Correct Fluid Research Articles

Analysis of heat transfer coefficient in radiator cooling system using TiO2/CuO hybrid fluid

The automotive industry is growing, encouraging more efficient car cooling systems, especially radiators. Innovations are constantly being made to improve the performance of radiators. Choosing the correct fluid is one of the ways to increase heat transfer. This study aimed to compare the performance of coolant OBC and TiO2/CuO hybrid fluid mixed with coolant OBC to investigate the increase in heat transfer in the car's radiator. The first step is to make TiO2/CuO hybrid fluid with a two-step method, with volume fraction variations of 1.0, 2.0, 3.0, 4.0, and 5.0%, and observe stability for 30 days. Viscosity and thermal conductivity tests are used to assess the thermophysical properties of the sample. Hybrid fluid samples of TiO2 / CuO with a volume fraction of 5.0% showed the best stability and thermal conductivity, then were added to the coolant brand OBC (1:4). The results showed an increase in heat transfer rate of 23% and a heat transfer coefficient of 20% in the TiO2/CuO hybrid fluid added to the coolant OBC

Treatment outcome and associated factors of infantile hypertrophic pyloric stenosis at eastern Ethiopia public hospitals

BackgroundInfantile hypertrophic pyloric stenosis (IHPS) is a condition whose etiology is not clear, but it is characterized by progressive hypertrophy of the circular muscles of the pylorus with consequent obstruction of the gastric outflow, mostly in neonates and infants under the age of one year.ObjectivesTo assess the treatment outcome and associated factors of infantile pyloric sphincter stenosis among paediatric patients admitted to HFCSUH and JUSHYRH.MethodologyA retrospective patient record review with 78 participants was studied consecutively using a structured questionnaire. The data was processed and analyzed using Epi Info 7 and SPSS version 24. Descriptive analysis was done, and then associated factors to the outcome were assessed using logistic regression analysis. The association’s significance was determined using an odds ratio with a 95% confidence interval and a P-value less than 0.05. The study period was from November 1st to 30th, 2022.ResultsThe magnitude of unfavorable IHPS was 17.1% with a 95% confidence interval of 16.7–23.9%. Hypokalemia (AOR = 2.3, CI = 3.015–19.54), severe dehydration (AOR = 30.9, CI = 2.89–31.75), and delayed presentation (AOR = 7.37, CI = 2.761–12.08) were independent predictors.ConclusionsThe study found a highly unfavorable treatment outcome with delayed presentation; dehydration and electrolyte disturbance were the main predictors of poor outcome. It is recommended to increase community awareness about non-bilious vomiting in infants and ensure high suspicion among healthcare providers. Moreover, following guidelines to correct fluid and electrolyte disturbances and managing these patients in the pediatric ICU postoperatively.

Cystic fibrosis.

Cystic fibrosis is a rare genetic disease caused by mutations in CFTR, the gene encoding cystic fibrosis transmembrane conductance regulator (CFTR). The discovery of CFTR in 1989 has enabled the unravelling of disease mechanisms and, more recently, the development of CFTR-directed therapeutics that target the underlying molecular defect. The CFTR protein functions as an ion channel that is crucial for correct ion and fluid transport across epithelial cells lining the airways and other organs. Consequently, CFTR dysfunction causes a complex multi-organ disease but, to date, most of the morbidity and mortality in people with cystic fibrosis is due to muco-obstructive lung disease. Cystic fibrosis care has long been limited to treating symptoms using nutritional support, airway clearance techniques and antibiotics to suppress airway infection. The widespread implementation of newborn screening for cystic fibrosis and the introduction of a highly effective triple combination CFTR modulator therapy that has unprecedented clinical benefits in up to 90% of genetically eligible people with cystic fibrosis has fundamentally changed the therapeutic landscape and improved prognosis. However, people with cystic fibrosis who are not eligible based on their CFTR genotype or who live in countries where they do not have access to this breakthrough therapy remain with a high unmet medical need.

