Evolutionary -Laplacian with convection and reaction under dynamic boundary condition

Möten med palliativa cancerpatienter utgör en del av allmänsjuksköterskans yrkesområde. Osäkerhet som leder till svårigheter att bemöta dessa patienter finns hos sjuksköterskor och sjuksköterskestudenter. Syftet var att undersöka vilka tankar, känslor och prioriteringar som var viktiga för den palliativa cancerpatienten samt vad som utmärkte en god relation till sjuksköterskan. En systematisk litteraturstudie enligt Goodmans sju steg genomfördes modifierat. I resultatet framkommer att patienter känner rädsla för att bli en börda och upplever osäkerhet samt ett kroppsligt förfall. Patienternas prioriteringar handlade om symtomkontroll, bevarandet av värdighet, det dagliga livet samt relationen till anhöriga. Att sjuksköterskan såg och tillgodosåg patientens behov samt hjälpte och skyddade patienten ingav tillit och hopp vilket stärkte relationen och kommunikationen.Encounters with palliative cancer patients are a part of the nursing profession. Uncertainty that leads to difficulties to respond to these patients exists in both nurses and nursing students. The aim was to explore which thoughts, feelings and priorities were important for the palliative cancer patient and features important for a good relationship with the nurse. A systematic literature review after Goodman´s seven steps was carried out with modifications. Emerging in the result was patient´s thoughts about fear of becoming a burden, feelings of insecurity and a bodily decay. Patient´s priorities concerned symptom control, preservation of dignity, daily life and the relationship with relatives. Nurses who saw and met patient´s needs and also helped and protected them gave trust and hope which strengthened the relationship and communication

"I couldn't do this with opposition from my colleagues": A qualitative study of physicians' experiences as clinical tutors

<p>Abstract</p> <p>Background</p> <p>Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors.</p> <p>Methods</p> <p>Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method.</p> <p>Results</p> <p>In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: <it>(a) Pleasure and stimulation</it>. Informants appreciated tutorship and meeting both students and fellow tutors, <it>(b) Disappointment and stagnation</it>. Occasionally, tutors were frustrated and expressed negative feelings, <it>(c) Demands and duty</it>. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, <it>(d) Impact of workplace relations</it>. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and <it>(e) Multitasking difficulties</it>. Combining several duties with those of a tutorship was often reported as difficult.</p> <p>Conclusions</p> <p>It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system.</p

The voices of youth in envisioning positive futures for nature and people

The unpredictable Anthropocene poses the challenge of imagining a radically different, equitable and sustainable world. Looking 100 years ahead is not easy, and especially as millennials, it appears quite bleak. This paper is the outcome of a visioning exercise carried out in a 2-day workshop, attended by 33 young early career professionals under the auspices of IPBES. The process used Nature Futures Framework in an adapted visioning method from the Seeds of Good Anthropocene project. Four groups envisioned more desirable future worlds; where humanity has organised itself, the economy, politics and technology, to achieve improved nature-human well-being. The four visions had differing conceptualisations of this future. However, there were interesting commonalities in their leverage points for transformative change, including an emphasis on community, fundamentally different economic systems based on sharing and technological solutions to foster sustainability and human-nature connectedness. Debates included questioning the possibility of maintaining local biocultural diversity with increased connectivity globally and the prominence of technology for sustainability outcomes. These visions are the first step towards a wider galvanisation of youth visions for a brighter future, which is often missing in the arena where it can be taken seriously, to trigger more transformative pathways towards meeting global goals

Quantum ergodicity for graphs related to interval maps

We prove quantum ergodicity for a family of graphs that are obtained from ergodic one-dimensional maps of an interval using a procedure introduced by Pakonski et al (J. Phys. A, v. 34, 9303-9317 (2001)). As observables we take the L^2 functions on the interval. The proof is based on the periodic orbit expansion of a majorant of the quantum variance. Specifically, given a one-dimensional, Lebesgue-measure-preserving map of an interval, we consider an increasingly refined sequence of partitions of the interval. To this sequence we associate a sequence of graphs, whose directed edges correspond to elements of the partitions and on which the classical dynamics approximates the Perron-Frobenius operator corresponding to the map. We show that, except possibly for subsequences of density 0, the eigenstates of the quantum graphs equidistribute in the limit of large graphs. For a smaller class of observables we also show that the Egorov property, a correspondence between classical and quantum evolution in the semiclassical limit, holds for the quantum graphs in question.Comment: 20 pages, 1 figur

High (but Not Low) Urinary Iodine Excretion Is Predicted by Iodine Excretion Levels from Five Years Ago

