Withoutholding and withdrawing life-support from critically ill patients

https://place.asburyseminary.edu/ecommonsatsdissertations/2110/thumbnail.jp

Promoting Strategic Thinking in American Indian Leaders

Native leaders are challenged with rebuilding, reuniting, and revitalizing their disseminated nations. The Native chief executive faces the tasks of asserting political sovereignty, protecting cultural rights, and improving the dire socioeconomic conditions on American Indian reservations. Strategic thinking is essential to addressing these challenges. The Constraints Model proposed by Irving Janis has been expanded to include American Indian perspectives regarding errors leaders make in policymaking and crisis management. Characteristics and educational needs of Native leaders crucial for strategic thinking are discussed. Recommendations include encouraging Native leaders to participate in executive education programs and to incorporate tools such as the Strategic Analysis protocol in their nation building efforts

Identification and Characterization of Novel Compounds Blocking Shiga Toxin Expression in Escherichia coli O157:H7

Infections caused by Shiga toxin-producing E. coli strains constitute a health problem, as they are problematic to treat. Shiga toxin (Stx) production is a key virulence factor associated with the pathogenicity of enterohaemorrhagic E. coli (EHEC) and can result in the development of haemolytic uremic syndrome in infected patients. The genes encoding Stx are located on temperate lysogenic phages integrated into the bacterial chromosome and expression of the toxin is generally coupled to phage induction through the SOS response. We aimed to find new compounds capable of blocking expression of Stx type 2 (Stx2) as this subtype of Stx is more strongly associated with human disease. High-throughput screening of a small-molecule library identified a lead compound that reduced Stx2 expression in a dose-dependent manner. We show that the optimised compound interferes with the SOS response by directly affecting the activity and oligomerisation of RecA, thus limiting phage activation and Stx2 expression. Our work suggests that RecA is highly susceptible to inhibition and that targeting this protein is a viable approach to limiting production of Stx2 by EHEC. This type of approach has the potential to limit production and transfer of other phage induced and transduced determinants

Strategic Research Alliance Final Report : Review of Continuing Professional Development in Nursing

Continuing Professional Development (CPD) is important in generating and sustaining capability and in ensuring high quality, person-centred, safe and effective nursing care. In the UK, changes to models of funding for nursing CPD have raised concerns about the opportunities available for nurses to meet the requirements for revalidation of registration, their ability to provide adequate supervision of future students in relation to the new NMC standards of proficiency, and the potential impact of reductions in CPD access to nursing recruitment and retention. Contemporary evidence suggests that it is not only the opportunity to access CPD that is important to the provision of quality care, but also the ability to transform knowledge and skills learnt into practice within diverse practice settings. The purpose of CPD therefore is not only transformation of an individual’s practice but also transformation of workplace culture and context. For the purpose of this report, we follow Manley and Jackson (2020) in suggesting that transformation “implies radical ways of doing things to reflect the values aspired to; it is not about quick wins or key performance indicators.” There is then a need to understand the evidence about what factors maximise CPD impact at the individual, team, organisational and system level. Following initial scoping work, the Strategic Research Alliance (SRA) working group, in consultation with Professor Kim Manley and Carolyn Jackson, agreed to complete a rapid review to consider this evidence focusing on the specific question: "What are the factors that enable or optimise CPD impact for learning, development and improvement in the workplace at the individual, team, organisation and system level?

Knowledge and behavior of Nigerian dentists concerning the treatment of children with special needs

BACKGROUND: Children with special needs (CSN) are reported to receive less adequate dental care due to various behavioral problems and barriers created by dental professionals. This study was carried out to determine the knowledge and behaviour of Nigerian dentists concerning the treatment of CSN. METHODS: Questionnaires consisting of open and closed ended questions requesting socio-demographic information, type of practice, undergraduate and postgraduate training, self-rated knowledge and behaviour concerning care of CSN, were hand delivered to 359 dentists in the 3 geographical zones of Nigeria over a period of 8 weeks. Responses were compared across age groups, gender, type of practice and training received. RESULT: Two hundred and eighty questionnaires were returned completed, constituting 79.9% response rate. Most of the respondents were aged 30 – 39 years (44.3%). There were more males (56.1%) and more recent graduates of 10 years and below (78.5%). Over 80% of respondents had treated children with disabilities, those with physical disabilities being most encountered. Only 19.3% of respondents rated their knowledge of management of CSN as adequate, with no significant difference across age groups and gender, but with a significantly higher number of older graduates reporting to have adequate knowledge (p < 0.05). Those who had undergraduate training in care of CSN were 69.5% compared with only 12.8% who had post graduate training. Only 11.8% rated their undergraduate training as adequate. Thirty seven percent of respondents rated the CSN they had treated as very challenging. A higher proportion of older graduates (of more than 10 years post graduation) and those who rated their undergraduate training as inadequate used sedation and general anaesthesia. Seventy one percent of respondents were willing to treat CSN, with no significant difference across age groups, gender and training, but with a significantly higher percentage among those who had rated their knowledge as adequate. Most of those who were unwilling to treat CSN felt their management was tedious and challenging. CONCLUSION: From this study, very few dentists reported to have adequate knowledge of management of CSN, irrespective of age, gender and place of practice. A significant number of those with more experience rated their knowledge as adequate. Although most dentists rated the children's behaviour as challenging, they indicated their willingness to treat them in their practices

