Palliative care challenges : implications for nurses' practice in renal settings

The very act of withdrawing dialysis places renal nurses in a unique practice setting requiring a sudden shift in care delivery from one of providing Ife-sustaining, active treatment to that of palliation. The impact of this act on the renal nurse remains largely invisible. Minimal research has been conducted that explores the significant issues and challenges that exist for renal nurses in the delivery of palliation following withdrawal of dialysis treatment. This paper attempts to highlight the issues and challenges that do exist for renal nurses in providing palliation and the subsequent lack of available research knowledge to inform practice in the renal setting. It recommends further research be conducted into the renal setting so as to inform the development of appropriate education to support renal nurses practice in the future.

Critical gap estimation by numerical and statistical highest likelihood search

Many traffic situations require drivers to cross or merge into a stream having higher priority. Gap acceptance theory enables us to model such processes to analyse traffic operation. This discussion demonstrated that numerical search fine tuned by statistical analysis can be used to determine the most likely critical gap for a sample of drivers, based on their largest rejected gap and accepted gap. This method shares some common features with the Maximum Likelihood Estimation technique (Troutbeck 1992) but lends itself well to contemporary analysis tools such as spreadsheet and is particularly analytically transparent. This method is considered not to bias estimation of critical gap due to very small rejected gaps or very large rejected gaps. However, it requires a sufficiently large sample that there is reasonable representation of largest rejected gap/accepted gap pairs within a fairly narrow highest likelihood search band.

Developing a research method to test a new first-order decision making model for the procurement of public sector major infrastructure

Given global demand for new infrastructure, governments face substantial challenges in funding new infrastructure and simultaneously delivering Value for Money (VfM). The paper begins with an update on a key development in a new early/first-order procurement decision making model that deploys production cost/benefit theory and theories concerning transaction costs from the New Institutional Economics, in order to identify a procurement mode that is likely to deliver the best ratio of production costs and transaction costs to production benefits, and therefore deliver superior VfM relative to alternative procurement modes. In doing so, the new procurement model is also able to address the uncertainty concerning the relative merits of Public-Private Partnerships (PPP) and non-PPP procurement approaches. The main aim of the paper is to develop competition as a dependent variable/proxy for VfM and a hypothesis (overarching proposition), as well as developing a research method to test the new procurement model. Competition reflects both production costs and benefits (absolute level of competition) and transaction costs (level of realised competition) and is a key proxy for VfM. Using competition as a proxy for VfM, the overarching proposition is given as: When the actual procurement mode matches the predicted (theoretical) procurement mode (informed by the new procurement model), then actual competition is expected to match potential competition (based on actual capacity). To collect data to test this proposition, the research method that is developed in this paper combines a survey and case study approach. More specifically, data collection instruments for the surveys to collect data on actual procurement, actual competition and potential competition are outlined. Finally, plans for analysing this survey data are briefly mentioned, along with noting the planned use of analytical pattern matching in deploying the new procurement model and in order to develop the predicted (theoretical) procurement mode.

Assessing the resilience of potable water supplies in Southeast Queensland Australia

Historically, cities as urban forms have been critical to human development. In 1950, 30% of the world’s population lived in major cities. By the year 2000 this had increased to 47% with further expected growth to 50% by the end of 2007. Projections suggest that city-based densities will edge towards 60% of the global total by 2030. Such rapidly increasing urbanisation, in both developed and developing economies, challenges options for governance and planning, as well as crisis and disaster management. A common issue to the livability of cities as urban forms through time has been access to clean and reliable water supply. This is an issue that is particularly important in countries with arid ecosystems, such as Australia. This paper examines preliminary aspects, and theoretical basis, of a study into the resilience of the (potable) water supply system in Southeast Queensland (SEQ), an area with one of the most significant urban growth rates in Australia. The first stage will be to assess needs and requirements for gauging resilience characteristics of a generic water supply system, consisting of supply catchment, storage reservoir/s and treatment plant/s. The second stage will extend the analysis to examine the resilience of the SEQ water supply system incorporating specific characteristics of the SEQ water grid made increasingly vulnerable due to climate variability and projected impacts on rainfall characteristics and compounded by increasing demands due to population growth. Longer-term findings will inform decision making based on the application of the concept of resilience to designing and operating stand-alone and networked water supply infrastructure systems as well as its application to water resource systems more generally.

