5,277 research outputs found
Ultrasonic locating devices for central venous cannulation: meta-analysis
OBJECTIVES: To assess the evidence for the clinical
effectiveness of ultrasound guided central venous
cannulation.
DATA SOURCES: 15 electronic bibliographic databases,
covering biomedical, science, social science, health
economics, and grey literature.
DESIGN: Systematic review and meta-analysis of
randomised controlled trials.
POPULATIONS: Patients scheduled for central venous
access.
INTERVENTION REVIEWED: Guidance using real time two
dimensional ultrasonography or Doppler needles and
probes compared with the anatomical landmark
method of cannulation.
DATA EXTRACTION: Risk of failed catheter placement
(primary outcome), risk of complications from
placement, risk of failure on first attempt at
placement, number of attempts to successful
catheterisation, and time (seconds) to successful
catheterisation.
DATA SYNTHESIS: 18 trials (1646 participants) were
identified. Compared with the landmark method, real
time two dimensional ultrasound guidance for
cannulating the internal jugular vein in adults was
associated with a significantly lower failure rate both
overall (relative risk 0.14, 95% confidence interval
0.06 to 0.33) and on the first attempt (0.59, 0.39 to
0.88). Limited evidence favoured two dimensional
ultrasound guidance for subclavian vein and femoral
vein procedures in adults (0.14, 0.04 to 0.57 and 0.29,
0.07 to 1.21, respectively). Three studies in infants
confirmed a higher success rate with two dimensional
ultrasonography for internal jugular procedures (0.15,
0.03 to 0.64). Doppler guided cannulation of the
internal jugular vein in adults was more successful
than the landmark method (0.39, 0.17 to 0.92), but the
landmark method was more successful for subclavian
vein procedures (1.48, 1.03 to 2.14). No significant
difference was found between these techniques for
cannulation of the internal jugular vein in infants. An
indirect comparison of relative risks suggested that
two dimensional ultrasonography would be more
successful than Doppler guidance for subclavian vein
procedures in adults (0.09, 0.02 to 0.38).
CONCLUSIONS: Evidence supports the use of two
dimensional ultrasonography for central venous
cannulation
The prevalence of medical reasons for non-participation in the Scottish breast and bowel cancer screening programmes
Objective: Increasing uptake of cancer screening is a priority for health systems internationally, however, some patients may not attend because they are undergoing active treatment for the cancer of interest or have other medical reasons that mean participation would be inappropriate. This study aims to quantify the proportion of non-participants who have a medical reason for not attending cancer screening.<p></p>
Methods: Medical reasons for not participating in breast and bowel screening were defined a priori on the basis of a literature review and expert opinion. The notes of 700 patients at two GP practices in Scotland were reviewed, to ascertain the prevalence of medical reasons amongst non-participants. Simple proportions and confidence intervals were calculated.<p></p>
Results: 17.4% of breast and 2.3% of bowel screening non-participants had a medical reason to not participate. The two most common reasons were previous breast cancer follow up (8.86%) and recent mammogram (6.57%).<p></p>
Conclusion: These patients may not benefit from screening while also being distressed by receiving an invitation. This issue also makes accurate monitoring and target-setting for improving uptake difficult. Further work is needed to estimate robustly the extent to which medical reasons account for screening non-participation in a larger population.<p></p>
Mapping the Evolution of Optically-Generated Rotational Wavepackets in a Room Temperature Ensemble of D
A coherent superposition of rotational states in D has been excited by
nonresonant ultrafast (12 femtosecond) intense (2 10
Wcm) 800 nm laser pulses leading to impulsive dynamic alignment.
Field-free evolution of this rotational wavepacket has been mapped to high
temporal resolution by a time-delayed pulse, initiating rapid double
ionization, which is highly sensitive to the angle of orientation of the
molecular axis with respect to the polarization direction, . The
detailed fractional revivals of the neutral D wavepacket as a function of
and evolution time have been observed and modelled theoretically.Comment: 4 pages, 3 figures. Accepted for publication in Phys. Rev. A. Full
reference to follow.
