Volume-Time Curve: An Alternative for Endotracheal Tube Cuff Management

BACKGROUND: Despite numerous studies on endotracheal tube cuff pressure (CP) management, the literature has yet to establish a technique capable of adequately tilling the cuff with an appropriate volume of air while generating low CP in a less subjective way. the purpose of this prospective study was to evaluate and compare the CP levels and air volume required to fill the endotracheal tubes cuff using 2 different techniques (volume-time curve versus minimal occlusive volume) in the immediate postoperative period after coronary artery bypass grafting. METHODS: A total of 267 subjects were analyzed. After the surgery, the lungs were ventilated using pressure controlled continuous mandatory ventilation, and the same ventilatory parameters were adjusted. Upon arrival in the ICU, the cuff was completely deflated and re-inflated, and at this point the volume of air to fill the cuff was adjusted using one of 2 randomly selected techniques: volume-time curve and minimal occlusive volume. We measured the volume of air injected into the cuff, the CP, and the expired tidal volume of the mechanical ventilation after the application of each technique. RESULTS: the volume-time curve technique demonstrated a significantly lower CP and a lower volume of air injected into the cuff, compared to the minimal occlusive volume technique (P < .001). No significant difference was observed in the expired tidal volume between the 2 techniques (P = .052). However, when the subjects were submitted to the minimal occlusive volume technique, 17% (n = 47) experienced air leakage as observed by the volume-time graph. CONCLUSIONS: the volume-time curve technique was associated with a lower CP and a lower volume of air injected into the cuff, when compared to the minimal occlusive volume technique in the immediate postoperative period after coronary artery bypass grafting. Therefore, the volume-time curve may be a more reliable alternative for endotracheal tube cuff management.

Mast Cell Curve-Response in Partial Achilles Tendon Rupture After 830 nm Phototherapy

Objective: the aim of this study was to quantify mast cells at different time intervals after partial Achilles tendon rupture in rats treated with low-level laser therapy (LLLT). Background data: There is a high incidence of lesions and ruptures in the Achilles tendon that can take weeks and even months to heal completely. As the mast cells help in the healing repair phase, and LLLT has favorable effects on this tissue repair process, study of this modality on the quantity of mastocytes in the ruptured tendon is relevant. Methods: Sixty Wistar rats were subjected to partial Achilles' tendon rupture by direct trauma, randomized into 10 groups, and then divided into the group treated with 80mW aluminum gallium arsenide infrared laser diode, continuous wave, 2.8W/cm(2) power density, 40J/cm(2) energy density, and 1.12J total energy, and the simulation group. Both the groups were subdivided according to the histological assessment period of the sample, either 6h, 12h, 24h, 2 days, or 3 days after the rupture, to quantify the mastocytes in the Achilles' tendon. Results: the group subjected to LLLT presented a greater quantity of mastocytes in the periods of 6h, 12h, 24h, 2 days, and 3 days after rupture, compared with the simulation groups, but differences were detected between the sample assessment periods only in the simulation group. Conclusions: LLLT was shown to increase the quantity of mastocytes in the assessment periods compared with the simulation groups.

Clinical Use of the Volume-Time Curve for Endotracheal Tube Cuff Management

BACKGROUND: Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. the purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting. METHODS: A total of 450 subjects were randomized into 2 groups for cuff management after intubation: MOV group (n = 222) and volume-time curve group (n = 228). We measured cuff pressure before extubation. We performed spirometry 24 h before and after surgery. We graded sore throat and cough according to a 4-point scale at 1, 24, 72, and 120 h after extubation and assessed thoracic pain at 24 h after extubation and quantified the level of pain by a 10-point scale. RESULTS: the volume-time curve group presented significantly lower cuff pressure (30.9 +/- 2.8 vs 37.7 +/- 3.4 cm H2O), less incidence and intensity of sore throat (1 h, 23.7 vs 51.4%; and 24 h, 18.9 vs 40.5%, P < .001), cough (1 h, 19.3 vs 48.6%; and 24 h, 18.4 vs 42.3%, P < .001), thoracic pain (5.2 +/- 1.8 vs 7.1 +/- 1.7), better preservation of FVC (49.5 +/- 9.9 vs 41.8 +/- 12.9%, P = .005), and FEV1, (46.6 +/- 1.8 vs 38.6 +/- 1.4%, P = .005) compared with the MOV group. CONCLUSIONS: the subjects who received the volume-time curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough, less thoracic pain, and minimally impaired pulmonary function than those subjects who received the MOV technique during the first 24 h after coronary artery bypass grafting.

