Optimal management of the critically Ill: Anaesthesia, monitoring, data capture, and point-of-care technological practices in ovine models of critical care

Animal models of critical illness are vital in biomedical research. They provide possibilities for the investigation of pathophysiological processes that may not otherwise be possible in humans. In order to be clinically applicable, the model should simulate the critical care situation realistically, including anaesthesia, monitoring, sampling, utilising appropriate personnel skill mix, and therapeutic interventions. There are limited data documenting the constitution of ideal technologically advanced large animal critical care practices and all the processes of the animal model. In this paper, we describe the procedure of animal preparation, anaesthesia induction and maintenance, physiologic monitoring, data capture, point-of-care technology, and animal aftercare that has been successfully used to study several novel ovine models of critical illness. The relevant investigations are on respiratory failure due to smoke inhalation, transfusion related acute lung injury, endotoxin-induced proteogenomic alterations, haemorrhagic shock, septic shock, brain death, cerebral microcirculation, and artificial heart studies. We have demonstrated the functionality of monitoring practices during anaesthesia required to provide a platform for undertaking systematic investigations in complex ovine models of critical illness.

Questionnaire design for airport passenger experience survey

Assessing airport service performance requires understanding of a complete set of passenger experiences covering all activities from departures to arrivals. Weight-based indicator models allow passengers to express their priority on certain evaluation criteria (airport domains) and their service attributes over the others. The application of multilevel regression analysis in questionnaire design is expected to overcome limitations of traditional questionnaires, which require application of all indicators with equal weight. The development of a Taxonomy of Passenger Activities (TOPA), which captures all passenger processing and discretionary activities, has provided a novel perspective in understanding passenger experience in various airport domains. Based on further literature reviews on various service attributes at airport passenger terminals, this paper constitutes questionnaire design to employ a weighting method for all activities from the time passengers enter an airport domain at the departure terminal until leaving the arrival terminal (i.e. seven airport domains for departure, four airport domains during transit, and seven airport domains for arrival). The procedure of multilevel regression analysis is aimed not only at identifying the ranking of each evaluation criterion from the most important to the least important but also to explain the relationship between service attributes in each airport domain and overall service performance.

A novel concept for airport terminal design integrating flexibility

The current research proposed a conceptual design framework for airports to obtain flexible departure layouts based on passenger activity analysis obtained from Business Process Models (BPM). BPMs available for airport terminals were used as a design tool in the current research to uncover the relationships existing between spatial layout and corresponding passenger activities. An algorithm has been developed that demonstrates the applicability of the proposed design framework by obtaining relative spatial layouts based on passenger activity analysis. The generated relative spatial layout assists architects in achieving suitable alternative layouts to meet the changing needs of an airport terminal.

Sustainable energy options for the future airport metropolis

Growth in aviation has resulted in large airports that can be described as Airport Metropolises. This thesis reviews a variety of sustainable energy options that are suitable for such airports, and presents a decision support framework that can be used to guide decision makers towards the adoption of sound sustainable energy projects and practices. The thesis demonstrates use of the decision support framework via a number of case studies and outlines a methodology which could be incorporated within a Decision Support System.

Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients

Introduction Recent reports have highlighted the prevalence of vitamin D deficiency and suggested an association with excess mortality in critically ill patients. Serum vitamin D concentrations in these studies were measured following resuscitation. It is unclear whether aggressive fluid resuscitation independently influences serum vitamin D. Methods Nineteen patients undergoing cardiopulmonary bypass were studied. Serum 25(OH)D3, 1α,25(OH)2D3, parathyroid hormone, C-reactive protein (CRP), and ionised calcium were measured at five defined timepoints: T1 - baseline, T2 - 5 minutes after onset of cardiopulmonary bypass (CPB) (time of maximal fluid effect), T3 - on return to the intensive care unit, T4 - 24 hrs after surgery and T5 - 5 days after surgery. Linear mixed models were used to compare measures at T2-T5 with baseline measures. Results Acute fluid loading resulted in a 35% reduction in 25(OH)D3 (59 ± 16 to 38 ± 14 nmol/L, P < 0.0001) and a 45% reduction in 1α,25(OH)2D3 (99 ± 40 to 54 ± 22 pmol/L P < 0.0001) and i(Ca) (P < 0.01), with elevation in parathyroid hormone (P < 0.0001). Serum 25(OH)D3 returned to baseline only at T5 while 1α,25(OH)2D3 demonstrated an overshoot above baseline at T5 (P < 0.0001). There was a delayed rise in CRP at T4 and T5; this was not associated with a reduction in vitamin D levels at these time points. Conclusions Hemodilution significantly lowers serum 25(OH)D3 and 1α,25(OH)2D3, which may take up to 24 hours to resolve. Moreover, delayed overshoot of 1α,25(OH)2D3 needs consideration. We urge caution in interpreting serum vitamin D in critically ill patients in the context of major resuscitation, and would advocate repeating the measurement once the effects of the resuscitation have abated.

