The safe insertion of peripheral intravenous catheters : a mixed methods descriptive study of the availability of the equipment needed

Background: Intravenous cannulation is undertaken in a high proportion of hospitalised patients. Much international attention has been given to the use of care bundles to reduce the incidence of infection in these patients. However, less attention has been given to the systems required to ensure availability of the equipment needed to support these care bundles. Our objectives were to assess how reliably the equipment recommended for a peripheral intravenous care bundle was available for use, and to explore factors which contributed to its non-availability. Methods: We studied 350 peripheral cannula insertions in three NHS hospital organisations across the UK. Staff inserting cannulae were asked to report details of all equipment problems. Key staff were then interviewed to identify the causes of problems with equipment availability, using semi-structured qualitative interviews and a standard coding frame. Results: 47 equipment problems were recorded during 46 of 350 cannulations, corresponding to a reliability of 87%, or 94% if problems with sharps disposal were excluded. Overall reliability was similar in all three organisations, but the types of problem varied. Interviews revealed a variety of causes including issues associated with purchasing policies, storage facilities, and lack of teamwork and communication in relation to reordering. The many human factors related to the supply chain were highlighted. Often staff had adopted work-arounds to deal with these problems. Conclusions: Overall, 87% of cannulations had the correct and functional equipment available. Different problems were identified in different organisations, suggesting that each had resolved some issues. Supply chain management principles may be useful to support best practice in care bundle delivery. Keywords: Cannulation, Patient safety, Equipment, Care bundles, Hospital acquired bacteraemia, Systems reliabilit

Discovery of Infection Associated Metabolic Markers in Human African Trypanosomiasis

Peer reviewedPublisher PD

Exploring quantum chaos with a single nuclear spin

Most classical dynamical systems are chaotic. The trajectories of two identical systems prepared in infinitesimally different initial conditions diverge exponentially with time. Quantum systems, instead, exhibit quasi-periodicity due to their discrete spectrum. Nonetheless, the dynamics of quantum systems whose classical counterparts are chaotic are expected to show some features that resemble chaotic motion. Among the many controversial aspects of the quantum-classical boundary, the emergence of chaos remains among the least experimentally verified. Time-resolved observations of quantum chaotic dynamics are particularly rare, and as yet unachieved in a single particle, where the subtle interplay between chaos and quantum measurement could be explored at its deepest levels. We present here a realistic proposal to construct a chaotic driven top from the nuclear spin of a single donor atom in silicon, in the presence of a nuclear quadrupole interaction. This system is exquisitely measurable and controllable, and possesses extremely long intrinsic quantum coherence times, allowing for the observation of subtle dynamical behavior over extended periods. We show that signatures of chaos are expected to arise for experimentally realizable parameters of the system, allowing the study of the relation between quantum decoherence and classical chaos, and the observation of dynamical tunneling.Comment: revised and published versio

How safe are clinical systems?

Th is study was commissioned by the Health Foundation to examine the extent, type and causes of failures in reliability in different healthcare systems: failures which have the potential to create risk or cause patient harm

Formation of octapod MnO nanoparticles with enhanced magnetic properties through kinetically-controlled thermal decomposition of polynuclear manganese complexes

Polynuclear manganese complexes are used as precursors for the synthesis of manganese oxide nanoparticles (MnO NPs). Altering the thermal decomposition conditions can shift the nanoparticle product from spherical, thermodynamically-driven NPs to unusual, kinetically-controlled octapod structures. The resulting increased surface area profoundly alters the NP's surface-dependent magnetism and may have applications in nanomedicine

996-11 Direct Gene Transfer and Expression with Arterial Iontophoretic Catheter Delivery

