Drip Rate Research Articles

1688-P: Peak Insulin Drip Rate Associated with Decreased Infections Post–Heart Transplant

Hyperglycemia is associated with infection and rejection in post-solid organ transplant (Tx) patients (pts), but little is known about peak insulin requirements and morbidity. We previously reported an unexpected finding in a retrospective cohort study of 207 liver Tx pts that evaluated the relationship to peak IV insulin requirements and subsequent morbidity. Pts were separated into quartiles (Q) by peak insulin drip rate [U/hr]. In that study, pts in Q4 of insulin requirements had significantly reduced infections out to 6 months post-Tx compared to Q1-3. In the present study, we sought to replicate these findings in 188 heart Tx pts. Peak drip rate Qs are shown in the Figure below. Compared to Q1-3, Q4 pts were similar in age (53 ± 10.7 vs. 50.3 ± 9.4) and BMI (30.4 ± 6.4 vs. 29.2 ± 6.8), but more had DM (42.6% vs. 38.3%, p=0.003). Q4 pts had significantly fewer infections (19.1% vs. 53.9%, p<0.000001) up to 6 mos but similar rejections (4.3% vs. 11.3%, p=0.15). Also, we showed that avg blood glucose levels were not significantly different between Q1-3 and Q4 (p = 1.03). These data in heart Tx pts confirm our findings in liver Tx pts that pts requiring higher insulin doses for glycemic control have decreased infections out to 6 months post Tx. We hypothesize that pts able to mount a greater counterregulatory hormone response to surgery may be healthier and able to better respond to infection. Alternatively, higher insulin doses could be protective. Disclosure G. Upadrasta: None. S.J. Kumar: None. A. Wallia: Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc., UnitedHealth Group. M. Molitch: Advisory Panel; Self; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Pfizer Inc. Consultant; Self; AstraZeneca. Research Support; Self; Novartis Pharmaceuticals Corporation, Novo Nordisk Inc.

SUN-698 Management of Hyperglycemia in an Adult Patient with Glycogen Storage Disease Type 1b

Background: Glycogen storage disease type 1b (GSD1b) is caused by a deficiency of glucose 6 phosphatase leading to glycogen deposition. The hallmark findings of GSD1b are hypoglycemia and lactic acidosis. GSD1b can be associated with hepatomegaly, hypertriglyceridemia, hematologic abnormalities, hypothyroidism, inflammatory bowel disease, proteinuria, and hypoglycemic seizures. Main stay of therapy is to avoid fasting and to ingest frequent feeds high in complex CHO. Raw cornstarch (CS) has been used for the treatment of hypoglycemia in GSD1b since the early 1980s. CS is digested slowly, providing a steady release of glucose allowing for more stable glucose levels over a longer period of time as compared with other sources of CHO. Adults may require more CS to maintain BG >70 mg/dL and lactate <2mmol/L during the night. We report a case of an adult patient with GSD1b admitted with inability to tolerate oral intake and found to have persistent hyperglycemia on admission requiring insulin therapy.Clinical Case: A 31 year old female with a history of GSD1b complicated by hypoglycemia, Crohn’s disease, chronic pancreatitis and neutropenia was admitted for abdominal pain, emesis and inability to tolerate CS. She was made NPO and was started on a dextrose drip to avoid hypoglycemia and hyperlactatemia. The rate of dextrose infusion was adjusted to maintain lactate levels <2 mmol/L. She developed persistent hyperglycemia with glucose values of 250–350 mg/dL. Laboratory evaluation revealed an HbA1c of 7.6% (reference [ref] 4.3–5.6%), C-peptide of 1.3 ng/mL (ref 0.8–3.9 ng/mL), lactate of 2.3–3.1 mmol/L (ref 0.5–2.2 mmol/L). BHB levels were normal (WNL). Anti-GAD, insulin and islet cell antibodies were negative. The main goal was to avoid hypoglycemia while keeping ketone and lactate levels WNL. The decision was made to start a regular insulin infusion at a constant rate of 1 u/hr to keep BG <180 mg/dL while on the dextrose infusion with close monitoring of lactate and BHB. Insulin and dextrose drip rates were adjusted based on BG. The ultimate goal was to determine total daily insulin requirements while ingesting her home CS doses and to transition to long acting insulin. Short acting insulin boluses were not used given risk of hypoglycemia. The patient’s unpredictable tolerance to CS made determining a fixed insulin dose challenging. She eventually managed to tolerate CS and was transitioned to 10 units of insulin Detemir twice daily. She was discharged with plans to get a CGM and a ketone meter. BG readings at home were between 140–170 mg/dL.Conclusion: We report a rare case of GSD1b and diabetes. The pathogenesis may be related to effects of chronic pancreatitis or metabolic syndrome. Treatment of hyperglycemia in patients with GSD1b is challenging given the heightened risk of fasting hypoglycemia. Treatment options are limited, and there are no data regarding the safe use of insulin in this patient population.

