Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children

Background Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion, however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. Objectives To assess the clinical effects (benefits and harms) of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Search Methods The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (Issue 3, 2015). We also searched the reference lists of retrieved trials. Selection criteria Randomised controlled trials that compared the efficacy of normal saline with heparin to prevent occlusion of long term CVCs in infants and children aged up to 18 years of age were included. We excluded temporary CVCs and peripherally inserted central catheters (PICC). Data Collection and Analysis Two review authors independently assessed trial inclusion criteria, trial quality and extracted data. Rate ratios were calculated for two outcome measures - occlusion of the CVC and central line-associated blood stream infection. Other outcome measures included duration of catheter placement, inability to withdraw blood from the catheter, use of urokinase or recombinant tissue plasminogen, incidence of removal or re-insertion of the catheter, or both, and other CVC-related complications such as dislocation of CVCs, other CVC site infections and thrombosis. Main Results Three trials with a total of 245 participants were included in this review. The three trials directly compared the use of normal saline and heparin, however, between studies, all used different protocols for the standard and experimental arms with different concentrations of heparin and different frequency of flushes reported. In addition, not all studies reported on all outcomes. The quality of the evidence ranged from low to very low because there was no blinding, heterogeneity and inconsistency between studies was high and the confidence intervals were wide. CVC occlusion was assessed in all three trials (243 participants). We were able to pool the results of two trials for the outcomes of CVC occlusion and CVC-associated blood stream infection. The estimated rate ratio for CVC occlusion per 1000 catheter days between the normal saline and heparin group was 0.75 (95% CI 0.10 to 5.51, two studies, 229 participants, very low quality evidence). The estimated rate ratio for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37, two studies, 231 participants; low quality evidence). The duration of catheter placement was reported to be similar between the two study arms, in one study (203 participants). Authors' Conclusions The review found that there was not enough evidence to determine the effects of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Ultimately, if this evidence were available, the development of evidenced-based clinical practice guidelines and consistency of practice would be facilitated.

An asymptotic analysis for the coupled dispersion characteristics of a structural acoustic waveguide

Analytical expressions are derived, using asymptotics, for the fluid-structure coupled wavenumbers in a one-dimensional (1-D) structural acoustic waveguide. The coupled dispersion equation of the system is rewritten in the form of the uncoupled dispersion equation with an added term due to the fluid-structure coupling. As a result of this coupling, the prior uncoupled structural and acoustic wavenumbers, now become coupled structural and acoustic wavenumbers. A fluid-loading parameter e, defined as the ratio of mass of fluid to mass of the structure per unit area, is introduced which when set to zero yields the uncoupled dispersion equation. The coupled wavenumber is then expressed in terms of an asymptotic series in e. Analytical expressions are found as e is varied from small to large values. Different asymptotic expansions are used for different frequency ranges with continuous transitions occurring between them. This systematic derivation helps to continuously track the wavenumber solutions as the fluid-loading parameter is varied from small to large values. Though the asymptotic expansion used is limited to the first-order correction factor, the results are close to the numerical results. A general trend is that a given wavenumber branch transits from a rigid-walled solution to a pressure-release solution with increasing E. Also, it is found that at any frequency where two wavenumbers intersect in the uncoupled analysis, there is no more an-intersection in the coupled case, but a gap is created at that frequency. (c) 2007 Elsevier Ltd. All rights reserved.

Asymptotic analysis for the coupled wavenumbers in an infinite fluid-filled flexible cylindrical shell: The axisymmetric mode

The coupled wavenumbers of a fluid-filled flexible cylindrical shell vibrating in the axisymmetric mode are studied. The coupled dispersion equation of the system is rewritten in the form of the uncoupled dispersion equation of the structure and the acoustic fluid, with an added fluid-loading term involving a parameter e due to the coupling. Using the smallness of Poisson's ratio (v), a double-asymptotic expansion involving e and v 2 is substituted in this equation. Analytical expressions are derived for the coupled wavenumbers (for large and small values of E). Different asymptotic expansions are used for different frequency ranges with continuous transitions occurring between them. The wavenumber solutions are continuously tracked as e varies from small to large values. A general trend observed is that a given wavenumber branch transits from a rigidwalled solution to a pressure-release solution with increasing E. Also, it is found that at any frequency where two wavenumbers intersect in the uncoupled analysis, there is no more an intersection in the coupled case, but a gap is created at that frequency. Only the axisymmetric mode is considered. However, the method can be extended to the higher order modes.

