An evaluation of protocolised weaning on the duration of mechanical ventilation

Using a before and after study design, we compared protocolised weaning from mechanical ventilation with usual non-protocolised practice in intensive care. Outcomes (duration of mechanical ventilation, duration of intubation, intensive care stay) and complications (re-intubations, tracheostomy, mortality) were compared between baseline (Phase I) and following implementation of protocolised weaning (Phase II). Over the same period, we collected data in a second (reference) unit to monitor practice changes over time. In the intervention unit, outcomes were longer in Phase II compared with Phase I (all p < 0.005). When adjusted for admission APACHE II score and diagnostic category, only intensive care stay remained significantly longer (p = 0.002). There were significantly more tracheostomies in Phase II (p = 0.004). The reference unit demonstrated no statistically significant differences in study outcomes or complications between Phases. Protocolised weaning did not reduce the duration of mechanical ventilation and was not associated with an increased rate of re-intubation or intensive care unit mortality.

How Does the Unemployment Insurance System Shape the Time Profile of Jobless Duration?

This paper updates a sparse literature on the effects of unemployment benefits (UB) on the time profile of escape rates from unemployment. These effects, as well as those of other regressors, are found to vary profoundly over the course of unemployment.

Unemployment Duration: Competing and Defective Risks

This paper examines the determinants of unemployment duration in a competing risks framework with two destination states: inactivity and employment. The innovation is the recognition of defective risks. A polynomial hazard function is used to differentiate between two possible sources of infinite durations. The first is produced by a random process of unlucky draws, the second by workers rejecting a destination state. The evidence favors the mover-stayer model over the search model. Refinement of the former approach, using a more flexible baseline hazard function, produces a robust and more convincing explanation for positive and zero transition rates out of unemployment.

Breast is Best? Reasons Why Mothers Decide to Breastfeed or Bottlefeed their Babies and Factors Influencing the Duration of Breastfeeding.

Breastfeeding is known to confer benefits, both in the short term and long term, to the child and also to the mother. Various health-promotion initiatives have aimed to increase breastfeeding rates and duration in the United Kingdom over the past decade. In order to assist in these endeavours, it is essential to understand the reasons why women decide whether to breastfeed and the factors that influence the duration of breastfeeding. This study reports breastfeeding initiation and duration rates of mothers participating in the Growth, Learning and Development study undertaken by the Child Health & Welfare Recognised Research Group. Although this study cannot provide prevalence data for all mothers in Greater Belfast, it can provide useful information on trends within particular groups of the population. In addition, it examines maternally reported reasons for choosing to breastfeed and for breastfeeding cessation. The likelihood of mothers initiating breastfeeding is influenced by factors such as increased age, higher educational attainment and higher socio-economic grouping. The most common reason cited for breastfeeding is that it is “best for baby”. Returning to work is the most important factor in influencing whether mothers continued to breastfeed. Women report different reasons for cessation depending on the age of their child when they stopped breastfeeding. This information should inform health-promotion initiatives and interventions.

Measurement of the duration of X-ray lasing pumped by an optical laser pulse of picosecond duration

Measurements of the duration of X-ray lasing pumped with picosecond pulses from the VULCAN optical laser are obtained using a streak camera with 700 fs temporal resolution. Combined with a temporal smearing due to the spectrometer employed, we have measured X-ray laser pulse durations for Ni-like silver at 13.9 nm with a total time resolution of 1.1 ps. For Ni-like silver, the X-ray laser output has a steep rise followed by an approximately exponential temporal decay with measured full-width at half-maximum (FWHM) of 3.7 (+/-0.5) ps. For Ne-like nickel lasing at 23.1 nm, the measured duration of lasing is approximate to10.7 (+/-1) ps (FWHM). An estimate of the duration of the X-ray laser gain has been obtained by temporally resolving spectrally integrated continuum and resonance line emission. For Ni-like silver, this time of emission is approximate to22 (+/-2) ps (FWHM), while for Ne-like nickel we measure approximate to35 (+/-2) ps (FWHM). Assuming that these times of emission correspond to the gain duration, we show that a simple model consistently relates the gain durations to the measured durations of X-ray lasing. (C) 2002 Elsevier Science B.V. All rights reserved.

