4,496 research outputs found
Investigating the causes of patient anxiety at induction of anaesthesia: A mixed methods study
Aim: To investigate patient anxiety at anaesthetic induction and whether this is affected by anaesthetic room interventions.
Methods: A mixed methods study was carried out: pre-induction interventions were directly observed. Patient anxiety was assessed quantitatively with cardiovascular changes, the visual analogue scale and the state-trait anxiety inventory. Interviews allowed qualitative assessment. Results: Patient-reported anxiety did not correlate with cardiovascular changes. Anaesthetic room interventions were not predictive of anxiety. Postoperative interviews identified five sources of anxiety, mostly related to preparation for surgery. Staff responses to anxiety were also highlighted.
Discussion: Patient-reported anxiety and its biological response are not correlated. Pre-induction interventions do not contribute to anxiety. Anxiety levels at induction are similar to or lower than earlier in the preoperative period.
Conclusions: On induction of anaesthesia, patients have little control over their situation but are actively reassured and distracted by theatre staff. Our data suggest staff are good at this. More could still be done to reduce preoperative sources of anxiety
Pulmonary Mycobacterium avium-intracellulare is the main driver of the rise in non-tuberculous mycobacteria incidence in England, Wales and Northern Ireland, 2007-2012
BACKGROUND: The incidence of non-tuberculous mycobacteria (NTM) isolation from humans is increasing worldwide. In England, Wales and Northern Ireland (EW&NI) the reported rate of NTM more than doubled between 1996 and 2006. Although NTM infection has traditionally been associated with immunosuppressed individuals or those with severe underlying lung damage, pulmonary NTM infection and disease may occur in people with no overt immune deficiency. Here we report the incidence of NTM isolation in EW&NI between 2007 and 2012 from both pulmonary and extra-pulmonary samples obtained at a population level. METHODS: All individuals with culture positive NTM isolates between 2007 and 2012 reported to Public Health England by the five mycobacterial reference laboratories serving EW&NI were included. RESULTS: Between 2007 and 2012, 21,118 individuals had NTM culture positive isolates. Over the study period the incidence rose from 5.6/100,000 in 2007 to 7.6/100,000 in 2012 (p < 0.001). Of those with a known specimen type, 90 % were pulmonary, in whom incidence increased from 4.0/100,000 to 6.1/100,000 (p < 0.001). In extra-pulmonary specimens this fell from 0.6/100,000 to 0.4/100,000 (p < 0.001). The most frequently cultured organisms from individuals with pulmonary isolates were within the M. avium-intracellulare complex family (MAC). The incidence of pulmonary MAC increased from 1.3/100,000 to 2.2/100,000 (p < 0.001). The majority of these individuals were over 60 years old. CONCLUSION: Using a population-based approach, we find that the incidence of NTM has continued to rise since the last national analysis. Overall, this represents an almost ten-fold increase since 1995. Pulmonary MAC in older individuals is responsible for the majority of this change. We are limited to reporting NTM isolates and not clinical disease caused by these organisms. To determine whether the burden of NTM disease is genuinely increasing, a standardised approach to the collection of linked national microbiological and clinical data is required
The changing epidemiology of varicella and herpes zoster in Hong Kong before universal varicella vaccination in 2014.
In Hong Kong, universal varicella vaccination started in July 2014. Before this, children could receive varicella vaccine via the private market. We analysed the epidemiology of varicella and zoster before universal vaccination. We estimated varicella vaccination coverage through surveys in preschool children. We estimated the burden of varicella and zoster with varicella notifications from 1999/00 to 2013/14, Accident and Emergency Department (A&E) attendance and inpatient admissions to public hospitals from 2004/05 to 2013/14. We fitted a catalytic model to serological data on antibodies against varicella-zoster virus to estimate the force of infection. We found that varicella vaccination coverage gradually increased to about 50% before programme inception. In children younger than 5 years, the annual rate of varicella notifications, varicella admission and zoster A&E attendance generally declined. The annual notification, A&E attendance and hospitalisation rate of varicella and zoster generally increased for individuals between 10 and 59 years old. Varicella serology indicated an age shift during the study period towards a higher proportion of infections in slightly older individuals, but the change was most notable before vaccine licensure. In conclusion, we observed a shift in the burden of varicella to slightly older age groups with a corresponding increase in incidence but it cannot necessarily be attributed to private market vaccine coverage alone. Increasing varicella vaccination uptake in the private market might affect varicella transmission and epidemiology, but not to the level of interrupting transmission
Connections to the Electrodes Control the Transport Mechanism in Single-Molecule Transistors.
When designing a molecular electronic device for a specific function, it is necessary to control whether the charge-transport mechanism is phase-coherent transmission or particle-like hopping. Here we report a systematic study of charge transport through single zinc-porphyrin molecules embedded in graphene nanogaps to form transistors, and show that the transport mechanism depends on the chemistry of the molecule-electrode interfaces. We show that van der Waals interactions between molecular anchoring groups and graphene yield transport characteristic of Coulomb blockade with incoherent sequential hopping, whereas covalent molecule-electrode amide bonds give intermediately or strongly coupled single-molecule devices that display coherent transmission. These findings demonstrate the importance of interfacial engineering in molecular electronic circuits
The Significance of the -Numerical Range and the Local -Numerical Range in Quantum Control and Quantum Information
This paper shows how C-numerical-range related new strucures may arise from
practical problems in quantum control--and vice versa, how an understanding of
these structures helps to tackle hot topics in quantum information.
