A scoping review of clinical practices and adherence to UK national guidance related to the placement and position confirmation of adult nasogastric feeding tubes.

The administration of nutrition or medication into the lungs or pleura via a misplaced nasogastric feeding tube is considered a never event. Despite guidance from the National Patient Safety Agency and NHS Improvement this never event is regularly reported. Confirmation of correct placement and correct use of nasogastric tubes requires appropriate actions and decisions by a multidisciplinary team. A scoping review identified 43 records that discussed and supported nasogastric tube misplacement as a Never Event. Searches were completed using Web of Science, CINAHL, Google Scholar, British Nursing Index (BNI), as well as selected journals. A further manual search revealed 22 publicly available NHS Trust policies related to nasogastric feeding tube procedures. Items generated between 2011 and 2020 were considered eligible. A thematic analysis was completed to assess adherence to guidance and the practices in place across the NHS. Three key themes were identified as part of the review: referral and authorisation of radiography, examination description, and visualisation of the nasogastric tube tip. Large variations in practice were identified. While there is recognition of national guidance, records showed inconsistency and lacked the required detail to ensure patient safety. Despite classification as a never event, it is apparent that there is still room for improvement and further guidance in ensuring patient safety with respect to nasogastric tube insertion. Practice requires further standardisation whilst also ensuring optimisation and safety. Guidance should address in depth imaging authorisation, language and exact standards of acceptability for imaging the full length of the nasogastric tube. [Abstract copyright: Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.

Stabilization and precise calibration of a continuous-wave difference frequency spectrometer by use of a simple transfer cavity

A novel, simple, and inexpensive calibration scheme for a continuous-wave difference frequency spectrometer is presented, based on the stabilization of an open transfer cavity by locking onto the output of a polarization stabilized HeNe laser. High frequency, acoustic fluctuations of the transfer cavity length are compensated with a piezoelectric transducer mounted mirror, while long term drift in cavity length is controlled by thermal feedback. A single mode Ar+ laser, used with a single mode ring dye laser in the difference frequency generation of 2–4 µm light, is then locked onto a suitable fringe of this stable cavity, achieving a very small long term drift and furthermore reducing the free running Ar+ linewidth to about 1 MHz. The dye laser scan provides tunability in the difference frequency mixing process, and is calibrated by marker fringes with the same stable cavity. Due to the absolute stability of the marker cavity, precise frequency determination of near infrared molecular transitions is achieved via interpolation between these marker fringes. It is shown theoretically that the residual error of this scheme due to the dispersion of air in the transfer cavity is quite small, and experimentally that a frequency precision on the order of 1 MHz per hour is routinely obtained with respect to molecular transitions. Review of Scientific Instruments is copyrighted by The American Institute of Physics

Application of a helicopter mathematical model to the Langley differential maneuvering simulator for use in a helicopter/fighter evasive maneuver study

A real time simulation study was conducted using a differential maneuvering simulator to determine and evaluate helicopter evasive maneuvers when attacked by fighter aircraft. A general helicopter mathematical model was modified to represent an H-53 helicopter. The helicopter model was compared to H-53 flight test data to determine any differences between the simulated and actual vehicles. The simulated helicopter was also subjectively validated by participating pilots. Two fighter mathematical models validated in previous studies were utilized for the attacking aircraft. The results of this simulation study have been verified in a flight test program conducted by the U. S. Air Force and were found to closely match the flight results

Space station automation of common module power management and distribution, volume 2

The new Space Station Module Power Management and Distribution System (SSM/PMAD) testbed automation system is described. The subjects discussed include testbed 120 volt dc star bus configuration and operation, SSM/PMAD automation system architecture, fault recovery and management expert system (FRAMES) rules english representation, the SSM/PMAD user interface, and the SSM/PMAD future direction. Several appendices are presented and include the following: SSM/PMAD interface user manual version 1.0, SSM/PMAD lowest level processor (LLP) reference, SSM/PMAD technical reference version 1.0, SSM/PMAD LLP visual control logic representation's (VCLR's), SSM/PMAD LLP/FRAMES interface control document (ICD) , and SSM/PMAD LLP switchgear interface controller (SIC) ICD

Coherent State Approach to Quantum Clocks

The ``problem of time'' has been a pressing issue in quantum gravity for some time. To help understand this problem, Rovelli proposed a model of a two harmonic oscillators system where one of the oscillators can be thought of as a ``clock'' for the other oscillator thus giving a natural time reference frame for the system. Recently, the author has constructed an explicit form for the coherent states on the reduced phase space of this system in terms of Klauder's projection operator approach. In this paper, by using coherent state representations and other tools from coherent state quantization, I investigate the construction of gauge invariant operators on this reduced phase space, and the ability to use a quantum oscillator as a ``clock.''Comment: 13 pages, Late

