Capnography monitoring during procedural sedation and analgesia: A systematic review protocol

Background An important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation. The hypothesis is that earlier identification of respiratory depression using capnography leads to a change in clinical management that prevents hypoxaemia. As inadequate oxygenation/ventilation is the most common reason for injury associated with PSA, reducing episodes of hypoxaemia would indicate that using capnography would be safer than relying on standard monitoring alone. Methods/design The primary objective of this review is to determine whether using capnography during PSA in the hospital setting improves patient safety by reducing the risk of hypoxaemia (defined as an arterial partial pressure of oxygen below 60 mmHg or percentage of haemoglobin that is saturated with oxygen [SpO2] less than 90 %). A secondary objective of this review is to determine whether changes in the clinical management of sedated patients are the mediating factor for any observed impact of capnography monitoring on the rate of hypoxaemia. The potential adverse effect of capnography monitoring that will be examined in this review is the rate of inadequate sedation. Electronic databases will be searched for parallel, crossover and cluster randomised controlled trials comparing the use of capnography with standard monitoring alone during PSA that is administered in the hospital setting. Studies that included patients who received general or regional anaesthesia will be excluded from the review. Non-randomised studies will be excluded. Screening, study selection and data extraction will be performed by two reviewers. The Cochrane risk of bias tool will be used to assign a judgment about the degree of risk. Meta-analyses will be performed if suitable. Discussion This review will synthesise the evidence on an important potential clinical benefit of capnography monitoring during PSA within hospital settings. Systematic review registration: PROSPERO CRD42015023740

Physiological and biomechanical responses to walking underwater on a non-motorised treadmill: Effects of different exercise intensities and depths in middle-aged healthy women

Non-motorised underwater treadmills are commonly used in fitness activities. However, no studies have examined physiological and biomechanical responses of walking on non-motorised treadmills at different intensities and depths. Fifteen middle-aged healthy women underwent two underwater walking tests at two different depths, immersed either up to the xiphoid process (deep water) or the iliac crest (shallow water), at 100, 110, 120, 130 step-per-minute (spm). Oxygen consumption (VO2), heart rate (HR), blood lactate concentration, perceived exertion and step length were determined. Compared to deep water, walking in shallow water exhibited, at all intensities, significantly higher VO2 (+13.5%, on average) and HR (+8.1%, on average) responses. Water depth did not influence lactate concentration, whereas perceived exertion was higher in shallow compared to deep water, solely at 120 (+40%) and 130 (+39.4%) spm. Average step length was reduced as the intensity increased (from 100 to 130 spm), irrespective of water depth. Expressed as a percentage of maximum, average VO2 and HR were: 64–76% of peak VO2 and 71–90% of maximum HR, respectively at both water depths. Accordingly, this form of exercise can be included in the “vigorous” range of exercise intensity, at any of the step frequencies used in this study.

Cambios hematológicos tras un programa de promoción de actividad física en sujetos inactivos. Ensayo aleatorizado controlado

Objetivo Comparar los cambios antropométricos y bioquímicos en personas inactivas, que realizan un programa de actividad física frente a los que no lo realizan desde los Centros de Atención Primaria. Métodos Cien personas inactivas de ambos sexos, mayores de 55 años fueron aleatorizadas a un grupo experimental (n = 50) y a un grupo control (n = 50). Se realizó un programa de promoción de actividad física siguiendo los criterios del Colegio Americano de Medicina del Deporte, de 60 min cada sesión, 2 sesiones por semana, durante 3 meses. Las medidas antropométricas incluyeron el índice de masa corporal y el porcentaje graso, y como variables bioquímicas el perfil lipídico, hematíes y la creatina kinasa. Resultados Completaron el estudio 75 personas. Esta investigación no presentó cambios significativos a nivel antropométrico, ni en las variables bioquímicas del perfil lipídico. Sí se observaron efectos clínicamente relevantes en la concentración de los hematíes de las mujeres que realizaron dicho programa. Conclusiones El efecto clínico global fue pequeño en las personas que realizaron el programa, pero relevante para la salud de la población. Esta intervención produce efectos a corto plazo en la bioquímica de las personas inactivas. Abstract in English Objective Compare anthropometry and biochemical changes in inactive people who participate in a physical activity program versus those who do not from the Primary Health Care Centers. Methods One hundred inactive subjects of both genders, 55 years and older, from Torremolinos, Spain were randomized into an experimental group (n = 50) and a control group (n = 50). A program promoting physical activity was carried out following the American Medical Society for Sport's Medicine criteria. The program included sessions a week for 3 months. Antropometric measurements included body mass index and fat percentage, and such as biochemical measures: the lipid profile, erythrocytes, and creatine kinase. Results Seventy-five persons completed the study. This research did not show significant changes to anthropometric or biochemical outcomes of the lipid profile. However, there were clinically relevant effects regarding red blood cells concentration in the women who participated in this program. Conclusions Overall clinical effect was small in those participating in the program, but relevant for the health of the population. This program has short-term effects on biochemistry results of inactive subjects.

