This thesis explores eight professionals’ views on the use of the multi-agency approach to assist young people involved in violent and offending behaviour. Parallel to this overall purpose, this thesis also examines the professionals’ views on possible risk factors for the involvement in such behaviour, and their perception of possible improvements to this particular approach. As a result of the policy changes during the 90’s, multi agency approaches became a popular way to deal with crime. In recent years, new frameworks and programs for multi-agency approaches have been introduced. Focus on a more streamlined multi-agency approach, as a way of targeting young people involved in violent and offending behavior, has been implemented by sharing information and working together across agencies for the benefit of children and young people. The method of this thesis applied semi-structured interviews, all of them with 13 prepared questions, to obtain the data necessary, and used snowball sampling to expand the network of informants. The results showed that most agencies saw benefits with the multi-agency approach primarily because of the way in which one can better obtain the needs of the child/youth and accommodate these on different levels thanks to the close interaction of the agencies. Moreover, the informants displayed a unified understanding of the underlying risk factors that might contribute to the involvement in violent or offending behaviour. Primarily, the informants addressed five risk factor themes: family, drugs and alcohol, gang culture and peer pressure, deprivation, and education. As for improvements, the informants saw the biggest need for such in the area of communication, not only between agencies, but also on a societal and political level where social issues must be addressed in policy making and resource funding.

Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2015-04-08T21:54:42Z No. of bitstreams: 2 Helena França Correia dos Reis - parte 1.pdf: 1172974 bytes, checksum: d6edfb49bf3aa7f8e7ec3e13bc775de1 (MD5) Helena França Correia dos Reis - parte 2.pdf: 9767 bytes, checksum: 61aa48c89a7f26d9fe7d717265a6cf24 (MD5) / Made available in DSpace on 2015-04-08T21:54:42Z (GMT). No. of bitstreams: 2 Helena França Correia dos Reis - parte 1.pdf: 1172974 bytes, checksum: d6edfb49bf3aa7f8e7ec3e13bc775de1 (MD5) Helena França Correia dos Reis - parte 2.pdf: 9767 bytes, checksum: 61aa48c89a7f26d9fe7d717265a6cf24 (MD5) Previous issue date: 2012 / A identificação do momento certo para extubação pode influenciar tanto para evitar falência da extubação como extubação retardada, que por sua vez implicam em maior tempo de ventilação mecânica e suas complicações. Objetivos: Desenvolver um escore de risco da falência de extubação em pacientes com traumatismo cranioencefálico (TCE) e verificar se existe associação entre a falência da extubação e desfechos clínicos e funcionais. Métodos: Foram avaliados prospectivamente 311 pacientes com TCE nas unidades de terapia intensiva de um hospital de referência em trauma. Um modelo de regressão logística múltipla foi desenvolvido para prever o risco de falência de extubação. Resultados: A falência de extubação ocorreu em 43 pacientes (13,8%). O escore foi criado pela soma aritmética de pontos dos preditores independentes. Cinco preditores foram identificados: sexo feminino (4 pontos), escore da escala de Glasgow motor ≤ 5 (4 pontos), volume de secreção moderado a grande (4 pontos), tosse ausente ou fraca (3 pontos) e tempo de ventilação mecânica ≥ 10 dias (2 pontos). Foi calculado o escore de risco para cada paciente e definidas três categorias de risco: baixo (0 a 3 pontos), moderado (4 a 7 pontos), alto (8 a 17 pontos). A estatística C para o escore de risco em pontuação foi de 0,81. A mortalidade hospitalar foi de 4,5% nos pacientes com sucesso e de 20,9% naqueles com falência da extubação (p=0,001). O tempo de permanência hospitalar nos pacientes com falência da extubação foi significativamente maior do que naqueles com sucesso (27 (19,2-36,8) vs. 44 (24,5-59,5, p=0,002). Os pacientes com falência da extubação apresentaram menor capacidade funcional na alta hospitalar. Conclusão: Um escore de risco foi desenvolvido para predizer falência de extubação em pacientes com TCE, podendo facilmente ser aplicado na unidade de terapia intensiva (UTI). E a falência da extubação esteve associada a maior mortalidade, maior permanência hospitalar e menor capacidade funcional na alta da UTI e hospitalar.

