Bridges and Barriers: Patients\u27 Perceptions of the Discharge Process Including Multidisciplinary Rounds on a Trauma Unit

Discharge planning is a complex process and ideally begins early in the patient stay. Despite evidence about the importance of discharge readiness, there is limited literature about the patient\u27s view during this transition. The goal of this study was to explore patient perspectives about the discharge process, including multidisciplinary rounds. Multidisciplinary rounding is a process where care providers from various specialties meet to communicate, coordinate patient care, make decisions, and manage responsibilities. The theme found was “bridges and barriers to discharge.” Participants identified timelines and tasks, communication, social support, and motivation as helpful and medical setbacks, insurance limitations, and infrequent communication as hindrances to the discharge. Future research is recommended examining efficacy of various discharge models and examination of communication and support throughout hospitalization

Moral Distress in Critical Care Nursing: The State of the Science

Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. Results: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. Conclusion: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended

The Reservoir Age Effect Varies With the Mobilization of Pre-Aged Organic Carbon in a High-Altitude Central Asian Catchment

Lake sediments provide excellent archives to study past environmental and hydrological changes at high temporal resolution. However, their utility is often restricted by chronological uncertainties due to the “ reservoir age effect ” (RAE), a phenomenon that results in anomalously old radiocarbon ages of total organic carbon (TOC) samples that is mainly attributed to the contribution of pre-aged carbon from aquatic organisms. Although the RAE is a well-known problem especially in high altitude lakes, detailed studies analyzing the temporal variations in the contribution of terrestrial and aquatic organic carbon (OC) on the RAE are scarce. This is partially due to the complexity of isolating individual compounds for subsequent compound-speci fi c radiocarbon analysis (CSRA). We developed a rapid method for isolating individual short-chain (C 16 and C 18 ) and long-chain ( > C 24 ) saturated fatty acid methyl esters (FAMEs) by using high-pressure liquid chromatography (HPLC). Our method introduces only minor contaminations (0.50 ± 0.22 µg dead carbon on average) and requires only few injections ( ≤ 10), therefore offering clear advantages over traditional preparative gas chromatography (prep-GC). Here we show that radiocarbon values ( Δ 14C) of long-chain FAs, which originate from terrestrial higher plant waxes, re fl ect carbon from a substantially pre-aged OC reservoir, whereas the Δ 14C of short-chain FAs that originate from aquatic sources were generally less pre-aged. 14 C ages obtained from the long-chain FAs are in closer agreement with 14 C ages of the corresponding bulk TOC fraction, indicating a high control of pre-aged terrestrial OC input from the catchment on TOC-derived 14 C ages. Variations in the age offset between terrestrial and aquatic biomarkers are related to changes in bulk sediment log(Ti/K) that re fl ect variations in detrital input from the catchment. Our results indicate that the chronological offset between terrestrial and aquatic OC in this high-altitude catchment is mainly driven by temporal variations in the mobilization of pre-aged OC from the catchment. In conclusion, to obtain accurate and process-speci fi c lake sediment chronologies, attention must be given to the temporal dynamics of the RAE. Variations in the apparent ages of aquatic and terrestrial contributions to the sediment and their mass balance can substantially alter the reservoir age effect

Biomolecular Evidence of Early Human Occupation of a High-Altitude Site in Western Central Asia During the Holocene

Reconstructions of early human occupation of high-altitude sites in Central Asia and possible migration routes during the Holocene are limited due to restricted archeological sample material. Consequently, there is a growing interest in alternative approaches to investigate past anthropogenic activity in this area. In this study, fecal biomarkers preserved in lake sediments from Lake Chatyr Kol (Tian Shan, Kyrgyzstan) were analyzed to reconstruct the local presence of humans and pastoral animals in this low-human-impact area in the past. Spanning the last ∼11,700 years, this high-altitude site (∼3,500 m above sea level) provides a continuous record of human occupancy in Western Central Asia. An early increase of human presence in the area during the mid-Holocene is marked by a sharp peak of the human fecal sterol coprostanol and its epimer epicoprostanol in the sediments. An associated increase in 5β-stigmastanol, a fecal biomarker deriving from herbivores indicates a human occupancy that most probably largely depended upon livestock. However, sterol profiles show that grazing animals had already occupied the catchment area of Lake Chatyr Kol before and also after a significant presence of humans. The biomarker evidence in this study demonstrates an early presence of humans in a high-altitude site in Central Asia at ∼5,900–4,000 a BP. Dry environmental conditions during this period likely made high altitude regions more accessible. Moreover, our results help to understand human migration in Western Central Asia during the early and mid-Holocene as part of a prehistoric Silk Road territory

