Informed consent prior to nursing care: Nurses' use of information

Background. Informed consent prior to nursing care procedures is an established principle which acknowledges the right of the patient to authorise what is done to him or her; consent prior to nursing care should not be assumed. Nursing care procedures have the potential to be unwanted by the patient and hence require an appropriate form of authorisation that takes into consideration the relationship between the nurse and patient and the ongoing nature of care delivery. Research question. How do nurses obtain consent from patients prior to nursing care?. Design. Critical incident technique and the collection of critical happenings. Participants. 17 participants who were all qualified nurses took part in in-depth interviews Ethical considerations. Ethical approval was obtained from the university ethics committee. Findings. Information giving is a key component prior to nursing care procedures. Nurses provide information to patients as a routine aspect of care delivery, and do so even when the patient is unable to communicate themselves. Whilst some participants described how information giving might be rushed or overlooked at times, it is clearly an established part of nursing care and is provided to ensure the patient knows what to expect when care is delivered. What is less clear is the extent to which information is given in order to seek the consent – rather than merely inform the patient – about nursing care. Conclusion. Implied consent is often an appropriate way in which consent is obtained prior to nursing care procedures. It takes into account the ongoing care provision and the relationship that exists between the nurse and patient. However implied consent should not be assumed. Nurses need to ensure that information is given not only to inform the patient about a procedure but to enable the patient to give his or her consent and to find an alternative way forward if the patient withholds their consent

Automated detection and staging of malaria parasites from cytological smears using convolutional neural networks

Microscopic examination of blood smears remains the gold standard for laboratory inspection and diagnosis of malaria. Smear inspection is, however, time-consuming and dependent on trained microscopists with results varying in accuracy. We sought to develop an automated image analysis method to improve accuracy and standardization of smear inspection that retains capacity for expert confirmation and image archiving. Here, we present a machine learning method that achieves red blood cell (RBC) detection, differentiation between infected/uninfected cells, and parasite life stage categorization from unprocessed, heterogeneous smear images. Based on a pretrained Faster Region-Based Convolutional Neural Networks (R-CNN) model for RBC detection, our model performs accurately, with an average precision of 0.99 at an intersection-over-union threshold of 0.5. Application of a residual neural network-50 model to infected cells also performs accurately, with an area under the receiver operating characteristic curve of 0.98. Finally, combining our method with a regression model successfully recapitulates intraerythrocytic developmental cycle with accurate lifecycle stage categorization. Combined with a mobile-friendly web-based interface, called PlasmoCount, our method permits rapid navigation through and review of results for quality assurance. By standardizing assessment of Giemsa smears, our method markedly improves inspection reproducibility and presents a realistic route to both routine lab and future field-based automated malaria diagnosis

Étude du rôle des G-quadruplexes et de leurs protéines d'interaction chez Plasmodium falciparum