Submitted by (edna.saturno@ufrpe.br) on 2016-10-20T14:21:22Z No. of bitstreams: 1 Moacir Bezerra de Andrade.pdf: 486371 bytes, checksum: 997bf7f6be2c645f0415215a82b09935 (MD5) / Made available in DSpace on 2016-10-20T14:21:22Z (GMT). No. of bitstreams: 1 Moacir Bezerra de Andrade.pdf: 486371 bytes, checksum: 997bf7f6be2c645f0415215a82b09935 (MD5) Previous issue date: 2008-02-28 / Considering that the consciousness level corresponds to the degree of behavioral alert shown by individuals and that the later is subject to strong variation among neurological patients, the relevance of its evaluation and measurement becomes clear. In that account, several scales were developed and proposed to human medicine, all of them based on the analysis of the patients and consequent scoring regarding their global consciousness level every other moment. The technological development and improved research of the nervous system enhanced the neurological knowledge regarding veterinary medicine. Advances in both scientific production and medical clinic were achieved, as in the philosophical debate about animal well-being and consciousness. Yet, additional research is required in order to develop safer and more accurate clinical instruments and proceedings. The objective of the present work is to modify the Pediatric Glasgow’s Scale of Coma focusing on its application in veterinarian clinical neurology, in order to evaluate and measure the consciousness levels ofcanine patients. Another objective is to test the applicability of the Glasgow’s Scale for Dogs. This study was conducted on 30 adult canine patients, disregarding the gender, race, and weight, which presented pathological processes causing them neurological changes suitable for consciousness level evaluation. Animals were provided by the Department of Clinic Neurology and Psychobiology of the Medical Clinic for Small Animals in the Veterinary Hospital of the Department of Veterinary Medicine (DMV) of the University Federal Rural of Pernambuco (UFRPE). The Glasgow’s Scale of Coma Modified for Dogs was applied in three distinct moments (m0, m1 e m2) with an interval of 48 hours between them, leading to 90 recorded events. Data were submitted to factorial analysis, and results suggested that the Glasgow’s Scale of Coma Modified for Dogs is valid for the evaluation of the consciousness levels of adult dogs in the ambulatory routine. / Considerando-se o conceito de que o nível de consciência é o grau de alerta comportamental que o indivíduo apresenta e também, as possibilidades de variação desse parâmetro em pacientes neurológicos, observa-se a relevância de sua avaliação e mensuração. Neste sentido, várias escalas foram desenvolvidas e propostas à medicina humana e todas elas baseadas na análise do paciente e na atribuição de um escore de pontuação que propicie uma idéia global da condição do nível de consciência, momento a momento. Na medicina veterinária, devido ao desenvolvimento tecnológico e aos estudos mais acurados do sistema nervoso, houve grandes avanços na área neurológica, tanto na produção científica quanto na clínica médica e no debate filosófico sobre o bem-estar animal e a consciência. Contudo, apesar dos incrementos, deve-se ressaltar a necessidade de realização de diversas pesquisas no campo da neurologia clínica veterinária que venham viabilizar o surgimento de instrumentos e procedimentos clínicos mais seguros e eficazes. O presente trabalho teve como objetivo modificar a Escala de Coma de Glasgow Pediátrica visando sua utilização na neurologiaclínica veterinária, a fim de avaliar e mensurar os níveis de consciência de pacientes da espécie canina. Uma outra finalidade do trabalho foi a aplicabilidade da Escala de Glasgow para Cães. No desenvolvimento deste estudo foram utilizados 30 pacientes da espécie canina, adultos, sem distinção de sexo, raça, peso, portadores de processos patológicos que causem alterações neurológicas, passíveis de avaliação do nível de consciência. Os animais foram provenientes do Serviço de Neurologia Clínica e Psicobiologia da Clínica Médica de Pequenos Animais do Hospital Veterinário do Departamento de Medicina Veterinária (DMV) da Universidade Federal Rural de Pernambuco (UFRPE). A Escala de Coma de Glasgow Modificada para Cães foi aplicada nos cães em três momentos distintos (m0, m1 e m2), sendo respeitado um intervalo de 48 horas entre as análises, ocasionando 90 eventos diversos. Os dados obtidos foram tratados estatisticamente através da Análise Fatorial, que permitiu concluir que a Escala de Coma de Gvalidade construída, possuindo a capacidade de avaliar, na rotina ambulatorial, o nível de consciência em cães adultos.

