like geometry. These features are interpreted to have formed as submarine channels in a lacustrine setting, subsequently infilled by sediments. Subsequently, the channels were eroded to the present topography, resulting in the thin, curved layering observed. Data cannot conclusively support one ILD formation hypothesis, but does indicate that the Ganges ILD postdates Chasma formation. The presence of water altered minerals, consistently thin layering, and layer orientations provide strong evidence that the ILD formed in a lacustrine setting.

A modelagem tridimensional como implemento do processo de desenvolvimento do produto de moda

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

New sensing platforms based on nanoscopic devices for probing protein-membrane interactions

A novel nanosized and addressable sensing platform based on membrane coated plasmonic particles for detection of protein adsorption using dark field scattering spectroscopy of single particles has been established. To this end, a detailed analysis of the deposition of gold nanorods on differently functionalized substrates is performed in relation to various factors (such as the pH, ionic strength, concentration of colloidal suspension, incubation time) in order to find the optimal conditions for obtaining a homogenous distribution of particles at the desired surface number density. The possibility of successfully draping lipid bilayers over the gold particles immobilized on glass substrates depends on the careful adjustment of parameters such as membrane curvature and adhesion properties and is demonstrated with complementary techniques such as phase imaging AFM, fluorescence microscopy (including FRAP) and single particle spectroscopy. The functionality and sensitivity of the proposed sensing platform is unequivocally certified by the resonance shifts of the plasmonic particles that were individually interrogated with single particle spectroscopy upon the adsorption of streptavidin to biotinylated lipid membranes. This new detection approach that employs particles as nanoscopic reporters for biomolecular interactions insures a highly localized sensitivity that offers the possibility to screen lateral inhomogeneities of native membranes. As an alternative to the 2D array of gold nanorods, short range ordered arrays of nanoholes in optically transparent gold films or regular arrays of truncated tetrahedron shaped particles are built by means of colloidal nanolithography on transparent substrates. Technical issues mainly related to the optimization of the mask deposition conditions are successfully addressed such that extended areas of homogenously nanostructured gold surfaces are achieved. Adsorption of the proteins annexin A1 and prothrombin on multicomponent lipid membranes as well as the hydrolytic activity of the phospholipase PLA2 were investigated with classical techniques such as AFM, ellipsometry and fluorescence microscopy. At first, the issues of lateral phase separation in membranes of various lipid compositions and the dependency of the domains configuration (sizes and shapes) on the membrane content are addressed. It is shown that the tendency for phase segregation of gel and fluid phase lipid mixtures is accentuated in the presence of divalent calcium ions for membranes containing anionic lipids as compared to neutral bilayers. Annexin A1 adsorbs preferentially and irreversibly on preformed phosphatidylserine (PS) enriched lipid domains but, dependent on the PS content of the bilayer, the protein itself may induce clustering of the anionic lipids into areas with high binding affinity. Corroborated evidence from AFM and fluorescence experiments confirm the hypothesis of a specifically increased hydrolytic activity of PLA2 on the highly curved regions of membranes due to a facilitated access of lipase to the cleavage sites of the lipids. The influence of the nanoscale gold surface topography on the adhesion of lipid vesicles is unambiguously demonstrated and this reveals, at least in part, an answer for the controversial question existent in the literature about the behavior of lipid vesicles interacting with bare gold substrates. The possibility of formation monolayers of lipid vesicles on chemically untreated gold substrates decorated with gold nanorods opens new perspectives for biosensing applications that involve the radiative decay engineering of the plasmonic particles.

