Education and support needs during recovery in acute respiratory distress syndrome survivors

Abstract Introduction There is a limited understanding of the long-term needs of survivors of the acute respiratory distress syndrome (ARDS) as they recover from their episode of critical illness. The Timing it Right (TIR) framework, which emphasizes ARDS survivors' journey from the ICU through to community re-integration, may provide a valuable construct to explore the support needs of ARDS survivors during their recovery. Methods Twenty-five ARDS survivors participated in qualitative interviews examining their needs for educational, emotional and tangible support for each phase of the TIR framework. Transcripts were analyzed using framework methodology. Results ARDS survivors' support needs varied across the illness trajectory. During the ICU stay, survivors were generally too ill to require information. The transfer to the general ward was characterized by anxiety surrounding decreased surveillance and concern for future health and treatment. Information needs focused on the events surrounding the acute illness, while physical and emotional needs revolved around physical therapy and psychological support for depression and anxiety. As patients were preparing for hospital discharge, they expressed a desire for specific information about the recovery and rehabilitation process following an episode of ARDS (e.g., outpatient physiotherapy, long-term sequela of the illness). Once in the community, survivors wanted guidance on home care, secondary prevention, and ARDS support groups. Conclusions Our findings support the need for future educational and support interventions to meet the changing needs of ARDS survivors during their recovery

Kuhn, Bird e a incomensurabilidade naturalizada: sobre a existência de hábitos cognitivos incomensuráveis

O objetivo deste artigo é o de apresentar a proposta de Alexander Bird de estabelecer um programa de pesquisa naturalista acerca da tese kuhniana de incomensurabilidade. Essa proposta representa um novo e importante desdobramento do debate filosófico sobre o tema e está embasada em várias pesquisas realizadas no domínio das ciências cognitivas. Em síntese, Bird defende que a incomensurabilidade pode ser concebida como um fenômeno psicológico que pode ser explicado através de hábitos cognitivos incompatíveis, que chama de Capacidades Cognitivas Quase-Intuitivas (QICC’s). De acordo com o autor, sua abordagem representa a retomada da abordagem naturalista sobre o fenômeno da incomensurabilidade que foi assumida pelo próprio Thomas Kuhn em The Structure of Scientific Revolutions (1962) e que, contudo, foi abandonada em seus trabalhos posteriores. Após a Introdução, apresento a tese da incomensurabilidade proposta por Kuhn em 1962 e as principais modificações nessa tese feitas nas três décadas seguintes, passando, na terceira seção do texto, ao projeto de uma incomensurabilidade naturalizada de Alexander Bird. Por fim, concluo o artigo com alguns comentários sobre esse projeto e sobre alguns possíveis desenvolvimentos que a pesquisa pode tomar

Kuhn, Bird e a incomensurabilidade naturalizada: sobre a existência de hábitos cognitivos incomensuráveis

O objetivo deste artigo é o de apresentar a proposta de Alexander Bird de estabelecer um programa de pesquisa naturalista acerca da tese kuhniana de incomensurabilidade. Essa proposta representa um novo e importante desdobramento do debate filosófico sobre o tema e está embasada em várias pesquisas realizadas no domínio das ciências cognitivas. Em síntese, Bird defende que a incomensurabilidade pode ser concebida como um fenômeno psicológico que pode ser explicado através de hábitos cognitivos incompatíveis, que chama de Capacidades Cognitivas Quase-Intuitivas (QICC’s). De acordo com o autor, sua abordagem representa a retomada da abordagem naturalista sobre o fenômeno da incomensurabilidade que foi assumida pelo próprio Thomas Kuhn em The Structure of Scientific Revolutions (1962) e que, contudo, foi abandonada em seus trabalhos posteriores. Após a Introdução, apresento a tese da incomensurabilidade proposta por Kuhn em 1962 e as principais modificações nessa tese feitas nas três décadas seguintes, passando, na terceira seção do texto, ao projeto de uma incomensurabilidade naturalizada de Alexander Bird. Por fim, concluo o artigo com alguns comentários sobre esse projeto e sobre alguns possíveis desenvolvimentos que a pesquisa pode tomar

Comparative Study Of Planned And Unplanned Excisions For The Treatment Of Soft Tissue Sarcoma Of The Extremities.

Unplanned excision of soft tissue sarcomas is common because benign soft tissue lesions are very frequent. This study evaluated the impact of unplanned resections on overall survival, local recurrence and distant metastasis in patients with soft tissue sarcomas of the extremities. In total, 52 patients who were diagnosed with soft tissue sarcomas between May 2001 and March 2011 were analyzed in a retrospective study. Of these patients, 29 (55.8%) had not undergone previous treatment and the remaining 23 (44.2%) patients had undergone prior resection of the tumor without oncological planning. All subsequent surgical procedures were performed at the same cancer referral center. The follow-up ranged from 6 to 122 months, with a mean of 39.89 months. Age, lesion size and depth, histological grade, surgical margins, overall survival, local and distant recurrence and adjuvant therapies were compared. Residual disease was observed in 91.3% of the re-resected specimens in the unplanned excision group, which exhibited greater numbers of superficial lesions, low histological grades and contaminated surgical margins compared with the re-resected specimens in the planned excision group. No differences were observed in local recurrence and 5-year overall survival between the groups, but distant metastases were significantly associated with planned excision after adjustment for the variables. There was no difference between patients undergoing unplanned excision and planned excision regarding local recurrence and overall survival. The planned excision group had a higher risk of distant metastasis, whereas there was a high rate of residual cancer in the unplanned excision group.69579-8

