Flow rate accuracy of infusion devices within healthcare settings: a systematic review

Background: One in five patients admitted to the hospital treated with intravenous (IV) fluid therapy suffer complications due to inappropriate administration. Errors have been reported in 13-84% of the preparation and administration of IV medications. The safe delivery of IV fluids requires precise rate administration. Objectives: This systematic review aims to determine the accuracy of infusion sets and devices and examine the factors that affect the flow rate accuracy of devices. Data sources and methods: Six databases (CINAHL, MEDLINE PubMed, EMBASE, Web of Science and Cochrane Database of systematic reviews) were systematically searched. Search terms included infusion pumps, infusion devices, flow rate accuracy, fluid administration rate, gravity-led infusion set and fluid balance. Studies were included if they examined infusion devices' flow rate accuracy and drop rates for fluids or non-oncological drugs. Findings were tabulated and synthesised qualitatively. The quality of the studies was examined based on the design of the studies due to their heterogeneity. Results: Eight studies were included: Four studies were conducted on human subjects in the hospital environment; studies recruited 182 participants between the ages of 18 and 94 years. Two studies examined flow rate accuracy in recruited patients across 509 observations and 2387 drip hours. No trials prospectively assessed the accuracy of infusion pumps in the clinical domain, and no studies were reported on patient safety outcomes. Four studies examined the impact of mechanical and physiological factors on the flow rate accuracies of infusion devices. Height and back pressure simulated vibrating conditions, the viscosity of IV fluid and the positions of patients were reported to have a significant impact on infusion volume and flow rates of infusion devices. Additionally, giving sets that vary from the manufacturer's specifications are reported to increase error percent by 10-20%. Conclusion: Infusion devices are an important source of error in administering IV fluids. Yet, there needs to be more prospective trial data to support their clinical accuracy and the impact on patient outcomes. Future flow variability and accuracy studies should capture their impact on patient safety and clinical outcomes

Prevalence and Risk Factors of High Risk Human Papillomavirus Infections among Women Attending Gynaecology Clinics in Kano, Northern Nigeria

Cervical cancer is the most common female cancer in northern Nigeria, yet the pattern of infection with human papillomavirus, the principal aetiologic agent is unknown. This was a preliminary study conducted in two referral hospitals in order to establish base-line data on the prevalence and risk factors for the infection in Kano state, Nigeria. Fifty (50) randomly selected women aged 18 years and above were recruited from gynaecology clinics in Murtala Muhammad Specialist Hospital and Aminu Kano teaching Hospital. Relevant sexual and socio-demographic information were obtained from each subject using a questionnaire. Exfoliated cervical cells were harvested and processed using Polymerase Chain Reaction to identify the DNAs of high-risk HPV types 16 and 18. The prevalence rate of HPV infection was 76% [(38/50) at 95% CI=61.8-86.9] with 60.5% (23/38) having co-infections with both HPV type 16 and 18. Risk factors of the infection include low literacy level; living in rural settlements; low parity; early menarche (<15 years of age); early onset of first sexual intercourse (≤16 years of age) and multiple sexual partners. There was however, no statistically significant association between oral contraceptive usage and acquisition of the infections. Findings of this study suggest a high prevalence of HPV types 16 and 18 among women attending gynaecology clinic in Kano and thus called for more elaborate community based study in order to establish the magnitude of the problem from wider perspective.Keywords: Human Papillomavirus; Prevalence; Risk Factors, Northern Nigeri

Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft in young patients

Objectives: Traditionally, bone-patella tendon-bone (BTB) autograft has been the gold standard graft choice for younger, athletic patients requiring ACL reconstruction. However, donor site morbidity, post-operative patella fracture, and increased operative time have led many surgeons to choose BTB allograft for their reconstructions. Opponents of allografts feel that slower healing time, higher rate of graft failure, and potential for disease transmission makes them undesirable graft choices in athletic patients. The purpose of this study is to evaluate the clinical outcomes, both subjective and objective, of young patients that who have undergone either BTB autograft or allograft reconstructions with a minimum of 2-year follow-up. Methods: One hundred and twenty patients (60 autograft, 60 allograft), age 25 and below at time of surgery, were contacted after being retrospectively identified as patients having an ACL reconstruction with either a BTB allograft or autograft by one senior surgeon. Patients were administered the Lysholm Knee Scoring Scale and IKDC Subjective Knee Evaluation questionnaires. Fifty (25 BTB autograft and 25 BTB allograft) of the 120 returned for physical examination as well as completion of a single leg hop test and laxity evaluation using a KT-1000 arthrometer evaluation. Of the 120 patients contacted, there were a total of 7 failures (5.8%) requiring revision, 6 in the allograft group (86%) and 1 in the autograft group (14%). Results: The average Lysholm scores were 89.0 and 89.56 and the average IKDC scores were 90.8 and 92.1 in the autograft and allograft groups respectively. The differences in the Lysholm scores and the IKDC scores were not significant. The single leg hop and KT-1000 scores were also not significantly different. One autograft patient had a minor motion deficit. Three allograft patients had a grade 1 Lachman and pivot glide. One autograft patient and two allograft patients had mild patellafemoral crepitus. There was no significant difference in anterior knee pain between the two groups Conclusion: There is no significant difference in patient-rated outcome between ACL reconstructions using BTB autografts versus allografts. However, the overall study group did reveal an increased failure rate requiring revision in the allograft group. © The Author(s) 2015

NUMERICAL SIMULATION OF OUTER DIE ANGLE OF EQUAL CHANNEL ANGULAR EXTRUSION PROCESS

The study of the simulation of effect of outer die angle in Equal Channel Angular Extrusion (ECAE) process was investigated. The simulation was carried out on 6063 aluminium alloy with a view to achieve ultra-fine grain structures. ADINA user interphase Version 8.6 (900 modes) was used for the simulation. The unextruded parameters of the 6063 aluminium alloy were used as input codes and some basic assumptions were made in designing the model on 2-Dimensional scale. The billet was meshed by dividing the vertical and horizontal geometry into 30 and 4 elements respectively. The die angle was varied from 0o to 90o and the simulation results were displayed. The results showed that the force of 27.5X106 N, 27.5X106 N, 27.6X106 N and 31.2 X106 N was required to deform when the outer die angle was 0o, 22.5o, 45o and 90o respectively. Also, the strains achieved were 0.61, 0.62, 0.66 and 0.69 respectively. Thus, highest force is required at 90o and the strain achieved at 0o is the lowest. Based on the results, it was recommended that it is more economical to extrude at an outer angle between 22.5o and 45o as a relatively higher effective strain will be induced

NUMERICAL SIMULATION OF OUTER DIE ANGLE OF EQUAL CHANNEL ANGULAR EXTRUSION PROCESS

The study of the simulation of effect of outer die angle in Equal Channel Angular Extrusion (ECAE) process was investigated. The simulation was carried out on 6063 aluminium alloy with a view to achieve ultra-fine grain structures. ADINA user interphase Version 8.6 (900 modes) was used for the simulation. The unextruded parameters of the 6063 aluminium alloy were used as input codes and some basic assumptions were made in designing the model on 2-Dimensional scale. The billet was meshed by dividing the vertical and horizontal geometry into 30 and 4 elements respectively. The die angle was varied from 0o to 90o and the simulation results were displayed. The results showed that the force of 27.5X106 N, 27.5X106 N, 27.6X106 N and 31.2 X106 N was required to deform when the outer die angle was 0o , 22.5o , 45o and 90o respectively. Also, the strains achieved were 0.61, 0.62, 0.66 and 0.69 respectively. Thus, highest force is required at 90o and the strain achieved at 0o is the lowest. Based on the results, it was recommended that it is more economical to extrude at an outer angle between 22.5o and 45o as a relatively higher effective strain will be induced

Microstructural Characterization and Some Mechanical Behaviour of Low Manganese Austempered Ferritic Ductile Iron

