Does preoperative oral carbohydrate reduce hospital stay?

Background Carbohydrate-rich fluids are used to improve postoperative recovery but the effectiveness of the product for reducing length of hospital stay is uncertain. Objective To assess the effectiveness of preoperative loading with carbohydrates on postoperative outcomes. Participants Forty six patients booked for elective colorectal surgery. Methods Participants were allocated to a Carbohydrate-rich fluid group or Usual Care group during their pre-admission clinic visit. The primary outcome was ‘Time to readiness for discharge’. Results Patients in the control group spent on average 4.3 days (95% confidence interval 3.2 to 5.7) and the Carbohydrate-rich fluid group spent 4.1 days (95% confidence interval 3.2 to 5.4) until the primary outcome was met (p=0.824). Conclusion The safety of preoperative high carbohydrate fluids is supported but we were unable to confirm or refute the benefit of CHO for shorter hospital stay following elective colorectal surgery.

Overstepping the fiduciary mark

The decision of Justice Boddice in The Public Trustee of Queensland (as Litigation Guardian for ADF) v Ban & Anor is the latest in a series of Supreme Court actions arising out of Ms Ban’s management of the affairs of her long-time elderly friend, ADF. Following on from an earlier decision in which it was determined that Ms Ban held her share of funds in a joint bank account with ADF on trust for him, this most recent case concerned a claim for an account of funds withdrawn from that account on the basis that as trustee Ms Ban owed fiduciary duties to ADF. The purpose of the accounting was to determine whether any withdrawals had been made in breach of trust, which would give rise to equitable remedies. The primary question for determination was therefore whether the withdrawals were applied for the benefit of ADF. Having regard to all the circumstances of the case, his Honour found that although some transactions were for ADF’s benefit, substantial withdrawals, (including a significant portion of a $700,000 transfer), were not applied for his benefit, and were therefore made in breach of fiduciary obligation, giving rise to equitable rights and remedies.

Are consumers fooled by discounts? An experimental test in a consumer search environment

In this article, we investigate experimentally whether people search optimally and how price promotions influence search behaviour. We implement a sequential search task with exogenous price dispersion in a baseline treatment and introduce discounts in two experimental treatments. We find that search behaviour is roughly consistent with optimal search but also observe some discount biases. If subjects do not know in advance where discounts are offered, the purchase probability is increased by 19 percentage points in shops with discounts, even after controlling for the benefit of the discount and for risk preferences. If consumers know in advance where discounts are given, then the bias is only weakly significant and much smaller (7 percentage points).

The Australian corporate rescue provisions : how do they compare?

A notable feature of corporate legislative development in western countries for the past 30 years is the various mechanisms introduced to facilitate the survival of company structures facing insolvency. Australia’s corporate rescue version, called a “voluntary administration”, is now contained in Part 5.3A of the Corporations Act 2001 (Cth), although first introduced in 1993. The Australian provisions apply to all corporate entities and commence with a short moratorium followed by a meeting of creditors. At the creditors’ meeting a “rescue” plan called a deed of company arrangement may be entered into, or, alternatively the company may be liquidated. The voluntary administration provisions have become a significant part of Australia’s corporate insolvency landscape and are critical to the operation of corporate law outside of insolvency. Australia does not have a specialist bankruptcy court, rather it utilises the English approach where insolvency practitioners are accountants and appointed to the insolvent company as administrators. In Australia, insolvency practitioners must be registered with the Australian Securities and Investments Commission (“ASIC”), the corporate and securities regulator. A voluntary administration is usually commenced by the board of directors appointing an insolvency practitioner to the company. There exists no opportunity for a voluntary administration to commence at the creditors’ or court’s behest. This chapter seeks to address the comparative necessity of Australia’s corporate regime.

