Outcome From Serious Injury in Older Adults

Purpose: The purpose of this paper is to analyze the research published in peer-reviewed journals between 1996 and 2005 that examine factors affecting the physical outcomes of older adults after serious traumatic injury. Organizing Construct: 27 primary research studies published in the last 10 years describe in-hospital and long-term outcomes of serious injury among older adults. Research specific to isolated hip injury, traumatic brain injury and burn trauma was excluded. Methods: An integrative review of research published between January 1996 and January 2005 was carried out to examine the relationship between older age and outcome from severe injury. MEDLINE, BIOSIS previews, CINAHL and PsycINFO databases were searched using the MeSH terms: injury, serious injury, trauma and multiple trauma, and crossed with type, severity, medical/surgical management, complication, outcome, mortality, morbidity, survival, disability, quality of life, functional status, functional recovery, function, and placement. Findings: Older adults experience higher short and long-term mortality when compared to younger adults. The relationship between older age and poorer outcome persists when adjusting for injury severity, number of injuries, comorbidities, and complications. At the same time, injury severity, number of injuries, complications, and gender each independently correlate to increased mortality among older adults. The body of research is limited by over-reliance on retrospective data and heterogeneity in definitional criteria for the older adult population. Conclusions: Additional research is needed to clarify the contributory effect of variables such as psychosocial sequelae and physiologic resilience on injury outcome. The field of geriatric trauma would benefit from further population-based prospective investigation of the determinants of injury outcome in older adults in order to guide interventions and acute care treatment

Staten som innovatør. Utviklingstillatelser i norsk havbruksnæring

Etter hvert som havbruksnæringen har vokst, har det med dagens driftsformer dukket opp problemer med spredning av lakselus, rømming av oppdrettslaks og utslipp av organiske materialer og avlusningsmidler. I tillegg, en begrensing i arealer som kan brukes til oppdrett av laks. Denne oppgaven er en dokument analyse hvor man ved hjelp av offentlige dokumenter, avisartikler og vitenskapelige artikler belyser bakgrunnen for at man fikk ordningen med utviklingskonsesjoner. Oppgaven skal også få frem hvordan ordningen ble organisert og hva det foreløpige resultatet av ordningen er, både hvilken teknologi som er kommet og hvem som har kommet med den. Konsesjonsbruken har lang tradisjon i norsk forvaltning, og med utviklingskonsesjonene blir de brukt for å stimulere til innovasjon av teknologi i næringen. Teknologien skal kunne bidra til å forbedre eller løse miljø- og arealproblemene næringen i dag står ovenfor. Årsaken til en egen ordning for innovasjon er at utvikling av slik teknologi kan være svært kostbart og innebærer stor risiko for den aktuelle aktøren. Ordningen ble til for å avlaste risikoen til svært dyre utviklingsprosjekter som uten ordningen ikke ville sett dagens lys. Utviklingskonsesjonene ble organiser slik at de som hadde et prosjekt kunne sende inn en søknad til Fiskeridirektoratet innen 17. november 2017. Fiskeridirektoratet skulle ut i fra gitte kriterier, bruke skjønn for å vurdere hvem som var innenfor kriteriene. De som får tilsagn om utviklingstillatelse blir tildelt ett antall konsesjoner med utvikling som formål. Utviklingen skal foregå i et begrenset antall år før konsesjonen kan søkes konvertert over til kommersiell konsesjon. Ved konvertering må aktøren betale vederlag, men til en kraftig rabattert pris. Denne rabatten er risikoavlastningen staten bidrar med. Frem til 1. februar 2019 er det kommet nye produksjonsenheter i kategoriene offshore, semilukket, lukket og nedsenkbar. Teknologien innenfor offshoreoppdrett tar sikte på å løse næringens arealproblematikk, og begrense problemene med lakselus, utslipp og rømming gjennom robuste konstruksjoner og eksponerte lokaliteter med mindre lus og bedre spredning av utslipp. Semilukket og lukket teknologi har barrierer som hindrer lus fra kontakt med laksen inne i merden, lukkede merder kan også samle opp avfall. Nedsenkbare anlegg satser på å holde laksen under lusebeltet for å forhindre lusepåslag. Av de som til nå har fått tildelt utviklingskonsesjoner er det to store selskap som har fått tildelt størstedelen av de foreløpig 76 konsesjonene

