Electromagnetic (EM) guided enteral tube placement may reduce lung misplacement to almost zero in... more Electromagnetic (EM) guided enteral tube placement may reduce lung misplacement to almost zero in expert centres, but more than 60 undetected misplacements had occurred by 2016 resulting in major morbidity or death. Aim: Determine the accuracy of manufacturer guidance in trace interpretation against what is referred to as the ‘GI flexure system’. Methods: The authors prospectively observed the accuracy of the ‘GI flexure system’ of trace interpretation against manufacturer guidance in primary nasointestinal (NI) tube placements. Findings: Contrary to manufacturer guidance, 33% of traces deviated >5 cm from the sagittal midline and 26.5% were oesophageal when entering the lower left quadrant, incorrectly indicating lung and gastric placement, respectively. Conversely, the GI flexure system identified ≥99.4% of GI traces when they reached the gastric body flexure; 100% at the superior duodenal flexure. All lung misplacements were identified by the absence of GI flexures. Conclusion...
Background: Blind (unguided) feeding tube placement results in 0.5% of patients suffering major c... more Background: Blind (unguided) feeding tube placement results in 0.5% of patients suffering major complications mainly due to lung misplacement detected prior to feeding. Electromagnet-guided (Cortrak) tube placement could pre-empt such complications but undetected misplacements still occur due to incorrect trace interpretation. By identifying gastrointestinal (GI) flexures from the trace, ‘the GI flexure system’, it has been proposed that tube position can be interpreted. Aims: To audit agreement between standards of interpreting tube position: the Cortrak ‘GI flexure’ system versus X-ray. Methods: In 185 primary nasointestinal tube placements tube position determined by Cortrak trace interpretation (GI flexure) was retrospectively compared with radiological position in a blinded study. Findings: Radiological and Cortrak interpretation agreed in 92.2–98.3% of placements at different GI flexures. Discrepancy mainly occurred because some radiological images were unclear or did not cove...
Samples that include both independent and paired observations cause a dilemma for researchers tha... more Samples that include both independent and paired observations cause a dilemma for researchers that covers the full breadth of empirical research. Parametric approaches for the comparison of two samples using all available observations are considered, under normality and non-normality. These approaches are compared to naive and newly proposed non-parametric alternatives.
Background: safe placement and securement of feeding tubes are essential to establishing early en... more Background: safe placement and securement of feeding tubes are essential to establishing early enteral nutrition. Nasogastric or nasojejunal feeding tubes are often inadvertently removed, and using a nasal bridle can reduce the number of tube replacements required. Aim: to review current nasal bridle practices on one intensive care unit. Over a 3-month period, nasal bridle use was recorded to measure unintentional tube loss and tube duration (the time a tube remained in situ). Method: an observational service evaluation. Findings: 109 patients were recruited; 205 tubes were passed and 77 bridles were inserted, with 42% (n=46) of the bridles placed on day 1. Tubes secured with tape were more likely to be dislodged than tubes secured with a bridle, P=0.0001. Duration of tubes remaining in situ was significantly longer in patients who had a bridle fitted on day 1, P=0.0001 compared with tubes secured with tape. Conclusion: securing a tube with a nasal bridle from day 1 is independently...
The police service in England and Wales has developed a new approach to police leadership where i... more The police service in England and Wales has developed a new approach to police leadership where individuals from outside of the police service can now enter directly to leadership ranks. Previous research identified that officers place great value on being led by someone who has experience of being a police officer. Adopting a social identity perspective, the current paper reports on quantitative and qualitative data about police officer views on direct entry and existing police leadership captured as part of a wider national survey (N = 12,549) of police officers in England and Wales. The paper identifies the importance that shared identity and credibility play in police follower/leadership relationships. It argues that direct-entry police leaders face credibility issues linked to their lack of shared police identity but also that serving officers perceive existing leaders to be poor because they believe they have forgotten what it is like to be a police officer. This paper develops a new theoretical and empirical approach to police leadership utilizing social and organizational psychology theory and research. The paper suggests that if police leaders understand police identity, then they can create propitious conditions within which police officers will follow their leaders.
