Factors influencing the provision of end-of-life care in critical care settings : development and testing of a survey instrument

Aim. To develop and psychometrically test a survey instrument to identify the factors influencing the provision of end-of-life care by critical care nurses. Background. Following a decision to withdraw life-sustaining treatment, critical care nurses remain with the patient and their family providing end-of-life care. Identification of factors influencing the provision of this care can give evidence to inform practice development and support nurses. Design. A cross-sectional survey of critical care nurses. Method. An online survey was developed, reviewed by an expert panel and pilot tested to obtain preliminary evidence of its reliability and validity. In May 2011, a convenience sample of critical care nurses (n = 392, response rate 25%) completed the survey. The analytical approach to data obtained from the 58 items measured on a Likert scale included exploratory factor analysis and descriptive statistics. Results. Exploratory factor analysis identified eight factors influencing the provision of end-of-life care: emotional support for nurses, palliative values, patient and family preferences, resources, organizational support, care planning, knowledge and preparedness. Internal consistency of each latent construct was deemed satisfactory. The results of descriptive statistics revealed a strong commitment to the inclusion of families in end-of-life care and the value of this care in the critical care setting. Conclusion. This paper reports preliminary evidence of the psychometric properties of a new survey instrument. The findings may inform practice development opportunities to support critical care nurses in the provision of endof- life care and improve the care that patients and their families receive.

Live from the Sydney Opera House: Remote musical interactions for teacher professional development

A significant challenge for the implementation of the Australian Curriculum: The Arts is the professional development of primary school teachers in all parts of the country. During 2012, the Sydney Symphony Orchestra (SSO) conducted a remote music professional development workshop as part of the Sydney Opera House’s Digital Education Program for teachers in New South Wales using the Department of Education’s Connected Classroom system which allows live synchronous interaction between facilitators and participants in multiple sites. In this article, we analyse observational and videotape data collected during this live professional development event to consider the opportunities and challenges presented by this type of professional learning experience in the arts. In particular, consideration is given to the impact of a remote musical interaction on embodied learning and aesthetic experience. We draw on actor-network theory to consider the ways in which a remote professional development experience differs to one in which all participants are present in the same space. Finally, we conclude that although there are significant differences in the type of learning that occurs in a remote music interaction, the online space provides a legitimate and potentially transforming experience for primary school teachers.

The development of an instrument for assessing cognitive ability and screening for the cognitive decline associated with dementia in people with moderate to profound intellectual disability

Individuals with intellectual disability have a greater risk of developing dementia.The diagnosis of dementia relies on accurate testing of cognitive function however existing tests have limited utility in people whose intellectual disability is moderate or greater. A new test was developed and underwent preliminary testing to determine use across a wider ability spectrum. The Cognitive Baseline & Screener for People with Intellectual Disability (CBS-ID) was administered to a sample of 17 dyads (n=34) (people with intellectual disability (who completed CBS-ID) and caregivers (who provided an independent rating of function)).The CBS-ID performed well on several usability metrics across all intellectual disability level and was highly correlated with existing measures of cognitive function to which it was compared.Further research with a larger sample is needed to assess the test's ability to detect change in cognition over time & determine if it aids the process of diagnosing dementia.

Country review on the main building energy-efficiency policy instrument

Building energy-efficiency (BEE) is the key to drive the promotion of energy saving in building sector. A large variety of building energy-efficiency policy instrument exist. Some are mandatory, some are soft scheme, and some use economic incentives from country to country. This paper presents the current development of implementing BEE policy instruments by examining the practices of BEE in seven selected countries and regions. In the study, BEE policy instruments are classified into three groups, including mandatory administration control instruments, economic incentive instruments and voluntary scheme instruments. The study shows that different countries have adopted different instruments in their practices for achieving the target of energy-saving and gained various kinds of experiences. It is important to share these experiences gained.

