Correct Placement Research Articles

The effectiveness of auscultatory, colorimetric capnometry and pH measurement methods to confirm placement of nasogastric tubes: A methodological study.

To determine the effectiveness of auscultatory, colorimetric capnometry and pH measurement methods for confirmation of correct nasogastric tube placement in critically ill patients. Incorrect nasogastric tube placement causes serious complications. This was a methodological and comparative study. The study sample consisted of 88 new insertions of nasogastric feeding tubes between April 2018-2019. Results from the 'auscultatory', 'pH' and 'colorimetric capnometry' methods were compared with the location of the nasogastric tube as determined through radiography. Descriptive statistics, Eta analysis and the Cohen kappa compliance test as well as sensitivity and specificity were conducted. There was a weak agreement (26.3%) between the auscultation and radiological evaluation for confirming nasogastric tube placement. The pH measurement and colorimetric capnometry methods were not correlated with radiological evaluation. Stomach pH increased as patient age increased and use of the colorimetric capnometry method failed to confirm the oesophageal and duodenal location. The specificity of the auscultation was low, and both the specificity and sensitivity pH methods were low. It was determined that auscultation, measuring pH and colorimetric capnometry were unreliable methods for confirming placement of nasogastric tubes. It is recommended to confirm initial placement of the nasogastric tube with radiography and to develop effective and reliable non-radiological measurement methods that can be performed at the bedside.

Augmented Reality in Nursing Education – A Pilot Study

Physical assessment is foundational to the nursing process. Knowledge of physical assessment is critical in nursing practice. Undergraduate nursing students. This quasi-experimental study integrated augmented reality (AR) to assist nursing students to learn techniques of heart/lung assessment. A treatment group using AR technology viewed an overlay of the heart, lungs and rib cage to enhance understanding of correct placement for assessment techniques using anatomical landmarks for respiratory/cardiac assessment compared to a control group without AR. Learning outcomes and learner satisfaction were compared. Psychomotor scores demonstrated an advantage to the AR group. Based on the comparisons between the AR group and the control group, our results demonstrated that the use of AR has the potential to improve the performance and content-mastery in nursing students. AR is a valuable tool for nursing students to apply concepts of physical assessment.

ENHANCEMENT WOOD CARVING IN PRODUCING PREMIUM PRODUCT

Engraving is a process of sculpting, carving and scratching a pattern. In ancient times the art of wood carving became a symbol of status of noble and courtiers. According to Halim Nasir (1986) the courtiers and sultans became patrons to revive the glory of wood carving. This shows that wood carving is high dignity. The Malays emphasizes every work of art and is designed by the soul attempts to communicate with the public in feel, thinking and interpretations, (Nazzri, 2016). However, the price of traditional wood carving product is too high and difficult to educate the public to love wood carving products. The discrepancy between the two modern and traditional industries makes the development of sculpture difficult to compete with modern products. Besides that, wood carving is also used at will in its placement in the design. This study will lead to several main objectives among which is to know the issues faced by these two industries and know the correct placement of carving in the design so as not to violate its philosophy and ethics. Methodology of the study is using interview data and ethnography with master craft. This research and development will involve ten members of timber manufacturing company around Malaysia which is from modern and traditional timber product companies. This research was conducted for 5 days from 14th -18th October 2020 in Temerloh, Pahang. Through this research found three mains issue they facing in order to preserve the wood carving and culture in product and design. The traditional wood carving can be applied on furniture or equipment and preserve the philosophy trough educate the modern practitioner and involvement of ‘pandai kayu’. The application of heritage in the first phase is very important so that it reaches the community indirectly and is not considered outdated.

Characterizing reproducibility of cerebral hemodynamic responses when applying short-channel regression in functional near-infrared spectroscopy.

