False memories for end-of-life decisions

Objective: To examine people’s false memories for end-of-life decisions. Design: In Study 1, older adults decided which life-sustaining treatments they would want if they were seriously ill. They made these judgments twice, approximately 12 months apart. At Time 2, older adults and their self-selected surrogate decision makers tried to recall the older adults’ Time 1 decisions. In Study 2, younger adults made treatment decisions twice, approximately 4 months apart. At Time 2, younger adults tried to recall their Time 1 decisions. Main Outcome Measures: Percentage of participants who falsely remembered that their original treatment decisions were the same as their current decisions. Results: In Study 1, older adults falsely remembered that 75% of their original decisions were the same as their current decisions; surrogates falsely thought that 86% of older adults’ decisions were the same. In Study 2, younger adults falsely remembered that 69% of their original decisions were the same as their current decisions. Conclusion: Age alone cannot account for people’s false memories of their end-of-life decisions; we discuss other mechanisms. The results have practical implications for policies that encourage people to make legal documents specifying their end-of-life treatment decisions.

Current negative mood encourages changes in end-of-life treatment decisions and is associated with false memories

To investigate the effects of mood on people’s end-of-life treatment decisions and their false memories of those decisions, participants took part in two sessions. At Time 1, participants were experimentally induced into positive or negative moods. They decided whether they would want to receive or refuse treatments in a range of hypothetical medical scenarios, such as tube feeding while in a coma. Four weeks later, at Time 2, participants were induced into the same or the opposite mood and made these decisions a second time. They also recalled their previous decisions. Participants in negative moods at Time 2 changed more of their current decisions and falsely remembered more of their previous decisions than participants in positive moods. These findings suggest that people’s current moods influence whether they change their treatment decisions; current decisions in turn bias recall of past decisions

Power, influence and intranet implementation : a safari of South African organizations

Intranets hold great promise as ``organizational Internets'' to allow information sharing and collaboration across departments, functions and different information systems within an organization. Yet not much is known about how to implement intranets. We adapt a taxonomy based on institutional theory and distinguish six broad diffusion drivers that might be considered to sustain the implementation process. An exploratory field study of four intranet implementations was conducted to analyze which drivers were used and the results that were yielded. We draw several conclusions. First, all six drivers were deployed in the analyzed cases. Second, the choice of drivers varied with the level of the intranet (corporate or unit), the implementation stage, and existing organizational practices and contingencies. Third, it seems that the critical drivers are knowledge building, subsidy and mobilization in the early stages of implementation. In the later stages knowledge deployment, subsidy and innovation directives were most commonly used.

Changing teaching practice using a school improvement cycle

This paper discusses the actions, strategies and responses of teachers during their involvement with a short cycle school improvement model in four schools. The school improvement cycles are designed to build the leadership of principals to support teachers at an individual level through a web of decision making and practices. In these cycles, teachers are both more supported and more accountable for implementing changed classroom practices in order to bring about improved student outcomes. T he school improvement model follows a pattern of decision making and negotiation across and between layers of leadership within the network and the school, but for improvement to occur at the level of the student, the teacher’s pedagogical practices need to be r(e)negotiated to ensure that teaching practice meet the needs of the students.
However, evaluating teacher practice is risky business. Teachers can say, and believe, that their practices are providing the best for their students, but this is an area of uncertainty. Using a number of strategies including observation of teacher meetings, teacher interviews and video capture, the research will investigate the issue of how directives for change are translated into classroom practice. The observation of meetings of teachers will provide an indication of the type of change required and the proposed strategies. Video-capture, which is followed by teacher interviews, will provide further information about changing teaching practice.
With teacher permission, students in the research will also view the video snippets to indicate what particular pedagogy was instrumental in their learning, providing substantial feedback to the teacher on what works best for that cohort of students at that time. Teachers will be provided with the opportunity to reflect on and learn from their practice, using video-capture as a self-reflective tool. Teachers can employ video capture as a strategy to assess their management of students, their pedagogical approaches, teaching strategies and student responses and is an emerging area of research of interest to teachers and teacher educators (e.g. Seidel, Sturmer, Blomberg, Kobarg, Schwindt, 2011). The paper will provide examples of changed teacher practice through vignettes of a number of schools, teachers and classrooms and will explore the methodological reflexivity associated with this dual role of the research: to evaluate, and to support improvement.