Under this Sky: Logan's Musical Celebration

A creative practice as research, UNDER THIS SKY is the latest investigation in a 12-year study into the “QMF Model”, an application of principles of community and cultural practice that generates large-scale, music spectacle events that derive their narrative and expression from the communities in which they are performed. UNDER THIS SKY is a large-scale musical specially commissioned for the city of Logan (Queensland) as the signature work of the 2015 Queensland Musical Festival. The investigation centres around the capacity of the “QMF Model” to engage with performers and musicians of Logan and then, through community consultation, create a narrative based on idiosyncratic stories and themes that would culminate in a performance event in August 2015. Previous creative projects, Boomtown (Gladstone), Behind the Cane (Bowen) and The Road We’re On (Charleville), were conducted in relatively small communities, Gladstone being the largest. In UNDER THIS SKY, the model is being tested in a large metropolitan city (Logan – 300,000). The core principles of CACD (community arts and cultural development) are being interrogated and adapted to fit this large-scale, whole of community environment. The purpose is to refine and further validate the “QMF Model” as a viable and effective process for community/artistic partnerships. Since February 2014, professional artists and managers have facilitated and shaped the work, up-skilling performers over a periods of 12 months, developing new relationships and creating opportunities for participation at all levels of experience. The research methodology involved creative practice through a continuous cycle of action, reflection, adaptation and application.

Building an evaluation instrument for China's hospital emergency preparedness: A systematic review of preparedness instruments

Objectives: The aim of this report is to identify from the literature common themes relating to the concept of hospital preparedness for emergencies to develop an agreed framework for evaluation. Method: A systematic literature search identified appropriate articles for critical appraisal. A meta-ethnography approach was used to synthesize the findings, using both reciprocal translation and line-of-argument synthesis. Results: From an initial 2162 articles, we identified 13 articles that specifically addressed the aims of this review and formed the basis of the intended analysis. Conclusion: Hospital emergency preparedness is essential for effective disaster relief. Developing a systematic and structured methodology is necessary to assess hospital preparedness. (Disaster Med Public Health Preparedness: 2014:0:1-9)

ISPCAN child abuse screening tool children's version (ICAST-C): Instrument development and multi-national pilot testing

Objective To develop a child victimization survey among a diverse group of child protection experts and examine the performance of the instrument through a set of international pilot studies. Methods The initial draft of the instrument was developed after input from scientists and practitioners representing 40 countries. Volunteers from the larger group of scientists participating in the Delphi review of the ICAST P and R reviewed the ICAST C by email in 2 rounds resulting in a final instrument. The ICAST C was then translated and back translated into six languages and field tested in four countries using a convenience sample of 571 children 12–17 years of age selected from schools and classrooms to which the investigators had easy access. Results The final ICAST C Home has 38 items and the ICAST C Institution has 44 items. These items serve as screeners and positive endorsements are followed by queries for frequency and perpetrator. Half of respondents were boys (49%). Endorsement for various forms of victimization ranged from 0 to 51%. Many children report violence exposure (51%), physical victimization (55%), psychological victimization (66%), sexual victimization (18%), and neglect in their homes (37%) in the last year. High rates of physical victimization (57%), psychological victimization (59%), and sexual victimization (22%) were also reported in schools in the last year. Internal consistency was moderate to high (alpha between .685 and .855) and missing data low (less than 1.5% for all but one item). Conclusions In pilot testing, the ICAST C identifies high rates of child victimization in all domains. Rates of missing data are low, and internal consistency is moderate to high. Pilot testing demonstrated the feasibility of using child self-report as one strategy to assess child victimization. Practice implications The ICAST C is a multi-national, multi-lingual, consensus-based survey instrument. It is available in six languages for international research to estimate child victimization. Assessing the prevalence of child victimization is critical in understanding the scope of the problem, setting national and local priorities, and garnering support for program and policy development aimed at child protection.

A towed instrument package for fisheries research in great barrier reef waters

A tethered remote instrument package (TRIP) has been developed for biological surveys over Queensland's continental shelf and slope. The present system, evolved from an earlier sled configuration, is suspended above the sea bed and towed at low speeds. Survey information is collected through video and film cameras while instrument and environmental variables are handled by a minicomputer. The operator was able to "fly" the instrument package above the substrate by using an altitude echosounder, forward-looking sonar and real-time television viewing. Unwanted movements of the viewing system were stabilized through a gyro-controlled camera-head panning system. the hydrodynamic drag of the umbilical presented a major control problem which could be overcome only by a reduction in towing speed. Despite the constraints of towing a device such as this through the coral reef environment, the package performed well during a recent biological survey where it was worked at 50% of its 350 m design depth.

