Psychosoziale Auswirkungen von Brandverletzungen bei Erwachsenen : Assessmentinstrumente und pflegerische Interventionen im stationären Setting

Darstellung Thema: Brandverletzungen hinterlassen bleibende physische Veränderungen und verursachen ausserdem psychosoziale Veränderungen. Pflegefachpersonen müssen psychosoziale Auswirkungen kennen, um diese im Alltag zu erkennen und geeignete pflegerische Interventionen ergreifen zu können. Fragestellung/ Zielsetzung: Diese Bachelorarbeit beschäftigt sich mit folgender Fragestellung: Mit welchen psychosozialen Auswirkungen sind erwachsene Brandverletzte konfrontiert und wie können Pflegefachpersonen diese im stationären Setting erkennen? Ziel ist eine Auflistung von psychosozialen Auswirkungen, Beobachtungsschwerpunkten und möglichen pflegerischen Interventionen. Methode: Eine systematisierte Literaturrecherche wurde in fünf Datenbanken durchgeführt. Die eingeschlossene Literatur wurde zusammengefasst, gewürdigt und die Güte und Evidenz eingeschätzt. Informationen aus der Praxis wurden ebenfalls mit eingeschlossen, alle Resultate synthetisiert und ein Merkblatt erstellt. Ergebnisse: Die psychosozialen Auswirkungen von Brandverletzungen liessen sich in Probleme (Schmerzen, Fatigue, Körperbildstörungen, Verminderungen von Selbstwert und Wohlbefinden, Schlafstörungen, negative Emotionen, Verschlechterungen zwischenmenschlicher Beziehungen, Sexualität und Arbeitsstatus), Bewältigungsstrategien (Spiritualität/ Religion, Reframing, Schuldzuweisungen, Erzählen, Humor) und positive Auswirkungen (Hoffnung, Selbstreflexion, posttraumatisches Wachstum) aufteilen. Beobachtungsschwerpunkte wurden keine erwähnt, dafür eine Übersicht an Assessmentinstrumenten erstellt. Schlussfolgerungen: Brandverletzte sind mit diversen psychosozialen Auswirkungen konfrontiert. Es besteht noch Forschungsbedarf im Gebiet psychosozialer Auswirkungen von Brandverletzungen, vor allem im Bereich der Isolation aufgrund einer Infektion, Sexualität, posttraumatisches Wachstum, Beobachtungsschwerpunkten und Interventionen

Easing the adoption of agent-based modelling (ABM) in tourism research

Agent-based modelling (ABM) is an emerging approach in tourism research. Despite the natural fit between theories of tourism as a complex, interconnected system, and the generative approach supported in ABM, there has been only limited integration within mainstream tourism research. This research letter reports on a recent gathering of tourism ABM researchers to define the main challenges that face the adoption of ABM in tourism research. These include technical, communications, and novelty issues. In response to these challenges, three potential strategies to ease adoption are outlined: education, awareness, and interdisciplinary teams. These findings are framed as a call for increased attention to the fit of ABM within tourism research, and a framework for negotiating constraints to adoption of this technology.info:eu-repo/semantics/publishedVersio

Elevated microsatellite instability at selected tetranucleotide (EMAST) repeats in gastric cancer: a distinct microsatellite instability type with potential clinical impact?

We investigated the clinical impact of elevated microsatellite instability at selected tetranucleotide (EMAST) repeats in the context of neoadjuvant chemotherapy (CTx) in gastric/gastro-oesophageal adenocarcinomas. We analysed 583 resected tumours (272 without and 311 after CTx) and 142 tumour biopsies before CTx. If at least two or three of the five tetranucleotide repeat markers tested showed instability, the tumours were defined as EMAST (2+) or EMAST (3+), respectively. Expression of mismatch repair proteins including MSH3 was analysed using immunohistochemistry. Microsatellite instability (MSI) and Epstein-Barr virus (EBV) positivity were determined using standard assays. EMAST (2+) and (3+) were detected in 17.8 and 11.5% of the tumours, respectively. The frequency of EMAST (2+) or (3+) in MSI-high (MSI-H) tumours was 96.2 or 92.5%, respectively, demonstrating a high overlap with this molecular subtype, and the association of EMAST and MSI status was significant (each overall p < 0.001). EMAST (2+ or 3+) alone in MSI-H and EBV-negative tumours demonstrated only a statistically significant association of EMAST (2+) positivity and negative lymph node status (42.3% in EMAST (2+) and 28.8% in EMAST negative, p = 0.045). EMAST alone by neither definition was significantly associated with overall survival (OS) of the patients. The median OS for EMAST (2+) patients was 40.0 months (95% confidence interval [CI] 16.4-63.6) compared with 38.7 months (95% CI 26.3-51.1) for the EMAST-negative group (p = 0.880). The median OS for EMAST (3+) patients was 46.7 months (95% CI 18.2-75.2) and 38.7 months (95% CI 26.2-51.2) for the negative group (p = 0.879). No statistically significant association with response to neoadjuvant CTx was observed (p = 0.992 and p = 0.433 for EMAST (2+) and (3+), respectively). In conclusion, our results demonstrate a nearly complete intersection between MSI-H and EMAST and they indicate that EMAST alone is not a distinct instability type associated with noticeable clinico-pathological characteristics of gastric carcinoma patients

