bluuebunny/crossref_metadata_2025 huggingface dataset:
Attracting Foreign Direct Investment
Authors: Gould David M. , Tan Congyan , Emamgholi Amir S. Sadeghi
Published: December 2014

Like many other developing countries, South Asian nations have been experiencing increased foreign direct investment inflows over the past decade as developing countries get a larger share of cross-border investments that were once sent to developed countries. Nonetheless, South Asia’s inflows of foreign direct investment remain the lowest relative to gross domestic product among developing country regions. Why are South Asia’s foreign direct investment inflows so low and what lessons can be drawn for developing countries as a whole? The analysis in this article uses a novel empirical model that accounts for possible trends in convergence in the ratio of foreign direct investment to gross domestic product between countries and cross-sectional data for 78 countries from 2000 to 2011. The sample contains 52 developing countries. The analysis finds that two key factors are at work—high overall regulatory restrictions on foreign direct investment and specific restrictions placed on doing business with other countries. These factors include overall trade restrictiveness, which reduces the benefits to cross-border investments, and weak institutions to protect foreign investors and facilitate investment. Nonetheless, the potential for faster growth in intra- and inter-regional foreign direct investment flows is significant. The main factors leading to this conclusion are South Asia’s current low levels of foreign direct investment, the many unexploited opportunities for embodied knowledge transfer, and supply-chain linkages. The overall lessons for developing countries are that liberalizing policy constraints in both trade and foreign investment, keeping corporate tax rates modest, and improving governance and transparency could help to substantially improve foreign direct investment flows.
Linkages between Services Sector’s Growth and Poverty in Pakistan
Authors: Fatima Alvina , Azeem Muhammad Masood , Abbas Sadia , Adil Sultan Ali
Published: December 2014

Despite of the fact that poverty is one of the major issues concerning policy makers, it has received less attention with respect to its linkages with services sector growth. In this research study, an attempt was made to quantitatively explore the nexus between growth in services sector of Pakistan and its poverty reducing impact. A time series data ranging from 1951 to 2010 were used in this study. The services sector was disaggregated into six sub-sectors. An Augmented Dickey–Fuller test was applied to check the stationarity of the data. An Auto-Regressive Distributed Lag approach to co-integration and error correction model was applied to estimate long- and short-run coefficients, respectively. The results of the study indicate that growth in wholesale and retail trade and the ownership of dwelling reduce poverty only in the short run. Growth in finance and insurance worsen poverty. The greatest impacts on poverty reduction occur as result of growth in community services (CS) and transportation, storage and communication (TSC). Among all variables, community services were found highly significant with the coefficients 0.62 and 0.308 in the long run and short run respectively. Therefore, it was concluded that relatively more stress should be given on community services such as education, and health, etc., in order to reduce poverty in Pakistan.
Regional Income Disparity and Government Intervention in India
Authors: Dash Bharatee Bhusana
Published: December 2014

This study examines the relationship between the fiscal intervention of the government and regional income disparity in 14 major Indian states. The impact of decentralization on the regional disparity of these states is also examined. The findings suggest that both policy measures have reduced the level of regional disparity. This study has also investigated the impacts of policy measures on regional income disparity within the clusters of states of similar income levels. Results suggest that both types of policy interventions have reduced regional disparity in low-income states, whereas only fiscal intervention is found significant in reducing regional disparity in middle-income states. Surprisingly, no relation is found between regional disparity and the policy measures in high-income states.
From punishment to protection: Containing and controlling the lives of people with disabilities in human rights
Authors: Spivakovsky Claire
Published: December 2014

In the last decade, criminology has begun to raise concerns about people with disabilities’ problematic relationship with criminal justice systems. Yet we have ignored their problematic relationship with civil justice systems; a relationship which has seen people with disabilities subject to a range of punitive civil controls in the wake of their deinstitutionalisation. This article draws attention to one such punitive civil control, the Supervised Treatment Order regime in the Australian state of Victoria. Drawing on Foucault and his interlocutors’ work on ‘governmentality’, and engaging with Cohen’s concept of ‘magical legalisms’, the article reveals how this civil regime has become an effective mechanism for governing the lives of sex offenders with disabilities post their release from criminal justice systems. The article illuminates how this unusual function of the regime has not only been obscured from criminology’s view through claims of legislative intent, but further reconstituted as protective of people with disabilities’ human rights. The article concludes by discussing the implications of criminology’s absence from engaging with such punitive civil orders for people with disabilities and the wider penal field.
Application of tabular contact search method to multibody gear dynamics simulation with tooth surface imperfections
Authors: Li Huaxia , Terao Akihiro , Sugiyama Hiroyuki
Published: December 2014

