Increasing compliance with low tidal volume ventilation in the ICU with two nudge-based interventions: evaluation through intervention time-series analyses

Objectives: Low tidal volume (TVe) ventilation improves outcomes for ventilated patients, and the majority of clinicians state they implement it. Unfortunately, most patients never receive low TVes. ‘Nudges’ influence decision-making with subtle cognitive mechanisms and are effective in many contexts. There have been few studies examining their impact on clinical decision-making. We investigated the impact of 2 interventions designed using principles from behavioural science on the deployment of low TVe ventilation in the intensive care unit (ICU). Setting: University Hospitals Bristol, a tertiary, mixed medical and surgical ICU with 20 beds, admitting over 1300 patients per year. Participants: Data were collected from 2144 consecutive patients receiving controlled mechanical ventilation for more than 1 hour between October 2010 and September 2014. Patients on controlled mechanical ventilation for more than 20 hours were included in the final analysis. Interventions: (1) Default ventilator settings were adjusted to comply with low TVe targets from the initiation of ventilation unless actively changed by a clinician. (2) A large dashboard was deployed displaying TVes in the format mL/kg ideal body weight (IBW) with alerts when TVes were excessive. Primary outcome measure: TVe in mL/kg IBW. Findings: TVe was significantly lower in the defaults group. In the dashboard intervention, TVe fell more quickly and by a greater amount after a TVe of 8 mL/kg IBW was breached when compared with controls. This effect improved in each subsequent year for 3 years. Conclusions: This study has demonstrated that adjustment of default ventilator settings and a dashboard with alerts for excessive TVe can significantly influence clinical decision-making. This offers a promising strategy to improve compliance with low TVe ventilation, and suggests that using insights from behavioural science has potential to improve the translation of evidence into practice

Estimates of the mean circulation in the deep (>2,000m) layer of the Eastern North Atlantic

A total of 131 current meter records of between 6 and 24 month duration are analysed to describe the deep flow field of the eastern North Atlantic from 19° to 54°N and from the Continental Slope to the Mid Atlantic Ridge. Mean flows are weak and may be statistically indeterminate in some records and locations, but appear to indicate cyclonic circulations around the Iberia and Porcupine abyssal plains with a generally southward flow along the Mid Atlantic ridge and a deep northward slope current (where measurements exist) along the eastern boundary. The deepest inflow to the north-eastern basin that has been identified to date takes place through the Discovery Gap of >4,700 m sill-depth at 37° 25′N 15° 45′W in the Azores-Portugal ridge. South of that ridge, observations are sparse and no systematic circulation is yet evident. These observations are discussed in relation to recent geostrophic estimates of the deep circulation

Monitoring Success in Choice Neighborhoods: A Proposed Approach to Performance Measurement

Offers a framework and tools for performance management in the initiative to transform poor neighborhoods into revitalized, sustainable mixed-income communities. Proposes system components, logic model, management reports, and performance indicators

Gaps in the Saturation Spectrum of Trees

A graph G is H-saturated if H is not a subgraph of G but the addition of any edge from the complement of G to G results in a copy of H. The minimum number of edges (the size) of an H-saturated graph on n vertices is denoted sat(n, H), while the maximum size is the well studied extremal number, ex(n, H). The saturation spectrum for a graph H is the set of sizes of H-saturated graphs between sat(n, H) and ex(n, H). In this paper we show that paths, trees with a vertex adjacent to many leaves, and brooms have a gap in the saturation spectrum

Embedded progressive-three-layered fiber long-period gratings for respiratory monitoring

A long-period grating (LPG) was written into a progressive three-layered single-mode fiber that was embedded into a flexible platform as a curvature sensor. The spectral location and profile of the LPGs were unaltered after implantation in the platform. The curvature sensitivity was 3.747 nm m with a resolution of ± 1.1 × 10-2 m-1. The bend sensor is intended to be part of a respiratory monitoring system and was tested on a resuscitation training manikin. © 2003 society of Photo-Optical Instrumentation Engineers

Iron solubilization during anaerobic growth of acidophilic microorganisms with a polymetallic sulfide ore

Acidithiobacillus ferrooxidans at 30 °C and Sulfobacillus thermosulfidooxidans at 47 °C were selected from a preliminary screening of various acidophiles for their ferric iron reduction capacities during anaerobic, autotrophic growth on sulfur. The selected cultures were used with a polymetallic sulfide ore under anoxic conditions to demonstrate enhanced solubilization of iron during leaching in shaken flasks and enhanced removal of iron from laboratory ore-leaching columns, compared to leaching with continuous aeration. Ore-associated, ferric iron-rich precipitates, which were formed under previously oxidizing conditions, were a potential influence on extraction of target metals and percolation through ore columns and were available as the source of ferric iron for anaerobic sulfur oxidation. Over twice as much iron was removed by moderate thermophiles when anoxic phases were introduced during the leaching. Enhanced removal of iron and some improvement in extraction of base metals from ore fragments were also demonstrated with a selected "Sulfolobus"-like strain during growth and leaching with alternating periods of aeration and anoxic conditions at 70 °C