Less Talk; More Action: SBAR as an Interactive Approach for Ethical Decision- Making

Oftentimes as educators, instructors approach ethics education as if students have all the time in the world to pontificate. This article provides an alternative teaching strategy where there is less ‘talk’, and more action as the SBAR model is utilized in the ethical decision making process. A case study depicting a difficult patient care situation provides the backdrop for a discussion of ethical decision making as a skill which can be developed when sound reasoning and principles are applied by the nursing student or novice nurse. By assuring that students have a working understanding of the concept of advocacy from an ethical perspective, educators can promote nurses’ voices at the multidisciplinary table. Nurses need a practical, relevant approach or tool such as SBAR, which can be universally applied to various practice areas and patient care situations

Barriers to Screening for Diabetic Retinopathy: A Scoping Review

Purpose/Background More than 34 million people in the United States have diabetes. Diabetic retinopathy (DR) is a major complication of diabetes and a leading cause of vision loss. Risk factors for diabetic retinopathy include Type 1 and Type 2 Diabetes, hypertension, smoking, and being African American or Hispanic/Latino. This scoping review seeks to analyze the current research on ways to increase vision screenings, thus reducing cases of diabetic retinopathy in adults. Methods Between September 2020 and November 2021, a search was conducted using PubMed, EBSCOhost, Medline, and CINAHL to identify articles using keywords such as diabetic retinopathy and ophthalmology. This extensive search led our group to twenty articles from different levels of evidence, which after undergoing rapid critical appraisal (RCA) left us with fifteen to be included in this scoping review. Our goal was to understand the barriers to receiving annual screening and strategies to enhance compliance with ophthalmology. Results The articles in our scoping review include systematic reviews, randomized control trials, and case-control studies. From the articles, we discovered barriers to receiving annual exams include cost, insurance, and education. We concluded that patient education along with annual referrals to ophthalmology as prevention for diabetic retinopathy is essential for reducing vision loss. Implications for Nursing Practice Based on our scoping review, we understand that multiple barriers exist that complicate compliance with annual vision screenings. Primary care providers play an essential role in providing patient education and referral to ophthalmology to decrease the prevalence of diabetic retinopathy. More research is needed on the effectiveness of interventions such as educational pamphlets in enhancing screening rates

Nonlinear Ultrasonic Properties of As-Quenched Steels

We have investigated the effect of carbon content on the nonlinear ultrasonic parameter β and the longitudinal phase velocity v L in a series of martensitic steel specimens. The specimens were measured in the as-quenched state to insure that the carbon was present primarily as an interstitial in the martensite. Experimentally, β increased with increasing mass percent carbon (or hardness), while v Lremained virtually the same for all specimens. Therefore we conclude that β is sensitive to microstructural variations between the specimens, but v L is not. X-ray diffraction experiments indicate that the dislocation density in the specimens is high (∼1011/cm2) and increases with increasing carbon content. These results support the hypothesis that the observed increase in β may be attributed to dislocations affected by internal stresses in the quenched specimens

Internal Carotid Artery Redundancy is Significantly Associated With Dissection.

BACKGROUND AND PURPOSE: Redundant internal carotid arteries have been considered a risk factor in tonsillectomy, adenoidectomy, and surgical treatment of peritonsillar abscess and also a potentially treatable cause of stroke. However, an association between internal carotid artery redundancy and spontaneous dissection has not yet been clearly demonstrated. METHODS: We reviewed, for spontaneous carotid artery dissection, records of all patients admitted to our institution during the period from 1986 through 1992 with the diagnosis of stroke or transient ischemic attack. We also reviewed 108 percutaneous cerebral arteriograms performed between September 1992 and December 1992 for presence of carotid artery redundancies. RESULTS: Thirteen patients exhibited spontaneous dissection. Of these, 8 of 13 (62%) patients and 13 of 20 (65%) internal carotid arteries, viewed to the siphon, had significant redundancies, kinks, coils, or loops. Of 108 consecutive arteriograms of patients without dissection, in which 187 internal carotid arteries were viewed to the siphon, there were 20 (19%) patients and 22 (12%) of 187 vessels with significant redundancy. Five patients in the dissection group and 2 in the nondissection group had bilateral internal carotid artery redundancy (P = .0019 and P = .0001, respectively). CONCLUSIONS: We found a significant correlation between internal carotid artery redundancy and dissection, particularly if redundancy is present bilaterally

The XIIIth Banff Conference on Allograft Pathology: The Banff 2015 Heart Meeting Report: Improving Antibody-Mediated Rejection Diagnostics: Strengths, Unmet Needs, and Future Directions.

The 13th Banff Conference on Allograft Pathology was held in Vancouver, British Columbia, Canada from October 5 to 10, 2015. The cardiac session was devoted to current diagnostic issues in heart transplantation with a focus on antibody-mediated rejection (AMR) and small vessel arteriopathy. Specific topics included the strengths and limitations of the current rejection grading system, the central role of microvascular injury in AMR and approaches to semiquantitative assessment of histopathologic and immunophenotypic indicators, the role of AMR in the development of cardiac allograft vasculopathy, the important role of serologic antibody detection in the management of transplant recipients, and the potential application of new molecular approaches to the elucidation of the pathophysiology of AMR and potential for improving the current diagnostic system. Herein we summarize the key points from the presentations, the comprehensive, open and wide-ranging multidisciplinary discussion that was generated, and considerations for future endeavors

Knockout studies reveal an important role of <i>plasmodium</i> lipoic acid protein ligase a1 for asexual blood stage parasite survival

Lipoic acid (LA) is a dithiol-containing cofactor that is essential for the function of a-keto acid dehydrogenase complexes. LA acts as a reversible acyl group acceptor and 'swinging arm' during acyl-coenzyme A formation. The cofactor is post-translationally attached to the acyl-transferase subunits of the multienzyme complexes through the action of octanoyl (lipoyl): &lt;i&gt;N&lt;/i&gt;-octanoyl (lipoyl) transferase (LipB) or lipoic acid protein ligases (LplA). Remarkably, apicomplexan parasites possess LA biosynthesis as well as scavenging pathways and the two pathways are distributed between mitochondrion and a vestigial organelle, the apicoplast. The apicoplast-specific LipB is dispensable for parasite growth due to functional redundancy of the parasite's lipoic acid/octanoic acid ligases/transferases. In this study, we show that &lt;i&gt;LplA1&lt;/i&gt; plays a pivotal role during the development of the erythrocytic stages of the malaria parasite. Gene disruptions in the human malaria parasite &lt;i&gt;P.falciparum&lt;/i&gt; consistently were unsuccessful while in the rodent malaria model parasite &lt;i&gt;P. berghei&lt;/i&gt; the &lt;i&gt;LplA1&lt;/i&gt; gene locus was targeted by knock-in and knockout constructs. However, the &lt;i&gt;LplA1&lt;/i&gt; &lt;sup&gt;(-)&lt;/sup&gt; mutant could not be cloned suggesting a critical role of LplA1 for asexual parasite growth &lt;i&gt;in vitro&lt;/i&gt; and &lt;i&gt;in vivo&lt;/i&gt;. These experimental genetics data suggest that lipoylation during expansion in red blood cells largely occurs through salvage from the host erythrocytes and subsequent ligation of LA to the target proteins of the malaria parasite