Engineering of Business Critical Web Applications

Research focus of this thesis is to explore options for building systems for business critical web applications. Business criticality here includes requirements for data protection and system availability. The focus is on open source software. Goals are to identify robust technologies and engineering practices to implement such systems. Research methods include experiments made with sample systems built around chosen software packages that represent certain technologies. The main research focused on finding a good method for database data replication, a key functionality for high-availability, database-driven web applications. Research included also finding engineering best practices from books written by administrators of high traffic web applications. Experiment with database replication showed, that block level synchronous replication offered by DRBD replication software offered considerably more robust data protection and high-availability functionality compared to leading open source database product MySQL, and its built-in asynchronous replication. For master-master database setups, block level replication is more recommended way to build high-availability into the system. Based on thesis research, building high-availability web applications is possible using a combination of open source software and engineering best practices for data protection, availability planning and scaling.

The determination of EONIA rate: The impact of the financial crisis and the effects of the changes in the monetary policy implementation framework

EONIA is a market based overnight interest rate, whose role as the starting point of the yield curve makes it critical from the perspective of the implementation of European Central Bank´s common monetary policy in the euro area. The financial crisis that started in 2007 had a large impact on the determination mechanism of this interest rate, which is considered as the central bank´s operational target. This thesis examines the monetary policy implementation framework of the European Central Bank and changes made to it. Furthermore, we discuss the development of the recent turmoil in the money market. EONIA rate is modelled by means of a regression equation using variables related to liquidity conditions, refinancing need, auction results and calendar effects. Conditional volatility is captured by an EGARCH model, and autocorrelation is taken into account by employing an autoregressive structure. The results highlight how the tensions in the initial stage of the market turmoil were successfully countered by ECB´s liquidity policy. The subsequent response of EONIA to liquidity conditions under the full allotment liquidity provision procedure adopted after the demise of Lehman Brothers is also established. A clear distinction in the behavior of the interest rate between the sub-periods was evident. In the light of the results obtained, some of the challenges posed by the exit-strategy implementation will be addressed.

The Hegel's Vorlesungen über die Philosophie der Religion (1821-1831) sources and critical editions from Marheineke to Jaeschke

In this paper I provide a concise plan about Hegel's Lectures on the Philosophy of Religion critical editions, laying stress on the method followed by editors in order to build a coherent text with the sources at their disposal. The Marheineke's edition (1832) is analysed with special attention since it was the edition that caused the division between a Right and a Left, opening the discussion on speculative theism as a consequence of the difficulty to distinguish the systematic part from the historical one in the reasoning carried out by Hegel.

Rebuilding Defenses: Explorations in Norman Fairclough’s Theory of Critical Discourse Analysis

Tutkielmassa eritellään Norman Faircloughin kriittisen diskurssianalyysin teoriaa ja siihen kohdistettua kritiikkiä. Pyrkimyksenä on sovittaa näitä erilaisia näkemyksiä keskenään ja tarjota ratkaisuja yhteen kiriittisen diskurssianalyysin keskeiseen ongelmaan eli emansipaation (sosiaalisten epäkohtien tunnistamisen ja ratkaisemisen) puutteellisuuteen. Teoriaosuudesta esiin nousevia mahdollisuuksia sovelletaan tekstianalyysiin. Tutkimuksen kohteena on teksti Rebuilding America’s Defenses: Strategy, Forces and Resources For a New Century ja jossain määrin sen tuottanut järjestö Project for the New American Century. Näitä tarkastellaan ennen kaikkea sosiaalisina ilmiöinä ja suhteessa toisiinsa. Faircloughin mallin suurimmiksi ongelmiksi muodostuvat perinteinen käsitys kielestä, jonka mukaan kielen järjestelmän abstraktit ja sisäiset suhteet ovat tärkeimpiä, sekä ideologinen vastakkainasettelu kritiikin lähtökohtana. Ensimmäinen johtaa kielellisten tutkimustulosten epätyydyttävään kykyyn selittää sosiaalisia havaintoja ja jälkimmäinen poliittiseen tai maailmankatsomukselliseen väittelyyn, joka ei mahdollista uusia näkemyksiä. Tutkielman lopputulema on, että keskittymällä asiasisältöön kielen rakenteen sijasta ja ymmärtämällä tekstin tuottaja yksittäisenä, rajattuna sosiaalisena toimijana voidaan analyysiin saada avoimuutta ja täsmällisyyttä. Kriittiinen diskurssianalyysi kaipaa tällaista näkemystä kielellisten analyysien tueksi ja uudenlaisen relevanssin löytääkseen.

