Providing Holistic and Spiritual Nursing Care

Holistic nursing is care of the whole person, which addresses physical, mental, emotional, spiritual, and relational aspects of health. Historically, nursing has always integrated these aspects into providing care. Nursing developed out of religious orders and was predominantly a way to serve God by serving the poor and the sick. Florence Nightingale believed that nursing was her calling from God and her faith and spirituality influenced every aspect of her care. Nurses today are often fearful of addressing the spiritual needs of their patients, despite research that demonstrates the importance of providing care in these areas. Nurses can use interventions such as prayer, Scripture, active listening and presence, as well as referral to meet the spiritual needs of their patients

Valor pronóstico de los parámetros de deformación miocárdica en una cohorte de pacientes con insuficiencia cardíaca crónica estable

La insuficiencia cardiaca (IC) es una patología de gran impacto a nivel mundial por sus elevadas cifras de morbilidad-mortalidad. A pesar de que la ecocardiografía es la prueba de elección para su diagnóstico y estratificación de riesgo, presenta importantes limitaciones y es incapaz de predecir el riesgo en pacientes con FEVI preservada. El estudio de la deformación miocárdica mediante rastreo de patrones, permite estimar el porcentaje de elongación o acortamiento de cada segmento miocárdico durante el ciclo cardíaco. Ha demostrado ser un parámetro capaz de identificar la disfunción miocárdica subclínica, asociándose con el riesgo de mortalidad y episodios adversos en subgrupos seleccionados de pacientes. La presente Tesis Doctoral tuvo como objetivo evaluar la relación entre la Deformación Global Longitudinal del Ventrículo izquierdo (DGL) y el riesgo de episodios adversos (muerte, ingresos cardiovasculares y descompensaciones recurrentes por IC) y determinar si esta relación es independiente de las variables clínicas y ecocardiográficas con valor pronóstico reconocido. Se trata de un estudio observacional y prospectivo, sobre una cohorte no seleccionada de pacientes con IC crónica estable, reclutados en el Hospital Clínico Universitario de Valencia entre 2017 y 2019 a los que se realizó un estudio ecocardiográfico basal con cuantificación de la DGL. El seguimiento clínico y registro de eventos se realizó mediante consulta de la historia clínica electrónica o contacto telefónico. Se incluyeron un total de 262 pacientes, en su mayoría (66%) hombres con FEVI deprimida (59%), siendo la causa isquémica la etiología predominante (34,4%). La mediana de seguimiento fue de 2,86 años, registrándose una mortalidad total del 29,77%. 33,20% de los pacientes presentaron al menos un episodio de insuficiencia cardíaca con repercusión clínica significativa (con o sin ingreso), para un registro total de 219 episodios recurrentes. El análisis de supervivencia por cuartiles de DGL mediante las curvas de Kaplan Meier mostró un mayor riesgo de mortalidad en los pacientes con DGL más patológico. La relación entre la DLG y los episodios adversos se analizó mediante regresión binomial negativa ajustada por los principales predictores de riesgo asociados a la IC. La DGL del ventrículo izquierdo mostró una relación independiente, positiva y no lineal, con los 4 eventos evaluados. Al analizar el comportamiento de la DGL en pacientes con FEVI preservada y reducida, no se observaron criterios de heterogeneidad, por lo que no parece haber un comportamiento diferencial de la variable predictora en ambos subgrupos. En conclusión, los resultados muestran que la DGL presenta una relación positiva con el riesgo de mortalidad, descompensaciones recurrentes de IC e ingresos de causa cardiovascular, sin evidenciarse criterios de un comportamiento diferencial en pacientes con FEVI preservada o reducida, lo que podría aportar información pronostica complementaria que sea de utilidad para la toma de decisiones, estrategias terapéuticas y de seguimiento clínico en beneficio de los pacientes.Heart failure (HF) is a globally significant pathology of considerable importance. Despite echocardiography being the preferred diagnostic and risk stratification tool, it has notable limitations and is incapable of predicting the risk in patients with preserved left ventricular ejection fraction (LVEF). Myocardial deformation analysis using strain imaging allows the estimation of the percentage of elongation or shortening of each myocardial segment throughout the cardiac cycle. It has proven to be a parameter capable of identifying subclinical myocardial dysfunction and is associated with the risk of mortality and adverse events in selected patient subgroups. The objective of this doctoral thesis was to evaluate the relationship between Global Longitudinal Strain (GLS) of the left ventricle and the risk of adverse events (death, cardiovascular hospitalizations, and recurrent decompensations due to HF). Additionally, it aimed to determine if this relationship is independent of clinically and echocardiographically recognized prognostic variables. This study was conducted as an observational and prospective investigation on an unselected cohort of stable chronic HF patients recruited at the Hospital Clínico de Valencia between 2017 and 2019. Baseline echocardiographic assessment with quantification of GLS was performed. Clinical follow-up and event recording were conducted through electronic medical records or telephone contact. A total of 262 patients were included in the study, predominantly male (66%) with reduced LVEF (59%), and with ischemic cardiopathy being the predominant etiology (34.4%). The median follow-up duration was 2.86 years, with a total mortality rate of 29.77%. Among the patients, 33.20% experienced at least one episode of clinically significant heart failure with or without hospitalization, resulting in a total of 219 recurrent episodes. Survival analysis using Kaplan-Meier curves based on GLS quartiles demonstrated a higher risk of mortality in patients with more pathological GLS values. The relationship between GLS and adverse events was analyzed using negative binomial regression adjusted for the main risk predictors associated with HF. Left ventricular GLS exhibited an independent, positive, and non-linear relationship with all four evaluated events. Upon analyzing the behavior of GLS in patients with preserved and reduced LVEF, no criteria of heterogeneity were observed, suggesting that there is no differential behavior of the predictive variable in both subgroups. In conclusion, the results demonstrate a positive relationship between GLS and the risk of mortality, recurrent HF decompensations, and cardiovascular hospitalizations. This provides complementary prognostic information that could be valuable for decision-making, therapeutic strategies, and clinical follow-up, ultimately benefiting the patients