Background. Many young people are involved in caring for parents, siblings, or other relatives wh... more Background. Many young people are involved in caring for parents, siblings, or other relatives who have an illness or disability. The aim of this study was to estimate the prevalence of caring by young people in England. Method. A national survey of 925 English young people was conducted using the 18-item survey version of the Multidimensional Assessment of Caring Activities Checklist for Young Carers (MACA-YC18). Results. Around 7% of young people were identified as doing a high amount of caring activity, and 3% a very high amount. Most frequently, caring by a young person is for a mother or a sibling, with a physical disability. Caring activity consisted mostly of domestic activities, household management, and emotional care. Conclusion. This study provides the most up to date and methodologically sophisticated survey data on the prevalence of young caring in England, with implications for policy and practice.
Recent national (NICE) guidelines in England recommend that initial debridement and wound excisio... more Recent national (NICE) guidelines in England recommend that initial debridement and wound excision of open tibial fractures take place within 12 h of the time of injury, a change from the previous target of 24 h. This study aims to assess the effect of timing of the initial debridement and wound excision on major infective complications, the impact of the new guidance, and the feasibility of adhering to the 12 h target within the infrastructure currently existing in four major trauma centres in England. A retrospective review was performed of Gustilo-Anderson grade 3B open tibial fractures presenting acutely to four Major Trauma Centres (MTCs) in England with co-located plastic surgery services over a ten-month period. The incidence of deep infective complications was compared between patients who underwent initial surgery according to the new NICE guidance and those who did not. Patients warranting emergency surgery for severely contaminated injury, concomitant life-threatening inj...
Anne Beeston writes: I am planning a study to evaluate the efficacy of a treatment to reduce the ... more Anne Beeston writes: I am planning a study to evaluate the efficacy of a treatment to reduce the microbial load in dried flowers, and need some advice on sample size to allow the determination of statistically significant differences in two groups
Standard approaches for analyzing the difference in two means, where partially overlapping sample... more Standard approaches for analyzing the difference in two means, where partially overlapping samples are present, are less than desirable. Here are introduced two test statistics, making reference to the t-distribution. It is shown that these test statistics are Type I error robust, and more powerful than standard tests.
Standard approaches for comparing the means of two samples, comprising both paired observations a... more Standard approaches for comparing the means of two samples, comprising both paired observations and independent observations, involve the discarding of valuable information. An alternative test which uses all of the available data, is the partially overlapping samples t-test. Two variations of the test are available, one assuming equal variances, and one assuming separate variances. Issues with standard procedures, and considerations for choosing appropriate tests in the partially overlapping scenario are discussed. An example with details of how to apply the partially overlapping samples t-test is given along with an R package that implement these new tests.
British journal of nursing (Mark Allen Publishing), Jan 22, 2017
Stroke patients with dysphagia often depend on nutrition, hydration and medication via nasogastri... more Stroke patients with dysphagia often depend on nutrition, hydration and medication via nasogastric (NG) feeding tubes. Securing tubes using tape is associated with repeated tube loss. In this study, the authors determined cause and effect by auditing tube placement methods, delays incurred, duration and costs. Of 202 NG tube placements in 75 patients, 67 placements occurred in 17 patients over a full course of enteral nutrition (EN) and 40 of these placements were tracked. Tubes were secured by tape in 100%, mittens 31% and special observation 5.4%. However, over an EN course, inadvertent tube loss occurred in 82% of patients and was associated with age (p=0.049) and mitten use (p<0.001): 64% of tubes were lost due to patients and 9% slipped. Average 'tube life' was 2 days, less than 25% of the EN episode (p<0.001). While tube placement occurred within 2.55 hours of request, X-ray confirmation led to a delay in feed and drugs of 8-9 hours per tube placement and loss of...
