Pain without words

Bacheloroppgave sykepleie, 2017Mennesker med psykisk utviklingshemming uten evne til verbal kommunikasjon oppfattes som en utfordrende pasientgruppe for sykepleiere som arbeider i sykehus. Dette er fordi sykepleieren ofte ikke er vant til å arbeide med denne pasientgruppen, og har dermed varierende, ofte lite kunnskap om dem. Samtidig kan pasientgruppen ha flere diagnoser i tillegg til sin psykiske utviklingshemming som kan føre til behov for kirurgi og sykehusopphold. Vurderinger og kartlegging i forhold til om denne typen nonverbale pasienter har smerter, oppleves som utfordrende for sykepleiere og blir ansett som en kompleks sykepleiehandling, til tross for det er grunnlag for å mistenke smerter i en postoperativ situasjon. Formålet med oppgaven, som er basert på faglitteratur og forskning, var å finne ut hvordan sykepleiere kan identifisere postoperative smerter hos mennesker med psykisk utviklingshemming uten verbal kommunikasjon. Informasjon om pasientens sykehistorie, medisinbruk, og adferd viser seg å være sentralt. Pasienten som informasjonskilde på nettopp disse punktene kan være vanskelig, og litteratur viser at sykepleieren kan ha behov for kontakt med pårørende eller helsepersonell som kjenner til pasienten fra tidligere. Flere kilder viser at endret adferd og endring og økning i fysiologiske parametere kan være faktorer som kan være til hjelp i identifiseringen av smerte. Disse kan oppdages ved hjelp av at sykepleieren utfører nøyaktige observasjoner, kliniske vurderinger basert på teoretiske kunnskaper, erfaringer og kunnskap om pasienten nåværende situasjon, samt bruk av tilpasset kartleggingsverktøy for smerte

Dilemmas of Sustainability: On Relevance and Critical Reflection in Sustainability Research; A Guide

The concept of sustainability is increasingly losing its contours. This study reflects on the understanding of sustainability used in research and science. Its authors thus enable us to concisely determine not only concrete contributions to sustainability, but also its limits. Based on an analytical understanding of sustainability and the basic structure of practical dilemmas, the book identifies typical conflicts as causes of dilemmas. Meta-criteria of sustainability allow us to identify dilemmas and to clarify and deal with them practically at an early stage. Finally, the study applies these meta-criteria in concrete project contexts by means of guiding questions for reflection.Der Begriff der Nachhaltigkeit verliert zunehmend an Kontur. Vor diesem Hintergrund gibt dieser Leitfaden die Möglichkeit, das jeweils verwendete Verständnis von Nachhaltigkeit in Forschung und Wissenschaft zu reflektieren und damit den konkreten Beitrag zu Nachhaltigkeit, aber auch die verbundenen Grenzen konkret festzustellen. Ausgehend von einem analytischen Nachhaltigkeitsverständnis und der Klärung der Grundstruktur praktischer Dilemmata benennt der Leitfaden typische Konflikte als Ursache von Dilemmata. Meta-Kriterien der Nachhaltigkeit erlauben, Dilemmata-Früherkennung, -Aufklärung und -Bearbeitung zu unterstützen. Diese werden abschließend mittels Reflexionsleitfaden für die Anwendung in konkreten Projektkontexten operationalisiert

Dilemmata der Nachhaltigkeit: Zur Relevanz und kritischen Reflexion in der Nachhaltigkeitsforschung; Ein Leitfaden

Der Begriff der Nachhaltigkeit verliert zunehmend an Kontur. Vor diesem Hintergrund gibt dieser Leitfaden die Möglichkeit, das jeweils verwendete Verständnis von Nachhaltigkeit in Forschung und Wissenschaft zu reflektieren und damit den konkreten Beitrag zu Nachhaltigkeit, aber auch die verbundenen Grenzen konkret festzustellen. Ausgehend von einem analytischen Nachhaltigkeitsverständnis und der Klärung der Grundstruktur praktischer Dilemmata benennt der Leitfaden typische Konflikte als Ursache von Dilemmata. Meta-Kriterien der Nachhaltigkeit erlauben, Dilemmata-Früherkennung, -Aufklärung und -Bearbeitung zu unterstützen. Diese werden abschließend mittels Reflexionsleitfaden für die Anwendung in konkreten Projektkontexten operationalisiert.The concept of sustainability is increasingly losing its contours. This study reflects on the understanding of sustainability used in research and science. Its authors thus enable us to concisely determine not only concrete contributions to sustainability, but also its limits. Based on an analytical understanding of sustainability and the basic structure of practical dilemmas, the book identifies typical conflicts as causes of dilemmas. Meta-criteria of sustainability allow us to identify dilemmas and to clarify and deal with them practically at an early stage. Finally, the study applies these meta-criteria in concrete project contexts by means of guiding questions for reflection

