The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation

Introduction and objectives Early recognition of deteriorating patients results in better patient outcomes. Modified early warning scores (MEWS) attempt to identify deteriorating patients early so timely interventions can occur thus reducing serious adverse events. We compared frequencies of vital sign recording 24 h post-ICU discharge and 24 h preceding unplanned ICU admission before and after a new observation chart using MEWS and an associated educational programme was implemented into an Australian Tertiary referral hospital in Brisbane. Design Prospective before-and-after intervention study, using a convenience sample of ICU patients who have been discharged to the hospital wards, and in patients with an unplanned ICU admission, during November 2009 (before implementation; n = 69) and February 2010 (after implementation; n = 70). Main outcome measures Any change in a full set or individual vital sign frequency before-and-after the new MEWS observation chart and associated education programme was implemented. A full set of vital signs included Blood pressure (BP), heart rate (HR), temperature (T°), oxygen saturation (SaO2) respiratory rate (RR) and urine output (UO). Results After the MEWS observation chart implementation, we identified a statistically significant increase (210%) in overall frequency of full vital sign set documentation during the first 24 h post-ICU discharge (95% CI 148, 288%, p value <0.001). Frequency of all individual vital sign recordings increased after the MEWS observation chart was implemented. In particular, T° recordings increased by 26% (95% CI 8, 46%, p value = 0.003). An increased frequency of full vital sign set recordings for unplanned ICU admissions were found (44%, 95% CI 2, 102%, p value = 0.035). The only statistically significant improvement in individual vital sign recordings was urine output, demonstrating a 27% increase (95% CI 3, 57%, p value = 0.029). Conclusions The implementation of a new MEWS observation chart plus a supporting educational programme was associated with statistically significant increases in frequency of combined and individual vital sign set recordings during the first 24 h post-ICU discharge. There were no significant changes to frequency of individual vital sign recordings in unplanned admissions to ICU after the MEWS observation chart was implemented, except for urine output. Overall increases in the frequency of full vital sign sets were seen.

Bismuth in interplanetary dust

Samples of a large (~60 µm) chondritic porous (CP) aggregate collected from the stratosphere have been analysed in detail by analytical electron microscopy (AEM). Previous studies of CP aggregates have shown that they are extraterrestrial in origin1–3 and may be related to cometary debris4. CP aggregates are dissimilar to C1 and C2 carbonaceous chondrite matrices and many have not been significantly altered by thermal or radiation processes since their assembly5. We report here a high concentration of Bi2O3 grains within the large CP aggregate designated W7029* A (~60 µm) and suggest they formed by rapid heating (~300 °C) of elemental Bi grains within the aggregate during atmospheric entry. We examine the possibilities for terrestrial Bi contamination of CP aggregate W7029* A but judge them unlikely. Enrichment of elemental Bi within components of extraterrestrial materials is consistent with a nebula condensation model6 and implies that Bi within CP aggregate W7029* A may have formed at a late stage of the condensation process.

Delineating the practice profile of advanced practice nursing : a cross-sectional survey using the modified strong model of advanced practice

AIMS: To test a model that delineates advanced practice nursing from the practice profile of other nursing roles and titles. BACKGROUND: There is extensive literature on advanced practice reporting the importance of this level of nursing to contemporary health service and patient outcomes. Literature also reports confusion and ambiguity associated with advanced practice nursing. Several countries have regulation and delineation for the nurse practitioner, but there is less clarity in definition and service focus of other advanced practice nursing roles. DESIGN: A statewide survey. METHODS: Using the modified Strong Model of Advanced Practice Role Delineation tool, a survey was conducted in 2009 with a random sample of registered nurses/midwives from government facilities in Queensland, Australia. Analysis of variance compared total and subscale scores across groups according to grade. Linear, stepwise multiple regression analysis examined factors influencing advanced practice nursing activities across all domains. RESULTS: There were important differences according to grade in mean scores for total activities in all domains of advanced practice nursing. Nurses working in advanced practice roles (excluding nurse practitioners) performed more activities across most advanced practice domains. Regression analysis indicated that working in clinical advanced practice nursing roles with higher levels of education were strong predictors of advanced practice activities overall. CONCLUSION: Essential and appropriate use of advanced practice nurses requires clarity in defining roles and practice levels. This research delineated nursing work according to grade and level of practice, further validating the tool for the Queensland context and providing operational information for assigning innovative nursing service.

Bismuth oxide nanoparticles in the stratosphere

Platey grains of cubic Bi2O3, α-Bi2O3, and Bi2O2.75 nanograins were associated with chondritic porous interplanetary dust particles W7029C1, W7029E5, and 2011C2 that were collected in the stratosphere at 17-19 km altitude. Similar Bi oxide nanograins were present in the upper stratosphere during May 1985. These grains are linked to the plumes of several major volcanic eruptions during the early 1980s that injected material into the stratosphere. The mass of sulfur from these eruptions is a proxy for the mass of stratospheric Bi from which we derive the particle number densities (p m -3) for "average Bi2O3 nanograins" due to this volcanic activity and those necessary to contaminate the extraterrestrial chondritic porous interplanetary dust particles via collisional sticking. The match between both values supports the idea that Bi2O3 nanograins of volcanic origin could contaminate interplanetary dust particles in the Earth's stratosphere. Copyright 1997 by the American Geophysical Union.

