49 research outputs found
A WireGuard Exploration
Internet users require secure means of communication. Virtual Private Networks (VPNs) often serve this purpose, for consumers and businesses. The research aims of this paper were an analysis and implementation of the new VPN protocol WireGuard. The authors explain the cryptographic primitives used, build server and client code implementations of WireGuard peers, and present the benefits and drawbacks of this new technology. The outcome was a functional WireGuard client and server implementation, capable of tunneling all Internet traffic through a cloud-based virtual private server (VPS), with minimal manual configuration necessary from the end user. The code is publicly available
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Evolution of substrate-specific gene expression and RNA editing in brown rot wood-decaying fungi.
Fungi that decay wood have characteristic associations with certain tree species, but the mechanistic bases for these associations are poorly understood. We studied substrate-specific gene expression and RNA editing in six species of wood-decaying fungi from the 'Antrodia clade' (Polyporales, Agaricomycetes) on three different wood substrates (pine, spruce, and aspen) in submerged cultures. We identified dozens to hundreds of substrate-biased genes (i.e., genes that are significantly upregulated in one substrate relative to the other two substrates) in each species, and these biased genes are correlated with their host ranges. Evolution of substrate-biased genes is associated with gene family expansion, gain and loss of genes, and variation in cis- and trans- regulatory elements, rather than changes in protein coding sequences. We also demonstrated widespread RNA editing events in the Antrodia clade, which differ from those observed in the Ascomycota in their distribution, substitution types, and the genomic environment. Moreover, we found that substrates could affect editing positions and frequency, including editing events occurring in mRNA transcribed from wood-decay-related genes. This work shows the extent to which gene expression and RNA editing differ among species and substrates, and provides clues into mechanisms by which wood-decaying fungi may adapt to different hosts
The manifesto as an instrument of the systematic control of reception in the architecture and design discourse
In der vorliegenden Arbeit werden ManifestĂ€uĂerungen des Design- und Architekturdiskurses im situativen, medialen, institutionellen und historischen Kontext untersucht. Auf Grundlage einer Analyse der Etymologie und der Ideengeschichte des Manifestes wird anhand ausgewĂ€hlter Beispiele die These belegt, dass das Medium vor allem der gezielten Rezeptionssteuerung im Diskurs dient. DarĂŒber hinaus wird die FĂ€higkeit und Bedeutung des Manifestes als Spiegel vergangener und gegenwĂ€rtiger, aber auch als Wegbereiter zukĂŒnftiger Diskurse analysiert und Entwicklungen des Manifestes hinsichtlich Stilistik, Inhalt, Funktion und Bedeutung im Design- und Architekturdiskurs dargestellt.This study examines manifestos from the design and architecture discourse in their situational, media, institutional and historical context. Based on an etymological analysis and on the manifestoâs history of ideas, the thesis uses selected examples to describe the manifesto as an instrument of the systematic control of reception in the discourse.
In addition, the ability of the manifesto to mirror past and present discourses as well as to shape future discourses is shown. Also, the evolution of the manifesto regarding style, content, function and historical meaning will be analyzed
Acute Depression and Anxiety Symptoms following Concussion in an Adolescent Outpatient Population
Introduction: Research has shown that concussed youth are at increased risk of developing psychiatric symptoms as compared to non-concussed youth. Few studies, however, have detailed the presence and severity of acute depression and anxiety symptoms following a concussion in adolescents, specifically. Thus, the current study aims to describe depression and anxiety symptoms in concussed and non-concussed adolescents using validated measures of depression and anxiety.
Methods: The current study includes 284 adolescents (114 cases, 170 controls), 13-18 years of age. Cases included concussed patients at the Childrenâs Hospital of Philadelphia, and controls were recruited from a local, Philadelphia high school. All subjects completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety (Pediatric Short Form 8b) measures at their visits. Adjusted risk ratios and 95% confidence intervals (CI) for above-normal limits of PROMIS Depression and Anxiety were calculated for all subjects.
Results: When controlling for sex and a medical history of anxiety, there is a 1.49 increased risk of an above-normal PROMIS Anxiety t-score for cases vs. controls (95% CI: 0.97-2.27, p=0.07). Although not significant, when controlling for sex and a medical history of depression, there is a 1.25 increased risk of an above-normal PROMIS Depression t-score for cases vs. controls (95% CI: 0.84-1.84, p=0.27).
Discussion: Our results demonstrate that acutely concussed adolescents have an increased risk of above-normal levels of anxiety, but not depressive, symptoms compared to controls. These findings suggest that clinicians should incorporate psychiatric screening into concussion care and treatment for their adolescent patient population
Bifactor Model of the Sport Concussion Assessment Tool Symptom Checklist: Replication and Invariance Across Time in the CARE Consortium Sample
Background: Identifying separate dimensions of concussion symptoms may inform a precision medicine approach to treatment. It was previously reported that a bifactor model identified distinct acute postconcussion symptom dimensions.
