The challenges of integrating the discussion of controversial issues in initial teacher training

In the framework of the Bologna process, and with regard to pre-service teacher education, it is necessary to model student-centred learning experiences in order to promote the required competences for future professional practice and critical participation in society. Despite the potential of discussion in promoting several competences, this methodology does not always integrate the teaching practices. This case study sought to: a) understand the experiences and views of future teachers from a School of Education on the use of discussion in their past education; and b) investigate the impact of an educational experience centred on discussion. Data were collected through narratives, questionnaires, interviews and participant observation. The learning situations experienced through this study contributed to the development of citizens more aware of their role in society and allowed the promotion of skills indispensable for an Elementary Education teacher.

At the end of the day: Macmillan's account of the Cuban missile crisis

Pre-publicity for the final volume of Harold Macmillan’s memoirs, At the End of the Day, stressed that it would provide the British side of the Cuban missile crisis for the first time. The Churchillian model chosen, changes required by the Cabinet Office and Macmillan’s desire to rebuke those political opponents who claimed that the crisis demonstrated a lack of British influence in Washington, however ensured a focus on his personal relationship with President Kennedy. His larding the text with contemporary observations from his diaries also skewed Macmillan’s account and, in particular, underplayed the significance of British moves at the United Nations in New York to secure a credible United Nations inspection regime and a US guarantee of the inviolability of Cuba. Careful reconstruction of Macmillan’s real-time experience of the Cuban missile crisis demonstrates the limitations of his own account of this event

A review of dynamic Bayesian network techniques with applications in healthcare risk modelling

Coping with an ageing population is a major concern for healthcare organisations around the world. The average cost of hospital care is higher than social care for older and terminally ill patients. Moreover, the average cost of social care increases with the age of the patient. Therefore, it is important to make efficient and fair capacity planning which also incorporates patient centred outcomes. Predictive models can provide predictions which their accuracy can be understood and quantified. Predictive modelling can help patients and carers to get the appropriate support services, and allow clinical decision-makers to improve care quality and reduce the cost of inappropriate hospital and Accident and Emergency admissions. The aim of this study is to provide a review of modelling techniques and frameworks for predictive risk modelling of patients in hospital, based on routinely collected data such as the Hospital Episode Statistics database. A number of sub-problems can be considered such as Length-of-Stay and End-of-Life predictive modelling. The methodologies in the literature are mainly focused on addressing the problems using regression methods and Markov models, and the majority lack generalisability. In some cases, the robustness, accuracy and re-usability of predictive risk models have been shown to be improved using Machine Learning methods. Dynamic Bayesian Network techniques can represent complex correlations models and include small probabilities into the solution. The main focus of this study is to provide a review of major time-varying Dynamic Bayesian Network techniques with applications in healthcare predictive risk modelling.

Utopia and its Discontents: Dreams of Catastrophe and the End of 'the End of History'

The institutionalization of Utopia Studies in the last decade is premised upon a specifically aesthetic reception of Ernst Bloch’s theory of the “utopian impulse” during the 1980s and 1990s. A postmodern uneasiness to both left and right formulations of the "End of History" during this period imposes a resistance to concepts of historical and political closure or totality, resulting in a "Utopianism without Utopia". For all the attractiveness of this pan-utopianism, its failure to consider the relation between historical representation and fulfillment renders it consummate with liberalism as a merely inverted conservatism. In contrast to this specific recuperation of a Bloch, the continuing importance of Walter Benjamin’s theory of the dialectical image and the speculative concept of historical experience which underlies it becomes apparent. The intrusion of the historical Absolute is coded throughout Benjamin’s thought as the eruptive and mortuary figure of catastrophe, which stands as the dialectical counterpart to the utopian wish images of the collective dream. Indeed, the motto under which the Arcades Project was to be constructed derives from Adorno: “Each epoch dreams of itself as annihilated by catastrophe”.

PLSR Models for Mechanical Strengths of Concrete Composite Materials Reinforced with Pultrusion Wastes

In this paper, we present two Partial Least Squares Regression (PLSR) models for compressive and flexural strength responses of a concrete composite material reinforced with pultrusion wastes. The main objective is to characterize this cost-effective waste management solution for glass fiber reinforced polymer (GFRP) pultrusion wastes and end-of-life products that will lead, thereby, to a more sustainable composite materials industry. The experiments took into account formulations with the incorporation of three different weight contents of GFRP waste materials into polyester based mortars, as sand aggregate and filler replacements, two waste particle size grades and the incorporation of silane adhesion promoter into the polyester resin matrix in order to improve binder aggregates interfaces. The regression models were achieved for these data and two latent variables were identified as suitable, with a 95% confidence level. This technological option, for improving the quality of GFRP filled polymer mortars, is viable thus opening a door to selective recycling of GFRP waste and its use in the production of concrete-polymer based products. However, further and complementary studies will be necessary to confirm the technical and economic viability of the process.

