Kinder und Jugendliche als pflegende Angehörige: Einblick in die Situation Betroffener und Möglichkeiten der Unterstüzung. T. 2, Konzeptentwicklung und Planung von familienorientierten Unterstützungsmaßnahmen für Kinder und Jugendliche als pflegende Angehörige

Ende des Jahres 2012 wurde eine Studie – beauftragt vom Bundesministerium für Arbeit, Soziales und Konsumentenschutz (Sozialministerium) – veröffentlicht, die erstmalig in Österreich auf die Situation pflegender Kinder und Jugendlicher aufmerksam machte. Damit rückte eine Gruppe ins öffentliche Interesse, die bisher als solche noch nicht wahrgenommen wurde. Laut dieser Studie leben in Österreich über 40.000 Kinder und Jugendliche, die regelmäßig im Sinne der Langzeitpflege Verantwortung für ein chronisch krankes Familienmitglied übernehmen. Die damit verbundenen Tätigkeiten sind vielfältig und gehen hinsichtlich ihrer Art und Intensität häufig über das hinaus, was für das Alter und die Entwicklung der Betroffenen angemessen ist (Nagl-Cupal et al. 2012). Dies hat zur Folge, dass Pflege durch Kinder und Jugendliche in direktem Zusammenhang mit negativen gesundheitlichen und sozialen Auswirkungen steht. Das Ziel der vorliegenden Arbeit besteht somit in der Entwicklung eines Rahmenkonzepts als Grundlage zur Unterstützung von Young Carers und deren Familien. Damit wird aufgezeigt, durch welche konkreten Maßnahmen Hilfe für diese Gruppe geleistet werden kann. Gleichzeitig gibt das Rahmenkonzept eine Orientierung für jene Institutionen, die zielgruppen- und bedürfnisorientierte Unterstützungsmaßnahmen für Young Carers implementieren wollen. Das Ziel der vorliegenden Arbeit besteht somit in der Entwicklung eines Rahmenkonzepts als Grundlage zur Unterstützung von Young Carers und deren Familien. Damit wird aufgezeigt, durch welche konkreten Maßnahmen Hilfe für diese Gruppe geleistet werden kann. Gleichzeitig gibt das Rahmenkonzept eine Orientierung für jene Institutionen, die zielgruppen- und bedürfnisorientierte Unterstützungsmaßnahmen für Young Carers implementieren wollen

Introducing an Interpretable Deep Learning Approach to Domain-Specific Dictionary Creation: A Use Case for Conflict Prediction

Recent advancements in natural language processing (NLP) methods have significantly improved their performance. However, more complex NLP models are more difficult to interpret and computationally expensive. Therefore, we propose an approach to dictionary creation that carefully balances the trade-off between complexity and interpretability. This approach combines a deep neural network architecture with techniques to improve model explainability to automatically build a domain-specific dictionary. As an illustrative use case of our approach, we create an objective dictionary that can infer conflict intensity from text data. We train the neural networks on a corpus of conflict reports and match them with conflict event data. This corpus consists of over 14,000 expert-written International Crisis Group (ICG) CrisisWatch reports between 2003 and 2021. Sensitivity analysis is used to extract the weighted words from the neural network to build the dictionary. In order to evaluate our approach, we compare our results to state-of-the-art deep learning language models, text-scaling methods, as well as standard, nonspecialized, and conflict event dictionary approaches. We are able to show that our approach outperforms other approaches while retaining interpretability

Tolerability of inhaled N-chlorotaurine in an acute pig streptococcal lower airway inflammation model

