The positioning of palliative care in acute care: A multiperspective qualitative study in the context of metastatic melanoma

Objective: The positioning and meaning of palliative care within the healthcare system lacks clarity which adds a level of complexity to the process of transition to palliative care. This study explores the transition to the palliative care process in the acute care context of metastatic melanoma. Method: A theoretical framework drawing on interpretive and critical traditions informs this research. The pragmatism of symbolic interactionism and the critical theory of Habermas brought a broad orientation to the research. Integration of the theoretical framework and grounded-theory methods facilitated data generation and analysis of 29 interviews with patients, family carers, and healthcare professionals. Results: The key analytical findings depict a scope of palliative care that was uncertain for users of the system and for those working within the system. Becoming “palliative” is not a defined event; nor is there unanimity around referral to a palliative care service. As such, ambiguity and tension contribute to the difficulties involved in negotiating the transition to palliative care. Significance of Results: Our findings point to uncertainty around the scopes of practice in the transition to palliative care. The challenge in the transition process lies in achieving greater coherency of care within an increasingly specialized healthcare system. The findings may not only inform those within a metastatic melanoma context but may contribute more broadly to palliative practices within the acute care setting.

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Èto i to v povesti Staruha Daniila Harmsa

This dissertation focuses on the short story Starukha (The Old Woman), one of the last works of the Russian writer Daniil Kharms (1905-1942). The story, written in 1939, is analysed using the Kharmsian concepts èto and to (this and that) as a heuristic interpretative model. The first chapter gives a detailed analysis of this model, as well as a survey of the critical work done to date on Kharms and Starukha. In the second chapter the model is applied to study the different states of consciousness of the male protagonist. This is significant, because he is the "I" of the work, from whose point of view everything is being told. The third chapter takes a closer look at the reality of the world that exists independently of the consciousness of the protagonist. Physical objects can be said to bear - besides their everyday meaning - a hidden symbolic meaning. Similarly, the characters can be considered as representatives of everyday reality and otherworldliness. The fourth chapter deals with the narrative devices of Starukha. The problematics of the relation between fact and fiction plays an essential role in the story. Kharms's use of Ich-Erzählung and different tenses, which contributes to achieving a complicated elaboration of this kind of problematics, is examined in detail. The fifth chapter provides an intertextual reading of Starukha, based on its allusions to the Bible and the Christian tradition. As a result, the whole story can be seen as a kind of meditation on the Passion of Christ. The final chapter examines how the important Kharmsian concepts of the grotesque and the absurd manifest themselves in Starukha. The old woman represents in a grotesque way two opposite systems: the religious and the totalitarian. The absurdity of Starukha can be claimed to be illusory. Therefore, it is better to speak about paradoxicality. Starukha itself is a kind of paradox, in the sense that it tries to say something of the ultimate truth of reality, which inevitably remains ineffable.

Caring for patients with limb amputation

This article provides an overview of the care of patients undergoing limb amputation. Absence of a limb can be congenital or the result of trauma or complications of chronic diseases. While the economic burden of limb amputation is significant, nurses have an important role in limiting other losses attributable to limb loss, such as long-term disability leading to loss of employment and delayed return to work or school. Comprehensive nursing assessments and appropriate interventions, pre and post-operatively, as well as early discharge planning and community reintegration can help avoid some of these losses. Nurses should be aware of the resources available in communities and work in multidisciplinary teams to ensure optimal outcomes for patients following limb amputation and their families.

From council dog catcher to critical scholar

Carol and I just missed each other in the early 1990s: Carol left Manchester for Australia in 1990, while I an·iv·ed in Manchester from Australia in 1993. Sixteen years later and on the very opposite side of the world, we found ourselves sharing an adjacent room during the 2009 Agri-Food Research Network conference in Auckland. Carol was already an accomplished sociologist; I was a newbie PhD student, presenting on a thesis topic that was only just starting to take shape...

Improving health and safety communication of migrant construction workers

Although statistical data in some developed countries indicate that migrant workers are nearly 30% more likely to have work-related injuries than local workers, no equivalent official injury/ incident statistics on the health and safety (H&S) of migrant workers are currently tracked in Australia. With increasing numbers of migrant workers having joined Australia’s extractive industries infrastructure and commercial construction industry, this suggests the need for some investigation. A particular issue is that lack of H&S communication is one of the key factors leading to construction industry accidents/ incidents as it prevents workers from effectively receiving H&S safety training and acquiring H&S information. Migrant workers whose first languages are not English are particularly affected by this problem and ways are needed to improve their situation. The research aims to do this by evaluating the H&S communication problems of migrant workers and identify an effective H&S communication structure. An overview of the challenge being addressed by the research is firstly provided, followed by a description of the research framework, and a report of the initial findings, from which recommendations are provided for improving H&S performance in the construction industry.

