Early detection of delirium in older medical inpatients: prodrome, predictors and motor subtyping

Background Delirium is highly prevalent, especially in older patients. It independently leads to adverse outcomes, but remains under-detected, particularly hypoactive forms. Although early identification and intervention is important, delirium prevention is key to improving outcomes. The delirium prodrome concept has been mooted for decades, but remains poorly characterised. Greater understanding of this prodrome would promote prompt identification of delirium-prone patients, and facilitate improved strategies for delirium prevention and management. Methods Medical inpatients of ≥70 years were screened for prevalent delirium using the Revised Delirium Rating Scale (DRS--‐R98). Those without prevalent delirium were assessed daily for delirium development, prodromal features and motor subtype. Survival analysis models identified which prodromal features predicted the emergence of incident delirium in the cohort in the first week of admission. The Delirium Motor Subtype Scale-4 was used to ascertain motor subtype. Results Of 555 patients approached, 191 patients were included in the prospective study. The median age was 80 (IQR 10) and 101 (52.9%) were male. Sixty-one patients developed incident delirium within a week of admission. Several prodromal features predicted delirium emergence in the cohort. Firstly, using a novel Prodromal Checklist based on the existing literature, and controlling for confounders, seven predictive behavioural features were identified in the prodromal period (for example, increasing confusion; and being easily distractible). Additionally, using serial cognitive tests and the DRS-R98 daily, multiple cognitive and other core delirium features were detected in the prodrome (for example inattention; and sleep-wake cycle disturbance). Examining longitudinal motor subtypes in delirium cases, subtypes were found to be predominantly stable over time, the most prevalent being hypoactive subtype (62.3%). Discussion This thesis explored multiple aspects of delirium in older medical inpatients, with particular focus on the characterisation of the delirium prodrome. These findings should help to inform future delirium educational programmes, and detection and prevention strategies.

Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries

Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

A Simple Model of Access and Capacity for Post-Secondary Schooling in Canada (Working Paper 40)

This paper develops a simple model of the post-secondary education system in Canada that provides a useful basis for thinking about issues of capacity and access. It uses a supply-demand framework, where demand comes on the part of individuals wanting places in the system, and supply is determined not only by various directives and agreements between educational ministries and institutions (and other factors), but also the money available to universities and colleges through tuition fees. The supply and demand curves are then put together with a stylised tuition-setting rule to describe the “market” of post-secondary schooling. This market determines the number of students in the system, and their characteristics, especially as they relate to “ability” and family background, the latter being especially relevant to access issues. The manner in which various changes in the system – including tuition fees, student financial aid, government support for institutions, and the returns to schooling – are then discussed in terms of how they affect the number of students and their characteristics, or capacity and access.

Digital anthropology and educational eGames: learning through behavioural patterns in digital, game-based contexts

