Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis

Introduction: While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the Post-Anaesthetic Care Unit. These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether use of PACT will i) enhance the recognition and response to patients at risk of deterioration in PACU; ii) improve documentation for handover from PACU nurse to ward nurse; iii) result in improved patient outcomes; and iv) reduce health care costs.

Methods and analysis: A prospective, non-randomised, pre- and post-implementation design comparing: (i) patients (n=750) who have surgery prior to the implementation of the PACT and (ii) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre- and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as odds ratios with the corresponding 95% confidence intervals.

Conclusion: This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce health care costs.

Is the frame broken? Seeking new metaphors for textual study in English

This article draws from a doctoral study of how female teachers design English curriculum around girls’ popular culture in a contemporary coeducational secondary setting and focuses on how English teachers contemplate the study of texts in the space of school-based curriculum planning. The article presents an argument for reflexivity around how we create both texts and identity through curriculum design; it advocates the pursuit of new metaphors for contemplating the study of text that might challenge models of education as delivery in a neoliberal imaginary, where curriculum design is depicted as the anonymous and rational articulation of aims and pedagogy to achieve outcomes.

The Panama canal expansion mega project : a case study and stakeholder´s analysis

As globalization increases integration, a new playing field is emerging which is driving the need for operational efficiencies and alignment of complementary capabilities among countries to build sustainable models and integrated offerings. As demands increase, companies are turning to effective project management as means to control operations and countries are increasing the amount of mega projects to boost their competitiveness and global footprint. Given the scale, complexity, political nature, multicultural makeup, and high level of visibility; mega projects rely on successful stakeholder management to effectively manage its operational, tactical, and strategic levels to execute their mission. This paper examines the success drivers of mega projects and presents an in depth stakeholder assessment of the Panama Canal Expansion mega project to identify the perceived value to its stakeholder community. The stakeholder categories include: the Panama Canal Authority, subcontractors executing the expansion project, customers of the canal in Panama and U.S., as well as the communities surrounding the Panama Canal and ports in the U.S. East Coast. The conclusion of this paper captures the relationship between the effective stakeholder engagement from the Panama Canal Authority, the perceived value of the Panamanian stakeholders, and compares it to U.S. based mega projects being executed simultaneously to allow the U.S. East Coast ports to accommodate increased cargo volumes.

Uma visita ao universo matemático de Lewis Carrol e o (re)encontro com sua lógica do nonsense

Notable mathematics teacher, Lewis Carroll, pseudonym of Charles Lutwidge Dodgson (1832-1898), made the mixture of mathematics with literature a ludic environment for learning that discipline. Author of Alice s Adventures In Wonderland and its sequel Alice Through The Looking Glass, he eventually created a real and complex universe which uses what we call the logic of the nonsense as an element to motivate the development of mathematical thinking of the reader, taking it as well, learn by establishing a link between the concrete (mathematics) and the imaginary (their universe). In order to investigate and discuss the educational potential of their works and state some elements that can contribute to a decentralized math education from the traditional method of following the models and decorate formulas, we visited his works based on the studies of archeology of knowledge (FOUCAULT, 2007), the rational thought and symbolic thinking (VERGANI, 2003) and about the importance of stories and narratives to the development of human cognition (FARIAS, 2006). Through a descriptive, analytical study, we used the literary construction and presented part of our study in form of a mathematical novel, to give the mathematical school a particular charm, without depriving it of its basics properties as discipline and content. Our study showed how the works of Carroll have a strong didactic element that can deploy in various activities of study and teaching for mathematics classes

Thermal study and physico-chemical characterization of some functional properties of guava seeds protein isolate (Psidium guajava)

The guava seed protein isolate ( PI) was obtained from the protein precipitation belonging to the class of the gluteline (Ip 4.5). The conditions for the preparation of the PI were determined by both the solubility curve and simultaneous thermogravimetry-differential thermal analysis (TG-DTA): pH 11.5, absence of NaCl and whiteners and T=( 25 +/- 3) degrees C. Under these conditions a yield of 77.0 +/- 0.4%, protein content of 94.2 +/- 0.3, ashes 0.50 +/- 0.05% and thermal stability, T= 200 degrees C, were obtained. The TG-DTA curves and the PI emulsification capacity study showed the presence of hydrophobic microdomains at pH 11.5 and 3.0 suggesting a random coil protein conformation and, to pH 10.0, an open protein conformation. The capacity of emulsification (CE), in the absence of NaCl, was verified for: 1 - pH 3.0 and 8.5, using the IP extracted at pH 10.0 and 11.5, CE >= 343 +/- 5 g of emulsified oil/g of protein; 2 - pH 6.60 just for the PI obtained at pH 11.5, CE >= 140 +/- 8 g of emulsified oil/g of protein.

