Hypovolaemic shock: assessment, pathophysiology and nursing care

Hypovolaemia leads to a number of key physiological responses which require systematic assessment and interpretation. This article focuses on a case study involving a patient with Parkinson’s disease who became hypovolaemic following a fall at home, to illustrate the impact of hypovolaemia and current recommendations regarding fluid resuscitation. ABCDE assessment is considered as well as arterial blood gas analysis and interpretation is explained in light of the patient scenario

A whole-health-economy approach to antimicrobial stewardship: Analysis of current models and future direction.

Antimicrobial stewardship (AMS) strategies are widely implemented in single healthcare sectors and organisations; however, the extent and impact of integrated AMS initiatives across the whole health economy are unknown. Assessing degree of integration of AMS across the whole health economy and its impact is essential if we are to achieve a ‘One Health’ approach to addressing antimicrobial resistance (AMR), and therefore we searched systematically for and analysed published examples of integrated AMS initiatives to address this gap. Application of a system-level framework to analyse integration of AMS initiatives across and within healthcare sectors shows that integration is emerging but needs strengthening. Findings from a small number of evaluations in high-income countries suggest that antimicrobial prescribing and healthcare-associated infections can be reduced using a multisectoral integrated AMS approach. More robust research designs to evaluate and understand the impact of multisectoral integrated AMS are needed, particularly with respect to differing health systems in different countries and local organisational contexts. Our analysis highlights a number of challenges and ways forward for enhancing the delivery of AMS through an integrated approach

RF communication with implantable wireless device: effects of beating heart on performance of miniature antenna

The frequency response of an implantable antenna is key to the performance of a wireless implantable sensor. If the antenna detunes significantly, there are substantial power losses resulting in loss of accuracy. One reason for detuning is because of a change in the surrounding environment of an antenna. The pulsating anatomy of the human heart constitutes such a changing environment, so detuning is expected but this has not been quantified dynamically before. Four miniature implantable antennas are presented (two different geometries) along with which are placed within the heart of living swine the dynamic reflection coefficients. These antennas are designed to operate in the short range devices frequency band (863-870 MHz) and are compatible with a deeply implanted cardiovascular pressure sensor. The measurements recorded over 27 seconds capture the effects of the beating heart on the frequency tuning of the implantable antennas. When looked at in the time domain, these effects are clearly physiological and a combination of numerical study and posthumous autopsy proves this to be the case, while retrospective simulation confirms this hypothesis. The impact of pulsating anatomy on antenna design and the need for wideband implantable antennas is highlighted

Plasmonic Hot Spots in Triangular Tapered Graphene Microcrystals

Recently, plasmons in graphene have been observed experimentally using scattering scanning near-field optical microscopy. In this paper, we develop a simplified analytical approach to describe the behavior in triangular samples. Replacing Coulomb interaction by a short-range one reduces the problem to a Helmholtz equation, amenable to analytical treatment. We demonstrate that even with our simplifications, the system still exhibits the key features seen in the experiment.Comment: 4 pages, 3 figure

An exploration into the client at the heart of therapy : a qualitative perspective

Over 50 years ago Eysenck challenged the existing base of research into psychotherapy. Since that time, a large number of investigations have been conducted to verify the efficacy of therapy. Recently however, an increasing number of studies have cast new doubts on this research base. Instead of therapy being a function of the therapist, it is now becoming ever more apparent that the client plays a prime role in the therapeutic process. The qualitative studies presented in this paper provide some examples of research that demonstrates that clients are actively involved in their therapy, even making counselling work despite their counsellor. These studies suggest that clients may not experience therapy as beneficially as traditional outcome studies indicate. This raises a new challenge to researchers to more fully explore the client's experience of therapy, a challenge to which qualitative methods of inquiry would appear well suited

