37,186 research outputs found

    A scoping review of parental values during prenatal decisions about treatment options after extremely premature birth.

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    AIM: To describe what is known in the literature about parental perspectives in making prenatal decisions regarding treatment after birth at the limit of viability, as a better understanding of parental values can help professionals support parents as they decide. METHODS: PubMed, Cochrane, Embase, CINAHL, PsycINFO and Web of Science were searched to identify relevant literature from 1 January 2010 to 22 April 2022 on parental decision making. Data were extracted from selected studies and organised into themes. The final themes were formed through collaboration with the parents of a premature infant born at 24 weeks. RESULTS: Of the 15,159 papers examined, 17 were included. Parental perspectives were described in terms of long-term outcomes for the infant, survival, protection against the burden of neonatal treatment, long-term impact on the family, religion and spiritual beliefs, to do everything possible, hope, sense of responsibility, wanting the best, doing what is right, giving a chance and the influence of experience. CONCLUSION: The extracted parental perspectives show the complexity of these decisions. Some perspectives were clear, but others were multi-interpretable. Increasing the understanding of common parental perspectives can help improve shared prenatal decisions and lead to further improvement and personalisation of the process

    Routine Postsurgical Anesthesia Visit to Improve 30-day Morbidity and Mortality: A Multicenter, Stepped-wedge Cluster Randomized Interventional Study (The TRACE Study)

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    OBJECTIVE: To study the impact of a standardized postoperative anesthesia visit on 30-day mortality in medium to high-risk elective surgical patients. BACKGROUND: Postoperative complications are the leading cause of perioperative morbidity and mortality. Although modified early warning scores (MEWS) were instituted to monitor vital functions and improve postoperative outcome, we hypothesized that complementary anesthesia expertise is needed to adequately identify early deterioration. METHODS: In a prospective, multicenter, stepped-wedge cluster randomized interventional study in 9 academic and nonacademic hospitals in the Netherlands, we studied the impact of adding standardized postoperative anesthesia visits on day 1 and 3 to routine use of MEWS in 5473 patients undergoing elective noncardiac surgery. Primary outcome was 30-day mortality. Secondary outcomes included: incidence of postoperative complications, length of hospital stay, and intensive care unit admission. RESULTS: Patients were enrolled between October 2016 and August 2018. Informed consent was obtained from 5473 patients of which 5190 were eligible for statistical analyses, 2490 in the control and 2700 in the intervention group. Thirty-day mortality was 0.56% (n = 14) in the control and 0.44% (n = 12) in the intervention group (odds ratio 0.74, 95% Confidence interval 0.34-1.62). Incidence of postoperative complications did not differ between groups except for renal complications which was higher in the control group (1.7% (n = 41) vs 1.0% (n = 27), P = 0.014). Median length of hospital stay did not differ significantly between groups. During the postanesthesia visits, for 16% (n = 437) and 11% (n = 293) of patients recommendations were given on day 1 and 3, respectively, of which 67% (n = 293) and 69% (n = 202) were followed up. CONCLUSIONS: The combination of MEWS and a postoperative anesthesia visit did not reduce 30-day mortality. Whether a postoperative anesthesia visit with strong adherence to the recommendations provided and in a high-risk population might have a stronger impact on postoperative mortality remains to be determined. TRIAL REGISTRATION: Netherlands Trial Registration, NTR5506/ NL5249, https://www.trialregister.nl/trial/5249

    From expansion to academic drift and declining student numbers: The Dutch case

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    Universities of applied sciences in the Netherlands have undergone a stormy process of development since the 1980s. Subsequently, a number of issues related to this growth have emerged and are currently the subject of reflection and discussion, in particular academic drift and recently declining student numbers

    Testing the nomological network for the Personal Engagement Model

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    The study of employee engagement has been a key focus of management for over three decades. The academic literature on engagement has generated multiple definitions but there are two primary models of engagement: the Personal Engagement Model of Kahn (1990), and the Work Engagement Model (WEM) of Schaufeli et al., (2002). While the former is cited by most authors as the seminal work on engagement, research has tended to focus on elements of the model and most theoretical work on engagement has predominantly used the WEM to consider the topic. The purpose of this study was to test all the elements of the nomological network of the PEM to determine whether the complete model of personal engagement is viable. This was done using data from a large, complex public sector workforce. Survey questions were designed to test each element of the PEM and administered to a sample of the workforce (n = 3,103). The scales were tested and refined using confirmatory factor analysis and then the model was tested determine the structure of the nomological network. This was validated and the generalisability of the final model was tested across different work and organisational types. The results showed that the PEM is viable but there were differences from what was originally proposed by Kahn (1990). Specifically, of the three psychological conditions deemed necessary for engagement to occur, meaningfulness, safety, and availability, only meaningfulness was found to contribute to employee engagement. The model demonstrated that employees experience meaningfulness through both the nature of the work that they do and the organisation within which they do their work. Finally, the findings were replicated across employees in different work types and different organisational types. This thesis makes five contributions to the engagement paradigm. It advances engagement theory by testing the PEM and showing that it is an adequate representation of engagement. A model for testing the causal mechanism for engagement has been articulated, demonstrating that meaningfulness in work is a primary mechanism for engagement. The research has shown the key aspects of the workplace in which employees experience meaningfulness, the nature of the work that they do and the organisation within which they do it. It has demonstrated that this is consistent across organisations and the type of work. Finally, it has developed a reliable measure of the different elements of the PEM which will support future research in this area