Impacts of cave ventilation on drip water δ13CDIC and its paleoclimate implication

The speleothem stable carbon isotope (δ13C) is an important proxy for paleoclimate reconstruction. Understanding the stable carbon isotope composition of dissolved inorganic carbon (δ13CDIC) in drip water is crucial for the interpretation of speleothem δ13C signals. In this study, we present two years of drip water δ13CDIC data and its hydrogeochemistry variables (e.g. PCO2, Ca2+, Mg/Ca, SO42−, pH, drip rate, saturation index of calcite, electrical conductivity) in the Shawan Cave. We also conducted continuous in situ monitoring of PCO2 in the atmosphere, soil air, and cave air and microenvironmental factors. The results show that cave air CO2 primarily originates from soil air CO2, but there is an unsynchronous seasonal variation between cave air CO2 and soil air CO2, which is likely caused by cave ventilation. Cave ventilation is also responsible for seasonal variations in drip water δ13CDIC and speleothem growth. Cave air exchange leads to higher drip water δ13CDIC and rapid speleothem growth in the spring and summer seasons, and cave air stagnation results in lower drip water δ13CDIC and slow speleothem growth. The impact of isotopically light CO2 of soil air on drip water δ13CDIC during spring and summer seasons is more than during autumn and winter seasons, where the more isotopically light CO2 of soil air is enriched by drip water under cave air exchange conditions. Since speleothems growth is rapid in the spring and summer seasons, the speleothems δ13C of the Shawan Cave have the potential to record climate information for the spring and summer seasons. Additionally, by comparing the speleothem δ13C values of eleven caves, we found that paleoclimate signals recorded by speleothem δ13C revealed different seasonal biases under different ventilation types. Therefore, it is necessary to determine the cave ventilation type in order to understand how speleothem δ13C responds to climate change in a ventilated cave.

Numerical Analysis of Meat Quality Traits of Ningdu Yellow Rooster

In order to study the meat quality characteristics of Ningdu yellow rooster, the 7 indexes of 120 healthy Ningdu yellow roosters after slaughter at the age of 16 weeks were determined, and correlation analysis, regression analysis and principal component analysis were carried out among the indexes. The results showed that the variation coefficient of PH value was smaller than that of water drop rate and meat colorimetric, and the lactic acid produced by anaerobic glycolysis of glycogen in chicken meat was slower. Through correlation analysis, the 24-hour drip rate was strongly correlated with the 48-hour drip rate (coefficient ≥ 0.7, p ≤ 0.05), and the other indicators were independent of each other. By means of regression analysis, the regression equation (fitting degree R2 = 0.984) of 24- and 48-hour drip rate was established. Principal component analysis synthesized 7 indicators into 3 principal components, with a cumulative contribution rate of 70.13%, indicating that the meat quality of Ningdu Yellow chicken rooster is mainly selected by water drop rate, PH value and meat color test.

Isotopic and Petrographic Evidence as a Proxy in Paleoclimatic Reconstructions from Flowstones in Southern Spain

Changes in the morphology and mineralogy of speleothems (flowstones) clearly respond to climate-related phenomena, such as drip rate variability and temperature-modulated cave ventilation. Detailed petrographic observations have been coupled with δ18O and δ13C values. Fabrics may show changes related to variations in supersaturation, drip rate or input of detrital particles or organic compounds. Fabrics formed under relatively constant and regular drips (columnar compact, open and elongated) show similar δ18O and δ13C values, which are more negative than those of micrite and microsparite. The combination of internal microstratigraphy studies and isotopic data (δ18O and δ13C) from two flowstones collected from two caves in the north of Almeria province (SE Spain), suggest a spectrum of environmental conditions ranging from wetter to drier periods. Both records constitute a very useful tool for screening and interpreting high-resolution paleoclimate reconstructions.

