Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. METHODS: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. RESULTS: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. CONCLUSION: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches

Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI

Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed based on literature and expert opinion, and pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n = 60, 91%) and designated level I trauma centers (n = 44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately ninety percent of the participants (n = 58) indicated placing an ICP monitor in patients with severe TBI and computed tomography abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as having a relatively aggressive approach to ICP monitoring and treatment (n = 32, 48%), whereas the others were considered more conservative (n = 34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with traumatic brain injury and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research

Multimodal analytics: Software and visualization techniques for analyzing and interpreting multimodal data

Multimodal analysis, the study of semantic patterns arising from the integration of language, images and audio resouces in multimodal texts, presents considerable challenges which are both theoretical and practical in nature. First, frameworks for modeling the semantic contributions of the different resources and the meaning arising from the interaction of choices in multimodal phenomena are required. Such frameworks also need to account for resemioticization of mulitmodal phenomena to investigate social practices over space and time (Iedema, 2001, 2003). In this repect, the social semiotic approach (Halliday, 1978; Halliday and Matthiese4n, 2004) developed by Kress and Van Leeuwen (2005 [1996] and O'Toole (2011 [1994]) has provided a powerful theoretical platform for investigating multimodal phenomena (eg. see this volume

Multimodal Analysis Image (Teacher Edition and Student Edition).

The aim of this resource book and the accompanying software Multimodal Analysis Image is to introduce a systematic approach to the study of multimodal texts consisting of linguistic and visual elements. The objectives are to promote analytical and critical thinking and to address literacy requirements in an age of digital media

"Above all": The myth of 'dreams' as advertising tool

Advertising helps us to make sense of things. It validates consumer commodities and a consumer life-style by associating goods with personal and social meanings and those aspirations and needs which are not fulfilled in real life. We come to think that consuming commodities will give us our identities

Multimodal digital semiotics: the interaction of language with other resources

10.1515/text-2013-0030Text and Talk334-5665-69

Práticas escolares de mobilização de cultura matemática

Neste artigo, temos como propósito situar o leitor na complexa discussão contemporânea relativa a práticas escolares de mobilização de cultura matemática. Para isso, numa primeira parte, procuramos caracterizar algumas perspectivas teóricas bastante difundidas relativas ao modo de se compreender e explicar essas práticas. Numa segunda parte, consideramos perspectivas mais recentes e menos ressonantes que vêm levantando novos e pertinentes elementos para a consideração do problema aqui em foco