Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

Importance Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).

Objectives To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts—for example prone positioning—in routine clinical practice for patients fulfilling the ARDS Berlin Definition.

Design, Setting, and Participants The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents.

Exposures Acute respiratory distress syndrome.

Main Outcomes and Measures The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS.

Results Of 29 144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS.

Conclusions and Relevance Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS.

Handbook of International Special Education:Northern Ireland

The intent of the Handbook of International Special Education is to provide a concise overview of special education services in countries across the world using the Article on Education in the United Nations Convention on the Rights of Persons with Disabilities as the analytical frame. The Handbook will provide concise, data-driven contributions from across the globe using two primary frames: the relationship between special and general education in the country and the country’s system as aligned with the Article on Education in the UN Convention on the Rights of Person with Disabilities.

An analysis of International NGOs design decision making for housing reconstruction in developing country contexts

The purpose of this paper is to explore the current design decision making process of selected foreign international non governmental organisations (INGO’s) operating in the field of housing and post disaster housing design and delivery in developing countries. The study forms part of a wider on-going study relation to a decision making in relation to affordable and sustainable housing in developing
countries. The paper highlights the main challenges and opportunities in relation to the design and delivery of low cost sustainable housing in developing countries as identified in current literature on the subject. Interviews and case studies with INGO’s highlight any specific challenges faced by foreign INGO’s operating in a developing country. The preliminary results of this research study provide a concise insight into the design decision making process of leading foreign INGO’s operating in developing countries and will be beneficial to policy makers, NGOs, government bodies and community organisations in practice as it offers unique evidence based insights into international bodies housing design decision making process.

Portuguese Adaptation of Students Engagement in Schools International Scale (SESIS)

The importance of student’s engagement has been recently pointed out in research. However, there has been a lack of engagement assessment instrument, pertaining psychometric qualities. Objective: This paper presents the Portuguese adaptation of the “Student’s Engagement in School International Scale” (SESIS), drawn up from a12 countries international study (Lam et al., 2012; Lam et al., in press). Method: Psychometric properties of this scale were examined with data from 685 students from different grades (6th, 7th, 9th and 10th), from both sexes, and different regions of the country. Results: Factorial analysis of the results, with varimax rotation, lead to three different factors which explain 50.88% of the variance. The scale integrates the original 33 items, and cognitive, affective and behavioural dimensions. For the external validity study, the relationship between student’s engagement in school results and other school variables — academic performance, self-concept — was considered, and significant relations were observed, as expected. Conclusion: The data presented highlights the qualities of SESIS, as well as its usefulness for research purposes. Suggestion: It is suggested the investigation of the extension of SESIS’s three-dimensionality, in future studiesKeywords: Innovation, technology, research projects, etc. [Arial 10-point, justified alignment].

Portuguese Adaptation of Students Engagement in Schools International Scale (Sesis)

The importance of student’s engagement has been recently pointed out in research. However, there has been a lack of engagement assessment instruments, showing psychometric qualities, such as reliability and validity. Objective: This paper presents the Portuguese adaptation of the “Student’s Engagement in Schools International Scale” (SESIS), drawn up from 12 countries international study (Lam et al., 2012; Lam et al., in press). Method: Psychometric properties of this scale were examined using data from 685 students, of both sexes, and from different grades (6th, 7th, 9th and 10th), and regions of the country. Results: Factorial analysis of the results, with varimax rotation, conducted to three different factors which explain 62,19% of the variance. The scale integrates the original 33 items, and cognitive, affective and behavioural dimensions. For the external validity study, the relationship between student’s engagement in school results and other school variables — academic performance, school conduct — was considered, and significant relations were observed, as expected. Conclusion: The data presented highlights the qualities of SESIS, as well as its usefulness for research purpose. Suggestion: It is suggested the investigation of the extension of SESIS’s three-dimensionality, in future studies

A influência do terrorismo nos comportamentos de viagem internacionais

A partir de uma amostra de 600 turistas internacionais que circulam em Portugal, Espanha e Itália, este estudo identifica as principais os conceitos chave relacionados com o terrorismo, a percepção de risco, envolvimento e motivação para a segurança dos turistas internacionais. Diferentes níveis de preocupação relativamente à segurança pode influenciar as decisões dos turistas. No seu processo de decisão, os turistas avaliam vários factores, nomeadamente, o nível de risco ou de segurança que consideram nos destinos (Sonmez, 1998). Os turistas adoptam uma atitude protectora alterando os seus comportamentos durante os processos de decisão, substituindo os destinos que consideram inseguros por outros associados a uma maior segurança (Gu & Martin, 1992; Mansfeld, 1996). O terrorismo exacerbado pelos media tem efeitos graves nas receitas dos destinos turísticos (Taylor, 2006). Através da publicidade negativa, um destino turístico que experiencia um incidente terrorista pode ver a sua reputação danificada e a actividade turística severamente comprometida (Sonmez, 1998). Inclusivamente, a imageme negativa de um destino pode ser generalizada e pode também afectar outros países ou regiões por períodos de tempo indeterminados (Taylor, 2006). Um modelo de equações estruturais revela que os turistas são motivados para adquirir informação sobre o terrorismo nos media, nomeadamente mostram atenção e interesse sobre essas notícias e esse facto influencia directamente o seu risco percebido. A percepção de risco influencia directamente o envolvimento dos turistas no planeamento da viagem, especificamente a procura de informação antes da viagem e quando estão no destino. A percepção de risco e o envolvimento dos turistas influencia a percepção da importância da segurança.A discussão foca as implicações deste modelo para a teoria e para as instituições e organizações turísticas. São igualmente apresentadas recomendações para os gestores e promotores dos destinos e para os gestores das organizações turísticas. Direcções futuras de investigação são igualmente apresentadas.