A discussion of Fashion Victims: Various responses to the report by War on Want, Critical Perspectives on International Business, Vol. 3 Iss: 2, pp.170 - 185

Purpose – The purpose of this paper is to present a selection of responses to the report Fashion Victims, published by War on Want in December 2006. It offers a range of viewpoints presented by members of the Editorial Advisory Board of CPOIB. These are presented in chronological order of submission. There is some cross-reference by contributors to the work of others, but no attempt is made to present a unified argument. Design/methodology/approach – Presents the full contributions of involved participants, without mediation or editorial change. Findings – A number of different perspectives are presented on the central issue that is summarised by the opening heading in War on Want’s report – “How cheap is too cheap?” It is seen that the answer to this question is very much dependent upon the standpoint of the respondent. Originality/value – In presenting this form of commentary, members of the CPOIB Editorial Board seek to stimulate debate about an issue of concern to contemporary society, without resort to the time delay and mediating processes of peer-review normally attached to academic writing. It is hoped that this discussion will provoke further contributions and a widening of the debate. Keywords Corporate social responsibility, Multinational companies, Conditions of employment, Trade unions

Vulnerability assessment of reinforced concrete columns subjected to vehicular impacts

Columns are one of the key load bearing elements that are highly susceptible to vehicle impacts. The resulting severe damages to columns may leads to failures of the supporting structure that are catastrophic in nature. However, the columns in existing structures are seldom designed for impact due to inadequacies of design guidelines. The impact behaviour of columns designed for gravity loads and actions other than impact is, therefore, of an interest. A comprehensive investigation is conducted on reinforced concrete column with a particular focus on investigating the vulnerability of the exposed columns and to implement mitigation techniques under low to medium velocity car and truck impacts. The investigation is based on non-linear explicit computer simulations of impacted columns followed by a comprehensive validation process. The impact is simulated using force pulses generated from full scale vehicle impact tests. A material model capable of simulating triaxial loading conditions is used in the analyses. Circular columns adequate in capacity for five to twenty story buildings, designed according to Australian standards are considered in the investigation. The crucial parameters associated with the routine column designs and the different load combinations applied at the serviceability stage on the typical columns are considered in detail. Axially loaded columns are examined at the initial stage and the investigation is extended to analyse the impact behaviour under single axis bending and biaxial bending. The impact capacity reduction under varying axial loads is also investigated. Effects of the various load combinations are quantified and residual capacity of the impacted columns based on the status of the damage and mitigation techniques are also presented. In addition, the contribution of the individual parameter to the failure load is scrutinized and analytical equations are developed to identify the critical impulses in terms of the geometrical and material properties of the impacted column. In particular, an innovative technique was developed and introduced to improve the accuracy of the equations where the other techniques are failed due to the shape of the error distribution. Above all, the equations can be used to quantify the critical impulse for three consecutive points (load combinations) located on the interaction diagram for one particular column. Consequently, linear interpolation can be used to quantify the critical impulse for the loading points that are located in-between on the interaction diagram. Having provided a known force and impulse pair for an average impact duration, this method can be extended to assess the vulnerability of columns for a general vehicle population based on an analytical method that can be used to quantify the critical peak forces under different impact durations. Therefore the contribution of this research is not only limited to produce simplified yet rational design guidelines and equations, but also provides a comprehensive solution to quantify the impact capacity while delivering new insight to the scientific community for dealing with impacts.

Adventure as the metaphoric basis for constructing a narrative to defuse a collective critical incident

This article describes an exercise in collective narrative practice, built around the metaphor of adventure. This metaphor helped to scaffold the development of stories of personal agency for a group of Australian primary school children whose teachers were afraid they might be traumatised by events which occurred during a school excursion. During the excursion, the group of 110 Year 5 and 6 school children had their accommodation broken into on two separate occasions and various belongings stolen. The very brief period made available for ‘debriefing’ was used to introduce the metaphor of adventure, and open up space for the children to begin constructing a story in which they were ‘powerful’, as an alternative to the story of powerlessness and victimhood in which they were initially caught up.

Structured Telephone Support or Telemonitoring Programs for Patients with Chronic Heart Failure

Background: Specialised disease management programmes for chronic heart failure (CHF) improve survival, quality of life and reduce healthcare utilisation. The overall efficacy of structured telephone support or telemonitoring as an individual component of a CHF disease management strategy remains inconclusive. Objectives: To review randomised controlled trials (RCTs) of structured telephone support or telemonitoring compared to standard practice for patients with CHF in order to quantify the effects of these interventions over and above usual care for these patients. Search strategy: Databases (the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database (HTA) on The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and Science Citation Index Expanded and Conference Citation Index on ISI Web of Knowledge) and various search engines were searched from 2006 to November 2008 to update a previously published non-Cochrane review. Bibliographies of relevant studies and systematic reviews and abstract conference proceedings were handsearched. No language limits were applied. Selection criteria: Only peer reviewed, published RCTs comparing structured telephone support or telemonitoring to usual care of CHF patients were included. Unpublished abstract data was included in sensitivity analyses. The intervention or usual care could not include a home visit or more than the usual (four to six weeks) clinic follow-up. Data collection and analysis: Data were presented as risk ratio (RR) with 95% confidence intervals (CI). Primary outcomes included all-cause mortality, all-cause and CHF-related hospitalisations which were meta-analysed using fixed effects models. Other outcomes included length of stay, quality of life, acceptability and cost and these were described and tabulated. Main results: Twenty-five studies and five published abstracts were included. Of the 25 full peer-reviewed studies meta-analysed, 16 evaluated structured telephone support (5613 participants), 11 evaluated telemonitoring (2710 participants), and two tested both interventions (included in counts). Telemonitoring reduced all-cause mortality (RR 0.66, 95% CI 0.54 to 0.81, P < 0.0001) with structured telephone support demonstrating a non-significant positive effect (RR 0.88, 95% CI 0.76 to 1.01, P = 0.08). Both structured telephone support (RR 0.77, 95% CI 0.68 to 0.87, P < 0.0001) and telemonitoring (RR 0.79, 95% CI 0.67 to 0.94, P = 0.008) reduced CHF-related hospitalisations. For both interventions, several studies improved quality of life, reduced healthcare costs and were acceptable to patients. Improvements in prescribing, patient knowledge and self-care, and New York Heart Association (NYHA) functional class were observed. Authors' conclusions: Structured telephone support and telemonitoring are effective in reducing the risk of all-cause mortality and CHF-related hospitalisations in patients with CHF; they improve quality of life, reduce costs, and evidence-based prescribing.

