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Search Results: 1 - 10 of 235 matches for " Charmaine Childs "
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Reliability issues in human brain temperature measurement
Charmaine Childs, Graham Machin
Critical Care , 2009, DOI: 10.1186/cc7943
Abstract: The aim of this study was to assess the performance and measurement uncertainty of body and brain temperature sensors currently in use in neurocritical care. Two organic fixed-point, ultra stable temperature sources were used as the temperature references. Two different types of brain sensor (brain type 1 and brain type 2) and one body type sensor were tested under rigorous laboratory conditions and at the bedside. Measurement uncertainty was calculated using internationally recognised methods.Average differences between the 26°C reference temperature source and the clinical temperature sensors were +0.11°C (brain type 1), +0.24°C (brain type 2) and -0.15°C (body type), respectively. For the 36°C temperature reference source, average differences between the reference source and clinical thermometers were -0.02°C, +0.09°C and -0.03°C for brain type 1, brain type 2 and body type sensor, respectively. Repeat calibrations the following day confirmed that these results were within the calculated uncertainties. The results of the immersion tests revealed that the reading of the body type sensor was sensitive to position, with differences in temperature of -0.5°C to -1.4°C observed on withdrawing the thermometer from the base of the isothermal environment by 4 cm and 8 cm, respectively. Taking into account all the factors tested during the calibration experiments, the measurement uncertainty of the clinical sensors against the (nominal) 26°C and 36°C temperature reference sources for the brain type 1, brain type 2 and body type sensors were ± 0.18°C, ± 0.10°C and ± 0.12°C respectively.The results show that brain temperature sensors are fundamentally accurate and the measurements are precise to within 0.1 to 0.2°C. Subtle dissociation between brain and body temperature in excess of 0.1 to 0.2°C is likely to be real. Body temperature sensors need to be secured in position to ensure that measurements are reliable.In rodent models of cerebral ischaemia, small (1° to 2°C) incre
Postpartum Infection in Morbidly Obese Women after Caesarean Section: Does Early Prophylactic Oral Antibiotic Use Make a Difference?  [PDF]
Hannah Yeeles, Sarah Trinick, Charmaine Childs, Hora Soltani, Tom Farrell
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.49077
Abstract:

The rising prevalence of morbid obesity particularly in women coupled with a higher likelihood of having a caesarean section (C-section) birth and an increased risk of surgical site infection (SSI) places wound management among priority areas in maternity care. There is ambiguity about the efficacy of routine preventative care pathways particularly in morbid obese women with regards to SSI after caesarean section. A pilot study was therefore undertaken to explore the number of women with a C-section infection in a cohort of morbidly obese women during six weeks postpartum against a protocol of standard care of early antibiotic prophylaxis and skin closure practice. A short questionnaire was sent to 59 women with an early pregnancy BMI ≥ 40 who gave birth via C-section in a large maternity unit in Sheffield, UK. Data were collated from 39 women with 20 (51%) developing a post-operative wound infection within 6 weeks postpartum. Infections were higher in the women who had emergency C-section births (14/24, 60%). There was no significant difference in wound infection risk with respect to wound closure material (Chi-square = 0.298, p-value = 0.86) or the use of oral prophylactic antibiotic after birth (Chi-square = 0.2053, p-value = 0.650). Although all the women received routine intravenous (IV) antibiotics before C-section, only 26/39 received the 5-day oral antibiotic prophylaxis after birth. Six of 13 women who did not receive postpartum oral antibiotics (46%) developed a SSI. In summary, over half of morbidly obese women who delivered by C-section developed a wound infection, despite receiving prophylactic antibiotics. We acknowledge the limitations of these results from a small-sample retrospective observational study. However, 

Infra-red Thermal Imaging of the Inner Canthus: Correlates with the Temperature of the Injured Human Brain  [PDF]
Charmaine Childs, Mya Myint Zu, Aung Phyo Wai, Yeo Tseng Tsai, Wang Li, Shiqian Wu
Engineering (ENG) , 2012, DOI: 10.4236/eng.2012.410B014
Abstract:

