Design-related bias in hospital fall risk screening tool predictive accuracy evaluations: systematic review and meta-analysis.

Introduction: Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals. Design-related bias in evaluations of tool predictive accuracy could lead to overoptimistic results, which would then contribute to program failure in practice.

Methods: A systematic review was undertaken. Two blind reviewers assessed the methodology of relevant publications into a four-point classification system adapted from multiple sources. The association between study design classification and reported results was examined using linear regression with clustering based on screening tool and robust variance estimates with point estimates of Youden Index (= sensitivity + specificity - 1) as the dependent variable. Meta-analysis was then performed pooling data from prospective studies.

Results: Thirty-five publications met inclusion criteria, containing 51 evaluations of fall risk screening tools. Twenty evaluations were classified as retrospective validation evaluations, 11 as prospective (temporal) validation evaluations, and 20 as prospective (external) validation evaluations. Retrospective evaluations had significantly higher Youden Indices (point estimate [95% confidence interval]: 0.22 [0.11, 0.33]). Pooled Youden Indices from prospective evaluations demonstrated the STRATIFY, Morse Falls Scale, and nursing staff clinical judgment to have comparable accuracy.

Discussion: Practitioners should exercise caution in comparing validity of fall risk assessment tools where the evaluation has been limited to retrospective classifications of methodology. Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular settings, but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment.

Trauma and holocaust video testimony : the intersection of history, memory, and judgment in the interview process

This article analyzes video testimonies recorded at the Jewish Holocaust Museum and Research Centre in Melbourne,Australia, which address the highly complex and sensitive issue of “privileged” Jews. The so-called privileged Jews include prisoners in the Nazi-operated camps and ghettos who held positions that gave them access to material and other benefits, while compelling them to act in ways that have been judged detrimental to fellow inmates. Although the issue of “privileged” Jews has been largely neglected, it relates to a crucial facet of the Holocaust and has vast implications for its aftermath. The ethical dilemmas facing these victims may be closely linked to what Lawrence Langer has termed choiceless choices, which challenge conventional notions of “judgment” and “responsibility.” This problem is also the primary subject of Auschwitz survivor Primo Levi’s essay titled “The Grey Zone,” which is arguably the most influential essay ever written on the Holocaust. Levi argues that one should abstain from judging individuals who confronted such extreme circumstances, positioning prisoners with “privileged” positions at the threshold of representation and understanding. However, moral evaluations of “privileged” Jews have a strong impact on Holocaust testimonies, whether these were constructed during the war or recorded long after the survivors’ experiences. The examples of video testimonies explored in this article reveal that this is particularly the case when interviewees are former “privileged” Jews and interviewers are themselves Holocaust survivors. The article argues that when confronted with such an emotionally and morally fraught issue, judgment may itself be seen as a “limit of representation.”

Testing the validity, reliability and utility of the Self-Administration of Medication (SAM) tool in patients undergoing rehabilitation.

Determination of patients' ability to self-administer medications in the hospital has largely been determined using the subjective judgment of health professionals.

O lazer e a difusão da moral protestante

This study of qualitative nature, aimed to investigate the relations arising from experiences in the context of leisure in recreational activities offered in religious camps, with the spread of Protestant moral values .. The study was conducted with the union of literature and exploratory research. First, we sought to understand, through the specific literature, the Protestant society manifestation with its ethics and values, showing how leisure has been sought and appropriated by Protestants institutions. Subsequently, we developed an exploratory research, using as instrument for data collection a mixed questionnaire, applied to a purposeful sample comprised of participants of a religious camp of Protestant institution. Data were analyzed descriptively by Technical Analysis of Thematic Content and indicate that the activities offered at religious camp can diffuse Protestant values directly intentioned, in order to carry religious values so intrinsic to the task, and, indirectly meaning as a tool of evangelism, which are supporting the process of transmission of these values

Vítimas invisíveis: o pânico moral acerca do tráfico de pessoas para exploração sexual por uma perspectiva de gênero

