Tracheostomy decannulation failure rate following critical illness : a prospective descriptive study

Background : Tracheostomy is a well established and practical approach to airway management for patients requiring extended periods of mechanical ventilation or airway protection. Little evidence is available to guide the process of weaning and optimal timing of tracheostomy tube removal. Thus, decannulation decisions are based on clinical judgement. The aim of this study was to describe decannulation practice and failure rates in patients with tracheostomy following critical illness.

Methods : A prospective descriptive study was conducted of consecutive patients who received a tracheostomy at a tertiary metropolitan public hospital intensive care unit (ICU) between March 2002 and December 2006. Data were analysed using descriptive and inferential tests.

Results : Of the 823 decannulation decisions, there were 40 episodes of failed decannulation, a failure rate of 4.8%. These 40 episodes occurred in 35 patients: 31 patients failed once, 3 patients failed twice and 1 patient failed three times. There was no associated mortality. Simple stoma recannulation was required in 25 episodes, with none of these patients readmitted to ICU. Translaryngeal intubation and readmission to ICU took place for the remaining 15 episodes. The primary reason for decannulation failure was sputum retention. Twenty-four patients (60%) failed decannulation within 24 h, with 14 of these occurring within 4 h.

Conclusions : Clinical assessments coupled with professional judgement to decide the optimal time to remove tracheostomy tubes in patients following critical illness resulted in a failure rate comparable with published data. Although reintubation and readmission to ICU was required in just over one third of failed decannulation episodes, there was no associated mortality or other significant adverse events. Our data suggest nurses need to exercise high levels of clinical vigilance during the first 24 h following decannulation, particularly the first 4 h to detect early signs of respiratory compromise to avoid adverse outcomes.

Analysis of fetal heart rate asymmetry before and after 35 weeks of gestation

In this study, we have investigated the evidence of fetal heart rate asymmetry and how the fetal heart rate asymmetry changes before and after 35 weeks of gestation. Noninvasive fetal electrocardiogram (fECG) signals from 45 pregnant women at the gestational age from16 to 41 weeks with normal single pregnancies were analysed. A nonlinear parameter called heart rate asymmetry (HRA) index that measures time asymmetry of RR interval time-series signal was used to understand the changes of HRA in early and late fetus groups. Results indicate that fetal HRA measured by Porta's Index (PI) consistently increases after 35 weeks gestation compared to foetus before 32 weeks of gestation. It might be due to significant changes of sympatho-vagal balance towards delivery with more sympathetic surge. On the other hand, Guzik's Index (GI) showed a mixed effect i.e., increases at lower lags and decreases at higher lags. Finally, fHRA could potentially help identify normal and the pathological autonomic nervous system development.

On- and off-campus student persistence and academic performance

A study of more than 9000 unit enrolments in an Australian engineering programme found that: (a) the off-campus withdrawal rate was close to twice that for on-campus students; (b) whether a student withdrew or not was highly correlated to their mode of study; (c) the rate of withdrawal was significantly different between the two student groups; (d) the grade distribution for completing students was significantly different between the two groups; (e) the mean final grade was significantly higher for off-campus students; (f) the failure rate for off-campus students was significantly lower; and (g) the overall wastage rate (withdrawn rate plus fail rate) was significantly higher for off-campus students

Comparative academic performance of engineering and technology students at Deakin University, Australia

Students completing three-year engineering technology and four-year professional engineering undergraduate courses may undertake a number of common study units. To gain an objective understanding of the academic performance characteristics of both student groups in the engineering and technology programs at Deakin University (Australia), a study was  undertaken of close to 9000 unit enrollments. It was found that: overall the BTech withdrawal rate was about 20% higher than for BE students; the rate of withdrawal was significantly different between the two student groups; the grade distribution for completing students was not significantly different between the two groups; the mean final grade was not significantly different between the two student groups; the failure rate was not significantly different between the two student groups; and the overall wastage rate (withdrawn rate plus fail rate) was significantly higher for BTech students. Other related results are also reported.

