Frequency of dressing changes for central venous access devices on catheter-related infections

Background People admitted to intensive care units and those with chronic health care problems often require long-term vascular access. Central venous access devices (CVADs) are used for administering intravenous medications and blood sampling. CVADs are covered with a dressing and secured with an adhesive or adhesive tape to protect them from infection and reduce movement. Dressings are changed when they become soiled with blood or start to come away from the skin. Repeated removal and application of dressings can cause damage to the skin. The skin is an important barrier that protects the body against infection. Less frequent dressing changes may reduce skin damage, but it is unclear whether this practice affects the frequency of catheter-related infections. Objectives To assess the effect of the frequency of CVAD dressing changes on the incidence of catheter-related infections and other outcomes including pain and skin damage. Search methods In June 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched clinical trials registries for registered trials. There were no restrictions with respect to language, date of publication or study setting. Selection criteria All randomised controlled trials (RCTs) evaluating the effect of the frequency of CVAD dressing changes on the incidence of catheter-related infections on all patients in any healthcare setting. Data collection and analysis We used standard Cochrane review methodology. Two review authors independently assessed studies for inclusion, performed risk of bias assessment and data extraction. We undertook meta-analysis where appropriate or otherwise synthesised data descriptively when heterogeneous. Main results We included five RCTs (2277 participants) that compared different frequencies of CVAD dressing changes. The studies were all conducted in Europe and published between 1995 and 2009. Participants were recruited from the intensive care and cancer care departments of one children's and four adult hospitals. The studies used a variety of transparent dressings and compared a longer interval between dressing changes (5 to15 days; intervention) with a shorter interval between changes (2 to 5 days; control). In each study participants were followed up until the CVAD was removed or until discharge from ICU or hospital. - Confirmed catheter-related bloodstream infection (CRBSI) One trial randomised 995 people receiving central venous catheters to a longer or shorter interval between dressing changes and measured CRBSI. It is unclear whether there is a difference in the risk of CRBSI between people having long or short intervals between dressing changes (RR 1.42, 95% confidence interval (CI) 0.40 to 4.98) (low quality evidence). - Suspected catheter-related bloodstream infection Two trials randomised a total of 151 participants to longer or shorter dressing intervals and measured suspected CRBSI. It is unclear whether there is a difference in the risk of suspected CRBSI between people having long or short intervals between dressing changes (RR 0.70, 95% CI 0.23 to 2.10) (low quality evidence). - All cause mortality Three trials randomised a total of 896 participants to longer or shorter dressing intervals and measured all cause mortality. It is unclear whether there is a difference in the risk of death from any cause between people having long or short intervals between dressing changes (RR 1.06, 95% CI 0.90 to 1.25) (low quality evidence). - Catheter-site infection Two trials randomised a total of 371 participants to longer or shorter dressing intervals and measured catheter-site infection. It is unclear whether there is a difference in risk of catheter-site infection between people having long or short intervals between dressing changes (RR 1.07, 95% CI 0.71 to 1.63) (low quality evidence). - Skin damage One small trial (112 children) and three trials (1475 adults) measured skin damage. There was very low quality evidence for the effect of long intervals between dressing changes on skin damage compared with short intervals (children: RR of scoring ≥ 2 on the skin damage scale 0.33, 95% CI 0.16 to 0.68; data for adults not pooled). - Pain Two studies involving 193 participants measured pain. It is unclear if there is a difference between long and short interval dressing changes on pain during dressing removal (RR 0.80, 95% CI 0.46 to 1.38) (low quality evidence). Authors' conclusions The best available evidence is currently inconclusive regarding whether longer intervals between CVAD dressing changes are associated with more or less catheter-related infection, mortality or pain than shorter intervals.

Naomi Block Manners Stern collection of Eleanor Roosevelt correspondence undated, 1941-1962, 1972, 1974, 1976, 1984, 2003

