Aim: The purpose of this study was to highlight in what forms and manifestations spirituality emerges in medical patients whether they consider themselves believers or not. The other aim was to analyse spiritual ideas of nursing scientists – authors of the patients’ oriented studies to come to the better understanding of the situation with spirituality in caring. Method: Descriptive meta-synthesis was chosen, in which 12 nursing studies were analyzed and compiled in a new integrity. Results: The analysis shows that caregivers must be ready to meet and confirm the spiritual dimension consisting of Faith, Meaning, Relationship and Questions without answers in the various forms and expressions they emerge in patient’s experience. Nursing scientists showed ideas broad enough to confirm patients’ experience. Relevance for clinical practice: By include spirituality only to religion and culture the dimension are easily forgotten, it can also in those forms mean that caregivers doesn’t see it as theirs to confirm. Nursing science do not with hold that small view of spirituality, instead the science presents a broad spectra of forms in which patients spirituality can appear. New insights about patients’ spirituality can be used by health care professionals to improve the care of patients as multidimensional human beings.

This article uses a discursive lens to illuminate how writing and the writing child is constructed in different texts since the nineteenth century. The concept ‘image’ is used as an analytical tool to gain perspective on dominant ideas about children as writers and their educational writing practices. These images are produced in educational practices, theories of writing, societal conceptions and didactic models, which together are referred to as a formation. The article ends by reflecting upon what consequences may be seen if taking a critical child perspective. The article provides an analysis against which writing teachers, teacher educators and researchers can gain a perspective on dominant ideas about young writers and their educational writing practices.

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease that has a highly variable disease course. Three biologic agents, adalimumab, etanercept, and infliximab, have been developed for the treatment of AS. We conducted three studies: 1) an exploratory analysis of a year-long longitudinal dataset to gain insight into the variability of disease activity, physical function, and well-being and to explore the relationship between these outcome measures; 2) a systematic review of the available evidence for the efficacy of biologic treatment; 3) a systematic review of potential adverse effects of this treatment. We found that repeated measures of disease activity, function and well-being fluctuate considerably between patients, with complex patterns occurring over time within patients. There was mostly high quality evidence that these biologics are efficacious against placebo. We did not find evidence of an increase in serious adverse events or serious infections from short-term randomized controlled trials.

It is the purpose of this Thesis to start an analysis of metaconstitutional review, understood as the process through which an entity such as a Constitutional Court or Supreme Court reviews the compliance of the acts of the Constituent with superior values or fills constitutional gaps with such values. This, in order to explain its separate nature from constitutional review, to determine whether it is compatible with the traditional conception of popular sovereignty as the ultimate source of power and the legitimizing element of the constitutional system and to determine whether or not metaconstitutional review could prevent social change by entrenching certain values.

Background: Teleradiology is currently being explored to enhance services for patients seeking emergency neurosurgical diagnoses in Ontario, Canada. Design: Systematic review of literature and cost-consequence analysis. Data sources: Medline, Embase, Cochrane, and Database of Abstracts of Reviews of Effects. Methods: Studies published between 1950 and 2008 describing remote consultations for neurosurgical assessments were retrieved. Two reviewers selected studies through multi-staged content screening and extracted data. Results 12 of 3765 studies met the inclusion criteria: two were randomized controlled trials and ten were case series. Teleradiology [88% (207/236)] and video-conferencing [89% (213/239] consultations produced higher diagnostic accuracy than telephone consultations [64% (150/235), p<0.001]. Savings varied by location and were based on avoided costs for ground and air transportation and hospitalization. Conclusions: There is limited evidence of clinical benefit of teleradiology. Savings associated with reduction in patient transfer rates depend on transportation mode and may be attenuated by higher operational costs.

Background: Systematic reviews (SRs) should be kept up-to-date to maintain importance in informing health care policy and practice. However, updating policies and practices of health care organizations (HCOs) that fund or conduct SRs are either unclear or non-existent. Objective: To examine updating policies and practices of relevant HCOs. Primary Research Design: An exploratory Internet survey of 195 HCOs within the international SR community. Results: The completed response rate was 58% (n=114) across 26 countries. Although 57% of organizations reported to have a formal updating policy, 59% reported updating practices as irregular. Moreover, 54% estimated more than half of their respective SRs were likely out dated. Resource constraints were a prominent barrier. Most (70%) supported centralizing updating efforts across institutions or agencies. Significance: This research provides a baseline glimpse of the state of updating among HCOs globally involved in evidence synthesis and therefore adds to a limited body of knowledge.

Background: Systematic reviews (SRs) should be kept up-to-date to maintain importance in informing health care policy and practice. However, updating policies and practices of health care organizations (HCOs) that fund or conduct SRs are either unclear or non-existent. Objective: To examine updating policies and practices of relevant HCOs. Primary Research Design: An exploratory Internet survey of 195 HCOs within the international SR community. Results: The completed response rate was 58% (n=114) across 26 countries. Although 57% of organizations reported to have a formal updating policy, 59% reported updating practices as irregular. Moreover, 54% estimated more than half of their respective SRs were likely out dated. Resource constraints were a prominent barrier. Most (70%) supported centralizing updating efforts across institutions or agencies. Significance: This research provides a baseline glimpse of the state of updating among HCOs globally involved in evidence synthesis and therefore adds to a limited body of knowledge.