In this investigation, an integrated numerical procedure for multibody gear dynamics simulation is developed using the tabular contact search method. Existing online contact search algorithms, which are widely used in multibody dynamics simulation, lead to extensive computational burden if detailed tooth surface geometry described by CAD or measured data points are considered with geometric imperfections. In the numerical procedure developed in this study, the contact geometry analysis based on the nonconformal contact condition is performed using the detailed tooth surface description prior to the dynamic simulation, and then the contact point as well as the tooth geometry at the contact point stored in the look-up contact tables are used to determine mesh forces in the multibody gear dynamics simulation. This allows for detecting multi-point contact without any iterative procedures, and the contact point on the back side of the tooth can also be considered by switching look-up contact tables in a straightforward manner. Furthermore, it is demonstrated that discontinuous contact event caused by the tooth surface imperfection can be predicted using a combined nodal and nonconformal contact search algorithm developed in this study. Several numerical examples are presented in order to demonstrate the use of the numerical procedure developed in this investigation.
Statistical origins of the “Protestant ethic”
Authors: Adair-Toteff Christopher
Published: December 2014

Max Weber’s Protestant Ethic and the Spirit of Capitalism has raised numerous questions, but one that has not been raised often is the question of its origins: What and who prompted Weber to write his work? My answer is that its origins are found in a series of statistics generated by Weber’s former student Martin Offenbacher. Offenbacher’s thesis that was the economic and social superiority of Protestants could be traced to better education and better jobs. Weber and Offenbacher have been attacked for ignoring an “alternative thesis”; I argue that on the contrary, they examined its possibilities and decided correctly that the Protestant “character” was crucial in explaining the economic differences between Protestants and Catholics. The statistical origins of the Protestant Ethic answer the question of what prompted Weber to write this work and also indicates that he realized that the subject of ascetic Protestantism was more complicated than he originally thought.
Norms, competition and visibility in contemporary science: The legacy of Robert K. Merton
Authors: Bucchi Massimiano
Published: December 2014

Can Robert K. Merton’s seminal work in the sociology of science still offer useful insights to understand key features, trends and challenges of science in contemporary societies? This article focuses on two main topics. It addresses the general theme of values and norms in science in the light of relevant organizational changes that have marked science in recent decades, as well as the resilience of the concept of ‘scientific community’ to those changes. Starting from Merton’s classical study of the ‘Matthew effect’, the article then analyses the theme of competition in science, with particular regard to the dynamics that characterize the reputation and visibility of scientists.
Smart thin-film piezoelectric composite sensors based on high lead zirconate titanate content
Authors: Saber Nasser , Meng Qingshi , Hsu Hung-Yao , Lee Sang-Heon , Kuan Hsu-Chiang , Marney Donavan , Kawashima Nobuyuki , Ma Jun
Published: December 2014

Piezoelectric composites are hybrid materials primarily consisting of polymer matrices and micro-sized particles of ferroelectric ceramic. While incorporating high-fraction ceramic particles into composites is indispensable to meet the ever increasing requirement of sensitivity, it is a great challenge to achieve such a high concentration due to processing difficulties. In this study, we developed piezoelectric composites of 0-3 geometry containing 95 wt% (∼73 vol%) lead zirconate titanate particles by modifying the surface of lead zirconate titanate particles with isophorone diisocyanate and polyoxyalkyleneamine (J2000) and compounding them with epoxy resin. The functional groups of J2000 molecules covalently grafted onto the particle surface can react with the matrix, thus creating a robust linkage between the matrix and the particles. This improved the particle dispersion and the interface, enabling the development of a superior composite film with high lead zirconate titanate fractions. Modified piezocomposites can save up to 75% poling time at 75% lower voltage in comparison with the unmodified sample as well as previous studies. The remarkable improvement is indebted to the two-stage interface modification process and the layer-by-layer fabrication method.
Propensity Score Analysis
Authors: Lane Forrest C. , Gibbs SherRhonda
Published: December 2014

The Problem

Flexible work arrangements (FWAs) have long been heralded as antecedent to numerous positive organizational attitudes and outcomes. However, results on FWAs benefits are mixed which may be due to differences in employee characteristics. Not all individuals may desire such arrangements. This can confound group comparisons and may bias the results used in the development of human resource development (HRD) theory.

The Solution

Propensity score analysis is a statistical approach that utilizes covariates to match participants (e.g., FWAs vs. non-FWAs) on their likelihood of group assignment. Once matched, these differences are mitigated thus improving the ability to more precisely estimate program effects.

The Stakeholders

The intended audience for this article includes HRD scholars and scholar-practitioners interested in reducing non-equivalent group design bias in the context of flexible working arrangements and other HRD-related theory.
Problem Gambling and Intimate Partner Violence
Authors: Dowling Nicki , Suomi Aino , Jackson Alun , Lavis Tiffany , Patford Janet , Cockman Suzanne , Thomas Shane , Bellringer Maria , Koziol-Mclain Jane , Battersby Malcolm , Harvey Peter , Abbott Max
Published: December 2014