Director in your pocket : holistic help for the hapless home videographer

We present a new aspect of our ongoing research aimed at providing technology for the amateur home videographer. We aim to enable the production of quality video presentations that are well structured and use the expressive properties of the medium to full effect, regardless of the technical or artistic abilities of the user. This task requires that help be given to the user at or before capture time. We use a PDA platform to deliver 3d visualizations of shot directives, instructions to the user about the type of footage to capture, and discuss issues connected with realizing high-level representations in concrete first person animations. Additionally, we discuss the mechanism for mating that metadata with captured footage and implementation issues.

(Un)ethical practices and ethical dilemmas in universities : academic leaders’ perceptions

In this paper we report on the qualitative component of a study that explored middle-level academic leaders’ experiences of (un)ethical practices and ethical dilemmas in their daily work. An electronic survey was distributed to academic leaders from universities across three Australian states. There are three major findings in this study. First, the messy context of universities is providing a fertile ground for ethical dilemmas to flourish. Second, the two main categories of unethical practices identified by participants were academic dishonesty and inappropriate behaviour towards staff and students. Third, the ethical dilemmas that emerged focused on the academic leaders’ strong sense of professional ethics that were in conflict with an ethic of care, supervisors’ directives, and the rules and policies of the organisation.

Healthy ageing: farming into the twilight

Policy directives in agriculture have long been concerned with encouraging low producing farmers to retire - with limited success. From a healthy ageing perspective, the choice to remain on the farm into advancing years could appear a desirable policy outcome. Yet as farmers age, many with little prospect of inter-generational succession, there is growing concern that some farm families are beginning to experience extraordinary isolation, reduced health and quality of life, and increasing vulnerability with seemingly no choice but to stay on the farm and soldier on. The John Richards Initiative in Aged Care in Rural Australia hosted a forum on ‘ageing farmers', where the issues of healthy ageing and the barriers to retirement were discussed from three different perspectives - the demographic and economic drivers of structural ageing in the farm sector, the cultural and identity issues underlying retirement choices of farmers and the health and well-being implications of ageing on-farm. This article brings these diverse and interdisciplinary viewpoints together to explore the challenges and options for ageing farmers, where the question may be shifting from concerns about ‘who will run the farm' to ‘who will be there to take care of me'?

Scripting, ritualising and performing leadership: interrogating recent policy developments in Australia

In this article, we argue that leadership of schools is a form of performance that has become ritualised and routinised through the official scripting of policy texts that mandate how leadership of schools should occur. Our interrogation of recent policy scripts in Australia reveals that there is limited scope for leadership in schools to occur as accountability mechanisms and policy directives codify the professional expertise that leaders are required to possess, act out and act on.

Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities

The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2–6) vs. 6 days (2–10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.

INTroducing a care bundle to prevent pressure injury (INTACT) in at-risk patients: a protocol for a cluster randomised trial

BACKGROUND: Pressure injuries are a significant clinical and economic issue, affecting both patients and the health care system. Many pressure injuries in hospitals are facility acquired, and are largely preventable. Despite growing evidence and directives for pressure injury prevention, implementation of preventative strategies is suboptimal, and pressure injuries remain a serious problem in hospitals. OBJECTIVES: This study will test the effectiveness and cost-effectiveness of a patient-centred pressure injury prevention care bundle on the development of hospital acquired pressure injury in at-risk patients. DESIGN: This is a multi-site, parallel group cluster randomised trial. The hospital is the unit of randomisation. METHODS: Adult medical and surgical patients admitted to the study wards of eight hospitals who are (a) deemed to be at risk of pressure injury (i.e. have reduced mobility), (b) expected to stay in hospital for ≥48h, (c) admitted to hospital in the past 36h; and (d) able to provide informed consent will be eligible to participate. Consenting patients will receive either the pressure injury prevention care bundle or standard care. The care bundle contains three main messages: (1) keep moving; (2) look after your skin; and (3) eat a healthy diet. Nurses will receive education about the intervention. Patients will exit the study upon development of a pressure injury, hospital discharge or 28 days, whichever comes first; transfer to another hospital or transfer to critical care and mechanically ventilated. The primary outcome is incidence of hospital acquired pressure injury. Secondary outcomes are pressure injury stage, patient participation in care and health care costs. A health economic sub-study and a process evaluation will be undertaken alongside the trial. Data will be analysed at the cluster (hospital) and patient level. Estimates of hospital acquired pressure injury incidence in each group, group differences and 95% confidence interval and p values will be reported. DISCUSSION: To our knowledge, this is the first trial of an intervention to incorporate a number of pressure injury prevention strategies into a care bundle focusing on patient participation and nurse-patient partnership. The results of this study will provide important information on the effectiveness and cost-effectiveness of this intervention in preventing pressure injuries in at-risk patients. If the results confirm the utility of the developed care bundle, it could have a significant impact on clinical practice worldwide. TRIAL REGISTRATION: This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613001343796.