.SignificanceFunctional near-infrared spectroscopy (fNIRS) enables the measurement of brain activity noninvasively. Optical neuroimaging with fNIRS has been shown to be reproducible on the group level and hence is an excellent research tool, but the reproducibility on the single-subject level is still insufficient, challenging the use for clinical applications.AimWe investigated the effect of short-channel regression (SCR) as an approach to obtain fNIRS measurements with higher reproducibility on a single-subject level. SCR simultaneously considers contributions from long- and short-separation channels and removes confounding physiological changes through the regression of the short-separation channel information.ApproachWe performed a test-retest study with a hand grasping task in 15 healthy subjects using a wearable fNIRS device, optoHIVE. Relevant brain regions were localized with transcranial magnetic stimulation to ensure correct placement of the optodes. Reproducibility was assessed by intraclass correlation, correlation analysis, mixed effects modeling, and classification accuracy of the hand grasping task. Further, we characterized the influence of SCR on reproducibility.ResultsWe found a high reproducibility of fNIRS measurements on a single-subject level ( and correlation ). SCR increased the reproducibility from 0.64 to 0.81 () but did not affect classification (85% overall accuracy). Significant intersubject variability in the reproducibility was observed and was explained by Mayer wave oscillations and low raw signal strength. The raw signal-to-noise ratio (threshold at 40 dB) allowed for distinguishing between persons with weak and strong activations.ConclusionsWe report, for the first time, that fNIRS measurements are reproducible on a single-subject level using our optoHIVE fNIRS system and that SCR improves reproducibility. In addition, we give a benchmark to easily assess the ability of a subject to elicit sufficiently strong hemodynamic responses. With these insights, we pave the way for the reliable use of fNIRS neuroimaging in single subjects for neuroscientific research and clinical applications.

The Comparison Between Supreme Laryngeal Mask Airway and Endotracheal Tube With Respect to Adequacy of Ventilation in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia-A Prospective, Randomized, Double-Blind Study, and Comparative Study.

Laparoscopic cholecystectomy is a commonly performed surgical procedure. Most anesthesiologists advocate tracheal intubation. Laparoscopic cholecystectomy is becoming a day care surgery, hence many anaesthesiologists have started using laryngeal masks to decrease airway manipulation seen with conventional laryngoscopy and endotracheal intubation and avoid hemodynamic pressor responses and postoperative sore throat. The Supreme laryngeal mask airway (LMA) is an innovative, sterile, single use, supraglottic airway management device which provides access to and functional separation of the respiratory and digestive tracts. In this study, there are two objectives-(1) primary objective: to assess the adequacy of ventilation when using LMA-Supreme^(TM) (LMA-S) and endotracheal tube (ETT), and (2) secondary objective: the first is to give the time for achieving effective airway and number of attempts for securing airway. The second is to assess haemodynamic parameters (heart rate and blood pressure). The last is to show the incidence of gastric distension, regurgitation and postoperative sore throat. A total of 132 American Society of Anesthesiologists (ASA) I-II patients were randomly assigned to LMA-S and ETT for intraoperative ventilation. After induction of general anaesthesia, the device was inserted, correct placement was checked, and parameters were recorded. SPSS version 20.0 software (IBM Corp., Armonk, NY, USA) was used for statistical analysis. A P-value less than 0.05 is statistically significant. Ventilatory parameters such as inspiratory and expiratory leak volumes, and peak airway pressure values were comparable between the groups throughout the entire time interval. The number of attempts for successful insertion were comparable, but the mean time required for achieving effective airway was significantly longer in ETT than LMA-S (25.2 ± 8.3 sec vs. 18.6 ± 5.1 sec, respectively [P ＜ 0.05]). There was no situation in which the patient from the LMA-S group had to be intubated. The haemodynamic responses to insertion, pneumoperitoneum inflation and deflation, and removal of the device were greater for the ETT than the LMA-S. There were no complications like gastric distension or regurgitation in either groups. The postoperative sore throat at 2 hours and 24 hours was significantly lower in group LMA-S than group ETT. Positive pressure ventilation with a correctly placed LMA-S allows adequate pulmonary ventilation, without the untoward hemodynamic and postoperative adverse effects of endotracheal intubation, in laparoscopic cholecystectomy surgery.