This study provides a systematic review of the empirical evidence related to the association between problem gambling and intimate partner violence (IPV). We identified 14 available studies in the systematic search (8 for victimisation only, 4 for perpetration only and 2 for both victimisation and perpetration). Although there were some equivocal findings, we found that most of the available research suggests that there is a significant relationship between problem gambling and being a victim of IPV. There was more consistent evidence that there is a significant relationship between problem gambling and perpetration of IPV. Meta-analyses revealed that over one third of problem gamblers report being victims of physical IPV (38.1%) or perpetrators of physical IPV (36.5%) and that the prevalence of problem gambling in IPV perpetrators is 11.3%. Although the exact nature of the relationships between problem gambling and IPV is yet to be determined, the findings suggest that less than full employment and clinical anger problems are implicated in the relationship between problem gambling and IPV victimization and that younger age, less than full employment, clinical anger problems, impulsivity, and alcohol and substance use are implicated in the relationship between problem gambling and IPV perpetration. The findings highlight the need for treatment services to undertake routine screening and assessment of problem gambling, IPV, alcohol and substance use problems, and mental health issues and provide interventions designed to manage this cluster of comorbid conditions. Further research is also required to investigate the relationship between problem gambling and violence that extends into the family beyond intimate partners.
Personality, Cognitive Style, Motivation, and Aptitude Predict Systematic Trends in Analytic Forecasting Behavior
Authors: Poore Joshua C. , Forlines Clifton L. , Miller Sarah M. , Regan John R. , Irvine John M.
Published: December 2014

The decision sciences are increasingly challenged to advance methods for modeling analysts, accounting for both analytic strengths and weaknesses, to improve inferences taken from increasingly large and complex sources of data. We examine whether psychometric measures—personality, cognitive style, motivated cognition—predict analytic performance and whether psychometric measures are competitive with aptitude measures (i.e., SAT scores) as analyst sample selection criteria. A heterogeneous, national sample of 927 participants completed an extensive battery of psychometric measures and aptitude tests and was asked 129 geopolitical forecasting questions over the course of 1 year. Factor analysis reveals four dimensions among psychometric measures; dimensions characterized by differently motivated “top-down” cognitive styles predicted distinctive patterns in aptitude and forecasting behavior. These dimensions were not better predictors of forecasting accuracy than aptitude measures. However, multiple regression and mediation analysis reveals that these dimensions influenced forecasting accuracy primarily through bias in forecasting confidence. We also found that these facets were competitive with aptitude tests as forecast sampling criteria designed to mitigate biases in forecasting confidence while maximizing accuracy. These findings inform the understanding of individual difference dimensions at the intersection of analytic aptitude and demonstrate that they wield predictive power in applied, analytic domains.
Protecting the confidentiality of interim data: Addressing current challenges
Authors: Fleming Thomas R
Published: December 2014

There is compelling evidence supporting the importance of maintaining confidentiality of interim data in clinical trials designed to reliably address the benefit-to-risk profile of interventions. While this is widely recognized, creative approaches are needed to achieve this in challenging settings where interim data are released for regulatory review and action, even though the trial would be continued to address its primary hypothesis. An illustration is the recently emerging setting of cardiovascular safety trials in type 2 diabetes mellitus. At the first stage of such trials, if large relative increases in cardiovascular major morbidity/mortality can be ruled out, data can be released solely for the purpose of allowing regulatory decision making about marketing approval. The trial is then continued in the post-marketing setting to address the primary hypothesis regarding whether smaller relative increases can be ruled out. Active rather than passive approaches are needed to protect the integrity of cardiovascular safety trials. Given the importance to trial integrity of maintaining confidentiality of interim data such as the estimated relative effect on cardiovascular risk, a Data Access Plan should be in place in these trials to ensure such data are not revealed to study participants and their caregivers, investigators involved in trial conduct, the sponsor’s management team, and the public, until trial completion. A Performance Standards Document also should be developed to pre-specify targeted and minimally acceptable levels for recruitment rate, best real-world achievable adherence, avoidance of cross-ins, and retention rate. This document should specify creative approaches for achieving these targets, oversight procedures during trial conduct to monitor performance levels, and actions to be taken if emerging data indicate minimally acceptable levels are not being reached. In settings where meaningful breaches in confidentiality have occurred, such oversight allows adverse effects on trial integrity to be detected earlier and more effectively addressed.
A framework for guiding learning in ultrasound scanning
Authors: Crofts Gillian
Published: December 2014

Ultrasound scanning is provided by a range of health professionals who need to be trained to a proficient level. In respect of education and training in ultrasound scanning, little attention has been given to how scanning skills are acquired and what assists and hinders the learning process. This study aims to develop a framework for guiding learning in ultrasound scanning. Overt participant observation and semi-structured interviews generated data on four learners undertaking a 12-month postgraduate ultrasound programme. Narrative analysis of the interview data was used to reveal dominant themes related to stages in learning to scan. Dominant themes associated with learning to scan were communication with the patient, navigation skills, image interpretation skills, observation of expert practice, feedback on performance and random practise. Detailed interpretation of the themes through narrative analysis provided characteristics of learning for each stage of a four staged process. This study provides an insight into the key features of scan performance and how scanning skills are acquired over a four-staged approach. These themes and characteristics are presented in a framework for guiding learning in ultrasound scanning.
Fragmented care and whole-person illness: Decision-making for people with chronic end-stage kidney disease
Authors: Allen Dawn , Badro Valerie , Denyer-Willis Laurie , Ellen Macdonald Mary , Paré Anthony , Hutchinson Tom , Barré Paul , Beauchemin Roch , Bocti Helen , Broadbent Alison , Cohen S Robin
Published: December 2014

Purpose

The study reported herein sought to better understand how patients with multi-morbid, chronic illness—who receive care in institutions designed for treatment of acute illness—experience and engage in health-related decisions.

