scholarly journals Ensuring administration of first dose of antibiotics within the golden hour of management in neonates with sepsis

2021 ◽  
Vol 10 (Suppl 1) ◽  
pp. e001365
Author(s):  
Somosri Ray ◽  
Venkataseshan Sundaram ◽  
Sourabh Dutta ◽  
Praveen Kumar
Keyword(s):  
Blood Culture ◽  
System Analysis ◽  
Decision Time ◽  
Time Interval ◽  
Significant Delay ◽  
Team Members ◽  
Golden Hour ◽  
Sharing Responsibility ◽  
Set Up ◽  
Improvement Team

Administration of first dose of antibiotics within the golden hour in infants with sepsis is critical. Delays can increase mortality. During our observations as part of antibiotic stewardship programme in inborn neonatal unit, we found a significant delay in the administration of first dose of antibiotics from the decision time. We set up a quality improvement team to improve the proportion of neonates with sepsis, who received first dose of antibiotics within 1 hour of decision, from 0% to 80% over 2 months.We included inborn neonates requiring initiation or upgradation of antibiotics for a diagnosis of sepsis, from 1 May to 30 November 2018. We assessed the root causes behind delayed administration and found the lack of immediate availability of blood culture bottles, lack of awareness and busy clinical area as the major contributors to the delays in first dose. Various change ideas like ensuring prior availability of blood culture bottles, sensitising nursing staff and resident doctors, utilisation of hospital attendants and sharing responsibility of drawing culture between team members were tested through plan–do–study–act (PDSA) cycles.The proportion of neonates receiving first dose of antibiotics within 1 hour increased from 0% to 91% over the study period and was sustained at 92% after 6 months. There was a significant reduction in median (IQR) time interval between decision and first dose from 120 (100–290) to 45 (30–60) min (p<0.001) and after 6 months, it further decreased to 30 (30–45) min. We achieved significant improvement in administration of first dose of antibiotics within 1 hour of decision, by using system analysis and testing change ideas in sequential PDSA cycles.

scholarly journals Developing a BIM-Based MUVR Treadmill System for Architectural Design Review and Collaboration

2021 ◽  
Vol 11 (15) ◽  
pp. 6881
Author(s):  
Calvin Chung Wai Keung ◽  
Jung In Kim ◽  
Qiao Min Ong
Keyword(s):  
Architectural Design ◽  
Human Locomotion ◽  
Virtual Space ◽  
Design Stage ◽  
Design Review ◽  
Team Members ◽  
Physical Constraints ◽  
Simulated Environment ◽  
Set Up ◽  
High Level

Virtual reality (VR) is quickly becoming the medium of choice for various architecture, engineering, and construction applications, such as design visualization, construction planning, and safety training. In particular, this technology offers an immersive experience to enhance the way architects review their design with team members. Traditionally, VR has used a desktop PC or workstation setup inside a room, yielding the risk of two users bump into each other while using multiuser VR (MUVR) applications. MUVR offers shared experiences that disrupt the conventional single-user VR setup, where multiple users can communicate and interact in the same virtual space, providing more realistic scenarios for architects in the design stage. However, this shared virtual environment introduces challenges regarding limited human locomotion and interactions, due to physical constraints of normal room spaces. This study thus presented a system framework that integrates MUVR applications into omnidirectional treadmills. The treadmills allow users an immersive walking experience in the simulated environment, without space constraints or hurt potentialities. A prototype was set up and tested in several scenarios by practitioners and students. The validated MUVR treadmill system aims to promote high-level immersion in architectural design review and collaboration.

scholarly journals Experimental assessment of harmonic contributions using a ternary pulse sequence

2021 ◽  
Vol 18 (3) ◽  
pp. 271-289
Author(s):  
Evgeniia Bulycheva ◽  
Sergey Yanchenko
Keyword(s):  
Real Time ◽  
Pulse Sequence ◽  
Wide Band ◽  
Voltage Source ◽  
Time Interval ◽  
Time Frequency ◽  
Grid Impedance ◽  
Set Up ◽  
Grid Voltage Distortion ◽  
Operational Modes