Critical-point model to estimate yield loss caused by Asian soybean rust

ABSTRACTA model to estimate yield loss caused by Asian soybean rust (ASR) (Phakopsora pachyrhizi) was developed by collecting data from field experiments during the growing seasons 2009/10 and 2010/11, in Passo Fundo, RS. The disease intensity gradient, evaluated in the phenological stages R5.3, R5.4 and R5.5 based on leaflet incidence (LI) and number of uredinium and lesions/cm2, was generated by applying azoxystrobin 60 g a.i/ha + cyproconazole 24 g a.i/ha + 0.5% of the adjuvant Nimbus. The first application occurred when LI = 25% and the remaining ones at 10, 15, 20 and 25-day intervals. Harvest occurred at physiological maturity and was followed by grain drying and cleaning. Regression analysis between the grain yield and the disease intensity assessment criteria generated 56 linear equations of the yield loss function. The greatest loss was observed in the earliest growth stage, and yield loss coefficients ranged from 3.41 to 9.02 kg/ha for each 1% LI for leaflet incidence, from 13.34 to 127.4 kg/ha/1 lesion/cm2 for lesion density and from 5.53 to 110.0 kg/ha/1 uredinium/cm2 for uredinium density.

Quantification of incubation, latent and infection periods of Phakopsora pachyrhizi in soybean, according to chronological time and degree-days

ABSTRACT In experiments conducted in a growth chamber, the chronological time and the accumulated degree-days were determined for the duration of incubation, latent and infectious periods of Phakopsora pachyrhizi cultivars BRSGO 7560 and BRS 246 RR. Detached soybean leaflets were placed in gerbox-type acrylic boxes and inoculated with 20 x 103 uredospores/mL. The study was conducted at 12-h photoperiod and temperatures of 10ºC, 15ºC, 22ºC, 25ºC and 30°C for 30 days. Lesions and uredia/cm2were evaluated and the number of uredia per lesion was quantified after the beginning of sporulation. The sporulation potential was also quantified for cultivars BRSGO 7560 and BRS 246 RR. The steps of the infection process can be quantified based on both the chronological time and the accumulated heat. The cultivar BRSGO 7560 produced 4,012.8 spores/cm2 and BRS 246 RR, 7,348.4 uredospores/cm2. The largest number of uredia was produced at 25ºC in both cultivars; however, BRS 246 RR presented 372.7 uredia/cm2 and BRSGO 7560, 231.6 uredia/cm2. At 10ºC and 30°C, leaf infection did not occur in both cultivars.

Finnish Critical Industries, Maritime Transport Vulnerabilities and societal Implications

