A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit

Objective: To compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients. Design: Randomized, controlled trial. Setting: General intensive care unit (24 beds) in an Australian metropolitan teaching hospital. Patients: Adult, mechanically ventilated patients (n = 312). Interventions: Patients were randomly assigned to receive sedation directed by formal guidelines (protocol group, n = 153) or usual local clinical practice (control, n = 159). Measurements and Main Results: The median (95% confidence interval) duration of ventilation was 79 hrs (56-93 hrs) for patients in the protocol group compared with 58 hrs (44-78 hrs) for patients who received control care (p = .20). Lengths of stay (median [range]) in the intensive care unit (94 [2-1106] hrs vs. 88 (14-962) hrs, p = .58) and hospital (13 [1-113] days vs. 13 (1-365) days, p = .97) were similar, as were the proportions of subjects receiving a tracheostomy (17% vs. 15%, p = .64) or undergoing unplanned self-extubation (1.3% vs. 0.6%, p = .61). Death in the intensive care unit occurred in 32 (21%) patients in the protocol group and 32 (20%) control subjects (p = .89), with a similar overall proportion of deaths in hospital (25% vs. 22%, p = .51). A Cox proportional hazards model, after adjustment for age, gender, Acute Physiology and Chronic Health Evaluation II score, diagnostic category, and doses of commonly used drugs, estimated that protocol sedation management was associated with a 22% decrease (95% confidence interval 40% decrease to 2% increase, p = .07) in the occurrence of successful weaning from mechanical ventilation. Conclusions: This randomized trial provided no evidence of a substantial reduction in the duration of mechanical ventilation or length of stay, in either the intensive care unit or the hospital, with the use of protocol-directed sedation compared with usual local management. Qualified high-intensity nurse staffing and routine Australian intensive care unit nursing responsibility for many aspects of ventilatory practice may explain the contrast between these findings and some recent North American studies. (C) 2008 Lippincott Williams & Wilkins, Inc.

‘My history is a tile in a mosaic’ : an interview with Jim Cullen

JIM CULLEN was born in Queens, New York, and attended public schools on Long Island. He received his B.A. in English from Tufts University, and his A.M. and Ph.D. degrees in American Civilization from Brown University. He has taught at a number of colleges and universities, including Harvard and Brown. He is currently a teacher, and serves on the Board of the Trustees, at the Ethical Culture Fieldston School in New York City. Jim is married to historian Lyde Cullen Sizer and has four children.
CONTEXT: Dr Glenn Moore co-ordinates the subject 'Searching for the American Dream’ at The University of Melbourne. For the last nine years he has taken second and third year history students to Boston, New York and Washington, D.C to explore the philosophy of genius loci. Dr Moore gets students to work in food banks, visit homeless shelters, museums and organizes an array of guest speakers with experts such as Boston public defender, Denise Regan, Neera Tanden, Hillary Clinton’s campaign manager and Alec Ross, vice president of One Economy. As the leading expert on the American Dream, with the publication of so many books in American history such as: The American Dream: A Short History of an Idea that Shaped a Nation, Born in the U.S.A.: Bruce Springsteen and the American Tradition and Restless in the Promised Land: Catholics and the American Dream, Jim Cullen has spoken to the students for the last five years. I interviewed him prior to his recent discussion with the students in New York on 5 July 2006 at the Fashion Institute of Technology.

A fish out of water? Legal practitioner - practitioner teacher? Bourdieu, the legal field and the scholarship of teaching in practical legal training

It is surprising to discover during early doctoral research that there is a paucity of Australian scholarship using Bourdieu’s theoretical tools in the field of law, and in the sub-field of post-graduate pre-admission practical legal training. This article introduces Bourdieu’s conceptions of habitus, field, categories of capital, symbolic violence, and misrecognition. It describes how Bourdieu applied these tools to identify structural hostility between legal academics and practitioners, and the struggles for control in the field of law. Review of three North American studies that used Bourdieu’s theories follows, involving law students’ habitus in transition, class stratification in legal education, and gender stratification in law firm partnerships. Drawing on three internally connected ‘moments’ necessary to use Bourdieu’s tools, together with four critical questions concerning teachers’ engagement with the scholarship of teaching, this article identifies new questions for investigation. These questions will frame further research to discover whether the objective structures of the practical legal training field and the habitus of legal practitioners constrains them to act as ‘fish out of water’ in the context of a scholarship of teaching.

