Thai emergency nurses’ management of patients with severe traumatic brain injury: comparison of knowledge and clinical management with best available evidence

Background:
In Thailand, the rate of TBI-related hospitalisation is increasing, however, little is known about the evidence-based management of severe TBI in the developing world. The aim of this study was to explore Thai emergency nurses’ management of patients with severe TBI.

Methods:
An exploratory descriptive mixed method design was used to conduct this two stage study: survey methods were used to examine emergency nurses’ knowledge regarding management of patients with severe TBI (Stage 1) and observational methods were used to examine emergency nurses’ clinical management of patients with severe TBI (Stage 2). The study setting was the emergency department (ED) at a regional hospital in Southern Thailand.

Results:
34 nurses participated in Stage 1 (response rate 91.9%) and the number of correct responses ranged from 33.3% to 95.2%. In Stage 2, a total of 160 points of measurement were observed in 20 patients with severe TBI over 40 h. In this study there were five major areas identified for the improvement of care of patients with severe TBI: (i) end-tidal carbon dioxide (ETCO2) monitoring and targets; (ii) use of analgesia and sedation; (iii) patient positioning; (iv) frequency of nursing assessment; and (v) dose of Mannitol diuretic.

Conclusions:
There is variation in Thai nurses’ knowledge and care practices for patients with severe TBI. To increase consistency of evidence-based TBI care in the Thai context, a knowledge translation intervention that is ecologically valid, appropriate to the Thai healthcare context and acceptable to the multidisciplinary care team is needed.

Lying idiots: reality television & lie to me

This article addresses perhaps the key question for Television Studies: Who does television think you are? It argues that Reality Television answers this question by producing its viewers as, in the Classical Greek sense, idiots (meaning private and ignorant persons). Idiots are the perfect target for the advertising dollar that supports commercial television production. As Reg Grundy observes, Reality Television is anything but reality. With its tight framings of reality, it paradoxically operates to sever the viewing self from reality—from the “truth” of life. Lie to Me is the type of television we are left with after the demise of Reality Television. Lie to Me makes us self-conscious, in the strongest sense, and thus sustains the mission of Reality Television. By dragging the notion of reality into its self-serving fictions, it puts the viewer into the dangerous position of being unable to lie to television. If Reality Television constrained reality to falsity, Lie to Me implicates the viewer in the zone where falsity transforms into reality. Lastly, this article enquires into the possibilities, in today’s television ecology, for a mode of TV citizenship that would counter the abject viewing position of the consumerist idiot.

Having the courage to measure up for education

In this “age of measurement” it is increasing difficult for educators to educate (Biesta, 2010). The pressures to conform to the demands of bureaucratic authorities generally trump over educators and their aims to educate. One of the factors contributing to this is because as Dewey (1929a, p. 133) has argued, our aims and our desires to educate don’t have deep enough roots. He suggests that educators ought to have “cultivated” and “significant conscious desires” and a disposition to be “courageous” (1929a, p. 134; 1929b, p. 38) in order to attain the independence to ensure that our practices in education are indeed educational. Dewey (1934) called such a disposition a “religious attitude” because it engages with the ultimate concerns that people can aspire towards. In this paper I shall argue that this religious attitude of Dewey’s which can enable our roots to deepen, does not just pertain to our aims of education as an intellectual phenomenon. Rather it can be understood as existential (Webster, 2009) in the sense that aims of education are specific to individuals in situation – not to abstract or universal understandings of education. It shall also be argued that this existential aspect of our being is emotive, and deepening its roots might enable us to become more courageous and thus more able to challenge the barriers inherent in our current ‘age of measurement’ so that education may become more of a reality.

Post-anaesthetic discharge scoring criteria: key findings from a systematic review

Background
Patient safety depends on nurses' clinical judgment. In post-anaesthetic care, objective scoring systems are commonly used to help nurses assess when a patient is ready to go back to the ward or be discharged home after day surgery. Although there are several criteria used to assess patient readiness for discharge from the post-anaesthetic care unit, evaluation of the validity and reliability of these criteria is scarce.

Aims
This article presents key findings from a systematic review conducted to identify the essential components of an effective and feasible scoring system to assess patients following surgical anaesthesia for discharge from the post-anaesthetic care unit.

