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Intensive & Critical Care Nursing Jun 2023Most intensive care unit patients require a feeding tube, but misplacement risk is high due to the presence of artificial airways and because unconsciousness reduces... (Review)
Review
Most intensive care unit patients require a feeding tube, but misplacement risk is high due to the presence of artificial airways and because unconsciousness reduces clinical warnings. Predominantly, tubes are placed 'blindly', where position is not known throughout placement. The result is that 1.6% enter the lung, 0.5% cause pneumothorax and potentially 5% are left in the oesophagus. Guided placement, by identifying tube position in real time, may prevent these problems, but undetected misplacements still occur. We review the safety of guided methods of confirming tube position, including rates of pneumothorax, in the context of current unguided methods. During blind tube placement, tube position can only be tracked intermittently. Excepting X-ray and ultra-sound, most methods of checking position are simple. Conversely, guided tube placement can track tube position from the nose to small intestine (IRIS®), or oesophagus to jejunum (Cortrak™, ENvue®). However, this requires expertise. Overall, guided placement is associated with lower rates of pneumothorax. Unfortunately, for Cortrak, low-use centres have higher rates of undetected misplacement compared with blind placement whereas Cortrak use in high-use centres had lower risk compared with blind placement and low use centres. Because guided placement requires high-level expertise manufacturer training packages have been developed but currently appear insufficient. Specifically, Cortrak's package is less accurate in determining tube position compared to the 'gastrointestinal flexure' system. Validation of an evidence-based guide for IRIS placement is underway. Recommendations are made regarding the training of new operators, including minimum numbers of placements required to achieve expertise.
Topics: Humans; Pneumothorax; Intubation, Gastrointestinal; Enteral Nutrition; Lung; Critical Care
PubMed: 36657250
DOI: 10.1016/j.iccn.2023.103387 -
Molecular Plant Mar 2017Maize is the most important agricultural crop used for food, feed, and biofuel as well as a raw material for industrial products such as packaging material. To increase... (Review)
Review
Maize is the most important agricultural crop used for food, feed, and biofuel as well as a raw material for industrial products such as packaging material. To increase yield and to overcome hybridization barriers, studies of maize gamete development, the pollen tube journey, and fertilization mechanisms were initiated more than a century ago. In this review, we summarize and discuss our current understanding of the regulatory components for germline development including sporogenesis and gametogenesis, the progamic phase of pollen germination and pollen tube growth and guidance, as well as fertilization mechanisms consisting of pollen tube arrival and reception, sperm cell release, fusion with the female gametes, and egg cell activation. Mechanisms of asexual seed development are not considered here. While only a few molecular players involved in these processes have been described to date and the underlying mechanisms are far from being understood, maize now represents a spearhead of reproductive research for all grass species. Recent development of essentially improved transformation and gene-editing systems may boost research in this area in the near future.
Topics: Fertilization; Ovule; Plant Proteins; Pollen Tube; Zea mays
PubMed: 28267957
DOI: 10.1016/j.molp.2017.01.012 -
AANA Journal Dec 2014The practice of securing the endotracheal tube with adhesive tape appears to be benign. However, evidence-based research suggests it is a high-risk practice. Common... (Review)
Review
The practice of securing the endotracheal tube with adhesive tape appears to be benign. However, evidence-based research suggests it is a high-risk practice. Common elements for the taping practice include the tape, anesthesia gas machine, and anesthesia provider. Researchers have found that adhesive tape outside its original packaging became contaminated with pathogens. The bacteria found on the tape included Pseudomonas, Escherichia coli, Klebsiella, Enterobacter, coagulase-positive staphylococci, methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcal organisms. In addition, a patient does not need to have direct contact with the anesthesia gas machine for pathogen transmission to occur. Anesthesia providers were identified as the origin of bacterial transmission in 12% of cases, with pathogens on their hands 66% of the time. Unfortunately, anesthesia providers are often noncompliant with hand hygiene. They failed to practice hand hygiene 82% of the time. Last, the tape can drop to the floor and harbor pathogens despite cleaning 41.6% of the time; it is often retrieved and reused. All the common elements, independently and collectively, involve the tape and its potential to increase the patient's exposure to pathogens and the risk of infection. This literature review presents evidence-based research regarding endotracheal tube taping practice to ensure patient safety.