The Use of a Rapid Fluid Infusion System in Children

Fluid resuscitation is the cornerstone of treatment for pediatric shock caused by conditions such as sepsis, dehydration, trauma, and anaphylaxis. Children presenting to the Emergency Department (ED) in shock have a high risk of mortality, and each hour of delay in shock reversal doubles the odds of death1,2. Pediatric Advanced Life Support (PALS) guidelines emphasize the importance of providing rapid fluid resuscitation to prevent the progression to hypotensive or refractory shock3. PALS and other septic shock guidelines recommend that patients receive a 20 mL/kg bolus of crystalloid immediately upon recognition of hypovolemic or distributive shock, with 20 mL/kg to be delivered within 5 minutes and up to 60 mL/kg within the first 15-60 minutes3-6. Studies based on these guidelines show that earlier fluid delivery directed at reversal of shock reversal leads to decreased morbidity7-9, mortality2,7,9-12, and hospital length of stay (LOS)9,11-13. Unfortunately, timely fluid delivery is often not achieved due to the technical challenges of obtaining adequate vascular access and delivering fluid boluses quickly in patients with shock or hypotension11,14-16. Current methods of fluid bolus delivery in the pediatric emergency care setting include infusion pumps, gravity drip, pressure bags, rapid infusers, and the push-pull syringe technique17,18. Each of these methods are limited by speed, ease of use, or safety concerns. Infusion pumps provide a maximum rate of 999 mL per hour, which for a 25kg child would provide a 60 mL/kg bolus in 90 minutes. In most patients, infusion pumps are therefore too slow to provide adequate fluid resuscitation. Gravity drip rates are unpredictable and inadequate for the treatment of shock and hypotension. For example, up to 50 minutes are required for one liter of fluid to flow through a 22G intravenous (IV) line, and up to 200 minutes via the intraosseous (IO) route19-22. A pressure cuff may speed flow modestly, but requires constant re-inflation, makes volume of infusion difficult to track, and carries the risk of inadvertent air embolism3,20,22-25. Rapid infusers can deliver fluids very quickly but are expensive, require frequent training, are not readily available in many emergency care settings, and importantly do not provide adequate flow with the small gauge IV or intraosseous (IO) access typical of pediatric resuscitation19,26. Due to the limitations of these common fluid delivery methods, pediatric emergency providers commonly use a syringe and 3-way stopcock to repeatedly draw fluid from the container of crystalloid and then deliver to the patient. This technique is referred to as the “push-pull” method and is recommended in the PALS guidelines3. An alternate technique involves disconnecting and reconnecting multiple pre-filled 60mL syringes, which often requires two providers18. Both methods may be associated with increased risk of nosocomial infection due to the difficulty of maintaining syringe sterility27-31. The LifeFlow® infuser (410 Medical, Inc; Durham, NC) is a new manually operated device for rapid fluid bolus delivery that overcomes some of these common barriers. The device is currently FDA-cleared for infusion of crystalloid and colloid fluids, and is in use at our center for emergency resuscitation. Using common IV gauges LifeFlow can deliver fluid 2 to 4 times faster than standard techniques, and allows providers to observe a clinical response immediately by improvements in vital signs, mental status and skin perfusion29,32-34. This study describes the use of the LifeFlow device in a busy academic children’s hospital ED with 74,000 patient visits per year.

Management of water bodies in show caves – A microbial approach

The aim of this study was to monitor factors affecting the microorganisms of water bodies in caves and apply the findings to improve their management. Four show-caves in Romania were sampled monthly to obtain an overview of the changes occurring in the fungal and bacterial communities of cave waters in relation to surface and underground impacts. Test plates were used for microbiological monitoring, alongside the recording of environmental parameters - physicochemical, drip rates, and number of both bats and tourists. A higher number of microbes were obtained during springtime and the summer tourist peak-season. None of the identified strains were cave-specific, and the presence of human-associated taxa was observed from all of the sites. A lack of significant correlation between the abundances of the microorganisms and the physicochemical parameters of the water emphasise the reliability of microorganisms as significant proxies for impacts on underground environments and their use in management decisions.

