Author response: "Missed opportunity related to statistical methods"

"We thank MrGilder for his considered comments and suggestions for alternative analyses of our data. We also appreciate Mr Gilder’s support of our call for larger studies to contribute to the evidence base for preoperative loading with high-carbohydrate fluids..."

Traversing the space between threats and violence: A review of threat assessment guidelines

While the majority of violent threats – defined as an expression of intent to do harm or act out violently against someone or something – do not progress to actual violence, a small proportion of threateners do go on to enact violence. Most researchers argue that violence risk assessments are inadequate for assessing threats of violence, which raises the question: how should a threat assessment (TA) be conducted? To begin to understand available frameworks for assessing threats, a systematic review of TA research literature was conducted. Most TA literature pertains to a specific domain (schools, public figure threats, workplaces) and target audience (clinicians, school personnel, law enforcement). TA guidelines are typically based on literature reviews with some based on empirical measures and others having no strong evidential basis. The most common concepts in TA are exploration of the threatener's mental health, the motivation for the threat and the presence of any plans. Rather than advocating for the development of a protocol for conducting TA, this article outlines the common areas of inquiry in assessing threats and highlights the limitations of current TA guidelines.

Current Care Guidelines for Cardiopulmonary Resuscitation : Implementation, skills and attitudes

Background: The national resuscitation guidelines were published in Finland in 2002 and are based on international guidelines published in 2000. The main goal of the national guidelines, available on the Internet free of charge, is early defibrillation by nurses in an institutional setting. Aim: To study possible changes in cardiopulmonary resuscitation (CPR) practices, especially concerning early defibrillation, nurses and students attitudes of guideline implementation and nurses and students ability to implement the guideline recommendations in clinical practices after publication of the Current Care (CC) guidelines for CPR 2002. Material and methods: CPR practices in Finnish health centres; especially concerning rapid defibrillation programmes, as well as the implementation of CC guidelines for CPR was studied in a mail survey to chief physicians of every health centre in Finland (Study I). The CPR skills using an automated external defibrillator (AED) were compared in a study including Objective stuctured clinical examination (OSCE) of resuscitation skills of nurses and nursing students in Finnish and Swedish hospital and institution (Studies II, III). Attitudes towards CPR-D and CPR guidelines among medical and nursing students and secondary hospital nurses were studied in surveys (Studies IV, V). The nurses receiving different CPR training were compared in a randomized trial including OSCE of CPR skills of nurses in Finnish Hospital (Study VI). Results: Two years after the publication, 40.7% of Finnish health centres used national resuscitation guidelines. The proportion of health centres having at least one AED (66%) and principle of nurse-performed defibrillation without the presence of a physician (42%) had increased. The CPR-D training was estimated to be insufficient regarding basic life support and advanced life support in the majority of health centres (Study I). CPR-D skills of nurses and nursing students in two specific Swedish and Finnish hospitals and institutions (Study II and III) were generally inadequate. The nurses performed better than the students and the Swedish nurses surpassed the Finnish ones. Geriatric nurses receiving traditional CPR-D training performed better than those receiving an Internet-based course but both groups failed to defibrillate within 60 s. Thus, the performance was not satisfactory even two weeks after traditional training (Study VI). Unlike the medical students, the nursing students did not feel competent to perform procedures recommended in the cardiopulmonary resuscitation guidelines including the defibrillation. However, the majority of nursing students felt confident about their ability to perform basic life support. The perceived ability to defibrillate correlated significantly with a positive attitude towards nurse-performed defibrillation and negatively with fear of damaging the patient s heart by defibrillation (Study IV). After the educational intervention, the nurses found their level of CPR-D capability more sufficient than before and felt more confident about their ability to perform defibrillation themselves. A negative attitude toward defibrillation correlated with perceived negative organisational attitudes toward cardiopulmonary resuscitation guidelines. After CPR-D education in the hospital, the majority (64%) of nurses hesitated to perform defibrillation because of anxiety and 27 % hesitated because of fear of injuring the patient. Also a negative personal attitude towards guidelines increased markedly after education (Study V). Conclusions: Although a significant change had occurred in resuscitation practices in primary health care after publication of national cardiopulmonary resuscitation guidelines the participants CPR-D skills were not adequate according to the CPR guidelines. The current way of teaching is unlikely to result in participants being able to perform adequate and rapid CPR-D. More information and more frequent training are needed to diminish anxiety concerning defibrillation. Negative beliefs and attitudes toward defibrillation affect the nursing students and nurses attitudes toward cardiopulmonary resuscitation guidelines. CPR-D education increased the participants self-confidence concerning CPR-D skills but it did not reduce their anxiety. AEDs have replaced the manual defibrillators in most institutions, but in spite of the modern devices the anxiety still exists. Basic education does not provide nursing students with adequate CPR-D skills. Thus, frequent training in the workplace has vital importance. This multi-professional program supported by the administration might provide better CPR-D skills. Distance learning alone cannot substitute for traditional small-group learning, tutored hands-on training is needed to learn practical CPR-D skills. Standardized testing would probably help controlling the quality of learning. Training of group-working skills might improve CPR performance.