CDA and values : interdisciplinarity as a critical turn

From their very outset, the disciplines of social science have claimed a need for interdisciplinarity. Proponents of new disciplines have also claimed the whole of human activity as their domain, whilst simultaneously emphasising the need for increased specialisation. Critical social analysis attempts to repair the flaws of specialisation. In this chapter, I argue that the trend towards academic specialisation in social science is most usefully viewed from the perspective of evaluative meaning, and that each new discipline, in emphasising one aspect of a broken conception of humanity, necessarily emphasises one aspect of an already broken conception of value. Critical discourse analysis, qua critical social analysis, may therefore benefit by firstly proceeding from the perspective of evaluative meaning to understand the dynamics of social change and overcome the challenges posed by centuries of intensive specialisation in social science.

Understanding nonsense : breathing life into shibboleths and killing critical thought in higher education

In this paper, I focus on the growing "nonsense industry" which is most apparent in the writing typical of business, government departments, and the financial press. This writing, like technical writing, is characterised by heavy reliance on grammatical metaphor. It endows shibboleths - for instance, "globalisation"; "efficiencies"; "competition"; "modernisation"; "consumer sentiment"; "reform"; and so on - with anthropomorphic qualities. These anthropomorphic artefacts of technocratised language are then presented as having immutable powers over people. Thus they become banal public excuses for negligent practices in both business and government.

Development of diagnostic and prognostic algorithms from vacuum circuit breaker restrike review and its validation proposal

The CIGRE WGs A3.20 and A3.24 identify the requirements of simulation tools to predict various stresses during the development and operational phases of medium voltage vacuum circuit breaker (VCB) testing. This paper reviews the modelling methodology [13], VCB models and tools to identify future research. It will include the application of the VCB model for the impending failure of a VCB using electro-magnetic-transient-program with diagnostic and prognostic algorithm development. The methodology developed for a VCB degradation model is to modify the dielectric equation to cover a restriking period of more than 1 millimetre.

Car following model improvement for traffic safety metrics reproduction

Car Following models have a critical role in all microscopic traffic simulation models. Current microscopic simulation models are unable to mimic the unsafe behaviour of drivers as most are based on presumptions about the safe behaviour of drivers. Gipps model is a widely used car following model embedded in different micro-simulation models. This paper examines the Gipps car following model to investigate ways of improving the model for safety studies application. The paper puts forward some suggestions to modify the Gipps model to improve its capabilities to simulate unsafe vehicle movements (vehicles with safety indicators below critical thresholds). The result of the paper is one step forward to facilitate assessing and predicting safety at motorways using microscopic simulation. NGSIM as a rich source of vehicle trajectory data for a motorway is used to extract its relatively risky events. Short following headways and Time To Collision are used to assess critical safety event within traffic flow. The result shows that the modified proposed car following to a certain extent predicts the unsafe trajectories with smaller error values than the generic Gipps model.

Learning and teaching from the edge to centre stage : Critical factors in embedding sustainable university-wide engagement in external awards and grants funding initiatives.

Teaching awards, grants and fellowships are strategies used to recognise outstanding contributions to learning and teaching, encourage innovation, and to shift learning and teaching from the edge to centre stage. Examples range from school, faculty and institutional award and grant schemes to national schemes such as those offered by the Australian Learning and Teaching Council (ALTC), the Carnegie Foundation for the Advancement of Teaching in the United States, and the Fund for the Development of Teaching and Learning in higher education in the United Kingdom. The Queensland University of Technology (QUT) has experienced outstanding success in all areas of the ALTC funding since the inception of the Carrick Institute for Learning and Teaching in 2004. This paper reports on a study of the critical factors that have enabled sustainable and resilient institutional engagement with ALTC programs. As a lens for examining the QUT environment and practices, the study draws upon the five conditions of the framework for effective dissemination of innovation developed by Southwell, Gannaway, Orrell, Chalmers and Abraham (2005, 2010): 1. Effective, multi-level leadership and management 2. Climate of readiness for change 3. Availability of resources 4. Comprehensive systems in institutions and funding bodies 5. Funding design The discussion on the critical factors and practical and strategic lessons learnt for successful university-wide engagement offer insights for university leaders and staff who are responsible for learning and teaching award, grant and associated internal and external funding schemes.