Gender Differences In Academic Ethics With Recommendations For Curricular Change

An extensive study has been performed on the importance of building ethical principles into secondary school and college curricula.  In published surveys, females are almost universally found to be more ethical, but experience tells us females lag behind males in their ability to maintain and act upon their convictions in the workplace.  We examined these issues by administering a survey on academic ethics to an undergraduate business school population, focusing heavily on gender differences. Careful analysis of survey results using one-way ANOVA, the Tukey-Kramer procedure, and two-way ANOVA procedures provided an understanding of differences in ethical beliefs and ethical behaviors based on gender and other demographic characterizations.  Predictive analysis was completed using logistic regression and discrete choice modeling to determine the likelihood of ethical behavior in the future and evolution of ethical beliefs.  The accumulated results of the analyses were used to guide the authors in the development of a strong and pervasive ethics-based curriculum for secondary schools and universities.  We have combined elements of classroom instruction, technology, active learning, games and extracurricular activities to embed ethical concepts and particularly encourage strength in convictions across the entire curricula. 

Stressors in the ICU: different perceptions of patients, relatives and staff members

Introduction The high-risk critically ill are exposed to signifi cant stressors, along with diffi culties in communicating them to relatives and members of the staff . The aim of this study was to compare the perception of stressors as reported by patients (P), relatives (R) and ICU staff members (S). Methods A validated questionnaire [1] was used to quantitatively assess discomforts related to the ICU stay. Items were clustered into categories; higher scores refer to a higher stressfulness. The median (IQR) was calculated for each category. Twenty-eight high-risk critically ill at discharge, 55 relatives 48 hours after admission of their next of kin, and a total of 125 staff members (55 attending physicians, 40 nurses and 30 medical students/specialist trainees) were interviewed. Fifty-six of the staff members were used to keep patients consciously sedated as for local guidelines; the remaining used deeper levels of sedation. Nonparametric tests were used as needed. Results All stressor categories were diff erently reported by the three groups analysed: environmental (S = 17 (15 to 19), R = 15 (13 to 18), P = 10 (8 to 11), P <0.01), relationships (S = 23 (21 to 25), R = 20.5 (17 to 24.5), P = 14 (11 to 17), P <0.01), emotional (S = 25.5 (23 to 28), R = 24 (20 to 26), P = 18 (15 to 22), P <0.01), and physical (S = 35 (31 to 38), R = 33 (26.5 to 37), P = 27 (21 to 30), P <0.01). Among the staff members, nurses overestimated more than attending physicians, while trainees are closer to relatives\u2019 perception (P = 0.03). Staff members used to conscious sedation overestimate less the impact of environmental stressors (P = 0.03). Years of experience (r = 0.24, P = 0.03) and age (r = 0.27, P = 0.01) are related to stressor overestimation among staff members. Conclusion Members of the staff should reconsider their beliefs on patients\u2019 perception of stressors. We argue that such an overestimation may bring inappropriate administration of analgesic and sedative drugs, particularly for nurses and older members of staff . Relatives might be useful intermediaries to have a better insight of patients\u2019 perception

Near-bed and surface flow division patterns in experimental river bifurcations

Understanding channel bifurcation mechanics is of great importance for predicting and managing multichannel river processes and avulsion in distributary river deltas. To date, research on river channel bifurcations has focused on factors determining the stability and evolution of bifurcations. It has recently been shown that, theoretically, the nonlinearity of the relation between sediment transport and flow discharge causes one of the two distributaries of a (slightly) asymmetrical bifurcation to grow and the other to shrink. The positive feedback introduced by this effect results in highly asymmetrical bifurcations. However, there is a lack of detailed insight into flow dynamics within river bifurcations, the consequent effect on bed load flux through bifurcating channels, and thus the impact on bifurcation stability over time. In this paper, three key parameters (discharge ratio, width-to-depth ratio, and bed roughness) were varied in order to examine the secondary flow field and its effect on flow partitioning, particularly near-bed and surface flow, at an experimental bifurcation. Discharge ratio was controlled by varying downstream water levels. Flow fields were quantified using both particle image velocimetry and ultrasonic Doppler velocity profiling. Results show that a bifurcation induces secondary flow cells upstream of the bifurcation. In the case of unequal discharge ratio, a strong increase in the secondary flow near the bed causes a larger volume of near-bed flow to enter the dominant channel compared to surface and depth-averaged flow. However, this effect diminishes with larger width-to-depth ratio and with increased bed roughness. The flow structure and division pattern will likely have a stabilizing effect on river channel bifurcations. The magnitude of this effect in relation to previously identified destabilizing effects is addressed by proposing an adjustment to a widely used empirical bed load nodal-point partition equation. Our finding implies that river bifurcations can be stable under a wider range of conditions than previously thought. Key Points Secondary flow in symmetrical bifurcations causes strong near-bed flow curvature A disproportional amount of near-bed flow enters the dominant downstream channel Flow curvature adds a stabilizing feedback on bifurcation evolution

Quality of Life in COVID-Related ARDS Patients One Year after Intensive Care Discharge (Odissea Study): A Multicenter Observational Study

