Mixed venous oxygen saturation monitoring revisited : thoughts for critical care nursing practice

Background Less invasive methods of determining cardiac output are now readily available. Using indicator dilution technique, for example has made it easier to continuously measure cardiac output because it uses the existing intra-arterial line. Therefore gone is the need for a pulmonary artery floatation catheter and with it the ability to measure left atrial and left ventricular work indices as well the ability to monitor and measure a mixed venous saturation (SvO2). Purpose The aim of this paper is to put forward the notion that SvO2 provides valuable information about oxygen consumption and venous reserve; important measures in the critically ill to ensure oxygen supply meets cellular demand. In an attempt to portray this, a simplified example of the septic patient is offered to highlight the changing pathophysiological sequelae of the inflammatory process and its importance for monitoring SvO2. Relevance to clinical practice SvO2 monitoring, it could be argued, provides the gold standard for assessing arterial and venous oxygen indices in the critically ill. For the bedside ICU nurse the plethora of information inherent in SvO2 monitoring could provide them with important data that will assist in averting potential problems with oxygen delivery and consumption. However, it has been suggested that central venous saturation (ScvO2) might be an attractive alternative to SvO2 because of its less invasiveness and ease of obtaining a sample for analysis. There are problems with this approach and these are to do with where the catheter tip is sited and the nature of the venous admixture at this site. Studies have shown that ScvO2 is less accurate than SvO2 and should not be used as a sole guiding variable for decision-making. These studies have demonstrated that there is an unacceptably wide range in variance between ScvO2 and SvO2 and this is dependent on the presenting disease, in some cases SvO2 will be significantly lower than ScvO2. Conclusion Whilst newer technologies have been developed to continuously measure cardiac output, SvO2 monitoring is still an important adjunct to clinical decision-making in the ICU. Given the information that it provides, seeking alternatives such as ScvO2 or blood samples obtained from femorally placed central venous lines, can unnecessarily lead to inappropriate treatment being given or withheld. Instead when using ScvO2, trending of this variable should provide clinical determinates that are useable for the bedside ICU nurse, remembering that in most conditions SvO2 will be approximately 16% lower.

Delirium in the ICU : a review

AIM The aim of this paper was to review the current discourse in relation to intensive care unit (ICU) delirium. In particular, it will discuss the predisposing and contributory factors associated with delirium's development as well as effects of delirium on patients, staff and family members. BACKGROUND Critically ill patients are at greater risk of developing delirium and, with an ageing population and increased patient acuity permitted by medical advances, delirium is a growing problem in the ICU. However, there is a universal consensus that the definition of ICU delirium needs improvement to aid its recognition and to ensure both hypoalert-hypoactive and hyperalert-hyperactive variants are easily and readily identified. RELEVANCE TO CLINICAL PRACTICE The effects of ICU delirium have cost implications to the National Health Service in terms of prolonged ventilation and length of hospital stay. The causes of delirium can be readily classified as either predisposing or precipitating factors, which are organic in nature and commonly reversible. However, contributory factors also exist to exacerbate delirium and having an awareness of all these factors promises to aid prevention and expedite treatment. This will avoid or limit the host of adverse physiological and psychological consequences that delirium can provoke and directly enhance both patient and staff safety. CONCLUSIONS Routine screening of all patients in the ICU for the presence of delirium is crucial to its successful management. Nurses are on the front line to detect, manage and even prevent delirium.

A dedicated retrieval and transfer service : the QUARTS project

Background The transfer and/or retrieval of a critically patient is inherently dangerous not only for the patient but for staff as well. The quality and experience of unplanned transfers can influence patient mortality and morbidity. However, international evidence suggests that dedicated transfer/retrieval teams can improve mortality and morbidity outcomes. Aims The initial aim of this paper is to describe an in-house competency-based training programme, which encompasses the STaR approach to develop members of our existing nursing team to be part of the dedicated transfer/retrieval service. The paper also presents audit data findings which examined the source of referrals, number of patients actually transferred and clinical status of those being transferred. Results Audit data illustrate that the most frequent source of referrals comes from Accident and Emergency and the Surgical Directorate with the most common presenting condition being cardio-respiratory failure or arrest. Audit data reveal that the number of patients actually transferred or retrieved is relatively small (33%) compared with the overall number of requests for assistance. However, 36% of those patients transferred had a level 2 or level 3 acuity status that necessitated the admission to a critical care area. Conclusions A number of studies have concluded that the ill-experienced and ill-equipped transfer team can place patients’ at serious risk of harm. Whether planned or unplanned, dedicated critical care transfer/retrieval teams have been shown to reduce patient mortality and morbidity.

