Clinical utility of standard base excess in the diagnosis and interpretation of metabolic acidosis in critically ill patients

The aims of this study were to determine whether standard base excess (SBE) is a useful diagnostic tool for metabolic acidosis, whether metabolic acidosis is clinically relevant in daily evaluation of critically ill patients, and to identify the most robust acid-base determinants of SBE. Thirty-one critically ill patients were enrolled. Arterial blood samples were drawn at admission and 24 h later. SBE, as calculated by Van Slyke's (SBE VS) or Wooten's (SBE W) equations, accurately diagnosed metabolic acidosis (AUC = 0.867, 95%CI = 0.690-1.043 and AUC = 0.817, 95%CI = 0.634-0.999, respectively). SBE VS was weakly correlated with total SOFA (r = -0.454, P < 0.001) and was similar to SBE W (r = -0.482, P < 0.001). All acid-base variables were categorized as SBE VS <-2 mEq/L or SBE VS <-5 mEq/L. SBE VS <-2 mEq/L was better able to identify strong ion gap acidosis than SBE VS <-5 mEq/L; there were no significant differences regarding other variables. To demonstrate unmeasured anions, anion gap (AG) corrected for albumin (AG A) was superior to AG corrected for albumin and phosphate (AG A+P) when strong ion gap was used as the standard method. Mathematical modeling showed that albumin level, apparent strong ion difference, AG A, and lactate concentration explained SBE VS variations with an R² = 0.954. SBE VS with a cut-off value of <-2 mEq/L was the best tool to diagnose clinically relevant metabolic acidosis. To analyze the components of SBE VS shifts at the bedside, AG A, apparent strong ion difference, albumin level, and lactate concentration are easily measurable variables that best represent the partitioning of acid-base derangements.

Changing roles of nurse educators employed in acute and chronic care settings : the impact of professional and statutory mandates in Ontario at four sites of one hospital corporation /

The role of the hospital-employed nurse educator is evolving. Factors influencing this change include the introduction of standards for nurse educators by the College of Nurses of Ontario (CNO), a change in the way nurses are educated, the emergence of nursing as a profession, and hospital restructuring as a result of budgetary constraints. Two of these influencing factors: the introduction of the updated Standards of Practice for Registered Nurses and Registered Practical Nurses (1996) and hospital restructuring occurred over the last 7 years at several hospitals in southern Ontario. Current literature as well as the Standards of Practice (1996) were utilized to examine the current roles and responsibilities of nurse educators and subsequently develop a questionnaire to study the impact of these influencing factors on the role of the nurse educator. This questionnaire was piloted and revised before its distribution at 4 hospitals in southern Ontario. Twenty-five of the 41 surveys (61%) distributed were returned for analysis. The data reflected that the Standards of Practice had a positive influence on the role of the nurse educator, while hospital restructuring had a negative impact. In addition, many of the roles and responsibilities identified in the literature were indeed part of the current role of nurse educators, as well as several responsibilities not captured in the literature. The predictions for the future of this role in its current state were not positive given the financial status of the health care system as well as the lack of clarity for the role and the current level ofjob satisfaction among practicing nurse educators. However, a list of recommendations were generated which, if implemented, could add clarity to the role and improve job satisfaction. This could enhance the retention of current nurse educators and the possibility of recruiting competent nurse educators to the role in the future.

Nietzsche's will-to-power ontology : an interpretation of Beyond Good and Evil

Abstract: Nietzsche's Will-to-Power Ontology: An Interpretation of Beyond Good and Evil § 36 By: Mark Minuk Will-to-power is the central component of Nietzsche's philosophy, and passage 36 of Beyond Good and Evil is essential to coming to an understanding of it. 1 argue for and defend the thesis that will-to-power constitutes Nietzsche's ontology, and offer a new understanding of what that means. Nietzsche's ontology can be talked about as though it were a traditional substance ontology (i.e., a world made up of forces; a duality of conflicting forces described as 'towards which' and 'away from which'). However, 1 argue that what defines this ontology is an understanding of valuation as ontologically fundamental—^the basis of interpretation, and from which a substance ontology emerges. In the second chapter, I explain Nietzsche's ontology, as reflected in this passage, through a discussion of Heidegger's two ontological categories in Being and Time (readiness-to-hand, and present-at-hand). In a nutshell, it means that the world of our desires and passions (the most basic of which is for power) is ontologically more fundamental than the material world, or any other interpretation, which is to say, the material world emerges out of a world of our desires and passions. In the first chapter, I address the problematic form of the passage reflected in the first sentence. The passage is in a hypothetical style makes no claim to positive knowledge or truth, and, superficially, looks like Schopenhaurian position for the metaphysics of the will, which Nietzsche rejects. 1 argue that the hypothetical form of the passage is a matter of style, namely, the style of a free-spirit for whom the question of truth is reframed as a question of values. In the third and final chapter, 1 address the charge that Nietzsche's interpretation is a conscious anthropomorphic projection. 1 suggest that the charge rests on a distinction (between nature and man) that Nietzsche rejects. I also address the problem of the causality of the will for Nietzsche, by suggesting that an alternative, perspectival form of causality is possible.

