bluuebunny/crossref_metadata_2025 huggingface dataset:
Combusting Jets Issued From Rectangular Nozzles of High and Low Aspect Ratios With Co-Flowing Air
Authors: Fung Huang Rong , Mwanza Kivindu Reuben , Min Hsu Ching
Published: January 2018

The flame behavior and the thermal structure of gaseous fuel jets issued from rectangular nozzles of high and low aspect ratios with co-flowing air were experimentally studied. Two rectangular nozzles with aspect ratios AR = 36 and 3.27 and with side channels for co-flowing air were examined. Flame behaviors were studied by photography techniques. Flame temperatures were measured using a fine-wire thermocouple. The AR = 36 burner exhibited three characteristic flame modes: attached flame, transitional flame, and lifted flame. The AR = 3.27 burner presented three characteristic flame modes: diffusion flame, transitional flame, and triple-layered flame. High AR jets promoted entrainment and mixing in the region around the flame base, whereas low AR jets enhanced mixing in the regions along the flame edges. At low co-flows, at Rec < 1200, the low AR burner flames were shorter, but at Rec > 1200, the high AR burner flames became shorter and wider. At Rec > 950, the high AR burner recorded higher flame temperatures, compared to the low AR burner by over 100 °C. At high fuel jet Reynolds numbers and moderate co-flow, high AR burner flames presented better combustion performances when compared to low AR jet flames. The good combustion performance of the high AR jet flames was due to enhanced entrainment and mixing, which were induced by flame lifting. However, at low Rec and high co-flow, the low AR jet flames exhibited desirable flame characteristics due to improved entrainment and turbulence at the jet interfaces.
Effect of Quarls on the Blowout Stability and Emission of Pollutants of a Liquid-Fueled Swirl Burner
Authors: Józsa Viktor , Kun-Balog Attila
Published: January 2018

Stringent emissions standards for NOx and carbon monoxide (CO) prompt lean combustor development. With this motivation, combustion stability issues emerge since the desired operating point approaches the lean blowout limit. In this paper, an atmospheric, 15 kW lean premixed prevaporizing-type swirl burner, equipped with a plain jet airblast atomizer, was investigated at various atomizing pressures and combustion air flow rates, using quarls from 0 deg to 60 deg in 15 deg steps. Both the 15 deg and the 30 deg quarls provided a 42% higher lean blowout stability on average in terms of mean mixing tube discharge velocity, compared to the baseline burner. However, the superior stability regime was encumbered by a rapidly increasing CO emission. In parallel, the NOx emission vanished due to the more dilution air and incomplete combustion. The 60 deg quarl provided a moderately extended blowout stability limitation, while the NOx emission slightly increased and the CO emission reduced compared to the baseline burner.
Design of Hybrid Cells to Facilitate Safe and Efficient Human–Robot Collaboration During Assembly Operations
Authors: Kaipa Krishnanand N. , Morato Carlos W. , Gupta Satyandra K.
Published: January 2018

This paper presents a framework to build hybrid cells that support safe and efficient human–robot collaboration during assembly operations. Our approach allows asynchronous collaborations between human and robot. The human retrieves parts from a bin and places them in the robot's workspace, while the robot picks up the placed parts and assembles them into the product. We present the design details of the overall framework comprising three modules—plan generation, system state monitoring, and contingency handling. We describe system state monitoring and present a characterization of the part tracking algorithm. We report results from human–robot collaboration experiments using a KUKA robot and a three-dimensional (3D)-printed mockup of a simplified jet-engine assembly to illustrate our approach.
Experimental and Numerical Analysis of Water Jet Peening on 6061 Aluminum Alloy
Authors: He Zhanshu , Zhao Shusen , Fu Ting , Chen Lei , Zhang Yuanxi , Zhang Meng , Wang Peizhuo
Published: January 2018

Water jet peening (WJP) is a mechanical surface strengthening process, which can improve the residual stress (RS) of the peened surface and then improve the fatigue life of components. In this paper, erosion experiments are conducted to investigate the influence of peening parameters on erosion. On this basis, RSs induced by WJP are studied in relation to the peening parameters. In addition, the coupled Eulerian–Lagrangian (CEL) technique is used to model and simulate the dynamic impact process of WJP on Al6061-T6. The influence of peening parameters such as jet pressure p, jet traverse velocity vf, and the number of water jet pass n on the modification of residual stress field (RSF) is examined by simulation and experiment. The influence of incidence angle α and water jet diameter d on RSF is also investigated by simulation. Results show that compressive RS σcrs is a result of the action of water-hammer pressure alone. Furthermore, σcrs increases with an increase in p, n and α. The optimal peening parameters for Al6061-T6 are found to be p = 60 MPa, vf = 2000 mm/min, n = 4, α = 90 deg and d = 2.0 mm. Finally, the depth of compressive RS layer D0 increases greatly with an increase in water jet diameter d and can reach 984 μm.
Thermal Aging Effect on the Ratcheting Behavior of Pressurized Elbow Pipe
Authors: Liu Caiming , Yu Dunji , Akram Waseem , Chen Xu
Published: January 2018