Maritime transports are very essential for Finland as over 80% of the foreign trade in the country is seaborne and possibilities to carry out these transports by are limited. Any disruption in maritime transports has negative consequences to many sectors in the Finnish economy. Maritime transport thus represents critical infrastructure for Finland. This report focuses on the importance of maritime transports on security of supply in Finland and for the so called critical industries in particular. The report summarizes the results of the Work Package 2 of the research project STOCA – “Study of cargo flows in the Gulf of Finland in emergency situations”. The aim of the research was to analyze the cargo flows and infrastructure that are vital for maintaining security of supply in Finland, as well as the consequences of disruptions in the maritime traffic for the Finnish critical industries and for the Finnish society. In the report we give a presentation of the infrastructure and transport routes which are critical for maintaining security of supply in Finland. We discuss import dependency of the critical industries, and the importance of the Gulf of Finland ports for Finland. We assess vulnerabilities associated with the critical material flows of the critical industries, and possibilities for alternative routings in case either one or several of the ports in Finland would be closed. As a concrete example of a transport disruption we analyze the consequences of the Finnish stevedore strike at public ports (4.3.–19.3.2010). The strike stopped approximately 80% of the Finnish foreign trade. As a result of the strike Finnish companies could not export their products and/or import raw materials, components and spare parts, or other essential supplies. We carried out personal interviews with representatives of the companies in Finnish critical industries to find out about the problems caused by the strike, how companies carried out they transports and how they managed to continue their operations during the strike. Discussions with the representatives of the companies gave us very practical insights about companies’ preparedness towards transport disruptions in general. Companies in the modern world are very vulnerable to transport disruptions because companies regardless of industries have tried to improve their performance by optimizing their resources and e.g. by reducing their inventory levels. At the same time they have become more and more dependent on continuous transports. Most companies involved in foreign trade have global operations and global supply chains, so any disruption anywhere in the world can have an impact on the operations of the company causing considerable financial loss. The volcanic eruption in Iceland in April 2010 stopping air traffic in the whole Northern Europe and most recently the earth quake causing a tsunami in Japan in March 2011 are examples of severe disruptions causing considerable negative impacts to companies’ supply chains. Even though the Finnish stevedore strike was a minor disruption compared to the natural catastrophes mentioned above, it showed the companies’ vulnerability to transport disruptions very concretely. The Finnish stevedore strike gave a concrete learning experience of the importance of preventive planning for all Finnish companies: it made them re-think their practical preparedness towards transport risks and how they can continue with their daily operations despite the problems. Many companies realized they need to adapt their long-term countermeasures against transport disruptions. During the strike companies did various actions to secure their supply chains. The companies raised their inventory levels before the strike began, they re-scheduled or postponed their deliveries, shifted customer orders between production plants among their company’s production network or in the extreme case bought finished products from their competitor to fulfil their customers’ order. Our results also show that possibilities to prepare against transport disruptions differ between industries. The Finnish society as a whole is very dependent on imports of energy, various raw materials and other supplies needed by the different industries. For many of the Finnish companies in the export industries and e.g. in energy production maritime transport is the only transport mode the companies can use due to large volumes of materials transported or due to other characteristics of the goods. Therefore maritime transport cannot be replaced by any other transport mode. In addition, a significant amount of transports are concentrated in certain ports. From a security of supply perspective attention should be paid to finding ways to decrease import dependency and ensuring that companies in the critical industries can ensure the continuity of their operations.

Nutritional status of Eucalyptus grandis clones evaluated by critical level and DRIS methods

Nutritional status of eight 1.0 and 4.7 years old clones of Eucalyptus grandis, cultivated in a medium textured Ustults - US - and a Quartzipsamments - PS - soils, in Lençóis Paulista, São Paulo, were evaluated by the Diagnosis and Recommendation Integrated System (DRIS) and Critical Level (CL) methods. Based on multivariate discriminant analysis, the DRIS indices described the nutritional status of trees better in relation to tree age and soil type than in relation to nutrient composition. Spearman's correlation coefficients showed statistically significant relationships between volumetric tree growth and nutrients when applying DRIS indices or foliar nutrient concentrations. However, the DRIS indices indicated a lower number of trees with nutritional deficiencies, in relation to the CL method. According to the CL method, P, S, and Ca were deficient in the majority of the soils and tree age categories. By the DRIS method, Ca was the only deficient nutrient in PS soils, and appeared to be particularly limited in one-year-old trees. In conclusion, the DRIS method was more efficient than the CL method in evaluating the nutritional status of eucalyptus trees.