Visual performance with lenses correcting peripheral refractive errors

Purpose To design and manufacture lenses to correct peripheral refraction along the horizontal meridian and to determine whether these resulted in noticeable improvements in visual performance. Method Subjective refraction of a low myope was determined on the basis of best peripheral detection acuity along the horizontal visual field out to ±30° for both horizontal and vertical gratings. Subjective refraction was compared to objective refractions using a COAS-HD aberrometer. Special lenses were made to correct peripheral refraction, based on designs optimized with and without smoothing across a 3 mm diameter square aperture. Grating detection was retested with these lenses. Contrast thresholds of 1.25’ spots were determined across the field for the conditions of best correction, on-axis correction, and the special lenses. Results The participant had high relative peripheral hyperopia, particularly in the temporal visual field (maximum 2.9 D). There were differences > 0.5D between subjective and objective refractions at a few field angles. On-axis correction reduced peripheral detection acuity and increased peripheral contrast threshold in the peripheral visual field, relative to the best correction, by up to 0.4 and 0.5 log units, respectively. The special lenses restored most of the peripheral vision, although not all at angles to ±10°, and with the lens optimized with aperture-smoothing possibly giving better vision than the lens optimized without aperture-smoothing at some angles. Conclusion It is possible to design and manufacture lenses to give near optimum peripheral visual performance to at least ±30° along one visual field meridian. The benefit of such lenses is likely to be manifest only if a subject has a considerable relative peripheral refraction, for example of the order of 2 D.

A role for IGF-1R-targeted therapies in small-cell lung cancer?

Background: Small-cell lung cancer (SCLC) is an aggressive disease with a poor prognosis. The insulin-like growth factor-1 receptor (IGF-1R) is an autocrine growth factor and an attractive therapeutic target in many solid tumors, but particularly in lung cancer. Patients and Methods: This study examined tumor samples from 23 patients diagnosed with SCLC, 11 resected specimens and 12 nodal biopsies obtained by mediastinoscopy, for expression of IGF-1R using the monoclonal rabbit anti-IGF-1R (clone G11, Ventana Medical Systems, Tucson, AZ) and standard immunohistochemistry (IHC). Results: All 23 tumor samples expressed IGF-1R with a range of stain intensity from weak (1+) to strong (3+). Ten tumors had a score of 3+, 7 tumors 2+, and 6 tumors 1+. Patient survival data were available for all 23 patients. Two patients died < 30 days post biopsy, therefore, the intensity of anti-IGF-1R immunostaining for 21 patients was correlated to survival. Patients with 3+ immunostaining had a poorer prognosis (P = .003). The overall survival of patients who underwent surgical resection was significantly better (median survival not reached) than patients who were not resected (median survival, 7.4 months) (P = .006). Conclusion: IGF-1R targeted therapies may have a role in the treatment of SCLC in combination with chemotherapy or as maintenance therapy. Further studies on the clinical benefit of targeting IGF-1R in SCLC are needed.

Lexis Nexis Questions and Answers : Equity and Trusts [4th Ed.]

"LexisNexis Questions and Answers: Equity and Trusts provides students with a clear and systematic approach to successfully analysing and answering assessment questions on equity and trusts. Each chapter commences with a discussion of key principles and issues including a summary of relevant leading cases and legislation for effective revision. Examples of written questions with fact scenarios follow, each with a suggested answer plan, sample answer and comments on how the answer might be viewed by an examiner. Readers are provided with advice on common errors to avoid when answering questions and practical hints and tips on how to achieve higher marks. Features • Summary of key issues helps students revise key areas before attempting problem questions • Sample questions with model answers assist students with effective exam study preparation"--publisher website

Learner-focused evaluation cycles : facilitating learning using feedforward, concurrent and feedback evaluation

There is a growing trend to offer students learning opportunities that are flexible, innovative and engaging. As educators embrace student-centred agile teaching and learning methodologies, which require continuous reflection and adaptation, the need to evaluate students’ learning in a timely manner has become more pressing. Conventional evaluation surveys currently dominate the evaluation landscape internationally, despite recognition that they are insufficient to effectively evaluate curriculum and teaching quality. Surveys often: (1) fail to address the issues for which educators need feedback, (2) constrain student voice, (3) have low response rates and (4) occur too late to benefit current students. Consequently, this paper explores principles of effective feedback to propose a framework for learner-focused evaluation. We apply a three-stage control model, involving feedforward, concurrent and feedback evaluation, to investigate the intersection of assessment and evaluation in agile learning environments. We conclude that learner-focused evaluation cycles can be used to guide action so that evaluation is not undertaken simply for the benefit of future offerings, but rather to benefit current students by allowing ‘real-time’ learning activities to be adapted in the moment. As a result, students become co-producers of learning and evaluation becomes a meaningful, responsive dialogue between students and their instructors.

