Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol.

AIM: To present a protocol for a multi-phase study about the current practice of end-of-life care in paediatric settings in Switzerland. BACKGROUND: In Switzerland, paediatric palliative care is usually provided by teams, who may not necessarily have specific training. There is a lack of systematic data about specific aspects of care at the end of a child's life, such as symptom management, involvement of parents in decision-making and family-centred care and experiences and needs of parents, and perspectives of healthcare professionals. DESIGN: This retrospective nationwide multicentre study, Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN), combines quantitative and qualitative methods of enquiry. METHODS: The PELICAN study consists of three observational parts, PELICAN I describes practices of end-of-life care (defined as the last 4 weeks of life) in the hospital and home care setting of children (0-18 years) who died in the years 2011-2012 due to a cardiac, neurological or oncological disease, or who died in the neonatal period. PELICAN II assesses the experiences and needs of parents during the end-of-life phase of their child. PELICAN III focuses on healthcare professionals and explores their perspectives concerning the provision of end-of-life care. CONCLUSION: This first study across Switzerland will provide comprehensive insight into the current end-of-life care in children with distinct diagnoses and the perspectives of affected parents and health professionals. The results may facilitate the development and implementation of programmes for end-of-life care in children across Switzerland, building on real experiences and needs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01983852.

Transición a la vida adulta de jóvenes con discapacidad intelectual. La opinión de los profesionales de servicios escolares y postescolares = Transition to adulthood of young people with intellectual disabilities. Views of professionals from school and postschool services

La transición a la edad adulta y vida activa es un proceso extremadamente complejo para los jóvenes con discapacidad. Para plantear propuestas de actuación que mejoren sus oportunidades de conseguir objetivos relacionados con la inclusión laboral y social en la vida adulta es imprescindible el diagnóstico en profundidad del contexto en que se construyen y desarrollan los procesos de transición. En este artículo se presenta un estudio en el que se ha aplicado el método Delphi con el propósito de obtener datos sobre la adecuación de los servicios o dispositivos que trabajan con jóvenes con discapacidad a lo largo de su proceso de transición a la edad adulta y vida activa, tanto en el escenario escolar como en el postescolar. Se han constituido dos paneles de expertos, uno con profesionales del ámbito educativo y otro con profesionales que trabajan en servicios postescolares. En ambos casos, los ejes temáticos son: visión del proceso de transición, aspectos curriculares y organizativos de los servicios, existencia de itinerarios de apoyo sistematizados, trabajo colaborativo entre profesionales, acciones de orientación con familias, adecuación de las alternativas postescolares, la formación de los profesionales, y coordinación de servicios. El análisis de los cuestionarios permite constatar las principales dificultades percibidas por los expertos en cada uno de los ámbitos y establece líneas básicas de actuación para mejorar los procesos de tránsito, entre las cuales destaca la necesidad de reforzar el papel de los equipos multiprofesionales en la articulación de redes de trabajo interprofesional

Trajectory and predictors of quality of life in first episode psychotic mania.

BACKGROUND: Little is known about the trajectory of quality of life (QoL) following a first episode of psychotic mania in bipolar disorder (BD). This 18-month longitudinal study investigated the trajectory of QoL, and the influence of premorbid adjustment and symptoms on 18-month QoL in a cohort of young people experiencing a first episode of psychotic mania. METHODS: As part of an overarching clinical trial, at baseline, sixty participants presenting with a first episode of psychotic mania (BD Type 1 - DSM-IV) completed symptomatic and functional assessments in addition to the Premorbid Adjustment Scale - General Subscale. Symptom measures were repeated at 18-month follow up. QoL was rated using the Quality of Life Scale (QLS) at designated time points. RESULTS: Mean QLS scores at initial measurement (8 weeks) were 61% of the maximum possible score, increasing significantly to 70% at 12 months, and 71.2% at 18-month follow-up. Premorbid adjustment and 18-month depressive symptoms were significantly associated with QoL at 18-month follow-up. LIMITATIONS: Study limitations include the small sample size, inclusion of participants with psychotic mania only, use of measures originally designed for use with schizophrenia spectrum disorders, and lack of premorbid or baseline measurement of QoL. CONCLUSIONS: Results suggest that QoL can be maintained early in BD, and reinforce the importance of assertively treating depressive symptoms throughout the course of this disorder. The emergence of a link between premorbid adjustment and poorer QoL in this cohort highlights the importance of assessing facets of adjustment when planning psychological interventions.