The Comparison Between Supreme Laryngeal Mask Airway and Endotracheal Tube With Respect to Adequacy of Ventilation in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia-A Prospective, Randomized, Double-Blind Study, and Comparative Study.

Laparoscopic cholecystectomy is a commonly performed surgical procedure. Most anesthesiologists advocate tracheal intubation. Laparoscopic cholecystectomy is becoming a day care surgery, hence many anaesthesiologists have started using laryngeal masks to decrease airway manipulation seen with conventional laryngoscopy and endotracheal intubation and avoid hemodynamic pressor responses and postoperative sore throat. The Supreme laryngeal mask airway (LMA) is an innovative, sterile, single use, supraglottic airway management device which provides access to and functional separation of the respiratory and digestive tracts. In this study, there are two objectives-(1) primary objective: to assess the adequacy of ventilation when using LMA-Supreme^(TM) (LMA-S) and endotracheal tube (ETT), and (2) secondary objective: the first is to give the time for achieving effective airway and number of attempts for securing airway. The second is to assess haemodynamic parameters (heart rate and blood pressure). The last is to show the incidence of gastric distension, regurgitation and postoperative sore throat.A total of 132 American Society of Anesthesiologists (ASA) I-II patients were randomly assigned to LMA-S and ETT for intraoperative ventilation. After induction of general anaesthesia, the device was inserted, correct placement was checked, and parameters were recorded. SPSS version 20.0 software (IBM Corp., Armonk, NY, USA) was used for statistical analysis. A P-value less than 0.05 is statistically significant.Ventilatory parameters such as inspiratory and expiratory leak volumes, and peak airway pressure values were comparable between the groups throughout the entire time interval. The number of attempts for successful insertion were comparable, but the mean time required for achieving effective airway was significantly longer in ETT than LMA-S (25.2 ± 8.3 sec vs. 18.6 ± 5.1 sec, respectively [P ＜ 0.05]). There was no situation in which the patient from the LMA-S group had to be intubated. The haemodynamic responses to insertion, pneumoperitoneum inflation and deflation, and removal of the device were greater for the ETT than the LMA-S. There were no complications like gastric distension or regurgitation in either groups. The postoperative sore throat at 2 hours and 24 hours was significantly lower in group LMA-S than group ETT.Positive pressure ventilation with a correctly placed LMA-S allows adequate pulmonary ventilation, without the untoward hemodynamic and postoperative adverse effects of endotracheal intubation, in laparoscopic cholecystectomy surgery.

Abstract No.: ABS2471: Comparison of landmark versus ECG-guided technique for correct insertion of central venous catheter in paediatric patients undergoing cardiothoracic surgery

Background & Aims:Central venous catheters (CVC), commonly indicated in paediatric patients during cardiac surgeries can cause various complications if not correctly positioned. Objective of this study was to compare correct placement of the CVC tip using anatomical landmark technique with ECG-guided technique.Methods:A prospective, randomised interventional study was conducted on 72 patients of <12 years age, randomly allotted to two groups of 36 patients each (landmark and ECG). After induction, central venous cannulation was performed in right IJV in all patients using either of the techniques. Post operative chest X rays were obtained in all patients and correct position of CVC was checked. CVC tip position within 0.5cm above/ below or at carina was considered as correct position. Analyses were performed using Student’s t-tests and Chi square-tests.Results:It was found that 22 (61.11%) in the landmark group were positioned correctly as compared to 33 (91.67%) in the ECG group (p = 0.006). The mean depth of CVC insertion was 9.05±1.66 in landmark group and 8.26±1.41 in the ECG group (p= 0.032). The landmark group had 12 (33.33%) participants with complications during the procedure, compared to 3 (8.33%) in the ECG-guided group (p = 0.020).Conclusion:ECG-guided technique was found to be more accurate for CVC tip placement than the anatomical landmark technique. ECG-guided technique had less complications than the anatomical landmark technique. Hence, ECG-guided CVC placement is relatively accurate, efficient, and safe.ParameterLandmark Group (n=36)ECG Group (n=36) P Age (in years)6.56±3.646.50±3.480.947Sex (M/F)21/1520/161.00Height (cm)114.04±22.95112.79±22.580.816Weight (kg)19.33±9.4019.83±8.480.810

