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.

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.

Teaching new product development to design led innovation

Recently many international tertiary educational programs have capitalised on the value design and business can have upon their interception (Martin, 2009; Brown, 2008; Bruce and Bessant, 2002; Manzini, 2009). This paper discusses the role that two teaching units – New Product Development and Design Led Innovation – play in forming an understanding of commercialisation needed in today’s Industrial Design education. These units are taught consecutively in the later years of the Bachelor of Industrial Design program at the Queensland University of Technology, Brisbane, Australia. In this paper, each teaching unit is discussed in detail and then as a conglomerate, in order to form a basis of knowledge students need in order to fully capitalise on the value design has in business, and to produce a more capable Industrial Design graduate of the future.

The search for individualism : Self-expression through product personalisation

This research paper explores the impact product personalisation has upon product attachment and aims to develop a deeper understanding of why, how and if consumers choose to do so. The current research in this field is mainly based on attachment theories and is predominantly product specific. This paper researches the link between product attachment and personalisation through in-depth, semi-structured interviews, where the data has been thematically analysed and broken down into three themes, and nine sub-themes. It was found that participants did become more attached to products once they were personalised and the reasons why this occurred varied. The most common reasons that led to personalisation were functionality and usability, the expression of personality through a product and the complexity of personalisation. The reasons why participants felt connected to their products included strong emotions/memories, the amount of time and effort invested into the personalisation, a sense of achievement. Reasons behind the desire for personalisation included co-designing, expression of uniqueness/individualism and having choice for personalisation. Through theme and inter-theme relationships, many correlations were formed, which created the basis for design recommendations. These recommendations demonstrate how a designer could implement the emotions and reasoning for personalisation into the design process.

The product of text and 'Other' statements : discourse analysis and the critical use of Foucault

Much has been written on Michel Foucault’s reluctance to clearly delineate a research method, particularly with respect to genealogy (Harwood 2000; Meadmore, Hatcher, & McWilliam 2000; Tamboukou 1999). Foucault (1994, p. 288) himself disliked prescription stating, “I take care not to dictate how things should be” and wrote provocatively to disrupt equilibrium and certainty, so that “all those who speak for others or to others” no longer know what to do. It is doubtful, however, that Foucault ever intended for researchers to be stricken by that malaise to the point of being unwilling to make an intellectual commitment to methodological possibilities. Taking criticism of “Foucauldian” discourse analysis as a convenient point of departure to discuss the objectives of poststructural analyses of language, this paper develops what might be called a discursive analytic; a methodological plan to approach the analysis of discourses through the location of statements that function with constitutive effects.

On the probability density function of the product of Rayleigh distributed random variables

In this paper we investigate the distribution of the product of Rayleigh distributed random variables. Considering the Mellin-Barnes inversion formula and using the saddle point approach we obtain an upper bound for the product distribution. The accuracy of this tail-approximation increases as the number of random variables in the product increase.

Licensed to sell : product placement in the James Bond film series

As one of the longest running franchises in cinema history, and with its well-established use of product placements, the James Bond film series provides an ideal framework within which to measure and catalogue the number and types of products used within a particular timeframe. This case study will draw upon extensive content analysis of the James Bond film series in order to chart the evolution of product placement across the franchise's 50 year history.

Product reputation model : an opinion mining based approach

Product rating systems are very popular on the web, and users are increasingly depending on the overall product ratings provided by websites to make purchase decisions or to compare various products. Currently most of these systems directly depend on users’ ratings and aggregate the ratings using simple aggregating methods such as mean or median [1]. In fact, many websites also allow users to express their opinions in the form of textual product reviews. In this paper, we propose a new product reputation model that uses opinion mining techniques in order to extract sentiments about product’s features, and then provide a method to generate a more realistic reputation value for every feature of the product and the product itself. We considered the strength of the opinion rather than its orientation only. We do not treat all product features equally when we calculate the overall product reputation, as some features are more important to customers than others, and consequently have more impact on customers buying decisions. Our method provides helpful details about the product features for customers rather than only representing reputation as a number only.