Intravenous (IV) Monitoring and Refilling S ystem

Intravenous (I.V.) Monitoring and Refilling System is a system for monitoring I.V. therapy and notifying abnormal drip rate and refilling of the I.V. bag. The system has a portable receiver device (for the nurse/nurse station) and a transmitter device (for the patient). The study uses Radio Frequency (RF) medium. RF module was used for transmitting and receiving of the current status data of the monitoring and notifying system. The system has also fiber optic sensors for detecting and counting the drip rate of the I.V. bag. The control panel of the system is placed on the transmitter (patient side). The main objective of the monitoring system is to process an accurate I.V. therapy, prevent the possible backflow of the blood by stopping the I.V. set attached to the system. It makes the I.V. therapy setup fast and easy allowing more time for nurses to perform duties other than monitoring the IV therapy of patients assigned to them. System test results show that transmission delay is not evident in closed area and can transmit accurately without delay up to 70 meters. A 100% detection rates were also recorded for different drip rates and percent IV bag content. Comparing the operating frequency of the I.V. monitoring and refilling system to other medical equipment, the RF module used in the system has an operating frequency that is unique among all the technologies and equipment that may be present in a hospital or clinical setting. The system can also cut down the cost of such medical equipment by 72% if compared to the infusion pump available in the market.

Warming efficacy of Ranger™ and FT2800 fluid warmer under different room temperatures and flow rates.

The comparison of the heating capabilities with different warming system between 3M™ Ranger™ warmer (3M) and FT2800 fluid warmer (FT) under different room temperatures and infusion rates, has been rarely reported previously. The study was then aimed to compare the warming efficacies of dry heat technology (3M) and coaxial warming system (FT) under different room temperatures and infusion rates, the advantages and disadvantages of both infusion systems would be compared to provide reference for clinical infusion practice. In the study, both target warming temperatures of 3M and FT warmer were set at 41°C, fluid was administrated under 20, 22 and 24°C room temperatures and drip rates of 60, 80, 100, 120, 140, 160, 200, 350 drops min-1. The fluid temperature at the outlet of the infusion tube (Toutlet) was measured and compared. The Toutlet of FT was higher than that of 3M (P < 0.001) under different room temperatures. The Toutlet of FT increased with the room temperature raised (P < 0.05). As for 3M, Toutlet was lowest at 20°C (P < 0.001) and no statistical difference of Toutlet was found between 22 and 24°C (P = 0.667). Linear regression showed that the Toutlet of 3M increased with the speed up of drip rate, while the Toutlet of FT was decreased. The relationship between Toutlet & room temperature & drip rate for both 3M and FT warmers was calculated by a formula.3M Ranger™ and FT2800 show different heating capabilities under different room temperatures and drip rates. 3M is more efficient at high flow rate while FT is more efficient at low flow rate. There is a formula relationship between Toutlet & room temperature & drip rate for both 3M and FT warmers.

Sol–gel synthesis and characterization of calcium-deficient hydroxyapatite photocatalysts suitable for hydrogen production: influence of the drip rate in the photocatalytic activity

In the present work, the sol–gel synthesis of calcium-deficient hydroxyapatite samples is reported, under four different drip rates, to investigate their effects on their photocatalytic activity in the water splitting reaction, under UV irradiation. The results of the structural and chemical composition characterizations show that the increase in the drip rate has a negative effect on the stoichiometry, inducing significant deficiencies in the calcium and oxygen content. Likewise, the values of the band gap and valence band energies were determined, showing a correlation between them, and the deficiencies of Ca, O and OH induced by the drip rate. Finally, the photocatalytic production of hydrogen in the presence of the synthesized samples was evaluated, showing in all cases production rates much higher than that obtained by using Degussa P25 as a photocatalyst, under the same conditions.

