Incorporation of spiritual care as a component of healthcare and medical education: comparison of viewpoints of healthcare providers from a rural community hospital in Uganda with those of medical students from United Kingdrom

This study addresses cultural differences regarding views on the place for spirituality within healthcare training and delivery. A questionnaire was devised using a 5-point ordinal scale, with additional free text comments assessed by thematic analysis, to compare the views of Ugandan healthcare staff and students with those of (1) visiting international colleagues at the same hospital; (2) medical faculty and students in United Kingdom. Ugandan healthcare personnel were more favourably disposed towards addressing spiritual issues, their incorporation within compulsory healthcare training, and were more willing to contribute themselves to delivery than their European counterparts. Those from a nursing background also attached a greater importance to spiritual health and provision of spiritual care than their medical colleagues. Although those from a medical background recognised that a patient’s religiosity and spirituality can affect their response to their diagnosis and prognosis, they were more reticent to become directly involved in provision of such care, preferring to delegate this to others with greater expertise. Thus, differences in background, culture and healthcare organisation are important, and indicate that the wide range of views expressed in the current literature, the majority of which has originated in North America, are not necessarily transferable between locations; assessment of these issues locally may be the best way to plan such training and incorporation of spiritual care into clinical practice.

Supra-treatment threshold neonatal jaundice: Incidence in HIV-exposed compared to non-exposed neonates at Queen Elizabeth Central Hospital in Blantyre, Malawi

INTRODUCTION: Jaundice is the yellowish pigmentation of the skin, sclera, and mucous membranes resulting from bilirubin deposition. Children born to mothers with HIV are more likely to be born premature, with low birth weight, and to become septic-all risk factors for neonatal jaundice. Further, there has been a change in the prevention of mother-to-child transmission (PMTCT) of HIV guidelines from single-dose nevirapine to a six-week course, all of which theoretically put HIV-exposed newborns at greater risk of developing neonatal jaundice.

AIM: We carried out a study to determine the incidence of severe and clinical neonatal jaundice in HIV-exposed neonates admitted to the Chatinkha Nursery (CN) neonatal unit at Queen Elizabeth Central Hospital (QECH) in Blantyre.

METHODS: Over a period of four weeks, the incidence among non-exposed neonates was also determined for comparison between the two groups of infants. Clinical jaundice was defined as transcutaneous bilirubin levels greater than 5 mg/dL and severe jaundice as bilirubin levels above the age-specific treatment threshold according the QECH guidelines. Case notes of babies admitted were retrieved and information on birth date, gestational age, birth weight, HIV status of mother, type of feeding, mode of delivery, VDRL status of mother, serum bilirubin, duration of stay in CN, and outcome were extracted.

RESULTS: Of the 149 neonates who were recruited, 17 (11.4%) were HIV-exposed. One (5.88%) of the 17 HIV-exposed and 19 (14.4%) of 132 HIV-non-exposed infants developed severe jaundice requiring therapeutic intervention (p = 0.378). Eight (47%) of the HIV-exposed and 107 (81%) of the non-exposed neonates had clinical jaundice of bilirubin levels greater than 5 mg/dL (p < 0.001).

CONCLUSIONS: The study showed a significant difference in the incidence of clinical jaundice between the HIV-exposed and HIV-non-exposed neonates. Contrary to our hypothesis, however, the incidence was greater in HIV-non-exposed than in HIV-exposed infants.

Women of Letters: Gender, Writing and the Life of the Mind in Early Modern England

Women of letters writes a new history of English women's intellectual worlds using their private letters as evidence of hidden networks of creative exchange. The book argues that many women of this period engaged with a life of the mind and demonstrates the dynamic role letter-writing played in the development of ideas. Until now, it has been assumed that women's intellectual opportunities were curtailed by their confinement in the home. This book illuminates the household as a vibrant site of intellectual thought and expression. Amidst the catalogue of day-to-day news in women's letters are sections dedicated to the discussion of books, plays and ideas. Through these personal epistles, Women of letters offers a fresh interpretation of intellectual life in the late seventeenth and early eighteenth centuries, one that champions the ephemeral and the fleeting in order to rediscover women's lives and minds.

