The initiation and administration of drugs for advanced life support by critical care nurses in the absence of a medical practitioner

Current legislation does not permit the administration of first line resuscitation medications by suitably qualified Division 1 registered nurses (RNs) in the absence of a medical officer. This omission by the Drugs,  Poisons and Controlled Substances Act 1981 (Vic) and the Drugs, Poisons and The Controlled Substances Regulations 1995 (Vic) leaves many critical care nurses in a vulnerable legal position.

The primary aim of this study was to gauge the view of critical care nurses with respect to lobbying for change to the current legislation. In addition, the study aimed to explore and describe the educational preparation, practice perceptions and experiences of RNs working in critical care regarding cardiopulmonary resuscitation and the administration of first line advanced life support (ALS) medications in the absence of a medical officer. It was anticipated that data collected would demonstrate some of the dilemmas associated with the initiation and administration of ALS medications for practising critical care nurses and could be used to inform controlling bodies in order for them to gain an appreciation of the issues facing critical care nurses during resuscitation.

A mailout survey was sent to all members of the Victorian Branch of the Australian College of Critical Care Nurses (ACCCN). The results showed that the majority of nurses underwent an annual ALS assessment and had current ALS accreditation. Nurses indicated that they felt educationally prepared and were confident to manage cardiopulmonary resuscitation without a medical officer; indeed, the majority had done so. The differences in practice issues for metropolitan, regional and rural nurses were highlighted. There is therefore clear evidence to suggest that legislative amendments are appropriate and necessary, given the time critical nature of cardiopulmonary arrest. There was overwhelming support for ACCCN Vic. Ltd to lobby the Victorian government for changes to the law.

A novel route for the preparation of dimeric tetraorganodistannoxanes

The reaction of polymeric diorganotin oxides, (R₂SnO)_n (R=Me, Et, n-Bu, n-Oct, c-Hex, i-Pr, Ph), with saturated aqueous NH₄X (X=F, Cl, Br, I, OAc) in refluxing 1,4-dioxane afforded in high yields dimeric tetraorganodistannoxanes, [R₂(X)SnOSn(X)R₂]₂, and in a few cases diorganotin dihalides or diacetates, R₂SnX₂. The reported method appears suitable for the synthesis of fluorinated tetraorganodistannoxanes. Identification of [R₂(OH)SnOSn(X)R₂]₂ (R=n-Bu; X=Cl, Br) and [R₂(OH)SnOSn(X)R₂] [R₂(X)SnOSn(X)R₂] suggest a serial substitution mechanism starting from [R₂(OH)SnOSn(OH)R₂]₂. X-ray crystal structure determinations are reported for [Me₂(AcO)SnOSn(OAc)Me₂]₂ (29a), [i-Pr₂(Br)SnOSn(Br)i-Pr₂]₂ (20a), [c-Hex2(F)SnOSn(F)c-Hex₂]₂ (5a) and [c-Hex₂(F)SnOSn(Cl)c-Hex₂]₂ (36), respectively. These show the presence of a central (R₂Sn)₂O₂ core that is connected, via the oxygen atoms, to R₂Sn entities. Acetate (29a) or halides (5a, 20a, 36) complete the coordination about the tin centres.

A comparative study on preparation of TiO2 pellets as photocatalysts based on different precursors

The porous Ti0₂ pellets were prepared based on pigment grade titaina, P25 titania powder and titaniurn(lV) butoxide. The characterization was done with X-Ray diffraction, scanning electron microscopy and BET measurements. The result shows that Ti0₂ pellets by using titaniurn(IV) butoxide with some addictive have the best surface porosity, with specific surface area of 196.9m²/g. For pigment grade titania and P25 titania powder, it is still effective to enhance the surface area after reassembling. The surface area increased from 11.6 to 29.2 m²/g for pigment grade titania and from 50 to 84.4 m²/g for P25 titania powder. Furthermore, it has been investigated on how to optimize and get the highest surface area by controlling the sintering temperature, reaction temperature, pH of solution, and the amount of alcohol and addictive of surfactant during preparation. The experimental photocatalytic degradation of acetone and toluene was performed using titania pellets made from P25 titania powder.