Improving the competence of construction management consultants to underpin sustainable construction in China

As a vital component of construction professional services (CPS), construction management consultancy is in nature knowledge-intensive and client-tailored. Although recent studies have acknowledged the increasing role of this subsector of CPS in the attainment of sustainable construction, little attention has been given to the education and training of its main body, namely construction management consultants (CMCs). This study investigated the competence and knowledge structure of CMCs by taking China as an example. Using the methods of interview and questionnaire survey, three key competences of CMCs and the underpinned knowledge structure were identified. The identified competences are personnel quality, onsite practical skills, and continuing professional learning. Underpinned these competences are the knowledge structure composed of a number of disciplines including construction cost planning and control, civil engineering and construction, engineering contract and law, and construction project management. The research findings lay a solid foundation for future studies to probe into the role of construction management consultants in the area of sustainable construction.

Soil N2O emissions under N2-fixing legumes and N-fertilised canola: A reappraisal of emissions factor calculations

Introducing nitrogen (N)-fixing legumes into cereal-based crop rotations reduces synthetic fertiliser-N use and may mitigate soil emissions of nitrous oxide (N2O). Current IPCC calculations assume 100% of legume biomass N as the anthropogenic N input and use 1% of this as an emission factor (EF)—the percentage of input N emitted as N2O. However, legumes also utilise soil inorganic N, so legume-fixed N is typically less than 100% of legume biomass N. In two field experiments, we measured soil N2O emissions from a black Vertosol in sub-tropical Australia for 12 months after sowing of chickpea (Cicer arietinum L.), canola (Brassica napus L.), faba bean (Vicia faba L.), and field pea (Pisum sativum L.). Cumulative N2O emissions from N-fertilised canola (624 g N2O-N ha−1) greatly exceeded those from chickpea (127 g N2O-N ha−1) in Experiment 1. Similarly, N2O emitted from canola (385 g N2O-N ha−1) in Experiment 2 was significantly greater than chickpea (166 g N2O-N ha−1), faba bean (166 g N2O-N ha−1) or field pea (135 g N2O-N ha−1). Highest losses from canola were recorded during the growing season, whereas 75% of the annual N2O losses from the legumes occurred post-harvest. Legume N2-fixation provided 37–43% (chickpea), 54% (field pea) and 64% (faba bean) of total plant biomass N. Using only fixed-N inputs, we calculated EFs for chickpea (0.13–0.31%), field pea (0.18%) and faba bean (0.04%) that were significantly less than N-fertilised canola (0.48–0.78%) (P < 0.05), suggesting legume-fixed N is a less emissive form of N input to the soil than fertiliser N. Inputs of legume-fixed N should be more accurately quantified to properly gauge the potential for legumes to mitigate soil N2O emissions. EF’s from legume crops need to be revised and should include a factor for the proportion of the legume’s N derived from the atmosphere.

