Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children

Background Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion, however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. Objectives To assess the clinical effects (benefits and harms) of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Search Methods The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (Issue 3, 2015). We also searched the reference lists of retrieved trials. Selection criteria Randomised controlled trials that compared the efficacy of normal saline with heparin to prevent occlusion of long term CVCs in infants and children aged up to 18 years of age were included. We excluded temporary CVCs and peripherally inserted central catheters (PICC). Data Collection and Analysis Two review authors independently assessed trial inclusion criteria, trial quality and extracted data. Rate ratios were calculated for two outcome measures - occlusion of the CVC and central line-associated blood stream infection. Other outcome measures included duration of catheter placement, inability to withdraw blood from the catheter, use of urokinase or recombinant tissue plasminogen, incidence of removal or re-insertion of the catheter, or both, and other CVC-related complications such as dislocation of CVCs, other CVC site infections and thrombosis. Main Results Three trials with a total of 245 participants were included in this review. The three trials directly compared the use of normal saline and heparin, however, between studies, all used different protocols for the standard and experimental arms with different concentrations of heparin and different frequency of flushes reported. In addition, not all studies reported on all outcomes. The quality of the evidence ranged from low to very low because there was no blinding, heterogeneity and inconsistency between studies was high and the confidence intervals were wide. CVC occlusion was assessed in all three trials (243 participants). We were able to pool the results of two trials for the outcomes of CVC occlusion and CVC-associated blood stream infection. The estimated rate ratio for CVC occlusion per 1000 catheter days between the normal saline and heparin group was 0.75 (95% CI 0.10 to 5.51, two studies, 229 participants, very low quality evidence). The estimated rate ratio for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37, two studies, 231 participants; low quality evidence). The duration of catheter placement was reported to be similar between the two study arms, in one study (203 participants). Authors' Conclusions The review found that there was not enough evidence to determine the effects of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Ultimately, if this evidence were available, the development of evidenced-based clinical practice guidelines and consistency of practice would be facilitated.

Focused Prefetching: Performance Oriented Prefetching Based On Commit Stalls

Loads that miss in L1 or L2 caches and waiting for their data at the head of the ROB cause significant slow down in the form of commit stalls. We identify that most of these commit stalls are caused by a small set of loads, referred to as LIMCOS (Loads Incurring Majority of COmmit Stalls). We propose simple history-based classifiers that track commit stalls suffered by loads to help us identify this small set of loads. We study an application of these classifiers to prefetching. The classifiers are used to train the prefetcher to focus on the misses suffered by LIMCOS. This, referred to as focused prefetching, results in a 9.8% gain in IPC over naive GHB based delta correlation prefetcher along with a 20.3% reduction in memory traffic for a set of 17 memory-intensive SPEC2000 benchmarks. Another important impact of focused prefetching is a 61% improvement in the accuracy of prefetches. We demonstrate that the proposed classification criterion performs better than other existing criteria like criticality and delinquent loads. Also we show that the criterion of focusing on commit stalls is robust enough across cache levels and can be applied to any prefetcher without any modifications to the prefetcher.

Hybrid constant factor incremental delta modulators

The paper presents a new adaptive delta modulator, called the hybrid constant factor incremental delta modulator (HCFIDM), which uses instantaneous as well as syllabic adaptation of the step size. Three instantaneous algorithms have been used: two new instantaneous algorithms (CFIDM-3 and CFIDM-2) and the third, Song's voice ADM (SVADM). The quantisers have been simulated on a digital computer and their performances studied. The figure of merit used is the SNR with correlated, /?C-shaped Gaussian signals and real speech as the input. The results indicate that the hybrid technique is superior to the nonhybrid adaptive quantisers. Also, the two new instantaneous algorithms developed have improved SNR and fast response to step inputs as compared to the earlier systems.

Neonatal intestinal obstruction associated with oral calcium supplementation

A case report of a 920 g infant developing a small intestinal obstruction following therapy for congestive cardiac failure is presented. Although the causation was thought to be milk curd obstruction, subsequent analysis revealed high concentration of calcium and phosphate in the stools. The possible pathogenesis is discussed in relation to the inspissated milk syndrome.