In this study, the ratcheting behaviors of pressurized Z2CN18.10 austenitic stainless steel elbow pipe influenced by the thermal aging process were experimentally investigated in controlled constant internal pressure and reversed in-plane bending after different thermal aging periods (1000 h and 2000 h) at thermal aging temperature of 500 °C. It is shown that the ratcheting behavior of pressured elbow pipe is highly affected by the thermal aging process. The evaluation of ratcheting behavior of pressured elbow pipe was performed using Chen–Jiao–Kim (CJK) kinematic hardening model as a user subroutine of ANSYS. The relationships of yield stress σs and multiaxial parameter χ with thermal aging time were proposed. Ratcheting shakedown boundary of aged elbow pipe was evaluated by CJK model with thermal aging time.
Characterization of thin carbon films capable of low-field electron emission
Authors: Andronov Alexander , Budylina Ekaterina , Shkitun Pavel , Gabdullin Pavel , Gnuchev Nikolay , Kvashenkina Olga , Arkhipov Alexander
Published: January 2018

Previous experiments have demonstrated that carbon nanoisland films (or disordered quantum-dot arrays) deposited on silicon wafers may possess the property of low-field electron emission. This paper presents our new work on comparative characterization of emitting and nonemitting thin carbon films. The experimental results acquired by Auger spectroscopy, electron energy loss spectroscopy, Anderson's technique for workfunction measurement, and secondary-emission techniques confirmed that the emitting films are discontinuous and consist of carbon in sp2-hybridization state, while their workfunction is relatively high (>4 eV). These experimental data clearly contradict the commonly accepted Fowler–Nordheim theory of field emission and suggest that the observed emission phenomenon has a different nature. A novel model is proposed as a development of the well-known hot-electron emission mechanism supplemented with nanoscale-related features of thermoelectric phenomena.
The impact of exploiting spectro-temporal context in computational speech segregation
Authors: Bentsen Thomas , Kressner Abigail A. , Dau Torsten , May Tobias
Published: January 2018

Computational speech segregation aims to automatically segregate speech from interfering noise, often by employing ideal binary mask estimation. Several studies have tried to exploit contextual information in speech to improve mask estimation accuracy by using two frequently-used strategies that (1) incorporate delta features and (2) employ support vector machine (SVM) based integration. In this study, two experiments were conducted. In Experiment I, the impact of exploiting spectro-temporal context using these strategies was investigated in stationary and six-talker noise. In Experiment II, the delta features were explored in detail and tested in a setup that considered novel noise segments of the six-talker noise. Computing delta features led to higher intelligibility than employing SVM based integration and intelligibility increased with the amount of spectral information exploited via the delta features. The system did not, however, generalize well to novel segments of this noise type. Measured intelligibility was subsequently compared to extended short-term objective intelligibility, hit–false alarm rate, and the amount of mask clustering. None of these objective measures alone could account for measured intelligibility. The findings may have implications for the design of speech segregation systems, and for the selection of a cost function that correlates with intelligibility.
P35 An experience of switching paediatric inflammatory bowel disease patients on infliximab therapy to the biosimilar ‘remsima’
Authors: Mary Healy , Joanne Crook , Charlene Chavda , Elaine Smith
Published: January 2018

Introduction

The treatment of inflammatory bowel disease (IBD) with anti-tumour necrosis factor (anti-TNF) biologic therapies such as infliximab is expensive, due to the complex development and manufacturing processes involved with the drug. The number of paediatric patients (PP) receiving infliximab at our trust is increasing, leading to NHS cost pressures. The patent for the infliximab reference molecule Remicade has expired and considerably cheaper biosimilar products are now available, such as Remsima. The license for Remsima was based on adult rheumatology patients; this data was then extrapolated across all licenses. There are currently no long term safety studies of Remsima in children.

A biosimilar drug can be defined as ‘a biotherapeutic product that is similar in terms of quality, safety and efficacy to an already licensed reference biotherapeutic product.’1

Aim

We wanted to switch all PP receiving infliximab for IBD at our trust from Remicade to a new biosimilar product – Remsima.

Method

The paediatric gastroenterology MDT agreed that all new patients started on infliximab since spring 2016 would be treated with Remsima.

Information was gathered regarding the safety, switchability and efficacy of Remsima before the change was made.2 For existing patients, we also contacted other trusts who had already made the switch to gain from their experience. Our current patients on Remsima were reviewed, and no problems were reported.

Existing patients were identified and a letter informing their parent/guardian of why we were changing from Remicade to Remsima was posted. An agreed date after which the switch in treatment would occur allowed any concerns or questions to be addressed on previous visits to the hospital.

Results

Overall, the method used was a success: all but one of the identified patients agreed to switch to Remsima – one family refused and the child continues to receive Remicade treatment. All patients on Remsima continue to be monitored closely for adverse reactions or a decline in their disease control. Infliximab levels and antibodies are checked as per local guidelines. Any adverse reactions are reported to the MHRA via the yellow card scheme; Remsima is a black triangle medicine.3

Conclusion

Biosimilar medicines present a considerable cost saving to the NHS, and by switching our paediatric IBD patients receiving treatment with infliximab from the reference molecule Remicade to the biosimilar Remsima, the Trust has been able to take advantage of this.

The saving is substantial and across our 60+patients is somewhere in the region of £250,000 – £2 75 000 a year. This money can be reinvested into the paediatric IBD service to improve patient care. We hope that our experience of switching can be used to support other Trusts in following suit.