Pós-graduação em Direito - FCHS

L'immagine di Roma nella cultura russa tra fine XVIII secolo e inizio XIX secolo

Nella tesi si osserva come nella cultura russa cambiava l’immagine di Roma. Se ancora alla fine del settecento l’antichità romana poteva risultare solamente uno strumento retorico-filologico da utilizzare per fare il proprio discorso più convincente, la generazione dei decabristi la stessa antica romanità la accostava alla cultura e storia russe tramite gli elevati ideali civici. La romanità ora risultava uno strumento di analisi della esperienza storica e politica della Russia anche nel contesto europeo. Da qui nasceva una serie di modelli russi legati all’antica Roma: il Catone di Radiscev, il Bruto dei decabristi, ecc. Vi attingeva generosamente anche una corrente di lirica russo-antica con i suoi ricchi riferimenti agli autori classici, Ovidio, Tacito, Orazio. Nasceva così una specie di Roma antica russa che viveva secondo le sue regole etiche ed estetiche. Con il fallimento dell’esperienza decabrista cambia anche l’approccio alle antichità: ci si distacca dalla visione storico-morale dell’antico, Roma non è più una categoria da emulare, ma una storia a sé stante e chiusa in sé stessa come ogni periodo storico. Essa smette di essere un criterio universale di giudizio etico e morale. Allo stesso tempo, una parte integrante della cultura russa all’epoca era il viaggio a Roma. I russi cresciuti con interesse e amore verso la Roma antica, impazienti ed emozionati, desideravano ora di vedere quella patria dei classici. Era come se fosse un appuntamento fra gli amici di vecchia data. Si affrettava a verificare di persona le muse di storia e di poesia. E con tutto questo si imparavano ad amare tutti i defetti della Roma reale, spesso inospitale, la Roma del dolore e della fatica. La voce importante nel racconto romano dei russi era anche la Roma del cristianesimo, dove ritrovare e ricoprire la propria “anima cristiana”.

Considering the Moral Complexity of Adolescents in Divided Societies

This paper focuses on adolescents who live in divided societies and how they navigate those divisions as they develop as civic actors. The study sites are Northern Ireland, South Africa, and the United States. In each setting we collected surveys, conducted focus groups with teachers and students, and followed students through the 9th and 10th grades in a case study classroom. In all locales, the students used materials from Facing History and Ourselves, and their teachers had participated in workshops on using those materials. In this paper we follow a case study student from the United States who provides a particularly complex look at issues of division and ethical civic development. The student, Pete, is a white immigrant from South Africa, studying in a multi-ethnic and multi-racial school in the United States. He confronts his South African legacies in the context of a foreign school system, which is working to help U.S. students confront their own legacies. Across two, one-semester, citizenship classes, Pete shows us the tension between an academic stance and a moral/emotional stance. When moral dilemmas become complex for him, he begins to lose his ability to judge. Teacher support and guidance is critical to help students like Pete learn to hold their moral ground, while understanding why others act as they do.

Community diagnosis: A working tool for developing culturally appropriate diarrhea intervention programs

Most studies related to diarrhea have been focused narrowly on the etiological and pathophysiological factors involved in inducing the disease. Such studies have often failed to consider other facets contributing to and possibly prolonging the problem, namely: socio-economic conditions, educational opportunities and attainments, cultural characteristics and beliefs, and the political administration and its commitment towards fulfilling its moral and ethical obligations in responding to and fostering human development.^ This study utilized the diagnostic approach of the PRECEDE model. The acronym stands for the predisposing reinforcing, and enabling constructs in educational diagnosis and evaluation. The constituents of this model were identified by utilizing participant observation field methods, traditionally applied by ethnographers to collect data describing the multiple facets of a culture, and linguistic anthropology used to capture and define characteristic semantics and viewpoints. The household study sample was randomly selected from a defined list of households known to have at least one child less than five years of age. An open-ended questionnaire format was used to interview the 115 mothers in the selected households sample.^ Kalama, the study community, is characteristically an agricultural village, situated in the Governorate of Kaliobia and located approximately 25 Km (about 15.5 miles) from the capital, Cairo, Egypt. The 1986 census indicates a population size of 13,328 people in 4,818 households. There were 65 deaths occurring among children less than five years in 1986. The causes of death were primarily related to diarrhea, followed by upper respiratory infections, congenital anomalies and birth injuries.^ This study outlines (a) practices related to the management of diarrhea, including the administration of foods and drinks during such episodes; (b) influences of governmental policies; and (c) recommended strategies for overcoming barriers and promoting effective diarrhea intervention programs. ^

