Structured training in intraosseous infusion to improve potentially life saving skills in pediatric emergencies - Results of an open prospective national quality development project over 3 years

BACKGROUND: Children in emergencies need peripheral intravenous (IV) access in order to receive drugs or fluids. The success of IV access is associated with the age of patients and fails in up to 50% of children younger than 6 years. In such situations, it is essential that physicians and paramedics have a tool and easily learnable skills with a high chance of success. According to international guidelines intraosseous (IO) access would be the next step after failed IV access. Our hypothesis was that the success rate in IO puncturing can be improved by standardizing the training; so we developed an IO workshop. METHODS: Twenty-eight hospitals and ambulance services participated in an evaluation process over 3 years. IO workshops and the distribution of standardized IO sets were coordinated by the study group of the University Hospital of Berne. Any attempted or successful IO punctures were evaluated with a standardized interview. RESULTS: We investigated 35 applications in 30 patients (a total of 49 punctures) between November 2001 and December 2004. IO puncture was not successful in 5 patients. The success rate depended neither on the occupation nor the experience of users. Attendance at a standardized IO workshop increased the overall success rate from 77% to 100%, which was statistically not significant (P = 0.074). CONCLUSIONS: Standardized training in IO puncturing seems to improve success more than previous experience and occupation of providers. However, we could not show a significant increase in success rate after this training. Larger supranational studies are needed to show a significant impact of teaching on rarely used emergency skills.

Hall-effect thruster-cathode coupling : the effect of cathode position and magnetic field topology

Hall-effect thruster (HET) cathodes are responsible for the generation of the free electrons necessary to initiate and sustain the main plasma discharge and to neutralize the ion beam. The position of the cathode relative to the thruster strongly affects the efficiency of thrust generation. However, the mechanisms by which the position affects the efficiency are not well understood. This dissertation explores the effect of cathode position on HET efficiency. Magnetic field topology is shown to play an important role in the coupling between the cathode plasma and the main discharge plasma. The position of the cathode within the magnetic field affects the ion beam and the plasma properties of the near-field plume, which explains the changes in efficiency of the thruster. Several experiments were conducted which explored the changes of efficiency arising from changes in cathode coupling. In each experiment, the thrust, discharge current, and cathode coupling voltage were monitored while changes in the independent variables of cathode position, cathode mass flow and magnetic field topology were made. From the telemetry data, the efficiency of the HET thrust generation was calculated. Furthermore, several ion beam and plasma properties were measured including ion energy distribution, beam current density profile, near-field plasma potential, electron temperature, and electron density. The ion beam data show how the independent variables affected the quality of ion beam and therefore the efficiency of thrust generation. The measurements of near-field plasma properties partially explain how the changes in ion beam quality arise. The results of the experiments show that cathode position, mass flow, and field topology affect several aspects of the HET operation, especially beam divergence and voltage utilization efficiencies. Furthermore, the experiments show that magnetic field topology is important in the cathode coupling process. In particular, the magnetic field separatrix plays a critical role in impeding the coupling between cathode and HET. Suggested changes to HET thruster designs are provided including ways to improve the position of the separatrix to accommodate the cathode.

A semi-structured interview to assess visual hallucinations in older people

OBJECTIVE: Visual hallucinations are under-reported by patients and are often undiscovered by health professionals. There is no gold standard available to assess hallucinations. Our objective was to develop a reliable, valid, semi-structured interview for identifying and assessing visual hallucinations in older people with eye disease and cognitive impairment. METHODS: We piloted the North-East Visual Hallucinations Interview (NEVHI) in 80 older people with visual and/or cognitive impairment (patient group) and 34 older people without known risks of hallucinations (control group). The informants of 11 patients were interviewed separately. We established face validity, content validity, criterion validity, inter-rater agreement and the internal consistency of the NEVHI, and assessed the factor structure for questions evaluating emotions, cognitions, and behaviours associated with hallucinations. RESULTS: Recurrent visual hallucinations were common in the patient group (68.8%) and absent in controls (0%). The criterion, face and content validities were good and the internal consistency of screening questions for hallucinations was high (Cronbach alpha: 0.71). The inter-rater agreements for simple and complex hallucinations were good (Kappa 0.72 and 0.83, respectively). Four factors associated with experiencing hallucinations (perceived control, pleasantness, distress and awareness) were identified and explained a total variance of 73%. Informants gave more 'don't know answers' than patients throughout the interview (p = 0.008), especially to questions evaluating cognitions and emotions associated with hallucinations (p = 0.02). CONCLUSIONS: NEVHI is a comprehensive assessment tool, helpful to identify the presence of visual hallucinations and to quantify cognitions, emotions and behaviours associated with hallucinations.