The selected publications are focused on the relations between users, eGames and the educational context, and how they interact together, so that both learning and user performance are improved through feedback provision. A key part of this analysis is the identification of behavioural, anthropological patterns, so that users can be clustered based on their actions, and the steps taken in the system (e.g. social network, online community, or virtual campus). In doing so, we can analyse large data sets of information made by a broad user sample,which will provide more accurate statistical reports and readings. Furthermore, this research is focused on how users can be clustered based on individual and group behaviour, so that a personalized support through feedback is provided, and the personal learning process is improved as well as the group interaction. We take inputs from every person and from the group they belong to, cluster the contributions, find behavioural patterns and provide personalized feedback to the individual and the group, based on personal and group findings. And we do all this in the context of educational games integrated in learning communities and learning management systems. To carry out this research we design a set of research questions along the 10-year published work presented in this thesis. We ask if the users can be clustered together based on the inputs provided by them and their groups; if and how these data are useful to improve the learner performance and the group interaction; if and how feedback becomes a useful tool for such pedagogical goal; if and how eGames become a powerful context to deploy the pedagogical methodology and the various research methods and activities that make use of that feedback to encourage learning and interaction; if and how a game design and a learning design must be defined and implemented to achieve these objectives, and to facilitate the productive authoring and integration of eGames in pedagogical contexts and frameworks. We conclude that educational games are a resourceful tool to provide a user experience towards a better personalized learning performance and an enhance group interaction along the way. To do so, eGames, while integrated in an educational context, must follow a specific set of user and technical requirements, so that the playful context supports the pedagogical model underneath. We also conclude that, while playing, users can be clustered based on their personal behaviour and interaction with others, thanks to the pattern identification. Based on this information, a set of recommendations are provided Digital Anthropology and educational eGames 6 /216 to the user and the group in the form of personalized feedback, timely managed for an optimum impact on learning performance and group interaction level. In this research, Digital Anthropology is introduced as a concept at a late stage to provide a backbone across various academic fields including: Social Science, Cognitive Science, Behavioural Science, Educational games and, of course, Technology-enhance learning. Although just recently described as an evolution of traditional anthropology, this approach to digital behaviour and social structure facilitates the understanding amongst fields and a comprehensive view towards a combined approach. This research takes forward the already existing work and published research onusers and eGames for learning, and turns the focus onto the next step — the clustering of users based on their behaviour and offering proper, personalized feedback to the user based on that clustering, rather than just on isolated inputs from every user. Indeed, this pattern recognition in the described context of eGames in educational contexts, and towards the presented aim of personalized counselling to the user and the group through feedback, is something that has not been accomplished before.

Of two contrasting philosophies that underpin openness in education and what that entails

From the conclusion: The ultimate question is a normative one: Which way do we want that openness in education to go? That question concerns educational resources, open educational practices and what other forms the educational system may spawn. For ultimately, we as stakeholders, in the learning of our children and grandchildren, in the professional development and Bildung of ourselves, should get the educational systems that we want, including appropriate forms of openness therein. Every individual then should decide for herself or himself to what extent this requires education as a public good and to what extent education as a private good, that is, as a commodity subject to market forces. It should not come as a surprise that we side with the humanitarian elaboration of openness. Indeed, we feel that governments as guardians of the public space should actively get involved in promoting this kind of openness, indeed, much as Delors in 1996 advocated for education as a whole.

Communication and behavior in high reliability organizations: An Analysis of Communication in Civil Aviation

Communication can be seen as one of the most important features to manage conflicts and the stress of the work teams that operate in environments with strong pressure, complex operations and continuous risk, which are aspects that characterize a high reliability organization. This article aims to highlight the importance of communication in high-reliability organizations, having as object of study the accidents and incidents in civil aviation area. It refers to a qualitative research, outlined by documental analysis based on investigations conducted by the Federal Aviation Administration and the Center of Investigation and Prevention of Aeronautical Accidents. The results point out that human errors account for 60 to 80 percent of accidents and incidents. Most of these occurrences are attributed to miscommunication between the professionals involved with the air and ground operation, such as pilots, crewmembers and maintenance staff, and flight controllers. Inappropriate tone of voice usage, difficulties to understand different accents between the issuer and the receiver or even difficulty to perceive red flags between the lines of verbal and non-verbal communication, are elements that contribute to the fata of understanding between people involved in the operation. As a research limitation this present research pointed out a lack of a special category of "interpersonal communications failures" in the official agency reports. So, the researchers must take the conceptual definition of "social ability", communication implied, to classify behaviors and communication matters accordingly. Other research finding indicates that communication is superficially approached in the contents of air operations courses what could mitigate the lack of communications skills as a social ability. Part of the research findings refers to the contents of communication skills development into the program to train professional involved in air flight and ground operations. So, it is expected that this present article gives an appropriate highlight towards the improvement of flight operations training programs. Developing communication skills among work teams in high reliability organizations can contribute to mitigate stress, accidents and incidents in Civil Aviation Field. The original contribution of this article is the proposal of the main contents that should be developed in a Communication Skills Training Program, specially addressed to Civil Aviation operations.