Gravitomagnetism and the Clock Effect

The main theoretical aspects of gravitomagnetism are reviewed. It is shown that the gravitomagnetic precession of a gyroscope is intimately connected with the special temporal structure around a rotating mass that is revealed by the gravitomagnetic clock effect. This remarkable effect, which involves the difference in the proper periods of a standard clock in prograde and retrograde circular geodesic orbits around a rotating mass, is discussed in detail. The implications of this effect for the notion of ``inertial dragging'' in the general theory of relativity are presented. The theory of the clock effect is developed within the PPN framework and the possibility of measuring it via spaceborne clocks is examined.Comment: 27 pages, LaTeX, submitted to Proc. Bad Honnef Meeting on: GYROS, CLOCKS, AND INTERFEROMETERS: TESTING GENERAL RELATIVITY IN SPACE (22 - 27 August 1999; Bad Honnef, Germany

Cysteine oxidation targets peroxiredoxins 1 and 2 for exosomal release through a novel mechanism of redox-dependent secretion

Non-classical protein secretion is of major importance as a number of cytokines and inflammatory mediators are secreted via this route. Current evidence indicates that there are several mechanistically distinct methods of non-classical secretion. We have recently shown that peroxiredoxin (Prdx) 1 and Prdx2 are released by various cells upon exposure to inflammatory stimuli such as LPS or TNF-α. The released Prdx then acts to induce production of inflammatory cytokines. However, Prdx1 and 2 do not have signal peptides and therefore must be secreted by alternative mechanisms as has been postulated for the inflammatory mediators IL-1β and HMGB1. We show here that circulating Prdx1 and 2 are present exclusively as disulphide-linked homodimers. Inflammatory stimuli also induce in vitro release of Prdx1 and 2 as disulfide-linked homodimers. Mutation of cysteines Cys51 or Cys172 (but not Cys70) in Prdx2, and Cys52 or Cys173 (but not Cys71 or Cys83) in Prdx1 prevented dimer formation and this was associated with inhibition of their TNF-α-induced release. Thus, the presence and oxidation of key cysteine residues in these proteins are a prerequisite for their secretion in response to TNF-α and this release can be induced with an oxidant. In contrast, the secretion of the nuclear-associated danger signal HMGB1 is independent of cysteine oxidation, as shown by experiments with a cysteine-free HMGB1 mutant. Release of Prdx1 and 2 is not prevented by inhibitors of the classical secretory pathway; instead, both Prdx1 and 2 are released in exosomes from both HEK cells and monocytic cells. Serum Prdx1 and 2 are also associated with the exosomes. These results describe a novel pathway of protein secretion mediated by cysteine oxidation that underlines the importance of redox-dependent signalling mechanisms in inflammation

Gravito-electromagnetic analogies

We reexamine and further develop different gravito-electromagnetic (GEM) analogies found in the literature, and clarify the connection between them. Special emphasis is placed in two exact physical analogies: the analogy based on inertial fields from the so-called "1+3 formalism", and the analogy based on tidal tensors. Both are reformulated, extended and generalized. We write in both formalisms the Maxwell and the full exact Einstein field equations with sources, plus the algebraic Bianchi identities, which are cast as the source-free equations for the gravitational field. New results within each approach are unveiled. The well known analogy between linearized gravity and electromagnetism in Lorentz frames is obtained as a limiting case of the exact ones. The formal analogies between the Maxwell and Weyl tensors are also discussed, and, together with insight from the other approaches, used to physically interpret gravitational radiation. The precise conditions under which a similarity between gravity and electromagnetism occurs are discussed, and we conclude by summarizing the main outcome of each approach.Comment: 60 pages, 2 figures. Improved version (compared to v2) with some re-write, notation improvements and a new figure that match the published version; expanded compared to the published version to include Secs. 2.3 and

Evidence of protective effects of recombinant ADAMTS13 in a humanized model of sickle cell disease

Sickle cell disease (SCD) is an inherited red blood cell disorder that occurs worldwide. Acute vaso-occlusive crisis is the main cause of hospitalization in patients with SCD. There is growing evidence that inflammatory vasculopathy plays a key role in both acute and chronic SCD-related clinical manifestations. In a humanized mouse model of SCD, we found an increase of von Willebrand factor activity and a reduction in the ratio of a disintegrin and metalloproteinase with thrombospondin type 1 motif, number 13 (ADAMTS13) to von Willebrand factor activity similar to that observed in the human counterpart. Recombinant ADAMTS13 was administered to humanized SCD mice before they were subjected to hypoxia/reoxygenation (H/R) stress as a model of vaso-occlusive crisis. In SCD mice, recombinant ADAMTS13 reduced H/R-induced hemolysis and systemic and local inflammation in lungs and kidneys. It also diminished H/R-induced worsening of inflammatory vasculopathy, reducing local nitric oxidase synthase expression. Collectively, our data provide for the firsttime evidence that pharmacological treatment with recombinant ADAMTS13 (TAK-755) diminished H/R-induced sickle cell-related organ damage. Thus, recombinant ADAMTS13 might be considered as a potential effective disease-modifying treatment option for sickle cell-related acute events

Line Defects in Molybdenum Disulfide Layers

Layered molecular materials and especially MoS2 are already accepted as promising candidates for nanoelectronics. In contrast to the bulk material, the observed electron mobility in single-layer MoS2 is unexpectedly low. Here we reveal the occurrence of intrinsic defects in MoS2 layers, known as inversion domains, where the layer changes its direction through a line defect. The line defects are observed experimentally by atomic resolution TEM. The structures were modeled and the stability and electronic properties of the defects were calculated using quantum-mechanical calculations based on the Density-Functional Tight-Binding method. The results of these calculations indicate the occurrence of new states within the band gap of the semiconducting MoS2. The most stable non-stoichiometric defect structures are observed experimentally, one of which contains metallic Mo-Mo bonds and another one bridging S atoms