Background: Teleradiology is currently being explored to enhance services for patients seeking emergency neurosurgical diagnoses in Ontario, Canada. Design: Systematic review of literature and cost-consequence analysis. Data sources: Medline, Embase, Cochrane, and Database of Abstracts of Reviews of Effects. Methods: Studies published between 1950 and 2008 describing remote consultations for neurosurgical assessments were retrieved. Two reviewers selected studies through multi-staged content screening and extracted data. Results 12 of 3765 studies met the inclusion criteria: two were randomized controlled trials and ten were case series. Teleradiology [88% (207/236)] and video-conferencing [89% (213/239] consultations produced higher diagnostic accuracy than telephone consultations [64% (150/235), p<0.001]. Savings varied by location and were based on avoided costs for ground and air transportation and hospitalization. Conclusions: There is limited evidence of clinical benefit of teleradiology. Savings associated with reduction in patient transfer rates depend on transportation mode and may be attenuated by higher operational costs.

This thesis presents the results of three complementary studies which were carried out to evaluate the accuracy of diagnostic tests for Salmonella in pigs. First, a research synthesis method approach, which included a systematic review, meta-analysis and meta-regression, was used to map out existing primary research investigating the accuracy of bacterial culture, antibody or antigen -capture ELISA, and PCR for Salmonella in pigs under field conditions.. Large statistical variability, limited methodological soundness and reporting precluded a quantitative synthesis of findings from multiple studies. The meta-regression identified significant factors, such as variations in test protocols, which explained much of the variability of reported estimates of test accuracy. The need for consistent use of a standard reference test is essential to ensure comparability of results generated in future studies.<p> In the second study, the accuracy of a bacterial culture, real-time (RT) PCR, and a mix-ELISA for Salmonella in were evaluated in western Canadian nursery and grow-finish pigs using traditional and Bayesian statistical methods. Ten farrow-to-finish pig farms from Alberta and Saskatchewan were purposively selected based on their presumptive Salmonella status. Bacteriological culture, RT-PCR and a mix-ELISA were performed on feces and blood samples collected from grow-finish (n=294) pigs and pens. Bayesian estimates of test sensitivity (Se) and specificity (Sp) at the individual pig level were similar to traditional statistical estimates. Sensitivity of culture and RT-PCR ranged from 65-75%, PCR Sp was 98-99% and ELISA Se and Sp at a cutoff of OD¡Ý20% ranged from 59-63% and 84-87%, respectively. In the third study, Salmonella serovar distribution and risk factors for Salmonella shedding were investigated in breeding, nursery, and grow-finish pigs using the same 10 herds. Among 418 Salmonella isolates, most common serovars were Derby (28.5%), Typhimurium, var. Copenhagen (19.1%), and Putten (11.8%). More Salmonella were detected in pooled pen than individual pig samples, confirming that the use of pooled samples is more effective for detecting the full range of serovars that may be present on Canadian pig farms. Sows shed significantly more Salmonella than nursery or grow to finish pigs, suggesting that the breeding herd is an important source of Salmonella persistence. Pelleted feed and nose-to-nose pig contact through pens were also associated with increased Salmonella prevalence, indicating that these factors are relevant as control targets.<p> The main advantages of research synthesis methods are increased power and precision in effect estimates and identification knowledge gaps and areas requiring further research. Bayesian methods for evaluating test accuracy are useful when there is no known "gold standard", which is often the case for zoonotic and food-borne pathogens. Both research synthesis and Bayesian methods are valuable tools for evaluating diagnostic test accuracy and should be more frequently used when developing monitoring and control programs in food safety.

This research is a meta-analytic review of the effects of transformational school leadership (TSL)-- a systematic, comprehensive synthesis of the quantitative research on transformational school leadership. The review method used in this research is standard meta-analysis supplemented by narrative synthesis and vote-counting methods. The types of effect sizes involved in meta-analytical calculations are correlation coefficients rs. The evidence reviewed was provided exclusively by unpublished theses or dissertations that were completed between 1996 and 2008. This study identified 33 dimensions of transformational leadership as developed by various scholars and captured by a variety of leadership measures, which were synthesized into 11 core leadership dimensions. This study meta-analyzed the effects of transformational school leadership and its dimensions on a large range of school outcomes, including 17 school conditions (e.g., school culture, shared decision-making processes), 23 teacher-related outcomes (e.g., teacher satisfaction), and five types of student outcomes. Transformational school leadership was most influential on teachers’ emotions and inner states. TSL had large effects on teachers’ individual inner states and their practices while it had small effects on their group inner states. Leaders effectively influence teachers’ psychological inner states and practices mainly through modeling good practices themselves, providing support and intellectual stimulation to teachers individually and setting shared school goals. TSL was also very influential on school conditions. It had large effects on four key school conditions. This review detected significant, positive small direct effects of TSL on student achievements. The indirect effects of TSL on student learning vary when different school or teacher variables are controlled. This review identified seven important moderators and three mediators that significantly contributed to student learning along with TSL. Specific leadership practices that effectively influenced school and student outcomes were also examined and discussed. Regarding the moderating effects of contextual and methodological factors, school level and leadership measures were found to moderate leadership impacts significantly in some cases. The findings of this study provide guidance for school administrators and policy makers who want to improve school leadership as a means of improving school quality.