An evaluation of the effectiveness of Value-at-Risk (VaR) models for Australian banks under Basel III

This study compares Value-at-Risk (VaR) measures for Australian banks over a period that includes the Global Financial Crisis (GFC) to determine whether the methodology and parameter selection are important for capital adequacy holdings that will ultimately support a bank in a crisis period. VaR methodology promoted under Basel II was largely criticised during the GFC for its failure to capture downside risk. However, results from this study indicate that 1-year parametric and historical models produce better measures of VaR than models with longer time frames. VaR estimates produced using Monte Carlo simulations show a high percentage of violations but with lower average magnitude of a violation when they occur. VaR estimates produced by the ARMA GARCH model also show a relatively high percentage of violations, however, the average magnitude of a violation is quite low. Our findings support the design of the revised Basel II VaR methodology which has also been adopted under Basel III.

Incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in day-case surgical patients

BACKGROUND After general surgery, the lower limb experiences some of the highest complication rates. However, little is known about contributing factors to surgical site failure in the lower limb dermatological surgery population. OBJECTIVE To determine the incidence of lower limb surgical site failure and to explore the predictors that contribute to surgical site failure. METHODS A prospective observational study design was used to collect data from 73 participants, from July 2010, to March 2012. Incidence was determined as a percentage of surgical site failure from the total population. Predictors were determined by the use of a binary logistic regression model. RESULTS The surgical site failure rate was 53.4%. Split-skin grafting had a higher failure rate than primary closures, 66% versus 26.1%. Predictors of lower limb surgical site failure were identified as increasing age (p = .04) and the presence of postoperative hematoma (p = .01), with all patients who developed surgical site infection experiencing surgical site failure (p = .01). CONCLUSION Findings from this study confirmed that the lower limb is at high risk of surgical site failure. Two predictors of surgical site failure from this cohort were determined. However, to understand this phenomenon and make recommendations to assist and reduce surgical site complications, further research in this field is required.

A Submission to the Inquiry into the Resale Royalty Right for Visual Artists Bill 2008 (Cth)

A right of resale, or droit de suite (a right to follow), is a legislative instrument under intellectual property law, which enables artists to receive a percentage of the sale price whenever artistic works are resold. A French legal scholar, Albert Vaunois, first articulated the need for a 'droit de suite' in connection with fine art back in 1893. The French Government introduced a scheme to protect the right of resale in 1920, after controversy over artists living in poverty, while public auction houses were profiting from the resale of their artistic creations. In the United States, there has been less support for a right of resale amongst legislatures. After lobbying from artists such as the king of pop art, Robert Rauschenberg, the state of California passed the Resale Royalties Act in 1977. At a Federal level, the United States Congress has shown some reluctance in providing national recognition for a right of resale in the United States. A number of other European countries have established a right of resale. In 2001, the European Council adopted the Artists' Resale directive and recognised that the 'artist's resale right forms an integral part of copyright and is an essential prerogative for authors.' In 2006, the United Kingdom promulgated regulations, giving effect to a right of resale in that jurisdiction. However, a number of Latin American and African countries have established a right of resale. The New Zealand Parliament has debated a bill on a right of resale.

Somewhere between haste and delay... Investigating the interactions of road users and pedestrians in a dynamic rail level crossing environment

There are currently 23,500 level crossings in Australia, broadly divided into one of two categories: active level crossings which are fully automatic and have boom barriers, alarm bells, flashing lights, and pedestrian gates; and passive level crossings, which are not automatic and aim to control road and pedestrianised walkways solely with stop and give way signs. Active level crossings are considered to be the gold standard for transport ergonomics when grade separation (i.e. constructing an over- or underpass) is not viable. In Australia, the current strategy is to annually upgrade passive level crossings with active controls but active crossings are also associated with traffic congestion, largely as a result of extended closure times. The percentage of time level crossings are closed to road vehicles during peak periods increases with the rise in the frequency of train services. The popular perception appears to be that once a level crossing is upgraded, one is free to wipe their hands and consider the job done. However, there may also be environments where active protection is not enough, but where the setting may not justify the capital costs of grade separation. Indeed, the associated congestion and traffic delay could compromise safety by contributing to the risk taking behaviour by motorists and pedestrians. In these environments it is important to understand what human factor issues are present and ask the question of whether a one size fits all solution is indeed the most ergonomically sound solution for today’s transport needs.