Methods

In an urban Canadian teaching hospital, we studied the interactions of six hemodialysis patients and 11 of the health professionals involved in their care. For 1 year (September 2009 to September 2010), we conducted ethnographic observation and interviews of six cases each comprising one hemodialysis patient and various health professionals including medical specialists, nurses, a social worker, and a dietician.

Results

We found that the ubiquity and complexity of health-related decision-making in the lives of these patients suggests the need for a more holistic interpretation of health-related decision-making.

Discussion

We propose an interpretation of decision-making as an ongoing process of integrating illness and life; as frequently open-ended, cumulative, and relational; and as fundamentally shaped by the fragmented delivery of care for patients with multiple morbidities.

Conclusion

Our understanding of decision-making suggests that people living with complex chronic illness need to receive care from institutions that recognize and address their multi-morbidity as a whole illness that is constantly being integrated into the life of a whole person.
Anaesthetic and Intensive Care Reservists Support during the Iraq War
Authors: Martin Terry
Published: December 2014

By mid January 2003, dozens of doctors, nurses and medics across the Country had received notification of call-up for military service in support of Operation Telic, popularly known as Gulf War 2, the war on Saddam Hussein's Ba'ath party in Iraq. Anaesthetists, intensive care nurses and theatre staff were amongst those who put on uniform and took up arms in support of regular medical personnel in the three services.
Severe Acute Respiratory Syndrome
Authors: Ramsay Sarah J. , Gomersoll Charles D.
Published: December 2014

The emergence of Severe Acute Respiratory Syndrome (SARS) is posing many challenges to public and clinical medicine. The origin of the disease appears to have been in southern China towards the end of 2002.
How to Get Your Abstract Accepted
Authors: Gordon Anthony , Griffiths Richard
Published: December 2014

Writing your first paper for a peer reviewed journal is a fairly daunting prospect. One stepping stone is to submit an abstract for presentation at a national or international conference.
President's Report
Authors: Ridley Saxon
Published: December 2014

I am pleased to report that the Society's Spring meeting in Harrogate was a huge success. Delegate numbers were in excess of 500 and the meeting generated a small profit for the Society. We were pleased to welcome our Patron, The Princess Royal, to attend port of the scientific programme and to meet members of the Industry Membership Scheme. For those of you who missed this important event, I would strongly urge you to book your professional or study leave for the London State of the Art meeting on 24/25th November.
PACT: An ESICM Multidisciplinary Distance Learning Programme for Intensive Care Training
Authors: Fluit C.R.M.G. , Phelan D. , Brown K. , Ramsay G.
Published: December 2014

Intensive Care Medicine (ICM) is a medical specialty where doctors from a variety of disciplinary backgrounds manage the medical care of critically ill patients. Training and continuing education for these doctors involves the acquisition and maintenance of the knowledge, skills and attitudes which allow them to manage the most severely ill. In order to improve and harmonise the quality of intensive care medicine, the European Society of Intensive Care Medicine (ESICM) is producing a distance learning programme: Patient-Centred Acute Care Training (PACT) for the training of doctors working in intensive care and acute medicine.
The DICM: Comments from an Observer
Authors: Low James
Published: December 2014

I was recently given the chance to be an observer at the DICM exam. I sat the exam last year and was a little surprised to discover how much I have forgotten. However, observing the exam did reinforce my view that this is a credible exam that requires considerable effort and knowledge to pass but is worth it in the end.
Report on the Intensive Care Society, Trainee Division Annual Meeting in Liverpool 14th & 15th August 2003
Authors: Al-Haddad Mo
Published: December 2014

After an eight hour journey from Dundee including two scheduled train changes and one unscheduled (the train broke down!), I arrived at the Liverpool Crown Plaza just in time for the first lecture of the Intensive Care Society, Trainee Division Annual Meeting.
A census of levels of critical care activity in acute hospitals in the Lancashire and South Cumbria Critical Care Network
Authors: Brookfield Sarah , Baldwin Andrea , Mousdale Stephen
Published: December 2014

Objective:

To examine the extent of critical care activity, on each weekday, in 9 hospitals accepting acute medical and surgical patients.

Design:

Census of 17339 patients in Lancashire and South Cumbria.

Setting:

All acute medical and surgical wards in these hospitals.

Participants:

Census conducted by the local service improvement leads for critical care.

