Minimal shedding of the glycocalyx layer during abdominal hysterectomy

Funding Information: This project was funded by the Stockholm City Council, the Kleberg Foundation and Riga Stradins University. Publisher Copyright: © 2017 The Author(s).Background: Surgery with and without hypervolaemia may cause shedding (breakdown) of the endothelial glycocalyx layer, but the severity of this problem is unclear. Methods: In this preliminary report of a larger clinical trial, the plasma and urine concentrations of three biomarkers of glycocalyx shedding (syndecan-1, hyaluronic acid and heparan sulfate) were measured in seven patients before, during, and after open hysterectomy. The fluid therapy consisted of 25ml/kg (approximately 2l) of Ringer's lactate, which was infused over 30min when the surgery started. The resulting plasma volume expansion at the end of the infusion was estimated from the haemodilution. Results: The mean plasma concentration of syndecan-1 was 21.7ng/ml before surgery and averaged 19.7ng/ml during and after the surgery. The plasma concentration of hyaluronic acid decreased from 38.0 to 27.7ng/ml (P<0.05), while heparan sulfate increased from 3.4 to 5.5μg/ml (P<0.05). The urine concentrations of syndecan-1 decreased significantly, while they increased for hyaluronic acid and heparan sulfate. Despite the vigorous fluid load, the urine flow did not exceed 1ml/min. Conclusions: No clear evidence was found for shedding of the endothelial glycocalyx layer when 2l of Ringer's lactate was infused over 30min during abdominal hysterectomy. Urine analyses yielded patterns of changes that differed from those in plasma. Trial registration:ISRCTN81005631. Registered May 17, 2016.publishersversionPeer reviewe

Fibrinolytic system changes in liver surgery : A pilot observational study

Publisher Copyright: © 2018 Ozolina, Nemme, Ozolins, Bjertnæs, Vanags, Gardovskis, Viksna and Krumina.Introduction: Bleeding occurs frequently in liver surgery. Unbalance between tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) concentrations might increase bleeding. Our aim was to analyze perioperative fibrinolytic changes during liver surgery. Materials and Methods: We evaluated 15 patients for inclusion into a prospective pilot study of liver surgery. We assessed fibrinolysis by plasma PAI-1 and t-PA: before surgery (T1), before Pringle maneuver (PM;T2), at the end of surgery (T3) and 24 h postoperatively (T4), and registered demographic and laboratory data, extent and duration of surgery, hemodynamic parameters, blood loss, and transfused volumes of blood products. Data presented as mean ± SD. Significance at P < 0.05. Results: After exclusion of six patients only undergoing biopsies, we included six women and three men aged 49.1 ± 19.6 years; two patients with liver metastases of colorectal cancer and hepatocellular carcinoma, respectively, two with focal nodular hyperplasia, two with hepatic hemangioma, and one with angiomyolipoma. Six patients underwent PM. PAI-1 plasma concentration (n = 9) rose from 6.25 ± 2.25 at T1 through 17.30 ± 14.59 ng/ml at T2 and 28.74 ± 20.4 (p = 0.007) and 22.5 ± 16.0 ng/ml (p = 0.04), respectively, at T3 and T4. Correspondingly, t-PA plasma concentration (n = 9) increased from 4.76 ± 3.08 ng/ml at T1 through 8.00 ± 5.10 ng/ml (p = 0.012) at T2 and decreased to 4.25 ± 2.29 ng/ml and 3.04 ± 3.09 at T3 and T4, respectively. Plasma t-PA level at T2 was significantly different from those at T1, T3, and T4 (p < 0.004). In PM patients, t-PA levels increased from T1, peaked at T2 (p = 0.001), and subsequently decreased at T3 and T4 (p = 0.011 and p = 0.037), respectively. Mean blood loss was 1,377.7 ± 1,062.8 ml; seven patients received blood products. Patients with higher PAI-1 levels at T3 received more fresh frozen plasma (r = 0.79; p = 0.01) and red blood cells (r = 0.88; p = 0.002). Conclusions: During liver surgery, fibrinolysis increased, as evidenced by rises in plasma PAI-1and t-PA, especially after start of surgery and following PM. Transfused volumes of blood products correlated with higher plasma concentrations of PAI-1. Confirming this tendency requires a larger cohort of patients.publishersversionPeer reviewe

