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To assess the impact of a newly developed Central-Line Insertion Site Assessment (CLISA) score on the incidence of local inflammation or infection for CLABSI prevention.
A pre- and postintervention, quasi-experimental quality improvement study.
Setting and participants:
Adult inpatients with central venous catheters (CVCs) hospitalized in an intensive care unit or oncology ward at a large academic medical center.
We evaluated CLISA score impact on insertion site inflammation and infection (CLISA score of 2 or 3) incidence in the baseline period (June 2014–January 2015) and the intervention period (April 2015–October 2017) using interrupted times series and generalized linear mixed-effects multivariable analyses. These were run separately for days-to-line removal from identification of a CLISA score of 2 or 3. CLISA score interrater reliability and photo quiz results were evaluated.
Among 6,957 CVCs assessed 40,846 times, percentage of lines with CLISA score of 2 or 3 in the baseline and intervention periods decreased by 78.2% (from 22.0% to 4.7%), with a significant immediate decrease in the time-series analysis (P < .001). According to the multivariable regression, the intervention was associated with lower percentage of lines with a CLISA score of 2 or 3, after adjusting for age, gender, CVC body location, and hospital unit (odds ratio, 0.15; 95% confidence interval, 0.06–0.34; P < .001). According to the multivariate regression, days to removal of lines with CLISA score of 2 or 3 was 3.19 days faster after the intervention (P < .001). Also, line dwell time decreased 37.1% from a mean of 14 days (standard deviation [SD], 10.6) to 8.8 days (SD, 9.0) (P < .001). Device utilization ratios decreased 9% from 0.64 (SD, 0.08) to 0.58 (SD, 0.06) (P = .039).
The CLISA score creates a common language for assessing line infection risk and successfully promotes high compliance with best practices in timely line removal.
Background: Continuous video-EEG (cvEEG) monitoring is the standard of care for diagnosis and management of neonatal seizures. However, it is labour-intensive. We aimed to establish consistency in monitoring of newborns utilising NICU nurses. Methods: Neonatal nurses were trained to apply scalp electrodes, troubleshoot technical issues. Guidelines, checklists and visual training modules were developed. A central network system allowed remote access to the cvEEGs by the epileptologist for timely interpretation and feedback. We compared 100 infants with moderate to severe HIE before and after the training program. Results: 192 cvEEGs were performed. Of the 100 infants compared; time to initiate brain monitoring decreased by average of 31.5 hours, in electrographic seizure detection increased(20% compared to 34% a), seizure clinical misdiagnosis decreased (65% compared to 36% ), and Anti-Seizure burden decreased. Conclusions: Training experienced NICU nurses to set-up, start and monitor cvEEG can decrease the time to initiate cvEEG which may lead to better seizure diagnosis and management.
Mesoporous silicas were synthesized via a surfactant-templated sol-gel route using castor oil as the templating agent under acidic medium. The resulting silicas were subsequently amine functionalized with 3-aminopropyltriethoxysilane (NH2-MTS), [3-(2-aminoethylamino)-propyl]trimethoxysilane (NN-MTS), and [3-(diethylamino)propyl]trimethoxysilane(DN-MTS) to introduce surface basicity. Surface physicochemical properties were characterized by field emission gun scanning electron microscopy (FEGSEM), nitrogen porosimetry, X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis (TGA), X-ray diffraction (XRD), and diffuse reflectance infrared fourier transform spectroscopy (DRIFTS). As-synthesised materials exhibit type IV adsorption-desorption isotherms characteristic of mesoporous structures. Clusters of spherical shaped materials were observed by FEGSEM, suggesting growth of silica occurs within colloidal dispersions. High-resolution N 1s XP spectra and DRIFT spectra confirmed the presence of amine groups in the organo-amine functionalised mesoporous silicas. The amine functionalised mesoporous silicas were active for the transesterification of tributyrin with methanol, with conversion found to increase from NH2-MTS< NN-MTS< DN-MTS.
Observers say that drug production fuels violence in Colombia, but does coca production explain different levels of violence? This article examines the relationship between coca production and guerrilla violence by reviewing national-level data over time and studying Colombia by department, exploring the interactions among guerrilla violence, exports, development, and displacement. It uses historical analysis, cartographic visualization, and analysis of the trends in four high coca-producing and four violent Colombian departments, along with a department-level fixed effects model. Contrary to the conventional wisdom, the department-level analysis suggests that coca production is not the driving force of contemporary Colombian guerrilla violence. Instead, economic factors and coca eradication emerge as prominent explanatory factors.
To evaluate the effects of oral steroids alone or followed by intranasal steroids versus watchful waiting on the resolution of otitis media with effusion in children aged 2–11 years.
A total of 290 children with bilateral otitis media with effusion were assigned to 3 groups: group A was treated with oral steroids followed by intranasal steroids, group B was treated with oral steroids alone and group C was managed with watchful waiting. Patients were evaluated with audiometry and tympanometry.