<p>Abstract</p> <p>Background</p> <p>Inhalation of N-chlorotaurine (NCT), an endogenous new broad spectrum non-antibiotic anti-infective, has been shown to be very well tolerated in the pig model recently. In the present study, inhaled NCT was tested for tolerability and efficacy in the infected bronchopulmonary system using the same model.</p> <p>Methods</p> <p>Anesthetized pigs were inoculated with 20 ml of a solution containing approximately 10⁸CFU/ml <it>Streptococcus pyogenes </it>strain d68 via a duodenal tube placed through the tracheal tube down to the carina. Two hours later, 5 ml of 1% NCT aqueous solution (test group, n = 15) or 5 ml of 0.9% NaCl (control group, n = 16) was inhaled via the tracheal tube connected to a nebulizer. Inhalation was repeated every hour, four times in total. Lung function and haemodynamics were monitored. Bronchoalveolar lavage samples were removed for determination of colony forming units (CFU), and lung samples for histology.</p> <p>Results</p> <p>Arterial pressure of oxygen (PaO₂) decreased rapidly after instillation of the bacteria in all animals and showed only a slight further decrease at the end of the experiment without a difference between both groups. Pulmonary artery pressure increased to a peak 1-1.5 h after application of the bacteria, decreased in the following hour and remained constant during treatment, again similarly in both groups. Histology demonstrated granulocytic infiltration in the central parts of the lung, while this was absent in the periphery. Expression of TNF-alpha, IL-8, and haemoxygenase-1 in lung biopsies was similar in both groups. CFU counts in bronchoalveolar lavage came to 170 (10; 1388) CFU/ml (median and 25 and 75 percentiles) for the NCT treated pigs, and to 250 (10; 5.5 × 10⁵) CFU/ml for NaCl treated pigs (p = 0.4159).</p> <p>Conclusions</p> <p>Inhaled NCT at a concentration of 1% proved to be very well tolerated also in the infected bronchopulmonary system. This study confirms the tolerability in this delicate body region, which has been proven in healthy pigs previously. Regarding efficacy, no conclusions can be drawn, mainly because of the limited test period of the model.</p

Mechanistic investigation of the effect of endoglucanases related to pulp refining

Endoglucanases are increasingly being touted as the ultimate solution for reducing energy consumption during the refining process in the pulp and paper industry. However, due to the high variety of endoglucanases in different enzyme formulations, these perform heterogeneously when applied to different pulps. In this study, the effect of four endoglucanases on softwood and hardwood pulp was studied using confocal laser scanning microscopy (CLSM) after addition of fluorescently labelled carbohydrate binding modules (CBMs). Nuclear magnetic resonance (NMR) analysis and high-performance liquid chromatography quantification of released oligo- and monosaccharides was performed for in-depth mechanistical investigation. Changes in the crystallinity levels caused by enzymatic degradation of amorphous regions were monitored by incubation with two different CBMs from Caldicellulosiruptor bescii and from Thermobifida fusca with high preference to either amorphous or crystalline regions of cellulose, respectively. When dosed at identical activity on the endoglucanase specific CellG5 substrate, CLSM analysis indicated the highest decrease of amorphous regions for those endoglucanases which were also most active in laboratory refining trials and which released highest amounts of cellooligomers from pulp. Using 13C-NMR analysis, an increase in para-crystalline cellulose caused by enzyme application was observed. Release of reducing sugars was determined at identical CellG5 dosage, indicating a high variance between the enzymes, especially when complex enzyme formulations were used. Scanning electron microscopy images were obtained for visualization of the endoglucanase activity. The results of mechanistical studies indicate that reduction of amorphous moieties of pulp by endoglucanases is especially beneficial for the refining proces

Isoforms of Retinol binding protein 4 (RBP4) are increased in chronic diseases of the kidney but not of the liver