Background: Investigating the health-related quality of life (HRQoL) after intensive care unit (ICU) discharge is necessary to identify possible modifiable risk factors. The primary aim of this study was to investigate the HRQoL in COVID-19 critically ill patients one year after ICU discharge. Methods: In this multicenter prospective observational study, COVID-19 patients admitted to nine ICUs from 1 March 2020 to 28 February 2021 in Italy were enrolled. One year after ICU discharge, patients were required to fill in short-form health survey 36 (SF-36) and impact of event-revised (IES-R) questionnaire. A multivariate linear or logistic regression analysis to search for factors associated with a lower HRQoL and post-traumatic stress disorded (PTSD) were carried out, respectively. Results: Among 1003 patients screened, 343 (median age 63 years [57–70]) were enrolled. Mechanical ventilation lasted for a median of 10 days [2–20]. Physical functioning (PF 85 [60–95]), physical role (PR 75 [0–100]), emotional role (RE 100 [33–100]), bodily pain (BP 77.5 [45–100]), social functioning (SF 75 [50–100]), general health (GH 55 [35–72]), vitality (VT 55 [40–70]), mental health (MH 68 [52–84]) and health change (HC 50 [25–75]) describe the SF-36 items. A median physical component summary (PCS) and mental component summary (MCS) scores were 45.9 (36.5–53.5) and 51.7 (48.8–54.3), respectively, considering 50 as the normal value of the healthy general population. In all, 109 patients (31.8%) tested positive for post-traumatic stress disorder, also reporting a significantly worse HRQoL in all SF-36 domains. The female gender, history of cardiovascular disease, liver disease and length of hospital stay negatively affected the HRQoL. Weight at follow-up was a risk factor for PTSD (OR 1.02, p = 0.03). Conclusions: The HRQoL in COVID-19 ARDS (C-ARDS) patients was reduced regarding the PCS, while the median MCS value was slightly above normal. Some risk factors for a lower HRQoL have been identified, the presence of PTSD is one of them. Further research is warranted to better identify the possible factors affecting the HRQoL in C-ARDS

Safety profile of enhanced thromboprophylaxis strategies for critically ill COVID-19 patients during the first wave of the pandemic: observational report from 28 European intensive care units

Introduction: Critical illness from SARS-CoV-2 infection (COVID-19) is associated with a high burden of pulmonary embolism (PE) and thromboembolic events despite standard thromboprophylaxis. Available guidance is discordant, ranging from standard care to the use of therapeutic anticoagulation for enhanced thromboprophylaxis (ET). Local ET protocols have been empirically determined and are generally intermediate between standard prophylaxis and full anticoagulation. Concerns have been raised in regard to the potential risk of haemorrhage associated with therapeutic anticoagulation. This report describes the prevalence and safety of ET strategies in European Intensive Care Unit (ICUs) and their association with outcomes during the first wave of the COVID pandemic, with particular focus on haemorrhagic complications and ICU mortality. Methods: Retrospective, observational, multi-centre study including adult critically ill COVID-19 patients. Anonymised data included demographics, clinical characteristics, thromboprophylaxis and/or anticoagulation treatment. Critical haemorrhage was defined as intracranial haemorrhage or bleeding requiring red blood cells transfusion. Survival was collected at ICU discharge. A multivariable mixed effects generalised linear model analysis matched for the propensity for receiving ET was constructed for both ICU mortality and critical haemorrhage. Results: A total of 852 (79% male, age 66 [37\u201385] years) patients were included from 28 ICUs. Median body mass index and ICU length of stay were 27.7 (25.1\u201330.7) Kg/m2 and 13&nbsp;(7\u201322) days, respectively. Thromboembolic events were reported in 146 patients (17.1%), of those 78 (9.2%) were PE. ICU mortality occurred in 335/852 (39.3%) patients. ET was used in 274 (32.1%) patients, and it was independently associated with significant reduction in ICU mortality (log odds = 0.64 [95% CIs 0.18\u20131.1; p = 0.0069]) but not an increased risk of critical haemorrhage (log odds = 0.187 [95%CI 12 0.591 to 12 0.964; p = 0.64]). Conclusions: In a cohort of critically ill patients with a high prevalence of thromboembolic events, ET was associated with reduced ICU mortality without an increased burden of haemorrhagic complications. This study suggests ET strategies are safe and associated with favourable outcomes. Whilst full anticoagulation has been questioned for prophylaxis in these patients, our results suggest that there may nevertheless be a role for enhanced / intermediate levels of prophylaxis. Clinical trials investigating causal relationship between intermediate thromboprophylaxis and clinical outcomes are urgently needed

Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards. The PERSEO study

BACKGROUND: Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management). METHOD: Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO – Psychiatric EmeRgency Study and EpidemiOlogy). RESULTS: 253 FPA aged <= 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers. CONCLUSION: Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved significantly from admission to discharge both for FPA and non-FPA patients

Affected Experiencers

Numerous languages permit an NP that is not selected by the verb to be added to a clause, with several different possible interpretations. We divide such non-selected arguments into possessor, benefactive, attitude holder, and affected experiencer categories, on the basis of syntactic and semantic differences between them. We propose a formal analysis of the affected experiencer construction. In our account, a syntactic head Aff(ect) introduces the experiencer argument, and adds a conventional implicature to the effect that any event of the type denoted by its syntactic sister is the source of the experiencer’s psychological experience. Hence, our proposal involves two tiers of meaning: the at-issue meaning of the sentence, and some not-at-issue meaning (an implicature). A syntactic head can introduce material on both tiers. Additionally, we allow two parameters of variation: (i) the height of the attachment of Aff, and (ii) how much of the semantics is at-issue and how much is an implicature. We show that these two parameters account for the attested variation across our sample of languages, as well as the significant commonalities among them. Our analysis also accounts for significant differences between affected experiencers and the other types of non-selected arguments, and we also note a generalization to the effect that purely not-at-issue non-selected arguments can only be weak or clitic pronouns