Reducing pressure injuries in critically ill patients by using a patient skin integrity care bundle (InSPiRE)

Purpose To test an interventional patient skin integrity bundle, InSPiRE protocol, on the impact of pressure injuries (PrIs) in critically ill patients in an Australian adult intensive care unit (ICU). Methods Before and after design was used where the group of patients receiving the intervention (InSPiRE protocol) was compared with a similar control group who received standard care. Data collected included demographic and clinical variables, skin assessment, PrI presence and stage, and a Sequential Organ Failure Assessment (SOFA) score. Results Overall, 207 patients were enrolled, 105 in the intervention group and 102 in the control group. Most patients were men, mean age 55. The groups were similar on major demographic variables (age, SOFA scores, ICU length of stay). Pressure injury cumulative incidence was significantly lower in the intervention group (18%) compared to the control group for skin injuries(30.4%) (χ2=4.271, df=1, p=0.039) and mucous injuries (t test =3.27, p=<0.001) . Significantly fewer PrIs developing over time in the intervention group (Logrank= 11.842, df=1, p=<0.001) and patients developed fewer skin injuries (>3 PrIs/patient = 1/105) compared with the control group (>3 injuries/patient = 10/102) (p=0.018). Conclusion The intervention group, recieving the InSPiRE protocol, had lower PrI cumulative incidence, and reduced number and severity of PrIs that developed over time. Systematic and ongoing assessment of the patient's skin and PrI risk as well as implementation of tailored prevention measures are central to preventing PrIs.

Selection criteria in the search for a sperm donor: Behavioural traits versus physical appearance

Despite extensive literature on female mate choice, empirical evidence on women’s mating preferences in the search for a sperm donor is scarce, even though this search, by isolating a male’s genetic impact on offspring from other factors like paternal investment, offers a naturally ”controlled” research setting. In this paper, we work to fill this void by examining the rapidly growing online sperm donor market, which is raising new challenges by offering women novel ways to seek out donor sperm. We not only identify individual factors that influence women’s mating preferences but find strong support for the proposition that behavioural traits (inner values) are more important in these choices than physical appearance (exterior values). We also report evidence that physical factors matter more than resources or other external cues of material success, perhaps because the relevance of good character in donor selection is part of a female psychological adaptation throughout evolutionary history. The lack of evidence on a preference for material resources, on the other hand, may indicate the ability of peer socialization and better access to resources to rapidly shape the female decision process. Overall, the paper makes useful contributions to both the literature on human behaviour and that on decision-making in extreme and highly important situations.

Commuting mode choice in transit oriented development: Disentangling the effects of competitive neighbourhoods, travel attitudes, and self-selection

This research identifies the commuting mode choice behaviour of 3537 adults living in different types of transit oriented development (TOD) in Brisbane by disentangling the effects of their “evil twin” transit adjacent developments (TADs), and by also controlling for residential self-selection, travel attitudes and preferences, and socio-demographic effects. A TwoStep cluster analysis was conducted to identify the natural groupings of respondents’ living environment based on six built environment indicators. The analysis resulted in five types of neighbourhoods: urban TODs, activity centre TODs, potential TODs, TADs, and traditional suburbs. HABITAT survey data were used to derive the commute mode choice behaviour of people living in these neighbourhoods. In addition, statements reflecting both respondents’ travel attitudes and living preferences were also collected as part of the survey. Factor analyses were conducted based on these statements and these derived factors were then used to control for residential self-selection. Four binary logistic regression models were estimated, one for each of the travel modes used (e.g. public transport, active transport, less sustainable transport such as the car/taxi, and other), to differentiate between the commuting behaviour of people living in the five types of neighbourhoods. The findings verify that urban TODs enhance the use of public transport and reduce car usage. No significant difference was found in the commuting behaviour between respondents living in traditional suburbs and TADs. The results confirm the hypothesis that TADs are the “evil twin” of TODs. The data indicates that TADs and the mode choices of residents in these neighbourhoods is a missed transport policy opportunity. Further policy efforts are required for a successive transition of TADs into TODs in order to realise the full benefits of these. TOD policy should also be integrated with context specific TOD design principles.

Costs assessor selection: A question of timing, or cost?

In Lessbrook Pty Ltd (in liq) v Whap; Stephen; Bowie; Kepa & Kepa [2014] QCA 63 the Queensland Court of Appeal dealt with significant questions of general application relating to the appointment of assessors to conduct an assessment of costs under the Uniform Civil Procedure Rules 1999 (Qld) (UCPR).