This collection is mainly composed of correspondence between Ms. Stern and Mrs. Roosevelt, spanning the years from their first acquaintance in 1941 to Mrs. Roosevelt's decease in 1962. Letters that hold particular interest concern Ms. Stern's experience at the Summer Student Leadership Institute, and the White House. Additional material in the collection encompasses articles, newsclippings, programs, press releases, and photographs. The articles and newsclippings folder contains information pertaining to Ms. Stern's college career, the first Summer Student Leadership Institute, Mrs. Roosevelt's talk at Community Day, National Youth Association, and a donation of an ambulance to the war effort by Hunter college students. Naomi Block Manners Stern personal folder contains an article Naomi Block wrote in her college magazine, "Echo," describing her perceptions of President Roosevelt and Prime Minister Winston Churchill during her first visit at the White House. Also included is her graduation program, listing Mrs. Roosevelt as the main speaker, a commemoration of President Roosevelt in 1972 in which Ms. Stern took part, an article and press release describing Ms. Stern's career at Revlon, and a 2003 written summary of Ms. Stern's relationship with Mrs. Roosevelt. Photographs were taken by Naomi Block and others at the Summer Leadership Institute in 1941 portray identified fellow students, Mrs. Roosevelt, James Roosevelt, the Roosevelt home in Campobello, and Felix Frankfurter.

End-of-life care pathways for improving outcomes in caring for the dying

This is an updated version of a Cochrane review published in Issue 11, 2013 in the Cochrane Library. In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans that detail essential steps in caring for patients with specific clinical problems. In particular, care pathways for the dying have been developed as a model to improve care of patients who are in the last days of life. The care pathways were designed with an aim of ensuring that the most appropriate management occurs at the most appropriate time, and that it is provided by the most appropriate health professional. Since the last update, there have been sustained concerns about the safety of implementing end-of-life care pathways, particularly in the United Kingdom (UK). Therefore, there is a significant need for clinicians and policy makers to be informed about the effects of end-of-life care pathways via a systematic review.

Structuring time and questioning to achieve tactical awareness in games lessons

Background: A paradigm shift in educational policy to create problem solvers and critical thinkers produced the games concept approach (GCA) in Singapore's Revised Syllabus for Physical Education (1999). A pilot study (2001) conducted on 11 primary school student teachers (STs) using this approach identified time management and questioning as two of the major challenges faced by novice teachers. Purpose: To examine the GCA from three perspectives: structure—lesson form in terms of teacher-time and pupil-time; product—how STs used those time fractions; and process—the nature of their questioning (type, timing, and target). Participants and setting: Forty-nine STs from three different PETE cohorts (two-year diploma, four-year degree, two-year post-graduate diploma) volunteered to participate in the study conducted during the penultimate week of their final practicum in public primary and secondary schools. Intervention: Based on the findings of the pilot study, PETE increased the emphasis on GCA content specific knowledge and pedagogical procedures. To further support STs learning to actualise the GCA, authentic micro-teaching experiences that were closely monitored by faculty were provided in schools nearby. Research design: This is a descriptive study of time-management and questioning strategies implemented by STs on practicum. Each lesson was segmented into a number of sub-categories of teacher-time (organisation, demonstration and closure) and pupil-time (practice time and game time). Questions were categorised as knowledge, technical, tactical or affective. Data collection: Each ST was video-taped teaching a GCA lesson towards the end of their final practicum. The STs individually determined the timing of the data collection and the lesson to be observed. Data analysis: Each lesson was segmented into a number of sub-categories of both teacher- and pupil-time. Duration recording using Noldus software (Observer 4.0) segmented the time management of different lesson components. Questioning was coded in terms of type, timing and target. Separate MANOVAs were used to measure the difference between programmes and levels (primary and secondary) in relation to time-management procedures and questioning strategies. Findings: No differences emerged between the programmes or levels in their time-management or questioning strategies. Using the GCA, STs generated more pupil time (53%) than teacher time (47%). STs at the primary level provided more technical practice, and those in secondary schools more small-sided game play. Most questions (58%) were asked during play or practice but were substantially low-order involving knowledge or recall (76%) and only 6.7% were open-ended or divergent and capable of developing tactical awareness. Conclusions: Although STs are delivering more pupil time (practice and game) than teacher-time, the lesson structure requires further fine-tuning to extend the practice task beyond technical drills. Many questions are being asked to generate knowledge about games but lack sufficient quality to enhance critical thinking and tactical awareness, as the GCA intends.

