The globesity trend: exploring the ethical concerns of registered nurses caring for bariatric surgery patients

Obesity is a major global health problem. The comorbidities associated with obesity (for example: diabetes mellitus type 2 and cardiovascular disease) are multisystem and require continual medical management which places a great strain on the healthcare system. Australia is ranked the 5th most obese population in the world and deaths associated with obesity and obesity related illnesses are estimated at 7,200 per year (Medibank, 2010). This lifestyle disease is now the leading cause of premature death in Australia. The obesity epidemic is blamed on changes in the social, economic and physical environment (obesogenic environments) which have influenced people to over-consume high-energy, processed food at the expense of fresh nutritious food. The World Health Organisation (2011) describes poverty and obesity as inextricably linked. As the prevalence of obesity increases globally, so does the demand for bariatric surgery. In Australia, hospital admissions for bariatric surgery increased from 500 in1998 to 17,000 in 2007-2008, at a cost to the public and private sectors of more than $108 million (Australian Institute of Health and Welfare, 2010). Many physicians and bariatric surgeons promote bariatric surgery as a safe procedure which can result in significant weight loss, thereby reducing the co-morbidities associated with obesity and possible premature death. However, there is an array of surgical and anaesthetic complications associated with bariatric surgery which are directly attributable to the fact the patient is obese. The attempt to balance the possible risks and benefits of a relatively new treatment such as bariatric surgery becomes a concern for many nurses. According to an American study by Camden (2009/2010) this benefit versus burden debate may give rise to ethical concerns for nurses involved in the care of bariatric surgery patients. The purpose of this present study is to determine if Australian nurses reflect the same or similar concerns as their US counterparts. This aim of this exploratory qualitative study was to determine if registered nurses expressed any ethical concerns in relation to caring for bariatric surgery patients in the perioperative anaesthetic and recovery room environment. The purposive sample group consisted of nine experienced anaesthetic and recovery room RNs who consented to an interview which was based upon a vignette of a potential bariatric surgery patient. Analysis of data was undertaken with reference to the ethical principles of beneficence, non-maleficence, autonomy, justice, veracity, fidelity and confidentiality. Themes and concepts were identified in relation to these ethical concepts to determine if the participants had any ethical concerns in relation to the bariatric surgical procedures orcaring for the bariatric patients. Results from the data revealed the participants expressed concern in relation to; a perceived lack of informed consent process, the inequity of access to bariatric surgery for the low socio-economic group without private health insurance, the perception of bariatric surgery being used as a “quick fix”, the view there is a lack of psychological preparation and treatment for bariatric surgery patients, perceived education deficits of nurses related to bariatric surgery and associated health care ethics, the cost of this intervention including the financial impact of equipment, the manual handling risks and the stress of providing high acuity care, the balance of benefits to risks of this surgery, obesity stigma and the lack of longitudinal studies into bariatric surgery patient outcomes. Findings of this study have implications for nurse education, nurse retention and patient outcomes. Given the current trends in obesity and the trajectory of bariatric surgery, educators need to include into the nursing curriculum and staff development programs, teaching about bariatric surgery including the serious surgical and anaesthetics risks. Also ethical issues need to be highlighted specifically for this surgical intervention such as informed consent, equity of access and resource allocation given the financial cost to the health care system

Where do graduates Develop their Enterprise Skills? The Value of the Contribution of Higher Education Institutions’ Context

This study investigates the value of the contribution of HEIs’ context in developing graduates enterprise skills. HEIs are under pressure to develop more enterprising graduates, particularly with the increasing numbers of graduates seeking employment and the growing dissatisfaction of employers. This study explores where graduates develop enterprise skills through investigating the impact of HE and employment contexts on their development. The paper draws on a qualitative study in the social constructionist paradigm within the pharmacy context, where interviews were conducted with pharmacy academics and employers. Results show that ability to demonstrate skills in one context does not necessarily mean ability to demonstrate them in another since the development and demonstration of enterprise skills is impacted by the contexts in which they are developed and demonstrated. The study adds value by highlighting the significant role of both HE and employment contexts in developing enterprise skills, while emphasising that these skills become more transferable through exposure to more contexts