As further biosimilar medications become available, the NHS could continue to benefit by switching patients receiving biologic treatment.
SP7 Development of a paediatric triage tool for use by pharmacists to aid clinical prioritisation of patients and delivery of pharmaceutical care
Authors: Jennifer Tait , Kirsten Thomson , Moira Kinnear , Gazala Akram , Caroline Souter
Published: January 2018

Aim

To gain consensus from an expert paediatric and neonatal clinical pharmacist panel on criteria to be applied in the design of a triage tool for use in paediatric and neonatal settings.

Methods

The ‘Delphi Technique’1 was used to identify pharmaceutical care issues, known as criteria, to aid in the prioritisation and targeting of pharmacists’ time to deliver pharmaceutical care to paediatric and neonatal patients. Criteria based ’statements’ based upon the literature2–4 were developed and put into a questionnaire format which was distributed amongst members of the Scottish Neonatal and Paediatric Pharmacy Group (SNAPP). A five point Likert-scale and option for free hand text was used to record responses. Responses were analysed and used to modify subsequent rounds of the Delphi technique.

Results

18 criteria were identified for use in the triage tool and were largely characterised upon time of review. Criteria pertaining to daily review included patients prescribed high risk medicines, psychotropic medication, continuous infusions and those with severe, acute kidney injury. Criteria pertaining to 48-hourly review included patients with stable chronic renal failure and mild kidney injury. Criteria for 72-hourly review included stable patients with no acute issues.

Conclusion

A triage tool to aid pharmaceutical prioritisation in paediatric and neonatal patients has been developed and will be piloted for use in clinical practice.

References

McMillian S, King M, Tully M. How to use the nominal group and Delphi techniques. Int J Clin Pharm 2016;38:655–622.

Abbas S. The sensitivity of the paediatric triage tool in identifying care issues. Abstracts from 21st Annual Conference of Neonatal and Paediatric Pharmacists Group, NPPG, 2015.

Cottrell R, Caldwell M, Jardine G. Developing and implementing a pharmacy risk screening tool. Hospital Pharmacy Europe (Magazine) 2013;71.

Stuart Z. The development and pilot evaluation of referral tool for pharmacy technicians to use within a paediatric medical acute receiving unit 2014. MSc Project submitted to the University of Strathclyde.
1 Developing consensus on hospital prescribing indicators of potential harm for infants and children
Authors: Fox Andy
Published: January 2018

Aims

To develop a list of hospital based paediatric prescribing indicators that can be used to assess the impact of electronic prescribing or clinical decision support tools on paediatric prescribing errors.

Background

Medication errors are a major cause for concern in the NHS. Prescribing is part of the medication use process and is a complex task requiring an understanding of medicines, disease processes, and patient parameters. Systematic reviews have reported that medication errors occur in as many as 50% of hospital admissions and prescribing error rates in the UK hospitals vary between 9% and 15%.

Prescribing for children is further complicated by the need to take into account weight, altered physiology and pharmacokinetics. Prescribing error rates of 13.1% have been reported in children with a potentially greater impact due to the nature of the patients.

Electronic prescribing (EP) while relatively uncommon in UK hospitals is an important tool in reducing prescribing errors. EP systems have been shown to have a positive impact on prescribing errors, however methodologies vary and the reduction in harm is rarely investigated. A standard tool to allow an evaluation of the harm reduction is desirable and currently does not exist for the paediatric setting.

Methods

Two rounds of an electronic consensus method (eDelphi) were carried out with 21 expert panellists from the UK. Panellists were asked to score each prescribing indicator for its likelihood of occurrence and severity of outcome should the error occur. The scores were combined to produce a risk score and a median score for each indicator calculated. The degree of consensus between panellists was defined as the proportion that gave a risk score in the same category as the median. Indicators were included if a consensus of 80% or higher was achieved and were in the high risk categories.

Results

An expert panel consisting of 8 pharmacists and 13 paediatricians with a total of 437 years of clinical experience completed an exploratory round and two rounds of scoring. This identified 41 paediatric prescribing indicators with a high risk rating and greater than 80% consensus. The most common error type within the indicators was wrong dose (n=19) and the most common drug classes were antimicrobials (n=10) and cardiovascular (n=7).

Conclusions

A set of 41 paediatric prescribing indicators describing potential harm for the hospital setting have been identified by an expert panel. The indicators provide a standardised method of evaluation of prescribing data on both paper and electronic systems. They can also be used to assess implementation of clinical decision support systems or other quality improvement initiatives.
P4 Outcome following switch between brand name and generic tacrolimus in paediatric population
Authors: Foxon Peter , Vijayan Swetha
Published: January 2018

Introduction

Generic preparations of drugs are often cheaper than brand names and offers significant cost benefits. For many medicines, a switch between preparations can be done with little or no monitoring. Tacrolimus prescription, however, provides an interesting challenge due to its narrow therapeutic window and requires careful medical supervision and therapeutic monitoring while switching. Adoport1 is a generic tacrolimus preparation introduced to the market after the exclusivity period for Prograf2 ended. At present there is limited evidence to show the effects of the switch between formulations in paediatric patients. In 2015, Nottingham Children’s Renal Unit undertook to switch all existing paediatric kidney transplant and nephrotic patients on Prograf to Adoport and we herewith present the effects on patients and their Tacrolimus levels.