The silent loss of neuronavigation accuracy: a systematic retrospective analysis of factors influencing the mismatch of frameless stereotactic systems in cranial neurosurgery

BACKGROUND Neuronavigation has become an intrinsic part of preoperative surgical planning and surgical procedures. However, many surgeons have the impression that accuracy decreases during surgery. OBJECTIVE To quantify the decrease of neuronavigation accuracy and identify possible origins, we performed a retrospective quality-control study. METHODS Between April and July 2011, a neuronavigation system was used in conjunction with a specially prepared head holder in 55 consecutive patients. Two different neuronavigation systems were investigated separately. Coregistration was performed with laser-surface matching, paired-point matching using skin fiducials, anatomic landmarks, or bone screws. The initial target registration error (TRE1) was measured using the nasion as the anatomic landmark. Then, after draping and during surgery, the accuracy was checked at predefined procedural landmark steps (Mayfield measurement point and bone measurement point), and deviations were recorded. RESULTS After initial coregistration, the mean (SD) TRE1 was 2.9 (3.3) mm. The TRE1 was significantly dependent on patient positioning, lesion localization, type of neuroimaging, and coregistration method. The following procedures decreased neuronavigation accuracy: attachment of surgical drapes (DTRE2 = 2.7 [1.7] mm), skin retractor attachment (DTRE3 = 1.2 [1.0] mm), craniotomy (DTRE3 = 1.0 [1.4] mm), and Halo ring installation (DTRE3 = 0.5 [0.5] mm). Surgery duration was a significant factor also; the overall DTRE was 1.3 [1.5] mm after 30 minutes and increased to 4.4 [1.8] mm after 5.5 hours of surgery. CONCLUSION After registration, there is an ongoing loss of neuronavigation accuracy. The major factors were draping, attachment of skin retractors, and duration of surgery. Surgeons should be aware of this silent loss of accuracy when using neuronavigation.

Separation of the Ribbon from globally distributed energetic neutral Atom Flux using the first five Years of Ibex Observations

The Interstellar Boundary Explorer (IBEX) observes the IBEX ribbon, which stretches across much of the sky observed in energetic neutral atoms (ENAs). The ribbon covers a narrow (~20°-50°) region that is believed to be roughly perpendicular to the interstellar magnetic field. Superimposed on the IBEX ribbon is the globally distributed flux that is controlled by the processes and properties of the heliosheath. This is a second study that utilizes a previously developed technique to separate ENA emissions in the ribbon from the globally distributed flux. A transparency mask is applied over the ribbon and regions of high emissions. We then solve for the globally distributed flux using an interpolation scheme. Previously, ribbon separation techniques were applied to the first year of IBEX-Hi data at and above 0.71 keV. Here we extend the separation analysis down to 0.2 keV and to five years of IBEX data enabling first maps of the ribbon and the globally distributed flux across the full sky of ENA emissions. Our analysis shows the broadening of the ribbon peak at energies below 0.71 keV and demonstrates the apparent deformation of the ribbon in the nose and heliotail. We show global asymmetries of the heliosheath, including both deflection of the heliotail and differing widths of the lobes, in context of the direction, draping, and compression of the heliospheric magnetic field. We discuss implications of the ribbon maps for the wide array of concepts that attempt to explain the ribbon's origin. Thus, we present the five-year separation of the IBEX ribbon from the globally distributed flux in preparation for a formal IBEX data release of ribbon and globally distributed flux maps to the heliophysics community.

Magnetic measurements of ODP Hole 178-1095B on the Pacific continental rise of the West Antarctic Peninsula

In this study we present a late Miocene - early Pliocene record of sixty-four zones with prominent losses in the magnetic susceptibility signal, taken on a sediment drift (ODP Site 1095) on the Pacific continental rise of the West Antarctic Peninsula. The zones are comparable in shape and magnitude and occur commonly at glacial-to-interglacial transitions. High resolution records of organic matter, magnetic susceptibility and clay mineral composition from early Pliocene intervals demonstrate that neither dilution effects nor provenance changes of the sediments have caused the magnetic susceptibility losses. Instead, reductive dissolution of magnetite under suboxic conditions seems to be the most likely explanation. We propose that during the deglaciation exceptionally high organic fluxes in combination with weak bottom water currents and prominent sediment draping diatom ooze layers produced temporary suboxic conditions in the uppermost sediments. It is remarkable that synsedimentary suboxic conditions can be observed in one of the best ventilated open ocean regions of the World.