Topics: Adhesives; Anesthesia; Anesthesiology; Bacterial Infections; Cross Infection; Evidence-Based Nursing; Hand Hygiene; Humans; Intubation, Intratracheal; Practice Guidelines as Topic; Risk Factors
PubMed: 25842644
DOI: No ID Found -
Toxicology and Industrial Health Dec 2022Silicon is one of the most monitored elements in extractables and leachables studies of pharmaceutical packaging systems and related components. There is a need to... (Review)
Review
Silicon is one of the most monitored elements in extractables and leachables studies of pharmaceutical packaging systems and related components. There is a need to review and evaluate toxicological thresholds of silicon because of its direct contact with drug products (DP) especially a liquid form of DP with the widely used pharmaceutical packaging systems made of silicon materials like glass and silicone. It is required by regulatory authorities to test silicon content in DP; however, there are no official guidelines on the toxicology of silicon that are currently available, yet the knowledge of toxicological thresholds of silicon is critical to justify the analytical limit of quantification (LOQ). Therefore, we reviewed the toxicity of silicon to derive a toxicological threshold by literature review of toxicity studies of both inorganic and organic silicon compounds. Oral toxicity is low for inorganic silicon like silicon dioxide or organic silicon polymers such as silicone tube/silicone oil (polydimethylsiloxane, or namely, PDMS as the major ingredient). In comparison, inhalational toxicity of silicon dioxide leads to pulmonary silicosis or even lung cancer. When orally administered, the toxicity of silicon dioxide, glass, polymers, or PDMS oligomers varies depending on their morphology, molecular weight (MW), and degrees of polymerization. PDMS with high MW has minimal toxic symptoms with non-detectable degradation/elimination by both intraperitoneal and subcutaneous administration routes, while exposure to either PDMS or small molecule dimethyl silicone compounds by the intravenous administration route may lead to death. We here determined a general parenteral permitted daily exposure (PDE) of 93 μg/day for inorganic silicon element and 100 μg/day for organic silicon element by reviewing toxicological data of both forms of silicon. In conclusion, this work provides evidence for pharmaceutical companies and regulatory agencies on the PDEs of silicon elements in pharmaceutical packaging and process components through a variety of administration routes.
Topics: Molecular Weight; Polymers; Silicon Dioxide; Silicones; Drug Packaging
PubMed: 36368686
DOI: 10.1177/07482337221123368 -
Mass Spectrometry Reviews Feb 2023Selected ion flow tube mass spectrometry (SIFT-MS) is now recognized as the most versatile analytical technique for the identification and quantification of trace gases... (Review)
Review
Selected ion flow tube mass spectrometry (SIFT-MS) is now recognized as the most versatile analytical technique for the identification and quantification of trace gases down to the parts-per-trillion by volume, pptv, range. This statement is supported by the wide reach of its applications, from real-time analysis, obviating sample collection of very humid exhaled breath, to its adoption in industrial scenarios for air quality monitoring. This review touches on the recent extensions to the underpinning ion chemistry kinetics library and the alternative challenge of using nitrogen carrier gas instead of helium. The addition of reagent anions in the Voice200 series of SIFT-MS instruments has enhanced the analytical capability, thus allowing analyses of volatile trace compounds in humid air that cannot be analyzed using reagent cations alone, as clarified by outlining the anion chemistry involved. Case studies are reviewed of breath analysis and bacterial culture volatile organic compound (VOC), emissions, environmental applications such as air, water, and soil analysis, workplace safety such as transport container fumigants, airborne contamination in semiconductor fabrication, food flavor and spoilage, drugs contamination and VOC emissions from packaging to demonstrate the stated qualities and uniqueness of the new generation SIFT-MS instrumentation. Finally, some advancements that can be made to improve the analytical capability and reach of SIFT-MS are mentioned.
