How Nurses Balance Risk with Patient Autonomy When Making Decisions about Physical Restraint Use with Older Patients in Acute Care

The use of physical restraints to reduce falls within the older adult population in acute care hospital settings, are regarded as an integral part of risk management and prevention of patient harm (Bigwood & Crowe, 2008). Although literature indicates that nurses apply physical restraints to prevent injuries from a fall, there appears to be no robust evidence that links this intervention to injury prevention (Oliver, Healey, & Haines, 2010). Adding to this, decision-making around physical restraint use is a complex process and is influenced by different contextual factors (Dierckx de Casterle, Goethals, & Gastmans, 2015). The purpose of this interpretive descriptive study was to further understand how nurses balance risk with patient autonomy when making decisions about physical restraint use for falls prevention, and to provide a deeper understanding of risk and patient autonomy that are applicable and meaningful to everyday nursing practice. Perceptions related to nurses’ experience with balancing risk with patient autonomy were elicited through individual interviews with seven participants and one focus group session made up of five additional participants. The results of this research study provides insight into factors that influence the nurses’ decision-making process about whether or not to apply physical restraints

Surface decoration of catanionic vesicles with superparamagnetic iron oxide nanoparticles: a model system for triggered release under moderate temperature conditions

International audienceWe report the design of new catanionic vesicles decorated with iron oxide nanoparticles, which could be used as a model system to illustrate controlled delivery of small solutes under mild hyperthermia. Efficient release of fluorescent dye rhodamine 6G was observed when samples were exposed to an oscillating magnetic field. Our system provides direct evidence for reversible permeability upon magnetic stimulation

When Military Fitness Standards No Longer Apply: The High Prevalence of Metabolic Syndrome in Recent Air Force Retirees

BACKGROUND: Metabolic syndrome (MetS) is strongly associated with cardiovascular disease. With MetS prevalence rates increasing in the U.S. population, prevention efforts have largely focused on diet and exercise interventions. Before retirement, military service members have met fitness requirements for at least 20 years, and have lower MetS rates compared to age-matched U.S. population controls (23.4% vs. 39.0%), which suggests a protective effect of the lifestyle associated with military service. However, MetS rates in military retirees have not been previously reported, so it is unknown whether this protective effect extends beyond military service. The purpose of this study was to examine the prevalence of MetS and individual diagnostic criteria in a population of recent U.S. Air Force (USAF) retirees. METHODS: We obtained institutional review board approval for all participating sites at Wilford Hall Ambulatory Surgical Center. From December 2011 to May 2013, USAF retirees within 8 years of their date of retirement were recruited at five USAF bases. Consenting subjects underwent examination and laboratory studies to assess the five diagnostic criteria measures for MetS. We used binary logistic regression to examine the relationship between various factors and the presence of MetS. RESULTS: The study population (n = 381) was primarily male (81.9%), enlisted (71.1%) and had a mean age of 48.2 years. When applying the American Heart Association MetS diagnostic criteria to this population, the MetS prevalence was 37.2%. When using alternative diagnostic criteria found in other published studies that did not include the use of cholesterol medications, the MetS prevalence was 33.6%. Per American Heart Association criteria, the prevalence of each of the MetS diagnostic criteria was as follows: central obesity, 39.8%; elevated fasting glucose, 32.4%; high blood pressure, 56.8%; low-high-density lipoproteins cholesterol, 33.3%; and elevated triglycerides, 42.7%. MetS was more common among males (odds ratio [OR] = 4.05; confidence interval [CI] = 1.94, 8.48) and enlisted (OR = 2.23; CI = 1.24, 4.01). It was also strongly associated with a history of participating in the Air Force Weight Management Program (OR = 2.82; CI = 1.41, 5.63) and increased weight since retirement (OR = 4.00; CI = 1.84, 8.70). However, the study did not find an association between the presence of MetS and time since retirement or self-reported diet and exercise changes since retirement. CONCLUSIONS: The MetS prevalence among recent USAF retirees represents a shift from age-matched active duty rates toward higher rates described in the overall U.S. POPULATION: This finding suggests the protective health effects of fitness standards may be reduced shortly after retirement. This is true despite activities such as screening before and during military service and exposure to USAF health promotion efforts and fitness standards throughout a period of active duty service lasting at least 20 years. In general, military members should be counseled that on retirement, efforts to maintain a healthy weight have continued benefit and should not be forgotten. The risk of MetS after retirement is particularly increased for those identified as being overweight during their active duty careers. Interventions that prevent and reduce unhealthy weight gain may be an appropriate investment of resources and should be studied further