Settling the Pop Score : Pop Texts and Identity Politics [Book Review]

Review(s) of: Settling the Pop Score: Pop Texts and Identity Politics, Stan Hawkins, Aldershot, Hants. : Ashgate, 2002, ISBN 0 7546 0352 0; pb, 234pp, ill, music exx, bibl. , discog. , index. The scholarly study of popular music has its origins in sociology and cultural studies, disciplinary areas in which musical meaning is often attributed to aspects of economical and sociological function. Against this tradition, recent writers have offered what is now referred to as ‘popular musicology’: a method or approach that tends towards a specific engagement with ‘pop texts’ on aesthetic, and perhaps even ‘musical’ terms. Stan Hawkins uses the term popular musicology ‘at his own peril,’ clearly recognising the implicit scholarly danger in his approach, whereby ‘formalist questions of musical analysis’ are dealt with ‘alongside the more intertextual discursive theorisations of musical expression’ (p. xii). In other words, popular musicologists dare to tread that fine line between text and context. As editor of the journal Popular Musicology Online, Hawkins is a leading advocate of this practice, specifically in the application of music-analytical techniques to popular music. His methodology attests to the influence of other leading figures in the area, notably Richard Middleton, Allan F. Moore and Derek Scott (general editor of the Ashgate Popular and Folk Music Series in which this book is published).

The acetal concept : regioselective access toortho,ortho-diphenols via dibenzo-1,3-dioxepines

Traditional methods are ill-suited for the synthesis of ortho,ortho-biphenols, a structural motif found in many polyphenolic natural products, as well as synthetically useful compounds such as the chiral ligands binol, vapol, and vanol. The new route consists of a radical-based reaction of an acetal-tethered biphenyl ether substrate and subsequent hydrolytic cleavage of the dibenzo-1,3-dioxepine intermediate.

The power of naming : the multifaceted value of learning students’ names

The modern day Australian law school is expected to educate and engage law students. Ideally law school will instil a sense of passion (or at least appreciation) for the law, promote a positive professional identity, foster a sense of community, and provide general support to law students. Collectively, the Australian legal academy is struggling with these goals. Significant numbers of students feel isolated, disconnected and unengaged throughout their tertiary legal education. Teaching students from increasingly diverse backgrounds, who spend less time on campus and less face-to-face time in class, many law academics feel ill-equipped to respond to the challenge of engaging law students in time and cost efficient ways. Intentionally learning and using student names has potential to humanise the law school experience, build community, and positively impact upon the wellbeing of students and staff.

Infrared and Raman spectroscopic characterization of the Borate mineral Vonsenite

There are a large number of boron-containing minerals, of which vonsenite is one. Some discussion about the molecular structure of vonsenite exists in the literature. Whether water is involved in the structure is ill-determined. The molecular structure of vonsenite has been assessed by the combination of Raman and infrared spectroscopy. The Raman spectrum is characterized by two intense broad bands at 997 and 1059 cm−1 assigned to the BO stretching vibrational mode. A series of Raman bands in the 1200–1500 cm−1 spectral range are attributed to BO antisymmetric stretching modes and in-plane bending modes. The infrared spectrum shows complexity in this spectral range. No Raman spectrum of water in the OH stretching region could be obtained. The infrared spectrum shows a series of overlapping bands with bands identified at 3037, 3245, 3443, 3556, and 3614 cm−1. It is important to understand the structure of vonsenite in order to form nanomaterials based on its structure. Vibrational spectroscopy enables a better understanding of the structure of vonsenite.