Academic performance and persistence of on- and off- campus engineering and technology students

A study of more than 9000 unit enrolments in an Australian engineering program found that: the off-campus withdrawal rate was close to twice that for on-campus students; whether a student withdrew or not was highly correlated to mode of study; the rate of withdrawal was significantly different between the two student groups; the grade distribution for completing students was significantly different between the two groups; the mean final grade was significantly higher for off-campus students; the failure rate for off-campus students was significantly lower; and the overall wastage rate (withdrawn rate plus fail rate) was significantly higher for off-campus students.

Goal-efficacy framework : an examination of domestic and international accounting students' academic performance

This study considers the psychological influences on academic performance using a goal-efficacy framework. Data were gathered using a survey questionnaire (N = 375). The paper is motivated by a repeated high failure rate for a second-year core accounting unit and anecdotal evidence that international students perform poorly in comparison with domestic students. The results demonstrate the role of self-regulated learning strategy as a mediating variable for goal orientation and academic performance. While the analyses suggest no significant differences between domestic and international students with respect to the main psychological variables and academic performance, further analyses reveal that four specific factors of the main psychological variables are significantly different between domestic and international students. © 2013 AFAANZ.

Auranofin: repurposing an old drug for a golden new age

Drug discovery, development and registration is an expensive and time-consuming process associated with a high failure rate [Pessetto et al. (Mol Cancer Ther 12:1299-1309, 2013), Woodcock and Woosley (Annu Rev Med 59:1-12, 2008)]. Drug 'repurposing' is the identification of new therapeutic purposes for already approved drugs and is more affordable and achievable than novel drug discovery [Pessetto et al. (Mol Cancer Ther 12:1299-1309, 2013)]. Auranofin is a drug that is approved for the treatment of rheumatoid arthritis but is being investigated for potential therapeutic application in a number of other diseases including cancer, neurodegenerative disorders, HIV/AIDS, parasitic infections and bacterial infections [Tejman-Yarden et al. (Antimicrob Agents Chemother 57:2029-2035, 2013)]. The main mechanism of action of auranofin is through the inhibition of reduction/oxidation (redox) enzymes that are essential for maintaining intracellular levels of reactive oxygen species. Inhibition of these enzymes leads to cellular oxidative stress and intrinsic apoptosis [Pessetto et al. (Mol Cancer Ther 12:1299-1309, 2013), Fan et al. (Cell Death Dis 5:e1191, 2014), Fiskus et al. (Cancer Res 74:2520-2532, 2014), Marzano et al. (Free Radic Biol Med 42:872-881, 2007)]. Drugs such as auranofin that have already been approved for human use [Tejman-Yarden et al. (Antimicrob Agents Chemother 57:2029-2035, 2013)] can be brought into clinical use for other diseases relatively quickly and for a fraction of the cost of new drugs.

Are firms with negative book equity in financial distress?

© 2015 World Scientific Publishing Co. and Center for Pacific Basin Business, Economics and Finance Research. This study examines whether negative book equity (BE) firms are in financial distress by analyzing their operating performance, financial characteristics, distress risk, and survivability when they first report negative BE. Firms with small magnitude of negative BE (SNBE firms) suffer from persistent negative earnings and financial distress, while firms with large magnitude of negative BE (LNBE firms) experience a temporary non-distress related earnings shock. LNBE firms report consecutive years of negative BE, but have lower distress risk and failure rate than both SNBE and control firms. However, all negative BE stocks have abysmal returns subsequent to their first report of negative BE.

