Haavasidoksen vaihto kirurgiseen haavaan : Opetusvideo keskivaiheen sairaanhoitajaopiskelijoille

Tuotokseen painottuvan opinnäytetyön tarkoituksena oli tuottaa Tampereen ammattikorkeakoulun kirurgisen hoitotyön keskivaiheen sairaanhoitajaopiskelijoille opetusvideo, aiheesta haavasidoksen vaihto kirurgiseen haavaan. Opinnäytetyön tehtävinä oli selvittää, millainen on kirurginen haava, millaista aseptiikkaa tarvitaan kirurgisen haavan hoidossa, miten haavasidos vaihdetaan kirurgisen haavaan ja millainen on hyvä opetusvideo. Työn tavoitteena oli tukea sairaanhoitajaopiskelijoiden oppimista liittyen alle 24 tuntia vanhan kirurgisen haavan hoitoon. Opetusvideolla havainnollistettiin haavan sidosvaihdon aseptiikkaa sekä valmistamaan opiskelijaa suunnittelemaan tulevaa haavanhoitoa. Opinnäytetyö toteutettiin toiminnallisena opinnäytetyönä, jonka tuotoksena oli opetusvideo ja kirjallinen raportti. Kirurgisella haavalla tarkoitetaan iholle tehtyä leikkaushaavaa. Kirurginen haava kuuluu pitää peiteltynä 24 tuntia leikkauksesta ja sitä käsitellään mahdollisimman vähän. Yleensä puhdas kirurginen haava paranee ongelmitta, mutta komplikaatioihin kuten verenvuotoon on osattava varautua. Haavan vuotaessa ja sidosten kastuessa haavasidos on vaihdettava pohjia myöten, vaikka haavan sulkemisesta olisi alle 24 tuntia. Tällöin haavasidoksen vaihto tulee tehdä steriilisti. Haavan paranemisen kannalta sairaanhoitajan ammattiosaaminen korostuu, jolloin on osattava kirurgisen haavan peittelyn perusteet. Aseptinen työskentely, haavasidoksen valinta ja tietotaito siitä, milloin haavasidoksen vaihto on tarpeellinen ehkäisevät mahdollisia komplikaatioita, kuten haavainfektioita. Opinnäytetyön tuotoksena valmistui opetusvideo kirjallisen raportin teoriatiedon pohjalta. Video toimii sairaanhoitajaopiskelijoille opetuksen tukena ja havainnollistaa konkreettisesti eri työvaiheita alle 24 tuntia vanhan kirurgisen haavan sidoksen vaihdossa. Opinnäytetyön kirjallista tuotosta ja opetusvideota voidaan hyödyntää kirurgisen hoitotyön opetuksessa. Alle 24 tuntia vanhan kirurgisen haavan sidosvaihdosta ei löydy selkeää ohjeistusta siitä, kuinka toimia, joten opinnäytetyö on hyvä lisämateriaali sairaanhoitajaopiskelijoille. Jatkotutkimusehdotuksena esitetään kvantitatiivista tutkimusta siitä, kuinka työelämässä kirurgisen haavan sidoksen vaihto tapahtuu ja kuinka eri työvaiheet toteutuvat.The aim of this study was to define the concept of a surgical wound, the methods of protection against infections in wound care and how to change the wound dressing for a surgical wound. Moreover, the aim was to produce a suitable educational video in addition to the theoretical part of the study.  The study had a functional approach with the written report and an educational video as a tangible output of the process. The aim of the report and the video was to support the education of nursing students in the care of an under 24-hour-old surgical wound. The educational video presents protection against infections during the change of a wound dressing. It also prepares the student to plan the upcoming wound care.  The surgical wound should be covered up and left untouched for 24 hours after the operation. The wound dressing should be changed thoroughly if the wound bleeds and the dressings get wet even though the operation has been performed less than 24 hours ago. In that case, the change of the dressings should be performed in a sterile manner. Written instructions on changing the surgical wound dressings being somewhat limited, this thesis provides important information about surgical wound care in this particular respect. There is a need for a further quantitative study about the various stages in changing the surgical wound dressings in hospital settings

Why people do not keep their promise: Understanding the pro-environmental behavior in China

