Sjuksköterskans roll i det multiprofessionella teamet - en litteraturstudie

Dagens hälso- och sjukvård fordrar en allt mer avancerad vårdform för att kunna tillgodose patienters behov. Det krävs en samverkan mellan professioner och svaret är ett välfungerande multiprofessionellt team som arbetar mot ett gemensamt mål, en personcentrerad och säker vård. Sjuksköterskan har i och med sin kompetens en central roll i det multiprofessionella teamet och ansvarar bland annat för att se till helheten samt föra patientens talan till teamet. Syftet med denna litteraturstudie var att undersöka vad som möjliggör respektive hindrar sjuksköterskan till att ha en tydlig roll i det multiprofessionella teamet. En litteraturstudie gjordes över åtta vetenskapliga artiklar. Resultatet visade att de fyra huvudsakliga faktorerna som möjliggör en tydlig roll för sjuksköterskan i det multiprofessionella teamet är en god kommunikation, en välfungerande organisation, personliga egenskaper och att det finns respekt och förtroende mellan teammedlemmarna. Om dessa faktorer inte finns eller fungerar blir det ett hinder. Det finns ett behov av att förtydliga sjuksköterskans roll i det multiprofessionella teamet vilket kräver ett engagemang som sträcker sig från en organisatorisk nivå till varje enskild individ i teamet

Advancing the Frontier of Peacekeeping Research

The impact of United Nations (UN) peacekeeping on conflict has received a sustained amount of attention in the empirical literature. The advent of new data on UN peacekeeping and new temporal units of analysis have enabled researchers to expand the frontiers of peacekeeping research and undertake a more nuanced examination of peacekeeping effectiveness. In this special section, a series of articles examine how UN peacekeeping affects different types of violence within conflicts and leads to different types of peaceful outcomes. Factors such as the cultural affinity between peacekeepers and local communities, the size of peacekeeping operations and the specific composition of UN forces are shown to be important variables associated with lower levels of casualties and violence and also a higher likelihood of mediation and timely peaceful settlements in civil wars. In the aggregate, these articles suggest that robust peacekeeping is associated with better outcomes in many stages of conflict

Do Child Soldiers Influence UN Peacekeeping?

The use of child soldiers in conflicts has received increasing academic attention in recent years. This article examines post-conflict periods to see whether the use of child soldiers mobilizes United Nations peacekeeping operations (UN PKO) in the aftermath of a conflict. Taking into consideration how child soldiers affect conflict and how important their reintegration is to sustainable peace and post-conflict development, we analyse whether the presence of child soldiers in a civil war increases the likelihood of the presence of a PKO. We argue that the UN deems a conflict with child soldiers as a difficult case for conflict resolution, necessitating a response from the international community. This is in line with our empirical results confirming that the use of child soldiers significantly increases the likelihood of peacekeeping

Particularized protection: UNSC mandates and the protection of civilians in armed conflict

The protection of civilians at risk in armed conflict has, since the late 1990s, become institutionalized at the United Nations (UN), gaining acceptance as a normative rationale for UN peacekeeping. However, the bulk of civilians in need of protection in armed conflict are unlikely to attain it. The article develops an argument on ‘particularized protection’ - particularized in that UN Security Council (SC) mandates are formulated and adjusted over time to direct mission protection to specific subsets of civilian populations, that is, those relevant to the UN itself, the host state, other states, NGOs and the media, leaving most local civilians receiving little effective protection. Particularized protection, we argue, is a result of the institutional dynamics involving actors producing mandates - the UNSC - and those providing protection - peacekeeping missions - whereby mandates are specified to direct mission protection to selected, particularized groups. We demonstrate these dynamics in two cases, Côte d’Ivoire and Somalia

Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead.

Lifestyle factors are responsible for a considerable portion of cancer incidence worldwide, but credible estimates from the World Health Organization and the International Agency for Research on Cancer (IARC) suggest that the fraction of cancers attributable to toxic environmental exposures is between 7% and 19%. To explore the hypothesis that low-dose exposures to mixtures of chemicals in the environment may be combining to contribute to environmental carcinogenesis, we reviewed 11 hallmark phenotypes of cancer, multiple priority target sites for disruption in each area and prototypical chemical disruptors for all targets, this included dose-response characterizations, evidence of low-dose effects and cross-hallmark effects for all targets and chemicals. In total, 85 examples of chemicals were reviewed for actions on key pathways/mechanisms related to carcinogenesis. Only 15% (13/85) were found to have evidence of a dose-response threshold, whereas 59% (50/85) exerted low-dose effects. No dose-response information was found for the remaining 26% (22/85). Our analysis suggests that the cumulative effects of individual (non-carcinogenic) chemicals acting on different pathways, and a variety of related systems, organs, tissues and cells could plausibly conspire to produce carcinogenic synergies. Additional basic research on carcinogenesis and research focused on low-dose effects of chemical mixtures needs to be rigorously pursued before the merits of this hypothesis can be further advanced. However, the structure of the World Health Organization International Programme on Chemical Safety 'Mode of Action' framework should be revisited as it has inherent weaknesses that are not fully aligned with our current understanding of cancer biology