Setting water quality objectives for the health of freshwater fish

An important responsibility of the Environment Protection Authority, Victoria, is to set objectives for levels of environmental contaminants. To support the development of environmental objectives for water quality, a need has been identified to understand the dual impacts of concentration and duration of a contaminant on biota in freshwater streams. For suspended solids contamination, information reported by Newcombe and Jensen [ North American Journal of Fisheries Management , 16(4):693--727, 1996] study of freshwater fish and the daily suspended solids data from the United States Geological Survey stream monitoring network is utilised. The study group was requested to examine both the utility of the Newcombe and Jensen and the USA data, as well as the formulation of a procedure for use by the Environment Protection Authority Victoria that takes concentration and duration of harmful episodes into account when assessing water quality. The extent to which the impact of a toxic event on fish health could be modelled deterministically was also considered. It was found that concentration and exposure duration were the main compounding factors on the severity of effects of suspended solids on freshwater fish. A protocol for assessing the cumulative effect on fish health and a simple deterministic model, based on the biology of gill harm and recovery, was proposed. References D. W. T. Au, C. A. Pollino, R. S. S Wu, P. K. S. Shin, S. T. F. Lau, and J. Y. M. Tang. Chronic effects of suspended solids on gill structure, osmoregulation, growth, and triiodothyronine in juvenile green grouper epinephelus coioides . Marine Ecology Press Series , 266:255--264, 2004. J.C. Bezdek, S.K. Chuah, and D. Leep. Generalized k-nearest neighbor rules. Fuzzy Sets and Systems , 18:237--26, 1986. E. T. Champagne, K. L. Bett-Garber, A. M. McClung, and C. Bergman. {Sensory characteristics of diverse rice cultivars as influenced by genetic and environmental factors}. Cereal Chem. , {81}:{237--243}, {2004}. S. G. Cheung and P. K. S. Shin. Size effects of suspended particles on gill damage in green-lipped mussel perna viridis. Marine Pollution Bulletin , 51(8--12):801--810, 2005. D. H. Evans. The fish gill: site of action and model for toxic effects of environmental pollutants. Environmental Health Perspectives , 71:44--58, 1987. G. C. Grigg. The failure of oxygen transport in a fish at low levels of ambient oxygen. Comp. Biochem. Physiol. , 29:1253--1257, 1969. G. Holmes, A. Donkin, and I.H. Witten. {Weka: A machine learning workbench}. In Proceedings of the Second Australia and New Zealand Conference on Intelligent Information Systems , volume {24}, pages {357--361}, {Brisbane, Australia}, {1994}. {IEEE Computer Society}. D. D. Macdonald and C. P. Newcombe. Utility of the stress index for predicting suspended sediment effects: response to comments. North American Journal of Fisheries Management , 13:873--876, 1993. C. P. Newcombe. Suspended sediment in aquatic ecosystems: ill effects as a function of concentration and duration of exposure. Technical report, British Columbia Ministry of Environment, Lands and Parks, Habitat Protection branch, Victoria, 1994. C. P. Newcombe and J. O. T. Jensen. Channel suspended sediment and fisheries: A synthesis for quantitative assessment of risk and impact. North American Journal of Fisheries Management , 16(4):693--727, 1996. C. P. Newcombe and D. D. Macdonald. Effects of suspended sediments on aquatic ecosystems. North American Journal of Fisheries Management , 11(1):72--82, 1991. K. Schmidt-Nielsen. Scaling. Why is animal size so important? Cambridge University Press, NY, 1984. J. S. Schwartz, A. Simon, and L. Klimetz. Use of fish functional traits to associate in-stream suspended sediment transport metrics with biological impairment. Environmental Monitoring and Assessment , 179(1--4):347--369, 2011. E. Al Shaw and J. S. Richardson. Direct and indirect effects of sediment pulse duration on stream invertebrate assemb ages and rainbow trout ( Oncorhynchus mykiss ) growth and survival. Canadian Journal of Fish and Aquatic Science , 58:2213--2221, 2001. P. Tiwari and H. Hasegawa. {Demand for housing in Tokyo: A discrete choice analysis}. Regional Studies , {38}:{27--42}, {2004}. Y. Tramblay, A. Saint-Hilaire, T. B. M. J. Ouarda, F. Moatar, and B Hecht. Estimation of local extreme suspended sediment concentrations in california rivers. Science of the Total Environment , 408:4221--

Occupational health psychology

In this chapter, the occupational stress process and implications for the management of occupational health and safety in organisations are discussed. The chapter begins by introducing occupational stress as a process by which stressors (e.g. time pressure) result in strains (e.g. ill health). The consequences of stress, to both the individual and the organisation are discussed, and several key sources of occupational stress are also described. Theories of occupational stress that attempt to explain how stressors lead to strain and also describe different job resources (e.g. autonomy, support, and security) that can alleviate the detrimental effects of occupational stressors are then presented. The management of occupational stress at both the individual and organisational levels is also discussed. In the subsequent section, work-life balance and various ways work impacts on life and vice versa are described. The management of work-life conflict and the effectiveness of initiatives designed to address imbalance between work and life are then discussed. Finally, occupational health and safety is described with a particular focus on primary prevention as well as the legislative frameworks that guide psychosocial risk management in Australian organisations.