Identifying beliefs underlying pre-drivers’ intentions to take risks: an application of the theory of planned behaviour

Novice motorists are at high crash risk during the first few months of driving. Risky behaviours such as speeding and driving while distracted are well-documented contributors to crash risk during this period. To reduce this public health burden, effective road safety interventions need to target the pre-driving period. We use the Theory of Planned Behaviour (TPB) to identify the pre-driver beliefs underlying intentions to drive over the speed limit (N = 77), and while over the legal alcohol limit (N = 72), talking on a hand-held mobile phone (N = 77) and feeling very tired (N = 68). The TPB explained between 41% and 69% of the variance in intentions to perform these behaviours. Attitudes were strong predictors of intentions for all behaviours. Subjective norms and perceived behavioural control were significant, though weaker, independent predictors of speeding and mobile phone use. Behavioural beliefs underlying these attitudes could be separated into those reflecting perceived disadvantages (e.g., speeding increases my risk of crash) and advantages (e.g., speeding gives me a thrill). Interventions that can make these beliefs safer in pre-drivers may reduce crash risk once independent driving has begun

Nurturing the inner lives of children: an exploration of children\u27s spirituality in three educational settings

Using the theoretical framework of Howard Gardner (1999) and David Hay and Rebecca Nye (2006) this qualitative inquiry aimed to identify and describe children’s day-to-day experiences of spirituality in a range of social settings. In the context of this study spirituality was described in terms of meaning and connectedness and as a means to direct and give value to an individual’s actions and beliefs. Case studies were employed at the early childhood, primary and lower high school settings to gain an understanding of spirituality across childhood. The research focused upon the classroom context and other social situations, investigating both formal teaching of spirituality and children’s informal interaction and exploration of spiritual matters. Data collection methods were primarily based upon observation but also included interviews, work samples and journal entries. The research involved two phases of data collection. In the course of Phase one, each of the research sites were visited for one day per week across eight weeks, whereby data collection focused on the whole class situation and on all consenting participants. After the eight weeks, data continued to be collected on all participants yet focused more specifically on six case-study children selected purposely for more detailed study. This thesis extends the classic work in the area by Gardner (1999) and Hay and Nye (2006) by illustrating what four spiritual sensing categories – State of being: Awareness-sensing, State of being: Mystery-sensing, Concern for existential issues: Mystery-sensing, and Concern for existential issues: Values-sensing – surfaced as in the day-to-day lives of children in secular educational settings and other social environments. What also emerged through the case studies was the existence of various factors that supported children’s engagement with their spirituality. Differences were identified regarding the approach of families and the educational settings, however, the influences of the media, sports, peers, and religious teachings were also recognised. In particular, spirituality was addressed differently at the three educational settings in terms of the teacher’s influence, school curriculum, and physical environment. Variance among these elements impacted the ways in which children could express their spirituality at school, thus affirming the important contribution that public school education can make towards young people\u27s spiritual development. As the result of this investigation, this present study suggested several recommendations for nurturing children’s spirituality at their home settings and in secular educational settings. These included: recognising children’s spirituality as an integral aspect of the child’s development; the provision of adequate time; demonstrating an open and approachable manner; awareness to spiritual dialogue and nonverbal communication; facilitating and addressing spiritual questions; creating belonging and community; encouraging self-reflection; demonstrating role-modeling behaviours and attitudes; attending to informal moments; awareness of expectation; creation of space and environment; and, supplying resources and experiences for engagement with the spiritual domain. Several factors were also identified specific to facilitating spirituality at educational settings. These included, building teacher-student relationships to develop awareness of the context in which children are located and employing spirituality as both an entry point and subject matter to engage learning. The recommendations also indicated the need for further policy development based upon empirical work, integrating the understanding of children’s spirituality into teacher training courses, and, future research which extends the spiritual framework of this inquiry to other populations of children