Harmonic contributions of utility and customer may feature significant variations due to network switchings and changing operational modes. In order to correctly define the impacts on the grid voltage distortion the frequency dependent impedance characteristic of the studied network should be accurately measured in the real-time mode. This condition can be fulfilled by designing a stimuli generator measuring the grid impedance as a response to injected interference and producing time-frequency plots of harmonic contributions during considered time interval. In this paper a prototype of a stimuli generator based on programmable voltage source inverter is developed and tested. The use of ternary pulse sequence allows fast wide-band impedance measurements that meet the requirements of real-time assessment of harmonic contributions. The accuracy of respective analysis involving impedance determination and calculation of harmonic contributions is validated experimentally using reference characteristics of laboratory test set-up with varying grid impedance.

scholarly journals Five-Year Experience of Liver Transplant at Kerman University of Medical Sciences: Afzalipoor Hospital

2020 ◽  
Author(s):  
Masood Dehghani
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Cross Sectional Study ◽  
Outcome Data ◽  
Time Interval ◽  
Cross Sectional ◽  
The Past ◽  
Transplantation Center ◽  
Set Up ◽  
End Stage

Introduction: The only option for treatment of end stage liver diseases is liver transplantation. Afzalipour Hospital in Kerman, Iran is the third largest liver transplantation center in Iran. In this study, the outcomes of this center have been studied during the past 5 years. Methods: In this cross-sectional study, the pre and post transplantation’s clinical, demographic and outcome data of all patients who received liver transplant at Afzalipour Hospital during the past 5 years have been collected and reviewed. SPSS software ver. 16 was used to analyze the data. Results: Forty-three patients have received liver transplantation during this time interval. The 3-year survival rate of patients was 77%. The most common cause of death was primary nonfunction graft after transplantation. The most common complication was acute rejection (15%), all of which were successfully treated with corticosteroids. Conclusion:  Due to increment of cases of acute and chronic liver failure in the community and since the final treatment of these cases is liver transplantation, so there is need to develop liver transplant centers in the future. Quantitative and qualitative study of the activity of centers based liver transplant in Iran is necessary to set up successful centers.

Understanding Composition and Conflict in Virtual Teams

2011 ◽  
pp. 35-48 ◽  
Author(s):  
Richard Potter ◽  
Pierre Balthazard
Keyword(s):  
Virtual Teams ◽  
Virtual Team ◽  
Conventional Wisdom ◽  
Team Members ◽  
Interaction Styles ◽  
Process Outcomes ◽  
Low Performance ◽  
Set Up ◽  
The Impact ◽  
Constructive Interaction

Drawing from several years of empirical research, in this chapter, we look at the impact of the personalities of individual team members on the performance and process outcomes of virtual teams. Our studies showed that both too few and too many extroverts in a virtual team may result in low performance. While conventional wisdom says that teams should be set up on the basis of expertise, we argue that the resulting interaction styles of the members must be considered when establishing a virtual team. We offer suggestions for managers on assessing the potential for constructive interaction styles.

scholarly journals The ability of Lithuanian ambulance services to provide first medical aid in trauma cases

Medicina ◽  
2007 ◽  
Vol 43 (6) ◽  
pp. 463 ◽  
Author(s):  
Raimondas Marozas ◽  
Rytis Rimdeika ◽  
Nedas Jasinskas ◽  
Eglė Vaitkaitienė ◽  
Dinas Vaitkaitis
Keyword(s):  
Emergency Medicine ◽  
Life Support ◽  
Advanced Life Support ◽  
Medical Procedures ◽  
Service Network ◽  
Medical Aid ◽  
Golden Hour ◽  
Medicine Service ◽  
Complete Set ◽  
Set Up