Patterns and controls of disequilibrium isotope effects in speleothems: Insights from an isotope-enabled diffusion-reaction model and implications for quantitative thermometry

Stable isotope composition of speleothems reflects the physicochemical condition of their formation environment such as the local temperature and the isotopic composition of surface precipitation, making them one of the best archives of terrestrial climate. However, quantitative reconstruction of paleo-temperature from speleothem isotope records is challenging, because most speleothems do not form in isotope equilibrium with the drip water. These disequilibrium isotope effects, often thought to arise from the rapid degassing of CO2 from a thin water film, vary among different speleothems and over time, and hinder the applications of many isotope thermometers in speleothems, including both the conventional carbonate-water oxygen isotope thermometer and the recently developed carbonate clumped isotope thermometer. Here we present an isotope-enabled reaction-diffusion model of speleothem formation (IsoCave), and use it to systematically examine the patterns and controls of the disequilibrium isotope effects in speleothems (δ13C, δ18O, Δ′17O, Δ47, Δ48 and Δ49) and explore their implications for isotope thermometry in speleothems.We show that prior calcite precipitation, cave air pCO2 and δ13CCO2exert the strongest controls on the disequilibrium isotope effects in speleothems, followed by cave temperature, water film thickness and water drip rate. Together, changes in these environment parameters explain the variations of disequilibrium isotope effects in natural speleothems. Our model reproduces the apparent temperature dependence of oxygen isotope compositions of speleothems compiled from multiple caves over a large temperature range, but highlights the challenges in the application of speoleothem-specific calibration of isotope thermometers due to the effects of non-temperature factors. Further, we show the disequilibrium effects in different isotope systems are highly correlated. The slopes of these correlations reflect mainly the kinetic isotope fractionations associated with HCO3− dehydration and dehydroxylation reactions, and remain relatively constant despite changes in environmental conditions especially for speleothems formed during the early evolution period of drip water. Based on these correlations, specifically the correlation between disequilibrium Δ47 and Δ48 effects, we propose a novel approach to quantitatively correct for disequilibrium isotope effects in speleothems and derive more accurate estimates of speleothem formation temperatures. Application of this coupled Δ47-Δ48 approach to synthetic speleothem isotope records reproduces the speleothem formation temperatures, suggesting new opportunities for quantitative paleo-temperature reconstruction based on speleothem isotope records.

The fabric and its formation mechanism of porous-compact laminae in the stalagmite from Shihua Cave, Beijing

The stalagmites in Shihua Cave, Beijing have been intensely studied as archives of regional palaeoclimate. They yield high resolution time series of multi-proxy records which have greatly improved the understanding of the relationship between speleothem formation and climate changes. The stalagmites studied in this cave were composed of fibrous calcite with clear visible and fluorescent laminae. Recently, porous-compact layers at the top 4 mm were found on an actively growing stalagmite (XMG). It consists of visible transparent-opaque layers. A noteworthy observation is that the laminae of calcite fabrics occurred on the top of XMG which formed after the cave open for tourism. The results from scanning electron microscopy analysis on this stalagmite indicates that the opaque microcrystalline calcite (MCC) porous sub-layers are composed of granular mosaic structures, comparing to the compact transparent fibrous columnar calcite (FCC) sub-layers with structures almost oriented perpendicular to the growth surface. Further analysis on the modern carbonate of this site was carried to investigate its formation mechanisms. Based on the size and habit of crystal, these modern carbonate crystallite formations can be categorized into three types. Type I contains larger rhombohedral grains, most of which are formed in the dry season of January–March. Most crystals with c -axis (along the growth direction) represent scales larger than 10 μm and structures of FCC. Type II includes the mixture of large rhombohedrons and small microcrystalline with a scale of less than 4 µm during the transition period of dry to rainy season, with deposition in April−May and October−December. During this period, the scale of large crystals with a diameter of more than 10 µm gradually decreases and the microcrystalline crystals begin growing. Type III consists of calcite precipitates with a spherical habit in the rainy season of June–September. Crystallites with diameters of less than 1 µm can be observed in this period, which is highly related to the new water recharge during this season. To investigate their elemental compositions, both the rhombohedral crystallites and microcrystalline were analyzed through an elemental spectrum analyzer. The results show that the elemental consistency is highly associated with the scales of crystallites. Trace elements, including silicon, aluminum, magnesium, etc. could be obtained on the microcrystalline specimen. On the contrary, only the basic formation elements of calcium carbonate as carbon, oxygen and calcium are detected on rhombohedral structures. Based on these observations, there are two hypotheses on this formation mechanism. Hypothesis I is that, FCC corresponded to the relatively decreased drip rates. During the dry season, the recharge contains high calcite saturation from a stable soil-water-rock interaction over the cave. On the other hand, new water inputs during the rain seasons of increased drip rates result in increased variables including lower index of calcite saturation, complex soil-water-rock interaction and variable amounts of prior calcite precipitation. Hereby, it presents a result of increased MCC with more impurities. Hypothesis II is that, the changed structure might be related to the cave tourism conditions. As the new structure is observed after the cave open to the public, it is expected to suggest a correlation to the tourist patterns. Moreover, both the increased CO2 level and aerosol levels inside cave systems are highly associated with increased visitors, which result in more venting as well as external air inputs. It is likely that the impurities from the external aerosol are the key factors of MCC Formation during the transition period. These anthropogenic factors might play a vital role in the thicker microcrystalline calcite layers formation.

