Dangers of Peripheral Intravenous Catheterization: The Forgotten Tourniquet and Other Patient Safety Considerations

Intravenous catheterization is a widely used invasive procedure, with applications in both ambulatory and hospital settings. Due to its inherently invasive nature, intravenous (IV) therapy is associated with a number of potential complications, many of which are directly relevant to patient safety (PS). PIV-related morbidity may be due to mechanical or nonmechanical factors. The most frequent nonmechanical peripheral venous catheterization adverse events (PVCAEs) include insertion site pain, phlebitis, hematoma formation, and infusate extravasation. The most common mechanical PVCAE is catheter obstruction/occlusion and dislodgement. Significant complications can also occur with the administration of incorrect type or wrong amount of IV fluids. Moreover, simultaneous infusion of incompatible medications can result in infusate precipitation. Finally, less frequent but significant complications have been reported, including bloodstream and local infections, air embolization, nerve damage, arterial puncture, skin necrosis associated with vasopressor infusions, and limb-threatening forgotten tourniquet events. Taken together, the above complications can lead to substantial patient discomfort, unnecessary or prolonged hospitalization, increased costs, and additional downstream morbidity. Efforts to prevent PVCAEs and improve patient outcomes should involve thorough provider education, clinical vigilance by all involved healthcare providers, health service level strategies, as well as the proactive participation of all stakeholders, including patients and their families

Seasonal dependence of peroxy radical concentrations at a Northern hemisphere marine boundary layer site during summer and winter: evidence for radical activity in winter

Peroxy radicals (HO2+Σ RO2) were measured at the Weybourne Atmospheric Observatory (52° N, 1° E), Norfolk using a PEroxy Radical Chemical Amplifier (PERCA) during the winter and summer of 2002. The peroxy radical diurnal cycles showed a marked difference between the winter and summer campaigns with maximum concentrations of 12 pptv at midday in the summer and maximum concentrations as high as 30 pptv (10 min averages) in winter at night. The corresponding nighttime peroxy radical concentrations were not as high in summer (3 pptv). The peroxy radical concentration shows a distinct anti-correlation with increasing NOx during the daylight hours. At night, peroxy radicals increase with increasing NOx indicative of the role of NO3 chemistry. The average diurnal cycles for net ozone production, N(O3) show a large variability in ozone production, P(O3), and a large ozone loss, L(O3) in summer relative to winter. For a daylight average, net ozone production in summer was higher than winter (1.51±0.5 ppbv h−1 and 1.11±0.47 ppbv h−1, respectively). The variability in NO concentration has a much larger effect on N(O3) than the peroxy radical concentrations. Photostationary state (PSS) calculations show an NO2 lifetime of 5 min in summer and 21 minutes in the winter, implying that steady-state NO-NO2 ratios are not always attained during the winter months. The results show an active peroxy radical chemistry at night and that significant oxidant levels are sustained in winter. The net effect of this with respect to production of ozone in winter is unclear owing to the breakdown in the photostationary state

Ozonolysis of a-phellandrene - Part 2 : Compositional analysis of secondary organic aerosol highlights the role of stabilized Criegee intermediates

The molecular composition of secondary organic aerosol (SOA) generated from the ozonolysis of α-phellandrene is investigated for the first time using high pressure liquid chromatography coupled to high-resolution Quadrupole-Orbitrap tandem mass spectrometry. In total, 21 prominent products or isomeric product groups were identified using both positive and negative ionisation modes, with potential formation mechanisms discussed. The aerosol was found to be composed primarily of polyfunctional first- and second-generation species containing one or more carbonyl, acid, alcohol and hydroperoxide functionalities, with the products significantly more complex than those proposed from basic gas-phase chemistry in the companion paper (Mackenzie-Rae et al., 2017a). Mass spectra show a large number of dimeric products are also formed. Both direct scavenging evidence using formic acid, and indirect evidence from double bond equivalency factors, suggests the dominant oligomerisation mechanism is the bimolecular reaction of stabilised Criegee intermediates (SCIs) with non-radical ozonolysis products. Saturation vapour concentration estimates suggest monomeric species cannot explain the rapid nucleation burst of fresh aerosol observed in chamber experiments, hence dimeric species are believed to be responsible for new particle formation, with detected first- and second-generation products driving further particle growth in the system. Ultimately, identification of the major constituents and formation pathways of α-phellandrene SOA leads to a greater understanding of the atmospheric processes and implications of monoterpene emissions and SCIs, especially around Eucalypt forests regions where α-phellandrene is primarily emitted

