Fluid strategies and outcomes in patients with acute respiratory distress syndrome, systemic inflammatory response syndrome and sepsis: a protocol for a systematic review and meta-analysis

Background
Fluid administration to critically ill patients remains the subject of considerable controversy. While intravenous fluid given for resuscitation may be life-saving, a positive fluid balance over time is associated with worse outcomes in critical illness. The aim of this systematic review is to summarise the existing evidence regarding the relationship between fluid administration or balance and clinically important patient outcomes in critical illness.

Methods
We will search Medline, EMBASE, the Cochrane Central Register of Controlled Trials from 1980 to the present and key conference proceedings from 2009 to the present. We will include studies of critically ill adults and children with acute respiratory distress syndrome (ARDS), sepsis and systemic inflammatory response syndrome (SIRS). We will include randomised controlled trials comparing two or more fluid regimens of different volumes of fluid and observational studies reporting the relationship between volume of fluid administered or fluid balance and outcomes including mortality, lengths of intensive care unit and hospital stay and organ dysfunction. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. We will conduct a narrative and/or meta-analysis as appropriate.

Discussion
While fluid management has been extensively studied and discussed in the critical care literature, no systematic review has attempted to summarise the evidence for post-resuscitation fluid strategies in critical illness. Results of the proposed systematic review will inform practice and the design of future clinical trials.

Systematic review registration
PROSPERO CRD42013005608. (http://​www.​crd.​york.​ac.​uk/​PROSPERO/​)

A multi-attribute ranking solutions confirmation procedure

Ranking problems arise from the knowledge of several binary relations defined on a set of alternatives, which we intend to rank. In a previous work, the authors introduced a tool to confirm the solutions of multi-attribute ranking problems as linear extensions of a weighted sum of preference relations. An extension of this technique allows the recognition of critical preference pairs of alternatives, which are often caused by inconsistencies. Herein, a confirmation procedure is introduced and applied to confirm the results obtained by a multi-attribute decision methodology on a tender for the supply of buses to the Porto Public Transport Operator. © 2005 Springer Science + Business Media, Inc.

Educar (para) o pensar : desenvolvimento de competências reflexíveis em professores e alunos do 1º CEB : contributos da "Filosofia para Crianças"

