The clinical effectiveness of interventions to assist perioperative temperature management for women undergoing Cesarean Section : a systematic review

Background Women undergoing Cesarean Section (CS) are vulnerable to the adverse effects associated with perioperative core temperature drop, in part due to the tendency for CS to be performed under neuraxial anesthesia, blood and fluid loss, and vasodilation. Inadvertent perioperative hypothermia (IPH) is a common condition that affects patients undergoing surgery of all specialties and is detrimental to all age groups, including neonates. Previous systematic reviews on IPH prevention largely focus on either adult or all ages populations, and have mainly overlooked pregnant or CS patients as a distinct group. Not all recommendations made by systematic reviews targeting all adult patients may be transferable to CS patients. Alternative, effective methods for preventing or managing hypothermia in this group would be valuable. Objectives To synthesize the best available evidence in relation to preventing and/or treating hypothermia in mothers after CS surgery. Types of participants Adult patients over the age of 18 years, of any ethnic background, with or without co-morbidities, undergoing any mode of anesthesia for any type of CS (emergency or planned) at healthcare facilities who have received interventions to limit or manage perioperative core heat loss were included. Types of intervention(s) Active or passive warming methods versus usual care or placebo, that aim to limit or manage core heat loss as applied to women undergoing CS were included. Types of studies Randomized controlled trials (RCTs) that met the inclusion criteria, with reduction of perioperative hypothermia a primary or secondary outcome were considered. Types of outcomes Primary outcome: maternal core temperature measured during the preoperative, intraoperative and postoperative phases of care Secondary outcomes: newborn core temperature at birth, umbilical pH obtained immediately after birth, Apgar scores, length of Post Anesthetic Care Unit (PACU) stay, maternal thermal comfort. Search strategy A comprehensive search was undertaken of the following databases from their inception until May 2012: ProQuest, Web of Science, Scopus, Dissertation and Theses PQDT (via ProQuest), Current Contents, CENTRAL, Mednar, OpenGrey, Clinical Trials. There were no language restrictions. Methodological quality Retrieved papers were assessed for methodological quality by two independent reviewers prior to inclusion using JBI software. Disagreements were resolved via consultation with the third reviewer. An assessment of quality of the included papers was also made in relation to five key quality factors. Data collection Two independent reviewers extracted data from the included papers using a previously piloted customized data extraction tool. Results 12 studies with a combined total of 719 participants were included. Three broad intervention groups were identified; intravenous (IV) fluid warming, warming devices, leg wrapping. IV fluid warming, whether administered intraoperatively or preoperatively, was found to be effective at maintaining maternal (but not neonatal) temperature and preventing shivering, but does not improve thermal comfort. The effectiveness of IV fluid warming on Apgar scores and umbilical pH remains unclear. Warming devices, including forced air warming and under body carbon polymer mattresses, were effective at preventing hypothermia and reduced shivering, however were most effective if applied preoperatively. The effectiveness of warming devices to improve thermal comfort remains unclear. Preoperative forced air warming appears to aid maintenance of neonatal temperature, while intraoperative forced air warming does not. Forced air warming was not effective at improving Apgar scores and the effects for umbilical pH remain unclear. Conclusions Intravenous fluid warming, by any method, improves maternal temperature and reduces shivering for women undergoing CS. Preoperative body warming devices also improve maternal temperature, in addition to reducing shivering.

The influence of oxygenated organic aerosols (OOA) on the oxidative potential of diesel and biodiesel particulate matter

Generally, the magnitude of pollutant emissions from diesel engines running on biodiesel fuel is ultimately coupled to the structure of respective molecules that constitutes the fuel. Previous studies demonstrated the relationship between organic fraction of PM and its oxidative potential. Herein, emissions from a diesel engine running on different biofuels were analysed in more detail to explore the role different organic fractions play in the measured oxidative potential. In this work, a more detailed chemical analysis of biofuel PM was undertaken using a compact Time of Flight Aerosol Mass Spectrometer (c-ToF AMS). This enabled a better identification of the different organic fractions that contribute to the overall measured oxidative potentials. The concentration of reactive oxygen species (ROS) was measured using a profluorescent nitroxide molecular probe 9-(1,1,3,3-tetramethylisoindolin-2-yloxyl-5-ethynyl)-10-(phenylethynyl)anthracene (BPEAnit). Therefore the oxidative potential of the PM, measured through the ROS content, although proportional to the total organic content in certain cases shows a much higher correlation with the oxygenated organic fraction as measured by the c-ToF AMS. This highlights the importance of knowing the surface chemistry of particles for assessing their health impacts. It also sheds light onto new aspects of particulate emissions that should be taken into account when establishing relevant metrics for assessing health implications of replacing diesel with alternative fuels.