IV DripAssist: An Innovative Way to Monitor Intravenous Infusions Away From an Outlet?

Intravenous (IV) administration of fluids and medications are a significant part of patient treatment. In austere environments, typical methods of counting drops from gravity drips or infusion pumps both have limitations such as accuracy, weight, and need for power. The DripAssist device calculates drip rates by counting drops in IV tubing drip chambers and may provide a useful patient safety monitor adjunct. The protocol was IRB approved, prospective, and designed as a pilot study involving 28 Madigan Army Medical Center Emergency Department personnel. After a brief didactic introduction to the device for clinical staff with no prior experience using the device, participants were timed setting three normal saline infusions at rates of 250 mL/h, 125 mL/h and 83 mL/h with 15gtt/mL tubing. Participants filled out a survey on perceived ease of use and utility of the device compared to pumps and manual counting. Most participants felt the DripAssist device was easy to understand and set up, but nurses and physician assistants were more likely than medics to perceive a benefit versus IV pumps or gravity drips. The DripAssist device may offer a safe, low-weight, functional tool which could improve care in a variety of resource-limited environments. However, additional studies using the device during actual field exercises would be beneficial.

Hydrological and geochemical responses of fire in a shallow cave system

The influence of wildfire on surface soil and hydrology has been widely investigated, while its impact on the karst vadose zone is still poorly understood. A moderate to severe experimental fire was conducted on a plot (10 m × 10 m) above the shallow Wildman's Cave at Wombeyan Caves, New South Wales, Australia in May 2016. Continuous sampling of water stable isotopes, inorganic geochemistry and drip rates were conducted from Dec 2014 to May 2017. After the fire, drip discharge patterns were significantly altered, which is interpreted as the result of increased preferential flows and decreased diffuse flows in the soil. Post-fire drip water δ18O decreased by 6.3‰ in the first month relative to the average pre-fire isotopic composition. Post-fire monitoring showed an increase in drip water δ18O in the following six months. Bedrock related solutes (calcium, magnesium, strontium) decreased rapidly after the fire due to reduced limestone dissolution time and potentially reduced soil CO2. Soil- and ash-derived solutes (boron, lead, potassium, sodium, silicon, iodine and iron) all decreased after the fire due to volatilisation at high temperatures, except for SO42−. This is the first study to understand the hydrological impact from severe fires conducted on a karst system. It provides new insights on the cave recharge process, with a potential explanation for the decreased d18O in speleothem-based fire study, and also utilise the decreased bedrock solutes to assess the wildfire impacts both in short and long time scales.

Development of a wireless intravenous drip rate monitoring device

Biotelemetry increases the efficiency of the healthcare professionals. This study proposes the development of a wireless-communication-enabled low-cost, automated drip rate monitoring system, used for intravenous (IV) therapy. The proposed system monitors the falling fluid drops inside the drip chamber, and subsequently calculates and displays the drip rate on a liquid crystal display (LCD) panel. It is capable of wirelessly notifying the central monitoring station when the drip rate is outside the set range. The system was designed using a light emitting diode (LED), a light-dependent resistor (LDR), a microcontroller and an Xbee wireless module. The proposed device is simple, user-friendly and can reduce the workload of the healthcare givers by reducing their regular visit to the patient site.

