Patient and community nurse perspectives on recruitment to a randomized controlled trial of urinary catheter washout solutions

Aims To provide evidence around the acceptability of a proposed randomised controlled trial (RCT) of catheter washout solutions. Design: A sample of senior community nursing staff (n=7) were interviewed and four focus groups with a sample of community nurses were conducted. Eleven semi-structured face-to-face interviews were undertaken with patients using a long-term catheter. Methods: An in-depth qualitative study using a phenomenological approach was employed. This approach was suitable to explore the lived experiences of subjects and gain their viewpoints and experiences. Results: Nurse participants raised concerns regarding the removal of treatment or increased risk of infection in relation to which arm of the trial patients were randomised to. There was concern that patients could get used to the increased contact with nursing staff. Six patients who agreed to participate cited personal benefit, benefiting others, and a sense of indifference. Four patients were unsure about taking part and one declined

Two- and three-dimensional viscous computations of a hypersonic inlet flow

The three-dimensional parabolized Navier-Stokes code has been used to investigate the flow through a Mach 7.4 inlet. A two-dimensional parametric study of grid resolution, turbulence modeling and effect of gamma has been done and compared with experimental results. The results show that mesh resolution of the shock waves, real gas effects and turbulence length scaling are very important to get accurate results for hypersonic inlet flows. In addition a three-dimensional calculation of the Mach 7.4 inlet has been done on a straight sideplate configuration. The results show that the glancing shock/boundary layer interaction phenomena causes significant three-dimensional flow in the inlet

The Limitation on Recovery in Medical Negligence Cases

Chapter 611, 1976 Acts of Assembly, provided for sweeping changes in the laws of medical and hospital negligence in Virginia. The Act affects all medical negligence actions arising after July 1, 1976. The legislation was enacted during a time when many perceived a medical malpractice crisis in Virginia. This article will review the historical background which led to this perception and will analyze whether, in fact, this crisis did exist. Finally, the article will demonstrate that the Act is both unnecessary and more importantly, unconstitutional

Recent Developments in the Law of the Sea: Synopsis

As part of its annual symposium on the law of the sea, the San Diego Law Review compiles a summary of significant recent developments in the field. This seventh annual synopsis reports major events which occurred between January 1, 1975, and December 31, 1975. Scope, format, and approach are substantially as employed in the past; a minor change is the extended use of footnotes, including citations to newspapers

Sediment Management for Southern California Mountians, Coastal Plains and Shoreline. Part D: Special Inland Studies

In southern California the natural environmental system involves the continual relocation of sedimentary materials. Particles are eroded from inland areas where there is sufficient relief and, precipitation. Then, with reductions in hydraulic gradient along the stream course and at the shoreline, the velocity of surface runoff is reduced and there is deposition. Generally, coarse sand, gravel and larger particles are deposited near the base of the eroding surfaces (mountains and hills) and the finer sediments are deposited on floodplains, in bays or lagoons, and at the shoreline as delta deposits. Very fine silt and clay particles, which make up a significant part of the eroded material, are carried offshore where they eventually deposit in deeper areas. Sand deposited at the shoreline is gradually moved along the coast by waves and currents, and provides nourishment for local beaches. However, eventually much of this littoral material is also lost to offshore areas. Human developments in the coastal region have substantially altered the natural sedimentary processes, through changes in land use, the harvesting of natural resources (logging, grazing, and sand and gravel mining); the construction and operation of water conservation facilities and flood control structures; and coastal developments. In almost all cases these developments have grown out of recognized needs and have well served their primary purpose. At the time possible deleterious effects on the local or regional sediment balance were generally unforeseen or were felt to be of secondary importance. In 1975 a large-scale study of inland and coastal sedimentation processes in southern California was initiated by the Environmental Quality Laboratory at the California Institute of Technology and the Center for Coastal Studies at Scripps Institution of Oceanography. This volume is one of a series of reports from this study. Using existing data bases, this series attempts to define quantitatively inland and coastal sedimentation processes and identify the effects man has had on these processes. To resolve some issues related to long-term sediment management, additional research and data will be needed. In the series there are four Caltech reports that provide supporting studies for the summary report (EQL Report No. 17). These reports include: EQL Report 17-A Regional Geological History EQL Report 17-B Inland Sediment Movements by Natural Processes EQL Report 17-C Coastal Sediment Delivery by Major Rivers in Southern California EQL Report 17-D -- Special Inland Studies Additional supporting reports on coastal studies (shoreline sedimentation processes, control structures, dredging, etc.) are being published by the Center for Coastal Studies at Scripps Institution of Oceanography, La Jolla, California