Capnography monitoring during procedural sedation and analgesia: A systematic review protocol

Background An important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation. The hypothesis is that earlier identification of respiratory depression using capnography leads to a change in clinical management that prevents hypoxaemia. As inadequate oxygenation/ventilation is the most common reason for injury associated with PSA, reducing episodes of hypoxaemia would indicate that using capnography would be safer than relying on standard monitoring alone. Methods/design The primary objective of this review is to determine whether using capnography during PSA in the hospital setting improves patient safety by reducing the risk of hypoxaemia (defined as an arterial partial pressure of oxygen below 60 mmHg or percentage of haemoglobin that is saturated with oxygen [SpO2] less than 90 %). A secondary objective of this review is to determine whether changes in the clinical management of sedated patients are the mediating factor for any observed impact of capnography monitoring on the rate of hypoxaemia. The potential adverse effect of capnography monitoring that will be examined in this review is the rate of inadequate sedation. Electronic databases will be searched for parallel, crossover and cluster randomised controlled trials comparing the use of capnography with standard monitoring alone during PSA that is administered in the hospital setting. Studies that included patients who received general or regional anaesthesia will be excluded from the review. Non-randomised studies will be excluded. Screening, study selection and data extraction will be performed by two reviewers. The Cochrane risk of bias tool will be used to assign a judgment about the degree of risk. Meta-analyses will be performed if suitable. Discussion This review will synthesise the evidence on an important potential clinical benefit of capnography monitoring during PSA within hospital settings. Systematic review registration: PROSPERO CRD42015023740

The importance of group-fit in new director selection

Purpose Director selection is an important yet under-researched topic. The purpose of this paper is to contribute to extant literature by gaining a greater understanding into how and why new board members are recruited. Design/methodology/approach This exploratory study uses in-depth interviews with Australian non-executive directors to identify what selection criteria are deemed most important when selecting new director candidates and how selection practices vary between organisations. Findings The findings indicate that appointments to the board are based on two key attributes: first, the candidates’ ability to contribute complementary skills and second, the candidates’ ability to work well with the existing board. Despite commonality in these broad criteria, board selection approaches vary considerably between organisations. As a result, some boards do not adequately assess both criteria when appointing a new director hence increasing the chance of a mis-fit between the position and the appointed director. Research limitations/implications The study highlights the importance of both individual technical capabilities and social compatibility in director selections. The authors introduce a new perspective through which future research may consider director selection: fit. Originality/value The in-depth analysis of the director selection process highlights some less obvious and more nuanced issues surrounding directors’ appointment to the board. Recurrent patterns indicate the need for both technical and social considerations. Hence the study is a first step in synthesising the current literature and illustrates the need for a multi-theoretical approach in future director selection research.

Top-down influences on lexical selection during spoken word production: A 4T fMRI investigation of refractory effects in picture naming

Spoken word production is assumed to involve stages of processing in which activation spreads through layers of units comprising lexical-conceptual knowledge and their corresponding phonological word forms. Using high-field (4T) functional magnetic resonance imagine (fMRI), we assessed whether the relationship between these stages is strictly serial or involves cascaded-interactive processing, and whether central (decision/control) processing mechanisms are involved in lexical selection. Participants performed the competitor priming paradigm in which distractor words, named from a definition and semantically related to a subsequently presented target picture, slow picture-naming latency compared to that with unrelated words. The paradigm intersperses two trials between the definition and the picture to be named, temporally separating activation in the word perception and production networks. Priming semantic competitors of target picture names significantly increased activation in the left posterior temporal cortex, and to a lesser extent the left middle temporal cortex, consistent with the predictions of cascaded-interactive models of lexical access. In addition, extensive activation was detected in the anterior cingulate and pars orbitalis of the inferior frontal gyrus. The findings indicate that lexical selection during competitor priming is biased by top-down mechanisms to reverse associations between primed distractor words and target pictures to select words that meet the current goal of speech.

Best individual template selection from deformation tensor minimization

We study the influence of the choice of template in tensor-based morphometry. Using 3D brain MR images from 10 monozygotic twin pairs, we defined a tensor-based distance in the log-Euclidean framework [1] between each image pair in the study. Relative to this metric, twin pairs were found to be closer to each other on average than random pairings, consistent with evidence that brain structure is under strong genetic control. We also computed the intraclass correlation and associated permutation p-value at each voxel for the determinant of the Jacobian matrix of the transformation. The cumulative distribution function (cdf) of the p-values was found at each voxel for each of the templates and compared to the null distribution. Surprisingly, there was very little difference between CDFs of statistics computed from analyses using different templates. As the brain with least log-Euclidean deformation cost, the mean template defined here avoids the blurring caused by creating a synthetic image from a population, and when selected from a large population, avoids bias by being geometrically centered, in a metric that is sensitive enough to anatomical similarity that it can even detect genetic affinity among anatomies.

