Controversies of prophylactic hypothermia and the emerging use of brain tissue oxygen tension monitoring and decompressive craniectomy in traumatic brain-injured children

Background Despite being the leading cause of death and disability in the paediatric population, traumatic brain injury (TBI) in this group is largely understudied. Clinical practice within the paediatric intensive care unit (PICU) has been based upon adult guidelines however children are significantly different in terms of mechanism, pathophysiology and consequence of injury. Aim To review TBI management in the PICU and gain insight into potential management strategies. Method To conduct this review, a literature search was conducted using MEDLINE, PUBMED and The Cochrane Library using the following key words; traumatic brain injury; paediatric; hypothermia. There were no date restrictions applied to ensure that past studies, whose principles remain current were not excluded. Results Three areas were identified from the literature search and will be discussed against current acknowledged treatment strategies: Prophylactic hypothermia, brain tissue oxygen tension monitoring and decompressive craniectomy. Conclusion Previous literature has failed to fully address paediatric specific management protocols and we therefore have little evidence-based guidance. This review has shown that there is an emerging and ongoing trend towards paediatric specific TBI research in particular the area of moderate prophylactic hypothermia (MPH).

Kava and St. John's wort : current evidence for use in mood and anxiety disorders

Background: Mood and anxiety disorders pose significant health burdens on the community. Kava and St John’s wort (SJW) are the most commonly used herbal medicines in the treatment of anxiety and depressive disorders, respectively. Objectives: To conduct a comprehensive review of kava and SJW, to review any evidence of efficacy, mode of action, pharmacokinetics, safety and use in Major Depressive Disorder (MDD), Bipolar Disorder (BP), Seasonal Affective Disorder (SAD), Generalized Anxiety Disorder (GAD), Social Phobia (SP), Panic Disorder (PD), Obsessive-Compulsive Disorder (OCD), and Post Traumatic Stress Disorder (PTSD). Methods: A systematic review was conducted using the electronic databases MEDLINE, CINAHL, and The Cochrane Library during late 2008. The search criteria involved mood and anxiety disorder search terms in combination with kava, Piper methysticum, kavalactones, St John’s wort, Hypericum perforatum, hypericin and hyperforin. Additional search criteria for safety, pharmacodynamics , and pharmacokinetics was employed. A subsequent forward search was conducted of the papers using Web of Science cited reference search. Results: Current evidence supports the use of SJW in treating mild-moderate depression, and for kava in treatment of generalized anxiety. In respect to the other disorders, only weak preliminary evidence exists for use of SJW in SAD. Currently there is no published human trial on use of kava in affective disorders, or in OCD, PTSD, PD or SP. These disorders constitute potential applications that warrant exploration. Conclusions: Current evidence for herbal medicines in the treatment of depression and anxiety only supports the use of Hypericum perforatum for depression, and Piper methysticum for generalized anxiety.

Managing the winds of change

Environmental impacts caused during Australia's comparatively recent settlement by Europeans are evident. Governments (both Commonwealth and States) have been largely responsible for requiring landholders – through leasehold development conditions and taxation concessions – to conduct clearing that is now perceived as damage. Most governments are now demanding resource protection. There is a measure of bewilderment (if not resentment) among landholders because of this change. The more populous States, where most overall damage has been done (i.e. Victoria and New South Wales), provide most support for attempts to stop development in other regions where there has been less damage. Queensland, i.e. the north-eastern quarter of the continent, has been relatively slow to develop. It also holds the largest and most diverse natural environments. Tree clearing is an unavoidable element of land development, whether to access and enhance native grasses for livestock or to allow for urban developments (with exotic tree plantings). The consequences in terms of regulations are particularly complex because of the dynamic nature of vegetation. The regulatory terms used in current legislation – such as 'Endangered' and 'Of concern' – depend on legally-defined, static baselines. Regrowth and fire damage are two obvious causes of change. A less obvious aspect is succession, where ecosystems change naturally over long timeframes. In the recent past, the Queensland Government encouraged extensive tree-clearing e.g. through the State Brigalow Development Scheme (mostly 1962 to 1975) which resulted in the removal of some 97% of the wide-ranging mature forests of Acacia harpophylla. At the same time, this government controls National Parks and other reservations (occupying some 4% of the State's 1.7 million km2 area) and also holds major World Heritage Areas (such as the Great Barrier Reef and the Wet Tropics Rainforest) promulgated under Commonwealth legislation. This is a highly prescriptive approach, where the community is directed on the one hand to develop (largely through lease conditions) and on the other to avoid development (largely by unusable reserves). Another approach to development and conservation is still possible in Queensland. For this to occur, however, a more workable and equitable solution than has been employed to date is needed, especially for the remote lands of this State. This must involve resident landholders, who have the capacity (through local knowledge, infrastructure and daily presence) to undertake most costeffectively sustainable land-use management (with suitable attention to ecosystems requiring special conservation effort), that is, provided they have the necessary direction, encouragement and incentive to do so.