Refining abacavir hypersensitivity diagnoses using a structured clinical assessment and genetic testing in the Swiss HIV Cohort Study

BACKGROUND: We aimed to assess the value of a structured clinical assessment and genetic testing for refining the diagnosis of abacavir hypersensitivity reactions (ABC-HSRs) in a routine clinical setting. METHODS: We performed a diagnostic reassessment using a structured patient chart review in individuals who had stopped ABC because of suspected HSR. Two HIV physicians blinded to the human leukocyte antigen (HLA) typing results independently classified these individuals on a scale between 3 (ABC-HSR highly likely) and -3 (ABC-HSR highly unlikely). Scoring was based on symptoms, onset of symptoms and comedication use. Patients were classified as clinically likely (mean score > or =2), uncertain (mean score > or = -1 and < or = 1) and unlikely (mean score < or = -2). HLA typing was performed using sequence-based methods. RESULTS: From 131 reassessed individuals, 27 (21%) were classified as likely, 43 (33%) as unlikely and 61 (47%) as uncertain ABC-HSR. Of the 131 individuals with suspected ABC-HSR, 31% were HLA-B*5701-positive compared with 1% of 140 ABC-tolerant controls (P < 0.001). HLA-B*5701 carriage rate was higher in individuals with likely ABC-HSR compared with those with uncertain or unlikely ABC-HSR (78%, 30% and 5%, respectively, P < 0.001). Only six (7%) HLA-B*5701-negative individuals were classified as likely HSR after reassessment. CONCLUSIONS: HLA-B*5701 carriage is highly predictive of clinically diagnosed ABC-HSR. The high proportion of HLA-B*5701-negative individuals with minor symptoms among individuals with suspected HSR indicates overdiagnosis of ABC-HSR in the era preceding genetic screening. A structured clinical assessment and genetic testing could reduce the rate of inappropriate ABC discontinuation and identify individuals at high risk for ABC-HSR.

The Theory of Alloy Deposition and The Effect of a Rotating Cathode Upon Such Deposition, with Special Attention to the Possibility of Depositing Sterling Silver

In the past few years a great deal of atten­tion has been given to the electrodeposition of alloys. For the main part, this investigation has been of scien­tific interest only; but in a few instances, such work has attained commercial importance.

The Determination of Aluminum in the Presence of Manganese and Iron by the Use of a Mercury Cathode

Since 1880, when Wolcott Gibbs made the suggestion that mercury could be used as a cathode in gravimetric electroanalysis, many articles have appeared in literature either criticizing the method or citing successful results which have been obtained by it.

Application of the Electric Furnace to the Melting of Cathode Copper at the Tacoma Smelter

In the field of copper metallurgy, the major chang­es effected in the original metallurgical scheme have been based largely upon the lowering in grade of copper ores, and the more particular demands of the fabricators of the metal. The former trend fostered the development of mineral beneficiation, which in turn caused the con­version from blast furnace to reverberatory furnace smelting.

Integrating structured and unstructured data in a business-intelligence-system

The recent liberalization of the German energy market has forced the energy industry to develop and install new information systems to support agents on the energy trading floors in their analytical tasks. Besides classical approaches of building a data warehouse giving insight into the time series to understand market and pricing mechanisms, it is crucial to provide a variety of external data from the web. Weather information as well as political news or market rumors are relevant to give the appropriate interpretation to the variables of a volatile energy market. Starting from a multidimensional data model and a collection of buy and sell transactions a data warehouse is built that gives analytical support to the agents. Following the idea of web farming we harvest the web, match the external information sources after a filtering and evaluation process to the data warehouse objects, and present this qualified information on a user interface where market values are correlated with those external sources over the time axis.

GuideView: structured multi-modal delivery of clinical guidelines.

GuideView is a system designed for structured, multi-modal delivery of clinical guidelines. Clinical instructions are presented simultaneously in voice, text, pictures or video or animations. Users navigate using mouse-clicks and voice commands. An evaluation study performed at a medical simulation laboratory found that voice and video instructions were rated highly.

Less structured movement patterns predict severity of positive syndrome, excitement, and disorganization

Disorganized behavior is a key symptom of schizophrenia. The objective assessment of disorganized behavior is particularly challenging. Actigraphy has enabled the objective assessment of motor behavior in various settings. Reduced motor activity was associated with negative syndrome scores, but simple motor activity analyses were not informative on other symptom dimensions. The analysis of movement patterns, however, could be more informative for assessing schizophrenia symptom dimensions. Here, we use time series analyses on actigraphic data of 100 schizophrenia spectrum disorder patients. Actigraphy recording intervals were set at 2 s. Data from 2 defined 60-min periods were analyzed, and partial autocorrelations of the actigraphy time series indicated predictability of movements in each individual. Increased positive syndrome scores were associated with reduced predictability of movements but not with the overall amount of movement. Negative syndrome scores were associated with low activity levels but unrelated with predictability of movement. The factors disorganization and excitement were related to movement predictability but emotional distress was not. Thus, the predictability of objectively assessed motor behavior may be a marker of positive symptoms and disorganized behavior. This behavior could become relevant for translational research.