AKS inom vård av äldre ur Nordiska sjuksköterskors perspektiv : Utveckling av en ny arbetsmodell för AKS inom äldrevård

Den framtida hälso- och sjukvården i Norden kommer att ställas inför en rad nya utmaningar. Medellivslängden ökar och den åldrande befolkningen får mer krävande och komplexa behov. En högre kompetens inom främst vården av äldre är starkt efterfrågad. Ett led i att försöka bemöta det ökade behovet av komptens är införandet av avancerade kliniska sjuksköterskor (AKS) inom hälso-och sjukvården. AKS är specialistutbildade sjuksköterskor med masterexamen. En högre kompetens inom farmakologi, patofysiologi och klinisk undersökningsmetodik i samverkan med exempelvis geriatrik ger AKS en bättre utgångspunkt i arbetet med de åldrande patienterna och deras hälsa. Syftet med denna studie var att utifrån sjuksköterskors synvinkel studera hur problematiken ser ut inom dagens äldrevård i de nordiska länderna (Sverige, Danmark, Norge och Färöarna) samt på vilket sätt en AKS skulle kunna vara en resurs inom äldrevården och vilka arbetsuppgifter denne skulle kunna ha. Metoden som användes var kvalitativ semistrukturerad intervjustudie och det insamlade materialet bestod av 5 intervjuer med vidareutbildade sjuksköterskor ifrån respektive land. Innehållet analyserades sedan genom tematisk innehållsanalys. Resultatet mynnade ut i 3 huvudkatergorier: Dagens äldrevård, AKS arbetsuppgifter och det nya. Det visade sig att sjuksköterskorna upplevde många brister med dagens vård. Patienterna upplevdes vara tvungna att åka fram och tillbaka för bedömningar och behandlingar som många gånger kunnat utföras på plats om kompetens fanns tillgänglig. Behovet bland kollegor och övrig personal var även stort när det gäller konsultation, rådgivning och undervisning. AKS rollen upplevdes som något mycket positivt men känslan genomsyrades ändå av en stor ambivalens inför denna nya funktion. Utifrån resultatet och teoretiska studier utvecklades en arbetsmodell för AKS inom primär och hemsjukvård. Språk: Svenska Nyckelord: Advanced practice nurse and primary health-care, roles, development and experiences.The health organizations in the Nordic countries are going to experience big challenges in future. This is mainly concerning the abilities of providing care for elderly people. The Nordic countries and Europe is facing a growing amount of population over 65 years and older. They are demanding more efficient care and are often suffering from multiple variation of diseases in the same time the number of physicians and nurses with special education is decreasing. This has led to the need of educate nurses with more clinically demanding skills, the APN. The aim of this study was to explore the problems with elderly care of today and determine how the new role as APN can assist in improving the care. And also what kind of duties the APN would be responsible of. The method that was used was a qualitative semi structured interview study with 5 nurses as participants from the Nordic countries (Sweden, Norway, Denmark and the Faroe Irelands). The material was analyzed with a thematic content analysis. Findings in the study show that elderly people has a complex situation, they often have to move from one institution to another for examination and treatment when they instead would have been able to be taken care of in their home if the competence would have been high enough. Colleague nurses and other employees would appreciate the APN as a consult and adviser. The participants of the study had a very positive impression of this APN but still you could recognize some kind of ambivalence or hesitation among them for this new role. Together with the results of the study and scientific research a working model has been created for the APN in primary health care and homecare. Language: Swedish Keywords Advanced practice nurse and primary health-care, roles , development and experiences

Prompt High-Energy Emission from Proton-Dominated Gamma-Ray Bursts

The prompt emission of gamma-ray bursts (GRBs) is widely thought to be radiation from accelerated electrons, but an appreciably larger amount of energy could be carried by accelerated protons, particularly if GRBs are the sources of ultra-high-energy cosmic rays (UHECRs). We model the expected photon spectra for such "proton-dominated" GRBs in the internal shock scenario through Monte Carlo simulations, accounting for various processes related to high-energy electrons and protons. Besides proton and muon synchrotron components, emission from photomeson-induced secondary pair cascades becomes crucial, generally enhancing the GeV-TeV and/or eV-keV photons and offering a signature of UHE protons. In some cases, it can overwhelm the primary electron component and result in GRBs peaking in the 10 MeV - 1 GeV range, which may be relevant to some bursts discussed in a recent re-analysis of EGRET TASC data. The dependence of the spectra on key quantities such as the bulk Lorentz factor, magnetic field and proton-to-electron ratio is nontrivial due to the nonlinear nature of cascading and the interplay of electron- and proton-induced components. Observations by {\it Fermi}, ground-based telescopes and other facilities should test these expectations and provide critical constraints on the proton acceleration efficiency.Comment: 16 pages, 6 figure