Purpose: To replicate previous findings of a bifactor structure of concussion symptoms in the Concussion Assessment Research and Education (CARE) Consortium sample, examine measurement invariance from pre- to postinjury, and evaluate whether factors are associated with other clinical and biomarker measures.
Study design: Cohort study (Diagnosis); Level of evidence, 2.
Methods: Collegiate athletes were prospectively evaluated using the Sport Concussion Assessment Tool-3 (SCAT-3) during preseason (N = 31,557); 2789 were followed at <6 hours and 24 to 48 hours after concussion. Item-level SCAT-3 ratings were analyzed using exploratory and confirmatory factor analyses. Bifactor and higher-order models were compared for their fit and interpretability. Measurement invariance tested the stability of the identified factor structure across time. The association between factors and criterion measures (clinical and blood-based markers of concussion severity, symptom duration) was evaluated.
Results: The optimal structure for each time point was a 7-factor bifactor model: a General factor, on which all items loaded, and 6 specific factors-Vestibulo-ocular, Headache, Sensory, Fatigue, Cognitive, and Emotional. The model manifested strict invariance across the 2 postinjury time points but only configural invariance from baseline to postinjury. From <6 to 24-48 hours, some dimensions increased in severity (Sensory, Fatigue, Emotional), while others decreased (General, Headache, Vestibulo-ocular). The factors correlated with differing clinical and biomarker criterion measures and showed differing patterns of association with symptom duration at different time points.
Conclusion: Bifactor modeling supported the predominant unidimensionality of concussion symptoms while revealing multidimensional properties, including a large dominant General factor and 6 independent factors: Headache, Vestibulo-ocular, Sensory, Cognitive, Fatigue, and Emotional. Unlike the widely used SCAT-3 symptom severity score, which declines gradually after injury, the bifactor model revealed separable symptom dimensions that have distinct trajectories in the acute postinjury period and different patterns of association with other markers of injury severity and outcome.
Clinical relevance: The SCAT-3 total score remains a valuable, robust index of overall concussion symptom severity, and the specific factors identified may inform management strategies. Because some symptom dimensions continue to worsen in the first 24 to 48 hours after injury (ie, Sensory, Fatigue, Emotional), routine follow-up in this time frame may be valuable to ensure that symptoms are managed effectively
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Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.
Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (nâ=â143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (nâ=â152), or no hydrocortisone (nâ=â108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (nâ=â137), shock-dependent (nâ=â146), and no (nâ=â101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707
Obdachlose im Krankenhaus: was benötigen professionell Pflegende in der stationÀren Versorgung wohnungsloser Patienten?; eine qualitative Untersuchung
Hintergrund
Aufgrund der Ergebnisse der Bachelorthesis der Autorinnen lĂ€sst sich festhalten, dass professionell Pflegende im stationĂ€ren Berufsalltag Probleme ihrerseits mit der Versorgung wohnungsloser Patienten haben. In der vorliegenden Masterthesis wird untersucht, was die Berufsgruppe benötigt, um diese Patienten versorgen zu können. Durch ihre Arbeit im Bildungswesen haben beide Verfasserinnen die Erfahrung gemacht, dass einige Auszubildende der Gesundheits- und Krankenpflege bereits ĂŒber eine negativ geprĂ€gte Haltung gegenĂŒber der Patientengruppe verfĂŒgen. Es soll dargestellt werden, wie der Umgang der professionell Pflegenden mit wohnungslosen Patienten ist. Gleichzeitig wird die derzeitige Ausbildungsgestaltung national und international in den Blick genommen. Die Autorinnen vermuten, dass hier der Ursprung der Problematik liegt, da die Auszubildenden nicht entsprechend auf die Versorgung und den Kontakt mit Wohnungslosen vorbereitet werden. Diese vulnerable Bevölkerungsgruppe ist in GroĂstĂ€dten prĂ€sent und benötigt vermehrt stationĂ€re pflegerische Versorgung. Somit ist dies ein wichtiger Aspekt fĂŒr die Pflege.
Methoden
Es handelt sich um eine dyadisch geteilte Qualifikationsarbeit. Aufbauend auf einem systematischen Literaturreview wird eine qualitative Untersuchung durchgefĂŒhrt. Das Review schlieĂt den nationalen sowie internationalen englischsprachigen Wissensbestand der Scientific Community (S. C.) ein. Insgesamt werden sieben Fachdatenbanken zu der Thematik der wohnungslosen Menschen allgemein sowie der pflegerischen Versorgung derer und die Ausbildungssituation in diesem Kontext durchsucht. Das Review orientiert sich an den Vorgaben der Cochrane Collaboration und verwendet den PRISMA-Standard. Insgesamt konnten so 488 Literaturtreffer generiert werden, davon entstammen 219 der nationalen und 269 der internationalen Recherche. 37 der so erlangten Treffer konnten eingeschlossen werden. Parallel dazu wurde eine Handrecherche durchgefĂŒhrt, mit deren Hilfe weitere 77 Treffer eingeschlossen werden konnten.