Feature overlap slows lexical selection: Evidence from the picture–word interference paradigm

How does the presence of a categorically related word influence picture naming latencies? In order to test competitive and noncompetitive accounts of lexical selection in spoken word production, we employed the picture–word interference (PWI) paradigm to investigate how conceptual feature overlap influences naming latencies when distractors are category coordinates of the target picture. Mahon et al. (2007. Lexical selection is not by competition: A reinterpretation of semantic interference and facilitation effects in the picture-word interference paradigm. Journal of Experimental Psychology. Learning, Memory, and Cognition, 33(3), 503–535. doi:10.1037/0278-7393.33.3.503) reported that semantically close distractors (e.g., zebra) facilitated target picture naming latencies (e.g., HORSE) compared to far distractors (e.g., whale). We failed to replicate a facilitation effect for within-category close versus far target–distractor pairings using near-identical materials based on feature production norms, instead obtaining reliably larger interference effects (Experiments 1 and 2). The interference effect did not show a monotonic increase across multiple levels of within-category semantic distance, although there was evidence of a linear trend when unrelated distractors were included in analyses (Experiment 2). Our results show that semantic interference in PWI is greater for semantically close than for far category coordinate relations, reflecting the extent of conceptual feature overlap between target and distractor. These findings are consistent with the assumptions of prominent competitive lexical selection models of speech production.

Academic stress, parental pressure, anxiety and mental health among Indian high school students

This work investigates the academic stress and mental health of Indian high school students and the associations between various psychosocial factors and academic stress. A total of190 students from grades 11 and 12 (mean age: 16.72 years) from three government-aided and three private schools in Kolkata India were surveyed in the study. Data collection involved using a specially designed structured questionnaire as well as the General Health Questionnaire. Nearly two-thirds (63.5%) of the students reported stress due to academic pressure – with no significant differences across gender, age, grade, and several other personal factors. About two-thirds (66%) of the students reported feeling pressure from their parents for better academic performance. The degree of parental pressure experienced differed significantly across the educational levels of the parents, mother’s occupation, number of private tutors, and academic performance. In particular, children of fathers possessing a lower education level (non-graduates) were found to be more likely to perceive pressure for better academic performance. About one-thirds (32.6%) of the students were symptomatic of psychiatric caseness and 81.6% reported examination-related anxiety. Academic stress was positively correlated with parental pressure and psychiatric problems, while examination-related anxiety also was positively related to psychiatric problems. Academic stress is a serious issue which affects nearly two thirds of senior high school students in Kolkata. Potential methods for combating the challenges of academic pressure are suggested.

A multi-criteria analysis approach for ranking and selection of microorganisms for the production of oils for biodiesel production

Oleaginous microorganisms have potential to be used to produce oils as alternative feedstock for biodiesel production. Microalgae (Chlorella protothecoides and Chlorella zofingiensis), yeasts (Cryptococcus albidus and Rhodotorula mucilaginosa), and fungi (Aspergillus oryzae and Mucor plumbeus) were investigated for their ability to produce oil from glucose, xylose and glycerol. Multi-criteria analysis (MCA) using analytic hierarchy process (AHP) and preference ranking organization method for the enrichment of evaluations (PROMETHEE) with graphical analysis for interactive aid (GAIA), was used to rank and select the preferred microorganisms for oil production for biodiesel application. This was based on a number of criteria viz., oil concentration, content, production rate and yield, substrate consumption rate, fatty acids composition, biomass harvesting and nutrient costs. PROMETHEE selected A. oryzae, M. plumbeus and R. mucilaginosa as the most prospective species for oil production. However, further analysis by GAIA Webs identified A. oryzae and M. plumbeus as the best performing microorganisms.