Value added products from modified kaolins : new chemical routes to new markets

Chemical treatments of kaolins to produce nanocrystalline or "X-ray amorphous", stable aluminosilicates with variable - but reproducible - types of micro- and meso-porosity have been developed. These materials show cation exchange capacities and surface area values significantly higher (ranging from 10x to 100x) than kaolin and show good acid resistance to pH~3.0. The combination of these properties offers strong potential for many new applications of kaolin-derived materials in large worldwide markets such as environmental remediation and catalysis. Kaolin amorphous derivative (KAD) is well-suited to removal of many toxic metals down to ppb range from acid mine drainage. Engineering development trials of the KAD manufacturing process and the utilisation of KAD in polluted waters such as acid mine drainage indicates that scale-up from bench-scale is not a barrier to market entry.

Modified kaolins

A process for the preparation of a modified kaolin from a kaolin group mineral which includes expansion and contraction of layers of the kaolin group mineral. The layers comprising one Si-tetrahedral sheet and one Al-octahedral sheet. The expansion and contraction may be initiated by initial intercalation of a reagent which can penetrate kaolin layers to reach an interlayer region there between to form an intercalate. Subsequently, the intercalation may be followed by de-intercalation which involves the removal of the reagent. By the above process, there is provided crystalline modified kaolins having the following properties: (i) an increased interlayer space compared to corresponding kaolin group minerals; (ii) an increased susceptibility to intercalation by cations, anions or salts compared to corresponding kaolin group minerals; and (iii) an increased exfoliated morphology compared to corresponding kaolin group minerals.

Advanced practice nursing role development : factor analysis of a modified role delineation tool

Aim his study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool. Background Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third paper from a multi-phase Australian study aimed at assigning advanced practice roles. Methods A postal survey was conducted of a random sample of state government employed Registered nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbach’s alpha coefficient determined reliability of the overall scale and identified factors. Results There were 658 responses (42% response rate). The five factors found with loadings of ≥.400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbach’s alpha coefficient was .94 overall and for the factors ranged from 0.83 to 0.95. Conclusion Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment.

Improving the hydrogen gas sensing performance of Pt/MoO3 nanoplatelets using a nano thick layer of La2O3

In this paper, we present how a thin RF sputtered layer of lanthanum oxide (La2O3) can alter electrical and improve hydrogen gas sensing characteristics of Pt/molybdenum oxide (MoO3) nanostructures Schottky diodes. We derived the barrier height, ideality factor and dielectric constant from the measured I–V characteristics at operating temperatures in the range of 25–300 ◦C. The dynamic response, response and recovery times were obtained upon exposure to hydrogen gas at different concentrations. Analysis of the results indicated a substantial improvement to the voltage shift sensitivity of the sensors incorporating the La2O3 layer. We associate this enhancement to the formation of numerous trap states due to the presence of the La2O3 thin film on the MoO3 nanoplatelets. These trap states increase the intensity of the dipolar charges at the metal–semiconductor interface, which induce greater bending of the energy bands. However, results also indicate that the presence of La2O3 trap states also increases response and recover times as electrons trapping and de-trapping processes occur before they can pass through this thin dielectric layer.

Non-Newtonian natural convection flow along an isothermal horizontal circular cylinder using modified power-law model

Laminar two-dimensional natural convection boundary-layer flow of non-Newtonian fluids along an isothermal horizontal circular cylinder has been studied using a modified power-law viscosity model. In this model, there are no unrealistic limits of zero or infinite viscosity. Therefore, the boundary-layer equations can be solved numerically by using marching order implicit finite difference method with double sweep technique. Numerical results are presented for the case of shear-thinning as well as shear thickening fluids in terms of the fluid velocity and temperature distributions, shear stresses and rate of heat transfer in terms of the local skin-friction and local Nusselt number respectively.

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 gas sensing performance of Pt/SnO2 nanowires/SiC MOS devices

This paper presents material and gas sensing properties of Pt/SnO2 nanowires/SiC metal oxide semiconductor devices towards hydrogen. The SnO2 nanowires were deposited onto the SiC substrates by vapour-liquid-solid growth mechanism. The material properties of the sensors were investigated using scanning electron microscopy, transmission electron microscopy and X-ray photoelectron spectroscopy. The current-voltage characteristics have been analysed. The effective change in the barrier height for 1% hydrogen was found to be 142.91 meV. The dynamic response of the sensors towards hydrogen at different temperatures has also been studied. At 530°C, voltage shift of 310 mV for 1% hydrogen was observed.

A comparison study on hydrogen sensing performance of Pt/MoO3 nanoplatelets coated with a thin layer of Ta2O5 or La2O3

In this work, we investigate how hydrogen sensing performance of thermally evaporated MoO3 nanoplatelets can be further improved by RF sputtering a thin layer of tantalum oxide (Ta2O5) or lanthanum oxide (La2O3). We show that dissociated hydrogen atoms cause the thin film layer to be polarised, inducing a measurable potential difference greater than that as reported previously. We attribute these observations to the presence of numerous traps in the thin layer; their states allow a stronger trapping of charge at the Pt-thin film oxide interface as compared to the MoO3 sensors without the coating. Under exposure to H2 (10 000 ppm) the maximum change in dielectric constant of 45.6 (at 260 °C) for the Ta2O5/MoO3 nanoplatelets and 31.6 (at 220 °C) for La2O3/MoO3 nanoplatelets. Subsequently, the maximum sensitivity for the Ta2O5/MoO3 is 16.87 (at 260 °C) and La2O3/MoO3 is 7.52 (at 300 °C).

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.