    Serum creatinine and urea assays on Atellica® CH and Architect® ci4100: method comparison

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    Serum creatinine and urea are markers of renal function usually measured in conjunction. This study aims to evaluate the comparability of a new analyzer incorporated to our laboratory, Atellica® with the established analyzer, Architect ® ci 4100 in serum creatinine and urea assays. We ran 110 tests for creatinine and 107 for urea. In both analyzers, serum creatinine assay is based on the Jaffe reaction while urea measurement is based on the Roch-Ramel enzymatic reaction. Linear association between methods was evaluated using Pearson's correlation coefficient. Methods comparability was assessed using Passing-Bablok and Deming linear regression. Differences between analyzers were evaluated using Bland-Altman plot. For serum creatinine, regression equations are Atellica = 0.9721 x Architect - 2.7282 (Passing & Bablok) and Atellica = 0.8884 x Architect + 1.3456 (Deming). The mean difference between the two methods is -11.7 µmol/L as indicated by Bland-Altman plot. For urea, regression lines are expressed as Atellica = 1.0252 x Architect – 0.1609 (Passing-Bablok) and Atellica = 1.1424 x Architect – 0.9532 (Deming). Bland-Altman plot presented a mean difference of -0.1 mmol/L. These results could be described as a very good agreement between the two methods, the two analyzers could be used interchangeably. DOI: http://dx.doi.org/10.5281/zenodo.754215

    Elite perceptions of the Victorian and Edwardian past in inter-war England

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    It is often argued by historians that members of the cultivated Elite after 1918 rejected the pre-war past. or at least subjected it to severe denigration. This thesis sets out to challenge such a view. Above all, it argues that inter-war critics of the Victorian and Edwardian past were unable to reject it even if that was what they felt inclined to do. This was because they were tied to those periods by the affective links of memory, family, and the continually unfolding consequences of the past in the present. Even the severest critics of the pre-war world, such as Lytton Strachey, were less frequently dismissive of history than ambivalent towards it. This ambivalence, it is argued, helped to keep the past alive and often to humanise it. The thesis also explores more positive estimation of Victorian and Edwardian history between the wars. It examines nostalgia for the past, as well as instances of continuity of practice and attitude. It explores the way in which inter-war society drew upon aspects of Victorian and Edwardian history both as illuminating parallels to contemporary affairs and to understand directly why the present was shaped as it was. Again, this testifies to the enduring power of the past after 1918. There are three parts to this thesis. Part One outlines the cultural context in which writers contemplated the Victorian and Edwardian past. Part Two explores some of the ways in which history was written about and used by inter-war society. Part Three examines the ways in which biographical depictions of eminent Victorians after 1918 encouraged emotional negotiation with the pas

    Radical Left Parties and the Role of Euroscepticism

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    Globalization has shifted the political competition landscape in Western Europe. Extensive research has studied the impact of this on the radical right, yet little attention has been paid to the radical left. This dissertation, comprised of three papers, analyses the impact of the increased European integration emphasis on the radical left. My first paper analyses whether there is a beneficial policy position for the radical left on European integration. The chapter finds that there is an electoral benefit to a Eurosceptic position for radical left parties but also shows that this benefit is constrained when a Eurosceptic competitor, i.e. radical right party, enters the party system. My second paper follows from this and examines an alternative approach for the radical left on European integration. While the benefit of a Eurosceptic position can be constrained, blurring the position on European integration can help avoid losing pro-EU voters. The chapter finds that position blurring on EU integration is beneficial when there is electorate polarization but harmful when the electorate is in consensus on EU integration. When there is consensus, radical left parties benefit from a clear position on EU integration. My third paper is co-authored with Royce Carroll and zooms into the findings of the first two chapters by examining the demand side of Euroscepticism. The paper finds that European integration is an important issue for vote choice of the electorate. The results of the chapter show that the more Eurosceptic voters are, the higher their propensity to vote for a radical left party becomes. These three papers demonstrate how the issue of European integration is in the centre of radical left strategy from a supply and demand side perspective. This thesis contributes to the literature by providing a detailed understanding of the success of small parties beyond their issue ownership
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