Open Access Minireview Article

The Role of IV Needleless Connectors and IV Complication Management and Prevention

Cynthia Chernecky, Denise Macklin

Advances in Research, Page 195-206
DOI: 10.9734/AIR/2014/8475

The most common complications associated with vascular access devices are catheter related bloodstream infections (CR-BSI), which occur in acute care patients every minute, and occlusions. This review will address major issues associated with patient care and research associated with vascular access and intravenous (IV) needleless connectors including descriptions of different types of connectors, care and maintenance issues such as septum disinfection and flushing, education of students and practitioners, a new framework for research and relevant questions for healthcare practitioners to ask during patient assessment. Two overall strategies to prevent CR-BSI’s and occlusions;                 1) prevent the active and passive migration of microorganisms into the fluid pathway and 2) prevent microorganism adhesion to the catheter surface will be discussed. The IV needleless connector, which is placed on the catheter hub is the gatekeeper to the intraluminal fluid pathway and its design directly impacts the success of strategies to prevent complications. Best practice requires that practitioners have specific knowledge of connector technology as well as patient factors for caring for vascular access devices.  There is a large gap in the scientific literature and in policies and procedures related to evidenced based decision making associated with care and maintenance of needleless intravenous connectors. Understanding IV needleless IV connectors is necessary to meld research and practice together for best patient practices, so the occurrences of CR-BSI’s and occlusions can be mitigated and eliminated.


Open Access Original Research Article

Parasitization of Helicoverpa armigera (Lepidoptera: Noctuidae) by four Indigenous Trichogrammatid Species/Strains in a Mixed Cropping System of Tomato and Okra

Andrew Kalyebi, S. Hassan, S. Sithanantham, J. M. Mueke

Advances in Research, Page 188-194
DOI: 10.9734/AIR/2014/8377

Aims: Egg parasitoids, Trichogramma are recognised as natural enemies of many lepidoptera pests worldwide. In Kenya, a number of indigenous parasitoids species have been recovered. We evaluated the relative preference (parasitism) by four Trichogrammatid egg parasitoid species/strains, namely, T. sp. nr. mwanzai (L), T. sp. nr. lutea (H), T. sp. nr. mwanzai (M) and T. sp. nr. lutea (M) for the African bollworm Helicoverpa armigera on two of its host plants, tomato and okra usually intercropped in smallholder farms in Kenya.

Study Design: Host parasitism on host plants.

Methodology: Evaluations of parasitism for H. armigera by Trichogrammatid species/strains on Tomato and Okra in bioassays in both laboratory and field cages, in choice and no-choice conditions were undertaken.

Results: In general, species/strains exhibited significant differences in parasitism for the host (F=2.8; df =3, 7; P= 0.05) but neither the host plant nor host plant x species/strain interaction affected parasitism. Chi-square analyses showed no significant preference by species/strains between the two host plants although there was greater tendency by the parasitoids to go for H. armigera on okra than tomato.

Conclusion: The results give useful insights in planning for augmentation biological control of H. armigera in mixed farming agroecosystems. The four Trichogrammatids could effectively be used in augmentation programs in the tomato-okra cropping systems.


Open Access Original Research Article

Infusing Intent and Its Management into Turing Machine: A Path to Cognitive Distributed Computing

