Variation in restraint use between hospitals: a multilevel analysis of multicentre prevalence measurements in Switzerland and Austria

Background: In restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level (hospital general effect) and b) to examine the impact of organisational factors on restraint use (specific contextual effects). Methods: A secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016–2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18+ with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed. Results: The study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.75). By adding the hospital as a random effect, the explained variance of the model increased from 24 to 55%. Conclusions: The use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible. Keywords: Hospitals, Multilevel analysis, Organisational culture, Quality of health care, Restrain

Language, Philosophy and Judaism in the Work of Emmanuel Levinas and Franz Rosenzweig

The dissertation examines the complex relationship between language, philosophy and Judaism in the work of Emmanuel Levinas (1906-1995) and Franz Rosenzweig (1886-1929) in light of previously unpublished writings of Levinas as well as new research literature. It is mainly thanks to the consideration of previously unpublished writings of Levinas, which appeared only recently in the first two volumes of the edition of his Completed Works, that the new insights presented in this work have come about. These writings provide new perspectives into the development of Levinas's philosophy. Further, results from international research literature, especially on the notion of the voice, have been extensively taken into consideration in order to analyze different aspects of the works of Levinas and Rosenzweig respectively and set them into relation to one another. The work is divided into three parts: - Judaism. The first part (Chapter I) deals with the topic of Judaism. This plays a key role not only in Levinas's writings but also in his life. In this respect, the influence of Franz Rosenzweig, whose major work "The Star of Redemption" (1921) Levinas read in the mid-thirties, is of crucial importance. The emergence and development of this influence will first be discussed through an analysis of Levinas's early work. It examines to what extent the notion of Judaism as a "category of being" ("catégorie de l'être"), which appears in Levinas's captivity notebooks (Carnets de captivité) as well as in his articles on Rosenzweig after the war, can be seen as a result of his reception of Rosenzweig's writings and how this reception furthermore influenced Levinas's thinking after the war. Finally, against the background of the different biographical and historical connections, this dissertation outlines the relationship between Judaism and philosophy in the work of Levinas with special reference to the influence of Rosenzweig. - Philosophy. The second part (Chapter II) outlines the question of the role of philosophy. Firstly, the issue of death is examined in relation to the notion of the "there is" (il y a), which Levinas elaborates upon especially in "De l'existence de l'existant" (1947). In this context the influence of Maurice Blanchot (1907-2003) on Levinas plays a crucial role. The aspect of death is further linked to the notions of eros and creation in the works of Levinas and Rosenzweig. Furthermore, the thesis discusses the temporal mode of eschatology and its special significance for Levinas's thinking, particularly regarding the role of language in his philosophy. - Language. Part III (Chapter III and IV) is primarily concerned with the topic of "language". In chapter III the connection between language and speech-thinking (Sprach-Denken) in the work of Rosenzweig is elaborated and related to the notion of language in Levinas. Based on Rosenzweig's article "Das neue Denken" (1925) the thesis analyzes what Rosenzweig actually meant by the notion of a "new thinking" (Neues Denken) and how it is reflected in his theoretical and biographical works. Two aspects are emphasized in this analysis: language and revelation. The close connection of these two aspects in the work of Rosenzweig is then set in relation to their role in Levinas. Further, Rosenzweig's concept of a messianic epistemology and his notion of truth are examined. Finally, the role of language is analyzed with respect to Rosenzweig's notion of truth. The silence and the vision of the divine face, as Rosenzweig discusses in the third part of "The Star of Redemption", are shown to be ultimately accorded a higher significance by Rosenzweig than language. The phenomenon of the voice in the works of Levinas and Rosenzweig is worked out in chapter IV. Firstly, the notion of the voice is applied in order to develop a new interpretation of the subject in Levinas's work. In a second step, the complex relationship between revelation, language and love in Rosenzweig's work is examined with special attention given to the role of the "voice of love" in "The Star of Redemption". In this way, the crucial significance of the voice in the act of revelation is outlined. This project demonstrates how the "mute" Self becomes a "speaking" soul and in which way the "voice of love" (Rosenzweig) plays a key role in this context. Each of these aspects is related critically to Levinas's work. Lastly, the thesis demonstrates the significance of the voice in the translation of the Bible, which Rosenzweig undertook together with Buber in 1925. In conclusion, this interpretation of Levinas's and Rosenzweig's thought is placed in the context of postmodern philosophy in order to make it fruitful for the present time

The multiferroic phase of DyFeO3_{3}:an ab--initio study

By performing accurate ab-initio density functional theory calculations, we study the role of $4f$ electrons in stabilizing the magnetic-field-induced ferroelectric state of DyFeO$_{3}$. We confirm that the ferroelectric polarization is driven by an exchange-strictive mechanism, working between adjacent spin-polarized Fe and Dy layers, as suggested by Y. Tokunaga [Phys. Rev. Lett, \textbf{101}, 097205 (2008)]. A careful electronic structure analysis suggests that coupling between Dy and Fe spin sublattices is mediated by Dy-$d$ and O-$2p$ hybridization. Our results are robust with respect to the different computational schemes used for $d$ and $f$ localized states, such as the DFT+$U$ method, the Heyd-Scuseria-Ernzerhof (HSE) hybrid functional and the GW approach. Our findings indicate that the interaction between the $f$ and $d$ sublattice might be used to tailor ferroelectric and magnetic properties of multiferroic compounds.Comment: 6 pages, 4 figures-Revised versio

