Alarm setting for the critically ill patient : A descriptive pilot survey of nurses’ perceptions of current practice in an Australian Regional Critical Care Unit

Aim: The aim of this survey was to assess registered nurse’s perceptions of alarm setting and management in an Australian Regional Critical Care Unit. Background: The setting and management of alarms within the critical care environment is one of the key responsibilities of the nurse in this area. However, with up to 99% of alarms potentially being false-positives it is easy for the nurse to become desensitised or fatigued by incessant alarms; in some cases up to 400 per patient per day. Inadvertently ignoring, silencing or disabling alarms can have deleterious implications for the patient and nurse. Method: A total population sample of 48 nursing staff from a 13 bedded ICU/HDU/CCU within regional Australia were asked to participate. A 10 item open-ended and multiple choice questionnaire was distributed to determine their perceptions and attitudes of alarm setting and management within this clinical area. Results: Two key themes were identified from the open-ended questions: attitudes towards inappropriate alarm settings and annoyance at delayed responses to alarms. A significant number of respondents (93%) agreed that alarm fatigue can result in alarm desensitisation and the disabling of alarms, whilst 81% suggested the key factors are those associated with false-positive alarms and inappropriately set alarms.

A new look at the restrictions on the speed and magnitude of train loads for bridge management

In current bridge management systems (BMSs), load and speed restrictions are applied on unhealthy bridges to keep the structure safe and serviceable for as long as possible. But the question is, whether applying these restrictions will always decrease the internal forces in critical components of the bridge and enhance the safety of the unhealthy bridges. To find the answer, this paper for the first time in literature, looks into the design aspects through studying the changes in demand by capacity ratios of the critical components of a bridge under the train loads. For this purpose, a structural model of a simply supported bridge, whose dynamic behaviour is similar to a group of real railway bridges, is developed. Demand by capacity ratios of the critical components of the bridge are calculated, to identify their sensitivity to increase of speed and magnitude of live load. The outcomes of this study are very significant as they show that, on the contrary to what is expected, by applying restriction on speed, the demand by capacity ratio of components may increase and make the bridge unsafe for carrying live load. Suggestions are made to solve the problem.

Anatomical specializations for enhanced olfactory sensitivity in kiwi, Apteryx mantelli

The ability to function in a nocturnal and ground-dwelling niche requires a unique set of sensory specializations. The New Zealand kiwi has shifted away from vision, instead relying on auditory and tactile stimuli to function in its environment and locate prey. Behavioral evidence suggests that kiwi also rely on their sense of smell, using olfactory cues in foraging and possibly also in communication and social interactions. Anatomical studies appear to support these observations: the olfactory bulbs and tubercles have been suggested to be large in the kiwi relative to other birds, although the extent of this enlargement is poorly understood. In this study, we examine the size of the olfactory bulbs in kiwi and compare them with 55 other bird species, including emus, ostriches, rheas, tinamous, and 2 extinct species of moa (Dinornithiformes). We also examine the cytoarchitecture of the olfactory bulbs and olfactory epithelium to determine if any neural specializations beyond size are present that would increase olfactory acuity. Kiwi were a clear outlier in our analysis, with olfactory bulbs that are proportionately larger than those of any other bird in this study. Emus, close relatives of the kiwi, also had a relative enlargement of the olfactory bulbs, possibly supporting a phylogenetic link to well-developed olfaction. The olfactory bulbs in kiwi are almost in direct contact with the olfactory epithelium, which is indeed well developed and complex, with olfactory receptor cells occupying a large percentage of the epithelium. The anatomy of the kiwi olfactory system supports an enhancement for olfactory sensitivities, which is undoubtedly associated with their unique nocturnal niche.

Conceptualisation and enactment of critical literacy for senior high school EAL learners in Queensland, Australia : commitments, constraints and contradictions

This case study examined four teachers' understandings and teaching of Critical Literacy with senior English as an Additional Language (EAL) learners in two Queensland high schools. Despite continuous, rapid curriculum change in Australia and efforts to diminish Critical Literacy, the four teachers continued to feature it successfully in their teaching with often marginalised learners. They used critical literacy to provide access to and critique dominant language codes, and to draw on learners' diverse experiences. To a lesser extent, the teachers created opportunities for redesigning dominant texts. Implications are important for policy production and interpretation, school planning and teacher professional development.