Acute care teaching in the undergraduate nursing curriculum

AIM: To incorporate basic aspects of acute care into the undergraduate nursing programme by providing an opportunity for the development of knowledge and skills in the early recognition and assessment of deteriorating patients on general hospital wards.
BACKGROUND: Acute care initiatives implemented in the hospital setting to improve the identification and management of 'at risk' patients have focused on the provision of education for trained or qualified staff. However, to ensure student nurses are 'fit to practice' at the point of registration, it has been recommended that acute care theory and skills are incorporated into the undergraduate nursing curriculum.
PRACTICE DEVELOPMENT INITIATIVE: An 'Integrated Nursing Care' module was incorporated into year 3 of the undergraduate nursing programme to introduce students to acute care theory and practice. Module content focuses on the early detection and management of acute deterioration in patients with respiratory, cardiac, neurological or renal insufficiencies. We used a competency-based framework to ensure the application of theory to practice through the use of group seminars. High-fidelity patient-simulated clinical scenarios were a key feature. The United Kingdom Resuscitation Council Intermediate Life Support course is also an important component of the module.
CONCLUSIONS: Incorporating the Integrated Nursing Care module into the undergraduate nursing curriculum provides pre-registration students the opportunity to develop their knowledge and skills in acute care.
RELEVANCE TO CLINICAL PRACTICE: The provision of undergraduate education in care of the acutely ill patient in hospital is essential to improve nurses' competence and confidence in assessing and managing deteriorating patients in general wards at the point of registration.

Strategic management in the Telecom industry to create competitive advantage

O presente trabalho teve por objetivos a identificação de uma estratégia e o desenvolvimento de um modelo que permita às operadoras de telecomunicações a sua sustentabilidade, bem como a identificação de caminhos para a adaptação a uma realidade sempre em mudança como é a da indústria das telecomunicações. Numa primeira parte do trabalho elaborou-se uma revisão de literatura do atual estado da arte das principais estratégias relevantes e com aplicação à indústria de telecomunicações. A pesquisa realizada investigou a estrutura atual da indústria de telecomunicações e o estado da competitividade das operadoras de telecomunicações. Dos resultados desta foi possível constatar uma evolução constante da tecnologia e dos modelos de negócio neste ecossistema, assim como a presença de uma pressão concorrencial significativa exercida sobre as operadoras, quer por parte das empresas já existentes no mercado quer por parte das emergentes. As operadoras têm de transformar o seu modelo de rede e de negócios para se adaptarem às mudanças e às tendências da indústria e do mercado. Com base na revisão de literatura, elegeu-se a metodologia baseada num inquérito de pesquisa empírica para aferir o estado da indústria e derivar as estratégias possíveis. Este inquérito foi efetuado a especialistas da área de telecomunicações de diferentes subsectores e países para abordar todos os elementos estratégicos do modelo de negócio futuro. Os resultados da pesquisa revelaram que as empresas que operam no mercado da Internet (Over The Top - OTT) representam a maior ameaça sobre o futuro dos operadores de telecomunicações. Os operadores só vão conseguir responder através da modernização de sua rede, melhorando a qualidade, reduzindo o custo global, e investindo em produtos inovadores e diferenciados e em serviços. Os resultados do inquérito revelam-se de acordo com os pressupostos da Blue Ocean Strategy. A aplicabilidade da Blue Ocean Strategy foi aprofundada permitindo concluir que o valor inovador obtido simultaneamente através da redução de custos e da diferenciação permitem aumentar as vantagens dos operadores existentes em termos das infra-estruturas físicas detidas e das relações estabelecidas com os clientes. O caso particular da fibra óptica até casa (FTTH) foi considerado como aplicação da Blue Ocean Strategy a uma nova tecnologia que as operadoras podem implementar para criar novas soluções e abrir segmentos de mercado inexplorados. Os resultados do inquérito e da investigação realizada à aplicação da Blue Ocean Strategy foram combinados para propor um novo modelo de negócio para as operadoras de telecomunicações que lhes permite, não só responder aos desafios existentes, mas, também, ter uma melhor posição competitiva no futuro. Foi, ainda, realizado um estudo de caso que destacou como a Verizon Communications foi capaz de transformar a sua rede e o modelo de negócio em resposta ao aumento da pressão competitiva. Através do valor da inovação transferida aos seus clientes, a Verizon foi capaz de aumentar significativamente as suas receitas e satisfação do cliente.