Schematic Representation of Case Study Research Designs

Aim. The paper is a report of a study to demonstrate how the use of schematics can provide procedural clarity and promote rigour in the conduct of case study research. Background. Case study research is a methodologically flexible approach to research design that focuses on a particular case – whether an individual, a collective or a phenomenon of interest. It is known as the 'study of the particular' for its thorough investigation of particular, real-life situations and is gaining increased attention in nursing and social research. However, the methodological flexibility it offers can leave the novice researcher uncertain of suitable procedural steps required to ensure methodological rigour. Method. This article provides a real example of a case study research design that utilizes schematic representation drawn from a doctoral study of the integration of health promotion principles and practices into a palliative care organization. Discussion. The issues discussed are: (1) the definition and application of case study research design; (2) the application of schematics in research; (3) the procedural steps and their contribution to the maintenance of rigour; and (4) the benefits and risks of schematics in case study research. Conclusion. The inclusion of visual representations of design with accompanying explanatory text is recommended in reporting case study research methods.

Generic one round group key exchange in the standard model

Minimizing complexity of group key exchange (GKE) protocols is an important milestone towards their practical deployment. An interesting approach to achieve this goal is to simplify the design of GKE protocols by using generic building blocks. In this paper we investigate the possibility of founding GKE protocols based on a primitive called multi key encapsulation mechanism (mKEM) and describe advantages and limitations of this approach. In particular, we show how to design a one-round GKE protocol which satisfies the classical requirement of authenticated key exchange (AKE) security, yet without forward secrecy. As a result, we obtain the first one-round GKE protocol secure in the standard model. We also conduct our analysis using recent formal models that take into account both outsider and insider attacks as well as the notion of key compromise impersonation resilience (KCIR). In contrast to previous models we show how to model both outsider and insider KCIR within the definition of mutual authentication. Our analysis additionally implies that the insider security compiler by Katz and Shin from ACM CCS 2005 can be used to achieve more than what is shown in the original work, namely both outsider and insider KCIR.

Modelling the process of dialogic communication in public relations: a role-based approach

This paper takes Kent and Taylor’s (2002) call to develop a dialogic theory of public relations and suggests that a necessary first step is the modelling of the process of dialogic communication in public relations. In order to achieve this, extant literature from a range of fields is reviewed, seeking to develop a definition of dialogic communication that is meaningful to the practice of contemporary public relations. A simple transmission model of communication is used as a starting point. This is synthesised with concepts relating specifically to dialogue, taken here in its broadest sense rather than defined as any one particular outcome. The definition that emerges from this review leads to the conclusion that dialogic communication in public relations involves the interaction of three roles – those of sender, receiver, and responder. These three roles are shown to be adopted at different times by both participants involved in dialogic communication. It is further suggested that variations occur in how these roles are conducted: the sender and receiver roles can be approached in a passive or an active way, while the responder role can be classified as being either resistant or responsive to the information received in dialogic communication. The final modelling of the definition derived provides a framework which can be tested in the field to determine whether variations in the conduct of the roles in dialogic communication actually exist, and if so, whether they can be linked to the different types of outcome from dialogic communication identified previously in the literature.

Labour rights as human rights : workers' safety at work in Australian-based supply chains