O presente estudo inscreve-se na área científica da Formação de Professores, incidindo, particularmente, na compreensão do processo de desenvolvimento das competências reflexivas percebidas como factor de promoção do seu próprio desenvolvimento profissional e pessoal, do desenvolvimento da capacidade de pensar dos seus alunos, da revalorização dos processos curriculares de ensino-aprendizagem e de inovação dos contextos educacionais. Num contexto de complexidade, incerteza e mudança, importa repensar estratégias de formação de professores e de alunos para que possam constituir-se como fatores potenciadores do desenvolvimento da competência reflexiva. Estratégias que convocam, quer o professor, quer o aluno, para um tipo de questionamento de maior exigência reflexiva e consideradas potenciadoras do pensamento crítico, criativo e de cuidado com o outro, numa perspetiva educativa centrada no cuidar, que valoriza a dimensão humana, a atuação responsável, ética e solidária, em todos os planos da vida. Neste estudo propomo-nos retomar algumas das estratégias de formação já configuradas no movimento Filosofia para Crianças e que se constituíram como um programa de formação em contexto, no qual se procurou aprofundar e compreender as múltiplas dimensões e modos como interatuam os diferentes participantes da relação educativa em práticas curriculares reconfiguradas à luz dos pressupostos que sustentam este estudo. Do ponto de vista metodológico, a investigação inscreve-se num paradigma de natureza qualitativa e interpretativa, de matriz hermenêutica e ecológica, configurando uma abordagem de tipo complexo, e com características de estudo de caso, que considera indispensável a participação ativa do sujeito na construção do conhecimento próprio, bem como o carácter de imprevisibilidade e de recursividade das condições e subsistemas em que tal ocorre. No sentido de construir uma visão integrada do objeto em estudo, foram desenvolvidos procedimentos específicos (mixed-methods), nomeadamente análise documental, entrevista semiestruturada, observação participante e inquirição por questionário. O estudo, que decorreu na região centro do país, envolveu 5 professoras do 1.º Ciclo do Ensino Básico, 100 alunos do mesmo nível de ensino e os seus pais/encarregados de educação, inquiridos através de questionário e desenvolveu-se em duas fases. A primeira destinou-se à formação teórico-prática das professoras e, na segunda, foram desenvolvidas sessões práticas de Filosofia para Crianças com os alunos. Os portfolios reflexivos construídos pelos participantes e pela investigadora principal constituíram outra fonte da informação recolhida no estudo empírico. Os resultados do estudo situam-se a quatro níveis: no que respeita aos saberes básicos, ao perfil de competência dos professores, à sua formação e às estratégias e recursos considerados como potenciadores de um pensar de mais elevada qualidade. Quanto ao primeiro nível, o presente estudo releva o carácter estruturante e epistémico de aprender a pensar (bem), salientando que este se processa numa maior amplitude e profundidade dos conteúdos da própria reflexão, às quais subjaz uma visão ampla de cidadania planetária e socialmente comprometida, evidenciando uma ampliação do quadro referencial dos saberes básicos e considerados imprescindíveis para a educação dos cidadãos. A um segundo nível, salienta-se a exigência de um perfil de competência profissional que permita aos professores desenvolver nos seus alunos um pensar de qualidade e, simultaneamente, melhorar a sua própria competência reflexiva. Neste sentido, o estudo aponta para a continuidade das respostas que têm vindo a ser equacionadas por vários autores nacionais e internacionais que, ao abordarem a problemática da formação, do conhecimento profissional e do desenvolvimento identitário dos professores, têm acentuado a importância dos modelos crítico-reflexivos da formação e de uma supervisão ecológica, integradora, não standard e humanizada, no desenvolvimento das sociedades contemporâneas. Conforme os dados sugerem, admite-se que a formação integral dos cidadãos passa pela inclusão e interligação de diferentes áreas do conhecimento que, concertada e complementarmente, possam contribuir para o desenvolvimento da sensibilidade, do pensamento crítico e criativo, de uma cultura da responsabilidade e de uma atitude ética mais ativa e interventiva. Neste sentido, reafirma-se a importância de um trajeto formativo que promova a efetiva articulação entre teoria e a prática, o diálogo crítico-reflexivo entre saberes científicos e experiência, que focalize o profissional na sua praxis e saliente a sua conexão com o saber situado em contexto vivencial e didático- -pedagógico. Realça-se a pertinência de dinâmicas formativas que, a exemplo de “comunidades de investigação/aprendizagem”, na sua aceção de redes de formação que, na prossecução de projetos e propósitos comuns, incentivam a construção de itinerários próprios e de aprendizagens individuais, mobilizando processos investigativos pessoais e grupais. Evidencia-se a valorização de práticas promotoras da reflexão, do questionamento, da flexibilidade cognitiva como eixos estruturadores do pensamento e da ação profissional e como suporte do desenvolvimento profissional e pessoal, corroborando a importância dos processos transformadores decorrentes da experiência, da ação e da reflexão sobre ela. Finalmente, no que respeita às estratégias e recursos, os dados permitem corroborar a riqueza e o potencial do uso de portfolios reflexivos no desenvolvimento de competências linguísticas, comunicacionais, reflexivas e meta-reflexivas e o entendimento de que o processo de construção da identidade profissional ocorre e desenha-se numa dinâmica reflexiva- -prospetiva (re)confirmadora ou (re)configuradora de ideias, convicções, saberes e práticas, ou seja, identitária. De igual modo, a investigação releva a importância da construção de portfolios, por parte dos alunos, para o desenvolvimento da qualidade do seu pensamento, sublinhando-se o seu carácter inovador nesta área. Evidencia-se, ainda, a diversidade de estratégias que respeitem os interesses, necessidades e expectativas dos alunos e o seu contexto de vida, tal como o recurso a materiais diversificados que, atentos ao conteúdo da mensagem, possibilitem a autonomia do pensamento, o exercício efetivo da reflexão crítica e do questionamento, na sua articulação com as grandes questões que sempre despertaram a curiosidade humana e cuja atualidade permanece. Materiais e recursos que estabeleçam o diálogo entre razão e imaginação, entre saber e sensibilidade, que estimulem o envolvimento dos alunos na resolução de problemas e na procura conjunta de soluções e na construção de projetos individuais na malha dos projetos comuns. Reafirma-se, pois, a importância da humanização do saber, a educação pensada como vivência solidária de direitos e deveres. Uma perspetiva educacional humanista que assenta nas trajetórias de vida, na recuperação de experiências pessoais e singulares, que procura compreender a identidade como um processo em (re)elaboração permanente. O presente estudo integra-se na rede de cooperação científica Novos saberes básicos dos alunos no século XXI, novos desafios à formação de professores sendo que, e na linha das investigações produzidas neste âmbito, destaca que o alargamento das funções do professor do 1.º Ciclo do Ensino Básico, que colocando a tónica da ação pedagógica no como se aprende e para quê e na possibilidade de aprender e incorporar o imprevisível, incide no desenvolvimento de um conjunto de capacidades que vão para além das tradicionalmente associadas ao ensinar a ler, escrever e contar. Releva-se, pois, a pertinência da criação de ambientes educativos nos quais professores e alunos entreteçam, conjunta e coerentemente, conhecer, compreender, fazer, sentir, dizer, ver, ouvir e (con)viver em prol de uma reflexão que nos encaminhe no sentido de ser(mos) consciência.

