Online Palliative Care Education in the Skilled Nursing Facility

America’s older adult population is expanding more quickly than any other age group. This is unprecedented in our history, especially in healthcare. The substantial increase in the number of older adults means people will be living longer with co-morbid, chronic medical conditions. As a result, nursing facilities have become an increasingly important setting for skilled nursing care including palliative (PC) and end-of-life (EOL) care for older adults. The need for nurses with PC and EOL knowledge is increasing as the population ages. However, research has shown that many nurses don’t feel equipped to care for these patients. Education on PC and EOL care in nursing schools and in clinical practice has been found to be inadequate as well. The Institute of Medicine in 2014 released key findings and recommendations on EOL care calling for basic competency in PC for all clinicians working with people with advanced serious illness. In addition, they recommended that educational institutions and professional societies should provide training in PC concepts to clinicians throughout their careers. In this one-group posttest only design study, a one hour Online PC Education was developed for nurses in a skilled nursing facility using 8 domains identified as key constructs to the provision of quality PC. Post Online PC Education, an evaluation of the impact on participants’ confidence in decision-making related to PC and acceptability ratings of the Online PC Education were examined. The overall mean score for confidence in decision-making related to PC was M = 91.11 (SD = 6.85). The overall mean score for Acceptability eScale for the Online PC Education was M = 26.55 (SD = 4.06). Both mean scores for confidence level in decision-making and acceptability of Online PC Education were found to be moderately high to very high levels after the completion of the Online PC Education

New treatment options in the management of glioblastoma multiforme: a focus on bevacizumab

Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults and carries the poorest prognosis. Despite recent progress in molecular biology, neuro-imaging and neuro-surgical care, the management of patients with GBM continues to harbor significant challenges. Survival after diagnosis is poor even with the most aggressive approach using multimodality therapy. Although the etiology of malignant gliomas is not known, the dependency of tumor growth on angiogenesis has identified this pathway as a promising therapeutic target. Bevacizumab was the first antiangiogenic therapy approved for use in cancer and received accelerated Food and Drug Administration approval for the treatment of recurrent GBM in 2009, the first new drug for this disease in over a decade. This review describes the rationale behind the treatment of GBM with bevacizumab. The pharmacology, efficacy, safety and tolerability of bevacizumab will also be reviewed

Quality Control in the Production of Offensive Rifles

Import 05/08/2014Diplomová práce se zabývá rozborem současného stavu kontroly jakosti ve výrobě útočných pušek za účelem zvyšování spolehlivosti a přesnosti těchto zbraní. V této práci je uveden popis útočných pušek a rozbor technických požadavků na tyto zbraňové systémy z pohledu zajištění spolehlivosti a přesnosti. Součástí této diplomové práce je samostatný dokument, ve kterém je navržen způsob kontroly součástí, které mají vliv na spolehlivou funkci zbraně. Součástí samostatného dokumentu diplomové práce je i praktické ověření návrhu včetně vyhodnocení. Praktické ověření proběhlo pomocí porovnání závadovosti, srovnáním rozptylového obrazce a změřením funkčního diagramu zbraně.The Issue of this Master Thesis is analysis of the current state of the quality control in production of assault rifles for the purpose of improving the reliability and accuracy of these weapons. This Thesis describes assault rifles and analysis of technical requirements for these weapons systems from the perspective of reliability and accuracy. Part of this Thesis is a separate document, which proposes a method to control of components that affect the reliable operation of weapon. Part of this Separate document is also practical proposal validation, including evaluation. Practical verification was carried out by comparing of failure rates, comparing the scattering pattern and measuring the functional diagram weapons.346 - Katedra obrábění a montáževýborn

Der Alltag von Menschen mit COPD (Chronic Obstructive Pulmonary Disease)

