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Background: Venous needle dislodgement (VND) is a serious and potentially fatal complication of haemodialysis. We identified that patients in our dialysis unit were potentially at risk from VND due to inconsistent clinical practice of taping needles and securing lines. Taping technique did not always meet recommended best practice. Furthermore, there was no protocol which new staff could follow, causing confusion and potentially leading to compromised practice. Aims: After a literature search, using current best practice recommendations, we aimed to develop a protocol for taping of dialysis needles and securing of dialysis lines. We followed a quality improvement framework. Methods: To clearly understand current practices, photographs of techniques used for taping needles and securing dialysis lines were taken across all shifts and staff mix. Patients and staff were not identified. Using current best practice recommendations, we developed a protocol using the chevron technique for taping dialysis needles. Recommendations were made for securing dialysis lines. Information and education was provided for staff and patients. Our protocol uses both written explanation and visual representation at each step of the securing process. Results: After extensive staff education, the protocol was successfully introduced. All patients were supportive and comfortable with the technique. A staff evaluation survey was carried out with positive results. Conclusion: By following a quality framework, this policy has been successfully introduced in our unit and within two other dialysis units of this renal service, minimising the risk of VND in our HD patients.

Pneumococcal disease (PD) remains a major health concern globally. In children, pneumococcal conjugate vaccines (PCVs) provide protection against PD from most vaccine serotypes, but non-vaccine serotypes contribute to residual disease. V114 is a 15-valent PCV containing all 13 serotypes in Prevnar 13™ (PCV13) and public health important serotypes 22F and 33F. This phase 3 study evaluated safety and immunogenicity of mixed PCV13/V114 regimens using a 3 + 1 dosing schedule when changing from PCV13 to V114 at doses 2, 3, or 4. 900 healthy infants were randomized equally to 5 intervention groups. PCVs were administered in a 3-dose infant series at 2, 4, and 6 months of age followed by a toddler dose at 12–15 months along with concomitant routine vaccines. Safety was evaluated as the proportion of participants with adverse events (AEs). Immunoglobulin G (IgG) responses to the 15 serotypes in V114 were measured at 30 days post-dose 3 and 30 days post-dose 4 (PD4). Frequencies of injection-site and systemic AEs were generally comparable across all intervention groups. At 30 days PD4 (primary endpoint), IgG geometric mean concentrations (GMCs) for the 13 shared serotypes were generally comparable between mixed V114/PCV13 and 4-dose regimens of PCV13 or V114. In mixed regimens at 30 days PD4, a toddler dose of V114 was sufficient to achieve IgG GMCs comparable to a 4-dose regimen of V114 for serotype 22F, while at least one infant dose was needed in addition to the toddler dose to achieve IgG GMCs comparable to a 4-dose regimen of V114 for serotype 33F. V114 was well tolerated with a generally comparable safety profile to PCV13. For 13 shared serotypes, both mixed regimens and the V114 4-dose regimen induced generally comparable antibody responses to 4-dose regimen with PCV13. Study results support interchangeability of V114 with PCV13 in infants. Trial registration:ClinicalTrials.gov: NCT03620162; EudraCT: 2018–001151-12.

A general method is developed to obtain conditions on initial data and forcing terms for the global existence of unique regular solutions to incompressible 3d Navier-Stokes equations. The basic idea generalizes a probabilistic approach introduced by LeJan and Sznitman (1997) to obtain weak solutions whose Fourier transform may be represented by an expected value of a stochastic cascade. A functional analytic framework is also developed which partially connects stochastic iterations and certain Picard iterates. Some local existence and uniqueness results are also obtained by contractive mapping conditions on the Picard iteration.

The complex measure condition was introduced by Itô (1965) as a sufficient condition on the potential term in a one-dimensional Schrödinger equation and/or corresponding linear diffusion equation to obtain a Feynman-Kac path integral formula. In this paper we provide an alternative probabilistic derivation of this condition and extend it to include any other lower order terms, i.e. drift and forcing terms, that may be present. In particular, under a complex measure condition on the lower order terms of the diffusion equation, we derive a representation of mild solutions of the Fourier transform as a functional of a jump Markov process in wave-number space.