Nurses'decision-making in ethically relevant clinical situations using the example of breathlessness: study protocol of a reflexive grounded theory integrating Goffman's framework analysis

Introduction: Decision-making (DM) in healthcare can be understood as an interactive process addressing decision makers' reasoning as well as their visible behaviour after the decision is made. Other key elements of DM are ethical aspects and the role as well as the treatment options of the examined professions. Nurses' DM to choose interventions in situations of severe breathlessness is such interactions. They are also ethically relevant regarding the vulnerability of affected patients and possible restrictions or treatment options. The study aims to explore which factors influence nurses' DM to use nursing interventions in situations where patients suffer from severe breathlessness. Methods and analysis: Qualitative study including nurses in German hospital wards and hospices. A triangulation of different methods of data collection-participant observation and qualitative expert interviews -and analysis merge in a reflexive grounded theory approach which integrates Goffman's framework analysis. It allows an analysis of nurses' self-statements about DM, their behaviour in relevant clinical situations and its influences. Data collection and analysis will be examined simultaneously. Ethics and dissemination: Informed consent will be gained from all participants and the institutional stakeholders. Ongoing consent has to be ensured since observations will take place in healthcare institutions and many patients will be highly vulnerable. The study has been evaluated and approved by the Witten/ Herdecke University Ethics Committee, Witten, Germany. Results of the study will be published at congresses and in journal papers

Analysis of Escherichia coli nicotinate mononucleotide adenylyltransferase mutants in vivo and in vitro

BACKGROUND: Adenylation of nicotinate mononucleotide to nicotinate adenine dinucleotide is the penultimate step in NAD(+ )synthesis. In Escherichia coli, the enzyme nicotinate mononucleotide adenylyltransferase is encoded by the nadD gene. We have earlier made an initial characterization in vivo of two mutant enzymes, NadD72 and NadD74. Strains with either mutation have decreased intracellular levels of NAD(+), especially for one of the alleles, nadD72. RESULTS: In this study these two mutant proteins have been further characterized together with ten new mutant variants. Of the, in total, twelve mutations four are in a conserved motif in the C-terminus and eight are in the active site. We have tested the activity of the enzymes in vitro and their effect on the growth phenotype in vivo. There is a very good correlation between the two data sets. CONCLUSION: The mutations in the C-terminus did not reveal any function for the conserved motif. On the other hand, our data has lead us to assign amino acid residues His-19, Arg-46 and Asp-109 to the active site. We have also shown that the nadD gene is essential for growth in E. coli

Kühlung großflächiger Brandwunden mit gesprühter Kühlflüssigkeit

This pilot study was designed to verify if sprayed coolant can improve initial cooling management in extensive burns. The cooling effects of one liter sprayed water and five liters poured water (22°C) were tested. Thus n=53 healthy test persons (28 male, 25 female, 20-30 years) were cooled twice (15 minutes long) at the front of their legs (18% TBSA). Thermographic imaging was used to measure the loss of skin temperature and to assess the homogeneity of cooling. The mean decrease of skin temperature was significant higher (p<0.003, paired t test) with spray cooling throughout the entire cooling period. “Root mean square” (rms) of temperature fluctuations was calculated to assess the homogeneity of cooling. A low rms level stands for a more even distribution of coolant. Spray-cooling led to significant lower values for rms the first nine minutes (p<0.003, paired t test). Infrared tympanic thermometry was used to estimate core body temperature. Neither poured nor sprayed water cooling caused hypothermia in this study with healthy test persons. Even with a fifth of the coolant volume, spray cooling provides a stronger and more evenly distributed local cooling. The usage of sprayed coolant affords an improvement of initial cooling management

How Avatar Customization Affects Fear in a Game-based Digital Exposure Task for Social Anxiety

The treatment of social anxiety through digital exposure therapy is challenging due to the cognitive properties of social anxiety-individuals need to be fully engaged in the task and feel themselves represented in the social situation; however, avatar customization has been shown to increase both engagement and social presence. In this paper, we harness techniques used in commercial games, and investigate how customizing self-representation in a novel digital exposure task for social anxiety influences the experience of social threat. In an online experiment with 200 participants, participants either customized their avatar or were assigned a predefined avatar. Participants then controlled the avatar through a virtual shop, where they had to solve a math problem, while a simulated audience within the virtual world observed them and negatively judged their performance. Our findings show that we can stimulate the fear of evaluation by others in our task, that fear is driven primarily by trait social anxiety, and that this relationship is strengthened for people higher in trait social anxiety. We provide new insights into the effects of customization in a novel therapeutic context, and embed the discussion of avatar customization into related work in social anxiety and human-computer interaction