Curriculum renewal in legal education

This project investigated ways in which the learning experience for students in Australian law schools could be enhanced by renewing final year legal curriculum through the design of effective capstone experiences to close the loop on tertiary legal studies and better prepare students for a smooth transition into the world of work and professional practice. Key project outcomes are a set of final year curriculum design principles and a transferable model for an effective final year program – a final year Toolkit comprising a range of templates, models and specific capstone examples for adoption or adaptation by legal educators. The project found that the efficacy of capstone experiences is affected by the curriculum context within which they are offered. For this reason, a number of ‘favourable conditions’, which promote the effectiveness of capstone experiences, have also been identified. The project’s final year principles and Toolkit promote program coherence and integration, should increase student satisfaction and levels of engagement with their experience of legal education and make a valuable contribution to assurance of learning in the new Tertiary Education Quality and Standards Agency (TEQSA) environment. From the point of view of the student experience, the final year principles and models address the current fragmented approach to final year legal curricula design and delivery. The knowledge and research base acquired under the auspices of this project is of both discipline and national importance as the project’s outcomes are transferable and have the potential to significantly influence the quality and coherence of the program experience of final year students in other tertiary disciplines, both within Australia and beyond. Project outcomes and deliverables are available on both the project’s website http://wiki.qut.edu.au/display/capstone/Home and on the Law Capstone Experience Forum website http://www.lawcapstoneexperience.com/. In the course of developing its deliverables, the project found that the design of capstone experiences varies significantly within and across disciplines; different frameworks may be used (for example, a disciplinary or inter-disciplinary focus, or to satisfy professional accreditation requirements), rationales and objectives may differ, and a variety of models utilised (for example, an integrated final year program, a single subject, a suite of subjects, or modules within several subjects). Broadly however, capstone experiences should provide final year students with an opportunity both to look back over their academic learning, in an effort to make sense of what they have accomplished, and to look forward to their professional and personal futures that build on that foundational learning.

Study of the underlying electrochemistry of polycrystalline gold electrodes in aqueous solution and electrocatalysis by large amplitude Fourier transformed alternating current voltammetry

Polycrystalline gold electrodes of the kind that are routinely used in analysis and catalysis in aqueous media are often regarded as exhibiting relatively simple double-layer charging/discharging and monolayer oxide formation/ removal in the positive potential region. Application of the large amplitude Fourier transformed alternating current (FT-ac) voltammetric technique that allows the faradaic current contribution of fast electron-transfer processes to be emphasized in the higher harmonic components has revealed the presence of well-defined faradaic (premonolayer oxidation) processes at positive potentials in the double-layer region in acidic and basic media which are enhanced by electrochemical activation. These underlying quasi-reversible interfacial electron-transfer processes may mediate the course of electrocatalytic oxidation reactions of hydrazine, ethylene glycol, and glucose on gold electrodes in aqueous media. The observed responses support key assumptions associated with the incipient hydrous oxide adatom mediator (IHOAM) model of electrocatalysis.

Characterisation of two distinctly different processes associated with the electrocrystallization of microcrystals of phase I CuTCNQ (TCNQ= 7, 7, 8, 8-tetracyanoquinodimethane)

Semi-conducting phase I CuTCNQ (TCNQ = 7,7,8,8-tetracyanoquinodimethane), which is of considerable interest as a switching device for memory storage materials, can be electrocrystallized from CH3CN via two distinctly different pathways when TCNQ is reduced to TCNQ˙− in the presence of [Cu(MeCN)4]+. The first pathway, identified in earlier studies, occurs at potentials where TCNQ is reduced to TCNQ˙− and involves a nucleation–growth mechanism at preferred sites on the electrode to produce arrays of well separated large branched needle-shaped phase I CuTCNQ crystals. The second pathway, now identified at more negative potentials, generates much smaller needle-shaped phase I CuTCNQ crystals. These electrocrystallize on parts of the surface not occupied in the initial process and give rise to film-like characteristics. This process is attributed to the reduction of Cu+[(TCNQ˙−)(TCNQ)] or a stabilised film of TCNQ via a solid–solid conversion process, which also involves ingress of Cu+via a nucleation–growth mechanism. The CuTCNQ surface area coverage is extensive since it occurs at all areas of the electrode and not just at defect sites that dominate the crystal formation sites for the first pathway. Infrared spectra, X-ray diffraction, surface plasmon resonance, quartz crystal microbalance, scanning electron microscopy and optical image data all confirm that two distinctly different pathways are available to produce the kinetically-favoured and more highly conducting phase I CuTCNQ solid, rather than the phase II material.