Method

Prescriptions for tacrolimus are dispensed and delivered by a homecare provider on a three monthly basis. Patients were given written and verbal advice to switch from Prograf to the same dose of Adoport two weeks before their next clinical appointment. After taking a stock of their existing Prograf supply, a prescription was given to ensure the patient did not run out of Prograf until their switch date and had enough Adoport until the following prescription was due. The Tacrolimus level was then reviewed by the patient’s doctor at their clinic appointment and dose adjustments were made if necessary as per standard of care. We reviewed data for Tacrolimus levels in the 3 months before and after the switch and assessed for any clinical variation in immunosuppression.

Results

36 patients were switched from Prograf to Adoport. One patient developed hair loss and requested to go back onto Prograf, all other patients tolerated the switch well. There was no significant change in the tacrolimus levels of the population following the switch (p=0.02). There was no significant change in creatinine of the population following the switch (p=0.02). One patient required a dose adjustment following the switch.

Conclusion

This study assessed the clinical outcomes for paediatric patients switching from Prograf to Adoport. We noted stable Tacrolimus levels in most patients following the switch and similar therapeutic effectiveness. The majority of patients tolerated the switch well. This resulted in a cost saving for NHS England from which a gain share was negotiated to benefit Nottingham University Hospitals NHS Trust. Our outcome data therefore support the use of Adoport in place of Prograf as a potential cost-saving measure.

References

Summary of Product characteristics Astella Pharma Ltd. Prograf 0.5 mg, 1 mg, 5 mg Hard capsules 2 November 2015. www.medicines.org.uk [Accessed: 30 April 2016].

Summary of Product characteristics Sandoz Ltd. Adoport 1 mg capsules 18 August 2015. www.medicines.org.uk [Accessed: 30 April 2016].
P10 To give, or not to give…
Authors: Lansdowne Zoe
Published: January 2018

Aim

‘Between September 2006 and June 2009, the NPSA (National Patient Safety Agency) received reports of 27 deaths, 68 severe harms and 21 383 other patient safety incidents relating to omitted or delayed medicines’.1 The Trust’s Medicines Code states that ‘critical’ medicines should be administered within one hour of the prescribed times, and all other medicines within 90 min.2 ‘Critical’ medicines relevant to NICU (Neonatal Intensive Care Unit) patients include injected antibiotics, anticoagulants, anticonvulsants, aminophylline infusions and strong opioid analgesics. The aim of this audit was to establish what proportion of medicines prescribed for patients on NICU were given outside of this policy.

Method

Data was downloaded for all NICU inpatients from the electronic prescribing system, ICCA, from 1/4/16 to 30/6/16 inclusive. It was then analysed using Excel. The data shows details of all regular drugs prescribed, the scheduled administration time and the time that the nurses recorded that the drug had been administered. Once only, when required and drug infusions longer than 4 hours were all excluded from this data capture. Scheduled doses of antibiotics that were intentionally delayed whilst awaiting levels, e.g. vancomycin and gentamicin, were excluded before data analysis.

Results

It was found that over the 3 month period, 137 different patients were administered 10 642 regular doses of 51 different medications. 5.86% of these were classified as ‘delayed’ according to Trust policy. 97.6% of these delayed ‘critical’ medications were antibiotics, accounting for over 45% of the total delayed doses.

Meropenem was found to be the antibiotic most frequently delayed, with over one quarter of all doses prescribed being administered more than 1 hour after the scheduled time. The delay in administration ranged from 65 mins to 6 hours. Ceftazidime was the next most frequently delayed, occurring 22.7% of the time, range 2.75 to 3.75 hours.

The time of day when most drug delays occurred was between the times of 15:00 and 15:59, accounting for 8.2%. The percentage for each hourly time slot varied from 2.1% to 8.2%. Throughout the week, the percentage of delays on an individual day ranged from the most on Saturdays, 17.9%, to the least on Wednesdays, 9.6%.

Conclusions

Delays in administering medicines can have significant detrimental effects for patient safety. Trust policy dictates that ‘critical’ medicines should be administered within 1 hour of the prescribed times.2 It can be seen from the results above that the administration of medications were delayed 5.86% of the time, with antibiotics accounting for over 45% of these delayed doses. The administration of meropenem was delayed over 25% of the time.

References

National Patient Safety Agency. Rapid Response Report 009. Reducing harm from omitted and delayed medicines in hospital2010.

Holmes, G. Chapter M09 policy for the administration of medicines [policy document]2016. University Hospitals Bristol NHS Foundation Trust.
P13 An evaluation of vitamin d supplementation to babies on the neonatal unit
Authors: Begum Razmin , Modha Jiten , Gaze Sian
Published: January 2018

Aim

In 2014, NICE guidance outlined the recommended amount of vitamin D in newborn infants.1 Such deficiency is associated with rickets, hypocalcaemia and seizures.2

The aim of this study was to determine whether babies on the neonatal unit received the recommended daily amount of vitamin D by comparing national guidance against our local neonatal policy. To assess how babies obtained their source of vitamin D on the neonatal unit.

Method

Local policy stipulates for pre-term babies<1.8 kg a daily intake of 800–1000 units is recommended and for term babies (>37 weeks) 400 units is recommend. Pre-term and term babies>1.8 kg a dose of 400 units is recommend.

