BACKGROUND AND OBJECTIVES: Unplanned extubation can be a significant event that places the patient at risk for adverse events. Our goal was to reduce unplanned extubations to <1 unplanned extubation per 100 patient-intubated days. METHODS: All unplanned extubations in the NICU beginning in October 2009 were audited. Data collected included time of day, patient weight, and patient care activity at the time of the event. Bundles of potentially better practices were implemented in sequential Plan-Do-Study-Act cycles. Rates of unplanned extubation (number per patient-intubated day) for each month were analyzed by using control charts, and causes of unplanned extubation were analyzed by using Pareto charts. RESULTS: We found a significant decrease in the unplanned extubation rate after implementation of the first bundle of potentially better practices in May 2010 (2.38 to 0.41 per 100 patient-intubated days). Several more Plan-Do-Study-Act cycles were conducted to sustain this improvement. A persistent reduction in the unplanned extubation rate (0.58 per 100 patient-intubated days) began in February 2013. Causes included dislodgement during care and procedures and variation in the fixation of the endotracheal tube. The majority of events occurred in very low birth weight infants during the daytime shift. CONCLUSIONS: Unplanned extubations in the NICU can be reduced by education of staff and by implementing standard practices of care. Sustainability of any practice change to improve quality is critically dependent on culture change within the NICU. We suggest that the benchmark for unplanned extubation should be a rate <1 per 100 patient-intubated days.
Zika virus detection was demonstrated using antibody-functionalized cover glasses externally connected to the gate electrode of an AlGaN/GaN high electron mobility transistor (HEMT). A pulsed bias voltage of 0.5 V was applied to an electrode on the region of the cover glass region functionalized with antibody, and the resulting changes of drain current of the HEMT were employed to determine the presence of Zika virus antigen concentration ranging from 0.1 to 100 ng/ml. The dynamic and static drain current changes as a function of Zika virus concentration were modeled with a spring-like elastic relaxation model and the Langmuir extension model, respectively. Excellent fits to the data were found with relaxation time constants of antibody and antigen molecules in the range of 11 ls and 0.66-24.4 ls, respectively, for the concentration range investigated. The ratio of antibody bound with antigen to the total available antibody on the functionalized contact window was in the range of 0.013-0.84 for the Zika antigen concentration range of 0.1-100 ng/ml. Since the HEMT is not exposed to the bio-solution, it can be used repeatedly. The functionalized glass is the only disposable part in the detection system, showing the potential of this approach for hand-held, low cost sensor packages for point-of-care applications. Published by AIP Publishing.
Sociocultural and economic limitations often deprive individuals of the freedoms to make decisions regarding their lives, hindering development. This article presents the Framework for Enabling Empowerment (FrEE), a model that emphasizes the importance of psychosocial factors and the individual in accessing freedoms and promoting health, productivity, and sustainable human development. FrEE is theoretically based in Amartya Sen's Capability Approach. Explaining the synergy between the context, the person, and psychosocial factors, FrEE provides a strategy to achieve the expansion of individual choice and freedoms. The authors present FrEE and its relationship to Sen's theories and explain how FrEE makes the Capability Approach operative. Finally the authors draw on empirical program evaluations in Mexico to discuss FrEE's potential impact on the field of human development.
Titanium is the metal of choice for many implantable devices including dental prostheses, orthopaedic devices and cardiac pacemakers. Titanium and its alloys are favoured for hard tissue replacement because of their high strength to density ratio providing excellent mechanical properties and biocompatible surface characteristics promoting in-vivo passivation due to spontaneous formation of a native protective oxide layer in the presence of an oxidizer. This study focuses on the development of a three-dimensional chemical, mechanical, surface nano-structuring (CMNS) process to induce smoothness or controlled nano-roughness on the bio-implant surfaces, particularly for applications in dental implants. CMNS is an extension of the chemical mechanical polishing (CMP) process. CMP is utilized in microelectronics manufacturing for planarizing the wafer surfaces to enable photolithography and multilayer metallization. In biomaterials applications, the same approach can be utilized to induce controlled surface nanostructure on three-dimensional implantable objects to promote or demote cell attachment. As a synergistic method of nano-structuring on the implant surfaces, CMNS also makes the titanium surface more adaptable for the bio-compatible coatings as well as the cell and tissue growth as demonstrated by the electrochemical and surface wettability evaluations on implants prepared by DI-water machining versus oil based machining.
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