Dominating set and network coding-based routing in wireless mesh networks

Wireless mesh networks are widely applied in many fields such as industrial controlling, environmental monitoring, and military operations. Network coding is promising technology that can improve the performance of wireless mesh networks. In particular, network coding is suitable for wireless mesh networks as the fixed backbone of wireless mesh is usually unlimited energy. However, coding collision is a severe problem affecting network performance. To avoid this, routing should be effectively designed with an optimum combination of coding opportunity and coding validity. In this paper, we propose a Connected Dominating Set (CDS)-based and Flow-oriented Coding-aware Routing (CFCR) mechanism to actively increase potential coding opportunities. Our work provides two major contributions. First, it effectively deals with the coding collision problem of flows by introducing the information conformation process, which effectively decreases the failure rate of decoding. Secondly, our routing process considers the benefit of CDS and flow coding simultaneously. Through formalized analysis of the routing parameters, CFCR can choose optimized routing with reliable transmission and small cost. Our evaluation shows CFCR has a lower packet loss ratio and higher throughput than existing methods, such as Adaptive Control of Packet Overhead in XOR Network Coding (ACPO), or Distributed Coding-Aware Routing (DCAR).

The role of IT governance in generating business value from IT investments in healthcare: lessons from an Australian experience

Digitizing the core processes of healthcare delivery is looked at as a solution to control the escalating costs without compromising quality or patient outcomes. However, to date the business value of such IT solutions remains elusive, especially in view of the high failure rate of many solutions coupled with the high user resistance. The uniqueness of the healthcare industry makes measuring the business value of IT a complex missions, yet it is the thesis of this research that such an activity is an essential first step if we are to realise the full potential of IT in healthcare. The role IT governance can play is of high importance to generate business value from IT investments in healthcare. This is investigated using an integrative model that is proffered to conceptualise the business value of IT in healthcare. This conceptual model is then used to guide an exploratory case study based at a leading private healthcare provider in Melbourne-Australia.

Role of ADRI model in teaching and assessing novice programmers

In this research, an ADRI approach was introduced in the teaching and learning process of an introductory programming course. The result shows that the ADRI approach impacted positively on the students learning outcomes. The ADRI approach not only reduced the failure rate but also improved student’s retention in the course.

Moderate-intensity resistance exercise training in patients with chronic heart failure improves strength, endurance, heart rate variability, and forearm blood flow

Thirty-nine CHF patients (New York Heart Association Functional Class = 2.3±0.5; left ventricular ejection fraction 28%±7%; age 65±11 years; 33:6 male:female) underwent 2 identical series of tests, 1 week apart, for strength and endurance of the knee and elbow extensors and flexors, VO_2peak, HRV, FBF at rest, and FBF activated by forearm exercise or limb ischemia. Patients were then randomized to 3 months of resistance training (EX, n = 19), consisting of mainly isokinetic (hydraulic) ergometry, interspersed with rest intervals, or continuance with usual care (CON, n = 20), after which they underwent repeat endpoint testing. Combining all 4 movement patterns, strength increased for EX by 21±30% (mean±SD, P<.01) after training, whereas endurance improved 21±21% (P<.01). Corresponding data for CON remained almost unchanged (strength P<.005, endurance P<.003 EX versus CON). VO_2peak improved in EX by 11±15% (P<.01), whereas it decreased by 10±18% (P<.05) in CON (P<.001 EX versus CON). The ratio of low-frequency to high-frequency spectral power fell after resistance training in EX by 44±53% (P<.01), but was unchanged in CON (P<.05 EX versus CON). FBF increased at rest by 20±32% (P<.01), and when stimulated by submaximal exercise (24±32%, P<.01) or limb ischemia (26±45%, P<.01) in EX, but not in CON (P<.01 EX versus CON).