Nonuniform Neutron-Rich Matter and Coherent Neutrino Scattering

Nonuniform neutron-rich matter present in both core-collapse supernovae and neutron-star crusts is described in terms of a semiclassical model that reproduces nuclear-matter properties and includes long-range Coulomb interactions. The neutron-neutron correlation function and the corresponding static structure factor are calculated from molecular dynamics simulations involving 40,000 to 100,000 nucleons. The static structure factor describes coherent neutrino scattering which is expected to dominate the neutrino opacity. At low momentum transfers the static structure factor is found to be small because of ion screening. In contrast, at intermediate momentum transfers the static structure factor displays a large peak due to coherent scattering from all the neutrons in a cluster. This peak moves to higher momentum transfers and decreases in amplitude as the density increases. A large static structure factor at zero momentum transfer, indicative of large density fluctuations during a first-order phase transition, may increase the neutrino opacity. However, no evidence of such an increase has been found. Therefore, it is unlikely that the system undergoes a simple first-order phase transition. It is found that corrections to the commonly used single heavy nucleus approximation first appear at a density of the order of $10^{13}$ g/cm$^3$ and increase rapidly with increasing density. Thus, neutrino opacities are overestimated in the single heavy nucleus approximation relative to the complete molecular dynamics simulations.Comment: 17 pages, 23 included ps figure

Love is the triumph of the imagination: daydreams about significant others are associated with increased happiness, love and connection

Social relationships and interactions contribute to daily emotional well-being. The emotional benefits that come from engaging with others are known to arise from real events, but do they also come from the imagination during daydreaming activity? Using experience sampling methodology with 101 participants, we obtained 371 reports of naturally occurring daydreams with social and non-social content and self-reported feelings before and after daydreaming. Social, but not non-social, daydreams were associated with increased happiness, love and connection and this effect was not solely attributable to the emotional content of the daydreams. These effects were only present when participants were lacking in these feelings before daydreaming and when the daydream involved imagining others with whom the daydreamer had a high quality relationship. Findings are consistent with the idea that social daydreams may function to regulate emotion: imagining close others may serve the current emotional needs of daydreamers by increasing positive feelings towards themselves and others

Structure and Magnetism of well-defined cobalt nanoparticles embedded in a niobium matrix

Our recent studies on Co-clusters embedded in various matrices reveal that the co-deposition technique (simultaneous deposition of two beams : one for the pre-formed clusters and one for the matrix atoms) is a powerful tool to prepare magnetic nanostructures with any couple of materials even though they are miscible. We study, both sharply related, structure and magnetism of the Co/Nb system. Because such a heterogeneous system needs to be described at different scales, we used microscopic and macroscopic techniques but also local selective absorption ones. We conclude that our clusters are 3 nm diameter f.c.c truncated octahedrons with a pure cobalt core and a solid solution between Co and Nb located at the interface which could be responsible for the magnetically inactive monolayers we found. The use of a very diluted Co/Nb film, further lithographed, would allow us to achieve a pattern of microsquid devices in view to study the magnetic dynamics of a single-Co cluster.Comment: 7 TeX pages, 9 Postscript figures, detailed heading adde