Too ill to will? deathbed wills: assessing testamentary capacity near the end of life

Assessing testamentary capacity in the terminal phase of an illness or at a person's deathbed is fraught with challenges for both doctors and lawyers. Numerous issues need to be considered when assessing capacity for a will. These issues are exacerbated when such an assessment needs to be undertaken at the bedside of a dying patient. The nature and severity of the illness, effects on cognition of the terminal illness, effects of medication, urgency, psychological and emotional factors, interactions with carers, family and lawyers, and a range of other issues confound and complicate the assessment of capacity. What is the doctor's role in properly assessing capacity in this context and how does this role intersect with the legal issues? Doctors will play an increasing role in assessing testamentary capacity in this setting. The ageing of society, more effective treatment of acute illness and, often, the prolongation of dying are only some of the factors leading to this increasing need. However, despite its importance and increasing prevalence, the literature addressing this challenging practical area is scarce and offers limited guidance. This paper examines these challenges and discusses some practical approaches.

When and why threats go undetected: Impacts of event rate and shift length on threat detection accuracy during airport baggage screening

Objective: We aimed to assess the impact of task demands and individual characteristics on threat detection in baggage screeners. Background: Airport security staff work under time constraints to ensure optimal threat detection. Understanding the impact of individual characteristics and task demands on performance is vital to ensure accurate threat detection. Method: We examined threat detection in baggage screeners as a function of event rate (i.e., number of bags per minute) and time on task across 4 months. We measured performance in terms of the accuracy of detection of Fictitious Threat Items (FTIs) randomly superimposed on X-ray images of real passenger bags. Results: Analyses of the percentage of correct FTI identifications (hits) show that longer shifts with high baggage throughput result in worse threat detection. Importantly, these significant performance decrements emerge within the first 10 min of these busy screening shifts only. Conclusion: Longer shift lengths, especially when combined with high baggage throughput, increase the likelihood that threats go undetected. Application: Shorter shift rotations, although perhaps difficult to implement during busy screening periods, would ensure more consistently high vigilance in baggage screeners and, therefore, optimal threat detection and passenger safety.

Translating emotional insights into digital channel designs: Opportunities to enhance the airport experience

Purpose The purpose of this study is to identify and understand the emotions behind a passenger’s airport experience and how this can inform digital channel engagements. Design/methodology/approach This study investigates the emotional experience of two hundred (200) passengers’ journeys at an Australian domestic airport. A survey was conducted which implemented the use of Emocards and an interview approach of laddering. The responses were then analysed into attributes, consequences and values. Findings The results indicate that across key stages of the airport (parking, retail, gates and arrivals) passengers had different emotional experiences (positive, negative and neutral). The attributes, consequences and values behind these emotions were then used to propose digital channel content and purpose of various future digital channel engagements. Research limitations/implications By gaining emotional insights airports are able to generate digital channel engagements, which align with passengers’ needs and values rather than internal operational motivations. Theoretical contributions include the development of the Technology Acceptance Model to include emotional drivers as influences in the use of digital channels. Originality/value This research provides a unique method to understand the passengers’ emotional journey across the airport infrastructure and suggest how to better design digital channel engagements to address passenger latent needs.

Essential nursing care of the critically ill patient

This chapter is about essential nursing care. Because it is often referred to as basic nursing, nurses may not always perceive it as deserving of priority. Yet, how well patients are cared for has a direct effect on their sense of wellbeing and their recovery. ‘Interventional patient hygiene’ is a systematic, evidence-based approach to nursing actions designed to improve patient outcomes using a framework of hygiene, catheter care, skin care, mobility and oral care.1 This chapter focuses on the physical care, infection control, preventative therapies and transport of critically ill patients. The first two areas are closely linked: poor-quality physical care increases the risk of infection. The final areas are essential features of critical care nursing.

International Arrivals Building, Idlewild Airport

[Book] The potential of electric light as a new building “material” was recognized in the 1920s and became a useful design tool by the mid-century. Skillful lighting allowed for theatricality, narrative, and a new emphasis on structure and space. The Structure of Light tells the story of the career of Richard Kelly, the field’s most influential figure. Six historians, architects, and practitioners explore Kelly’s unparalleled influence on modern architecture and his lighting designs for some of the 20th century’s most iconic buildings: Philip Johnson’s Glass House; Louis Kahn’s Kimbell Art Museum; Eero Saarinen’s GM Technical Center; and Mies van der Rohe’s Seagram Building, among many others. This beautifully illustrated history demonstrates the range of applications, building types, and artistic solutions he employed to achieve a “nocturnal modernity” that would render buildings evocatively different at night. The survival of Kelly’s rich correspondence and extensive diaries allows an in-depth look at the triumphs and uncertainties of a young profession in the making. The first book to focus on the contributions of a master in the field of architectural lighting, this fascinating volume celebrates the practice’s significance in modern design.