The promise-implementation gap is a particularly salient feature in promoting individuals' pro-environmental behavior (PEB). Many individuals are becoming aware that their past behavior has not actually been in line with the norms they have made promise to. Prior studies have suggested an array of constraints restricting individuals' pro-environmental involvement. In addition to individuals' behavioral incapability, the said inconsistency can also be traced back to the affected willingness, hard trade-off decisions, and/or the failure of stakeholders' collaboration. Based on the line of reasoning, this research develops an attitude model and frames the potential types of gaps from the perspective of attitude formation and transition surrounding PEBs. The promise-implementation gap is closely related to a sequence of attitudes showing great motivation differences from being reactive to reactive-active transition and to the active-proactive transition. The paper contextualizes the model to examine the promise-implementation gap in the Chinese environmental context. Importance of this context is high with quite mixed economic and social development across the country, which is the same across the world. The application of the model in the Chinese context justifies the validity and generalizability of the theoretic framework. The paper contributes a novel understanding of the promise-implementation gap, and illuminates potential analytic measures and managerial implications for literature of this stream

A new mechanically-interlocked [Pd2L4] cage motif by dimerization of two peptide-based lemniscates

Most metallo-supramolecular assemblies of low nuclearity adopt simple topologies, with bridging ligands spanning neighboring metal centers in a direct fashion. Here we contribute a new structural motif to the family of host compounds with low metal count (two) that consists of a pair of doubly-interlocked, Figure-eight-shaped subunits, also termed “lemniscates”. Each metal is chelated by two chiral bidentate ligands, composed of a peptidic macrocycle that resembles a natural product with two pyridyl-terminated arms. DFT calculation results suggest that dimerization of the mononuclear halves is driven by a combination of 1) Coulomb interaction with a central anion, 2) π-stacking between intertwined ligand arms and 3) dispersive interactions between the structure's compact inner core bedded into an outer shell composed of the cavitand-type macrocycles. The resulting cage-like architecture was characterized by NMR, MS and X-ray structure analyses. This new mechanically bonded system highlights the scope of structural variety accessible in metal-mediated self-assemblies composed of only a few constituents

Impacts of enhanced weathering on biomass production for negative emission technologies and soil hydrology

Limiting global mean temperature changes to well below 2 °C likely requires a rapid and large-scale deployment of negative emission technologies (NETs). Assessments so far have shown a high potential of biomass-based terrestrial NETs, but only a few assessments have included effects of the commonly found nutrient-deficient soils on biomass production. Here, we investigate the deployment of enhanced weathering (EW) to supply nutrients to areas of afforestation-reforestation and naturally growing forests (AR) and bioenergy grasses (BG) that are deficient in phosphorus (P), besides the impacts on soil hydrology. Using stoichiometric ratios and biomass estimates from two established vegetation models, we calculated the nutrient demand of AR and BG. Insufficient geogenic P supply limits C storage in biomass. For a mean P demand by AR and a lowgeogenic-P-supply scenario, AR would sequester 119 Gt C in biomass; for a high-geogenic-P-supply and low-AR-Pdemand scenario, 187 Gt C would be sequestered in biomass; and for a low geogenic P supply and high AR P demand, only 92 GtC would be accumulated by biomass. An average amount of ∼ 150 Gt basalt powder applied for EW would be needed to close global P gaps and completely sequester projected amounts of 190 Gt C during the years 2006-2099 for the mean AR P demand scenario (2-362 Gt basalt powder for the low-AR-P-demand and for the high-AR-P-demand scenarios would be necessary, respectively). The average potential of carbon sequestration by EW until 2099 is ∼ 12 GtC (∼ 0:2-∼ 27 Gt C) for the specified scenarios (excluding additional carbon sequestration via alkalinity production). For BG, 8 kg basaltm2 a1 might, on average, replenish the exported potassium (K) and P by harvest. Using pedotransfer functions, we show that the impacts of basalt powder application on soil hydraulic conductivity and plant-Available water, to close predicted P gaps, would depend on basalt and soil texture, but in general the impacts are marginal. We show that EW could potentially close the projected P gaps of an AR scenario and nutrients exported by BG harvest, which would decrease or replace the use of industrial fertilizers. Besides that, EW ameliorates the soil's capacity to retain nutrients and soil pH and replenish soil nutrient pools. Lastly, EW application could improve plant-Available-water capacity depending on deployed amounts of rock powder - adding a new dimension to the coupling of land-based biomass NETs with EW. © 2020 Royal Society of Chemistry. All rights reserved

Evidence for reduced immune gene diversity and activity during the evolution of termites

