Bench-to-bedside review: Dealing with increased intensive care unit staff turnover: a leadership challenge

Critical care leaders frequently must face challenging situations requiring specific leadership and management skills for which they are, not uncommonly, poorly prepared. Such a fictitious scenario was discussed at a Canadian interdisciplinary critical care leadership meeting, whereby increasing intensive care unit (ICU) staff turnover had led to problems with staff recruitment. Participants discussed and proposed solutions to the scenario in a structured format. The results of the discussion are presented. In situations such as this, the ICU leader should first define the core problem, its complexity, its duration and its potential for reversibility. These factors often reside within workload and staff support issues. Some examples of core problems discussed that are frequently associated with poor retention and recruitment are a lack of a positive team culture, a lack of a favorable ICU image, a lack of good working relationships between staff and disciplines, and a lack of specific supportive resources. Several tools or individuals (typically outside the ICU environment) are available to help determine the core problem. Once the core problem is identified, specific solutions can be developed. Such solutions often require originality and flexibility, and must be planned, with specific short-term, medium-term and long-term goals. The ICU leader will need to develop an implementation strategy for these solutions, in which partners who can assist are identified from within the ICU and from outside the ICU. It is important that the leader communicates to all stakeholders frequently as the process moves forward

Factors influencing the relationship between the dose of amlodipine required for blood pressure control and change in blood pressure in hypertensive cats

BACKGROUND: Hypertension is a common problem in elderly cats. In most cats, systolic blood pressure (SBP) of <160 mmHg is achieved in response to amlodipine besylate at either 0.625 or 1.25 mg q24h. The individual cat factors determining dose requirement dose have not been explored. AIMS: To determine whether individual cat factors influence the dose of amlodipine required to achieve adequate blood pressure control and to determine whether factors other than the prescribed dose of drug alter the achieved plasma amlodipine concentrations. METHODS: Fifty‐nine hypertensive cats that required 0.625 mg (A) and 41 cats that required 1.25 mg (B) amlodipine to reach a target SBP of <160 mmHg were identified, and plasma amlodipine concentrations were determined. Comparisons were made between groups, and multivariable linear regression models were performed to investigate predictors of antihypertensive response. RESULTS: Cats that required a greater dose of amlodipine had significantly higher SBP at diagnosis of hypertension (A: (median [25th, 75th percentile]) 182 [175,192] mmHg; B: 207 [194,217] mmHg, P < .001), but comparable blood pressure was achieved after treatment. Plasma amlodipine concentrations were directly related to the dose of amlodipine administered. At diagnosis, cats in group B had significantly lower plasma potassium concentration (A: 4.1 [3.8,4.5]; B: 3.8 [3.6,4.2] mEq/L, P < .01). Weight did not differ between groups. The decrease in SBP was directly and independently associated with the SBP at diagnosis and the plasma amlodipine concentration. CONCLUSIONS AND CLINICAL IMPORTANCE: Cats with higher blood pressure at diagnosis might require a greater dose of amlodipine to control their blood pressure adequately. Differences in amlodipine pharmacokinetics between cats do not seem to play a role in the antihypertensive response

Design of high-area-ratio nozzle contours using circular arcs

A method using circular arcs to generate the divergence contour in a supersonic nozzle is presented. Comparison of the arc-based geometry with existing nozzle contours demonstrated that an average decrease in axial length of 7.5% can be expected when the arc-based design method is applied to a core stage nozzle. Two arc-based and conventional nozzles were evaluated numerically across the pressure operating range of a core stage engine to compare calculated thrust and separation characteristics with existing data. The length-weighted thrust coefficient was increased by 0.3–1.8% in the arc-based design in both configurations. Separated flow characteristics were compared using contours of Mach number and static pressure distributions, which suggested equivalent side loading in the arc-based nozzle at separated flow conditions. The result indicates that a geometric advantage independent of thrust may be achieved when the arc-based method is applied to high-area-ratio nozzle contour design

