A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartcareTM/PS

Objective
Preliminary assessment of an automated weaning system (SmartCare™/PS) compared to usual management of weaning from mechanical ventilation performed in the absence of formal protocols.


Design and setting
A randomised, controlled pilot study in one Australian intensive care unit.


Patients
A total of 102 patients were equally divided between SmartCare/PS and Control.

Interventions
The automated system titrated pressure support, conducted a spontaneous breathing trial and provided notification of success (“separation potential”).

Measurements and results
The median time from the first identified point of suitability for weaning commencement to the state of “separation potential” using SmartCare/PS was 20 h (interquartile range, IQR, 2–40) compared to 8 h (IQR 2–43) with Control (log-rank P = 0.3). The median time to successful extubation was 43 h (IQR 6–169) using SmartCare/PS and 40 (14–87) with Control (log-rank P = 0.6). Unadjusted, the estimated probability of reaching “separation potential” was 21% lower (95% CI, 48% lower to 20% greater) with SmartCare/PS compared to Control. Adjusted for other covariates (age, gender, APACHE II, SOFAmax, neuromuscular blockade, corticosteroids, coma and elevated blood glucose), these estimates were 31% lower (95% CI, 56% lower to 9% greater) with SmartCare/PS. The study groups showed comparable rates of reintubation, non-invasive ventilation post-extubation, tracheostomy, sedation, neuromuscular blockade and use of corticosteroids.

Conclusions
Substantial reductions in weaning duration previously demonstrated were not confirmed when the SmartCare/PS system was compared to weaning managed by experienced critical care specialty nurses, using a 1:1 nurse-to-patient ratio. The effect of SmartCare/PS may be influenced by the local clinical organisational context.

Aggressive responses to broadband trills are related to subsequent pairing success in nightingales

In sexually selected signals, distinct components often have specific signal value in mate choice or male-male competition. In songbirds, structural song traits such as trills, that is, a series of repetitive notes, can be important in female choice. However, little is known about their signal value in male-male interactions. Here, we investigated the hypothesis that males assess the competitive abilities of rivals based on the use and performance of rapid broadband trills produced within songs. Using a 2-speaker playback experiment, we exposed territorial male nightingales, Luscinia megarhynchos, that differed in their subsequent pairing success, to a simulated vocal interaction between 2 unfamiliar rivals. The singing of the 2 simulated rivals differed in the number of songs containing rapid broadband trills. Subjects responded significantly more strongly to the loudspeaker that broadcast songs containing such trills than to the loudspeaker that broadcast exclusively songs without such trills. Moreover, responses also depended on the fine structure of trills. Males that became paired later in the season significantly increased their response intensity with increasing trill performance, whereas males that remained unpaired responded in the opposite way and decreased their response intensity with increasing trill performance. These results indicate that rapid broadband trills are a signal of aggression and that the nature of the response in vocal interactions reflects aspects of the challenged male's fitness. © The Author 2008. Published by Oxford University Press on behalf of the International Society for Behavioral Ecology. All rights reserved.


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Organisational Self-Evaluation and Teacher Education for Community Relations in a Transforming Society?

During 2004, the School of Education at the University of Ulster embarked on an innovative three-year project designed to embed community relations objectives within initial teacher education. With the advent of more peaceful times in Northern Ireland, this was a precipitous time for initial teacher educators to review the preparation given to beginner teachers for teaching in an increasingly pluralist society emerging from conflict. The present paper reports on one very specific and time-limited element of the broader project. That is, development work designed to investigate the possibilities of using processes of self-review and evaluation as a lever for improvements in initial teacher education for community relations. Following a brief contextualisation, the background to, and the development of, a set of materials designed to support rigorous and systematic self-review of all aspects of provision in a university-based initial teacher education department is described. The Community Relations Index for Initial Teacher Education (Cr-ITE) was envisaged as being of use to initial teacher education establishments in order to help teacher educators take responsibility for rigorous learning from their practice, whilst placing inclusive values at the centre of organisational development. The final section includes further critical reflection on the role of organisational self-review in transforming teacher education for inclusion in a society emerging from longstanding communal conflict.

Strategic Complexity and Success - Small Firms Strategies in a Mature Market

his paper develops a typology of strategic options for small firms in the furniture industry and examines the extent to which firms are re-engineering their strategies in response to profit performance. Empirical analysis is based on data from 39 firms with between 10 and 100 employees in the Irish furniture industry. Three main results emerge from the analysis. First, firms in the Irish furniture industry predominantly adopt “simple” business development strategies. Secondly, in terms of profit performance, we find no evidence that simple strategies unambiguously outperform more complex approaches. Instead, the success of both simple and complex business strategies is directly related to the strength of firms’ resource base. Finally, systematic differences were found in firms’ ability or willingness to re-engineer their strategies in the light of their profit performance.

Help or hindrance? Supplier involvement and causal ambiguity within inter-organisational NPD teams

Suppliers are increasingly involved in buyer firms’ interorganizational new product development (NPD) teams. Yet the transfer of knowledge within this context may be subject to varying degrees of causal ambiguity, potentially limiting the effect of supplier involvement on performance. We develop a theoretical model exploring the effect of supplier involvement practices on the level of causal ambiguity within interorganizational NPD teams, and the subsequent impact on competitor imitation, new product advantage, and project performance. Our model also serves as a test of the paradox that causal ambiguity both inhibits imitation by competitors, but also adversely affects organisational outcomes. Results from an empirical study of 119 R&D intensive manufacturing firms in the United Kingdom largely support these hypotheses. Results from structural equation modeling show that supplier involvement orientation and long-term commitment lower causal ambiguity within interorganizational NPD teams. In turn, this lower causal ambiguity generates a new product advantage and increases project performance for the buyer firm, but has no significant effect on competitor imitation. Instead, competitor imitation is delayed by the extent to which the firm develops a new product advantage within the market. These results shed light on the causal ambiguity paradox showing that lower causal ambiguity during interorganizational new product development increases both product and project performance, but without reducing barriers to imitation. Product development managers are encouraged to utilize supplier involvement practices to minimise ambiguity in the NPD project, and to target their supplier involvement efforts on solving causally ambiguous technological problems to sustain a competitive advantage.

Critical Success Factors for Transfer-Operate-Transfer Urban Water Supply Projects in China

Over the years, build-operate-transfer (BOT) has continuously attracted research interests. Many studies on BOT have been carried out. Variations of BOT such as build-own-operate-transfer and build-own-operate have also been reported in some relevant publications. However, few investigations thus far have been conducted for transfer-operate-transfer (TOT). Therefore, there is a knowledge gap in this particular field. TOT is a new model that is suitable for existing infrastructure and public utility projects formerly funded by the governments and currently operated by state-owned enterprises. It refers to the transfer of a running public project to a foreign business or domestic private entity. Based on four case studies carried out in the Chinese water supply industry, this paper examines why there is an increasing need for TOT projects and identifies the distinctive features of TOT practice in China. This is followed by an introduction of a framework of critical success factors (CSFs) for TOT projects. The most important factors include project profitability, asset quality, fair risk allocation, competitive tendering, internal coordination within government, employment of professional advisors, corporate governance, and government supervision. The identification of CSFs provides a useful guidance to project parties planning to participate in TOT practice.