The effect of chronotherapy on delirium in critical care - a systematic review

BACKGROUND: Delirium is highly prevalent within critical care and is linked to adverse clinical outcomes, increased mortality and impaired quality of life. Development of delirium is thought to be caused by multiple risk factors, including disruption of the circadian rhythm. Chronotherapeutic interventions, such as light therapy, music and use of eye shades, have been suggested as an option to improve circadian rhythm within intensive care units. AIM: This review aims to answer the question: Can chronotherapy reduce the prevalence of delirium in adult patients in critical care? DESIGN: This study is a systematic review of quantitative studies. RESEARCH METHOD: Six major electronic databases were searched, and a hand search was undertaken using selected key search terms. Research quality was assessed using the critical appraisal skills programme tools. The studies were critically appraised by both authors independently, and data were extracted. Four themes addressing the research question were identified and critically evaluated. FINDINGS: Six primary research articles that investigated different methods of chronotherapy were identified, and the results suggest that multi-component non-pharmacological interventions are the most effective for reducing the prevalence of delirium in critical care. The melatonergic agonist Ramelteon demonstrated statistically significant reductions in delirium; however, the reliability of the results in answering the review question was limited by the research design. The use of bright light therapy (BLT) and dynamic light application had mixed results, with issues with the research design and outcomes measured limiting the validity of the findings. CONCLUSION: Multi-component non-pharmacological interventions, such as noise and light control, can reduce delirium in critical care, whereas other interventions, such as BLT, have mixed outcomes. Melatonin, as a drug, may be a useful alternative to sedative-hypnotics. RELEVANCE TO CLINICAL PRACTICE: Chronotherapy can reduce the incidence of delirium within critical care, although further research is warranted. Staff education is essential in the implementation of chronotherapy

Approximated maximum likelihood estimation in multifractal random walks

We present an approximated maximum likelihood method for the multifractal random walk processes of [E. Bacry et al., Phys. Rev. E 64, 026103 (2001)]. The likelihood is computed using a Laplace approximation and a truncation in the dependency structure for the latent volatility. The procedure is implemented as a package in the R computer language. Its performance is tested on synthetic data and compared to an inference approach based on the generalized method of moments. The method is applied to estimate parameters for various financial stock indices.Comment: 8 pages, 3 figures, 2 table

Using Liminality to Understand How Identity and Temporary Status Influence Interns’ Vulnerability

Viewing internships as a transitionary stage (i.e., a liminal space) where interns are shedding their student identity and developing their professional identity provides a useful lens for understanding the experiences of interns and holds implications for social and economic justice. As interns adapt to the temporary and transitionary space of the internship they experience powerlessness, ambiguity, and, in many cases exploitation, sexual harassment, and abuse. The stress and precarity of this status are compounded for interns from marginalized or underrepresented groups that must also conform to the (typically white male and middle class) hegemony of the workplace, all of which can impact their response to poor treatment during the internship and the development of their professional identity

A Search for Companions to Brown Dwarfs in the Taurus and Chamaeleon Star Forming Regions

We present the results of a search for companions to young brown dwarfs in the Taurus and Chamaeleon I star forming regions (1/2-3 Myr). We have used WFPC2 on board HST to obtain F791W and F850LP images of 47 members of these regions that have spectral types of M6-L0 (0.01-0.1 Msun). An additional late-type member of Taurus, FU Tau (M7.25+M9.25), was also observed with adaptive optics at Keck Observatory. We have applied PSF subtraction to the primaries and have searched the resulting images for objects that have colors and magnitudes that are indicative of young low-mass objects. Through this process, we have identified promising candidate companions to 2MASS J04414489+2301513 (rho=0.105"/15 AU), 2MASS J04221332+1934392 (rho=0.05"/7 AU), and ISO 217 (rho=0.03"/5 AU). We reported the discovery of the first candidate in a previous study, showing that it has a similar proper motion as the primary through a comparison of astrometry measured with WFPC2 and Gemini adaptive optics. We have collected an additional epoch of data with Gemini that further supports that result. By combining our survey with previous high-resolution imaging in Taurus, Chamaeleon, and Upper Sco (10 Myr), we measure binary fractions of 14/93 = 0.15+0.05/-0.03 for M4-M6 (0.1-0.3 Msun) and 4/108 = 0.04+0.03/-0.01 for >M6 (10 AU. Given the youth and low density of these three regions, the lower binary fraction at later types is probably primordial rather than due to dynamical interactions among association members. The widest low-mass binaries (>100 AU) also appear to be more common in Taurus and Chamaeleon than in the field, which suggests that the widest low-mass binaries are disrupted by dynamical interactions at >10 Myr, or that field brown dwarfs have been born predominantly in denser clusters where wide systems are disrupted or inhibited from forming.Comment: Astrophysical Journal, in pres