Koulutetut maahanmuuttajat työmarkkinoilla. Tutkimus korkeakoulututkinnon suorittaneiden maahanmuuttajien työllistymisestä ja työurien alusta Suomessa

Maahanmuuttajien määrä on Suomessa merkittävämmin lisääntynyt vasta 1990- ja 2000-luvuilla. Vuonna 2010 Suomessa asui lähes 170 000 ulkomaan kansalaista. Tavallisimmin Suomeen muutetaan avioliiton, paluumuuton tai pakolaisuuden vuoksi. Pieni, joskin kasvava joukko muuttaa työn tai opiskelun vuoksi. Myös kansalaisuuksien, koulutustaustojen, ammattien jne. kirjo muuttajien joukossa on suuri. Ulkomaan kansalaisten lisääntyessä Suomessa on jouduttu kohtaamaan monenlaisia maahanmuuttoon liittyviä haasteita, joista työllistymiseen liittyvät kysymykset eivät ole vähäisimpiä. Tutkimuksessa tarkastellaan lähtömaassaan korkeakoulututkinnon suorittaneiden maahanmuuttajien työllistymistä ja työuran alkua Suomessa. Tutkimuksen tarkoituksena on selvittää, miten korkeakoulutetut maahanmuuttajat ovat Suomessa työllistyneet, minkälaisia heidän työuriensa alut ovat Suomessa olleet ja miten he ovat onnistuneet uudessa maassa hyödyntämään lähtömaassa hankkimaansa koulutusta. Lisäksi tutkimuksessa tarkastellaan, miten maahanmuuttajien lähtömaan erilaiset elämäntilanteet, olosuhteet ja valinnat ovat vaikuttaneet työuran muotoutumiseen Suomessa. Tutkimuksen aineisto muodostuu kysely- sekä haastatteluaineistosta. Kyselyaineiston (n=99) tarkoituksena on luoda määrällistä kuvaa korkeakoulutettujen maahanmuuttajien työllistymisestä Suomessa. Numerotietojen taakse jää kuitenkin näkymättömiin tieto maahanmuuttajien yksilöllisistä kokemuksista liittyen työllistymiseen ja työuran muotoutumiseen uudessa maassa. Toisena aineistona hyödynnettävän elämäkerrallisen haastatteluaineiston (n=20) kautta on mahdollista tehdä näkyväksi ne tutkittavien yksilölliset työ- ja koulutusuraan liittyvät valinnat, joita maahanmuuttajat ovat tehneet niin lähtömaassa kuin Suomessa sekä ne tilanteet ja olosuhteet, joissa tutkittavat ovat lähtömaassa eläneet ja joiden pohjalta he ovat tulleet Suomeen ja Suomen työmarkkinoille. Aineistoissa mukana olevat maahanmuuttajat olivat pääosin avioliiton, paluumuuton sekä pakolaisuuden vuoksi Suomeen tulleita. Vain muutama oli tullut työn vuoksi. Maahanmuuttajien työmarkkina-asemaa selitetään usein maahanmuuttajien resursseilla, kuten kielitaidolla, koulutuksella, työkokemuksella, sosiaalisten suhteiden ja verkostojen laadulla ja määrällä jne. Myös maahanmuuttajiin kohdistuvilla syrjivillä ja ennakkoluuloisilla asenteilla on keskeinen merkitys työllistymisessä. Koulutuksen ollessa yksi keskeisimmistä työmarkkina-asemaa määräävistä tekijöistä, tulisi koulutettujen maahanmuuttajien sijoittua hankitun tutkinnon oikeuttamiin tehtäviin. Tutkimuksessa kuitenkin havaittiin, että työllistyminen oli maahanmuuttajilla vaikeaa hyvästä koulutuksesta huolimatta. Kyselyaineistoon vastanneista vain muutama (6 %) oli työssä heti Suomeen muuttovuoden lopussa, kolme vuotta Suomessa asuttuaan työssä oli runsas kolmannes (35 %) ja aineistonkeruuhetkellä eli vuonna 2004 työssä oli 38 % vastaajista. Työsuhteet olivat tutkittavilla useimmiten määräaikaisia ja kestoltaan lyhyitä. Lisäksi työurat koostuivat runsaasta työttömyydestä sekä koulutukseen