Increased sedation requirements in patients receiving extracorporeal membrane oxygenation for respiratory and cardiorespiratory failure

Critically ill patients receiving extracorporeal membrane oxygenation (ECMO) are often noted to have increased sedation requirements. However, data related to sedation in this complex group of patients is limited. The aim of our study was to characterise the sedation requirements in adult patients receiving ECMO for cardiorespiratory failure. A retrospective chart review was performed to collect sedation data for 30 consecutive patients who received venovenous or venoarterial ECMO between April 2009 and March 2011. To test for a difference in doses over time we used a regression model. The dose of midazolam received on ECMO support increased by an average of 18 mg per day (95% confidence interval 8, 29 mg, P=0.001), while the dose of morphine increased by 29 mg per day (95% confidence interval 4, 53 mg, P=0.021) The venovenous group received a daily midazolam dose that was 157 mg higher than the venoarterial group (95% confidence interval 53, 261 mg, P=0.005). We did not observe any significant increase in fentanyl doses over time (95% confidence interval 1269, 4337 µg, P=0.94). There is a significant increase in dose requirement for morphine and midazolam during ECMO. Patients on venovenous ECMO received higher sedative doses as compared to patients on venoarterial ECMO. Future research should focus on mechanisms behind these changes and also identify drugs that are most suitable for sedation during ECMO.

Oblique-Shock-Wave/Boundary-Layer Interaction Using Near-Wall Reynolds-Stress Models

A synthesis is presented of the predictive capability of a family of near-wall wall-normal free Reynolds stress models (which are completely independent of wall topology, i.e., of the distance fromthe wall and the normal-to-thewall orientation) for oblique-shock-wave/turbulent-boundary-layer interactions. For the purpose of comparison, results are also presented using a standard low turbulence Reynolds number k–ε closure and a Reynolds stress model that uses geometric wall normals and wall distances. Studied shock-wave Mach numbers are in the range MSW = 2.85–2.9 and incoming boundary-layer-thickness Reynolds numbers are in the range Reδ0 = 1–2×106. Computations were carefully checked for grid convergence. Comparison with measurements shows satisfactory agreement, improving on results obtained using a k–ε model, and highlights the relative importance of redistribution and diffusion closures, indicating directions for future modeling work.

Influence of inflow turbulence in shock-wave/turbulent-boundary-layer interaction computations

The influence of inflow turbulence on the results of Favre–Reynolds-averaged Navier–Stokes computations of supersonic oblique-shock-wave/turbulent-boundary-layer interactions (shock-wave Mach-number MSW ∼2.9), using seven-equation Reynolds-stress model turbulence closures, is studied. The generation of inflow conditions (and the initialization of the flowfield) for mean flow, Reynolds stresses, and turbulence length scale, based on semi-analytic grid-independent boundary-layer profiles, is described in detail. Particular emphasis is given to freestream turbulence intensity and length scale. The influence of external-flow turbulence intensity is studied in detail both for flat-plate boundary-layer flow and for a compression-ramp interaction with large separation. It is concluded that the Reynolds-stress model correctly reproduces the effects of external flow turbulence.

Dying in hospital: medical failure or natural outcomes?

The purpose of this study was to describe patterns of medical and nursing practice in the care of patients dying of oncological and hematological malignancies in the acute care setting in Australia. A tool validated in a similar American study was used to study the medical records of 100 consecutive patients who died of oncological or hematological malignancies before August 1999 at The Canberra Hospital in the Australian Capital Territory. The three major indicators of patterns of end-of-life care were documentation of Do Not Resuscitate (DNR) orders, evidence that the patient was considered dying, and the presence of a palliative care intention. Findings were that 88 patients were documented DNR, 63 patients' records suggested that the patient was dying, and 74 patients had evidence of a palliative care plan. Forty-six patients were documented DNR 2 days or less prior to death and, of these, 12 were documented the day of death. Similar patterns emerged for days between considered dying and death, and between palliative care goals and death. Sixty patients had active treatment in progress at the time of death. The late implementation of end-of-life management plans and the lack of consistency within these plans suggested that patients were subjected to medical interventions and investigations up to the time of death. Implications for palliative care teams include the need to educate health care staff and to plan and implement policy regarding the management of dying patients in the acute care setting. Although the health care system in Australia has cultural differences when compared to the American context, this research suggests that the treatment imperative to prolong life is similar to that found in American-based studies.

A lawyer's duty of care : beware the failure to advise of contingencies and foreseeable risks

It is trite law that a lawyer owes their client a duty of care requiring the lawyer to take reasonable steps to avoid their client suffering foreseeable economiic loss: Hawkins v Clayton. In the context of a property transaction this will include a duty to warn the client of anything that is unusual or anything which may affect the client obtaining the full benefit of the contract entered into: Macindoe v Parbery.

