Part 2. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: A patient perspective

An important goal of the care for the mechanically ventilated patient is to minimize patient discomfort and anxiety. This is partly achieved by frequent use of chemical and physical restraints. The majority of patients in intensive care will receive some form of sedation. The goal and use of sedation has changed considerably over the past few decades with literature evidencing trends toward overall lighter sedation levels and daily interruption of sedation. Conversely, the use of physical restraint for the ventilated patient in ICU differs considerably between nations and continents. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. Recent literature suggests minimal use of physical restraint in the ICU, and that reduction programmes have been initiated. However, very few papers illuminate the patient's experience of physical and chemical restraints as a treatment strategy. In Part 1 of this two-part review, the evidence on chemical and physical restraints was explored with specific focus on definitions of terms, unplanned extubation, agitation, delirium as well as the impact of nurse–patient ratios in the ICU on these issues. This paper, Part 2, examines the evidence related to chemical and physical restraints from the mechanically ventilated patient's perspective.

Metallic glass fiber-reinforced Zr-based bulk metallic glass

A novel Zr-based bulk metallic glass composite was fabricated using stainless steel capillaries as the reinforcement. Large plasticity (14%) was achieved in the composite with a reinforcement volume fraction of 38%. The high plasticity observed can be attributed to the formation of small glass fibers encapsulated by the steel capillaries, which promotes multiple shear bands in both metallic glass matrix and the fibers themselves. A new parameter was also proposed to approximately evaluate the reinforcement efficiency.

Queensland Aborigines, multiple realities and the social sources of suffering. Part 2: Suicide, spirits and symbolism

This is the second part of a paper that explores a range of magico-religious experiences such as immaterial voices and visions, in terms of local cultural, moral and socio-political circumstances in an Aboriginal town in rural Queensland. This part of the paper explores the political and cultural symbolism and meaning of suicide. It charts the saliency of suicide amongst two groups of kin and cohorts and the social meaningfulness and problematic of the voices and visions in relation to suicide, to identity and family forms and to funerals and a heavily drinking lifestyle. I argue that voices and visions are used to reinterpret social experience and to establish meaning and that tragically suicide evokes connectivity rather than anomie and here cannot be understood merely as an individualistic act or evidence of individual pathology. Rather it is about transformation and crossing a threshold to join an enduring domain of Aboriginality. In this life world, where family is the highest social value and where a relational view of persons holds sway, the individualistic practice of psychiatric and other helping professions, is a considerable problem.

A review of rationale for allocating costs and payments in producing and supplying public sector information PART A of 2 Parts – Chapters 1, 2 and 3) 13 March 2011 version

This work reviews the rationale and processes for raising revenue and allocating funds to perform information intensive activities that are pertinent to the work of democratic government. ‘Government of the people, by the people, for the people’ expresses an idea that democratic government has no higher authority than the people who agree to be bound by its rules. Democracy depends on continually learning how to develop understandings and agreements that can sustain voting majorities on which democratic law making and collective action depends. The objective expressed in constitutional terms is to deliver ‘peace, order and good government’. Meeting this objective requires a collective intellectual authority that can understand what is possible; and a collective moral authority to understand what ought to happen in practice. Facts of life determine that a society needs to retain its collective competence despite a continual turnover of its membership as people die but life goes on. Retaining this ‘collective competence’ in matters of self-government depends on each new generation: • acquiring a collective knowledge of how to produce goods and services needed to sustain a society and its capacity for self-government; • Learning how to defend society diplomatically and militarily in relation to external forces to prevent overthrow of its self-governing capacity; and • Learning how to defend society against divisive internal forces to preserve the authority of representative legislatures, allow peaceful dispute resolution and maintain social cohesion.

The Brisbane Cordon scheme : part A - preliminary investigation

It could be said that road congestion is one of the most significant problems within any modern metropolitan area. For several decades now, around the globe, congestion in metropolitan areas has been worsening for two main reasons. Firstly, road congestion has significantly increased due to a higher demand for road space because of growth in populations, economic activity and incomes (Hensher & Puckett, 2007). This factor, in conjunction with a significant lack of investment in new road and public transport infrastructure, has seen the road network capacities of cities exceeded by traffic volumes and thus, resulted in increased traffic congestion. This relentless increase in road traffic congestion has resulted in a dramatic increase in costs for both the road users and ultimately the metropolitan areas concerned (Bureau of Transport and Regional Economics, 2007). In response to this issue, several major cities around the world, including London, Stockholm and Singapore, have implemented congestion-charging schemes in order to combat the effects of road congestion. A congestion-charging scheme provides a mechanism for regulating traffic flows into the congested areas of a city, whilst simultaneously generating public revenue that can be used to improve both the public transport and road networks of the region. The aim of this paper was to assess the concept of congestion-charging, whilst reflecting on the experiences of various cities that have already implemented such systems. The findings from this paper have been used to inform the design of a congestion-charging scheme for the city of Brisbane in Australia in a supplementary study (Whitehead, Bunker, & Chung, 2011). The first section of this paper examines the background to road congestion; the theory behind different congestion-charging schemes; and the various technologies involved with the concept. The second section of this paper details the experiences, in relation to implementing a congestion-charging scheme, from the city of Stockholm in Sweden. This research has been crucial in forming a list of recommendations and lessons learnt for the design of a congestion-charging scheme in Australia. It is these recommendations that directly inform the proposed design of the Brisbane Cordon Scheme detailed in Whitehead et al. (2011).