osallistumisesta. Myönteistä kuitenkin oli, että mikäli korkeakoulutetut maahanmuuttajat onnistuivat Suomessa työllistymään, vastasi työ usein joko kokonaan tai ainakin osittain hankittua korkeakoulututkintoa. Korkeakoulutettujen maahanmuuttajien työuran alut Suomessa voidaan tyypitellä kolmeen ryhmään, joista kukin jakaantui vielä kahteen alaryhmään siten, että kaiken kaikkiaan saatiin kuusi erilaista työuran alun tyyppiä: koulutusta vastaava vakaa ja vakiintuva ura, koulutusta osittain vastaava sekaura ja laskeva ura sekä koulutusta vastaamaton sisääntuloura ja työttömän ura . Haastatteluaineiston kautta tarkastellaan korkeakoulutettujen maahanmuuttajien yksilöllisiä elämänuria lähtien liikkeelle korkeakoulutettujen maahanmuuttajien lähtömaassa tekemistä ura- ja ammatinvalinnoista jatkuen Suomeen muuton kautta aina työuran muotoutumiseen Suomessa. Haastatteluja toisistaan erottelevina keskeisinä teemoina olivat toisaalta pärjääminen Suomessa ja suomalaisilla työmarkkinoilla toisaalta elämän muotoutuminen lähtömaassa ja nimenomaan siellä tehdyt ura- ja ammatinvalinnat ja niihin liittyvät kokemukset ja elämäntilanteet. Näiden kriteerien pohjalta aineisto jakaantui kolmeen ryhmään, jotka nimettiin pärjääjiksi, harhailijoiksi ja sinnittelijöiksi. Pärjääjien kertomukset muotoutuivat tietyllä tavalla myönteisen kehän kautta: niin lähtömaassa tehdyt ammatinvalinnat kuin työuran muotoutuminen Suomessa tapahtuivat suhteellisen vaivattomasti. Useimmiten työt Suomessa vastasivat lähtömaassa hankittua koulutusta. Omiin uravalintoihin oltiin myöhemmin myös tyytyväisiä. Harhailijoille oman paikan löytyminen oli puolestaan hankalampaa. Leimallista tälle ryhmälle oli tietynlainen valintojen vaikeus sekä tyytymättömyys omiin aikaisemmin tehtyihin ratkaisuihin. Jotkut harmittelivat nuorena tekemiään uravalintoja niin, että päättivät Suomessa hankkia kokonaan uuden ammatin. Muutto Suomeen merkitsi useimmille ammatillisen aseman laskua. Sinnittelijät kertoivat jo lähtökohdiltaan kahteen muuhun ryhmään nähden hyvin erilaista tarinaa. Tämän ryhmän lähes koko elämä lähtömaassa oli sodan ja levottomuuksien sävyttämää. Tämä näkyi myös ammatinvalinnassa: opiskelupaikka oli saatettu valita esimerkiksi sen perusteella, missä oli milloinkin turvallista opiskella. Myös Suomeen muutto erosi kahdesta aikaisemmasta ryhmästä, sillä lähtö entisestä kotimaasta oli tapahtunut usein hyvinkin yllättäen vailla etukäteissuunnittelua tilanteiden kärjistyttyä nopeasti. Suomessa työelämään pääseminen oli kaikille sinnittelijöille vaikeaa ja haastatteluhetkellä useilla vielä hyvin alkutekijöissä. Hyväkään koulutus ei aina takaa maahanmuuttajille työtä uudessa maassa, sillä hankittua tutkintoa ja osaamista ei ole helppo siirtää maasta toiseen. Pahimmassa tapauksessa vieraassa maassa suoritettu korkeakoulututkinto voi kokonaan mitätöityä uudessa maassa ja korkeakoulututkinnon myötä hankittu osaaminen menettää täysin arvonsa. Kyse on niin yksilön kuin yhteiskunnankin resurssien tuhlaamisesta tilanteessa, jossa maassa pysyvästi asuvat koulutetut maahanmuuttajat työskentelevät tavalla tai toisella koulutustaan vastaamattomissa epävakaissa töissä, työmarkkinoiden laitamilla tai ovat kokonaan työmarkkinoiden ulkopuolella.

