Disappearing pressure cuffs

Wireless, biodegradable pressure sensors provide continuous short-term monitoring of arterial pulse in rats. Blood vessel anastomosis (connecting two open ends of vessels) is an important part of complex reconstructive surgeries including coronary artery bypass grafts (CABG), critical limb ischemia, and traumatic vascular repair. Ensuring sucient blood ow at vessel anastomoses post-procedure is crucial, yet blood ow monitoring can be inconsistent. Insucient blood ow or anastomotic failure can require repeat intervention. Boutry and colleagues have developed a biodegradable, exible, wireless sensor for the continuous monitoring of blood ow that may offer a solution. In their recent publication, Boutry et al. report their exible sensor design, which uses a fringe-eld capacitive sensor to measure capacitance changes associated with changes in vessel diameter during arterial pulsation. Their design, which can be wrapped as a cuff around an artery, uses inductive coupling with an external reader coil to wirelessly monitor the blood vessel. After in vitro testing, the device was implanted around a rat femoral artery, which has a similar diameter to a pediatric facial artery, and the output pulse wave was compared with results detected using an external Doppler ultrasound system. The pulse rate output by the device was similar to the analyzed ultrasound waveform result, and the wireless monitoring capability persisted with similar results obtained one week after implantation. The device also performed favorably in an occlusion test in which blood ow through the femoral artery was transiently blocked and then restored. This new device offers short-term continuous monitoring of vessel patency that could improve outcomes after surgical procedures requiring vessel anastomosis. The authors contend that the exible sensor readings could be optimized by improving the sampling rate of the network analyzer associated with the device. The biodegradable materials used in the device avoid the need for a subsequent procedure to remove the implant. Although further evaluation is needed in additional vessels to investigate sensor behavior to pressure loads, the results of the study have translational potential

No time for college? An investigation of time poverty and parenthood

Postsecondary outcomes are significantly worse for student parents even though they earn higher G.P.A.\u27s on average. This study used institutional records and survey data from a large urban U.S. university to explore whether time poverty explains this trend. The results of regression and KHB decomposition analysis reveal that students with preschool-aged children have a significantly lower quantity and quality of time for college than comparable peers with older or no children, and that time spent on childcare is the primary reason for this difference. Both quantity and quality of time for education had a significant direct effect on college persistence and credit accumulation, even when controlling for other factors. Thus, greater availability of convenient and affordable childcare (e.g. increased on-campus childcare, revised financial aid formulas that include more accurate estimates of childcare costs) would likely lead to better college outcomes for students with young children

Development of advanced practice competency standards for dietetics in Australia

Aim: This study aimed to explore the work roles, major tasks and core activities of advanced practice dietitians in Australia to define the Competency Standards for advanced practice. Methods: A qualitative approach was used to review advanced dietetic practice in Australia involving experienced professionals, mostly dietitians. Four focus groups were conducted with a total of 17 participants and an average of 20 years experience: 15 dietitian practitioners plus 2 employers (1 dietitian and 1 non-dietitian). The focus groups explored the key purpose, roles and outcomes of these practitioners. Data from the focus groups were confirmed with in-depth interviews about their core activities with a purposive sample of 10 individuals recently recognised as Advanced Accredited Practising Dietitians. Data from both focus groups and interviews were analysed adductively to identify key themes. Results: The key theme that emerged to define advanced dietetics practice was leadership, with four subthemes that described in more detail the major work roles and outcomes of advanced practice. These subthemes identified that advanced practitioners were (i) outcome-focused, having impact; (ii) influence others and advocate; (iii) innovate and embrace change; and (iv) inspire others and are recognised for their practice. These outcomes were conceptualised within a broad generalist framework to generate revised Competency Standards. Conclusions: This study confirmed that leadership rather than specialist practice skills is the key determinant of advanced practice

Standardised coding of diet records: experiences from INTERMAP UK

Coding diet records is a basic element of most dietary surveys, yet it often receives little attention even though errors in coding can lead to flawed study results. In the INTERnational study of MAcro- and micronutrients and blood Pressure (INTERMAP study), efforts were made to minimise errors in coding the 18 720 diet records. Staff were centrally trained and certified before being able to process study data and ongoing quality control checks were performed. This involved the senior (site) nutritionist re-coding randomly selected diet records. To facilitate standardisation of coding in the UK, a code book was designed; it included information about coding brand items, density and portion size information, and default codes to be assigned when limited information was available for food items. It was found that trainees, despite previous experience in coding elsewhere, made coding errors that resulted in errors in estimates of daily energy and nutrient intakes. As training proceeded, the number of errors decreased. Compilation of the code book was labour-intensive, as information from food manufacturers and retailers had to be collected. Strategies are required to avoid repetition of this effort by other research groups. While the methods used in INTERMAP to reduce coding errors were time consuming, the experiences suggest that such errors are important and that they can be reduced