Arvoja näkyvissä : Kaunokirjallisuuden etiikka Ludwig Wittgensteinin filosofian valossa

The goal of this dissertation was to study whether it is possible and meaningful to apply Ludwig Wittgenstein s distinction between saying (Sagen) and showing (Zeigen) to ethically oriented literary criticism. The following questions were used as the primary guidelines: 1. Is it possible, in the context of literary criticism, to put in practice Wittgenstein s ethical conceptions, which are quite theoretical and metaphysical by nature? 2. If so, what practical literary devices do authors use if they want to demonstrate their ethical values within the frame of a fictional work? 3. Does philosophy offer useful ethical consepts that open us new and interesting readings in fiction? The philosophical background of Wittgenstein s distinction is clarified in chapter I. This clarification is based on his main works, Tractatus logico-philosophicus and Philosophishe Untersuchungen, the published correspondence between Wittgenstein and Paul Engelmann, and selected Wittgenstein research and papers. Analyzing ethics and it s expression in Georg Trakl s poetry further elucidates Wittgenstein s concept of showing. The concept that a literary work is an act of an author was used as a starting point. The presumption was that analyzing this act of an author will reveal how ethical values can be demonstrated in literature. Categorizing an author s act at different levels of literary expression provides the structure of this study. In chapters IV - XIII literary devices useful for demonstrating ethics are examined and explained using examples from the works of Joseph Conrad, Charles Dickens, Nikolay Leskov, Ludwig Uhland, Eino Leino, Pentti Haanpää and Maria Jotuni. The concepts and views of researchers and writers such as Mihail Bahtin, Peter Juhl, E. D. Hirsch, Peter Lamarque and Stein Haugom Olsen are used. The concepts outlined in previous chapters are then applied in three case studies: Aeschylus s Oresteia trilogy, J-L. Runeberg s poem Sven Dufva and Sofi Oksanen s novel Puhdistus (Purge). On the whole, Wittgenstein s idea that ethical values can be demonstrated (shown) by means of literature is revealed as a fruitful point of departure for a more exact ethical reading, offering a new perspective on literary works.

Coro celeste a quatro vozes : vida musica em solfa metrica, da esclarecida, augustiniana, beata Rita : advogada poderosa dos impossiveis com hum ramilhete de seus milagres, colhido na floresta das suas virtudes, com hum encomio mais a mesma Santa, e um periodo Latino a sua morte, com que a devoção obsequiosa do author coroa o livro : offerecido ao senhor Sylvestre Peyxoto da Silva / author Luís Botelho Froes de Figueyredo, philosopho, canonista, natural de Villa de Santarem

Luis Botelho Fróis de Figueiredo nasceu em Santarém, em 1675, e morreu em Alicante, Espanha, em 1720. Estudou direito canônico e filosofia na Universidade de Coimbra.

Eneida portugueza : que contem os primeiros seis livros de Virgilio : seu author João Franco Barreto, natural da cidade de Lisboa : com argumentos de Cosmo Ferreira de Brum, e com o Diccionario de todos os nomes proprios, e fabulas, que nestes seis livros de Virgilio se contem, e a explicação delles, para melhor intelligencia do poeta

João Franco Barreto, escritor português, nasceu em Lisboa em 1600, ignorando-se a data de sua morte. Em 1624, integrou expedição de libertação da Bahia das mãos dos holandeses. Ao regressar a Portugal dedicou-se às letras: escreveu obras como ‘Cyparisso’, ‘Biblioteca Portuguesa’, ‘Ortografia portuguesa’; traduziu a Eneida, de Virgílio; e dirigiu a edição de um Dicionário dos nomes próprios que se encontram nos Lusíadas de Luis de Camões. Segundo Inocêncio, essa tradução de Barreto, publicada em 1763, corresponde à segunda edição, ainda que esta informação não figure no corpo da obra, e ‘seja em demasia parafrástica, e que muitas vezes não reproduza fielmente o sentido do original, em razão das dificuldades da rima, a que o tradutor quis sujeitar-se, todavia, a pureza e correção de linguagem com que foi escrita juntas à louçania do estilo, e a uma versificação quase sempre fluida e harmoniosa, fazem e farão sempre com que este trabalho não seja de todo esquecido, apesar de terem aparecido depois outras versões sem dúvida mais perfeitas’. A coleção, dividida em dois volumes, traz os livros I a Vl e VII a XII. A primeira parte, que corresponde à ‘Odisséia’, narra as viagens de Enéas até a sua chegada à Itália. A segunda, a exemplo da ‘llíada’, descreve as guerras pela conquista do Lácio até a fundação do reino de Lavinio.

Designing Spaces for Effective Learning: A guide to 21st century learning space design

Increasing investment in estate and learning technologies, combined with the need for more cost-effective space utilisation, is making it increasingly important for senior managers to keep abreast of new thinking about the design of technology-rich learning spaces. Designing Spaces for Effective Learning, one of a series of guides, was launched at the JISC Conference 2006 which helped to meet this need. A visually-rich publication, it was designed to promote better understanding of what makes an effective design for the 21 century and to summarise the key points to consider when approaching a refurbishment or new-build project. The publication takes the reader on a ’walk through’ an educational institution, exploring the relationship between learning technologies and innovative examples of physical space design at each stage of the journey. Discussion of the key points is illustrated by ten case studies from further and higher education, and floor plans from AMA Alexi Marmot Associates, architects and space planners, which provide up-to-date guidelines on the integration of technologies into teaching and learning accommodation.