Rao Mikkilineni

Advances in Research, Page 207-224
DOI: 10.9734/AIR/2014/8798

The holy grail of Artificial Intelligence (AI) has been the reproduction of the cognitive processes in Silicon based computing machines to mimic the human or animal cognitive behavior. Computationalism attempts to explain cognition in terms of different internal representations and symbol-manipulating processes operating over these representations. On the other hand, Connectionism explains cognition in terms of a finite automaton which computes associative function specified by a set of input-output pairs that in turn, introduce interaction into the computing model.  However, both theories have critics who believe that they fall short in explaining the cognitive processes observed either in humans or animals. Computationalism tied to the Turing computing model which is restricted to single, sequential processes does not support concurrency, mobility and synchronization observed in cognitive processes. The connectionist systems are also dedicated to single tasks and do not support complex environments which require behaviors that are coordinated and integrated. Above all, cognition is associated with intent of a system and its accomplishment efficiently through various processes that monitor and control itself and its environment. Any computing model incorporating cognition must accommodate dynamic coupling between various elements of the system, where each change in one element continually influences every other element’s direction of change. We discuss the newly introduced DIME (distributed intelligent managed element) computing model which is shown to be one of the implementing architectures for π–calculus and argue that its non-von Neumann parallel implementation of a managed Turing machine with a signaling network overlay addresses some of the limitations of both Computationalism and Connectionism. The DIME network architecture provides a mechanism for injecting sensors and actuators into a Turing Machine and allows implementing autonomic distributed computing where the computers and the programs they execute are orchestrated to achieve the overall intent while optimizing the computing resources available.


Open Access Original Research Article

The Validation of Ottawa Ankle Rules in a Prospective Study of 315 Consecutive Patients: A Prevelance Study in a Single-center

Cafer Akpinar, Cemil Kavalci, Fevzi Yilmaz, Mehmet Ali Ceyhan, Muhittin Serkan Yilmaz

Advances in Research, Page 225-230
DOI: 10.9734/AIR/2014/8730

Aim: This study was a prospective validation of the Ottawa Ankle Rules (OAR) in our patient population with ankle injury.

Materials and Methods: This was a prospective study conducted. Each patient’s demographic characteristics, radiography results, and status of meeting OAR criteria were recorded on a previously prepared study form. The descriptive statistics were presented as Mean, Standard Deviation, and percentage. Categorical variables were analyzed using Chi-Square test. The correlation between OAR positivity and presence of a fracture was analyzed using the Spearman’s correlation analysis.

Results: The sensitivity of OAR was 100%, specificity 27%, negative predictive value 100%, and the positive predictive value 17%.

Conclusion: A careful physical examination and use of OAR may allow avoiding unnecessary tests.


Open Access Original Research Article

Decision-making and Consent of Paediatric Cancer Patients: Between Guidance and Promotion of Child Autonomy

Marie Bonnet

Advances in Research, Page 231-239
DOI: 10.9734/AIR/2014/8274

Aims: Assessing how medical teams in a paediatric cancer hospital cope with the legal requirement to search for the child’s consent for an inclusion in a clinical trial and children’s participation in tough medical decisions.

Study Design: Anthropologic Field Study.

Place and Duration of Study: Department of Paediatric Solid Cancer of La Timone Hospital (Marseille, France) between August 2004 and February 2007.

Methodology: The author attended medical staff meetings, visits and conversations between doctors, children and their parents. About 200 patients where included in the study. Numerous interviews took place with staff, parents and children, as well as with two cancer-survivors, who were cured of their childhood cancer 30 or 40 years ago. Two “blogs” written by mother of young patients were read in order to assess how medical information was disseminating towards families.

Results: The announce of a cancer diagnosis, the search for the child’s consent or participation in tough medical decisions, imply new kinds of relationships between medical teams and children. That modification of positions is not easy for several reasons. First, children do not always feel free to express their views and choices. Besides, these changes disrupt the traditional model of a “medical paternalism”, where physicians would know by themselves what is good for their patients. Above all, confronting children with medical choices may be of the utmost psychic violence, since children are faced with impossible choice or “double bind”. Thus, medical teams have to recognise the child as a person capable of autonomy but also to provide special protection regarding their vulnerability. They experiment different ways to establish a dialog with children, through picturing, “discursive avoidance” and symbolisation.

Conclusion: Looking for the right balance between guidance and promotion of child autonomy, medical staff can create some “protected areas”, where children are sheltered from the naked truth by symbolisation and “discursive avoidance”, and where a genuine dialog may be established.