The European Union as a trigger of discursive change: The impact of the structural deficit rule in Estonia and Latvia

Our paper explores how a rule prescribed by the European Union can bring about changes in the policy discourse of a member state. Drawing on the literatures of discursive institutionalism and Europeanization, the theoretical part discusses the factors that influence discursive shifts. The empirical part examines the discursive impacts of the introduction of the structural budget deficit rule, required by the Fiscal Compact, in Estonia and Latvia. It demonstrates how the discursive shifts have been shaped by the localized translations offered by civil servants, the entrance of additional actors to the policy-making arena, crisis experience, and the strategic interests of policy actors

A consensus statement for the management and rehabilitation of communication and swallowing function in the ICU : a global response to COVID-19

Objective To identify core practices for workforce management of communication and swallowing functions in COVID-19 positive patients within the ICU. Design A modified Delphi methodology was utilized, with 3 electronic voting rounds. AGREE II and an adapted COVID-19 survey framework from physiotherapy were used to develop survey statements. Sixty-six statements pertaining to workforce planning and management of communication and swallowing function in the ICU were included. Setting Electronic modified Delphi process. Participants 35 speech-language pathologists (SLPs) from 6 continents representing 12 countries. Interventions Not applicable. Main Outcome Measures The main outcome was consensus agreement, defined a priori as ≥70% of participants with a mean Likert score ≥7.0 (11-point scale: “0” = strongly disagree, “10” strongly agree). Prioritization rank order of statements in a 4th round was also conducted. Results SLPs with a median of 15 years ICU experience, working primarily in clinical (54%), in academic (29%) or managerial (17%) positions, completed all voting rounds. After the third round, 64 statements (97%) met criteria. Rank ordering identified issues of high importance. Conclusions A set of global consensus statements to facilitate planning and delivery of rehabilitative care for patients admitted to the ICU during the COVID-19 pandemic were agreed by an international expert SLP group. Statements focus on considerations for workforce preparation, resourcing and training, and the management of communication and swallowing functions. These statements support and provide direction for all members of the rehabilitation team to use for patients admitted to the ICU during a global pandemic

Method of reinforcing a building

The present invention is directed to structural molding members and to a structural molding system designed to retroactively connect together walls, the roof, floors, and the foundation of a preexisting house or building. The structural members are for reinforcing a building so that all external forces applied to the building are transferred to the foundation. The structural molding members are particularly useful for preventing damage to the building when the building is exposed to high winds and seismic activity. In general, the structural molding members include a support bracket that is mounted directly to the exterior surfaces of a building and connected to internal frame components. The support bracket can then be covered with a molding member, a light fixture, or the like to provide an aesthetic appeal to the reinforcing structure

The leading Clydesdale sires in Canada

The outlook for the Clydesdale horse trade in Canada has brightened considerably in the course of the past year. Contractors and others have at length found that, for short hauls and town work, horse traction is the most economical. Clydesdale breeders have taken courage again, and steps have been adopted to increase the draught horse population (5). In 1931, only four Clydesdales were imported from Scotland, but in 1932, the number was 33. This, however, is far behind the business done in pre-war days. There has been considerable demand for mares and fillies thus indicating a revival in horse breeding (5). Numbers in brackets refer to bibliography

Earlier tracheostomy is associated with an earlier return to walking, talking, and eating

Background: Conjecture remains regarding the optimal timing for tracheostomy. Most studies examine patient mortality, ventilation duration, intensive care unit (ICU) length of stay, and medical complications. Few studies examine patient-centric outcomes. The aim of this study was to determine whether timing of tracheostomy had an impact on length of stay, morbidity, mortality, and patient-centric outcomes towards their functional recovery. Methods: This prospective observational study included data for all tracheostomised patients over 4 y in a tertiary ICU. The study time period commenced with the insertion of an endotracheal tube. Data collected included patient and disease specifics; mortality up to 4 y; mobility scores; and time to oral intake, talking, and out-of-bed exercises. To assess differences between timing of tracheostomy, a survival analysis was conducted to dynamically compare patients on days before and after tracheostomy tube (TT) placement during their ICU admission. Results: TT was placed in 276 patients. After tracheostomy, the patients were able to (on average) verbally communicate 7.4 d earlier (confidence interval [CI] = -9.1 to −4.9), return to oral intake 7.0 d earlier (CI = -10 to −4.6), and perform out-of-bed exercises 6.2 d earlier (CI = -8.4 to −4) than those who did not yet have a TT. In patients with an endotracheal tube, none were able to talk or have oral intake, and the majority (99%) did not participate in out-of-bed exercises/active rehabilitation. After tracheostomy, patients subsequently received significantly less analgesic and sedative drugs and more antipsychotics. No clear differences in ICU and long-term mortality were associated with tracheostomy timing. Conclusions: Earlier tracheostomy is associated with earlier achievement of patient-centric outcomes – patients returning to usual daily activities such as talking, out-of-bed mobility, and eating/drinking significantly earlier, whilst also receiving less sedatives and analgesics

Effectiveness, experience, and usability of low-technology augmentative and alternative communication in intensive care: A mixed-methods systematic review

Background Patients in the intensive care unit (ICU) are commonly on mechanical ventilation, either through endotracheal intubation or tracheostomy, which usually leaves them nonverbal. Low-technology augmentative and alternative communication (AAC) strategies are simple and effective ways to enhance communication between patients and their communication partners but are underutilised. Aim The aim of this study was to systematically review current evidence regarding the effectiveness, experience of use, and usability of low-technology AAC with nonverbal patients and their communication partners in the ICU. Methods This review included quantitative, qualitative, and mixed-methods studies of adult ICU patients aged 18 or older who were nonverbal due to mechanical ventilation and their communication partners. Studies using low-technology AAC, such as communication boards and pen and paper, were included. Six databases were searched, and the review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A convergent segregated approach was used for data synthesis. Results Thirty-two studies were included. Low-technology AAC improved patient satisfaction, facilitated communication, and met patients' physical and psychological needs. Communication boards with mixed content (e.g., pictures, words, and letters) were preferred but were used less frequently than unaided strategies due to patients' medical status, tool availability, and staff attitudes. Boards should be user-friendly, tailored, include pen/paper, and introduced preoperation to increase patient's comfort when using them postoperatively. Conclusion Existing evidence support low-technology AAC's efficacy in meeting patients' needs. Better usability hinges on proper implementation and addressing challenges. Further research is crucial for refining communication-board design, ensuring both user-friendliness and sophistication to cater to ICU patients' diverse needs