In Europa ist COPD bereits die dritthäufigste Todesursache und die Prävalenz beträgt weltweit betrachtet ca. 5%. Allerdings existieren bisher nur wenige Studien, die sich mit dem subjektiven Erleben der körperlichen, psychischen und sozialen Belastungen der Erkrankten, sowie deren pflegende Angehörigen befassen. Außerdem gibt es bisher wenige Untersuchungen, welche die COPD spezifischen Bewältigungsstrategien der Kranken behandeln. Deshalb wurden für diese Diplomarbeit der derzeitige Wissensstand zu diesem Thema analysiert und die wichtigsten Literaturquellen zusammengefügt. Im ersten Teil setzt sich die Arbeit mit der Krankheitsdefinition, der Diagnose und der Klassifikation auseinander. Weiters werden die Epidemiologie, die Kosten für das Gesundheitssystem und die Risikofaktoren dargestellt. Zudem werden das Management, die Therapiemöglichkeiten, sowie die pneumologische Rehabilitation behandelt. Der zweite Abschnitt befasst sich mit den Stresstheorien, den Belastungen von chronisch Kranken und von pflegenden Familienmitgliedern. Außerdem wird der Krisenbegriff erläutert. Im dritten Teil werden die spezifischen Belastungen von COPD kranken Menschen dargestellt. Dabei wird auf die körperlichen Auswirkungen, nämlich Atemnot, verringerte körperliche Belastbarkeit, Gewichtsverlust und kognitive Beeinträchtigungen, sowie auf die bei Dyspnoe einhergehende Angst, eingegangen. Weiters werden die sozialen und sexuellen Beeinträchtigungen beschrieben. Zudem wird die Problematik der Krankheitsverschlechterungen behandelt. Am Ende des Kapitels werden häufig auftretende Begleiterkrankungen dargelegt. Die letzten zwei Teile der Arbeit befassen sich mit den Belastungen der pflegenden Angehörigen von Menschen mit der chronisch obstruktiven Lungenerkrankung und den spezifischen Bewältigungsstrategien der COPD Kranken. Die Intention dieser Diplomarbeit besteht darin, das Verständnis für Menschen mit der chronisch obstruktiven Lungenerkrankung (COPD) und deren pflegende Angehörigen zu erhöhen. Weiters soll dem Pflegepersonal Wissen über die speziellen Belastungen dieser Lungenkrankheit zur Verfügung gestellt werden, um Anregungen für eine Verbesserung der Pflege zu geben.In Europe COPD is the third leading cause of death and the worldwide prevalence is about 5%. However, at the moment there are only few studies dealing with the subjective experiences of the physical, psychological and social burden of those suffering and their caregivers. There is dearth literature about the specific coping strategies of COPD patients. Therefore, for this thesis, the current state of knowledge on this subject was analyzed and the most important literature was assembled. The first part of the thesis is dealing with the definition of this disease, the diagnosis and the classification. Moreover, the epidemiology, the costs for the health care system and the risk factors will be described. Furthermore, the management of the disease, the therapies and the pulmonary rehabilitation will be presented. The second section describes the theories of stress, the burden of people concerned with chronic diseases and the difficulties of caring family members to cope with it. Thus, the concept of crisis is explained. In the third part, the specific burden of people with COPD is presented. In this case, the physical effects, namely dyspnea, decreased exercise tolerance, weight loss and cognitive impairment, and the anxiety associated with the shortness of breath will be explained. The social and sexual problems will be described. At the end of this chapter the common comorbid diseases are presented. The following part is dealing with the burden of the caregiving people. The last section deals with the COPD-specific coping strategies. The intention of this thesis is to increase the understanding of people with chronic obstructive pulmonary disease (COPD) and their caregivers. Furthermore, knowledge about the special burdens of this lung disease should be provided to the nursing staff, to improve the quality of everyday care

Determination of Requirements for an Assault Rifle

Import 03/08/2012Bakalářská práce se zabývá analýzou bojové činnosti vojáka u různých druhů vojsk za účelem specifikace jeho potřeb na útočnou pušku. Zpracovává návrh dotazníku umožňujícího analýzu požadavků na útočnou pušku dle různých hledisek. V bakalářské práci je navržen způsob provedení a vyhodnocení průzkumu u zvolených skupin vojáků a odborníků. Na základě vyhodnocení provedeného průzkumu formuluje a definuje základní požadavky na moderní útočnou pušku. Součástí bakalářské práce je přehled historického vývoje útočné pušky u vybraných armád.The Bachelor thesis deals with the analysis of combat operations of a soldier acting in different forces, specifying his/her needs of an assault rifle. It elaborates a questionnaire proposal providing an analysis of requirements for an assault rifle in different views. In the Bachelor thesis, there is a facture proposed and survey results at selected groups of soldiers and experts. On the basis of survey results conducted, the thesis formulates and defines basic requirements for a modern assault rifle. Another part of the Bachelor thesis is the historical development review of an assault rifle at selected armies.340 - Katedra výrobních strojů a konstruovánívýborn

PARP1 gene variation and microglial activity on [11C]PBR28 PET in older adults at risk for Alzheimer's disease