Equivalent circuit parameters of the film-covered magnesium/electrolyte interface in Mg/MnO2 dry cells from transient and ac impedance measurements

The electrochemical properties of the film-covered anode/solution interface in the magnesium/ manganese dioxide dry cell have been evaluated. The most plausible electrical equivalent circuit description of the Mg/solution interface with the passive film intact, has been identified. These results are based on the analysis of ac impedance and voltage transient measurements made on the dry cell under conditions which cause no damage to the protective passive film on the anode. The study demonstrates the complementary character of impedance and transient measurements when widely different frequency ranges are sampled in each type of investigation. The values and temperature dependence of the anode-film resistance, film capacitance, double-layer capacitance and charge-transfer resistance of the film-covered magnesium/solution interface have been determined. The magnitude of these values and its implications in understanding the important performance aspects of the magnesium/manganese dioxide dry cell are discussed. The study may be extended, in principle, to Li, Al and Ca batteries.

Equivalent circuit parameters of the film-covered magnesium/electrolyte interface in Mg/MnO2 dry cells from transient and ac impedance measurements

The electrochemical properties of the film-covered anode/solution interface in the magnesium/ manganese dioxide dry cell have been evaluated. The most plausible electrical equivalent circuit description of the Mg/solution interface with the passive film intact, has been identified. These results are based on the analysis of ac impedance and voltage transient measurements made on the dry cell under conditions which cause no damage to the protective passive film on the anode. The study demonstrates the complementary character of impedance and transient measurements when widely different frequency ranges are sampled in each type of investigation. The values and temperature dependence of the anode-film resistance, film capacitance, double-layer capacitance and charge-transfer resistance of the film-covered magnesium/solution interface have been determined. The magnitude of these values and its implications in understanding the important performance aspects of the magnesium/manganese dioxide dry cell are discussed. The study may be extended, in principle, to Li, Al and Ca batteries.

High-temperature dielectric response in pulsed laser deposited Bi1.5Zn1.0Nb1.5O7 thin films

Cubic pyrochlore Bi1.5Zn1.0Nb1.5O7 thin films were deposited by pulsed laser ablation on Pt(200)/SiO2/Si at 500, 550, 600, and 650 degrees C. The thin films with (222) preferred orientation were found to grow at 650 degrees C with better crystallinity which was established by the lowest full-width half maxima of similar to 0.38. The dielectric response of the thin films grown at 650 degrees C have been characterized within a temperature range of 270-650 K and a frequency window of 0.1-100 kHz. The dielectric dispersion in the thin films shows a Maxwell-Wagner type relaxation with two different kinds of response confirmed by temperature dependent Nyquist plots. The ac conduction of the films showed a varied behavior in two different frequency regions. The power law exponent values of more than 1 at high frequency are explained by a jump-relaxation-model. The possibility of grain boundary related large polaronic hopping, due to two different power law exponents and transformation of double to single response in Nyquist plots at high temperature, has been excluded. The ``attempt jump frequency'' obtained from temperature dependent tangent loss and real part of dielectric constants, has been found to lie in the range of their lattice vibronic frequencies (10(12)-10(13) Hz). The activation energy arising from a large polaronic hopping due to trapped charge at low frequency region has been calculated from the ac conduction behavior. The range of activation energies (0.26-0.59. eV) suggests that the polaronic hopping at low frequency is mostly due to oxygen vacancies. (C) 2010 American Institute of Physics. doi:10.106311.3457335]