Disclaimer UWE has obtained warranties from all depositors as to their title in the material depo... more Disclaimer UWE has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material. UWE makes no representation or warranties of commercial utility, title, or fitness for a particular purpose or any other warranty, express or implied in respect of any material deposited. UWE makes no representation that the use of the materials will not infringe any patent, copyright, trademark or other property or proprietary rights. UWE accepts no liability for any infringement of intellectual property rights in any material deposited but will remove such material from public view pending investigation in the event of an allegation of any such infringement.
In this work, the infrared (IR) spectra of living neural cells in suspension, native brain tissue... more In this work, the infrared (IR) spectra of living neural cells in suspension, native brain tissue, and native brain tumor tissue were investigated. Methods were developed to overcome the strong IR signal of liquid water so that the signal from the cellular biochemicals could be seen. Measurements could be performed during surgeries, within minutes after resection. Comparison between normal tissue, different cell lineages in suspension, and tumors allowed preliminary assignments of IR bands to be made. The most dramatic difference between tissues and cells was found to be in weaker IR absorbances usually assigned to the triple helix of collagens. Triple helix domains are common in larger structural proteins, and are typically found in the extracellular matrix (ECM) of tissues. An algorithm to correct offsets and calculate the band heights and positions of these bands was developed, so the variance between identical measurements could be assessed. The initial results indicate the triple helix signal is surprisingly consistent between different individuals, and is altered in tumor tissues. Taken together, these preliminary investigations indicate this triple helix signal may be a reliable biomarker for a tumor-like microenvironment. Thus, this signal has potential to aid in the intra-operational delineation of brain tumor borders. Citation: Stelling AL, Toher D, Uckermann O, Tavkin J, Leipnitz E, et al. (2013) Infrared Spectroscopic Studies of Cells and Tissues: Triple Helix Proteins as a Potential Biomarker for Tumors. PLoS ONE 8(3): e58332.
In this work, the infrared (IR) spectra of living neural cells in suspension, native brain tissue... more In this work, the infrared (IR) spectra of living neural cells in suspension, native brain tissue, and native brain tumor tissue were investigated. Methods were developed to overcome the strong IR signal of liquid water so that the signal from the cellular biochemicals could be seen. Measurements could be performed during surgeries, within minutes after resection.
Comparison between normal tissue, different cell lineages in suspension, and tumors allowed preliminary assignments of IR bands to be made. The most dramatic difference between tissues and cells was found to be in weaker IR absorbances usually assigned to the triple helix of collagens. Triple helix domains are common in larger structural proteins, and are typically found in the extracellular matrix (ECM) of tissues.
An algorithm to correct offsets and calculate the band heights and positions of these bands was developed, so the variance between identical measurements could be assessed. The initial results indicate the triple helix signal is surprisingly consistent between different individuals, and is altered in tumor tissues. Taken together, these preliminary investigations indicate this triple helix signal may be a reliable biomarker for a tumor-like microenvironment. Thus, this signal has potential to aid in the intra-operational delineation of brain tumor borders.
Electromagnetic (EM) guided enteral tube placement may reduce lung misplacement to almost zero in... more Electromagnetic (EM) guided enteral tube placement may reduce lung misplacement to almost zero in expert centres, but more than 60 undetected misplacements had occurred by 2016 resulting in major morbidity or death. Aim: Determine the accuracy of manufacturer guidance in trace interpretation against what is referred to as the ‘GI flexure system’. Methods: The authors prospectively observed the accuracy of the ‘GI flexure system’ of trace interpretation against manufacturer guidance in primary nasointestinal (NI) tube placements. Findings: Contrary to manufacturer guidance, 33% of traces deviated >5 cm from the sagittal midline and 26.5% were oesophageal when entering the lower left quadrant, incorrectly indicating lung and gastric placement, respectively. Conversely, the GI flexure system identified ≥99.4% of GI traces when they reached the gastric body flexure; 100% at the superior duodenal flexure. All lung misplacements were identified by the absence of GI flexures. Conclusion...
