A systematic review of educational interventions aiming to reduce prehospital delay in patients with acute coronary syndrome

Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Interventions aiming at reducing prehospital delay (PHD) in patients with acute coronary syndrome (ACS) have yielded inconsistent findings. Therefore, we aimed to systematically review studies which investigated the impact of educational interventions on reducing PHD in patients with ACS. We searched four electronic databases (Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Embase, Cochrane) from inception throughout December 2016 for studies that reported the impact of either mass-media or personalised intervention on PHD. Reporting quality was assessed with the Template for Intervention Description and Replication checklist for interventional trials. Two reviewers screened 12 184 abstracts and performed full-text screening on 86 articles, leading to 34 articles which met our inclusion criteria. We found 18 educational interventions with a total of 180 914 participants (range: n=100-125 161) and a median of 1342 participants. Among these educational interventions, 13 campaigns employed a mass-media approach and five a personalised approach. Ten studies yielded no significant effects on the primary outcome while the remaining interventions reported a significant reduction with a decrease between 17 and 324 min (median reduction: 40 min, n=5). The success was partly driven by an increase in emergency medical services use. Two studies reported an increase in acute myocardial infarction knowledge. We observed no superiority of the personalised over the mass-media approach. Although methodological shortcomings and the heterogeneity of included interventions still do not allow definite recommendations for future campaigns, it becomes evident that either mass media or personalised interventions can be successful in reducing PHD, especially those who address behavioural consequences and psychological barriers (eg, denial) and provide practical action plan considerations as part of their campaign messages. CRD42017055684 (PROSPERO registration number)

The Economical Impact of Mountain Bicycle Events in Oregon

The current project aimed to quantify the economic impact of several mountain biking events and one tour operator in Oregon during 2012. Participants from three events and customers of one mountain bike tour company (Cog Wild) were surveyed in 2012 using an online survey. Our work summarizes the initial data analysis of participant responses to the survey questions. Specifically, we outlined the county level economic impact travel estimates, participant demographics, travel party size and spending averages across the four events. Only data from non-local participants (i.e., participants living outside of the event host county) were used for the economic impact analysis

Transparenz von Zentralbanken am Beispiel der EZB

Wird die Unabhängigkeit von Zentralbanken schon lange in der Literatur diskutiert, hat die Thematisierung von Transparenz erst durch neue Praktiken der Zentralbanken größere Aufmerksamkeit erlangen können. In dieser Arbeit wird eine Klassifikation ders Aspekte von Transparenz erarbeitet, anhand derer die unterschiedlichen Forschungsarbeiten systematisiert und in ihrer Relevanz analysiert werden können. Diese Analyse erfolgt am Beispiel der Politik der Europäischen Zentralbank, da diese sich einerseits permanenter Kritik bezüglich ihrer Intranparenz ausgesetzt findet und anderseits ihre neuen Praktiken die Grenzen der bsiherigen Forschung aufzeigen können

Online Learning in Graduate Health Programs: Andragogy, Lecture Preference, and the Effectiveness of Synchronous and Asynchronous Participation

Accelerated by the COVID-19 pandemic, graduate health programs have undertaken greater utilization of online learning, employing synchronous and asynchronous online lectures as a replacement for traditional face-to-face instruction. Although supported in previous literature as a method at least equally effective to traditional learning, online learning has been a source of frustration for students and instructors expecting face-to-face instruction. This dissertation project seeks to explore (1) the ways in which principles of andragogy have been implemented in graduate health programs in response to the COVID-19 pandemic, (2) the factors that contribute to preference for online method of lecture participation (synchronous or asynchronous) among graduate health students, and (3) if one method of online lecture participation (synchronous or asynchronous) is superior for students enrolled in traditional style graduate health programs and if it is in the student’s best academic interest to choose, based on preference, between synchronous and asynchronous lecture. This project includes a review of literature, a survey, and a post-test only quasi-experimental design to explore the preferences and performance of physical and occupational therapy students enrolled in graduate programs at a Midwestern university