2nd Australian producer survey 2012 : understanding Australian screen content producers : wave 2

This report presents the top-line findings of the Australian Screen Producer survey conducted in December 2011. The report was prepared by Bergent Research and commissioned by the ARC Centre of Excellence for Creative Industries and Innovation (CCI), Queensland University of Technology, with assistance from the Centre for Screen Business, Australian Film Television and Radio School (AFTRS). The 2011 producer survey was a national study of the demographics, motivations, sentiments and activities of screen producers across four industry segments: Film, Television, Commercial and Digital Media. This survey is the second Australian Screen Producer survey and builds upon research undertaken in the Australian Screen Content Producer Survey conducted in 2009. The 2011 study is referred to in this report as Wave 2 and the 2009 study is referred to as Wave 1.

Free-surface flow past arbitrary topography and an inverse approach for wave-free solutions

An efficient numerical method to compute nonlinear solutions for two-dimensional steady free-surface flow over an arbitrary channel bottom topography is presented. The approach is based on a boundary integral equation technique which is similar to that of Vanden-Broeck's (1996, J. Fluid Mech., 330, 339-347). The typical approach for this problem is to prescribe the shape of the channel bottom topography, with the free-surface being provided as part of the solution. Here we take an inverse approach and prescribe the shape of the free-surface a priori while solving for the corresponding bottom topography. We show how this inverse approach is particularly useful when studying topographies that give rise to wave-free solutions, allowing us to easily classify eleven basic flow types. Finally, the inverse approach is also adapted to calculate a distribution of pressure on the free-surface, given the free-surface shape itself.

Disclosure obligations on ex parte application for freezing order - duty of practitioners to the court - failure to comply with duty - serious dereliction of duty to court - supplemental order for costs against solicitors personally

The decision of Applegarth J in Heartwood Architectural & Joinery Pty Ltd v Redchip Lawyers [2009] QSC 195 (27 July 2009) involved a costs order against solicitors personally. This decision is but one of several recent decisions in which the court has been persuaded that the circumstances justified costs orders against legal practitioners on the indemnity basis. These decisions serve as a reminder to practitioners of their disclosure obligations when seeking any interlocutory relief in an ex parte application. These obligations are now clearly set out in r 14.4 of the Legal Profession (Solicitors) Rule 2007 and r 25 of 2007 Barristers Rule. Inexperience or ignorance will not excuse breaches of the duties owed to the court.

Protection of structural systems and mechanisms from catastrophic and life-threatening failure caused by unforeseeable events

Structural framing systems and mechanisms designed for normal use rarely possess adequate robustness to withstand the effects of large impacts, blasts and extreme earthquakes that have been experienced in recent times. Robustness is the property of systems that enables them to survive unforeseen or unusual circumstances (Knoll & Vogel, 2009). Queensland University of Technology with industry collaboration is engaged in a program of research that commenced 15 years ago to study the impact of such unforeseeable phenomena and investigate methods of improving robustness and safety with protective mechanisms embedded or designed in structural systems. This paper highlights some of the research pertaining to seismic protection of building structures, rollover protective structures and effects of vehicular impact and blast on key elements in structures that could propagate catastrophic and disproportionate collapse.

Rebuilding housing after a disaster : factors for failure

Unlike most normal construction projects, post-disaster housing projects are diverse in nature, have unique socio-cultural and economical requirements, and are extremely dynamic and thus necessitate a meaningful and dynamic response. Post-disaster reconstruction practices that lack a strategy compatible with the severity of disaster, community culture, socio-economic requirements, environmental condition, government legislations, and technical and technological situations, often fail to operate and respond effectively to the needs of the wider affected population. Factors that frequently pose real threats to the eventual success of reconstruction projects are rarely given appropriate consideration when designing such projects. Research into past reconstruction practices has shown that ignoring these factors altogether or failing to give them meaningful consideration can affect housing reconstruction projects. In other words, they either miss their targets altogether or undergo serious modifications after their occupancy, subsequently resulting in an overall loss of project resources. This article touches upon the common factors that negatively impact the outcome of such projects.

Graphene-like nano-sheets/36° LiTaO3 surface acoustic wave hydrogen gas sensor

Presented is the material and gas sensing properties of graphene-like nano-sheets deposited on 36° YX lithium tantalate (LiTaO3) surface acoustic wave (SAW) transducers. The graphene-like nano-sheets were characterized via scanning electron microscopy (SEM), atomic force microscopy(AFM)and X-ray photoelectron spectroscopy (XPS). The graphenelike nano-sheet/SAW sensors were exposed to different concentrations of hydrogen (H2) gas in a synthetic air at room temperature. The developed sensors exhibit good sensitivity towards low concentrations of H2 in ambient conditions, as well as excellent dynamic performance towards H2 at room temperature.