Attainment of precision in implementation of 24h dietary recalls: INTERMAP UK

Collection of complete and accurate dietary intake data is necessary to investigate the association of nutrient intakes with disease outcomes. A standardised multiple-pass 24 h dietary recall method was used in the International Collaborative Study of Macro- and Micronutrients and Blood Pressure (INTERMAP) to obtain maximally objective data. Dietary interviewers were intensively trained and recalls taped, with consent, for randomly selected evaluations by the local site nutritionist (SN) and/or country nutritionists (CN) using a twelve-criterion checklist marked on a four-point scale (1, retrain, to 4, excellent). In the Belfast centre, seven dietary interviewers collected 932 24 h recalls from 40-59-year-old men and women. Total scores from the 134 evaluated recalls ranged from thirty-four to the maximum forty-eight points. All twelve aspects of the interviews were completed satisfactorily on average whether scored by the SN (n 53, range: probing 3.25 to privacy of interview 3.98) or CN (n 19, range: probing 3.26 to pace of interview and general manner of interviewer 3.95); the CN gave significantly lower scores than the SN for recalls evaluated by both nutritionists (n 31, Wilcoxon signed rank test, P=0.001). Five evaluations of three recalls identified areas requiring retraining or work to improve performance. Reporting accuracy was estimated using BMR; energy intake estimates less than 1.2 x BMR identifying under-reporting. Mean ratios in all age, se

Performance measurement and KPIs for remanufacturing

The paper provides a brief background to remanufacturing and the general use of Performance Measurement and Key Performance Indicators (KPIs) before introducing selected and newly formulated KPIs designed specifically for remanufacturing. Their relationships with the remanufacturing challenges faced by two contrasting remanufacturing businesses and the wider reman industry are described in detail. Subsets of KPIs forming a ‘Balanced Scorecard’ for each of the two remanufacturing cases conclude the paper. They arise through close working with Centro Ricerche FIAT (CRF) and SKF, and are triangulated by literature review and wider expert interviews. The two businesses represent contrasting remanufacturing scenarios: well-established high-volume low-margin automotive engine remanufacturing by the OEM ( >1000 units per year, < €10 k per unit) verses low-volume high-value wind turbine gearbox reman by an independent start-up ( €100 k per unit). The 10 general production engineering KPIs selected for the reman KPI toolbox are as follows: Work In Progress (WIP), Overall Equipment Effectiveness (OEE), Lead Time (LT), Cycle Time (CT), Hours Per Unit (HPU), Product Margin (PM), Quotation Accuracy (QA), Number of Concessions (NC), Number of managed mBOMs (BOM), and Personnel Saturation (PS). The Eco KPIs selected are: Material Used (MU), Recycled Material Used (RMU), Direct Energy Consumption (ECD), Indirect Energy Consumption (ECI), Water Withdrawal (WW), Green House Gas emissions (GHG), Total Waste (TW) by weight. The 8 Remanufacturing KPIs compiled and formulated as part of this research are: Core / Product Ratio (CPR), Core / Product Value Ratio (CPV), New Component Costs (NCC), Component Salvage Rate (SRC), Product Salvage Rate (SRP), Core Disposal Rate (CDR), Core Class Accuracy (CCA), and Core Class Distribution (CCD)

Advancements in left ventricular assist devices to prevent pump thrombosis and blood coagulopathy

Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs) are very useful in improving outcomes in patients with advanced-stage heart failure. Despite recent advances in LVAD development, pump thrombosis is one of the most severe adverse events caused by LVADs. The contact of blood with artificial materials of LVAD pumps and cannulas triggers the coagulation cascade. Heat spots, for example, produced by mechanical bearings are often subjected to thrombus build-up when low-flow situations impair washout and thus the necessary cooling does not happen. The formation of thrombus in an LVAD may compromise its function, causing a drop in flow and pumping power leading to failure of the LVAD, if left unattended. If a clot becomes dislodged and circulates in the bloodstream, it may disturb the flow or occlude the blood vessels in vital organs and cause internal damage that could be fatal, for example, ischemic stroke. That is why patients with LVADs are on anti-coagulant medication. However, the anti-coagulants can cause a set of issues for the patient-an example of gastrointestinal (GI) bleeding is given in illustration. On account of this, these devices are only used as a last resort in clinical practice. It is, therefore, necessary to develop devices with better mechanics of blood flow, performance and hemocompatibility. This paper discusses the development of LVADs through landmark clinical trials in detail and describes the evolution of device design to reduce the risk of pump thrombosis and achieve better hemocompatibility. Whilst driveline infection, right heart failure and arrhythmias have been recognised as LVAD-related complications, this paper focuses on complications related to pump thrombosis, especially blood coagulopathy in detail and potential strategies to mitigate this complication. Furthermore, it also discusses the LVAD implantation techniques and their anatomical challenges