Modification and Assessment of the Bedside Pediatric Early Warning Score in the Pediatric Allogeneic Hematopoietic Cell Transplant Population

OBJECTIVES: To determine the validity of the Bedside Pediatric Early Warning Score system in the hematopoietic cell transplant population, and to determine if the addition of weight gain further strengthens the association with need for PICU admission. DESIGN: Retrospective cohort study of pediatric allogeneic hematopoietic cell transplant patients from 2009 to 2016. Daily Pediatric Early Warning Score and weights were collected during hospitalization. Logistic regression was used to identify associations between maximum Pediatric Early Warning Score or Pediatric Early Warning Score plus weight gain and the need for PICU intervention. The primary outcome was need for PICU intervention; secondary outcomes included mortality and intubation. SETTING: A large quaternary free-standing children's hospital. PATIENTS: One-hundred two pediatric allogeneic hematopoietic cell transplant recipients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 102 hematopoietic cell transplant patients included in the study, 29 were admitted to the PICU. The median peak Pediatric Early Warning Score was 11 (interquartile range, 8-13) in the PICU admission cohort, compared with 4 (interquartile range, 3-5) in the cohort without a PICU admission (p < 0.0001). Pediatric Early Warning Score greater than or equal to 8 had a sensitivity of 76% and a specificity of 90%. The area under the receiver operating characteristics curve was 0.83. There was a high negative predictive value at this Pediatric Early Warning Score of 90%. When Pediatric Early Warning Score greater than or equal to 8 and weight gain greater than or equal to 7% were compared together, the area under the receiver operating characteristic curve increased to 0.88. CONCLUSIONS: In this study, a Pediatric Early Warning Score greater than or equal to 8 was associated with PICU admission, having a moderately high sensitivity and high specificity. This study adds to literature supporting Pediatric Early Warning Score monitoring for hematopoietic cell transplant patients. Combining weight gain with Pediatric Early Warning Score improved the discriminative ability of the model to predict the need for critical care, suggesting that incorporation of weight gain into Pediatric Early Warning Score may be beneficial for monitoring of hematopoietic cell transplant patients

The Connecting School: A Qualitative Evaluation of Intranet Development and the Role of the School Librarian in Scottish Secondary Schools.

This study investigates the development of intranets in Scottish secondary schools and within that development the role of the school librarian. There is little written on the development of intranets in schools. There has been a lack of recent research on the role of the school librarian in the UK, and in particular there have been no studies investigating their involvement in ICT. This research adopted an interactionist approach which has been used in studying the social impact of computing (see Hiltz 1992). A grounded methodology has produced original substantive theory. Methods include a questionnaire to Scottish education authorities and semi-structured interviews with key individuals at authority level and in fifteen Scottish secondary schools. Schools which have successfully developed their own intranets were found to have a supportive culture which enabled key individuals to work on the intranet and develop content relevant to the internal curricular needs and ethos of the school. Examples of materials on the intranet was important in encouraging further content through a snowball effect. The key individuals were defined as activators (people with the technical skills to create content), mediators (people willing to encourage, provide ideas and examples) and to a lesser extent gatherers (who collected content from school staff). A predictive model for intranet development has been produced based on these findings. There appears to be flexibility within the role of the school librarian for individuals to take on a variety of roles. This research on intranet development found that the librarians who qualified within the last five years focussed on the intranet as a way of developing and promoting their role. Their involvement with the intranet has put school librarians in the role of intranet builder, intranet manager and content creators. Most significantly they have operated as activators and mediators in intranet development. Some librarians have broadened into network administration roles. This is increasing the difference between recently qualified librarians and longer serving school librarians. However it was found that the more recent graduates involvement with these more technical roles is not distancing them from their traditional areas of work. There is evidence that through these new roles, close curriculum cooperation has been achieved.sub_behunpub124_ethesesunpu

