Diarrhoea risk factors in enterally tube fed critically ill patients : a retrospective audit

Objective: Diarrhoea in the enterally tube fed (ETF) intensive care unit (ICU) patient is a multifactorial problem. Diarrhoeal aetiologies in this patient cohort remain debatable; however, the consequences of diarrhoea have been well established and include electrolyte imbalance, dehydration, bacterial translocation, peri anal wound contamination and sleep deprivation. This study examined the incidence of diarrhoea and explored factors contributing to the development of diarrhoea in the ETF, critically ill, adult patient. ---------- Method: After institutional ethical review and approval, a single centre medical chart audit was undertaken to examine the incidence of diarrhoea in ETF, critically ill patients. Retrospective, non-probability sequential sampling was used of all emergency admission adult ICU patients who met the inclusion/exclusion criteria. ---------- Results: Fifty patients were audited. Faecal frequency, consistency and quantity were considered important criteria in defining ETF diarrhoea. The incidence of diarrhoea was 78%. Total patient diarrhoea days (r = 0.422; p = 0.02) and total diarrhoea frequency (r = 0.313; p = 0.027) increased when the patient was ETF for longer periods of time. Increased severity of illness, peripheral oxygen saturation (Sp02), glucose control, albumin and white cell count were found to be statistically significant factors for the development of diarrhoea. ---------- Conclusion: Diarrhoea in ETF critically ill patients is multi-factorial. The early identification of diarrhoea risk factors and the development of a diarrhoea risk management algorithm is recommended.

Probiotics and diarrhoea management in enterally tube fed critically ill patients : what is the evidence?

Objective: The aim of this literature review is to identify the role of probiotics in the management of enteral tube feeding (ETF) diarrhoea in critically ill patients.---------- Background: Diarrhoea is a common gastrointestinal problem seen in ETF patients. The incidence of diarrhoea in tube fed patients varies from 2% to 68% across all patients. Despite extensive investigation, the pathogenesis surrounding ETF diarrhoea remains unclear. Evidence to support probiotics to manage ETF diarrhoea in critically ill patients remains sparse.---------- Method: Literature on ETF diarrhoea and probiotics in critically ill, adult patients was reviewed from 1980 to 2010. The Cochrane Library, Pubmed, Science Direct, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic databases were searched using specific inclusion/exclusion criteria. Key search terms used were: enteral nutrition, diarrhoea, critical illness, probiotics, probiotic species and randomised clinical control trial (RCT).---------- Results: Four RCT papers were identified with two reporting full studies, one reporting a pilot RCT and one conference abstract reporting an RCT pilot study. A trend towards a reduction in diarrhoea incidence was observed in the probiotic groups. However, mortality associated with probiotic use in some severely and critically ill patients must caution the clinician against its use.---------- Conclusion: Evidence to support probiotic use in the management of ETF diarrhoea in critically ill patients remains unclear. This paper argues that probiotics should not be administered to critically ill patients until further research has been conducted to examine the causal relationship between probiotics and mortality, irrespective of the patient's disease state or projected prophylactic benefit of probiotic administration.

Design of decoupling networks for circulant symmetric antenna arrays

Small element spacing in compact arrays results in strong mutual coupling between array elements. Performance degradation associated with the strong coupling can be avoided through the introduction of a decoupling network consisting of interconnected reactive elements. We present a systematic design procedure for decoupling networks of symmetrical arrays with more than three elements and characterized by circulant scattering parameter matrices. The elements of the decoupling network are obtained through repeated decoupling of the characteristic eigenmodes of the array, which allows the calculation of element values using closed-form expressions.

Dual-frequency decoupling networks for compact antenna arrays

Decoupling networks can alleviate the effects of mutual coupling in antenna arrays. Conventional decoupling networks can provide decoupled and matched ports at a single frequency. This paper describes dual-frequency decoupling which is achieved by using a network of series or parallel resonant circuits instead of single reactive elements.

Beam steering with high front-to-back ratio and high directivity on small platforms using decoupled antenna pairs

Beam steering with high front-to-back ratio and high directivity on a small platform is proposed. Two closely spaced antenna pairs with eigenmode port decoupling are used as the basic radiating elements. Two orthogonal radiation patterns are obtained for each antenna pair. High front-to-back ratio and high directivity are achieved by combining the two orthogonal radiation patterns. With an infinite groundplane, a front-to-back ratio of 21 dB with a directivity of 9.8 dB can be achieved. Beam steering, at the expense of a slight decrease in directivity, is achieved by placing the two antenna pairs 0.5λ apart. The simulated half power beamwidth is 58°. A prototype was designed and the 2-D radiation patterns were measured. The prototype supports three directions of beam steering. The half power beamwidth was measured as 46°, 48°, and 50° for the three respective beam directions. The measured front-to-back ratio in azimuth plane is 8.5 dB, 8.0 dB and 7.6 dB, respectively.

Microstrip to parallel strip balun as spiral antenna feed

This paper presents the design and implementation of a microstrip to parallel strip balun which are frequently used as balanced antennas feed. This wideband balun transition is composed of a parallel strip which is connected to the spiral antenna and a microstrip line where the width of the ground plane is gradually reduced to eventually resemble the parallel strip. The taper accomplishes the mode and impedance transformation. This balun has significantly improved bandwidth characteristics. The entire circuit was fabricated on RT Duriod 5880 substrate. The circuit designs were simulated and optimised using CST Microwave Studio and the simulated results are compared with the measured results. The back-to-back microstrip to parallel strip has a return loss of better than 10 dB over a wide bandwidth from 1.75 to 15 GHz. The performance of the proposed balun was validated with the spiral antenna. The measured results were compared with the simulated results and it shows that the antenna operates well in wideband frequency range from 2.5 to 15 GHz.