Role of Aquaporin Water Channels in Airway Fluid Transport, Humidification, and Surface Liquid Hydration

Several aquaporin-type water channels are expressed in mammalian airways and lung: AQP1 in microvascular endothelia, AQP3 in upper airway epithelia, AQP4 in upper and lower airway epithelia, and AQP5 in alveolar epithelia. Novel quantitative methods were developed to compare airway fluid transport–related functions in wild-type mice and knockout mice deficient in these aquaporins. Lower airway humidification, measured from the moisture content of expired air during mechanical ventilation with dry air through a tracheotomy, was 54–56% efficient in wild-type mice, and reduced by only 3–4% in AQP1/AQP5 or AQP3/AQP4 double knockout mice. Upper airway humidification, measured from the moisture gained by dry air passed through the upper airways in mice breathing through a tracheotomy, decreased from 91 to 50% with increasing ventilation from 20 to 220 ml/min, and reduced by 3–5% in AQP3/AQP4 knockout mice. The depth and salt concentration of the airway surface liquid in trachea was measured in vivo using fluorescent probes and confocal and ratio imaging microscopy. Airway surface liquid depth was 45 ± 5 μm and [Na+] was 115 ± 4 mM in wild-type mice, and not significantly different in AQP3/AQP4 knockout mice. Osmotic water permeability in upper airways, measured by an in vivo instillation/sample method, was reduced by ∼40% by AQP3/AQP4 deletion. In doing these measurements, we discovered a novel amiloride-sensitive isosmolar fluid absorption process in upper airways (13% in 5 min) that was not affected by aquaporin deletion. These results establish the fluid transporting properties of mouse airways, and indicate that aquaporins play at most a minor role in airway humidification, ASL hydration, and isosmolar fluid absorption

The structure and robustness of nocturnal Lepidopteran pollen-transfer networks in a Biodiversity Hotspot

1. The role of nocturnal moths within plant-pollinator networks is poorly understood but could be important in the context of declining biodiversity and the ecosystem services they provide. 2. For the first time, this study examined the role of moths as pollen vectors in the Mediterranean Biodiversity Hotspot. Light traps were used to sample moths in SW Portugal in 2010. The pollen on moth head parts was collected, identified, and counted to construct a nocturnal pollen-transfer and flower-visitor network. 3. A total of 257 moths belonging to 95 species were captured in 11 trapping sessions in 2010; 196 moths (76%) carried pollen and the total number of pollen grains counted and identified was 9064. 4. The pollen-transfer network exhibited a high degree of selectivity (H20) but low robustness when the most-to-least connected plants were made extinct in the network. The flower-visitor network (based on the incidences of interactions by individual moths), however, exhibited high linkage density and was generally more robust to simulated plant or moth extinction. 5. Including nocturnal moths in plant–pollinator networks will provide a better understanding of their robustness to species extinctions due to environmental change as well as the impacts on ecosystem structure and functioning. Nocturnal pollen–transfer networks could be developed for identifying key species for targeted conservation

The Kondo Resonance in Electron Spectroscopy

The Kondo resonance is the spectral manifestation of the Kondo properties of the impurity Anderson model, and also plays a central role in the dynamical mean-field theory (DMFT) for correlated electron lattice systems. This article presents an overview of electron spectroscopy studies of the resonance for the 4f electrons of cerium compounds, and for the 3d electrons of V_2O_3, including beginning efforts at using angle resolved photoemission to determine the k-dependence of the resonance. The overview includes the comparison and analysis of spectroscopy data with theoretical spectra as calculated for the impurity model and as obtained by DMFT, and the Kondo volume collapse calculation of the cerium alpha-gamma phase transition boundary, with its spectroscopic underpinnings.Comment: 32 pages, 11 figures, 151 references; paper for special issue of J. Phys. Soc. Jpn. on "Kondo Effect--40 Years after the Discovery