Discharge from critical care into the community for end-of-life care

This article discusses the considerations and actions taken to facilitate the discharge of a ventilated end-of-life patient called Michael, whose name has been changed for confidentiality, from a critical care unit (CCU) to his expressed preferred place of care. It focuses on how the district nurse (DN) and the single point of access (SPA) for end-of-life care teams by working between primary and secondary care services and across organisational service units were able to facilitate this discharge and achieve the wishes of Michael to die peacefully at home. For all services involved, this proved to be a complex discharge and following completion of the care episode a root cause analysis was undertaken to capture the lessons learnt and advise the CCU at a services debrief how discharges to the community from the CCU could be improved

Indexed induction and coinduction, fibrationally.

This paper extends the fibrational approach to induction and coinduction pioneered by Hermida and Jacobs, and developed by the current authors, in two key directions. First, we present a sound coinduction rule for any data type arising as the final coalgebra of a functor, thus relaxing Hermida and Jacobs’ restriction to polynomial data types. For this we introduce the notion of a quotient category with equality (QCE), which both abstracts the standard notion of a fibration of relations constructed from a given fibration, and plays a role in the theory of coinduction dual to that of a comprehension category with unit (CCU) in the theory of induction. Second, we show that indexed inductive and coinductive types also admit sound induction and coinduction rules. Indexed data types often arise as initial algebras and final coalgebras of functors on slice categories, so our key technical results give sufficent conditions under which we can construct, from a CCU (QCE) U : E -> B, a fibration with base B/I that models indexing by I and is also a CCU (QCE)

Indexed Induction and Coinduction, Fibrationally

This paper extends the fibrational approach to induction and coinduction pioneered by Hermida and Jacobs, and developed by the current authors, in two key directions. First, we present a dual to the sound induction rule for inductive types that we developed previously. That is, we present a sound coinduction rule for any data type arising as the carrier of the final coalgebra of a functor, thus relaxing Hermida and Jacobs' restriction to polynomial functors. To achieve this we introduce the notion of a quotient category with equality (QCE) that i) abstracts the standard notion of a fibration of relations constructed from a given fibration; and ii) plays a role in the theory of coinduction dual to that played by a comprehension category with unit (CCU) in the theory of induction. Secondly, we show that inductive and coinductive indexed types also admit sound induction and coinduction rules. Indexed data types often arise as carriers of initial algebras and final coalgebras of functors on slice categories, so we give sufficient conditions under which we can construct, from a CCU (QCE) U:E \rightarrow B, a fibration with base B/I that models indexing by I and is also a CCU (resp., QCE). We finish the paper by considering the more general case of sound induction and coinduction rules for indexed data types when the indexing is itself given by a fibration

Reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation

Background: There is currently no effective preoperative assessment for patients undergoing kidney transplantation that is able to identify those at high perioperative risk requiring admission to critical care unit (CCU). We sought to determine if functional measures of cardiovascular reserve, in particular the anaerobic threshold (VO2AT) could identify these patients. Methods: Adult patients were assessed within 4 weeks prior to kidney transplantation in a University hospital with a 37-bed CCU, between April 2010 and June 2012. Cardiopulmonary exercise testing (CPET), echocardiography and arterial applanation tonometry were performed. Results: There were 70 participants (age 41.7614.5 years, 60% male, 91.4% living donor kidney recipients, 23.4% were desensitized). 14 patients (20%) required escalation of care from the ward to CCU following transplantation. Reduced anaerobic threshold (VO2AT) was the most significant predictor, independently (OR = 0.43; 95% CI 0.27–0.68; p,0.001) and in the multivariate logistic regression analysis (adjusted OR = 0.26; 95% CI 0.12–0.59; p = 0.001). The area under the receiveroperating- characteristic curve was 0.93, based on a risk prediction model that incorporated VO2AT, body mass index and desensitization status. Neither echocardiographic nor measures of aortic compliance were significantly associated with CCU admission. Conclusions: To our knowledge, this is the first prospective observational study to demonstrate the usefulness of CPET as a preoperative risk stratification tool for patients undergoing kidney transplantation. The study suggests that VO2AT has the potential to predict perioperative morbidity in kidney transplant recipients

UNICS - An Unified Instrument Control System for Small/Medium Sized Astronomical Observatories

Although the astronomy community is witnessing an era of large telescopes, smaller and medium sized telescopes still maintain their utility being larger in numbers. In order to obtain better scientific outputs it is necessary to incorporate modern and advanced technologies to the back-end instruments and to their interfaces with the telescopes through various control processes. However often tight financial constraints on the smaller and medium size observatories limit the scope and utility of these systems. Most of the time for every new development on the telescope the back-end control systems are required to be built from scratch leading to high costs and efforts. Therefore a simple, low cost control system for small and medium size observatory needs to be developed to minimize the cost and efforts while going for the expansion of the observatory. Here we report on the development of a modern, multipurpose instrument control system UNICS (Unified Instrument Control System) to integrate the controls of various instruments and devices mounted on the telescope. UNICS consists of an embedded hardware unit called Common Control Unit (CCU) and Linux based data acquisition and User Interface. The Hardware of the CCU is built around the Atmel make ATmega 128 micro-controller and is designed with a back-plane, Master Slave architecture. The Graphical User Interface (GUI) has been developed based on QT and the back end application software is based on C/C++. UNICS provides feedback mechanisms which give the operator a good visibility and a quick-look display of the status and modes of instruments. UNICS is being used for regular science observations since March 2008 on 2m, f/10 IUCAA Telescope located at Girawali, Pune India.Comment: Submitted to PASP, 10 Pages, 5 figure

Influence of Thyme and Juniper on the Microbiological Properties of Pork Brisket

The aim of the work is to determine an influence of non-traditional mixtures of spicy-aromatic plants of thyme and juniper, their essential oils and alcohol extracts on the course of microbiological processes in pork brisket. Pork brisket was an experimental sample. It was added with black pepper, thyme and juniper, in the dry condition, as essential oils and alcohol extracts. Pork brisket, added with dry plants, essential oils, extracts of black and fragrant pepper, was taken as a control. According to the microbiological studies, it was established, that an exceed of the standard index of the content of mesophilic-aerobic and facultative anaerobic microorganisms (more than 1,0×103 g/CCU) takes place in brisket samples with dry black pepper. And also in samples with thyme and juniper in ratios 0,9:0,7:0,2 and 0,9:0,6:0,3. An exceed of nMAFAM index is also fixed in experiments using essential oils of these spices. It was established, that after 80 min of the experiment, these mixtures remain resistant to spoilage by 20 min longer comparing with using dry black and fragrant pepper. Most intense antibacterial properties relative to the development of microorganisms were observed in experimental samples. It is noticeable in a sample with using dry comminuted spices thyme and juniper in ratios 0,9:0,8:0,1. The use of spicy-aromatic plants of thyme and juniper allow to increase the storage term of ready products