50 research outputs found

    Images in Emergency Medicine: Traumatic Pneumocephalus

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    The development of project management capability in complex organisational settings: towards a knowledge-based view

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    This exploratory case-based study investigates the development of project management (PM) as an organisational capability in two public sector organisations (PSO) during a period of rapid environmental change. Within the PM literature, the concept of project management capability (PMC) and how it develops over time through organizational learning is still an emerging tradition led to date by mainly European scholars (Lindkvist, Söderlund, Davies, Brady, Hobday, etc.). This investigation locates itself within this emerging tradition and represents a unique empirical opportunity to study the learning processes involved in PMC development in a complex setting that shows these processes in greater relief. In both of the organizations studied, the elevation and enhancement of PMC from a relatively low-level activity to a strategic supporting competence was triggered by radical and rapid change in the external environment during the 2000s. The main process insight is that PMC is found to be developed as a dynamic organisational capability in complex PM settings through organisational complex problem-solving (CPS). The overall outcomes of the study build upon and extend the emerging PMC literature in at least three important respects, with implications for traditional PM research and practice. Firstly, in contrast to the mechanistic view of traditional PM, this study supports an integrated knowledge-based view of ‘projects as process’ and ‘PM as practice’. In this view, a project is seen to be ‘a mode of organising to accomplish a temporary undertaking’ and PMC is seen as a strategic organisational practice in organising complex projects. Secondly, PMC is honed as a practice through goal-directed organisational CPS. This builds upon and extends the work of Popper on the evolutionary growth of knowledge by revealing problemsolving as a two-stage process of differentiation-integration, or disorder-order. In contrast to traditional PM which follows a path from ‘order to order’, the development of PMC as an organisational capability is found to proceed from ‘order to disorder to order’. Thirdly, using the lens of PM as practice, a 'distributed organising' approach is suggested for coordinating the formation of ‘complex knowledge’ under organisational CPS, which is inherently emergent and dynamic. This contrasts with the ‘centralised planning’ approach of traditional PM, which assumes that knowledge is manifest in pre-given plans that are executed with little organisational learning expected beyond the application of prior knowledge

    Student Awareness and Use of Rubrics in Online Classes

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    The design, development and deployment of online instruction has become standard practice. The focus of the study was on student perceptions of course rubrics and not on the rubrics, themselves, or the instructors. In order to improve student engagement online we conducted an exploratory study of the awareness and perceptions of course rubrics. Fifty graduate students completed an online survey at the end of the semester about their awareness and perceptions of course rubrics. All students reported that they were aware that course rubrics existed. They indicated that they had learned about this information through the course syllabus, professor announcements via email and posts to LMS. Most students reported reviewing rubrics prior to submitting an assignment. One of the key findings from this study was that students see rubrics as a mechanism for scaffolding their performance, and thus, instructors need to focus more effort on designing rubrics to accomplish more than student assessment

    Excited Delirium

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    Excited (or agitated) delirium is characterized by agitation, aggression, acute distress and sudden death, often in the pre-hospital care setting. It is typically associated with the use of drugs that alter dopamine processing, hyperthermia, and, most notably, sometimes with death of the affected person in the custody of law enforcement. Subjects typically die from cardiopulmonary arrest, although the cause is debated. Unfortunately an adequate treatment plan has yet to be established, in part due to the fact that most patients die before hospital arrival. While there is still much to be discovered about the pathophysiology and treatment, it is hoped that this extensive review will provide both police and medical personnel with the information necessary to recognize and respond appropriately to excited delirium

    Teaching & Learning The Spanish Aspect Using Blogs and Wikis: An Exploratory Study

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    This study investigated the influence of asynchronous computer text based technologies on the students’ performance when learning the preterite and the imperfect aspects in Spanish. Two research questions guided the study: Research Question 1) Is there a difference in students’ achievement levels in Spanish preterite and imperfect between those using wiki technologies and those using blog technologies after controlling for pre-intervention achievement levels? and Research Question 2) Are there differences in satisfaction levels for students learning Spanish preterite and imperfect via blog technologies as compared to those learning via wiki technologies? Results indicate that there were not significant differences between students who use blog or wiki technologies on performance levels when controlling for pre-existing knowledge. Results also indicated that there were not significant differences in satisfaction levels between those students using a wiki and those using a blog. These results suggest that wikis and blogs are good potential tools that may facilitate the teaching and learning of problematic grammar structures in a narrative context

    Teaching Courses Online: A Review of the Research

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    This literature review summarizes research on online teaching and learning. It is organized into four topics: course environment, learners’ outcomes, learners’ characteristics, and institutional and administrative factors. The authors found little consistency of terminology, discovered some conclusive guidelines, and identified developing lines of inquiry. The conclusions overall suggest that most of the studies reviewed were descriptive and exploratory, that most online students are nontraditional and Anglo American, and that few universities have written policies, guidelines, or technical support for faculty members or students. Asynchronous communication seemed to facilitate in-depth communication (but not more than in traditional classes), students liked to move at their own pace, learning outcomes appeared to be the same as in traditional courses, and students with prior training in computers were more satisfied with online courses. Continued research is needed to inform learner outcomes, learner characteristics, course environment, and institutional factors related to delivery system variables in order to test learning theories and teaching models inherent in course design