Transport behavior of particles and evolution of plugging zones in rough fractures: Insights from a novel coupled CFD-DEM model

The meso-mechanism of particle bridging and plugging in rough fractures remains unclear. Therefore, this study explores a novel meso-model for simulating particle transport in rough fractures by combining Computational Fluid Dynamics and Discrete Element Method (CFD-DEM). The dynamic behavior of particles and the corresponding evolution mechanism of plugging zones are investigated. The simulation innovatively uses particle boundaries to correct fluid flow, greatly simplifying the fluid mesh partitioning while ensuring accuracy. The results reveal the connection between particles’ transport and bridging behavior in rough fracture spaces, the distribution characteristics of plugging zones, and fluid flow characteristics. The distribution of bridging favorable zones determines the position and pattern of the front edge of subsequent plugging zones. The stress accumulated by particles has little effect on the strong force chain of the front edge. The force chain strength of the double-particle bridging structure is greater than that of the single-particle bridging structure. Due to weak shear planes, the double-particle bridging structure is more prone to shear failure and instability under external loads. Improving the particle size distribution range can reduce bridging blind zones and achieve better sealing performance. The results provide theoretical help for the design of field operation processes.

SGLT2 Inhibitors Correct Fluid Overload in Adult Kidney Transplant Recipients-A Prospective Observational Study.

In this longitudinal observational study, we measured urinary glucose concentration, body composition and volume status (bioimpedance spectroscopy) and plasma renin and aldosterone concentrations in n = 22 kidney transplant recipients (KTRs) initiating on SGLT2I at baseline (BL), and after 1week and 1, 3, and 6months. Estimated glomerular filtration rate (eGFR) decreased by -2mL/min/1.73m2 (IQR -10-0) after 1week and remained stable thereafter. Urinary glucose concentration was 10 (3-24) g/g creatinine after 1week and correlated with eGFR (r2 = 0.273; p = 0.057). SGLT2I did not affect HbA1c, fasting blood glucose, body weight, fat or lean mass. SGLT2I decreased fluid overload dependent on baseline overhydration (OH, r2 = 0.54, p = 0.0003) without occurrence of dehydration. Plasma aldosterone increased at day 7, while plasma renin did not change significantly. In conclusion, SGLT2I corrected fluid overload in patients with elevated overhydration at baseline, while in euvolemic KTRs fluid status remained stable without reduction of body water below the reference range, thus promoting the safety of SGLT2I therapy in patients following kidney transplantation. Glucosuria, together with effects of SGLT2I on blood glucose control and body weight, is attenuated in KTRs dependent on eGFR.

Carrollian hydrodynamics and symplectic structure on stretched horizons

The membrane paradigm displays underlying connections between a timelike stretched horizon and a null boundary (such as a black hole horizon) and bridges the gravitational dynamics of the horizon with fluid dynamics. In this work, we revisit the membrane viewpoint of a finite-distance null boundary and present a unified geometrical treatment of the stretched horizon and the null boundary based on the rigging technique of hypersurfaces. This allows us to provide a unified geometrical description of null and timelike hypersurfaces, which resolves the singularity of the null limit appearing in the conventional stretched horizon description. We also extend the Carrollian fluid picture and the geometrical Carrollian description of the null horizon, which have been recently argued to be the correct fluid picture of the null boundary, to the stretched horizon. To this end, we draw a dictionary between gravitational degrees of freedom on the stretched horizon and the Carrollian fluid quantities and show that Einstein’s equations projected onto the horizon are the Carrollian hydrodynamic conservation laws. Lastly, we report that the gravitational pre-symplectic potential of the stretched horizon can be expressed in terms of conjugate variables of Carrollian fluids and also derive the Carrollian conservation laws and the corresponding Noether charges from symmetries.

Fluid balance versus weighing: A comparison in ICU patients: A single center observational study.

The fluid balance is a critical parameter in intensive care units (ICU) as it provides information about the patient's volume status. However, the accuracy of fluid balance measurements is often compromised due to the complexity and repetition of actions involved. Additionally, the fluid balance could be recalculated for insensible fluid loss. Weighing is an alternative method to estimate the patient's volume status. Built-in scales in beds make patient weighing easier and less time-consuming, allowing clinicians to intervene more quickly on existing treatments. This study compares fluid balance, and body weight changes over time in ICU patients. Furthermore, it seeks to determine the degree of congruence between the fluid balance corrected for insensible fluid loss and daily body weight in ICU patients. A single-center observational study was conducted in an ICU of a university hospital. All consecutive patients admitted to a bed with an integrated weighing scale were eligible. Exclusion criteria were (1) body weight ≥254,4 kilograms; (2) oral nutrition; (3) a flush catheter or balance; (4) only a single weight measurement; (5) delta body weight change of ≥5kg in 12 hours. Weights and fluid balances were obtained every 12 hours. We obtained 2282 measurements (n = 187 patients). The correlation between weight and fluid balance was weak (r = 0.274). After adjusting the fluid balance for insensible fluid loss, the correlation remained weak (r = 0,268). Bland Altman analysis revealed a wide confidence interval for both the fluid balance and corrected fluid balance versus weight. This study shows a weak correlation between weight and fluid balance. Therefore, when monitoring the volume status in the ICU, fluid balance and weight should both be taken into account. This two-pronged approach is crucial because it provides more control over erroneous fluid balance or weighing measurements.