Generalized asymptotic expansions for the wavenumbers in infinite flexible in vacuo orthotropic cylindrical shells

Analytical expressions are found for the wavenumbers and resonance frequencies in flexible, orthotropic shells using the asymptotic methods. These expressions are valid for arbitrary circumferential orders n. The Donnell-Mushtari shell theory is used to model the dynamics of the cylindrical shell. Initially, an in vacuo cylindrical isotropic shell is considered and expressions for all the wavenumbers (bending, near-field bending, longitudinal and torsional) are found. Subsequently, defining a suitable orthotropy parameter epsilon, the problem of wave propagation in an orthotropic shell is posed as a perturbation on the corresponding problem for an isotropic shell. Asymptotic expressions for the wavenumbers in the in vacuo orthotropic shell are then obtained by treating epsilon as an expansion parameter. In both cases (isotropy and orthotropy), a frequency-scaling parameter (eta) and Poisson's ratio (nu) are used to find elegant expansions in the different frequency regimes. The asymptotic expansions are compared with numerical solutions in each of the cases and the match is found to be good. The main contribution of this work lies in the extension of the existing literature by developing closed-form expressions for wavenumbers with arbitrary circumferential orders n in the case of both, isotropic and orthotropic shells. Finally, we present natural frequency expressions in finite shells (isotropic and orthotropic) for the axisymmetric mode and compare them with numerical and ANSYS results. Here also, the comparison is found to be good. (C) 2011 Elsevier Ltd. All rights reserved.

A Guided Wave approach for the detection of damage in a structure having elements with periodic damage

A wave propagation based approach for the detection of damage in components of structures having periodic damage has been proposed. Periodic damage pattern may arise in a structure due to periodicity in geometry and in loading. The method exploits the Block-Floquet band formation mechanism, a feature specific to structures with periodicity, to identify propagation bands (pass bands) and attenuation bands (stop bands) at different frequency ranges. The presence of damage modifies the wave propagation behaviour forming these bands. With proper positioning of sensors a damage force indicator (DFI) method can be used to locate the defect at an accuracy level of sensor to sensor distance. A wide range of transducer frequency may be used to obtain further information about the shape and size of the damage. The methodology is demonstrated using a few 1-D structures with different kinds of periodicity and damage. For this purpose, dynamic stiffness matrix is formed for the periodic elements to obtain the dispersion relationship using frequency domain spectral element and spectral super element method. The sensitivity of the damage force indicator for different types of periodic damages is also analysed.

Photon-photon scattering in a plasma channel

The Heisenberg-Euler correction due to photon-photon scattering, a still unverified quantum electrodynamics effect, on electromagnetic wave interaction inside a plasma channel is investigated theoretically. From a signal laser beam in the relativistic overdense plasma channel, photon-photon scattering can produce a detectable output beam of different frequency and polarization. (C) 2003 American Institute of Physics.

Phase control of switching from positive to negative index material in a four-level atomic system

Electric and magnetic responses of the medium to the probe field are analysed in a four-level loop atomic system by taking into account the relative phase of the applied fields. An interesting phenomenon is found: under suitable conditions, a change of the refractive index from positive to negative can occur by modulating the relative phase of the applied fields. Then the medium can be switched from a positive index material to a negative index material in our scheme. In addition, a negative index material can be realized in different frequency regions by adjusting the relative phase. It may give us a convenient way to obtain the desired material with positive or negative index.