Biomolecular Evidence of Early Human Occupation of a High-Altitude Site in Western Central Asia During the Holocene

Reconstructions of early human occupation of high-altitude sites in Central Asia and possible migration routes during the Holocene are limited due to restricted archeological sample material. Consequently, there is a growing interest in alternative approaches to investigate past anthropogenic activity in this area. In this study, fecal biomarkers preserved in lake sediments from Lake Chatyr Kol (Tian Shan, Kyrgyzstan) were analyzed to reconstruct the local presence of humans and pastoral animals in this low-human-impact area in the past. Spanning the last ∼11,700 years, this high-altitude site (∼3,500 m above sea level) provides a continuous record of human occupancy in Western Central Asia. An early increase of human presence in the area during the mid-Holocene is marked by a sharp peak of the human fecal sterol coprostanol and its epimer epicoprostanol in the sediments. An associated increase in 5β-stigmastanol, a fecal biomarker deriving from herbivores indicates a human occupancy that most probably largely depended upon livestock. However, sterol profiles show that grazing animals had already occupied the catchment area of Lake Chatyr Kol before and also after a significant presence of humans. The biomarker evidence in this study demonstrates an early presence of humans in a high-altitude site in Central Asia at ∼5,900–4,000 a BP. Dry environmental conditions during this period likely made high altitude regions more accessible. Moreover, our results help to understand human migration in Western Central Asia during the early and mid-Holocene as part of a prehistoric Silk Road territory

How to deal with multi-proxy data for paleoenvironmental reconstructions: Applications to a Holocene lake sediment record from the Tian Shan, Central Asia

Multi-proxy investigations on geological archives provide valuable information about environmental variations in the past. As opposed to single-proxy studies, the combination of several proxies can reveal more detailed information and strengthen subsequent paleoenvironmental reconstructions. However, there is still no consensus about how to deal with resulting highly dimensional datasets in a statistical manner. In many cases, the interpretations of multi-proxy datasets rely on visually matching several proxy records, which can lead to incorrect or insufficient interpretations. Here we report an innovative approach that combines the novel dimension reduction technique Uniform Manifold Approximation and Projection (UMAP) and the time series analysis R package asdetect to identify and characterize Holocene environmental phases and phase boundaries in a sediment core from Lake Chatyr Kol, southern Kyrgyzstan. Despite the fact that the Holocene climate evolution of Central Asia has been intensively studied during the last decades, knowledge about regional climate development during the Holocene and the underlying mechanisms is still relatively scarce. We particularly focus on phase transitions and differentiate between event-based shifts as opposed to gradual phase transitions. For this study, long-chain alkenones were used as a paleotemperature proxy and variations in long-chain alkyl diol distributions were ascribed to relative changes of algal input. The compound-specific stable hydrogen isotope compositions (δD) of individual n-alkanes were utilized as paleohydrological proxies, with the δD of mid-chain n-alkanes reflecting changes in the δD of the lake water and the δD of long-chain n-alkanes recording the δD of the meteoric water. We show the potential of modern analysis tools for data-driven paleoenvironmental reconstructions and advocate for their more frequent implementation in multi-proxy studies

Dietary flavonoids and nitrate: effects on nitric oxide and vascular function

Emerging evidence highlights dietary flavonoids and nitrate as candidates that may explain at least part of the cardioprotective effect of a fruit and vegetable diet. Nitric oxide plays a pivotal role in cardiovascular health. Components of a fruit and vegetable diet that are cardioprotective, in part through effects on nitric oxide status, could substantially reduce the cardiovascular risk profile of the general population with increased intake of such a diet. Epidemiological evidence suggests that dietary flavonoids and nitrate have a cardioprotective effect. Clinical trials with flavonoid- and nitrate-rich foods have shown benefits on measures of vascular health. While the molecular mechanisms by which flavonoids and nitrate are cardioprotective are not completely understood, recent evidence suggests both nonspecific and specific effects through nitric oxide pathways. This review presents an overview of nitric oxide and its key role in cardiovascular health and discusses the possible vascular benefits of flavonoids and nitrate, individually and in combination, through effects on nitric oxide status