Introduction: Infra-red (IR) thermometry is a safe and valid method to determine internal and surface temperature in human subjects. Under conditions of brain damage (head injury or stroke) knowledge of changes in the temperature of intracranial tissue is justified because of the vulnerability of neurons to accelerated damage at temperatures at the upper end of the febrile range. Aim: To determine the temperature at the inner canthus (IC) of the eye as a potential surrogate for brain temperature. Methods: Invasive monitoring of deep brain structures, lateral ventricle and deep white matter. IR temperature readings obtained at right and left IC. Results:  Strong correlations were evident between R and L IC and brain. Close, as well as poor, agreement between   sites was shown in some patients and at some times. For right hemispheric lesions four had a better correlation between TbrV and TRIC when compared to TLIC.  When the correlation between TbrV and TLIC was better compared to TbrV and TRIC, four had a predominant right hemispheric lesion. Conclusions: Improved techniques for IR thermal imaging accuracy at the bedside has the potential to improve temperature measurement agreement. The predominant lesion side may have a bearing on maximum ipsilateral IC temperature Further studies are ongoing in this pilot study population.

Surrogate consent for critical care research: exploratory study on public perception and influences on recruitment
Daphne AFN Lim, Moon Chan, Charmaine Childs
Critical Care , 2013, DOI: 10.1186/cc11927
Abstract: To determine public willingness for surrogate consent, a quantitative cross-sectional study was undertaken at a University Teaching Hospital in South East Asia during a three month interval. Four hypothetical critical care research scenarios were presented and responses from the public were analysed using a three-part questionnaire.Three hundred and five members of the public were recruited. In general, participants had a positive view of research. The level of education was significantly associated with a person's views about research especially in studies regarded as high risk. For low risk studies, a person's perception of research and willingness to be recruited to a study in the event that they were the (unconscious) patient, was the same whether they were the study subject or the person (legally acceptable representative) giving surrogate consent' on behalf of another (spouse, parent, child). Across all study scenarios, 60-80% of the public preferred to be approached by doctors to discuss the surrogate consent process.Given the hypothetical scenarios presented in this study, the odds of a person having a positive view and willingness to be consented to a critical care research study on the advice of another (surrogate consent) was greater than for those who had a negative or unfavourable view. Nurses may be disadvantaged in leading on the recruitment process due to a preference for information to be delivered by medically qualified clinicians. In the setting of South East Asia, cultural attitudes to nurse-led research in critical care must be taken in to consideration in the multidisciplinary approaches to building the research team.Recruitment of critically ill patients is essential to undertake critical care research. However, the patient frequently lacks capacity to decide for him/herself whether to give informed consent for participation in clinical research. To counteract the barrier that would otherwise exclude research from being undertaken on unconscio
Risk Factors for Acute Delirium in Critically Ill Adult Patients: A Systematic Review
Ihsan Mattar,Moon Fai Chan,Charmaine Childs
ISRN Critical Care , 2013, DOI: 10.5402/2013/910125
Abstract: Background. Delirium is characterized by disturbances of consciousness, attention, cognition, and perception. Delirium is a serious but reversible condition associated with poor clinical outcomes. This has implications for the critically ill patient; the effects of delirium cause long term sequelae, principally cognitive deficits, and functional decline. Objectives. The objective of the paper was to describe risk factors associated with delirium in critically ill adult patients. Methods. Published and unpublished literature from 1990 to 2012, limited to English, was searched using ten databases. Results. Twenty-two studies were included in this paper. A large number of risk factors were presented in the literature; some of these were common across all settings whilst others were exclusive to the type of setting. Benzodiazepines and opioids were shown to be risk factors for delirium independent of setting. Conclusion. With regard to patients admitted to medical and surgical intensive care units, risk factors of older age and comorbidity were common. In the cardiac ICU, older age and lower Mini-Mental Status Examination scores were cited most often as risk factors for delirium, but other risk factors exclusive to the setting were also significant. Benzodiazepines were identified as the most significant pharmacological risk factor for delirium. 