Effects of web-based electrocardiography simulation on strategies and learning styles

Objective: To identify the association between the use of web simulation electrocardiography and the learning approaches, strategies and styles of nursing degree students. Method: A descriptive and correlational design with a one-group pretest– posttest measurement was used. The study sample included 246 students in a Basic and Advanced Cardiac Life Support nursing class of nursing degree. Results: No significant differences between genders were found in any dimension of learning styles and approaches to learning. After the introduction of web simulation electrocardiography, significant differences were found in some item scores of learning styles: theorist (p < 0.040), pragmatic (p < 0.010) and approaches to learning. Conclusion: The use of a web electrocardiogram (ECG) simulation is associated with the development of active and reflexive learning styles, improving motivation and a deep approach in nursing students

The intertropical convergence zone modulates intense hurricane strikes on the western North Atlantic margin

© The Author(s), 2016. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Scientific Reports 6 (2016): 21728, doi:10.1038/srep21728Most Atlantic hurricanes form in the Main Development Region between 9°N to 20°N along the northern edge of the Intertropical Convergence Zone (ITCZ). Previous research has suggested that meridional shifts in the ITCZ position on geologic timescales can modulate hurricane activity, but continuous and long-term storm records are needed from multiple sites to assess this hypothesis. Here we present a 3000 year record of intense hurricane strikes in the northern Bahamas (Abaco Island) based on overwash deposits in a coastal sinkhole, which indicates that the ITCZ has likely helped modulate intense hurricane strikes on the western North Atlantic margin on millennial to centennial-scales. The new reconstruction closely matches a previous reconstruction from Puerto Rico, and documents a period of elevated intense hurricane activity on the western North Atlantic margin from 2500 to 1000 years ago when paleo precipitation proxies suggest that the ITCZ occupied a more northern position. Considering that anthropogenic warming is predicted to be focused in the northern hemisphere in the coming century, these results provide a prehistoric analog that an attendant northern ITCZ shift in the future may again return the western North Atlantic margin to an active hurricane interval.This research was supported by NSF Awards: OCE-1519578, OCE-1356708, BCS-1118340

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Pleiotropic effect of the proton pump inhibitor esomeprazole leading to suppression of lung inflammation and fibrosis

Background: The beneficial outcome associated with the use of proton pump inhibitors (PPIs) in idiopathic pulmonary fibrosis (IPF) has been reported in retrospective studies. To date, no prospective study has been conducted to confirm these outcomes. In addition, the potential mechanism by which PPIs improve measures of lung function and/or transplant-free survival in IPF has not been elucidated. Methods: Here, we used biochemical, cell biological and preclinical studies to evaluate regulation of markers associated with inflammation and fibrosis. In our in vitro studies, we exposed primary lung fibroblasts, epithelial and endothelial cells to ionizing radiation or bleomycin; stimuli typically used to induce inflammation and fibrosis. In addition, we cultured lung fibroblasts from IPF patients and studied the effect of esomeprazole on collagen release. Our preclinical study tested efficacy of esomeprazole in a rat model of bleomycin-induced lung injury. Furthermore, we performed retrospective analysis of interstitial lung disease (ILD) databases to examine the effect of PPIs on transplant-free survival. Results: The cell culture studies revealed that esomeprazole controls inflammation by suppressing the expression of pro-inflammatory molecules including vascular cell adhesion molecule-1, inducible nitric oxide synthase, tumor necrosis factor-alpha (TNF-alpha) and interleukins (IL-1 beta and IL-6). The antioxidant effect is associated with strong induction of the stress-inducible cytoprotective protein heme oxygenase-1 (HO1) and the antifibrotic effect is associated with potent inhibition of fibroblast proliferation as well as downregulation of profibrotic proteins including receptors for transforming growth factor beta (TGF beta), fibronectin and matrix metalloproteinases (MMPs). Furthermore, esomeprazole showed robust effect in mitigating the inflammatory and fibrotic responses in a murine model of acute lung injury. Finally, retrospective analysis of two ILD databases was performed to assess the effect of PPIs on transplant-free survival in IPF patients. Intriguingly, this data demonstrated that IPF patients on PPIs had prolonged survival over controls (median survival of 3.4 vs 2 years). Conclusions: Overall, these data indicate the possibility that PPIs may have protective function in IPF by directly modulating the disease process and suggest that they may have other clinical utility in the treatment of extra-intestinal diseases characterized by inflammatory and/or fibrotic phases.Stanford School of Medicine [1049528-149- KAVFB]; Tobacco-Related Disease Research Program of the University of California [20FT-0090]; National Institutes of Health National Heart, Lung, and Blood Institute [5K01HL118683, P01HL114470]; Houston Methodist Research Institute [25150001]; Stanford SPARK Translational Research ProgramSCI(E)[email protected]