Objective. To evaluate the ability of country ambulance services to provide first medical aid in trauma cases. Material and methods. A survey of chiefs of emergency medicine service was performed in October–November 2005, in which 34 of the 59 institutions (58%) were participating. The questionnaire presented questions concerning physical and human resources, performance values, and system configuration. The study has shown that emergency medicine service operates in radius of 23 km, each team providing service for about 40 000 inhabitants. Taking into consideration distance and average on-scene time values, emergency medicine service is capable to render the first medical aid within so-called “golden hour” in case the accident is reported immediately. The physical resources are not quite complete. Not all the cars are equipped with essential first aid measures. Among more rarely found resources are vacuum pumps, intubation sets, defibrillators, vacuum splints, back immobilization devices, and hammock immobilization devices. There are less mentioned resources than working teams and even more than two times less than emergency cars at all. Two-thirds of the operating emergency medicine services do not provide advanced life support procedures. The evaluation of theoretical/practical ability to provide some important medical procedures used in emergency medical care showed that medical staff quite often fails to perform defibrillation, intubation, and pleural cavity drainage. Conclusions. Country ambulance service network configuration according to area under service, number of people served, and response frequency comply with the requirement set. The ambulance vehicles lack complete set up as well as some important supplies. Only rarely the staff is skilled enough to perform such advanced life support procedures as intubation, defibrillation, and pleural drainage.

A trans-cultural comparison of the organisation of care at headache centres world-wide

Cephalalgia ◽  
2010 ◽  
Vol 31 (3) ◽  
pp. 316-330 ◽  
Author(s):  
Ria Bhola ◽  
Peter J Goadsby
Keyword(s):  
Physical Therapists ◽  
Cultural Economic ◽  
Team Members ◽  
Nursing Role ◽  
Global Perspectives ◽  
Organisation Of Care ◽  
Service Organisation ◽  
Set Up ◽  
The Uk ◽  
Headache Centres

Background: The need to provide better outcomes for patients with headache, and to minimise the costs involved in doing so, has prompted the search for new modes of service delivery by exploring the service organisation and nursing role from various cultural, economic and global perspectives. Materials and Methods: This study was based on comparisons with the UK headache service up to 2007, the point at which this study was set up. This UK service was based at the National Hospital for Neurology and Neurosurgery (NHNN, UCLH Trust). Data were obtained from US headache centres in 2008 and from centres in Copenhagen, Bangkok, Sydney and Porto Alegre in 2009. Results: A comparison shows the key components of services at all centres showing the team structure and size of service. Prominent features at the centres included: team-working, regular meetings, educational input, good access and communication among team members, headache-trained neurologists, specialist nursing at most centres, and the input of psychological and physical therapists at some centres. Conclusions: The problems of tertiary headache care are very similar throughout the world and seem to transcend ethnic, cultural and economic considerations.

scholarly journals Modelling and Simulation of Cooperative Control for Bus Rapid Transit Vehicle Platoon in a Connected Vehicle Environment

2017 ◽  
Vol 29 (1) ◽  
pp. 67-75 ◽  
Author(s):  
Jiahui Liu ◽  
Peiqun Lin ◽  
Jing(Peter) Jin
Keyword(s):  
Cooperative Control ◽  
Control Model ◽  
Bus Rapid Transit ◽  
Time Interval ◽  
Connected Vehicle ◽  
Rapid Transit ◽  
Vehicle Platoon ◽  
Connected Vehicle Technology ◽  
Pass Through ◽  
Set Up

The aim of this paper is to develop a cooperative control model for improving the operational efficiency of Bus Rapid Transit (BRT) vehicles. The model takes advantage of the emerging connected vehicle technology. A connected vehicle centre is established to assign a specific reservation time interval and transmit the corresponding dynamic speed guidance to each BRT vehicle. Furthermore, a set of constraints have been set up to avoid bus queuing and waiting phenomena in downstream BRT stations. Therefore, many BRT vehicles are strategically guided to form a platoon, which can pass through an intersection with no impedance. An actual signalized intersection along the Guangzhou BRT corridor is employed to verify and assess the cooperative control model in various traffic conditions. The simulation-based evaluation results demonstrate that the proposed approach can reduce delays, decrease the number of stops, and improve the sustainability of the BRT vehicles.