Data collected over a 6 week period (1 week pilot study) included prescribed medication, milk volume, milk type (formula or fortifier) and demographics of the patient population. Inclusion criteria: babies with a postnatal age >2 weeks and enteral feeds >120 ml/kg/day. Exclusion criteria: babies with a postnatal age <2 weeks, on TPN, donor breast milk or on demand breast-feeding.

Results

30 babies identified of, which 21 were classified as pre term and 9 as term. 100% (9/9) of term babies and (3/3) pre-term babies weighing >1.8 kg received the recommended daily vitamin D intake (either as colecalciferol or abidec). The remaining 18 pre-term babies weighing <1.8 kg; 83% (15/18) received the recommended daily intake (either as colecalciferol, abidec, fortifier or milk formula). Overall, from the 30 babies identified in this study 90% (27/30) received their daily recommended intake of vitamin D.

Conclusion

This is the first study conducted, which concluded that 90% of babies received the recommend daily intake of vitamin D as outlined in both national and local guidance. It demonstrated that there needs to be a greater focus on vitamin D supplementation on the unit to ensure that all babies are nutritionally optimised.

References

NICE Guidelines [PH56]. Vitamin D: Increasing supplement in at-risk groups November 2014.

Parisaei M, GovindA, Clements J, etal. Prevalence of vitamin D deficiency in a North London antenatal population. Obstetric Medicine: The Medicine of Pregnancy 2011;4(3):113–116.
P14 Discord between patients’ general practitioner repeat prescriptions and the medication list held by a paediatric cf centre
Authors: Cunliffe Helen , Smith Rachel
Published: January 2018

Aim

To audit GP repeat prescription records in comparison with medication lists held in patients’ electronic notes (EMIS) in our centre, to identify any discrepancies and pharmacist interventions.

Method

Between October 2011 and June 2014, a pharmacist retrospectively reviewed the CF Centre medication lists, and compared them with the patient’s GP repeat prescription (accessed using Summary Care Record), identifying differences in doses, formulation, and directions. In addition, omissions from each list, drug-class duplications, drugs requiring cessation, and dosing errors were noted.

The last date of dispensing was used as an indicator of adherence, and where necessary, GPs were contacted for further information.

Pharmacist interventions requiring further action were recorded.

Results

Drugs (n=2009), were reviewed from 232 patient episodes. Total number of pharmacist interventions was 589 (29.3% drugs), with 20 prescribing errors identified as being clinically significant requiring immediate resolution. Dose and formulation discrepancies were noted in 141 (7.0%) and 48 (2.4%) drugs respectively. Omissions occurred on the GP prescription for 73 medications (3.6%), 30 of which were unlicensed. There were 69 (3.4%) omissions on the CF Unit medication list. Common drugs missed off the GP prescriptions were unlicensed medicines (ULM), accounting for 40% of GP omissions. Common drugs missed off the CF Centre drug list were dietary products and ‘acute’ courses (e.g. antifungals, eradication regimens) initiated by the CF Centre. The CF Centre was unaware of some GP prescribing of contraceptives and inhalers.

25 patients were identified as having adherence issues.

Only 35/232 (15%) prescriptions matched identically.

Conclusions

This audit identified the need for a more thorough medicine review and reconciliation in the clinic, which should at least include the GP repeat prescription. The audit identified areas of discrepancy between the CF Centre list and the GP prescription, that were previously unknown and had not been considered. It is essential that teams are aware of additional prescribing by GPs and the medication list at the CF Centre should be updated at each clinic visit. Communication regarding drug therapy needs to be improved between the CF Centre and GPs.

A comprehensive medication review should to be completed before altering any drug/doses in response to poor clinical response, as it cannot be assumed that patients have access to, or are taking, medicines as perceived by the CF Team. A pharmacist in a CF clinic would be ideally placed to complete this.
P22 Using an elastomeric pump to administer continuous infusions of antibiotics as part of an outpatient parenteral antimicrobial therapy (opat) programme
Authors: Sharpe David , Crouch Claire , Porter David , Paulus Stephane
Published: January 2018

Aims

Continuous intravenous infusion using an elastomeric pump is an alternative delivery method in paediatric patients who need intravenous antibiotics (IVAB) which would otherwise need to be administered three times daily, such as piperacillin/tazobactam or ceftazidime.1 We describe our experience using elastomeric pumps in the OPAT setting.

Methods

A retrospective case series of 5 children (aged 5–17 years) discharged home on IVAB continuous infusion administered via an elastomeric pump. One child received this mode of delivery twice therefore 6 patient-episodes are described in this case series. Outcomes were assessed using the BSAC p-OPAT (British Society of Antimicrobial Chemotherapy Paediatric-OPAT) criteria. Ethics approval was not required because the information was gathered retrospectively and patient data has been anonymised.

Results

In 5 of the episodes the indication was lower respiratory tract infection treated with continuous IV piperacillin/tazobactam. All patients had a background of neurodisability, recurrent respiratory tract infections and Pseudomonas aeruginosa carriage. The remaining patient was treated for an infective exacerbation of cystic fibrosis with a regimen that included continuous IV ceftazidime. All episodes had an outcome defined as ‘Success’ according to the BSAC p-OPAT criteria; having an infection outcome of ‘improved’ or ‘cured’ with no adverse events reported.

