International perspectives on the influence of structure and process of weaning from mechanical ventilation.

<p><strong>Background��</strong><br/> Recently, clinical and research attention has been focused on refining weaning processes to improve outcomes for critically ill patients who require mechanical ventilation. One such process, use of a weaning protocol, has yielded conflicting results, arguably because of the influence of existing context and processes.</p> <p><strong>Objective</strong>��<br/> To compare international data to assess differences in context and processes in intensive care units that could influence weaning. ��</p> <p><strong>Methods</strong>��<br/> Review of existing national data on provision of care for critically ill patients, including structure, staffing, skill mix, education, roles, and responsibilities for weaning in intensive care units of selected countries.</p> <p><strong>Results</strong>��<br/> Australia, New Zealand, Denmark, Norway, Sweden, and the United Kingdom showed similarities in critical care provision, structure, skill mix, and staffing ratios in intensive care units. Weaning in these countries is generally a collaborative process between nurses and physicians. Notable differences in intensive care units in the United States were the frequent use of an open structure and inclusion of respiratory therapists on the intensive care unit���s health care team. Nurses may be excluded from direct management of ventilator weaning in some institutions, as this role is primarily assumed by respiratory therapists guided by medical directives. Availability of critical care beds was highest in the United States and lowest in the United Kingdom.</p> <p><strong>Conclusion</strong>��<br/> Context and processes of care that could influence ventilator weaning outcomes varied considerably across countries. Further quantification of these contextual influences should be considered when translating research findings into local clinical practice and when designing randomized, controlled trials.</p>

Creating advantage in peripheral regions: The role of publicly funded R&amp;D centres

Regional investment in R&amp;D, technological development and innovation is perceived as being strongly associated with productivity, growth and sustained international competitiveness. One policy instrument by which policy makers have attempted to create regional advantage has been the establishment of publicly funded research centres (PRCs). In this paper we develop a logic model for this type of regional intervention and examine the outputs and longer-term outcomes from a group of (18) publicly funded R&amp;D centres. Our results suggest some positive regional impacts but also identify significant differences in terms of innovation, additionality and sustainability between university-based and company-based PRCs. University-based PRCs have higher levels of short-term additionality, demonstrate higher levels of organisational innovation but prove less sustainable. Company-based PRCs demonstrate more partial additionality in the short-term but ultimately prove more sustainable.<br/>

The use of process simulation methods in support of organisational learning in availability contracting

Traditional business models in the aerospace industry are based on a conventional supplier to customer relationship based on the design, manufacture and subsequent delivery of the physical product. Service provision, from the manufacturer's perspective, is typically limited to the supply of procedural documentation and the provision of spare parts to the end user as the product passes through the latter stages of its intended lifecycle. Challenging economic and political conditions have resulted in end users re-structuring their core business activities, particularly in the defence sector. This has resulted in the need for original equipment manufacturers (OEMs) to integrate and manage support service activities in partnership with the customer to deliver platform availability. This improves the probability of commercial sustainability for the OEM through shared operational risks while reducing the cost of platform ownership for the customer. The need for OEMs to evolve their design, manufacture and supply strategies by focusing on customer requirements has revealed a need for reconstruction of traditional internal behaviours and design methodologies. Application of organisational learning is now a well recognised principle for innovative companies to achieve long term growth and sustained technical development, and hence, greater market command. It focuses on the process by which the organisation's knowledge and value base changes, leading to improved problem solving ability and capacity for action. From the perspective of availability contracting, knowledge and the processes by which it is generated, used and retained, become primary assets within the learning organisation. This paper will introduce the application of digital methods to asset management by demonstrating how the process of learning can benefit from a digital approach, how product and process design can be integrated within a virtual framework and finally how the approach can be applied in a service context.

Non-aqueous silicone elastomer gels as a vaginal microbicide delivery system for the HIV-1 entry inhibitor maraviroc

Aqueous semi-solid polymeric gels, such as those based on hydroxyethylcellulose (HEC) and polyacrylic acid (e.g. Carbopol��), have a long history of use in vaginal drug delivery. However, despite their ubiquity, they often provide sub-optimal clinical performance, due to poor mucosal retention and limited solubility for poorly water-soluble actives. These issues are particularly pertinent for vaginal HIV microbicides, since many lead candidates are poorly water-soluble and where a major goal is the development of a coitally independent, once daily gel product. In this study, we report the use of a non-aqueous silicone elastomer gel for vaginal delivery of the HIV-1 entry inhibitor maraviroc. In vitro rheological, syringeability and retention studies demonstrated enhanced performance for silicone gels compared with a conventional aqueous HEC gel, while testing of the gels in the slug model confirmed a lack of mucosal irritancy. Pharmacokinetic studies following single dose vaginal administration of a maraviroc silicone gel in rhesus macaques showed higher and sustained MVC levels in vaginal fluid, vaginal tissue and plasma compared with a HEC gel containing the same maraviroc loading. The results demonstrate that non-aqueous silicone gels have potential as a formulation platform for coitally independent vaginal HIV microbicides.

