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.

Effect of metal coating and residual stress on the resonant frequency of MEMS resonators

MEMS resonators are designed for a fixed resonant frequency. Therefore, any shift in the resonant frequency of the final fabricated structure can be a denting factor for its suitability towards a desired application. There are numerous factors which alter the designed resonant frequency of the fabricated resonator such as the metal layer deposited on top of the beam and the residual stresses present in the fabricated structure. While the metal coating, which acts as electrode, increases the stiffness and the effective mass of the composite structure, the residual stress increases or decreases the net stiffness if it is a tensile or compressive type respectively. In this paper, we investigate both these cases by taking two different structures, namely, the micro cantilever beam with gold layer deposited on its top surface and the MEMS gyroscope with residual stresses. First, we carry out experiments to characterize both these structures to find their resonant frequencies. Later, we analytically model those effects and compare them with the experimentally obtained values. Finally, it is found that the analytical models give an error of less than 10% with respect to the experimental results in both the cases.

Effect of static deflection on natural frequency of non-linear spring mass system by direct linearization method

An exact expression for the frequency of a non-linear cubic spring mass system is obtained considering the effect of static deflection. An alternative expression for the approximate frequency is also obtained by the direct linearization procedure; it is shown that this is very accurate as compared with the exact method. This approximate frequency equation is used to explain a “dual behaviour” of the frequency amplitude curves.

Ligand series from V = O stretching frequency of oxovanadium(IV) complexes*1

A ligand series obtained from V = O stretching frequencies for different monomeric complexes of oxovanadium(IV) is shown to parallel the nephelauxetic series. The ligand series obtained from streching frequencies of other systems are also shown to compare well with the nephelauxetic series rather than the spectrochemical series.

Language independent automated segmentation of speech using Bach scale filter-banks

This correspondence describes a method for automated segmentation of speech. The method proposed in this paper uses a specially designed filter-bank called Bach filter-bank which makes use of 'music' related perception criteria. The speech signal is treated as continuously time varying signal as against a short time stationary model. A comparative study has been made of the performances using Mel, Bark and Bach scale filter banks. The preliminary results show up to 80 % matches within 20 ms of the manually segmented data, without any information of the content of the text and without any language dependence. The Bach filters are seen to marginally outperform the other filters.

Correlations between frequency of infra-red active vibrational modes and copper-oxygen distance in copper oxides. Application to superconductors

The infra-red spectra of a large number of ternary Cu(II) oxides with at least a quasi square-planar coordination of oxygen around the copper ions have been studied. The frequency of the bands with the highest frequency,v max, is found to correlate extremely well with the shortest Cu–O distance.v max increases at an impressive rate of sim20 cm–1 per 0.01 Å when the Cu–O distance becomes less than 1.97 Å, which is the Cu2+–O2– distance in square-planar CuO4 complexes as obtained from empirical ionic radii considerations. The marked sensitivity may be used as a ldquotitrationrdquo procedure not only to assign bands but also to obtain diagnostic information about local coordination in compounds derived, for example, from the YBa2Cu3O7–d structure such as LaCaBaCu3O7–d . The only example where this correlation fails is in the two-layer non-superconducting oxides derived from La2(Ca, Sr)Cu2O6. The significance of this result is discussed. The marked dependence of frequency on the bond-distance is qualitatively examined in terms of an increased electron-phonon coupling to account for the observed tendency of the superconducting transition temperature to go through a maximum as the average basal plane Cu–O distance is decreased.

A new model for the breakage frequency of drops in turbulent stirred dispersions

A model of drop breakage in turbulent stirred dispersions based on interaction of a drop with eddies of a length scale smaller than the drop diameter has been developed. It predicts that, unlike the equal breakage assumed by earlier models, a large drop reduces in size due to stripping of smaller segments off it through unequal breakage. It is only when the drop nears the value of the maximum stable drop diameter that it breaks into equal parts. This new model of drop breakage, coupled with the pattern of interaction of drops with eddies of different sizes existing in the vessel, has been used to evaluate not only the breakage frequency, but also the size distribution of the daughter droplets(which was hitherto assumed). The model has been incorporated in the population balance equation and the resulting cumulative size distributions compared with those availble in the literature.