PubMed: 36776107
DOI: 10.1002/mas.21835 -
Journal of Medical Microbiology Mar 2019Lowenstein-Jensen (LJ) medium used for cultivating Mycobacterium tuberculosis (MTB) is marketed in glass packaging. Breakage of glass slope is a major biosafety risk,... (Comparative Study)
Comparative Study
Performance of bioMérieux Lowenstein-Jensen slopes in plastic tube packaging, compared to existing phenotypic methods, for efficient recovery of the Mycobacterium tuberculosis complex.
PURPOSE
Lowenstein-Jensen (LJ) medium used for cultivating Mycobacterium tuberculosis (MTB) is marketed in glass packaging. Breakage of glass slope is a major biosafety risk, especially during processing and storage, which gets magnified in large laboratories. We evaluated the performance of new bioMérieux (bMx) LJ slopes in plastic packaging, compared to bMx glass LJ medium and Becton Dickinson Mycobacterial Growth Indicator Tube (MGIT), for MTB recovery.
METHODOLOGY
Consecutive pulmonary/extra-pulmonary samples (n=240) were processed using routine methods of decontamination, inoculation and incubation.
RESULTS
Plastic LJ slopes detected all 213 true-positive cases. The mean time-to-growth detection was 17.97 days for plastic LJ slopes, compared to 18.08 and 13.53 days for glass LJ slopes and MGIT, respectively. No statistically significant difference was observed between the two LJ slopes (P< 0.05). Both LJ slopes had a sensitivity and specificity of 100%, with respect to MGIT.
CONCLUSION
Plastic LJ slopes are a good alternative to the traditional glass slopes. The medium quality did not differ with the packaging material. Increased surface area of these slants allowed enhanced growth, and the clear plastic material allowed accurate recording of growth. The wide mouth of these containers eased inoculation. Increased biosafety, by elimination of breakage risk, is the biggest advantage of this modification.
Topics: Bacteriological Techniques; Bronchoalveolar Lavage Fluid; Culture Media; Drug Packaging; Glass; Humans; Mycobacterium tuberculosis; Plastics; Sensitivity and Specificity; Sputum; Tuberculosis, Pulmonary
PubMed: 30724723
DOI: 10.1099/jmm.0.000930 -
Journal of the American Academy of... Mar 2022
Topics: Anesthesia, Local; Dermatologic Surgical Procedures; Drug Packaging; Humans; Syringes
PubMed: 32437723
DOI: 10.1016/j.jaad.2020.05.009 -
Optics Express Jan 2022The remote-refocusing approach of Botcherby et al. [Opt. Lett.32, 2007 (2007)10.1364/OL.32.002007] has been applied widely to 2D and 3D fluorescence microscopes to...
The remote-refocusing approach of Botcherby et al. [Opt. Lett.32, 2007 (2007)10.1364/OL.32.002007] has been applied widely to 2D and 3D fluorescence microscopes to enable rapid refocusing of the optical system without mechanically perturbing the sample. In order for this approach to operate correctly, it requires that the overall magnification of the first two microscope systems matches the ratio of the refractive indices in sample and intermedia image spaces. However, commercially available tube lenses are not always suitable to produce the desired overall magnification. Therefore, a practical approach to produce tube lenses with low expense and diffraction-limited performance is required. Tube lenses can be formed using a pair of stock achromatic doublets, however, selecting appropriate pairs of achromatic doublets from stock optics is a time-consuming process, as many combinations can be considered. In this paper, we present two software packages (Catalogue Generator and Doublet Selector) developed in MATLAB that use the application programming interface (ZOS-API) to the Zemax OpticStudio optical design software to realise an automatic search of stock achromatic doublets to produce microscope tube lenses with a specified focal length, entrance pupil diameter and maximum design field angle. An algorithm to optimise principal plane positions in versions of OpticStudio before 20.2 was also introduced to enable the use of older software versions. To evaluate the performance of Catalogue Generator and Doublet Selector, we used them to generate ten tube lens designs. All of the software-produced tube lenses have a better optical performance than those using manually selected pairs of stock doublets lenses.