International cooperation for development in tourism destinations

The main goal of this thesis is to propose a conceptual theoretical model of critical success factors of International Development Cooperation programmes that are based in knowledge transfer approaches in the context of tourism development. The research was structured around three main theoretical pillars: international development cooperation (IDC), tourism as a tool for development, and knowledge transfer (KT). By exploring these pillars´ main interrelations, it was possible to gather the necessary background to develop the theoretical model and apply it to a real context. It was adopted a qualitative research approach using as a case study an IDC programme in tourism - the UNWTO.Volunteers programme. The key contribution of this thesis in the theoretical realm is the bridging of fields of study that are insufficiently covered in the scientific literature. The resulting model proposal applied to a real context of an IDC programme implementation permitted to test it partially providing useful insights for future research. It is postulated that IDC programmes in these contexts constitute a process rather than an end in itself. Therefore, they should be seen as a way of changing the state of the art of the tourism system in a sustainable manner so that it potentially generates positive development changes. This study suggested that it is not possible to achieve positive results if, instead of encouraging a KT and learning environment, it is simply disseminated knowledge in a linear, static, north-south approach. The characteristics of these interventions should be reviewed in that it was found that it is very difficult to guarantee the maintenance of the development changes induced by them if it is not safeguarded the necessary conditions and accountability to implement the recommended actions. While it was perceived a great potential for development changes to be induced by some IDC programmes in tourism destinations, it was concluded that these processes are too much dependent on the local political systems and existing power relations, as well as on the level of tourism development of the destination. However, more research is needed to examine the ability to generalise the findings to other IDC programmes and different destinations of developing countries.

Pensar e filosofar a partir do problema da existência de Deus

Relatório da Prática de Ensino Supervisionada, Mestrado em Ensino de Filosofia, Universidade de Lisboa, 2010

