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.

Study of synchronously mode-locked and internally frequency-doubledcw dye laser

The analysis of the characteristics of a synchronously mode-locked and internally frequency-doubled dye laser is presented. Dependence of dye laser pulse characteristics on the cavity length mismatch of the pump laser and dye laser is studied. Variation of the minimum pulsewidth with intracavity bandwidth and the harmonic conversion efficiency is presented in the form of graphs.

Adaptive frequency scaled wavelet packet decomposition for frog call classification

Environmental changes have put great pressure on biological systems leading to the rapid decline of biodiversity. To monitor this change and protect biodiversity, animal vocalizations have been widely explored by the aid of deploying acoustic sensors in the field. Consequently, large volumes of acoustic data are collected. However, traditional manual methods that require ecologists to physically visit sites to collect biodiversity data are both costly and time consuming. Therefore it is essential to develop new semi-automated and automated methods to identify species in automated audio recordings. In this study, a novel feature extraction method based on wavelet packet decomposition is proposed for frog call classification. After syllable segmentation, the advertisement call of each frog syllable is represented by a spectral peak track, from which track duration, dominant frequency and oscillation rate are calculated. Then, a k-means clustering algorithm is applied to the dominant frequency, and the centroids of clustering results are used to generate the frequency scale for wavelet packet decomposition (WPD). Next, a new feature set named adaptive frequency scaled wavelet packet decomposition sub-band cepstral coefficients is extracted by performing WPD on the windowed frog calls. Furthermore, the statistics of all feature vectors over each windowed signal are calculated for producing the final feature set. Finally, two well-known classifiers, a k-nearest neighbour classifier and a support vector machine classifier, are used for classification. In our experiments, we use two different datasets from Queensland, Australia (18 frog species from commercial recordings and field recordings of 8 frog species from James Cook University recordings). The weighted classification accuracy with our proposed method is 99.5% and 97.4% for 18 frog species and 8 frog species respectively, which outperforms all other comparable methods.

L2-stability of nonstationary feedback systems: Frequency-domain criteria

A frequency-domain positivity condition is derived for linear time-varying operators in2and is used to develop2stability criteria for linear and nonlinear feedback systems. These criteria permit the use of a very general class of operators in2with nonstationary kernels, as multipliers. More specific results are obtained by using a first-order differential operator with a time-varying coefficient as multiplier. Finally, by employing periodic multipliers, improved stability criteria are derived for the nonlinear damped Mathieu equation with a forcing function.

Mössbauer Lineshape in the Presence of Radio-Frequency Fields

A general expression for the Mössbauer lineshape in the presence of a radio frequency field is derived. As an example the effect of the rf field on Fe57 nuclei is discussed for a situation where the 3/2 sublevel of 14.4 keV state of Fe57 is selectively populated. At resonance, both the diagonal and non-diagonal matrix elements contribute to the correlation function. As a result, in addition to a slight rf induced distortion of the main Mössbauer line. additional transition lines are obtained. Thus the present calculation supports the experimental observations of Heiman et al.

Protection of a Static Frequency Converter fed traction network, a case study

Aurizon, Australia's largest rail freight operator, is introducing the Static Frequency Converter (SFC) technology into its electric railway network as part of the Bauhinia Electrification Project. The introduction of SFCs has significant implications on the protection systems of the 50kV traction network. The traditional distance protection calculation method does not work in this configuration because of the effect that the SFC in combination with the remote grid has on the apparent impedance, and was substantially reviewed. The standard overcurrent (OC) protection scheme is not suitable due to the minimum fault level being below the maximum load level and was revised to incorporate directionality and under-voltage inhibit. Delta protection was reviewed to improve sensitivity. A new protection function was introduced to prevent back-feeding faults in the transmission network through the grid connection. Protection inter-tripping was included to ensure selectivity between the SFC protection and the system downstream.