PubMed: 35209667
DOI: 10.1364/OE.450320 -
Biochimica Et Biophysica Acta. General... Mar 2017Genome packaging and delivery are fundamental steps in the replication cycle of all viruses. Icosahedral viruses with linear double-stranded DNA (dsDNA) usually package...
Genome packaging and delivery are fundamental steps in the replication cycle of all viruses. Icosahedral viruses with linear double-stranded DNA (dsDNA) usually package their genome into a preformed, rigid procapsid using the power generated by a virus-encoded packaging ATPase. The pressure and stored energy due to this confinement of DNA at a high density is assumed to drive the initial stages of genome ejection. Membrane-containing icosahedral viruses, such as bacteriophage PRD1, present an additional architectural complexity by enclosing their genome within an internal membrane vesicle. Upon adsorption to a host cell, the PRD1 membrane remodels into a proteo-lipidic tube that provides a conduit for passage of the ejected linear dsDNA through the cell envelope. Based on volume analyses of PRD1 membrane vesicles captured by cryo-electron tomography and modeling of the elastic properties of the vesicle, we propose that the internal membrane makes a crucial and active contribution during infection by maintaining the driving force for DNA ejection and countering the internal turgor pressure of the host. These novel functions extend the role of the PRD1 viral membrane beyond tube formation or the mere physical confinement of the genome. The presence and assistance of an internal membrane might constitute a biological advantage that extends also to other viruses that package their linear dsDNA to high density within an internal vesicle.
Topics: Adenosine Triphosphatases; Bacteriophage PRD1; Capsid; Cell Membrane; DNA; DNA, Viral; Genome, Viral; Viral Proteins; Virus Assembly
PubMed: 27993658
DOI: 10.1016/j.bbagen.2016.12.013 -
International Journal of Food... Oct 2022The goal of this study was to develop dry heat processing conditions that could achieve a >5-log reduction of Salmonella with minimal negative impact on almond quality....
The goal of this study was to develop dry heat processing conditions that could achieve a >5-log reduction of Salmonella with minimal negative impact on almond quality. The effects of almond's water activity (a) levels and packaging methods on Salmonella inactivation by dry heat were determined. Almonds were dip-inoculated in a four-strain Salmonella cocktail and conditioned to a of 0.43, 0.33, 0.23, and 0.20. The inoculated almonds were then placed in vacuum-sealed mylar bags (vacuum packaging), ambient-sealed glass tubes (non-vacuum packaging), and petri dishes without covers (no packaging). The packaged and un-packaged almonds were treated by dry heat with 13 % relative humidity at 73 °C. Vacuum packaging in general achieved slightly better (in some cases significantly better (p < 0.05)) or similar inactivation effect on Salmonella than non-vacuum packaging. Both vacuum and non-vacuum packaging methods achieved much greater Salmonella inactivation than the no packaging method. For example, a 4-h treatment at 73 °C reduced Salmonella on almonds with a of 0.43 by 5.1-, 4.4-, and 1.3-log for mylar bag, tube, and petri dish, respectively. Higher a levels resulted in better inactivation of Salmonella. To achieve a >4-log reduction of Salmonella on almonds packaged in mylar bags, 3-, 6-, 8-, and 8-h of heat treatment were needed for almonds with a values of 0.43, 0.33, 0.23 and 0.20, respectively. Vacuum packaging in combination with a 4-h heat treatment of almonds with initial a of 0.43 or 8-h heat treatment of almonds with initial a of 0.33 could achieved a ≥5-log reduction of Salmonella. Those two combinations resulted in very little weight loss (≤0.05 %), insignificant color change (∆E ≤ 1.26), and unnoticeable change in visual appearance of almonds, demonstrating that they could be potentially used for raw almond pasteurization.
Topics: Colony Count, Microbial; Decontamination; Food Microbiology; Hot Temperature; Prunus dulcis; Salmonella
PubMed: 35926399
DOI: 10.1016/j.ijfoodmicro.2022.109849