"I’ll call you when we are ready" (One family’s experience of critical care and end of life decision making)

The purpose of this paper is to explore through narrative accounts one family's expérience of critical care, after the admission of a family member to an Intensive Care Unit (ICU) and their subséquent death five weeks later. Numerous studies support the need for effective communication and clear information to be given to the family. In this instance it was évident from their stories that there were numerous barriers to communication, including language and a lack of insight into the needs of the family. Many families do not understand the complexities of nursing care in an ICU so lack of communication by nursing staff was identified as uncaring behavior and encounters. Facilitating a family's proximity to a dying patient and encouraging them to participate in care helps to maintain some sensé of personal control. Despite a commitment to involving family members in care, which was enshrined in the Unit Philosophy, relatives were banished to the waiting room for hours. They experienced feelings of powerlessness and helplessness as they waited with other relatives for news following investigations or until 'the doctor had completed his rounds'. Explanations of "we must make 'the patient' comfortable" was no consolation for those who wished to be involved in care. The words "I'il call you when we are ready" became a mantra to the forgotten families who waited patiently for those with power to admit them to the ICU. Implications are this family felt they were left alone to cope with the traumatic expériences leading up to and surrounding the death. They felt mainly supported by the priest, who not only administered the last rites but provided spiritual support to the family and dealt sensitively with many issues. Paternalism in décision making when there is a moral obligation to ensure that discussions on end of life dilemmas are an inclusive process with families, doctors, nurses was not understood, therefore it caused conflict within the family over EOL décision making. The family felt that the opportunity to share expériences through telling and retelling their stories would enable them to reconfigure the past and create purpose in the future.

Melatonin for cardioprotection in ST elevation myocardial infarction: Are we ready for the challenge?

Melatonin, an endocrine product of the pineal gland, is formed predominantly during the nighttime. Light has an inhibitory effect on pineal melatonin secretion. Pineal melatonin release is synchronised by this daily light-dark cycle via a multisynaptic pathway between the eyes and the pineal gland. Light stimulates the retina to modulate the activity of the suprachiasmatic nucleus, the master biological clock.1 The suprachiasmatic nucleus controls pineal melatonin synthesis and the concentrations of melatonin in the sera of healthy subjects, which reach values of 10−10 to 10−9 mol/L during the night, with much lower concentrations being present during the day. Many publications have shown that melatonin has an important role in a variety of cardiovascular pathophysiologic processes: the indoleamine has anti-inflammatory, antioxidant, antihypertensive, antithrombotic and antilipaemic properties.

9 months to get ready

This document explains what to expect during each month of pregnancy. It also discusses exercise during pregnancy, prenatal care, sex during pregnancy, normal complaints and problems of pregnancy and other issues.

Fresh Techniques: Getting ready to use hip hop in the classroom

A workbook-style reflection exercise prompts readers to consider potential uses of hip-hop in their own library instruction in a culturally responsive manner.

The development of a new four-year Construction Technology and Management Stream at QUT

This paper focuses on the development and delivery of a core construction management (CM) unit, which forms the capstone of a four-unit CM stream in an undergraduate programme in the Faculty of Built Environment and Engineering at the Queensland University of Technology. UDB410 (Construction Management) is a final year unit that consolidates skills students have learned throughout their degree, hopefully graduating them as work-ready construction managers. It was developed in consultation with the Queensland Chapter of the Australian Institute of Building (AIB) and is a final year unit in the undergraduate Bachelor of Urban Development (CM) course. The unit uses various tools such as the OSIRIS business database (Bureau van Dijk Electronic Publishing, 2009), the AROUSAL (UK Version) construction business simulation (Lansley, 2009) and the Denison Organisational Culture Survey (Denison, 2000) to facilitate the development of skills in managing a construction company. The objectives of the paper are: • To track the rationale and development of the UDB410 unit sand describe the way in which this final year unit integrates learning from other parts of the course within which it is located as well as capping-off the CM stream of core units; • To highlight the difficulties of blending a balance of technology and management in a single unit; and • To explain how partnering with the construction industry benefited the learning quality of the unit.