The process of basic training, applied training, maintaining the performance of an observer

In the field of observational methodology the observer is obviously a central figure, and close attention should be paid to the process through which he or she acquires, applies, and maintains the skills required. Basic training in how to apply the operational definitions of categories and the rules for coding, coupled with the opportunity to use the observation instrument in real-life situations, can have a positive effect in terms of the degree of agreement achieved when one evaluates intra- and inter-observer reliability. Several authors, including Arias, Argudo, & Alonso (2009) and Medina and Delgado (1999), have put forward proposals for the process of basic and applied training in this context. Reid y De Master (1982) focuses on the observer's performance and how to maintain the acquired skills, it being argued that periodic checks are needed after initial training because an observer may, over time, become less reliable due to the inherent complexity of category systems. The purpose of this subsequent training is to maintain acceptable levels of observer reliability. Various strategies can be used to this end, including providing feedback about those categories associated with a good reliability index, or offering re-training in how to apply those that yield lower indices. The aim of this study is to develop a performance-based index that is capable of assessing an observer's ability to produce reliable observations in conjunction with other observers.

Ações de divulgação de química na Casa da Descoberta - centro de divulgação de ciência da Universidade Federal Fluminense

This paper describes the main activities regarding scientific dissemination in the field of Chemistry at Casa da Descoberta (CD) - a Scientific Dissemination Center of the Fluminense Federal University. It presents a brief history of CD and discusses the difficulties concerning the dissemination of Chemistry at Scientific Dissemination Centers. This work also approaches some activities developed throughout the years: experiments performed in relation to the visitors' daily life, training of monitors to act as mediators in the non-formal teaching of Chemistry, production of dissemination materials, elaboration of books, as well as activities that relate formal to non-formal education.

Resa i röstens landskap : en narrativ studie av hur lärare blir professionella röstanvändare

The theme of this thesis is the learning process that occurs when teachers become professional voice users. The aim is to explore what it (really) means to become a professional voice user in a teaching profession; thereby developing an understanding of how future education in this field can be arranged so as to both effectively prevent vocal problems and to develop oral didactical competence among teachers. The ambition is to describe, interpret, and understand the learning process through a combination of emic and ethic research perspectives. The theoretical frame of reference reflects the cross disciplinary character of the thesis. Voice problems are common among both student teachers and inservice teachers and adversely affect professional competence, identity and quality of life. Additionally, vocal problems are proven to have a negative impact on pupils´ learning. The individual elements of learning are explored in the light of experiential learning theory and transformative learning theory. The social elements of learning are explored in relation to the theory of situated learning. In addition, theories of teacher professionalisation in terms of competence and identity are outlined. The empirical study has a longitudinal and multi method character. It is anchored in a phenomenological hermeneutical tradition, more specifically in narrative inquiry. The point of departure is the learning experiences of ten student teachers, who attended a ten week long course on voice production as part of their teacher training at Åbo Akademi University, in the autumn of 2002 and the spring of 2003. Four interviews in the form of conversations were conducted with each participant. These were crystallised with a process diary, a Swedish Voice Handicap Index, a voice observation, and a video observation. A fifth interview was conducted with each participant five years post teacher training, in the spring of 2008. Participant observation was also conducted throughout the course. The research materials have been analysed and interpreted narratively using a phenomenological hermeneutical method. The results are presented descriptively as individual narratives, which are reflected in logopedic research materials. Learning is here understood as emergent awareness. This is followed by a meta narrative concerning learning as experiences in the four dimensions body, thought, feeling, and relation. Finally, interpretation is expressed with respect to the theory of relational education. Learning is here understood as a movement in the field between the actual and the possible voice. It is also viewed as fundamentally rooted in inter-human relationships, in moments of presence and coexistence. As a tentative answer to the call for an existential space for learning in order to be a professional voice user, I suggest the concept of a learning refuge as a locus for a learning process built on trust, mutuality and openness.

The holistic military capability life cycle model

Abstract - This paper reviews existing military capability models and the capability life cycle. It proposes a holistic capability life-cycle model (HCLCM) that combines capability systems with related capability models. ISO 15288 standard is used as a framework to construct the HCLCM. The HCLCM also shows how capability models and systems relate to each other throughout the capability life cycle. The main contribution of this paper is conceptual in nature. The model complements the existing, but still evolving, understanding of the military capability life cycle in a holistic and systemic way. The model also increases understanding and facilitates communication among various military capability stakeholders.