Malaria continues to be one of the major causes of morbidity and mortality in the developing countries. The development of the resistance against the available antimalarial drugs and scarcity of effective vaccines have demanded the urgent need of finding new antimalarial targets. The severe form of malaria is caused by Plasmodium falciparum, which manifests a complex life cycle involving various morphologically and functionally distinct forms within two different hosts - human and Anopheles mosquitoes. In order to thrive in two distinctive host’s environment, these parasites employ different mechanisms to regulate their tightly coordinated gene expression. This thesis project is focused on exploring the regulation, which is mediated by guanine-rich DNA secondary structures, predominantly G-quadruplexes. These structures are found in wide range of organisms and are involved in gene regulation such as transcription, DNA replication and telomeric maintenance. Recently, they are also found to be involved in the process of virulence to evade the host’s immune response in numerous pathogens such as bacteria, protozoa and viruses. In Plasmodium, the G-quadruplex forming motifs are found to be enriched in the telomeric and sub-telomeric regions, where the virulence genes are present. The G4 existence in these AT biased genome points towards their role in the mechanism of gene regulation and antigenic variation. However, there is a lack of experimental evidence to support this hypothesis. The aim of this project is to provide the first comprehensive survey of the G4-interactome in order to understand the role of G4-mediated regulatory mechanisms in Plasmodium biology. Using a combination of unbiased approaches (Yeast one-hybrid and DNA pull-down assay), we have identified ~152 putative G4 interacting proteins in Plasmodium falciparum. The orthologs of some of these proteins were shown to interact with G4s, thus strengthening our results. Furthermore, to understand how these candidates contribute to G4 mediated regulatory processes, we have selected and characterized two proteins (GBP2 and DNAJ) to perform functional studies following validation of their binding properties. These proteins are shown to play an important role in Plasmodium biology. In this study, we have found that the GBP2 is a dispensable protein that interacts with the selected G4. Even though the deletion of the gene is not lethal to the parasites, it still affects the expression of var genes. Whereas putative DNAJ is an essential protein and its deletion results into the arrest of the parasites at the late stages of erythrocytic cycle. Collectively, this study sheds light on this understudied DNA structure based regulatory mechanism and provide the first systematic survey of the G4 interactome. Given their essential role in parasite development further characterization of obtained candidates will likely generate new targets for antimalarial drugs that will in the long term contribute to the eradication of the disease.Le paludisme continue d'être l'une des principales causes de morbidité et de mortalité dans les pays en développement. Le développement de la résistance aux médicaments antipaludiques disponibles et la rareté des vaccins efficaces ont rendu nécessaire la recherche urgente de nouvelles cibles antipaludiques. La forme grave du paludisme est causée par Plasmodium falciparum, qui présente un cycle de vie complexe impliquant diverses formes morphologiquement et fonctionnellement distinctes chez deux hôtes différents - l'humain et le moustique anophèle. Afin de se développer dans l'environnement de deux hôtes distincts, ces parasites utilisent différents mécanismes pour réguler leur expression génétique étroitement coordonnée. Ce projet de thèse se concentre sur l'exploration de cette régulation, qui est médiée par des structures secondaires d'ADN riches en guanine, principalement des G-quadruplexes. Ces structures se trouvent dans une large gamme d'organismes et sont impliquées dans la régulation des gènes tels que la transcription, la réplication de l'ADN et la maintenance télomérique. Récemment, on a découvert qu'elles sont également impliquées dans le processus de virulence pour échapper à la réponse immunitaire de l'hôte dans de nombreux pathogènes tels que les bactéries, les protozoaires et les virus. Chez Plasmodium, les motifs formant le quadruplex-G sont enrichis dans les régions télomériques et sous-télomériques, où les gènes de virulence sont présents. L'existence de G4 dans le génome de ces parasites riches en AT indique leur rôle dans le mécanisme de régulation des gènes et de variation antigénique. Cependant, il y a un manque de preuves expérimentales pour appuyer cette hypothèse. Le but de ce projet est de fournir la première étude complète de l'interactome G4 afin de comprendre le rôle des mécanismes de régulation médiés par le G4 dans la biologie du Plasmodium. En utilisant une combinaison d'approches non biaisées (levure hybride et test d'ADN pull-down), nous avons identifié ~152 protéines interagissant potentiellement avec les motifs G4 Plasmodium falciparum. Il a été démontré que les orthologues de certaines de ces protéines interagissent avec les G4, ce qui renforce nos résultats. De plus, pour comprendre comment ces candidats contribuent aux processus de régulation médiés par les G4, nous avons sélectionné et caractérisé deux protéines (GBP2 et DNAJ) pour effectuer des études fonctionnelles après validation de leurs propriétés de liaison. Il est démontré que ces protéines jouent un rôle important dans la biologie du Plasmodium. Dans cette étude, nous avons découvert que la GBP2 est une protéine dispensable qui interagit avec la G4 sélectionnée. Même si la délétion du gène n'est pas mortelle pour les parasites, elle affecte toujours l'expression des gènes var. Alors que l'ADNJ putatif est une protéine essentielle et que sa délétion entraîne l'arrêt des parasites aux derniers stades du cycle érythrocytaire. Collectivement, cette étude fait la lumière sur ce mécanisme de régulation basé sur la structure de l'ADN, encore peu étudié, et fournit la première étude systématique de l'interactome G4. Etant donné leur rôle essentiel dans le développement des parasites, une caractérisation plus poussée des candidats obtenus permettra probablement de générer de nouvelles cibles pour les antipaludiques qui contribueront à long terme à l'éradication de la maladie

Use of information and communication technology in diabetes management : a descriptive literature review