Social gender stereotypes and their implications in Hindi

This essay looks at the subtle ways in which gender identities are constructed and reinforced in India through social norms of language use. Language itself becomes a medium for perpetuating gender stereotypes, forcing its speakers to confirm to socially defined gender roles. Using examples from a classroom discussion about a film, this essay will highlight the underlying rigid male-female stereotypes in Indian society with their more obvious expressions in language. For the urban woman in India globalisation meant increased economic equality and exposure to changed lifestyles. On an individual level it also meant redefining gender relations and changing the hierarchy in man-woman relationships. With the economic independence there is a heightened sense of liberation in all spheres of social life, a confidence to fuzz the rigid boundaries of gender roles. With the new films and media celebrating this liberated woman, who is ready to assert her sexual needs, who is ready to explode those long held notions of morality, one would expect that the changes are not just superficial. But as it soon became obvious in the course of a classroom discussion about relationships and stereotypes related to age, the surface changes can not become part of the common vocabulary, for the obvious reason that there is still a vast gap between the screen image of this new woman and the ground reality. Social considerations define the limits of this assertiveness of women, whereas men are happy to be liberal within the larger frame of social sanctions. The educated urban woman in India speaks in favour of change and the educated urban male supports her, but one just needs to scratch the surface to see the time tested formulae of gender roles firmly in place. The way the urban woman happily balances this emerging promise of independence with her gendered social identity, makes it necessary to rethink some aspects of looking at gender in a gradually changing, traditional society like India.

Literacia de informação na Polícia de Segurança Pública

Orientadora: Doutora Anabela Mesquita Teixeira Sarmento

Retratos de uma musa do século XXI: a figura feminina na GQ Portugal

Relatório de estágio apresentado à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Jornalismo.

Atividades promotoras do pensamento crítico no âmbito das ciências da natureza

Relatório Final apresentado à Escola Superior de Educação de Lisboa para obtenção de grau de mestre em Ensino do 1.º e 2.º Ciclos do Ensino Básico

A importância da educação alimentar : o papel das escolas promotoras de saúde

RESUMO - Este artigo aborda a situação do consumo alimentar em Portugal e apresenta resultados de vários estudos sobre as estratégias para influenciar os comportamentos alimentares, junto da população jovem, na escola. Aplicando os fundamentos teóricos da promoção da saúde à educação nas escolas e à gestão da rede das escolas promotoras de saúde, ilustra uma abordagem da educação alimentar coerente com esses fundamentos teóricos e sugere algumas orientações para promover uma alimentação saudável.

Insertion dans les soins après une première hospitalisation dans un secteur pour psychose [Linkage to care after first hospitalisation for psychosis]

BACKGROUND: First hospitalisation for a psychotic episode causes intense distress to patients and families, but offers an opportunity to make a diagnosis and start treatment. However, linkage to outpatient psychiatric care remains a notoriously difficult step for young psychotic patients, who frequently interrupt treatment after hospitalisation. Persistence of symptoms, and untreated psychosis may therefore remain a problem despite hospitalisation and proper diagnosis. With persisting psychotic symptoms, numerous complications may arise: breakdown in relationships, loss of family and social support, loss of employment or study interruption, denial of disease, depression, suicide, substance abuse and violence. Understanding mechanisms that might promote linkage to outpatient psychiatric care is therefore a critical issue, especially in early intervention in psychotic disorders. OBJECTIVE: To study which factors hinder or promote linkage of young psychotic patients to outpatient psychiatric care after a first hospitalisation, in the absence of a vertically integrated program for early psychosis. Method. File audit study of all patients aged 18 to 30 who were admitted for the first time to the psychiatric University Hospital of Lausanne in the year 2000. For statistical analysis, chi2 tests were used for categorical variables and t-test for dimensional variables; p<0.05 was considered as statistically significant. RESULTS: 230 patients aged 18 to 30 were admitted to the Lausanne University psychiatric hospital for the first time during the year 2000, 52 of them with a diagnosis of psychosis (23%). Patients with psychosis were mostly male (83%) when compared with non-psychosis patients (49%). Furthermore, they had (1) 10 days longer mean duration of stay (24 vs 14 days), (2) a higher rate of compulsory admissions (53% vs 22%) and (3) were more often hospitalised by a psychiatrist rather than by a general practitioner (83% vs 53%). Other socio-demographic and clinical features at admission were similar in the two groups. Among the 52 psychotic patients, 10 did not stay in the catchment area for subsequent treatment. Among the 42 psychotic patients who remained in the catchment area after discharge, 20 (48%) did not attend the scheduled or rescheduled outpatient appointment. None of the socio demographic characteristics were associated with attendance to outpatient appointments. On the other hand, voluntary admission and suicidal ideation before admission were significantly related to attending the initial appointment. Moreover, some elements of treatment seemed to be associated with higher likelihood to attend outpatient treatment: (1) provision of information to the patient regarding diagnosis, (2) discussion about the treatment plan between in- and outpatient staff, (3) involvement of outpatient team during hospitalisation, and (4) elaboration of concrete strategies to face basic needs, organise daily activities or education and reach for help in case of need. CONCLUSION: As in other studies, half of the patients admitted for a first psychotic episode failed to link to outpatient psychiatric care. Our study suggests that treatment rather than patient's characteristics play a critical role in this phenomenon. Development of a partnership and involvement of patients in the decision process, provision of good information regarding the illness, clear definition of the treatment plan, development of concrete strategies to cope with the illness and its potential complications, and involvement of the outpatient treating team already during hospitalisation, all came out as critical strategies to facilitate adherence to outpatient care. While the current rate of disengagement after admission is highly concerning, our finding are encouraging since they constitute strategies that can easily be implemented. An open approach to psychosis, the development of partnership with patients and a better coordination between inpatient and outpatient teams should therefore be among the targets of early intervention programs. These observations might help setting up priorities when conceptualising new programs and facilitate the implementation of services that facilitate engagement of patients in treatment during the critical initial phase of psychotic disorders.

