Using a novel ambulatory monitoring system to support patient safety on an acute infectious disease ward during an unfolding pandemic

Aim: To gain staff feedback on the implementation and impact of a novel ambulatory monitoring system to support coronavirus patient management on an isolation ward. Design: Qualitative service evaluation. Methods: Semi-structured interviews were conducted with 15 multidisciplinary isolation ward staff in the United Kingdom between July 2020 and May 2021. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Findings: Adopting Innovation to Assist Patient Safety was identified as the overriding theme. Three interlinked sub-themes represent facets of how the system supported patient safety. Patient Selection was developed throughout the pandemic, as clinical staff became more confident in choosing which patients would benefit most. Trust In the System described how nurses coped with discrepancies between the ambulatory system and ward observation machines. Finally, Resource Management examined how, once trust was built, staff perceived the ambulatory system assisted with caseload management. This supported efficient personal protective equipment resource use by reducing the number of isolation room entries. Despite these reported benefits, face-to-face contact was still highly valued, despite the risk of coronavirus exposure. Conclusion: Hospital wards should consider using ambulatory monitoring systems to support caseload management and patient safety. Patients in isolation rooms or at high risk of deterioration may particularly benefit from this additional monitoring. However, these systems should be seen as an adjunct to nursing care, not a replacement. Implications for the Profession and/or Patient Care: Nurses valued ambulatory monitoring as a means of ensuring the safety of patients at risk of deterioration and prioritizing their workload. Impact: The findings of this research will be useful to all those developing or considering implementation of ambulatory monitoring systems in hospital wards. Reporting Method: This manuscript follows the Consolidated criteria for Reporting Qualitative Research (COREQ) guidelines with inclusion of relevant SQUIRE guidelines for reporting quality improvement. Patient or Public Contribution: No Patient or Public Contribution

Using a novel ambulatory monitoring system to support patient safety on an acute infectious disease ward during an unfolding pandemic

Aim. To gain staff feedback on the implementation and impact of a novel ambulatory monitoring system to support coronavirus patient management on an isolation ward. Design. Qualitative service evaluation. Methods. Semi-structured interviews were conducted with 15 multidisciplinary isolation ward staff in the United Kingdom between July 2020 and May 2021. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Findings. Adopting Innovation to Assist Patient Safety was identified as the overriding theme. Three interlinked sub-themes represent facets of how the system supported patient safety. Patient Selection was developed throughout the pandemic, as clinical staff became more confident in choosing which patients would benefit most. Trust In the System described how nurses coped with discrepancies between the ambulatory system and ward observation machines. Finally, Resource Management examined how, once trust was built, staff perceived the ambulatory system assisted with caseload management. This supported efficient personal protective equipment resource use by reducing the number of isolation room entries. Despite these reported benefits, face-to-face contact was still highly valued, despite the risk of coronavirus exposure. Conclusion. Hospital wards should consider using ambulatory monitoring systems to support caseload management and patient safety. Patients in isolation rooms or at high risk of deterioration may particularly benefit from this additional monitoring. However, these systems should be seen as an adjunct to nursing care, not a replacement. Implications for the Profession and/or Patient Care. Nurses valued ambulatory monitoring as a means of ensuring the safety of patients at risk of deterioration and prioritizing their workload. Impact. The findings of this research will be useful to all those developing or considering implementation of ambulatory monitoring systems in hospital wards. Reporting Method. This manuscript follows the Consolidated criteria for Reporting Qualitative Research (COREQ) guidelines with inclusion of relevant SQUIRE guidelines for reporting quality improvement. Patient or Public Contribution. No Patient or Public Contribution

Multi-wavelength study of Mrk 421 during a TeV flare

The blazar Mrk 421 shows frequent, short flares in the TeV energy regime. Due to the fast nature of such episodes, we often fail to obtain sufficient simultaneous information about flux variations in several energy bands. To overcome this lack of multi-wavelength (MWL) coverage, especially for the pre- and post-flare periods, we have set up a monitoring program with the FACT telescope (TeV energies) and the Neil Gehrels Swift Observatory (X-rays). On 2019 June 9, Mrk 421 showed a TeV outburst reaching a flux level of more than two times the flux of the Crab Nebula at TeV energies. We acquired simultaneous data in the X-rays with additional observations by XMM-Newton and INTEGRAL. For the first time, we can study a TeV blazar in outburst taking advantage of highly sensitive X-ray data from XMM-Newton and INTEGRAL combined. Our data set is complemented by pointed radio observations by Effelsberg at GHz frequencies. We present our first results, including the gamma-ray and X-ray light curves, a timing analysis of the X-ray data obtained with XMM-Newton, as well as the radio spectra before, during and after the flare.ISSN:1824-803

The Proteasome Is an Integral Part of Solar Ultraviolet A Radiation-induced Gene Expression*

Solar ultraviolet (UV) A radiation is a well known trigger of signaling responses in human skin fibroblasts. One important consequence of this stress response is the increased expression of matrix metalloproteinase-1 (MMP-1), which causes extracellular protein degradation and thereby contributes to photoaging of human skin. In the present study we identify the proteasome as an integral part of the UVA-induced, intracellular signaling cascade in human dermal fibroblasts. UVA-induced singlet oxygen formation was accompanied by protein oxidation, the cross-linking of oxidized proteins, and an inhibition of the proteasomal system. This proteasomal inhibition subsequently led to an accumulation of c-Jun and phosphorylated c-Jun and activation of activator protein-1, i.e. transcription factors known to control MMP-1 expression. Increased transcription factor activation was also observed if the proteasome was inhibited by cross-linked proteins or lactacystin, indicating a general mechanism. Most importantly, inhibition of the proteasome was of functional relevance for UVA-induced MMP-1 expression, because overexpression of the proteasome or the protein repair enzyme methionine sulfoxide reductase prevented the UVA-induced induction of MMP-1. These studies show that an environmentally relevant stimulus can trigger a signaling pathway, which links intracellular and extracellular protein degradation. They also identify the proteasome as an integral part of the UVA stress response