A review of LCADesign

Objective The review addresses two distinct sets of issues: 1. specific functionality, interface, and calculation problems that presumably can be fixed or improved; and 2. the more fundamental question of whether the system is close to being ready for ‘commercial prime time’ in the North American market. Findings Many of our comments relate to the first set of issues, especially sections B and C. Sections D and E deal with the second set. Overall, we feel that LCADesign represents a very impressive step forward in the ongoing quest to link CAD with LCA tools and, more importantly, to link the world of architectural practice and that of environmental research. From that perspective, it deserves continued financial support as a research project. However, if the decision is whether or not to continue the development program from a purely commercial perspective, we are less bullish. In terms of the North American market, there are no regulatory or other drivers to press design teams to use a tool of this nature. There is certainly interest in this area, but the tools must be very easy to use with little or no training. Understanding the results is as important in this regard as knowing how to apply the tool. Our comments are fairly negative when it comes to that aspect. Our opinion might change to some degree when the ‘fixes’ are made and the functionality improved. However, as discussed in more detail in the following sections, we feel that the multi-step process — CAD to IFC to LCADesign — could pose a serious problem in terms of market acceptance. The CAD to IFC part is impossible for us to judge with the information provided, and we can’t even begin to answer the question about the ease of using the software to import designs, but it appears cumbersome from what we do know. There does appear to be a developing North American market for 3D CAD, with a recent survey indicating that about 50% of the firms use some form of 3D modeling for about 75% of their projects. However, this does not mean that full 3D CAD is always being used. Our information suggests that AutoDesk accounts for about 75 to 80% of the 3D CAD market, and they are very cautious about any links that do not serve a latent demand. Finally, other system that link CAD to energy simulation are using XML data transfer protocols rather than IFC files, and it is our understanding that the market served by AutoDesk tends in that direction right now. This is a subject that is outside our area of expertise, so please take these comments as suggestions for more intensive market research rather than as definitive findings.

ARCS collaboration tools

The Australian Research Collaboration Service (ARCS) has been supporting a wide range of Collaboration Services and Tools which have been allowing researchers, groups and research communities to share ideas and collaborate across organisational boundaries.----- This talk will give an introduction to a number of exciting technologies which are now available. Focus will be on two main areas of Video Collaboration Tools, allowing researchers to talk face-to-face and share data in real-time, and Web Collaboration Tools, allowing researchers to share information and ideas with other like-minded researchers irrespective of distance or organisational structure. A number of examples will also be shown of how these technologies have been used with in various research communities.----- A brief introduction will be given to a number of services which ARCS is now operating and/or supporting such as:--- * EVO – A video conferencing application, which is particularly suited to desktop or low bandwidth applications.--- * AccessGrid – An open source video conferencing and collaboration tool kit, which is great for room to room meetings.--- * Sakai – An online collaboration and learning environment, support teaching and learning, ad hoc group collaboration, support for portfolios and research collaboration.--- * Plone – A ready-to-run content management system, that provides you with a system for managing web content that is ideal for project groups, communities, web sites, extranets and intranets.--- * Wikis – A way to easily create, edit, and link pages together, to create collaborative websites.

ARCS collaboration tools and support workshop

Registration fees for this workshop are being met by ARCS. There is no cost to attend; however space is limited.----- The Australian Research Collaboration Service (ARCS) has been supporting a wide range of Collaboration Services and Tools which have been allowing researchers, groups and research communities to share ideas and collaborate across organisational boundaries.----- This workshop will give an introduction into a number of web based and real-time collaboration tools and services which researchers may find useful for day-to-day collaboration with members of a research team located within an institution or across institutions. Attendees will be shown how a number of these tools work with strong emphasis placed on how these tools can help facilitate communication and collaboration. Attendees will have the opportunity to try out a number of examples themselves, and interact with the workshop staff to discuss how their own use cases could benefit from the tools and services which can be provided.----- Outline: A hands on introduction will be given to a number of services which ARCS is now operating and/or supporting such as:--- * EVO – A video conferencing environment, which is particularly suited to desktop or low bandwidth applications.--- * AccessGrid – An open source video conferencing and collaboration tool kit, which is great for room to room meetings.--- * Sakai – An online collaboration and learning environment, support teaching and learning, ad hoc group collaboration, support for portfolios and research collaboration.--- * Plone and Drupal – A ready-to-run content management system, that provides you with a system for managing web content that is ideal for project groups, communities, web sites, extranets and intranets.--- * Wikis – A way to easily create, edit, and link pages together, to create collaborative websites.