Reinventing America on the battlefields of Spain or following the party line: conflicting perceptions of the Spanish Civil War in the present and in the past

Isolationism and neutrality are two of the recurrent themes in the study of the history of the U.S. foreign policy in the interwar years. The trauma of the Great War, which had swept away 130.000 U.S. lives and had cost $30 billion, had led public opinion to strongly oppose any involvement with European affairs. Besides, the urgent need for economic recovery during the dismal years of the Great Depression did not leave Roosevelt much room for manoeuvre to influence international events. His positions regarding the intentions of the Fascist states remained, at best, ambivalent. These facts notwithstanding, about 2800 U.S. citizens crossed the Atlantic and rushed in to help democratic Spain, which was on the verge of becoming one more hostage in the hands of the Fascism. They joined the other British, Irish and Canadian volunteers and formed the XV International Brigade. 900 Americans never returned home. This alone should challenge the commonly held assumption that the American people were indifferent to the rise of the Fascist threat in Europe. But it also begs other questions. Considering the prevailing isolationist mood, what really motivated them? With what discursive elements did these men construct their anti Fascist representations? How far did their understanding of the Spanish democracy correspond to their own American democratic ideal? In what way did their war experience across the Atlantic mould their perception of U.S. politics (both domestic and foreign)? How far did the Spanish Civil War constitute one first step towards the realization that the U.S. might actually be drawn into another international conflict of unpredictable consequences? Last but not the least, what ideological, political and cultural complicity existed between the men from the English-speaking battalions? In order to unearth some of the answers, I intend to examine their letters and see how these men recorded the historical events in which they took part. Their correspondence emerged from the desire to prove their commitment to a common cause and spoke of a common war experience, but each letter, in its uniqueness, ends up mirroring not only the social and political background of each individual fighter, but also his own particular perspective of the war, of world politics and of the Spanish people. We shall see how these letters differ and converge and how these particular accounts weave, as in an epistolary novel, a larger-than-life narrative of outrage and solidarity, despair and hope.

Evaluation of the human factor in the scheduling of smart appliances in smart grids

Recently there has been an increase of interest in implementing a new set of home appliances, known as Smart Appliances that integrate Information Technologies, the Internet of Things and the ability of communicating with other devices. While Smart Appliances are characterized as an important milestone on the path to the Smart Grid, by being able to automatically schedule their loads according to a tariff or reflecting the power that is generated using renewable sources, there is not a clear understanding on the impact that the behavior of such devices will have in the comfort levels of users, when they shift their working periods to earlier, or later than, a preset time. Given these considerations, in this work we analyse the results of an assessment survey carried out to a group of Home Appliance users regarding their habits when dealing with these machines and the subjective impact in quality caused by either finishing its programs before or after the time limit set by the user. The results of this work are expected to be used as input for the evaluation of load scheduling algorithms running in energy management systems. © 2014 Springer International Publishing.

Efficiency in the Enrollment Process for the South Carolina Intellectual Disability and Related Disabilities Waiver Program

The Intellectual Disability and Related Disabilities waiver has had many changes over the years and has evolved into a robust service package that can be a significant help to individuals who wish to remain in the community or at home but would otherwise require institutional level care. Due to the limited amount of funds, it was necessary to create a waiting list for individuals who wish to participate in the ID/RD Waiver program. This project was undertaken to assess if there were practical steps that could be taken to assist in reducing the time and cost involved in the ID/RD Waiver enrollment process.

(Un)settling the Irish emigrant identity: representation and construction of an Irish emigrant/exile identity in the travel narratives of Kathleen Nevin and William Bulfin

Through an examination of the travel works of William Bulfin, Tales of the Pampas (1900) and Kathleen Nevin's You'll Never Go Back this paper considers the representation of the Irish in Argentina and the contribution of these narratives in the construction of identity and the reconstruction of the emigrant identity into an exilic one. Escaping one colonial framework (Britain/Ireland), travelling to and writing from within another postcolonial construct (Argentina and the Spanish Empire), this paper analyses how Bulfin and Nevin use language as a tool to construct, and even invent, an Irish identity. This identity is inextricably linked to home and the desire to return there. Despite this desire, Argentina becomes internalised to some extent, which in Bulfin can be seen in the mix of the Spanish, English and Irish languages in his stories, highlighting that the Irish were doing with language what they had already done with their lives; trying to adapt it to their new situation. In Nevin, the contrast between us and them (Irish and 'Native') demonstrates her attempts to shape an exilic rather than emigrant mentality. Through these texts I analyse how Argentina never quite becomes a new home, but a place where Irish identity is played out and acquires form.

