Part 1. Chemical and Physical Restraints in the Management of Mechanically Ventilated Patients in the ICU: Contributing Factors

Chemical and physical restraints are frequently used in the intensive care unit (ICU) to control agitated patients and to prevent self-harm and unplanned extubations. Published work relating to the numerous issues of the care and treatment strategies for these patients remains conflicting and unclear. Literature regarding sedation and chemical restraint reveals a trend towards management with lighter sedation, use of sedation assessment tools and sedation protocols. It remains unclear which treatment is best for agitated and delirious patients, and the evidence on the effect of sedation is conflicting. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. The purpose of this paper is to provide a summary of the existing literature on the use of physical and chemical restraints in the ICU setting. In Part 1 of this two-part paper, the evidence on chemical and physical restraints is explored with specific focus on definition of terms, unplanned

PIPP #1 - Pedestrian Interaction Patch Project

The Pedestrian Interaction Patch Project (PIPP) seeks to exert influence over and encourage abnormal pedestrian behavior. By placing an unadvertised (and non recording) interactive video manipulation system and projection source in a high traffic public area, the PIPP allows pedestrians to privately (and publically) re-engage with a previously inactive physical environment, like a commonly used walkway or corridor. This system, the results of which are projected in real time on the architectural surface, inadvertently provides pedestrians with questions around preconceived notions of self and space. In an attempt to re-activate our relationship with the physical surrounds we occupy each day the PIPP creates a new set of memories to be recalled as we re-enter known environments once PIPP has moved on and as such re-enlivens our relationship with the everyday architecture we stroll past everyday. The PIPP environment is controlled using the software program Isadora, devised by Mark Coniglio at Troika Ranch, and contains a series of video manipulation patches that are designed to not only grab the pedestrians attention but to also encourage a sense of play and interaction between the architecture, the digital environment, the initially unsuspecting participant(s) and the pedestrian audience. The PIPP was included as part of the planned walking tour for the “Playing in Urban Spaces” seminar day, and was an installation that ran for the length of the symposium in a reclaimed pedestrian space that was encountered by both the participants and general public during the course of the day long event. Ideally once discovered PIPP encouraged pedestrians to return through the course of the seminar day to see if the environmental patches had changed or altered, and changed their standard route to include the PIPP installation or to avoid it, either way, encouraging an active response to the pathways normally traveled or newly discovered each day.

Prandial subcutaneous injections of glucagon-like peptide-1 cause weight loss in obese human subjects

Recombinant glucagon-like peptide-1 (7–36)amide (rGLP-1) was recently shown to cause significant weight loss in type 2 diabetics when administered for 6 weeks as a continuous subcutaneous infusion. The mechanisms responsible for the weight loss are not clarified. In the present study, rGLP-1 was given for 5d by prandial subcutaneous injections (PSI) (76nmol 30min before meals, four times daily; a total of 302·4nmol/24h) or by continuous subcutaneous infusion (CSI) (12·7nmol/h; a total of 304·8nmol/24h). This was performed in nineteen healthy obese subjects (mean age 44·2 (sem 2·5) years; BMI 39·0 (sem 1·2)kg/m2) in a prospective randomised, double-blind, placebo-controlled, cross-over study. Compared with the placebo, rGLP-1 administered as PSI and by CSI generated a 15% reduction in mean food intake per meal (P=0·02) after 5d treatment. A weight loss of 0·55 (sem 0·2) kg (P<0·05) was registered after 5d with PSI of rGLP-1. Gastric emptying rate was reduced during both PSI (P<0·001) and CSI (P<0·05) treatment, but more rapidly and to a greater extent with PSI of rGLP-1. To conclude, a 5d treatment of rGLP-1 at high doses by PSI, but not CSI, promptly slowed gastric emptying as a probable mechanism of action of increased satiety, decreased hunger and, hence, reduced food intake with an ensuing weight loss.

Port of Brisbane stormwater quality : stage 1 rainfall simulation to evaluate pollutant build-up and wash-off from selected land uses