<p>Abstract</p> <p>Background</p> <p>The levels of retinol-binding protein 4 (RBP4) – the carrier protein for Vitamin A in plasma – are tightly regulated under healthy circumstances. The kidney, the main site of RBP4 catabolism, contributes to an elevation of RBP4 levels during chronic kidney disease (CKD) whereas during chronic liver disease (CLD) RBP4 levels decrease. Little is known about RBP4 isoforms including apo-RBP4, holo-RBP4 as well as RBP4 truncated at the C-terminus (RBP4-L and RBP4-LL) except that RBP4 isoforms have been reported to be increased in hemodialysis patients. Since it is not known whether CLD influence RBP4 isoforms, we investigated RBP4 levels, apo- and holo-RBP4 as well as RBP4-L and RBP4-LL in plasma of 36 patients suffering from CKD, in 55 CLD patients and in 50 control subjects. RBP4 was determined by ELISA and apo- and holo-RBP4 by native polyacrylamide gel electrophoresis (PAGE). RBP4-L and RBP4-LL were analyzed after immunoprecipitation by mass spectrometry (MALDI-TOF-MS).</p> <p>Results</p> <p>RBP4 isoforms and levels were highly increased in CKD patients compared to controls (P < 0.05) whereas in CLD patients RBP4 isoforms were not different from controls. In addition, in hepatic dysfunction RBP4 levels were decreased whereas the amount of isoforms was not affected.</p> <p>Conclusion</p> <p>The occurrence of RBP4 isoforms is not influenced by liver function but seems to be strongly related to kidney function and may therefore be important in investigating kidney function and related disorders.</p

Kinder und Jugendliche als pflegende Angehörige: Einblick in die Situation Betroffener und Möglichkeiten der Unterstüzung. T. 1, Einsicht in die Situation gegenwärtiger und ehemaliger pflegender Kinder in Österreich

Kinder und Jugendliche, die regelmäßig ein chronisch krankes Familienmitglied pflegen, sind ein globales Phänomen. In Österreich ist der Situation pflegender Kinder und Jugendlicher, mit Ausnahme einer größeren Anzahl von Diplomarbeiten am Institut für Pflegewissenschaft der Universität Wien, bisher noch wenig Aufmerksamkeit geschenkt worden. Es fehlt sowohl am Einblick in das Thema der sogenannten „Young Carers“ generell als auch an qualifizierten Hilfsangeboten. Ausgehend von einem parlamentarischen Entschließungsantrag hat das Bundesministerium für Arbeit, Soziales und Konsumentenschutz das Institut für Pflegewissenschaft der Universität Wien mit einer Studie beauftragt, die die Situation pflegender Kinder in Österreich untersuchen soll. Das Ziel der vorliegenden Studie besteht darin, Einsicht in die Situation pflegender Kinder zu nehmen. Diese Einsicht erfolgt in Form einer fundierten Zahlenbasis über die genaue Anzahl und die Situation gegenwärtig pflegender Kinder ebenso wie auf Grundlage der Beleuchtung der Situation ehemaliger pflegender Kinder und der Auswirkungen kindlicher Pflegeerfahrungen im Erwachsenenalter. Abgeleitet von den Ergebnissen und dem internationalen Diskurs werden Empfehlungen formuliert, auf deren Grundlage pflegende Kinder und Jugendliche unterstützt werden können

Pain Interventions for people with dementia: a quasi-experimental study

Abstract Background Due to the complexity of the provision of care for people with dementia, pain assessment and management is still considered to be lacking. An optimal way to support frontline staff in providing pain assessment and management for people with dementia living in nursing homes has not yet been identified. The success of supporting interventions seems dependent on contextual factors in the nursing homes. This study, therefore, analyzes the feasibility of a nurse-led training intervention, using repeated on-site case studies, in modifying pain intensity and frequency in people with dementia. Methods Using a quasi-experimental design, we undertook a multi-center study of nurse-led training in pain management, with subsequent on-site case studies. Healthcare workers from 3 nursing homes assessed pain in 164 residents with dementia over 147 days. We used mixed-effect growth curve models with spline regression to analyze the data. Results We found that on-site case studies support frontline staff with pain management and assessment. Repeated reflection in case studies led to significantly longer pain free intervals (from 4.7 at baseline to 37.1 days at second follow-up) and decreased frequency of pain events (OR 0.54 at first follow-up and 0.43 at second follow-up). However no trends regarding pain intensity could be found. Therefore, on-site case studies may be valuable for improving pain frequency and pain-free intervals over time. Conclusion This feasibility study shows the potential of on-site support for frontline nursing home staff. On-site case studies may also affect health outcomes in people with dementia. However, the complexity of dementia care necessitates the management of a broader range of needs. Trial registration The study was retrospectively registered on the tenth of January 2017 with the German registry of clinical trials (DRKS00009726)

