PHOTOSYNTHETIC – FERMENTATIVE FUEL CELL USED IN A BIOFUEL PROCESSING FACILITY

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Suicide care from the nursing perspective: a meta‐synthesis of qualitative studies

Aims: to explore nurses' experiences of suicide care and to identify and synthesize the most suitable interventions for the care of people with suicidal behaviour from a nursing perspective. Design: qualitative meta-synthesis. Data sources: comprehensive search of five electronic databases for qualitative studies published between January 2015 and June 2019. Review methods: the PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method. Results: seventeen articles met the inclusion criteria. The data analysis revealed 13 subcategories from which four main categories emerged: 'Understanding suicidal behaviour as a consequence of suffering', 'Nurses' personal distress in suicide care', 'The presence of the nurse as the axis of suicide care' and, 'Improving nurses' relational competences for a better therapeutic environment'. Conclusion: further training of nurses on the therapeutic relationship, particularly in non-mental health care work settings, and monitoring of the emotional impact on nurses in relation to suicide is required to promote more effective prevention and care. Impact: this review provides new insights on how suicide is interpreted, the associated emotions, the way suicide is approached and proposals for improving clinical practice from the point of view of nurses. The results demonstrate that the nurse-patient relationship, ongoing assessment, and the promotion of a sense of security and hope are critical in nursing care for patients who exhibit suicidal behaviour. Consequently, to promote an effective nursing care of suicide, nurses should be provided with further training on the therapeutic relationship. Thus, health institutions do not only provide the time and space to conduct an adequate therapeutic relationship, but also, through their managers, they should supervise and address the emotional impact that is generated in nurses caring for patients who exhibit suicidal behaviour

Meridional Survey of the Central Pacific Reveals Iodide Accumulation in Equatorial Surface Waters and Benthic Sources in the Abyssal Plain

The distributions of iodate and iodide were measured along the GEOTRACES GP15 meridional transect at 152°W from the shelf of Alaska to Papeete, Tahiti. The transect included oxygenated waters near the shelf of Alaska, the full water column in the central basin in the North Pacific Basin, the upper water column spanning across seasonally mixed regimes in the north, oligotrophic regimes in the central gyre, and the equatorial upwelling. Iodide concentrations are highest in the permanently stratified tropical mixed layers, which reflect accumulation due to light-dependent biological processes, and decline rapidly below the euphotic zone. Vertical mixing coefficients (Kz), derived from complementary 7Be data, enabled iodide oxidation rates to be estimated at two stations. Iodide half-lives of 3–4 years show the importance of seasonal mixing processes in explaining north-south differences in the transect, and also contribute to the decrease in iodide concentrations with depth below the mixed layer. These estimated half-lives are consistent with a recent global iodine model. No evidence was found for significant inputs of iodine from the Alaskan continental margin, but there is a significant enrichment of iodide in bottom waters overlying deep sea sediments from the interior of the basin

Probabilistic risk analysis of groundwater remediation strategies

Heterogeneity of subsurface environments and insufficient site characterization are some of the reasons why decisions about groundwater exploitation and remediation have to be made under uncertainty. A typical decision maker chooses between several alternative remediation strategies by balancing their respective costs with the probability of their success or failure. We conduct a probabilistic risk assessment (PRA) to determine the likelihood of the success of a permeable reactive barrier, one of the leading approaches to groundwater remediation. While PRA is used extensively in many engineering fields, its applications in hydrogeology are scarce. This is because rigorous PRA requires one to quantify structural and parametric uncertainties inherent in predictions of subsurface flow and transport. We demonstrate how PRA can facilitate a comprehensive uncertainty quantification for complex subsurface phenomena by identifying key transport processes contributing to a barrier's failure, each of which is amenable to uncertainty analysis. Probability of failure of a remediation strategy is computed by combining independent and conditional probabilities of failure of each process. Individual probabilities can be evaluated either analytically or numerically or, barring both, can be inferred from expert opinio

Measuring wearing time of knee-ankle-foot orthoses in children with cerebral palsy: comparison of parent-report and objective measurement

Purpose State Orthotic wearing time may be an important confounder in efficacy studies of treatment in children with spastic cerebral palsy (SCP). Most studies measure parent-reported wearing time with questionnaires, but it is questionable whether this yields valid results. This study aims to compare parent-reported wearing time (WTparent) with objectively measured wearing time (WTobj) in children with SCP receiving orthotic treatment. Method Eight children with SCP participated in this observational study. For one year, they received knee-ankle-foot orthosis (KAFO) treatment. WTparent was measured using questionnaires. WTobj was measured using temperature sensor-data-loggers that were attached to the KAFOs. The 2.5th and 97.5th percentiles and median of differences between methods (per participant) were used to calculate limits of agreement and systematic differences. Results There was no systematic difference between WTparent and WTobj (0.1 hours per week), but high inter-individual variation of the difference was found, as reflected by large limits of agreement (lower limit/2.5th percentile: -1.7. hours/week; upper limit/97.5th percentile: 11.1 hours/week). Conclusions Parent-reported wearing time of a knee-ankle-foot orthosis differs largely from objectively measured wearing time using temperature sensors. Therefore, parent-reported wearing time of KAFOs should be interpreted with utmost care