1. Introduction Delirium is a syndrome characterized by disturbances of consciousness, attention, cognition, and perception [1]. Delirium has multiple aetiologies, but the predisposing risk factors most frequently cited are older age, cognitive impairment, severity of illness, and iatrogenic causes [2, 3]. Delirium has an acute onset. Symptoms fluctuate over a 24-hour period [4, 5]. Although its presentation is typically associated with symptoms of hyperactive delirium (restlessness, agitation) [4], two other subtypes exist, “hypoactive” and “mixed” [1]. Hypoactive delirium is characterized by lethargy, reduced activity, and apathy [5], whereas mixed delirium features characteristics of both hyperactive and hypoactive deliriums. Although associated with poor clinical outcomes, delirium is typically reversible [6, 7]. This has implications for management of the critically ill patient; not only is the patient’s life threatened by the primary illness, but also the effects of delirium may cause long term sequelae, principally cognitive deficits, and functional decline [8]. Hypoactive and mixed deliriums often go unrecognized despite being more common than hyperactive delirium [3, 8], resulting in undertreatment and
Infra-red thermometry: the reliability of tympanic and temporal artery readings for predicting brain temperature after severe traumatic brain injury
Danielle Kirk, Timothy Rainey, Andy Vail, Charmaine Childs
Critical Care , 2009, DOI: 10.1186/cc7898
Abstract: Brain parenchyma, tympanic membrane and temporal artery temperatures were recorded every 15–30 min for five hours during the first seven days after admission.Twenty patients aged 17–76 years were recruited. Brain and tympanic membrane temperature differences ranged from -0.8 °C to 2.5 °C (mean 0.9 °C). Brain and temporal artery temperature differences ranged from -0.7 °C to 1.5 °C (mean 0.3 °C). Tympanic membrane temperature differed from brain temperature by an average of 0.58 °C more than temporal artery temperature measurements (95% CI 0.31 °C to 0.85 °C, P < 0.0001).At temperatures within the normal to febrile range, temporal artery temperature is closer to brain temperature than is tympanic membrane temperature.Temperature measurement is important during routine neurocritical care. There is retrospective evidence that moderate to high body temperature is an independent predictor of intensive care unit (ICU) and hospital length of stay and leads to a higher mortality and worse outcome in a mixed population of neurosurgical ICU patients [1]. Recent prospective data of brain temperature and outcome in a relatively homogenous population of patients with severe traumatic brain injury (TBI) show that outcome is worse at temperature extremes (high and low) [2]. Current opinion favours treatment of pyrexia in patients with neurological injury. However, there are no published guidelines or recommendations for the management of raised temperature [3]. The focus of the most recent (2007) Brain Trauma Foundation (BTF) guidelines for the management of temperature after human TBI was on the management of hypothermia (a treatment which is limited to a level III recommendation only [4]). Popular opinion has, therefore, considered controlled normothermia as a clinical therapeutic option, but whether normothermia has the potential for therapeutic benefit for the TBI patient remains untested.As body core temperature frequently dissociates from brain temperature [5,6] there remain
Using Abbreviated Injury Scale (AIS) codes to classify Computed Tomography (CT) features in the Marshall System
Mehdi M Lesko, Maralyn Woodford, Laura White, Sarah J O'Brien, Charmaine Childs, Fiona E Lecky
BMC Medical Research Methodology , 2010, DOI: 10.1186/1471-2288-10-72