Knowledge based strategy: appraising knowledge creation capability in organisations.

This thesis sets out a journey which culminates in the development of an analytical framework, the "Organisational Creativity Appraisal" which is intended to assist organisations in evaluating their ability to support and develop creativity. This framework is derived from the common thread of the thesis, which is drawn from a range of research and consultancy projects, and the resulting published work, spanning an eight year period, centring on the role of knowledge and creativity in the strategy and performance of organisations. The literature of strategy, learning and creativity increasingly recognises that organisational context is critical to the formation of strategy, to the content of the strategy and to its successful implementation. The thesis explores the ways in which learning and creativity, the basis of knowledge-based strategy, are influenced by organisational context or social architecture. The research explores the ways in which managers can gain greater understanding of the social architectures of their organisations so as to assist in supporting their strategic development. The central core of the thesis is the nine published papers upon which it is based but it also derives from the broader perspective of my published work in the form of both articles and books. The thesis further draws upon my own experience as a leader and manager in the context of university business schools and as a consultant, researcher and developer in the context of a range of international private and public sector organisations. The work is based upon a premise that theory should inform practice and that practice should inform theory. The "Organisational Creativity Appraisal" framework is informed by both theory and practice and is intended to assist in management practice. There is no assumption that management research can arrive at prescriptions for managerial and organisational behaviour. On the other hand management research can usefully inform management and organisational behaviour, as long as it is employed in a critically reflective manner. The "Organisational Creativity Appraisal" presented in this work should be regarded as the framework in its present form which is likely to develop further as my research progresses in the future.

Developing organisational change capability

Oxtoby, B.; McGuinness, T.; and Morgan, R. (2002). Developing organisational change capability. European Management Journal. 20(3), pp.310-320 RAE2008

The effect of market and learning orientation on strategy dynamics : The contributing effect of organisational change capability

McGuinness, T. and Morgan, R. (2005). The effect of market and learning orientation on strategy dynamics: The contributing effect of organisational change capability. European Journal of Marketing. 39(11-12), pp.1306-1326 RAE2008

IS capability assessment - the MIND canvas

With the increasing ubiquity and growing pervasiveness of Information Systems (IS) in todays’ organisations, one of the capabilities of essential value to an organisation is its IS/IT (henceforth IS) capability. However, despite this increasing importance of the IS capability, research has barely focused on providing a measure for assessing the IT capability of an organization. In overview, IS capability has contributed significantly in understanding how information technology remains a valuable component of any modern day firm (Bharadwaj 2000, Santhanam and Hartono 2003). While these prior research focus in itself is of value in establishing the importance of IS capability, this current study posits that this research area is attaining maturity and it is about time we extend this stream to provide a measure for assessing and evaluating the IS capability that defines an organization. To borrow a quote from Peter Drucker - “if it can be measured; it can be improved”.

Developing executive capability — banking and beyond

The transition to becoming a leader is perhaps the least understood and most difficult in business. This Portfolio of Exploration examines the development of conscious awareness and meaning complexity as key transformational requirements to operate competently at leadership level and to succeed in a work environment characterised by change and complexity. It recognises that developing executive leadership capability is not just an issue of personality increasing what we know or expertise. It requires development of complexity in terms of how we know ourselves, relate to others, construe leadership and organisation, problem solve in business and understand the world as a whole. The exploration is grounded in the theory of adult mental development as outlined by Robert Kegan (1982, 1994) and in his collaborations with Lisa Laskow Lahey (2001, 2009). The theory points to levels of consciousness which impact on how we make meaning of and experience the world around us and respond to it. Critically it also points to transformational processes which enable us to evolve how we make meaning of our world as a means to close the mismatch between the demands of this world and our ability to cope. The exploration is laid out in three stages. Using Kegan’s (1982, 1994) theory as a framework it begins with a reflection of my career to surface how I made meaning of banking, management and subsequently leadership. In stage two I engage with a range of source thinkers in the areas of leadership, decision making, business, organisation, growth and complexity in a transformational process of developing greater conscious and complex understanding of organisational leadership (also recognising ever increasing complexity in the world). Finally, in stage three, I explore how qualitative changes as a result of this transformational effort have benefitted my professional, leadership and organisational capabilities.