Conclusions

The successful outcomes in this case series suggest that elastomeric pumps are a safe and effective option for administering selected antibiotics by continuous IV infusion to children, although central venous access is a requirement. This option should be considered to facilitate the early discharge of patients to be treated with IVAB such as piperacillin/tazobactam under the guidance of an OPAT service.

Reference

Patel S, Abrahamson E, Goldring S, Green H, Wickens H, Laundy M. Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: A consensus statement. J Antimicrob Chemother2015;70(2):360–73.
P34 Successful introduction of an outpatient parenteral antimicrobial therapy (opat) programme in a large uk paediatric hospital
Authors: Crouch Claire , Sharpe David , Porter David , Paulus Stephane
Published: January 2018

Introduction

An OPAT service was launched at large paediatric hospital in November 2014 to facilitate the safe and efficient discharge of patients from hospital into the community. The OPAT service is delivered by a multi-disciplinary team including a Consultant in Paediatric Infectious Diseases, an OPAT/Intravascular Access Nurse, an Antimicrobial Pharmacist, and involves collaborative working with community nursing teams across the region. We present an evaluation of our service based on audit data and patient feedback collected over a 12 month period.

Methods

Prospective audit using the BSAC p-OPAT (British Society of Antimicrobial Chemotherapy Paediatric Out-patient Parenteral Antimicrobial Therapy) database including data from 1 st January 2015 to 31 st December 2015.

Results

Two hundred and thirteen patients were admitted to the OPAT service leading to 1749 bed-days saved for the trust. Seventy-four patients avoided admission. The most common conditions were: bronchiectasis/chronic respiratory tract infection (15.5%), bacteraemia (15%), pre-septal cellulitis (15%) and respiratory tract infection (11.2%). Complex infections were less common but they accounted for longer antibiotic courses, such as cerebral abscess (5 patients – 170 days of intravenous therapy) and endocarditis (3 patients – 75 days of intravenous therapy).Using the BSAC outcomes definitions, we reported a 90% infection cure rate with a further 6.5% showing clinical improvement. OPAT outcomes were: success in 87% and partial success in 8.5%. The remaining patients (n=6) were classified as OPAT failures due to worsening of infection, drug reactions or inability to re-establish lost vascular access.Feedback from children and parents showed overall satisfaction with the OPAT service. Completed feedback questionnaires (n=30) rated the support and care as satisfactory or better in all cases, with over 83% rating the service as excellent.

Conclusion

We report a positive financial and clinical impact of a new paediatric OPAT service. The service expansion will focus on the involvement of new patient groups (oncology, general surgery) and the increase use of elastomeric devices allowing for an increase number of patients to be treated in their home environment.
P37 A single paediatric centre experience of l-carnitine supplementation in medium-chain acyl-coa dehydrogenase deficiency (mcadd)
Authors: Batten William , Chronopoulou Efstathia , Pierre Germaine
Published: January 2018

University Hospitals Bristol

Aim

The aim of the project was to establish whether patients with MCADD treated at Bristol Royal Hospital for Children (BRHC) are supplemented with l-carnitine and to establish further details for supplementation.

Background

MCADD is the most common type of fatty acid oxidation disorder in the UK.1l-carnitine is a co-factor in the oxidation of fatty acids in mitochondria and eliminates excess medium chain fatty acids. l-carnitine supplementation in MCADD is controversial with no consistent findings in publications.2

Methods

The paediatric metabolic database at BRHC was interrogated to find the number of patients with MCADD. Patients who were either deceased or discharged from the metabolic service were excluded. Medical notes and pharmacy records were reviewed for each patient to determine patient demographics, dosing information and reasons for implementation of l-carnitine using a data collection tool which was piloted on the first 5 patients. The data was analysed using Microsoft Excel.

Results

Of 35 patients treated for MCADD, 13 patients (37%) received l-carnitine. The most common age group treated was 6–10 years (n=6). The mean dose of L-carnitine=77.7 mg/kg/day; range 45–100 mg/kg/day; most common dose=100 mg/kg/day (n=6). 92% of patients received the 300 mg/mL liquid. Of the 13 patients, 1 had low free carnitine but was asymptomatic; 8 were symptomatic with low levels and 3 were symptomatic with borderline low levels and 1 had no reason documented. All symptomatic patients improved with therapy. Those who stopped supplementation on correction (n=3), all restarted due to return of symptoms with falling levels. 2 of these patients have a vegetarian diet, a reason for low free carnitine. 2 patients had their doses reduced from 100 to 50 mg/kg/day due to side effects, particularly fishy body odour exacerbated by hot weather. 1 patient complained of the same effect, but the dose remained the same.

Conclusion

The majority of patients in this centre are not treated with l-carnitine. The reason for treatment is mainly low free carnitine associated with symptoms. Clinical and biochemical improvement was observed with treatment. The most common dose prescribed was 100 mg/kg/day; with the observed side effect of a fishy body odour also being the most common reason for dose reduction. The most commonly prescribed preparation is a 300 mg/mL licensed liquid. Problems with availability and palatability reduce the usage of licensed tablet preparations. We hope to expand the project nationally with other UK metabolic centres.