Abstract No.: ABS3164 : Awake fiberoptic intubation in paediatric patients with temporomandibular joint ankylosis

Background and Aims:Endotracheal Intubation in temporomandibular joint (TMJ) ankylosis is considered as difficult airway manaegment. Fibreoptic intubation is the gold standard for TMJ ankylosis.Methods:In the present study 30 patients aged 5 -14 yrs were enroled for awake fiberoptic intubation [Table 1]. The procdure of awake fiberoptic intubation was explained to them. Patients were preoxygentaion for 5 min using nasal airway. All patient xyolcaine jelly was inserted in more patent nostril and nostril and 1% inj xylocaine was injected trans-tracheal. Following this trachea was intubated using fiber optic intubation. The correct placement of tracheal tube was confirmed with chest auscultation and and endtidal carbondioxide monitoring.Table 1Age of the patients enroled for awake fiberoptic intubation in temporomandibular joint ankylosis n Age 5-7 years18 8-10 years8 10-14 years 4Results:Out of 30 patients,three patients could not be intubated and tracheostomy was done in one patient and in two patients surgery was postponed. In these 2 patients surgery which was done after two weeks using fiberoptic intubation successfully using spontaneous ventilation with oxygen in sevoflurane.Conclusion:The use of awake fiberoptic intubation after explaining to patients and parents resulted in successful outcome in patients of TM ankylosis.

Accurate Location of Catheter Tip With the Free-to-Total Metanephrine Ratio During Adrenal Vein Sampling.

BackgroundThe selectivity index (SI) of cortisol is used to document correct catheter placement during adrenal vein sampling (AVS) in patients with primary aldosteronism (PA). We aimed to determine the cutoff values of the SIs based on cortisol, free metanephrine, and the free-to-total metanephrine ratio (FTMR) using an adapted AVS protocol in combination with CT.MethodsAdults with PA and referred for AVS were recruited in two hypertension centers. The cortisol and free metanephrine-derived SIs were calculated as the concentration of the analyte in adrenal veins divided by the concentration of the analyte in the distal vena cava. The FTMR-derived SI was calculated as the concentration of free metanephrine in the adrenal vein divided by that of total metanephrine in the ipsilateral adrenal vein. The AVS was classified as an unequivocal radiological success (uAVS) if the tip of the catheter was seen in the adrenal vein. The SI cutoffs of each index marker were established using receiver operating characteristic curve analysis.ResultsOut of 125 enrolled patients, 65 patients had an uAVS. The SI cutoffs were 2.6 for cortisol, 10.0 for free metanephrine, 0.31 for the FTMR on the left side, and 2.5, 9.9, and 0.25 on the right side. Compared to free metanephrine and the FTMR, cortisol misclassified AVS as unsuccessful in 36.6% and 39.0% of the cases, respectively.ConclusionThis study is the first to calculate the SIs of cortisol, free metanephrine, and the FTMR indices for the AVS procedure. It confirms that free metanephrine-based SIs are better than those based on cortisol.

Ultrasonographic Confirmation of Nasogastric Tube Placement in the COVID-19 Era.