Better peacekeepers, better protection? Troop quality of United Nations peace operations and violence against civilians

Why do similarly sized peacekeeping missions vary in their effectiveness to protect civilians in conflicts? We argue that peace operations with a large share of troops from countries with high-quality militaries are better able to deter violence from state and non-state actors, create buffer zones within conflict areas, can better reach remote locations, and have superior capabilities—including diplomatic pressure by troop contributing countries—to monitor the implementation of peace agreements. These operational advantages enable them to better protect civilians. Combining data from military expenditures of troop contributing countries together with monthly data on the composition of peace operations, we create a proxy indicator for the average troop quality of UN PKOs. Statistical evidence from an extended sample of conflicts in Africa and Asia between 1991 and 2010 supports our argument

do non state armed groups influence each other in attack timing and frequency generating analyzing and comparing empirical data and simulation

Non-State Armed Groups (NSAGs) operate in complex environments, commonly existing as one of the many organizations engaged in one-sided violent attacks against the state and/or the civilian population. When trying to explain the execution and timing of these attacks, most theories look at NSAGs' internal organizational features or how these groups interact with the state or civilian population. In this study, we take a different approach: we use a self-exciting temporal model to ask if the behavior of one NSAG affects the behavior of other groups operating in the same country and if the actions of groups with actual ties (i.e., groups with some recognized relationship) have a larger effect than those with environmental ties (i.e., groups simply operating in the same country). We focus on three cases where multiple NSAGs operated at the same time: Afghanistan, Iraq, and Colombia, from 2001 to 2005. We find mixed results for the notion that the actions of one NSAG influence the actions of others operating in the same conflict. In Iraq and Afghanistan, we find evidence that NSAG actions do influence the timing of attacks by other NSAGs; however, there is no discernible link between NSAG actions and the timing of attacks in Colombia. Nevertheless, we do consistently find that there is no significant difference between the effect that actual or environmental ties could have in these three cases

A communal catalogue reveals Earth's multiscale microbial diversity

Our growing awareness of the microbial world's importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earth's microbial diversity.Peer reviewe

A communal catalogue reveals Earth’s multiscale microbial diversity

Our growing awareness of the microbial world’s importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earth’s microbial diversity

Genome-wide association study identifies 30 Loci Associated with Bipolar Disorder

This paper is dedicated to the memory of Psychiatric Genomics Consortium (PGC) founding member and Bipolar disorder working group co-chair Pamela Sklar. We thank the participants who donated their time, experiences and DNA to this research, and to the clinical and scientific teams that worked with them. We are deeply indebted to the investigators who comprise the PGC. The views expressed are those of the authors and not necessarily those of any funding or regulatory body. Analyses were carried out on the NL Genetic Cluster Computer (http://www.geneticcluster.org ) hosted by SURFsara, and the Mount Sinai high performance computing cluster (http://hpc.mssm.edu).Bipolar disorder is a highly heritable psychiatric disorder. We performed a genome-wide association study including 20,352 cases and 31,358 controls of European descent, with follow-up analysis of 822 variants with P<1x10-4 in an additional 9,412 cases and 137,760 controls. Eight of the 19 variants that were genome-wide significant (GWS, p < 5x10-8) in the discovery GWAS were not GWS in the combined analysis, consistent with small effect sizes and limited power but also with genetic heterogeneity. In the combined analysis 30 loci were GWS including 20 novel loci. The significant loci contain genes encoding ion channels, neurotransmitter transporters and synaptic components. Pathway analysis revealed nine significantly enriched gene-sets including regulation of insulin secretion and endocannabinoid signaling. BDI is strongly genetically correlated with schizophrenia, driven by psychosis, whereas BDII is more strongly correlated with major depressive disorder. These findings address key clinical questions and provide potential new biological mechanisms for BD.This work was funded in part by the Brain and Behavior Research Foundation, Stanley Medical Research Institute, University of Michigan, Pritzker Neuropsychiatric Disorders Research Fund L.L.C., Marriot Foundation and the Mayo Clinic Center for Individualized Medicine, the NIMH Intramural Research Program; Canadian Institutes of Health Research; the UK Maudsley NHS Foundation Trust, NIHR, NRS, MRC, Wellcome Trust; European Research Council; German Ministry for Education and Research, German Research Foundation IZKF of Münster, Deutsche Forschungsgemeinschaft, ImmunoSensation, the Dr. Lisa-Oehler Foundation, University of Bonn; the Swiss National Science Foundation; French Foundation FondaMental and ANR; Spanish Ministerio de Economía, CIBERSAM, Industria y Competitividad, European Regional Development Fund (ERDF), Generalitat de Catalunya, EU Horizon 2020 Research and Innovation Programme; BBMRI-NL; South-East Norway Regional Health Authority and Mrs. Throne-Holst; Swedish Research Council, Stockholm County Council, Söderström Foundation; Lundbeck Foundation, Aarhus University; Australia NHMRC, NSW Ministry of Health, Janette M O'Neil and Betty C Lynch