Patients’ Experiences of Recovery: Beyond the Intensive Care Unit and into the Community

Aims To understand barriers and facilitators of recovery for critical illness survivors’, who are discharged home from the hospital and do not have access to dedicated outpatient care. Design Multi-site descriptive study guided by interpretive phenomenology using semi-structured interviews. Methods Interviews were conducted between December 2017 -July 2018. Eighteen participants were included. Data were collected from interview recordings, transcripts, field notes, and a retrospective chart review for sample demographics. Analysis was completed using Interpretive Phenomenological Analysis which provided a unique view of recovery through the survivors’ personal experiences and perception of those experiences. Results Participants encountered several barriers to their recovery; however, they were resilient and initiated ways to overcome these barriers and assist with their recovery. Facilitators of recovery experienced by survivors included seeking support from family and friends, lifestyle adaptations, and creative management of their multiple medical needs. Barriers included unmet needs experienced by survivors such as mental health issues, coordination of care, and spiritual needs. These unmet needs left participants feeling unsupported from healthcare providers during their recovery. Conclusion This study highlights important barriers and facilitators experienced by critical illness survivors during recovery that need be addressed by healthcare providers. New ways to support critical illness survivors, that can reach a broader population, must be developed and evaluated to support survivors during their recovery in the community. Impact This study addressed ICU survivors’ barriers and facilitators to recovery. Participants encountered several barriers to recovery at home, such as physical, cognitive, psychosocial, financial, and transportation barriers, however, these survivors were also resilient and resourceful in the development of strategies to try to manage their recovery at home. These results will help healthcare providers develop interventions to better support ICU survivors in the community

Electron-acoustic plasma waves: oblique modulation and envelope solitons

Theoretical and numerical studies are presented of the amplitude modulation of electron-acoustic waves (EAWs) propagating in space plasmas whose constituents are inertial cold electrons, Boltzmann distributed hot electrons and stationary ions. Perturbations oblique to the carrier EAW propagation direction have been considered. The stability analysis, based on a nonlinear Schroedinger equation (NLSE), reveals that the EAW may become unstable; the stability criteria depend on the angle $\theta$ between the modulation and propagation directions. Different types of localized EA excitations are shown to exist.Comment: 10 pages, 5 figures; to appear in Phys. Rev.

Oblique amplitude modulation of dust-acoustic plasma waves

Theoretical and numerical studies are presented of the nonlinear amplitude modulation of dust-acoustic (DA) waves propagating in an unmagnetized three component, weakly-coupled, fully ionized plasma consisting of electrons, positive ions and charged dust particles, considering perturbations oblique to the carrier wave propagation direction. The stability analysis, based on a nonlinear Schroedinger-type equation (NLSE), shows that the wave may become unstable; the stability criteria depend on the angle $\theta$ between the modulation and propagation directions. Explicit expressions for the instability rate and threshold have been obtained in terms of the dispersion laws of the system. The possibility and conditions for the existence of different types of localized excitations have also been discussed.Comment: 21 pages, 6 figures, to appear in Physica Script

An integrable discretization of KdV at large times

An "exact discretization" of the Schroedinger operator is considered and its direct and inverse scattering problems are solved. It is shown that a differential-difference nonlinear evolution equation depending on two arbitrary constants can be solved by using this spectral transform and that for a special choice of the constants it can be considered an integrable discretization of the KdV equation at large times. An integrable difference-difference equation is also obtained.Comment: 12 page

A discrete Schrodinger spectral problem and associated evolution equations

A recently proposed discrete version of the Schrodinger spectral problem is considered. The whole hierarchy of differential-difference nonlinear evolution equations associated to this spectral problem is derived. It is shown that a discrete version of the KdV, sine-Gordon and Liouville equations are included and that the so called `inverse' class in the hierarchy is local. The whole class of related Darboux and Backlund transformations is also exhibited.Comment: 14 pages, LaTeX2

An Emancipatory Approach to Cultural Competency: The Application of Critical Race, Postcolonial, and Intersectionality Theories

Nurses teach, work, and conduct research in an increasingly hostile sociopolitical climate where health inequities persist among marginalized communities. Current approaches to cultural competency do not adequately equip nurses to address these complex factors and risk perpetuating stereotypes and discrimination. A theory-driven emancipatory approach to cultural competency will instead lead to lasting change and uphold the core nursing value of commitment to social justice. This article explicates key tenets of critical race, postcolonial feminist, and intersectionality theories and then applies them, using an emancipatory approach to cultural competency that can reshape nursing education, research, and practice

Mass drug administration of azithromycin for trachoma reduces the prevalence of genital Chlamydia trachomatis infection in the Solomon Islands.

OBJECTIVES: Chlamydia trachomatis is the most common bacterial sexually transmitted infection and is frequently asymptomatic; ocular C. trachomatis strains cause trachoma. Mass drug administration (MDA) of azithromycin for trachoma might also reduce the prevalence of genital C. trachomatis. In a survey conducted in the Solomon Islands in 2014, prior to MDA, the prevalence of genital C. trachomatis was 20.3% (95% CI 15.9% to 25.4%). We conducted a survey to establish the impact of MDA with azithromycin on genital C. trachomatis. METHODS: Women attending three community outpatient clinics, predominantly for antenatal care, 10 months after MDA with azithromycin given for trachoma elimination, were enrolled in this survey. Self-taken high vaginal swabs were for C. trachomatis and Neisseria gonorrhoeae using the BD Probetec strand displacement assay. RESULTS: 298 women were enrolled. C. trachomatis infection was diagnosed in 43 women (14.4%, 95% CI 10.6% to 18.9%) and N. gonorrhoeae in 9 (3%, 95% CI 1.4% to 5.7%). The age-adjusted OR for C. trachomatis infection was consistent with a significant decrease in the prevalence of C. trachomatis following MDA (OR 0.58, 95% CI 0.37 to 0.94, p=0.027). There was no change in the prevalence of N. gonorrhoeae between following MDA (OR 0.51, 95% CI 0.22 to 1.22, p=0.13). CONCLUSIONS: This study demonstrated a 40% reduction in the age-adjusted prevalence of genital C. trachomatis infection following azithromycin MDA for trachoma elimination