A case of tuberculous peritonitis accompanied by tuberculous pleuritis

Tuberculous peritonitis is a form of extrapulmonary tuberculosis, a peritoneal or visceral inflammation caused by Mycobacterium tuberculosis. The disease is rarely independent, but is usually a continuation of the tuberculosis process elsewhere, especially pulmonary tuberculosis. We report a case of TB peritonitis accompanied by TB pleurisy, a 29-year-old female patient with complaints of an enlarged abdomen, heartburn, fever, diarrhea, and decreased appetite. Treatment history was Acitral, Zinc, and Metronidazole. On physical examination, it was found that the general condition was weak and the axilla temperature was 39.5ºC. Thorax examination; decreased vesicular sound on the left chest. Abdominal examination; found distension, epigastric tenderness, undulation, shifting dullness, checkerboard phenomenon, and increased bowel noise. Laboratory examination of complete blood; within normal limits. Complete stool; yellow color, mucus (+), leukocytes 4-6/LPB, bacteria (+). The thorax photo showed left pleural effusion, BOF 3 position: ascites. Abdominal ultrasound results: thickening of the peritoneum, ascites, suspected TB peritonitis. Results of ascites and pleural fluid analysis: rivalta (+) and Adenosine Deaminase (ADA) increased. So that from anamnesis, physical examination, supporting examination can be established diagnosis of TB Peritonitis and TB Pleuritis, followed by OAT therapy; FDC for 12 months. From this case it can be concluded that clinical and supporting examinations (radiology) are needed to make a correct diagnosis and body fluid analysis examinations can help confirm the diagnosis.

Six‐Month Consistency of NIH Toolbox Cognition Battery Scores in Healthy Older Black Women with Subjective Cognitive Decline

AbstractBackgroundInterest in the NIH Toolbox Cognition Battery (NIHTB‐CB) for the clinical assessment of older adults is burgeoning. Longitudinal neuropsychological assessments are the most sensitive way to establish cognitive decline and dementia risk of older adults. The psychometric property of measurement invariance is essential to valid interpretations of change. However, few studies have evaluated the stability of NIHTB‐CB scores in a sample of cognitively normal older adults with subjective cognitive decline (SCD). This study aims to analyze measurement consistency of NIHTB‐CB performance over 6 months.Method N = 29 cognitively normal, older Black adult women (65‐81 years of age) with SCD were administered the NIHTB‐CB at baseline and six‐month follow‐up. Diagnostic status was determined via consensus conference following NACC UDS guidelines. We evaluated the mean change by matched‐pairs t‐tests, and measurement consistency by two‐way mixed effects models of intraclass correlations coefficients and Bland‐Altman plots. Uncorrected standard scores and fully corrected T scores were analyzed from NIHTB‐CB Cognition Composites of Total Cognition, Fluid Cognition, and Crystallized Cognition.ResultThere were no significant mean differences from baseline to follow‐up for corrected and uncorrected Total Cognition Scores. The uncorrected Fluid Score significantly increased by 2.5 points at follow‐up (t(28) = 2.18, p = .04), and the corrected Crystallized Score increased by 1.8 points at follow‐up (t(28) = ‐2.25, p = .03). The uncorrected Crystallized Score and the corrected Fluid Score did not differ across assessments. Consistency for the uncorrected and corrected Total scores was good, (ICC(3,1) = 0.83 and 0.80, respectively). Similarly, consistency for uncorrected and corrected Fluid Scores was also good (ICC(3,1) = 0.77 and 0.78). Consistency was excellent for uncorrected Crystallized Scores (ICC(3,1) = .92), but good for corrected scores (ICC(3,1) = .87). Discrepancy scores (baseline vs follow‐up) derived from uncorrected scores for the three composites were unrelated to age and education. Bland‐Altman plots of uncorrected scores for the Composite Scores were consistent with the ICC analyses, showing good agreement between measures.ConclusionNIHTB‐CB corrected and uncorrected composite scores have good longitudinal psychometric properties in a sample of older Black adult women with SCD, a relatively under‐investigated examinee sample. These findings also suggest that change in fluid or crystallized cognition over six months is unlikely in persons with SCD.