Modern Groove

Robert Venturi’s assertion that “Orthodox Modern[ists] have tended to recognize complexity insufficiently or inconsistently” is at the heart of the disconnection between modernist and post-modernist responses to the world around us and represents the primary rift in the modernist continuum (Venturi, 1966). Whether for rhetorical impact or his own dogmatic beliefs, the point that Venturi failed to acknowledge is that often designers do not choose to “eschew ambiguity” because they don’t recognize complexity. Rather some prefer clarity as a natural reaction to complexity, and some fifty years after his “gentle manifesto” the search for order in a chaotic world is still an important creative imperative. The goal of my research is not to argue against the merits of embracing complexity directly. It is to create a personal guidebook for why I choose not to. My work is not a misguided attempt to suggest that life and the world are simple. My tendency to favor the design principle of unity over variety is due to my appreciation for the preciousness of aesthetically quiet moments precisely because the world is complex. I prefer to use formal qualities to create harmony rather than tension in an attempt to create elegant moments as a counterbalance to a sometimes chaotic existence. Throughout this investigation I have also realized that there is an important distinction to be made between the goals and responsibilities of a furniture designer as opposed to other disciplines, and I have found there to be more latitude within furniture to embrace post-modernist ideas than I originally expected. Scale and the use of furniture automatically make it able to have specific conversations with the user and viewer, but similar to my thoughts on architecture, furniture’s lifespan and prominence in an environment make overtly ironic compositions difficult for me to justify when the user must interact with the work daily. With some pieces I have purposefully experimented with the effects that furniture and posture can have on the user, and I have embraced the use of metaphor and semiology to extend the potential of my furniture to communicate visually more effectively. I believe that chronological distance from the hardline orthodoxy that Venturi challenged has given me more freedom to utilize post-modern concepts without feeling the need to use them as an argument for or against modernism, but it is still important to me that complexities and contradictions in my designs are perceived as whispers rather than screams

Do Animals Have Rights?

Do animals have moral rights? An affirmative answer follows from the best justification for human rights that we can give. The moral status not only of humans but also of animals consists in an egalitarian right to have rights. From this equal status, however, substantially equal rights follow only if the morally relevant interests are equal. A reasonably broad and differentiated understanding of our own, human animal nature reveals which interests we share with many other animals. Thus, sentient animals have basic rights to life and well-being, including volitional activities and access to beneficial social relationships. Further rights arise from special human–animal relationships that are also politically relevant. By subjecting animals and, thus, making them existentially dependent on us, we owe them more than mere protection and help in easily remediable emergencies. We thereby also assume associative duties, as they exist among fellow citizens. Therefore, we should open our understanding of the common good to the reality of species-mixed communities and represent animals politically

Negative Effekte von Psychotherapie – Ein Mixed-Methods Ansatz

Während der positive Einfluss psychotherapeutischer Behandlung eindrücklich belegt ist, sind mögliche negative Effekte von Psychotherapie bisher nur selten Gegenstand wissenschaftlicher Forschung gewesen (Jacobi, 2002; Margraf, 2009; Märtens & Petzold, 2002). Ziel der vorliegenden Dissertation ist es, Häufigkeiten und Einflussfaktoren dieser negativen Effekte von Psychotherapie in der Standardversorgung mit quantitativen und qualitativen Methoden zu untersuchen. Mit dem Wissen, wann Psychotherapie auch zu negativen Wirkungen führen kann, ist eine balancierte Evaluation von psychotherapeutischen Interventionen möglich. Somit werden informierte und autonome Behandlungsentscheidungen im Sinne des Patientenrechtegesetztes gestärkt. Hierzu werden drei Publikationen in die kumulative Promotion einbezogen. In Studie I wurde zunächst ein standardisierter Fragebogen zur Erfassung negativer Effekte von Psychotherapie und unethischem Therapeutenverhalten/Kunstfehlern entwickelt. Dazu wurde ein per Expertengremium generierter Itempool im Rahmen einer Onlineerhebung an N=195 ehemaligen Psychotherapie-Patienten evaluiert und daraus das Inventar zur Erfassung negativer Effekte nach Psychotherapie (INEP) mit 21 Items erstellt. Die Teilnehmer wurden dabei zu negativen Effekten in verschiedenen Bereichen befragt (Verschlechterung von Symptomen; Auftreten neuer Symptome; Abhängigkeit vom Therapeuten; Konflikte in Partnerschaft, Familie oder Freundeskreis; Konflikte auf der Arbeit; Stigmatisierung durch Behandlung). Anschließend erfolgte eine Erhebung (Studie II) mit dem Ziel, das neu entwickelte Instrument weiter zu evaluieren und dabei Aufschluss zu Häufigkeiten und Einflussfaktoren negativer Effekte in verschiedenen Behandlungssettings zu geben. Dazu wurden sowohl Patienten im ambulanten (N=182, querschnittliche Erhebung) als auch im stationären Setting (N=118, längsschnittlich) nach ihrer Behandlung zu negativen Effekten und unethischem Therapeutenverhalten/Kunstfehlern befragt. Dabei berichten ambulante Patienten am häufigsten von Schwierigkeiten mit ihrer Krankenversicherung, während stationäre Patienten am häufigsten über Verschlechterung ihrer Symptome berichten. Im Bezug auf unethisches Therapeutenverhalten/Kunstfehler durch den Therapeuten beklagen Patienten aus beiden Behandlungssettings am häufigsten, dass sie sich durch Aussagen ihres Behandlers verletzt und zu Interventionen gezwungen fühlten. Gleichzeitig berichtet ein Großteil der Patienten positive Effekte ihrer psychotherapeutischen Behandlung. Prädiktoranalysen ergaben, dass negative Effekte von Psychotherapie und unethischem Therapeutenverhalten/Kunstfehlern u.a. durch Vorerfahrung mit Psychotherapie, negativen Erwartungen und einer negativen therapeutischen Beziehung begünstigt werden. Zusätzlich zu der quantitativen Datenerhebung im ambulanten und stationären Setting fand eine qualitative Erhebung statt (Studie III). Hierzu wurden insgesamt N=24 ehemalige Psychotherapiepatienten in einem selbstentwickelten halbstrukturierten Interview zu ihren negativen Erfahrungen mit Psychotherapie befragt. Es wurde mittels qualitativer Analysen untersucht, in welchen Lebensbereichen negative Effekte auftraten und welche Ursachen für diese negativen Effekte von Patienten genannt wurden. Dabei zeigte sich, dass ein wesentlicher Teil der Ursachen außerhalb der therapeutischen Beziehung gesehen werden; zum Beispiel in den Rahmenbedingungen der Klinik und der Inflexibilität des Gesundheitssystems. 7Im Rahmen der vorliegenden Arbeit wurde mit der Erstellung eines neu entwickelten Fragebogens, welcher negative Effekte von Psychotherapie aus Patientenperspektive erfasst, ein ökonomisches Instrument entwickelt, um negative Effekte systematisch untersuchen zu können. Weiterhin konnten erste wichtige Erkenntnisse dazu geworden werden, was das Auftreten von negativen Effekten und Kunstfehlern begünstigt. Besonders frühere Therapieerfahrungen und ungünstige Erwartungen stellen hier einen Risikofaktor dar. Zudem konnten qualitative Daten einen vertieften Einblick darin geben, wodurch negative Effekte aus Patientensicht entstehen

