Nursing resources and patient outcomes in intensive care: a systematic review of the literature

Objectives: To evaluate the empirical evidence linking nursing resources to patient outcomes in intensive care settings as a framework for future research in this area. Background: Concerns about patient safely and the quality of care are driving research on the clinical and cost-effectiveness of health care interventions, including the deployment of human resources. This is particularly important in intensive care where a large proportion of the health care budget is consumed and where nursing staff is the main item of expenditure. Recommendations about staffing levels have been trade but may not be evidence based and may not always be achieved in practice. Methods: We searched systematically for studies of the impact of nursing resources (e.g. nurse-patient ratios, nurses' level of education, training and experience) on patient Outcomes, including mortality and adverse events, in adult intensive care. Abstracts of articles were reviewed and retrieved if they investigated the relationship between nursing resources and patient Outcomes. Characteristics of the studies were tabulated and the quality of the Studies assessed. Results: Of the 15 studies included in this review, two reported it statistical relationship between nursing resources and both mortality and adverse events, one reported ail association to mortality only, seven studies reported that they Could not reject the null hypothesis of no relationship to mortality and 10 studies (out of 10 that tested the hypothesis) reported a relationship to adverse events. The main explanatory mechanisms were the lack of time for nurses to perform preventative measures, or for patient surveillance. The nurses' role in pain control was noted by One author. Studies were mainly observational and retrospective and varied in scope from 1 to 52 units. Recommendations for future research include developing the mechanisms linking nursing resources to patient Outcomes, and designing large multi-centre prospective Studies that link patient's exposure to nursing care oil a shift-by-shift basis over time. (C) 2007 Elsevier Ltd. All rights reserved.

Jung’s cultural writing: spiral essays and performing symbols (in literature)

Performance is a key ingredient of Jung’s writings on culture and of the function of the Jungian symbol in literature. This paper will compare and contrast Jung’s performance of cultural analysis and healing in his essays with the way his notion of the symbol works in literature to knit the individual psyche into the collective. It will explore Jung’s unique essay form of the spiral as a literary innovation, and look at the way a Jungian reading of literary reveals a significant contribution to cultural studies. [From the Author]

Literature and the shaman: Jung, trauma stories and new origin stories in The Lion, the witch and the wardrobe by C.S. Lewis

The paper first considers the role of Jungian ideas in relation to academic disciplines and to literary studies in particular. Jung is a significant resource in negotiating developments in literary theory because of his characteristic treatment of the ‘other’. The paper then looks at The Lion, the Witch and the Wardrobe (1950) by C.S. Lewis whose own construction of archetypes is very close to Jung’s. By drawing upon new post-Jungian work from Jerome Bernstein’s Living in the Borderland (2005), the novel is revealed to be intimately concerned with narratives of trauma and of origin. Indeed, a Jungian and post-Jungian approach is able to situate the text both within nature and in the historical traumas of war as well as the personal traumas of subjectivity. Where Bernstein connects his work to the postcolonial ethos of the modern Navajo shaman, this new weaving of literary and cultural theory points to the residue of shamanism within the arts of the West. [From the Publisher]

Discourse and soul: Jung, literature, science and tragedy as mythical writing

This paper will propose that literature and science, far from being discrete spheres of cultural activity, are, in fact, the cultural expressions of interlocking myths. They therefore overlap and even take each other’s places, as examination of the ‘science’ of C.G. Jung and the ‘art’ of a writer such as John Cowper Powys, will show. ‘Dis-course’, I argue, is the material aspect of the mythical structuring of psychic experience. In the work of Jung and Powys, discourse is the articulation of the soul in the world that spans personal, social, natural and cosmic space. [From the Author]

Postcolonial futures: postcolonial literature and the Obama moment

Since the late 1970s the western academy has encouraged the development of postcolonial literary theory and the formulation of a postcolonial literary canon existing outside the prescriptive narratives of the ‘mother’ country and empire. Having lost faith in the binary oppositions underpinning such narratives, we turned to alternative fictions that contested the construction of the ‘other’, the world divided between the ‘West and the Rest’. The publication of Edward Said’s Orientalism in 1978 marked the beginning of the discipline now known as postcolonial studies with its new ways of understanding ‘the west’s’ relationship with ‘the east’ and, by extension, all the former colonies of empire. Despite these radical origins, however, postcolonialism’s more recent emphasis on the psychological and its affirmation of the hybrid text and self has, for many, served to obscure real economic social realities that have very little to do with the magical or wondrous textual expression of a postcolonial identity. This paper considers problems associated with defining the postcolonial and proposes that, in a literary context, we broaden its meaning to include texts traditionally outside the category of postcolonial literature. To extend the meaning of postcolonial is timely as we are now witnessing its relocation from ‘margin’ to ‘centre’ with the election of Barack Obama. This moment may be seen as a disruption of conventional understandings of what constitutes postcolonial literature, essentially as oppositional discourse that could only define itself as peripheral to, or ‘post’, metropolitan and economic concerns. [From the Author]

Vibrational spectroscopic studies of the structure of di-amino acid peptides. Part II: cyclo(L-Asp-L-Asp) in the solid state and in aqueous solution

Solid-state protonated and N,O-deuterated Fourier transform infrared (IR) and Raman scattering spectra together with the protonated and deuterated Raman spectra in aqueous solution of the cyclic di-amino acid peptide cyclo(L-Asp-L-Asp) are reported. Vibrational band assignments have been made on the basis of comparisons with previously cited literature values for diketopiperazine (DKP) derivatives and normal coordinate analyses for both the protonated and deuterated species based upon DFT calculations at the B3-LYP/cc-pVDZ level of the isolated molecule in the gas phase. The calculated minimum energy structure for cyclo(L-Asp-L-Asp), assuming C-2 symmetry, predicts a boat conformation for the DKP ring with both the two L-aspartyl side chains being folded slightly above the ring. The C=O stretching vibrations have been assigned for the side-chain carboxylic acid group (e.g. at 1693 and 1670 cm(-1) in the Raman spectrum) and the cis amide I bands (e.g. at 1660 cm(-1) in the Raman spectrum). The presence of two bands for the carboxylic acid C=O stretching modes in the solid-state Raman spectrum can be accounted for by factor group splitting of the two nonequivalent molecules in a crystallographic unit cell. The cis amide II band is observed at 1489 cm(-1) in the solid-state Raman spectrum, which is in agreement with results for cyclic di-amino acid peptide molecules examined previously in the solid state, where the DKP ring adopts a boat conformation. Additionally, it also appears that as the molecular mass of the substituent on the C-alpha atom is increased, the amide II band wavenumber decreases to below 1500 cm(-1); this may be a consequence of increased strain on the DKP ring. The cis amide II Raman band is characterized by its relatively small deuterium shift (29 cm(-1)), which indicates that this band has a smaller N-H bending contribution than the trans amide II vibrational band observed for linear peptides.