Cardiorespiratory adaptations induced by aerobic training in middle-aged men: the importance of a decrease in sympathetic stimulation for the contribution of dynamic exercise tachycardia

We investigated the effects of aerobic training on the efferent autonomic control of heart rate (HR) during dynamic exercise in middle-aged men, eight of whom underwent exercise training (T) while the other seven continued their sedentary (S) life style. The training was conducted over 10 months (three 1-h sessions/week on a field track at 70-85% of the peak HR). The contribution of sympathetic and parasympathetic exercise tachycardia was determined in terms of differences in the time constant effects on the HR response obtained using a discontinuous protocol (4-min tests at 25, 50, 100 and 125 watts on a cycle ergometer), and a continuous protocol (25 watts/min until exhaustion) allowed the quantification of the parameters (anaerobic threshold, VO2 AT; peak O2 uptake, VO2 peak; power peak) that reflect oxygen transport. The results obtained for the S and the T groups were: 1) a smaller resting HR in T (66 beats/min) when compared to S (84 beats/min); 2) during exercise, a small increase in the fast tachycardia (D0-10 s) related to vagal withdrawal (P<0.05, only at 25 watts) was observed in T at all powers; at middle and higher powers a significant decrease (P<0.05 at 50, 100 and 125 watts) in the slow tachycardia (D1-4 min) related to a sympathetic-dependent mechanism was observed in T; 3) the VO2 AT (S = 1.06 and T = 1.33 l/min) and VO2 peak (S = 1.97 and T = 2.47 l/min) were higher in T (P<0.05). These results demonstrate that aerobic training can induce significant physiological adaptations in middle-aged men, mainly expressed as a decrease in the sympathetic effects on heart rate associated with an increase in oxygen transport during dynamic exercise.

Effect of training on the ability of dual-task coordination

Within the framework of the working memory model proposed by A. Baddeley and G. Hitch, a dual-task paradigm has been suggested to evaluate the capacity to perform simultaneously two concurrent tasks. This capacity is assumed to reflect the functioning of the central executive component, which appears to be impaired in patients with dysexecutive syndrome. The present study extends the investigation of an index ("mu"), which is supposed to indicate the capacity of coordination of concurrent auditory digit span and tracking tasks, by testing the influence of training on the performance in the dual task. The presentation of the same digit sequence lists or always-different lists did not differently affect the performance. The span length affected the mu values. The improved performance in the tasks under the dual condition closely resembled the improvement in the single-task performance. So, although training improved performance in the single and dual conditions, especially for the tracking component, the mu values remained stable throughout the sessions when the single tasks were performed first. Conversely, training improved the capacity of dual-task coordination throughout the sessions when dual task was performed first, addressing the issue of the contribution of the within-session practice to the mu index.

Swimming training increases cardiac vagal activity and induces cardiac hypertrophy in rats

The effect of swimming training (ST) on vagal and sympathetic cardiac effects was investigated in sedentary (S, N = 12) and trained (T, N = 12) male Wistar rats (200-220 g). ST consisted of 60-min swimming sessions 5 days/week for 8 weeks, with a 5% body weight load attached to the tail. The effect of the autonomic nervous system in generating training-induced resting bradycardia (RB) was examined indirectly after cardiac muscarinic and adrenergic receptor blockade. Cardiac hypertrophy was evaluated by cardiac weight and myocyte morphometry. Plasma catecholamine concentrations and citrate synthase activity in soleus muscle were also determined in both groups. Resting heart rate was significantly reduced in T rats (355 ± 16 vs 330 ± 20 bpm). RB was associated with a significantly increased cardiac vagal effect in T rats (103 ± 25 vs 158 ± 40 bpm), since the sympathetic cardiac effect and intrinsic heart rate were similar for the two groups. Likewise, no significant difference was observed for plasma catecholamine concentrations between S and T rats. In T rats, left ventricle weight (13%) and myocyte dimension (21%) were significantly increased, suggesting cardiac hypertrophy. Skeletal muscle citrate synthase activity was significantly increased by 52% in T rats, indicating endurance conditioning. These data suggest that RB induced by ST is mainly mediated parasympathetically and differs from other training modes, like running, that seems to mainly decrease intrinsic heart rate in rats. The increased cardiac vagal activity associated with ST is of clinical relevance, since both are related to increased life expectancy and prevention of cardiac events.

Can course format influence the performance of students in an advanced cardiac life support (ACLS) program?

Advanced cardiac life support (ACLS) is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003) and Model 2 (N = 2085; 2003-2007). Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given). Compared to Model 1, Model 2 presented odds ratios (OR) indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64), practical (OR = 1.19; 95%CI = 0.90-1.57), and combined (OR = 1.38; 95%CI = 1.13-1.68) outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students.

Shelf life of irradiated minimally processed (MP) watercress (Nasturtium officinale)

This study was carried out to evaluate the shelf life of minimally processed (MP) watercress exposed to gamma radiation with doses of 1.0; 3.0; 4.0 kGy. Packaged irradiated and non-irradiated MP watercress was subject to sensory analysis. A panel consisting of 25-30 non-trained members, aged 20-55 years, was used. Sensory evaluation was carried out on days 0, 2, 5, 7, 9 and 12 after treatment with packages maintained at 7 °C. The members of the panel rated each sample for overall liking on a hybrid 10 hedonic scale (0 = extremely dislike; 10 = extremely like). Microbiological analyses were also conducted. Compared to the non-irradiated sample, 1 kGy irradiated watercress increased its shelf life by one day (16 days). Shelf lives of samples exposed to higher doses were reduced to 9 days (3 kGy) and 6 days (4 kGy) due to changes in appearance. The microbiological quality was good throughout the experiment.