Failure of conjugated linoleic acid supplementation to enhance biosynthesis of docosahexaenoic acid from α-linolenic acid in healthy human volunteers

A rate-limiting step in docosahexaenoic acid (DHA) formation from α-linolenic acid (ALA) involves peroxisomal oxidation of 24:6n-3 to DHA. The aim of the study was to determine whether conjugated linoleic acid (CLA) would enhance conversion of ALA to DHA in humans on an ALA-supplemented diet. The subjects (n=8 per group) received daily supplementation of ALA (11g) and either CLA (3.2g) or placebo for 8 weeks. At baseline, 4 and 8 weeks, blood was collected for plasma fatty acid analysis and a number of physiological measures were examined. The ALA-supplemented diet increased plasma levels of ALA and eicosapentaenoic acid (EPA). The addition of CLA to the ALA diet resulted in increased plasma levels of CLA, as well as ALA and EPA. Plasma level of DHA was not increased with either the ALA alone or ALA plus CLA supplementation. The results demonstrated that CLA was not effective in enhancing DHA levels in plasma in healthy volunteers.

Heterogeneity in service delivery and inequity in access are common characteristics of chronic heart failure management programs

Background: The prevalence of heart failure in Australia is similar to that of Europe. In Australia, chronic heart failure management programs (CHF-MPs) have become part of standard care for patients with Chronic Heart Failure (CHF). However, heterogeneity among programs is common which can result in variable patient outcomes.

Method: A national survey was undertaken of 59 post-discharge CHF-MPs identified from within the Australian health care system. Two had ceased operating and one centre declined to participate in the study. A 33-item investigator-developed questionnaire, examining the characteristics and interventions used within each CHF-MP, was sent to the remaining 56 CHF-MPs. A response rate of 100% was achieved.

Results: Our survey revealed a disproportional distribution of CHF-MPs across the Australian continent: the State of Victoria had 3.6 CHF-MPs/million population, New South Wales had 3.7 CHF-MPs/million population, Queensland had 1 program/million population, South Australia had 0.3 CHF-MPs/million population and Western Australia had 1 program/million population.Overall, 8000 postdischarge CHF pts (median: 126; IQR: 26-260) were managed via CHF-MPs. Approximately 40,000 CHF pts are discharged from metropolitan institutions nationally, this represents only 22% of the potential caseload for these cost-effective CHF-MPs. Only 8% of these programs were located within rural regions. The majority of CHF-MPs were located within an acute metropolitan hospital (52%) and 36% were community based (all associated with a hospital). Heterogeneity of CHF-MPs in applied models of care was evident with 75% of CHF-MPs offering CHF outpatient clinics and 77% conducting home visits. Of the programs offering home visits 78% were funded by regional government (p<0.048). There were no nurse-led CHF outpatient clinics. A hybrid approach to CHF-MPs was common with many CHF-MPs comprising an outpatient clinic, home visits and inpatient visits. Various medications were titrated by nurses in 43% of CHF-MPs. In the programs that allowed nurses to titrate medications 79% were located in an acute hospital (p<0.011).

Conclusion: Variability of service availability is of concern within the context of universal coverage. In addition, heterogeneity between programs and the diversity in models of care delivery highlights the inconsistency and questions the quality of health related outcomes. We are currently analysing health outcome data from the 1015 patients managed in these CHF-MPs to describe the relationship between quality of care and health outcomes.

Measuring the success of intervention programmes designed to increase the participation rate by women in computing

Many intervention programmes to encourage greater female participation in computer education and careers have been conducted in the last twenty years. These intervention programmes take considerable time, effort and money to design and implement. If success were to be measured by an increase in the percentage of female students undertaking computing courses then these programmes would have to be considered a failure. This paper describes a research project which examined fourteen intervention programmes in detail. From the perspective of the programme champions each of the intervention programmes was considered successful, even when this success was restricted to specific areas or limited to small groups of individuals. Formal evaluation appeared to have been an afterthought rather than a priority of many of the programme champions. Some programmes appeared to be less effective due to the lack of targeted and clear goals or predetermined evaluation criteria. It is recommended that during the initial planning phase for intervention programmes a clear objective is to consider what a successful programme would look like and what the evaluation criteria would be. Further work is needed to understand how intervention programmes can be better designed and evaluated so that their impact and success can be expanded.