Corporate Diseases of Excellence

Corporations, like people, develop various afflictions during their evolution. Sometimes these ailments are from outdated habits; sometimes they are caused by frailties; sometimes they are just the product of youth or age; and occasionally they result from tremendous exertions of energy in the pursuit of being the best, which are followed by eventual breakdowns. This article will examine what we consider to be the top 5 corporate diseases of excellence—those management maladies which prevent the majority of U.S. corporations from being great and stop the successful corporations from being even better. The common thread running through all 5 afflictions is loss of commitment, leading to a loss of profits

Participative Management: Selective Means Effective

Participative management has been a hot topic of debate for decades. intuitively, if workers are allowed to take part in decision that affect their work lives they should be happier and, therefore, more productive. While this hypothesis is attractive, especially to caring managers and writers, the effective use of PM has proven to be much more complicated than originally anticipated. What is PM? What costs are associated with PM? What benefits does PM produce? When can PM be used most effectively? To date, management experts and practitioners have agreed to disagree regarding PM. Conflicting and ambiguous studies and experiences abound. In view of the recently uncovered complexity and resulting confusion surrounding the use of PM, this article will attempt to clarify the relevant concepts and direct us toward an effective, selective approach

Trends in gabapentinoid prescribing in patients with osteoarthritis: a United Kingdom national cohort study in primary care

Summary Objective To investigate trends in gabapentinoid prescribing in patients with osteoarthritis (OA). Methods Patients aged 40 years and over with a new OA diagnosis recorded between 1995 and 2015 were identified in the Clinical Practice Research Datalink and followed to first prescription of gabapentin or pregabalin, or other censoring event. We estimated the crude and age-standardised annual incidence rates of gabapentinoid prescribing, stratified by patient age, sex, geographical region, and time since OA diagnosis, and the proportion of prescriptions attributable to OA, or to other conditions representing licensed and unlicensed indications for a gabapentinoid prescription. Results Of 383,680 newly diagnosed OA cases, 35,031 were prescribed at least one gabapentinoid. Irrespective of indication, the annual age-standardised incidence rate of first gabapentinoid prescriptions rose from 1.6 (95% CI: 1.3, 2.0) per 1,000 person-years in 2000, to 27.6 (26.7, 28.4) in 2015, a trend seen across all ages and not explained by length of follow-up. Rates were higher among women, younger patients, and in Northern Ireland, Scotland and the North of England. Approximately 9% of first prescriptions could be attributed to OA, a further 13% to comorbid licensed or unlicensed indications. Conclusion Gabapentinoid prescribing in patients with OA increased dramatically between 1995 and 2015. In most cases, diagnostic codes for licensed or unlicensed indications were absent. Gabapentinoid prescribing may be attributable to OA in a significant proportion but evidence for their effectiveness in OA is lacking. Further research to investigate clinical decision making around prescribing these expensive and potentially harmful medicines is recommended

C1 inhibitor deficiency: 2014 United Kingdom consensus document

C1 inhibitor deficiency is a rare disorder manifesting with recurrent attacks of disabling and potentially life-threatening angioedema. Here we present an updated 2014 United Kingdom consensus document for the management of C1 inhibitor-deficient patients, representing a joint venture between the United Kingdom Primary Immunodeficiency Network and Hereditary Angioedema UK. To develop the consensus, we assembled a multi-disciplinary steering group of clinicians, nurses and a patient representative. This steering group first met in 2012, developing a total of 48 recommendations across 11 themes. The statements were distributed to relevant clinicians and a representative group of patients to be scored for agreement on a Likert scale. All 48 statements achieved a high degree of consensus, indicating strong alignment of opinion. The recommendations have evolved significantly since the 2005 document, with particularly notable developments including an improved evidence base to guide dosing and indications for acute treatment, greater emphasis on home therapy for acute attacks and a strong focus on service organisation. This article is protected by copyright. All rights reserved

Space station automation of common module power management and distribution

The purpose is to automate a breadboard level Power Management and Distribution (PMAD) system which possesses many functional characteristics of a specified Space Station power system. The automation system was built upon 20 kHz ac source with redundancy of the power buses. There are two power distribution control units which furnish power to six load centers which in turn enable load circuits based upon a system generated schedule. The progress in building this specified autonomous system is described. Automation of Space Station Module PMAD was accomplished by segmenting the complete task in the following four independent tasks: (1) develop a detailed approach for PMAD automation; (2) define the software and hardware elements of automation; (3) develop the automation system for the PMAD breadboard; and (4) select an appropriate host processing environment