A hitchhiker's guide to European lake ecological assessment and intercalibration

The Water Framework Directive is the first international legislation to require European countries to establish comparable ecological assessment schemes for their freshwaters. A key element in harmonising quality classification within and between Europe's river basins is an "Intercalibration" exercise, stipulated by the WFD, to ensure that the good status boundaries in all of the biological assessment methods correspond to similar levels of anthropogenic pressure. In this article, we provide a comprehensive overview of this international comparison, focusing on the assessment schemes developed for freshwater lakes. Out of 82 lake ecological assessment methods reported for the comparison, 62 were successfully intercalibrated and included in the EC Decision on intercalibration, with a high proportion of phytoplankton (18), macrophyte (17) and benthic fauna (13) assessment methods. All the lake assessment methods are reviewed in this article, including the results of intercalibration. Furthermore, the current gaps and way forward to reach consistent management objectives for European lakes are discussed. (C) 2015 The Authors. Published by Elsevier Ltd.Peer reviewe

Optical Coherence Tomography in Parkinsonian Syndromes

BACKGROUND/OBJECTIVE: Parkinson's disease (PD) and the atypical parkinsonian syndromes multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) are movement disorders associated with degeneration of the central nervous system. Degeneration of the retina has not been systematically compared in these diseases. METHODS: This cross-sectional study used spectral-domain optical coherence tomography with manual segmentation to measure the peripapillar nerve fiber layer, the macular thickness, and the thickness of all retinal layers in foveal scans of 40 patients with PD, 19 with MSA, 10 with CBS, 15 with PSP, and 35 age- and sex-matched controls. RESULTS: The mean paramacular thickness and volume were reduced in PSP while the mean RNFL did not differ significantly between groups. In PSP patients, the complex of retinal ganglion cell- and inner plexiform layer and the outer nuclear layer was reduced. In PD, the inner nuclear layer was thicker than in controls, MSA and PSP. Using the ratio between the outer nuclear layer and the outer plexiform layer with a cut-off at 3.1 and the additional constraint that the inner nuclear layer be under 46 µm, we were able to differentiate PSP from PD in our patient sample with a sensitivity of 96% and a specificity of 70%. CONCLUSION: Different parkinsonian syndromes are associated with distinct changes in retinal morphology. These findings may serve to facilitate the differential diagnosis of parkinsonian syndromes and give insight into the degenerative processes of patients with atypical parkinsonian syndromes

A Meta-analysis of Multiple Myeloma Risk Regions in African and European Ancestry Populations Identifies Putatively Functional Loci

Genome-wide association studies (GWAS) in European populations have identified genetic risk variants associated with multiple myeloma (MM)

Genetic correlation between amyotrophic lateral sclerosis and schizophrenia

A. Palotie on työryhmän Schizophrenia Working Grp Psychiat jäsen.We have previously shown higher-than-expected rates of schizophrenia in relatives of patients with amyotrophic lateral sclerosis (ALS), suggesting an aetiological relationship between the diseases. Here, we investigate the genetic relationship between ALS and schizophrenia using genome-wide association study data from over 100,000 unique individuals. Using linkage disequilibrium score regression, we estimate the genetic correlation between ALS and schizophrenia to be 14.3% (7.05-21.6; P = 1 x 10(-4)) with schizophrenia polygenic risk scores explaining up to 0.12% of the variance in ALS (P = 8.4 x 10(-7)). A modest increase in comorbidity of ALS and schizophrenia is expected given these findings (odds ratio 1.08-1.26) but this would require very large studies to observe epidemiologically. We identify five potential novel ALS-associated loci using conditional false discovery rate analysis. It is likely that shared neurobiological mechanisms between these two disorders will engender novel hypotheses in future preclinical and clinical studies.Peer reviewe

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder