BackgroundOcclusions of intravenous (IV) tubing can prevent vital and time-critical medication or solutions from being delivered into the bloodstream of patients receiving IV therapy. At low flow rates (≤ 1 ml/h) the alarm delay (time to an alert to the user) can be up to 2 h using conventional pressure threshold algorithms. In order to reduce alarm delays we developed and evaluated the performance of two new real-time occlusion detection algorithms and one co-occlusion detector that determines the correlation in trends in pressure changes for multiple pumps.MethodsBench-tested experimental runs were recorded in triplicate at rates of 1, 2, 4, 8, 16, and 32 ml/h. Each run consisted of 10 min of non-occluded infusion followed by a period of occluded infusion of 10 min or until a conventional occlusion alarm at 400 mmHg occurred. The first algorithm based on binary logistic regression attempts to detect occlusions based on the pump’s administration rate Q(t) and pressure sensor readings P(t). The second algorithm continuously monitored whether the actual variation in the pressure exceeded a threshold of 2 standard deviations (SD) above the baseline pressure. When a pump detected an occlusion using the SD algorithm, a third algorithm correlated the pressures of multiple pumps to detect the presence of a shared occlusion. The algorithms were evaluated using 6 bench-tested baseline single-pump occlusion scenarios, 9 single-pump validation scenarios and 7 multi-pump co-occlusion scenarios (i.e. with flow rates of 1 + 1, 1 + 2, 1 + 4, 1 + 8, 1 + 16, and 1 + 32 ml/h respectively). Alarm delay was the primary performance measure.ResultsIn the baseline single-pump occlusion scenarios, the overall mean ± SD alarm delay of the regression and SD algorithms were 1.8 ± 0.8 min and 0.4 ± 0.2 min, respectively. Compared to the delay of the conventional alarm this corresponds to a mean time reduction of 76% (P = 0.003) and 95% (P = 0.001), respectively. In the validation scenarios the overall mean ± SD alarm delay of the regression and SD algorithms were respectively 1.8 ± 1.6 min and 0.3 ± 0.2 min, corresponding to a mean time reduction of 77% and 95%. In the multi-pump scenarios a correlation > 0.8 between multiple pump pressures after initial occlusion detection by the SD algorithm had a mean ± SD alarm delay of 0.4 ± 0.2 min. In 2 out of the 9 validation scenarios an occlusion was not detected by the regression algorithm before a conventional occlusion alarm occurred. Otherwise no occlusions were missed.ConclusionsIn single pumps, both the regression and SD algorithm considerably reduced alarm delay compared to conventional pressure limit-based detection. The SD algorithm appeared to be more robust than the regression algorithm. For multiple pumps the correlation algorithm reliably detected co-occlusions. The latter may be used to localize the segment of tubing in which the occlusion occurs.
LINK
Background: The emphasis on impact factors and the quantity of publications intensifies competition between researchers. This competition was traditionally considered an incentive to produce high-quality work, but there are unwanted side-effects of this competition like publication pressure. To measure the effect of publication pressure on researchers, the Publication Pressure Questionnaire (PPQ) was developed. Upon using the PPQ, some issues came to light that motivated a revision.Method: We constructed two new subscales based on work stress models using the facet method. We administered the revised PPQ (PPQr) to a convenience sample together with the Maslach Burnout Inventory (MBI) and the Work Design Questionnaire (WDQ). To assess which items best measured publication pressure, we carried out a principal component analysis (PCA). Reliability was sufficient when Cronbach's alpha > 0.7. Finally, we administered the PPQr in a larger, independent sample of researchers to check the reliability of the revised version.Results: Three components were identified as 'stress', 'attitude', and 'resources'. We selected 3 × 6 = 18 items with high loadings in the three-component solution. Based on the convenience sample, Cronbach's alphas were 0.83 for stress, 0.80 for attitude, and 0.76 for resources. We checked the validity of the PPQr by inspecting the correlations with the MBI and the WDQ. Stress correlated 0.62 with MBI's emotional exhaustion. Resources correlated 0.50 with relevant WDQ subscales. To assess the internal structure of the PPQr in the independent reliability sample, we conducted the principal component analysis. The three-component solution explains 50% of the variance. Cronbach's alphas were 0.80, 0.78, and 0.75 for stress, attitude, and resources, respectively.Conclusion: We conclude that the PPQr is a valid and reliable instrument to measure publication pressure in academic researchers from all disciplinary fields. The PPQr strongly relates to burnout and could also be beneficial for policy makers and research institutions to assess the degree of publication pressure in their institute.