Unprecedented loss of ammonia assimilation capability in a urease-encoding bacterial mutualist.

BACKGROUND: Blochmannia are obligately intracellular bacterial mutualists of ants of the tribe Camponotini. Blochmannia perform key nutritional functions for the host, including synthesis of several essential amino acids. We used Illumina technology to sequence the genome of Blochmannia associated with Camponotus vafer. RESULTS: Although Blochmannia vafer retains many nutritional functions, it is missing glutamine synthetase (glnA), a component of the nitrogen recycling pathway encoded by the previously sequenced B. floridanus and B. pennsylvanicus. With the exception of Ureaplasma, B. vafer is the only sequenced bacterium to date that encodes urease but lacks the ability to assimilate ammonia into glutamine or glutamate. Loss of glnA occurred in a deletion hotspot near the putative replication origin. Overall, compared to the likely gene set of their common ancestor, 31 genes are missing or eroded in B. vafer, compared to 28 in B. floridanus and four in B. pennsylvanicus. Three genes (queA, visC and yggS) show convergent loss or erosion, suggesting relaxed selection for their functions. Eight B. vafer genes contain frameshifts in homopolymeric tracts that may be corrected by transcriptional slippage. Two of these encode DNA replication proteins: dnaX, which we infer is also frameshifted in B. floridanus, and dnaG. CONCLUSIONS: Comparing the B. vafer genome with B. pennsylvanicus and B. floridanus refines the core genes shared within the mutualist group, thereby clarifying functions required across ant host species. This third genome also allows us to track gene loss and erosion in a phylogenetic context to more fully understand processes of genome reduction.

Association of a peripheral blood metabolic profile with coronary artery disease and risk of subsequent cardiovascular events.

BACKGROUND: Molecular tools may provide insight into cardiovascular risk. We assessed whether metabolites discriminate coronary artery disease (CAD) and predict risk of cardiovascular events. METHODS AND RESULTS: We performed mass-spectrometry-based profiling of 69 metabolites in subjects from the CATHGEN biorepository. To evaluate discriminative capabilities of metabolites for CAD, 2 groups were profiled: 174 CAD cases and 174 sex/race-matched controls ("initial"), and 140 CAD cases and 140 controls ("replication"). To evaluate the capability of metabolites to predict cardiovascular events, cases were combined ("event" group); of these, 74 experienced death/myocardial infarction during follow-up. A third independent group was profiled ("event-replication" group; n=63 cases with cardiovascular events, 66 controls). Analysis included principal-components analysis, linear regression, and Cox proportional hazards. Two principal components analysis-derived factors were associated with CAD: 1 comprising branched-chain amino acid metabolites (factor 4, initial P=0.002, replication P=0.01), and 1 comprising urea cycle metabolites (factor 9, initial P=0.0004, replication P=0.01). In multivariable regression, these factors were independently associated with CAD in initial (factor 4, odds ratio [OR], 1.36; 95% CI, 1.06 to 1.74; P=0.02; factor 9, OR, 0.67; 95% CI, 0.52 to 0.87; P=0.003) and replication (factor 4, OR, 1.43; 95% CI, 1.07 to 1.91; P=0.02; factor 9, OR, 0.66; 95% CI, 0.48 to 0.91; P=0.01) groups. A factor composed of dicarboxylacylcarnitines predicted death/myocardial infarction (event group hazard ratio 2.17; 95% CI, 1.23 to 3.84; P=0.007) and was associated with cardiovascular events in the event-replication group (OR, 1.52; 95% CI, 1.08 to 2.14; P=0.01). CONCLUSIONS: Metabolite profiles are associated with CAD and subsequent cardiovascular events.