609 research outputs found

    Utilizing TIGER Competencies to Improve Informatics Practice

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    Nursing Informatics (NI) is quickly becoming an essential part of nursing. From the classroom, to the bedside, and to the boardroom, nurses across the nursing continuum are expected to use NI in their practice with the hopes of delivering better quality care to their patients. However, the training and education of NI provided to all levels of nurses is unable to keep up with the pace of technology. This project seeks to improve the NI competency of the nursing workforce at a pediatric hospital through an educational course using NI competencies identified by the Technology Informatics Guiding Educational Reform (TIGER) Initiative (2009). The value of this project is that it addresses the gap in NI education and competencies at a 265-bed pediatric hospital and creates a NI curriculum that is relevant, timely, and teaches nurses the essential skills to use NI to provide quality care and become a driver of patient quality outcomes

    Rules-based international order and US Indo-Pacific strategy: what does it mean for China's BRI?

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    The third decade of the 21st century has witnessed more tensions, instabilities, and new alliances in the Indo-Pacific/Asia-Pacific region due to intensifying rivalry and strategic competition between the US Indo-Pacific Strategy (IPS) and China's Belt and Road Initiative (BRI), two grand strategies of the US and China respectively. This article aims to assess the Rules-Based International Order (RBIO) and comprehend Biden's IPS, particularly exploring how the Indo-Pacific Economic Framework (IPEF) may impact China's BRI. This paper argues that RBIO is debatable and not universal. It is also argued that while the IPEF unveiled by President Biden represents a strategically important step forward, a long-term US genuine commitment to its implementation to counter China's BRI is essential. The methodology of this research is primarily based on secondary literature and official documents. This study concludes that although China is reluctant to pay too much attention to the US IPEF in its official statements, China is concerned about this economic initiative. The paper also concludes that because of the intense US-China rivalry, new alliances will emerge in the region leading to a new cold war or new world order

    Synergistic activity of mobile genetic element defences in Streptococcus pneumoniae

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    A diverse set of mobile genetic elements (MGEs) transmit between Streptococcus pneumoniae cells, but many isolates remain uninfected. The best-characterised defences against horizontal transmission of MGEs are restriction-modification systems (RMSs), of which there are two phase-variable examples in S. pneumoniae. Additionally, the transformation machinery has been proposed to limit vertical transmission of chromosomally integrated MGEs. This work describes how these mechanisms can act in concert. Experimental data demonstrate RMS phase variation occurs at a sub-maximal rate. Simulations suggest this may be optimal if MGEs are sometimes vertically inherited, as it reduces the probability that an infected cell will switch between RMS variants while the MGE is invading the population, and thereby undermine the restriction barrier. Such vertically inherited MGEs can be deleted by transformation. The lack of between-strain transformation hotspots at known prophage att sites suggests transformation cannot remove an MGE from a strain in which it is fixed. However, simulations confirmed that transformation was nevertheless effective at preventing the spread of MGEs into a previously uninfected cell population, if a recombination barrier existed between co-colonising strains. Further simulations combining these effects of phase variable RMSs and transformation found they synergistically inhibited MGEs spreading, through limiting both vertical and horizontal transmission

    Survival and Synapse Formation of Transplanted Rat Rods

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    Isolated rods enzymatically removed from normal adult rat retina have been transplanted to the subretinal space of adult rats with a retinal dystrophy winich has destroyed almost all the photoreceptors. These transplanted rods survive for months after transplantation during which time they form synapses with other retinal cells. Rod spherules with large amounts of synaptic vesicles and synaptic ribbons are found forming discreet contacts with pre- and postsynaptic densities in arrangements closely resembling those seen in the normal retina

    Stereotactic body radiotherapy for moderately central and ultra-central oligometastatic disease: initial outcomes

