Services for preschool children with special needs in state day care centres in Greece : issues and national policy directions

In 1984, integration of children ages 6-12 years with special needs was legislated in Greece with the introduction of the resource room model of service delivery at the primary school level. However, this model did not extend into the preschool years. There is increasing empirical support for the importance of early intervention for children at risk. A survey was conducted in 55 state-run, day care centres in Greater Athens to examine current acceptance rates, preferred service delivery models and projected needs. The survey found that preschoolers with special needs are grossly under-served. Although it is generally accepted that 10% of the population is challenged, only 2.5% of the total enrollment in the surveyed day care centres had special needs. Despite the lack of supports, almost half of these centres accepted children with mild to moderate special needs (primarily language problems, behaviour challenges, and developmental delays). The most preferred model of service delivery identified by centre directors was total integration with support from a special needs teacher. Additional issues and concerns voiced by directors are addressed and national policy recommendations are made.peer-reviewe

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants. Clinical trial registration: NCT02350348

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

BACKGROUND: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. METHODS: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. RESULTS: Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). CONCLUSIONS: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2&lt;90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event

Elementary school children's empathetic response to poetry

The present thesis studies the empathetic response in reading poetry, a particular literary genre, which predominantly motivates the emotions of the reader. Based on the review of the conceptual content of empathy in relation to the literary theory, a basic assumption of this thesis is the investigation of the empathetic response of pupils of primary school to poetry, through reading poems in their school textbooks. For this purpose, initially, at the first (theoretical) part of the present thesis, the literature review aims at the clarification and definition of the concept and its individual dimensions through various theoretical approaches historically, while in the second (research) part individual aspects of the central topic are investigated, through the application of phenomenological case study (pupils of the sixth grade of primary school, 11-12 years old).Although the results of this research do not seek generalizations, the findings are clear and confirm the ways in which the reader approaches, understands and evaluates a poem. In this context, empathetic response is recorded as a complex process of the reader’s inner experiencing of the poem, capable of contributing to the deeper understanding of the self and the other. As the reader becomes involved emotionally, s/he gains experience and consciousness of the emotional state of the self and the other, which s/he transforms and extends, in order to understand it, interpret it and assign meaning and value to it. Through the relationship of the reader with his/her own self and the world of the poem, there is demonstrated the importance of empathetic responsiveness, which gives the opportunity to the reader to understand, interpret and critically reflect, to “see”, eventually, his/her own self and the others and communicate with them under a new perspective.With the detection, representation and description of the multiple dimensions of the response of this kind, the way opens up for further investigation of the matter. The inherent qualities of empathetic response render necessary its application and adoption as a teaching principle for the purpose of literary education, as well as the methodological renewal and the enrichment of the teaching approaches of poetry and literature in general.Στην παρούσα διατριβή αντικείμενο μελέτης αποτελεί η ενσυναισθητική ανταπόκριση αναφορικά με την ποίηση, ένα ιδιαίτερο λογοτεχνικό είδος, που κινητοποιεί κατεξοχήν τα συναισθήματα του αναγνώστη. Με βάση την εξέταση του εννοιολογικού περιεχομένου της ενσυναίσθησης και την επαναξιολόγηση της σημασίας της σε σχέση με τη λογοτεχνική θεωρία, βασική υπόθεση εργασίας της παρούσας έρευνας αποτελεί η διερεύνηση της ενσυναισθητικής ανταπόκρισης των μαθητών του Δημοτικού Σχολείου στην ποίηση, μέσω ποιητικών κειμένων των σχολικών εγχειριδίων. Για το σκοπό αυτό, αρχικά, στο α΄ μέρος (θεωρητικό) της παρούσας μελέτης, η βιβλιογραφική ανασκόπηση στοχεύει στην αποσαφήνιση και την οριοθέτηση της έννοιας και των επιμέρους διαστάσεών της μέσα από ποικίλες θεωρητικές προσεγγίσεις ιστορικά, ενώ στο β΄ μέρος (εμπειρικό) διερευνώνται επιμέρους ζητήματα του κεντρικού θέματος, με τη χρήση της φαινομενολογικής μελέτης περίπτωσης (εδώ, μαθητές της Στ΄ τάξης του Δημοτικού Σχολείου). Αν και τα συμπεράσματα της παρούσας έρευνας δεν επιζητούν γενικεύσεις, τα ευρήματα είναι σαφή και επιβεβαιώνουν τους τρόπους με τους οποίους ο αναγνώστης προσεγγίζει αναγνωστικά, κατανοεί και αξιολογεί αισθητικά ένα ποίημα. Στο πλαίσιο αυτό, η ενσυναισθητική ανταπόκριση καταγράφεται ως μία πολύπλοκη διαδικασία εμβίωσης (ζω εντός) του αναγνώστη στην ποιητική εμπειρία, ικανή να συμβάλει στη βαθύτερη κατανόηση του εαυτού και του άλλου. Καθώς ο αναγνώστης εμπλέκεται συναισθηματικά, αποκτά εμπειρία και επίγνωση της συγκινησιακής κατάστασης του εαυτού και του άλλου, την οποία μετασχηματίζει και επεκτείνει, με σκοπό να την κατανοήσει, να την ερμηνεύσει και να της αποδώσει νόημα και αξία. Μέσα από τη σχέση του αναγνώστη με τον εαυτό του και με τον «κόσμο» του ποιήματος, καταδεικνύεται η σημασία της ενσυναισθητικής ανταπόκρισής του, η οποία του δίνει τη δυνατότητα να κατανοήσει, να ερμηνεύσει και να αναστοχαστεί κριτικά, να «δει», εν τέλει, τον εαυτό του και τους άλλους και να επικοινωνήσει μαζί τους υπό μία νέα οπτική. Με την ανίχνευση, αποτύπωση και περιγραφή των πολλαπλών διαστάσεων της ανταπόκρισης αυτού του είδους, ανοίγονται δρόμοι για την περαιτέρω διερεύνηση του θέματος. Τα εγγενή ποιοτικά χαρακτηριστικά της ενσυναισθητικής ανταπόκρισης επιβάλλουν την ανάγκη αξιοποίησής της και υιοθέτησής της ως διδακτικής αρχής για τους σκοπούς της λογοτεχνικής αγωγής, αλλά και για τη μεθοδολογική ανανέωση και τον εμπλουτισμό της διδακτικής προσέγγισης της ποίησης και, γενικότερα, της λογοτεχνίας