Knowledge sharing leveraging new product development activities to derive enhanced business performance : mixed method study

Knowledge has been widely recognised as a determinant of business performance. Business capabilities require an effective share of resource and knowledge. Specifically, knowledge sharing (KS) between different companies and departments can improve manufacturing processes since intangible knowledge plays an enssential role in achieving competitive advantage. This paper presents a mixed method research study into the impact of KS on the effectiveness of new product development (NPD) in achieving desired business performance (BP). Firstly, an empirical study utilising moderated regression analysis was conducted to test whether and to what extent KS has leveraging power on the relationship between NPD and BP constructs and variables. Secondly, this empirically verified hypothesis was validated through explanatory case studies involving two Taiwanese manufacturing companies using a qualitative interaction term pattern matching technique. The study provides evidence that knowledge sharing and management activities are essential for deriving competitive advantage in the manufacturing industry.

Consumer product-related injuries in Queensland children : A snapshot of current problem areas for potential action

This report presents a snapshot from work which was funded by the Queensland Injury Prevention Council in 2010-11 titled “Feasibility of Using Health Data Sources to Inform Product Safety Surveillance in Queensland children”. The project provided an evaluation of the current available evidence-base for identification and surveillance of product-related injuries in children in Queensland and Australia. A comprehensive 300 page report was produced (available at: http://eprints.qut.edu.au/46518/) and a series of recommendations were made which proposed: improvements in the product safety data system, increased utilisation of health data for proactive and reactive surveillance, enhanced collaboration between the health sector and the product safety sector, and improved ability of health data to meet the needs of product safety surveillance. At the conclusion of the project, a Consumer Product Injury Research Advisory group (CPIRAG) was established as a working party to the Queensland Injury Prevention Council (QIPC), to prioritise and advance these recommendations and to work collaboratively with key stakeholders to promote the role of injury data to support product safety policy decisions at the Queensland and national level. This group continues to meet monthly and is comprised of the organisations represented on the second page of this report. One of the key priorities of the CPIRAG group for 2012 was to produce a snapshot report to highlight problem areas for potential action arising out of the larger report. Subsequent funding to write this snapshot report was provided by the Institute for Health and Biomedical Innovation, Injury Prevention and Rehabilitation Domain at QUT in 2012. This work was undertaken by Dr Kirsten McKenzie and researchers from QUT's Centre for Accident Research and Road Safety - Queensland. This snapshot report provides an evidence base for potential further action on a range of children’s products that are significantly represented in injury data. Further information regarding injury hazards, safety advice and regulatory responses are available on the Office of Fair Trading (OFT) Queensland website and the Product Safety Australia websites. Links to these resources are provided for each product reviewed.

Reasoning about component similarity in building product models from the construction perspective

Identifying the design features that impact construction is essential to developing cost effective and constructible designs. The similarity of building components is a critical design feature that affects method selection, productivity, and ultimately construction cost and schedule performance. However, there is limited understanding of what constitutes similarity in the design of building components and limited computer-based support to identify this feature in a building product model. This paper contributes a feature-based framework for representing and reasoning about component similarity that builds on ontological modelling, model-based reasoning and cluster analysis techniques. It describes the ontology we developed to characterize component similarity in terms of the component attributes, the direction, and the degree of variation. It also describes the generic reasoning process we formalized to identify component similarity in a standard product model based on practitioners' varied preferences. The generic reasoning process evaluates the geometric, topological, and symbolic similarities between components, creates groupings of similar components, and quantifies the degree of similarity. We implemented this reasoning process in a prototype cost estimating application, which creates and maintains cost estimates based on a building product model. Validation studies of the prototype system provide evidence that the framework is general and enables a more accurate and efficient cost estimating process.