Anthrax in Iowa

Central Iowa was the scene of a recent outbreak of anthrax which, up to the present time, involved four herds of cattle and one person. The following cases outline the recent outbreak which is typical of such enzootic diseases

A regularização fundiária e a interface com o Sistema Único de Assistência Social: alguns Apontamentos

TCC (Graduação) - Universidade Federal de Santa Catarina. Centro Socioeconômico. Serviço Social.O presente trabalho abrange um pouco da história de lutas por maior participação nas políticas públicas, principalmente com relação à Assistência Social. A escolha pelo tema se deu por ter realizado estágio no Centro de Referência em Assistência Social – CRAS, durante o período de Agosto 2015 a Agosto 2016, onde foi possível vivenciar uma compreensão maior da importância do conhecimento participativo dos usuários nessa política e especificamente em um grupo mobilizado pela demanda de regularização fundiária. Com isso, o objetivo geral desse trabalho de conclusão de curso é problematizar e realizar uma reflexão com relação à iniciativa de mobilização, promovida pelo CRAS Rio Tavares de Florianópolis, a partir do reconhecimento de território, com perspectiva de despertar a participação dos sujeitos envolvidos, um grupo de moradores que buscam a regularização de suas moradias no território. Mostrando a temática regularização fundiária e a interface com o Sistema Único de Assistência Social: uma experiência com a participação popular no processo de mobilização dos moradores das Zeis – Zona Especial de Interesse Social – no Bairro Areias do Campeche, em Florianópolis/SC. O percurso metodológico deste trabalho foi com técnica de pesquisa documental e bibliográfica e este levantamento contempla as bibliografias estudadas nas disciplinas curriculares durante o curso de Serviço Social, com relação ao trabalho com famílias, a assistência social, politica habitacional e direito à moradia. Alguns dos principais autores são: Marilda Iamamoto, Ana Fani Carlos, Renata Nunes, Bruna Córdova, Beatriz Augusto de Paiva, Potyara Pereira, dentre outros autores, e algumas leis e Estatutos, como o Estatuto da Cidade, bem como a participação diretamente em reuniões deste grupo específico de regularização fundiária. Delimitou-se a pesquisa na construção de dois capítulos, contemplando apontamentos históricos e legislações da assistência social e sobre direito à moradia, já no segundo capitulo, após um breve contexto de Florianópolis, discursa – se sobre o grupo demandante em questão, sobre regularização fundiária. As considerações finais foram construídas em direção a uma análise da participação dos usuários na política da assistência social com relação ao grupo específico de regularização fundiária

Parodien und Struwwelpetriaden in der Universitätsbibliothek Johann Christian Senckenberg und der Bibliothek für Jugendbuchforschung Frankfurt am Main

Die Bibliographie erscheint im Rahmen der Ausstellung "Parodien und Struwwelpetriaden" des Instituts für Jugendbuchforschung und der Universitätsbibliothek Johann Christian Senckenberg, die vom 8. Mai bis 30. Juli 2009 in der Universitätsbibliothek zu sehen ist