The increase of buyer-driven supply chains, outsourcing and other forms of non-traditional employment has resulted in challenges for labour market regulation. One business model which has created substantial regulatory challenges is supply chains. The supply chain model involves retailers purchasing products from brand corporations who then outsource the manufacturing of the work to traders who contract with factories or outworkers who actually manufacture the clothing and textiles. This business model results in time and cost pressures being pushed down the supply chain which has resulted in sweatshops where workers systematically have their labour rights violated. Literally millions of workers work in dangerous workplaces where thousands are killed or permanently disabled every year. This thesis has analysed possible regulatory responses to provide workers a right to safety and health in supply chains which provide products for Australian retailers. This thesis will use a human rights standard to determine whether Australia is discharging its human rights obligations in its approach to combating domestic and foreign labour abuses. It is beyond this thesis to analyse Occupational Health and Safety (OHS) laws in every jurisdiction. Accordingly, this thesis will focus upon Australian domestic laws and laws in one of Australia’s major trading partners, the Peoples’ Republic of China (China). It is hypothesised that Australia is currently breaching its human rights obligations through failing to adequately regulate employees’ safety at work in Australian-based supply chains. To prove this hypothesis, this thesis will adopt a three- phase approach to analysing Australia’s regulatory responses. Phase 1 will identify the standard by which Australia’s regulatory approach to employees’ health and safety in supply chains can be judged. This phase will focus on analysing how workers’ rights to safety as a human right imposes a moral obligation on Australia to take reasonablely practicable steps regulate Australian-based supply chains. This will form a human rights standard against which Australia’s conduct can be judged. Phase 2 focuses upon the current regulatory environment. If existing regulatory vehicles adequately protect the health and safety of employees, then Australia will have discharged its obligations through simply maintaining the status quo. Australia currently regulates OHS through a combination of ‘hard law’ and ‘soft law’ regulatory vehicles. The first part of phase 2 analyses the effectiveness of traditional OHS laws in Australia and in China. The final part of phase 2 then analyses the effectiveness of the major soft law vehicle ‘Corporate Social Responsibility’ (CSR). The fact that employees are working in unsafe working conditions does not mean Australia is breaching its human rights obligations. Australia is only required to take reasonably practicable steps to ensure human rights are realized. Phase 3 identifies four regulatory vehicles to determine whether they would assist Australia in discharging its human rights obligations. Phase 3 then analyses whether Australia could unilaterally introduce supply chain regulation to regulate domestic and extraterritorial supply chains. Phase 3 also analyses three public international law regulatory vehicles. This chapter considers the ability of the United Nations Global Compact, the ILO’s Better Factory Project and a bilateral agreement to improve the detection and enforcement of workers’ right to safety and health.

Industrial design in endoscopy : the development of a tissue and organ extractor

Throughout history, developments in medicine have aimed to improve patient quality of life, and reduce the trauma associated with surgical treatment. Surgical access to internal organs and bodily structures has been traditionally via large incisions. Endoscopic surgery presents a technique for surgical access via small (1 Omm) incisions by utilising a scope and camera for visualisation of the operative site. Endoscopy presents enormous benefits for patients in terms of lower post operative discomfort, and reduced recovery and hospitalisation time. Since the first gall bladder extraction operation was performed in France in 1987, endoscopic surgery has been embraced by the international medical community. With the adoption of the new technique, new problems never previously encountered in open surgery, were revealed. One such problem is that the removal of large tissue specimens and organs is restricted by the small incision size. Instruments have been developed to address this problem however none of the devices provide a totally satisfactory solution. They have a number of critical weaknesses: -The size of the access incision has to be enlarged, thereby compromising the entire endoscopic approach to surgery. - The physical quality of the specimen extracted is very poor and is not suitable to conduct the necessary post operative pathological examinations. -The safety of both the patient and the physician is jeopardised. The problem of tissue and organ extraction at endoscopy is investigated and addressed. In addition to background information covering endoscopic surgery, this thesis describes the entire approach to the design problem, and the steps taken before arriving at the final solution. This thesis contributes to the body of knowledge associated with the development of endoscopic surgical instruments. A new product capable of extracting large tissue specimens and organs in endoscopy is the final outcome of the research.

Tendering ethics : a study of collusive tendering from a marketing perspective

This thesis provides a behavioural perspective to the problem of collusive tendering in the construction market by examining the decision making factors of individuals potentially involved in such agreements using marketing ethics theory and techniques. The findings of a cross disciplinary literature review were synthesised into a model of factors theoretically expected to determine the individual's behavioural intent towards a set of collusive tendering agreements and the means of reaching them. The factors were grouped as internal cognitive (the individuals' value systems) and affective (demographic and psychographic characteristics) as well as external environmental (legal, industrial and organisational codes and norms) and situational (company, market and economic conditions). The model was tested using empirical data collected through a questionnaire survey of estimators employed in the largest Australian construction firms. All forms of explicit collusive tendering agreements were considered as having a prohibitive moral content by the majority of respondents who also clearly differentiated between agreements and discussions of contract terms (which they found to be a moral concern but not prohibitive) or of prices. The comparisons between those of the respondents that would never participate in a collusive agreement and the potential offenders clearly showed two distinctly different groups. The law abiding estimators are less reliant on situational factors, happier and more comfortable in their work environments and they live according to personal value and belief systems. The potential offenders on the other hand are mistrustful of colleagues, feel their values are not respected, put company priorities above principles and none of them is religious or a member of a professional body. The research results indicate that Australian estimators are, overall law abiding and principled and accept the existing codification of collusion as morally defensible and binding. Professional bodies' and organisational codes of conduct as well as personal value and belief systems that guide one's own conduct appear to be deterrents to collusive tendering intent and so are moral comfort and work satisfaction. These observations are potential indicators of areas where intervention and behaviour modification can increase individuals' resistance to collusion.