Methods
The protocol for the systematic review of quantitative studies investigating assessment criteria for discharge of adult patients from the post-anaesthetic care unit was approved by the Joanna Briggs Institute and conducted consistent with the methodology of the Institute. Twelve databases and grey literature, such as conference proceedings, were searched for published studies between 1970 and 2010. Two reviewers independently assessed study eligibility for inclusion. Reference lists of included studies were appraised.

Results
Eight studies met the inclusion criteria; only one was a randomised controlled trial. Variables identified as essential when assessing a patient's readiness for discharge from the post-anaesthetic care unit were conscious state, blood pressure, nausea and vomiting, and pain. Assessment of psychomotor and cognitive recovery and other vital signs were also identified as relevant variables to consider.

Conclusions
There was limited high-quality research regarding criteria to assess patient readiness for discharge from the post-anaesthetic unit. The key recommendations, with moderate to high risk of bias, include that assessment of specific variables (pain, conscious state, blood pressure, and nausea and vomiting) should be made before patient discharge. These key findings have informed a subsequent study to reach international consensus on effective assessment criteria and a project to test the clinical reliability of a tool for use by nurses in assessing patient readiness for discharge from post-anaesthetic care.

Light the towel: narrative and the negotiated unconscious

The thesis consists of a creative component: a novel in multiple first-person voices, and a theoretical component: investigating the interaction between conscious and unconscious processes, in creative writing. The concept of alterity as ‘otherness’, at the heart of the theoretical inquiry, derives its momentum from the experience of the operation of the ‘other’ in the ‘I’ in narrative composition.

Discovering consumer personality clusters in prestige sensitivity and fashion consciousness context

This article aims to discover the differences among consumer personality clusters in regard to their extent of fashion consciousness and prestige sensitivity. Data were collected from 251 undergraduate students using self-administered questionnaires. Cluster analysis and MANOVA were employed to assess whether significant differences exist among four personality clusters. The study used the Big Five scale items to measure consumer personality and found that respondents who score low on the “openness to experience” dimension tend to be less prestige sensitive, and those who score high on “extraversion,” “agreeableness,” and “conscientiousness” tend to be highly fashion conscious.

Altered responsiveness of the kidney to activation of the renal nerves in fat-fed rabbits

We tested whether mild adiposity alters responsiveness of the kidney to activation of the renal sympathetic nerves. After rabbits were fed a high-fat or control diet for 9 wk, responses to reflex activation of renal sympathetic nerve activity (RSNA) with hypoxia and electrical stimulation of the renal nerves (RNS) were examined under pentobarbital anesthesia. Fat pad mass and body weight were, respectively, 74% and 6% greater in fat-fed rabbits than controls. RNS produced frequency-dependent reductions in renal blood flow, cortical and medullary perfusion, glomerular filtration rate, urine flow, and sodium excretion and increased renal plasma renin activity (PRA) overflow. Responses of sodium excretion and medullary perfusion were significantly enhanced by fat feeding. For example, 1 Hz RNS reduced sodium excretion by 79 ± 4% in fat-fed rabbits and 46 ± 13% in controls. RNS (2 Hz) reduced medullary perfusion by 38 ± 11% in fat-fed rabbits and 9 ± 4% in controls. Hypoxia doubled RSNA, increased renal PRA overflow and medullary perfusion, and reduced urine flow and sodium excretion, without significantly altering mean arterial pressure (MAP) or cortical perfusion. These effects were indistinguishable in fat-fed and control rabbits. Neither MAP nor PRA were significantly greater in conscious fat-fed than control rabbits. These observations suggest that mild excess adiposity can augment the antinatriuretic response to renal nerve activation by RNS, possibly through altered neural control of medullary perfusion. Thus, sodium retention in obesity might be driven not only by increased RSNA, but also by increased responsiveness of the kidney to RSNA.