Bem comum, razoabilidade prática e direito : a fundamentação do conceito de bem comum na obra de John M. Finnis

Esta dissertação expõe a fundamentação do conceito de bem comum no pensamento de JOHN MITCHELL FINNIS. Este jusfilósofo tem como ponto de partida para sua reflexão uma reinterpretação da ética tomista. Dela interessa o tratamento dado à separação das quatro ordens de conhecimento, particularmente a separação entre ordem natural e prática. A ordem prática de conhecimento tem suas próprias diretrizes. Logo, assim como na ordem natural de conhecimento a primeira diretriz é o princípio da não contradição, na ordem prática o primeiro princípio é o bem é para ser feito e buscado e o mal evitado. Estes postulados não são imperativos e nem indicativos, mas diretivos; e, no caso da ordem prática, uma diretiva para ação. A implicação epistemológica está em que a fundamentação imediata do agir humano não reside na natureza humana, mas na percepção prática de bens a serem realizados e dos males a serem evitados. Há um número determinado de bens humanos básicos, que são as razões primeiras para o agir humano. Eles são objetivos, incomensuráveis, auto-evidentes e pré-morais. O rol que FINNIS propõe é vida, conhecimento, matrimônio, excelência na realização, sociabilidade/amizade, razoabilidade prática e ‘religião’. O conteúdo da moral resulta destes bens humanos e tem como princípio supremo toda a escolha deve favorecer e respeitar o bem humano integral. Além de sintetizar a correção para o agir individual, a moral também fundamenta e demanda um agir social correto, que está expresso no conceito de bem comum. FINNIS define bem comum nos seguintes termos: um conjunto de condições que tornam aptos os membros de uma comunidade a alcançar por si mesmos objetivos razoáveis, ou realizar razoavelmente por si mesmos o(s) valor(es) pelos quais eles têm razão em colaborar uns com os outros (positiva e/ou negativamente) em uma comunidade. O conteúdo específico do bem comum da comunidade política é constituído pela justiça. O direito é o objeto da justiça e, assim, meio pelo qual o Estado a realiza e, por conseqüência, o bem comum.

Performance analysis and analysis for performance : a study of Villa-Lobos's Bachianas Brasileiras No. 9

This study of Villa-Lobos’s Bachianas Brasileiras No. 9 aims at gaining insight into the decision-making processes of translating a score into a musical performance. Chapter I presents a discussion of selected issues related to interpretative analysis. Chapter II is an overview of the approaches to recording comparison deemed relevant to the present study. Chapter III is a comparative study of the vocal and string versions of Bachianas Brasileiras No. 9, while Chapter IV offers a structural analysis of the work. Chapter V compares four recordings: the composer’s own with the Orchestre National de La Radiodiffusion Française—EMI 7243 5 66964 2 6; Odaline de la Martinez and the BBC Singers, LNT 102; Michael Tilson Thomas and the New World Symphony —RCA 09026-68538-2; and my own CD, Construção, Orquestra de Câmara Theatro São Pedro- Limited Edition (live recording made on December 11, 1995 in Bayreuth, Germany). This comparison utilizes data obtained with the software Tempo. The tabulation of these results is shown in graphs that compare how matters of tempo flexibility affect each performance. This multi-faceted study shows that although painstaking analysis can lead to insightful solutions, the fleeting nature of musical performance requires an open mind and imagination to deal with the often contradictory directives of the score.