Measuring Online user engagement : the limitations of Web analytics

The ability to identify and assess user engagement with transmedia productions is vital to the success of individual projects and the sustainability of this mode of media production as a whole. It is essential that industry players have access to tools and methodologies that offer the most complete and accurate picture of how audiences/users engage with their productions and which assets generate the most valuable returns of investment. Drawing upon research conducted with Hoodlum Entertainment, a Brisbane-based transmedia producer, this chapter outlines an initial assessment of the way engagement tends to be understood, why standard web analytics tools are ill-suited to measuring it, how a customised tool could offer solutions, and why this question of measuring engagement is so vital to the future of transmedia as a sustainable industry.

Post-disaster reconstruction projects : a logical framework for community participation

In a post-disaster environment, housing reconstruction projects frequently face enormous difficulties due to the various, often apparently ill-considered, internal and external factors. Non-Governmental Organisations (NGOs) operating in post-disaster settings such as in Afghanistan continue to face blame over the failure of reconstruction projects, and worse, they are sometimes even viewed as being corrupt entities. While it is not always possible for NGOs to eliminate or reduce the impact of factors that are outside their control, they certainly can increase the chances of project success by placing considerable emphasis on working more effectively with the affected communities. To achieve maximum community participation in reconstruction projects , this research develops a specific logical framework to guide the process of community participation in post-disaster housing reconstruction in Afghanistan.

Six theories of neoliberalism

This article takes as its starting point the observation that neoliberalism is a concept that is ‘oft-invoked but ill-defined’. It provides a taxonomy of uses of the term neoliberalism to include: (1) an all-purpose denunciatory category; (2) ‘the way things are’; (3) an institutional framework characterizing particular forms of national capitalism, most notably the Anglo-American ones; (4) a dominant ideology of global capitalism; (5) a form of governmentality and hegemony; and (6) a variant within the broad framework of liberalism as both theory and policy discourse. It is argued that this sprawling set of definitions are not mutually compatible, and that uses of the term need to be dramatically narrowed from its current association with anything and everything that a particular author may find objectionable. In particular, it is argued that the uses of the term by Michel Foucault in his 1978–9 lectures, found in The Birth of Biopolitics, are not particularly compatible with its more recent status as a variant of dominant ideology or hegemony theories. It instead proposes understanding neoliberalism in terms of historical institutionalism, with Foucault’s account of historical change complementing MaxWeber’s work identifying the distinctive economic sociology of national capitalisms.

Air pollution and invisible violence

In recent years air pollution has been referred to as an ‘invisible killer’, and ‘an invisible health crisis’ (European Respiratory Society 2012). As other chapters in this collection have argued, the invisibility of crime is manifested through various lenses: lack of knowledge, lack of political and media attention, an absence of policing and regulatory focus, and an unwitting and ill-informed public. All such arguments pertain to air pollution; however, toxic emissions are also literally invisible from sight and consciousness, as are the associated consequences.

Wicked problems in designing open online learning

This paper will report on the “wicked” problems encountered when designing an online course with bounded content in an unbounded learning environment. It will describe the dilemmas faced and decisions made by academics in an Australian university challenged by an institutional initiative to design radical, disruptive learning experiences making use of readily available online media. This bounded/unbounded environment demands new roles for instructors in adopting innovative pedagogies and teaching and learning strategies. It also creates changing and challenging roles for course designers as they deal with ill-defined parameters and unknown audiences. In this paper, we propose a novel methodology for making curricular decisions in ill-defined spaces.

Computational strategies for surface fitting using thin plate spline finite element methods

Thin plate spline finite element methods are used to fit a surface to an irregularly scattered dataset [S. Roberts, M. Hegland, and I. Altas. Approximation of a Thin Plate Spline Smoother using Continuous Piecewise Polynomial Functions. SIAM, 1:208--234, 2003]. The computational bottleneck for this algorithm is the solution of large, ill-conditioned systems of linear equations at each step of a generalised cross validation algorithm. Preconditioning techniques are investigated to accelerate the convergence of the solution of these systems using Krylov subspace methods. The preconditioners under consideration are block diagonal, block triangular and constraint preconditioners [M. Benzi, G. H. Golub, and J. Liesen. Numerical solution of saddle point problems. Acta Numer., 14:1--137, 2005]. The effectiveness of each of these preconditioners is examined on a sample dataset taken from a known surface. From our numerical investigation, constraint preconditioners appear to provide improved convergence for this surface fitting problem compared to block preconditioners.