Developing capabilities for ongoing learning and change in intermediary programs

In dynamic environments, firms seek to build capabilities which will permit them to become innovation and change ready. Programs offered by intermediaries, while varying greatly in content and format, are designed to support those firms wishing to enhance their competitiveness. Firms which participate in intermediary programs have displayed their willingness to overcome deficiencies or barriers to competitiveness through acquiring knowledge which is external to the firm. This paper reports on interviews with 24 firms who were involved in a MAP or TAP program offered by QMI Solutions. The findings of the research suggest that knowledge intermediaries serve to disrupt organisational paths and in so doing establish mechanisms for ongoing learning and change. They do this first by disrupting the firm with a positive learning experience and also by establishing processes for developing new relationships and access to knowledge which are critical for learning and change. It is the experience of learning through knowledge exchange which can trigger the pursuit of new paths and it is the processes involving new relations and knowledge processing that provides the micro-foundations for ongoing learning and change. This suggests that the role of intermediaries goes well beyond merely knowledge transfer to include longer term effects on the capability of organisations to innovate, which is critical to economic competitiveness and the survival rate of firms.

Promoting the use of cycling as an environmentally and socially sustainable form of transport.

Solar Cities Congress 2008 “Energising Sustainable Communities – Options for Our Future” THEME 3: Climate Change. Impact on Society and Culture. Sub Theme: planning and implementing holistic strategies for sustainable transport Abstract Promoting the use of cycling as an environmentally and socially sustainable form of transport. We need to reduce carbon emissions. We need to reduce fuel consumption. We need to reduce pollution. We need to reduce traffic congestion. As obesity levels and associated health problems in the developed nations continue to increase we need to adopt a healthier lifestyle. Few if any would argue with these statements. In fact many would consider these problems to be amongst the most urgent that our society faces. What if we had a vehicle that uses no fossil fuel to power it, creates no pollution, takes up far less space on the roads and promotes an active, healthy lifestyle. What if this machine would have energy efficiency levels 50 times greater than the car? This is a solution that is here, now and ready to go and many of us already own one. It is the humble bicycle. Although bicycle sales in Australia now outnumber car sales, bicycle use as a form of transport (as opposed to recreation) only constitutes around 3% to 4% of all trips. So, why are bicycles the forgotten form of transport if they promise to deliver the benefits that I have just outlined? This paper examines the underlying reasons for the relatively low use of bicycles as a means of transport. It identifies the areas of greatest potential for encouraging the use of the world’s most efficient form of transport. Tim Williams - May 2007