Quality of Life Predictors and Normative Data

This study identifies predictors and normative data for quality of life (QOL) in a sample of Portuguese adults from general population. A cross-sectional correlational study was undertaken with two hundred and fifty-five (N = 255) individuals from Portuguese general population (mean age 43 years, range 25–84 years; 148 females, 107 males). Participants completed the European Portuguese version of the World Health Organization Quality of Life short-form instrument and the European Portuguese version of the Center for Epidemiologic Studies Depression Scale. Demographic information was also collected. Portuguese adults reported their QOL as good. The physical, psychological and environmental domains predicted 44 % of the variance of QOL. The strongest predictor was the physical domain and the weakest was social relationships. Age, educational level, socioeconomic status and emotional status were significantly correlated with QOL and explained 25 % of the variance of QOL. The strongest predictor of QOL was emotional status followed by education and age. QOL was significantly different according to: marital status; living place (mainland or islands); type of cohabitants; occupation; health. The sample of adults from general Portuguese population reported high levels of QOL. The life domain that better explained QOL was the physical domain. Among other variables, emotional status best predicted QOL. Further variables influenced overall QOL. These findings inform our understanding on adults from Portuguese general population QOL and can be helpful for researchers and practitioners using this assessment tool to compare their results with normative data

A Clinical Support System Based on Quality of Life Estimation

Quality of life is a concept influenced by social, economic, psychological, spiritual or medical state factors. More specifically, the perceived quality of an individual's daily life is an assessment of their well-being or lack of it. In this context, information technologies may help on the management of services for healthcare of chronic patients such as estimating the patient quality of life and helping the medical staff to take appropriate measures to increase each patient quality of life. This paper describes a Quality of Life estimation system developed using information technologies and the application of data mining algorithms to access the information of clinical data of patients with cancer from Otorhinolaryngology and Head and Neck services of an oncology institution. The system was evaluated with a sample composed of 3013 patients. The results achieved show that there are variables that may be significant predictors for the Quality of Life of the patient: years of smoking (p value 0.049) and size of the tumor (p value < 0.001). In order to assign the variables to the classification of the quality of life the best accuracy was obtained by applying the John Platt's sequential minimal optimization algorithm for training a support vector classifier. In conclusion data mining techniques allow having access to patients additional information helping the physicians to be able to know the quality of life and produce a well-informed clinical decision.

Impact of Syncope on Quality of Life: Validation of a Measure in Patients Undergoing Tilt Testing

INTRODUCTION AND OBJECTIVES: Recurrent syncope has a significant impact on quality of life. The development of measurement scales to assess this impact that are easy to use in clinical settings is crucial. The objective of the present study is a preliminary validation of the Impact of Syncope on Quality of Life questionnaire for the Portuguese population. METHODS: The instrument underwent a process of translation, validation, analysis of cultural appropriateness and cognitive debriefing. A population of 39 patients with a history of recurrent syncope (>1 year) who underwent tilt testing, aged 52.1 ± 16.4 years (21-83), 43.5% male, most in active employment (n=18) or retired (n=13), constituted a convenience sample. The resulting Portuguese version is similar to the original, with 12 items in a single aggregate score, and underwent statistical validation, with assessment of reliability, validity and stability over time. RESULTS: With regard to reliability, the internal consistency of the scale is 0.9. Assessment of convergent and discriminant validity showed statistically significant results (p<0.01). Regarding stability over time, a test-retest of this instrument at six months after tilt testing with 22 patients of the sample who had not undergone any clinical intervention found no statistically significant changes in quality of life. CONCLUSIONS: The results indicate that this instrument is of value for assessing quality of life in patients with recurrent syncope in Portugal.