Analysis of Flow Rate Distribution in Progressive Divider for Reciprocating Compressor Lubrication

Reciprocating compressors require a correct fluid delivery to each lubrication point. Lubricant defeat means higher component wear and damages, whereas lubricant excess leads to undesired contamination of the processed gas, energy waste and ambient pollution. Two main lubrication systems are used for reciprocating compressors, namely “Pump To Point” (PTP) and “Progressive Divider” (PD) systems. In the first one, there are as many pumps as lubrication points and on each pump unit it is possible to adjust the flow rate delivery. In the second one, a single pump delivers the lubricant to a volumetric flow divider, which provides the metered amount to each lubrication point. A Progressive Divider is modelled under lumped parameter approach, with the aim to highlight its sensitivity to the main operating parameters and to provide awareness about its available operating range. The model is built in Amesim environment and validated thanks to a specific experimental activity that allows to relate the distributed amounts to the lubrication points. The model allows to simulate the PD system under the typical conditions of reciprocating compressors, pointing out its sensitivity on the pressure unbalance among the lubrication points and on the fluid properties. The lumped parameter modelling of PD systems is found to provide reliable information on fluid distribution, effective for design and diagnose activities and for research and development in the field of hydraulic progressive dividers.

Impact of a Treatment Guide on Intravenous Fluids in Minimising the Risk of Hospital-Acquired Hyponatraemia in Denmark.

Hypotonic intravenous (IV) fluids are associated with an increased risk of hospital-acquired hyponatraemia, eventually leading to brain injury and death. We evaluated the effectiveness of a treatment guide to improve prescribing practices of IV fluids. We conducted a before-and-after cross-sectional survey among physicians working at Danish emergency departments. The primary outcome was prescribing practices of IV fluids. Participants were asked which IV fluid they would select in four clinical scenarios. We applied multivariate logistic regression models to estimate the odds ratio of selecting hypotonic fluids. Secondary outcomes included knowledge about IV fluids and hyponatraemia, and the receipt, reading, and usefulness of the treatment guide. After the intervention, about a third (47/154) reported that they would use hypotonic fluids in patients with increased intracranial pressure, and a quarter (39/154) would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. A total of 46% selected the correct fluid, a 3% hypertonic saline solution for a patient with hyponatraemia and severe neurological symptoms. None of the knowledge questions met the predefined criteria of success of 80% correct answers. Of the respondents, 22% had received the treatment guide. Since the implementation failed, we recommend improving distribution by applying methods from implementation science.

Chemical profiling of a 130‐year‐old manuscript reveals the early use of synthetic lead white correction fluid in ancient China

AbstractIn practice, correction fluid to mask text errors has been continuously in demand since papers began to be predominantly used since the late fourth century AD in ancient China. However, research on the trajectory of correction fluid composition has been largely overlooked and has not been revealed currently. In this study, a multianalytical approach was used to investigate a thin whiteout layer, used as correction fluids applied in 1890, on a book page from the famous Imperial Encyclopedia (1726 bronze‐type repaint version). The results showed that the white layer was composed of hydrocerussite ((PbCO3)2·Pb (OH)2) in mixture with plant oil and a tiny portion of calcium carbonate, which had been applied to conceal the originally printed Chinese characters upon which they were rewritten in preparing photographic negatives for reprinting using photolithography. The analysis results also suggest that lead white was likely domestically made using a local lead ore source by the wet synthetic process. Considering the prolonged use of orpiment (As2S3) as a correction fluid ingredient in Chinese tradition, a trajectory to lead white suggests not only advances in pulping and papermaking technology but also a shift in cultural habits and aesthetic psychology in the late Qing Dynasty.