Diverse populations of T cells with NK cell receptors accumulate in the human intestine in health and in colorectal cancer

T cells expressing NK cell receptors (NKR) display rapid MHC-unrestricted cytotoxicity and potent cytokine secretion and are thought to play roles in immunity against tumors. We have quantified and characterized NKR+ T cells freshly isolated from epithelial and lamina propria layers of duodenum and colon from 16 individuals with no evidence of gastrointestinal disease and from tumor and uninvolved tissue from 19 patients with colorectal cancer. NKR+ T cell subpopulations were differentially distributed in different intestinal compartments, and CD161+ T cells accounted for over one half of T cells at all locations tested. Most intestinal CD161+ T cells expressed alpha beta TCR and either CD4 or CD8. Significant proportions expressed HLA-DR,CD69 and Fas ligand. Upon stimulation in vitro, CD161+ T cells produced IFN-gamma and TNF-alpha but not IL-4. NKT cells expressing the Valpha24Vbeta11 TCR, which recognizes CD1d,were virtually absent from the intestine, but colonic cells produced IFN-gamma in response to the NKT cell agonist ligand alpha-galactosylceramide. NKR+ T cells were not expanded in colonic tumors compared to adjacent uninvolved tissue. The predominance, heterogeneity and differential distribution of NKR+ T cells at different intestinal locations suggests that they are central to intestinal immunity.

A novel single pot synthesis of binuclear copper(II) complexes of macrocyclic and macroacyclic compartmental ligands: Structures and magnetic properties

Two binuclear copper(II) complexes one (complex 1) with a macrocyclic ligand (H(2)L1) and other (complex 2) with a macroacyclic (end-off type) compartmental ligand (HL2) have been synthesized from single pot template synthesis involving copper(II) nitrate, 1,2diaminoethane, 4-methyl-2,6-diformylphenol, and sodium azide. Structure analysis of complex I reveals that there are actually two half molecules present in the asymmetric unit and so two complexes (molecule-I and molecule-II) are present in unit cell, although they show slight differences. The two Cu(II) centers are in distorted square pyramidal coordination environment with two endogenous phenoxo bridges provided by the phenolate of H(2)L1 I having Cu-Cu separations of 2.9133(10) angstrom and 2.9103(10) in the two molecules. In complex 2 the coordination environments around two Cu(II) centers are asymmetric, Cu1 is in distorted square pyramidal environment whereas, the coordination environment around Cu2 is distorted octahedral. The two Cu(II) centers in complex 2 are connected by two different kinds of bridges, one is endogenous phenoxo bridge provided by the phenolate of the ligand HL2 and the other is exogenous azido bridge (mu-(1),(l) type) with Cu-Cu distance of 3.032(10) angstrom. Variable temperature magnetic studies show that two Cu(II) centers in both the complexes are strongly antiferromagnetically coupled with J = -625 +/- 5 cm(-1) and J = -188.6 +/- 1cm(-1) for complex 1 and 2, respectively. (C) 2006 Elsevier B.V. All rights reserved.

Author response: "Missed opportunity related to statistical methods"

"We thank MrGilder for his considered comments and suggestions for alternative analyses of our data. We also appreciate Mr Gilder’s support of our call for larger studies to contribute to the evidence base for preoperative loading with high-carbohydrate fluids..."

Onko tutkijan sukupuolella väliä? : Kemian ja fysiikan alan tutkijoiden ja tohtoriopiskelijoiden tutkijanura IDECAT-verkostossa sukupuoliperspektiivistä.