Objectives: Intracranial subdural empyema (ICSDE) can be a devastating condition, with a sequelae ranging from epilepsy, focal deficits to death. Factors affecting the outcome in subdural empyema range from level of consciousness, the extend of subdural pus at the time of diagnosis and the type of surgical procedure performed. Previous studies have conflicting results of unfavourable prognostic factors associated with ICSDE. The outcome of this condition at Steve Biko Academic Hospital (SBAH) is reported, as well as factors influencing the outcome. Methods: A retrospective analysis of all the patients admitted at neurosurgery unit of SBAH during 2006 – 2010 period with confirmed subdural empyema on brain CT scan and at surgery. Data sheet was used to collect all clinical information from patients’ records. Glasgow Outcome Scale and Henk W. Mauser grading were used to report on the outcome. Results: A total of 34 patients (20 males and 14 females) with mean age of 16.1 years were admitted with a diagnosis of ICSDE. The common presenting features were headache (58.8%), fever and seizures (47.0% each). Over 61% of patients had hemiplegia at presentation. CT scan confirmed subdural collections with 70.6% over the convexity, 23.5% at the convexity and parafalx and only 5.9% had bilateral collections. Complicated paranasal sinusitis was the origin of infection in 82.3%, followed by meningitis with 8.8%. Burr hole washout was done in 52.9% of patients, while 38.2% had burr holes with drains in situ and 8.8% had craniotomy to evacuate the subdural pus. All the patients were given empiric triple antibiotic therapy. Streptococci species were the most cultured organisms in the 19 (56.0%) patients who had positive cultures, however 15 (44.0%) patients had negative cultures. Resistance to penicillin was noted in 5.0% of cases only. Sixty-five percent of patients had good outcome with no seizures nor neurological deficits. The overall mortality was 15.0% in this study, with none from patients who had craniotomy. Conclusion: Clinical presenting features and organisms cultured seems to be the same internationally, particularly those due to complicated sinusitis. Empiric triple antibiotic therapy of 3rd generation cephalosporin plus vancomycin plus metronidazole is still relevant at SBAH. Factors associated with favourable outcome were ages between 11 and 20 years, and craniotomy as the surgical procedure of choice. / Dissertation (MMEd)--University of Pretoria, 2013. / Neurology / Unrestricted

This master thesis examines the representation of climate justice discourses at the by various parties at the COP26 in Glasgow, 2021 and how these are manifested in the subsequent policy outcome, the Glasgow Pact. To coherently categorize the wide interpretations of climate justice, this study adopts a theoretical framework proposed by Schapper (2018), where climate justice is differentiated through international, intra-societal and intergenerational dimensions. Through the lens of critical discourse analysis, statements made at the higher-level segment of the event are analyzed according to their storylines to identify which climate justice discourses are exercised by varying actors. The sample consists of 17 statements of various countries categorized by different coalitions. In comparison, the findings indicate that the Glasgow Pact recognizes most discourses in some form, but that it sides with developed nations on account of knowledge claims, non-binding policy language and an absence of any discourse on historical responsibility or the right to use fossil fuels. Consequently, the mismatch of what is said and done reveals power imbalances at the negotiations, and therefore threaten the credibility of the COP as a fair and inclusive arena for climate negotiations.