Abstract: Initially, a Marshall Class was allocated to each AIS code through cross-tabulation. This was agreed upon through several discussion meetings with experts from both fields (clinicians and AIS coders). Furthermore, in order to make this translation possible, some necessary assumptions with regards to coding and classification of mass lesions and brain swelling were essential which were all approved and made explicit.The proposed method involves two stages: firstly to determine all possible Marshall Classes which a given patient can attract based on allocated AIS codes; via cross-tabulation and secondly to assign one Marshall Class to each patient through an algorithm.This method can be easily programmed in computer softwares and it would enable future important TBI research programs using trauma registry data.Trauma registries hold records of patients with Traumatic Brain Injury (TBI) across a designated region mainly for assessment of trauma care centres/systems compared with a national standard e.g. analysing data to predict survival probability (observed - expected survival rates). The demographic and clinical details of trauma patients are submitted to these registries primarily to provide data that will improve clinical outcome for trauma patients but they also form a valuable dataset for epidemiological studies. The Abbreviated Injury Scale (AIS) [1,2] was proposed by the Association for the Advancement of Automotive Medicine and was designed specifically for coding various types of injury and for scoring them based on the severity. Using a standard dictionary, each entry in a trauma registry dataset is assigned a 6-digit AIS code number with a post decimal place representing score of severity. The description for each AIS code is contained in the AIS dictionary. Each post-decimal score of the injury severity ranges from 1 (minimal) to 6 (maximal).The AIS dictionary is structured by anatomical region of the body such as face, neck, abdomen and pelvic contents e
Report of a Consensus Meeting on Human Brain Temperature After Severe Traumatic Brain Injury: Its Measurement and Management During Pyrexia
Charmaine Childs,Tadeusz Wieloch,Fiona Lecky,Graham Machin,Bridget Harris,Nino Stocchetti
Frontiers in Neurology , 2010, DOI: 10.3389/fneur.2010.00146
Abstract: Temperature disturbances are common in patients with severe traumatic brain injury. The possibility of an adaptive, potentially beneficial role for fever in patients with severe brain trauma has been dismissed, but without good justification. Fever might, in some patients, confer benefit. A cadre of clinicians and scientists met to debate the clinically relevant, but often controversial issue about whether raised brain temperature after human traumatic brain injury (TBI) should be regarded as “good or bad” for outcome. The objective was to produce a consensus document of views about current temperature measurement and pyrexia treatment. Lectures were delivered by invited speakers with National and International publication track records in thermoregulation, neuroscience, epidemiology, measurement standards and neurocritical care. Summaries of the lectures and workshop discussions were produced from transcriptions of the lectures and workshop discussions. At the close of meeting, there was agreement on four key issues relevant to modern temperature measurement and management and for undergirding of an evidence-based practice, culminating in a consensus statement. There is no robust scientific data to support the use of hypothermia in patients whose intracranial pressure is controllable using standard therapy. A randomized clinical trial is justified to establish if body cooling for control of pyrexia (to normothermia) vs moderate pyrexia leads to a better patient outcome for TBI patients.
Heptane-1,7-diaminium sulfate monohydrate
Charmaine Arderne
Acta Crystallographica Section E , 2011, DOI: 10.1107/s1600536811030030
Abstract: The crystal structure of the title compound, C7H20N22+·SO42 ·H2O, is presented, with particular focus on the packing arrangement in the crystal structure and selected hydrogen-bonding interactions that the compound forms. The crystal structure exhibits parallel stacking of the diammonium dication in its packing arrangement, together with inorganic–organic layering that is typical of these n-alkyldiammonium salts. An intricate three-dimensional hydrogen-bonding network exists in the crystal structure where the hydrogen bonds link the cation and anion layers together through the sulfate anions and the water molecules.
Heptane-1,7-diaminium dinitrate
Charmaine Arderne
Acta Crystallographica Section E , 2011, DOI: 10.1107/s1600536811042917
Abstract: In the title molecular salt, C7H20N22+·2NO3 , the crystal structure exhibits an unusual back-to-back paired double-stacked packing arrangement culminating in an overall double zigzag pattern of the dications. The nitrate anions form a ring around one pair of double-stacked dications. An intricate three-dimensional N—H...O and N—H...(O,O) hydrogen-bonding network exists in the crystal structure.
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