A Multiwavelength Study of the Intracluster Medium and the Characterization of the Multiwavelength Sub/millimeter Inductance Camera

The first part of this thesis combines Bolocam observations of the thermal Sunyaev-Zel’dovich (SZ) effect at 140 GHz with X-ray observations from Chandra, strong lensing data from the Hubble Space Telescope (HST), and weak lensing data from HST and Subaru to constrain parametric models for the distribution of dark and baryonic matter in a sample of six massive, dynamically relaxed galaxy clusters. For five of the six clusters, the full multiwavelength dataset is well described by a relatively simple model that assumes spherical symmetry, hydrostatic equilibrium, and entirely thermal pressure support. The multiwavelength analysis yields considerably better constraints on the total mass and concentration compared to analysis of any one dataset individually. The subsample of five galaxy clusters is used to place an upper limit on the fraction of pressure support in the intracluster medium (ICM) due to nonthermal processes, such as turbulent and bulk flow of the gas. We constrain the nonthermal pressure fraction at r500c to be less than 0.11 at 95% confidence, where r500c refers to radius at which the average enclosed density is 500 times the critical density of the Universe. This is in tension with state-of-the-art hydrodynamical simulations, which predict a nonthermal pressure fraction of approximately 0.25 at r500c for the clusters in this sample.

The second part of this thesis focuses on the characterization of the Multiwavelength Sub/millimeter Inductance Camera (MUSIC), a photometric imaging camera that was commissioned at the Caltech Submillimeter Observatory (CSO) in 2012. MUSIC is designed to have a 14 arcminute, diffraction-limited field of view populated with 576 spatial pixels that are simultaneously sensitive to four bands at 150, 220, 290, and 350 GHz. It is well-suited for studies of dusty star forming galaxies, galaxy clusters via the SZ Effect, and galactic star formation. MUSIC employs a number of novel detector technologies: broadband phased-arrays of slot dipole antennas for beam formation, on-chip lumped element filters for band definition, and Microwave Kinetic Inductance Detectors (MKIDs) for transduction of incoming light to electric signal. MKIDs are superconducting micro-resonators coupled to a feedline. Incoming light breaks apart Cooper pairs in the superconductor, causing a change in the quality factor and frequency of the resonator. This is read out as amplitude and phase modulation of a microwave probe signal centered on the resonant frequency. By tuning each resonator to a slightly different frequency and sending out a superposition of probe signals, hundreds of detectors can be read out on a single feedline. This natural capability for large scale, frequency domain multiplexing combined with relatively simple fabrication makes MKIDs a promising low temperature detector for future kilopixel sub/millimeter instruments. There is also considerable interest in using MKIDs for optical through near-infrared spectrophotometry due to their fast microsecond response time and modest energy resolution. In order to optimize the MKID design to obtain suitable performance for any particular application, it is critical to have a well-understood physical model for the detectors and the sources of noise to which they are susceptible. MUSIC has collected many hours of on-sky data with over 1000 MKIDs. This work studies the performance of the detectors in the context of one such physical model. Chapter 2 describes the theoretical model for the responsivity and noise of MKIDs. Chapter 3 outlines the set of measurements used to calibrate this model for the MUSIC detectors. Chapter 4 presents the resulting estimates of the spectral response, optical efficiency, and on-sky loading. The measured detector response to Uranus is compared to the calibrated model prediction in order to determine how well the model describes the propagation of signal through the full instrument. Chapter 5 examines the noise present in the detector timestreams during recent science observations. Noise due to fluctuations in atmospheric emission dominate at long timescales (less than 0.5 Hz). Fluctuations in the amplitude and phase of the microwave probe signal due to the readout electronics contribute significant 1/f and drift-type noise at shorter timescales. The atmospheric noise is removed by creating a template for the fluctuations in atmospheric emission from weighted averages of the detector timestreams. The electronics noise is removed by using probe signals centered off-resonance to construct templates for the amplitude and phase fluctuations. The algorithms that perform the atmospheric and electronic noise removal are described. After removal, we find good agreement between the observed residual noise and our expectation for intrinsic detector noise over a significant fraction of the signal bandwidth.