Emerging trends in the use of drugs to manage the challenging behaviour of people with intellectual disability

Background Concerns about the pharmacological management of the behaviour of individuals with intellectual disability have resulted in the development of legislative and procedural controls.
Method This Australian study provided a comparison of 873 reported cases where drugs were administered to manage behaviour in March 2000, with 762 cases reported in March 1993. Drug use in individuals who remained medicated across time (n = 316: recurrent sample) was also compared with those who were reported only in 1993 (n = 329: limited sample).
Results A small decrease in the proportion of individuals who were reported to have received medication was evident over time (from 5% to 4.5% of total population). However, this was accompanied by an increase in drug diversity and interclass polypharmacy. An increase in antidepressant use was evident (from 7.4% to 13.8% of reported drugs), and there was a trend towards greater reporting of medication for acute behavioural problems and medication use with children. Greater use of antipsychotic drugs was evident in individuals who remained medicated across time compared with those who did not.
Conclusions The findings suggest the need for continuous research into practice. The fact that many individuals receive medication over long periods makes it incumbent on service providers to engage in regular, comprehensive and individualized review and evaluation of medication regimes.

Systematic review and meta-analysis of evidence for increasing numbers of drugs in antiretroviral combination therapy

Objective: To assess the evidence for the effectiveness of increasing numbers of drugs in antiretroviral combination therapy.

Design: Systematic review, meta-analysis, and meta-regression of fully reported randomised controlled trials. All studies included compared quadruple versus triple therapy, triple versus double therapy, double versus monotherapy, or monotherapy versus placebo or no treatment.

Participants: Patients with any stage of HIV infection who had not received antiretroviral therapy.

Main outcome measures: Changes in disease progression or death (clinical outcomes); CD4 count and plasma viral load (surrogate markers).
Search strategy: Six electronic databases, including Medline, Embase, and the Cochrane Library, searched up to February 2001.

Results: 54 randomised controlled trials, most of good quality, with 66 comparison groups were included in the analysis. For both the clinical outcomes and surrogate markers, combinations with up to and including three (triple therapy) were progressively and significantly more effective. The odds ratio for disease progression or death for triple therapy compared with double therapy was 0.6 (95% confidence interval 0.5 to 0.8). Heterogeneity in effect sizes was present in many outcomes but was largely related to the drugs used and trial quality.

Conclusions: Evidence from randomised controlled trials supports the use of triple therapy. Research is needed on the effectiveness of quadruple therapies and the relative effectiveness of specific combinations of drugs.

Disentangling the stigma of HIV/AIDS from the stigmas of drugs use, commercial sex and commercial blood donation - a factorial survey of medical students in China

Background
HIV/AIDS related stigma interferes with the provision of appropriate care and support for people living with HIV/AIDS. Currently, programs to address the stigma approach it as if it occurs in isolation, separate from the co-stigmas related to the various modes of disease transmission including injection drug use (IDU) and commercial sex (CS). In order to develop better programs to address HIV/AIDS related stigma, the inter-relationship (or 'layering') between HIV/AIDS stigma and the co-stigmas needs to be better understood. This paper describes an experimental study for disentangling the layering of HIV/AIDS related stigmas.

Methods
The study used a factorial survey design. 352 medical students from Guangzhou were presented with four random vignettes each describing a hypothetical male. The vignettes were identical except for the presence of a disease diagnosis (AIDS, leukaemia, or no disease) and a co-characteristic (IDU, CS, commercial blood donation (CBD), blood transfusion or no co-characteristic). After reading each vignette, participants completed a measure of social distance that assessed the level of stigmatising attitudes.

Results
Bivariate and multivariable analyses revealed statistically significant levels of stigma associated with AIDS, IDU, CS and CBD. The layering of stigma was explored using a recently developed technique. Strong interactions between the stigmas of AIDS and the co-characteristics were also found. AIDS was significantly less stigmatising than IDU or CS. Critically, the stigma of AIDS in combination with either the stigmas of IDU or CS was significantly less than the stigma of IDU alone or CS alone.

Conclusion
The findings pose several surprising challenges to conventional beliefs about HIV/AIDS related stigma and stigma interventions that have focused exclusively on the disease stigma. Contrary to the belief that having a co-stigma would add to the intensity of stigma attached to people with HIV/AIDS, the findings indicate the presence of an illness might have a moderating effect on the stigma of certain co-characteristics like IDU. The strong interdependence between the stigmas of HIV/AIDS and the co-stigmas of IDU and CS suggest that reducing the co-stigmas should be an integral part of HIV/AIDS stigma intervention within this context.

Preparation of Mg55Ni35Si10 amorphous powders by mechanical alloying and consolidation by vacuum hot pressing

Amorphous 55Mg35NilOSi alloy powder has been synthesized by mechanical alloying technique using pure Mg, Ni and Si elemental powders. The transformation of the crystalline powders into an amorphous one has been investigated by X-ray diffraction, scanning electron microscopy, transmission electron microscopy and differential scanning calorimetry. The new material produced has a higher thermal stability than reported results, which is beneficial to the fabrication of Mg-Ni-Si bulk amorphous components through powder metallurgy.