The passionate critic

It's hard to be dispassionate about Reyner Banham. For me, and for the plethora of other people with strong opinions about Banham, his writing is compelling, and one’s connection to him as a figure quite personal. For me, frankly, he rocks. As a landscape architect, I gleaned most of my knowledge about Modern architecture from Banham. His Theory and Design in the First Machine Age, along with Rowe and Koetter’s Collage City and Venturi’s Complexity and Contradiction in Architecture were the most influential books in my library, by far. Later, as a budding “real scholar”, I was disappointed to find that, while these authors had serious credibility, the writings themselves were regarded as “polemical” – when in fact what I admired about them most was their ability and willingness to make rough groupings and gross generalizations, and to offer fickle opinions. It spoke to me of a real personal engagement and an active, participatory reading of the architectural culture they discussed. They were at their best in their witty, cutting, but generally pithy, creative prose, such as in Rowe’s extrapolation of the modern citizen as the latest “noble savage”, or Banham railing against conservative social advocates and their response to high density housing: “those who had just re-discovered ‘community’ in the slums would fear megastructure as much as any other kind of large-scale renewal program, and would see to it that the people were never ready.” Any reader of Banham will be able to find a gem that will relate, somehow, personally, to what they are doing right now. For Banham, it was all personal, and the gaps in his scholarship, rather, were the dispassionate places: “Such bias is essential – an unbiased historian is a pointless historian – because history is an essentially critical activity, a constant re-scrutiny and rearrangement of the profession.” Reyner Banham: Historian of the Immediate Future, Nigel Whiteley’s recent “intellectual biography” (the MIT Press, 2002), allowed me to revisit Banham’s passionate mode of criticism and to consider what his legacy might be. The book examines Banham’s body of work, grouped according to his various primary fascinations, as well as his relationship to contemporaneous theoretical movements, such as postmodernism. His mode of practice, as a kind of creative critic, is also considered in some depth. While there are points where the book delves into Banham’s personal life, on the whole Whiteley is very rigorous in considering and theorizing the work itself: more than 750 articles and twelve books. In academic terms, this is good practice. However, considering the entirely personal nature of Banham’s writing itself, this separation seems artificial. Banham, as he himself noted, “didn’t mind a gossip”, and often when reading the book I was curious about what was happening to him at the time. Banham’s was an amazing type of intellectual practice, and one that academics (a term he hated) could do well to learn from. While Whiteley spends a lot of time arguing for his practice to be regarded as such, and makes strong points about both the role of the critic, and the importance of journalism, rather than scholarly publishing, I found myself wondering what his study looked like. What books he had in his library. Did he smoke when he wrote? What sort of teaching load did he have? He is an inspiration to design writers and thinkers, and I, personally, wanted to know how he did it.

Bringing academics on board : encouraging institution-wide diffusion of e-learning environments

Rapid advances in educational and information communications technology (ICT)have encouraged some educators to move beyond traditional face to face and distance education correspondence modes toward a rich, technology mediated e-learning environment. Ready access to multimedia at the desktop has provided the opportunity for educators to develop flexible, engaging and interactive learning resources incorporating multimedia and hypermedia. However, despite this opportunity, the adoption and integration of educational technologies by academics across the tertiary sector has typically been slow. This paper presents the findings of a qualitative study that investigated factors influencing the manner in which academics adopt and integrate educational technology and ICT. The research was conducted at a regional Australian university, the University of Southern Queensland (USQ), and focused on the development of e-learning environments. These e-learning environments include a range of multimodal learning objects and multiple representations of content that seek to cater for different learning styles and modal preferences, increase interaction, improve learning outcomes, provide a more inclusive and equitable curriculum and more closely mirror the on campus learning experience. This focus of this paper is primarily on the barriers or inhibitors academics reported in the study, including institutional barriers, individual inhibitors and pedagogical concerns. Strategies for addressing these obstacles are presented and implications and recommendations for educational institutions are discussed.

Building information modelling project decision support framework

Building Information Modelling (BIM) is an information technology [IT] enabled approach to managing design data in the AEC/FM (Architecture, Engineering and Construction/ Facilities Management) industry. BIM enables improved interdisciplinary collaboration across distributed teams, intelligent documentation and information retrieval, greater consistency in building data, better conflict detection and enhanced facilities management. Despite the apparent benefits the adoption of BIM in practice has been slow. Workshops with industry focus groups were conducted to identify the industry needs, concerns and expectations from participants who had implemented BIM or were BIM “ready”. Factors inhibiting BIM adoption include lack of training, low business incentives, perception of lack of rewards, technological concerns, industry fragmentation related to uneven ICT adoption practices, contractual matters and resistance to changing current work practice. Successful BIM usage depends on collective adoption of BIM across the different disciplines and support by the client. The relationship of current work practices to future BIM scenarios was identified as an important strategy as the participants believed that BIM cannot be efficiently used with traditional practices and methods. The key to successful implementation is to explore the extent to which current work practices must change. Currently there is a perception that all work practices and processes must adopt and change for effective usage of BIM. It is acknowledged that new roles and responsibilities are emerging and that different parties will lead BIM on different projects. A contingency based approach to the problem of implementation was taken which relies upon integration of BIM project champion, procurement strategy, team capability analysis, commercial software availability/applicability and phase decision making and event analysis. Organizations need to understand: (a) their own work processes and requirements; (b) the range of BIM applications available in the market and their capabilities (c) the potential benefits of different BIM applications and their roles in different phases of the project lifecycle, and (d) collective supply chain adoption capabilities. A framework is proposed to support organizations selection of BIM usage strategies that meet their project requirements. Case studies are being conducted to develop the framework. The results of the preliminary design management case study is presented for contractor led BIM specific to the design and construct procurement strategy.