Sustaining productivity of a Vertosol at Warra, Queensland, with fertilisers, no-tillage or legumes. 9. Production and nitrogen benefits from mixed grass and legume pastures in rotation with wheat

Reduced supplies of nitrogen (N) in many soils of southern Queensland that were cropped exhaustively with cereals over many decades have been the focus of much research to avoid declines in profitability and sustainability of farming systems. A 45-month period of mixed grass (purple pigeon grass, Setaria incrassata Stapf; Rhodes grass, Chloris gayana Kunth.) and legume (lucerne, Medicago sativa L.; annual medics, M. scutellata L. Mill. and M. truncatula Gaertn.) pasture was one of several options that were compared at a fertility-depleted Vertosol at Warra, southern Queensland, to improve grain yields or increase grain protein concentration of subsequent wheat crops. Objectives of the study were to measure the productivity of a mixed grass and legume pasture grown over 45 months (cut and removed over 36 months) and its effects on yield and protein concentrations of the following wheat crops. Pasture production (DM t/ha) and aboveground plant N yield (kg/ha) for grass, legume (including a small amount of weeds) and total components of pasture responded linearly to total rainfall over the duration of each of 3 pastures sown in 1986, 1987 and 1988. Averaged over the 3 pastures, each 100 mm of rainfall resulted in 0.52 t/ha of grass, 0.44 t/ha of legume and 0.97 t/ha of total pasture DM, there being little variation between the 3 pastures. Aboveground plant N yield of the 3 pastures ranged from 17.2 to 20.5 kg/ha per 100 mm rainfall. Aboveground legume N in response to total rainfall was similar (10.6 - 13.2 kg/ha. 100 mm rainfall) across the 3 pastures in spite of very different populations of legumes and grasses at establishment. Aboveground grass N yield was 5.2 - 7.0 kg/ha per 100mm rainfall. In most wheat crops following pasture, wheat yields were similar to that of unfertilised wheat except in 1990 and 1994, when grain yields were significantly higher but similar to that for continuous wheat fertilised with 75 kg N/ha. In contrast, grain protein concentrations of most wheat crops following pasture responded positively, being substantially higher than unfertilised wheat but similar to that of wheat fertilised with 75 kg N/ha. Grain protein averaged over all years of assay was increased by 25 - 40% compared with that of unfertilised wheat. Stored water supplies after pasture were < 134mm (< 55% of plant available water capacity); for most assay crops water storages were 67 - 110 mm, an equivalent wet soil depth of only 0.3 - 0.45 m. Thus, the crop assays of pasture benefits were limited by low water supply to wheat crops. Moreover, the severity of common root rot in wheat crop was not reduced by pasture - wheat rotation.

Exercise and psychosocial interventions in breast cancer survivors: Preliminary results of a randomized controlled trial

Physical and psychological decline is common in the post-treatment breast cancer population, yet the efficacy of concurrent interventions to meet both physical- psychosocial needs in this population has not been extensively examined. PURPOSE: This study explores the effects of a combined exercise and psychosocial intervention model on selected physiological-psychological parameters in post-treated breast cancer. METHODS: Forty-one breast cancer survivors were randomly assigned to one of four groups for an 8-week intervention: exercise only [EX, n=13] (aerobic and resistance training), psychosocial therapy only [PS, n=11] (biofeedback), combined EX and PS [EX+PS, n=11], or to control conditions [CO, n=6]. Mean delta score (post-intervention - baseline) were calculated for each of the following: body weight, % body fat (skin folds), predicted VO2max (Modified Bruce Protocol), overall dynamic muscular endurance [OME] (RMCRI protocol), static balance (Single leg stance test), dynamic balance (360° turn and 4-square step test), fatigue (Revised Piper Scale), and quality of life (FACT-B). A one-way ANOVA was used to analyze the preliminary results of this on-going randomized trial. RESULTS: Overall, there were significant differences in the delta scores for predicted VO2max, OME, and dynamic balance among the 4 groups (p<0.05). The EX+PS group showed a significant improvement in VO2max compared with the PS group (4.2 ± 3.8 vs. -0.9 ± 4.2 mL/kg/min; p<0.05). Both the EX+PS and EX groups showed significant improvements in OME compared with the PS and CO groups (44.5 ± 23.5 and 43.4 ± 22.1 vs. -3.9 ± 15.2 and 2.7 ± 13.7 repetitions; p<0.05). All 3 intervention groups showed significant improvements in dynamic balance compared with the CO group (-0.8 ± 0.6, -0.6 ± 0.8, and -0.6 ±1.0 vs. 0.6 ± 0.6 seconds; p<0.05). Overall, changes in fatigue tended towards significance among the 4 groups (p = 0.08), with decreased fatigue in the intervention groups and increased fatigue in the CO group. CONCLUSIONS: Our preliminary findings suggest that EX and PS seem to produce greater positive changes in the outcome measures than CO. However, at this point no definite conclusions can be made on the additive effects of combining the EX and PS interventions.