How to Obtain NNT from Cohen's d: Comparison of Two Methods

Background: In the literature we find many indices of size of treatment effect (effect size: ES). The preferred index of treatment effect in evidence-based medicine is the number needed to treat (NNT), while the most common one in the medical literature is Cohen’s d when the outcome is continuous. There is confusion about how to convert Cohen’s d into NNT. Methods: We conducted meta-analyses of individual patient data from 10 randomized controlled trials of second generation antipsychotics for schizophrenia (n = 4278) to produce Cohen’s d and NNTs for various definitions of response, using cutoffs of 10 % through 90 % reduction on the symptom severity scale. These actual NNTs were compared with NNTs calculated from Cohen’s d according to two proposed methods in the literature (Kraemer, et al., Biological Psychiatry, 2006; Furukawa, Lancet, 1999). Results: NNTs from Kraemer’s method overlapped with the actual NNTs in 56%, while those based on Furukawa’s method fell within the observed ranges of NNTs in 97 % of the examined instances. For various definitions of response corresponding with 10 % through 70 % symptom reduction where we observed a non-small number of responders, the degree of agreement for the former method was at a chance level (ANOVA ICC of 0.12, p = 0.22) but that for the latter method was ANOVA ICC of 0.86 (95%CI: 0.55 to 0.95, p,0.01)

Protein Kinase C Iota Regulates Pancreatic Acinar-to-Ductal Metaplasia

Pancreatic acinar-to-ductal metaplasia (ADM) is associated with an increased risk of pancreatic cancer and is considered a precursor of pancreatic ductal adenocarcinoma. Transgenic expression of transforming growth factor alpha (TGF-α) or K-rasG12D in mouse pancreatic epithelium induces ADM in vivo. Protein kinase C iota (PKCι) is highly expressed in human pancreatic cancer and is required for the transformed growth and tumorigenesis of pancreatic cancer cells. In this study, PKCι expression was assessed in a mouse model of K-rasG12D-induced pancreatic ADM and pancreatic cancer. The ability of K-rasG12D to induce pancreatic ADM in explant culture, and the requirement for PKCι, was investigated. PKCι is elevated in human and mouse pancreatic ADM and intraepithelial neoplastic lesions in vivo. We demonstrate that K-rasG12D is sufficient to induce pancreatic ADM in explant culture, exhibiting many of the same morphologic and biochemical alterations observed in TGF-α-induced ADM, including a dependence on Notch activation. PKCι is highly expressed in both TGF-α- and K-rasG12D-induced pancreatic ADM and inhibition of PKCι significantly reduces TGF-α- and K-rasG12D-mediated ADM. Inhibition of PKCι suppresses K-rasG12D–induced MMP-7 expression and Notch activation, and exogenous MMP-7 restores K-rasG12D–mediated ADM in PKCι-depleted cells, implicating a K-rasG12D-PKCι-MMP-7 signaling axis that likely induces ADM through Notch activation. Our results indicate that PKCι is an early marker of pancreatic neoplasia and suggest that PKCι is a potential downstream target of K-rasG12D in pancreatic ductal metaplasia in vivo

Comparative study of in situ N2 rotational Raman spectroscopy methods for probing energy thermalisation processes during spin-exchange optical pumping

Spin-exchange optical pumping (SEOP) has been widely used to produce enhancements in nuclear spin polarisation for hyperpolarised noble gases. However, some key fundamental physical processes underlying SEOP remain poorly understood, particularly in regards to how pump laser energy absorbed during SEOP is thermalised, distributed and dissipated. This study uses in situ ultra-low frequency Raman spectroscopy to probe rotational temperatures of nitrogen buffer gas during optical pumping under conditions of high resonant laser flux and binary Xe/N2 gas mixtures. We compare two methods of collecting the Raman scattering signal from the SEOP cell: a conventional orthogonal arrangement combining intrinsic spatial filtering with the utilisation of the internal baffles of the Raman spectrometer, eliminating probe laser light and Rayleigh scattering, versus a new in-line modular design that uses ultra-narrowband notch filters to remove such unwanted contributions. We report a ~23-fold improvement in detection sensitivity using the in-line module, which leads to faster data acquisition and more accurate real-time monitoring of energy transport processes during optical pumping. The utility of this approach is demonstrated via measurements of the local internal gas temperature (which can greatly exceed the externally measured temperature) as a function of incident laser power and position within the cell