Disorder and the body of drugs : addiction, consumption, control, and city space

Different cultures and the specific culture manifested within them are intrinsically linked to addiction in a complex fashion which has a long history. For important thinkers, such as Nietzsche, addiction actually embodies human culture, rendering addiction and culture inseparable. This is clearly seen within the Western world’s addiction to the consumption of material goods and the damage that results.

Utopia has often become dystopia. Not only is an understanding of addiction key to understanding culture but to an understanding of the very act thinking itself and the way of being in the world. Addiction raises key philosophical questions, such as: do people really have a choice in their behavior, and what governs them; is it free will or predetermination? Is it biology or environment is it the external world or the internal that drives addiction, or a complex combination of both?

In a contemporary context the media frenzy around celebrity addiction continually fuels public debate in this area, and this book deepens the understanding of addiction within this contentious context. This book addresses a key concern over how addiction became the norm, and it seeks to understand its dominance comprehensively. How did it come to pass that not being an addict was a transgressive act and way of being?

While there has been a great deal of debate about addiction utilizing the discourse of individual and often competing disciplines such as biology and psychology, little attention has been paid to the cultural aspects of addiction. The innovative approach taken by this book is to offer insights into this complex area through a contemporary methodology that covers diverse interrelated areas. Drawing on different disciplines, offering deeper insights, from the analysis of music lyrics to empirical social science and anthropological work in AA groups in Mexico and the portrayal of the “addiction’ to therapy in film and television, amongst other areas, this book addresses the need for a more comprehensive approach.

Academic analysis is also given to the discourse on celebrity culture and addiction. A contemporary fusion of the humanities and the social sciences is the best way forward to tackle this subject and move the debate on. The focus of this study is an innovative interdisciplinary and intercultural approach to addiction, from the social sciences to the humanities, including cultural studies, film and media studies, and literary studies. Areas that have been overlooked, such as lost women’s writings, are examined, in addition to comics, popular film and television, and the work of AA groups.

This edited collection is the first study to provide such a comprehensive analysis of the cultures of addiction. Traversing cultures across the globe, including Asia, Central America, as well as Europe and America, this book opens up the debate in addiction studies and cultural studies. The important insights the book delivers helps to answer questions such as: In what way can Deleuze further the understanding of addiction through the analysis of rock lyrics? How does anthropology improve the understanding of AA groups? How can cultural studies deepen knowledge on the “addiction” to therapy? These are just some of the vast array of areas this book covers. Other areas include the condemnation of “addiction” to comic reading through an historical examination, violence in popular culture, and lost women’s writing on addiction. No other book has such depth and contemporary breadth.

Cultures of Addiction is an important book for those taking cultural studies courses across a range of interrelated disciplines, including English and literary studies, history, American studies, and film and media studies. This will be invaluable to library collections in these fields and beyond in the social sciences, and specifically in addiction studies and psychology.

(Jason Lee, Editor)

Examining ‘Latinidad’ in Latin America: race, ‘Latinidad’ and the decolonial option

This article provides a critical account of the idea of race, conceived of and derived from European colonisers in the New World. The paper argues that race became a crucial category to the colonising projects of the New World, and in particular in the distribution of power during colonialism. The paper further examines how the notion of Latinidad (Latinity), entrenched in the term Latin America, continued to enact a discourse of racial superiority/inferiority even after the battles for Independence had taken place. Employing the critical vocabulary and framework of Decolonial theory, the paper introduces key arguments against Western European universality, and calls for a re-reading of the processes that structure privilege across racial and ethnic lines.

Student perspectives on the value of experiential learning in history

This paper is a reflective study of experiential learning as an American history teaching-tool. It is based on a survey of students who took a University of Melbourne study tour to the United States in the years from 2001–2011. This survey asked students to identify the tour’s long-term outcomes. The responses showed that students believed the study tour was beneficial academically, and that it also opened up employment opportunities. However, the most significant benefit identified by the students was positive social outcomes—in other words, the friends they made on the tour and the professional networks they formed. The conclusion we drew from these results was that students believe that experiential learning has a legitimate place in history curriculums, and that it is an antidote to the loneliness they feel in traditional classroom settings.