One night CPAP withdrawal impairs performance at a driving simulator task faster than sleep restriction to 5 hours with treatment in OSA patients

Introduction Sleep restriction and missing 1 night’s continuous positive air pressure (CPAP) treatment are scenarios faced by obstructive sleep apnoea (OSA) patients, who must then assess their own fitness to drive. This study aims to assess the impact of this on driving performance. Method 11 CPAP treated participants (50–75 yrs), drove an interactive car simulator under monotonous motorway conditions for 2 hours on 3 afternoons, following;(i)normal night’s sleep (average 8.2 h) with CPAP (ii) sleep restriction (5 h), with CPAP (iii)normal length of sleep, without CPAP. Driving incidents were noted if the car came out of the designated driving lane. EEG was recorded continually and KSS reported every 200 seconds. Results Driving incidents: Incidents were more prevalent following CPAP withdrawal during hour 1, demonstrating a significant condition time interaction [F(6,60) = 3.40, p = 0.006]. KSS: At the start of driving participants felt sleepiest following CPAP withdrawal, by the end of the task KSS levels were similar following CPAP withdrawal and sleep restriction, demonstrating a significant condition, time interaction [F(3.94,39.41) = 3.39, p = 0.018]. EEG: There was a non significant trend for combined alpha and theta activity to be highest throughout the drive following CPAP withdrawal. Discussion CPAP withdrawal impairs driving simulator performance sooner than restricting sleep to 5 h with CPAP. Participants had insight into this increased sleepiness reflected by the higher KSS reported following CPAP withdrawal. In the practical terms of driving any one incident could be fatal. The earlier impairment reported here demonstrates the potential danger of missing CPAP treatment and highlights the benefit of CPAP treatment even when sleep time is short.

Stimulating organizational ingenuity with design methods

Organizations invest in ways to stimulate new ideas for new products and services for the benefit of the organization, engaging in tournaments and competitions to generate new ideas or to combine existing ideas in new ways for new products and services (Terweisch and Uhlrich, 2009). Specifically, some large companies have developed platforms for posting intractable problems to tap into the ideas and problem solving abilities of a broader range of people (Huston and Sakkab, 2006; Morgan and Wang, 2010), and to develop new and elegant solutions often in an open innovation approach (Chesbrough, 2003). The notion of ingenuity is often applied to individuals who create innovative solutions in situations of constraint, where ingenuity in the form of elegant solutions can be understood as one form of resourcefulness (Young, 2011). However, the notion of organizational ingenuity locates ingenuity more centrally to an organization's strategic decision making and implementation, embedding ingenuity into the company's culture. Studies of organizations displaying ingenuity indicate a range of possibilities from extreme ingenuity (Baker and Nelson, 2005) to less dramatic but substantial changes (Thomke, 2003), sometimes in an experimental phase or as part of a move towards a new and distinct identity for ongoing innovation.

Entrepreneurship in the public sector : new possibilities?

Previous research has described potential roles for entrepreneurs in public sector organisations as either closely related to corporate entrepreneurship, or as normative prescriptions regarding the importance of entrepreneurship in the public sector (Ireland, Covin & Kuratko, 2009: Morris & Jones, 1999). While some might argue that entrepreneurship in the public sector context is an oxymoron, recent studies have demonstrated that entrepreneurship in the public sector is alive and well (Currie, Humphreys, Ucbasaran & McManus 2008; Kim, 2010). Entrepreneurship in the public sector can take many forms and generate a range of benefits but to date less attention has been given to the potential to generate new public value (Moore, 1995). The purpose of this paper is to increase our knowledge and understanding of the types of strategies and activities the public sector is using to capture initiative, create new public value, and generate new economic activity for the benefit of multiple stakeholders. This paper explores entrepreneurship in one public sector context. Findings indicate that entrepreneurship and commercialisation is more likely to be encouraged in contexts where contestability in develop and exploit capabilities.

