Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients

Background and objective

Stroke volume variation (SVV) has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit (ICU) patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of PiCCO-monitoring (primary endpoint) and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis.

Methods

The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients.Results: In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent: the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter (36.1% vs. 21.9%; P<0.001). Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis.

Conclusions

The applicability of SVV in a predominantly medical ICU is only about 25%–35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.

     

AutoFocus – Ein Werkzeugprototyp zur Entwicklung eingebetteter Systeme

Der Beitrag stellt AutoFocus vor, einen Werkzeugprototyp zur Entwicklung verteilter, eingebetteter Systeme auf der Grundlage formaler Techniken. AutoFocus unterstützt die Systementwicklung mit integrierten, im wesentlichen graphischen Beschreibungstechniken, mit deren Hilfe sowohl unterschiedliche Sichten als auch verschiedene Abstraktionsebenen eines Systems beschrieben werden. Um konsistente und vollst?ndige Beschreibungen sicherzustellen, bietet AutoFocus die M?glichkeit, Konsistenzbedingungen zu formulieren und Systembeschreibungen daraufhin zu überprüfen. Aus ausführbaren Spezifikationen k?nnen Prototypen des entwickelten Systems erzeugt werden und in einer Simulationsumgebung ausgeführt und visualisiert werden. Zur formalen Verifikation von Systemeigenschaften verfügt AutoFocusüber Anbindungen an Modellprüfungswerkzeuge wie -cke oder SMV.     

Mathe mit der Matte – Verkörperlichtes Training basisnumerischer Kompetenzen

Basic numerical representations are seen as the building block for the successful development of more complex numerical and arithmetic competencies. Extending previous studies focusing on improving basic numerical representations by means of embodied training schemes, the current study focused on an embodied training of children’s place-value understanding. In this vein, 49 secondgraders were trained on solving a number line estimation task by stepping on different fields of a dance mat allowing for separate estimations of tens and units with more effort needed to step on the tens. In a partially randomized cross-over design, two control conditions were used to controll for training effects caused exclusively by the numerical content trained or the use of the dance mat. Interestingly, results revealed specific training effects after both the embodied and the control conditions. However, training effects were significantly more pronounced after the embodied training, thereby providing further evidence for the benefit of an embodied training of the place-value structure of the Arabic number system.     

Comparing effects and side effects of different school inspection systems across Europe

In this article, different inspection models are compared in terms of their impact on school improvement and the mechanisms each of these models generates to have such an impact. Our theoretical framework was drawn from the programme theories of six countries’ school inspection systems (i.e. the Netherlands, England, Sweden, Ireland, the province of Styria in Austria and the Czech Republic). We describe how inspection models differ in the scheduling and frequency of visits (using a differentiated or cyclical approach), the evaluation of process and/or output standards, and the consequences of visits, and how these models lead to school improvement through the setting of expectations, the use of performance feedback and actions of the school's stakeholders. These assumptions were tested by means of a survey of principals in primary and secondary schools in these countries (n?=?2239). The data analysis followed a three-step approach: (1) confirmatory factor analyses, (2) path modelling and (3) fitting of multiple-indicator multiple-cause models. The results indicate that Inspectorates of Education that use a differentiated model (in addition to regular visits), in which they evaluate both educational practices and outcomes of schools and publicly report inspection findings of individual schools, are the most effective. These changes seem to be mediated by improvements in the schools’ self-evaluations and the schools' stakeholders’ awareness of the findings in the public inspection reports. However, differentiated inspections also lead to unintended consequences as principals report on narrowing the curriculum and on discouraging teachers from experimenting with new teaching methods.     

Forms and practices of accountability in education

Educational Assessment, Evaluation and Accountability -     

Obtaining Diagnostic Classification Model Estimates Using Mplus

Diagnostic classification models (aka cognitive or skills diagnosis models) have shown great promise for evaluating mastery on a multidimensional profile of skills as assessed through examinee responses, but continued development and application of these models has been hindered by a lack of readily available software. In this article we demonstrate how diagnostic classification models may be estimated as confirmatory latent class models using Mplus, thus bridging the gap between the technical presentation of these models and their practical use for assessment in research and applied settings. Using a sample English test of three grammatical skills, we describe how diagnostic classification models can be phrased as latent class models within Mplus and how to obtain the syntax and output needed for estimation and interpretation of the model parameters. We also have written a freely available SAS program that can be used to automatically generate the Mplus syntax. We hope this work will ultimately result in greater access to diagnostic classification models throughout the testing community, from researchers to practitioners.     

Disguises, invisibility and disqualification of the guards of children in French-speaking Switzerland

Various factors oblige today's parents to entrust their children to a child-care worker (CCW), providing services in the domestic sphere, either at the child's parental house or at the day-care worker's (DCW's) own home. Taking this into account, this paper examines job offers and applications for DCWs published in a regional Swiss newspaper as well as other job offers and applications published on a website called bestnounou.ch. The parents often tend to use a variety of terms, which do not point to the child-caring or rearing activity itself, but rather emphasise sociological characteristics of the CCW (age, gender, civil status), requesting, for example, a “lady”, a “grandmother”, a “student”. Thereby, the parents present the child-care work as: (1) a secondary and temporary activity in relation to another major stable activity (motherhood, apprenticeship, retirement); and (2) an activity that does not require professional skills but inborn aptitudes. Moreover, employers use as synonyms distinctive terms, which refer to various categories of CCW and domestic workers, whose schedules of conditions and salaries are regulated and differ. The parents' inclination to use terms designating the most precarious and underpaid CCW underscores the importance of child-care in the domestic sphere. It leads also to a public image of child-care workers as being a fragmented, unstable, little qualified and economically inconsistent workforce, in contrast to the stable and structural need for their specific services, allowing parents to face their familial and professional responsibilities.     

A Community of Practice Model for Introducing Mobile Tablets to University Faculty

We examined the effectiveness of a community of practice (CoP) model for introducing tablets to 139 faculty members at a higher education institution. Using a CoP within a systems model, we used large- and small-group mentorship to foster collaboration among faculty members. Most faculty members agreed that the project was well organized and activities were useful. In terms of measurable outcomes, many participants had developed plans for or completed scholarly activities related to tablets. Our findings support the use of CoP models to integrate technology within higher education. Additionally, they support such integrations as proof of concept for large, whole-campus technology integrations.