Central America: Labor Reports and Child Labor Reports Pursuant to the Trade Act of 2002, Section 2102(c)(8)-(9)

[Excerpt] These comments are in response to the “Request for Information Concerning Labor Rights in Costa Rica, El Salvador, Guatemala, Honduras and Nicaragua and their Laws Governing Exploitative Child Labor” published at 68 Fed. Reg. 19580 (April 21, 2003). This Request for Information was issued pursuant to Section 2102(c)(8) and (9) of the Trade Act of 2002, Pub. L. 107-210, which requires the President, with respect to any proposed trade agreement, to submit to Congress a “meaningful labor rights report” and a “report describing the extent to which the country or countries that are parties to the agreement have in effect laws governing exploitative child labor.”

Preparation and in vitro release of drug-loaded microparticles for oral delivery using wholegrain sorghum kafirin protein

Kafirin microparticles have been proposed as an oral nutraceutical and drug delivery system. This study investigates microparticles formed with kafirin extracted from white and raw versus cooked red sorghum grains as an oral delivery system. Targeted delivery to the colon would be beneficial for medication such as prednisolone, which is used in the management of inflammatory bowel disease. Therefore, prednisolone was loaded into microparticles of kafirin from the different sources using phase separation. Differences were observed in the protein content, in vitro protein digestibility, and protein electrophoretic profile of the various sources of sorghum grains, kafirin extracts, and kafirin microparticles. For all of the formulations, the majority of the loaded prednisolone was not released in in vitro conditions simulating the upper gastrointestinal tract, indicating that most of the encapsulated drug could reach the target area of the lower gastrointestinal tract. This suggests that these kafirin microparticles may have potential as a colon-targeted nutraceutical and drug delivery system.

Coastal Wetlands Resources Investigation of the Burdekin Delta for declaration as fisheries reserves. Report to Ocean Rescue 2000

A project to investigate the coastal wetland resources of the Burdekin Delta, north Queensland, was undertaken as part of the long-term assessment of the coastal fisheries resources of Queensland. Extending from November 1993 to May 1995, fieldwork was undertaken in November 1993 and August 1994. The scope of the coastal wetlands resources investigation of the Burdekin Delta for declaration as a Fish Habitat Area was: 1. To document and map the marine wetland vegetation communities in the Burdekin River delta. 2. To document levels of existing disturbance to wetlands, existing recreational and commercial fisheries resources, and existing fishing activities. 3. To evaluate the conservation values of the areas investigated from the viewpoint of fisheries productivity and as habitat for important/threatened species. 4. To initiate Fish Habitat Area declaration under Section 120 of the Queensland Fisheries Act 1994 with formal consultation to all stakeholders. This report concentrates on Points 1 and 3, the documentation of the marine wetland vegetation communities and the evaluation of conservation values from a fisheries viewpoint. Dataset URL Link: Queensland Coastal Wetlands Resources Mapping data. [Dataset]

Force Measurements on a Reflex Cambered Delta Wing

AREFLEX spanwise cambered delta wing with a conical camber designed for M= 1.4, using the method of Ref. 1, was tested at the design Mach number as well as off-design Mach number M=0.15 and 2.3, respectively. The test results are compared with those of a plane wing and also with the available theoretical results at the design condition. At subsonic speed, the cambered wing has less lift at a given incidence and higher lift-to-drag ratio at a given lift than the plane wing, while at supersonic speeds, both of these quantities were less on the cambered wing. At supersonic speed, at the design incidence and Mach number, there is good agreement between results from theory and experiment. The center of pressure on the cambered wing is ahead of that on the plane wing at subsonic speed, while the reverse is true at supersonic speeds. Finally, it is found that over a useful range of lift the cambered wing is aerodynamically more efficient at subsonic speeds, and less so at supersonic speeds, than the plane wing.

"Mut ei tää oo hei midsommarista!" - ruotsin kielen viestinnällinen suullinen harjoittelu yhteistoiminnallisten skeema- ja elaborointitehtävien avulla