A Comparison of the Performance of Brand-Affiliated and Unaffiliated Hotel Properties

Research has shown that performance differences exist between brand-affiliated hotels and unaffiliated properties. However, the extant empirical results are mixed. Some research has shown that brands outperform unaffiliated hotels on various metrics, whereas other research has shown the opposite. This article analyzes this issue using a matched-pair approach where we compare the performance differences of brand-affiliated and unaffiliated properties between 1998 and 2010. The matched-pair approach ensures that local competitive conditions as well as hotel characteristics are the same across the comparison pair. In addition, all potential omitted-variable bias and model misspecifications are avoided. Thus, to address our research question, we compare branded hotels with unaffiliated properties that are identical in age, market segment, location, and duration of operation, as well as having a similar number of rooms. Our analysis shows that performance differentials are present, albeit not systematic. We found no consistent advantages in all segments for either the affiliated hotels or the comparable unaffiliated properties, taking into account our comparison factors. That said, the methodology of our approach yields results that are more informative to the affiliation choice of owners and to the growth strategies of hotel brand–owner companies than those of previous empirical studies.

Hotel Profit Implications from Rising Wages and Inflation in the U.S.

Macroeconomic models based on the Phillips Curve predict that as the unemployment rate declines toward the long-run, natural rate, the pace of wage and price growth accelerates and inflation rises.1 In this paper I analyze the profitability prospects for the U.S. hotel industry in today’s relatively volatile economic environment, keeping in mind the Phillips Curve’s general principle that inflation and employment have an inverse, but relatively stable short-term relationship. Although employment and economic growth in the U.S. have been uneven in recent months, the unemployment rate has declined to less than 5 percent, which many economists believe is close to the natural rate. Growth in wages and salaries, as measured by the Employment Cost Index, has concurrently been moving upward between 2.5 and 3.0 percent during the past 12 months. At the same time, general inflation remains below levels that might typically be expected this late in the cycle, although core inflation is bumping up against the Federal Reserve’s 2-percent target. If the inflation rate continues to move upward as predicted by Phillips Curve models (and encouraged by the Federal Reserve), rising labor costs and other expenses will exert downward pressure on U.S. business profits. Backward movement up the Phillips Curve (with greater inflation) coincides with an expanding economy. In that scenario, prices of goods and services also will rise in real terms if their supply cannot keep up with demand, and producers have the ability to raise prices (absent fixed-price contracts such as leases).

Experimental Evidence that Retaliation Claims Are Unlike Other Employment Discrimination Claims

The type of discrimination claim that strikes fear in the hearts of all employers is the dreaded retaliation claim. While employers contend, and plaintiffs admit, that retaliation is different from other discrimination complaints, employee advocates have put forth legislation that would equalize retaliation with the other types of discrimination. This bill, Protecting Older Workers against Discrimination Act (POWADA), would expand the so-called mixed-motive jury instruction to age, and disability, as well as retaliation. Moreover, it would allow plaintiffs, not judges, to decide which types of instruction the jury would receive. In this article, the authors argue that retaliation claims should not receive the same treatment as other discrimination claims (including age and disability), because it’s easy for juries to believe that retaliation is a factor, regardless of other facts. Once a fact-finding jury checks the box to indicate that an employer’s motive might include retaliation, the employer will likely have to pay fees and costs, at minimum, regardless of the claim’s final resolution.

Worries and possibilities in active citizenship : Three Swedish educational contexts

This article examines how the concept of active citizenship has been given a neo-liberal character by examining practice in three different educational contexts in Sweden. The concept of active citizenship has become influential in educational policy and practice throughout the European Union. The aim of this article is to highlight concerns at how this concept has come to be re-shaped by neo-liberal principles in Swedish education. The analysis highlights three themes, based on voice, ethical awareness and complexity and mutuality of lived experience, and argues that they provide the basis for a shift away from the present neo-liberal colouring of the concept.