The complete resolution rates of otitis media with effusion were higher in groups A and B than in group C at six weeks. There were no significant differences in otitis media with effusion resolution rates between the groups at three, six and nine months.
Oral steroids lead only to a quick resolution of otitis media with effusion, with no long-term benefits. There was no benefit of using intranasal steroids in the management of otitis media with effusion.
The design of a novel microstrip ultra-wideband (UWB) bandpass filter with quad narrow notched-band functionality is presented. The filter consists of a multi-mode resonator (MMR) constituted from two modified stepped-impedance stubs that generate six resonate modes, five of which are within the UWB passband where the sixth mode is used to extend the upper stopband of the filter. Two transmission zeroes are located at the 3-dB edge of the passband to enhance the filter's selectivity with a skirt factor of 0.955. The MMR is fed through asymmetric interdigital coupled-lines feed to produce controllable notched-band. Additional notched-bands are generated with a parasitic coupled line. The notched-bands are centered exactly to eliminate interference at 5.2 GHz (wireless local area network (WLAN)), 5.8 GHz (WLAN), 6.8 GHz (radio-frequency identification), and 8 GHz (X-band). Good agreement is obtained between simulation and measurement results. The highly compact filter has dimensions of 8.0 × 9.83 mm2.
The effect of the transverse magnetic field on laser-induced breakdown spectroscopy and surface modifications of germanium (Ge) has been investigated at various fluences. Ge targets were exposed to Nd: YAG laser pulses (1064 nm, 10 ns, 1 Hz) at different fluences ranging from 3 to 25.6 J/cm2 to generate Ge plasma under argon environment at a pressure of 50 Torr. The magnetic field of strength 0.45 Tesla perpendicular to the direction of plasma expansion was employed by using two permanent magnets. The emission spectra of laser-induced Ge plasma was detected by the laser-induced breakdown spectroscopy system. The electron temperature and number density of Ge plasma are evaluated by using the Boltzmann plot and stark broadening methods, respectively. The variations in emission intensity, electron temperature (Te), and number density (ne) of Germanium plasma are explored at various fluences, with and without employment of the magnetic field. It is observed that the magnetic field is responsible for significant enhancement of both excitation temperature and number density at all fluences. It is revealed that an excitation temperature increases from Te,max,without B = 16,190 to Te,max,with B = 20,123 K. Similarly, the two times enhancement in the electron density is observed from ne,max,without B = 2 × 1018 to ne,max,with B = 4 × 1018 cm−3. The overall enhancement in Ge plasma parameters in the presence of the magnetic field is attributed to the Joule heating effect and adiabatic compression. With increasing fluence both plasma parameters increase and achieve their maxima at a fluence of 12.8 J/cm2 and then decrease. In order to correlate the plasma parameters with surface modification, scanning electron microscope analysis of irradiated Ge was performed. Droplets and cones are formed for both cases. However, the growth of ridges and distinctness of features is more pronounced in case of the absence of the magnetic field; whereas surface structures become more diffusive in the presence of the magnetic field.
Imprinting is a well-established technique to induce recognition features in both organic and inorganic materials for a variety of target analytes. In this study, ion imprinted polysiloxanes with varying percentage of coupling agent i.e. 3-chloro propyl trimethoxy silane (CPTM) were synthesized by sol-gel method for imprinting of Cr3+. The imprinting of Cr3+ in cross-linked siloxane network was investigated by FT-IR which indicates the metal ion is coordinated with oxygen atoms of polysiloxanes. SEM images revealed that imprinted polysiloxanes possess uniform particles of submicron size. It was experienced that by increasing the concentration of CPTM up to 10% (v/v) substantially improves the binding capacity of polysiloxanes which allows us to recognized Cr3+ down to 50µg/L. Furthermore, the selectivity of Cr3+-imprinted polysiloxanes was evaluated by treating them with other competing metal ions of same concentration i.e. Cr6+, Pb2+ and Ni2+. In this regard, polysiloxanes showed much higher binding for imprint ion i.e. Cr3+ in comparison to above mentioned metal ions. Finally, the regenerated polysiloxanes were studied in order to reuse them thus, developing cost effective biomimetic sensor coatings.
The objective of this article is to present the dimensional synthesis of serial and
parallel spherical wrists, an important step in the design process of medical robots. This
step is carried out to obtain optimal dimensions of tool-guidance medical robots. With
this goal, we have first studied the specifications of two robots with different medical
applications: one for tele-echography examination and one for minimally invasive surgery.
Then, we have established that the medical needs expressed by the doctors were very
different but the specifications in robotic terms have a lot of common points (kinematics,
workspace, bulkiness). For both applications studied, robots need a mobility of three
rotations around a fixed point (probe contact point on the patient’s skin or trocar
incision). So, a spherical wrist architecture is adapted to their needs. An important
constraint related to medical applications is that the robot must be compact in order to
not obstruct or collide with its environment (medical personnel or patient). We perform
dimensional synthesis allowing determination of dimensions of the mechanism for serial and
parallel spherical wrists, for a tele-echography robot, and a serial wrist for a minimally
invasive surgery robot. We use multi-criteria optimization methods minimizing a cost
function to obtain both good kinematic performance and compactness for the architecture.
The difficulty/challenge of this design process, depending of the studied applications, is
the choice of efficient criteria describing the performances and the constraints of the
robot. The design variables must faithfully represent the specifications of the robot so
that its performance can respond to the medical requirements. We show, here, the different
methods used for optimizing the chosen kinematic architecture for the particular medical
application. These studies lead to prototypes which are validated after medical
experiments. This process of dimensional synthesis will be applied to other medical
applications with different sets of specified constraints.
Obstructive sleep apnea (OSA) is a nocturnal respiratory disorder associated with cognitive and behavioral sequelae, including impairments in executive functioning (EF). Previous literature has focused on “cool” EF, meaning abilities such as working memory and planning that do not involve affective control requirements. Little is known about the impact OSA may have on “hot” EF that involves regulation of affect and risk-related decision-making, and that may be particularly salient during adolescence, when these skills are rapidly developing. This study examined performance on the Iowa Gambling Task (IGT), a task believed to assess aspects of “hot” EF, in overweight adolescents at risk for OSA. Consistent with hypotheses, individuals without OSA made more beneficial decisions on the IGT over time, but participants with OSA did not benefit from feedback and continued to make choices associated with higher initial rewards, but greater long-term losses. The relationship between developmental level and IGT performance was moderated by OSA status. Individuals with OSA did not demonstrate the expected developmental gains in performance during the IGT. This finding suggests that OSA may impact the development of critical aspects of EF, or at least the expression of these skills during the developmentally important period of adolescence. (JINS, 2012, 18, 481–489)
Copper oxide (CuO) and zinc oxide (ZnO) nanostructures complement each other since CuO is unintentional p-type and ZnO unintentional n-type. Using the low temperature chemical growth approach, the effect on morphology of varying the pH of the grown ZnO nanostructures and CuO micro structures is monitored. For both materials the variation of the pH was found to lead to a large variation on the morphology achieved. The grown ZnO NRs and CuO micro flowers material were used to fabricate devices. We demonstrate results from ZnO nanorods (NRs)/polymer p-n hybrid heterojunctions chemically grown on paper and using a process on paper for light emitting diodes (LEDs) applications as well as some large area light emitting diodes LEDs. The growth of CuO micro flowers indicated good quality material for sensing applications. The grown CuO micro flowers were employed as pH sensors. The results indicated a superior performance as expect due to the catalytic properties of this material.
Energy storage, high-penetration renewables, and grid stabilization
S. Massoud Amin, Technological Leadership Institute, College of Science and Engineering, University of Minnesota, Minneapolis, MN, USA,
Anthony M. Giacomoni, Electrical and Computer Engineering Department, University of Minnesota, Minneapolis, MN, USA
Electric power systems constitute the fundamental infrastructure of modern society. Electric power grids and distribution networks, often continental in scale, reach virtually every home, office, factory, and institution in developed countries and have made remarkable, albeit remarkably insufficient, penetration in developing countries such as China and India.
The electric power grid can be defined as the entire apparatus of wires and machines that connects the sources of electricity, namely the power plants, with customers and their myriad needs. Power plants convert a primary form of energy, such as the chemical energy stored in coal, the radiant energy in sunlight, the pressure of wind, or the energy stored at the core of uranium atoms, into electricity, which is no more than a temporary, flexible, and portable form of energy. It is important to remember that electricity is not a fuel: it is an energy carrier. At the end of the grid, at factories and homes, electricity is transformed back into useful forms of energy or activity, such as heat, light, torque for motors, or information processing.
Cystic echinococcosis caused by Echinococcus granulosus is considered to be an important parasitic infection in livestock. In the present study, which aimed to determine the epidemiology of hydatidosis in buffalo in Iran, slaughterhouses of West Azerbaijan (Urmia), East Azerbaijan (Tabriz), Ardabil (Ardabil), Gilan (Rasht and Hashtpar) and Khuzestan (Ahvaz) were inspected. Age, sex and infected organs were recorded separately, and the observed cysts were examined for fertility and viability. Our results showed that 344 (9%) of 3832 inspected buffaloes were infected with hydatid cysts. The maximum and minimum infection rates occurred in Khuzestan (9.9%) and Ardabil (8%) provinces, respectively. There was no significant difference in the rate of infection in all provinces. Of 344 infected buffaloes, the rate of fertility was 7.3% and the rate of viability in fertile cysts was 78.75%. Hydatid cysts were more prevalent in female compared with male buffaloes (P < 0.05). There was a positive correlation between the age and number of infected hosts in all provinces except East Azerbaijan. The prevalence of infection in lungs was significantly higher than that in the livers of buffaloes in the provinces studied (P < 0.001). In conclusion, the fertility of hydatid cysts in buffaloes was low, as previously demonstrated in cattle, and this animal may play a minor role in the epidemiology of hydatidosis in Iran.