Compact multiport antenna with isolated ports

The small element spacing of compact multiport arrays introduces strong mutual coupling between the antenna ports. Due to this coupling, the input impedance of the array changes when elements excitations are varied, and consequently, the array cannot be matched for an arbitrary excitation. Decoupling networks have in the past been used to provide an additional connection between antenna ports in order to cancel the coupling between elements. An alternative approach is to design the antenna so that each port does not excite a single element, but all elements simultaneously instead. The geometry of the antenna is optimized so that this direct excitation of elements counteracts the mutual coupling, thus yielding decoupled ports. This paper describes the design of such a 4-port antenna.

UWB antenna array for wireless transmission along corridors

A 2-element elliptical patch antenna array with a bi-directional radiation pattern has been developed for ultra wideband indoor wireless communications. The array is constructed by means of feeding two omni-directional elliptical patch elements with a 3-section hybrid power divider. Experimental results show that the array has a stable radiation pattern and low return loss over a broad bandwidth of 64% (3.1 - 6 GHz).

Reduced-Size microstrip patch antenna for Bluetooth applications

A novel reduced-size microstrip rectangular patch antenna for Bluetooth operation is presented in this paper. The proposed antenna operates in the 2400 to 2484 MHz ISM Band. Although an air substrate is introduced, antenna occupies a small volume of 33.3×6.6×0.8 mm3. The gain and the impedance bandwidth of the antenna are predicted using a commercial Finite Element Method software package. The predicted results show good agreement with measured data.

Characteristics of a two-layer microstrip patch antenna for Bluetooth applications

A double-layer rectangular patch microstrip antenna suitable for Bluetooth applications is investigated. The patch is etched on a separate substrate which is suspended above the ground plane and supported by an MCX connector. The air gap between the patch and the ground plane increases the impedance bandwidth and can be used to tune the resonant frequency. This paper presents experimental results on the effects of various parameters on the antenna characteristics and provides guidelines for the design of such an antenna.

Design and implementation of wideband baluns for Archimedean spiral antennas

The demand for high-speed data services for portable device has become a driving force for development of advanced broadband access technologies. Despite recent advances in broadband wireless technologies, there remain a number of critical issues to be resolved. One of the major concerns is the implementation of compact antennas that can operate in a wide frequency band. Spiral antenna has been used extensively for broadband applications due to its planar structure, wide bandwidth characteristics and circular polarisation. However, the practical implementation of spiral antennas is challenged by its high input characteristic impedance, relatively low gain and the need for balanced feeding structures. Further development of wideband balanced feeding structures for spiral antennas with matching impedance capabilities remain a need. This thesis proposes three wideband feeding systems for spiral antennas which are compatible with wideband array antenna geometries. First, a novel tapered geometry is proposed for a symmetric coplanar waveguide (CPW) to coplanar strip line (CPS) wideband balun. This balun can achieve the unbalanced to balanced transformation while matching the high input impedance of the antenna to a reference impedance of 50 . The discontinuity between CPW and CPS is accommodated by using a radial stub and bond wires. The bandwidth of the balun is improved by appropriately tapering the CPW line instead of using a stepped impedance transformer. Next, the tapered design is applied to an asymmetric CPW to propose a novel asymmetric CPW to CPS wideband balun. The use of asymmetric CPW does away with the discontinuities between CPW and CPS without having to use a radial stub or bond wires. Finally, a tapered microstrip line to parallel striplines balun is proposed. The balun consists of two sections. One section is the parallel striplines which are connected to the antenna, with the impedance of balanced line equal to the antenna input impedance. The other section consists of a microstrip line where the width of the ground plane is gradually reduced to eventually resemble a parallel stripline. The taper accomplishes the mode and impedance transformation. This balun has significantly improved bandwidth characteristics. Characteristics of proposed feeding structures are measured in a back-to-back configuration and compared to simulated results. The simulated and measured results show the tapered microstrip to parallel striplines balun to have more than three octaves of bandwidth. The tapered microstrip line to parallel striplines balun is integrated with a single Archimedean spiral antenna and with an array of spiral antennas. The performance of the integrated structures is simulated with the aid of electromagnetic simulation software, and results are compared to measurements. The back-to-back microstrip to parallel strip balun has a return loss of better than 10 dB over a wide bandwidth from 1.75 to 15 GHz. The performance of the microstrip to parallel strip balun was validated with the spiral antennas. The results show the balun to be an effective mean of feeding network with a low profile and wide bandwidth (2.5 to 15 GHz) for balanced spiral antennas.

‘They get fed up with playing.’ Parents’ views on play-based learning in the Preparatory Year

Within early childhood education two ideas are firmly held: play is the best way for children to learn and parents are partners in the child’s learning. While these ideas have been explored, limited research to date has investigated the confluence of the two - how parents of young children view the concept of play. This paper investigates parents’ views on play by analysing the views of small group of parents of Prep Year children in Queensland, Australia. The parents in this study held varying definitions of what constitutes play, and complex and contradictory notions of its value. Positive views of play were linked to learning without knowing it, engaging in hands-on activities, and preparation for Year One through a strong focus on academic progress. Some parents held that Prep was play-based, while others did not. The complexities and diversity of parental opinion in this study echo the ongoing commentary about how play ought to be defined. Moreover, the notion that adults may interpret play in different ways is also reflected here. The authors suggest that for early childhood educators these complexities require an ongoing engagement, debate and reconceptualisation of the place of play in light of broader curricular and socio-political agendas.