Ab initio study and NMR analysis of the complexion of citric acid with ion lithium

Quantum mechanics calculations at the ab initio HF/3-21G* level were carried out with Nuclear Magnetic Resonance (NMR) measurements to characterize citric acid and lithium interactions. The results indicate the formation of a tridentate organometallic compound with one lithium and one citric acid molecule and a tridentate and bidentate compound of two lithium atoms and one citric acid molecule. The results are in agreement with the experimental and theoretical data. (C) 1999 Elsevier B.V. B.V. All rights reserved.

Phytochemical study and antiulcerogenic activity of Syngonanthus bisulcatus (Eriocaulaceae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Thermoanalytical study and characterization of native starches of Paraná pine seeds (Araucaria angustiofolia, Bert O. Ktze) and European chestnut seeds (Castanea sativa, Mill)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Population dynamics and net primary production of the aquatic macrophite Nymphaea rudgeana C. F. Mey in a lotic environment of the Itanhaém River basin (SP, Brazil)

Neste trabalho, foi estudada a dinâmica populacional e estimada a produção primária líquida da macrófita aquática Nymphaea rudgeana em um braço do rio Itanhaém (Estado de São Paulo, Brasil). Esta espécie apresenta uma ampla variação anual de biomassa, em função da estação do ano, no local estudado. A partir do mês de novembro (13,1 g PS/m²), pode ser observado um aumento gradual da biomassa, atingindo o máximo em fevereiro (163,1 g PS/m²). Posteriormente, a biomassa diminui, mantendo-se em níveis baixos até um novo período de crescimento. A diminuição de biomassa está associada ao desenvolvimento de macrófitas flutuantes (Pistia stratiotes e Salvinia molesta) e, subseqüentemente, às condições ambientais desfavoráveis (valores de salinidade elevados) ao seu desenvolvimento. A produção primária líquida de N. rudgeana foi obtida a partir dos dados de biomassa e seu valor é estimado entre 3,02 e 3,82 t/ha/ano.

Spectroscopic study and local coordination of polyphosphate colloidal systems

The interaction between metaphosphate chains and the metal ions Ca2+ and Eu3+ has been studied in water by Eu3+ luminescence, infrared absorption, and P-31 NMR spectroscopy. Two main families of sites could be identified for the metal ions in the aqueous polyphosphate colloidal systems: (1) cagelike sites provided by the polyphosphate chain and (2) a family which arises following saturation of cagelike sites. Occupation of this second family leads to supramolecular interactions between polyphosphate chains and the consequent destabilization of the colloidal system. In the polyphosphate-Ca2+ system, this destabilization appears as a coacervation process. Equilibrium existing between colloidal species as a function of the compositions could be reasoned based on the spectroscopic measurements. The determination of coordination numbers and the correlation of the results with the observation of coacervates show that Eu3+ luminescence properties can be used to probe in a unique way the coacervation process.

Glucose- and insulin-induced phosphorylation of the insulin receptor and its primary substrates IRS-1 and IRS-2 in rat pancreatic islets

The presence of tyrosine-phosphorylated proteins was studied in cultured rat pancreatic islets, Immunoblotting performed with total extracts of islets cultured in the presence of 1.8 or 5.6 mM glucose revealed at least three distinct tyrosine-phosphorylated bands (25 kDa, 95 kDa and 165-185 kDa). After 12 h incubation in medium containing 1.8 mM glucose, a pulse exposition to 11 or 22 mM glucose or to 10(-7) M insulin led to a substantial increase in the phosphorylation of all three bands, with no appearance of novel bands. Immunoprecipitation with specific antibodies demonstrated that the signal detected at 95 kDa corresponds to the beta subunit of the insulin receptor (IR) while the band at 165-185 kDa corresponds to the early substrates of the insulin receptor, IRS-1 and IRS-2. Immunoprecipitation with IRS-I or IRS-2 antisera detected their association with the lipid metabolizing enzyme phosphatidylinositol 3-kinase (PI 3-kinase), Thus, this is the first demonstration that elements involved in the insulin-signalling pathway of traditional target tissues are also present in pancreatic islets and are potentially involved in auto- and paracrine-signalling in this organ.