Reducing falls in hospital through education to change patient and staff behaviour: A stepped wedge cluster randomised controlled effectiveness trial

Background: Falls remain the most frequent adverse event reported in hospitals, particularly geriatric rehabilitation wards. Randomised trials reducing fall injuries in hospitals have been elusive. Our previous randomised trial (n = 1206) demonstrated that multimedia education with physiotherapist falls educator support reduced falls among patients with higher cognition levels, but this benefit was offset by a potential increase in falls rates among patients with poor cognition. In the previous trial, hospital staff were blinded to the allocation of individual patients, and only delivered usual care.

Theoretical gain optimization in CO2-N2-H2 gasdynamic lasers with two-dimensional wedge nozzles

Attention is given to the results of optimization studies with a 16-micron CO2-N2-H2 GDL employing two-dimensional wedge nozzles. The optimum value of the achievable gain reaches 12.7 percent/cm on the P(15) line for a 30:50:20 percent respective apportionment of the aforementioned gases. The corresponding optimum values for reservoir pressure and area ratio are computed as functions of reservoir temperature, and presented graphically.

Researching effective approaches to cleaning in hospitals: Protocol of the REACH study, a multi-site stepped-wedge randomised trial

Background The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. Methods/design The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Discussion Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12615000325​505

Self-Assembly of a Nanoscopic Prism via a New Organometallic Pt3 Acceptor and Its Fluorescent Detection of Nitroaromatics

A nanoscale-sized cage with a trigonal prismatic shape is prepared by coordination-driven self-assembly of a predesigned organometallic Pt-3 acceptor with an organic clip-type ligand. This trigonal prism is fluorescent and undergoes efficient fluorescence quenching by nitroaromatics, which are the chemical signatures of many explosives.

Prediction of solid block masonry prism compressive strength using FE model

Masonry strength is dependent upon characteristics of the masonry unit,the mortar and the bond between them. Empirical formulae as well as analytical and finite element (FE) models have been developed to predict structural behaviour of masonry. This paper is focused on developing a three dimensional non-linear FE model based on micro-modelling approach to predict masonry prism compressive strength and crack pattern. The proposed FE model uses multi-linear stress-strain relationships to model the non-linear behaviour of solid masonry unit and the mortar. Willam-Warnke's five parameter failure theory developed for modelling the tri-axial behaviour of concrete has been adopted to model the failure of masonry materials. The post failure regime has been modelled by applying orthotropic constitutive equations based on the smeared crack approach. Compressive strength of the masonry prism predicted by the proposed FE model has been compared with experimental values as well as the values predicted by other failure theories and Eurocode formula. The crack pattern predicted by the FE model shows vertical splitting cracks in the prism. The FE model predicts the ultimate failure compressive stress close to 85 of the mean experimental compressive strength value.

Steady compressible flow of granular materials through a wedge-shaped hopper: The smooth wall, radial gravity problem

A continuum model based on the critical state theory of soil mechanics is used to generate stress and density profiles, and to compute discharge velocities for the plane flow of cohesionless materials. Two types of yield loci are employed, namely, a yield locus with a corner, and a smooth yield locus. The yield locus with a corner leads to computational difficulties. For the smooth yield locus, results are found to be relatively insensitive to the shape of the yield locus, the location of the upper traction-free surface and the density specified on this surface. This insensitivity arises from the existence of asymptotic stress and density fields, to which the solution tends to converge on moving down the hopper. Numerical and approximate analytical solutions are obtained for these fields and the latter is used to derive an expression for the discharge velocity. This relation predicts discharge velocities to within 13% of the exact (numerical) values. While the assumption of incompressibility has been frequently used in the literature, it is shown here that in some cases, this leads to discharge velocities which are significantly higher than those obtained by the incorporation of density variation.

Steady incompressible flow of cohesionless granular materials through a wedge-shaped hopper: Frictional 14kinetic solution to the smooth wall, radial gravity problem

Hybrid frictional-kinetic equations are used to predict the velocity, grain temperature, and stress fields in hoppers. A suitable choice of dimensionless variables permits the pseudo-thermal energy balance to be decoupled from the momentum balance. These balances contain a small parameter, which is analogous to a reciprocal Reynolds number. Hence an approximate semi-analytical solution is constructed using perturbation methods. The energy balance is solved using the method of matched asymptotic expansions. The effect of heat conduction is confined to a very thin boundary layer near the exit, where it causes a marginal change in the temperature. Outside this layer, the temperature T increases rapidly as the radial coordinate r decreases. In particular, the conduction-free energy balance yields an asymptotic solution, valid for small values of r, of the form T proportional r-4. There is a corresponding increase in the kinetic stresses, which attain their maximum values at the hopper exit. The momentum balance is solved by a regular perturbation method. The contribution of the kinetic stresses is important only in a small region near the exit, where the frictional stresses tend to zero. Therefore, the discharge rate is only about 2.3% lower than the frictional value, for typical parameter values. As in the frictional case, the discharge rate for deep hoppers is found to be independent of the head of material.

Ruthenium-Oxygen Coordination-Driven Self-Assembly of a Ru-8(II) Incomplete Prism: Synthesis, Structure, and Shape-Selective Molecular Recognition Study

Coordination-driven self-assembly of 1,3,5-benzenetricarboxylate (tma; 1) and oxalato-bridged p-cymeneruthenium(II) building block Ru-2(mu-eta(4)-C2O4)(MeOH)(2)(eta(6)-p-cymene)(2)](O3SCF3)(2) (2) affords an unusual octanuclear incomplete prism Ru-8(eta(6)-p-cymene)(8)(tma)(2)(mu-eta(4)-C2O4)(2)(OMe)(4)](O3SCF3)( 2) (3), which exhibits a remarkable shape-selective binding affinity for neutral phenolic compounds via hydrogen-bonding interactions (p-cymene = p-(PrC6H4Me)-Pr-i). Such a binding was confirmed by single-crystal X-ray diffraction analysis using 1,3,5-trihydroxybenzene as an analyte.