Background: Nasogastric tube (NGT) placement is a daily routine in the Intensive Care Unit (ICU), and misplacement of the NGT can cause serious complications. In COVID-19 ARDS patients, proning has emerged the need for frequent NGT re-evaluations. The gold standard technique, chest X-ray, is not always feasible. In the present study we report our experience with the use of ultrasonographic confirmation of NGT position. Methods: A prospective study in 276 COVID-19 ARDS patients admitted after intubation in the ICU. Ultrasonographic evaluation was performed using longitudinal or sagittal epigastric views. Examinations were performed during the initial NGT placement and every time the patients returned to the supine position after they had been proned or whenever critical care physicians or nurses considered that reconfirmation was necessary. Results: Ultrasonographic confirmation of correct NGT placement was feasible in 246/276 (89.13%) patients upon ICU admission. In 189/246 (76.8%) the tube could be visualized in the stomach (two parallel lines), in 172/246 (69.9%) the ultrasonographic whoosh test (“flash” due to air instillation through the tube, seen with ultrasonography) was evident, while in 164/246 (66.7%) both tests confirmed correct NGT placement. During ICU stay 590 ultrasonographic NGT evaluations were performed, and in 462 (78.14%) cases correct NGT placement were confirmed. In 392 cases, a chest X-ray was also ordered. The sensitivity of ultrasonographic NGT confirmation in these cases was 98.9%, specificity 57.9%, PPV 96.2%, and NPV 3.8%. The time for the full evaluation was 3.8 ± 3.4 min. Conclusion: Ultrasonographic confirmation of correct NGT placement is feasible in the initial placement, but also whenever needed thereafter, especially in the COVID-19 era, when changes in posture have become a daily practice in ARDS patients.

Actual depth of subarachnoid space - A correlation between subarachnoid space depth estimated by stocker’s formula, craig’s formula and ultrasound guided spinal anaesthesia in the lumbar region

In any patient, the skin to subarachnoid space depth varies significantly at completely different levels of the spinal cord and it additionally varies from patient to patient at the same vertebral level as per patient characteristics like age, sex and body mass index. An estimate of the skin to subarachnoid space depth has been shown to minimize the number of unsuccessful tries, consecutive attempts, traumatic or blood-filled lumbar punctures, typically acting as a depth guide for correct spinal needle placement. In this study we estimated the subarachnoid space depth using ultrasound, stocker’s formula and craig’s formula to determine which provided better correlation to the actual subarachnoid space depth. This study is a Prospective observational study done in the Department of Anaesthesiology, Saveetha Medical College and Hospital, Chennai from August 2020 to February 2021.This study concluded that Ultrasound guided measurement of subarachnoid space depth provided better correlation with actual subarachnoid space depth compared to stocker’s and craig’s.

Changing the peritoneal dialysis access algorithm with a precise technique of percutaneous Seldinger PD catheter placement.

In 1953, Swedish radiologist Sven Seldinger introduced a technique for blood vessel or hollow organ access using a needle, guide wire and catheter. Over the last two decades, this technique has been used for Peritoneal Dialysis (PD) catheter placement, "Seldinger PD" (SPD). To improve the safety and accuracy of SPD, ultrasound, X-ray guidance, contrast imaging and micropuncture techniques have been incorporated to a greater or lesser extent. This manuscript describes a new and rigorous technique of SPD developed at our unit and results in the first 64 cases. One of our goals was to replace emergency Central Vein Catheter Hemodialysis with "Urgent-Start" PD. We therefore sought to develop a procedure that was ultra-safe, minimally invasive and readily done on the sickest patients under Local Anesthetic. As the technique was new to our unit, and because of progressive modifications of the technique, some of the results reflect our "learning curve." In addition, 55% of the patients referred to our program had "crashed" into renal failure, 32% were deemed "unfit for General Anaesthesia" by the Anaesthetists and 53% were moderately to severely obese, resulting in a very morbid and vulnerable cohort. Despite this, we had no procedure related mortality, no organ injury and no significant bleeding. Technical success was 97% (intention-to-treat). Urgent Start PD was used in 36%; overall, 3/61 catheters placed experienced PD fluid leak. Correct catheter tip placement - in the Pelvic Pouch - was documented in all cases; significant catheter migration was seen in 18% of those with imaging follow-up, only two requiring revision. Most catheter migrations occurred early in our series before our low peritoneal puncture technique became standard. We believe this SPD technique is safe, precise, clinically and financially cost-effective and can replace other forms of PD placement in most situations.