The interpretation of music videos : an interactive relationship between medium and viewer

There is a great deal of evidence to support the examination of an interactive relationship between the medium and the viewer in the interpretation of mainstream media. The exact nature of this relationship, however, is not well understood. The current study was carried out to assess the variables that may help explain why certain people interpret media, such as music videos, differently than others. Jensen's concept of reception analysis describes the relationship between the medium and the audience, and thus remains a strong focus within this study. Differences in the interpretation of music videos were investigated as a function of Absorption, gender role, screen size, age and viewing experience. Multiple regression analyses uncovered independent predictions of sexuality and violence scores by absorption and experience, as well as an interaction between absorption and screen size in the sexuality rating of the music videos.

The interpretation of environmental sustainability (ES) by the IOC/Olympic Games 1994-2008

The purpose of this qualitative multi-case study was to examine the interpretation of environmental sustainability (ES) within the Olympic 11 Movement. Two research questions guided the inquiry - first, how has the concept of ES been defined by the International Olympic Committee (lOC), and second, how has the concept of ES been defined and enacted by the Organizing Committees ofthe Olympic Games (OCOGs)? During the past two decades, the International Olympic Committee (lOC) established several policies and programs related to ES. Its actions reflect a broader trend of environmentalism within economic and social spheres around the world (Milton-Smith, 2002). Despite the numerous initiatives, the Olympic Games continue to cause significant environmental damage. Frey, et al. (2007) argued that the Olympic Movement contradicts the fundamental premises of ES because the Games are hosted in a two week time period, are situated in a confined area, and accumulate operating and infrastructure costs in the billions of dollars. Further, Etzion (2007) stated "there is positive and significant correlation between firm siz~ and environmental performance" (p. 642) and in the context of the Olympics the sizeimpact relation is striking. Since 1972, the year the UN launched its international environmental awareness efforts, the Summer Olympics grew to 201 nations (39% increase), 10,500 athletes (32% increase), 28 sports (30% increase), and 302 events (43% increase) (Johnson, 2004; Girginov & Parry, 2005; Upegui, 2008). The proliferation of Games activities counters the ES principles that exist within many of the IOC declarations, policies and programs.

Metaphorical Interpretation: Measuring and Facilitating Growth.

Abstract A total of 378 grade 9 students participated in this study to address the problem that although metaphorical literacy and thought are expected and necessary for success in junior and senior high school and beyond, metaphorical concepts and thought are not required to be explicitly taught to these students. The students were from 20 different classes from 4 levels: English language learners (ELL), school to work (SSTW), applied, and academic. All were from 7 secondary schools within a board in southern Ontario. Nine classes made up the control group and 11 classes made up the treatment group. All classes were given 3 pretests and the posttest. The treatment group was given Socratic lessons and direct instruction on metaphorical thought and expressions during 1 semester and in conjunction with their other classroom material. The pretest scores (TOLD, Peabody, preproverbs concrete, and preproverbs abstract) did not reveal any effect of gender, but the academic students had higher scores than the applied students. The SSTW student results are more variable: (a) for the TOLD test, SSTW scores were between those of the academic and applied students; (b) for Peabody scores, SSTW students’ scores are the same as academic and are greater than applied; (c) for preproverbs concrete and preproverbs abstract, the SSTW scores are not different from the applied scores. The postproverbs concrete and postproverbs abstract scores for the treatment groups also showed no effect of gender but revealed that all students who received the treatment did better on their post scores. The positive changes of the treatment group illustrate a measured movement from literal understanding to abstract understanding using direct Socratic instruction and proverbs as a medium.