Assessment of body composition of Sri Lankan Australian children using ethnic specific equations

Since ethnic differences exist in body composition, assessment methods need to be validated prior to use in different populations. This study attempts to validate the use of Sri Lankan based body composition assessment tools on a group of 5 - 15 year old Australian children of Sri Lankan origin. The study was conducted at the Body Composition Laboratory of the Children’s Nutrition Research Centre at the Royal Children’s Hospital, Brisbane, Australia. Height (Ht), weight (Wt), segmental length (Lsegment name) and skinfold thickness (SFT) were measured. The whole body and segmental bio impedance analysis (BIA) were also measured. The body composition determined by the deuterium dilution technique (criterion method) was compared with the assessments done using prediction equations developed on Sri Lankan children. 27 boys and 15 girls were studied. All predictions of body composition parameters, except percentage fat mass (FM) assessed by the SFT-FM equation in girls gave statistically significant correlations with the criterion method. They had a low mean bias and most were not influenced by the measured parameter. Although living in a different socioeconomic state, the equations developed on children of the same ethnic background gives a better predictive value of body composition. This highlights the ethnic influence on body composition.

Use of Skin-Fold Thickness in Sri Lankan Children: Comparison of Several Prediction Equations

Objective There are many prediction equations available in the literature for the assessment of body composition from skinfold thickness (SFT). This study aims to cross validate some of those prediction equations to determine the suitability of their use on Sri Lankan children. Methods Height, weight and SFT of 5 different sites were measured. Total body water was assessed using the isotope dilution method (D2O). Percentage Fat mass (%FM) was estimated from SFT using prediction equations described by five authors in the literature. Results Five to 15 year old healthy, 282 Sri Lankan children were studied. The equation of Brook gave Ihe lowest bias but limits of agreement were high. Equations described by Deurenberg et al gave slightly higher bias but limits of agreement were narrowest and bias was not influence by extremes of body fat. Although prediction equations did not estimate %FM adequately, the association between %FM and SFT measures, were quite satisfactory. Conclusion We conclude that SFT can be used effectively in the assessment of body composition in children. However, for the assessment of body composition using SFT, either prediction equations should be derived to suit the local populations or existing equations should be cross-validated to determine the suitability before its application.

Defining anthropometric cut-off levels related to metabolic risk in a group of Sri Lankan children

Background: Body mass index (BMI) is widely used as a measure of adiposity. However, currently used cut-off values are not sensitive in diagnosing obesity in South Asian populations. Aim: To define BMI and waist circumference (WC), cut-off values representing percentage fat mass (%FM) associated with adverse health outcomes. Subjects and methods: A cross-sectional descriptive study of 285 5–14 year old Sri Lankan children (56% boys) was carried out. Fat mass (FM) was assessed using the isotope (D2O) dilution technique based on 2C body composition model. BMI and WC cut-off values were defined based on %FM associated with adverse health outcomes. Results: Sri Lankan children had a low fat free mass index (FFMI) and a high fat mass index (FMI). Individuals with the same BMI had %FM distributed over a wide range. Lean body tissue grew very little with advancing age and weight gain was mainly due to increases in body fat. BMI corresponding to 25% in males and 35% in females at 18 years was 19.2 kg/m2 and 19.7 kg/m2, respectively. WC cut-off values for males and females were 68.4 cm and 70.4 cm, respectively. Conclusion: This chart analysis clearly confirms that Sri Lankan children have a high %FM from a young age. With age, more changes occur in FM than in fat free mass (FFM). Although the newly defined BMI and WC cut-off values appear to be quite low, they are comparable to some recent data obtained in similar populations.

