Reflective career dialogues

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The importance of combating malnutrition in care

Malnutrition results from a deficiency of macronutrients (energy and protein) and micronutrients (vitamins and minerals), that may impact on body composition, function and/or clinical outcomes (National Institute for Health and Care Excellence, 2006). A range of factors, including impaired food intake (seen in individuals who are anorexic or have difficulties swallowing), increased nutrient requirements (seen during infection) and/or loss of nutrients which may be present in individuals with inflammatory bowel disease, have been known to cause malnutrition (Dunne, 2009)

Evaluation of coagulation activation after Rhinovirus infection in patients with asthma and healthy control subjects: an observational study

Background Asthma exacerbations are frequently triggered by rhinovirus infections. Both asthma and respiratory tract infection can activate haemostasis. Therefore we hypothesized that experimental rhinovirus-16 infection and asthmatic airway inflammation act in synergy on the haemostatic balance. Methods 28 patients (14 patients with mild allergic asthma and 14 healthy non-allergic controls) were infected with low-dose rhinovirus type 16. Venous plasma and bronchoalveolar lavage fluid (BAL fluid) were obtained before and 6 days after infection to evaluate markers of coagulation activation, thrombin-antithrombin complexes, von Willebrand factor, plasmin-antiplasmin complexes, plasminogen activator inhibitor type-1, endogenous thrombin potential and tissue factor-exposing microparticles by fibrin generation test, in plasma and/or BAL fluid. Data were analysed by nonparametric tests (Wilcoxon, Mann Whitney and Spearman correlation). Results 13 patients with mild asthma (6 females, 19-29 y) and 11 healthy controls (10 females, 19-31 y) had a documented Rhinovirus-16 infection. Rhinovirus-16 challenge resulted in a shortening of the fibrin generation test in BAL fluid of asthma patients (t = -1: 706 s vs. t = 6: 498 s; p = 0.02), but not of controls (t = -1: 693 s vs. t = 6: 636 s; p = 0.65). The fold change in tissue factor-exposing microparticles in BAL fluid inversely correlated with the fold changes in eosinophil cationic protein and myeloperoxidase in BAL fluid after virus infection (r = -0.517 and -0.528 resp., both p = 0.01). Rhinovirus-16 challenge led to increased plasminogen activator inhibitor type-1 levels in plasma in patients with asthma (26.0 ng/mL vs. 11.5 ng/mL in healthy controls, p = 0.04). Rhinovirus-16 load in BAL showed a linear correlation with the fold change in endogenous thrombin potential, plasmin-antiplasmin complexes and plasminogen activator inhibitor type-1. Conclusions Experimental rhinovirus infection induces procoagulant changes in the airways of patients with asthma through increased activity of tissue factor-exposing microparticles. These microparticle-associated procoagulant changes are associated with both neutrophilic and eosinophilic inflammation. Systemic activation of haemostasis increases with Rhinoviral load

Ignition of fuel–air mixtures from a hot circular cylinder

Ignition of hydrogen–air, ethylene–air and n-hexane–air mixtures from a horizontally and vertically oriented heated circular cylinder was studied experimentally in a wide range of equivalence ratio. Initial pressure and temperature were 101.3 kPa and 296 K, respectively. The cylinder with outer diameter 10 mm and heated length 10 mm was designed for high temperature uniformity. Two-color pyrometry measured the surface temperature; Time-resolved Mach–Zehnder interferometry acquired ignition dynamics, gas temperature fields and heat transfer characteristics. Ignition from the horizontal cylinder occurred at temperatures between 960 K and 1100 K for hydrogen, between 1060 K and 1110 K for ethylene, and between 1150 K and 1190 K for n-hexane. Vertical cylinder orientation increased ignition thresholds by 50–110 K for ethylene and n-hexane, whereas only little variation was observed for hydrogen. Infinite-fringe interferograms visualized the ignition dynamics and identified the most favorable ignition locations, which coincided with locations of lowest wall heat flux (largest thermal boundary layer thickness) and long residence time. Gas temperature fields were obtained by post-processing the interferograms, resolving the temporal and spatial development of thermal boundary layers and enabling local heat transfer analysis. The convective pattern around a horizontal cylinder features distinctly shallow temperature gradients, i.e., low heat flux, at the cylinder top due to thermal plume formation, which promotes ignition compared to the vertical cylinder. An analytical scaling model for ignition from hot surfaces was evaluated to determine the sensitivity of ignition threshold to heat transfer variations, and to reveal the influence of chemical mixture properties. This analysis predicts a particularly low sensitivity for hydrogen–air mixtures at temperatures near the extended second explosion limit, and a larger sensitivity of ethylene–air and n-hexane–air mixtures, which is in accordance with the experiments