This study was supported by Freie Universität Internal Research Funding and Devtsche Forschungsgemeinschaft (DFG, grant no. MC 436/5-1) to D.P.M. S.H., P.S. and J.S. are supported by ‘EVA4.0’ (no. CZ.02.1.01/0.0/0.0/16_019/0000803), and P.S. and J.S. are supported by CIGA no. 20184306. Y.C. and Z.W. are supported by the National Natural Science Foundation of China (grant no. 31672329).The evolution of biological complexity is associated with the emergence of bespoke immune systems that maintain and protect organism integrity. Unlike the well-studied immune systems of cells and individuals, little is known about the origins of immunity during the transition to eusociality, a major evolutionary transition comparable to the evolution of multicellular organisms from single-celled ancestors. We aimed to tackle this by characterizing the immune gene repertoire of 18 cockroach and termite species, spanning the spectrum of solitary, subsocial and eusocial lifestyles. We find that key transitions in termite sociality are correlated with immune gene family contractions. In cross-species comparisons of immune gene expression, we find evidence for a caste-specific social defence system in termites, which appears to operate at the expense of individual immune protection. Our study indicates that a major transition in organismal complexity may have entailed a fundamental reshaping of the immune system optimized for group over individual defence.Peer reviewe

Eating in a losing cause : limited benefit of modified macronutrient consumption following infection in the oriental cockroach Blatta orientalis

Open Access funding enabled and organized by Projekt DEAL. S.H. was supported by the Chinese Scholarship Council and D.P.M. was supported by a seed-funding Grant provided by the Freie Universität Berlin and grant MC 436/6-1 from the Deutsche Forschungsgemeinschaft (DFG).Background Host–pathogen interactions can lead to dramatic changes in host feeding behaviour. One aspect of this includes self-medication, where infected individuals consume substances such as toxins or alter their macronutrient consumption to enhance immune competence. Another widely adopted animal response to infection is illness-induced anorexia, which is thought to assist host immunity directly or by limiting the nutritional resources available to pathogens. Here, we recorded macronutrient preferences of the global pest cockroach, Blatta orientalis to investigate how shifts in host macronutrient dietary preference and quantity of carbohydrate (C) and protein (P) interact with immunity following bacterial infection. Results We find that B. orientalis avoids diets enriched for P under normal conditions, and that high P diets reduce cockroach survival in the long term. However, following bacterial challenge, cockroaches significantly reduced their overall nutrient intake, particularly of carbohydrates, and increased the relative ratio of protein (P:C) consumed. Surprisingly, these behavioural shifts had a limited effect on cockroach immunity and survival, with minor changes to immune protein abundance and antimicrobial activity between individuals placed on different diets, regardless of infection status. Conclusions We show that cockroach feeding behaviour can be modulated by a pathogen, resulting in an illness-induced anorexia-like feeding response and a shift from a C-enriched to a more P:C equal diet. However, our results also indicate that such responses do not provide significant immune protection in B. orientalis, suggesting that the host’s dietary shift might also result from random rather than directed behaviour. The lack of an apparent benefit of the shift in feeding behaviour highlights a possible reduced importance of diet in immune regulation in these invasive animals, although further investigations employing pathogens with alternative infection strategies are warranted.Peer reviewe

Evidence for reduced immune gene diversity and activity during the evolution of termites

The evolution of biological complexity is associated with the emergence of bespoke immune systems that maintain and protect organism integrity. Unlike the well-studied immune systems of cells and individuals, little is known about the origins of immunity during the transition to eusociality, a major evolutionary transition comparable to the evolution of multicellular organisms from single-celled ancestors. We aimed to tackle this by characterizing the immune gene repertoire of 18 cockroach and termite species, spanning the spectrum of solitary, subsocial and eusocial lifestyles. We find that key transitions in termite sociality are correlated with immune gene family contractions. In cross-species comparisons of immune gene expression, we find evidence for a caste-specific social defence system in termites, which appears to operate at the expense of individual immune protection. Our study indicates that a major transition in organismal complexity may have entailed a fundamental reshaping of the immune system optimized for group over individual defence

Efficacy and safety of immune checkpoint inhibitor rechallenge in individuals with hepatocellular carcinoma