Η αρχή της αμεσότητας στον Κώδικα Πολιτικής Δικονομίας

Σκοπό της παρούσας εργασίας αποτελεί η μελέτη και η εφαρμογή της αρχής της αμεσότητας στον ΚΠολΔ. Για την πληρέστερη κατανόηση της αρχής αυτής, προηγείται η ιστορική αναδρομή της αρχής της αμεσότητας από την Δικονομία του Maurer μέχρι και την μεταρρύθμιση του ν. 4335/2015. Ακολουθεί ανάλυση των διακρίσεων της αρχής της αμεσότητας, σε υποκειμενική και αντικειμενική, όσο και των ζητημάτων που δημιουργεί η εφαρμογή ή η κάμψη αυτής, καθώς και της εφαρμογής της στα κατ΄ ιδίαν αποδεικτικά μέσα. Εν συνεχεία, εξετάζουμε εάν, η μη εφαρμογή της αρχής αυτής, επιφέρει κυρώσεις και ποιες είναι αυτές και κατόπιν ερευνούμε κατά πόσο η αρχή της αμεσότητας εντοπίζεται στη διαδικασία των ασφαλιστικών μέτρων, την εκουσία δικαιοδοσία, καθώς και τη διαιτησία. Η παρούσα μελέτη ολοκληρώνεται με την έκθεση των συμπερασμάτων, που αποτελεί και τον επίλογο της.The present thesis aims to delve into the subject of the principle of “immediacy” in the context of the Greek Code of Civil Procedure (hereinafter referred to as GCCP). To apprehend the precise scope of the said principle, it is necessary to begin with a summary of the history behind it, from its origins which trace back to the Mauer Code of Civil Procedure up until the recent Law 4335/2015. We will then address the various manifestations of the principle of “immediacy”, concentrating on the distinction between “objective” and “subjective immediacy” in particular, as well as the various issues which arise from the application thereof. In addition, we will focus on examining the potential consequences of the non-application of the principle of “immediacy” and we will attempt to answer the question whether the said principle applies to the special procedures of interim measures, non-contentious proceedings and arbitration. By way of conclusion, we will refer to the main results of the research which was conducted while drafting this study