Segregation, precipitation, and \alpha-\alpha' phase separation in Fe-Cr alloys: a multi-scale modelling approach

Segregation, precipitation, and phase separation in Fe-Cr systems is investigated. Monte Carlo simulations using semiempirical interatomic potential, first-principles total energy calculations, and experimental spectroscopy are used. In order to obtain a general picture of the relation of the atomic interactions and properties of Fe-Cr alloys in bulk, surface, and interface regions several complementary methods has to be used. Using Exact Muffin-Tin Orbitals method the effective chemical potential as a function of Cr content (0-15 at.% Cr) is calculated for a surface, second atomic layer and bulk. At ~10 at.% Cr in the alloy the reversal of the driving force of a Cr atom to occupy either bulk or surface sites is obtained. The Cr containing surfaces are expected when the Cr content exceeds ~10 at.%. The second atomic layer forms about 0.3 eV barrier for the migration of Cr atoms between bulk and surface atomic layer. To get information on Fe-Cr in larger scales we use semiempirical methods. Using combined Monte Carlo molecular dynamics simulations, based on semiempirical potential, the precipitation of Cr into isolated pockets in bulk Fe-Cr and the upper limit of the solubility of Cr into Fe layers in Fe/Cr layer system is studied. The theoretical predictions are tested using spectroscopic measurements. Hard X-ray photoelectron spectroscopy and Auger electron spectroscopy investigations were carried out to explore Cr segregation and precipitation in Fe/Cr double layer and Fe_0.95Cr_0.05 and Fe_0.85Cr_0.15 alloys. Initial oxidation of Fe-Cr was investigated experimentally at 10^-8 Torr pressure of the spectrometers showing intense Cr_2O_3 signal. Cr segregation and the formation of Cr rich precipitates were traced by analysing the experimental spectral intensities with respect to annealing time, Cr content, and kinetic energy of the exited electron.Comment: 16 pages, 14 figures, 52 reference

Ethical problems in nursing management – a cross-sectional survey about solving problems

Background: Nurse managers encounter a wide range of ethical problems related to patients, staff, the organisation and themselves. However, little is known about the methods they use to try to solve these problems. In this study, our goal is to fill this knowledge gap by investigating the ethical problems encountered by nurse managers, the frequency of use and usefulness of different methods to solve these problems, and the background factors associated with the use of the methods.Methods: A cross-sectional survey study was conducted in November 2014-May 2015 in Finland. The data were collected from nurse managers in strategic, middle and ward management (n=214) using a questionnaire developed for this study. The questionnaire consisted of four parts: socio-demographic background factors, frequency and difficulty of ethical problems in nursing management, frequency of use and usefulness of the methods in solving ethical problems, and work-related background factors.Results: Discussions with nurses was the most frequently used method, used by 94% of the nurse managers either often or always in the case of ethical problems, followed by the use of personal values (74%) and discussions with manager colleagues (70%). However, almost all methods in the different groups - discussion and deliberation, use of outside experts, written instructions and ethical principles, acts and degrees as well as work arrangements - were considered somewhat or very useful by more than half of the respondents. The use of outside experts was the least used and the least useful method.Conclusions: When solving ethical problems, nurse managers use most frequently the same methods as a few decades ago. A more diverse range of methods would be helpful in ethical problem-solving. The use of outside experts, ethics literature and codes of ethics should be combined with ethical reasoning and decision-making to get new dimensions and outside knowledge.</div

Validation of the Youth Efficacy/Empowerment Scale – Mental Health Finnish version

Αdolescents face mental health problems and still their mental health needs are often neglected. Empowerment provides adolescents with the skills to impact their own lives and communities in general. The aim of the study is to examine the validity and reliability of the Finnish version of the Youth Efficacy/Empowerment Scale – Mental Health (YES-MH). Data was collected through an online questionnaire from pupils aged 12–17 years in Western Finland, comprised of the following instruments; the YES-MH, the Goodman’s the Strengths and Difficulties Questionnaire (SDQ), and the Warwick-Edinburgh Mental Wellbeing Scale. Exploratory factor analysis was carried out to evaluate construct validity and disclose underlying structures which yielded the following subscales: Self, Services, System. The internal consistency of subscales was analyzed with Cronbach’s α. Construct validity was further investigated by computing the Pearson’s correlations coefficients between the subscales. Furthermore, correlations with SDQ and mental well-being dimensions were explored as measures of convergent validity. In the final model all items the Youth Efficacy/ Empowerment Scale – Mental Health were entered into the factor analysis. All factor loadings were more than 0.40, ranging from 0.63 to 0.89. All the scales exceeded the minimum reliability standard of 0.70 and all corrected item-total correlations were high. All the YES-MH subscales were significantly and positively correlated each other with correlations coefficients ranging from medium to high. Correlations of Mental Well-being score with Self and Services subscales were significant. Moreover, Self subscale was significantly correlated with all SDQ dimensions. Services subscale was significantly correlated with Emotional symptoms and total SDQ score, while System subscale was significantly correlated with Conduct problems. The exploratory factor analysis showed a clear factor structure and the results suggest that the YES-MH is a reliable scale for assessing empowerment among young people. The YES-MH can be useful for health professionals not only as an assessment tool but also when they need to evaluate mental health interventions and examine empowerment as an outcome. However, further research can provide insights for the use of the scale in specific adolescent target groups and among different ethnic groups as well.</p

Consistent practice for pressure ulcer prevention in long-term older people care: A quasi-experimental intervention study