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.

Secure Tropos: A Security-Oriented Extension of the Tropos methodology

Although security plays an important role in the development of multiagent systems, a careful analysis of software development processes shows that the definition of security requirements is, usually, considered after the design of the system. One of the reasons is the fact that agent oriented software engineering methodologies have not integrated security concerns throughout their developing stages. The integration of security concerns during the whole range of the development stages can help towards the development of more secure multiagent systems. In this paper we introduce extensions to the Tropos methodology to enable it to model security concerns throughout the whole development process. A description of the new concepts and modelling activities is given along with a discussion on how these concepts and modelling activities are integrated to the current stages of Tropos. A real life case study from the health and social care sector is used to illustrate the approach.

Civil defence pedagogies and narratives of democracy: disaster education in Germany

‘Disaster education’ is a fledgling area of study in lifelong education. Many countries educate their populations for disasters, to mitigate potential damage and loss of life, as well as contribute to national security. In this paper, which draws on interview data from the German Federal Office for Civil Defence and Disaster Assistance and the Federal Agency for Technical Relief, archival research, analysis of websites and promotional materials as well as relevant academic literature, I examine disaster education and preparedness for national emergencies in Germany. I argue that it is not generally extended to the general public, rather confined to trained experts, decentralised, localised and exclusive. Theorising disaster education as a ‘civil defence pedagogy’ (Preston, 2008), a type of public pedagogy, which contributes to shaping narratives of national identity, I argue that it is unlikely that Germany will develop a more inclusive, universal, formalised, nor high-profile campaign in disaster education in the foreseeable future. This, I suggest, is due to narratives of the German democratic nation state as secure, federal, peaceful and unified, which originated at the founding of West Germany in 1949, and continue to shape contemporary political narratives.

Security trumps drug control: How securitization explains drug policy paradoxes in Thailand and Vietnam

This paper investigates the paradoxes inherent in Thai and Vietnamese drug policies. The two countries have much in common. Both are ultra-prohibitionist states which employ repressive policies to contain drug markets. Their policies have, however, diverged in two key areas: opium suppression and harm reduction. Thailand implemented an effective intervention to suppress opium farming centred upon alternative development, whereas Vietnam suppressed opium production through coercive negotiation with nominal alternative development. Vietnam has embraced elements of harm reduction, whereas Thailand has been slow to implement harm reduction policies. This paper hypothesises that these two differences are largely a product of their perceived relationship to security. The two cases demonstrate how once an issue is securitized the ultra-prohibitionist rules of the game can be broken to allow for more humane and pragmatic policies.

Brazil's Emerging Roadmap for Internet Governance

Thesis (Master's)--University of Washington, 2014

Long-term performance of mergers and acquisitions in ASEAN countries

The study looks at mergers and acquisitions (M&As) in ASEAN countries and examines the post-M&A performance using data from 2001 to 2012. The industry-adjusted operating performance tends to decline in the 3 years following an M&A. Yet, the results suggest that M&As completed during the financial crisis are more profitable than those implemented before and/or after the crisis. We argue that this is mainly due to the synergies created between the firms’ resources during the crisis which augur well for firms’ economic performance. We find that, during the crisis, certain characteristics of the firms like the relative size of the target, cross-border nature of deals, acquirer's cash reserves and friendly nature of deals are important determinants of long-term post-M&A operating performance. However, for M&As during the crisis, there appears to be no relationship between performance and firms’ characteristics linked to M&A activity such as payment method, industry relatedness and percentage of target's share acquired.

Digital evidence as a means of proof before the International Court of Justice

This article discusses the use of digital evidence as a means of proof before the International Court of Justice (ICJ). The absence of specific Court rules and procedures for digital evidence (with the exception of Practice Direction IX bis) is not necessarily an obstacle to its production and evaluation before the ICJ, as the general evidentiary rules can also be applied to digital evidence. The article first looks at the rules on the production of documentary evidence and then examines the specific issues related to audiovisual evidence. Finally, it examines the admissibility of digital evidence unlawfully obtained by a litigant through unilateral transborder access to data. The article concludes that, even if specific regulation may be needed as to the specific way in which authenticity and accuracy of digital evidence are to be established, the particular facts of the case and the grounds of challenge can vary widely, and it is doubtful that any regulation could be sufficiently flexible to deal with this in advance.