Estimating the mean critical gap

The estimation of the critical gap has been an issue since the 1970s, when gap acceptance was introduced to evaluate the capacity of unsignalized intersections. The critical gap is the shortest gap that a driver is assumed to accept. A driver’s critical gap cannot be measured directly and a number of techniques have been developed to estimate the mean critical gaps of a sample of drivers. This paper reviews the ability of the Maximum Likelihood technique and the Probability Equilibrium Method to predict the mean and standard deviation of the critical gap with a simulation of 100 drivers, repeated 100 times for each flow condition. The Maximum Likelihood method gave consistent and unbiased estimates of the mean critical gap. Whereas the probability equilibrium method had a significant bias that was dependent on the flow in the priority stream. Both methods were reasonably consistent, although the Maximum Likelihood Method was slightly better. If drivers are inconsistent, then again the Maximum Likelihood method is superior. A criticism levelled at the Maximum Likelihood method is that a distribution of the critical gap has to be assumed. It was shown that this does not significantly affect its ability to predict the mean and standard deviation of the critical gaps. Finally, the Maximum Likelihood method can predict reasonable estimates with observations for 25 to 30 drivers. A spreadsheet procedure for using the Maximum Likelihood method is provided in this paper. The PEM can be improved if the maximum rejected gap is used.

A critical evaluation of written discharge advice for people with mild traumatic brain injury : what should we be looking for?

Objective: To formally evaluate the written discharge advice for people with mild traumatic brain injury (mTBI). Methods: Eleven publications met the inclusion criteria: (1) intended for adults; (2) ≤two A4 pages; (3) published in English; (4) freely accessible; and (5) currently used (or suitable for use) in Australian hospital emergency departments or similar settings. Two independent raters evaluated the content and style of each publication against established standards. The readability of the publication, the diagnostic term(s) contained in it and a modified Patient Literature Usefulness Index (mPLUI) were also evaluated. Results: The mean content score was 19.18 ± 8.53 (maximum = 31) and the mean style score was 6.8 ± 1.34 (maximum = 8). The mean Flesch-Kincaid reading ease score was 66.42 ± 4.3. The mean mPLUI score was 65.86 ± 14.97 (maximum = 100). Higher scores on these metrics indicate more desirable properties. Over 80% of the publications used mixed diagnostic terminology. One publication scored optimally on two of the four metrics and highly on the others. Discussion: The content, style, readability and usefulness of written mTBI discharge advice was highly variable. The provision of written information to patients with mTBI is advised, but this variability in materials highlights the need for evaluation before distribution. Areas are identified to guide the improvement of written mTBI discharge advice.

Afterschool MediaClub: Critical literacy in a high diversity, high poverty urban setting

In this chapter we present analyses of data produced with young people in an afterschool digital literacy program for 9 – 12 year olds. The young people were students at a high diversity, high poverty outer suburban elementary school in Queensland, Australia. The club was part of the URLearning research project (2010-14). In the classroom-based component of the project we worked with teachers to develop intellectually substantive and critical digital literacy practice. MediaClub was in some ways complementary to the classroom component; it was designed to skill up interested kids as digital media experts not only for their families and communities, but also for the classroom. Given the critical literacy traditions established in Australian schools, we approached MediaClub with certain critical expectations. In this chapter we look at what ensued, highlighting unanticipated critical outcomes at a time of heightened struggle over English curriculum. Critical literacy has been part of official English curriculum in Queensland since the early 1990s. The approach has been primarily text analytic, concerned with giving students access to genres of power and tools for understanding the ideological work of language through text. Many ideas for translating this normative critical project into classroom practice have been developed for use from the earliest elementary grades onwards. However, curricular space for critical literacy is under pressure. Amongst other things, this reflects both the development of Australia’s first national curriculum and the construction of a regimen of national literacy testing. At MediaClub we found a certain resistance to learning activities which were “too much like school”. However, in a context of increased control of teachers’ and students’ work in the classroom, MediaClub evolved as a learning space that can be understood in critical terms. Our experience in this regard might be of interest to teachers and researchers in high diversity high poverty settings that are strongly controlled through increasingly prescriptive – even scripted – pedagogies.

Real-time and interactive attacks on DNP3 critical infrastructure using Scapy

The Distributed Network Protocol v3.0 (DNP3) is one of the most widely used protocols, to control national infrastructure. Widely used interactive packet manipulation tools, such as Scapy, have not yet been augmented to parse and create DNP3 frames (Biondi 2014). In this paper we extend Scapy to include DNP3, thus allowing us to perform attacks on DNP3 in real-time. Our contribution builds on East et al. (2009), who proposed a range of possible attacks on DNP3. We implement several of these attacks to validate our DNP3 extension to Scapy, then executed the attacks on real world equipment. We present our results, showing that many of these theoretical attacks would be unsuccessful in an Ethernet-based network.