The chair of food Banks UPM as a tool of raising awareness and promoting a culture of rational food comsumption

The Chair of Food Banks UPM arises from a cooperation agreement between the Spanish Federation of Food Banks (FESBAL) and the Technical University of Madrid (UPM), with the aim of raising awareness and promoting rational food consumption to avoid food waste, through activities of training, transfer of knowledge and promotion of I+D+i. The aim of this paper is to reflect on the activities carried out during the first year in order to obtain learning lessons and improve the management of activities and resources.

Percepção e orientação de condutas de conselheiros tutelares sobre práticas sexuais de menores de 18 anos

A abertura política do Brasil à democracia promoveu uma série de mudanças legislativas e de organização do Estado. Na área da infância e adolescência, após a promulgação do Estatuto da Criança e do Adolescente (ECA), foram criados conselhos de nível federal, estadual e municipal, com o objetivo de promover e defender os direitos dessa população específica. Também foram formados os Conselhos Tutelares compostos por membros da sociedade civil, diretamente eleitos pela população, com a função de informar e promover esses direitos localmente. Utilizando a metodologia qualitativa-quantitativa do Discurso do Sujeito Coletivo, a pesquisa analisou a percepção e opinião dos conselheiros tutelares a respeito de situações que envolvem a prática sexual voluntária heterossexual e homossexual de adolescentes da faixa etária de 12 a 17 anos. Os dados foram colhidos com o uso de questionários semiestruturados para autopreenchimento, apresentados em visita técnica aos membros dos 44 Conselhos Tutelares do município de São Paulo. Além do perfil social e familiar, foram coletadas opiniões dos conselheiros quanto à autonomia dos adolescentes e suas noções de desrespeito legal, além de sugestões de orientação de condutas frente a três casos hipotéticos de prática sexual realizada por adolescentes. Responderam à pesquisa 80 (36,4 por cento ) conselheiros de um total de 220, de 29 (65,9 por cento ) dos 44 Conselhos Tutelares da cidade. Observou-se que apresentaram tendência a reproduzir os modelos tradicionais negativos da sociedade brasileira no julgamento da prática sexual de adolescentes, avaliando sua ocorrência pela ótica moral e de opinião de familiares e outros adultos. Mais da metade não associa tais práticas a impactos específicos sobre a saúde e os direitos sexuais e reprodutivos dos adolescentes, nem realiza encaminhamentos para sua promoção. Adotam noções desiguais de gênero do senso comum, que remetem à preocupação com a imagem e impactos da publicização da sexualidade de meninas, não fazendo o mesmo para adolescentes meninos e veem as práticas homoafetivas sob a ótica da violência e sedução, associando-as à necessidade de orientação psicológica e problemas de saúde mental. Considera-se que conselheiros tutelares estão pouco preparados para lidar com a sexualidade de adolescentes e normalmente treinados para avaliá-la tal qual a violência sexual que acomete crianças. Como possuem status local de legitimidade, são procurados e tem poder de averiguação e encaminhamento público de ocorrências, terminando por, muitas vezes, desrespeitar os direitos humanos de adolescentes quanto à expressão e vivência da sexualidade e da prática sexual saudável. Considera-se fundamental discutir o papel dos Conselhos Tutelares frente aos direitos de adolescentes, de forma que ao contrário do proposto na democratização do país, não se configurem como mais um instrumentos de exercício de poder para perpetuar desigualdades sociais. Na área da sexualidade, a defesa dos direitos de adolescentes passa pelo respeito a sua sexualidade, acesso à informação, à garantia de serviços públicos que efetivamente os atendam para proporcionar exames, contracepção, prevenção de doenças sexualmente transmissíveis, etc., com respeito a sua cidadania, especificidades, necessidades, autonomia e dignidade pessoal, promovendo-os e defendendo-os frente a famílias, comunidade, a toda a sociedade e ao próprio poder público.