The Brisbane Cordon scheme : part B - investigation into feasibility and effects

As detailed in Whitehead, Bunker and Chung (2011), a congestion-charging scheme provides a mechanism to combat congestion whilst simultaneously generating revenue to improve both the road and public transport networks. The aim of this paper is to assess the feasibility of implementing a congestion-charging scheme in the city of Brisbane in Australia and determine the potential effects of this initiative. In order to so, a congestion-charging scheme was designed for Brisbane and modelled using the Brisbane Strategic Transport Model with a base line year of 2026. This paper argues that the implementation of this initiative would prove to be effective in reducing the cities road congestion and increasing the overall sustainability of the region.

The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment : Part 1 (New South Wales)

This is the first article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in New South Wales. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals’ legal knowledge in this area. The article examines the level of training medical professionals receive on issues such as advance directives and substitute decision-making, and the available empirical evidence as to the state of medical professionals’ knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in New South Wales.

The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment : Part 2 (Queensland)

This is the second article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in Queensland, including the parens patriae jurisdiction of the Supreme Court. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals’ legal knowledge in this area. The article examines the level of training medical professionals receive on issues such as advance health directives and substitute decision-making, and the available empirical evidence as to the state of medical professionals’ knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in Queensland.

CRE workshop part I : comprehending the context

CRE (Corporate Real Estate) decisions should not simply deal with the management of individual facilities, but should especially be concerned with the relationships that a facility has with the corporate business strategy and with the larger real estate markets. Both the practice and the research of CRE management have historically tended to emphasize real estate issues and ignore the corporation’s business issues, causing real estate strategies to be disconnected from the goal and priorities of the corporation’s senior management. With regard to office cycles, a large number of econometric models have been proposed during the last 20 years. However, evidence from historical data and previous research in the field of real estate forecasting seem to agree only on one thing: the existence of interconnected property cycles that are concentrated on vacancy rates (demand). Vacancy also represents the linkage between the inadequacy of existing CRE strategies and the inability of existing econometric models to correctly forecast office rent cycles. Business cycles, across different industry sectors, have decreased from 5-7 years to 1-3 years today, yet corporations are still entering into leases of 5-10 years, causing hidden vacancy levels to rise. Possibly, once CRE strategies are totally in tune with the overall business, hidden vacancy will fade away providing forecasters with better quality data. The aim of this paper is not to investigate whether and when the supply-side will eventually evolve to provide flexible occupancy arrangements to accommodate corporate agility requirements, but rather to propose a general framework for corporations to improve the decision making process of their CRE executives, while emphasizing the importance of understanding the context as a precondition to effective real estate involvements.

The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment : part 3 (Victoria)

This is the final article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in Victoria. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals’ legal knowledge in this area. The article examines the level of training that medical professionals receive on issues such as refusal of treatment certificates and substitute decision-making, and the available empirical evidence as to the state of medical professionals’ knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in Victoria. The article also draws together themes from the series as a whole, including conclusions about the need for more and better medical education and about law reform generally.

Design for eco-services. Part A - Environmental Services

Without the virtually free services of nature like clean air and water, humans would not last long. Natural systems can be incorporated in existing urban structures or spaces to add public amenity, mitigate the heat island effect, reduce pollution, add oxygen, and ensure water, electricity and food security in urban areas. Th ere are many eco-solutions that could radically reduce resource consumption and pollution and even provide surplus ecosystem services in the built environment at little or no operational cost, if adequately supported by design. Th is paper is the fi rst of a two part paper that explains what eco-services are, then provides examples of how design can generate natural as well as social capital. Using examples of actual and notional solutions, both papers set out to challenge designers to ‘think again’, and invent ways of creating net positive environmental gains through built environment design.

Design for eco-services. Part B - Building Services

Without the virtually free services of nature like clean air and water, humans would not last long. Natural systems can be incorporated in existing urban structures or spaces to add public amenity, mitigate the heat island eff ect, reduce pollution, add oxygen, and ensure water, electricity and food security in urban areas. Th ere are many eco-solutions that could radically reduce resource consumption and pollution and even provide surplus ecosystem services in the built environment at little or no operational cost, if adequately supported by design. Th is is the second part of a two part paper that explains what eco-services are, then provides examples of how design can generate natural as well as social capital. Using examples of actual and notional solutions, both papers set out to challenge designers to ‘think again’, and invent ways of creating net positive environmental gains through built environment design.