Locality and diel cycling of viral production revealed by a 24 h time course cross-omics analysis in a coastal region of Japan

International audienceViruses infecting microorganisms are ubiquitous and abundant in the ocean. However, it is unclear when and where the numerous viral particles we observe in the sea are produced and whether they are active. To address these questions, we performed time-series analyses of viral metagenomes and microbial metatranscriptomes collected over a period of 24 h at a Japanese coastal site. Through mapping the metatranscriptomic reads on three sets of viral genomes ((i) 878 contigs of Osaka Bay viromes (OBV), (ii) 1766 environmental viral genomes from marine viromes, and (iii) 2429 reference viral genomes), we revealed that all the local OBV contigs were transcribed in the host fraction. This indicates that the majority of viral populations detected in viromes are active, and suggests that virions are rapidly diluted as a result of diffusion, currents, and mixing. Our data further revealed a peak of cyanophage gene expression in the afternoon/dusk followed by an increase of genomes from their virions at night and less-coherent infectious patterns for viruses putatively infecting various groups of heterotrophs. This suggests that cyanophages drive the diel release of cyanobacteria-derived organic matter into the environment and viruses of heterotrophic bacteria might have adapted to the population-specific life cycles of hosts

Hemangiopericytoma of the Greater Omentum

A 41-year-old Chinese woman was admitted to our hospital with epigastric pain. Computed tomography detected a heterogeneous enhancement tumor fed by the left gastroepiploic artery in the left lower quadrant and cholelithiasis. Excision of the tumor in the greater omentum and cholecystectomy were performed laparoscopically. Histological findings confirmed a diagnosis of hemangiopericytoma with low-grade malignancy. To our knowledge, hemangiopericytoma of the greater omentum is very rare, and only 12 cases were reported in English literature. We report a case of hemangiopericytoma arising in the greater omentum and review the literature

Prospects for Detecting Gamma-Ray Bursts at Very High Energies with the Cherenkov Telescope Array

We discuss the prospects for the detection of gamma-ray bursts (GRBs) by the Cherenkov Telescope Array (CTA), the next generation, ground-based facility of imaging atmospheric Cherenkov telescopes (IACTs) operating above a few tens of GeV. By virtue of its fast slewing capabilities, the lower energy threshold compared to current IACTs, and the much larger effective area compared to satellite instruments, CTA can measure the spectra and variability of GRBs with excellent photon statistics at multi-GeV energies. Employing a model of the GRB population whose properties are broadly consistent with observations by the Gamma-ray Burst Monitor (GBM) and Large Area Telescope (LAT) onboard Fermi, we simulate follow-up observations of GRBs with the Large Size Telescopes (LSTs), the component of CTA with the fastest slew speed and the best sensitivity at energies below a few hundred GeV. For our fiducial assumptions, we foresee that the LSTs can detect ~0.1 GRBs per year during the prompt phase and ~0.5 per year in the afterglow phase, considering only one array site and both GBM and the Space-based multi-band astronomical Variable Object Monitor (SVOM) as the alert instruments. The detection rates can be enhanced by a factor of about 5 and 6 for the prompt emission and the afterglow, respectively, assuming two array sites with the same sensitivity and that the GBM localization error can be reduced to less than 1 deg. The expected distribution of redshift and photon counts are presented, showing that despite the modest event rate, hundreds or more multi-GeV photons can be anticipated from a single burst once they are detected. We also study how the detection rate depends on the intrinsic GRB properties and the delay time between the burst trigger and the follow-up observation.Comment: 15 pages, 9 figures, accepted for publication in MNRA

Glucoraphanin Ameliorates Obesity and Insulin Resistance Through Adipose Tissue Browning and Reduction of Metabolic Endotoxemia in Mice