Playing "Nordic": The Women of Niskavuori, Agri/Culture, and Imagining Finland on the Third Reich Stage

The theatrical censorship of the Third Reich considered the playwright's race and politics alongside the content of the drama. Given the political stigma of its "leftist" author, it is rather surprising that Hella Wuolijoki's Niskavuoren naiset opened in 1938 at the Staatliches Schauspielhaus in Hamburg. The play ran for fourteen performances before being closed by the Reichsdramaturgie, apparently at the instigation of Finnish critics. Yet this was not the end of the play's or its author's fortunes in the Third Reich, as the possibility of staging the play was raised several times over the next four years, coming to a close in 1942. Playing "Nordic" examines the ideological and theatrical background of this extended "cultural performance," as a means to reopening and reconstructing the work of the 1938 Die Frauen auf Niskavuori. Written by a Finnish, northern, "Nordic" author, and preoccupied with the dynamics of rural culture in an increasingly urbanized world, Niskavuoren naiset was understood in the Third Reich to illustrate and reinforce the racial, agri/cultural themes of Blut und Boden ("veri ja maa"). Playing "Nordic" examines this thematic relationship in three phases. The first phase uses archival materials to investigate the Reichsdramaturgie's understanding of the play and its author, and its ongoing discussion of Wuolijoki from 1937 to 1942. Play evaluator Sigmund Graff's description of Niskavuoren naiset as hamsunartig, or "Hamsun-esque," inspires the second phase of the dissertation, which first elaborates the meanings of Blut und Boden through a reading of contemporary "racial" theory and anthropology, and then assesses the representation of Finland within this discourse, one of the dominant cultural paradigms of the Third Reich. Imaging Finland for German audiences, the play stood among analogous, continued efforts to represent Finland and the rural life in the Third Reich, colored by Blut und Boden: art and agricultural exhibitions, essays and propaganda literature, mass demonstrations of the peasantry. This wider framework for the performance of "Finland" materializes the abstract or theoretical program of Blut und Boden in its everyday performed meanings; as such it provides the essential background for reading the Hamburg production of Die Frauen auf Niskavuori, which sustains the third and final phase. The German translation and the Hamburg photographic record are compared with the Helsinki premiere to assess the impact of Blut und Boden on the representation of Wuolijoki's play in the Third Reich. The journalistic critical response illuminates the effect that the dramatic complex of rural and racial values - generically identified as Bauerndrama in the Third Reich - had on the reception of the play; at the same time, both visual and critical documents also suggest possible moments of theatrical dissent in the Hamburg production. Playing "Nordic" undertakes a documentary and cultural reading of the changing theatrical meanings of Wuolijoki's Niskavuoren naiset as it crossed the frontier from Finland to the stage of the Third Reich. It also provides a model for the ways theatrical signification operates within a network of cultural and ideological meanings, suggesting the ideological work of theatrical production depends on, reinforces, and contests that tissue of values. Although Finnish criticism of Niskavuoren naiset has assumed the play's Blut und Boden resonance contributed to Wuolijoki's success in the Third Reich, this study shows a considerably more complex situation. This revealing production dramatizes the changing uses of plays in a politicized national and transnational context. As part of the framing of "Nordic" identity on the wider stage of the Third Reich, Die Frauen auf Niskavuori exemplifies the conjunction of concurrent - sometimes independent, sometimes interlocking - "racial" and national ideologies.

Historiebruk kring Nådendal : och den kommemorativa anatomin av klostrets minnesplats

This thesis examines the ruins of the medieval Bridgettine (Birgittan) monastery of Naantali (Vallis Gratiae, f. 1443) in Finland and the transformation of the site into a national heritage and a memory landscape. It was archaeologically surveyed in the 19th century by Professor Sven Gabriel Elmgren (1817 1897). His work was followed by Dr. Reinhold Hausen (1850 1942), who excavated the site in the 1870s. During this time the memories of Saint Bridget (Birgitta) in Sweden were also invented as heritage. Hausen published his results in 1922 thus forming the connection with the next generation of actors involved with the Naantali site: the magnate Amos Anderson (1878 1961), the teacher Julius Finnberg (1877 1955) and the archaeologist Juhani Rinne (1872 1950). They erected commemorative monuments etc. on the Naantali site, thus creating a memory landscape there. For them, the site represented the good homeland in connection with a western-oriented view of the history of Finland. The network of actors was connected to the Swedish researchers and so-called Birgitta Friends, such as state antiquarian Sigurd Curman (1879 1966), but also to the members of the Societas Sanctae Birgittae and the Society for the Embellishment of Pirita, among others. Historical jubilees as manifestations of the use of history were also arranged in Naantali in 1943, 1993 and 2003. It seems as if Naantali is needed in Finnish history from time to time after a period of crisis, i.e. after the Crimean War in the 1850s, the civil war of 1918, during World War II and also after the economic crisis of the early 1990s. In 2003, there was a stronger focus on the international Saint Bridget Jubilee in Sweden and all over Europe. Methodologically, the thesis belongs to the history of ideas, but also to research on the use of history, invented traditions and lieux de mémoire. The material for the work consists of public articles and scholarly texts in books or newspapers and letters produced by the actors and kept in archives in Finland, Sweden and Estonia, in addition to pictures and erected commemorative monuments in situ in the Western Finnish region. Keywords: Nådendal, Naantali monastery, Bridgettines, St. Bridget, use of history, lieux de mémoire, invented traditions, commemorative anatomy, memory landscape, Saint Bridget jubilees , S. G. Elmgren, R. Hausen, A. Anderson, J. Finnberg, J. Rinne, S. Curman, High Church Movement, Pirita, Vadstena.