Cryoreservation of alginate-fibrin beads involving bone marrow derived mesenchymal stromal cells by vitrification

Application of cell-–biomaterial systems in regenerative medicine can be facilitated by their successful low temperature preservation. Vitrification, which avoids ice crystal formation by amorphous solidification, is an emerging approach to cryopreservation. Developing vitrification strategy, effective cryopreservation of alginate–fibrin beads with porcine mesenchymal stromal cells has been achieved in this study. The cell–biomaterial constructs were pre-cultured for 20 days before cryopreservation, allowing for cell proliferation and construct stabilization. Ethylene glycol (EG) was employed as the basic cryoprotectant for two equilibration solutions. Successful cryopreservation of the constructs was achieved using vitrification solution composed of penetrating (EG MW 62 Da) and non-penetrating (sucrose MW 342 Da) cryoprotectants. Stepwise procedure of introduction to and removal of cryoprotectants was brief; direct plunging into liquid nitrogen was applied. Cell viability, evaluated by combining live/death staining and confocal laser microscopy, was similar for both control and vitrified cells in the beads. No detectable damage of microstructure of cryopreserved beads was found as shown by scanning electron microscopy. Both osteogenically induced control and vitrified cells in the constructs were equally capable of mineral production and deposition. There was no statistically significant difference in metabolic activity and proliferation between both groups during the entire culture period. Our study leads to the conclusion that the developed cryopreservation protocol allowed to maintain the integrity of the beads while preserving the ability of the pig bone marrow derived mesenchymal stromal cells to proliferate and subsequently differentiate; demonstrating that vitrification is a promising approach for cryopreser-vation of “ready-to-use” cell–biomaterial constructs.

Project team’s internal and external social networks and their influence on project performance

The research on project learning has recognised the significance of knowledge transfer in project based organisations (PBOs). Effective knowledge transfer across projects avoids reinventions, enhances knowledge creation and saves lots of time that is crucial in project environment. In order to facilitate knowledge transfer, many PBOs have invested lots of financial and human resources to implement IT-based knowledge repository. However, some empirical studies found that employees would rather turn for knowledge to colleagues despite their ready access to IT-based knowledge repository. Therefore, it is apparent that social networks play a pivotal role in the knowledge transfer across projects. Some scholars attempt to explore the effect of network structure on knowledge transfer and performance, however, focused only on egocentric networks and the groups’ internal social networks. It has been found that the project’s external social network is also critical, in that the team members can not handle critical situations and accomplish the projects on time without the assistance and knowledge from external sources. To date, the influence of the structure of a project team’s internal and external social networks on project performance, and the interrelation between both networks are barely known. In order to obtain such knowledge, this paper explores the interrelation between the structure of a project team’s internal and external social networks, and their effect on the project team’s performance. Data is gathered through survey questionnaire distributed online to respondents. Collected data is analysed applying social network analysis (SNA) tools and SPSS. The theoretical contribution of this paper is the knowledge of the interrelation between the structure of a project team’s internal and external social networks and their influence on the project team’s performance. The practical contribution lies in the guideline to be proposed for constructing the structure of project team’s internal and external social networks.