Tutkimukseni kohteena ovat mies- ja naispuoliset tutkijat ja tohtoriopiskelijat, jotka ovat osallistuneet katalyysitutkimukseen keskittyvän tutkimusverkosto IDECAT:in toimintaan. Tutkielmassani pyrin selvittämään, onko naisten ja miesten tutkijanuran välillä eroa ja jos on, niin minkälainen tämä ero on. Pyrin myös saamaan selville, onko naisten tutkijanuralla esteitä ja esiintyykö tiedeyhteisössä sukupuolesta johtuvaa syrjintää. IDECAT (Integrated Design of Catalytic Nanomaterials for a Sustainable Production) on EU-rahoitteinen, kemian tekniikkaan liittyvään katalyysitutkimukseen keskittyvä tutkimusverkosto, johon kuuluu alan tutkimusyksiköitä ja yliopistoja 12 Euroopan maasta. IDECAT:iin kuuluu noin 500-600 henkilöä. Tutkimukseni pohjautuu kahteen kyselytutkimukseen, jotka toteutettiin Internetissä 2009-2010. Ensimmäinen kyselytutkimus oli vastaajien saatavilla loka-marraskuussa 2009 ja siinä selvitettiin IDECAT:in tutkijoiden ja tohtoriopiskelijoiden tasa-arvotilannetta yleisesti. Kyselyyn vastasi 83 henkilöä, joista 51% oli naisia ja 49 % miehiä. Kyselyssä käytettiin strukturoitua kyselylomaketta ja tulokset analysoitiin kvantitatiivisesti SPSS tilasto-ohjelmalla. Tilastollisena menetelmänä käytän ristiintaulukointia. Toinen kyselytutkimus (jatkokysely) keskittyy tiedeyhteisössä tapahtuvaan sukupuolesta johtuvaan syrjintään ja se oli vastaajien saatavilla huhti-toukokuussa 2010. Jatkokyselyn kysymykset ovat avokysymyksiä ja ne analysoitiin laadullisesti. Jatkokyselyyn vastasi 24 henkilöä, joista 6 kuvasi yksityiskohtaisesti syrjintäkokemuksiaan tiedeyhteisössä. Teoreettisena viitekehyksenä käytän tutkimuksessani Joan Ackerin sukupuolittuneen organisaation teoriaa ja siihen liittyviä, organisaation toiminnassa ilmeneviä sukupuolittuneita prosesseja. Sukupuolittuneet prosessit ovat ajattelutapoja , käytäntöjä ja asenteita, joilla sukupuolet erotetaan toisistaan ja joilla tuotetaan sukupuolten välisiä valtasuhteita. Naisten ja miesten tutkijanuran välillä on aineistossani joitakin merkittäviä eroja. Sukupuolesta johtuva syrjintä on yleistä vastaajien keskuudessa ja naiset ovat kokeneet sitä useammin kuin miehet. 67% naisvastaajista ja 37% miesvastaajista on kokenut sukupuolesta johtuvaa syrjintää. Naisvastaajat myös kokevat miehiä useammin, että he eivät saa riittävästi tukea ja kannustusta esimiehiltään. Lisäksi naisia on pyydetty mukaan tieteelliseen yhteistyöhön miehiä harvemmin. Useimmat muuttujat eivät kuitenkaan tuo eroa sukupuolten välille. Tutkijanaiset kokevat ylenemismahdollisuutensa lähes yhtä hyviksi kuin miehet, naiset ja miehet työskentelevät yhtä usein määräaikaisissa tehtävissä ja naiset työskentelevät kokopäiväisesti lähes yhtä usein kuin miehet. Naiset pitävät perheen ja työn yhdistämistä helppona. Sukupuolittuneita prosesseja ilmenee erityisesti sukupuolten väliseen työnjakoon ja sosiaalisen tuen ja vallan jakoon tiedeyhteisössä liittyvissä tilanteissa. Sukupuolittuneisuus ei kuitenkaan ole totaalista, monien kyselyn muuttujien kohdalla sukupuolittumista tai eroa sukupuolten välille ei tullut. Monet kyselyn muuttujat osoittavatkin, että naiset ja miehet kokevat, että heitä kohdellaan melko tasa-arvoisesti. Tietyillä osa-alueilla epätasa-arvoisen kohtelun kokemukset ovat kuitenkin yleisiä, mikä tuottaa ristiriitaisen kuvan tiedeyhteisön tasa-arvotilanteesta. Tämä voi viitata siihen, että tutkijanaisten ja miesten asemat ja roolit tiedeyhteisössä eivät ole pysyviä ja staattisia, vaan aktiivisessa muutoksen tilassa. Tutkijanaisten asemaa tiedeyhteisössä voidaan lisäksi parantaa reagoimalla ja puuttumalla sukupuolesta johtuvaan syrjintään, pitämällä tasa-arvoasioita esillä sekä kiinnittämällä huomiota johtamiskäytäntöihin, esimerkiksi palkkaamalla lisää naisjohtajia. Avainsanat Keywords: Sukupuolittunut organisaatio, sukupuolittuneet prosessit, kyselytutkimus, kvantitatiivinen tutkimus, tiedeyhteisö, sukupuolisyrjintä, tutkijanaiset, naistutkijat, sukupuolten tasa-arvo, gendered organization, academia, female scientists, gender equality

Competing magnetic interactions in a dinuclear Ni(II) complex: Antiferromagnetic O-H center dot center dot center dot O moiety and ferromagnetic N-3(-) ligand

Synthesis, structural characteristics, magnetic studies and DFT calculations in Ni(II) dinuclear complexes containing two bridging N-3(-) and an O-(HO)-O-... linkage reveal the existence of ferromagnetic interactions between Ni(II) centers via N-3(-) ligands and antiferromagnetic interactions through the H-bonded moiety. The overall magnetic behavior of the system depends on the delicate balance between these two competing interactions.