Osakeyhtiölain maksukykytesti pienissä osakeyhtiöissä - tilitoimiston rooli neuvonantajana

Osakeyhtiölakiin on vuodesta 2006 asti sisältynyt maksukykytesti (OYL 13:2), jonka tulkinnallinen epäselvyys on motivoinut useita tutkimuksia ja melko kriittistäkin kirjoittelua. Säännöksen tarkoituksena on ehkäistä osakeyhtiön velkojia uhkaava varojenjako velvoittamalla yhtiön johto huolellisuusvelvoitteensa nojalla arvioimaan varojenjaon vaikutukset yhtiön maksukyvyn säilymiseen. Oikeuskäytännön puuttuessa maksukykytestin toteuttamistapaan liittyy kuitenkin edelleenkin merkittävää epävarmuutta. Tämän tutkimuksen tavoitteena on pyrkiä selvittämään, miten osakeyhtiölain mukainen maksukykytesti pitäisi toteuttaa pienissä osakeyhtiöissä, joiden taloushallinto on kokonaan tai osittain ulkoistettu tilitoimistolle. Olennainen osa tutkimuksen tavoitetta on ottaa kantaa tilitoimiston rooliin maksukykytestin toteuttamisessa. Tutkimuksen johtopäätöksenä voidaan todeta, että yksityiskohtaisten tilinpäätöksen tunnuslukuihin perustuvien maksukykyarvioiden laatiminen maksukykytestin toteuttamiseksi on pienissä osakeyhtiöissä pääsääntöisesti tarpeetonta. Merkitystä tulisi sen sijaan antaa yhtiön johdolla olevalle hiljaiselle tiedolle, sillä yhtiön johto tuntee yrityksen tilanteen parhaiten ja kykenee siten myös arvioimaan tuleva kehitystä. Tilitoimiston rooliksi jää tällöin varmistaa, että asiakasyrityksen johto tuntee oman vastuuasemansa. Tutkimuksen perusteella tilitoimistot voisivat myös hyödyntää omaa asemaansa pienten yhtiöiden neuvonantajina nykyistä paremmin ohjeistamalla asiakasyrityksiään dokumentoimaan maksukykytestin hallituksen kokouspöytäkirjaan esimerkiksi osana hallituksen osingonjakoehdotusta.