Predicting the Future Development of Depression or PTSD After Injury

OBJECTIVE: The objective was to develop a predictive screener that when given soon after injury will accurately differentiate those who will later develop depression or posttraumatic stress disorder (PTSD) from those who will not. METHOD: This study used a prospective, longitudinal cohort design. Subjects were randomly selected from all injured patients in the emergency department; the majority was assessed within 1 week postinjury with a short predictive screener, followed with in-person interviews after 3 and 6 months to determine the emergence of depression or PTSD within 6 months after injury. RESULTS: A total of 192 completed a risk factor survey at baseline; 165 were assessed over 6 months. Twenty-six subjects [15.8%, 95% confidence interval (CI) 10.2-21.3] were diagnosed with depression, four (2.4%, 95% CI 0.7-5.9) with PTSD and one with both. The final eight-item predictive screener was derived; optimal cutoff scores were ≥2 (of 4) depression risk items and ≥3 (of 5) PTSD risk items. The final screener demonstrated excellent sensitivity and moderate specificity both for clinically significant symptoms and for the diagnoses of depression and PTSD. CONCLUSIONS: A simple screener that can help identify those patients at highest risk for future development of PTSD and depression postinjury allows the judicious allocation of costly mental health resources

Ein Labor für Assistive Technologien und Barrierefreiheit Rehabilitationstechnologische Grundlagen im Kontext praxisorientierter Hochschullehre

Bestehende Studienangebote in Deutschland unterliegen häufig der Kritik einer Transferproblematik aufgrund der fehlenden Verbindung von Studieninhalten und der späteren Arbeitsrealität. Dabei ist vor allem für (rehabilitations-)pädagogische Studiengänge der Lebensweltbezug in der Arbeit mit vulnerablen Gruppen von grundlegender Bedeutung. Deshalb lernen Studierende in Veranstaltungen im Kontext einer Lern- und Forschungswerkstatt, dem Labor für Assistive Technologien und Barrierefreiheit (LAB) des Fachgebiets Rehabilitationstechnologie an der Technischen Universität Dortmund, in angeleiteten und freien Selbstversuchen sogenannte Assistive Technologien kennen. Der Beitrag stellt das Konzept des LABs und die einzelnen Veranstaltungen, deren Lehrangebot dem Konzept der praxisorientierten Hochschullehre zuzuordnen ist, vor und diskutiert die Entwicklungen und Herausforderungen, die sich in den letzten Jahren ergeben haben.Especially for pedagogical and educational students the connection between course content and the working reality is of fundamental importance. Therefore, the Department of Rehabilitation Technology at TU Dortmund University provides a learning and research environment called the Laboratory for assistive technologies and Accessibility (LAB). The article presents the LABs practice-oriented concept and range of courses and discusses the developments and challenges that have arisen in recent years

Assessing Graduate Teaching Development Programs for Impact on Future Faculty

Long-term training programs for teaching assistants have greater impactTraining programs for university teaching assistants (TAs) improve the quality of teaching and learning. But a new HEQCO study of short and long-term training programs at two Ontario universities finds that while both make important contributions, long programs had a greater impact.Assessing Graduate Teaching Development Programs for Impact on Future Faculty was conducted at the University of Windsor and Western University, whose teaching and learning centres offer a wide range of TA training programs -- short, orientation-style conferences and longer, intensive workshops throughout the year.Project descriptionThe study used self-reported measures of TAs’ attitudes to teaching and teaching self-efficacy before and after each program, combined with focus group interviews four months after program completion. The goal was to assess and compare the impact of the programs and to link specific types of programming to measurable outcomes. FindingsTeaching development programs help improve the teaching effectiveness of new TAs in a variety of ways, according to the study. TAs felt better prepared for their role as instructors after participating in training. Both short (one-day events) and long programs (20-40 hours) contributed to increased teaching self-efficacy and to an increase in student-focused approaches to teaching. The focus groups found that when TAs began to teach on their own, they were able to apply the teaching techniques, course design principles and student-focused approaches to teaching that they learn in TA training programs. Participants in short programs emphasized concrete teaching techniques for facilitating discussions, marking, asking effective questions and becoming more familiar with expectations for the teaching assistant role. Participants in longer programs demonstrated greater confidence in using principles of course design and alignment and articulating learning outcomes, and showed a greater depth of reflection on teaching. Long programs also created communities of TAs from a variety of disciplines, where discussion about teaching continued beyond the end of the program. Participants also shared innovative teaching techniques or course design strategies with their peers and with faculty members. The study found that both programs make an important contribution – but do so in different ways. Short programs serve as a gateway to further teaching development, allowing new graduate students to learn a few very practical teaching strategies and better understand the benefits of further training. Longer programs allow participants to build community and strategically prepare for careers in teaching, whether inside or outside academia.The authors note that it is important for teaching centres and departments to clearly communicate the differences between the outcomes of orientation-style and more in-depth programs.Further researchAddition research could explore long-term changes in TAs’ approaches to teaching after training, as well as the impact of TA training on student learning, say the authors, complementing the self-report measures used in this study with observer and student ratings of TA teaching in real classroom settings. Other HEQCO studies that explore teaching and TA development include a report on two University of Toronto TA training programs, a study of Western University’s international TA training programs and an overview of the evolution of teaching and learning centres in Ontario colleges and universities.Authors of Assessing Graduate Teaching Development Programs for Impact on Future Faculty are Nanda Dimitrov, Ken Meadows, Erika Kustra, Theimann Ackerson, Laura Prada, Nick Baker, Pierre Boulos, Gayle McIntyre and Michael K. Potter