Flow compressibility effects around an open-wheel racing car

A numerical investigation has been conducted into the influence of flow compressibility effects around an open-wheeled racing car. A geometry was created to comply with 2012 F1 regulations. Incompressible and compressible CFD simulations were compared-firstly with models which maintained Reynolds number as Mach number increased, and secondly allowing Mach number and Reynolds number to increase together as they would on track. Results demonstrated significant changes to predicted aerodynamic performance even below Mach 0·15. While the full car coefficients differed by a few percent, individual components (particularly the rear wheels and the floor/ diffuser area) showed discrepancies of over 10% at higher Mach numbers when compressible and incompressible predictions were compared. Components in close ground proximity were most affected due to the ground effect. The additional computational expense required for the more physically-realistic compressible simulations would therefore be an additional consideration when seeking to obtain maximum accuracy even at low freestream Mach numbers

Computational simulation of an altitude adaptive nozzle concept

A computational analysis of an annular converging-diverging (CD) and an altitude adaptive expansion-deflection (ED) nozzle is presented. Numerical results were generated using a 2D axisymmetric, pressure-coupled solver in conjunction with the Spalart-Allmaras turbulence closure model and second order spatial discretisation schemes. Results were recorded over a theoretical altitude range and compared to experimental static pressure readings and schlieren images. The correlation between numerical and experimental static pressure values was high for all cases. Comparison of schlieren imagery outlined the large variety of flow regions within the ED nozzle flow field. The interactions between these regions were highly sensitive to turbulence and reinforced that conventional inviscid analytical techniques are unable to accurately describe behaviour within the ED nozzle flow field. The results highlight the salient effect of viscous effects within the ED nozzle flow field and justify a continued approach utilising computational fluid dynamics to increase understanding of the ED nozzle concept

Explosive-driven shock wave and vortex ring interaction with a propane flame

Experiments were performed to analyze the interaction of an explosively driven shock wave and a propane flame. A 30 g explosive charge was detonated at one end of a 3-m-long, 0.6-m-diameter shock tube to produce a shock wave which propagated into the atmosphere. A propane flame source was positioned at various locations outside of the shock tube to investigate the effect of different strength shock waves. High-speed retroreflective shadowgraph imaging visualized the shock wave motion and flame response, while a synchronized color camera imaged the flame directly. The explosively driven shock tube was shown to produce a repeatable shock wave and vortex ring. Digital streak images show the shock wave and vortex ring propagation and expansion. The shadowgrams show that the shock wave extinguishes the propane flame by pushing it off of the fuel source. Even a weak shock wave was found to be capable of extinguishing the flame

Influence of wing span on the aerodynamics of wings in ground effect

A computational fluid dynamics study of the influence of wing span has been conducted for an inverted wing with endplates in ground effect. Aerodynamic coefficients were determined for different spans at different ground clearances, highlighting a trend for shorter spans to delay the onset of both separation and resulting loss of negative lift. The vortices at the wing endplates were not observed to change significantly in terms of strength and size; thus, at shorter spans, their influence over a larger percentage of the wing helped the flow stay attached and reduced the severity of the adverse pressure gradient which invokes separation at greater spans. Consequently, it was shown that, compared to a large-span wing, a wing with a shorter span may have a lower lift coefficient but can operate closer to the ground before performance is adversely affected

Implications of compressibility effects for Reynolds-scaled testing of an inverted wing in ground effect

The influence of compressibility around an isolated inverted wing at a fixed Reynolds number was examined as relevant to the issue of wind tunnel scaling effects. Three-dimensional simulations were conducted for low ground clearances, at: full scale and a Mach number of 0.088, at 50% scale at Mach 0.176, and at 25% scale at Mach 0.352. As the scale was reduced, the increasing peak local Mach number between the wing and the ground resulted in a higher propensity of the flow to separate towards the trailing edge, and for incompressible or full-scale CFD to underestimate the lift and drag coefficients by an ever-increasing margin. The lower vortex path was less affected. The results suggest that compressible CFD of a scale experiment ought to be conducted at the same Reynolds number and Mach number as the tunnel test for the best possible correlation at free-stream Mach numbers beyond 0.15