Synthesis, Binding and Antiviral Properties of Potent Core-Extended Naphthalene Diimides Targeting the HIV-1 Long Terminal Repeat Promoter G-Quadruplexes

We have previously reported that stabilization of the G-quadruplex structures in the HIV-1 long terminal repeat (LTR) promoter suppresses viral transcription. Here we sought to develop new G-quadruplex ligands to be exploited as antiviral compounds by enhancing binding toward the viral G-quadruplex structures. We synthesized naphthalene diimide derivatives with a lateral expansion of the aromatic core. The new compounds were able to bind/stabilize the G-quadruplex to a high extent, and some of them displayed clear-cut selectivity toward the viral G-quadruplexes with respect to the human telomeric G-quadruplexes. This feature translated into low nanomolar anti-HIV-1 activity toward two viral strains and encouraging selectivity indexes. The selectivity depended on specific recognition of LTR loop residues; the mechanism of action was ascribed to inhibition of LTR promoter activity in cells. This is the first example of G-quadruplex ligands that show increased selectivity toward the viral G-quadruplexes and display remarkable antiviral activity

Изучение электрохимического поведения иридия (+4) методом полярографии с накоплением

Целью нашей работы было выяснить возможность применения метода пленочной полярографии с накоплением (ППН) для определения микрограммовых количеств ирридия. В литературе подобные исследования не описаны. Пики анодного электрорастворения иридия при потенциалах +0,7 отн. нас, к. э. с поверхности графитового электрода, полученные на фоне 1 м НСl с добавлением ионов ртути, имеют удобную для измерений форму и линейно растут с увеличением концентрации ионов иридия в исследуемом растворе, что позволяет применять метод ППН для определения иридия в интервале изученных концентраций 0,0000001-0,00001 моль/л

Restraining patients in acute care hospitals: a qualitative study on the experiences of healthcare staff

Aim: The focus was to explore the perceptions and experiences of healthcare workers with respect to the use of restraints in acute care hospitals. Design: The study followed a qualitative design. Methods: Three topic-based focus group interviews were conducted, involving 19 participants from the fields of nursing, physical therapy and medicine. For data collection and analysis, the method of mapping techniques for rapid qualitative data analysis was used. After discussing and validating the individual mind maps, all data were condensed to identify the key findings. Results: Participants described restraints as safety measures for the patients. The implementation of most restraints was led by nurses. The use of restraints differed significantly, even in the interprofessional team. Attitudes and experiences were the main determinants for restraint use. Nurses asked for more discussion about restraints in the team, for more support at an interprofessional level and for better guidelines to help with the decision-making process

Restraint use as a quality indicator for the hospital setting: a secondary data analysis

INTRODUCTION: A reduction in restraint use is recommended for all health care settings. For this purpose, local or national quality measurement and improvement initiatives have been implemented in various countries, primarily in the mental health and long-term care settings. However, restraints are also frequently used in the somatic acute care hospital setting, and strong variations in their prevalence rates have been reported. Therefore, the aim of this study was to reanalyse existing data on restraint use in Swiss hospitals in order to assess the potential of restraint use as a national quality indicator for the hospital setting. METHODS: Using a cross-sectional, multicentre design, data were collected between 2016 and 2018 as part of the ANQ"s (Swiss National Association for Quality Development in Hospitals and Clinics) "falls and pressure ulcers" national prevalence measurement in acute care hospitals in Switzerland. The hospitals measured restraint use on a voluntary basis in addition to falls and pressure ulcers. All medical specialities and patients aged 18 and over who gave their informed consent were included in the measurement. Descriptive and multilevel regression analyses were performed using institutional, ward and patient-level data relating to restraint use. RESULTS: The sample consisted of 18,938 inpatients from 55 hospitals. The 30-day prevalence rate of patients with at least one restraint was 10.2% (n = 1933). The riskadjusted hospital comparison revealed that hospitals in Switzerland differ significantly in their restraint use, even after adjusting for patient characteristics. In total, 10 hospitals used restraints significantly less and 12 used them significantly more than the national average. CONCLUSION: Restraint use varies significantly between Swiss hospitals: 40% of all hospitals used restraints either significantly more or significantly less often than the average. In comparison to the other quality indicators, this is a very high value, indicating potential for improvements in the quality of care. Since restraint use is associated not only with quality of care, but also with human rights, these large differences seem questionable from a professional, ethical and legal point of view. Clearer and binding regulations in combination with monitoring and benchmarking of restraint use in hospitals, such as with a national quality indicator, seem necessary. These would help to ensure that restraint use is in alignment with professional values, as well as ethical and legal requirement