Communicative oral practice in Swedish through collaborative schema-based and elaboration tasks The general aim of this study was to learn how to better understand foreign language communicative oral practice and to develop it as part of communicative language teaching. The language-specific aim was to study how Swedish was being practised communicatively and orally in a classroom context as part of the didactic teaching-studying-learning process, and how the students' communicative oral practice in Swedish was carried out through collaborative schema-based and elaboration tasks. The scientific problem of this study focused on the essence of foreign language communicative oral proficiency. The research questions were concerned with 1) the students' involvement in carrying out the given oral tasks; 2) the features of communication and interaction strategies; 3) thematic vocabulary, and 4) the students' experiences and conceptions of the communicative oral tasks used. The study consisted of two groups of students from a Helsinki-area school (a group of upper secondary school students, Swedish Level A, Courses 2 and 3, n=9; and a group of basic education students, Swedish Level B, Course 2, n=13). The study was carried out as a pedagogically oriented case study which included certain features of ethnographic research and where the students' teacher acted as a researcher of her own work. The communicative oral practice contained five different tasks. The research data were gathered through systematic observation, audio recordings and by a questionnaire. The data were analysed through ethnographic content analysis methods. The main research finding was that a good deal of social interaction, collaboration and communication took place between the students when involved in communicative oral practice in Swedish. The students took almost optimal advantage of the allocated training time. They mostly used Swedish when participating in interactional communication. Finnish was mostly used by the students when they were deciding how to carry out a given task, aiming at intersubjectivity or negotiating meaning. The students were relaxed when practising Swedish. They also asked for and gave linguistic help in the spirit of collaborative learning principles. This resulted in interaction between students that highlighted certain features of negotiation of meaning, scaffolding and collaborative dialogue. Asking for and giving help in language issues concentrated mainly on vocabulary, and only in a few cases on grammar or pronunciation. The students also needed the teacher as a mentor. As well, the students had an enjoyable time when practising, which was most often related to carrying out the oral tasks. The thematic vocabulary used by the students corresponded well to the thematic lexis that served as a basis for the practice. At its most efficient, this lexis was most evident when the basic education students were carrying out schema-based tasks. The students' questionnaire answers agreed with the research findings gained through systematic observation and the analysis of audio recordings. The communicative tasks planned by the teacher and implemented by the students were very much in line. The language-didactic theory as presented in this study and the research findings can be widely utilised in pre-service and in-service teacher education, as well as, more generally, when developing communicative language teaching. Key words: communicative oral practice; the Swedish language; foreign language; didactic teaching-studying-learning process; communicative language teaching; collaborative task; schema-based task; elaboration task.

Queensland Coastal Wetlands Resources Mapping Data

1:100,000 coastal wetland vegetation mapping for Queensland including mangrove communities, saltpans and saline grasslands. Mapping taken from Landsat TM images with ground truthing. Additional metadata is available for details of techniques and accuracy for each section of coastline. Data Currency for each section of coast: NT border to Flinders River - 1995 SE Gulf of Carpentaria - 1987, 1988, 1991, 1992 Cape York Peninsula - 1986-88, 1991 Cape Trib to Bowling Green Bay - 1997-99 The Burdekin Region - 1991 The Bowen Region - 1994-95 The Whitsunday Region - 1997 Repulse Bay - 1989 Central Qld - 1995, 1997 The Curtis Coast Region - 1997 Round Hill Head to Tin Can Inlet - 1997 Moreton Region - 1995. Article Links: 1/ #1662. Queensland Coastal Wetland Resources: the Northern Territory Border to Flinders River. Project Report. Information Series QI00099. 2/ #1663. Queensland Coastal Wetland Resources: Sand Bay to Keppel Bay. Project Report. Information Series QI00100. 3/ #1664. Queensland Coastal Wetland Resources: Cape Tribulation to Bowling Green Bay. Project Report. Information Series QI01064. 4/ #1666. Coastal Wetlands Resources Investigation of the Burdekin Delta for declaration as fisheries reserves. Report to Ocean Rescue 2000. Project Report. 5/ #1667. Queensland Coastal Wetland Resource Investigation of the Bowen Region: Cape Upstart to Gloucester Island. Project Report. 6/ #1784. Resource Assessment of the Tidal Wetland Vegetation of Western Cape York Peninsula, North Queensland, Report to Ocean Rescue 2000. Project Report. 7/ #1785. Marine Vegetation of Cape York Peninsula. Cape York Peninsula Land Use Strategy. Project Report. 8/ #3544. Queensland Coastal Wetland Resources: The Whitsunday Region. Project Report.Information Series QI01065. 9/ #3545. Queensland Coastal Wetland Resources: Round Hill Head to Tin Can Inlet. Project Report. Information Series QI99081.

Constant factor incremental delta modulator

This paper presents a new algorithm for the step-size change of instantaneous adaptive delta modulator. The present strategy is such that the step-size at any sampling instant can increase or decrease by either of the two constant factors or can remain the same, depending upon the combination of three or four most recent output bits. The quantizer has been simulated on a digital computer, and its performance compared with other quantizers. The figure of merit used is the SNR with gaussian signals as the input. The results indicate that the new design can give an improved SNR over a wider dynamic range and fast response to step inputs, as compared to the earlier systems.