This work studied the microstructural characterization and mechanical behavior of low manganese Austempered Ductile Iron (ADI), with a view to improve the properties of iron and to increase the areas of applications. Three sets of ductile iron of specified composition were machined from Y-blocks to tensile and hardness pieces. The samples were preheated at 350 0C for 1hr and austenitised at 900 0C for 1hr in salt bath furnace. The three sets of samples were immediately austempered in the austempering salt bath furnace at uniform austempering temperatures of 300 0C, 350 0C and 400 0C for 90, 120 and 150 minutes; each sample for each temperature window. All sets were prepared for metallographic examination; tensile and hardness tests were carried out. The results showed that maximum hardness, tensile and yield strength were obtained at austempering temperature of 350 0C and at 150 minutes. At 300 0C and 350 0C, it was noticed that the hardness and strength increase with austempering time. The optimum tensile strength was 1300 MPa at 350 0C after austempering for 150 minutes. In conclusion the austempering operation has a significant effect on the mechanical and microstructural properties of ADI

Effect of Piper guineensees on physicochemical and organoleptic properties of watermelon (Citrulus lanatus) juice stored in refrigerator and ambient

Extracted juice from watermelon containing 0.01gPiper guineensesstored in refrigerator (6±2 oC) and on the shelf (28±1oC) usingpolyethylene bottles was evaluated for physicochemical and organoleptic changes. pH, total soluble sugars, titratable acidity and organolepticevaluation of the juice was carried out till deterioration sets in. Results showed that the sample stored in therefrigerator kept for 7 days while the sample on the shelf lasted for 3 days. pH value decreased from 5.40 to 4.80 and 5.70 for the samplestored in the refrigerator and on the shelf respectively while TSS increased from 0.064%Brix to 0.435% Brix and 0.578%Brix for sample stored in refrigerator and shelf respectively. Titratable acidity decreased from 2.90 % to 0.20% and 0.50% for samples for the juice stored in the refrigerator and on shelf respectively.All these changes were statistically significant (p<0.05).The sample stored on the shelf lost its organoleptic qualities on the third day with an average value less than 2 for taste, smell and colour. However, the juice stored in the fridge lost its organoleptic qualities at the 7th day with an average value of 3.0, 2.90 and 2.80 for taste, smell andcolour respectively.  From the results, juice extracted from water meloncannot be kept at ambient temperature beyond 3 days without proper refrigeration and an additive. This calls for alternative way of extending its shelf life in the absence of electricity supply using local spice like P. guineenses and to make it available during off season

Material Selection for Gas Turbine Blade Coating Using GRANTA Material Selector

This paper presents the selection of suitable candidate materials for thermal barrier coating of gas turbine blade using GRANTA software. There have been reported cases of gas turbine blade failure in service due to the extreme service conditions. Such failure could possibly have occurred due to poor material selection for thermal barrier coatings on the turbine blade thereby exposing the blade to harsh condition over time. The major adverse effects on these blades are thermal fatigue, high temperature oxidation, hot corrosion, interdiffusion, high cycle fatigue and creep

Assessment of aflatoxigenicAspergillusand other fungi in millet and sesame from Plateau State, Nigeria

Sixteen fonio millet and 17 sesame samples were analysed for incidence of moulds, especially aflatoxigenic Aspergillus species, in order to determine the safety of both crops to consumers, and to correlate aflatoxin levels in the crops with levels produced by toxigenic isolates on laboratory medium. Diverse moulds including Alternaria, Aspergillus, Cercospora, Fusarium, Mucor, Penicillium, Rhizopus and Trichoderma were isolated. Aspergillus was predominantly present in both crops (46–48%), and amongst the potentially aflatoxigenic Aspergillus species, A. flavus recorded the highest incidence (68% in fonio millet; 86% in sesame kernels). All A. parvisclerotigenus isolates produced B and G aflatoxins in culture while B aflatoxins were produced by only 39% and 20% of A. flavus strains isolated from the fonio millet and sesame kernels, respectively. Aflatoxin concentrations in fonio millet correlated inversely (r = −0.55; p = 0.02) with aflatoxin levels produced by toxigenic isolates on laboratory medium, but no correlation was observed in the case of the sesame samples. Both crops, especially sesame, may not be suitable substrates for aflatoxin biosynthesis. This is the first report on A. parvisclerotigenus in sesame

The Thermal Analysis of Fuel Fired Crucible Furnace Using Autodesk Inventor Simulation Software

The reasons for failure of locally made furnace in the foundries were as a result of cycles of operating temperatures that they were subjected to, which caused thermal stress and strain on the furnaces. This paper studied the simulation of thermal analysis of Fuel fired Crucible Furnace to predict the effect of thermal stress and strain on it