Hydraulic System Simulation Research of Demolishing Robots Based on Matlab

2013 ◽  
Vol 753-755 ◽  
pp. 2757-2760
Author(s):  
Jing Yan
Keyword(s):  
Hydraulic System ◽  
System Analysis ◽  
Low Cost ◽  
Characteristic Curve ◽  
Response Characteristic ◽  
Analysis Software ◽  
Simulation Research ◽  
Modular Modeling ◽  
Modeling Methods ◽  
Set Up

Modular modeling methods based on the reasonable simplifying and supposing of hydraulic system of demolishing robots are proposed in this paper, dynamic mathematical model of each hydraulic element of demolishing robots is set up by the dynamic system analysis software package Simulink of Matlab, response characteristic curve is obtained by the simulation, and analysis of the simulation results is operated in this paper. The experimental results explicate that the hydraulic system is stably, real-time, low-cost, and easy to expand; it can meet the applying requirements of demolishing robots, and it provides the theory basis for the project applying of the hydraulic system of demolishing robots.

scholarly journals Characteristics of spirochetemic patients with a solitary erythema migrans skin lesion in Europe

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250198
Author(s):  
Vera Maraspin ◽  
Katarina Ogrinc ◽  
Tereza Rojko ◽  
Petra Bogovič ◽  
Eva Ružić-Sabljić ◽  
...  
Keyword(s):  
Skin Lesion ◽  
Blood Culture ◽  
Erythema Migrans ◽  
Skin Lesions ◽  
Time Interval ◽  
Negative Blood Culture ◽  
Borrelia Garinii ◽  
Pre Treatment ◽  
Culture Positive ◽  
Age And Sex

Neither pre-treatment characteristics, nor the outcome after antibiotic therapy, have been reported for spirochetemic European patients with Lyme borreliosis. In the present study, patients with a solitary erythema migrans (EM) who had a positive blood culture for either Borrelia afzelii (n = 116) or Borrelia garinii (n = 37) were compared with age- and sex-matched patients who had a negative blood culture, but were culture positive for the corresponding Borrelia species from skin. Collectively, spirochetemic patients significantly more often recalled a tick bite at the site of the EM skin lesion, had a shorter time interval from the bite to the onset of EM, had a shorter duration of the skin lesion prior to diagnosis, and had a smaller EM skin lesion that was more often homogeneous in appearance. Similar results were found for the subset of spirochetemic patients infected with B. afzelii but not for those infected with B. garinii. However, patients with B. garinii bacteremia had faster-spreading and larger EM skin lesions, and more often reported itching at the site of the lesion than patients with B. afzelii bacteremia. Treatment failures were rare (7/306 patients, 2.3%) and were not associated with having spirochetemia or with which Borrelia species was causing the infection.

scholarly journals Initial tasks

2019 ◽  
pp. 70-85
Author(s):  
Ted Lankester
Keyword(s):  
Local Community ◽  
House Staff ◽  
Team Members ◽  
Health Team ◽  
External Sources ◽  
Project Cycle ◽  
Set Up ◽  
And Training ◽  
Different Levels ◽  
Health Programme

This chapter explores how the community and the health programme can work together in selecting and training appropriate health team members at different levels of expertise. It identifies situations that require caution and understanding, and describes the project cycle. It outlines how to set up a project base, house staff, and identify security needs. It describes options for transport, how transport may be perceived by the local community, and includes questions that should be asked when considering buying a vehicle. It describes methods for ordering supplies, equipment vital to the project, and medicines that should be considered. Finally, it gives a range of ideas on how to fund a project, both from internal and external sources, and provides examples of each.

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