Salmonella Phage ST64B Encodes a Member of the SseK/NleB Effector Family

Salmonella enterica is a species of bacteria that is a major cause of enteritis across the globe, while certain serovars cause typhoid, a more serious disease associated with a significant mortality rate. Type III secreted effectors are major contributors to the pathogenesis of Salmonella infections. Genes encoding effectors are acquired via horizontal gene transfer, and a subset are encoded within active phage lysogens. Because the acquisition of effectors is in flux, the complement of effectors possessed by various Salmonella strains frequently differs. By comparing the genome sequences of S. enterica serovar Typhimurium strain SL1344 with LT2, we identified a gene with significant similarity to SseK/NleB type III secreted effector proteins within a phage ST64B lysogen that is absent from LT2. We have named this gene sseK3. SseK3 was co-regulated with the SPI-2 type III secretion system in vitro and inside host cells, and was also injected into infected host cells. While no role for SseK3 in virulence could be identified, a role for the other family members in murine typhoid was found. SseK3 and other phage-encoded effectors were found to have a significant but sparse distribution in the available Salmonella genome sequences, indicating the potential for more uncharacterised effectors to be present in less studied serovars. These phage-encoded effectors may be principle subjects of contemporary selective processes shaping Salmonella-host interactions

Collaboration between Science and Religious Education teachers in Scottish Secondary schools

The article reports on quantitative research that examines: (1) the current practice in collaboration; and (2) potential for collaboration between Science and Religious Education teachers in a large sample of Scottish secondary schools. The authors adopt and adapt three models (conflict; concordat and consonance) to interrogate the relationship between science and religion (and the perceived relation between these two subjects in schools) (Astley and Francis 2010). The findings indicate that there is evidence of limited collaboration and, in a few cases, a dismissive attitude towards collaboration (conflict and concordat and very weak consonance). There is, however, evidence of a genuine aspiration for greater collaboration among many teachers (moving towards a more robust consonance model). The article concludes by discussing a number of key factors that must be realised for this greater collaboration to be enacted

Structural relaxation in a system of dumbbell molecules

The interaction-site-density-fluctuation correlators, the dipole-relaxation functions, and the mean-squared displacements of a system of symmetric dumbbells of fused hard spheres are calculated for two representative elongations of the molecules within the mode-coupling theory for the evolution of glassy dynamics. For large elongations, universal relaxation laws for states near the glass transition are valid for parameters and time intervals similar to the ones found for the hard-sphere system. Rotation-translation coupling leads to an enlarged crossover interval for the mean-squared displacement of the constituent atoms between the end of the von Schweidler regime and the beginning of the diffusion process. For small elongations, the superposition principle for the reorientational $\alpha$-process is violated for parameters and time intervals of interest for data analysis, and there is a strong breaking of the coupling of the $\alpha$-relaxation scale for the diffusion process with that for representative density fluctuations and for dipole reorientations.Comment: 15 pages, 14 figures, Phys. Rev. E in pres

Evaluating the impact of career management skills module and internship programme within a university business school

This study evaluates the impact of an intervention on business school graduates’ employability comprising of a curriculum-based career management skills (CMS) module and an industrial placement year. The study uses data from the destinations of leavers of higher education survey to examine the employability of different groups within the cohort (no intervention, CMS module only and CMS module plus structured work experience). It finds that structured work experience has clear, positive effects on the ability of graduates to secure employment in ‘graduate level’ jobs within six months of graduation. Furthermore, participation in the CMS module also has a clear, positive effect upon the ability of participants to secure employment

Comprehensive behavioral testing in the R6/2 mouse model of Huntington's disease shows no benefit from CoQ10 or minocycline

Previous studies of the effects of coenzyme Q10 and minocycline on mouse models of Huntington's disease have produced conflicting results regarding their efficacy in behavioral tests. Using our recently published best practices for husbandry and testing for mouse models of Huntington's disease, we report that neither coenzyme Q10 nor minocycline had significant beneficial effects on measures of motor function, general health (open field, rotarod, grip strength, rearing-climbing, body weight and survival) in the R6/2 mouse model. The higher doses of minocycline, on the contrary, reduced survival. We were thus unable to confirm the previously reported benefits for these two drugs, and we discuss potential reasons for these discrepancies, such as the effects of husbandry and nutrition

Using Enterprise Education to Prepare Healthcare Professional Graduates for the Real-world