Biofilm Formation by Listeria monocytogenes 15G01, a Persistent Isolate from a Seafood-Processing Plant, Is Influenced by Inactivation of Multiple Genes Belonging to Different Functional Groups

Listeria monocytogenes is a ubiquitous foodborne pathogen that results in a high rate of mortality in sensitive and immunocompromised people. Contamination of food with L. monocytogenes is thought to occur during food processing, most often as a result of the pathogen producing a biofilm that persists in the environment and acting as the source for subsequent dispersal of cells onto food. A survey of seafoodprocessing plants in New Zealand identified the persistent strain 15G01, which has a high capacity to form biofilms. In this study, a transposon library of L. monocytogenes 15G01 was screened for mutants with altered biofilm formation, assessed by a crystal violet assay, to identify genes involved in biofilm formation. This screen identified 36 transposants that showed a significant change in biofilm formation compared to the wild type. The insertion sites were in 27 genes, 20 of which led to decreased biofilm formation and seven to an increase. Two insertions were in intergenic regions. Annotation of the genes suggested that they are involved in diverse cellular processes, including stress response, autolysis, transporter systems, and cell wall/membrane synthesis. Analysis of the biofilms produced by the transposants using scanning electron microscopy and fluorescence microscopy showed notable differences in the structure of the biofilms compared to the wild type. In particular, inactivation of uvrB and mltD produced coccoid-shaped cells and elongated cells in long chains, respectively, and the mgtB mutant produced a unique biofilm with a sandwich structure which was reversed to the wild-type level upon magnesium addition. The mltD transposant was successfully complemented with the wild-type gene, whereas the phenotypes were not or only partially restored for the remaining mutants. IMPORTANCE The major source of contamination of food with Listeria monocytogenes is thought to be due to biofilm formation and/or persistence in food-processing plants. By establishing as a biofilm, L. monocytogenes cells become harder to eradicate due to their increased resistance to environmental threats. Understanding the genes involved in biofilm formation and their influence on biofilm structure will help identify new ways to eliminate harmful biofilms in food processing environments. To date, multiple genes have been identified as being involved in biofilm formation by L. monocytogenes; however, the exact mechanism remains unclear. This study identified four genes associated with biofilm formation by a persistent strain. Extensive microscopic analysis illustrated the effect of the disruption of mgtB, clsA, uvrB, and mltD and the influence of magnesium on the biofilm structure. The results strongly suggest an involvement in biofilm formation for the four genes and provide a basis for further studies to analyze gene regulation to assess the specific role of these biofilm-associated genes.Peer reviewe