Superactivation of metal electrode surfaces and its relevance to COads oxidation at fuel cell anodes

The inhibiting effect of COads on platinum-based anodes is a major problem in the development of ambient temperature, polyelectrolyte membrane-type fuel cells. One of the unusual features of the response for the oxidative removal of the species in question is that the response observed for this reaction in the positive sweep is highly dependent on the CO admission potential, for example, when the COads is formed in the Hads region it undergoes oxidation at unusually low potentials. Such behaviour is attributed here to hydrogen activation of the platinum surface, with the result that oxide mediators (and COads oxidation) occurs at an earlier stage of the positive sweep. It is also demonstrated, for both platinum and gold in acid solution, that dramatic premonolayer oxidation responses may be observed following suitable preactivation of the electrode surfaces. It is suggested that the defect state of a solid electrode surface is an important variable whose investigation may yield improved fuel cell anode performance.

An investigation of silver electrodeposition from ionic liquids : influence of atmospheric water uptake on the silver electrodeposition mechanism and film morphology

The electrodeposition of silver from two ionic liquids, 1-butyl-3-methylimidazolium tetrafluoroborate ([BMIm][BF4]) and N-butyl-N-methyl-pyrrolidinium bis(trifluoromethanesulfonyl)imide ([C4mPyr][TFSI]), and an aqueous KNO3 solution on a glassy carbon electrode was undertaken. It was found by cyclic voltammetry that the electrodeposition of silver proceeds through nucleation–growth kinetics. Analysis of chronoamperometric data indicated that the nucleation–growth mechanism is instantaneous at all potentials in the case of [BMIm][BF4] and [C4mPyr][TFSI], and instantaneous at low overpotentials tending to progressive at high overpotentials for KNO3. Significantly, under ambient conditions, the silver electrodeposition mechanism changes to progressive nucleation and growth in [C4mPyr][TFSI], which is attributed to the uptake of atmospheric water in the IL. It was found that these differences in the growth mechanism impact significantly on the morphology of the resultant electrodeposit which is characterised ex situ by scanning electron microscopy and X-ray diffraction.

Large amplitude Fourier transformed AC voltammetric investigation of the active state electrochemistry of a copper/aqueous base interface and implications for electrocatalysis

The higher harmonic components available from large-amplitude Fourier-transformed alternating current (FT-ac) voltammetry enable the surface active state of a copper electrode in basic media to be probed in much more detail than possible with previously used dc methods. In particular, the absence of capacitance background current allows low-level Faradaic current contributions of fast electron-transfer processes to be detected; these are usually completely undetectable under conditions of dc cyclic voltammetry. Under high harmonic FT-ac voltammetric conditions, copper electrodes exhibit well-defined and reversible premonolayer oxidation responses at potentials within the double layer region in basic 1.0 M NaOH media. This process is attributed to oxidation of copper adatoms (Cu*) of low bulk metal lattice coordination numbers to surface-bonded, reactive hydrated oxide species. Of further interest is the observation that cathodic polarization in 1.0 M NaOH significantly enhances the current detected in each of the fundamental to sixth FT-ac harmonic components in the Cu*/Cu hydrous oxide electron-transfer process which enables the underlying electron transfer processes in the higher harmonics to be studied under conditions where the dc capacitance response is suppressed; the results support the incipient hydrous oxide adatom mediator (IHOAM) model of electrocatalysis. The underlying quasi-reversible interfacial Cu*/Cu hydrous oxide process present under these conditions is shown to mediate the reduction of nitrate at a copper electrode, while the mediator for the hydrazine oxidation reaction appears to involve a different mediator or active state redox couple. Use of FT-ac voltammetry offers prospects for new insights into the nature of active sites and electrocatalysis at the electrode/solution interface of Group 11 metals in aqueous media.

Reduction of Au3+ ions by activated surface atoms of platinum

In this work it is demonstrated that Pt electrodes can be activated by cathodic polarisation in the hydrogen evolution region which makes it prone to oxidation at potentials below that of bulk oxide formation. When an activated Pt electrode is placed in an aqueous HAuCl4 solution the electroless deposition of Au onto the surface of the electrode is observed and confirmed by cyclic voltammetry and XPS measurements. It is demonstrated that the oxidation of active Pt surface atoms provides the driving force for the spontaneous reduction of Au3+ ions into metallic Au to generate a Pt/Au surface which is highly active for the electro-oxidation of ethanol.