References

Saudebray. Inborn metabolic diseases: Diagnosis and treatment (5th ed.) 2011. Springer.

Matern D, Rinaldo P. Medium-chain acyl-coenzyme a dehydrogenase deficiency 2015. GeneReviews®. 2000, updated 2015. http://www.ncbi.nlm.nih.gov/books/NBK1424/
P38 Clinical pearl: pharmaceutical management of primary erythromelalgia (pe) (scn9a)
Authors: Batten William
Published: January 2018

Situation

Patient RL is a 7 year old female with a confirmed genetic diagnosis for Primary Erythromelalgia PE, with a heterozygous sequence change in the SCN9A gene: c.2623C>G, p.(Gln875Glu). This genetic mutation of SCN9A results in sodium chanellopathy specifically for the voltage gated sodium channel Nav1.7. This genetic mutation makes the Nav1.7 channel hypersensitive to stimulus and over activation.1 As a result, she suffers from severe intermittent episodes of bilateral erythema and burning pain of the lower limbs. These symptoms are difficult to manage and PE is also known as ‘man-on-fire syndrome’.1

Background

PE in a child is a complex diagnosis with severely limited pharmacological treatments available. Inadequate pain relief was achieved with routine analgesics such as paracetamol and ibuprofen. A multidisciplinary team (MDT) approach including pharmacy was implemented with; review of available literature, alternative medications for relief of pain and other PE symptoms, advice on formulation and dosing.

Outcome

When initially diagnosed, RL was frequently admitted to hospital for uncontrollable and pain and the family were unable to manage at home. Since her diagnosis and full MDT involvement, her pain relief has improved, her hospital admissions have decreased and her family are coping better at home. However, despite pharmacological interventions she is still not entirely free from pain and her other symptoms. Patient RL has also received intensive psychology input for coping strategies in managing her pain, and her parents have received psychological and social input to help them. She is managing to walk more and but still relies on her pushchair. Her current medication regimen is as follows: gabapentin, cetirizine, chlorphenamine, naproxen, paracetamol, clonidine, mexiletine, amitriptyline and topical application of amitriptyline and ketamine. Unsuccessful treatments included: magnesium supplementation, menthol in aqueous cream, lidocaine patches, tramadol and aspirin.

Lessons learnt

There is little information in the literature on the treatment of paediatric patients with PE and they are mainly case reports. Management of RL has been multidisciplinary with pharmacy playing an important role advising on treatment of anecdotal evidence, dosing and formulation advice, counselling, sourcing amitriptyline and ketamine gel and therapeutic drug monitoring for mexiletine. Future treatments we hope to trial include novel drugs still in development that specifically target the voltage gated sodium channel Nav1.7 such as raxatrigine.

Reference

Lawrence J. Nav1.7: A new channel for pain treatment. The Pharmaceutical Journal2016;296:7887. Available from: http://www.pharmaceutical-journal.com/publications/the-pharmaceutical-journal/20200841.article [Accessed: 26 July 2016.
P40 The effect of a pharmacist-led inhaler technique assessment, education and training intervention on asthma control test scores in a paediatric hospital outpatient setting
Authors: Kirrane Michelle , Cunney Rob , McNamara Roisin , Okafor Ike
Published: January 2018

Background

Studies have consistently demonstrated that the correct and effective use of inhaler therapy reduces the frequency and severity of asthma symptoms and thus improves asthma control. Pharmacists are particularly well positioned to educate and train patients in the correct use of their inhaled therapy.1 They are often the last healthcare professionals to have contact with patients prior to the use of prescribed inhaled medication.2 This places pharmacists in an opportune situation for patient counselling with regard to inhaler technique. An extensive literature search revealed that pharmacist-led inhaler technique assessment and training has not, to my knowledge, been carried out in the paediatric population in a hospital setting.

Aim

To determine if pharmacist-led inhaler technique assessment, education and training improves asthma control scores in the paediatric population (4–16 years).

Method

This prospective single-centre interventional study was undertaken in patients with a confirmed diagnosis of asthma between the 1 st April and 30th June 2014. Those prescribed inhaled therapy prior to attendance at clinic, were referred to the investigating pharmacist. Patients with concurrent respiratory conditions and those under the age of four were excluded. The pharmacist delivered structured inhaler technique assessment and practical training with regard to correct inhaler technique. Additional educational advice was provided and baseline asthma control scores recorded.

Results

The results of this study show that inhaler technique assessment, education and training in a single session by a hospital based clinical pharmacist significantly improved ACT scores [Baseline Score=19.33±3.312, Follow-up Score=21.75±2.701, (p=0.04)] and cACT scores [Baseline Score=19.50±4.993, Follow-up Score=21.04±4.647, (p=0.047)].

Conclusion

This study shows feasibility and potential for clinical pharmacists in the hospital healthcare setting to provide inhaler technique assessment, education and training for patients with asthma. This study also provides a unique insight into a snapshot of the paediatric population with asthma in Ireland. References 1. Government of Western Australia: DoH (2012). Asthma Model of Care: Respiratory Health Network.

References

http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Asthma_Model_of_Care.pdf [Accessed: 15 September 2014.