Background Consistent practice, an agreed clinical practice based on evidence, has been considered as a base for effective provision of quality and safety of care. As a result, patients have an equal quality of care regardless of the organisation or worker. However, despite the international guidelines, pressure ulcer prevention practices vary in long-term older people care.Aim To develop, implement and evaluate the impact of renewed, consistent practice for pressure ulcer prevention, in long-term older people care.Design A quasi-experimental intervention study.Methods Two long-term older people care facilities chosen with convenience sampling were randomly allocated to intervention or comparison group. Registered and practical nurses, in total 141/112, participated in the study. The renewed consistent practice based on international guidelines for pressure ulcer prevention was developed and implemented using the Operational Model for Evidence-Based Practices (OMEBP). Frequencies and agreement of PU prevention practices in line with international guidelines in the care facilities were measured using the PUPreP instrument.Results In the intervention facility, improvement in line with international guidelines was seen in the frequency of PU prevention practices in risk assessment, nutrition, pressure-relieving devices and documentation. Furthermore, improvement was seen in the intervention facility in all six areas of agreement on practices.Conclusions The results of this study support the implementation of PU prevention guidelines in long-term older people care (LOPC) and more widely in healthcare settings for older people to promote consistent practice, and safety and equal quality of care

Career development of doctorally prepared nurses

Aim: To integrate research literature regarding careers, career development and factors influencing the career development of doctorally prepared nurses. Design: An integrative review. Data Sources: Medline, CINAHL and Embase were searched in June 2022 without time restrictions. Methods: Peer-reviewed empirical publications written in English with different types of study designs were included. Two researchers independently applied eligibility criteria, selected studies and conducted quality appraisals using Joanna Briggs checklists. Data were extracted and analysed using a convergent integrated approach with thematic analysis. Themes were established within three categories based on the research questions: career, career development and factors influencing career development. Results: Twenty-two studies were included. Nine themes were identified. One theme regarding careers describes that doctorally prepared nurses need to prioritize work within different positions. The two themes focusing on career development described the need to determine career goals after the doctorate and further develop competencies. Six themes described factors influencing career development: ‘Intrinsic motivation to improve health care and nursing education’, ‘Available support sources’, ‘Professional development programmes’, ‘Work–life balance’, ‘Organizational infrastructures for career advancement’ and ‘Competition and hostile treatment among colleagues’. Conclusion: Limited knowledge of the careers and career development of doctorally prepared nurses was found. Doctorally prepared nurses need to balance work with various part-time positions. Careers and career development could be supported by the development of structures for career advancement as well as supportive working environments. Impact: Doctorally prepared nurses with strong careers are important to health care and nursing as they generate and implement new knowledge into clinical practice and thereby support the improvement of (nursing) care and patient outcomes. This study provides considerations towards strengthening the careers of doctorally prepared nurses. Reporting Method: PRISMA. Patient or Public Contribution: No Patient or Public Contribution

Skills and practices of European orthopedic nurses in empowering patient education

Purpose: This study provides an overview of the self-defined skills and practices of European orthopedic nurses in empowering patient education. Nurses themselves have highlighted the necessity to enhance their own skills, but possibilities for further education have been limited. Methods: The data (n = 317 nurses) from a structured survey were collected during the years 2009–2012 in seven European countries with an EPNURSE—questionnaire (Empowering Patient Education from the point of view of Nurses). Results: Nurses considered patient education as an important part of their work and evaluated their own skills as good. However, their patient education practices were based more on practices on their ward and their own experience than on further education or evidence-based knowledge. On the other hand, lack of time for patient education and experienced overload were the major barriers experienced by nurses. Implications for Practice: Further education of orthopedic nurses in empowering evidence-based patient education is highly needed. Nurse leaders need to acknowledge the strong need for supporting nurses within clinical practice, improve their evidence-based knowledge and support practices that prioritize patient education within the hospital environment. Further international collaboration in nursing research and health-care organizations is desirable to reach these patient educational goals in clinical nursing practice.</p

Novel Type of Streptococcus pneumoniae Causing Multidrug-Resistant Acute Otitis Media in Children

A new multidrug-resistant strain of serotype 19A has been characterized in upstate New York

Brn2 Is a Transcription Factor Regulating Keratinocyte Differentiation with a Possible Role in the Pathogenesis of Lichen Planus

Terminal differentiation of skin keratinocytes is a vertically directed multi-step process that is tightly controlled by the sequential expression of a variety of genes. In this study, we investigated the role of the POU domain-containing transcription factor Brn2 in keratinocyte differentiation. Immunohistochemical analysis showed that Brn2 is expressed primarily in the upper granular layer. Consistent with its epidermal localization, Brn2 expression was highly induced at 14 days after calcium treatment of cultured normal human epidermal keratinocytes. When Brn2 was overexpressed by adenoviral transduction, Brn2 led to increased expression of the differentiation-related genes involucrin, filaggrin, and loricrin in addition to inhibition of their proliferation. Chromatin immunoprecipitation demonstrated that Brn2 bound to the promoter regions of these differentiation-related genes. We injected the purified Brn2 adenovirus into rat skin, which led to a thickened epidermis with increased amounts of differentiation related markers. The histopathologic features of adenovirus-Brn2 injected skin tissues looked similar to the features of lichen planus, a human skin disease showing chronic inflammation and well-differentiated epidermal changes. Moreover, Brn2 is shown to be expressed in almost all cell nuclei of the thickened epidermis of lichen planus, and Brn2 also attracts T lymphocytes. Our results demonstrate that Brn2 is probably a transcriptional factor playing an important role in keratinocyte differentiation and probably also in the pathogenesis of lichen planus lesions