Texting while driving: Psychosocial influences on young people's texting intentions and behaviour

Despite the dangers and illegality, there is a continued prevalence of texting while driving amongst young Australian drivers. The present study tested an extended theory of planned behaviour (TPB) to predict young drivers’ (17 to 24 years) intentions to [1] send and [2] read text messages while driving. Participants (N = 169 university students) completed measures of attitudes, subjective norm, perceived behavioural control, intentions, and the additional social influence measures of group norm and moral norm. One week later, participants reported on the number of texts sent and read while driving in the previous week. Attitude predicted intentions to both send and read texts while driving, and subjective norm and perceived behavioural control determined sending, but not reading, intentions. Further, intention, but not perceptions of control, predicted both texting behaviours 1 week later. In addition, both group norm and moral norm added predictive ability to the model. These findings provide support for the TPB in understanding students’ decisions to text while driving as well as the inclusion of additional normative influences within this context, suggesting that a multi-strategy approach is likely to be useful in attempts to reduce the incidence of these risky driving behaviours

Trading development tendencies in the Baltic States and their impact on national economic growth

Viens no ekonomiskās izaugsmes ietekmes faktoriem ir starptautiskā tirdzniecība. Starptautiskā tirdzniecība ietekmē valstu ekonomiskās izaugsmes tempu vai to lejupslīdi, ietekmē vispārējo valsts labklājības līmeni. Diplomdarbā tiek veikta statistikas datu analīze. Diplomdarba izvirzītais uzdevums ir izanalizēt Baltijas valstu tirdzniecības attīstības tendences un to ietekmi uz valstu ekonomisko izaugsmi. Pētījuma daļā tiek veikta eksporta, importa attiecībā pret iekšzemes kopproduktu uz vienu iedzīvotāju datu pāru korelāciju. Veikt secinājumus un priekšlikumus vadoties pēc diplomdarbā veiktajiem pētījumiem balstoties uz darba autores secinājumiem darba izpildes procesā. Galvenais secinājums – Starptautiskajai tirdzniecībai ir būtiska loma valstu ekonomikas izaugsmes procesā. Ārējā tirdzniecība un valstu ekonomiskā izaugsme ir savstarpēji cieši saistīti valstu ekonomiskās attīstības procesā.One of the economic growth factors is impact of international trade. International trade can affect economic growth or recession, international trade affecting the overall national level of welfare. In diploma thesis are carried out statistical data analysis. The present paper main task is to analyze the Baltic States trade tendencies and their impact of national economic growth. Part of the research study is carried out exports, imports relations with GDP per capita data pair correlation. Take the conclusions and recommendations based on diploma thesis author conclusions execution of work process. The main conclusion – International trade plays an important role for economic growth process. Foreign trade and national economic growth are closely related in national economic development process

Patient-related potential risk factors for postoperative nausea and vomiting after caesarean section