Torsion pairs and simple-minded systems in triangulated categories

Let T be a Hom-finite triangulated Krull-Schmidt category over a field k. Inspired by a definition of Koenig and Liu, we say that a family S of pairwise orthogonal objects in T with trivial endomorphism rings is a simple-minded system if its closure under extensions is all of T. We construct torsion pairs in T associated to any subset X of a simple-minded system S, and use these to define left and right mutations of S relative to X. When T has a Serre functor \nu, and S and X are invariant under \nu[1], we show that these mutations are again simple-minded systems. We are particularly interested in the case where T is the stable module category of a self-injective algebra \Lambda. In this case, our mutation procedure parallels that introduced by Koenig and Yang for simple-minded collections in the derived category of \Lambda. It follows that the mutation of the set of simple \Lambda-modules relative to X yields the images of the simple \Gamma-modules under a stable equivalence between \Gamma\ and \Lambda, where \Gamma\ is the tilting mutation of \Lambda\ relative to X.Comment: Minor corrections. To appear in Applied Categorical Structures. The final publication is available at springerlink.com: http://link.springer.com/article/10.1007%2Fs10485-014-9365-

Derived equivalence classification of the cluster-tilted algebras of Dynkin type E

We obtain a complete derived equivalence classification of the cluster-tilted algebras of Dynkin type E. There are 67, 416, 1574 algebras in types E6, E7 and E8 which turn out to fall into 6, 14, 15 derived equivalence classes, respectively. This classification can be achieved computationally and we outline an algorithm which has been implemented to carry out this task. We also make the classification explicit by giving standard forms for each derived equivalence class as well as complete lists of the algebras contained in each class; as these lists are quite long they are provided as supplementary material to this paper. From a structural point of view the remarkable outcome of our classification is that two cluster-tilted algebras of Dynkin type E are derived equivalent if and only if their Cartan matrices represent equivalent bilinear forms over the integers which in turn happens if and only if the two algebras are connected by a sequence of "good" mutations. This is reminiscent of the derived equivalence classification of cluster-tilted algebras of Dynkin type A, but quite different from the situation in Dynkin type D where a far-reaching classification has been obtained using similar methods as in the present paper but some very subtle questions are still open.Comment: 19 pages. v4: completely rewritten version, to appear in Algebr. Represent. Theory. v3: Main theorem strengthened by including "good" mutations (cf. also arXiv:1001.4765). Minor editorial changes. v2: Third author added. Major revision. All questions left open in the earlier version by the first two authors are now settled in v2 and the derived equivalence classification is completed. arXiv admin note: some text overlap with arXiv:1012.466

Microbiological pattern of arterial catheters in the intensive care unit

<p>Abstract</p> <p>Background</p> <p>Intravascular catheter related infection (CRI) is one of the most serious nosocomial infections. Diagnostic criteria include a positive culture from the catheter tip along with blood, yet in many patients with signs of infection, current culture techniques fail to identify pathogens on catheter segments. We hypothesised that a molecular examination of the bacterial community on short term arterial catheters (ACs) would improve our understanding of the variety of organisms that are present in this niche environment and would help develop new methods for the diagnosis of CRI.</p> <p>Results</p> <p>The whole bacterial community presenting on all ACs was evaluated by molecular methods, i.e., a strategy of whole community DNA extraction, PCR amplification followed by cloning and 16S rDNA sequence analysis. Ten ACs were removed from patients suspected of CRI and 430 clones from 5 "colonised" and 5 "uncolonised" (semi-quantitative method) AC libraries were selected for sequencing and subsequent analysis. A total of 79 operational taxonomic units (OTUs) were identified at the level of 97% similarity belonging to six bacterial divisions. An average of 20 OTUs were present in each AC, irrespective of colonisation status. Conventional culture failed to reveal the majority of these bacteria.</p> <p>Conclusions</p> <p>There was no significant difference in the bacterial diversity between the 'uncolonised' and 'colonised' ACs. This suggests that vascular devices cultured conventionally and reported as non infective may at times potentially be a significant source of sepsis in critically ill patients. Alternative methods may be required for the accurate diagnosis of CRI in critically ill patients.</p