Dissecting the molecular mechanisms of breast cancer bone metastasis for therapeutic targeting

Breast cancer that has metastasized to bone is currently an incurable disease, causing significant morbidity and mortality. The aim of this thesis work was to elucidate molecular mechanisms of bone metastasis and thereby gain insights into novel therapeutic approaches. First, we found that L‐serine biosynthesis genes, phosphoglycerate dehydrogenase (PHGDH), phosphoserine aminotransferase 1 (PSAT1) and phosphoserine phosphatase (PSPH), were up‐regulated in highly bone metastatic MDA‐MB‐231(SA) cells as compared with the parental breast cancer cell line. Knockdown of serine biosynthesis inhibited proliferation of MDA‐MB‐231(SA) cells, and L‐serine was essential for the formation of bone resorbing osteoclasts. Clinical data demonstrated that high expression of PHGDH and PSAT1 was associated with decreased relapse‐free and overall survival and with features typical of poor outcome in breast cancer. Second, RNA interference screening pointed out heparan sulfate 6‐O‐sulfotransferase 2 (HS6ST2) as a critical gene for transforming growth factor β (TGF‐β)‐induced interleukin 11 (IL‐11) production in MDA‐MB‐231(SA) cells. Exogenous heparan sulfate glycosaminoglycans heparin and K5‐NSOS also inhibited TGF‐β‐induced IL‐11 production in MDA‐MB‐231(SA) cells. Furthermore, K5‐NSOS decreased osteolytic lesion area and tumor burden in bone in mice. Third, we discovered that the microRNAs miR‐204, ‐211 and ‐379 inhibited IL‐11 expression in MDA‐MB‐231(SA) cells through direct targeting of the IL‐11 mRNA. MiR‐379 also inhibited Smad‐mediated signaling. Gene expression profiling of miR‐204 and ‐379 transfected cells indicated that these microRNAs down‐regulate several bone metastasis‐relevant genes, including prostaglandin‐endoperoxide synthase 2 (PTGS2). Taken together, this study identified three potential treatment strategies for bone metastatic breast cancer: inhibition of serine biosynthesis, heparan sulfate glycosaminoglycans and restoration of miR‐204/‐211/‐379.

Transport of broilers: load microclimate during Brazilian summer

The objective of this study was to characterize the microclimatic profile of broiler transport trucks under commercial conditions, in the summer, by continuous monitoring of environmental variables (temperature and air relative humidity). Three loads were monitored from farm to slaughterhouse, considering factors such as distance and day periods (morning, afternoon, and night). To obtain the profile of the environmental variables during journey, data loggers, that determined the microclimate to which birds were submitted, were installed in the trucks; data loggers also allowed visualization of the Enthalpy Comfort Index (ECI) so that load regions could be classified according to heat comfort limits for 6-week old poultries. Temperature, relative humidity, and ECI in the truck were analyzed, using geostatistics, by the ordinary kriging method. The afternoon was the most critical period, and truck central and rear regions were most problematic for chickens, thus most susceptible to losses.

Competence in intensive and critical care nursing - development of a basic assessment scale for graduating nursing students