MedicīnaVeselības aprūpeMedicineHealth CareIevads. Spinālā anestēzija ir visbiežāk lietotā anestēzijas metode ķeizargrieziena operācijā, kuras bieža komplikācija ir pēcoperācijas slikta dūša un vemšana (PONV). Riska faktori PONV dzemdniecībā nav specifiski pētīti. Pētījuma mērķis bija noskaidrot ar pacientēm saistītos riska faktorus pēcoperācijas sliktai dūšai un vemšanai pēc ķeizargrieziena operācijas. Metodes. Retrospektīvā pētījumā piedalījās 133 grūtnieces, kurām tika veikta ķeizargrieziena operācija ar spinālo anestēziju Rīgas Dzemdību Namā laikā no 2017. gada novembra līdz 2018. gada jūnijam. Dati, kas tika iegūti no atlasītām slimību vēsturēm, iekļāva mātes vecumu, grūtniecības ķermeņa masas indeksu, grūtniecību skaitu, dzemdību skaitu, ķeizargriezienu skaitu, ķeizargrieziena steidzamības kategoriju, smēķēšanas statusu un postoperācijas intervijas rezultātus par PONV 3, 6, 12, 24 stundas pēc ķeizargrieziena operācijas. Atpazīstos intratekāli saņemto morfiju kā jaucējfaktoru, statistiskai analīzei pacientes tika sadalītas 2 grupās: M50 (50 μg) un M100 (100 μg). Rezultāti. Dati tika iekļauti no 133 slimības vēsturēm (M50 grupā 67; M100 grupā 66). Kopējā PONV incidence bija 22,5% (n=30) un tikai vemšanas incidence bija 17,2% (n=23). PONV incidence pēc 6 stundām bija lielāka pacientēm ar vairāk nekā vienu grūtniecību nekā pacientēm ar pirmo grūtniecību M100 grupā (31,9% vs 5,3%, p=0,027); lielāka multiparām nekā pacientēm, kurām pirmās dzemdības notika pētījuma laikā M100 grupā (35,9% vs 7,4%, p=0,008) un M50 grupā (19,5% vs 0%, p = 0,019); lielāka pacientēm ar otro un trešo ķeizargrieziena operāciju nekā pirmo ķeizargrieziena operāciju pētījuma laikā M100 grupā (35,5% vs 14,3%, p=0,045) un M50 grupā (22,6% vs 2,8%, p=0,020). Secinājumi. Lielāks grūtniecību skaits, multiparitāte un lielāks ķeizargrieziena operāciju skaits pacientēm ir saistīts ar augstāku risku pēcoperācijas sliktai dūšai un vemšanai pēc ķeizargrieziena operācijas. Salīdzinoši mazs pacientu skaits var ietekmēt rezultātu ticamību.Objectives. Spinal anaesthesia is the most common method in Caesarean section (CS) with postoperative nausea and vomiting (PONV) being a common complication of anaesthesia.Risk factors for PONV have not been specifically studied in obstetric patients. Aim of the study was to investigate patient-related potential risks factors for PONV after CS. Materials and Methods. A retrospective study was conducted on 133 pregnant women who had Caesarean section under spinal anaesthesia in Riga Maternity Hospital between 2017 November and 2018 June. Data used for analysis was taken from eligible charts and included maternal age, pregnancy body mass index, gravidity, parity, number of CS, category of CS urgency, smoking history and postoperative interview results about PONV 3, 6, 12, 24 hours after CS. Recognizing intrathecally received morphine as a confounding factor, patients were divided in 2 groups for statistical analysis: M50 (50 μg) and M100 (100 μg). Results. Data from 133 medical charts (M50 group 67; M100 group 66) were included. The overall incidence of PONV was 22,5% (n=30) and incidence of only vomiting was 17,2% (n=23). PONV incidence after 6 hours was higher among multigravida than primigravida in M100 group (31,9% vs 5,3%, p=0,027); higher among multiparous women than primiparous who had delivered during the study period in M100 group (35,9% vs 7,4%, p=0,008) and in M50 group (19,5% vs 0%, p=0,019); higher among women who had their second and third CS than first CS during the study period in M100 group (35,5% vs 14,3%, p=0,045) and in M50 group (22,6% vs 2,8%, p=0,020). Conclusions. Multigravidity, multiparity and higher number of Caesarean sections are associated with higher risk of PONV after CS. Relatively small sample size may influence result reliability

The executives and subordinates assumptions about the factors of employee motivation.

