International perspectives on the influence of structure and process of weaning from mechanical ventilation.

Background 
Recently, clinical and research attention has been focused on refining weaning processes to improve outcomes for critically ill patients who require mechanical ventilation. One such process, use of a weaning protocol, has yielded conflicting results, arguably because of the influence of existing context and processes.

Objective 
To compare international data to assess differences in context and processes in intensive care units that could influence weaning.  

Methods 
Review of existing national data on provision of care for critically ill patients, including structure, staffing, skill mix, education, roles, and responsibilities for weaning in intensive care units of selected countries.

Results 
Australia, New Zealand, Denmark, Norway, Sweden, and the United Kingdom showed similarities in critical care provision, structure, skill mix, and staffing ratios in intensive care units. Weaning in these countries is generally a collaborative process between nurses and physicians. Notable differences in intensive care units in the United States were the frequent use of an open structure and inclusion of respiratory therapists on the intensive care unit’s health care team. Nurses may be excluded from direct management of ventilator weaning in some institutions, as this role is primarily assumed by respiratory therapists guided by medical directives. Availability of critical care beds was highest in the United States and lowest in the United Kingdom.

Conclusion 
Context and processes of care that could influence ventilator weaning outcomes varied considerably across countries. Further quantification of these contextual influences should be considered when translating research findings into local clinical practice and when designing randomized, controlled trials.

“An Examination of the Key Factor of Influence In the Development Process of Credit Union Industries,”

The aim of this paper is to analyse credit union industries within a development framework. Explicit consideration is given to credit union industries in four countries – Great Britain, Ireland, New Zealand and the United States. It is argued that in terms of a developmental typology the credit union industry in Great Britain is at a nascent stage of development, the industries in Ireland and New Zealand are at a transition stage while the US credit union industry is mature in nature. In progression between stages the analysis considers the influence of factors such as situational leadership, the complexion of trade associations, professionalisation, regulatory and legislative initiatives and technology. The analysis concluded that while there was a substantial commonality of experience, there were also significant differences in the impact of these factors. This consequently encouraged the recognition of the existence of ‘a variety of the species’ in respect of credit union development.

The Supremacy of the Sequence: Key Elements and Dimensions in the Process of Change

How single organizations manage the process of change and why only some of them are able to actually reach radical change are central questions in today’s theoretical debate. The role played by the process of change and its dimensions (namely, pace, sequence and linearity), however, has been poorly investigated. Drawing on archetype theory, this paper explores: (i) whether a specific pace of radical change exists; (ii) whether different outcomes of change are characterized by different sequences of change in key-structures and systems (iii) how the three dimensions of the process of change possibly interact. As an example of organizational change the study takes into consideration processes of accounting change in three departments of two Canadian and two Italian municipalities. The results suggest the supremacy of the sequence of implemented changes over the other two dimensions of the process in order to achieve a radical outcome of change.

From the Land to Sea and Back Again? Using Terrestrial Planning to Understand the Process of Marine Spatial Planning

Over the last 5–10 years, marine spatial planning (MSP) has emerged as a new management regime for national and international waters and has already attracted a substantial body of multi-disciplinary research on its goals and policy processes. This paper argues that this literature has generally lacked deeper reflexive engagement with the emerging system of governance for our seas that has meant that many of MSP’s core concepts, assumptions and institutional arrangements have not been subject rigorous intellectual debate. In an attempt to initiate such an approach, this article explores the relationship between MSP and its land-based cousin, terrestrial spatial planning (TSP). While it is recognized that there are inherent limitations to a comparison of these two systems, it is argued that the tradition of social science debate over the purpose and processes of TSP can be used as a useful stimulus for a more rigorous reflection of such issues as they relate to MSP. The article therefore explores some of the parallels between MSP and TSP and then discusses some of the key intellectual traditions that have shaped TSP and the implications these may have for future marine planning practice. The article concludes with a number of potentially useful new avenues that may form the basis of a critical research agenda for MSP.

Perceptions of the process of care among caregivers and care recipients in Dementia Care Networks

The Dementia Care Networks Study investigated 4 community-based, not-for-profit dementia care networks in Ontario, Canada. Investigators examined whether sociodemographic and health characteristics, type of support network, and amount of service use among care recipients and caregivers (n = 267 dyads) were associated with experiences with care processes. The process-of-care constructs were: family physicians' awareness of services; experiences with health care workers, and assessment and placement activities. The findings highlighted that family physicians' understanding of dementia and their ability to work with the dyad to become aware of and accept services, was an important component in the dyad's satisfaction. If caregivers received home support and the care recipients received emotional support from their social support network, they were more likely to be satisfied with their experiences with health care workers. In summary, increased awareness and provision of services were associated with more positive perceptions of network effectiveness. © 2007 Sage Publications.

Process of debonding in RC beams shear-strengthened with FRP U-strips or side strips

Reinforced concrete (RC) beams may be strengthened for shear using externally bonded fiber reinforced polymer (FRP) composites in the form of side bonding, U-jacketing or complete wrapping. The shear failure of almost all RC beams shear-strengthened with side bonded FRP and the majority of those strengthened with FRP U-jackets, is due to debonding of the FRP. The bond behavior between the externally-bonded FRP reinforcement (referred to as FRP strips for simplicity) and the concrete substrate therefore plays a crucial role in the failure process of these beams. Despite extensive research in the past decade, there is still a lack of understanding of how debonding of FRP strips in such a beam propagates and how the debonding process affects its shear behavior. This paper presents an analytical study on the progressive debonding of FRP strips in such strengthened beams. The complete debonding process is modeled and the contribution of the FRP strips to the shear capacity of the beam is quantified. The validity of the analytical solution is verified by comparing its predictions with numerical results from a finite element analysis. This analytical treatment represents a significant step forward in understanding how interaction between FRP strips, steel stirrups and concrete affects the shear resistance of RC beams shear-strengthened with FRP strips.

Modelling and characterization of ultrasonic consolidation process of Aluminium alloys

Ultrasonic consolidation process is a rapid manufacturing process used to join thin layers of metal at low temperatures and low energy consumption. In this work, finite element method has been used to simulate the ultrasonic consolidation of Aluminium alloys 6061 (AA-6061) and 3003 (AA-3003). A thermomechanical material model has been developed in the framework of continuum cyclic plasticity theory which takes into account both volume (acoustic softening) and surface (thermal softening due to friction) effects. A friction model based on experimental studies has been developed, which takes into account the dependence of coefficient of friction upon contact pressure, amount of slip, temperature and number of cycles. Using the developed material and friction model ultrasonic consolidation (UC) process has been simulated for various combinations of process parameters involved. Experimental observations are explained on the basis of the results obtained in the present study. The current research provides the opportunity to explain the differences of the behaviour of AA-6061 and AA-3003 during the ultrasonic consolidation process. Finally, trends of the experimentally measured fracture energies of the bonded specimen are compared to the predicted friction work at the weld interface resulted from the simulation at similar process condition. Similarity of the trends indicates the validity of the developed model in its predictive capability of the process. © 2008 Materials Research Society.