    Symptomatic androgen deficiency develops only when both total and free testosterone decline in obese men who may have incident biochemical secondary hypogonadism: prospective results from the EMAS

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    Objective: Limited evidence supports the use of free testosterone (FT) for diagnosing hypogonadism when sex hormone binding globulin (SHBG) is altered. Low total testosterone (TT) is commonly encountered in obesity where SHBG is typically decreased. We aimed to assess the contribution of FT in improving the diagnosis of symptomatic secondary hypogonadism (SH), identified initially by low total testosterone (TT), and then further differentiated by normal FT (LNSH) or low FT (LLSH). Design: Prospective observational study with a median follow‐up of 4.3 years. Patients: 3369 community‐dwelling men aged 40‐79 years from eight European centres. Measurements: Subjects were categorised according to baseline and follow‐up biochemical status into persistent eugonadal (referent group; n=1880), incident LNSH (eugonadism to LNSH; n=101) and incident LLSH (eugonadism to LLSH; n=38). Predictors and clinical features associated with the transition from eugonadism to LNSH or LLSH were assessed. Results: The cumulative incidence of LNSH and LLSH over 4.3 years was 4.9% and 1.9% respectively. Baseline obesity predicted both LNSH and LLSH but the former occurred more frequently in younger men. LLSH, but not LNSH, was associated with new/worsened sexual symptoms, including low desire [OR= 2.67 (1.27‐5.60)], erectile dysfunction [OR= 4.53 (2.05‐10.01)] and infrequent morning erections [OR= 3.40 (1.48‐7.84)]. Conclusions: These longitudinal data demonstrate the importance of FT in the diagnosis of hypogonadism in obese men with low TT and SHBG. The concurrent fall in TT and FT identifies the minority (27.3%) of men with hypogonadal symptoms, which were not present in the majority developing low TT with normal FT

    The androgen receptor gene CAG repeat in relation to 4-year changes in androgen-sensitive endpoints in community-dwelling older European men

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    Context: The Androgen Receptor (AR) gene exon 1 CAG repeat length has been proposed to be a determinant of between-individual variations in androgen action in target tissues, which might regulate phenotypic differences of human ageing. However, findings on its phenotypic effects are inconclusive.Objective: To assess whether the AR CAG repeat length is associated with longitudinal changes in endpoints which are influenced by testosterone (T) levels in middle-aged and elderly European men.Design: Multinational European observational prospective cohort studyParticipants: 1887 men (mean±sd age: 63±11 years; median follow-up: 4.3 years) from centres of 8 European countries comprised the analysis sample after exclusion of those with diagnosed diseases of the hypothalamic-pituitary-testicular (HPT) axis.Main outcome measures: Longitudinal associations between the AR CAG repeat and changes in androgen-sensitive endpoints (ASEs) and medical conditions were assessed using regression analysis adjusting for age and centre. The AR CAG repeat length was treated both as a continuous and categorical (6-20; 21-23; 24-39 repeats) predictor. Additional analysis investigated whether results were independent of baseline T or oestradiol (E2) levels.Results: The AR CAG repeat, when used as a continuous or categorical predictor, was not associated with longitudinal changes in ASEs or medical conditions after adjustments. These results were independent of T and E2 levels.Conclusion: Within a 4-year timeframe, variations in the AR CAG repeat do not contribute to the rate of phenotypic ageing, over and above, that, which might be associated with the age-related decline in T levels

    Development of and recovery from secondary hypogonadism in aging men: prospective results from the EMAS

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    Context: Secondary hypogonadism is common in aging men; its natural history and predisposing factors are unclear. Objectives: The objectives were 1) to identify factors that predispose eugonadal men (T >= 10.5 nmol/L) to develop biochemical secondary hypogonadism (T = 30 kg/m(2); odds ratio [OR] = 2.86 [95% confidenceinterval, 1.67; 4.90]; P = 102 cm, respectively). Incident secondary hypogonadal men experienced new/worsening sexual symptoms (low libido, erectile dysfunction, and infrequent spontaneous erections). Recovery from secondary hypogonadism was predicted by nonobesity(OR = 2.28 [1.21; 4.31]; P = .011), weight loss (OR = 2.24 [1.04; 4.85]; P = .042), normal waist circumference (OR = 1.93 [1.01; 3.70]; P = .048), younger age (<60 y; OR = 2.32 [1.12; 4.82]; P = .024), and higher education (OR = 2.11 [1.05; 4.26]; P = .037), but symptoms did not show significant concurrent improvement. Conclusion: Obesity-related metabolic and lifestyle factors predispose older men to the development of secondary hypogonadism, which is frequently reversible with weight loss
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