Part-of-Speech Tagging using Parallel Weighted Finite-State Transducers

We use parallel weighted finite-state transducers to implement a part-of-speech tagger, which obtains state-of-the-art accuracy when used to tag the Europarl corpora for Finnish, Swedish and English. Our system consists of a weighted lexicon and a guesser combined with a bigram model factored into two weighted transducers. We use both lemmas and tag sequences in the bigram model, which guarantees reliable bigram estimates.

Ultrasound modulated optical tomography: Young's modulus of the insonified region from measurement of natural frequency of vibration

We demonstrate a method to recover the Young's modulus (E) of a tissue-mimicking phantom from measurements of ultrasound modulated optical tomography (UMOT). The object is insonified by a dualbeam, confocal ultrasound transducer (US) oscillating at frequencies f(0) and f(0) + Delta f and the variation of modulation depth (M) in the autocorrelation of light traversed through the focal region of the US transducer against Delta f is measured. From the dominant peaks observed in the above variation, the natural frequencies of the insonified region associated with the vibration along the US transducer axis are deduced. A consequence of the above resonance is that the speckle fluctuation at the resonance frequency has a higher signal-to-noise to ratio (SNR). From these natural frequencies and the associated eigenspectrum of the oscillating object, Young's modulus (E) of the material in the focal region is recovered. The working of this method is confirmed by recovering E in the case of three tissue-mimicking phantoms of different elastic modulus values. (C) 2011 Optical Society of America

A finite-rate-of-innovation signal sampling perspective of the source-filter model of speech production

We consider the speech production mechanism and the asso- ciated linear source-filter model. For voiced speech sounds in particular, the source/glottal excitation is modeled as a stream of impulses and the filter as a cascade of second-order resonators. We show that the process of sampling speech signals can be modeled as filtering a stream of Dirac impulses (a model for the excitation) with a kernel function (the vocal tract response),and then sampling uniformly. We show that the problem of esti- mating the excitation is equivalent to the problem of recovering a stream of Dirac impulses from samples of a filtered version. We present associated algorithms based on the annihilating filter and also make a comparison with the classical linear prediction technique, which is well known in speech analysis. Results on synthesized as well as natural speech data are presented.

Joint pitch-analysis formant-synthesis framework for CS recovery of speech

A joint analysis-synthesis framework is developed for the compressive sensing (CS) recovery of speech signals. The signal is assumed to be sparse in the residual domain with the linear prediction filter used as the sparse transformation. Importantly this transform is not known apriori, since estimating the predictor filter requires the knowledge of the signal. Two prediction filters, one comb filter for pitch and another all pole formant filter are needed to induce maximum sparsity. An iterative method is proposed for the estimation of both the prediction filters and the signal itself. Formant prediction filter is used as the synthesis transform, while the pitch filter is used to model the periodicity in the residual excitation signal, in the analysis mode. Significant improvement in the LLR measure is seen over the previously reported formant filter estimation.

Co-registration of speech production datasets from electromagnetic articulography and real-time magnetic resonance imaging

This paper describes a spatio-temporal registration approach for speech articulation data obtained from electromagnetic articulography (EMA) and real-time Magnetic Resonance Imaging (rtMRI). This is motivated by the potential for combining the complementary advantages of both types of data. The registration method is validated on EMA and rtMRI datasets obtained at different times, but using the same stimuli. The aligned corpus offers the advantages of high temporal resolution (from EMA) and a complete mid-sagittal view (from rtMRI). The co-registration also yields optimum placement of EMA sensors as articulatory landmarks on the magnetic resonance images, thus providing richer spatio-temporal information about articulatory dynamics. (C) 2014 Acoustical Society of America