194 research outputs found
Negotiated reorienting: a grounded theory of nursesâ end-of-life decision-making in the intensive care unit
Background
Intensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nursesâ end-of-life (EoL) decision-making practice across cultures.
Objectives
To understand nursesâ EoL decision-making practices in ICUs in different cultural contexts.
Design
We collected and analysed qualitative data using Grounded Theory.
Settings
Interviews were conducted with experienced ICU nurses in university or hospital premises in five countries: Brazil, England, Germany, Ireland and Palestine.
Participants
Semi-structured interviews were conducted with 51 nurses (10 in Brazil, 9 in
The Astropy Problem
The Astropy Project (http://astropy.org) is, in its own words, "a community
effort to develop a single core package for Astronomy in Python and foster
interoperability between Python astronomy packages." For five years this
project has been managed, written, and operated as a grassroots,
self-organized, almost entirely volunteer effort while the software is used by
the majority of the astronomical community. Despite this, the project has
always been and remains to this day effectively unfunded. Further, contributors
receive little or no formal recognition for creating and supporting what is now
critical software. This paper explores the problem in detail, outlines possible
solutions to correct this, and presents a few suggestions on how to address the
sustainability of general purpose astronomical software
Dichrostachys cinerea (L.) Wight et Arn (Mimosaceae) hydro-alcoholic extract action on the contractility of tracheal smooth muscle isolated from guinea-pig
<p>Abstract</p> <p>Background</p> <p><it>Dichrostachys cinerea </it>(L.) Wight et Arn. (Mimosaceae) is largely used in ethno-medically across Africa, and mainly employed for the treatment of asthma in Ivory Coast and Gabon. The paper analyses the relaxation induced by the methanolic extract of <it>D. cinerea </it>(Edici) in the guinea-pig trachea preparations (GPTPs). Purpose: This study aimed to bring out the scientific basis to the use of this plant leading to the validation of this phytomedicine.</p> <p>Method</p> <p>The aorta obtained from guinea-pigs was immediately placed in a Mac Ewen solution. Experiments were performed in preparations suspended between two L-shaped stainless steel hooks in a 10 ml organ bath containing Mac Ewen solution. The isometric contractile force of the aorta strips of guinea-pig were recorded by using a strain gauge. The different drugs were directly administered into the organ bath and the magnitude of GPTPs was evaluated.</p> <p>Results</p> <p>Phytochemical analysis of the methanolic extract of Dichrostachys <it>cinerea </it>(Edici) using chemical methods revealed the presence of flavenoids, tannins, sterols, triterpenes and polyphenols. Pharmacological studies performed in GPTPs show that of <it>Dichrostachys cinerea </it>(0.1 mg/ml - 2 mg/ml) evoked a broncho-constriction in GPTPs. Whereas, at concentration up to 2 mg/ml, Edici induced a significant dose-dependent relaxation in the GPTPs. KCl-, ACh- or histamine-evoked contractions of isolated trachea was significantly inhibited by increasing concentrations of Edici (3.5-10 mg/ml). Edici (10 mg/ml) as well as promethazine (0.25 mg/ml) significantly inhibited contractions induced by increasing concentrations of histamine (1Ă10<sup>-7</sup>-1Ă10<sup>-4</sup>mg/ml). In the presence of atropine at a concentration of 10<sup>-6</sup>mg/ml, contractile response curve (CRC) evoked by ACh (1Ă10<sup>-5</sup>-1Ă10<sup>-2 </sup>mg/ml) was significantly abolished in concentration-dependent manner. Edici did not significantly reduced ACh evoked contraction (10<sup>-5</sup>-10<sup>-2</sup>mg/ml).</p> <p>Conclusion</p> <p>These observations suggest that Edici could act through two mechanisms: firstly by activation of ÎČ-adrenergic or histaminergic receptors; and secondly muscarinic receptors may not be greatly involved, that justifying the use of the extract in traditional Medicine in Africa.</p
A qualitative analysis exploring preferred methods of peer support to encourage adherence to a Mediterranean diet in a Northern European population at high risk of cardiovascular disease.