Giraud V, Allaert F, Roche N. Inhaler technique and asthma: Feasibility and acceptability of training by pharmacists. Respiratory Medicine2011;105(12):1815–22.
When is the right time?
Authors: Reid Jacky , Nolan Andrea , Scott Marian
Published: January 2018

Veterinary medicine is veering further towards prolongation of life at all costs, without the safeguard of being able to robustly measure quality of life. Jacky Reid, Andrea Nolan and Marian Scott discuss major steps forward in the ability to measure changes in health‐related quality of life.
Utilizing siphon for effective management of air in gravity-fed water pipelines
Authors: Fang Yujian , Yuan Shouqi , Zhang Jinfeng , Weng Yimeng , Liu Jianrui
Published: January 2018

A novel siphon design has been invented and continuously optimized by Mr. Weng to adapt various pipe diameters since 1990. Within the past 30 years of practical experience, although its success is in increasing transmission capacity, delivering water to higher elevation, and longer distance without additional power input has drawn wide social attention. But this technology has not obtained the industrial acceptance so far due to the lack of theoretical knowledge to explain how the head loss is reduced significantly. This paper presents the experimental findings in the laboratory from an undulating water pipeline with a novel siphon inlet, and reveals the excellence of this design for air management in the pipeline. Together with the experimental findings and relevant literature, two engineering projects utilizing this novel siphon are investigated in detail to illustrate its superior hydraulic performance.
A Comparative Study on Determining Nonlinear Function Parameters of the Izhikevich Neuron Model
Authors: Korkmaz Nimet , Öztürk İsmail , Kalinli Adem , Kiliç Recai
Published: January 2018

In the literature, the parabolic function of the Izhikevich Neuron Model (IzNM) is transformed to the Piecewise Linear (PWL) functions in order to make digital hardware implementations easier. The coefficients in this PWL functions are identified by utilizing the error-prone classical step size method. In this paper, it is aimed to determine the coefficients of the PWL functions in the modified IzNM by using the stochastic optimization methods. In order to obtain more accurate results, Genetic Algorithm and Artificial Bee Colony Algorithm (GA and ABC) are used as alternative estimation methods, and amplitude and phase errors between the original and the modified IzNMs are specified with a newly introduced error minimization algorithm, which is based on the exponential forms of the complex numbers. In accordance with this purpose, GA and ABC algorithms are run 30 times for each of the 20 behaviors of a neuron. The statistical results of these runs are given in the tables in order to compare the performance of three parameter-search methods and especially to see the effectiveness of the newly introduced error minimization algorithm. Additionally, two basic dynamical neuronal behaviors of the original and the modified IzNMs are realized with a digital programmable device, namely FPGA, by using new coefficients identified by GA and ABC algorithms. Thus, the efficiency of the GA and ABC algorithm for determining the nonlinear function parameters of the modified IzNM are also verified experimentally.
VT/VF Detection Method Based on ECG Signal Quality Assessment
Authors: Jovanović Borisav , Milenković Srdan , Pavlović Milan
Published: January 2018

Artefacts which are present in electrocardiogram (ECG) recordings distort detection of life-threatening arrhythmias such as ventricular tachycardia and ventricular fibrillation. The method examines single ECG lead and exploits time domain signal parameters for real-time detection of severe cardiac arrhythmias. The method is dedicated to implementation in mobile ECG telemetry systems, which are designed by using low-power microcontrollers, operating more than a week on a single battery charge. The method has been validated on publicly available databases and the results are presented. We verified our method on ECG signals obtained without pre-selection meaning that the noisy intervals were not omitted from signal analysis.
Calculations on the half-lives of Cluster decay in two-potential approach
Authors: Soylu A.
Published: January 2018

The half-lives of the cluster decay (CD) from the isotopes having the known experimental values, the half-lives of the [Formula: see text]-decay (AD) of same nuclei and also the branching ratios are obtained, within the framework of two-potential approach with cosh potential including with and without the isospin effects. Using two-potential approach and taking into account the isospin effects in the calculations decrease the rms values and they improve the results. The obtained branching ratios are in good agreement with the experimental ones for some isotopes. It is obtained that the isospin-dependent potentials have an influence on the half-lives of the cluster decays of nuclei. Present calculations would be important for predicting the experimental half-lives and branching ratios for the cluster decays of different types of isotopes.
Spin and Charge Nernst Effects in Four-Terminal Ferromagnetic Graphene
Authors: Zheng Jun , Jin Jing-Jing , Zhao Xin , Li Chun-Lei , Guo Yong
Published: January 2018

The spin and charge Nernst effects in a four-terminal ferromagnetic graphene are theoretically investigated by using the nonequilibrium Green’s function method. The results of this study reveal that (1) when the four leads are normal graphene, the pure charge Nernst effect can be obtained under the assistance of magnetic field, (2) when the ferromagnetic graphene leads are in a parallel configuration of the magnetizations, both the spin and charge Nernst effects can be generated simultaneously, it is worth noting that, for the first two cases, the Nernst effect cannot be obtained without the [Formula: see text] direction magnetic field, and (3) the pure spin Nernst effect (without charge Nernst effect) emerged only by the temperature difference for the antiparallel configuration. In addition, the magnitude of the spin and charge Nernst coefficients can be tuned by adjusting the strength of magnetic flux and exchange field. All the results indicate that the proposed multi-terminal graphene nanosystem is a promising candidate for spin caloritronics devices.