Projeto para a criação do Centro de Memória do Instituto de Matemática Pura e Aplicada: uma história de competência, paixão e perseverança

O Instituto Nacional de Matemática Pura e Aplicada (IMPA) foi o primeiro órgão de pesquisa criado pelo Conselho Nacional de Pesquisas (CNPq), em 1952. Desde seu início o IMPA dedicou-se à pesquisa científica em matemática do mais alto nível e promoveu a formação de novos pesquisadores, promovendo também a difusão e aprimoramento da cultura matemática no país. Mais recentemente, passou a dedicar-se também às aplicações da matemática em outras áreas do conhecimento e em setores tecnológicos. Ao longo de mais de cinqüenta anos de trabalho, consolidou-se como o centro de referência em pesquisa matemática e formação de novos pesquisadores no Brasil e na América Latina. Tendo em vista a relevância da instituição para os rumos da pesquisa na área no país, este trabalho de conclusão de curso tem como objetivo estabelecer as diretrizes para a criação do Centro de Memória do Instituto Nacional de Matemática Pura e Aplicada (CEMIMPA), que seria um espaço para produção e re-elaboração de identidade e memória institucional – seguindo uma tendência que se afirma, no Brasil, desde a década de 1970. Discute-se aqui a trajetória do IMPA, os conceitos sobre memória, acervo e identidade para conseguir demarcar as linhas gerais do CEMIMPA e precisar sua importância para a instituição. A criação de um centro de memória como o que propomos, ajudaria a dar visibilidade à história do IMPA, de seus pesquisadores, suas áreas de atuação para além dos limites do cenário da pesquisa matemática, alcançando um público cada vez mais amplo e diverso. Isto poderia influenciar de forma ainda mais vigorosa a formação de jovens em geral, e em particular, de futuros matemáticos. Também poderá incrementar as pesquisas sobre a história da matemática no Brasil e a trajetória dos pesquisadores que a fizerem e dela fazem parte.

Uma avaliação do programa de DST/AIDS do município do Rio de Janeiro: a ótica dos atores sociais

Avaliação do Programa de DST/AIDS do Município do Rio de Janeiro. A pesquisa objetiva identificar as percepções, expectativas e sugestões sobre o referido Programa, a partir da ótica dos usuários, profissionais de saúde e coordenadores das unidades no que tange à qualidade dos serviços prestados. A opção teóricometodológica do estudo fundamenta-se na abordagem hermenêutico-dialética, pois busca a análise dos significados sociais. Tendo em vista a complexidade da temática em destaque, prioriza a metodologia qualitativa na coleta e no tratamento dos dados, por considerar que a abordagem permite uma aproximação e aprofundamento da compreensão do fenômeno. Privilegia a pesquisa descritiva e analítica. A pesquisa de campo ocorre num Centro Municipal de Saúde e num Centro de Testagem Anônima de AIDS situados no Rio de Janeiro, que prestam serviços de atendimento ambulatorial e testagem, com ênfase na prevenção. Para o resgate da fala dos atores, foi utilizada a entrevista semi-estruturada. A pesquisa focaliza a ótica dos atores sociais sobre a assistência prestada. A análise do material empírico indica que a qualidade dos serviços prestados pelo programa de DST/AIDS no município é eficiente no que tange aos meios utilizados no desenvolvimento do trabalho. Porém, em relação aos recursos humanos e materiais ocorrem limitações para o alcance da eficácia e ter um impacto mais efetivo, do ponto de vista de mudança de comportamento e controle da epidemia no Município do Rio de Janeiro. Essa problemática aponta para uma reformulação das diretrizes, políticas, técnicas e orçamentárias e, principalmente de canais de comunicação mais eficazes junto à população usuária dos serviços e aos profissionais que desenvolvem atividades do Programa, a fim de ouvir e discutir suas demandas, o que incidirá numa contribuição para o encaminhamento do programa.