Space in Musical Semiosis : An Abductive Theory of the Musical Composition Process

Space in musical semiosis is a study of musical meaning, spatiality and composition. Earlier studies on musical composition have not adequately treated the problems of musical signification. Here, composition is considered an epitomic process of musical signification. Hence the core problems of composition theory are core problems of musical semiotics. The study employs a framework of naturalist pragmatism, based on C. S. Peirce’s philosophy. It operates on concepts such as subject, experience, mind and inquiry, and incorporates relevant ideas of Aristotle, Peirce and John Dewey into a synthetic view of esthetic, practic, and semiotic for the benefit of grasping musical signification process as a case of semiosis in general. Based on expert accounts, music is depicted as real, communicative, representational, useful, embodied and non-arbitrary. These describe how music and the musical composition process are mental processes. Peirce’s theories are combined with current morphological theories of cognition into a view of mind, in which space is central. This requires an analysis of space, and the acceptance of a relativist understanding of spatiality. This approach to signification suggests that mental processes are spatially embodied, by virtue of hard facts of the world, literal representations of objects, as well as primary and complex metaphors each sharing identities of spatial structures. Consequently, music and the musical composition process are spatially embodied. Composing music appears as a process of constructing metaphors—as a praxis of shaping and reshaping features of sound, representable from simple quality dimensions to complex domains. In principle, any conceptual space, metaphorical or literal, may set off and steer elaboration, depending on the practical bearings on the habits of feeling, thinking and action, induced in musical communication. In this sense, it is evident that music helps us to reorganize our habits of feeling, thinking, and action. These habits, in turn, constitute our existence. The combination of Peirce and morphological approaches to cognition serves well for understanding musical and general signification. It appears both possible and worthwhile to address a variety of issues central to musicological inquiry in the framework of naturalist pragmatism. The study may also contribute to the development of Peircean semiotics.

Kaukainen rakkaus : Saavuttamattomuuden semantiikka Kaija Saariahon oopperassa

L Amour de loin: The semantics of the unattainable in Kaija Saariaho s opera Kaija Saariaho (born 1952) is one of the most internationally successful Finnish composers there has ever been. Her first opera L Amour de loin (Love from afar, 1999-2000) has been staged all over the world and has won a number of important prizes. The libretto written for L Amour de loin by Amin Malouf (born 1949) sets the work firmly in the culture of courtly love and the troubadours, which flourished in Occitania in the South of France during the Middle Ages. The male lead in the opera is the troubadour Jaufré Rudel, who lived in the twelfth century and is known to have taken part in the Second Crusade in 1147-1148. This doctoral thesis L Amour de loin: The semantics of the unattainable in Kaija Saariaho s opera, which comes within the field of musicology and opera research, examines the dimensions of meaning contained in Kaija Saariaho s opera L Amour de loin. This hermeneutic-semiotic study is the first doctoral thesis dealing with Saariaho to be completed at the University of Helsinki. It is also the first thesis-level study of Saariaho s opera to be completed anywhere in the world. The study focuses on the libretto and music of the opera, that is to say the dramatic text (L Amour de loin 1980), and examines on the one hand the dimensions of meaning produced by the dramatic text and on the other, the way in which they fix the dramatic text in a historical and cultural context. Thus the study helps to answer questions about the dimensions of meaning contained in the dramatic text of the opera and how they can be interpreted. The most important procedural viewpoint is Lawrence Kramer s hermeneutic window (1990), supplemented by Raymond Monelle s semiotic theory of musical topics (2000, 2006) and the philosophical concept of Emmanuel Levinas (1996, 2002) in which the latter acts as an instrument for semantic interpretation to build up an analysis. The analytical section of the study is built around the three characters in the opera, Jaufré Rudel, Clémence the Countess of Tripoli, and the Pilgrim. The study shows that the music of Saariaho, who belongs to the third generation of Finnish modernists, has become distanced from the post-serial aesthetic towards a more diatonic form of expression. There is diatonicity, for instance, in the sonorous individuality of the male lead, which is based on the actual melodies of the historical Jaufré Rudel. The use of outside material in this context is exceptional in the work of Saariaho. At the same time, Saariaho s opera contains a wealth of expressive devices she has used in her earlier work. It became apparent during the study that, as a piece of music, L Amour de loin is a many layered and multi-dimensional work that does not unambiguously represent any single stylistic trend or aesthetic. Despite the composer s post-serial background and its abrasive relationship with opera, L Amour de loin is firmly attached to the tradition of western opera. The analysis based on the theory of musical topics that was carried out in the study, shows that topics referring to death and resurrection, used in opera since the seventeenth century, appear in L Amour de loin. The troubadour topic, mainly identified with the harp, also emerges in the work. The study also shows that the work is firmly attached to the tradition of western opera in other aspects, too, such as the travesti or trouser role played by the Pilgrim, and the idea of deus ex machina derived from Ancient Greek theatre. The study shows that the concept of love based on the medieval practices of courtly love, and the associated longing for another defined by almost 1,000 years of western culture, are both manifested in the semantics of Kaija Saariaho s opera which takes its place in the contemporary music genre.