Low-grade sustained inflammation links obesity to insulin resistance and nonalcoholic fatty liver disease (NAFLD). However, therapeutic approaches to improve systemic energy balance and chronic inflammation in obesity are limited. Pharmacological activation of nuclear factor (erythroid-derived 2)–like 2 (Nrf2) alleviates obesity and insulin resistance in mice; however, Nrf2 inducers are not clinically available owing to safety concerns. Thus, we examined whether dietary glucoraphanin, a stable precursor of the Nrf2 inducer sulforaphane, ameliorates systemic energy balance, chronic inflammation, insulin resistance, and NAFLD in high-fat diet (HFD)–fed mice. Glucoraphanin supplementation attenuated weight gain, decreased hepatic steatosis, and improved glucose tolerance and insulin sensitivity in HFD-fed wild-type mice but not in HFD-fed Nrf2 knockout mice. Compared with vehicle-treated controls, glucoraphanin-treated HFD-fed mice had lower plasma lipopolysaccharide levels and decreased relative abundance of the gram-negative bacteria family Desulfovibrionaceae in their gut microbiomes. In HFD-fed mice, glucoraphanin increased energy expenditure and the protein expression of uncoupling protein 1 (Ucp1) in inguinal and epididymal adipose depots. Additionally, in this group, glucoraphanin attenuated hepatic lipogenic gene expression, lipid peroxidation, classically activated M1-like macrophage accumulation, and inflammatory signaling pathways. By promoting fat browning, limiting metabolic endotoxemia-related chronic inflammation, and modulating redox stress, glucoraphanin may mitigate obesity, insulin resistance, and NAFLD

ジンブンガクブ キョウショク カテイ ウンエイ イインカイ 4ネンカン ノ トリクミ セイカ ト コンゴ ノ カダイ

本稿は、人文学部が完成年度を迎えた今年（平成29）度に、これまでの4年間の教職課程運営委員会の取組成果を明らかにし、今後の課題を明確にすることによって、学生の資質能力の一層の向上を図ることを目的としている。第1に本委員会の使命について述べ、第2に「師道塾」における実践的指導力の基礎の錬磨について考察した。（この項は、別稿において「論文」として投稿した。）第3に教育実習の参観指導について述べ、第4に「教職実践演習」による学生の質保証への取組とWEB入力上の諸問題を明らかにし、最後に、本委員会が着実な歩みを展開してきたことを示す資料として、平成27年度と平成29年度の「自己点検中間振り返り票」を事例として取り上げ、比較考察しながら、本委員会が達成できなかった事業を今後の課題として明らかにした

Precocious Metamorphosis in the Juvenile Hormone–Deficient Mutant of the Silkworm, Bombyx mori

Insect molting and metamorphosis are intricately governed by two hormones, ecdysteroids and juvenile hormones (JHs). JHs prevent precocious metamorphosis and allow the larva to undergo multiple rounds of molting until it attains the proper size for metamorphosis. In the silkworm, Bombyx mori, several “moltinism” mutations have been identified that exhibit variations in the number of larval molts; however, none of them have been characterized molecularly. Here we report the identification and characterization of the gene responsible for the dimolting (mod) mutant that undergoes precocious metamorphosis with fewer larval–larval molts. We show that the mod mutation results in complete loss of JHs in the larval hemolymph and that the mutant phenotype can be rescued by topical application of a JH analog. We performed positional cloning of mod and found a null mutation in the cytochrome P450 gene CYP15C1 in the mod allele. We also demonstrated that CYP15C1 is specifically expressed in the corpus allatum, an endocrine organ that synthesizes and secretes JHs. Furthermore, a biochemical experiment showed that CYP15C1 epoxidizes farnesoic acid to JH acid in a highly stereospecific manner. Precocious metamorphosis of mod larvae was rescued when the wild-type allele of CYP15C1 was expressed in transgenic mod larvae using the GAL4/UAS system. Our data therefore reveal that CYP15C1 is the gene responsible for the mod mutation and is essential for JH biosynthesis. Remarkably, precocious larval–pupal transition in mod larvae does not occur in the first or second instar, suggesting that authentic epoxidized JHs are not essential in very young larvae of B. mori. Our identification of a JH–deficient mutant in this model insect will lead to a greater understanding of the molecular basis of the hormonal control of development and metamorphosis