Investigational drugs for schizophrenia targeting the dopamine receptor: phase II trials

Introduction: For over half a century now, the dopamine hypothesis has provided the most widely accepted heuristic model linking pathophysiology and treatment in schizophrenia. Despite dopaminergic drugs being available for six decades, this system continues to represent a key target in schizophrenia drug discovery. The present article reviews the scientific rationale for dopaminergic medications historically and the shift in our thinking since, which is clearly reflected in the investigational drugs detailed. Areas covered: We searched for investigational drugs using the key words `dopamine,' `schizophrenia,' and `Phase II' in American and European clinical trial registers (clinicaltrials. gov; clinicaltrialsregister.eu), published articles using National Library of Medicine's PubMed database, and supplemented results with a manual search of cross-references and conference abstracts. We provide a brief description of drugs targeting dopamine synthesis, release or metabolism, and receptors (agonists/partial agonists/antagonists). Expert opinion: There are prominent shifts in how we presently conceptualize schizophrenia and its treatment. Current efforts are not as much focused on developing better antipsychotics but, instead, on treatments that can improve other symptom domains, in particular cognitive and negative. This new era in the pharmacotherapy of schizophrenia moves us away from the older `magic bullet' approach toward a strategy fostering polypharmacy and a more individualized approach shaped by the individual's specific symptom profile.

Targeting the dopamine receptor in schizophrenia: investigational drugs in Phase III trials

Introduction: Antipsychotic drugs date back to the 1950s and chlorpromazine. Soon after, it was established that blockade of dopamine and, in particular, the D-2 receptor was central to this effect. Dopamine continues to represent a critical line of investigation, although much of the work now focuses on its potential in other symptom domains. Areas covered: A search was carried out for investigational drugs using the key words `dopamine', `schizophrenia' and `Phase III' in an American clinical trial registry (clinicaltrials.gov), published articles using the National Library of Medicine's PubMed database, and supplemented results with a manual search of cross-references and conference abstracts. Drugs were excluded that were already FDA approved. Expert opinion: There remains interest, albeit diminished, in developing better antipsychotic compounds. The greatest enthusiasm currently centres on dopamine's role in negative and cognitive symptom domains. With theories conceptualising hypodopaminergic activity as underlying these deficits, considerable effort is focused on drug strategies that will enhance dopamine activity. Finally, a small body of research is investigating dopaminergic compounds vis-a-vis side-effect treatments. In domains beyond psychosis, however, dopamine arguably is not seen as so central, reflected in considerable research following other lines of investigation.

Strings vs. spins on the null orbifold

We study the null orbifold singularity in 2+1 d flat space higher spin theory as well as string theory. Using the Chern-Simons formulation of 2+1 d Einstein gravity, we first observe that despite the singular nature of this geometry, the eigenvalues of its Chern-Simons holonomy are trivial. Next, we construct a resolution of the singularity in higher spin theory: a Kundt spacetime with vanishing scalar curvature invariants. We also point out that the UV divergences previously observed in the 2-to-2 tachyon tree level string amplitude on the null orbifold do not arise in the at alpha' -> infinity limit. We find all the divergences of the amplitude and demonstrate that the ones remaining in the tensionless limit are physical IR-type divergences. We conclude with a discussion on the meaning and limitations of higher spin (cosmological) singularity resolution and its potential connection to string theory.

La excéntrica centralidad de las materias artúrica y caballeresca en la narrativa gallega y catalana de la década de 1950 (Merlín e familia de Cunqueiro y Llibre cavalleries de Perucho)

Integran este número de la revista ponencias presentadas en Studia Hispanica Medievalia VIII: Actas de las IX Jornadas Internacionales de Literatura Española Medieval, 2008, y de Homenaje al Quinto Centenario de Amadis de Gaula

Del combate singular al singular combate sexual en la sátira trovadoresca medieval gallego-portuguesa

Integran este número de la revista ponencias presentadas en Studia Hispanica Medievalia VIII: Actas de las IX Jornadas Internacionales de Literatura Española Medieval, 2008, y de Homenaje al Quinto Centenario de Amadis de Gaula.