Critical success factors in distance learning construction programs at Central Queensland University : students’ perspective

Distance education has gone through rapid expansion over the years. Many Australian universities are pushing the use of distance education in delivering construction education programs. However, the critical success factors (CSFs) in distance learning construction programs (DLCPs) are not fully understood. More importantly, students’ demographic features may affect the selection of distance education technologies. Situation-matching strategies should therefore be taken by universities or institutions with different student cohorts. A survey is adopted in Central Queensland University (CQU) to identify and rank the critical success factors in a DLCP in Australia where there is a significant number of earner-learners and students with low socioeconomic background. The findings suggest that the most important CSFs include access to computers and internet, reliability of web-based learning sites, high relevance and clarity of learning materials and assessment items, the availability of web-based learning sites that can be easily manipulated, and the capability of the instructors to provide well-structured courses. The findings also suggest that students with low socioeconomic background have more rigorous requirements on interface design, instructors’ support, and the integration of practical components into courses. The results provide good guidance of the design and delivery of DLCPs and will be useful for universities and institutions that are seeking to implement the distance mode in construction education.

Endotoxin removal : a critical step in vaccine production

A major drawback to the immunological potency of conventional vaccines, resulting in reduced level of immune responses, tissue injury, shock and high cytotoxicity, thus making their applications contraindicated in immunodeficiency diseases, is the presence of high contaminant concentrations in vaccine titers. Vaccine contamination arises from the simultaneous occurrence of competitive pathways resulting in the formation of other bio-products during cellular metabolism aside the pathways necessary for the production of vaccine molecules. One of such vaccine contaminating molecules is endotoxins which are mainly lipopolysaccharides (LPS) complexes found in the membrane of bacterial cell wall. The structural dynamics of these molecules make their removal from vaccine titers problematic, thus making vaccine endotoxin removal a major research endeavour. This presentation will discuss a novel technique for reducing the endotoxin level of vaccines. The technique commences with the disentanglement of endotoxin-vaccine molecular bonding and then capturing the vaccine molecules on an affinity monolith to separate the vaccine molecules from the endotoxins.

Factors influencing the provision of end-of-life care in critical care settings : development and testing of a survey instrument

Aim. To develop and psychometrically test a survey instrument to identify the factors influencing the provision of end-of-life care by critical care nurses. Background. Following a decision to withdraw life-sustaining treatment, critical care nurses remain with the patient and their family providing end-of-life care. Identification of factors influencing the provision of this care can give evidence to inform practice development and support nurses. Design. A cross-sectional survey of critical care nurses. Method. An online survey was developed, reviewed by an expert panel and pilot tested to obtain preliminary evidence of its reliability and validity. In May 2011, a convenience sample of critical care nurses (n = 392, response rate 25%) completed the survey. The analytical approach to data obtained from the 58 items measured on a Likert scale included exploratory factor analysis and descriptive statistics. Results. Exploratory factor analysis identified eight factors influencing the provision of end-of-life care: emotional support for nurses, palliative values, patient and family preferences, resources, organizational support, care planning, knowledge and preparedness. Internal consistency of each latent construct was deemed satisfactory. The results of descriptive statistics revealed a strong commitment to the inclusion of families in end-of-life care and the value of this care in the critical care setting. Conclusion. This paper reports preliminary evidence of the psychometric properties of a new survey instrument. The findings may inform practice development opportunities to support critical care nurses in the provision of endof- life care and improve the care that patients and their families receive.

Male and female, cyclist and driver perceptions of crash risk in critical road situations

Male and Female, Cyclist and Driver Perceptions of Crash Risk in Critical Road Situations. Governments are promoting cycling but many Australians, particularly women, do not ride because they perceive it to be too risky. This research compared the risks perceived by female and male, cyclists and drivers in specific on-road situations, accounting for factors such as travel patterns and experience, perceived skill, and risk taking behaviours. Compared to their male counterparts, female cyclists and drivers gave similarly elevated perceptions of risk. These differences are not completely accounted for by cycling patterns or perceptions of skill. Thus, these gender differences are not specific to cycling, but may reflect wider differences in risk perception.