Development of a wireless intravenous drip rate monitoring device

Biotelemetry increases the efficiency of the healthcare professionals. This study proposes the development of a wireless-communication-enabled low-cost, automated drip rate monitoring system, used for intravenous (IV) therapy. The proposed system monitors the falling fluid drops inside the drip chamber, and subsequently calculates and displays the drip rate on a liquid crystal display (LCD) panel. It is capable of wirelessly notifying the central monitoring station when the drip rate is outside the set range. The system was designed using a light emitting diode (LED), a light-dependent resistor (LDR), a microcontroller and an Xbee wireless module. The proposed device is simple, user-friendly and can reduce the workload of the healthcare givers by reducing their regular visit to the patient site.

The Effect of Smartphone-Based Application Learning on the Nursing Students' Performance in Preventing Medication Errors in the Pediatric Units.

Introduction:Medication errors (MEs) are potentially harmful patient safety events in all age groups. MEs are particularly hazardous in the pediatric population, especially with patients who require special attention due to the high incidence and severity of disease. This study aimed to determine the effect of a smartphone messenger application on nursing students’ learning regarding the prevention of MEs in pediatric patients.Methods:We performed this quasi-experimental study with 80 nursing students who were randomly divided into intervention and control groups. We collected the data using a researcher-made checklist. We conducted learning through Telegram, a smartphone messenger application (app), for 3 weeks. We analyzed data using SPSS version 16.0 by utilizing descriptive and inferential statistics, and P < 0.05 was considered to be significant.Results:The mean age of the students was 23.5 ± 2.9 years. The majority of mistakes related to MEs in the control groups included the lack of proper control of the following: high risk medication administration, medication incompatibility interactions, medication administration card, medication dose calculations, adverse drug event recognition, pharmaceutical name recognition during drug selection, aseptic and sterile technique adherence, microbore IV tubing flush practices, IV drip rate adjustment, and medication administration schedules. The mean scores of students’ performance were significantly different in the knowledge of preventing MEs between the 2 groups. (P = 0.022).Conclusions:Smartphone learning with the Telegram messenger app improves nursing student knowledge regarding the prevention of MEs in pediatric patients. We recommend that this form of learning be used in nursing schools to prevent errors related to medication ordering, dosing, and administration.

Seasonal variation of bacterial community and their functional diversity in drip water from a karst cave

Caves are natural laboratories to study the subsurface deep biosphere, where drip water connect the caves with outside environments. Drip water may bring microorganisms and DOC from the outside environments into caves which subsequently play a fundamental role in sustaining the oligotrophic subsurface ecosystem. To understand the seasonal dynamics of bacterial communities, their potential metabolic functions, and their association with environmental factors such as precipitation, temperature, drip rate, pH, NO₃⁻, SO₄²⁻, Ca²⁺, Mg²⁺, TOC and FI, drip water samples from Heshang Cave were collected across a two years’ sampling period and subject to 16S rRNA Illumina sequencing and the Biolog-ECO plates analysis. Our results show that the richness and diversity of bacterial communities in the drip water revealed no significant seasonal difference, whereas the compositions of bacterial communities showed a clear seasonal variation, especially <italic>Acinetobacter</italic> and <italic>Pseudomonas</italic>, the dominant groups. In details, the relative abundance of <italic>Acinetobacter </italic>was higher in spring and summer seasons, while lower in autumn and winter seasons. In contrast, the relative abundance of <italic>Pseudomonas</italic> showed an opposite variation to that of <italic>Acinetobacter</italic>. Precipitation, temperature inside and outside the cave, drip rate and conductivity showed strong seasonal variations, whereas other environmental factors exhibited moderate variation within the two years’ period. Among all the environmental factors investigated, precipitation significantly shaped the bacterial community structure, explaining about 27.6% of their seasonal variation. <italic>Pseudomonas</italic> significantly negatively correlated with multiple environmental factors such as precipitation, drip rate and temperature, whereas <italic>Acinetobacter</italic> showed a positive correlation only with the drip rate. Furthermore, potential metabolic functions of bacterial communities in drip water also show clear seasonal variation as indicated both by 16S rRNA PICRUSt and Biolog-ECO plate analysis. The redundancy analysis (RDA) results showed that the relative abundance of <italic>Acinetobacter</italic> demonstrated a significant relationship with the seasonal dynamics of metabolic ability. In addition, <italic>Acinetobacter</italic> revealed a remarkable positive correlation with amino acid metabolism, lipid metabolism, metabolism of terpenoids and polyketid, xenobiotics biodegradation and metabolism, and carboxylic acids metabolism. <italic>Pseudomonas</italic> showed a significant negative correlation with lipid metabolism, metabolism of terpenoids and polyketid, xenobiotics biodegradation and metabolism, and amine metabiolism. Overall, our results showed that precipitation significantly controls the seasonal variation of bacterial communities in drip water and <italic>Acinetobacter</italic> plays an important role in the variation of bacterial functions. This the first report about the bacterial communities and their carbon utilization variation over a 2 years’ period which greatly enhances our understanding about the seasonal dynamics of microbial communities and their correlation with environmental conditions.