Background: Blind (unguided) feeding tube placement results in 0.5% of patients suffering major c... more Background: Blind (unguided) feeding tube placement results in 0.5% of patients suffering major complications mainly due to lung misplacement detected prior to feeding. Electromagnet-guided (Cortrak) tube placement could pre-empt such complications but undetected misplacements still occur due to incorrect trace interpretation. By identifying gastrointestinal (GI) flexures from the trace, ‘the GI flexure system’, it has been proposed that tube position can be interpreted. Aims: To audit agreement between standards of interpreting tube position: the Cortrak ‘GI flexure’ system versus X-ray. Methods: In 185 primary nasointestinal tube placements tube position determined by Cortrak trace interpretation (GI flexure) was retrospectively compared with radiological position in a blinded study. Findings: Radiological and Cortrak interpretation agreed in 92.2–98.3% of placements at different GI flexures. Discrepancy mainly occurred because some radiological images were unclear or did not cove...
Samples that include both independent and paired observations cause a dilemma for researchers tha... more Samples that include both independent and paired observations cause a dilemma for researchers that covers the full breadth of empirical research. Parametric approaches for the comparison of two samples using all available observations are considered, under normality and non-normality. These approaches are compared to naive and newly proposed non-parametric alternatives.
Background: safe placement and securement of feeding tubes are essential to establishing early en... more Background: safe placement and securement of feeding tubes are essential to establishing early enteral nutrition. Nasogastric or nasojejunal feeding tubes are often inadvertently removed, and using a nasal bridle can reduce the number of tube replacements required. Aim: to review current nasal bridle practices on one intensive care unit. Over a 3-month period, nasal bridle use was recorded to measure unintentional tube loss and tube duration (the time a tube remained in situ). Method: an observational service evaluation. Findings: 109 patients were recruited; 205 tubes were passed and 77 bridles were inserted, with 42% (n=46) of the bridles placed on day 1. Tubes secured with tape were more likely to be dislodged than tubes secured with a bridle, P=0.0001. Duration of tubes remaining in situ was significantly longer in patients who had a bridle fitted on day 1, P=0.0001 compared with tubes secured with tape. Conclusion: securing a tube with a nasal bridle from day 1 is independently...
The police service in England and Wales has developed a new approach to police leadership where i... more The police service in England and Wales has developed a new approach to police leadership where individuals from outside of the police service can now enter directly to leadership ranks. Previous research identified that officers place great value on being led by someone who has experience of being a police officer. Adopting a social identity perspective, the current paper reports on quantitative and qualitative data about police officer views on direct entry and existing police leadership captured as part of a wider national survey (N = 12,549) of police officers in England and Wales. The paper identifies the importance that shared identity and credibility play in police follower/leadership relationships. It argues that direct-entry police leaders face credibility issues linked to their lack of shared police identity but also that serving officers perceive existing leaders to be poor because they believe they have forgotten what it is like to be a police officer. This paper develops a new theoretical and empirical approach to police leadership utilizing social and organizational psychology theory and research. The paper suggests that if police leaders understand police identity, then they can create propitious conditions within which police officers will follow their leaders.
Background. Many young people are involved in caring for parents, siblings, or other relatives wh... more Background. Many young people are involved in caring for parents, siblings, or other relatives who have an illness or disability. The aim of this study was to estimate the prevalence of caring by young people in England. Method. A national survey of 925 English young people was conducted using the 18-item survey version of the Multidimensional Assessment of Caring Activities Checklist for Young Carers (MACA-YC18). Results. Around 7% of young people were identified as doing a high amount of caring activity, and 3% a very high amount. Most frequently, caring by a young person is for a mother or a sibling, with a physical disability. Caring activity consisted mostly of domestic activities, household management, and emotional care. Conclusion. This study provides the most up to date and methodologically sophisticated survey data on the prevalence of young caring in England, with implications for policy and practice.
