Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs

Operational understanding of the covariance of classical electrodynamics

It is common in the literature on classical electrodynamics and relativity theory that the transformation rules for the basic electrodynamical quantities are derived from the pre-assumption that the equations of electrodynamics are covariant against these---unknown---transformation rules. There are several problems to be raised concerning these derivations. This is, however, not our main concern in this paper. Even if these derivations were completely correct, they leave open the following fundamental question: Are the so-obtained transformation rules indeed identical with the true transformation rules of the fundamental electrodynamical quantities? In other words, is it indeed the case that the values calculated from the quantities in one inertial frame by means of the transformation rules we derived are equal to the values of the same quantities obtained by the same operations with the same measuring equipments when they are co-moving with the other inertial frame? This is of course an empirical question. In this paper, we will investigate the problem in a purely theoretical framework by applying what J. S. Bell calls “Lorentzian pedagogy”---according to which the laws of physics in any one reference frame account for all physical phenomena. We will show that the transformation rules of the electrodynamical quantities are indeed identical with the ones obtained by presuming the covariance of the equations of electrodynamics, and that the covariance is indeed satisfied. Beforehand, however, we need to clarify the operational definitions of the fundamental electrodynamical quantities. As we will see, these semantic issues are not as trivial as one might think

The starfish experiment: a Lagrangian approach

The present paper analyses the free surface deformation of a liquid metal drop under the influence of an alternating magnetic field. The analysis is restricted to the first axi- symmetric mode oscillation. In the low frequency case, the electromagnetic forces are of gradient type and purely oscillatory. Without any viscous damping, it is then possible to build a Lagrangian function, which involves the kinetic energy, the gravitational energy, the surface energy and the electromagnetic energy. The time evolution of the pool height is easily obtained from the Lagrange equation. It is shown that the pool height behaves like a non-linear forced oscillator

Relativistic structure formation models and gravitoelectromagnetism

In the framework of Lagrangian perturbation theory in general relativity we discuss the possibility to split the Einstein equations, written in terms of spatial Cartan coframes within a 3+1 foliation of spacetime, into gravitoelectric and gravitomagnetic parts. While the former reproduces the full hierarchy of the Newtonian perturbation solutions, the latter contains non-Newtonian aspects like gravitational waves. This split can be understood and made unique through the Hodge decomposition of Cartan coframe fields.Comment: 6 pages; contribution to the proceedings of MG14, Parallel Session DE

Beyond the knowledge gap paradigm: the role of psychological empowerment in parents’ vaccination decision

Even though the efficacy and safety of immunization have been widely proven (Plotkin, 2014), an increasing number of parents have refused to vaccinate their children against serious infectious diseases in the past twenty years (Dubé, Gagnon, Nickels, Jeram, & Schuster, 2014). A recent shift in the study of vaccination decision- making has seen scholars moving beyond the idea that mere lack of knowledge could explain why parents decide to opt out of the recommended schedule, showing that making a vaccination decision is a complex cognitive and emotional process where several factors play a role. Variables such as risk perception, anticipated regret or prosocial attitude can potentially contribute to choosing or not choosing a given vaccination (Yaqub, Castle-Clarke, Sevdalis, & Chataway, 2014). The aim of this dissertation, which is based on the Health Empowerment Model (Schulz & Nakamoto, 2013), is to explore and assess the role of vaccination knowledge (as a dimension of vaccination literacy) in parental vaccination decision-making, while studying, at the same time, the implications of parents’ psychological empowerment on the decision about immunizing their child, with a special focus on the measles-mumps-rubella (MMR) vaccination. Six unique studies that employed both qualitative (individual interviews and focus groups) and quantitative (content analysis, survey and experiment) methods are presented, which aim to assess the influence of vaccination literacy and psychological empowerment on vaccination-related outcomes such as intention, while providing a valid and reliable measurement tool for the empowerment construct as well as a context-specific conceptualization. A content analysis (Chapter II) focusing on the arguments cited by users posting online about vaccination shows that a distinction can be made between an anti-vaccination group, a general pro- vaccination group (using diverse arguments supporting vaccination) and a safety- focused pro-vaccination group. The anti-vaccination group appears to be more active than the others and to also use multiple sources (mainly its own experience and media). The findings of an interview study (Chapter III) reveal that parents tend to misinterpret current vaccination recommendations and experience negative outcomes of their low self-perceived competence. The study also shows that parents think that their MMR vaccination decision can have an impact on different levels and that they have a preference for shared-decision making in relation to their child’s healthcare provider. A second qualitative study employing focus group interviews (Chapter IV) shows that parents are concerned with their legal responsibility and issues of freedom with regards to the MMR vaccination decision. A key finding is that parents’ relationship with the pediatrician in terms of trust is crucial to their self-perceived competence, suggesting their preference for a model of autonomy that does not exclude a shared decision-making approach with the child’s healthcare provider. Finally, a distinction emerges between information seekers, avoiders, and passive recipients. A scale is developed and its psychometric properties are evaluated (Chapter V) to provide a valid and reliable tool to measure psychological empowerment in the vaccination decision. The final tool captures parents’ perceived influence of one’s personal and family experience regarding vaccination, their desire not to ask other parents about their experience with vaccinations and their lack of interest in the vaccination opinion of other parents. These elements can be seen as context-specific extensions of the empowerment dimension of self-determination. The findings of an experimental study (Chapter VI) demonstrate that providing accurate information on the vaccination through a smartphone app employing gamification can positively and significantly increase parents’ knowledge and empowerment. Furthermore, providing information in a gamified way also led to a higher intention to vaccinate and higher parental confidence in the decision. Finally, a mixed method study to evaluate the experiment described above (Chapter VII), suggests that parents have a preference for information and opinions, compared to solely being empowered and pushed to look for information. The results recommend that empowering efforts be always accompanied by proper and exhaustive information. On the basis of these findings, this dissertation contributes to understanding parents’ empowerment needs in the vaccination decision, providing new insights to current research that seeks to study the vaccination decision as a complex process. The results of the studies can significantly inform ways to improve not only communication between health professionals and parents on the vaccination topic, but also future public health strategies and policies ultimately aimed at increasing vaccination coverage