Ajatuksista operaatioiksi : Suomen armeijan hyökkäysoperaatioiden suunnittelu jatkosodassa

In the research on the Continuation War, interest in the events themselves had exceeded the interest in military planning. Careful consideration has not been given to the planning process and the options that were available. This study shows how the planning of these operations was carried out and identifies the persons responsible. Contrary to earlier research this study shows that persons other than Field-Marshal Carl Gustaf Mannerheim and Quartermaster-General Aksel Airo took part in the planning. Furthermore, the plan was to carry out the operations further east than was ultimately done. The operation plans were coordinated by the Operations Department of Headquarters, which had the opportunity to influence on both Mannerheim and Airo. Part of the actual planning was made outside Headquarters, but final decisions were taken at Headquarters. It is worth observing that many times Mannerheim asked President Risto Ryti for his opinion concerning these operations. The Germans tried to influence the Finnish plans, but the Finns took their decisions independently, although they took German requests into account. It is well-known that the attack by the Finnish forces was stopped at the end of the year 1941. It is less well-known that the Finns planned new attacks until the autumn of 1942. At that point the Finns were convinced that the Germans would lose the war. The Finns were thus prepared to keep advancing should the Germans progress in the direction of Leningrad. This study shows that the Finnish military leaders worked for Finland s own plans and their cooperation with the Germans was directed to achieving this goal. In other words, Finland tried expand eastward with the help of the Germans. This purpose was particularly evident in the planning of the operations in the Hanko district and the Karelian Isthmus in the summer and autumn of 1941, in the Sorokka district in the spring of 1942 and around Lake Ladoga in the summer and autumn of 1942. The Finns reduced their activities when Germans took over responsibility for the operations. However, at the same time the Finns tried to support Germans in passive ways. The Finns justified the decrease in their activities with lack of Finnish forces and numerous defeats. Earlier research has shown that Finland was an active operator in the Continuation War and tried to take back the areas lost in the Winter War. In this study that view becomes more precise and clear especially with regard to Field-Marshal Mannerheim and other high military leaders. There is clear indication that the Finns would have attacked much further east had a German success made such an attack possible.

"Det utspridda kärret; överallt och växande form" : Eva Wichmans novell "Kärret" som en prosamodernistisk berättelse om kvinnligt skapande