Living with chronic conditions like diabetes requires a lot of changes in one´s daily life from modifications in nutrition, medication and many more. The new emerging information and communication technologies have contributed in many ways to the management of diabetes among patients and health care providers. The aim of this study is to examine the use of ICT in diabetes self-care and management. The purpose of this thesis was to improve knowledge among diabetic patients and health professionals on ICTs interventions in the care process. The method selected to conduct this thesis was a descriptive literature review. Different articles were gathered by performing an electronic database search in PubMed, CINAHL and Google Scholar, using inclusion and exclusion criteria. The data analysis used was qualitative analysis and it was done by using thematic analysis. The codes obtained from the articles were noted, organized and developed into themes. One of the main themes that were identified after analyzing the articles was “ Benefits of ICT in diabetes management” that was further sub-categorized into “emotional and psychological benefits”, co-ordination of care” and convenient access to healthcare services”. In addition, another main theme identified was “Limitations of ICT in diabetes management” that was sub-themed into “ lack of knowledge and technical skills”, “inability to continue care” and “privacy concern”. In conclusion, it was discovered that involving the diabetic patient in self-management of their condition improves their quality of life and prevents many acute complications. The education and skills developed using various communication and technologically advanced devices in care management enhance the knowledge regarding their disease condition and measures to prevent complications. The number of increasing ICT and digital platforms in healthcare is evident to enhance health and diminish the undeniable burden of diabetesKroonisten sairauksien, kuten diabeteksen, kanssa eläminen vaatii paljon muutoksia jokapäiväisessä elämässä muutoksista ravitsemukseen, lääkkeisiin ja moniin muihin. Uudet syntyvät tieto- ja viestintätekniikat ovat vaikuttaneet monin tavoin diabeteksen hallintaan potilaiden ja terveydenhuollon tarjoajien keskuudessa. Tämän tutkimuksen tavoitteena on selvittää ICT: n käyttöä diabeteksen omahoidossa ja hoidossa. Opinnäytetyön tarkoituksena oli parantaa diabeetikkojen ja terveydenhuollon ammattilaisten tietämystä hoitoprosessin ICT-interventioista. Opinnäytetyön suorittamiseen valittu menetelmä oli kuvaava kirjallisuuskatsaus. Eri artikkeleita koottiin suorittamalla elektroninen tietokantahaku PubMedissä, CINAHL: ssä ja Google Scholarissa käyttämällä sisällyttämis- ja poissulkemisperusteita. Käytetty data-analyysi oli laadullinen analyysi ja se tehtiin käyttämällä temaattista analyysiä. Artikkeleista saadut koodit merkittiin, järjestettiin ja kehitettiin aiheiksi. Yksi pääteemoista, jotka tunnistettiin artikkeleiden analysoinnin jälkeen, oli ”ICT: n edut diabeteksen hoidossa”, joka jaoteltiin edelleen ”tunne- ja psykologisiin hyötyihin”, hoidon koordinointiin ”ja terveyspalvelujen helppoon saatavuuteen”. . Lisäksi toinen tunnistettu pääteema oli ”TVT: n rajoitukset diabeteksen hoidossa”, jonka alateema oli ”tietämättömyys ja tekniset taidot”, “kyvyttömyys jatkaa hoitoa” ja yksityinen huolenaihe ”. Yhteenvetona todettiin, että diabeetikon osallistuminen tilansa itsehallintoon parantaa heidän elämänlaatuaan ja estää monia akuutteja komplikaatioita. Erilaisilla viestinnän ja teknologisesti parannetuilla laitteilla hoidon hoidossa kehitetty koulutus ja taidot parantavat tietoa heidän sairaustilastaan ja toimenpiteistä komplikaatioiden estämiseksi. Lisääntyvien tieto- ja viestintätekniikan ja digi-alustojen lukumäärä terveydenhoidossa on ilmeistä terveyden parantamisessa ja diabeteksen kiistattoman taantuman vähentämisessä

Genome-wide survey and phylogenetic analysis of histone acetyltransferases and histone deacetylases of Plasmodium falciparum