Decoration of active sites to create bimetallic surfaces and its implication for electrochemical processes

The creation of electrocatalysts based on noble metals has received a significant amount of research interest due to their extensive use as fuel cell catalysts and electrochemical sensors. There have been many attempts to improve the activity of these metals through creating nanostructures, as well as post-synthesis treatments based on chemical, electrochemical, sonochemical and thermal approaches. In many instances these methods result in a material with active surface states, which can be considered to be adatoms or clusters of atoms on the surface that have a low lattice co-ordination number making them more prone to electrochemical oxidation at a wide range of potentials that are significantly less positive than those of their bulk metal counterparts. This phenomenon has been termed pre-monolayer oxidation and has been reported to occur on a range of metallic surfaces. In this work we present findings on the presence of active sites on Pd that has been: evaporated as a thin film; electrodeposited as nanostructures; as well as commercially available Pd nanoparticles supported on carbon. Significantly, advantage is taken of the low oxidation potential of these active sites whereby bimetallic surfaces are created by the spontaneous deposition of Ag from AgNO3 to generate Pd/Ag surfaces. Interestingly this approach does not increase the surface area of the original metal but has significant implications for its further use as an electrode material. It results in the inhibition or promotion of electrocatalytic activity which is highly dependent on the reaction of interest. As a general approach the decoration of active catalytic materials with less active metals for a particular reaction also opens up the possibility of investigating the role of the initially present active sites on the surface and identifying the degree to which they are responsible for electrocatalytic activity.

Kaleidoscope : Reframing learning and teaching evaluation through a shared stakeholder lens

Sector wide interest in Reframe: QUT’s Evaluation Framework continues with a number of institutions requesting finer details as QUT embeds the new approach to evaluation across the university in 2013. This interest, both nationally and internationally has warranted QUT’s collegial response to draw upon its experiences from developing Reframe into distilling and offering Kaleidoscope back to the sector. The word Reframe is a relevant reference for QUT’s specific re-evaluation, reframing and adoption of a new approach to evaluation; whereas Kaleidoscope reflects the unique lens through which any other institution will need to view their own cultural specificity and local context through an extensive user-led stakeholder engagement approach when introducing new approaches to learning and teaching evaluation. Kaleidoscope’s objectives are for QUT to develop its research-based stakeholder approach to distil the successful experience exhibited in the Reframe Project into a transferable set of guidelines for use by other tertiary institutions across the sector. These guidelines will assist others to design, develop, and deploy, their own culturally specific widespread organisational change informed by stakeholder engagement and organisational buy-in. It is intended that these guidelines will promote, support and enable other tertiary institutions to embark on their own evaluation projects and maximise impact. Kaleidoscope offers an institutional case study of widespread organisational change underpinned by Reframe’s (i) evidence-based methodology; (ii) research including published environmental scan, literature review (Alderman, et al., 2012), development of a conceptual model (Alderman, et al., in press 2013), project management principles (Alderman & Melanie, 2012) and national conference peer reviews; and (iii) year-long strategic project with national outreach to collaboratively engage the development of a draft set of National Guidelines. Kaleidoscope’s aims are to inform Higher Education evaluation policy development through national stakeholder engagement, the finalisation of proposed National Guidelines. In correlation with the conference paper, the authors will present a Draft Guidelines and Framework ready for external peer review by evaluation practitioners from the Higher Education sector, as part of Kaleidoscope’s dissemination strategy (Hinton & Gannaway, 2011) applying illuminative evaluation theory (Parlett & Hamilton, 1976), through conference workshops and ongoing discussions (Shapiro, et al., 1983; Jacobs, 2000). The initial National Guidelines will be distilled from the Reframe: QUT’s Evaluation Framework’s Policy, Protocols, and incorporated Business Rules. It is intended that the outcomes of Kaleidoscope are owned by and reflect sectoral engagement, including iterative evaluation through multiple avenues of dissemination and collaboration including the Higher Education sector. The dissemination strategy with the inclusion of Illuminative Evaluation methodology provides an inclusive opportunity for other institutions and stakeholders across the Higher Education sector to give voice through the information-gathering component of evaluating the draft Guidelines, providing a comprehensive understanding of the complex realities experienced across the Higher Education sector, and thereby ‘illuminating’ both the shared and unique lenses and contexts. This process will enable any final guidelines developed to have broader applicability, greater acceptance, enhanced sustainability and additional relevance benefiting the Higher Education sector, and the adoption and adaption by any single institution for their local contexts.