Method:

A programme of dates was agreed on which to collect the data, in February and March 2004, for each day of the week including Saturday and Sunday. On each of these days the service improvement leads visited each ward in their acute hospitals and counted patients at different levels of need using the Intensive Care Society's Definitions of levels of critical care for Adult Patients (published in their standards and guidelines document). The locations of these patients were noted, in addition to the specific criteria which defined the individual level. Data was entered into a database for analysis and then returned to individual trusts' critical care delivery groups for discussion. Hospitals were also contacted to define their numbers of beds allocated for intensive care and high dependency care.

Results:

19.49% (3380) of patients were defined as Level 1, 3.45% (598) of patients were level 2 and 0.99 % (171) were Level 3.

Conclusions:

Clinical activity at all levels was evenly distributed throughout the week and weekend. Demand for Level 2 support outstrips the supply of beds in higher care areas such as ITU and HDU. Many of these patients are managed on general wards, whereas beds defined as ITU beds outstrip Level 3 demand. Critical care services should focus on increasing flexibility of critical care bed use rather than predefining beds as for either ITU or HDU.
A Retrospective Study on the Initiation and Maintenance of Therapeutic Hypothermia after Cardiac Arrest. Are Simple Guidelines Easy to Follow?
Authors: Faber Peter , MacMillan Michael
Published: December 2014

Background:

Patients surviving a cardiac arrest often suffer debilitating neurological injury as a result of anoxic brain damage. Recent studies have demonstrated improved neurological outcome in cardiac arrest patients undergoing 12–24 hours of mild hypothermia. Reviewing the results from such studies the International Liaison Committee on Resuscitation has issued guidelines on hypothermia treatment in survivors of cardiac arrest.

Aims:

To determine the feasibility of a treatment protocol implementing the International Liaison Committee on Resuscitation guidelines on therapeutic hypothermia after cardiac arrest.

Methods:

A one-year retrospective analysis of cardiac arrest patients assigned to hypothermia treatment in an Intensive Care Unit.

Results:

Fifteen patients were assigned to hypothermia after cardiac arrest. No adverse side effects were observed as a result of the cooling procedure. The length of time to initiate and maintain cooling was the major deviation from the protocol.

Conclusion:

We recommend that hypothermia should be commenced as early as possible by using cold intravenous crystalloids. This is a safe procedure that can be done after the immediate resuscitation.
General Purpose Computer-Alert System in Intensive Care: Evaluation of Effect on Practitioner Performance
Authors: Tridente Asconio , Read Martin
Published: December 2014

Objective: We report the effect of an electronic alerting system that uses multiple data sources and requires minimal user interaction on doctors' behaviour in Intensive Care. Design: Observational study. Setting: University Hospital ICU. Participants: Medical staff. Intervention: Interview of medical staff, commenting on computerised expert system alerts generated without user prompting. Results: 289 alerts were generated from a list of 11 different alerts on 25 days during eight weeks. Overall, 29.06% of the alerts were considered useful. These alerts pertained to 41 of the 225 ICU patients involved (18.22%). They generated management changes in 84 of the 713 patient-days involved (11.78%). Conclusions: For minimal user-effort, this system generated one or more management changes in around one-fifth of patients at a ratio of one management change for every ten patient-days.
Critical Events Simulation for Neonatal and Paediatric Extracorporeal Membrane Oxygenation
Authors: Nimmo Graham R , Wylie Gillian , Scarth Jennifer , Simpson Judith , Gracie Edith , Torrance Ida , Liddell Morag , Davies Carl
Published: December 2014

Extracorporeal membrane oxygenation (ECMO) is a form of life support used when conventional management with mechanical ventilation is failing. Depending on the type of ECMO support utilised, it can provide temporary lung support in neonates and children with respiratory failure (usually veno-venous access) and cardiac support (veno-arterial access) particularly around the time of corrective cardiac surgery. Unlike cardio-pulmonary bypass during cardiac surgery, ECMO support is usually provided for a number of days or even weeks. It is essential that this intense and relatively complex form of life support is free from potentially avoidable adverse incidents. We have developed a course for training in critical incident management during an ECMO ‘run’ using clinical event scenarios and based on a high-fidelity patient simulator. We present the development process and our initial thoughts about its use.
The Effect of Introducing a Consultant Weekly Working Pattern on Mortality in a Critical Care Unit
Authors: Royle Peter , Bramall Jonathan , Norrington Amy
Published: December 2014

Previous publications have suggested that increasing the continuity of consultant working in critical care has a positive effect on patient outcomes. We introduced weekly day-time consultant working in a critical care unit and assessed the impact on mortality after one year. Two critical care units in separate district general hospitals in the same trust, with the same clinical management structure, treatment protocols and equipment, introduced changes in clinical practice at the same time during the study period. Unit one introduced a consultant work pattern of weekly working. Unit two retained the previous pattern of half-day or single full-day consultant working and acted as a control group. The mortality of all admissions and of a subgroup of ventilated admissions were compared for the year before and a year after this change. The mortality of all admissions showed a reduction in both units but this did not achieve statistical significance. The mortality of ventilated admissions in unit one showed a statistically significant reduction. There was a smaller reduction in unit two that was not statistically significant. Consultant weekly working was associated with a reduction in mortality of ventilated admissions to a general critical care unit.
Antibiotic Prescribing in Critical Care: Specific Indications
Authors: Watson Nick , Denton Miles
Published: December 2014