BACKGROUND: Epidemiological and randomised controlled trial evidence demonstrates that adherence to a Mediterranean diet (MD) can reduce cardiovascular disease (CVD) risk. However, methods used to support dietary change have been intensive and expensive. Peer support has been suggested as a possible cost-effective method to encourage adherence to a MD in at risk populations, although development of such a programme has not been explored. The purpose of this study was to use mixed-methods to determine the preferred peer support approach to encourage adherence to a MD. METHODS: Qualitative (focus groups) and quantitative methods (questionnaire and preference scoring sheet) were used to determine preferred methods of peer support. Sixty-seven high CVD risk participants took part in 12 focus groups (60% female, mean age 64Â years) and completed a questionnaire and preference scoring sheet. Focus group data were transcribed and thematically analysed. RESULTS: The mean preference score (1 being most preferred and 5 being least preferred) for group support was 1.5, compared to 3.4 for peer mentorship, 4.0 for telephone peer support and 4.0 for internet peer support. Three key themes were identified from the transcripts: 1. Components of an effective peer support group: discussions around group peer support were predominantly positive. It was suggested that an effective group develops from people who consider themselves similar to each other meeting face-to-face, leading to the development of a group identity that embraces trust and honesty. 2. Catalysing Motivation: participants discussed that a group peer support model could facilitate interpersonal motivations including encouragement, competitiveness and accountability. 3. Stepping Stones of Change: participants conceptualised change as a process, and discussed that, throughout the process, different models of peer support might be more or less useful. CONCLUSION: A group-based approach was the preferred method of peer support to encourage a population at high risk of CVD to adhere to a MD. This finding should be recognised in the development of interventions to encourage adoption of a MD in a Northern European population
Direct Measurement of Perchlorate Exposure Biomarkers in a Highly Exposed Population: A Pilot Study
Exposure to perchlorate is ubiquitous in the United States and has been found to
be widespread in food and drinking water. People living in the lower Colorado
River region may have perchlorate exposure because of perchlorate in ground
water and locally-grown produce. Relatively high doses of perchlorate can
inhibit iodine uptake and impair thyroid function, and thus could impair
neurological development in utero. We examined human exposures to perchlorate in
the Imperial Valley among individuals consuming locally grown produce and
compared perchlorate exposure doses to state and federal reference doses. We
collected 24-hour urine specimen from a convenience sample of 31 individuals and
measured urinary excretion rates of perchlorate, thiocyanate, nitrate, and
iodide. In addition, drinking water and local produce were also sampled for
perchlorate. All but two of the water samples tested negative for perchlorate.
Perchlorate levels in 79 produce samples ranged from non-detect to 1816 ppb.
Estimated perchlorate doses ranged from 0.02 to 0.51 ”g/kg of body
weight/day. Perchlorate dose increased with the number of servings of dairy
products consumed and with estimated perchlorate levels in produce consumed. The
geometric mean perchlorate dose was 70% higher than for the NHANES
reference population. Our sample of 31 Imperial Valley residents had higher
perchlorate dose levels compared with national reference ranges. Although none
of our exposure estimates exceeded the U. S. EPA reference dose, three
participants exceeded the acceptable daily dose as defined by bench mark dose
methods used by the California Office of Environmental Health Hazard
Assessment
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Treatment for Mild Chronic Hypertension during Pregnancy.
BACKGROUND: The benefits and safety of the treatment of mild chronic hypertension (blood pressure, \u3c160/100 mm Hg) during pregnancy are uncertain. Data are needed on whether a strategy of targeting a blood pressure of less than 140/90 mm Hg reduces the incidence of adverse pregnancy outcomes without compromising fetal growth.
METHODS: In this open-label, multicenter, randomized trial, we assigned pregnant women with mild chronic hypertension and singleton fetuses at a gestational age of less than 23 weeks to receive antihypertensive medications recommended for use in pregnancy (active-treatment group) or to receive no such treatment unless severe hypertension (systolic pressure, â„160 mm Hg; or diastolic pressure, â„105 mm Hg) developed (control group). The primary outcome was a composite of preeclampsia with severe features, medically indicated preterm birth at less than 35 weeks\u27 gestation, placental abruption, or fetal or neonatal death. The safety outcome was small-for-gestational-age birth weight below the 10th percentile for gestational age. Secondary outcomes included composites of serious neonatal or maternal complications, preeclampsia, and preterm birth.