Influence of glycosidic linkage on the nature of carbohydrate binding in beta-prism I fold lectins: An X-ray and molecular dynamics investigation on banana lectin-carbohydrate complexes

The three crystal structures reported here provide details of the interactions of mannose and the mannosyl-alpha-1,3-mannose component of a pentamannose with banana lectin and evidence for the binding of glucosyl-alpha-1,2-glucose to the lectin. The known structures involving the lectin include a complex with glucosyl-beta-1,3-glucose. Modeling studies on the three disaccharide complexes with the reducing end and the nonreducing end at the primary binding site are also provided here. The results of the Xray and modeling studies show that the disaccharides with an alpha-1,3 linkage prefer to have the nonreducing end at the primary binding site, whereas the reducing end is preferred at the site when the linkage is beta-1,3 in mannose/glucose-specific beta-prism I fold lectins. In the corresponding galactose-specific lectins, however, alpha-1,3-linked disaccharides cannot bind the lectin with the nonreducing end at the primary binding site on account of steric clashes with an aromatic residue that occurs only when the lectin is galactose-specific. Molecular dynamics simulations based on the known structures involving banana lectin enrich the information on lectin-carbohydrate interactions obtained from crystal structures. They demonstrate that conformational selection as well as induced fit operate when carbohydrates bind to banana lectin.

Finite element simulation of wedge indentation

A finite element simulation of frictionless wedge indentation of a copper strip has been carried out under plane strain conditions. The problem was first modelled using an one-pass contact algorithm. The difficulties associated with using this method to model wedge indentation problems are explained. An alternative procedure which alleviates some of the problems associated with the one-pass contact algorithm is proposed for modelling frictionless wedge indentation. Also, a re-meshing procedure which has to be carried out when the distortion of the elements around the indenter becomes significant, is discussed. A sample problem involving indentation of a 4 mm copper strip by a rigid wedge indenter has been modelled and the results are compared with experimental and theoretical results.

Nonsimilar mixed convection flow of a non-Newtonian fluid past a vertical wedge

The flow and heat transfer characteristics of a second-order fluid over a vertical wedge with buoyancy forces have been analysed. The coupled nonlinear partial differential equations governing the nonsimilar mixed convection flow have been solved numerically using Keller box method. The effects of the buoyancy parameter, viscoelastic parameter, mass transfer parameter, pressure gradient parameter, Prandtl number and viscous dissipation parameter on the skin friction and heat transfer have been examined in detail. Particular cases of the present results match exactly with those available in the literature.

Method for measurement of the angles of an equilateral (60-deg) prism

A simple technique is devised io measure the angles of equilateral (60-deg) prisms, without using the expensive spectrometers, autocollimators, and angle gauges. The method can be extended to unpolished and opaque prisms made out of materials other than glass. (C) 1997 Society of Photo-Optical Instrumentation Engineers.

Steady compressible flow of cohesionless granular materials through a wedge-shaped bunker

A continuum model based on the critical-state theory of soil mechanics is used to generate stress, density, and velocity profiles, and to compute discharge rates for the flow of granular material in a mass flow bunker. The bin–hopper transition region is idealized as a shock across which all the variables change discontinuously. Comparison with the work of Michalowski (1987) shows that his experimentally determined rupture layer lies between his prediction and that of the present theory. However, it resembles the former more closely. The conventional condition involving a traction-free surface at the hopper exit is abandoned in favour of an exit shock below which the material falls vertically with zero frictional stress. The basic equations, which are not classifiable under any of the standard types, require excessive computational time. This problem is alleviated by the introduction of the Mohr–Coulomb approximation (MCA). The stress, density, and velocity profiles obtained by integration of the MCA converge to asymptotic fields on moving down the hopper. Expressions for these fields are derived by a perturbation method. Computational difficulties are encountered for bunkers with wall angles θw [gt-or-equal, slanted] 15° these are overcome by altering the initial conditions. Predicted discharge rates lie significantly below the measured values of Nguyen et al. (1980), ranging from 38% at θw = 15° to 59% at θw = 32°. The poor prediction appears to be largely due to the exit condition used here. Paradoxically, incompressible discharge rates lie closer to the measured values. An approximate semi-analytical expression for the discharge rate is obtained, which predicts values within 9% of the exact (numerical) ones in the compressible case, and 11% in the incompressible case. The approximate analysis also suggests that inclusion of density variation decreases the discharge rate. This is borne out by the exact (numerical) results – for the parameter values investigated, the compressible discharge rate is about 10% lower than the incompressible value. A preliminary comparison of the predicted density profiles with the measurements of Fickie et al. (1989) shows that the material within the hopper dilates more strongly than predicted. Surprisingly, just below the exit slot, there is good agreement between theory and experiment.

Multiple beam interference of light in an absorbing wedge

Multiple beam interference of light in a wedge is considered when the wedge is filled with an absorbing medium. The aim is to examine a method that may give values of both the real and the imaginary parts of the refractive index of the absorbing medium. We propose here a method to determine these quantities from simple techniques like fringe counting and interferometry, by using as the incident wave either a single Gaussian beam or two parallel Gaussian beams.