95 research outputs found

    Education on Fall Prevention to Improve Self-Efficacy of Nursing Staff in Long Term Care: a Pilot Study

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    Purpose: Fall prevention is an ongoing concern in long-term care. Self-efficacy of nursing staff affects their performance levels related to fall prevention. Research concerning falls in the elderly is plentiful but there are no published studies addressing self-efficacy of nursing staff for implementation of fall prevention strategies in long-term care. The authors hypothesize that fall prevention education by an occupational therapist would be effective to improve the self-efficacy of nursing staff for implementation of fall prevention strategies and self-efficacy to prevent resident falls. Method: A pre-test post-test pilot study implementing a five-week, multifaceted, fall prevention education course was conducted by an occupational therapist. The SEPF-A and SEPF-N were administered to the nursing staff respective of their professional licensure to assess falls self-efficacy before and after the course. Results: Eight participants (6 certified nursing assistants & 2 nurses) completed the course. A statistically significant improvement (p = .043, a = .05) in falls self-efficacy was noted for the nursing assistants. Following training, there was a 40% increase in the SEPF-A and a 67% increase in the SEPF-N indicating an improvement in self-efficacy related to falls. Conclusion: Fall prevention training by a licensed expert may be an effective approach to increase self-efficacy of nursing staff for implementation of fall prevention strategies and for prevention of resident falls in long-term care

    Use of the KAWA Model for Teambuilding with Rehabilitative Professionals: An Exploratory Study

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    Purpose: The KAWA model, a culturally-sensitive model of occupational therapy practice, can enhance patient-provider collaboration, but its use as a tool for teambuilding and collaboration among an interprofessional group has not been studied. Teambuilding has been positively correlated with job satisfaction, and quality of client care. The purpose of this exploratory qualitative study was to identify potential uses of the KAWA model and areas for future research related to teambuilding. Method: Trainings on the model, including a review of model components, its potential utility with clients, and an interactive activity, were provided to two rehabilitative teams (N=26) within two skilled nursing facilities. Results: Focus groups were conducted and analysis of the discussions revealed 4 potential applications of the model: (1) as a teambuilding tool to build team cohesiveness/morale; (2) as a tool to address performance issues with individual team members; (3) as a tool for conflict resolution among multiple team members; and (4) as a means to address workplace challenges external to the team itself. Conclusions & Recommendations: Teambuilding in healthcare settings can benefit both clients and rehab professionals, and the KAWA model may be an effective tool for this purpose. Limitations include a modest sample, and interpreter bias; however, this study provides a foundation for future research on the KAWA model related to teambuilding and interprofessional collaboration

    Use of the Kawa Model to Facilitate Interprofessional Collaboration: A Pilot Study

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    Purpose: The Kawa (river in Japanese) model uses the metaphor of a river to view one’s life from a metaphysical perspective, with consideration given to the interaction between social and physical environments, life circumstances, assets, and liabilities. Preliminary research suggests that the Kawa model may be an effective tool for interprofessional collaboration, but studies employing the model with diverse groups of healthcare professionals have not been undertaken. The purpose of this pilot study was to determine if the Kawa model could serve as an effective collaboration tool for a diverse healthcare team within a skilled nursing facility. Method: A pilot study using survey methodology was conducted with an interprofessional team (N=10) involving rehabilitation, nursing, administration, social work, and activities personnel. Education on the Kawa model and its components was provided to the team, followed by their participation in an interactive activity involving application of the model to a case study. An author-generated survey was administered before and after the study to elicit views about the Kawa model’s potential use as a team collaboration tool. Results: All 10/10 participants agreed or strongly agreed the Kawa model provides a common language for interprofessional collaboration, and 9/10 felt it would be an effective tool to increase collaboration in their facility. Conclusions: Healthcare professionals from a variety of fields must collaborate effectively for quality client care. Using a tool, such as the Kawa model, may provide a common ground for interprofessional discussions when making decisions about a client’s care. Recommendations include replication of this study with larger, more diverse healthcare teams, incorporation of an actual client and his or her family in the team, and comparison of other collaborative practices with those employing the Kawa model

    Melanocytic naevi and melanoma in survivors of childhood cancer.

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    There is evidence from previous studies of small numbers of children who received cytotoxic therapy for cancer, that they may develop increased numbers of melanocytic naevi (moles), the strongest known risk factors for melanoma. Our aim was to investigate a large number of survivors of childhood cancer in order to test the hypothesis that they have more melanocytic naevi than matched controls. Total-body naevus counts were obtained from 263 oncology patients ascertained in paediatric oncology departments in Queensland, Australia, and from 263 hospital controls matched for age and sex. Additional information was gathered from children's parents about concurrent factors influencing naevus development such as type of complexion and history of sun exposure. Matched analyses, both crude and adjusted for possible confounding factors, revealed no significant difference in overall density of naevi among oncology patients and control subjects, according to diagnosis or to duration or type of chemotherapy. However significantly more oncology patients had atypical naevi (P < 0.05) and acral naevi (P < 0.0001) than controls. One patient developed a malignant melanoma 13 years after chemotherapy and radiotherapy for rhabdomyosarcoma. These findings support an association between treatment for childhood cancer and acral naevi and suggest that atypical naevi may also be associated with chemotherapy in childhood