Background: The quality of stormwater runoff from ports is significant as it can be an important source of pollution to the marine environment. This is also a significant issue for the Port of Brisbane as it is located in an area of high environmental values. Therefore, it is imperative to develop an in-depth understanding of stormwater runoff quality to ensure that appropriate strategies are in place for quality improvement. ---------------- The Port currently has a network of stormwater sample collection points where event based samples together with grab samples are tested for a range of water quality parameters. Whilst this information provides a ‘snapshot’ of the pollutants being washed from the catchment/s, it does not allow for a quantifiable assessment of total contaminant loads being discharged to the waters of Moreton Bay. It also does not represent pollutant build-up and wash-off from the different land uses across a broader range of rainfall events which might be expected. As such, it is difficult to relate stormwater quality to different pollutant sources within the Port environment. ----------------- Consequently, this would make the source tracking of pollutants to receiving waters extremely difficult and in turn the ability to implement appropriate mitigation measures. Also, without this detailed understanding, the efficacy of the various stormwater quality mitigation measures implemented cannot be determined with certainty. --------------- Current knowledge on port stormwater runoff quality Currently, little knowledge exists with regards to the pollutant generation capacity specific to port land uses as these do not necessarily compare well with conventional urban industrial or commercial land use due to the specific nature of port activities such as inter-modal operations and cargo management. Furthermore, traffic characteristics in a port area are different to a conventional urban area. Consequently, as data inputs based on an industrial and commercial land uses for modelling purposes is questionable. ------------------ A comprehensive review of published research failed to locate any investigations undertaken with regards to pollutant build-up and wash-off for port specific land uses. Furthermore, there is very limited information made available by various ports worldwide about the pollution generation potential of their facilities. Published work in this area has essentially focussed on the water quality or environmental values in the receiving waters such as the downstream bay or estuary. ----------------- The Project: The research project is an outcome of the collaborative Partnership between the Port of Brisbane Corporation (POBC) and Queensland University of Technology (QUT). A key feature of this Partnership is the undertaking of ‘cutting edge’ research to strengthen the environmental custodianship of the Port area. This project aims to develop a port specific stormwater quality model to allow informed decision making in relation to stormwater quality improvement in the context of the increased growth of the Port. --------------- Stage 1 of the research project focussed on the assessment of pollutant build-up and wash-off using rainfall simulation from the current Port of Brisbane facilities with the longer-term objective of contributing to the development of ecological risk mitigation strategies for future expansion scenarios. Investigation of complex processes such as pollutant wash-off using naturally occurring rainfall events has inherent difficulties. These can be overcome using simulated rainfall for the investigations. ----------------- The deliverables for Stage 1 included the following: * Pollutant build-up and wash-off profiles for six primary land uses within the Port of Brisbane to be used for water quality model development. * Recommendations with regards to future stormwater quality monitoring and pollution mitigation measures. The outcomes are expected to deliver the following benefits to the Port of Brisbane: * The availability of Port specific pollutant build-up and wash-off data will enable the implementation of customised stormwater pollution mitigation strategies. * The water quality data collected would form the baseline data for a Port specific water quality model for mitigation and predictive purposes. * To be at the cutting-edge in terms of water quality management and environmental best practice in the context of port infrastructure. ---------------- Conclusions: The important conclusions from the study are: * It confirmed that the Port environment is unique in terms of pollutant characteristics and is not comparable to typical urban land uses. * For most pollutant types, the Port land uses exhibited lower pollutant concentrations when compared to typical urban land uses. * The pollutant characteristics varied across the different land uses and were not consistent in terms of the land use. Hence, the implementation of stereotypical structural water quality improvement devices could be of limited value. * The <150m particle size range was predominant in suspended solids for pollutant build-up as well as wash-off. Therefore, if suspended solids are targeted as the surrogate parameter for water quality improvement, this specific particle size range needs to be removed. ------------------- Recommendations: Based on the study results the following preliminary recommendations are made: * Due to the appreciable variation in pollutant characteristics for different port land uses, any water quality monitoring stations should preferably be located such that source areas can be easily identified. * The study results having identified significant pollutants for the different land uses should enable the development of a more customised water quality monitoring and testing regime targeting the critical pollutants. * A ‘one size fits all’ approach may not be appropriate for the different port land uses due to the varying pollutant characteristics. As such, pollution mitigation will need to be specifically tailored to suit the specific land use. * Any structural measures implemented for pollution mitigation to be effective should have the capability to remove suspended solids of size <150m. * Based on the results presented and the particularly the fact that the Port land uses cannot be compared to conventional urban land uses in relation to pollutant generation, consideration should be given to the development of a port specific water quality model.

Expression of chondromodulin-1 in the temporomandibular joint condylar cartilage and disc