Causes of prehospital misinterpretations of ST elevation myocardial infarction

Objectives: To determine the causes of software misinterpretation of ST elevation myocardial infarction (STEMI) compared to clinically identified STEMI to identify opportunities to improve prehospital STEMI identification. Methods: We compared ECGs acquired from July 2011 through June 2012 using the LIFEPAK 15 on adult patients transported by the Los Angeles Fire Department. Cases included patients ≥18 years who received a prehospital ECG. Software interpretation of the ECG (STEMI or not) was compared with data in the regional EMS registry to classify the interpretation as true positive (TP), true negative (TN), false positive (FP), or false negative (FN). For cases where classification was not possible using registry data, 3 blinded cardiologists interpreted the ECG. Each discordance was subsequently reviewed to determine the likely cause of misclassification. The cardiologists independently reviewed a sample of these discordant ECGs and the causes of misclassification were updated in an iterative fashion. Results: Of 44,611 cases, 50% were male (median age 65; inter-quartile range 52–80). Cases were classified as 482 (1.1%) TP, 711 (1.6%) FP, 43371 (97.2%) TN, and 47 (0.11%) FN. Of the 711 classified as FP, 126 (18%) were considered appropriate for, though did not undergo, emergent coronary angiography, because the ECG showed definite (52 cases) or borderline (65 cases) ischemic ST elevation, a STEMI equivalent (5 cases) or ST-elevation due to vasospasm (4 cases). The sensitivity was 92.8% [95% CI 90.6, 94.7%] and the specificity 98.7% [95% CI 98.6, 98.8%]. The leading causes of FP were ECG artifact (20%), early repolarization (16%), probable pericarditis/myocarditis (13%), indeterminate (12%), left ventricular hypertrophy (8%), and right bundle branch block (5%). There were 18 additional reasons for FP interpretation (<4% each). The leading causes of FN were borderline ST-segment elevations less than the algorithm threshold (40%) and tall T waves reducing the ST/T ratio below threshold (15%). There were 11 additional reasons for FN interpretation occurring ≤3 times each. Conclusion: The leading causes of FP automated interpretation of STEMI were ECG artifact and non-ischemic causes of ST-segment elevation. FN were rare and were related to ST-segment elevation or ST/T ratio that did not meet the software algorithm threshold

Quahogs in Eastern North America: Part II, History by Province and State

The northern quahog, Mercenaria mercenaria, ranges along the Atlantic Coast of North America from the Canadian Maritimes to Florida, while the southern quahog, M. campechiensis, ranges mostly from Florida to southern Mexico. The northern quahog was fished by native North Americans during prehistoric periods. They used the meats as food and the shells as scrapers and as utensils. The European colonists copied the Indians treading method, and they also used short rakes for harvesting quahogs. The Indians of southern New England and Long Island, N.Y., made wampum from quahog shells, used it for ornaments and sold it to the colonists, who, in turn, traded it to other Indians for furs. During the late 1600’s, 1700’s, and 1800’s, wampum was made in small factories for eventual trading with Indians farther west for furs. The quahoging industry has provided people in many coastal communities with a means of earning a livelihood and has given consumers a tasty, wholesome food whether eaten raw, steamed, cooked in chowders, or as stuffed quahogs. More than a dozen methods and types of gear have been used in the last two centuries for harvesting quahogs. They include treading and using various types of rakes and dredges, both of which have undergone continuous improvements in design. Modern dredges are equipped with hydraulic jets and one type has an escalator to bring the quahogs continuously to the boats. In the early 1900’s, most provinces and states established regulations to conserve and maximize yields of their quahog stocks. They include a minimum size, now almost universally a 38-mm shell width, and can include gear limitations and daily quotas. The United States produces far more quahogs than either Canada or Mexico. The leading producer in Canada is Prince Edward Island. In the United States, New York, New Jersey, and Rhode Island lead in quahog production in the north, while Virginia and North Carolina lead in the south. Connecticut and Florida were large producers in the 1990’s. The State of Tabasco leads in Mexican production. In the northeastern United States, the bays with large openings, and thus large exchanges of bay waters with ocean waters, have much larger stocks of quahogs and fisheries than bays with small openings and water exchanges. Quahog stocks in certified beds have been enhanced by transplanting stocks to them from stocks in uncertified waters and by planting seed grown in hatcheries, which grew in number from Massachusetts to Florida in the 1980’s and 1990’s

The Need For Speed: Rapid Refitting Techniques for Bayesian Spectral Characterization of the Gravitational Wave Background Using PTAs

Current pulsar timing array (PTA) techniques for characterizing the spectrum of a nanohertz-frequency stochastic gravitational-wave background (SGWB) begin at the stage of timing data. This can be slow and memory intensive with computational scaling that will worsen PTA analysis times as more pulsars and observations are added. Given recent evidence for a common-spectrum process in PTA data sets and the need to understand present and future PTA capabilities to characterize the SGWB through large-scale simulations, we have developed efficient and rapid approaches that operate on intermediate SGWB analysis products. These methods refit SGWB spectral models to previously-computed Bayesian posterior estimations of the timing power spectra. We test our new methods on simulated PTA data sets and the NANOGrav $12.5$-year data set, where in the latter our refit posterior achieves a Hellinger distance from the current full production-level pipeline that is $\lesssim 0.1$. Our methods are $\sim10^2$--$10^4$ times faster than the production-level likelihood and scale sub-linearly as a PTA is expanded with new pulsars or observations. Our methods also demonstrate that SGWB spectral characterization in PTA data sets is driven by the longest-timed pulsars with the best-measured power spectral densities which is not necessarily the case for SGWB detection that is predicated on correlating many pulsars. Indeed, the common-process spectral properties found in the NANOGrav $12.5$-year data set are given by analyzing only the $\sim10$ longest-timed pulsars out of the full $45$ pulsar array, and we find that the ``shallowing'' of the common-process power-law model occurs when gravitational-wave frequencies higher than $\sim 50$~nanohertz are included. The implementation of our methods is openly available as a software suite to allow fast and flexible PTA SGWB spectral characterization and model selection.Comment: 19 pages, 12 figures. Submitting to Physical Review