26 research outputs found
Avtenticizem v sodobni slovenski literarni kritiki
No full textDiplomsko delo sledi ključnim genealoškim prelomnicam dispozitiva avtetničnosti, predvsem pa njegovim pojavnim oblikam v zgodovini literarnega vrednotenja in pri tem pokaže, da svojega osrednjega mesta v literarnem panteonu ni začel dobivati šele v romantiki, temveč že v razsvetljenstvu. Namen tega zgodovinskega ekskurza je pokazati, da je avtentičnost integralni element pojma literature (ki nastane v času, ko je dispozitv avtentičnosti v Evropi že zelo dominanten) in njenih osrednjih kategorij: avtor, delo, bralec itn. Zato pa se tako literarna veda kot kritika, kljub številnim teoretskim in literarnim poskusom (nekatere od teh naloga jemlje kot svoje izhodšče) ne moreta zares znebiti tega dispozitivaše več: sodobne prakse teh disciplin pogosto zapadajo v revizionizem in vero v avtentično jedro, ki naj bi konstituiralo tako "izkušnjo literarnega dela" kot sodobni subjekt nasploh. Diplomsko delo to pozicijo imenuje avtenticizem. Nato na izbranih primerih pokaže, kako avtenticizem v sodobni slovenski literarni kritiki vodi v cinizem in trdovraten literarni misticizem kot dve plati iste medalje, vendar na koncu nakaže tudi pot iz te zagate, ki je lahko zgolj v tem, da se literarna kritika (in veda) ove(-sta) svojega lastnega avtenticizma in se kritično sooči(-ta) z njim.The diploma thesis follows the crucial genealogical ruptures of the dispositif of authenticity, foremost its forms of occurrence in the history of literary valuation and thus shows that its central place in the literary pantheon wasn\u27t gained in Romanticism, but already in the Enlightenment. The purpose of this historical excursus is to show that authenticity is an integral element of the establishement of the concept of literature itself (which arises at the time, when the dispositif of authenticity in Europe is already dominant) as well as its focal categories: the author, the work, the reader, etc. This is why both literary science and critique, despite numerous theoretical and literary attempts (some of them are used as a basis for this thesis), cannot get rid of this dispositifeven more: contemporary practices of these disciplines often fall into revisionism and the belief in an authentic core that should supposedly constitute the "experience of the literary work" as much as the contemporary subject in general. The diploma thesis names this position authenticism. Through the chosen examples it si shown, how authenticism in contemporary Slovenian literary critique leads into cynicism and an inveterate literary mysticism as two sides of the same medalbut at the end it also marks a way out of this problem, which can only be in the realization of literary critique (and science) of its (their) own authenticism and its (their) critical confrontation with it
Understanding sepsis recognition and management in a Ghanaian emergency department: a convergent mixed methods study
No full textBackground: Sepsis is a severe response to an overwhelming infection, resulting in inflammation, coagulation, multi-organ failure and potentially death when not recognised and treated promptly. Sepsis is recognised as a significant cause of hospital admission and preventable deaths globally, hence it is considered a medical emergency. Many high-income countries have prioritised sepsis; however, it has received less attention in adult populations in low-income healthcare contexts, including Ghana, except in children and pregnant women. This study, therefore, explored existing practices associated with the recognition and management of sepsis in a Ghanaian secondary level hospital emergency department (ED) in order to develop a context-sensitive evidence-based sepsis bundle and pathway for future implementation and testing.
Methods: A convergent multiphase mixed methods design was employed. This included a: (1) systematic literature review; (2) a retrospective case record review (n=75); and (3) process mapping of ED sepsis practices, including interviews with healthcare professionals (n=14). Quantitative data were analysed using SPSS version 28.0.0 and interviews and field notes after transcription were analysed using thematic analysis supported by NVIVO© version 14. Data were integrated and findings were (4) presented at a series of co-production workshops with stakeholders to develop a sepsis intervention and plan for future implementation.