Šī darba mērķis ir noskaidrot, vai pastāv statistiski nozīmīgas atšķirības darba motivācijas faktoriem valsts pārvaldē strādājošiem vadošajiem un padotajiem darbiniekiem, kā arī, vai pastāv statistiski nozīmīgas atšķirības starp šo vadītāju pieņēmumiem par padoto darbinieku darba motivācijas faktoriem un padoto darbinieku darba motivācijas faktoriem. Kā mērinstruments darba motivācijas faktoriem šī darba kontekstā tika izmantotas darba vērtības. Tika izvirzīti šādi pētījuma jautājumi: 1. Kādas ir vadošo darbinieku galvenās darba vērtības? 2. Kādas ir padoto darbinieku galvenās darba vērtības? 3. Vai pastāv statistiski nozīmīgas atšķirības starp vadošo un padoto darbinieku galvenajām darba vērtībām? 4. Vai pastāv statistiski nozīmīgas atšķirības starp vadītāju pieņēmumiem par padoto darbinieku galvenajām darba vērtībām un padoto darbinieku galvenajām darba vērtībām? Pētījumā piedalījās divas respondentu grupas: 1. Viena grupa sastāvēja no 5 augstākā un 25 vidējā līmeņa vadītājiem strādājošiem valsts pārvaldē, vecumā no 35 līdz 62 gadiem. No tiem 14 vīrieši un 16 sievietes. 28 respondentiem no šīs grupas dzimtā valoda ir latviešu valoda un 2 respondentiem – krievu. Visi šajā grupā esošie respondenti ir ieguvuši augstāko izglītību. 2. Otra grupa sastāvēja no 30 padotajiem darbiniekiem strādājošiem valsts pārvaldē, pēc amata – 5 lietveži, 19 pārvaldes vecākie referenti, 2 personāla inspektori, 3 namu pārziņi un viens jaunākais grāmatvedis, vecumā no 22 līdz 58 gadiem. No tiem 11 vīrieši un 19 sievietes. 29 respondentiem no šīs grupas dzimtā valoda ir latviešu valoda un 1 respondentam – krievu. 21 respondents ir ieguvis augstāko izglītību, 5 respondenti – vidējo profesionālo izglītību, bet 4 respondenti – vispārējo vidējo izglītību. Kā pētījuma metode tika izmantota Furnhama (Furnham, Petrides, Thaousis, Pappas & Garrod, 2005) izstrādātā aptauja WVQ (Work Values Questionaire). Galvenie šī darba secinājumi ir, ka vadītājiem visu darba vērtību veidi ir izteikti spilgtāk. Pastāv statistiski nozīmīgas atšķirības starp vadošo un padoto darbinieku galvenajām darba vērtībām. Vadošajiem darbiniekiem izteiktāki ir satura jeb iekšējie faktori, bet padotajiem darbiniekiem konteksta jeb ārējie faktori. Kā arī, ka nepastāv statistiski nozīmīgas atšķirības starp vadītāju pieņēmumiem par padoto darbinieku galvenajām darba vērtībām un padoto darbinieku galvenajām darba vērtībām. Šajā pētījumā iegūtos rezultātus var izmantot, lai efektīvāk veidotu izmaiņas personāla vadības politikā valsts pārvaldē, piedāvājot nodarbinātajiem darba motivācijas sistēmu, kas izstrādāta, ņemot vērā nodarbināto darba vērtības. Atslēgas vārdi: darba motivācija, vadošais darbinieks, padotais darbinieks, darba vērtības, satura jeb iekšējie faktori, konteksta jeb ārējie faktori.The goal of this research paper is to find out if there exist some statistically significant differences between managers and subordinates in state administration factors of work motivation and also to find out if there exist some statistically significant differences between the manager’s presumptions about the factors that motivate the subordinates and the real factors that motivate them. The work values are used as measurement instrument for the factors of work motivation. The following research questions have been raised: 1.What kind of work values do managers set as the most important? 2.What kind of work values do subordinates set as the most important? 3.Does there exist some statistically significant differences between the work values to managers and subordinates? 4.Does there exist some statistically significant differences between the manager’s presumptions about the factors that motivate the subordinates and the real factors that motivate them? Two groups of respondents have taken part in the research: 1. First group was composed of 5 highest level and 25 middle level managers, working in the state administration, 35 to 62 aged, 14 male, 16 female, out of 30 participants, 28 consider Latvian to be their mother tongue, while remaining 2 consider Russian to be their mother tongue. All respondents in this group are with higher education. 2. Second group was composed of 30 subordinates, working in the state administration, varied professions, 22 to 58 aged, 11 male, 19 – female, out of 30 participants, 29 consider Latvian to be their mother tongue, while remaining 1 consider Russian to be their mother tongue. 21 respondents in this group are with higher education, 5 respondents – with vocational education, but 4 respondents – with secondary education. Furnham`s (Furnham, Petrides, Thaousis, Pappas & Garrod, 2005) WVQ (Work Values Questionnaire) is used as the measurement method. The main conclusions of this research are that all the kinds of work values are more important for managers and there exist statistically significant differences between the work values to managers and subordinates. Intrinsic factors are more typical to managers, while extrinsic factors are more typical to subordinates. But there are no statistically significant differences between the manager’s presumptions about the factors that motivate the subordinates and the real factors that motivate them. The outcome of this research can be used to make changes in policy of human resources management more effectively – offering employees the work motivational system, developed in response to the employees work values. Keywords: work motivation, manager, subordinate, work values, intrinsic factors, extrinsic factors