Psychiatric Disorders in Patients Presenting to the Emergency Department for Minor Injury

BACKGROUND: Thirty-five percent of all Emergency Department (ED) visits are for physical injury. OBJECTIVES: To examine the proportion of patients presenting to an ED for physical injury with a history of or current Axis I/II psychiatric disorders and to compare patients with a positive psychiatric history, a negative psychiatric history, and a current psychiatric disorder. METHODS: A total of 275 individuals were selected randomly from adults presenting to the ED with a documented anatomic injury but with normal physiology. Exclusion criteria were: injury in the previous 2 years or from medical illness or domestic violence; or reported treatment for major depression or psychoses. Psychiatric history and current disorders were diagnosed using the Structured Clinical Interview for the Diagnostic and Statistical Manual Disorders, 4th edition (DSM-IV), a structured psychiatric interview. Three groups (positive psychiatric history, negative psychiatric history, current psychiatric disorder) were compared using Chi-square and analysis of variance. RESULTS: The sample was composed of men (51.6%) and women (48.4%), with 57.1% Black and 39.6% White. Out of this sample, 103 patients (44.7%) met DSM-IV criteria for a positive psychiatric history (n = 80) or a current psychiatric disorder (n = 43). A past history of depression (24%)exceeded the frequency of a history of other disorders (anxiety, 6%; alcohol use/abuse, 14%; drug use/abuse, 15%; adjustment, 23%; conduct disorders, 14%). Current mood disorders (47%) also exceeded other current diagnoses (anxiety, 9%; alcohol, 16%; drug, 7%; adjustment, 7%; personality disorders, 12%). Those with a current diagnosis were more likely to be unemployed (p CONCLUSIONS: Psychiatric comorbid disorders or a positive psychiatric history was found frequently in individuals with minor injury. An unplanned contact with the healthcare system (specifically an ED) for treatment of physical injury offers an opportunity for nurses to identify patients with psychiatric morbidity and to refer patients for appropriate therapy

The Effect of Post-injury Depression on Return to Pre-injury Function: a Prospective Cohort Study

BACKGROUND: Millions of people seek emergency department (ED) care for injuries each year, the majority for minor injuries. Little is known about the effect of psychiatric co-morbid disorders that emerge after minor injury on functional recovery. This study examined the effect of post-injury depression on return to pre-injury levels of function. METHOD: This was a longitudinal cohort study with follow-up at 3, 6 and 12 months post-injury: 275 adults were randomly selected from those presenting to the ED with minor injury; 248 were retained over the post-injury year. Function was measured with the Functional Status Questionnaire (FSQ). Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR disorders (SCID). RESULTS: During the post-injury year, 18.1% [95% confidence interval (CI) 13.3-22.9] were diagnosed with depression. Adjusting for clinical and demographic covariates, the depressed group was less likely to return to pre-injury levels of activities of daily living [odds ratio (OR) 8.37, 95% CI 3.78-18.53] and instrumental activities of daily living (OR 3.25, 95% CI 1.44-7.31), less likely to return to pre-injury work status (OR 2.37, 95% CI 1.04-5.38), and more likely to spend days in bed because of health (OR 2.41, 95% CI 1.15-5.07). CONCLUSIONS: Depression was the most frequent psychiatric diagnosis in the year after minor injury requiring emergency care. Individuals with depression did not return to pre-injury levels of function during the post-injury year

Preferences for care towards the end of life when decision-making capacity may be impaired: A large scale cross-sectional survey of public attitudes in Great Britain and the United States