Sensory auditory processing and intuitive sound detection : an investigation of musical experts and nonexperts

The auditory system can detect occasional changes (deviants) in acoustic regularities without the need for subjects to focus their attention on the sound material. Deviant detection is reflected in the elicitation of the mismatch negativity component (MMN) of the event-related potentials. In the studies presented in this thesis, the MMN is used to investigate the auditory abilities for detecting similarities and regularities in sound streams. To investigate the limits of these processes, professional musicians have been tested in some of the studies. The results show that auditory grouping is already more advanced in musicians than in nonmusicians and that the auditory system of musicians can, unlike that of nonmusicians, detect a numerical regularity of always four tones in a series. These results suggest that sensory auditory processing in musicians is not only a fine tuning of universal abilities, but is also qualitatively more advanced than in nonmusicians. In addition, the relationship between the auditory change-detection function and perception is examined. It is shown that, contrary to the generally accepted view, MMN elicitation does not necessarily correlate with perception. The outcome of the auditory change-detection function can be implicit and the implicit knowledge of the sound structure can, after training, be utilized for behaviorally correct intuitive sound detection. These results illustrate the automatic character of the sensory change detection function.

Cortical processing of musical pitch as reflected by behavioural and electrophysiological evidence

In a musical context, the pitch of sounds is encoded according to domain-general principles not confined to music or even to audition overall but common to other perceptual and cognitive processes (such as multiple pattern encoding and feature integration), and to domain-specific and culture-specific properties related to a particular musical system only (such as the pitch steps of the Western tonal system). The studies included in this thesis shed light on the processing stages during which pitch encoding occurs on the basis of both domain-general and music-specific properties, and elucidate the putative brain mechanisms underlying pitch-related music perception. Study I showed, in subjects without formal musical education, that the pitch and timbre of multiple sounds are integrated as unified object representations in sensory memory before attentional intervention. Similarly, multiple pattern pitches are simultaneously maintained in non-musicians' sensory memory (Study II). These findings demonstrate the degree of sophistication of pitch processing at the sensory memory stage, requiring neither attention nor any special expertise of the subjects. Furthermore, music- and culture-specific properties, such as the pitch steps of the equal-tempered musical scale, are automatically discriminated in sensory memory even by subjects without formal musical education (Studies III and IV). The cognitive processing of pitch according to culture-specific musical-scale schemata hence occurs as early as at the sensory-memory stage of pitch analysis. Exposure and cortical plasticity seem to be involved in musical pitch encoding. For instance, after only one hour of laboratory training, the neural representations of pitch in the auditory cortex are altered (Study V). However, faulty brain mechanisms for attentive processing of fine-grained pitch steps lead to inborn deficits in music perception and recognition such as those encountered in congenital amusia (Study VI). These findings suggest that predispositions for exact pitch-step discrimination together with long-term exposure to music govern the acquisition of the automatized schematic knowledge of the music of a particular culture that even non-musicians possess.