Findings: Twenty-two papers met the inclusion criteria for the literature review. Most of the papers used the Surviving Sepsis Campaign (SSC) bundle (21/22): one adopted the integrated management of adolescent and adult illness (IMAI) tool. Prior to introducing the bundle, various engagement strategies were employed with local teams and bespoke training was developed for staff. Reduction in mortality was associated with timely interventions, however, one reported increased mortality as a consequence of oversimplification of the implemented bundle.
The retrospective case record review identified delays and inaccurate sepsis recognition at presentation, time to medical assessment, omission or delayed vital sign/deteriorating patient re-assessment, access to lactate estimation and speed of reporting of routine blood tests and blood cultures. Elements of the SSC bundle were embedded in practice but others were unavailable due to resource and financial constraints. Similar findings were uncovered in the process mapping interviews and workshops, including, not thinking of sepsis as a probable diagnosis until later whereas it was found that other conditions, such as malaria, contribute to targeted management delays and poorer outcomes. Integration using the capability, opportunity, motivation - behaviour (COM-B) model was used to illuminate findings which were discussed in the co- production workshops to improve the recognition of sepsis and implementation of appropriate interventions. In this case, a sepsis algorithm and educational package were designed.
Discussion: The literature review suggested the SSC bundle could be successfully implemented in LMICs if contextual needs were accommodated and engagement with local multidisciplinary teams occurred. With this background, the retrospective review of case notes and process mapping aided in identifying the current practices regarding sepsis recognition and care. With this, possible pathway components and processes were identified through the lens of COM-B and Kotter’s eight step change models and debated through integration and co-production workshops. These were contextualised, and a sepsis algorithm with a standard operating procedure was adapted to enhance sepsis identification and management (nurse led approach to identification), including regular monitoring of vital signs/deterioration, reorganisation of sample collection and reporting services and a policy approach for antimicrobial stewardship. These were developed to support implementation together with an education programme.
Conclusion: This study demonstrates that engagement with key stakeholders in the target site is complex and necessary to develop a culturally specific evidence-based sepsis pathway. Early phases identified potential barriers and facilitators to successful implementation, and these have been considered, and where appropriate, integrated into the proposed implementation model. Recommendations for the designed intervention and implementation plan are outlined for future testing in the target clinical setting
Defining catastrophic costs and comparing their importance for adverse tuberculosis outcome with multi-drug resistance: a prospective cohort study, Peru.
No full textBACKGROUND: Even when tuberculosis (TB) treatment is free, hidden costs incurred by patients and their households (TB-affected households) may worsen poverty and health. Extreme TB-associated costs have been termed "catastrophic" but are poorly defined. We studied TB-affected households' hidden costs and their association with adverse TB outcome to create a clinically relevant definition of catastrophic costs. METHODS AND FINDINGS: From 26 October 2002 to 30 November 2009, TB patients (n = 876, 11% with multi-drug-resistant [MDR] TB) and healthy controls (n = 487) were recruited to a prospective cohort study in shantytowns in Lima, Peru. Patients were interviewed prior to and every 2-4 wk throughout treatment, recording direct (household expenses) and indirect (lost income) TB-related costs. Costs were expressed as a proportion of the household's annual income. In poorer households, costs were lower but constituted a higher proportion of the household's annual income: 27% (95% CI = 20%-43%) in the least-poor houses versus 48% (95% CI = 36%-50%) in the poorest. Adverse TB outcome was defined as death, treatment abandonment or treatment failure during therapy, or recurrence within 2 y. 23% (166/725) of patients with a defined treatment outcome had an adverse outcome. Total costs ≥20% of household annual income was defined as catastrophic because this threshold was most strongly associated with adverse TB outcome. Catastrophic costs were incurred by 345 households (39%). Having MDR TB was associated with a higher likelihood of incurring catastrophic costs (54% [95% CI = 43%-61%] versus 38% [95% CI = 34%-41%], p<0.003). Adverse outcome was independently associated with MDR TB (odds ratio [OR] = 8.4 [95% CI = 4.7-15], p<0.001), previous TB (OR = 2.1 [95% CI = 1.3-3.5], p = 0.005), days too unwell to work pre-treatment (OR = 1.01 [95% CI = 