Kaleidoscope : shaping a better future through a stakeholder approach to widespread organisational change

The main focus of ‘Kaleidoscope: Reframing evaluation through a stakeholder approach to sustainable, cultural change in Higher Education’ is to develop a set of principles to guide user-led engagement in widespread organisational change and maximise its impact. The word kaleidoscope represents the unique lens through which each institution will need to view their cultural specificity and local context through an extensive process of collaboration and engagement, followed by communication and dissemination. Kaleidoscope has particular relevance when new approaches to learning and teaching evaluation are introduced by tertiary institutions. Building on the Reframe Project, which involved three years of user-led consultation and was designed to meet stakeholders’ needs, QUT successfully introduced a new evaluation framework in 2013 across the university. Reframe was evidence based, involved scholarly reflection and was founded on a strong theoretical framework. The evolution of the evaluation framework included analysis of scholarly literature and environmental scans across the higher education sector (Alderman, et al., 2012), researched development of conceptual theory (Alderman, et al., in press 2013), incorporated the stakeholder voice and framed within project management principles (Alderman & Melanie, 2012). Kaleidoscope’s objectives are for QUT to develop its research-based stakeholder approach to distil the successful experience exhibited in the Reframe Project into a transferable set of guidelines for use by other tertiary institutions across the sectors. These guidelines will assist others to design, develop, and deploy, their own culturally specific widespread organisational change informed by stakeholder engagement and organisational buy-in. It is intended that these guidelines will promote, support and enable other tertiary institutions to embark on their own projects and maximise the impact. In correlation with a our conference paper, this round table presents the Draft Guidelines and Framework ready for external peer review by evaluation practitioners, as part of Kaleidoscope’s dissemination (Hinton & Gannaway, 2011) applying illuminative evaluation theory (Parlett & Hamilton, 1976), through conference workshops and linked round table discussions (Shapiro, et al., 1983; Jacobs, 2000).

On Presence, Collective Performance and Assumptions of Causality

The ways we assume, observe and model “presence” and its effects are the focus in this paper. Entities with selectively shared presences are the basis of any collective, and of attributions (such as “humorous”, “efficient” or “intelligent”). The subtleties of any joint presence can markedly influence potentials, perceptions and performance of the collective as demonstrated when a humorous tale is counterpoised with disciplined thought. Disciplines build on presences assumed known or knowable while fluid and interpretable presences pervade humor. Explorations in this paper allow considerations of collectives, causality and the philosophy of computing. Economics has long considered issues of collective action in ways circumscribed by assumptions about the presence of economic entities. Such entities are deemed rational but they are clearly not intelligent. To reach its potential, collective intelligence research needs more adequate considerations of alternate presences and their impacts.

Complexity and the science of implementation in health IT — knowledge gaps and future visions

Objectives The intent of this paper is in the examination of health IT implementation processes – the barriers to and facilitators of successful implementation, identification of a beginning set of implementation best practices, the identification of gaps in the health IT implementation body of knowledge, and recommendations for future study and application. Methods A literature review resulted in the identification of six health IT related implementation best practices which were subsequently debated and clarified by participants attending the NI2012 Research Post Conference held in Montreal in the summer of 2012. Using the framework for implementation research (CFIR) to guide their application, the six best practices were applied to two distinct health IT implementation studies to assess their applicability. Results Assessing the implementation processes from two markedly diverse settings illustrated both the challenges and potentials of using standardized implementation processes. In support of what was discovered in the review of the literature, “one size fits all” in health IT implementation is a fallacy, particularly when global diversity is added into the mix. At the same time, several frameworks show promise for use as “scaffolding” to begin to assess best practices, their distinct dimensions, and their applicability for use. Conclusions Health IT innovations, regardless of the implementation setting, requires a close assessment of many dimensions. While there is no “one size fits all”, there are commonalities and best practices that can be blended, adapted, and utilized to improve the process of implementation. This paper examines health IT implementation processes and identifies a beginning set of implementation best practices, which could begin to address gaps in the health IT implementation body of knowledge.

Pornography as creative industry

Much academic writing on pornography focuses on the genre’s exceptionalism (the ways in which it is different from other forms of culture). This paper rather focuses on its typicality as a Creative Industry. As with other Creative Industries, in the production and distribution of pornography it is producers who make most money. While a small number of on-camera performers become wealthy and powerful the majority lack creative control and are poorly paid. The careers of performers are typically short examples of “nomadic labour”. Many creative workers are involved in the production of pornography apart those in front of the camera, and the skills of these behind-the-camera creatives can be transferable across sectors. Like other Creative Industries, the pornography business is facing challenges from increased digitalization and globalization; and like other Creative Industries the solutions to these challenges lie in branding, niche marketing, and exploiting new technological possibilities.