The Design and Development of Educational Immersive Environments: From Theory to Classroom Deployment

Computer game technology is poised to make a significant impact on the way our youngsters will learn. Our youngsters are ‘Digital Natives’, immersed in digital technologies, especially computer games. They expect to utilize these technologies in learning contexts. This expectation, and our response as educators, may change classroom practice and inform curriculum developments. This chapter approaches these issues ‘head on’. Starting from a review of the current educational issues, an evaluation of educational theory and instructional design principles, a new theoretical approach to the construction of “Educational Immersive Environments” (EIEs) is proposed. Elements of this approach are applied to development of an EIE to support Literacy Education in UK Primary Schools. An evaluation of a trial within a UK Primary School is discussed. Conclusions from both the theoretical development and the evaluation suggest how future teacher-practitioners may embrace both the technology and our approach to develop their own learning resources.

The ins of the striatum: Utilizing chemogenetics to define the contribution of cortical and thalamic afferents during addiction behaviors

Thesis (Ph.D.)--University of Washington, 2016-08

CALS brochure and visitor guide (Center for the Advancement of Laboratory Science)

Located in Coralville in the heart of Iowa’s Creative Corridor, the center for the Advancement of Laboratory Science (CALS) is a public venue intended for use by environmental and public health stakeholders, educational groups, and community businesses and organizations with needs for meeting space. This conference and training facility was established in recognition of a need for a space that unites working professionals, students, educators, community business partners and other community members in a cultivating environment dedicated to environmental and public health stewardship. The CALS is located within the State Hygienic Laboratory at the University of Iowa (SHL) and is comprised of a conference center and training laboratory. The Hygienic Laboratory has a rich history as a national leader in public health education and training and through the CALS. The SHL aims to provide training to the current workforce, recruit the workforce of tomorrow and strengthen community engagement

Using Action Research to Develop My Solution-Focused Practice in Collaboration with Year 6 And 7 Pupils When Discussing Their Behavioural Self-Regulation at School

This action research study aimed to develop the researcher's use of solutionfocused techniques when working with Year 6 and 7 pupils’ self-regulation. A systematic literature review highlighted an evidence base that demonstrated the efficacy of solution-focused methods when working with this population. The researcher’s intention was to add to the body of Educational Psychology practice-based evidence in this area. The researcher recruited eight participants from primary and secondary school provisions. Solution-focused techniques were systematically trialled in partnership with the pupils and were modified through an action research cycle. Semistructured interviewing provided participants the opportunity to critically evaluate the researcher’s solution-focused practice. Thematic Analysis was used to assess feedback in order to adapt the delivery of solution-focused techniques. Developments to practice explored within this study included modifications to the use of the six core components of Solution Focused Brief Therapy. Adaptations have the potential to inform the use of these solution-focused approaches with other educational practitioners.

Unlocking Characteristics of Outstanding Leadership in Schools and Colleges in England

The workshop will invite participants to engage in a discussion of the characteristics of outstanding leadership by taking part in an interactive activity which we have developed and used in different types of schools and colleges in England. The activity uses Q-methodology to develop and refine characteristics of outstanding leaders and outstanding leadership in education from a range of stakeholder perspectives. Q-methodology is a research method which originates from psychology and is used to study people's subjective viewpoints. We are applying the methodology to the study of enacted leadership practice in different educational contexts. Our sample of stakeholders consists of school and college leaders, governors, middle leaders, teachers, teacher educators, researchers and scholars in educational leadership and management research and practice. The range of contexts in which they work represents different age phases of education; primary, secondary and further education colleges, urban and rural schools and colleges and selective and non-selective schools. In the workshop participants will be invited to take part in the Q-sort activity we have used with in our research, using statements from leadership theory and practice. The Q-sort will be followed by discussion and reflection on the statements in relation to participants’ own experiences of leadership, management and governance in different contexts.