Objectives: Every year, HEIs around the world provide an increasing number of graduates with professional degrees in various areas of healthcare including for example medicine, pharmacy, dentistry and podiatry. In most cases, these graduates will get the opportunity to develop a range of generic transferable skills during their HE. Yet, many of these become self-employed or responsible for managing a business, but are not always exposed to curricula that develop their awareness of the concepts of enterprise and entrepreneurship and their role in developing economies and societies, and, thus, do not have the necessary range of enterprise skills that they will need in the real-world, whether employed or self-employed. This paper investigates the extent to which Enterprise Education (EE) is applied at professional health schools at HEIs to develop graduates’ ‘soft’ and ‘functional’ enterprise skills, and how effective the process of delivering this education is. Prior work: Previous literature mainly deals with the application of EE through business and management schools, rather than professional ones. Yet, there is a call for researching EE and skills with more focus on exploring the methods and objectives of specific disciplines. At the same time, research investigating learning in professional degrees focuses almost entirely on the development of technical skills related to the discipline, without a general perspective on developing a wider range of enterprise skills. Approach: The study draws on a qualitative research study in the pharmacy education context. Personal interviews with pharmacy employers and academics were carried out, and thematic analysis was applied to identify themes and codes. Results: Despite that experiential and interactive learning approaches, which can support the development of graduates’ enterprise skills, are applied quite often at pharmacy schools, the application of these approaches is focused on discipline-related material and, therefore, can only support the development of graduates’ ‘soft’ enterprise skills. However, there appears to be resistance against developing graduates’ ‘functional’ enterprise skills in pharmacy disciplines, especially in light of the lack of awareness of the concept of EE among academics. The study offers some possible opportunities/propositions that could facilitate the development of more enterprising healthcare graduates, while highlighting the importance of raising the awareness of academics in this regard and embedding EE as part of schools’ philosophies. Implication: This study should help professional health schools at HEIs decide more accurately on how to develop their graduates’ ‘soft’ and ‘functional’ enterprise skills, and address the needs of the real-world. Value: This study directs the attention of HEIs to support developing professional graduates who are ready for the real-world, and who can support the growth and success of any organisation whether employed or self-employed

Sleep and recovery in physicians on night call: a longitudinal field study

<p>Abstract</p> <p>Background</p> <p>It is well known that physicians' night-call duty may cause impaired performance and adverse effects on subjective health, but there is limited knowledge about effects on sleep duration and recovery time. In recent years occupational stress and impaired well-being among anaesthesiologists have been frequently reported for in the scientific literature. Given their main focus on handling patients with life-threatening conditions, when on call, one might expect sleep and recovery to be negatively affected by work, especially in this specialist group. The aim of the present study was to examine whether a 16-hour night-call schedule allowed for sufficient recovery in anaesthesiologists compared with other physician specialists handling less life-threatening conditions, when on call.</p> <p>Methods</p> <p>Sleep, monitored by actigraphy and Karolinska Sleep Diary/Sleepiness Scale on one night after daytime work, one night call, the following first and second nights post-call, and a Saturday night, was compared between 15 anaesthesiologists and 17 paediatricians and ear, nose, and throat surgeons.</p> <p>Results</p> <p>Recovery patterns over the days after night call did not differ between groups, but between days. Mean night sleep for all physicians was 3 hours when on call, 7 h both nights post-call and Saturday, and 6 h after daytime work (p < 0.001). Scores for mental fatigue and feeling well rested were poorer post-call, but returned to Sunday morning levels after two nights' sleep.</p> <p>Conclusions</p> <p>Despite considerable sleep loss during work on night call, and unexpectedly short sleep after ordinary day work, the physicians' self-reports indicate full recovery after two nights' sleep. We conclude that these 16-hour night duties were compatible with a short-term recovery in both physician groups, but the limited sleep duration in general still implies a long-term health concern. These results may contribute to the establishment of safe working hours for night-call duty in physicians and other health-care workers.</p

Investigating the prevalence of Salmonella in dogs within the Midlands region of the United Kingdom

Background - The intimate relationship between dogs and their owners has the potential to increase the risk of human exposure to bacterial pathogens. Over the past 40 years, there have been several reports on transmission of salmonellae from dogs to humans. This study therefore aimed to determine the prevalence of Salmonella in the faeces of dogs from the Midlands region of the United Kingdom to assess exposure risk and potential for zoonotic transmission. Results - A total of 436 apparently healthy dogs without diarrhoea from households (n = 126), rescue centres (n = 96), boarding kennels (n = 43), retired greyhound kennels (n = 39) and a pet nutrition facility (n = 132) were investigated for Salmonella shedding. Faecal samples were processed by an enrichment culture based method. The faeces from one dog (0.23 %; 95 % confidence limit 0.006 %, 1.27 %) was positive for Salmonella. The species was S. enterica subspecies arizonae. Conclusion - This study showed that the prevalence of Salmonella from faeces from apparently healthy dogs from a variety of housing conditions is low; however, Salmonella shedding was still identified