Understanding How Student Nurses Experience Morally Distressing Situations: Caring for Patients with Different Values and Beliefs in the Clinical Environment

Introduction/Background: Moral distress and related concepts surrounding morality and ethical decision-making have been given much attention in nursing. Despite the general consensus that moral distress is an affective response to being unable to act morally, the literature attests to the need for increased clarity regarding theoretical and conceptual constructs used to describe precisely what the experience of moral distress involves. The purpose of this study is to understand how student nurses experience morally distressing situations when caring for patients with different values and beliefs than their own in the clinical environment Methods: This study is based on secondary analysis of participant data. The stories of eight student nurses who completed the original study were reviewed following Yin’s multiple-case study design. Results: Findings suggest there is a subtle form of moral distress that has been under appreciated in the literature and differs from Jameton’s classic definition. While traditional institutional triggers to moral distress are pervasive, personal conflict as a result of differing value systems may be a moral challenge faced by nursing students working with culturally diverse patients. Conclusion: Ethics education is needed in nursing school to reduce moral distress in the clinical environment. Nursing students need opportunities to develop moral reasoning skills in addition to their clinical skills. A philosophical approach to ethics education may be needed to prevent and alleviate moral distress

Analisis Manfaat Investasi Teknologi Informasi Menggunakan Metode IT Valuation Di Kantor Sinode Gmim

Gereja, sebagai organisasi perlu mengoptimalkan manfaat Teknologi Informasi (TI) untuk kepentingan manajemen organisasi. TI merupakan salah satu factor pemungkin (key enabler )yang mendukung efisiensi manajemen organisasi gereja. Mengetahui hasil manfaat dari suatu investasi TI adalah langkah awal untuk mengukur manfaat TI dalam gereja, sebagai organisasi non-profit. Metode IT Valuation Matrix dapat digunakan untuk mengidentifikasi, mengklasifikas dan mengkuantifikasi setiap manfaat TI dari investasi yang sudah dilakukan. Hasil kuantifikasi manfaat bisnis diukur dari setiap project TI yang telah dilakukan dan menunjukan besaran manfaat terukur yang sigifikan untuk organisasi non-profit seperti gerej

α-Syntrophin regulates ARMS localization at the neuromuscular junction and enhances EphA4 signaling in an ARMS-dependent manner

EphA4 signaling has recently been implicated in the regulation of synapse formation and plasticity. In this study, we show that ankyrin repeat-rich membrane spanning (ARMS; also known as a kinase D–interacting substrate of 220 kD), a substrate for ephrin and neurotrophin receptors, was expressed in developing muscle and was concentrated at the neuromuscular junction (NMJ). Using yeast two-hybrid screening, we identified a PDZ (PSD-95, Dlg, ZO-1) domain protein, α-syntrophin, as an ARMS-interacting protein in muscle. Overexpression of α-syntrophin induced ARMS clustering in a PDZ domain–dependent manner. Coexpression of ARMS enhanced EphA4 signaling, which was further augmented by the presence of α-syntrophin. Moreover, the ephrin-A1–induced tyrosine phosphorylation of EphA4 was reduced in C2C12 myotubes after the blockade of ARMS and α-syntrophin expression by RNA interference. Finally, α-syntrophin–null mice exhibited a disrupted localization of ARMS and EphA4 at the NMJ and a reduced expression of ARMS in muscle. Altogether, our findings suggest that ARMS may play an important role in regulating postsynaptic signal transduction through the syntrophin-mediated localization of receptor tyrosine kinases such as EphA4

Transcriptional Regulation of Chemical Diversity in Aspergillus fumigatus by LaeA

Secondary metabolites, including toxins and melanins, have been implicated as virulence attributes in invasive aspergillosis. Although not definitively proved, this supposition is supported by the decreased virulence of an Aspergillus fumigatus strain, ΔlaeA, that is crippled in the production of numerous secondary metabolites. However, loss of a single LaeA-regulated toxin, gliotoxin, did not recapitulate the hypovirulent ΔlaeA pathotype, thus implicating other toxins whose production is governed by LaeA. Toward this end, a whole-genome comparison of the transcriptional profile of wild-type, ΔlaeA, and complemented control strains showed that genes in 13 of 22 secondary metabolite gene clusters, including several A. fumigatus–specific mycotoxin clusters, were expressed at significantly lower levels in the ΔlaeA mutant. LaeA influences the expression of at least 9.5% of the genome (943 of 9,626 genes in A. fumigatus) but positively controls expression of 20% to 40% of major classes of secondary metabolite biosynthesis genes such as nonribosomal peptide synthetases (NRPSs), polyketide synthases, and P450 monooxygenases. Tight regulation of NRPS-encoding genes was highlighted by quantitative real-time reverse-transcription PCR analysis. In addition, expression of a putative siderophore biosynthesis NRPS (NRPS2/sidE) was greatly reduced in the ΔlaeA mutant in comparison to controls under inducing iron-deficient conditions. Comparative genomic analysis showed that A. fumigatus secondary metabolite gene clusters constitute evolutionarily diverse regions that may be important for niche adaptation and virulence attributes. Our findings suggest that LaeA is a novel target for comprehensive modification of chemical diversity and pathogenicity

Improving Interpretation of Cardiac Phenotypes and Enhancing Discovery With Expanded Knowledge in the Gene Ontology.

BACKGROUND: A systems biology approach to cardiac physiology requires a comprehensive representation of how coordinated processes operate in the heart, as well as the ability to interpret relevant transcriptomic and proteomic experiments. The Gene Ontology (GO) Consortium provides structured, controlled vocabularies of biological terms that can be used to summarize and analyze functional knowledge for gene products. METHODS AND RESULTS: In this study, we created a computational resource to facilitate genetic studies of cardiac physiology by integrating literature curation with attention to an improved and expanded ontological representation of heart processes in the Gene Ontology. As a result, the Gene Ontology now contains terms that comprehensively describe the roles of proteins in cardiac muscle cell action potential, electrical coupling, and the transmission of the electrical impulse from the sinoatrial node to the ventricles. Evaluating the effectiveness of this approach to inform data analysis demonstrated that Gene Ontology annotations, analyzed within an expanded ontological context of heart processes, can help to identify candidate genes associated with arrhythmic disease risk loci. CONCLUSIONS: We determined that a combination of curation and ontology development for heart-specific genes and processes supports the identification and downstream analysis of genes responsible for the spread of the cardiac action potential through the heart. Annotating these genes and processes in a structured format facilitates data analysis and supports effective retrieval of gene-centric information about cardiac defects. Circ Genom Precis Med 2018 Feb; 11(2):e001813

Report from IPITA-TTS opinion leaders meeting on the future of β-cell replacement

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