A review of benchmarking in carbon labelling schemes for building materials

As one of the largest sources of greenhouse gas (GHG) emissions, the building and construction sector is facing increasing pressure to reduce its life cycle GHG emissions. One central issue in striving towards reduced carbon emissions in the building and construction sector is to develop a practical and meaningful yardstick to assess and communicate GHG results through carbon labelling. The idea of carbon labelling schemes for building materials is to trigger a transition to a low carbon future by switching consumer-purchasing habits to low-carbon alternatives. As such, failing to change purchasing pattern and behaviour can be disastrous to carbon labelling schemes. One useful tool to assist customers to change their purchasing behaviour is benchmarking, which has been very commonly used in ecolabelling schemes. This paper analyses the definition and scope of benchmarking in the carbon labelling schemes for building materials. The benchmarking process has been examined within the context of carbon labelling. Four practical issues for the successful implementation of benchmarking, including the availability of benchmarks and databases, the usefulness of different types of benchmarks and the selection of labelling practices have also been clarified.

Quality-aware review selection based on product feature taxonomy

As of today, user-generated information such as online reviews has become increasingly significant for customers in decision making process. Meanwhile, as the volume of online reviews proliferates, there is an insistent demand to help the users tackle the information overload problem. In order to extract useful information from overwhelming reviews, considerable work has been proposed such as review summarization and review selection. Particularly, to avoid the redundant information, researchers attempt to select a small set of reviews to represent the entire review corpus by preserving its statistical properties (e.g., opinion distribution). However, one significant drawback of the existing works is that they only measure the utility of the extracted reviews as a whole without considering the quality of each individual review. As a result, the set of chosen reviews may consist of low-quality ones even its statistical property is close to that of the original review corpus, which is not preferred by the users. In this paper, we proposed a review selection method which takes review quality into consideration during the selection process. Specifically, we examine the relationships between product features based upon a domain ontology to capture the review characteristics based on which to select reviews that have good quality and preserve the opinion distribution as well. Our experimental results based on real world review datasets demonstrate that our proposed approach is feasible and able to improve the performance of the review selection effectively.

Manifestations of type 2 diabetes in corneal endothelial cell density, corneal thickness and intraocular pressure

We sought to evaluate central corneal thickness (CCT), corneal endothelial cell density (ECD) and intraocular pressure (IOP) in patients with type 2 diabetes mellitus (DM) and to associate potential differences with diabetes duration and treatment modality in a prospective, randomized study. We measured ECD, CCT and IOP of 125 patients with type 2 DM (mean age 57.1¡11.5 years) and compared them with 90 age-matched controls. Measured parameters were analyzed for association with diabetes duration and glucose control modalities (insulin injection or oral medication) while controlling for age. In the diabetic group, the mean ECD (2511¡252 cells/mm2), mean CCT (539.7¡33.6 mm) and mean IOP (18.3¡2.5 mmHg) varied significantly from those the control group [ECD: 2713¡132 cells/mm2 (P,0.0001), CCT: 525.0¡45.3 mm (P50.003) and IOP: 16.7¡1.8 mmHg (P,0.0001)]. ECD was significantly reduced by about 32 cell/mm2 for diabetics with duration of .10 years when compared with those with duration of ,10 years (P,0.05). CCT was thicker and IOP was higher for diabetics with duration of .10 years than those with duration of ,10 years (P.0.05). None of the measured parameters was significantly associated with diabetes duration and treatment modality (P.0.05). In conclusion, subjects with type 2 DM exhibit significant changes in ECD, IOP and CCT, which, however, are not correlated with disease duration or if the patients receive on insulin injection or oral medications.

The role of time pressure and different psychological safety climate referents in the prediction of nurses’ hand hygiene compliance

In this study of 638 Australian nurses, compliance to hand hygiene (HH), as defined by the “five moments” recommended by the World Health Organisation (2009), was examined. Hypotheses focused on the extent to which time pressure reduces compliance and safety climate (operationalised in relation to HH using colleagues, manager, and hospital as referents) increases compliance. It also was proposed that HH climate would interact with time pressure, such that the negative effects of time pressure would be less marked when HH climate is high. The extent to which the three HH climate variables would interact among each other, either in the form of boosting or compensatory effects, was tested in an exploratory manner. A prospective research design was used in which time pressure and the HH climate variables were assessed at Time 1 and compliance was assessed by self-report two weeks later. Compliance was high but varied significantly across the 5 HH Moments, suggesting that nurses make distinctions between inherent and elective HH and also seemed to engage in some implicit rationing of HH. Time pressure dominated the utility of HH climate to have its positive impact on compliance. The most conducive workplace for compliance was one low in time pressure and high in HH climate. Colleagues were very influential in determining compliance, more so than the manager and hospital. Manager and hospital support for HH enhanced the positive effects of colleagues on compliance. Providing training and enhancing knowledge was important, not just for compliance, but for safety climate.