This article outlines recommendations for the treatment of specific infections occurring in the setting of critical care. In the interests of brevity, a limited number of infections are discussed and recommendations are largely confined to empirical therapy. Basic principles of diagnosis and treatment apply in all cases, including appropriate de-escalation when an organism is identified. These aspects of treatment have been dealt with in part one of this article – ‘Antibiotic prescribing in critical care: general principles' published in the winter 2007 edition of JICS.
Sleep Assessment in Critically Ill Patients
Authors: Khalil Mohsen
Published: December 2014

Sleep disruption in the intensive care unit (ICU) is a well-recognised phenomenon that may have detrimental effects on critically ill patients. There are relatively few studies in the literature on this topic, with conflicting findings. Investigators differ in their conclusions as to whether patients in ICU are sleep-deprived. This difference in findings between studies may be due to different types of patient populations, different unit designs and work load, different practices of daily nursing activities, and/or different practices in patients' management and use of sedative medications.
Delirium in the Intensive Care Unit: A Narrative Review of Published Assessment Tools and the Relationship between ICU Delirium and Clinical Outcomes
Authors: Waters Claire
Published: December 2014

Delirium is defined as an acute change or fluctuation in mental status, plus inattention, and either disorganised thinking or altered level of consciousness at the time of evaluation. Increasing numbers of studies confirm that delirium is very common in intensive care unit patients. This review summarises current knowledge about ICU delirium and offers some avenues for future research. This is a summary of Dr Waters' dissertation for the DICM.
Severe Hyponatraemia Due to Water Intoxication in a Schizophrenic Patient
Authors: Day Thomas , Nightingale Peter
Published: December 2014

A 57-year-old patient with schizophrenia and epilepsy presented to the emergency department with clinical signs of severe hyponatraemia. The patient was incontinent of urine and neurological signs were present; she was eventually transferred to the high dependency unit (HDU). Several causes for the low sodium were considered, but the discovery of a large number of empty water bottles in the patient's home confirmed the suspected diagnosis of water intoxication during a psychotic state. The patient's plasma sodium levels were restored over the course of several days and she was eventually transferred home uneventfully.
A ‘Near Miss’
Authors: McGrattan Ken , Chaudry Irfan , Pugh Mark , Laha Shond
Published: December 2014

We would like to report a ‘near miss' critical incident that occurred with the use of Activated Protein C (APC). It has raised a number of issues, which highlight the importance of safety, continuity of care and handover.
Survey of Trainee Membership of the Intensive Care Society
Authors: Cadamy Andrew J , Osborne Kate , Waddy Sam , Perkins Gavin , Challiner Rachael , Kause Juliane , Moore John , Sim Malcolm , Waddy Sam
Published: December 2014

In October/November 2007 we conducted a survey of the trainee membership of the Intensive Care Society in order to ascertain their views, primarily on the potential introduction of a compulsory examination in intensive care medicine (ICM). Their views on other training issues were also sought. There were 313 responses from a trainee membership of 446. A majority were supportive of a compulsory examination, but this view was heavily qualified by a large number of free text responses. The current UK diploma in ICM was not felt to be suitable as a compulsory examination. The timing of any examination would have to be flexible to avoid conflict with parent specialty training and associated examinations. Many of those training in ICM are at an advanced stage in their careers and the burden on their work and home lives presented by a further examination would be considerable. The survey also highlighted other matters important to training and employment in ICM in the UK, including the difficulties in finding employment in ICM faced by those training from parent specialties other than anaesthesia.
A District General Hospital's Experience of Critically Ill Children
Authors: Hindocha Rakhee , Beringer Richard , Handel Jeff
Published: December 2014

The 1997 report “Paediatric Intensive Care: A framework for the future” recommended that all hospitals be included in a unified intensive care service with lead centres providing round-the-clock advice and retrieval service. We audited paediatric intensive care admissions to our district general hospital ICU for the five-year period following publication of this report, to investigate how many patients were admitted, how many were transferred, problems associated with retrieval and patient outcomes. Of the 137 children who were admitted to our ICU between 1998 and 2003, 89% were unplanned admissions, the commonest diagnoses being asthma, pneumonia and CNS infection. Thirty-seven per cent were transferred to lead or other specialist centres. The proportion retrieved has steadily increased. No major problems occurred during retrieval. Delays or failure to transfer due to bed shortage occurred in a small number of cases with no adverse sequelae. Overall the retrieval process was efficient. Outcomes for patients managed locally were good suggesting that skills in managing critically ill children have been well maintained.
Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis
Authors: O'Neil Pauline , Cuthbertson Brian , Cairns Chris
Published: December 2014

Neither intensive insulin therapy nor the use of pentastarch as the resuscitation fluid reduces 28-day mortality or morbidity from severe sepsis. Intensive insulin therapy may cause harm because of increased hypoglycaemic episodes. Use of pentastarch increases the need for renal replacement therapy.