Bei der im Anschluss durchgefĂŒhrten pflegewissenschaftlichen, qualitativen Untersuchung unter Verwendung sozialwissenschaftlicher Forschungsmethoden handelt es sich um sieben leitfadengestĂŒtzte face-to-face Experteninterviews. Befragt wurden professionell Pflegende, die ihre Ausbildung nach der Ausbildungsrichtlinie von 2004 absolviert haben und wohnungslose Patienten in ihrem Berufsalltag versorgen. Die Auswahl der Auswertungsmethode erfolgte nach DurchfĂŒhrung eines Methodenreviews. Entsprechend erfolgte die Interviewauswertung mittels der qualitativen Inhaltsanalyse nach GlĂ€ser und Laudel und ihren Forschungsparadigmen.
Ergebnisse
Zur Gruppe der Wohnungslosen können zahlreiche Aussagen gefunden werden. Der Schwerpunkt liegt hier auf der Beschreibung genereller Fakten diese Gruppe betreffend. Es handelt sich um eine inhomogene und international gröĂtenteils vergleichbare Bevölkerungsgruppe. National wie international lassen sich nur wenige Literaturhinweise identifizieren, welche sich mit dem Erleben der professionell Pflegenden im Umgang mit wohnungslosen Patienten auseinandersetzen. Gleiches gilt fĂŒr die Ausbildungssituation in diesem Zusammenhang.
Die Experteninterviews liefern Antworten auf die Frage, wie die pflegerische Versorgung wohnungsloser Patienten durch die professionell Pflegenden stattfindet und empfunden wird. Ihre Haltungen/Einstellungen werden deutlich. Sie geben Anregungen fĂŒr die Ausgestaltung der Gesundheits- und Krankenpflegeausbildung, um Auszubildenden einen positiven Umgang mit der Patientengruppe der Menschen ohne Wohnung zu ermöglichen.
Schlussfolgerungen
Es lĂ€sst sich aussagen, dass die Pflege dieser Patientengruppe als âandersâ und nicht unbedingt negativ beschrieben wird. Als Motiv fĂŒr die als âandersâ zu bezeichnende Pflege kann u. a. âHelfen wollenâ bezeichnet werden. Weiter scheinen groĂe Teile der Pflegenden durch den körperlichen Zustand (Hygiene, Kleidung) der wohnungslosen Patienten beeinflusst zu werden. Dadurch und durch andere Faktoren wird Handlungsbedarf bei den Pflegenden ausgelöst. Zudem zeigt sich bei der pflegerischen Versorgung wohnungsloser Patienten ein weiter gefasstes PflegeverstĂ€ndnis, was sich z. B. durch das Anbieten von GesprĂ€chen charakterisiert. Diese Fakten lassen sich auch international bestĂ€tigen.
Aus den Aussagen der Experten kann geschlussfolgert werden, dass in der Gesundheits- und Krankenpflegeausbildung das Thema Wohnungslosigkeit in Theorie und Praxis vermittelt werden muss. Einen hohen Stellenwert hat hier die UnterstĂŒtzung der Auszubildenden bei der IdentitĂ€tskonstruktion.
Weiterer Forschungsbedarf wird als unerlÀsslich angesehen, da das Verhalten und die Sicht der professionell Pflegenden sowie der Auszubildenden noch weiter untersucht werden sollten
The manifesto as a tool of reception control in architecture and design discourse.
In der vorliegenden Arbeit werden ManifestĂ€uĂerungen des Design- und Architekturdiskurses im situativen, medialen, institutionellen und historischen Kontext untersucht. Auf Grundlage einer Analyse der Etymologie und der Ideengeschichte des Manifestes wird anhand ausgewĂ€hlter Beispiele die These belegt, dass das Medium vor allem der gezielten Rezeptionssteuerung im Diskurs dient. DarĂŒber hinaus wird die FĂ€higkeit und Bedeutung des Manifestes als Spiegel vergangener und gegenwĂ€rtiger, aber auch als Wegbereiter zukĂŒnftiger Diskurse analysiert und Entwicklungen des Manifestes hinsichtlich Stilistik, Inhalt, Funktion und Bedeutung im Design- und Architekturdiskurs dargestellt.This study examines manifestos from the design and architecture discourse in their situational, media, institutional and historical context. Based on an etymological analysis and on the manifestoâs history of ideas, the thesis uses selected examples to describe the manifesto as an instrument of the systematic control of reception in the discourse. In addition, the ability of the manifesto to mirror past and present discourses as well as to shape future discourses is shown. Also, the evolution of the manifesto regarding style, content, function and historical meaning will be analyzed