Design Considerations and Optimization of Calorimetric Flow Sensor for Respiratory Monitoring

This paper evaluates the impact of the operating modes, power consumption, and placement of temperature sensors against the heater to the design of a calorimetric flow sensor, for the range of 4.7 to 56.5 liters per minute (slm). In contrast to previous works most of which simply indicated the choice of various design parameters rather than providing a justification, this work provides useful guidelines for optimizing low-power small-area flow sensors for respiratory monitoring applications. A figure of merit (FoM) which is defined as the product of power consumption and sensor size, the two most challenging design parameters in developing small medical devices and systems, is proposed for quantifying flow sensor performance. Although the analysis and simulation was drawn upon designs in the mm scale, a similar optimization process can be applied to flow sensors of anysize

A Smart Dual-Mode Calorimetric Flow Sensor

A smart thermal flow sensor system is presented. It makes use of a novel heater control circuit which can automatically set the operating mode to either constant power or constant temperature difference. It overcomes the limitations of single-mode thermal flow sensors, such as temperature overshoots at low flow rates at constant power mode, or excessive power consumption at high flow rates at constant temperature difference mode. The system is especially useful for temperature sensitive and portable applications, such as respiratory monitoring for medical diagnostics. In this paper, detailed description of the sensor’s design, implementation, and experimental validation are presented. The proposed dual-mode flow sensor achieves an overtemperature reduction up to 9.5% compared with thermal flow sensors operating in constant power mode alone, and a power reduction up to 13.6% compared with thermal flow sensors operating in constant temperature difference mode alone for the flow range of 0 to 50 slm while offering an improved overall sensitivity

Who Helps the Helper? Lessons on Grieving

Context: Grief is something that will touch all of us. We expect loss to occur in our personal lives and seem to be somewhat prepared for how to cope with it when it happens. In the profession of athletic training, we may not expect loss to occur as readily–especially if we are working with a young, seemingly healthy population. As such, when an athlete, student, or colleague suffers a catastrophic injury, illness, or death, we may not be able to process the loss and be left with unresolved grief. Objective: The purpose of this article is to review theories on grief, identify successful interventions by allied health care providers and offer suggestions on how to implement teaching strategies within athletic training curriculum regarding the issues of death, dying, and coping strategies. Data Sources: We searched various databases, including MEDLINE, ERIC, SportDiscus, and CINAHL Information Systems using the terms grieving, death, bereavement, loss, and coping. Data Synthesis: Pertinent articles were cross-referenced to gain additional information regarding the search terms. Conclusions: Athletic trainers should consider using strategies that introduce issues concerning bereavement, death, dying, and healthy coping skills into the athletic training curriculum. Additionally, it is critical to create a support network for athletic training professionals and students to use in time of loss

Medication prescribing quality in Australian primary care patients with chronic kidney disease

Background: Australian patients with chronic kidney disease (CKD) are routinely managed in general practices with multiple medications. However, no nationally representative study has evaluated the quality of prescribing in these patients. The objective of this study was to examine the quality of prescribing in patients with CKD using nationally representative primary care data obtained from the NPS MedicineWise's dataset, MedicineInsight. Methods: A cross-sectional analysis of general practice data for patients aged 18 years or older with CKD was performed from 1 February 2016 to 1 June 2016. The study examined the proportion of patients with CKD who met a set of 16 published indicators in two categories: (1) potentially appropriate prescribing of antihypertensives, renin-angiotensin system (RAS) inhibitors, phosphate binders, and statins; and (2) potentially inappropriate prescribing of nephrotoxic medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), at least two RAS inhibitors, triple therapy (an NSAID, a RAS inhibitor and a diuretic), high-dose digoxin, and metformin. The proportion of patients meeting each quality indicator was stratified using clinical and demographic characteristics. Results: A total of 44,259 patients (24,165 (54.6%) female; 25,562 (57.8%) estimated glomerular filtration (eGFR) 45-59 mL/1.73 m2) with CKD stages 3-5 were included. Nearly one-third of patients had diabetes and were more likely to have their blood pressure and albumin-to-creatinine ratio monitored than those without diabetes. Potentially appropriate prescribing of antihypertensives was achieved in 79.9% of hypertensive patients with CKD stages 4-5. The prescribing indicators for RAS inhibitors in patients with microalbuminuria and diabetes and in patients with macroalbuminuria were achieved in 69.9% and 62.3% of patients, respectively. Only 40.8% of patients with CKD and aged between 50 and 65 years were prescribed statin therapy. The prescribing of a RAS inhibitor plus a diuretic was less commonly achieved, with the indicator met in 20.6% for patients with microalbuminuria and diabetes and 20.4% for patients with macroalbuminuria. Potentially inappropriate prescribing of NSAIDs, metformin, and at least two RAS inhibitors were apparent in 14.3%, 14.1%, and 7.6%, respectively. Potentially inappropriate prescribing tended to be more likely in patients aged ≥65 years, living in regional or remote areas, or with socio-economic indexes for areas (SEIFA) score ≤ 3. Conclusions: We identified areas for possible improvement in the prescribing of RAS inhibitors and statins, as well as deprescribing of NSAIDs and metformin in Australian general practice patients with CKD