On the mobility of a one-dimensional damped Frenkel-Kontorova chain: Commensurate versus incommensurate

The mobility of a one-dimensional damped Frenkel-Kontorova chain under a de driving force is studied numerically and analytically For the commensurate case, the particles in the chain me synchronized st high driving force. For the incommensurate chain, a single mode solution dominates st high mobility regime. We are able to calculate the mobilities for both the cases analytically, and a good agreement with numerical results is found. The mobility hysteresis for the incommensurate chain is explained by the existence of two branches of physical solutions, and transitions occur when one of them breaks up.

TUNING COLOURIMETRIC AND FLUOROMETRIC GAS SENSORS FOR CARBON-DIOXIDE

The basic theory behind conventional colourimetric and fluorimetric optical sensors for CO2 is examined and special attention is given to the effect on sensor response of the key parameters of initial base concentration and dye acid dissociation constant, K(D). Experimental results obtained in aqueous solution using a variety of different dyes and initial base concentrations are consistent with the predictions made by the theoretical model. A series of model-generated pK(D) versus %CO2 curves for different initial base concentrations allow those interested in constructing an optical CO2 sensor to readily identify the optimum dye/initial base combination for their sensor; the response of the sensor can be subsequently fine-tuned through a minor variation in the initial base concentration. The model and all its predictions appear also to apply to the new generation of plastic film CO2 sensors which have just been developed.

Weibel-induced filamentation during an ultrafast, laser-driven plasma expansion

The development of current instabilities behind the front of a cylindrically expanding plasma has been investigated experimentally via proton probing techniques. A multitude of tubelike filamentary structures is observed to form behind the front of a plasma created by irradiating solid-density wire targets with a high-intensity (I~1019??W/cm2), picosecond-duration laser pulse. These filaments exhibit a remarkable degree of stability, persisting for several tens of picoseconds, and appear to be magnetized over a filament length corresponding to several filament radii. Particle-in-cell simulations indicate that their formation can be attributed to a Weibel instability driven by a thermal anisotropy of the electron population. We suggest that these results may have implications in astrophysical scenarios, particularly concerning the problem of the generation of strong, spatially extended and sustained magnetic fields in astrophysical jets.

The contribution of the United Nations Convention on the Rights of the Child to understanding and promoting the interests of young people making the transition from care to adulthood

The United Nations Convention on the Rights of the Child (UNCRC) acknowledges that young people without parental care are entitled to special support and assistance from the State. In detailing their expectations, the UN Committee have issued Guidelines for the Alternative Care of Children which recognise that State parties have a number of responsibilities towards care leavers. The paper explores how the UNCRC reporting process, and guidelines from the Committee outlining how States should promote the rights of young people making the transition from care to adulthood, can be used as an instrument to track global patterns of change in policy and practice. Content analysis of State Party Reports and Concluding Observations from 15 countries reveals that to date there has been limited engagement with understanding and promoting the needs of this group in the reporting process; although where a government is committed to developing legislation and practice then this does find its way into their national reports. Data supplied by affiliates of the International Research Network on Transitions to Adulthood from Care (INTRAC) reveals that national concerns, political ideology, public awareness, attitudes and knowledge of the vulnerability of care leavers influence service responses to protect and promote the rights of this group and the attention afforded to such issues in reports to the Committee. Findings also suggest that global governance is not simply a matter of top down influence. Future work on both promoting and monitoring of the impact of the UNCRC needs to recognise that what is in play is the management of a complex global/national dynamic with all its uneven development, levels of influence and with a range of institutional actors involved.