Sensitive determination of naftazone using carbon quantum dots nanoprobe by fluorimetry and smartphone-based techniques

A simple, fast, and direct mix-and-read spectrofluorimetric method has been developed for the sensitive determination of naftazone (NFZ) utilizing graphene quantum dots (GQDs) as a greener and highly luminescent nanosensor. NFZ effectively quenches the strong fluorescence of GQDs at λex/λem of 350/440 nm via the inner filter effect mechanism. The nanosensor exhibits excellent linearity for NFZ over the concentration range of 0.46 to 186 μM with a limit of detection of 0.04 μM. The proposed method was validated for the successful determination of NFZ in tablets and on manufacturing equipment surfaces with good % recoveries of 98.4–101.6 and 96.3 – 102.2%, respectively. Furthermore, an integrated smartphone-based reader has been implemented and successfully applied for the determination of NFZ. The smartphone-based reader consists of a 365 nm UV torch as an excitation source, a smartphone for recording images, and smartphone-powered image analysis software for signal interpretation, together with a paper-based analytical device (PAD) utilizing filter paper as a substrate and correction fluid as a barrier for creation of detection zones. This smart platform showed excellent sensitivity with a limit of detection down to 0.12 nmol/zone, and it could be used for in-site determination of NFZ, especially for the limited resources laboratories.

RelaxNet: A structure-preserving neural network to approximate the Boltzmann collision operator

The extremely high dimensionality and nonlinearity in the Boltzmann equation bring tremendous difficulties to the study of rarefied gas dynamics. This paper addresses a neural network-based surrogate model that provides a structure-preserving approximation for the fivefold collision integral. The notion originates from the similarity in structure between the BGK-type relaxation model and residual neural network (ResNet) when a particle distribution function is treated as the input to the neural network function. Therefore, we extend the ResNet architecture and construct what we call the relaxation neural network (RelaxNet). Specifically, two feed-forward neural networks with physics-informed connections and activations are introduced as building blocks in RelaxNet, which provide bounded and physically realizable approximations of the equilibrium distribution and velocity-dependent relaxation time respectively. The evaluation of the collision term is thus significantly accelerated due to the fact that the convolution in the fivefold integral is replaced by tensor multiplication in the neural network. We fuse the mechanical advection operator and the RelaxNet-based collision operator into a unified model named the universal Boltzmann equation (UBE). We prove that UBE preserves the key structural properties in a many-particle system, i.e., positivity, conservation, invariance, H-theorem, and correct fluid dynamic limit. These properties promise that RelaxNet is superior to strategies that naively approximate the right-hand side of the Boltzmann equation using a machine learning model. A novel sampling strategy based on closure hierarchies of the moment system of the Boltzmann equation is developed to generate reliable and unbiased sampling for the supervised learning. The construction of the RelaxNet-based UBE and its solution algorithm are demonstrated in detail. Several numerical experiments, where the ground-truth datasets are produced by the Shakhov model, velocity-dependent ν-BGK model, and the full Boltzmann equation, are investigated. The capability of the current approach for simulating non-equilibrium flow physics is validated through satisfactory in- and out-of-distribution performance. The open-source codes to reproduce the numerical results are available under the MIT license [1].

Selected personal resources and nutritional behaviours of Polish handball players.

Diet, as one of the factors influencing exercise capacity depends, among others, on individual conditions. The aim of the study was to analyse the nutritional behaviours of Polish handball players depending on their level of generalised self-efficacy as well as disposable optimism and satisfaction with life. The study was carried out among a group of 142 men, aged 20-34, professionally training handball, using the author's original nutritional behaviour questionnaire and the Generalised Self-Efficacy Scale (GSES), the Life Orientation Scale (LOT-R) and Satisfaction with Life Scale (SWLS). Statistical analysis of the results was conducted by estimating Spearman's signed rank correlation coefficients, assuming the significance level of p <0.05. To the highest degree, the handball players fulfilled recommendations regarding the regular consumption of at least 3 meals a day, adequate fluid supplementation in conditions of physical exercise and eating the most caloric meal before or after main training sessions. Along with the increase in sense of efficacy (GSES), the scale of reducing sweet and salty snacks increased (p<0.05). Increasing optimism was conducive to proper hydration (p<0.05) and avoidance of sweet and salty snacks (p<0.05). With the increase in sense of satisfaction with life, the implementation of recommendations regarding the consumption of dairy products and vegetable fats, as well as adequate fluid supplementation in conditions of physical exercise, increased (p<0.05). In the studied group of handball players, a limited scale of implementing qualitative nutritional recommendations for athletes was demonstrated. Moreover, positive correlations were noted between the analysed personal resources and some rational nutritional behaviours of the athletes, especially in terms of avoiding non-recommended products and correct fluid replenishment.