A double-blind, placebo-controlled, phase II, randomized study of lovastatin therapy in the treatment of mildly active rheumatoid arthritis

© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. 3-hydroxy-3-methylglutaryl coenzyme-A (HMG Co-A) reductase inhibitors (statins) are standard treatment for hyperlipidaemia. In addition to lipid-lowering abilities, statins exhibit multiple anti-inflammatory effects. The objectives of this study were to determine whether treatment of patients with RA with lovastatin decreased CRP or reduced disease activity. Methods: We conducted a randomized double-blind placebo-controlled 12 week trial of lovastatin vs placebo in 64 RA patients with mild clinical disease activity but an elevated CRP. The primary efficacy end point was the reduction in mean log CRP. Secondary end points included disease activity, RF and anti-CCP antibody titres. Mechanistic end points included levels of serum cytokines. Safety was assessed; hepatic and muscle toxicities were of particular interest. Results: Baseline features were similar between groups. No significant difference in mean log CRP reduction between the two groups was observed, and disease activity did not change from baseline in either treatment group. Mechanistic analyses did not reveal significant changes in any biomarkers. A post hoc analysis of subjects not using biologic therapy demonstrated a significantly greater proportion achieving ≥20% reduction in CRP from baseline in the lovastatin group compared with placebo (P-value = 0.007). No difference was observed in subjects receiving biologics. Lovastatin was well tolerated with no serious safety concerns. Conclusion: This study showed no anti-inflammatory or clinical effects on RA disease activity after 12 weeks of treatment with lovastatin. Lovastatin had a modest effect on CRP in subjects not using biologics, suggesting statins may be anti-inflammatory in selected patients. Trial registration: ClinicalTrials.gov, http://clinicaltrials.gov, NCT00302952

Occurrence and determinants of parental psychosocial stress and mental health disorders in parents and their children in early childhood: rationale, objectives, and design of the population-based SKKIPPI cohort study

Purpose: The postnatal period is a vulnerable time for parents and children but epidemiological and health care utilisation data for Germany on parental mental health during early childhood is scarce. This protocol describes the rationale, aim and study design of a population-based cohort study to assess the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use and cost of health care and social services in early childhood. Methods: As part of the collaborative SKKIPPI project, we will contact a random sample of 30,000 infants listed in the residents’ registration offices of three German towns and we expect to include 6,000 mother–child pairs. Both parents are invited to fill out an online screening questionnaire. Mothers with indications of psychosocial stress will be interviewed to assess mental health disorders, regulatory problems of their children, as well as health care and social services utilisation, with a follow-up assessment after 6 months. Results: After description of sociodemographic and health data, we will analyse occurrences, patterns, and potential determinants (maternal age, social status, household factors, migration status etc.) of psychosocial stress and mental health disorders in the mothers and their children in early childhood. Conclusions: Our study will identify potential risk and protective factors for postnatal mental health and health care utilization of psychosocially burdened families. This will help to improve prevention and treatment strategies to strengthen the parent–child relationship, to reduce persisting vulnerability of children, and to improve health care and social services. Trial registration: The study has been registered in the German Clinical Trial Registry on February 8th 2019 (DRKS-ID: DRKS00016653)

Association of Pain Centralization and Patient‐Reported Pain in Active Rheumatoid Arthritis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156205/2/acr23994_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156205/1/acr23994.pd

Level of dietary protein intake affects glucose turnover in endurance-trained men

<p>Abstract</p> <p>Background</p> <p>To examine the effects of higher-protein diets on endogenous glucose metabolism in healthy, physically active adults, glucose turnover was assessed in five endurance-trained men (age 21.3 ± 0.3 y, VO_2peak70.6 ± 0.1 mL kg^-1min^-1) who consumed dietary protein intakes spanning the current dietary reference intakes.</p> <p>Findings</p> <p>Using a randomized, crossover design, volunteers consumed 4 week eucaloric diets providing either a low (0.8 g kg^-1d^-1; LP), moderate (1.8 g kg^-1d^-1; MP), or high (3.6 g kg^-1d^-1; HP) level of dietary protein. Glucose turnover (Ra, glucose rate of appearance; and Rd glucose rate of disappearance) was assessed under fasted, resting conditions using primed, constant infusions of [6,6-²H₂] glucose. Glucose Ra and Rd (mg kg^-1min^-1) were higher for MP (2.8 ± 0.1 and 2.7 ± 0.1) compared to HP (2.4 ± 0.1 and 2.3 ± 0.2, <it>P </it>< 0.05) and LP (2.3 ± 0.1 and 2.2 ± 0.1, <it>P </it>< 0.01) diets. Glucose levels (mmol/L) were not different (<it>P </it>> 0.05) between LP (4.6 ± 0.1), MP (4.8 ± 0.1), and HP (4.7 ± 0.1) diets.</p> <p>Conclusions</p> <p>Level of protein consumption influenced resting glucose turnover in endurance athletes in a state of energy balance with a higher rate of turnover noted for a protein intake of 1.8 g kg^-1d^-1. Findings suggest that consumption of protein in excess of the recommended dietary allowance but within the current acceptable macronutrient distribution range may contribute to the regulation of blood glucose when carbohydrate intake is reduced by serving as a gluconeogenic substrate in endurance-trained men.</p