1.00-1.01], p = 0.02), and catastrophic costs (OR = 1.7 [95% CI = 1.1-2.6], p = 0.01). The adjusted population attributable fraction of adverse outcomes explained by catastrophic costs was 18% (95% CI = 6.9%-28%), similar to that of MDR TB (20% [95% CI = 14%-25%]). Sensitivity analyses demonstrated that existing catastrophic costs thresholds (≥10% or ≥15% of household annual income) were not associated with adverse outcome in our setting. Study limitations included not measuring certain "dis-saving" variables (including selling household items) and gathering only 6 mo of costs-specific follow-up data for MDR TB patients. CONCLUSIONS: Despite free TB care, having TB disease was expensive for impoverished TB patients in Peru. Incurring higher relative costs was associated with adverse TB outcome. The population attributable fraction indicated that catastrophic costs and MDR TB were associated with similar proportions of adverse outcomes. Thus TB is a socioeconomic as well as infectious problem, and TB control interventions should address both the economic and clinical aspects of this disease. Please see later in the article for the Editors' Summary
The Centrality of the Language Question in the Decolonization of Education in Africa1
No full textThis paper draws attention to the relevance of decolonization as a notion and process for education in our times. It points to specific instances of Eurocentric biases which affect the structure and content of contemporary education in Africa. These include the historical periodization scheme which is utilized across the board in the social sciences and humanities in African education and also the notion of ‘African Studies’ in African universities. It is argued that societal relevance is a crucial factor for education to be meaningful. The author argues that the language question; the need to use local languages that are shared by the masses of specific societies is essential for development and emancipation. It provides better bases for the upliftment of people; the requirements for knowledge production and the development of human capital. The paper points to historical and contemporary examples from Europe and Asia to explain how and why language is central to all attempts to create knowledge-based and knowledge-producing societies
Inter‐ and intra‐observer variability in the echocardiographic evaluation of wall motion abnormality in patients with ST‐elevation myocardial infarction or takotsubo syndrome – A novel approach
No full textIntroduction and ObjectivesUsing existing transthoracic echocardiographic indices to quantify left ventricular wall motion abnormalities (WMAs) can be difficult due to the variations in the location of the abnormalities within the left ventricle, the quality of examinations, and the inter-/intra-observer variability of available indices. This study aimed to evaluate a new approach for measuring the extent of WMA by calculating the percentage of abnormal wall motion and comparing it to the wall motion score index (WMSI). The study also sought to assess inter- and intra-observer variability. MethodsThe study included 140 echocardiograms from 54 patients presenting with ST-elevation myocardial infarction or Takotsubo syndrome. All patients underwent an echocardiographic examination according to a standard protocol and the images were used to measure the extent of akinesia (proportion akinesia, PrA), akinesia and hypokinesia (proportion akinesia/hypokinesia, PrAH), and WMSI. The inter-observer variability between the two operators was analyzed. The intra-observer analysis was performed by one observer using the same images at least 1 month after the first measurement. The agreement was analyzed using the Pearson correlation coefficient and Bland-Altman plots. ResultsInter- and intra-observer variability for PrA and PrAH were low and comparable to those for WMSI. ConclusionPrA and PrAH are reliable and reproducible echocardiographic methods for the evaluation of left ventricular wall motion
The Perceived Effectiveness of Information Security Awareness
No full textThe need to protect information systems as much as possible from security threats and risks has risen in the last few decades due to the increase and sophistication of threats. The purpose of this dissertation is to examine the methods used to implement Information Security Awareness (ISA) programs. And also to investigate how the perceived effectiveness of ISA programs in preventing and mitigating security threats and risks organisations face, is assessed. The inductive research approach was used to explore the human side of the information security problem and how this impacts the perceived effectiveness of ISA programs. Then a prototype of a model to assess an ISA program was replicated. The results indicated that the awareness level of the region used for the implementation was average, meaning the ISA program was not as effective as it was expected to be. The model provides a guide to both researchers and practitioners in assessing ISA programs and obtaining statistical data or empirical data in order to prove how effective it is. Keywords: Information Security Awareness, Information Security Policy, Information System, Security threats/risks and Perceived Effectiveness