Level of evidence: 1+ (RCT with a low risk of bias)
Complications Associated with the use of Temporary Tracheostomies: An Ill-Defined Problem?
Authors: Gratrix Andrew P , Graves Emma L , Murphy Paul G
Published: December 2014

Tracheostomy is one of the most commonly conducted procedures in critically ill patients. However even a temporary tracheostomy has risks which include the life-threatening complications of obstruction and displacement. This survey examined the use of temporary tracheostomies by critical care clinicians in the UK. The results suggest that although progress is being made, practice relating to temporary tracheostomy varies considerably as do the governance arrangements that underpin it. In the absence of national guidance, clinicians need to review their operational policies relating to patients with a temporary tracheostomy, including choice of tracheostomy tube, education and training of relevant staff and governance arrangements underpinning patient care in all clinical areas caring for patients with tracheostomies.
Prolonged use of the Non-Invasive Ventilation Helmet in Acute Respiratory Distress Syndrome
Authors: Prinzlin Jorg , Schwab Martin , Scott Nicholas B , Sutcliffe Nicholas
Published: December 2014

The management of acute respiratory distress syndrome (ARDS) with non-invasive ventilation (NIV) is controversial. We report a case of a 69-year-old patient who developed ARDS after elective total hip replacement. During a 33-day stay in the intensive care unit (ICU) his respiratory failure was successfully managed with intermittent NIV through a transparent ventilation helmet, when he became intolerant of the facemask. Nearly four days were spent almost continuously in the NIV hood. The origin of the ARDS was never confirmed; possible causes included amiodarone toxicity, atypical pneumonia and fat embolus. The patient remained awake throughout, never exceeded single-organ failure, his respiratory function improved gradually and he was eventually discharged home.
Building a Critical Care Unit for Sheffield using a New NHS Estates Building Strategy — ProCure21: A Partnership Approach to NHS Building
Authors: Scott Christopher J
Published: December 2014

Conventional approaches to tendering and building NHS buildings have led in the past to poor practice, budget over-runs and disappointing results. The ProCure21 process aims to streamline the process, involving clinicians earlier to ensure that designs and building are fit for purpose and built on time and to budget. This article describes building a new unit in Sheffield using ProCure21, and details some of the novel approaches to building and design that resulted from this collaboration.
Weaning Strategies in Problem Patients
Authors: Polkey Michael I , Walters Nicola
Published: December 2014

Weaning usually accounts for approximately 40–50% of the total duration of mechanical ventilation. Approximately two-thirds of patients can tolerate withdrawal of ventilation without the need for more gradual weaning, but there are a significant number of patients for whom weaning is difficult. Weaning failure is defined as the failure of a spontaneous breathing trial, or the need for re-intubation within 48 hours of extubation. This article reviews the causes of failure to wean, and outlines a practical approach to dealing with the difficult-to-wean patient. The key to successful weaning combines an approach which optimises ventilation at night, adopts a stepwise approach to reducing ventilatory dependence during the day, and uses non-invasive ventilation as a ‘bridge’ out of the ICU. Having a weaning protocol and ensuring it is initiated in a timely manner is likely to be as important as what is in the protocol.
The Effect of Obesity on Intensive Care Morbidity and Mortality
Authors: Brown James , Cairns Chris
Published: December 2014

Obesity is not demonstrated to be associated with a higher ICU mortality. Obese patients have an increased morbidity on the ICU as evidenced by prolonged requirement for mechanical ventilation and intensive care admission length.

Level of evidence: 1+ (Meta-analysis with a low risk of bias)
What is the Best Outcome from Severe Head Injury?
Authors: Eynon Andy
Published: December 2014

Traumatic brain injury (TBI) remains the commonest cause of death in the first four decades of life, accounting for 15–20% of deaths between 5 and 35 years.1 There is a ten-fold greater mortality in trauma patients with a head injury compared to those without.2 The effects of head injury for survivors, their families and for society can be devastating; TBI is the cause of severe disability for 150–200 people per million annually.3,4 Perhaps it is better if we do nothing, don't contact the neurosurgeons, don't admit them to specialist units, don't treat the pneumonia that develops – keep them comfortable, allow them some dignity? Or is this a situation where therapeutic nihilism leads to a self-fulfilling prophecy of poor outcome?
Implementing Change – the Experience of a District General ICU
Authors: Tehan Brian , O'Keeffe Sue
Published: December 2014