Transference of isotopic signal from rainfall to dripwaters and farmed calcite in Mediterranean semi-arid karst

This study was conducted in Ejulve cave (Spain, southwestern Europe) over a period of four years (2013–2016) to identify the factors affecting the isotopic composition of rainfall, dripwaters, and farmed calcite. The results indicate that δ18O of rainfall in the study area was mainly controlled by the temperature effect (r2 = 0.82, p-value < 0.001) with source effect and amount effect being secondary controls. Additionally, it exhibited a seasonal pattern with lower values indicated during winter and higher in summer. The use of effective infiltration to evaluate the recharge of the epikarst is extremely important in semi-arid karst climate conditions. This analysis revealed that while the amount effect exerted a moderate control on the annual δ18O in rainfall, it had a lower influence on the isotopic variability of the rainfall potentially infiltrating the karst aquifer. The sampling of 12 drip locations in Ejulve cave indicated that seepage and seasonal drips featured similar δ18O values in dripwaters. The homogenisation process during the infiltration in the epikarst was not complete, therefore, the δ18O seasonality seen in rainfall was also observed in dripwater δ18O, albeit attenuated and lagged. With the seasonal increase in rainfall in autumn, drip rates of seasonal and seepage groups increased within a few weeks. However, the lower δ18O of autumn–winter rain was observed in dripwaters with a lag as long as 21 weeks. The δ18O in farmed calcite showed a small variation of 0.11‰ while the δ13C varied seasonally with a variation of about 0.22‰ and indicated higher values during summer and autumn and lower values in winter and spring. Seasonal and seepage sites exhibited similar δ18O variability. However, δ13C was more positive in seepage sites and was enhanced by degassing kinetics to produce a variability of up to 0.42‰ in contrast to the 0.29‰ observed in the seasonal sites. The δ18O of calcite showed dependence on the δ18O of dripwater with a weak influence of the drip rate. However, δ13C exhibited a higher correlation with the drip rate and high δ13C was explained by enhanced degassing and low water availability while low δ13C values were in concordance with higher microbial activity, vegetation productivity, and greater water availability. The ventilation of the cave during late autumn through spring favoured the higher calcite deposition rates found during that time.

Drip heterogeneity and the impact of decreased flow rates on the vadose zone fauna in Ciur‐Izbuc Cave, NW Romania

AbstractThe aim of this study was to better understand the unsaturated zone of a karst massif habitat for aquatic fauna by defining patterns of cave drip flow rates. Dripping was logged over a period of 4 years at three points inside Ciur‐Izbuc Cave (north‐western Romania). Drip rates have been analysed at different scales and also compared with rainfall. The results show the individual behaviour of drips on daily, monthly, and yearly timescales and no significant correlations between the three drip points or between them and rainfall. Yearly differences are statistically significant, showing large changes in drip behaviour over the study period. The results point to two different aspects of the water flow through the vadose zone: (a) a space and time heterogeneity raising questions about related stress for the groundwater invertebrates inhabiting this zone and (b) relative uniformity given by signals at certain time intervals that explain species diversity preservation in such a heterogeneous environment. Conservation concerns, and the need for long‐term monitoring of fauna and hydrological processes, are stressed.