Applying life cycle management of colombian cocoa production

The present research aims to evaluate the usefulness of the application of Life Cycle Management in the agricultural sector focusing on the environmental and socio-economic aspects of decision making in the Colombian cocoa production. Such appraisal is based on the application of two methodological tools: Life Cycle Assessment, which considers environmental impacts throughout the life cycle of the cocoa production system, and Taguchi Loss Function, which measures the economic impact of a process' deviation from production targets. Results show that appropriate improvements in farming practices and supply consumption can enhance decision-making in the agricultural cocoa sector towards sustainability. In terms of agri-business purposes, such qualitative shift allows not only meeting consumer demands for environmentally friendly products, but also increasing the productivity and competitiveness of cocoa production, all of which has helped Life Cycle Management gain global acceptance. Since farmers have an important role in improving social and economic indicators at the national level, more attention should be paid to the upgrading of their cropping practices. Finally, one fundamental aspect of national cocoa production is the institutional and governmental support available for farmers in face of socio-economic or technological needs.

Item-level life-cycle model for maintenance network – from cost to additional value

The importance of industrial maintenance has been emphasized during the last decades; it is no longer a mere cost item, but one of the mainstays of business. Market conditions have worsened lately, investments in production assets have decreased, and at the same time competition has changed from taking place between companies to competition between networks. Companies have focused on their core functions and outsourced support services, like maintenance, above all to decrease costs. This new phenomenon has led to increasing formation of business networks. As a result, a growing need for new kinds of tools for managing these networks effectively has arisen. Maintenance costs are usually a notable part of the life-cycle costs of an item, and it is important to be able to plan the future maintenance operations for the strategic period of the company or for the whole life-cycle period of the item. This thesis introduces an itemlevel life-cycle model (LCM) for industrial maintenance networks. The term item is used as a common definition for a part, a component, a piece of equipment etc. The constructed LCM is a working tool for a maintenance network (consisting of customer companies that buy maintenance services and various supplier companies). Each network member is able to input their own cost and profit data related to the maintenance services of one item. As a result, the model calculates the net present values of maintenance costs and profits and presents them from the points of view of all the network members. The thesis indicates that previous LCMs for calculating maintenance costs have often been very case-specific, suitable only for the item in question, and they have also been constructed for the needs of a single company, without the network perspective. The developed LCM is a proper tool for the decision making of maintenance services in the network environment; it enables analysing the past and making scenarios for the future, and offers choices between alternative maintenance operations. The LCM is also suitable for small companies in building active networks to offer outsourcing services for large companies. The research introduces also a five-step constructing process for designing a life-cycle costing model in the network environment. This five-step designing process defines model components and structure throughout the iteration and exploitation of user feedback. The same method can be followed to develop other models. The thesis contributes to the literature of value and value elements of maintenance services. It examines the value of maintenance services from the perspective of different maintenance network members and presents established value element lists for the customer and the service provider. These value element lists enable making value visible in the maintenance operations of a networked business. The LCM added with value thinking promotes the notion of maintenance from a “cost maker” towards a “value creator”.

Training distribution and the acquisition of maximal isometric elbow flexion strength

Twenty-six sedentary, college-aged females were matched and randomly assigned to one of two groups. The massed group (n=13) completed 15 maximal isometric elbow flexion strength trials in one session, while the distributed group (n=13) performed five such contractions on three successive days. After a two-week and three month rest interval, both groups returned to perfonn another five maximal isometric elbow flexion strength trials to assess retention of any potential strength gains. Elbow flexion torque and surface electromyography (SEMG) of the biceps and triceps were monitored concurrently. There was a significant (P < 0.05) increase in strength in both groups from block one (first five contractions) to block four (first retest) and from block one to block five (second retest). Both groups exhibited a similar linear increasing (P < 0.05) trend in biceps root-mean-square (RMS) SEMG amplitude. A significant (P < 0.05) decrease in triceps RMS SEMG amplitude was found between block one and block four for the distributed group. However, a significant (P < 0.05) increase was then found between block one and five for the massed group, and between blocks four and five for distributed group. These results suggest that there is flexibility in resistive exercise schedules. An increase in neural drive to the agonist muscle continued throughout testing. This was accompanied by a reduction in antagonist co activation that was a short-tenn (two weeks) training effect, dissipated over the longer rest interval (three months).