Novel modulation strategy for a CLC resonant dual active bridge

This paper proposes a novel modulation strategy for a phase controlled Capacitor-Inductor-Capacitor (CLC) Resonant Dual Active Bridge (RDAB). The proposed modulation strategy improves the soft turn-on, Zero-Current-Switching (ZCS) and Zero-Voltage-Switching (ZVS) range of the converter while only minimally increasing the required reactive currents in the ac link. A mathematical analysis of the proposed modulation scheme is presented along with a theoretical loss comparison between several modulation strategies. The proposed modulation strategy was implemented and the experimental results are presented.

Dual Drug Delivery Microcapsules via Layer-by-Layer Self-Assembly

The integration of hydrophobic and hydrophilic drugs in the polymer microcapsule offers the possibility of developing a new drug delivery system that combines the best features of these two distinct classes of material. Recently, we have reported the encapsulation of an uncharged water-insoluble drug in the polymer membrane. The hydrophobic drug is deposited using a layer-by-layer (LbL) technique, which is based on the sequential adsorption of oppositely charged polyelectrolytes onto a charged substrate. In this paper, we report the encapsulation of two different drugs, which are invariably different in structure and in their solubility in water. We have characterized these dual drug vehicular capsules by confocal laser scanning microscopy, atomic force microscopy, visible microscopy, and transmission electron microscopy. The growth of a thin film on a flat substrate by LbL was monitored by UV−vis spectra. The desorption kinetics of two drugs from the thin film was modeled by a second-order rate model.

(v, k, λ) Configurations and self-dual codes

The incidence matrix of a (v, k, λ) configuration is used to construct a (2v, v) and a (2v + 2, v + 1) self-dual code. If the incidence matrix is a circulant, the codes obtained are quasi-cyclic and extended quasi-cyclic, respectively. The weight distributions of some codes of this type are obtained.

Elements of Volatility at High Frequency

Volatility is central in options pricing and risk management. It reflects the uncertainty of investors and the inherent instability of the economy. Time series methods are among the most widely applied scientific methods to analyze and predict volatility. Very frequently sampled data contain much valuable information about the different elements of volatility and may ultimately reveal the reasons for time varying volatility. The use of such ultra-high-frequency data is common to all three essays of the dissertation. The dissertation belongs to the field of financial econometrics. The first essay uses wavelet methods to study the time-varying behavior of scaling laws and long-memory in the five-minute volatility series of Nokia on the Helsinki Stock Exchange around the burst of the IT-bubble. The essay is motivated by earlier findings which suggest that different scaling laws may apply to intraday time-scales and to larger time-scales, implying that the so-called annualized volatility depends on the data sampling frequency. The empirical results confirm the appearance of time varying long-memory and different scaling laws that, for a significant part, can be attributed to investor irrationality and to an intraday volatility periodicity called the New York effect. The findings have potentially important consequences for options pricing and risk management that commonly assume constant memory and scaling. The second essay investigates modelling the duration between trades in stock markets. Durations convoy information about investor intentions and provide an alternative view at volatility. Generalizations of standard autoregressive conditional duration (ACD) models are developed to meet needs observed in previous applications of the standard models. According to the empirical results based on data of actively traded stocks on the New York Stock Exchange and the Helsinki Stock Exchange the proposed generalization clearly outperforms the standard models and also performs well in comparison to another recently proposed alternative to the standard models. The distribution used to derive the generalization may also prove valuable in other areas of risk management. The third essay studies empirically the effect of decimalization on volatility and market microstructure noise. Decimalization refers to the change from fractional pricing to decimal pricing and it was carried out on the New York Stock Exchange in January, 2001. The methods used here are more accurate than in the earlier studies and put more weight on market microstructure. The main result is that decimalization decreased observed volatility by reducing noise variance especially for the highly active stocks. The results help risk management and market mechanism designing.

Radio frequency emission in electron beam-plasma and beam-beam interaction

A linear excitation of electromagnetic modes at frequencies (n + ı89 in a plasma through which two electron beams are contra-streaming along the magnetic field is investigated. This may be a source of the observed {cote emissions at auroral latitudes.