Dynamics of the Indonesian seas circulation. Part II ��� The role of pressure head

The aim of this paper is to analyze the role of the pressure head, i.e., the difference of total pressure forces acting on the Indonesian seas waters from the western Pacific and the eastern Indian Ocean, in driving the Indonesian Throughflow (ITF) and in determining the total transport of the ITF. These questions have been discussed in the literature but no consensus has been reached. A regional model of the Indonesian seas circulation has been developed that properly resolves all major topographic features in the region. The results of model runs have been used to calculate all components of the overall momentum balance. The estimates disclose that the dynamical balance is primarily between the volume integrated Coriolis acceleration, pressure gradient and the area integral of local wind stress. It is shown that consideration of components of momentum balance in the direction of the outflow through the Indian Ocean port leads to the formulation of a diagnostic relation between total inflow transports due to the Mindanao and New Guinea Coastal Currents and the external pressure head, internal pressure head, bottom form stress, and area integrated wind stress. Based on this relation, it is concluded that the external pressure head is not the major driving force of the ITF, which is why there is no unique relation between the total transport of the ITF and the external pressure head. However, Wyrtki's suggestion to monitor the variability of the total transport of the ITF by measurement of the sea-surface-height difference between the western Pacific and the eastern Indian Ocean is validated.

Before the Volcano:Reverberations of Identity on Montserrat

How is identity claimed, contested and sustained? <br/> <br/>This book looks at retentions, reconstructions and reverberations of identity in a colonial Caribbean setting. It is an ���uncomfortable��� and ���impressionistic��� ethnography of life on the island of Montserrat leading up to and including the present day volcanic eruptions. It explores Montserrat���s existing colonial identity and emerging postcolonial identity drawing upon examples from local poets, calypsonians and historians; controversial development and trade union struggles; and the impact of tourism and colonialism on the island ��� Black Irish identity claims and the celebration and/or commemoration of St. Patrick���s Day in particular. <br/> <br/>This book will appeal to Anthropologists, Sociologists, and Cultural Studies and Caribbean Studies scholars, as well as those involved in and concerned for the reconstruction of Montserrat the place and Mons���rat the people. <br/>

We Never Give Up II

Ten years after the production of the initial 'We Never Give Up' film, this documentary filmis a follow-up film about the experiences of ten survivors of South Africa apartheid and their struggle for reparations. Produced by the Human Rights Media Centre, Cape Town, the film was directed and filmed by Cahal McLaughlin in a collaborative relationship with Khulumani Support Group Western Cape.<br/><br/>Further Information:<br/><br/>This documentary film, produced with the Human Rights Media Centre, Cape Town, and in collaboration with Khulumani Support Group Western Cape, is the ten-year follow up to We Never Give Up (2002), which addressed the issues of reparations as dealt with by the South African government and the Truth and Reconciliation Commission. We Never Give Up II (2012) returns to these themes and to the same participants, asking how life has changed in the interim. The process of collaborative practices acknowledges the importance of sharing ownership/authorship in the storytelling processes as well as in validating traumatic experiences by those who survived major and sustained political violence. Made over a two-year period, involving close consultation with participants, the film offers insights, by those most directly affected, to what might constitute legal, financial, social and psychological reparations. The film has been screened in Cape Town, Bloemfontain, Zanzibar Film Festival, Belfast (Belfast Film Festival), Brighton, Guildford, Galway and London, always accompanied by discussion of the issues raised in Q&amp;As. To emphasise the importance of the film for debates on policy around reparations, a 25 minute edited version was selected to be screened on SABC on ���Special Assignment��� by SABC on April 29th, 2013 (South Africa���s ���Freedom Day���), followed by a debate with Department of Justice spokesperson, Dr Khotso De Wee. The chapter 'Maureen Never Gave Up' in Daniels, McLaughlin and Pearce (eds.) 'Truth, Dare or Promise' (2013) Cambridge Scholars Press (ISBN: 1-4438-4959-6, ISBN 13: 978-1-4438-4959-3, Release Date: 2013-09-01), which analyses the production of this film, is offered as part of the portfolio.<br/><br/>

Welcoming the World: Governing Hospitality in London's 2012 Olympic Bid

London���s successful bid for the 2012 Olympic Games presented a diverse, cosmopolitan city opening its arms and ���welcoming the world.��� This article explores the apparently benign gesture of hospitality contained in London���s official candidature files submitted in 2004 and asks how such a promise of inclusiveness is managed. We argue that London���s depiction of itself as hospitable to every kind of visitor relies on subtle techniques of governmentality in which the subject positions of ���host��� and ���guest��� are imagined and produced in ways that make them more governable. By this, we are not referring to acts of authority, coercion, or discipline that exclude subjects or render them docile bodies within a rigid panoptical city. Rather, we are referring to the delicate ways in which the official bid document imagines and produces the ideal subject positions of host and guest and in so doing enables, encourages, and incentivizes certain behaviors. This analysis of urban welcoming takes us beyond reductive oppositions of hospitality and hostility, inclusion and exclusion, self and other. It focuses instead on how London���s inclusive welcome produces a variety of host and guest positions (for example, the ���Olympic Family,��� volunteers, guest workers), segregates them within the city, and then ���conducts their conduct��� in the areas of planning, security, transport, accommodation, education, and training. By analyzing the techniques of governmentality at work in London���s 2004 bid document, this article foregrounds the enabling form of power driving the city���s inclusive welcome and exposes its inherent micropolitics.