David Bowie: dancing with madness and proselytising the socio-political in art and life

A longstanding, successful and frequently controversial career spanning more than four decades establishes David Bowie as charged with individual agency. The notion of ‘agency’ here refers particularly to the ‘ability of people, individually and collectively to influence their own lives and the society in which they live’ (Germov and Poole, 2007: 7). That Bowie has influenced many lives is undeniable to his fans. He has long demonstrated an avid curiosity for the enduring patterns of social life which is reflected in his art. Bowie’s opus contains the elements of ideological narratives around sexual (mis)adventure, expressivity, and; resistance to ‘normative’ behaviour. He requisitions his audiences, through frequently indirect lyrics and images, to critically question sanity, identity and essentially what it means to be ‘us’ and why we are here. Here, in this context, ‘dancing with madness’ assumes an intimate relationship, even if brief, where ideas and emotions come passionately together for the purpose of creative expression much like the intertwining and energetic performance of the partner dance Tango. As such, ‘dancing’ is argued here to be an appropriate descriptor for how Bowie has engaged with creative cultural forms but not meant to be self-conscious nor indicate superficiality or ignorance. The idea of madness for its part is a theme in many of his compositions, for example the original album cover for The Man Who Sold the World (1971)  depicts an asylum and includes the song ‘All The Madmen’ and Aladdin Sane (1973)—a lad insane--are but two examples. This paper argues that Bowie’s frequently astute contemplations, manifest through his art over a period now spanning more than forty years, continues to draw fans of like mind to his work with the result that he has a legitimate claim to influence and affect.

Not-I/Thou : the other subject of art and architecture

Not-I/Thou: The Other Subject of Art and Architecture is a series of essays delineating the gray areas and black zones in present-day cultural production. Part One is an implicit critique of neoliberal capitalism and its assault on the humanities through the pseudo-scientific and pseudo-empirical biases of academic and professional disciplines, while Part Two returns to apparent lost causes in the historical development of modernity and post-modernity, particularly the recourse to artistic production as both a form of mnemonics and periodic (and renascent) avant-garde agitation. In-between these twin systems of taking the measure of things, Art and Architecture, as forms of speculative intellectual capital, emerge from the shadow-lands of half-conscious and half-unconscious forces to become gestures toward a type of knowledge that has no utilitarian or generic agency. Defying the tendencies of such discourses to fall prey to instrumental orders that effectively neuter the inherent radical agenda of both, Art and Architecture are represented in this series of essays as noetic apparatuses, operating at the edge of authorized systems of knowledge, quietly and secretly validating and valorizing the shadowy and recondite, collective and personal operations of intellect in service to no particular end.

Offending: drug-related expertise and decision making

Drug use is endemic within offender populations and, as a result, considerable heterogeneity can be found in drug-related crime. Expertise in drug-related offending covers an equally broad base from internal mental processes through skill acquisition to social interactions. This review considers decision making and expertise for crimes in the domains of direct causal effects (e.g., burglary) and non-causal relationships (e.g., apprehension avoidance, detection). Also considered is the notion of expertise as it applies to addiction, in particular the conscious and unconscious goal-directed behaviors articulated in the Selfish Goal model (Huang & Bargh, 2014) and a cool cognition/hot affect dual processing model of criminal decision making (Van Gelder, 2013). The review findings would suggest (a) the need for more focused research into whether expertise differs as a function of drug use and (b) a paradigm shift in terms of treatment for drug-using offenders.

Educating law students for rural and regional legal practice: embedding place consciousness in law curricula

As with other professions, the declining rates of recruitment and retention of lawyers in rural and regional Australia is of significant concern. Whilst the causes of this vary between communities, common depictions of the rural and regional lawyer’s role indicate that employment as a lawyer in such areas is characterised by unique personal and professional challenges. Nonetheless, employment as a rural and regional lawyer also offers practitioners rewarding opportunities and lifestyle benefits. Research from other disciplines indicates that the challenges inherent in rural and regional professional practice may be alleviated, and benefits more easily harnessed, via place conscious discipline-specific curriculum that sensitises tertiary students to, and prepares them for, the rural and regional career context.Largely oriented towards substantive content to satisfy external accrediting bodies, undergraduate legal education does not typically acknowledge the ‘places’in which graduates will practice as professionals. This article argues however that there is scope to incorporate place within legal education, and documents an innovative curriculum development project which embeds place consciousness to better prepare law students for employment in rural and regional legal practice.Drawing upon methods from other disciplines, the project team designed a curriculum package which aims to sensitise students to the rural and regional legal practice context, and equip them with the skills to overcome challenges and take advantage of the opportunities available in a rural or regional professional career.