Quantum Chessboards in the Deuterium Molecular Ion
We present a new algorithm for vibrational control in deuterium molecules
that is feasible with current experimental technology. A pump mechanism is used
to create a coherent superposition of the D2+ vibrations. A short, intense
infrared control pulse is applied after a chosen delay time to create selective
interferences. A `chessboard' pattern of states can be realized in which a set
of even- or odd-numbered vibrational states can be selectively annihilated or
enhanced. A technique is proposed for experimental realization and observation
of this effect using 5 fs pulses of 790 nm radiation, with intermediate
intensity (5e13 W/cm2)Comment: 12 pages, 5 figure
Stereolithography for 3D photoelasticity
Recently, the use of photoelasticity has become more widespread due to the development of digital methods of fringe analysis [1] that allow a significant reduction in the time taken to achieve a stress map for any given model, particularly when only fractional fringe orders are displayed. However, in order for the full potential of the photoelastic method to be realised, a technique for rapidly producing complex 3-dimensional photoelastic models must be developed. Stereolithography is one so-called ‘rapid-prototype’ method that works by building a laminar model from a tank of photo-curing resin. A perforated metal plate is submerged in the liquid resin to a depth of typically around 0.1mm. A laser then traces the shape of the first layer of the component onto the plate, curing a thin layer of the resin. The plate is lowered by 0.1mm, and a further layer of resin cured by the laser. By this method, complex structures may be ‘laid-up’ in a matter of hours.
Previous studies concerned with the use of stereolithography for the production of photoelastic models [2] have noted that unacceptable levels of residual birefringence and stress have remained in the photoelastic model even after conventional annealing methods. Thus the use of such methods has been limited. If the stereolithographic method were developed for photoelasticity, one possible area of interest would be the design and analysis of orthopedic implants.
This paper outlines a series of studies looking at the requirements of photoelastic materials for three-dimensional stress analysis
Relationship between ferromanganese nodule compositions and sedimentation in a small survey area of the equatorial Pacific
The bulk chemical compositions of ferromanganese nodules recovered from 14 of 38 sediment cores collected from a 230 km2 area of abyssal hill topography in the northern equatorial Pacific (8°20\u27N; 153W; regional depth 5000m) vary nonrandornly between fairly wide limits. The nodules have Mn/Fe ratios ranging from 2.60 to 5.38 and all samples contain todorokite and 8-MnO2. The variation in the Mn/Fe ratio is governed by the total Fe contents of the nodules; Mn varies to a much smaller extent. Cu and Ni contents average about 1% and vary independently of the Mn contents...
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ESICM LIVES 2017 : 30th ESICM Annual Congress. September 23-27, 2017.
INTRODUCTION. Unplanned readmission to intensive care is highly
undesirable in that it contributes to increased variance in care,
disruption, difficulty in resource allocation and may increase length
of stay and mortality particularly if subject to delays. Unlike the ICU
admission from the ward, readmission prediction has received
relatively little attention, perhaps in part because at the point of ICU
discharge, full physiological information is systematically available to
the clinician and so it is expected that readmission should be largely
due to unpredictable factors. However it may be that there are
multidimensional trends that are difficult for the clinician to perceive
that may nevertheless be predictive of readmission.
OBJECTIVES. We investigated whether machine learning (ML)
techniques could be used to improve on the simple published SWIFT
score [1] for the prediction of unplanned readmission to ICU within
48 hours.
METHODS. We extracted systolic BP, pulse pressure, heart and
respiration rate, temperature, SpO2, bilirubin, creatinine, INR, lactate,
white cell count, platelet count, pH, FiO2, and total Glasgow Coma
Score from ICU stays of over 2000 adult patients from our hospital
electronic patient record system. We trained our own custom
multidimensional / time-sensitive algorithmic ML system to predict
failed discharges defined as either readmission or unexpected death
within 48 hours of discharge. We used 10-fold cross validation to assess performance. We also assessed the effect of augmenting our
system by transfer learning (TL) with 44,000 additional cases from
the MIMIC III database.
RESULTS. The SWIFT score performed relatively poorly with an
AUROC of around 0.6 which our ML system trained on local data was
also able to match. However when augmented with an additional
dataset by TL, the AUROC for the ML system improved statistically
and clinically significantly to over 0.7.
CONCLUSIONS. Machine learning is able to improve on predictors
based on simple multiple logistic regression. Thus there is likely to
be information in the trends and in combinations of variables. A
disadvantage with this technique is that ML approaches require large
amounts of data for training. However, ML approaches can be
improved by TL. Basing prediction models on locally derived data
augmented by TL is a potentially novel approach to generating tools
that customised to the institution yet can exploit the potential power
of ML algorithms.
REFERENCES
[1] Gajic O, Malinchoc M, Comfere TB, et al. The Stability and
Workload Index for Transfer score predicts unplanned intensive care
unit patient readmission: initial development and validation. Crit Care
Med. 2008;36(3):676–82.
Grant Acknowledgement
This work was internally funded
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