Recent national (NICE) guidelines in England recommend that initial debridement and wound excisio... more Recent national (NICE) guidelines in England recommend that initial debridement and wound excision of open tibial fractures take place within 12 h of the time of injury, a change from the previous target of 24 h. This study aims to assess the effect of timing of the initial debridement and wound excision on major infective complications, the impact of the new guidance, and the feasibility of adhering to the 12 h target within the infrastructure currently existing in four major trauma centres in England. A retrospective review was performed of Gustilo-Anderson grade 3B open tibial fractures presenting acutely to four Major Trauma Centres (MTCs) in England with co-located plastic surgery services over a ten-month period. The incidence of deep infective complications was compared between patients who underwent initial surgery according to the new NICE guidance and those who did not. Patients warranting emergency surgery for severely contaminated injury, concomitant life-threatening inj...
Anne Beeston writes: I am planning a study to evaluate the efficacy of a treatment to reduce the ... more Anne Beeston writes: I am planning a study to evaluate the efficacy of a treatment to reduce the microbial load in dried flowers, and need some advice on sample size to allow the determination of statistically significant differences in two groups
Standard approaches for analyzing the difference in two means, where partially overlapping sample... more Standard approaches for analyzing the difference in two means, where partially overlapping samples are present, are less than desirable. Here are introduced two test statistics, making reference to the t-distribution. It is shown that these test statistics are Type I error robust, and more powerful than standard tests.
Standard approaches for comparing the means of two samples, comprising both paired observations a... more Standard approaches for comparing the means of two samples, comprising both paired observations and independent observations, involve the discarding of valuable information. An alternative test which uses all of the available data, is the partially overlapping samples t-test. Two variations of the test are available, one assuming equal variances, and one assuming separate variances. Issues with standard procedures, and considerations for choosing appropriate tests in the partially overlapping scenario are discussed. An example with details of how to apply the partially overlapping samples t-test is given along with an R package that implement these new tests.
British journal of nursing (Mark Allen Publishing), Jan 22, 2017
Stroke patients with dysphagia often depend on nutrition, hydration and medication via nasogastri... more Stroke patients with dysphagia often depend on nutrition, hydration and medication via nasogastric (NG) feeding tubes. Securing tubes using tape is associated with repeated tube loss. In this study, the authors determined cause and effect by auditing tube placement methods, delays incurred, duration and costs. Of 202 NG tube placements in 75 patients, 67 placements occurred in 17 patients over a full course of enteral nutrition (EN) and 40 of these placements were tracked. Tubes were secured by tape in 100%, mittens 31% and special observation 5.4%. However, over an EN course, inadvertent tube loss occurred in 82% of patients and was associated with age (p=0.049) and mitten use (p<0.001): 64% of tubes were lost due to patients and 9% slipped. Average 'tube life' was 2 days, less than 25% of the EN episode (p<0.001). While tube placement occurred within 2.55 hours of request, X-ray confirmation led to a delay in feed and drugs of 8-9 hours per tube placement and loss of...
Disclaimer UWE has obtained warranties from all depositors as to their title in the material depo... more Disclaimer UWE has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material. UWE makes no representation or warranties of commercial utility, title, or fitness for a particular purpose or any other warranty, express or implied in respect of any material deposited. UWE makes no representation that the use of the materials will not infringe any patent, copyright, trademark or other property or proprietary rights. UWE accepts no liability for any infringement of intellectual property rights in any material deposited but will remove such material from public view pending investigation in the event of an allegation of any such infringement.