Validity of BMI as a measure of obesity in Australian white Caucasian and Australian Sri Lankan children

Background: Body mass index (BMI) is used to diagnose obesity. However, its ability to predict the percentage fat mass (%FM) reliably is doubtful. Therefore validity of BMI as a diagnostic tool of obesity is questioned. Aim: This study is focused on determining the ability of BMI-based cut-off values in diagnosing obesity among Australian children of white Caucasian and Sri Lankan origin. Subjects and methods: Height and weight was measured and BMI (W/H2) calculated. Total body water was determined by deuterium dilution technique and fat free mass and hence fat mass derived using age- and gender-specific constants. A %FM of 30% for girls and 20% for boys was considered as the criterion cut-off level for obesity. BMI-based obesity cut-offs described by the International Obesity Task Force (IOTF), CDC/NCHS centile charts and BMI-Z were validated against the criterion method. Results: There were 96 white Caucasian and 42 Sri Lankan children. Of the white Caucasians, 19 (36%) girls and 29 (66%) boys, and of the Sri Lankans 7 (46%) girls and 16 (63%) boys, were obese based on %FM. The FM and BMI were closely associated in both Caucasians (r = 0.81, P<0.001) and Sri Lankans (r = 0.92, P<0.001). Percentage FM and BMI also had a lower but significant association. Obesity cut-off values recommended by IOTF failed to detect a single case of obesity in either group. However, NCHS and BMI-Z cut-offs detected cases of obesity with low sensitivity. Conclusions: BMI is a poor indicator of percentage fat and the commonly used cut-off values were not sensitive enough to detect cases of childhood obesity in this study. In order to improve the diagnosis of obesity, either BMI cut-off values should be revised to increase the sensitivity or the possibility of using other indirect methods of estimating the %FM should be explored.

Cough and reflux esophagitis in children: their co-existence and airway cellularity

Background There are no prospective studies that have examined for chronic cough in children without lung disease but with gastroesophageal reflux (GER). In otherwise healthy children undergoing flexible upper gastrointestinal endoscopy (esophago-gastroscopy), the aims of the study were to (1) define the frequency of cough in relation to symptoms of GER, (2) examine if children with cough and reflux esophagitis (RE) have different airway cellularity and microbiology in bronchoalveolar lavage (BAL) when compared to those without. Methods Data specific for chronic cough (>4-weeks), symptoms of GER and cough severity were collected. Children aged <16-years (n = 150) were defined as 'coughers' (C+) if a history of cough in association with their GER symptoms was elicited before BAL were obtained during elective esophago-gastroscopy. Presence of esophagitis on esophageal biopsies was considered reflux esophagitis positive (E+). Results C+ (n = 69) were just as likely as C- (n = 81) to have esophagitis, odds ratio 0.87 (95%CI 0.46, 1.7). Median neutrophil percentage in BAL was significantly different between groups; highest in C+E- (7, IQR 28) and lowest in C-E+ (5, IQR 6). BAL positive bacterial culture occurred in 20.7% and were more likely present in current coughers (OR 3.37, 95%CI 1.39, 8.08). Airway neutrophilia (median 20%, IQR 34) was significantly higher in those with BAL positive bacterial cultures than those without (5%, 4; p = 0.0001). Conclusion In children without lung disease, the common co-existence of cough with symptoms of GER is independent of the occurrence of esophagitis. Airway neutrophilia when present in these children is more likely to be related to airway bacterial infection and not to esophagitis.

Teaching independent learning skills in the first year: A positive psychology strategy for promoting law student well-being

Empirical evidence in Australia and overseas has established that in many university disciplines, students begin to experience elevated levels of psychological distress in their first year of study. There is now a considerable body of empirical data that establishes that this is a significant problem for law students. Psychological distress may hamper a law student’s capacity to learn successfully, and certainly hinders their ability to thrive in the tertiary environment. We know from Self-Determination Theory (SDT), a conceptual branch of positive psychology, that supporting students’ autonomy in turn supports their well-being. This article seeks to connect the literature on law student well-being and independent learning using Self-Determination Theory (SDT) as the theoretical bridge. We argue that deliberate instruction in the development of independent learning skills in the first year curriculum is autonomy supportive. It can therefore lay the foundation for academic and personal success at university, and may be a protective factor against decline in law student psychological well-being.