Exploring the events that engage graduate students in transformative learning /

This research explored the events that engaged graduate students in transformative learning within a graduate program in education. This context was chosen because one objective of a graduate program is to facilitate critical thinking and transformative learning. The question ofhow adult learners perceive and experience learning steered the direction ofthis study. However, the purpose ofthis research was to study critical incidents that led to profound cognitive and affective changes as perceived by the graduate students. Specifically, the questions to be answered were what critical incidents happened to graduate students while in the Master ofEducation program, how were the incidents experienced, and what transformation resulted? The research design evolved over the course of a year and was highly influenced by previous empirical studies and criticisms oftransformative learning theory. The overall design was qualitative and phenomenological. A critical and interpretive approach was made to empirical data collected through a critical incident questionnaire and in-depth interviews. Inductive analysis allowed theory to be built from the data by making comparisons. New questions emerged and attention was given to social context, the passage oftime, and sequence ofevents in order to give meaning and translation ofthe participants' experiences and to build the interpretive narratives. Deductive analysis was also used on the data and a blending ofthe two forms of analysis; this resulted in the development ofa foundational model for transformative learning to be built.The data revealed critical incidents outside ofthe graduate school program that occurred in childhood or adult life prior to graduate school. Since context of individuals' lives had been an important critique of past transformative learning models and studies, this research expanded the original boundaries of this study beyond graduate school to incorporate incidents that occurred outside of graduate school. Critical incidents were categorized into time-related, people-related, and circumstancerelated themes. It was clear that participants were influenced and molded by the stage oftheir life, personal experiences, familial and cultural conditioning, and even historic events. The model developed in this document fiom an overview ofthe fmdings identifies a four-stage process of life difficulty, disintegration, reintegration, and completion that all participants' followed. The blended analysis was revealed from the description ofhow the incidents were experienced by the participants. The final categories were what were the feelings, what was happening, and what was the enviromnent? The resulting transformation was initially only going to consider cognitive and affective changes, however, it was apparent that contextual changes also occurred for all participants, so this category was also included. The model was described with the construction metaphor of a building "foimdation" to illustrate the variety of conditions that are necessary for transformative learning to occur. Since this was an exploratory study, no prior models or processes were used in data analysis, however, it appeared that the model developed from this study incorporated existing models and provided a more encompassing life picture oftransformative learning.

Monstrum : the vampire in the detective story /

My approach to the vampire detective highlights its connections to the private detective's story and reveals the monstrous investigators' debt to early feminist forms of detection -specifically in their reformation of the' other' and of traditional forms of power and authority. Seen in this light the movement of horror's imaginary 'other' into the rational world of detection can be seen as not an abrupt breach of detection's realist conventions, but an almost seamless transition into symbolic spaces that point to the detective's primary function -- to make sense of the senseless. It is in this light that I explore the monster that is a detective as a symbol that is also a sense-maker, and a quintessential postmodern figure. I argue that the distinctions between monsters and 'others', and between popular narratives and postmodern religion have faded, culminating in a character that can not only model 'otherness' as an exemplary condition, but also provide strategies for modeling the form of active postmodern subjectivity that postmodern theorist Jim Collins' (1989) conceives of as heretical activity.

A Handbook for Ontario J/I Pre-Service Teachers Developing Inclusive Pedagogy: Understanding Pre-Service Teachers' Thoughts and Feelings About Diversity

This project presents a handbook for Ontario Junior/Intermediate (J/I) pre-service teachers, Ontario J/I teacher education instructors, and J/I associate teachers that facilitates the identification, analysis, and reorganization of J/I pre-service teachers’ thoughts and feelings about diversity characteristics to develop inclusive teaching pedagogy. The handbook outlines collaborative and independent learning activities designed for integration into compulsory J/I Bachelor of Education (B.Ed.) program courses, practicum placements, and independent reflective situations. The handbook is composed of 5 sections: (a) Rationale for Importance; (b) Cross-Curricular Activities for J/I B.Ed. Courses; (c) Course-Specific Activities; (d) Practicum Placement Activities; and (e) Resources for Inclusive Educators. A critical content analysis of a 2011-2012 J/I B.Ed. program in Ontario enabled the creation of the handbook to address specific teacher education programming focused on helping pre-service teachers understand their thoughts and feelings about diversity for the development of inclusive teaching pedagogy. This research contributes to the advancement of theory and practice regarding development of teacher education programming that promotes J/I pre-service teachers’ inclusive pedagogy.