A method to assess the impact of safe return to port regulatory framework on passenger ships concept design

The introduction of the ‘Safe Return to Port’ (SRtP) regulations strongly impacted the design of passenger ships. To meet the functional requirements of these regulations, the systems on board reached an extreme level of complexity in terms of redundancy and segregation, considerably increasing the difficulties to assess the compliance of the designs. However, non-compliant designs are a major risk for every design company which must prevent at all costs the possibility of expensive re-designs in later stages of the process. The aim of this research is to address the gap in the literature and in the market of design support tools, presenting a method to effectively mitigate the risks of non-compliant solutions with SRtP. The method comprises a thorough analysis of the spaces on board and a software tool for the assessment of the correct placement of the systems components. The value of the solution proposed was assessed in two case studies in which the method has been proven capable of effectively identifying the non-compliant solutions in a convenient and time-saving manner. Additional features for the suggestion of solutions to achieve the compliance have been implemented in the tool to further support designers during the complex design process of SRtP projects.

Development and internal validation of an equation using anthropometric measures to predict correct endotracheal tube insertion depth.

PurposeTo develop, internally validate, and assess the utility of implementing a regression model for determining endotracheal tube (ETT) insertion depth.Research methodsWe recorded height, weight, age, sex, ETT internal diameter (ID), lip marking, and tracheal position from the electronic record from a random subset of 2,000 intubated subjects obtained from 1 January 2009 to 5 May 2012. A multivariable linear regression model was constructed and validated by a nonparametric bootstrapping technique using unrestricted random sampling methods. A prospective pilot of subjects admitted to the pediatric intensive care unit requiring invasive mechanical ventilatory support was conducted from 7 January 2019 to 31 May 2019. Those with spinal and/or skeletal malformations, without a post-intubation chest-x-ray (CXR) order, or whose CXR quality impaired visualizing the carina and ETT tip, were excluded. The validated regression equation determined insertion depth. CXR following intubation determined ETT position. Demographic data were summarized. Two-tailed, one-sample binomial test of proportions assessed differences in the proportion of correct position by the equation.Main findingsFour hundred and seventy-seven subjects included in model construction yielded 10,000 independent samples for internal validation; 55% were female, and the mean age (SD) was 47 (63) months. Bias between bootstrap coefficients and refined model estimates were negligible (P < 0.01). Eleven subjects in the pilot were female (64%), mean age (SD) of 36.7 (38) months. Four protocol violations (36.4%) resulted in malposition. Subsequent repositioning per protocol resulted in 100% correct positioning (P = 0.01).ConclusionThe regression equation [0.8636 * (Ht. 0.6223)] facilitated correct ETT placement. A larger, diverse sample is required for external model validation.

Methods for estimating X-ray machine output through measurement and simulation

Ball grid arrays are increasingly being applied in the electronics industry and may require X-ray inspection to ensure the integrity and correct placement of solder pins. However, as the architecture of integrated circuits continues to narrow while simultaneously growing more complex, the risk of electronic failure due to radiation damage increases. While medical X-ray devices have been held to high standards and are repeatedly shown to be well characterized, devices used for electronic inspection are often lacking detailed characterization. This study presents unique methods to solve for important properties in X-ray inspection devices such as source to object distance and energy spectrum. This information can then be applied to Monte Carlo models to achieve better overall dose estimates to electronics, which will lead to superior manufactured products. Since X-ray devices can vary greatly in source characteristics, this work investigates spectral measurement and Monte Carlo representation of three X-ray devices. For a Philips SRO 33 100 medical diagnostic device, the spectral output followed expected trends given by the prediction software SpekCalc and Spektr. For the Dage XD7500NT, direct measurement showed a spectral artifact that through the use of Gafchromic films, was shown to be a contributing effect in the dose output. For the Rad Source RS1800, a high powered irradiation device, direct spectral measurement was not achieved. However, a Monte Carlo model using an assumed spectra was found to match ion chamber measurements to a high degree.