Flexural behaviour and design of the new built-up LiteSteel beams

LiteSteel Beam (LSB) is a new cold-formed steel beam produced by OneSteel Australian Tube Mills. The new beam is effectively a channel section with two rectangular hollow flanges and a slender web, and is manufactured using a combined cold-forming and electric resistance welding process. OneSteel Australian Tube Mills is promoting the use of LSBs as flexural members in a range of applications, such as floor bearers. When LSBs are used as back to back built-up sections, they are likely to improve their moment capacity and thus extend their applications further. However, the structural behaviour of built-up beams is not well understood. Many steel design codes include guidelines for connecting two channels to form a built-up I-section including the required longitudinal spacing of connections. But these rules were found to be inadequate in some applications. Currently the safe spans of builtup beams are determined based on twice the moment capacity of a single section. Research has shown that these guidelines are conservative. Therefore large scale lateral buckling tests and advanced numerical analyses were undertaken to investigate the flexural behaviour of back to back LSBs connected by fasteners (bolts) at various longitudinal spacings under uniform moment conditions. In this research an experimental investigation was first undertaken to study the flexural behaviour of back to back LSBs including its buckling characteristics. This experimental study included tensile coupon tests, initial geometric imperfection measurements and lateral buckling tests. The initial geometric imperfection measurements taken on several back to back LSB specimens showed that the back to back bolting process is not likely to alter the imperfections, and the measured imperfections are well below the fabrication tolerance limits. Twelve large scale lateral buckling tests were conducted to investigate the behaviour of back to back built-up LSBs with various longitudinal fastener spacings under uniform moment conditions. Tests also included two single LSB specimens. Test results showed that the back to back LSBs gave higher moment capacities in comparison with single LSBs, and the fastener spacing influenced the ultimate moment capacities. As the fastener spacing was reduced the ultimate moment capacities of back to back LSBs increased. Finite element models of back to back LSBs with varying fastener spacings were then developed to conduct a detailed parametric study on the flexural behaviour of back to back built-up LSBs. Two finite element models were developed, namely experimental and ideal finite element models. The models included the complex contact behaviour between LSB web elements and intermittently fastened bolted connections along the web elements. They were validated by comparing their results with experimental results and numerical results obtained from an established buckling analysis program called THIN-WALL. These comparisons showed that the developed models could accurately predict both the elastic lateral distortional buckling moments and the non-linear ultimate moment capacities of back to back LSBs. Therefore the ideal finite element models incorporating ideal simply supported boundary conditions and uniform moment conditions were used in a detailed parametric study on the flexural behaviour of back to back LSB members. In the detailed parametric study, both elastic buckling and nonlinear analyses of back to back LSBs were conducted for 13 LSB sections with varying spans and fastener spacings. Finite element analysis results confirmed that the current design rules in AS/NZS 4600 (SA, 2005) are very conservative while the new design rules developed by Anapayan and Mahendran (2009a) for single LSB members were also found to be conservative. Thus new member capacity design rules were developed for back to back LSB members as a function of non-dimensional member slenderness. New empirical equations were also developed to aid in the calculation of elastic lateral distortional buckling moments of intermittently fastened back to back LSBs. Design guidelines were developed for the maximum fastener spacing of back to back LSBs in order to optimise the use of fasteners. A closer fastener spacing of span/6 was recommended for intermediate spans and some long spans where the influence of fastener spacing was found to be high. In the last phase of this research, a detailed investigation was conducted to investigate the potential use of different types of connections and stiffeners in improving the flexural strength of back to back LSB members. It was found that using transverse web stiffeners was the most cost-effective and simple strengthening method. It is recommended that web stiffeners are used at the supports and every third points within the span, and their thickness is in the range of 3 to 5 mm depending on the size of LSB section. The use of web stiffeners eliminated most of the lateral distortional buckling effects and hence improved the ultimate moment capacities. A suitable design equation was developed to calculate the elastic lateral buckling moments of back to back LSBs with the above recommended web stiffener configuration while the same design rules developed for unstiffened back to back LSBs were recommended to calculate the ultimate moment capacities.