Australian consumers' decision-making styles for everyday products

Investigated are the decision-making styles of Australian consumers for everyday products. Specifically, the applicability of Sproles and Kendall's Consumer Styles Inventory (CSI) is examined in relation to the purchase of everyday products. Based on a sample of 214 respondents who had recently purchased a confectionery product, exploratory and confirmatory factor analysis is used to validate the CSI. Six decision-making styles are retained from the original CSI ('perfectionist, high quality', 'confused by over-choice', 'impulsive', 'habitual/brand loyal', 'novelty/fashion', and 'recreation conscious') and one new decision-making style is developed ('rational, price conscious'). Marketing and managerial implications are discussed.

Diabolical literature: questioning the morality of modernism

This thesis explores the significance of representations of the devil in key works of modernist literature. It demonstrates that certain writers engaged with the idea that literature was devilish, attesting to the modernists’ self-conscious preoccupation with the morality of literature.

Psychiatric disorders, psychotropic medication use and falls among women: an observational study

BACKGROUND: Psychotropic agents known to cause sedation are associated with an increased risk of falls, but the role of psychiatric illness as an independent risk factor for falls is not clear. Thus, this study aimed to investigate the association between psychiatric disorders, psychotropic medication use and falls risk. METHODS: This study examined data collected from 1062 women aged 20-93 yr (median 50 yr) participating in the Geelong Osteoporosis Study, a large, ongoing, population-based study. Depressive and anxiety disorders for the preceding 12-month period were ascertained by clinical interview. Current medication use and falls history were self-reported. Participants were classified as fallers if they had fallen to the ground at least twice during the same 12-month period. Anthropometry, demographic, medical and lifestyle factors were determined. Logistic regression was used to test the associations, after adjusting for potential confounders. RESULTS: Fifty-six women (5.3%) were classified as fallers. Those meeting criteria for depression within the past 12 months had a 2.4-fold increased odds of falling (unadjusted OR = 2.4, 95% CI 1.2-4.5). Adjustment for age and mobility strengthened the relationship (adjusted OR = 2.7, 95% CI 1.4-5.2) between depression and falling, with results remaining unchanged following further adjustment for psychotropic medication use (adjusted OR = 2.7, 95% CI 1.3-5.6). In contrast, past (prior to 12-month) depression were not associated with falls. No association was observed between anxiety and falls risk. Falling was associated with psychotropic medication use (unadjusted OR = 2.8, 95% CI 1.5-5.2), as well as antidepressant (unadjusted OR = 2.4, 95% CI 1.2-4.8) and benzodiazepine use (unadjusted OR = 3.4, 95% CI 1.6-7.3); associations remained unchanged following adjustment for potential confounders. CONCLUSION: The likelihood of falls was increased among those with depression within the past 12 months, independent of psychotropic medication use and other recognised confounders, suggesting an independent effect of depression on falls risk. Psychotropic drug use was also confirmed as an independent risk factor for falls, but anxiety disorders were not. Further research into the underlying mechanisms is warranted.

Words Between Worlds: Portal Fantasy as Dialogic in Gaiman and Miéville

Step through the looking-glass and where do you go? Inherently, every text exposes the reader to other worlds. However, the fantastic, like no other mode, not only exposes, but explores, explains, and employs other worlds (and how we enter them) to question what is real and unreal, possible and impossible.Using Farah Mendelsohn’s (2008) examination of portal fantasy, this paper argues that when you step into another world you leave something behind and bring something back. This Bakhtinian dialogic will then frame an analysis of Neil Gaiman’s American Gods (2001) and China Miéville’s The City and the City (2009) which explore notions of organic subjectivity, reader expectations, and if gaps actually exist between textual and extra-textual, real and unreal.These atypical, self- reflexive, satirical portal fantasies express how writers position readers (not unlike their protagonists) in alternative conceptual realms, disturbing the everyday, the commonplace realities we often take for granted. As such, both texts and the discursive strategies they use ask: what do we see, or, as may be the case, un-see? Significantly, this paper suggests that, via self-conscious world-building, portal fantasies allow reader and writer the opportunity to inhabit those spaces between textual, ideological, generic, metaphorical, irrational, fantastic worlds.