H3+ in Diffuse Interstellar Clouds: a Tracer for the Cosmic-Ray Ionization Rate

Using high resolution infrared spectroscopy we have surveyed twenty sightlines for H3+ absorption. H3+ is detected in eight diffuse cloud sightlines with column densities varying from 0.6x10^14 cm^-2 to 3.9x10^14 cm^-2. This brings to fourteen the total number of diffuse cloud sightlines where H3+ has been detected. These detections are mostly along sightlines concentrated in the Galactic plane, but well dispersed in Galactic longitude. The results imply that abundant H3+ is common in the diffuse interstellar medium. Because of the simple chemistry associated with H3+ production and destruction, these column density measurements can be used in concert with various other data to infer the primary cosmic-ray ionization rate, zeta_p. Values range from 0.5x10^-16 s^-1 to 3x10^-16 s^-1 with an average of 2x10^-16 s^-1. Where H3+ is not detected the upper limits on the ionization rate are consistent with this range. The average value of zeta_p is about an order of magnitude larger than both the canonical rate and rates previously reported by other groups using measurements of OH and HD. The discrepancy is most likely due to inaccurate measurements of rate constants and the omission of effects which were unknown when those studies were performed. We believe that the observed column density of H3+ is the most direct tracer for the cosmic-ray ionization rate due to its simple chemistry. Recent models of diffuse cloud chemistry require cosmic-ray ionization rates on the order of 10^-16 s^-1 to reproduce observed abundances of various atomic and molecular species, in rough accord with our observational findings.Comment: Accepted to ApJ, 35 pages, 5 figures, 5 table

Interferometric 12CO(J=2-1) image of the Nuclear Region of Seyfert 1 Galaxy NGC 1097

We have mapped the central region of the Seyfert 1 galaxy NGC 1097 in 12CO(J=2-1) with the Submillieter Array (SMA). The 12CO(J=2-1) map shows a central concentration and a surrounding ring, which coincide respectively with the Seyfert nucleus and a starburst ring. The line intensity peaks at the nucleus, whereas in a previously published 12CO(J=1-0) map the intensity peaks at the starburst ring. The molecular ring has an azimuthally averaged 12CO(J=2-1)/(J=1-0) intensity ratio (R21) of about unity, which is similar to those in nearby active star forming galaxies, suggesting that most of the molecular mass in the ring is involved in fueling the starburst. The molecular gas can last for only about 1.2\times10^8 years without further replenishment assuming a constant star formation rate and a perfect conversion of gas to stars. The velocity map shows that the central molecular gas is rotating with the molecular ring in the same direction, while its velocity gradient is much steeper than that of the ring. This velocity gradient of the central gas is similar to what is usually observed in some Seyfert 2 galaxies. To view the active nucleus directly in the optical, the central molecular gas structure can either be a low-inclined disk or torus but not too low to be less massive than the mass of the host galaxy itself, be a highly-inclined thin disk or clumpy and thick torus, or be an inner part of the galactic disk. The R21 value of ~1.9 of the central molecular gas component, which is significantly higher than the value found at the molecular gas ring, indicates that the activity of the Seyfert nucleus may have a significant influence on the conditions of the molecular gas in the central component.Comment: 22 pages, 4 figures, accepted by Ap

High-resolution ice thickness and bed topography of a land-terminating section of the Greenland Ice Sheet

We present ice thickness and bed topography maps with a high spatial resolution (250–500 m) of a land-terminating section of the Greenland Ice Sheet derived from ground-based and airborne radar surveys. The data have a total area of ~12 000 km2 and cover the whole ablation area of the outlet glaciers of Isunnguata Sermia, Russell, Leverett, Ørkendalen and Isorlersuup up to the long-term mass balance equilibrium line altitude at ~1600 m above sea level. The bed topography shows highly variable subglacial trough systems, and the trough of Isunnguata Sermia Glacier is overdeepened and reaches an elevation of ~500 m below sea level. The ice surface is smooth and only reflects the bedrock topography in a subtle way, resulting in a highly variable ice thickness. The southern part of our study area consists of higher bed elevations compared to the northern part. The compiled data sets of ground-based and airborne radar surveys cover one of the most studied regions of the Greenland Ice Sheet and can be valuable for detailed studies of ice sheet dynamics and hydrology. The combined data set is freely available at doi:10.1594/pangaea.830314