You Should Never Look a Gift Horse in the Mouth: One-Size-Fits-All Compensation in Wrongful Conception

This article reconsiders the House of Lords decision in Rees v. Darlington Memorial Hospital NHS Trust (2003) and the decision to award a conventional award of £15,000 in all cases of failed sterilisation resulting in the birth of an unwanted child. In so doing, it briefly recites the history of the Wrongful Conception action and the unique facts of Rees. It then goes on the consider the implications of two fundamental aspects of the judgment. Firstly, it looks at the 'conventional award' itself and considers the reasoning behind the award and the effect that it has on our understanding of (particularly women's) reproductive autonomy. Secondly, it analyses the rather 'unique' judgment of Lord Scott and his decision to evaluate these cases using the possessory analogy of an unwanted foal; particular focus is given to the notion of parental 'choice' in these cases and whether mitigation (i.e. abortion or adoption) can ever be considered "reasonable".

Global sport in the suburbs: the Regent Street Polytechnic’s sports facilities at Chiswick, 1888–1938

This article shows how the elite origins and religious mission of the Regent Street Polytechnic encouraged participation in amateur sport in London, and promoted the suburb of Chiswick as a global context for competitive sports. From the 1880s to the outbreak of World War 2, the Polytechnic and its facilities forged synergies between the city centre and the burgeoning suburbs in London, engendering a city-wide culture of amateur sports, and embedding the Polytechnic into a global network of athletes. Suburbs are typically presented by writers as being ‘on the edge’ of metropolitan life, but such perspectives are wrong. The West London suburb of Chiswick was the home of Polytechnic facilities that provided a dynamic context for the internationalization and modernization of sport in the capital.

Women in the driving seat Eastern European immigrant women s citizenship participation and educational inclusion in Portugal

This paper is a case study of Eastern European immigrant women’s social inclusion in Portugal through civic participation. An analysis of interviews conducted with women leaders and members of two ethnic associations provides a unique insight into their migrant pathways as highly educated women and the ways in which these women are constructing their citizenship in new contexts in Northern Portugal. These women’s accounts of their immigrant experience embrace both the public realm, in using their own education and their children’s as a means of integration but also spill over into ‘non-public’ familial relationships at home in contradictory ways. These include the sometimes traditional, gender-defined division of labour within the associations and at home and the new ways that they negotiate their relative autonomies to escape forms of violence and subordination that they face as women and immigrants.

Influencing factors on the buying behavior in the software market

The case of desktop Operating System and Office Suite choices considering Proprietary and Open Source Software alternatives.

Saving energy in the GFRP pultrusion process

This study addresses to the optimization of pultrusion manufacturing process from the energy-consumption point of view. The die heating system of external platen heaters commonly used in the pultrusion machines is one of the components that contribute the most to the high consumption of energy of pultrusion process. Hence, instead of the conventional multi-planar heaters, a new internal die heating system that leads to minor heat losses is proposed. The effect of the number and relative position of the embedded heaters along the die is also analysed towards the setting up of the optimum arrangement that minimizes both the energy rate and consumption. Simulation and optimization processes were greatly supported by Finite Element Analysis (FEA) and calibrated with basis on the temperature profile computed through thermography imaging techniques. The main outputs of this study allow to conclude that the use of embedded cylindrical resistances instead of external planar heaters leads to drastic reductions of both the power consumption and the warm-up periods of the die heating system. For the analysed die tool and process, savings on energy consumption up to 60% and warm-up period stages less than an half hour were attained with the new internal heating system. The improvements achieved allow reducing the power requirements on pultrusion process, and thus minimize industrial costs and contribute to a more sustainable pultrusion manufacturing industry.

Age-period-cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in risk

Introduction: Healthcare improvements have allowed prevention but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000–2008. Methods: From the National Hospital Discharge Register, we selected admissions (aged ≥49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages, we used an age–period–cohort model (1-year intervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures. Results: There were 77,083 hospital admissions (77.4 % women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increasing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable–increasing), 1940 (decreasing–increasing) and 1950 (increasing–decreasing only among women). Conclusions: Hip fracture risk was higher for those born during major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birth may determine future risk for hip fractures.