The Affinity 2.0 has been recently upgraded to the Affinity 2.5. Both instruments purport to measure sexual interest using viewing time as a form of measurement using non-pornographic images of people of varying ages and genders. The Affinity 2.5 increased the number of slides by 42.9%. This increase may have impacted the expected Chi square weights established for the Affinity 2.0 for non-pedophilic, exclusively heterosexual males. The purpose of this study was to create new expected Chi square weights for the Affinity 2.5 for non-pedophilic, exclusively heterosexual males. Additionally, this study re-examined the temporal stability of the Affinity 2.0 using a Chi-square procedure instead of traditional correlational procedures. The Affinity 2.5 was administered to 50 self-reported non-pedophilic, exclusively heterosexual males. The results of this study indicated that the expected Chi-square weights created for the Affinity 2.5 were extremely similar to the weights created for the Affinity 2.0. The re-examination of the temporal stability of the Affinity 2.0 using Chi-square procedures demonstrated that 76.6% of subjects were consistent in their responses from time-1 to time-2.

Edith Wharton, Ellen Glasgow, and Willa Cather are often mentioned together as traditionalists, the supposition being that their common interest was inspired by similar forces; all women, all of the same era, all greatly appreciative of many of the same values, and all doing most of their outstanding work during their middle and late years. It has become a convenience of criticism and scholarship to consider authors as belonging to certain schools. It has also been a convenience to study the origins of these schools as social phenomena having more to do with a direction of society as a whole than with individual psychological forces within each author. Such an approach may be adequate for a movement that rises to its apex and dwindles to a shadow all within one generation--as did the extreme Naturalism of Norris--, but it is not sufficient for traditionalism which has repeated itself several times throughout literary history. It is, therefore, the purpose of this study to investigate the lives and works of Edith Wharton, Ellen Glasgow, and Willa Cather in order to demonstrate the different forces tending each towards vastly different tradition-influenced work, specifically novels. In such treatment, each author can be presented individually in a brief biographical study, and then her novels can be discussed with her own psychological framework and the whole field of traditionalism kept in mind as a balance. The emphasis here will be upon the diverse influences in their lives and the extremely varied work these differences motivated. Traditionalism will not be exactly defined because this paper has been undertaken with the hope of broadening rather than limiting the concept of "traditionalism." It is the intention here to investigate and evaluate both the intent and extent of the various degrees and elements of traditionalism as they appear in the bulk of these authors' novels.

No description available.

This study shows that her fiction was an influence in pointing the way to American Naturalism as a literary school and that, by her devotion to a single idea over a long span of years, she endows all womankind with stature.