Maritime Security in the Gulf of Guinea: Issues and Solutions for the 21st Century

A producer of 5.4 M bbl/d, totalling almost half of the consumption of the entire European Union, the Gulf of Guinea is a fundamental lifeline and maritime link between Europe, the Americas and Africa. Geographically positioned as a staging post for transit originating in Latin America and coupled with its relatively porous borders, the region is also the perfect stepping stone for contraband heading to European shores. While blessed with an enviable wealth of marine and mineral resources, the region is also plagued by an ever-increasing spectre of maritime piracy; accounting for around 30% of incidents in African waters from 2003 to 2011. It is for these reasons that this research centres around the issues of maritime security in the Gulf of Guinea, with a particular focus on the first two decades of the 21st century. This research looks to examine the overall picture of the present state of play in the area, before going on to provide an analysis of potential regional developments in maritime security. This research begins with the analysis of concepts/phenomena that have played a notable role in the shaping of the field of maritime security, namely Globalisation and security issues in the post-Cold War era. The ensuing chapter then focuses in on the Gulf of Guinea and the issues dominating the field of maritime security in the region. The penultimate chapter presents a SWOT analysis, undertaken as part of this research with the aim of correlating opinions from a variety of sectors/professions regarding maritime security in the Gulf of Guinea. The final chapter builds upon the results obtained from the abovementioned SWOT analysis, presenting a series of potential proposals/strategies that can contribute to the field of maritime security in the region over the coming years. This research draws to a close with the presentation of conclusions taken from this particular investigation, as well as a final overview of the earlier presented proposals applicable to the field of maritime security during the second decade of the 21st century.

Quality of life of hypertensive and diabetic patients: Who suffers the most?

Objective: Quality of life was measured using the EQ-5D index for Portugal and a Self-Assessed Ranking of Health (SARH) to understand which patients suffer the most decrease in quality of life: diabetics or hypertensive. Method: Using the National Health Survey (NHS), two analyses were conducted on 5649 respondents. The EQ-5D index was calculated by matching questions in the NHS with its dimensions. The SARH was calculated based on a specific question in the NHS. Results: Differences between diseases do not occur using the EQ-5D index. Using the SARH, type 1 diabetics suffer the most while hypertensive suffers the least.

Validation of the IMPACT-III quality of life questionnaire in Swiss children with inflammatory bowel disease.

BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) frequently manifests during childhood and adolescence. For providing and understanding a comprehensive picture of a patients' health status, health-related quality of life (HRQoL) instruments are an essential complement to clinical symptoms and functional limitations. Currently, the IMPACT-III questionnaire is one of the most frequently used disease-specific HRQoL instrument among patients with IBD. However, there is a lack of studies examining the validation and reliability of this instrument. METHODS: 146 paediatric IBD patients from the multicenter Swiss IBD paediatric cohort study database were included in the study. Medical and laboratory data were extracted from the hospital records. HRQoL data were assessed by means of standardized questionnaires filled out by the patients in a face-to-face interview. RESULTS: The original six IMPACT-III domain scales could not be replicated in the current sample. A principal component analysis with the extraction of four factor scores revealed the most robust solution. The four factors indicated good internal reliability (Cronbach's alpha=.64-.86), good concurrent validity measured by correlations with the generic KIDSCREEN-27 scales and excellent discriminant validity for the dimension of physical functioning measured by HRQoL differences for active and inactive severity groups (p<.001, d=1.04). CONCLUSIONS: This study with Swiss children with IBD indicates good validity and reliability for the IMPACT-III questionnaire. However, our findings suggest a slightly different factor structure than originally proposed. The IMPACT-III questionnaire can be recommended for its use in clinical practice. The factor structure should be further examined in other samples.

Advance directives and the impact of timing. A qualitative study with Swiss general practitioners.

PRINCIPLES: Advance directives are seen as an important tool for documenting the wishes of patients who are no longer competent to make decisions in regards to their medical care. Due to their nature, approaching the subject of advance directives with a patient can be difficult for both the medical care provider and the patient. This paper focuses on general practitioners' perspectives regarding the timing at which this discussion should take place, as well as the advantages and disadvantages of the different moments. METHODS: In 2013, 23 semi-structured face-to-face interviews were performed with Swiss general practitioners. Interviews were analysed using qualitative content analysis. RESULTS: In our sample, 23 general practitioners provided different options that they felt were appropriate moments: either (a) when the patient is still healthy, (b) when illness becomes predominant, or (c) when a patient has been transferred to a long-term care facility. Furthermore, general practitioners reported uncertainty and discomfort regarding initiating the discussion. CONCLUSION: The distinct approaches, perspectives and rationales show that there is no well-defined or "right" moment. However, participants often associated advance directives with death. This link caused discomfort and uncertainty, which led to hesitation and delay on the part of general practitioners. Therefore we recommend further training on how to professionally initiate a conversation about advance directives. Furthermore, based on our results and experience, we recommend an early approach with healthy patients paired with later regular updates as it seems to be the most effective way to inform patients about their end-of-life care options.