Protektive Effekte von Simvastatin beim Endotoxinschock

Simvastatin wurde wegen seiner pleiotropen Effekte mehrfach in Studien in der Sepsis eingesetzt. Ziel der Arbeit war es dessen Effekte in einem Endotoxinschockmodell in Ratten zu untersuchen. Der Endotoxinschock wurde intravenös induziert (Lipopolysaccharid 10 mg/kg, Escherichia coli). Simvastatin(100 μg/kg) wurde 24 Stunden zuvor verabreicht. Untersuchungszeitraum: 4 Stunden. Simvastatin verdoppelt den mittleren arteriellen Blutdruck, senkt den Hämatokrit um 12%, vermindert die Leukozytenakkumulation in Lunge (67%) und Dünndarm (92%), reduziert die histopathologischen Veränderungen in den Schockorganen, reduziert die Induktion der Hitze-Schock-Proteine 25-, 60- und 70. Simvastatin inhibiert den Transkriptionsfaktor NF-κB und die Expression von Adhäsionsmolekülen in Herzgefäßen (ß1-Integrin 7,2-fach und VCAM 0,6-fach). Die Simvastatingabe verlängert die Überlebenszeit um 32%. Es konnten eindeutige antiinflammatorische Effekte von Simvastatin im Endotoxinschock aufgezeigt werden. Diese Eigenschaften könnten therapeutisch genutzt werden.Simvastatin has often been used in trials in sepsis, because of its pleiotropic effects. The aim of this study was to investigate its effects in a endotoxin shock model in rats. The endotoxin shock was intravenously induced (lipopolysaccharide 10 mg/kg, Escherichia coli). Simvastatin (100ug/kg) was administered 24 hours previously. Investigation period: 4 hours. Simvastatin doubled the mean arterial blood pressure, lowers the hematocrit by 12%, reduced the leukocyte accumulation in the lung (67%) and small intestine (92%), reduced the histopathological changes in the shock organs, reduces the induction of heat shock proteins 25 -, 60- and 70. Simvastatin inhibits the transcription factor NF-KB and the expression of adhesion molecules in heart vessels (ß1-Integrin 7.2-fold and VCAM 0.6-fold). Simvastatin prolongs survival time by 32%. There is clear evidence for antiinflammatory effects of simvastatin in endotoxin shock. These properties could be used therapeutically.vorgelegt von Martin Gustav Otto Schnel

High resolution position measurement from dispersed reference interferometry using template matching

This paper describes a method to extract high resolution position data from a dispersed reference interferometry (DRI) by applying a template matching technique to the acquired spectral interferograms. Calculation of the correlation coefficient between windowed spectral interferograms acquired from the DRI apparatus and a set of numerically calculated template interferograms allows the absolute determination of position with nanometer resolution. Both the operating principle of the DRI apparatus and implementation of the template matching method is presented. Experimental validation of the method is provided through the demonstration of position tracking and an assessment of linearity, repeatability and noise performanc

Carotid Intima-Media Thickness Progression in HIV-Infected Adults Occurs Preferentially at the Carotid Bifurcation and Is Predicted by Inflammation.

BackgroundShear stress gradients and inflammation have been causally associated with atherosclerosis development in carotid bifurcation regions. The mechanism underlying higher levels of carotid intima-media thickness observed among HIV-infected individuals remains unknown.Methods and resultsWe measured carotid intima-media thickness progression and development of plaque in the common carotid, bifurcation region, and internal carotid artery in 300 HIV-infected persons and 47 controls. The median duration of follow-up was 2.4 years. When all segments were included, the rate of intima-media thickness progression was greater in HIV-infected subjects compared with controls after adjustment for traditional risk factors (0.055 vs. 0.024 mm/year, P=0.016). Rate of progression was also greater in the bifurcation region (0.067 vs. 0.025 mm/year, P=0.042) whereas differences were smaller in the common and internal regions. HIV-infected individuals had a greater incidence of plaque compared with controls in the internal (23% vs. 6.4%, P=0.0037) and bifurcation regions (34% vs. 17%, P=0.014). Among HIV-infected individuals, the rate of progression in the bifurcation region was more rapid compared with the common carotid, internal, or mean intima-media thickness; in contrast, progression rates among controls were similar at all sites. Baseline hsCRP was elevated in HIV-infected persons and was a predictor of progression in the bifurcation region.ConclusionsAtherosclerosis progresses preferentially in the carotid bifurcation region in HIV-infected individuals. hsCRP, a marker of inflammation, is elevated in HIV and is associated with progression in the bifurcation region. These data are consistent with a model in which the interplay between hemodynamic shear stresses and HIV-associated inflammation contribute to accelerated atherosclerosis. (J Am Heart Assoc. 2012;1:jah3-e000422 doi: 10.1161/JAHA.111.000422.)Clinical trial registrationURL: http://clinicaltrials.gov. Unique identifier: NCT01519141

Chronic thoracic hemisection spinal cord injury in adult rats induces a progressive decline in transmission from uninjured fibers to lumbar motoneurons

Although most spinal cord injuries are anatomically incomplete, only limited functional recovery has been observed in people and rats with partial lesions. To address why surviving fibers cannot mediate more complete recovery, we evaluated the physiological and anatomical status of spared fibers after unilateral hemisection (HX) of thoracic spinal cord in adult rats. We made intracellular and extracellular recordings at L5 (below HX) in response to electrical stimulation of contralateral white matter above (T6) and below (L1) HX. Responses from T6 displayed reduced amplitude, increased latency and elevated stimulus threshold in the fibers across from HX, beginning 1-2 weeks after HX. Ultrastructural analysis revealed demyelination of intact axons contralateral to the HX, with a time course similar to the conduction changes. Behavioral studies indicated partial recovery which arrested when conduction deficits began. These findings suggest a chronic pathological state in intact fibers and necessity for prompt treatment to minimize it