In support of authentic research practice by students in design education

Both the Animation and Product design programmes at the University of Technology Sydney share a common goal, with the early teaching focus being engagement with traditional analogue skills. We deem observational drawing and analysis from life an authentic research tool as it creates a clear and tangible experience between the observer and the subject in three-dimensional space. It also provides the opportunity for a physical and empathetic response to occur. Where students have not been directed to observe from life, we find they rely on the collection of images and video from online sources. The experience of pre-formatted, screen-based observation restricts the possibility of authentic engagement as the chosen subject matter is already pre-designed by a third party. In order to understand if students identify the benefits of an authentic research experience an experiment with two separate tasks was conducted. In the first task, students were asked to undertake a drawing exercise inside a computer lab with a computer terminal being the only research tool available. We call this the ‘screen-based studio’ (SBS). The second task directed the students to undertake a studio exercise where they drew from life, which we call the ‘drawing from life studio’ (DFLS). The goal of these studio exercises was to investigate ways for students to understand that producing innovative work requires stepping out of their comfort zones and engaging in a more challenging and authentic information gathering experience. This paper discusses the results of this experiment

Integrating generative design and topology optimisation with product design values

Advances in computer technology and software increasingly encourage the usage of CAD tools for designing forms that algorithmically manipulate ‘structural’ and ‘surface’ features. These sophisticated new computational processes, broadly known as ‘generative design’ and ‘topology optimisation’, are very likely to become a regular part of the product design process for many types of products. A core value of design practice is the development of intuition and iterative skills to explore the technical and experiential performance of design concepts through sketching, model making, and prototyping. Identifying ways to integrate ‘generative design’ and ‘topology optimisation’ CAD processes with ‘making’ as a core value in product design concept development is a significant challenge - particularly for design education. A related concern is that ‘topology optimisation’ can generate structurally optimised parts for the amount and type of material used, which essentially determines the fabrication method. Often these parts in their raw form can only be made using 3D printing technologies, though they can (and often need to) be ‘styled’ or modified. Therefore, the relationship to 3D printing and its limitations as an end-part manufacturing technology must be critically tested as part of the design process. The practice-led research presented includes a case study of the design of a mountain bike (MTB) crank arm developed using an integrated design process that incorporates a series of ‘topology optimisation’ simulations. The authors undertook the project to inform the design of a new ‘generative design’ and ‘topology optimisation’ studio-based subject to be offered to second and third-year product design students at the University of Technology Sydney. The research proposes a form of integrated design practice that values ‘making’ iteratively, and the advancing CAD-based ‘generative design’ and ‘topology optimisation’ tools to responsibly support experiential learning in product design, manufacturing and engineering