The constitution of the United States, a critical discussion of it'sgenesis, development, and interpretation

UANL

Regulatory History Material as an Extrinsic Aid to Interpretation: An Empirical Study on the Use of RIAS by the Federal Court of Canada

Since 1986, the Canadian Public Administration is required to analyze the socio-economic impact of new regulatory requirements or regulatory changes. To report on its analysis, a Regulatory Impact Analysis Statement (RIAS) is produced and published in the Canada Gazette with the proposed regulation to which it pertains for notice to, and comments by, interested parties. After the allocated time for comments has elapsed, the regulation is adopted with a final version of the RIAS. Both documents are again published in the Canada Gazette. As a result, the RIAS acquires the status of an official public document of the Government of Canada and its content can be argued in courts as an extrinsic aid to the interpretation of a regulation. In this paper, an analysis of empirical findings on the uses of this interpretative tool by the Federal Court of Canada is made. A sample of decisions classified as unorthodox show that judges are making determinations on the basis of two distinct sets of arguments built from the information found in a RIAS and which the author calls “technocratic” and “democratic”. The author argues that these uses raise the general question of “What makes law possible in our contemporary legal systems”? for they underline enduring legal problems pertaining to the knowledge and the acceptance of the law by the governed. She concludes that this new interpretive trend of making technocratic and democratic uses of a RIAS in case law should be monitored closely as it may signal a greater change than foreseen, and perhaps an unwanted one, regarding the relationship between the government and the judiciary.

Statutory, judicial, and administrative stays in immigration matters

La grande majorité des causes tranchées par la Cour fédérale relève du droit de l’immigration. Environ 80% des causes plaidées devant la Cour fédérale sont en matière d’immigration. La plupart des causes qui se rendent à la Cour fédérale aboutissent au renvoi de la personne concernée. La requête en sursis est généralement le dernier recours que la personne peut exercer afin d’éviter ou à tout le moins retarder son renvoi du Canada. Près de 800 de ces requêtes en sursis ont été décidées par la Cour fédérale en 2008. Malgré un si grand nombre de causes et malgré le rôle important que ces requêtes peuvent jouer dans la vie d’une personne, aucun auteur n’a organisé et présenté les règles législatives et jurisprudentielles qui s’appliquent à ces procédures. Aucun livre, article ou commentaire n’a été rédigé sur ce sujet. De même, il n’existe aucun cours d’université ni de formations professionnelles sur les requêtes en sursis. Le droit des sursis consiste exclusivement de la jurisprudence des cours fédérales. Ainsi, on s’attend à ce qu’un avocat prépare une requête en sursis intuitivement. Toutefois, à cause de la nature urgente de cette procédure, il est pratiquement impossible pour un avocat inexpérimenté de se préparer adéquatement et de bien représenter les intérêts de son client. Beaucoup de causes ayant un fort potentiel sont perdues par manque d’expérience de l’avocat ou à cause d’une préparation inadéquate. La jurisprudence émanant de la Cour fédérale relativement aux sursis semble être incohérente et parfois même contradictoire. Ce livre organise, présente et explique de façon claire et concise le droit des sursis. Plus particulièrement, nous examinerons en détail les trois types de sursis – les sursis législatifs, administratifs et judiciaires. Tant les juges que les plaideurs trouveront cet ouvrage de référence utile dans la préparation et l’adjudication des causes.

Conceptions of God and narratives of modernity : a hermeneutical interpretation of Charles Taylor's A Secular Age

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Le formalisme du contrat électronique dans l’ASEAN : définition et interprétation des notions d’écrit et de signature

Plus de dix ans après la mise en place du projet d’harmonisation du droit du commerce électronique, l’ASEAN, « The Association of Southeast Asian Nations » rassemblant dix États membres en Asie du Sud-est, n’arrive toujours pas à doter chacun de ses États membres d’une législation harmonisée en la matière. Dans cette optique, nous tenterons, pour contribuer à cette harmonisation, de démontrer la situation problématique relative au droit du commerce électronique dans six des dix États membres de l’ASEAN où, en plus de leur non-uniformité législative, les textes nationaux régissant le formalisme du contrat électronique demeurent difficiles à comprendre, à interpréter et donc à appliquer ; ce qui cause parfois des erreurs interprétatives voire l’oubli total de ces textes. Cette expérience n’est pas unique dans l’ASEAN, car l’on trouve également de similaires situations dans d’autres juridictions, telles que le Canada et les États-Unis. Pour pallier cette rupture entre la loi et la jurisprudence, nous proposons une quête d’une méthode d’interprétation comme une piste de solution qui nous semble la plus pertinente au regard de l’état des textes déjà en vigueur et de l’objectif de l’harmonisation du droit du commerce électronique dans l’ASEAN. Parmi les méthodes interprétatives très variées, nous arrivons à identifier la méthode contextuelle, aussi large soit-elle, comme la méthode la plus pertinente eu égard aux caractéristiques particulières du formalisme du contrat électronique, à savoir l’écrit et la signature électroniques. Nous proposons donc une grille d’analyse de cette méthode composée de contextes juridique, technique et social, qui aideront les juristes, surtout les juges, à mieux saisir le sens des textes et à leur donner « une meilleure interprétation » en faveur de l’objectif de l’harmonisation du droit dans l’ASEAN.