Late Weichselian fluvial evolution of the southern Kara Sea

Glaciations had a profound impact on the global sea-level and particularly on the Arctic environments. One of the key questions related to this topic is, how did the discharge of the Siberian Ob and Yenisei rivers interact with a proximal ice sheet? In order to answer this question high-resolution (1-12 kHz), shallow-penetration seismic profiles were collected on the passive continental margin of the Kara Sea Shelf to study the paleo-drainage pattern of the Ob and Yenisei rivers. Both rivers incised into the recent shelf, leaving filled and unfilled river channels and river canyons/valleys connecting to a complex paleo-drainage network. These channels have been subaerially formed during a regressive phase of the global sea-level during the Last Glacial Maximum. Beyond recent shelf depths of 120 m particle transport is manifested in submarine channel-levee complexes acting as conveyor for fluvial-derived fines. In the NE area, uniform draping sediments are observed. Major morphology determining factors are (1) sea-level fluctuations and (2) LGM ice sheet influence. Most individual channels show geometries typical for meandering rivers and appear to be an order of magnitude larger than recent channel profiles of gauge stations on land. The Yenisei paleo-channels have larger dimensions than the Ob examples and could be originated by additional water release during the melt of LGM Putoran ice masses. Asymmetrical submarine channel-levee complexes with channel depths of 60 m and more developed, in some places bordered by glacially dominated morphology, implying deflection by the LGM ice masses. A total of more than 12,000 km of acoustic profiles reveal no evidence for an ice-dammed lake of greater areal extent postulated by several workers. Furthermore, the existence of the channel-levee complexes is indicative of unhindered sediment flow to the north. Channels situated on the shelf above 120-m water depth exhibit no phases of ponding and or infill during sea-level lowstand. These findings denote the non-existence of an ice sheet on large areas of the Kara Sea shelf.

Core correlation data and revised composite depth scale of Exp302 (ACEX) cores

Expedition 302 of the Integrated Ocean Drilling Program (IODP), also known as the Arctic Coring Expedition (ACEX), successfully penetrated a sequence of Cenozoic sediments draping the crest of the Lomonosov Ridge in the central Arctic Ocean. The cumulative sedimentary record spans the last 57 m.y. and was recovered from three sites located within 15 km of each other. Merging the recovered cores onto a common depth scale that accurately reflects their stratigraphic placement below the seafloor is a fundamental step toward interpreting this unique sedimentary record. However, the lack of overlapping recovery in adjacent holes and intervals of high core disturbance complicated traditional methods of stratigraphic correlation. Here we present a revised composite depth scale for the ACEX sediments, generated in part by performing a regional stratigraphic correlation with sediments recovered from previous expeditions to the Lomonosov Ridge. The revised depth scale also reassesses the offsets for cores in the upper 55 meters below seafloor, where no overlapping recovery was acquired, and proposes modifications to these depths.

Thermobonded Fabrics

In 2009 Avella created a series of innovative fabrics for the Yves St Laurent (YSL) collection, deploying techniques from vehicle engineering to generate new materials for a range of garments. Studying the bonding of layers of material in ceramic plate thermobonding technology, Avella conducted a series of experiments with textiles such as flannel, silk and synthetics, and material such as leather, layered with polyamide foam and textile substrate to create new, textured and insulating fabrics with beautiful surfaces and interesting forms. The lightweight properties of the foam enabled the maximum insulation/weight ratio, and the panel moulding technology brought new forms of draping prêt-a-porter fashion design. Exclusive to YSL, this technique was patented and then shown at the Premiere Vision textiles trade fair in 2010. Much documented in specialist journals this innovation also breached the trade-culture barrier and was reported and documented in mainstream newspapers (New York Herald Tribune). Avella’s background in textile workshop studio experimentation at the RCA brought to YSL textiles research for manufacture, the innovative collaboration between fashion couture and engineering laboratory experiments from vehicle design.