DESCRIBING SLEEP AND SEDATION PRACTICES IN THE ICU: A MULTINATIONAL SURVEY

Introduction Sleep disturbances are common in critically ill patients treated in the intensive care unit (ICU) with the potential for serious consequences and long-term effects on health outcomes and patient morbidity.
Objectives Our aim was to describe sleep management and sedation practices of adult ICUs in ten countries and to evaluate roles and responsibilities of the ICU staff in relation to key sleep and sedation decisions.
Methods A multicenter, self-administered survey sent to nurse managers of adult ICUs across 10 countries. The questionnaire comprised four domains: sleep characteristics of the critically ill; sleep and sedation practices; non-pharmacological and pharmacological interventions used to improve sleep; and the autonomy and influence of nurses on sleeping practices in the ICU.
Results Overall response rate was 66% (range 32% UK to 100% Cyprus), providing data from 522 ICUs. In all countries, the most frequent patient characteristic perceived to identify sleep was lying quietly with closed eyes (N=409, 78%) (range 92% Denmark to 36% Italy). The most commonly used sedation scale was the Richmond Agitation-Sedation Score (RASS) (N=220, 42%) (range 81% UK to 0% Denmark, Cyprus where most ICUs used the Ramsay score). In most ICUs, selection of sleep medication (N=265, 51%) and assessment of effect (N=309, 59%) was performed by physicians and nurses based on collaborative discussion. In a minority of ICUs (N=161, 31%), decisions and assessments were made by physicians alone. The most commonly used (in all countries) non-pharmacological intervention to promote sleep was reducing ICU staff noise (N=473, 91%) (range 100% Denmark, Norway to 78% Canada). Only 95 ICUs (18%) used earplugs on a frequent basis (range 0% Greece, Cyprus, Denmark to 57% Sweden). Propofol was the drug used most commonly for sedation (N=359, 69%) (range 96% Sweden to 29% Canada). Chloral hydrate was used by only 63 (12%) ICUs (range 0% Greece, Cyprus, Denmark, Italy to 56% Germany). Sedation scales were used on a routine basis by 77% of the 522 ICUs. Participants scored nursing autonomy for sleep and sedation management as moderate; median score of 5 (scale of 0 to 10), range 7 (Canada, Greece, Sweden) to 4 (Norway, Poland). Nursing influence on sleep and sedation decisions was perceived considerable; median score 8, range 9 (Denmark) to 5 (Poland).
Conclusions We found considerable across country variation in sleep promotion and sedation management practices though most have adopted a sedation scale as recommended in professional society guidelines. Most ICUs in all countries used a range of pharmacological and non-pharmacological interventions to promote sleep. Most units reported inter-professional decision-making with nurses perceived to have substantial influence on sleep/sedation decisions.

Balancing cultural diversity and social cohesion in education: The potential of shared education in divided contexts

This article considers how the education systems of divided societies have been shaped in response to the experience of ethnic and religious conflict. The analysis identifies two competing priorities in such contexts – the development of social cohesion and the protection of cultural, ethnic and religious identities - and explores how these may be reconciled through a model of ‘shared education’. Drawing on research evidence and recent experience of shared education in relation to Northern Ireland, the Former Yugoslav Republic of Macedonia and Cyprus, we reflect on the advantages and challenges of this model in areas experiencing conflict and division.

Report of the striped red mullet (Mullus surmuletus) and red mullet (Mullus barbatus) Exchange 2016

In September 2015, the Working Group on Biological Parameters (WGBIOP) recommended an otolith exchange for Mullus surmuletus and Mullus barbatus in 2016 (Otolith Exchanges proposals for 2016/2017; ICES, 2015). Kélig Mahe (IFREMER, France) was decided to be the responsible to organise this otolith exchange. Two otolith exchanges (2008, 2011), and two age reading workshops (ICES, 2009; 2012), have been taken place until now (Mahé et al., 2012). A total of 13 readers from 5 countries (France, Spain, Italy, Cyprus and Greece) participated at the exchange of 2016. The otoliths of 465 individuals (345 M. barbatus & 120 M. surmuletus), sampled from 2011 to 2014 in the Mediterranean Sea (Central Adriatic Sea, Cyprus, Levantine Spain coasts, Balearic Islands) were used for this exchange. For both Mullus species, the precision values were very low, the PA ranged between 56 and 67% the CV ranged from 32 to 64% and the APE ranged from 1.9 to 3.6%. The results by area and species showed the same trend with the first age groups presenting the higher CV values and in some cases lower PA values. These results could be explained by the position of the first growth increment and the two different approaches of reading interpretation used by the readers (ICES, 2012).

A probabilistic approach to user mobility prediction for wireless services.

Mobile and wireless networks have long exploited mobility predictions, focused on predicting the future location of given users, to perform more efficient network resource management. In this paper, we present a new approach in which we provide predictions as a probability distribution of the likelihood of moving to a set of future locations. This approach provides wireless services a greater amount of knowledge and enables them to perform more effectively. We present a framework for the evaluation of this new type of predictor, and develop 2 new predictors, HEM and G-Stat. We evaluate our predictors accuracy in predicting future cells for mobile users, using two large geolocation data sets, from MDC [11], [12] and Crawdad [13]. We show that our predictors can successfully predict with as low as an average 2.2% inaccuracy in certain scenarios.

Análisis de mujeres cachemires como sujetos subalternos en la representación institucional de India y Paquistán a partir del fenómeno de desaparición forzada (1989-2008)

El interés de esta monografía es analizar las consecuencias de la representación institucional de India y Paquistán en la disputa territorial por Cachemira durante el periodo de 1989 a 2008. Puntualmente, se analiza y explica cómo la representación institucional prestada individualmente por India y Paquistán validó sus intereses como agentes de poder en la región, pasó por alto las necesidades de la población cachemir y fomentó la práctica de la desaparición forzada, lo que en consecuencia convirtió a las mujeres cachemires en un grupo subalterno. Para tal objetivo, se hará uso de la teoría postcolonialista, específicamente el enfoque subalternista de la autora Gayatri Chakravorty Spivak ya que permite explicar adecuadamente el proceso mediante el cual las mujeres cachemires se convirtieron en un grupo subalterno.

Historias de mujeres excombatientes en estado de reclusión. Tensiones socio-jurídicas en torno a la Ley de Justicia y Paz

Historias de mujeres ex combatientes en estado de reclusión” tiene como objetivo central reconstruir, visibilizar y analizar las experiencias de vida de cuatro mujeres excombatientes de las guerrillas postuladas a la Ley de Justicia y Paz.