Verification of Endotracheal Tube Position by Emergency Nurses Using Ultrasound: A Repeated Measures Cadaver Study

IntroductionEndotracheal intubation is a lifesaving procedure frequently performed in emergency departments. It is associated with some potential risks. Rapid and reliable confirmation of endotracheal tube placement during intubation is critical. Nurses play an important role in the care of patients in various settings. Ultrasound can be performed and interpreted not only by physicians but also by nurses. The aim of this study was to evaluate how well nurses without previous ultrasound experience can determine both esophageal and tracheal localization of endotracheal tubes in cadavers after a short ultrasound training. MethodsThis was a repeated measures study with an educational intervention and no control/contemporaneous comparison group. The study was performed to evaluate the ability of emergency nurses to confirm correct endotracheal tube placement and identify esophageal intubations. A total of 7 emergency nurses were given theoretical education and hands-on training about ultrasound. They diagnosed tracheal or esophageal intubation using ultrasound. ResultsFour cadavers were used 8 times each for the study. A total of 32 intubation procedures were evaluated with ultrasound by each nurse. In the analysis based on 224 responses, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and overall accuracy of ultrasound applied by nurses to detect tracheal intubation were 95.61% (90.06%-98.56%), 97.27% (92.24%-99.43%), 35.06 (11.48-107.10), 0.05 (0.02-0.11), and 96.43% (93.08%-98.45%), respectively. The mean time to evaluate the tube location by ultrasound was 6.57 seconds. DiscussionThe results support that ultrasound can be performed by nurses for the confirmation for esophageal and tracheal intubations quickly and accurately.

Optimization of Agricultural Land Use in Chimbay District of the Republic of Karakalpakstan Using GIS Technologies

The article deals with the issue of optimizing the use of agricultural land. The negative impact of the environmental factors of the Aral Sea requires more work on the efficient use of agricultural land in the region. The focus of the research is on the efficient use of agricultural land based on the optimal placement of Agricultural crops. The main factor in optimizing the use of agricultural land is to reduce the resources spent on agricultural production and increase the productivity of agricultural products. Land use optimization work was carried out using GIS technologies and the results were mapped. Agricultural lands in the Chimbay district with complex ecological conditions were selected as a key object, and it was proposed to place crops based on 3 different solutions. Scenario maps for the placement of Agricultural crops were created using the ArcGIS program and its ArcPy application. Irrigated land for the key object was calculated as the amount and productivity of resources used for growing crops. Through the proposed optimal solution, the resources spent on crop production were reduced by 11% and yields were increased by 34%. This optimization model will greatly help to improve the efficiency of agricultural land use with the correct placement of agricultural networks, taking into account environmental and economic factors.

Real time wire localization by ultrasound during central line insertion improves accurate positioning in all upper torso sites.

To investigate whether point of care ultrasound can improve central venous catheter tip positioning. A single center retrospective case control study. We compared the precision of central venous catheter tip positioning between two intensive care units while in only one of the units, we used point of care ultrasound for guidewire identification. 207 cases in which central venous catheter was inserted using point of care ultrasound guided method, compared to 192 controls. The primary outcome of correct placement of the central venous catheter tip was significantly higher in the point of care ultrasound guided group (97.6% vs 88.0% p=0.001). Central venous catheter tip was located too low among 12% of patients in the control group while in only 2.4% of patients in the point of care ultrasound group (p=0.001). Logistics regression analysis revealed that the correct placement of central venous catheter tip in the point of care ultrasound group versus the control group had an odds ratio of 4.9 (CI 1.6-14.5 P=0.004). Point of care ultrasound for guidewire identification and localization, while inserting central venous catheter from all upper torso sites, improves precision positioning.