Smoothing effect in the broadband laser through a dispersive wedge

The propagation expression of a broadband laser passing through a dispersive wedge is derived on the basis of the Huygens-Fresnel diffraction integral, Smoothing effects caused by the phase perturbation of the dispersive wedge on the intensity profiles are investigated in detail. The phase perturbation of the dispersive wedge induces a relative transverse position shift between the diffraction patterns of different frequency components. The relative transverse position shift is of great benefit to the fill of the intensity peaks of some patterns in the valleys of others when these patterns are overlapped and thus the smoothing effect is achieved. (c) 2006 Elsevier B.V. All rights reserved.

Smoothing the side lobes of a focused pattern by spectral dispersion in the broadband laser

Starting from the Huygens-Fresnel diffraction integral, the propagation equations of a broadband laser passing through a dispersive lens and a dispersive wedge are derived. Smoothing effect on the side lobes of the focused pattern is achieved as the broadband laser passes through the lens because of the spectral dispersion of the lens. By inserting a dispersive wedge behind the lens, better smoothing effect is realized because a relative position shift between focused patterns of different frequency components is generated due to the spectral dispersion of the wedge. Smoothing effect on the side lobe is obtained even with small bandwidth of the broadband laser as the wedge is used. (c) 2006 Elsevier GmbH. All rights reserved.

Absolute and convective instability in gas turbine fuel injectors

Hydrodynamic instabilities in gas turbine fuel injectors help to mix the fuel and air but can sometimes lock into acoustic oscillations and contribute to thermoacoustic instability. This paper describes a linear stability analysis that predicts the frequencies and strengths of hydrodynamic instabilities and identifies the regions of the flow that cause them. It distinguishes between convective instabilities, which grow in time but are convected away by the flow, and absolute instabilities, which grow in time without being convected away. Convectively unstable flows amplify external perturbations, while absolutely unstable flows also oscillate at intrinsic frequencies. As an input, this analysis requires velocity and density fields, either from a steady but unstable solution to the Navier-Stokes equations, or from time-averaged numerical simulations. In the former case, the analysis is a predictive tool. In the latter case, it is a diagnostic tool. This technique is applied to three flows: a swirling wake at Re = 400, a single stream swirling fuel injector at Re - 106, and a lean premixed gas turbine injector with five swirling streams at Re - 106. Its application to the swirling wake demonstrates that this technique can correctly predict the frequency, growth rate and dominant wavemaker region of the flow. It also shows that the zone of absolute instability found from the spatio-temporal analysis is a good approximation to the wavemaker region, which is found by overlapping the direct and adjoint global modes. This approximation is used in the other two flows because it is difficult to calculate their adjoint global modes. Its application to the single stream fuel injector demonstrates that it can identify the regions of the flow that are responsible for generating the hydrodynamic oscillations seen in LES and experimental data. The frequencies predicted by this technique are within a few percent of the measured frequencies. The technique also explains why these oscillations become weaker when a central jet is injected along the centreline. This is because the absolutely unstable region that causes the oscillations becomes convectively unstable. Its application to the lean premixed gas turbine injector reveals that several regions of the flow are hydrodynamically unstable, each with a different frequency and a different strength. For example, it reveals that the central region of confined swirling flow is strongly absolutely unstable and sets up a precessing vortex core, which is likely to aid mixing throughout the injector. It also reveals that the region between the second and third streams is slightly absolutely unstable at a frequency that is likely to coincide with acoustic modes within the combustion chamber. This technique, coupled with knowledge of the acoustic modes in a combustion chamber, is likely to be a useful design tool for the passive control of mixing and combustion instability. Copyright © 2012 by ASME.

Dynamic P-I and P-V Curves for Semiconductor Lasers and Modulators

In this paper, we propose the dynamic P-V curve for modulator and P-I curve for laser diode, and present a simple approach to deriving the curves from the small-signal frequency responses measured using a microwave network analyzer. The linear response range, modulation efficiency, optimal driving conditions at different frequency can, therefore, be determined. It is demonstrated that the large-signal performance of electro-absorption (EA) modulator and the directly modulated semiconductor lasers can be predicted from the dynamic curved surface. Experiments show a good agreement between the evaluated characteristics and the measured large-signal performance.