Wirksamkeit von Aromatherapie bei postoperativer Nausea und Vomiting bei Erwachsenen: Systematische Literaturreview

Problembeschreibung: Postoperative Nausea und Vomiting (PONV) stellt neben Schmerz eine der häufigsten postoperativen Komplikationen dar. Die Inzidenz beträgt bei gynäkologischen Patientinnen 80%. Symptome und Folgen von PONV können physische, psychische, emotionale und finanzielle Auswirkungen für die Patienten und das Personal haben. Postoperative Nausea und Vomiting wird meistens medikamentös mit Antiemetika behandelt. Diese Medikamente können jedoch viele Nebenwirkungen aufweisen. Deshalb ist die Bedeutung von pflegerischen Interventionen bei PONV gross. Die Aromatherapie ist eine nicht-medikamentöse Intervention, welche in den Nursing Interventions Classifica-tion (NIC) aufgeführt ist. Fragestellung: Wie wird die Wirksamkeit von Aromatherapie auf postoperative Nausea und Vomiting (PONV) bei Erwachsenen in der wissenschaftlichen Literatur beschrieben? Ziel: Das Ziel der vorliegenden Arbeit bestand darin, einen Überblick von Aromatherapie bei PONV aufzuzeigen. Ebenso wurde der aktuelle Forschungsstand dargelegt und die Arbeit soll evidenzbasierte Pflegeinterventionen bei PONV aufzeigen und somit die Pfle-gequalität verbessern

Dysfunktionaler bis pathologischer MMORPG-Gebrauch: Mögliche Ein- und Ausstiegsfaktoren aus dem problematischen Gebrauch bei Jugendlichen und jungen Erwachsenen

Die vorliegende Bachelorarbeit befasst sich mit der Thematik des dysfunktionalen bis pathologischen MMORPG-Gebrauchs bei Jugendlichen und jungen Erwachsenen. Es soll aufgezeigt werden, unter welchen Gegebenheiten/Voraussetzungen diese den Einstieg in aber auch den Ausstieg aus solch einem Verhalten finden. Damit der dieser schriftlichen Arbeit zugrunde liegenden Forschungsfrage nachgegangen werden konnte, wurden Interviews mit Jugendlichen und jungen Erwachsenen geführt, welche nach eigener und/oder fremder Einschätzung ein abhängiges Verhalten von einem Computerrollenspiel gezeigt haben. Damit ein theoretisches Wissen zur Thematik erworben werden kann, behandelt die vorliegende Abschlussarbeit die dafür relevanten Themen der Auswirkungen eines dysfunktionalen bis pathologischen MMORPG-Gebrauchs, der Profilerhebung eines MMORPGNutzers sowie der grundsätzlichen Spielbeschreibung/-erklärung eines MMORPGs. Damit dieses Thema ganzheitlich in Verbindung zur Abhängigkeitsthematik betrachtet werden kann, folgt die theoretische Aufarbeitung der Suchtthematik. Als theoretischer Abschluss dient die theoretische Beschreibung der Diagnostik und der Intervention sowie der Prävention des dysfunktionalen bis pathologischen MMORPG-Konsums bei Jugendlichen und jungen Erwachsenen. Aufgrund der geführten Interviews konnte eine Datenerhebung zur Richtungsweisung in der Beantwortung der zu erforschenden Forschungsfrage erstellt werden. Aufgrund der Datenanalyse kann behauptend geschlussfolgert werden, dass sich der dysfunktionale bis pathologische MMORPG-Gebrauch von Jugendlichen und jungen Erwachsenen aufgrund mehrerer Risikofaktoren ergibt und häufig eine Begleiterscheinung der Adoleszenzphase ist. Diese Erkenntnisse lassen schlussfolgern, dass es bei der Thematik des Einstiegs wie auch des Ausstiegs essentiell wichtig ist, dass das ganzheitliche System – sprich in der Diagnose und Intervention das familiale System - sowie die Motivation des Betroffenen einbezogen wird. Mithilfe der Erkenntnisse über die erforschten Datenaussagen werden zum Schluss dieser Bachelorarbeit noch mögliche Handlungsvorschläge für die Soziale Arbeit aufgezeigt