I min avhandling diskuterar jag om och hur man kan läsa Eva Wichmans novell "Kärret" (ur Molnet såg mig, 1942) som en prosamodernistisk berättelse om ett kvinnligt subjekt, och om kvinnligtskapande. Jag vill mot en prosamodernistisk bakgrund visa min tolkning med en stilistisk och entematisk analys. I min inledning markerar jag att forskare har haft svårt att avgöra vad Eva Wichman egentligen vill säga med "Kärret". De flesta definierar "Kärret" som en fabel, en moralisk berättelse. I min tolkning betonar jag att novellen kan läsas som en prosamodernistisk fabel om det kvinnliga skapandet. Eva Wichman har i många av sina verk beskrivit en kvinnlig konstnärs svårigheter i massamhället och den manliga världen. Jag anser därför att denna tolkning inte är långsökt då det gäller en naturallegori som "Kärret". Jag redovisar kort för bakgrunden till prosamodernismen; definierar stilistiska grundbegrepp i lyrikoch prosa samt diskuterar med hjälp av Peter Luthersson och Gunilla Domellöf hur den modernistiska individualiteten konstituerar sig i förhållande till samhället ochmoderniseringsprocessen. Jag tar fasta på den kvinnliga författarens skapandeprocess och poängterar, med hjälp av bl.a. Dominique Head och Domellöf, att det kvinnliga skapandet ofta är svårt att erhålla i ett traditionellt manligt samhälle. Head, Domellöf och Rachel Blau DuPlessis menar att det modernistiska skapandet hos kvinnor i stor grad sker med hjälp av stilistiska brott och luckor. I synnerhet förhållandet mellan metafor och metonymi utgör en viktig metod för den kvinnliga modernisten. I mitt tredje kapitel analyserar jag "Kärret" stilistiskt. Modernismen i "Kärret" går ut sammanställa motsatser och sinnesanalogier. Jag tar upp det lyriska och metaforiska i "Kärret"; upprepningar,parallellismer, rytm och dynamik, samt förhållandet mellan metaforer och metonymier utgående från en artikel av David Lodge. Jag demonstrerar i stilanalysen hur Eva Wichman bygger upp ett cykliskt mytiskt berättande. Detta cirkelberättande kan, enligt Domellöf, ses som en kvinnlig utmaning mot det traditionella manliga berättandet. Förhållandet mellan metaforer och metonymier spelar en stor roll också i min tematiska analys. Jag läser kärret i novellen som en symbol för ett kvinnlig subjekt. Kärret är uppbyggt av motsatser. Dessamotsatser kan ses som metaforer i min tolkning av kärret som kvinnligt subjekt. Motsatsparen yta/djup läser jag som den medvetna respektive undermedvetna nivån i det kvinnliga subjektet. Djupet, den undermedvetna nivån, analyserar jag delvis med hjälp av Julia Kristevas begrepp abjektet. Metaforerna spegel/öga ser jag som subjekt/objekt och manligt/kvinnligt i förhållande till det kvinnliga subjektet. Med hjälp av abjektet, omnipotens/känslighet, rörelse/statis samt liv/död visar jag hur Eva Wichman beskriver det konstnärliga skapandet, och den konstnärliga alieneringen i kontrast till det förtryckandet massamhället. Här baserar jag mig på Lutherssons resonemang om den modernistiska individualiteten. På så sätt drar jag slutsatsen att kärret som kvinnligt subjekt kan läsas som ett kvinnligt författarjag. "Kärret" är en berättelse om kvinnlig skaparkraft, om ett kvinnligt subjekt som skapar och verkar isamhället. Eva Wichman gestaltar det kvinnliga berättandet både tematiskt och språkligt. Därför är "Kärret" enligt mig inte en pessimistisk berättelse om ett "säkert nederlag" som många påstår, utan en storslagen fabel om ett modernistiskt subjekt i process. Nyckelord: Eva Wichman, Molnet såg mig, prosamodernism, kvinnligt subjekt, abjekt, metafor, metonymi

Food security in welfare capitalism: Comparing social entitlements to food in Australia and Norway

The concept of food security is often anchored in popular understandings of the challenge to produce and supply enough food. However, decades of policies for intensive agriculture have not alleviated hunger and malnutrition, with an absence of food security featuring in both economically developing and developed nations. Despite perceptions that the economic growth in advanced, capitalist societies will ensure freedom from hunger, this is not universal across so-called ‘wealthy nations’. To explore the dynamics of food security in economically developed countries, this paper considers institutional approaches to domestic food security primarily through responses to poverty and welfare entitlements, and, secondarily, through food relief. Through the lens of social entitlements to food and their formation under various expressions of welfare capitalism, we highlight how the specific institutional settings of two economically developed nations, Australia and Norway, respond to uncertain or insufficient access to food. Whilst Norway's political agenda on agricultural support, food pricing regulation and universal social security support offers a robust, although indirect, safety net in ensuring entitlements to food, Australia's neoliberal trajectory means that approaches to food security are ad hoc and rely on a combination of self-help, charitable and market responses. Despite its extensive food production Australia appears less capable of ensuring food security for all its inhabitants compared to the highly import-dependent Norway.

Teacher professional conversations – the oz- Teachers story

The oz-Teachers listserv, an email list for teachers, ran continuously for 20 years, from 1995 to 2015. It provided the technical infrastructure for professional communication with the majority of its members being Australian teachers based in classrooms across the country. An analysis of the list archives provides us with interesting insights as to how teachers learn from and within communities of their peers and how such communities offer social and educational affordances to allow teachers to generate and enhance their own learning. This paper begins with a brief review of the response to the announcement of the list’s closure. It then moves to a report of the types of communication which emerged from the list over time with comparisons drawn from extant research, namely, an early analysis of email lists and a more contemporary study of teacher communication through microblogging. We identified 14 categories with eight of these being paired, namely, as asking/seeking and responding/giving. The key finding of this analysis was that the list, and its professional discussions, were sustained through reciprocity and collective intelligence, that is, sharing of information and resources and that this was evident through the life of the listserv.

Dispelling Myths about Doctorates in the Australian Public Service

Many doctoral candidates pursue their studies with the goal of ultimately securing an academic position in a university. There are, however, many other career options for doctoral graduates in non-academic positions, including a career in the public service, either at the state or national level. Public service managers are interested in people who can demonstrate a range of skills and capacities, and most doctoral graduates will have developed a range of these skills.