Increasing evidence suggests that inflammation is one pathophysio-logical mechanism in Alzheimer's disease (AD). Recent studies have identified an association between the poly (ADP-ribose) polymerase 1 (PARP1) gene and AD. This gene encodes a protein that is involved in many biological functions, including DNA repair and chromatin remodeling, and is a mediator of inflammation. Therefore, we performed a targeted genetic association analysis to investigate the relationship between the PARP1 polymorphisms and brain micro-glial activity as indexed by [11C]PBR28 positron emission tomography (PET). Participants were 26 non-Hispanic Caucasians in the Indiana Memory and Aging Study (IMAS). PET data were intensity-normalized by injected dose/total body weight. Average PBR standardized uptake values (SUV) from 6 bilateral regions of interest (thalamus, frontal, parietal, temporal, and cingulate cortices, and whole brain gray matter) were used as endophenotypes. Single nucleotide polymorphisms (SNPs) with 20% minor allele frequency that were within +/− 20 kb of the PARP1 gene were included in the analyses. Gene-level association analyses were performed using a dominant genetic model with translocator protein (18-kDa) (TSPO) genotype, age at PET scan, and gender as covariates. Analyses were performed with and without APOE ε4 status as a covariate. Associations with PBR SUVs from thalamus and cingulate were significant at corrected p<0.014 and <0.065, respectively. Subsequent multi-marker analysis with cingulate PBR SUV showed that individuals with the “C” allele at rs6677172 and “A” allele at rs61835377 had higher PBR SUV than individuals without these alleles (corrected P<0.03), and individuals with the “G” allele at rs6677172 and “G” allele at rs61835377 displayed the opposite trend (corrected P<0.065). A previous study with the same cohort showed an inverse relationship between PBR SUV and brain atrophy at a follow-up visit, suggesting possible protective effect of microglial activity against cortical atrophy. Interestingly, all 6 AD and 2 of 3 LMCI participants in the current analysis had one or more copies of the “GG” allele combination, associated with lower cingulate PBR SUV, suggesting that this gene variant warrants further investigation

Sagopilone (ZK-EPO, ZK 219477) for recurrent glioblastoma. A phase II multicenter trial by the European Organisation for Research and Treatment of Cancer (EORTC) Brain Tumor Group

Background: Sagopilone (ZK 219477), a lipophylic and synthetic analog of epothilone B, that crosses the blood–brain barrier has demonstrated preclinical activity in glioma models

Heterocyclic scaffolds as promising anticancer agents against tumours of the central nervous system: Exploring the scope of indole and carbazole derivatives

Tumours of the central nervous system are intrinsically more dangerous than tumours at other sites, and in particular, brain tumours are responsible for 3% of cancer deaths in the UK. Despite this, research into new therapies only receives 1% of national cancer research spend. The most common chemotherapies are temozolomide, procarbazine, carmustine, lomustine and vincristine, but because of the rapid development of chemoresistance, these drugs alone simply aren’t sufficient for long-term treatment. Such poor prognosis of brain tumour patients prompted us to research new treatments for malignant glioma, and in doing so, it became apparent that aromatic heterocycles play an important part, especially the indole, carbazole and indolocarbazole scaffolds. This review highlights compounds in development for the treatment of tumours of the central nervous system which are structurally based on the indole, carbazole and indolocarbazole scaffolds, under the expectation that it will highlight new avenues for research for the development of new compounds to treat these devastating neoplasms

The immune response of the human brain to abdominal surgery

ObjectiveSurgery launches a systemic inflammatory reaction that reaches the brain and associates with immune activation and cognitive decline. Although preclinical studies have in part described this systemic-to-brain signaling pathway, we lack information on how these changes appear in humans. This study examines the short- and long-term impact of abdominal surgery on the human brain immune system by positron emission tomography (PET) in relation to blood immune reactivity, plasma inflammatory biomarkers, and cognitive function.MethodsEight males undergoing prostatectomy under general anesthesia were included. Prior to surgery (baseline), at postoperative days 3 to 4, and after 3 months, patients were examined using [11 C]PBR28 brain PET imaging to assess brain immune cell activation. Concurrently, systemic inflammatory biomarkers, ex vivo blood tests on immunoreactivity to lipopolysaccharide (LPS) stimulation, and cognitive function were assessed.ResultsPatients showed a global downregulation of gray matter [11 C]PBR28 binding of 26 ± 26% (mean ± standard deviation) at 3 to 4 days postoperatively compared to baseline (p = 0.023), recovering or even increasing after 3 months. LPS-induced release of the proinflammatory marker tumor necrosis factor-α in blood displayed a reduction (41 ± 39%) on the 3rd to 4th postoperative day, corresponding to changes in [11 C]PBR28 distribution volume. Change in Stroop Color-Word Test performance between postoperative days 3 to 4 and 3 months correlated to change in [11 C]PBR28 binding (p = 0.027).InterpretationThis study translates preclinical data on changes in the brain immune system after surgery to humans, and suggests an interplay between the human brain and the inflammatory response of the peripheral innate immune system. These findings may be related to postsurgical impairments of cognitive function. Ann Neurol 2017;81:572-582