I. EFFECTS OF GLASGOW OUTCOME SCALE MISCLASSIFICATION ON TRAUMATIC BRAIN INJURY CLINICAL TRIALS The Glasgow Outcome Scale (GOS) is the primary endpoint for efficacy analysis of clinical trials in traumatic brain injury (TBI). Accurate and consistent assessment of outcome after TBI is essential to the evaluation of treatment results, particularly in the context of multicenter studies and trials. The inconsistent measurement or interobserver variation on GOS outcome, or for that matter, on any outcome scales, may adversely affect the sensitivity to detect treatment effects in clinical trial. The objective of this study is to examine effects of nondifferential misclassification of the widely used five-category GOS outcome scale and in particular to assess the impact of this misclassification on detecting a treatment effect and statistical power. We followed two approaches. First, outcome differences were analyzed before and after correction for misclassification using a dataset of 860 patients with severe brain injury randomly sampled from two TBI trials with known differences in outcome. Second, the effects of misclassification on outcome distribution and statistical power were analyzed in simulation studies on a hypothetical 800-patient dataset. Three potential patterns of nondifferential misclassification (random, upward and downward) on the dichotomous GOS outcome were analyzed, and the power of finding treatments differences was investigated in detail. All three patterns of misclassification reduce the power of detecting the true treatment effect and therefore lead to a reduced estimation of the true efficacy. The magnitude of such influence not only depends on the size of the misclassification, but also on the magnitude of the treatment effect. In conclusion, nondifferential misclassification directly reduces the power of finding the true treatment effect. An awareness of this procedural error and methods to reduce misclassification should be incorporated in TBI clinical trials. II. IMPACT OF MISCLASSIFICATION ON THE ORDINAL GLASGOW OUTCOME SCALE IN TRAUMATIC BRIAN INJURY CLINICAL TRIALS The methods of ordinal GOS analysis are recommended to increase efficiency and optimize future TBI trials. To further explore the utility of the ordinal GOS in TBI trials, this study extends our previous investigation regarding the effect of misclassification on the dichotomous GOS to examine the impact of misclassification on the 5-point ordinal scales. The impact of nondifferential misclassification on the ordinal GOS was explored via probabilistic sensitivity analyses using TBI patient datasets contained in the IMPACT database (N=9,205). Three patterns of misclassification including random, upward and downward patterns were extrapolated, with the pre-specified outcome classification error distributions. The conventional 95% confidence intervals and the simulation intervals, which account for the misclassification only and the misclassification and random errors together, were reported. Our simulation results showed that given a specification of a minimum of 80%, modes of 85% and 95% and a maximum of 100% for both sensitivity and specificity (random pattern), or given the same trapezoidal distributed sensitivity but a perfect specificity (upward pattern), the misclassification would have caused an underestimated ordinal GOS in the observed data. In another scenario, given the same trapezoidal distributed specificity but a perfect sensitivity (downward pattern), the misclassification would have resulted in an inflated GOS estimation. Thus, the probabilistic sensitivity analysis suggests that the effect of nondifferential misclassification on the ordinal GOS is likely to be small, compared with the impact on the binary GOS situation. The results indicate that the ordinal GOS analysis may not only gain the efficiency from the nature of the ordinal outcome, but also from the relative smaller impact of the potential misclassification, compared with the conventional binary GOS analysis. Nevertheless, the outcome assessment following TBI is a complex problem. The assessment quality could be influenced by many factors. All possible aspects must be considered to ensure the consistency and reliability of the assessment and optimize the success of the trial. III. A METHOD FOR REDUCING MISCLASSIFICATION IN THE EXTENDED GLASGOW OUTCOME SCORE The eight-point extended Glasgow Outcome Scale (GOSE) is commonly used as the primary outcome measure in traumatic brain injury (TBI) clinical trials. The outcome is conventionally collected through a structured interview with the patient alone or together with a caretaker. Despite the fact that using the structured interview questionnaires helps reach agreement in GOSE assessment between raters, significant variation remains among different raters. We introduce an alternate GOSE rating system as an aid in determining GOSE scores, with the objective of reducing inter-rater variation in the primary outcome assessment in TBI trials. Forty-five trauma centers were randomly assigned to three groups to assess GOSE scores on sample cases, using the alternative GOSE rating system coupled with central quality control (Group 1), the alternative system alone (Group 2), or conventional structured interviews (Group 3). The inter-rater variation between an expert and untrained raters was assessed for each group and reported through raw agreement and with weighted kappa (k) statistics. Groups 2 and 3 without central review yielded inter-rater agreements of 83% (weighted k¼0.81; 95% CI 0.69, 0.92) and 83% (weighted k¼0.76, 95% CI 0.63, 0.89), respectively, in GOS scores. In GOSE, the groups had an agreement of 76% (weighted k¼0.79; 95% CI 0.69, 0.89), and 63% (weighted k¼0.70; 95% CI 0.60, 0.81), respectively. The group using the alternative rating system coupled with central monitoring yielded the highest inter-rater agreement among the three groups in rating GOS (97%; weighted k¼0.95; 95% CI 0.89, 1.00), and GOSE (97%; weighted k¼0.97; 95% CI 0.91, 1.00). The alternate system is an improved GOSE rating method that reduces inter-rater variations and provides for the first time, source documentation and structured narratives that allow a thorough central review of information. The data suggest that a collective effort can be made to minimize inter-rater variation.