Examining triage, recognition and clinician decision making in patients with sepsis attending a Ghanaian emergency department
No full textSepsis is a severe response to overwhelming infection resulting in inflammation, coagulation, multi-organ failure and potentially death when not recognised and treated promptly1. Hence, considered a medical emergency2. Globally sepsis is recognised as a significant cause of hospital admission and preventable deaths3; hence considerable efforts are being made to improve recognition and care2. Sepsis has been prioritised in many high-income countries but has received less attention in non-pregnant adult populations in low-income healthcare contexts. To improve outcomes the WHO recommends implementation of the Sepsis 6 bundle4 but this has not yet been implemented in many countries including Ghana
Technological properties of reconstituted milk powder
No full textRad obuhvaća ispitivanje tehnoloških svojstava mliječnog praha proizvedenog u našim tvornicama. Ispitivanja su obuhvatila sirišno-fermentativnu probu i probu grušanja. Utvrđeno je da je kvaliteta gruša dobivena od mlijeka sušenog na valjcima slabija od onog sušenog raspršivanjem. Nadalje je utvrđeno da je gruš dobiven od rekonstituiranog mlijeka mnogo slabije kvalitete od gruša rekonstituiranog mlijeka. Autor zaključuje da za proizvodnju sira ne bi mogao poslužiti ni mliječni prah ni obrani mliječni prah kojim su vršeni pokusi s obzirom na nisku prosječnu ocjenu dobivenog proizvoda, što upozorava na neki nedostatak u tehnološkom procesu proizvodnje.The article describes the results of the research of some properties of milk powder and skimmed milk powder produced in local factories. The research included renneting-fermentation test and coagulation test of reconstituted milk. The curd obtained from reconstituted roller-dried milk powder was of inferior quality than from spray-dried, further reconstituted skim milk powder gave curd of lower quality than from full fat milk powder. The author finally concludes that reconstituted milk powder could not be utilized for cheese manufacture, giving the products of inferior quality than fresh milk
Community engagement and involvement in Ghana: conversations with community stakeholders to inform surgical research
No full textPlain English summary Evidence in the literature shows that research that was designed and implemented with the help of patients or other members of the community affected by the study, is more likely to be relevant to the needs of the end user. This can have positive effects on the quality and impact of the study. However, working collaboratively with patient or public contributors can have certain challenges, especially in low- and middle- income countries. For example, factors such as different languages or dialects, religious beliefs, health beliefs, level of literacy, understanding of research, and poverty can potentially make it more difficult for researchers to reach, communicate and involve relevant members of the public. On top of this, the evidence base for successfully implementing these so-called community engagement and involvement activities is sparse, making it more challenging for researchers to learn from others’ experiences. Members of the Global Surgery Unit, who are based in Ghana, proposed a clinical trial to address the shortfall of specialist surgeons at rural hospitals. This will be achieved by training medically qualified doctors, who have not yet gone through the specialist training to become qualified surgeons, to perform inguinal hernia repairs proficiently. Before the study gets funded and a protocol can be designed, the researchers need to ensure its relevance, acceptability, and feasibility. This is usually done by getting the opinion and thoughts of key stakeholders, mainly individuals who will be affected by the research. To achieve this, the team in Ghana worked together with Global Surgery Unit members in the UK to identify the best ways to approach and have conversations with 31 inguinal hernia patients who either previously had surgery or currently live with hernias, two Chiefs (community leaders), a community finance officer and a local politician in a variety of locations in Ghana that are representative of the patient cohort for the study. The intention was to understand the impact of hernias on individual patients, their families, and entire communities to inform the relevance, acceptability and feasibility of the clinical trial, and ensure that relevant aspects are captured in the study protocol. A UK-based public advisory group provided initial input to help eliminate potential barriers of addressing patient contributors in rural Ghana. This paper states in detail how these conversations were planned and organised, the challenges the team had to overcome, and what they learned and gained from talking to community members - which goes far beyond just informing a study