The near wall effect of synthetic jets in a boundary layer

Copyright @ 2007 Elsevier Inc. All rights reserved.An experimental investigation to analyse the qualitative near wall effect of synthetic jets in a laminar boundary layer has been undertaken for the purpose of identifying the types of vortical structures likely to have delayed separation on a 2D circular cylinder model described in this paper. In the first instance, dye visualisation of the synthetic jet was facilitated in conjunction with a stereoscopic imaging system to provide a unique quasi three-dimensional identification of the vortical structures. Secondly, the impact of synthetic jet structures along the wall was analysed using a thermochromic liquid crystal-based convective heat transfer sensing system in which, liquid crystals change colour in response to the thermal footprints of a passing flow structure. Of the different vortical structures produced as a result of varying actuator operating and freestream conditions, the footprints of hairpin vortices and stretched vortex rings revealed a marked similarity with the oil flow pattern of a vortex pair interacting with the separation line on the cylinder hence suggesting that either of these structures was responsible in delaying separation. Conditions were established for the formation of the different synthetic jet structures in non-dimensional parameter space

The Domain Interface of the Human Glutamate Transporter EAAT1 Mediates Chloride Permeation

AbstractThe concentration of glutamate within the glutamatergic synapse is tightly regulated by the excitatory amino-acid transporters (EAATs). In addition to their primary role of clearing extracellular glutamate, the EAATs also possess a thermodynamically uncoupled Cl− conductance. Several crystal structures of an archaeal EAAT homolog, GltPh, at different stages of the transport cycle have been solved. In a recent structure, an aqueous cavity located at the interface of the transport and trimerization domains has been identified. This cavity is lined by polar residues, several of which have been implicated in Cl− permeation. We hypothesize that this cavity opens during the transport cycle to form the Cl− channel. Residues lining this cavity in EAAT1, including Ser-366, Leu-369, Phe-373, Arg-388, Pro-392, and Thr-396, were mutated to small hydrophobic residues. Wild-type and mutant transporters were expressed in Xenopus laevis oocytes and two-electrode voltage-clamp electrophysiology, and radiolabeled substrate uptake was used to investigate function. Significant alterations in substrate-activated Cl− conductance were observed for several mutant transporters. These alterations support the hypothesis that this aqueous cavity at the interface of the transport and trimerization domains is a partially formed Cl− channel, which opens to form a pore through which Cl− ions pass. This study enhances our understanding as to how glutamate transporters function as both amino-acid transporters and Cl− channels

User quality of experience of mulsemedia applications

User Quality of Experience (QoE) is of fundamental importance in multimedia applications and has been extensively studied for decades. However, user QoE in the context of the emerging multiple-sensorial media (mulsemedia) services, which involve different media components than the traditional multimedia applications, have not been comprehensively studied. This article presents the results of subjective tests which have investigated user perception of mulsemedia content. In particular, the impact of intensity of certain mulsemedia components including haptic and airflow on user-perceived experience are studied. Results demonstrate that by making use of mulsemedia the overall user enjoyment levels increased by up to 77%

An advanced numerical model of friction stir welding of DH36 steel

A numerical model of Friction Stir Welding (FSW) of DH36 steel plate (6mm thickness) has been developed using a CFD technique. Two welding speed conditions were used, a low welding speed of 200 RPM - 100mm/min, and a high welding speed of 550RPM- 400 mm/min. The heat generation, material flow and strain rate were calculated based on plastic deformation and frictional contact between the tool and workpiece. A CFD-based model has been produced to represent the asymmetry in temperature distribution between the advancing and retreating side, the material flow and the strain rate. The geometry of the model includes the tool plunged into the plate. The cooling system was also included in the simulation by calculating the heat flux lost for each part of the tool. The heat generated by viscous dissipation away from the tool was also taken into account. The total heat generated was divided into the individual tool parts (shoulder, probe side and probe end) and was found to be in good agreement with the experimental results for the areas affected by these parts. The maximum temperature obtained for the slow welding speed was 1012oC and for the high welding speed was 1250oC. Experimental metallographic examination has also been carried out on DH36 FSW steel plates to validate the CFD model. SEM analysis showed the formation of a fine microstructure of bainite, acicular ferrite and ferrite/cementite aggregate in the welded zone as compared to the ferrite/pearlite morphology in the base metal. It is found from the CFD and experimental results that the high speed welding conditions can produce defects such as wormholes and cracks in the welds associated with the probe side and probe end due to the lack of material flow especially on the advancing side. Tensile and fatigue testing were carried out for both slow and high welding speed samples, which broke outside the welded region in the tensile test, however, slow welding speed samples show more resistance to fatigue test and survived 644128 cycles, the high speed welding samples failed after 111,736 cycles under the same load