Peripheral vision benefits spatial learning by guiding eye movements

The loss of peripheral vision impairs spatial learning and navigation. However, the mechanisms underlying these impairments remain poorly understood. One advantage of having peripheral vision is that objects in an environment are easily detected and readily foveated via eye movements. The present study examined this potential benefit of peripheral vision by investigating whether competent performance in spatial learning requires effective eye movements. In Experiment 1, participants learned room-sized spatial layouts with or without restriction on direct eye movements to objects. Eye movements were restricted by having participants view the objects through small apertures in front of their eyes. Results showed that impeding effective eye movements made subsequent retrieval of spatial memory slower and less accurate. The small apertures also occluded much of the environmental surroundings, but the importance of this kind of occlusion was ruled out in Experiment 2 by showing that participants exhibited intact learning of the same spatial layouts when luminescent objects were viewed in an otherwise dark room. Together, these findings suggest that one of the roles of peripheral vision in spatial learning is to guide eye movements, highlighting the importance of spatial information derived from eye movements for learning environmental layouts.

Graft versus host disease in oncology nursing practice

INTRODUCTION: Gastrointestinal graft-versus-host disease (GI-GvHD) is extremely debilitating and is multifactorial in its causative factors, management and treatment. It is an exaggeration of normal physiological mechanisms wherein the donor immune system attempts to rid itself of the host. The inflammatory process that follows has the benefit of providing an anti-tumour effect for many diseases, but unfortunately in patients undergoing human stem-cell transplantation, the nature of the inflammation can result in disability, wasting and death. AIM: The aim of this article is to discuss the pathophysiology of this often misunderstood or misdiagnosed condition, as well as its signs and symptoms, management and considerations for nursing care. Considerations for nursing practice: While the medical management is aimed at minimising GvHD through the reduction of T-cell production and proliferation and gastrointestinal decolonisation, the nursing care is often focused on the signs and symptoms that can have the most prominent impact on patients. CONCLUSION: GI-GvHD has serious life-threatening complications, namely wasting syndrome, diarrhoea and dehydration. The basis of signs and symptomology is easily recognisable owing to the stages of progression through the human stem-cell transplantation process. Oncology nurses are in a prime position to identify these serious risks, initiate treatment immediately and collaborate effectively within the multidisciplinary team to minimise GvHD onset and provide expert support to patients, family and caregivers.

A hypothesis test using bias-adjusted AR estimators for classifying time series in small samples

A new test of hypothesis for classifying stationary time series based on the bias-adjusted estimators of the fitted autoregressive model is proposed. It is shown theoretically that the proposed test has desirable properties. Simulation results show that when time series are short, the size and power estimates of the proposed test are reasonably good, and thus this test is reliable in discriminating between short-length time series. As the length of the time series increases, the performance of the proposed test improves, but the benefit of bias-adjustment reduces. The proposed hypothesis test is applied to two real data sets: the annual real GDP per capita of six European countries, and quarterly real GDP per capita of five European countries. The application results demonstrate that the proposed test displays reasonably good performance in classifying relatively short time series.

Creating flexible mappings between building information models and cost information

During the early design stages of construction projects, accurate and timely cost feedback is critical to design decision making. This is particularly challenging for cost estimators, as they must quickly and accurately estimate the cost of the building when the design is still incomplete and evolving. State-of-the-art software tools typically use a rule-based approach to generate detailed quantities from the design details present in a building model and relate them to the cost items in a cost estimating database. In this paper, we propose a generic approach for creating and maintaining a cost estimate using flexible mappings between a building model and a cost estimate. The approach uses queries on the building design that are used to populate views, and each view is then associated with one or more cost items. The benefit of this approach is that the flexibility of modern query languages allows the estimator to encode a broad variety of relationships between the design and estimate. It also avoids the use of a common standard to which both designers and estimators must conform, allowing the estimator added flexibility and functionality to their work.