Knowledge, practices and associated factors regarding intravenous fluid electrolyte managements among Jimma University Medical Center Nurses, Southwest Ethiopia: Institution based Cross-Sectional study

BackgroundUnderstanding of fluid compartments within the body and how fluid moves between these compartments helps the nurses to make a competent assessment of fluid and electrolyte balance. Maintaining homeostasis in the body by correct fluid and electrolyte balance is one of the key issues extremely important for health. ObjectiveThe study aimed to assess the nurses’ knowledge, practices and associated factors regarding intravenous fluid electrolyte managements at Jimma University Medical Center, Southwest Ethiopia, 2018. MethodsAn Institution based Cross-Sectional study was conducted from March to May. 422 participants were randomly selected and data was collected using self-administered questionnaire. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 20. The associated factors were identified using Binary and multiple logistic regression models. P-values < 0.05 were considered to be statistically significant. ResultThe result showed that 59.6% and 88.3% of participants had adequate knowledge and good practice respectively. Professional attainment ((AOR = 2.561, 95% CI: 1.645–3.898)), experience ((AOR = 0.8.953, 95% CI: 2.399–33.410)) and respective unit/ward ((AOR = 2.092, 95% CI: 0.499–8.765)) were factors associated with knowledge. While education on intravenous fluid electrolyte (IVF) ((AOR = 3.748, 95% CI: 1.816–7.736)), presence of guide line in the unit ((AOR = 5.414, 95% CI: 1.889–15.518)), presence of fluid balance chart in the unit ((AOR = 3.412, 95% CI: 1.608–7.240)) and experience were associated with practice. Conclusion and recommendationMore than half and majority of respondents have had adequate knowledge good practice respectively. However, there is still knowledge and practice gap regarding intravenous fluid electrolyte managements. Therefore it is recommended to provide in service training and education for nurses.

From Multivalent Writing to a Poetics of the Book: A Media-Specific Analysis of Mary Ruefle’s A Little White Shadow

Mary Ruefle’s A Little White Shadow (2006) asks the reader to consider the book as more than a container for poetry by playing with our expectations of print books: namely stability, permanence, and authority. This work of erasure reproduces the marks Ruefle made to obscure words in the source text of the same name by Emily Malbone Morgan, published in 1889, by creating a facsimile of the original altered with white correction fluid. By utilizing the material object as an essential element of the poem, Ruefle engages this form to move beyond the concept of the book as object or apparatus for presenting poetry. She achieves this by physically erasing an already historically “erased” book – a text that was largely unavailable and unremembered at the time Ruefle published her poem – that treats themes of writing, reading, and literature. This aligns with Johanna Drucker’s definition of the artist’s book as a fine arts practice that interrogates the form and meaning of the medium and questions what a book is. Through this same relationship of form and content, Ruefle develops a poetics of the book. Ultimately, she rejects the idea that the poetry book is dead with the caveat that the codex as a de facto form that does not affect the meaning of the poetry is dying. Instead, Ruefle weaves our expectations and assumptions about the medium into her erasure poem to make this formerly default form an active part of her project.

PSUN220 Audit on Variable Rate Intravenous Insulin Infusion (VRIII) in inpatients in Scarborough General Hospital