Statistical Basis for Predicting Technological Progress

Forecasting technological progress is of great interest to engineers, policy makers, and private investors. Several models have been proposed for predicting technological improvement, but how well do these models perform? An early hypothesis made by Theodore Wright in 1936 is that cost decreases as a power law of cumulative production. An alternative hypothesis is Moore's law, which can be generalized to say that technologies improve exponentially with time. Other alternatives were proposed by Goddard, Sinclair et al., and Nordhaus. These hypotheses have not previously been rigorously tested. Using a new database on the cost and production of 62 different technologies, which is the most expansive of its kind, we test the ability of six different postulated laws to predict future costs. Our approach involves hindcasting and developing a statistical model to rank the performance of the postulated laws. Wright's law produces the best forecasts, but Moore's law is not far behind. We discover a previously unobserved regularity that production tends to increase exponentially. A combination of an exponential decrease in cost and an exponential increase in production would make Moore's law and Wright's law indistinguishable, as originally pointed out by Sahal. We show for the first time that these regularities are observed in data to such a degree that the performance of these two laws is nearly tied. Our results show that technological progress is forecastable, with the square root of the logarithmic error growing linearly with the forecasting horizon at a typical rate of 2.5% per year. These results have implications for theories of technological change, and assessments of candidate technologies and policies for climate change mitigation

Low birthweight and preterm birth in young people with special educational needs: a magnetic resonance imaging analysis

<p>Abstract</p> <p>Background</p> <p>Although neuroanatomical and cognitive sequelae of low birthweight and preterm birth have been investigated, little is understood as to the likely prevalence of a history of low birthweight or preterm birth, or neuroanatomical correlates of such a history, within the special educational needs population. Our aim was to address these issues in a sample of young people receiving additional learning support.</p> <p>Methods</p> <p>One hundred and thirty-seven participants aged 13–22 years, receiving additional learning support, were recruited via their schools or colleges and underwent structural magnetic resonance imaging (MRI). Obstetric records, available in 98 cases, included birthweight and gestational data in 90 and 95 cases, respectively. Both qualitative and quantitative voxel-based analyses of MRI data were conducted.</p> <p>Results</p> <p>A history of low birthweight and preterm birth was present in 13.3% and 13.7% of cases, respectively. Low birthweight and preterm birth were associated with specific qualitative anomalies, including enlargement of subarachnoid cisterns and thinning of the corpus callosum. Low birthweight was associated with reduced grey matter density (GMD) in the superior temporal gyrus (STG) bilaterally, left inferior temporal gyrus and left insula. Prematurity of birth was associated with reduced GMD in the STG bilaterally, right inferior frontal gyrus and left cerebellar hemisphere. Comparison of subjects with no history of low birthweight or preterm birth with a previously defined control sample of cognitively unimpaired adolescents (<it>n </it>= 72) demonstrated significantly greater scores for several anomalies, including thinning of the corpus callosum, loss of white matter and abnormalities of shape of the lateral ventricles.</p> <p>Conclusion</p> <p>Although a two-fold increased prevalence of a history of low birthweight and preterm birth exists within the special educational needs population, other aetiological factors must be considered for the overwhelming majority of cases. Neuroanatomical findings within this sample include qualitative anomalies of brain structure and grey matter deficits within temporal lobe structures and the cerebellum that persist into adolescence. These findings suggest a neurodevelopmental mechanism for the cognitive difficulties associated with these obstetric risk factors.</p

Microbes with higher metabolic independence are enriched in human gut microbiomes under stress

A wide variety of human diseases are associated with loss of microbial diversity in the human gut, inspiring a great interest in the diagnostic or therapeutic potential of the microbiota. However, the ecological forces that drive diversity reduction in disease states remain unclear, rendering it difficult to ascertain the role of the microbiota in disease emergence or severity. One hypothesis to explain this phenomenon is that microbial diversity is diminished as disease states select for microbial populations that are more fit to survive environmental stress caused by inflammation or other host factors. Here, we tested this hypothesis on a large scale, by developing a software framework to quantify the enrichment of microbial metabolisms in complex metagenomes as a function of microbial diversity. We applied this framework to over 400 gut metagenomes from individuals who are healthy or diagnosed with inflammatory bowel disease (IBD). We found that high metabolic independence (HMI) is a distinguishing characteristic of microbial communities associated with individuals diagnosed with IBD. A classifier we trained using the normalized copy numbers of 33 HMI-associated metabolic modules not only distinguished states of health versus IBD, but also tracked the recovery of the gut microbiome following antibiotic treatment, suggesting that HMI is a hallmark of microbial communities in stressed gut environments