BACKGROUND: The temporomandibular joint (TMJ) cartilage consists of condylar cartilage and disc and undergoes continuous remodeling throughout post-natal life. To maintain the integrity of the TMJ cartilage, anti-angiogenic factors play an important role during the remodeling process. In this study, we investigated the expression of the anti-angiogenic factor, chondromodulin- 1 (ChM-1), in TMJ cartilage and evaluate its potential role in TMJ remodeling. METHODS: Eight TMJ specimens were collected from six 4-month-old Japanese white rabbits. Safranin-O staining was performed to determine proteoglycan content. ChM-1 expression in TMJ condylar cartilage and disc was determined by immunohistochemistry. Three human perforated disc tissue samples were collected for investigation of ChM-1 and vascular endothelial growth factor (VEGF) distribution in perforated TMJ disc. RESULTS: Safranin-O stained weakly in TMJ compared with tibial articular and epiphyseal cartilage. In TMJ, ChM-1 was expressed in the proliferative and hypertrophic zone of condylar cartilage and chondrocyte-like cells in the disc. No expression of ChM-1 was observed in osteoblasts and subchondral bone. ChM-1 and VEGF were both similarly expressed in perforated disc tissues. CONCLUSIONS: ChM-1 may play a role in the regulation of TMJ remodeling by preventing blood vessel invasion of the cartilage, thereby maintaining condylar cartilage and disc integrity.

ERK-1/2 and p38 in the Regulation of Hypertrophic Changes of Normal Articular Cartilage Chondrocytes Induced by Osteoarthritic Subchondral Osteoblasts

Objective. Previous studies have shown the influence of subchondral bone osteoblasts (SBOs) on phenotypical changes of articular cartilage chondrocytes (ACCs) during the development of osteoarthritis (OA). The molecular mechanisms involved during this process remain elusive, in particular, the signal transduction pathways. The aim of this study was to investigate the in vitro effects of OA SBOs on the phenotypical changes in normal ACCs and to unveil the potential involvement of MAPK signaling pathways during this process. Methods. Normal and arthritic cartilage and bone samples were collected for isolation of ACCs and SBOs. Direct and indirect coculture models were applied to study chondrocyte hypertrophy under the influence of OA SBOs. MAPKs in the regulation of the cell–cell interactions were monitored by phosphorylated antibodies and relevant inhibitors. Results. OA SBOs led to increased hypertrophic gene expression and matrix calcification in ACCs by means of both direct and indirect cell–cell interactions. In this study, we demonstrated for the first time that OA SBOs suppressed p38 phosphorylation and induced ERK-1/2 signal phosphorylation in cocultured ACCs. The ERK-1/2 pathway inhibitor PD98059 significantly attenuated the hypertrophic changes induced by conditioned medium from OA SBOs, and the p38 inhibitor SB203580 resulted in the up-regulation of hypertrophic genes in ACCs. Conclusion. The findings of this study suggest that the pathologic interaction of OA SBOs and ACCs is mediated via the activation of ERK-1/2 phosphorylation and deactivation of p38 phosphorylation, resulting in hypertrophic differentiation of ACCs.

Coding speech signals at very low rates (below 1 kb/s) with high intelligibility

This thesis presents an original approach to parametric speech coding at rates below 1 kbitsjsec, primarily for speech storage applications. Essential processes considered in this research encompass efficient characterization of evolutionary configuration of vocal tract to follow phonemic features with high fidelity, representation of speech excitation using minimal parameters with minor degradation in naturalness of synthesized speech, and finally, quantization of resulting parameters at the nominated rates. For encoding speech spectral features, a new method relying on Temporal Decomposition (TD) is developed which efficiently compresses spectral information through interpolation between most steady points over time trajectories of spectral parameters using a new basis function. The compression ratio provided by the method is independent of the updating rate of the feature vectors, hence allows high resolution in tracking significant temporal variations of speech formants with no effect on the spectral data rate. Accordingly, regardless of the quantization technique employed, the method yields a high compression ratio without sacrificing speech intelligibility. Several new techniques for improving performance of the interpolation of spectral parameters through phonetically-based analysis are proposed and implemented in this research, comprising event approximated TD, near-optimal shaping event approximating functions, efficient speech parametrization for TD on the basis of an extensive investigation originally reported in this thesis, and a hierarchical error minimization algorithm for decomposition of feature parameters which significantly reduces the complexity of the interpolation process. Speech excitation in this work is characterized based on a novel Multi-Band Excitation paradigm which accurately determines the harmonic structure in the LPC (linear predictive coding) residual spectra, within individual bands, using the concept 11 of Instantaneous Frequency (IF) estimation in frequency domain. The model yields aneffective two-band approximation to excitation and computes pitch and voicing with high accuracy as well. New methods for interpolative coding of pitch and gain contours are also developed in this thesis. For pitch, relying on the correlation between phonetic evolution and pitch variations during voiced speech segments, TD is employed to interpolate the pitch contour between critical points introduced by event centroids. This compresses pitch contour in the ratio of about 1/10 with negligible error. To approximate gain contour, a set of uniformly-distributed Gaussian event-like functions is used which reduces the amount of gain information to about 1/6 with acceptable accuracy. The thesis also addresses a new quantization method applied to spectral features on the basis of statistical properties and spectral sensitivity of spectral parameters extracted from TD-based analysis. The experimental results show that good quality speech, comparable to that of conventional coders at rates over 2 kbits/sec, can be achieved at rates 650-990 bits/sec.