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    Background: Delivery of SBRT to central thoracic tumours within 2 cm of the proximal bronchial tree (PBT), and especially ultra-central tumours which directly abut the PBT, has been controversial due to concerns about high risk of toxicity and treatment-related death when delivering high doses close to critical mediastinal structures. We present dosimetric and clinical outcomes from a group of oligometastatic patients treated with a risk-adapted SBRT approach. Methods: Between September 2015 and October 2018, 27 patients with 28 central thoracic oligometastases (6 moderately central, 22 ultra-central) were treated with 60 Gy in 8 fractions under online CBCT guidance. PTV dose was compromised where necessary to meet mandatory OAR constraints. Patients were followed up for toxicity and disease status. Results: Mandatory OAR constraints were met in all cases; this required PTV coverage compromise in 23 cases, with V100% reduced to <70% in 11 cases. No acute or late toxicities of Grade ≥ 3 were reported. One and 2 year in-field control rates were 95.2% and 85.7% respectively, progression-free survival rates were 42.8% and 23.4% respectively, and overall survival rates were 82.7% and 69.5% respectively. No significant differences were seen in control or survival rates by extent of PTV underdosage or between moderately and ultra-central cases. Conclusion: It appears that compromising PTV coverage to meet OAR constraints allows safe and effective delivery of SBRT to moderately and ultra-central tumours, with low toxicity rates and high in-field control rates. This treatment can be delivered on standard linear accelerators with widely available imaging technology

    Modeling the interrelating effects of plastic deformation and stress on magnetic properties of materials

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    A model has been developed that describes the interrelating effects of plastic deformation and applied stress on hysteresis loops based on the theory of ferromagnetichysteresis. In the current model the strength of pinning sites for domain walls is characterized by the pinning coefficient keff given by keff=k0+k′σ. The term k0 depicts pinning of domain walls by dislocations and is proportional to ρn, where ρ is the number density of dislocation which is related to the amount of plastic strain, and the exponent n depends on the strength of pinning sites. The second term k′σ∝−3/2λs/2mσ, where m is magnetization and λs is magnetostriction constant, describes the changes in pinning strength on a domain wall induced by an applied stress σ. The model was capable of reproducing the stress dependence of hysteresis loop properties such as coercivity and remanence of a series of nickel samples which were pre-strained to various plastic strain levels. An empirical relation was found between the parameter k0 and the plastic strain, which can be interpreted in terms of the effects on the strength of domain wall pinning of changes in dislocation density and substructure under plastic deformation

    Expression profiling identifies genes involved in emphysema severity

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    Chronic obstructive pulmonary disease (COPD) is a major public health problem. The aim of this study was to identify genes involved in emphysema severity in COPD patients

    The frontline antibiotic vancomycin induces a zinc starvation response in bacteria by binding to Zn(II).

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    Vancomycin is a front-line antibiotic used for the treatment of nosocomial infections, particularly those caused by methicillin-resistant Staphylococcus aureus. Despite its clinical importance the global effects of vancomycin exposure on bacterial physiology are poorly understood. In a previous transcriptomic analysis we identified a number of Zur regulon genes which were highly but transiently up-regulated by vancomycin in Streptomyces coelicolor. Here, we show that vancomycin also induces similar zinc homeostasis systems in a range of other bacteria and demonstrate that vancomycin binds to Zn(II) in vitro. This implies that vancomycin treatment sequesters zinc from bacterial cells thereby triggering a Zur-dependent zinc starvation response. The Kd value of the binding between vancomycin and Zn(II) was calculated using a novel fluorometric assay, and NMR was used to identify the binding site. These findings highlight a new biologically relevant aspect of the chemical property of vancomycin as a zinc chelator.This work was supported by funding from the Royal Society, UK (516002.K5877/ROG), the Medical Research Council, UK (G0700141). A.Z. was supported from the Said foundation and Cambridge Trust.This is the final version of the article. It first appeared from Nature Publishing Group via http://dx.doi.org/10.1038/srep1960

    Primary thoracic cancers incidentally detected on CT attenuation correction images during myocardial perfusion scintigraphy

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    Low-dose, non-breath-holding computed tomography (CT) images of a significant portion of the thorax can be used to provide CT attenuation correction (CTAC) in myocardial perfusion scintigraphy, enhancing the accuracy of evaluation for myocardial ischaemia.Incidental findings of potential clinical significance, most commonly pulmonary nodules, are seen on the CTAC images in a considerable number of cases and may represent undiagnosed malignancy.Early detection allowed curative surgical treatment to be undertaken in 40% of cases, with no recurrence or metastasis at 1 year in these patients. The nature and location within the thorax of the incidental low-dose CT findings, which represented undiagnosed malignancy, was varied.Review of CTAC images in MPI for incidental lesions and reporting of any suspicious findings should be mandatory given the ability to detect undiagnosed malignancy and potentially improve patient outcomes.Direct communication of suspicious incidental findings between the nuclear medicine physicians and referring doctors at time of reporting may help to reduce the interval between MPI and definitive diagnosis. The position would be further strengthened if reinforced in the guidelines of the major nuclear medicine associations. (C) 2018 Elsevier Inc. All rights reserved
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