Abstract Introduction A Variable Rate Intravenous Insulin Infusion (VRIII) is an infusion of insulin at an interchangeable rate. It involves taking regular capillary blood glucose levels, aiming to control the serum glucose levels with in a specific range and an infusion of glucose containing fluid to prevent insulin induced hypoglycaemia (1). A VRIII is used in patients with known diabetes or with hospital related hyperglycaemia who are unable to take oral fluids/food and for whom adjustment of their own insulin regime is not possible (1). The advantage of a VRIII is the fact is that it involves target driven glucose control for specified indications and avoids metabolic decompensation. Aim To test the compliance of the ward medical staff with VRIII protocol against the local trust policy and the Joint British Diabetes Society guidelines (JBDS). Methodology A retrospective audit on sample of 15 patients at Scarborough General Hospital receiving VRIII on medical and surgical wards. Data was collected over a period of a month. Data collection and analysis performed utilising Microsoft Excel. Audits standards based on trust guidelines and JBDS guidelines. Results Most patients were above age of 60 years, female and type 2 diabetic. 100% of patients had daily electrolytes monitoring, 27% had hypoglycaemia, 13% did not have long-acting insulin started before stopping the VRIII. In 40% of patients, blood glucose levels were not maintained between 6-12 mmol/L. Furthermore, in 13% of patients, blood glucose was not monitored hourly. Conclusion This audit showed a good compliance with daily electrolytes measurement, early referral to diabetic team as well as starting the VRIII with dextrose. It is concerning however that integral measures such as ruling out DKA, not prescribing the correct fluid, not checking blood glucose levels and lowering the incidence of hypoglycaemia were not always present. Overall, this audit has identified areas required for improvement to optimise our compliance with VRIII protocol against local and national guidelines. We hope this can be improved via spreading greater awareness of the VRIII protocol, to promote early recognition of DKA and ensure safety checks occur when applying the VRIII protocol. References George, S., 2022. JBDS-IP The use of Variable Rate Intravenous Insulin Infusion (VRIII) in medical patients. Joint British Diabetes Society. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

842 An audit to assess adherence to the Tongue Reduction Integrated Care Pathway for Beckwith Wiedemann Syndrome

Abstract Aim Beckwith-Wiedemann Syndrome (BWS) is a congenital overgrowth syndrome that occurs in approximately 1 in 15,000 births. A cardinal is macroglossia which can lead to sleep apnoea, difficulties feeding, speech, drooling and malalignment of teeth/jaw. Some children require tongue reduction surgery and are managed with a specific protocol to ensure the correct analgesia, fluid regime and commencement of oral feeds are delivered post-operatively. The aim of the audit was to improve adherence and awareness of the protocol to improve the patient journey. Method Initial audit cycle between 22/01/21 – 03/02/21 in the form of anonymous staff survey. Following initial results staff underwent two separate teaching sessions and posters were applied in key wards and staff areas. Repeat audit was completed between 01/07/2021 – 01/08/2021. Results Initial audit results demonstrated 44% (11/25) of ward staff were unaware of the Tongue Reduction Integrated Care Pathway and 56% (14/25) did not know which condition this protocol and surgical procedure was related to. Following both sets of interventions there was an improvement to 77.8% (14/18) of staff being aware of the protocol and 88.9% (16/18) of staff members knew which syndrome was associated with this pathology. Additionally, in the re-audit we demonstrated that 100% of participants were aware of the analgesia protocol. Correct rationale for fluid regime was demonstrated in 56% vs 24% demonstrating there is still room for improvement in this domain. Conclusion We have demonstrated that through teaching and the implementation of a poster we have improved the awareness of the Tongue Reduction Protocol.

944 Re Audit: Maintenance Iv Fluids Prescribing

Abstract Aim Many hospital admissions require intravenous (IV) fluid therapy to prevent or correct fluid status and/or electrolyte disturbances. Within our trust the recommended IV maintenance fluid is 0.18% Saline in Glucose 4%. This Re audit aimed to assess the knowledge and improve understanding of junior clinicians for IV maintenance fluid prescribing at Royal Preston Hospital by comparing our current practice to Trust guidelines/NICE guidelines Method A multiple choice knowledge questionnaire was used evaluate the knowledge of foundation doctors, core trainee's and advanced care practitioners (n=21). The trusts electronic system was used to review patients prescribed maintenance fluid. (n=50). 1st audit was conducted in October 2020 followed by re audit in April 2021. Results In 1st cycle only 16% of the patients had the recommended maintenance fluid prescribed. We displayed posters and sent email reminders of the trust IV fluid prescribing guidelines. Junior's knowledge of the IV fluid prescribing guidelines improved regarding: recommended maintenance fluid (52% to 80%), Daily fluid requirement in ml/kg/day (66% to 70%) and Recommended monitoring (52% to 100%). This ultimately led to the prescribing of 0.18% Saline in Glucose 4% in 38% of patients. Plasma-Lyte remained the most commonly fluid prescribed in both audit cycles (42% vs 50%). Conclusion Changes implemented after 1st cycle led to improvement is prescribing fluid of choice but there is still room for improvement. Juniors report consultant lead decisions influencing their prescribing and the availability of fluids on the wards.