The Co-Design Pressure Cooker was set up to gather knowledge on co-design in product development activities of Small-to-Medium Enterprises(SMEs). This booklet gives an impression of ten projects conducted in the Province of Utrecht, the Netherlands. In these ten projects, a total of 22 companies were involved. 5000 booklets have already been printed in Dutch and handed out to SMEs for knowledge dissemination. We have received ample requests from the international community, which leads us to believe that there is an international audience for the cases conducted and knowledge gathered. This is why we decided to publish an English version of this booklet. The booklet will be followed by a scientific publication on the knowledge gathered for the academic community. Feel free to contact us for more information on this project
The pressure on the European health care system is increasing considerably: more elderly people and patients with chronic diseases in need of (rehabilitation) care, a diminishing work force and health care costs continuing to rise. Several measures to counteract this are proposed, such as reduction of the length of stay in hospitals or rehabilitation centres by improving interprofessional and person-centred collaboration between health and social care professionals. Although there is a lot of attention for interprofessional education and collaborative practice (IPECP), the consortium senses a gap between competence levels of future professionals and the levels needed in rehabilitation practice. Therefore, the transfer from tertiary education to practice concerning IPECP in rehabilitation is the central theme of the project. Regional bonds between higher education institutions and rehabilitation centres will be strengthened in order to align IPECP. On the one hand we deliver a set of basic and advanced modules on functioning according to the WHO’s International Classification of Functioning, Disability and Health and a set of (assessment) tools on interprofessional skills training. Also, applications of this theory in promising approaches, both in education and in rehabilitation practice, are regionally being piloted and adapted for use in other regions. Field visits by professionals from practice to exchange experiences is included in this work package. We aim to deliver a range of learning materials, from modules on theory to guidelines on how to set up and run a student-run interprofessional learning ward in a rehabilitation centre. All tested outputs will be published on the INPRO-website and made available to be implemented in the core curricula in tertiary education and for lifelong learning in health care practice. This will ultimately contribute to improve functioning and health outcomes and quality of life of patients in rehabilitation centres and beyond.
Due to the existing pressure for a more rational use of the water, many public managers and industries have to re-think/adapt their processes towards a more circular approach. Such pressure is even more critical in the Rio Doce region, Minas Gerais, due to the large environmental accident occurred in 2015. Cenibra (pulp mill) is an example of such industries due to the fact that it is situated in the river basin and that it has a water demanding process. The current proposal is meant as an academic and engineering study to propose possible solutions to decrease the total water consumption of the mill and, thus, decrease the total stress on the Rio Doce basin. The work will be divided in three working packages, namely: (i) evaluation (modelling) of the mill process and water balance (ii) application and operation of a pilot scale wastewater treatment plant (iii) analysis of the impacts caused by the improvement of the process. The second work package will also be conducted (in parallel) with a lab scale setup in The Netherlands to allow fast adjustments and broaden evaluation of the setup/process performance. The actions will focus on reducing the mill total water consumption in 20%.
De markt vraagt om steeds meer productvariëteit. Veel bedrijven realiseren productvariëteit nu met veel klant-specifiek engineeringswerk (Engineer-to-Order/EtO). Dit zet druk op alle afdelingen in het bedrijf zoals sales, engineering, productie en service. Een uitdagende manier voor deze bedrijven, om beter met het spanningsveld tussen externe en interne eisen om te gaan, is het ontwikkelen van meer configureerbare producten (lego principe}. Hiervoor is een modulaire opbouw van het product nodig waarin verschillende productonderdelen gestandaardiseerd zijn en gebruikt kunnen worden in verschillende eindproducten. Zo kan, met minder engineeringsactiviteiten, een product geconfigureerd worden (Configure-to-Order/CtO) en de klant productvariëteit worden geboden zonder alle interne druk. Voor diverse bedrijven vormen ook de mogelijkheden van Industry 4.0 en sustainabilty ambities belangrijke drivers in hun streven naar meer CtO. Het implementeren van CtO is echter niet eenvoudig. Het vraagt om aanzienlijke capaciteit, kennis en kunde op het gebied van productontwikkeling, procesontwikkeling en het veranderproces. Betrokkenheid van medewerkers uit alle belangrijke afdelingen (verkoop, engineering, productie, service etc.) is een vereiste. Mkb-bedrijven worstelen hiermee en hebben behoefte aan goede tools en technieken, zowel inhoudelijk, over de ontwikkeling van de productarchitectuur en de impact hiervan op de bedrijfsprocessen, als veranderkundig, hoe deze transitie tot stand te brengen. In dit Sia RAAK-mkb onderzoek willen wij samen met productie mkb-bedrijven, kennisinstellingen en brancheorganisaties een integrale aanpak ontwikkelen om CtO op een goede manier te implementeren. De deelnemende mkb-bedrijven hebben de duidelijke wens om dit de komende jaren te doen. Voor de specifieke casussen zullen met casestudies en interventieonderzoek aanpakken ontwikkeld worden. Studentprojecten zullen ondersteuning geven aan de verschillende interventies. Vervolgens zal systematisch case-vergelijkend onderzoek worden uitgevoerd om inzicht te krijgen in wat in welke situatie werkt. Op basis van het case-vergelijkend onderzoek worden tools en technieken ontwikkeld die enerzijds generiek zijn en anderzijds kunnen worden aangepast aan specifieke bedrijfssituaties.