RESULTS: A total of 2408 women were enrolled in the trial. The incidence of a primary-outcome event was lower in the active-treatment group than in the control group (30.2% vs. 37.0%), for an adjusted risk ratio of 0.82 (95% confidence interval [CI], 0.74 to 0.92; P
CONCLUSIONS: In pregnant women with mild chronic hypertension, a strategy of targeting a blood pressure of less than 140/90 mm Hg was associated with better pregnancy outcomes than a strategy of reserving treatment only for severe hypertension, with no increase in the risk of small-for-gestational-age birth weight. (Funded by the National Heart, Lung, and Blood Institute; CHAP ClinicalTrials.gov number, NCT02299414.)
The Occurrence of Rocky Habitable-zone Planets around Solar-like Stars from Kepler Data
We present the occurrence rates for rocky planets in the habitable zones (HZs) of main-sequence dwarf stars based on the Kepler DR25 planet candidate catalog and Gaia-based stellar properties. We provide the first analysis in terms of star-dependent instellation flux, which allows us to track HZ planets. We define ηâ as the HZ occurrence of planets with radii between 0.5 and 1.5 Râ orbiting stars with effective temperatures between 4800 and 6300 K. We find that ηâ for the conservative HZ is between 0.37^(+0.48)_(â0.21) (errors reflect 68% credible intervals) and 0.60^(+0.90)_(â0.36) planets per star, while the optimistic HZ occurrence is between 0.58^(+0.73)_(â0.33) and 0.88^(+1.28)_(â0.51) planets per star. These bounds reflect two extreme assumptions about the extrapolation of completeness beyond orbital periods where DR25 completeness data are available. The large uncertainties are due to the small number of detected small HZ planets. We find similar occurrence rates between using Poisson likelihood Bayesian analysis and using Approximate Bayesian Computation. Our results are corrected for catalog completeness and reliability. Both completeness and the planet occurrence rate are dependent on stellar effective temperature. We also present occurrence rates for various stellar populations and planet size ranges. We estimate with 95% confidence that, on average, the nearest HZ planet around G and K dwarfs is ~6 pc away and there are ~4 HZ rocky planets around G and K dwarfs within 10 pc of the Sun
The Occurrence of Rocky Habitable Zone Planets Around Solar-Like Stars from Kepler Data
We present occurrence rates for rocky planets in the habitable zones (HZ) of
main-sequence dwarf stars based on the Kepler DR25 planet candidate catalog and
Gaia-based stellar properties. We provide the first analysis in terms of
star-dependent instellation flux, which allows us to track HZ planets. We
define as the HZ occurrence of planets with radius between 0.5
and 1.5 orbiting stars with effective temperatures between 4800 K
and 6300 K. We find that for the conservative HZ is between
(errors reflect 68\% credible intervals) and
planets per star, while the optimistic HZ occurrence is
between and planets per star.
These bounds reflect two extreme assumptions about the extrapolation of
completeness beyond orbital periods where DR25 completeness data are available.
The large uncertainties are due to the small number of detected small HZ
planets. We find similar occurrence rates using both a Poisson likelihood
Bayesian analysis and Approximate Bayesian Computation. Our results are
corrected for catalog completeness and reliability. Both completeness and the
planet occurrence rate are dependent on stellar effective temperature. We also
present occurrence rates for various stellar populations and planet size
ranges. We estimate with confidence that, on average, the nearest HZ
planet around G and K dwarfs is about 6 pc away, and there are about 4 HZ rocky
planets around G and K dwarfs within 10 pc of the Sun.Comment: To appear in The Astronomical Journa
Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort
BACKGROUND: While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR.
PURPOSE: To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR.
STUDY DESIGN: Case-control study; Level of evidence, 3.
METHODS: A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation.
RESULTS: Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P = .007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P = .052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate.
CONCLUSION: There was a significant reoperation rate after revision ACLR at 2 years (11%), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR
A framework for human microbiome research
A variety of microbial communities and their genes (the microbiome) exist throughout the human body, with fundamental roles in human health and disease. The National Institutes of Health (NIH)-funded Human Microbiome Project Consortium has established a population-scale framework to develop metagenomic protocols, resulting in a broad range of quality-controlled resources and data including standardized methods for creating, processing and interpreting distinct types of high-throughput metagenomic data available to the scientific community. Here we present resources from a population of 242 healthy adults sampled at 15 or 18 body sites up to three times, which have generated 5,177 microbial taxonomic profiles from 16S ribosomal RNA genes and over 3.5 terabases of metagenomic sequence so far. In parallel, approximately 800 reference strains isolated from the human body have been sequenced. Collectively, these data represent the largest resource describing the abundance and variety of the human microbiome, while providing a framework for current and future studies
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