In this work, the infrared (IR) spectra of living neural cells in suspension, native brain tissue... more In this work, the infrared (IR) spectra of living neural cells in suspension, native brain tissue, and native brain tumor tissue were investigated. Methods were developed to overcome the strong IR signal of liquid water so that the signal from the cellular biochemicals could be seen. Measurements could be performed during surgeries, within minutes after resection. Comparison between normal tissue, different cell lineages in suspension, and tumors allowed preliminary assignments of IR bands to be made. The most dramatic difference between tissues and cells was found to be in weaker IR absorbances usually assigned to the triple helix of collagens. Triple helix domains are common in larger structural proteins, and are typically found in the extracellular matrix (ECM) of tissues. An algorithm to correct offsets and calculate the band heights and positions of these bands was developed, so the variance between identical measurements could be assessed. The initial results indicate the triple helix signal is surprisingly consistent between different individuals, and is altered in tumor tissues. Taken together, these preliminary investigations indicate this triple helix signal may be a reliable biomarker for a tumor-like microenvironment. Thus, this signal has potential to aid in the intra-operational delineation of brain tumor borders. Citation: Stelling AL, Toher D, Uckermann O, Tavkin J, Leipnitz E, et al. (2013) Infrared Spectroscopic Studies of Cells and Tissues: Triple Helix Proteins as a Potential Biomarker for Tumors. PLoS ONE 8(3): e58332.
In this work, the infrared (IR) spectra of living neural cells in suspension, native brain tissue... more In this work, the infrared (IR) spectra of living neural cells in suspension, native brain tissue, and native brain tumor tissue were investigated. Methods were developed to overcome the strong IR signal of liquid water so that the signal from the cellular biochemicals could be seen. Measurements could be performed during surgeries, within minutes after resection.
Comparison between normal tissue, different cell lineages in suspension, and tumors allowed preliminary assignments of IR bands to be made. The most dramatic difference between tissues and cells was found to be in weaker IR absorbances usually assigned to the triple helix of collagens. Triple helix domains are common in larger structural proteins, and are typically found in the extracellular matrix (ECM) of tissues.
An algorithm to correct offsets and calculate the band heights and positions of these bands was developed, so the variance between identical measurements could be assessed. The initial results indicate the triple helix signal is surprisingly consistent between different individuals, and is altered in tumor tissues. Taken together, these preliminary investigations indicate this triple helix signal may be a reliable biomarker for a tumor-like microenvironment. Thus, this signal has potential to aid in the intra-operational delineation of brain tumor borders.
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Papers by Deirdre Toher
Comparison between normal tissue, different cell lineages in suspension, and tumors allowed preliminary assignments of IR bands to be made. The most dramatic difference between tissues and cells was found to be in weaker IR absorbances usually assigned to the triple helix of collagens. Triple helix domains are common in larger structural proteins, and are typically found in the extracellular matrix (ECM) of tissues.
An algorithm to correct offsets and calculate the band heights and positions of these bands was developed, so the variance between identical measurements could be assessed. The initial results indicate the triple helix signal is surprisingly consistent between different individuals, and is altered in tumor tissues. Taken together, these preliminary investigations indicate this triple helix signal may be a reliable biomarker for a tumor-like microenvironment. Thus, this signal has potential to aid in the intra-operational delineation of brain tumor borders.
Comparison between normal tissue, different cell lineages in suspension, and tumors allowed preliminary assignments of IR bands to be made. The most dramatic difference between tissues and cells was found to be in weaker IR absorbances usually assigned to the triple helix of collagens. Triple helix domains are common in larger structural proteins, and are typically found in the extracellular matrix (ECM) of tissues.
An algorithm to correct offsets and calculate the band heights and positions of these bands was developed, so the variance between identical measurements could be assessed. The initial results indicate the triple helix signal is surprisingly consistent between different individuals, and is altered in tumor tissues. Taken together, these preliminary investigations indicate this triple helix signal may be a reliable biomarker for a tumor-like microenvironment. Thus, this signal has potential to aid in the intra-operational delineation of brain tumor borders.