Shedding light on the D1-like receptors : a fluorescence-based toolbox for visualization of the D1 and D5 receptors

Funding: Universitat de Barcelona; Fonds der Chemischen Industrie. Grant Number: 661688; University of Regensburg graduate school “Receptor Dynamics: Emerging Paradigms for Novel Drugs. Grant Number: K-BM-2013-247; Elite Network of Bavaria Deutsche Forschungsgemeinschaft. Grant Numbers: 421152132, SFB1423, SFB1470; Spanish MCIN/AEI/10.13039/501100011033. Grant Number: PID2021-126600OB−I00; European Union Next Generation EU/PRTR.Dopamine D1-like receptors are the most abundant type of dopamine receptors in the central nervous system and, even after decades of discovery, still highly interesting for the study of neurological diseases. We herein describe the synthesis of a new set of fluorescent ligands, structurally derived from D1R antagonist SCH-23390 and labeled with two different fluorescent dyes, as tool compounds for the visualization of D1-like receptors. Pharmacological characterization in radioligand binding studies identified UR-NR435 (25) as a high-affinity ligand for D1-like receptors (pKi (D1R) = 8.34, pKi (D5R) = 7.62) with excellent selectivity towards D2-like receptors. Compound 25 proved to be a neutral antagonist at the D1R and D5R in a Gs heterotrimer dissociation assay, an important feature to avoid receptor internalization and degradation when working with whole cells. The neutral antagonist 25 displayed rapid association and complete dissociation to the D1R in kinetic binding studies using confocal microscopy verifying its applicability for fluorescence microscopy. Moreover, molecular brightness studies determined a single-digit nanomolar binding affinity of the ligand, which was in good agreement with radioligand binding data. For this reason, this fluorescent ligand is a useful tool for a sophisticated characterization of native D1 receptors in a variety of experimental setups.Publisher PDFPeer reviewe

Intensive care nurse-family engagement from a global perspective: A qualitative multi-site exploration

Background: Critical illness is distressing for families, and often results in negative effects on family health that influence a family\u27s ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood. Objectives: To describe nurses’ perceptions and practices of family engagement in adult intensive care units from a global perspective. Design: A qualitative-descriptive multi-site design using content analysis. Settings: The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents. Participants: A total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. Methods: Semi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis. Results: We found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses’ practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses’ attitudes and perceptions of family, the patient\u27s condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses’ ability to engage with families. Conclusions: This global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in intensive care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of intensive care

Shedding Light on the D1‐Like Receptors: A Fluorescence‐Based Toolbox for Visualization of the D1 and D5 Receptors

Dopamine D1-like receptors are the most abundant type of dopamine receptors in the central nervous system and, even after decades of discovery, still highly interesting for the study of neurological diseases. We herein describe the synthesis of a new set of fluorescent ligands, structurally derived from D1R antagonist SCH-23390 and labeled with two different fluorescent dyes, as tool compounds for the visualization of D1-like receptors. Pharmacological characterization in radioligand binding studies identified UR-NR435 (25) as a high-affinity ligand for D1-like receptors (pKi (D1R)=8.34, pKi (D5R)=7.62) with excellent selectivity towards D2-like receptors. Compound 25 proved to be a neutral antagonist at the D1R and D5R in a Gs heterotrimer dissociation assay, an important feature to avoid receptor internalization and degradation when working with whole cells. The neutral antagonist 25 displayed rapid association and complete dissociation to the D1R in kinetic binding studies using confocal microscopy verifying its applicability for fluorescence microscopy. Moreover, molecular brightness studies determined a single-digit nanomolar binding affinity of the ligand, which was in good agreement with radioligand binding data. For this reason, this fluorescent ligand is a useful tool for a sophisticated characterization of native D1 receptors in a variety of experimental setups