    Crowd-Driven Deep Learning Tracks Amazon Deforestation

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    The Amazon forests act as a global reserve for carbon, have very high biodiversity, and provide a variety of additional ecosystem services. These forests are, however, under increasing pressure, coming mainly from deforestation, despite the fact that accurate satellite monitoring is in place that produces annual deforestation maps and timely alerts. Here, we present a proof of concept for rapid deforestation monitoring that engages the global community directly in the monitoring process via crowdsourcing while subsequently leveraging the power of deep learning. Offering no tangible incentives, we were able to sustain participation from more than 5500 active contributors from 96 different nations over a 6-month period, resulting in the crowd classification of 43,108 satellite images (representing around 390,000 km2). Training a suite of AI models with results from the crowd, we achieved an accuracy greater than 90% in detecting new and existing deforestation. These findings demonstrate the potential of a crowd–AI approach to rapidly detect and validate deforestation events. Our method directly engages a large, enthusiastic, and increasingly digital global community who wish to participate in the stewardship of the global environment. Coupled with existing monitoring systems, this approach could offer an additional means of verification, increasing confidence in global deforestation monitoring

    Ligand Activation of the Prokaryotic Pentameric Ligand-Gated Ion Channel ELIC

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    While the pentameric ligand-gated ion channel ELIC has recently provided first insight into the architecture of the family at high resolution, its detailed investigation was so far prevented by the fact that activating ligands were unknown. Here we describe a study on the functional characterization of ELIC by electrophysiology and X-ray crystallography. ELIC is activated by a class of primary amines that include the neurotransmitter GABA at high micro- to millimolar concentrations. The ligands bind to a conserved site and evoke currents that slowly desensitize over time. The protein forms cation selective channels with properties that resemble the nicotinic acetylcholine receptor. The high single channel conductance and the comparably simple functional behavior make ELIC an attractive model system to study general mechanisms of ion conduction and gating in this important family of neurotransmitter receptors

    Molecular Sites for the Positive Allosteric Modulation of Glycine Receptors by Endocannabinoids

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    Glycine receptors (GlyRs) are transmitter-gated anion channels of the Cys-loop superfamily which mediate synaptic inhibition at spinal and selected supraspinal sites. Although they serve pivotal functions in motor control and sensory processing, they have yet to be exploited as drug targets partly because of hitherto limited possibilities for allosteric control. Endocannabinoids (ECs) have recently been characterized as direct allosteric GlyR modulators, but the underlying molecular sites have remained unknown. Here, we show that chemically neutral ECs (e.g. anandamide, AEA) are positive modulators of α1, α2 and α3 GlyRs, whereas acidic ECs (e.g. N-arachidonoyl-glycine; NA-Gly) potentiate α1 GlyRs but inhibit α2 and α3. This subunit-specificity allowed us to identify the underlying molecular sites through analysis of chimeric and mutant receptors. We found that alanine 52 in extracellular loop 2, glycine 254 in transmembrane (TM) region 2 and intracellular lysine 385 determine the positive modulation of α1 GlyRs by NA-Gly. Successive substitution of non-conserved extracellular and TM residues in α2 converted NA-Gly-mediated inhibition into potentiation. Conversely, mutation of the conserved lysine within the intracellular loop between TM3 and TM4 attenuated NA-Gly-mediated potentiation of α1 GlyRs, without affecting inhibition of α2 and α3. Notably, this mutation reduced modulation by AEA of all three GlyRs. These results define molecular sites for allosteric control of GlyRs by ECs and reveal an unrecognized function for the TM3-4 intracellular loop in the allosteric modulation of Cys-loop ion channels. The identification of these sites may help to understand the physiological role of this modulation and facilitate the development of novel therapeutic approaches to diseases such as spasticity, startle disease and possibly chronic pain

    A Linear Framework for Time-Scale Separation in Nonlinear Biochemical Systems

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    Cellular physiology is implemented by formidably complex biochemical systems with highly nonlinear dynamics, presenting a challenge for both experiment and theory. Time-scale separation has been one of the few theoretical methods for distilling general principles from such complexity. It has provided essential insights in areas such as enzyme kinetics, allosteric enzymes, G-protein coupled receptors, ion channels, gene regulation and post-translational modification. In each case, internal molecular complexity has been eliminated, leading to rational algebraic expressions among the remaining components. This has yielded familiar formulas such as those of Michaelis-Menten in enzyme kinetics, Monod-Wyman-Changeux in allostery and Ackers-Johnson-Shea in gene regulation. Here we show that these calculations are all instances of a single graph-theoretic framework. Despite the biochemical nonlinearity to which it is applied, this framework is entirely linear, yet requires no approximation. We show that elimination of internal complexity is feasible when the relevant graph is strongly connected. The framework provides a new methodology with the potential to subdue combinatorial explosion at the molecular level

    The mechanism of DNA unwinding by the eukaryotic replicative helicase

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    Accurate DNA replication is tightly regulated in eukaryotes to ensure genome stability during cell division and is performed by the multi-protein replisome. At the core an AAA+ hetero-hexameric complex, Mcm2-7, together with GINS and Cdc45 form the active replicative helicase Cdc45/Mcm2-7/GINS (CMG). It is not clear how this replicative ring helicase translocates on, and unwinds, DNA. We measure real-time dynamics of purified recombinant Drosophila melanogaster CMG unwinding DNA with single-molecule magnetic tweezers. Our data demonstrates that CMG exhibits a biased random walk, not the expected unidirectional motion. Through building a kinetic model we find CMG may enter up to three paused states rather than unwinding, and should these be prevented, in vivo fork rates would be recovered in vitro. We propose a mechanism in which CMG couples ATP hydrolysis to unwinding by acting as a lazy Brownian ratchet, thus providing quantitative understanding of the central process in eukaryotic DNA replication
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