Preparation of bioactive porous Ti-Sn-Nb alloy for biomedical applications

A porous Ti-16Sn-4Nb alloy with an average pore size of 300 µm and porosity of 60 % was prepared by powder metallurgy, and a bone-like apatite coating was obtained by soaking the samples in a concentrated simulated body fluid (lOx SBF). The changes of the microstructure and composition on the surface with soaking time were investigated by using X-ray diffractometry (XRD), and scanning electron microscopy equipped with energy dispersive spectroscopy (SEM-EDS), The bone-like apatite granules started to deposit throughout the porous Ti alloy foam aner 1 h soaking, and the number of granules increased with the increase of the soaking time. A uniform bone-like apatite layer covered the entire surface of the sample after soaking in Ihe lOx SBF for 6h. The Ti-16Sn-4Nb foam showed a good bioactivity after a thermochemical process and soaking into a 1Ox SBF.

Preparation of nanofibre yarns from electrospun nonwoven strips

From ancient to modern time, humans have been trying to use finer fibres to make fibrous products for various purposes and believing that finer fibres have better aesthetic qualities. So far, the commercial fibres have been reduced to microns in diameter, but it seems difficult to further reduce the fibre fineness to submicrons using conventional fibre-making techniques.
Electrospinning is a promising technique to produce continuous fibres with diameters on nanometre scales. This technique involves stretching a polymer fluid under a strong electric field into fine filaments, which are deposited randomly on the electrode collector forming a nonwoven nanofibre mat in most cases. Despite considerable efforts in exploring the applications of electrospun nanofibres in non-fibrous fields [1], very limited work has been conducted on using this material to process mechanically robust nanofibre yarns [2,3].

Partial purification and characterization of exoinulinase from kluyveromyces marxianus YS-1 for preparation of high-fructose syrup

An extracellular exoinulinase( ^{2, 1}- ß- D fructan fructanohydrolase, EC 3.2.1.7), which catalyzes the hydrolysis of inulin into fructose and glucose, was purified 23.5-fold by ethanol precipitation, followed by Sephadex G-100 gel permeation from a cell-free extract of Kluyveromyces marxianus YS-1. The partially purified enzyme exhibited considerable activity between pH 5 to 6, with an optimum pH of 5.5, while it remained stable(100%) for 3 h at the optimum temperature of 50º c. Mn²⁺ and Ca²⁺ produced a 2A-fold and 1.2-fold enhancement in enzyme activity, whereas Hg²⁺ and Ag²⁺  completely inhibited the inulinase. A preparation of the partially purified enzyme effectively hydrolyzed inulin, sucrose, and raffinose, yet no activity was found with starch, lactose, and maltose. The enzyme preparation was then successfully used to hydrolyze pure inulin and raw inulin from Asparagus racemosus for the preparation of a high-fructose syrup. In a batch system, the exoinulinase hydrolyzed 84.8% of the pure inulin and 86.7% of the raw Asparagus racemosus inulin, where fructose represented 43.6mg/ml and 41.3mg/ml, respectively.

Preparation of cross-linked nanoporous poly(ethylene glycol) diacrylate membrane in hexagonal lyotropic liquid crystal phases

Cross-linked poly(ethylene glycol) diacrylate (PEGDA) membranes were prepared by polymerization in periodic nanostructured lyotropic liquid crystals (LLC) hexagonal phases under UV light. A series of membranes were prepared under different purification treatment conditions. Polarized light microscope was employed to determine the LLC phase texture of LLC system before and after polymerization. It is found that the LLC hexagonal structure retained to some degree after polymerization. The interior structures of final membranes were investigated with scanning electron microscope (SEM). The results suggested that purification process affect the structure retention.

Preparation of bioactive porous titanium-molybdenum alloy through powder metallurgy

Porous Ti-Mo alloy samples with different porosities from 52% to 72% were successfully fabricated by the space-holder sintering method. The pore size of the porous Ti-Mo alloy samples were ranged from 200 to 500 μm. The plateau stress and elastic modulus of the porous Ti-Mo alloy samples increases with the decreasing of the porosity. Moreover, an apatite coating on the Ti-Mo alloy after an alkali and heat treatment was obtained through soaking into a simulated body fluid (SBF). The porous Ti-Mo alloy provides promising potential for new implant materials with new bone tissue ingrowth ability, bioactivity and mechanical properties mimicking those of natural bone.

Use of drugs to manage the behaviour of individuals with intellectual disability

Provides a detailed description and analysis over time of the use of medication to manage the behaviour of individuals with intellectual disability. Drug use was extensive and reasons provided were commonly outside those permitted by legislation. The findings enabled critical appraisal of current monitoring procedures and recommendations regarding policy and practice.