Development and validation of a novel approach to work sampling : a study of nurse practitioner work patterns

Objectives: This methodological paper reports on the development and validation of a work sampling instrument and data collection processes to conduct a national study of nurse practitioners’ work patterns. ---------- Design: Published work sampling instruments provided the basis for development and validation of a tool for use in a national study of nurse practitioner work activities across diverse contextual and clinical service models. Steps taken in the approach included design of a nurse practitioner-specific data collection tool and development of an innovative web-based program to train and establish inter rater reliability of a team of data collectors who were geographically dispersed across metropolitan, rural and remote health care settings. ---------- Setting: The study is part of a large funded study into nurse practitioner service. The Australian Nurse Practitioner Study is a national study phased over three years and was designed to provide essential information for Australian health service planners, regulators and consumer groups on the profile, process and outcome of nurse practitioner service. ---------- Results: The outcome if this phase of the study is empirically tested instruments, process and training materials for use in an international context by investigators interested in conducting a national study of nurse practitioner work practices. ---------- Conclusion: Development and preparation of a new approach to describing nurse practitioner practices using work sampling methods provides the groundwork for international collaboration in evaluation of nurse practitioner service.

Validation of FHWA crash models for rural intersections - Lessons learned

A national-level safety analysis tool is needed to complement existing analytical tools for assessment of the safety impacts of roadway design alternatives. FHWA has sponsored the development of the Interactive Highway Safety Design Model (IHSDM), which is roadway design and redesign software that estimates the safety effects of alternative designs. Considering the importance of IHSDM in shaping the future of safety-related transportation investment decisions, FHWA justifiably sponsored research with the sole intent of independently validating some of the statistical models and algorithms in IHSDM. Statistical model validation aims to accomplish many important tasks, including (a) assessment of the logical defensibility of proposed models, (b) assessment of the transferability of models over future time periods and across different geographic locations, and (c) identification of areas in which future model improvements should be made. These three activities are reported for five proposed types of rural intersection crash prediction models. The internal validation of the model revealed that the crash models potentially suffer from omitted variables that affect safety, site selection and countermeasure selection bias, poorly measured and surrogate variables, and misspecification of model functional forms. The external validation indicated the inability of models to perform on par with model estimation performance. Recommendations for improving the state of the practice from this research include the systematic conduct of carefully designed before-and-after studies, improvements in data standardization and collection practices, and the development of analytical methods to combine the results of before-and-after studies with cross-sectional studies in a meaningful and useful way.

Conducting statistical tests of hypotheses : five common misconceptions found in transportation research

Most statistical methods use hypothesis testing. Analysis of variance, regression, discrete choice models, contingency tables, and other analysis methods commonly used in transportation research share hypothesis testing as the means of making inferences about the population of interest. Despite the fact that hypothesis testing has been a cornerstone of empirical research for many years, various aspects of hypothesis tests commonly are incorrectly applied, misinterpreted, and ignored—by novices and expert researchers alike. On initial glance, hypothesis testing appears straightforward: develop the null and alternative hypotheses, compute the test statistic to compare to a standard distribution, estimate the probability of rejecting the null hypothesis, and then make claims about the importance of the finding. This is an oversimplification of the process of hypothesis testing. Hypothesis testing as applied in empirical research is examined here. The reader is assumed to have a basic knowledge of the role of hypothesis testing in various statistical methods. Through the use of an example, the mechanics of hypothesis testing is first reviewed. Then, five precautions surrounding the use and interpretation of hypothesis tests are developed; examples of each are provided to demonstrate how errors are made, and solutions are identified so similar errors can be avoided. Remedies are provided for common errors, and conclusions are drawn on how to use the results of this paper to improve the conduct of empirical research in transportation.

Flood fatalities in contemporary Australia (1997-2008) : disaster medicine

Objective: Flood is the most common natural disaster in Australia and causes more loss of life than any other disaster. This article describes the incidence and causes of deaths directly associated with floods in contemporary Australia. ---------- Methods: The present study compiled a database of flood fatalities in Australia in the period of 1997–2008 inclusive. The data were derived from newspapers and historic accounts, as well as government and scientific reports. Assembled data include the date and location of fatalities, age and gender of victims and the circumstances of the death. ---------- Results: At least 73 persons died as a direct result of floods in Australia in the period of 1997–2008. The largest number of fatalities occurred in New South Wales and Queensland. Most fatalities occurred during February, and among men (71.2%). People between the ages of 10 and 29 and those over 70 years are overrepresented among those drowned. There is no evident decline in the number of deaths over time. 48.5% fatalities related to motor vehicle use. 26.5% fatalities occurred as a result of inappropriate or high-risk behaviour during floods. ---------- Conclusion: In modern developed countries with adequate emergency response systems and extensive resources, deaths that occur in floods are almost all eminently preventable. Over 90% of the deaths are caused by attempts to ford flooded waterways or inappropriate situational conduct. Knowledge of the leading causes of flood fatalities should inform public awareness programmes and public safety police enforcement activities.