Asymmetrical Sensing Configuration for Improved Sensitivity in Calorimetric High Flow Measurements in Constant Power Mode

This work compares the resolution of calorimetric flow sensors in constant power mode using symmetrically located sensing elements to those using asymmetrical locations, for flow rates higher than the turn-over point. The experimental results show that the resolution can be improved up to six times by placing the temperature sensors in unequal distances, for the same power consumption

Industrial path development in the UK space sector: processes of legitimacy building in the establishment of Space 2.0

This paper explores the processes behind legitimacy building and its role in new path creation and the path transformation or the ‘de-locking’ of an established industry. We use a mixed-methods approach and focus on the emergence of ‘New Space’ or Space 2.0 in the UK, a new-to-the-world industry, with radically different products and/or conventions. Legitimation of new product categories is essential to enable future adoption by regulators and consumers. Our findings suggest that this is not a linear process but involves interlayering, or complex feedback loops, between three distinct types of legitimacy building: regulatory, normative, and cognitive. Failure in some of these feedback loops, for example, problems with altering regulatory legitimacy, would prevent the formation of new industrial pathways with significant implications for the development of new-to-the-world and new-to-region industries

Measuring Transformational Leadership in Establishing Nursing Care Excellence

Transformational leadership (TL) is known to be essential to achieving Magnet® recognition,an internationally prestigious status for nursing care excellence. Since its inception in the 1980s,empirical studies have identified benefits of implementing the Magnet® Model involving improvedpatient care and nursing workforce outcomes. However, little is known about the leadership styles ofnurse managers (NMs) working in a regional Australian context, which may hinder achieving Magnet®status. To close the knowledge gap, a self-administered survey was conducted to measure leadershipstyles of NMs at a large health organization comprising hospitals with a wide range of service profilesin regional Australia using a validated tool—the Multifactor Leadership Questionnaire (MLQ-6S).One-way of variance (ANOVA) was used to identify statistical significance between respondents’demographic characteristics (e.g., age, education, gender) and their MLQ-6S scores. Respondents(n = 78) reported their leadership styles as more transformational, compared to transactional orpassive/avoidant leadership styles. The findings indicated that NMs’ higher education (p = 0.02)and older age (p = 0.03) were associated with TL styles, whereas passive/avoidant leadership wasgenerally reported by female (p = 0.04) and younger (p = 0.06) respondents. This study has identifieddifferences in reported leadership styles among NMs, providing a unique organizational insight intodeveloping strategies to improve NMs’ TL, which could help to facilitate the implementation of theMagnet® framework. Healthcare organizations in similar settings could benefit from replicating thisstudy to identify a dominant leadership style and customize strategies to improve TL

The kidney failure risk equation predicts kidney failure: Validation in an Australian cohort

Aims: Predicting progression to kidney failure for patients with chronic kidney disease is essential for patient and clinicians' management decisions, patient prognosis, and service planning. The Tangri et al Kidney Failure Risk Equation (KFRE) was developed to predict the outcome of kidney failure. The KFRE has not been independently validated in an Australian Cohort. Methods: Using data linkage of the Tasmanian Chronic Kidney Disease study (CKD. TASlink) and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), we externally validated the KFRE. We validated the 4, 6, and 8-variable KFRE at both 2 and 5 years. We assessed model fit (goodness of fit), discrimination (Harell's C statistic), and calibration (observed vs predicted survival). Results: There were 18 170 in the cohort with 12 861 participants with 2 years and 8182 with 5 years outcomes. Of these 2607 people died and 285 progressed to kidney replacement therapy. The KFRE has excellent discrimination with C statistics of 0.96–0.98 at 2 years and 0.95–0.96 at 5 years. The calibration was adequate with well-performing Brier scores (0.004–0.01 at 2 years, 0.01–0.03 at 5 years) however the calibration curves, whilst adequate, indicate that predicted outcomes are systematically worse than observed. Conclusion: This external validation study demonstrates the KFRE performs well in an Australian population and can be used by clinicians and service planners for individualised risk prediction.Georgina L. Irish, Laura Cuthbertson, Alex Kitsos, Tim Saunder, Philip A. Clayton, Matthew D. Jos