We start out with an overview on the role of C-numerical ranges in current
research problems in quantum theory: the quantum mechanical task of maximising
the projection of a point on the unitary orbit of an initial state onto a
target state C relates to the C-numerical radius of A via maximising the trace
function |\tr \{C^\dagger UAU^\dagger\}|. In quantum control of n qubits one
may be interested (i) in having U\in SU(2^n) for the entire dynamics, or (ii)
in restricting the dynamics to {\em local} operations on each qubit, i.e. to
the n-fold tensor product SU(2)\otimes SU(2)\otimes >...\otimes SU(2).
Interestingly, the latter then leads to a novel entity, the {\em local}
C-numerical range W_{\rm loc}(C,A), whose intricate geometry is neither
star-shaped nor simply connected in contrast to the conventional C-numerical
range. This is shown in the accompanying paper (math-ph/0702005).
We present novel applications of the C-numerical range in quantum control
assisted by gradient flows on the local unitary group: (1) they serve as
powerful tools for deciding whether a quantum interaction can be inverted in
time (in a sense generalising Hahn's famous spin echo); (2) they allow for
optimising witnesses of quantum entanglement. We conclude by relating the
relative C-numerical range to problems of constrained quantum optimisation, for
which we also give Lagrange-type gradient flow algorithms.Comment: update relating to math-ph/070200
Correlation of psychomotor findings and the ability to partially weight bear
<p>Abstract</p> <p>Background</p> <p>Partial weight bearing is thought to avoid excessive loading that may interfere with the healing process after surgery of the pelvis or the lower extremity. The object of this study was to investigate the relationship between the ability to partially weight bear and the patient's psychomotor skills and an additional evaluation of the possibility to predict this ability with a standardized psychomotor test.</p> <p>Methods</p> <p>50 patients with a prescribed partial weight bearing at a target load of 15 kg following surgery were verbally instructed by a physical therapist. After the instruction and sufficient training with the physical therapist vertical ground reaction forces using matrix insoles were measured while walking with forearm crutches. Additionally, psychomotor skills were tested with the Motorische Leistungsserie (MLS). To test for correlations Spearman's Rank correlation was used. For further comparison of the two groups a Mann-Withney test was performed using Bonferroni correction.</p> <p>Results</p> <p>The patient's age and body weight significantly correlated with the ability to partially weight bear at a 15 kg target load. There were significant correlations between several subtests of the MLS and ground reaction forces measured while walking with crutches. Patients that were able to correctly perform partial weight bearing showed significant better psychomotor skills especially for those subtests where both hands had to be coordinated simultaneously.</p> <p>Conclusions</p> <p>The ability to partially weight bear is associated with psychomotor skills. The MLS seems to be a tool that helps predicting the ability to keep within the prescribed load limits.</p
Optimized T1- and T2-weighted volumetric brain imaging as a diagnostic tool in very preterm neonates.
BACKGROUND:
T1- and T2-W MR sequences used for obtaining diagnostic information and morphometric measurements in the neonatal brain are frequently acquired using different imaging protocols. Optimizing one protocol for obtaining both kinds of information is valuable.
OBJECTIVE:
To determine whether high-resolution T1- and T2-W volumetric sequences optimized for preterm brain imaging could provide both diagnostic and morphometric value.
MATERIALS AND METHODS:
Thirty preterm neonates born between 24 and 32 weeks' gestational age were scanned during the first 2 weeks after birth. T1- and T2-W high-resolution sequences were optimized in terms of signal-to-noise ratio, contrast-to-noise ratio and scan time and compared to conventional spin-echo-based sequences.
RESULTS:
No differences were found between conventional and high-resolution T1-W sequences for diagnostic confidence, image quality and motion artifacts. A preference for conventional over high-resolution T2-W sequences for image quality was observed. High-resolution T1 images provided better delineation of thalamic myelination and the superior temporal sulcus. No differences were found for detection of myelination and sulcation using conventional and high-resolution T2-W images.
CONCLUSION:
High-resolution T1- and T2-W volumetric sequences can be used in clinical MRI in the very preterm brain to provide both diagnostic and morphometric information
E-nursing homes: transforming access to nurses in nursing homes in response to the staffing crisis
The UK is facing a nationwide staffing crisis within adult social care, due to difficulties in recruiting and retaining registered nurses. Current interpretation of legislation means nursing homes must always have the physical presence of a registered nurse on duty within the home. With the shortage of registered nurses increasing, reliance on agency workers is commonplace, a practice impacting service cost and continuity of care. Lack of innovation to tackle this issue means the question of how to transform service delivery to combat staffing shortages is open for debate. The potential for technology to augment the provision of care was highlighted during the COVID-19 pandemic. In this article the authors present one possible solution focused on the provision of digital nursing care within nursing homes. Anticipated benefits include enhanced accessibility of nursing roles, reduced risk of viral spread and opportunities for upskilling staff. However, challenges include the current interpretation of legislation
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