Net-surplus as a useful tool to analyse financial information in co-op societies

This paper aims to analyse a sample of Galician co-ops to verify whether or not it is possible to deduce different financial behaviours among co-op partners from the amount of net-surplus. To this end, our study adds net-surplus to the variation registered in some account entries so that other residual incomes yielded by the co-op may be considered. The distribution of these revenues shows that partners do not usually choose to fully anticipate residual incomes. This reveals that some firms follow a positive net-surplus strategy, which is actually different from the null net-surplus strategy asserted by the classical financial theory. Furthermore, results show that differences between both strategies are statistically significant. This opens a path to future research on determinants explaining why co-op partners voluntarily renounce to anticipating these residual incomes. Such behaviour only arises when yearly accounts render a positive result, thereby making the accounting net-surplus a useful tool to analyse financial information in co-op societies.

Safety Assessment Tool for Construction Zone Work Phasing Plans, 2016

The Highway Safety Manual (HSM) is the compilation of national safety research that provides quantitative methods for analyzing highway safety. The HSM presents crash modification functions related to freeway work zone characteristics such as work zone duration and length. These crash modification functions were based on freeway work zones with high traffic volumes in California. When the HSM-referenced model was calibrated for Missouri, the value was 3.78, which is not ideal since it is significantly larger than 1. Therefore, new models were developed in this study using Missouri data to capture geographical, driver behavior, and other factors in the Midwest. Also, new models for expressway and rural two-lane work zones that barely were studied in the literature were developed. A large sample of 20,837 freeway, 8,993 expressway, and 64,476 rural two-lane work zones in Missouri was analyzed to derive 15 work zone crash prediction models. The most appropriate samples of 1,546 freeway, 1,189 expressway, and 6,095 rural two-lane work zones longer than 0.1 mile and with a duration of greater than 10 days were used to make eight, four, and three models, respectively. A challenging question for practitioners is always how to use crash prediction models to make the best estimation of work zone crash count. To solve this problem, a user-friendly software tool was developed in a spreadsheet format to predict work zone crashes based on work zone characteristics. This software selects the best model, estimates the work zone crashes by severity, and converts them to monetary values using standard crash estimates. This study also included a survey of departments of transportation (DOTs), Federal Highway Administration (FHWA) representatives, and contractors to assess the current state of the practice regarding work zone safety. The survey results indicate that many agencies look at work zone safety informally using engineering judgment. Respondents indicated that they would like a tool that could help them to balance work zone safety across projects by looking at crashes and user costs.

Reflective judgment vs. investigation of things – a comparative study of Kant and Zhu Xi

This thesis is devoted to studying two historical philosophical events that happened in the West and the East. A metaphysical crisis stimulated Kant’s writings during his late critical period towards the notion of the supersensible. It further motivated a methodological shift and his coining of reflective judgment, which eventually brought about a systemic unfolding of his critical philosophy via Kantian moral teleology. Zhu Xi and his Neo-Confucian contemporaries confronted a transformed intellectual landscape resulting from the Neo-Daoist and Buddhist discourses of “what is beyond the form”. The revival of Confucianism required a method in order to relocate the formless Dao back into daily life and to reconstruct a meta-ethical foundation within a social context. This led to the Neo-Confucian recasting of “investigation of things” from The Great Learning via complex hermeneutic operations. By the respective investigation on, as well as the comparative analysis of the two events, I reveal the convergence and incommensurability between the two distinct cultural traditions concerning the metaphysical quests, the mechanism of intellectual development, and moral teleology, so as to capture the intrinsic characteristics of philosophical research in general.