$\textbf{BACKGROUND}$: There is continuing public debate about treatment preferences at the end of life, and the acceptability and legal status of treatments that sustain or end life. However, most surveys use binary yes/no measures, and little is known about preferences in neurological disease when decision-making capacity is lost, as most studies focus on cancer. This study investigates changes in public preferences for care towards the end of life, with a focus on measures to sustain or end life. $\textbf{METHODS}$: Large-scale international public opinion surveys using a six-stage patient vignette, respondents chose a level of intervention for each stage as health and decision-making capacity deteriorated. Cross-sectional representative samples of the general public in Great Britain and the USA (N = 2016). Primary outcome measure: changes in respondents' preferences for care, measured on a four-point scale designed before data collection. The scale ranged from: maintaining life at all costs; to intervention with agreement; to no intervention; to measures for ending life. $\textbf{RESULTS}$: There were no significant differences between GB and USA. Preference for measures to sustain life at all costs peaked at short-term memory loss (30.2%, n = 610). Respondents selecting 'measures to help me die peacefully' increased from 3.9% to 37.0% as the condition deteriorated, with the largest increase occurring when decision-making capacity was lost (10.3% to 23.0%). Predictors of choosing 'measures to help me die peacefully' at any stage were: previous personal experience (OR = 1.34, p<0.010), and older age (OR = 1.09 per decade, p<0.010). Negative predictors: living with children (OR = 0.72, p<0.010) and being of "black" race/ethnicity (OR = 0.45, p<0.001). $\textbf{CONCLUSIONS}$: Public opinion was uniform between GB and USA, but markedly heterogeneous. Despite contemporaneous capacitous consent providing an essential legal safeguard in most jurisdictions, there was a high prevalence of preference for "measures to end my life peacefully" when decision-making capacity was compromised, which increased as dementia progressed. In contrast, a significant number chose preservation of life at all costs, even in end stage dementia. It is challenging to respect the longstanding values of people with dementia concerning either the inviolability of life or personal autonomy, whilst protecting those without decision-making capacity.This work was supported by The Dunhill Medical Trust [grant number R317/1113]. AH and SB are supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England at Cambridgeshire and Peterborough NHS Foundation Trust. AH is also supported by the Health Foundation. The funders had no role in the design, undertaking or writing of this paper, and no part in the decision to submit for publication. This paper presents independent research partly funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health

Bærekraftig utvikling i KRLE

Denne oppgaven undersøker hvordan et utvalg KRLE-lærere forstår bærekraftig utvikling som et tverrfaglig tema i KRLE-faget. Oppgaven tar utgangspunkt i at bærekraftig utvikling er innført som et tverrfaglig tema i læreplanverket etter fagfornyelsen (LK20) både i overordnet del (Kunnskapsdepartementet, 2017) og i KRLE-faget (Utdanningsdirektoratet, 2019). Oppgavens problemstilling er: Hvordan forstår et utvalg lærere bærekraftig utvikling i KRLE-faget? Undersøkelsen er basert på kvalitative intervjuer med fem lærere om deres forståelse av bærekraftig utvikling i KRLE-faget knyttet til ulike perspektiver. Hensikten har vært å finne ut hvordan lærere forstår det tverrfaglige temaets rolle i KRLE-faget. Som et tverrfaglig tema har det vært nødvendig å sette det inn i en mer overordnet sammenheng som her knyttes til skolens dannelsesoppdrag. Disse forskningsspørsmålene har derfor ligget til grunn for studien: Hvilke oppfatninger har et utvalg lærere av bærekraftig utvikling i og utenfor faget? Hvordan kan et utvalgt læreres syn på bærekraftig utvikling relateres til dannelse? Undersøkelsen viser at lærerne fremhever flere religion- og etikkdidaktiske innganger til det sammensatte begrepet bærekraftig utvikling, men også at noen perspektiver som gjerne forbindes med temaet, er nedtonet. Etikkundervisningens betydning i tilknytning til bærekraftig utvikling anses av lærerne som fagets sterkeste bånd til det tverrfaglige temaet. Både som knyttet til kunnskaper og ferdigheter, men også som et overordnet perspektiv på undervisningen. Religions- og livssynskunnskapens relevans for det tverrfaglige temaet tillegges vekt av noen av lærerne, men ikke av andre, og nevnes ikke i læreplanverket. Her argumenterer jeg for at det er rom for videre fagdidaktisk refleksjon og kreativitet. Et annet viktig funn er at mulige innganger til bærekraftig utvikling som globale perspektiver, naturen og kulturen, ikke løftet nevneverdig frem av lærerne som relevant for faget. Likevel viser teoretiske perspektiver at det er gode muligheter for at dette også kan knyttes til KRLE-faget, blant annet i et humanioraperspektiv. Til sist er skolens samfunnsmandat og dannelsesoppdrag sin relevans for bærekraftig utvikling i KRLE-faget vurdert som viktig av de intervjuede lærerne. Dermed setter de arbeidet med dette tverrfaglige temaet i sammenheng med individets utvikling og samfunnets beste