Psychometric properties of the Monitoring of the Path of Rehabilitation (MPR) Form.

The correct placement of people with mental disorders in psychiatric residential facilities (PRF) and the monitoring of their progress in these facilities is a critical issue that has not been fully settled in the Italian system. To overcome this problem, some validated instruments are used, which mostly assess the patient's functioning/disability, while no instruments have been set up to assess functional autonomy in patients with a psychiatric disorder residents in RFs. The Verona Department of Mental Health has created the Monitoring of the Path of Rehabilitation (MPR) Form with the aim of assessing the functional autonomy of patients to admit and monitor them adequately in their residential pathways. The aim of this study is to test the main psychometric properties of the MPR Form. The study of the psychometric properties of the MPR Form consisted of three steps: an evaluation conducted more than 15 days apart by two independent evaluators on 18 clinical cases to investigate the test-retest reliability; a test of the 18 clinical cases by the two evaluators to measure the inter-rater rieliability; a measure of convergent validity using the Personal and Social Functioning Scale. Eight professionals completed a satisfaction questionnaire regarding the acceptability of the MPR Form. Inter-rater and test-retest analyses were conducted using intraclass correlation coefficients. Convergent validity was investigated using Kendall's tau-b rank correlation coefficient and acceptability using a frequency analysis. Inter-rater and test-retest reliability were good, as well for concurrent validity and acceptability. The data presented in this article demonstrate that it is possible to measure the functional autonomy of patients in Italian SRPs using the MPR Form.

Unusual substrate specificity in GH family 12: structure-function analysis of glucanases Bgh12A and Xgh12B from Aspergillus cervinus, and Egh12 from Thielavia terrestris.

In this study, we compared the properties and structures of three fungal GH12 enzymes: the strict endoglucanase Bgh12A and the xyloglucanase Xgh12B from Aspergillus cervinus, and the endoglucanase Egh12 from Thielavia terrestris combining activity on linear β-glucan and branched xyloglucan. Egh12 from T. terrestris was produced in Pichia pastoris, purified, and characterized as a thermostable enzyme with maximal activity at 70 ºC and a half-life time of 138min at 65°C. We for the first time demonstrated that the GH12 endoglucanases Egh12 and Bgh12A, but not the strict xyloglucanase Xgh12B, hydrolyzed (1,3)-β-linkages in (1,3;1,4)-β-D-glucooligosaccharides and had transglycosylase activity on (1,3)-β-D-glucooligosaccharides. Phylogenetic analysis indicated that Egh12 from T. terrestris and Bgh12A from A. cervinus are more related than Bgh12A and Xgh12B isolated from one strain. The X-ray structure of Bgh12A was determined with 2.17Å resolution and compared with 3D-homology models of Egh12 and Xgh12B. The enzymes have a β-jelly roll structure with a catalytic cleft running across the protein. Comparative analysis and a docking study demonstrated the importance of endoglucanase-specific loop 1 partly covering the catalytic cleft for correct placement of the linear substrates. Variability in substrate specificity between the GH12 endoglucanases is determined by non-conservative residues in structural loops framing the catalytic cleft. A residue responsible for the thermostability of Egh12 was predicted. The key structural elements and residues described in this study may serve as potential targets for modification aimed at the improvement of enzymatic properties. KEY POINTS: • Thermostable endoglucanase Egh12 from T. terrestris was produced in P. pastoris, purified, and characterized • The X-ray structure of GH12 endoglucanase Bgh12A from A. cervinus was resolved • GH12 endoglucanases, but not GH12 xyloglucanases, hydrolyze (1,3)-β-linkages in (1,3;1,4)-β-D-glucooligosaccharides.