Tropical Pacific response to continental ice sheet topography

The last glacial maximum was marked by maximum land ice extent and lowest greenhouse gases concentration during the last ice age. We explore the impact of glacial continental ice sheet topography on the large-scale tropical ocean–atmosphere climate, in particular the tropical Pacific, in an intermediate complexity coupled model. Increasing the thickness of continental ice sheets causes a southward displaced Pacific Intertropical Convergence Zone (ITCZ) and a strengthening (weakening) of northern (southern) hemisphere winter Hadley cell. The equatorial zonal sea surface temperature gradient weakened with an increased continental ice sheets thickness, the reduction being caused by cooling in the western equatorial Pacific and warming in the eastern equatorial Pacific. The evolution of the tropical climate with changing ice thickness has distinct quasi-linear and nonlinear parts. While the linear part is a direct response to the ice topographic changes, the nonlinear part was a result of the tropical thermocline adjustment. Our analysis of a fully-coupled transient deglacial simulation strongly indicates the dominant role of ice sheet topography in determining the deglacial evolution of the simulated Pacific climate. The thickness of continental ice sheet, separate from ice albedo effect, has significant impact on the tropical ocean–atmosphere climate in particular with the meridional displacement in the Pacific ITCZ. The altered circulation states seen in the model may aid understanding of the relationship between tropical and high-latitude climate records in glacial-interglacial cycles

Long-term behavior of the atlantic interhemispheric sst gradient in the cmip5 historical simulations

Multidecadal and longer changes to the Atlantic interhemispheric sea surface temperature gradient (AITG) in phase 5 of the Coupled Model Intercomparison Project (CMIP5) historical simulations are investigated. Observations show a secular trend to this gradient over most of the twentieth century, with the southern lobe warming faster relative to its northern counterpart. A previous study of phase 3 of the CMIP (CMIP3) suggests that this trend is partially forced by anthropogenic sulfate aerosols. This analysis collectively confirms the partially forced trend for the CMIP5 and by anthropogenic aerosols. Like the CMIP3, the CMIP5 also simulates a reversal in the AITG trend in the late 1970s, which was attributed to a leveling offof the anthropogenic aerosol influence and increased influence of greenhouse gases in the late twentieth century. Two (of 25) CMIP5 models, however, systematically simulate a twentieth-century trend opposite to observed, leading to some uncertainty regarding the forced nature of the AITG trend. The observed AITG also exhibits a pronounced multidecadal modulation on top of the trend, associated with the Atlantic multidecadal oscillation (AMO). Motivated by a recent suggestion that the AMO is a forced response to aerosols, the causes of this multidecadal behavior were also examined. A few of the CMIP5 models analyzed do produce multidecadal AITG variations that are correlated to the observed AMO-like variation, but only one, the Hadley Centre Global Environmental Model, version 2 (HadGEM2), systematically simulates AMO-like behavior with both the requisite amplitude and phase. The CMIP5 simulations thus point to a robust aerosol influence on the historical AITG trend but not to the AMO-like multidecadal behavior. © 2013 American Meteorological Society

Sulfate aerosol control of tropical atlantic climate over the twentieth century

The tropical Atlantic interhemispheric gradient in sea surface temperature significantly influences the rainfall climate of the tropical Atlantic sector, including droughts over West Africa and Northeast Brazil. This gradient exhibits a secular trend from the beginning of the twentieth century until the 1980s, with stronger warming in the south relative to the north. This trend behavior is on top of a multidecadal variation associated with the Atlantic multidecadal oscillation. A similar long-term forced trend is found in a multimodel ensemble of forced twentieth-century climate simulations. Through examining the distribution of the trend slopes in the multimodel twentieth-century and preindustrial models, the authors conclude that the observed trend in the gradient is unlikely to arise purely from natural variations; this study suggests that at least half the observed trend is a forced response to twentieth-century climate forcings. Further analysis using twentiethcentury single-forcing runs indicates that sulfate aerosol forcing is the predominant cause of the multimodel trend. The authors conclude that anthropogenic sulfate aerosol emissions, originating predominantly from the Northern Hemisphere, may have significantly altered the tropical Atlantic rainfall climate over the twentieth century. © 2011 American Meteorological Society

Neuroprotective effects of wolfberry in normal tension glaucoma : abridged secondary publication

202302 bcwwVersion of RecordOthersHealth and Medical Research Fund, Food and Health Bureau, Hong Kong SAR GovernmentPublishe