Background: It has not been investigated whether there are associations between urinary iodine (UI) excretion measurements some years apart, nor whether such an association remains after adjustment for nutritional habits. The aim of the present study was to investigate the relation between iodine-creatinine ratio (ICR) at two measuring points 5 years apart. Methods: Data from 2,659 individuals from the Study of Health in Pomerania were analyzed. Analysis of covariance and Poisson regressions were used to associate baseline with follow-up ICR. Results: Baseline ICR was associated with follow-up ICR. Particularly, baseline ICR >300 mu g/g was related to an ICR >300 mu g/g at follow-up (relative risk, RR: 2.20; p < 0.001). The association was stronger in males (RR: 2.64; p < 0.001) than in females (RR: 1.64; p = 0.007). In contrast, baseline ICR <100 mu g/g was only associated with an ICR <100 mu g/g at follow-up in males when considering unadjusted ICR. Conclusions: We detected only a weak correlation with respect to low ICR. Studies assessing iodine status in a population should take into account that an individual with a low UI excretion in one measurement is not necessarily permanently iodine deficient. On the other hand, current high ICR could have been predicted by high ICR 5 years ago. Copyright (C) 2011 S. Karger AG, Base

Control and stabilization of waves on 1-d networks

We present some recent results on control and stabilization of waves on 1-d networks.The fine time-evolution of solutions of wave equations on networks and, consequently, their control theoretical properties, depend in a subtle manner on the topology of the network under consideration and also on the number theoretical properties of the lengths of the strings entering in it. Therefore, the overall picture is quite complex.In this paper we summarize some of the existing results on the problem of controllability that, by classical duality arguments in control theory, can be reduced to that of observability of the adjoint uncontrolled system. The problem of observability refers to that of recovering the total energy of solutions by means of measurements made on some internal or external nodes of the network. They lead, by duality, to controllability results guaranteeing that L 2-controls located on those nodes may drive sufficiently smooth solutions to equilibrium at a final time. Most of our results in this context, obtained in collaboration with R. Dáger, refer to the problem of controlling the network from one single external node. It is, to some extent, the most complex situation since, obviously, increasing the number of controllers enhances the controllability properties of the system. Our methods of proof combine sidewise energy estimates (that in the particular case under consideration can be derived by simply applying the classical d'Alembert's formula), Fourier series representations, non-harmonic Fourier analysis, and number theoretical tools.These control results belong to the class of the so-called open-loop control systems.We then discuss the problem of closed-loop control or stabilization by feedback. We present a recent result, obtained in collaboration with J. Valein, showing that the observability results previously derived, regardless of the method of proof employed, can also be recast a posteriori in the context of stabilization, so to derive explicit decay rates (as) for the energy of smooth solutions. The decay rate depends in a very sensitive manner on the topology of the network and the number theoretical properties of the lengths of the strings entering in it.In the end of the article we also present some challenging open problems

Real patient learning integrated in a preclinical block musculoskeletal disorders. Does it make a difference?

Although musculoskeletal disorders are the most common reason for general practitioner visits, training did not keep pace. Implementation of learning from patients with rheumatologic disorders linked together with the teaching of theoretical knowledge in the preclinical medical education might be an important step forward in the improvement of quality of care for these patients. The Leiden Medical School curriculum has implemented two non-obligatory real patient learning (RPL) practicals integrated within the preclinical block musculoskeletal disorders. This study investigates the educational effectiveness of the practicals, the expectations students have of RPL, and students’ satisfaction. Participants’ grades on the end-of-block test served as the test results of the educational effectiveness of the practicals and were compared with those of the non-participants. Qualitative data was collected by means of questionnaires generated by focus groups. The participants in practicals scored significantly higher at the end-of-block test. The expected effects of the contact with real patients concerned positive effects on cognition and skills. ‘Contextualizing of the theory’, ‘better memorizing of clinical pictures’, and ‘understanding of the impact of the disease’ were the most frequently mentioned effects of the practicals. Overall, the participants were (very) enthusiastic about this educational format. The RPL practicals integrated within a preclinical block musculoskeletal disorders are a valuable addition to the Leiden medical curriculum. This relatively limited intervention exhibits a strong effect on students’ performance in tests. Future research should be directed towards the long-term effects of this intervention

Hearing shapes of drums - mathematical and physical aspects of isospectrality

In a celebrated paper '"Can one hear the shape of a drum?"' M. Kac [Amer. Math. Monthly 73, 1 (1966)] asked his famous question about the existence of nonisometric billiards having the same spectrum of the Laplacian. This question was eventually answered positively in 1992 by the construction of noncongruent planar isospectral pairs. This review highlights mathematical and physical aspects of isospectrality.Comment: 42 pages, 60 figure

Rhodococcus Bacteremia in Cancer Patients Is Mostly Catheter Related and Associated with Biofilm Formation

Rhodococcus is an emerging cause of opportunistic infection in immunocompromised patients, most commonly causing cavitary pneumonia. It has rarely been reported as a cause of isolated bacteremia. However, the relationship between bacteremia and central venous catheter is unknown. Between 2002 and 2010, the characteristics and outcomes of seventeen cancer patients with Rhodococcus bacteremia and indwelling central venous catheters were evaluated. Rhodococcus bacteremias were for the most part (94%) central line-associated bloodstream infection (CLABSI). Most of the bacteremia isolates were Rhodococcus equi (82%). Rhodococcus isolates formed heavy microbial biofilm on the surface of polyurethane catheters, which was reduced completely or partially by antimicrobial lock solution. All CLABSI patients had successful response to catheter removal and antimicrobial therapy. Rhodococcus species should be added to the list of biofilm forming organisms in immunocompromised hosts and most of the Rhodococcus bacteremias in cancer patients are central line associated