BACKGROUND & AIMS: We investigated the efficacy and safety of immune checkpoint inhibitor (ICI) rechallenge in patients with hepatocellular carcinoma (HCC) who received ICI-based therapies in a previous systemic line. METHODS: In this international, retrospective multicenter study, patients with HCC who received at least two lines of ICI-based therapies (ICI-1, ICI-2) at 14 institutions were eligible. The main outcomes included best overall response and treatment-related adverse events. RESULTS: Of 994 ICI-treated patients screened, a total of 58 patients (male, n = 41; 71%) with a mean age of 65.0±9.0 years were included. Median systemic treatment lines of ICI-1 and ICI-2 were 1 (range, 1-4) and 3 (range, 2-9), respectively. ICI-based therapies used at ICI-1 and ICI-2 included ICI alone (ICI-1, n = 26, 45%; ICI-2, n = 4, 7%), dual ICI regimens (n = 1, 2%; n = 12, 21%), or ICI combined with targeted therapies/anti-VEGF (n = 31, 53%; n = 42, 72%). Most patients discontinued ICI-1 due to progression (n = 52, 90%). Objective response rate was 22% at ICI-1 and 26% at ICI-2. Responses at ICI-2 were also seen in patients who had progressive disease as best overall response at ICI-1 (n = 11/21; 52%). Median time-to-progression at ICI-1 and ICI-2 was 5.4 (95% CI 3.0-7.7) months and 5.2 (95% CI 3.3-7.0) months, respectively. Treatment-related adverse events of grade 3-4 at ICI-1 and ICI-2 were observed in 9 (16%) and 10 (17%) patients, respectively. CONCLUSIONS: ICI rechallenge was safe and resulted in a treatment benefit in a meaningful proportion of patients with HCC. These data provide a rationale for investigating ICI-based regimens in patients who progressed on first-line immunotherapy in prospective trials. IMPACT AND IMPLICATIONS: Therapeutic sequencing after first-line immune checkpoint inhibitor (ICI)-based therapy for advanced hepatocellular carcinoma (HCC) remains a challenge as no available second-line treatment options have been studied in immunotherapy-pretreated patients. Particularly, the role of ICI rechallenge in patients with HCC is unclear, as data from prospective trials are lacking. We investigated the efficacy and safety of ICI-based regimens in patients with HCC pretreated with immunotherapy in a retrospective, international, multicenter study. Our data provide the rationale for prospective trials investigating the role of ICI-based regimens in patients who have progressed on first-line immunotherapy

Efficacy and safety of immune checkpoint inhibitor rechallenge in individuals with hepatocellular carcinoma

BACKGROUND & AIMS: We investigated the efficacy and safety of immune checkpoint inhibitor (ICI) rechallenge in patients with hepatocellular carcinoma (HCC) who received ICI-based therapies in a previous systemic line. METHODS: In this international, retrospective multicenter study, patients with HCC who received at least two lines of ICI-based therapies (ICI-1, ICI-2) at 14 institutions were eligible. The main outcomes included best overall response and treatment-related adverse events. RESULTS: Of 994 ICI-treated patients screened, a total of 58 patients (male, n = 41; 71%) with a mean age of 65.0±9.0 years were included. Median systemic treatment lines of ICI-1 and ICI-2 were 1 (range, 1-4) and 3 (range, 2-9), respectively. ICI-based therapies used at ICI-1 and ICI-2 included ICI alone (ICI-1, n = 26, 45%; ICI-2, n = 4, 7%), dual ICI regimens (n = 1, 2%; n = 12, 21%), or ICI combined with targeted therapies/anti-VEGF (n = 31, 53%; n = 42, 72%). Most patients discontinued ICI-1 due to progression (n = 52, 90%). Objective response rate was 22% at ICI-1 and 26% at ICI-2. Responses at ICI-2 were also seen in patients who had progressive disease as best overall response at ICI-1 (n = 11/21; 52%). Median time-to-progression at ICI-1 and ICI-2 was 5.4 (95% CI 3.0-7.7) months and 5.2 (95% CI 3.3-7.0) months, respectively. Treatment-related adverse events of grade 3-4 at ICI-1 and ICI-2 were observed in 9 (16%) and 10 (17%) patients, respectively. CONCLUSIONS: ICI rechallenge was safe and resulted in a treatment benefit in a meaningful proportion of patients with HCC. These data provide a rationale for investigating ICI-based regimens in patients who progressed on first-line immunotherapy in prospective trials. IMPACT AND IMPLICATIONS: Therapeutic sequencing after first-line immune checkpoint inhibitor (ICI)-based therapy for advanced hepatocellular carcinoma (HCC) remains a challenge as no available second-line treatment options have been studied in immunotherapy-pretreated patients. Particularly, the role of ICI rechallenge in patients with HCC is unclear, as data from prospective trials are lacking. We investigated the efficacy and safety of ICI-based regimens in patients with HCC pretreated with immunotherapy in a retrospective, international, multicenter study. Our data provide the rationale for prospective trials investigating the role of ICI-based regimens in patients who have progressed on first-line immunotherapy