Nurses' support needs in providing high-quality palliative care to persons with dementia in the hospital setting:A cross-sectional survey study

Background  Since dementia is an irreversible progressive disease characterized by a decline in mental functions and overall health, a palliative care approach is recommended. Nevertheless, many persons with dementia experience burdensome hospitalizations in end-of-life care. Their quality of life during hospitalization can be improved by palliative nursing care that suits their fragile health.  Aim  To explore hospital nurses' perceived support needs while providing high-quality palliative care for persons with dementia and to identify differences between nurses in different ward types and at different educational levels.  Design  Cross-sectional, multicenter survey study. Method Between January 2021 and April 2021, a convenience sample of Dutch hospital nurses received a web-based questionnaire on the topics of palliative caregiving, communication, collaboration, and hospital admissions. The data were analyzed using descriptive statistics.  Results  The survey was completed by 235 nurses. The most frequently endorsed support needs were "communicating with persons with severe dementia" (58.3%), "appointing a permanent contact person in the care for persons with dementia" (53.6%), and "dealing with family disagreement in end-of-life care" (53.2%). If nurses had more time to provide care, 66.4% of them would prioritize providing personal attention. Most support needs identified by nurses were similar.  Conclusion  A heterogeneous group of nurses demonstrates overall similar support needs in providing palliative care for persons with dementia and their families in the hospital setting. Clinical Relevance Nursing practices should implement dementia-friendly interventions to improve the quality of dementia care in the hospital

The effects of enhanced sea ice export from the Ross Sea on recent cooling and freshening of the Southeast Pacific

The top 2000 m of the Southern Ocean has freshened and warmed over recent decades. However, the high-latitude (south of 50°S) southeast Pacific was observed to be cooler and fresher in the years 2008-2010 compared to 2005-2007 over a wide depth range including surface, mode, and intermediate waters. The causes and impacts of this event are analyzed using the ocean—sea-ice data-assimilating Southern Ocean State Estimate (SOSE) and observationally based products. In 2008-2010, a strong positive Southern Annular Mode coincided with a negative El Niño Southern Oscillation and a deep Amundsen Sea Low. Enhanced meridional winds drove strong sea ice export from the eastern Ross Sea, bringing large amounts of ice to the Amundsen Sea ice edge. In 2008, together with increased precipitation, this introduced a strong freshwater anomaly that was advected eastward by the Antarctic Circumpolar Current (ACC), mixing along the way. This anomaly entered the ocean interior not only as Antarctic Intermediate Water, but also as lighter Southeast Pacific Subantarctic Mode Water (SEPSAMW). A numerical particle release experiment carried out in SOSE , showed that the Ross Sea sector was the dominant source of particles reaching the SEPSAMW formation region. This suggests that large-scale climate fluctuations can induce strong interannual variability of volume and properties of SEPSAMW. These fluctuations act at different time scales: instantaneously via direct forcing, and also lagged over advective time scales of several years from upstream regions

The State of Strain in Single GaN Nanocolumns As Derived from Micro-Photoluminescence Measurements

In the present paper, studies on the state of strain in single and ensembles of nanocolumns investigated by photoluminescence spectroscopy will be presented. The GaN nanocolumns were either grown in a bottom-up approach or prepared in a top-down approach by etching compact GaN layers grown on Si(111) and sapphire (0001) substrates. Experimental evidence for strain relaxation of the nanocolumns was found. The difference and development of the strain value for different nanocolumns could be verified by spatially resolved micro-photoluminescence on single nanocolumns separated from their substrate. A common D0X spectral position at 3.473 eV was found for all separated single GaN nanocolumns independent of the substrate or processing technique used, as expected for a relaxed system