Patient safety is a major challenge and goal for NHS trusts. This paper describes the experiences of a district general hospital (DGH) intensive care unit (ICU) implementing change methodology under the auspices of the Safer Patients' Initiative (SPI). The team applied small tests of change (PDSA – Plan, Do, Study, Act) and, supported by education and measurement, introduced bundles of care, without the need for significant investment. Ventilator and central line bundles were applied, along with multidisciplinary ward rounds and daily goal sheets. Over a two year period, average length of stay fell from 6 to 2.7 days. The rate of ventilator-acquired pneumonia (VAP) decreased from 24.39 per 1,000 intubated days to 0. As a consequence, there was increased available capacity and admissions increased by one third. At the same time, overall drug costs fell. The application of the change methodology has made a significant difference to the performance of this DGH ICU.
ICU Follow-up – Can We Predict the Problems?
Authors: Jones Christina
Published: December 2014

Evidence is emerging to help identify critically ill patients at high risk of developing adverse psychological sequelae. This article reviews current research on cognitive and psychological problems after critical care, and highlights the need for early recognition and intervention.
Pharmacology and Pharmacokinetics of Sedative Agents
Authors: Borthwick Mark
Published: December 2014

Our understanding of the pharmacology and pharmacokinetics of agents acting on the central nervous system has made considerable advances. This article describes the actions of the drugs most commonly used in critical care units for sedation of critically ill patients.
Do we know if our Patients are Delirious?
Authors: Kaye Callum
Published: December 2014

Delirium in the intensive care unit (ICU) setting is a significant cause of morbidity, mortality and increases ICU, as well as hospital length of stay1,2. Furthermore, with so many of the risk factors being present in the critically ill patient in the ICU environment, it's not surprising that other studies have found that up to 80% of patients will be delirious at some point during admission3,4.

We performed a small study in a Toronto Medical-Surgical ICU using the Confusion Assessment Method for the ICU (CAM-ICU)5 to determine the prevalence of delirium in this unit. We concurrently reviewed medical and nursing notes to identify documentation of symptoms and signs that could indicate possible delirium during routine clinical assessment of the patient.
Pro-Con Debate: We should not Measure Cardiac output in Critical Care
Authors: Morris Craig G , Pearse Rupert M
Published: December 2014

The measurement of cardiac output in critical care appears to be increasingly common. However, both the monitoring technologies and the therapeutic approaches they inform have often proved highly controversial. As the range of alternative technologies available continues to increase, it seems worthwhile to question whether this monitoring modality should be used at all. The aim of this pro-con debate is to review the key evidence and to explain the often quite widely differing interpretations placed upon it. The term cardiac output monitoring refers to technology, whose primary purpose is to monitor global blood flow. The principles of the various technologies have been reviewed elsewhere.1
The Sepsis Syndrome in Odontogenic Infection
Authors: Handley Thomas PB , Devlin Mark F , Koppel David A , McCaul James A
Published: December 2014

Odontogenic infection is a common cause of sepsis in the head and neck. Infection frequently spreads in a predictable pattern within the fascial spaces of the neck and can result in airway compromise. Often the condition results in significant morbidity and a prolonged hospital stay. In this study, we assessed the incidence of sepsis syndrome in patients presenting to a regional maxillofacial unit with odontogenic infection. Six months of prospective data were collected, with sixty-seven patients included. The focus of infection was mandibular in 70.1% and maxillary in 29.9%. The mean length of stay was four days and 61.2% of patients were diagnosed with sepsis syndrome on admission. This group remained in hospital significantly longer than non-sepsis syndrome patients (sepsis=4.7 days, non-sepsis=2.9 days. p=0.0145.) The site of infection was not a significant factor in the development of the systemic inflammatory response syndrome (SIRS).
Sildenafil in Acute Pulmonary Embolism: Case Report and Review of Literature
Authors: Galea Marilise , Quiney Nial
Published: December 2014

We discuss the use of sildenafil in a patient who sustained a massive pulmonary embolism (PE). She remained haemodynamically unstable after thrombolysis, and needed large doses of inotropic support. She was treated with oral sildenafil at a dose of 75 mg three times a day which enabled weaning from inotropic support and clinical improvement.
Renal Replacement Therapy: High dose Therapy does not Improve Outcome
Authors: Daniel Malcolm
Published: December 2014

In ICU patients with acute tubular necrosis (ATN), high dose renal replacement therapy does not improve outcome, whether measured by survival or recovery of renal function.

Level of evidence: 1+ (RCT with a low risk of bias)
Raised Creatine Kinase as an Indicator of Inadequate Muscle Debridement in Ballistic Injuries
Authors: Nordmann Giles , Galbraith Keith , Mellor Adrian
Published: December 2014

A male civilian in his forties presented with multiple thoraco-abdominal gunshot wounds (GSW). After resuscitation and surgical repair of intra-abdominal injuries and debridement of wounds, he improved initially and was extubated successfully. However, his creatine kinase (CK) continued to rise post-operatively and this, together with the development of pyrexia on the fifth post-operative day, led to re-exploration of his wounds. At operation he was found to have large areas of dead muscle within the abdominal and chest walls which required extensive resection. In our view the continued rise in CK was a sensitive marker for ongoing muscle death and is useful in this kind of war surgery.