Low-frequency degenerate surface modes of an electron-hole plasma

The computations of Flahive and Quinn1 of the dispersion curves of low frequency degenerate surface (DS) modes propagating along the magnetic field in an electron-hole plasma are extended to higher values of the wavenumber. We find that beyond a certain value of the wavenumber the DS mode re-enters the allowed region of surface wave propagation and tends to an asymptotic frequency ωR (<ωLH). These low frequency resonances of an electron-hole plasma are discussed with reference to the experimental observations.

Field-Effect and Frequency Dependent Transport in Semiconductor-Enriched Single-Wall Carbon Nanotube Network Device

The electrical and optical response of a field-effect device comprising a network of semiconductor-enriched single-wall carbon nanotubes, gated with sodium chloride solution is investigated. Field-effect is demonstrated in a device that uses facile fabrication techniques along with a small-ion as the gate electrolyte-and this is accomplished as a result of the semiconductor enhancement of the tubes. The optical transparency and electrical resistance of the device are modulated with gate voltage. A time-response study of the modulation of optical transparency and electrical resistance upon application of gate voltage suggests the percolative charge transport in the network. Also the ac response in the network is investigated as a function of frequency and temperature down to 5 K. An empirical relation between onset frequency and temperature is determined.

BRCA1 and BRCA2 germline mutation analysis among Indian women from south India: identification of four novel mutations and high-frequency occurrence of 185delAG mutation

Mutations in the BRCA1 and BRCA2 genes profoundly increase the risk of developing breast and/or ovarian cancer among women. To explore the contribution of BRCA1 and BRCA2 mutations in the development of hereditary breast cancer among Indian women, we carried out mutation analysis of the BRCA1 and BRCA2 genes in 61 breast or ovarian cancer patients from south India with a positive family history of breast and/or ovarian cancer. Mutation analysis was carried out using conformation-sensitive gel electrophoresis (CSGE) followed by sequencing. Mutations were identified in 17 patients (28.0%); 15 (24.6%) had BRCA1 mutations and two (3.28%) had BRCA2 mutations. While no specific association between BRCA1 or BRCA2 mutations with cancer type was seen, mutations were more often seen in families with ovarian cancer. While 40% (4/10) and 30.8% (4/12) of families with ovarian or breast and ovarian cancer had mutations, only 23.1% (9/39) of families with breast cancer carried mutations in the BRCA1 and BRCA2 genes. In addition, while BRCA1 mutations were found in all age groups, BRCA2 mutations were found only in the age group of <= 40 years. Of the BRCA1 mutations, there were three novel mutations (295delCA; 4213T -> A; 5267T -> G) G) and three mutations that have been reported earlier. Interestingly, 185delAG, a BRCA1 mutation which occurs at a very high frequency in Ashkenazi Jews, was found at a frequency of 16.4% (10/61). There was one novel mutation (4866insT) and one reported mutation in BRCA2. Thus, our study emphasizes the importance of mutation screening in familial breast and/or ovarian cancers, and the potential implications of these findings in genetic counselling and preventive therapy.

Sampling frequency affects estimates of annual nitrous oxide fluxes

Quantifying nitrous oxide (N(2)O) fluxes, a potent greenhouse gas, from soils is necessary to improve our knowledge of terrestrial N(2)O losses. Developing universal sampling frequencies for calculating annual N(2)O fluxes is difficult, as fluxes are renowned for their high temporal variability. We demonstrate daily sampling was largely required to achieve annual N(2)O fluxes within 10% of the best estimate for 28 annual datasets collected from three continents, Australia, Europe and Asia. Decreasing the regularity of measurements either under- or overestimated annual N(2)O fluxes, with a maximum overestimation of 935%. Measurement frequency was lowered using a sampling strategy based on environmental factors known to affect temporal variability, but still required sampling more than once a week. Consequently, uncertainty in current global terrestrial N(2)O budgets associated with the upscaling of field-based datasets can be decreased significantly using adequate sampling frequencies.