Modelling Patient Duration of Stay to Facilitate Resource Management of Geriatric Hospitals

A fundamental aspect of health care management is the effective allocation of resources. This is of particular importance in geriatric hospitals where elderly patients tend to have more complex needs. Hospital managers would benefit immensely if they had advance knowledge of patient duration of stay in hospital. Managers could assess the costs of patient care and make allowances for these in their budget. In this paper, we tackle this important problem via a model which predicts the duration of stay distribution of patients in hospital. The approach uses phase-type distributions conditioned on a Bayesian belief network.

Using Coxian Phase-Type Distributions to Identify Patient Characteristics for Duration of Stay in Hospital

Coxian phase-type distributions are a special type of Markov model that describes duration until an event occurs in terms of a process consisting of a sequence of latent phases. This paper considers the use of Coxian phase-type distributions for modelling patient duration of stay for the elderly in hospital and investigates the potential for using the resulting distribution as a classifying variable to identify common characteristics between different groups of patients according to their (anticipated) length of stay in hospital. The identification of common characteristics for patient length of stay groups would offer hospital managers and clinicians possible insights into the overall management and bed allocation of the hospital wards.

Rise time and formant transition duration in the discrimination of speech sounds: The Ba–Wa distinction in developmental dyslexia

Across languages, children with developmental dyslexia have a specific difficulty with the neural representation of the sound structure (phonological structure) of speech. One likely cause of their difficulties with phonology is a perceptual difficulty in auditory temporal processing (Tallal, 1980). Tallal (1980) proposed that basic auditory processing of brief, rapidly successive acoustic changes is compromised in dyslexia, thereby affecting phonetic discrimination (e.g. discriminating /b/ from /d/) via impaired discrimination of formant transitions (rapid acoustic changes in frequency and intensity). However, an alternative auditory temporal hypothesis is that the basic auditory processing of the slower amplitude modulation cues in speech is compromised (Goswami , 2002). Here, we contrast children's perception of a synthetic speech contrast (ba/wa) when it is based on the speed of the rate of change of frequency information (formant transition duration) versus the speed of the rate of change of amplitude modulation (rise time). We show that children with dyslexia have excellent phonetic discrimination based on formant transition duration, but poor phonetic discrimination based on envelope cues. The results explain why phonetic discrimination may be allophonic in developmental dyslexia (Serniclaes , 2004), and suggest new avenues for the remediation of developmental dyslexia. © 2010 Blackwell Publishing Ltd.

Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis.

Objective To investigate the effects of weaning protocols on the total duration of mechanical ventilation, mortality, adverse events, quality of life, weaning duration, and length of stay in the intensive care unit and hospital.

Design Systematic review.

Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, LILACS, ISI Web of Science, ISI Conference Proceedings, Cambridge Scientific Abstracts, and reference lists of articles. We did not apply language restrictions.

Review methods We included randomised and quasi-randomised controlled trials of weaning from mechanical ventilation with and without protocols in critically ill adults.

Data selection Three authors independently assessed trial quality and extracted data. A priori subgroup and sensitivity analyses were performed. We contacted study authors for additional information.

Results Eleven trials that included 1971 patients met the inclusion criteria. Compared with usual care, the geometric mean duration of mechanical ventilation in the weaning protocol group was reduced by 25% (95% confidence interval 9% to 39%, P=0.006; 10 trials); the duration of weaning was reduced by 78% (31% to 93%, P=0.009; six trials); and stay in the intensive care unit length by 10% (2% to 19%, P=0.02; eight trials). There was significant heterogeneity among studies for total duration of mechanical ventilation (I(2)=76%, P

Conclusion There is evidence of a reduction in the duration of mechanical ventilation, weaning, and stay in the intensive care unit when standardised weaning protocols are used, but there is significant heterogeneity among studies and an insufficient number of studies to investigate the source of this heterogeneity. Some studies suggest that organisational context could influence outcomes, but this could not be evaluated as it was outside the scope of this review.