Malaria parasites can readily sense and adapt to environmental changes, thus making the control and eradication of this disease difficult. Molecular studies have unraveled a very tightly coordinated transcriptional machinery governed by complex regulatory mechanisms including chromatin modification and spatiotemporal compartmentalization. Histone modifying enzymes play key roles in the regulation of chromatin modification and gene expression, which are associated with cell cycle progression, antigenic variation and immune evasion. Here, we present a comprehensive review of the key regulators of the Plasmodium falciparum histone acetylome; histone acetyltransferases (HATs); and histone deacetylases (HDACs). We describe the genome-wide occurrence of HATs and HDACs in the P. falciparum genome and identify novel, as well as previously unclassified HATs. We re-confirm the presence of five known HDACs and identify, a novel putative HDAC. Interestingly, we identify several HATs and HDACs with unique and noncanonical domain combinations indicating their involvement in other associated functions. Moreover, the phylogenetic analyses of HATs and HDACs suggest that many of them are close to the prokaryotic systems and thus potential candidates for drug development. Our review deciphers the phylogeny of HATs and HDACs of the malaria parasite, investigates their role in drug-resistance generation, and highlights their potential as therapeutic targets.</p

Genome wide distribution of G-quadruplexes and their impact on gene expression in malaria parasites

International audienceMechanisms of transcriptional control in malaria parasites are still not fully understood. The positioning patterns of G-quadruplex (G4) DNA motifs in the parasite's AT-rich genome, especially within the var gene family which encodes virulence factors, and in the vicinity of recombination hotspots, points towards a possible regulatory role of G4 in gene expression and genome stability. Here, we carried out the most comprehensive genome-wide survey, to date, of G4s in the Plasmodium falciparum genome using G4Hunter, which identifies G4 forming sequences (G4FS) considering their G-richness and G-skewness. We show an enrichment of G4FS in nucleosome-depleted regions and in the first exon of var genes, a pattern that is conserved within the closely related Laverania Plasmodium parasites. Under G4-stabilizing conditions, i.e., following treatment with pyridostatin (a high affinity G4 ligand), we show that a bona fide G4 found in the non-coding strand of var promoters modulates reporter gene expression. Furthermore, transcriptional profiling of pyridostatin-treated parasites, shows large scale perturbations, with deregulation affecting for instance the ApiAP2 family of transcription factors and genes involved in ribosome biogenesis. Overall, our study highlights G4s as important DNA secondary structures with a role in Plasmodium gene expression regulation, sub-telomeric recombination and var gene biology

PfGBP2 is a novel G‐quadruplex binding protein in Plasmodium falciparum

International audienceGuanine-quadruplexes (G4s) are non-canonical DNA structures that can regulate key biological processes such as transcription, replication and telomere maintenance in several organisms including eukaryotes, prokaryotes and viruses. Recent reports have identified the presence of G4s within the AT-rich genome of Plasmodium falciparum, the protozoan parasite causing malaria. In Plasmodium, potential G4-forming sequences (G4FS) are enriched in the telomeric and sub-telomeric regions of the genome where they are associated with telomere maintenance and recombination events within virulence genes. However, there is a little understanding about the biological role of G4s and G4-binding proteins. Here, we provide the first snapshot of G4-interactome in P. falciparum using DNA pull-down assay followed by LC-MS/MS. Interestingly, we identified ~24 potential G4-binding proteins (G4-BP) that bind to a stable G4FS (AP2_G4). Furthermore, we characterised the role of G-strand binding protein 2 (PfGBP2), a putative telomere-binding protein in P. falciparum. We validated the interaction of PfGBP2 with G4 in vitro as well as in vivo. PfGBP2 is expressed throughout the intra-erythrocytic developmental cycle and is essential for the parasites in the presence of G4-stabilising ligand, pyridostatin. Gene knockout studies showed the role of PfGBP2 in the expression of var genes. Taken together, this study suggests that PfGBP2 is a bona fide G4-binding protein, which is likely to be involved in the regulation of G4-related functions in these malarial parasites. In addition, this study sheds light on this understudied G4 biology in P. falciparum

Geomorphic and geologic controls of geohazards induced by Nepal's 2015 Gorkha earthquake

The Gorkha earthquake (magnitude 7.8) on 25 April 2015 and later aftershocks struck South Asia, killing ~9000 people and damaging a large region. Supported by a large campaign of responsive satellite data acquisitions over the earthquake disaster zone, our team undertook a satellite image survey of the earthquakes' induced geohazards in Nepal and China and an assessment of the geomorphic, tectonic, and lithologic controls on quake-induced landslides. Timely analysis and communication aided response and recovery and informed decision-makers. We mapped 4312 coseismic and postseismic landslides. We also surveyed 491 glacier lakes for earthquake damage but found only nine landslide-impacted lakes and no visible satellite evidence of outbursts. Landslide densities correlate with slope, peak ground acceleration, surface downdrop, and specific metamorphic lithologies and large plutonic intrusions