The mechanism of maturation of insulin-like growth factor-1

This study, to elucidate the role of des(1-3)IGF-I in the maturation of IGF-I,used two strategies. The first was to detect the presence of enzymes in tissues, which would act on IGF-I to produce des(1-3)IGF-I, and the second was to detect the potential products of such enzymic activity, namely Gly-Pro-Glu(GPE), Gly-Pro(GP) and des(l- 3)IGF-I. No neutral tripeptidyl peptidase (TPP II), which would release the tripeptide GPE from IGF-I, was detected in brain, urine nor in red or white blood cells. The TPPlike activity which was detected, was attributed to a combined action of a dipeptidyl peptidase (DPP N) and an aminopeptidase (AP A). A true TPP II was, however, detected in platelets. Two purified TPP II enzymes were investigated but they did not release GPE from IGF-I under a variety of conditions. Consequently, TPP II seemed unlikely to participate in the formation of des(1-3)IGF-I. In contrast, an acidic tripeptidyl peptidase activity (TPP I) was detected in brain and colostrum, the former with a pH optimum of 4.5 and the latter 3.8. It seems likely that such an enzyme would participate in the formation of des( 1-3 )IGF-I in these tissues in vitro, ie. that des(1-3)IGF-I may have been produced as an artifact in the isolation of IGF-I from brain and colostrum in acidic conditions. This contrasts with suggestions of an in vivo role for des(1-3)IGF-I, as reported by others. The activity of a dipeptidyl peptidase N (DPP N) from urine, which should release the dipeptide GP from IGF-I, was assessed under a variety of conditions and with a variety of additives and potential enzyme stimulants, but there was no release of GP. The DPP N also exhibited a transferase activity with synthetic substrates in the presence of dipeptides, at lower concentrations than previously reported for other acceptors or other proteolytic enzymes. In addition, a low concentration of a product,possibly the tetrapeptide Gly-Pro-Gly-Leu, was detected with the action of the enzyme on IGF-I in the presence of the dipeptide Gly-Leu. As part of attempts to detect tissue production of des(1-3)IGF-I, a monoclonal antibody (MAb ), directed towards the GPE- end ofiGF-I was produced by immunisation with a 10-mer covalently attached to a carrier protein. By the use of indirect ELISA and inhibitor studies, the MAb was shown to selectively recognise peptides with anNterminal GPE- sequence, and applied to the indirect detection of des(1-3)IGF-I. The concentration of GPE in brain, measured by mass spectrometry ( MS), was low, and the concentration of total IGF-I (measured by ELISA with a commercial polyclonal antibody [P Ab]) was 40 times higher at 50 nmol/kg. This also, was not consistent with the action of a tripeptidyl peptidase in brain that converted all IGF-I to des(1-3)IGF-I plus GPE. Contrasting ELISA results, using the MAb prepared in this study, suggest an even higher concentration of intact IGF-I of 150 nmollkg. This would argue against the presence of any des( 1-3 )IGF-I in brain, but in turn, this indicates either the presence of other substances containing a GPE amino-terminus or other cross reacting epitope. Although the results of the specificity studies reported in Chapter 5 would make this latter possibility seem unlikely, it cannot be completely excluded. No GP was detected in brain by MS. No GPE was detected in colostrum by capillary electrophoresis (CE) but the interference from extraneous substances reduced the detectability of GPE by CE and this approach would require further, prior, purification and concentration steps. A molecule, with a migration time equal to that of the peptide GP, was detected in colostrum by CE, but the concentration (~ 10 11mo/L) was much higher than the IGF-I concentration measured by radio-immunoassay using a PAb (80 nmol/L) or using a Mab (300-400 nmolL). A DPP IV enzyme was detected in colostrum and this could account for the GP, derived from substrates other than IGF-1. Based on the differential results of the two antibody assays, there was no indication of the presence of des(1-3)IGF-I in brain or colostrum. In the absence of any enzyme activity directed towards the amino terminus of IGF-I and the absence any potential products, IGF-I, therefore, does not appear to "mature" via des(1-3)IGF-I in the brain, nor in the neutral colostrum. In spite of these results which indicate the absence of an enzymic attack on IGF-I and the absence of the expected products in tissues, the possibility that the conversion of IGF-I may occur in neutral conditions in limited amounts, cannot be ruled out. It remains possible that in the extracellular environment of the membrane, a complex interaction of IGF-I, binding protein, aminopeptidase(s) and receptor, produces des(1- 3)IGF-I as a transient product which is bound to the receptor and internalised.