Mortality and implant survival with simultaneous and staged bilateral total knee arthroplasty experience from the Australian Orthopaedic Association National Joint Replacement Registry

BACKGROUND: Total knee arthroplasty (TKA) is an effective procedure for relieving pain and restoring function in osteoarthritis, with a significant proportion of patients having severe disease bilaterally. However, although there are differences in patient selection criteria for bilateral procedures, there is no consensus regarding the optimal timing for bilateral TKA. The aim of this study was to compare rates and causes of revision and 30-day mortality between simultaneous and staged bilateral TKA using data from the Australian Orthopaedic Association National Joint Replacement Registry. METHODS: Data for over 36,000 bilateral TKAs were collected from September 1999 to December 2015. Rates and causes of revision and 30-day mortality rates were obtained for simultaneous bilateral and staged procedures with intervals of 1 day-6 weeks, 6 weeks-3 months, and 3-6 months. Yearly cumulative percent revision or cumulative percent survival with 95% confidence intervals calculated using the Kaplan-Meier method and adjusted hazard ratios were used for comparisons. RESULTS: There was no significant difference between revision rates or reasons for revision between staged bilateral and simultaneous TKA (hazard ratio 1.09 [95% confidence interval {CI} 0.85-1.40; P = .511] for 1 day-6 weeks, 0.93 [95% CI 0.77-1.14; P = .494] for 6 weeks-3 months, and 1.10 [95% CI 0.98-1.23; P = .115] for 3-6 months). The most common reasons for revision were loosening/lysis and infection. The 30-day mortality rates were lower in the 6 weeks-3 months group than simultaneous bilaterals (P = .007). CONCLUSION: This study demonstrates that simultaneous and staged bilateral TKA have similar rates of revision over the medium term but that 30-day mortality is reduced in the 6 weeks-3 months group

Low-temperature and low-voltage, solution-processed metal oxide n-TFTs and flexible circuitry on large-area polyimide foil

In this article, we report on high-performance solution-based n-type metal oxide TFTs processed directly on polyimide foil and annealed at 250 °C. Saturation mobilities exceeding 2 cm²/(Vs) and Ion/Ioff ratios beyond 108 have been achieved. Using these oxide n-TFTs, fast and low-voltage flexible circuitry is presented. Furthermore, a complete 8-bit RFID transponder chip, containing 294 oxide n-TFTs has been fabricated. Both high-speed and low-voltage operation makes the presented oxide n-TFT technology suited for both the pixel driving and embedded line-drive circuitry at the borders of flexible AMOLED displays

Spatially heterogeneous argon-isotope systematics and apparent ⁴⁰Ar/³⁹Ar ages in perlitised obsidian

In situ laser ablation Ar-isotope analyses of variably hydrated and devitrified obsidian from the ~ 27 Ma Cochetopa Dome, San Juan, USA, reveal complex interplay between degassing of initial Ar and absorption of atmospheric Ar. These processes have locally modified the Ar-isotope composition of the obsidian and led to spurious, spatially-heterogeneous Ar-isotope and 40Ar/39Ar age data. Small perlite beads exhibit older apparent Ar-ages at the rims than the cores. This is interpreted as an apparent excess of 40Ar at the rims, produced either by a) diffusion of excess 40Ar into the bead during flushing of the lava with excess 40Ar-bearing volcanic gas, or by b) isotopic fractionation during degassing of initial Ar, causing preferential loss of 36Ar over 40Ar at the bead rims. The second interpretation is favoured by a relative enrichment of 36Ar in the core of a perlite bead along a microlite-free (poorly degassed) flow band, and by a lack of age variation in a larger, fresh, well-degassed perlite bead. These isotopic gradients were later overprinted during glass hydration by absorption of Ar with near-atmospheric composition, resulting in elevated 36Ar and reduced radiogenic 40Ar* yields at the rims of perlite beads. These complex interactions essentially represent the mixing of three distinct Ar reservoirs: initial trapped Ar that may or may not be fractionated, an isotopically atmospheric Ar component introduced during hydration, and radiogenic 40Ar*. Such reservoir mixing is the underlying reason for poor correlations on isotope correlation diagrams and the difficulties in validating the composition of the non-radiogenic Ar component. We thus suggest that high 36Ar yields are a combination of the incomplete degassing of initial (possibly magmatic) Ar and the gain of Ar during interaction between the obsidian and meteoric/atmospheric fluids. Our analyses emphasise the challenging nature of 40Ar/39Ar dating obsidian samples, but also point to possible solutions by careful sample characterisation and selection of highly degassed samples

Optical and Near-IR Microwave Kinetic Inductance Detectors (MKIDs) in the 2020s

Optical and near-IR Microwave Kinetic Inductance Detectors, or MKIDs, are superconducting photon counting detectors capable of measuring the energy and arrival time of individual OIR photons without read noise or dark current. In this whitepaper we will discuss the current status of OIR MKIDs and MKID-based instruments.Comment: Astro2020 APC Whitepaper. 16 pages, 10 figure