Iontophoresis is a technique of molecular delivery which uses electric current to enhance movement of charged molecules into tissues. A porous balloon catheter was tested with a central silver chloride electrode capable of generating a potential gradient across the arterial wall using an adhesive patch placed on the skin to serve as the anode. We hypothesized that this catheter delivery system might effectively transfer negatively charged plasmid DNA into arterial cells in vivo.MethodsTo localize plasmid DNA arterial delivery, a 7 Fr iontophoretic porous balloon catheterwast,’aced into porcine carotid arteries underflouroscopic guidance. 15μg of 35S-Iabeled plasmid DNA (1.4×106 cpm/μg) expressing the heat stable human alkaline phosphatase (hAP) gene with an RSV promoter was infused through the balloon at 6 atm pressure. A constant current density of 2.5 mA/cm2 was maintained for 10 minutes. The ;35S-labeled plasmid DNA delivery was repeated on the contralateral carotid artery under identical conditions with the absence of electric current. 20 minutes after gene transfer, the arteries were fixed in situ and processed for autoradiography. To analyze gene transfer and expression, 8 porcine carotid arterial segments were subject to iontophoretic gene delivery for 10 minutes at 6 atm with a current density of 2.5 mA/cm2 using the RSV hAP plasmid (n=6) or control plasmid (n=2). Animals were sacrificed 5 days after gene delivery and the transfected arteries analyzed by PCR and heat stable alkaline phosphatase histochemistry.ResultsAutoradiography of the arteries which underwent ;35S-labeled plasmid delivery revealed minimal radiolabel in the luminal cells of the control artery in which current was not delivered. In contrast, significant amounts of radiolabel were present in the media and adventitia of the artery subject to current delivery. PCR analysis of the arterial segments studied 5 days after delivery confirmed gene transfer in all hAP segments and was negative in control arteries. Staining for heat stable recombinant alkaline phosphatase activity demonstrated recombinant protein expression in 5% of medial cells and 10% of adventitial cells in arteries which underwent hAP gene transfer. Control arteries were negative for hAP staining.ConclusionsIontophoretic catheter gone delivery can be used to perform direct plasmid DNA delivery with expression of recombinant protein in medial and adventitial cells

Metabolic Profiling of Central Nervous System Disease in Trypanosoma brucei rhodesiense infection

Acknowledgments. We thank Isabel Garcia-Perez and Maria Lopez-Gonzales, for performing additional mass spectrometry analyses at Imperial College London. Financial support. This work was supported by the Medical Research Council MRC; (to S. D. L.), and Imperial College (MRC doctoral training award G1000390 to S. D. L.), and the Wellcome Trust (grant 082786 to J. M. S. and V. P. A.).Peer reviewedPublisher PD

Surface-directed dewetting of a block copolymer for fabricating highly uniform nanostructured microdroplets and concentric nanorings

Through a combination of nanoimprint lithography and block copolymer self-assembly, a highly regular dewetting process of a symmetric diblock copolymer occurs whereby the hierarchal formation of microdroplets and concentric nanorings emerges. The process is driven by the unique chemical properties and geometrical layout of the underlying patterned silsesquioxane micrometer-sized templates. Given the presence of nonpreferential substrate−polymer interactions, directed dewetting was utilized to produce uniform arrays of microsized droplets of microphase separated polystyrene-block-poly(methyl methylacrylate) (PS-b-PMMA), following thermal annealing at 180 °C. Microdroplets with diameters greater than 400 nm exhibited a hexagonal close-packed arrangement of nanodots on the surface with polydomain ordering. At the droplet periphery, the polydomain ordering was severely disrupted because of a higher in-plane radius of curvature. By reducing the droplet size, the in-plane radius of curvature of the microdroplet becomes significant and the PMMA cylinders adopt parallel structures in this confined geometry. Continuous scaling of the droplet results in the generation of isolated, freestanding, self-aligned, and self-supported oblique nanorings (long axis ∼250−350 nm), which form as interstitial droplets between the larger microdroplets. Optical and magnetic-based nanostructures may benefit from such hierarchal organization and self-supporting/aligned nanoring templates by combining more than one lithography technique with different resolution capabilities