Governing Ireland:From Cabinet Government to Delegated Governance

The structures of Irish government were once considered reliably stable, professional and efficient. The economic crash of 2008 swept away all such sureties. How did we fail to foresee the challenges and avert a crisis that has undermined the state in every respect? Initial explanations have focused on the absence of robust mechanisms to challenge policy, a lack of imagination and expertise in policy design, and inadequacies in policy implementation and evaluation. Others still have pointed to the inability of traditional structures of decision-making and oversight to manage the multidimensional nature of modern policy problems, as well as an increasingly complex administrative system.<br/> <br/>This new book offers a fresh and sustained scrutiny of the Irish system of national government. It examines the cabinet, the departments of Finance and the Taoiseach, ministerial relationships with civil servants, the growth and decline of agencies, the executive's relationship with D��il ��ireann and other monitoring agencies, the impact of the European Union, the courts, the media and social partnership. Distinguished academics are brought together in this volume to reassess Irish governance structures in the context of much greater diversity in policy processes and delegation in government. The book is essential reading for anyone interested in how the Irish state is governed, including practitioners and students of Irish politics.<br/>

The relationship between informal caregiving and mortality: an analysis using the ONS Longitudinal Study of England and Wales.

BACKGROUND: <br/><br/>Many studies have suggested that caregiving has a detrimental impact on health. However, these conclusions are challenged by research which finds evidence of a comparative survivorship advantage, as well as work which controls for group differences in the demand for care.<br/><br/>METHODS: <br/><br/>We use a large record linkage study of England and Wales to investigate the mortality risks of carers identified in the 2001 Census. The analysis focuses on individuals aged 35-74 living with others in private households and a distinction is made between those providing 1-19 and 20 or more hours of care per week. Logit models identify differences in carers' health at baseline and postcensal survival is analysed using Cox proportional hazards models.<br/><br/>RESULTS: <br/><br/>12.2% of study members reported providing 1-19 h of care and 5.4% reported providing 20 or more hours. While carers were significantly more likely to report poorer health at baseline, survival analyses suggested that they were at a significantly lower risk of dying. This comparative advantage also held when the analyses were restricted to individuals living with at least one person with poor health.<br/><br/>CONCLUSIONS: <br/><br/>The comparative mortality advantage revealed in this analysis challenges common characterisations of carers' health and draws attention to important differences in the way carers are defined in existing analyses. The survival results are consistent with work using similar data for Northern Ireland. However, the study also affords more uniform conclusions about carers' baseline health and this provides grounds for questioning existing hypotheses about the reasons for this advantage.<br/>

Preliminary analysis of organic Rankine cycles to improve vehicle efficiency

This paper presents the background rationale and key findings for a model-based study of supercritical waste heat recovery organic Rankine cycles. The paper���s objective is to cover the necessary groundwork to facilitate the future operation of a thermodynamic organic Rankine cycle model under realistic thermodynamic boundary conditions for performance optimisation of organic Rankine cycles. This involves determining the type of power cycle for organic Rankine cycles, the circuit configuration and suitable boundary conditions. The study focuses on multiple heat sources from vehicles but the findings are generally applicable, with careful consideration, to any waste heat recovery system. This paper introduces waste heat recovery and discusses the general merits of organic fluids versus water and supercritical operation versus subcritical operation from a theoretical perspective and, where possible, from a practical perspective. The benefits of regeneration are investigated from an efficiency perspective for selected subcritical and supercritical conditions. A simulation model is described with an introduction to some general Rankine cycle boundary conditions. The paper describes the analysis of real hybrid vehicle data from several driving cycles and its manipulation to represent the thermal inertia for model heat input boundary conditions. Basic theory suggests that selecting the operating pressures and temperatures to maximise the Rankine cycle performance is relatively straightforward. However, it was found that this may not be the case for an organic Rankine cycle operating in a vehicle. When operating in a driving cycle, the available heat and its quality can vary with the power output and between heat sources. For example, the available coolant heat does not vary much with the load, whereas the quantity and quality of the exhaust heat varies considerably. The key objective for operation in the vehicle is optimum utilisation of the available heat by delivering the maximum work out. The fluid selection process and the presentation and analysis of the final results of the simulation work on organic Rankine cycles are the subjects of two future publications.