Intensive and critical care nursing is a speciality in its own right and with its own nature within the nursing profession. This speciality poses its own demands for nursing competencies. Intensive and critical care nursing is focused on severely ill patients and their significant others. The patients are comprehensively cared for, constantly monitored and their vital functions are sustained artificially. The main goal is to win time to cure the cause of the patient’s situation or illness. The purpose of this empirical study was i) to describe and define competence and competence requirements in intensive and critical care nursing, ii) to develop a basic measurement scale for competence assessment in intensive and critical care nursing for graduating nursing students, and iii) to describe and evaluate graduating nursing students’ basic competence in intensive and critical care nursing by seeking the reference basis of self-evaluated basic competence in intensive and critical care nursing from ICU nurses. However, the main focus of this study was on the outcomes of nursing education in this nursing speciality. The study was carried out in different phases: basic exploration of competence (phase 1 and 2), instrumentation of competence (phase 3) and evaluation of competence (phase 4). Phase 1 (n=130) evaluated graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care with Basic Knowledge Assessment Tool version 5 (BKAT-5, Toth 2012). Phase 2 focused on defining competence in intensive and critical care nursing with the help of literature review (n=45 empirical studies) as well as competence requirements in intensive and critical care nursing with the help of experts (n=45 experts) in a Delphi study. In phase 3 the scale Intensive and Critical Care Nursing Competence Scale (ICCN-CS) was developed and tested twice (pilot test 1: n=18 students and n=12 nurses; pilot test 2: n=56 students and n=54 nurses). Finally, in phase 4, graduating nursing students’ competence was evaluated with ICCN-CS and BKAT version 7 (Toth 2012). In order to develop a valid assessment scale of competence for graduating nursing students and to evaluate and establish the competence of graduating nursing students, empirical data were retrieved at the same time from both graduating nursing students (n=139) and ICU nurses (n=431). Competence can be divided into clinical and general professional competence. It can be defined as a specific knowledge base, skill base, attitude and value base and experience base of nursing and the personal base of an intensive and critical care nurse. Personal base was excluded in this self-evaluation based scale. The ICCN-CS-1 consists of 144 items (6 sum variables). Finally, it became evident that the experience base of competence is not a suitable sum variable in holistic intensive and critical care competence scale for graduating nursing students because of their minor experience in this special nursing area. ICCN-CS-1 is a reliable and tolerably valid scale for use among graduating nursing students and ICU nurses Among students, basic competence of intensive and critical care nursing was self-rated as good by 69%, as excellent by 25% and as moderate by 6%. However, graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care were poor. The students rated their clinical and professional competence as good, and their knowledge base and skill base as moderate. They gave slightly higher ratings for their knowledge base than skill base. Differences in basic competence emerged between graduating nursing students and ICU nurses. The students’ self-ratings of both their basic competence and clinical and professional competence were significantly lower than the nurses’ ratings. The students’ self-ratings of their knowledge and skill base were also statistically significantly lower than nurses’ ratings. However, both groups reported the same attitude and value base, which was excellent. The strongest factor explaining students’ conception of their competence was their experience of autonomy in nursing. Conclusions: Competence in intensive and critical care nursing is a multidimensional concept. Basic competence in intensive and critical care nursing can be measured with self-evaluation based scale but alongside should be used an objective evaluation method. Graduating nursing students’ basic competence in intensive and critical care nursing is good but their knowledge and skill base are moderate. Especially the biological and physiological knowledge base is poor. Therefore in future in intensive and critical care nursing education should be focused on both strengthening students’ biological and physiological knowledge base and on strengthening their overall skill base. Practical implications are presented for nursing education, practice and administration. In future, research should focus on education methods and contents, mentoring of clinical practice and orientation programmes as well as further development of the scale.

Critical analysis of thoracotomies performed in the emergency room in 10 years

OBJECTIVE: To conduct a critical analysis of thoracotomies performed in the emergency rooms.METHODS: We analyzed mortality rates and survival as outcome variables, mechanism of injury, site of injury and anatomic injury as clinical variables, and gender and age as demographic variables of patients undergoing thoracotomy in the emergency room after traumatic injury.RESULTS: Of the 105 patients, 89.5% were male. The average age was 29.2 years. Penetrating trauma accounted for 81% of cases. The most common mechanism of trauma was wound by a firearm projectile (gunshot), in 64.7% of cases. Patients with stab wounds (SW) accounted for 16.2% of cases. Overall survival was 4.7%. Survival by gunshot was 1.4%, and by SW, 23.5%. The ERT following blunt trauma showed a 100%mortality.CONCLUSION: The results obtained in the Emergency Hospital of Porto Alegre POA-HPS are similar to those reported in the world literature.

Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence

Objective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.