Content Analysis Of Applied Learning From High FIdelity Patient Simulation Orientation to Critical Care

The Institute of Medicine (IOM) reported that over 98,000 deaths occur in hospitals from medical errors in the United States. In a follow-up IOM report, it was noted that nurses have a direct impact on patient morbidity and mortality and are often the last line of defense for patient safety. The challenge for nurse educators in hospitals is to ensure that as newly licensed nurses enter the workforce, orientation outcomes reflect acquisition of knowledge and skills, which are applied in practice. When newly licensed registered nurses are hired into critical care units, this puts them in a position where they have to learn basic competencies as well as the specialized practice of critical care. One teaching strategy adopted in acute care hospitals is use of high fidelity patient simulation as a way to address the competency gap of these nurses and improve patient safety and outcomes. However, little is known about the practice application of the skills and knowledge used by nurses who complete such orientation. This qualitative exploratory study analyzed newly licensed nurses\u27 description of knowledge and skills used in critical care practice following critical care orientation using high fidelity patient simulation. Data collection consisted of individual, semi-structured, guided interviews based on the Nursing Education Simulation Framework. A sample of 8 registered nurses participated in the interview and completion of a demographic questionnaire. Content analysis was performed using Krippendorf technique. The 8 themes that emerged are consistent with previous research studies that point to the steep learning curve faced by newly licensed nurses in critical care. Implications for nursing practice include expanding high fidelity simulation to specialty practice, developing interdisciplinary orientation and to proactively address the continued experience of culture shock

HIF-1 alpha-independent hypoxia-induced rapid PTK6 stabilization is associated with increased motility and invasion

© 2014 Landes Bioscience. PTK6/Brk is a non-receptor tyrosine kinase overexpressed in cancer. Here we demonstrate that cytosolic PTK6 is rapidly and robustly induced in response to hypoxic conditions in a HIF-1-independent manner. Furthermore, a proportion of hypoxic PTK6 subsequently re-localized to the cell membrane. We observed that the rapid stabilization of PTK6 is associated with a decrease in PTK6 ubiquitylation and we have identified c-Cbl as a putative PTK6 E3 ligase in normoxia. The consequences of hypoxia-induced PTK6 stabilization and subcellular re-localization to the plasma membrane include increased cell motility and invasion, suggesting PTK6 targeting as a therapeutic approach to reduce hypoxia-regulated metastatic potential. This could have particular significance for breast cancer patients with triple negative disease

Magnetotransport in wide parabolic PbTe quantum wells

The 3D- and 2D- behaviour of wide parabolic PbTe single quantum wells, which consist of PbTe p-n-p-structures, are studied theoretically and experimentally. A simple model combines the 2D- subband levels and the 3D-Landau levels in order to calculate the density of states in a magnetic field perpendicular to the 2D plane. It is shown that at a channel width of about 300nm on can expect to observe 3D- and 2D-behaviour at the same time. Magnetotransport experiments in selectively contacted Hall bar samples are performed at temperatures down to T = 50 mK and at magnetic fields up to B = 17 T.Comment: postscript file including 2 figs, 4 pages, Paper presented at EP2DS-XI, Nottingham 199

Incomplete quality of life data in lung transplant research: comparing cross sectional, repeated measures ANOVA, and multi-level analysis

BACKGROUND: In longitudinal studies on Health Related Quality of Life (HRQL) it frequently occurs that patients have one or more missing forms, which may cause bias, and reduce the sample size. Aims of the present study were to address the problem of missing data in the field of lung transplantation (LgTX) and HRQL, to compare results obtained with different methods of analysis, and to show the value of each type of statistical method used to summarize data. METHODS: Results from cross-sectional analysis, repeated measures on complete cases (ANOVA), and a multi-level analysis were compared. The scores on the dimension 'energy' of the Nottingham Health Profile (NHP) after transplantation were used to illustrate the differences between methods. RESULTS: Compared to repeated measures ANOVA, the cross-sectional and multi-level analysis included more patients, and allowed for a longer period of follow-up. In contrast to the cross sectional analyses, in the complete case analysis, and the multi-level analysis, the correlation between different time points was taken into account. Patterns over time of the three methods were comparable. In general, results from repeated measures ANOVA showed the most favorable energy scores, and results from the multi-level analysis the least favorable. Due to the separate subgroups per time point in the cross-sectional analysis, and the relatively small number of patients in the repeated measures ANOVA, inclusion of predictors was only possible in the multi-level analysis. CONCLUSION: Results obtained with the various methods of analysis differed, indicating some reduction of bias took place. Multi-level analysis is a useful approach to study changes over time in a data set where missing data, to reduce bias, make efficient use of available data, and to include predictors, in studies concerning the effects of LgTX on HRQL

Universality in the Crossover between Edge Channel and Bulk Transport in the Quantum Hall Regime

We present a new theoretical approach for the integer quantum Hall effect, which is able to describe the inter-plateau transitions as well as the transition to the Hall insulator. We find two regimes (metallic and insulator like) of the top Landau level, in which the dissipative bulk current appears in different directions. The regimes are separated by a temperature invariant point.Comment: 4 page, 2 eps figures included, submitte

Pengaruh Pemberian Ketamin terhadap Persentase Sel Granulosit Imatur pada Tikus Putih (Rattus norvegicus) dari Galur Wistar Model Sepsis

Sepsis merupakan salah satu masalah kesehatan penting di dunia. Di seluruh dunia, terdapat 13 juta orang mengalami sepsis tiap tahun dan sebanyak empat juta orang meninggal karenanya. Sepsis berat dan syok sepsis memiliki angka kematian yang tinggi hingga 46%. Sepsis menyumbangkan lebih dari 250.000 kematian setiap tahun di Amerika Serikat. Respons imun tubuh terhadap sepsis diawali oleh fase hiperinflamasi yang dimediasi oleh sitokin, yaitu terjadinya peningkatan faktor inflamasi yang ditandai dengan adanya badai sitokin. Sebagian besar pasien mampu bertahan pada fase hiperinflamasi ini, kemudian dilanjutkan dengan fase hipoinflamasi atau imunosupresi di mana terjadi penurunan aktivitas imun sebagai bagian homeostasis yang dipicu oleh faktor antiinflamasi. Granulosit imatur yang beredar memprediksi penurunan kondisi awal pada sepsis dan diperkaya dengan sel supresor derivat mieloid yang bertanggung jawab terhadap imunosupresi melalui induksi limfopenia sel T. Studi yang dilakukan oleh Nierhaus et al. pada tahun 2013 menunjukkan bahwa sepsis dikaitkan dengan peningkatan jumlah granulosit imatur. Jumlah ganulosit imatur dapat membedakan antara pasien dengan infeksi dan mereka yang tidak terinfeksi, khususnya dalam beberapa jam kritis awal setelah peringatan SIRS awal. Dengan menggunakan analisis area di bawah kurva, ditemukan bahwa jumlah hitung granulosit imatur merupakan biomarker sepsis yang lebih superior bila dibandingkan dengan C-reactive protein, protein pengikat lipopolisakarida, dan interleukin 6. Studi-studi tersebut memberi kesan bahwa terdapat efek protektif ketamin dalam pasien sepsis karena adanya penekanan pada produksi sitokin proinflamasi yang berlebihan sehingga diharapkan dapat menurunkan morbiditas maupun mortalitas akibat sepsis. Metode Penelitian ini merupakan penelitian eksperimental dengan desain true experimental laboratory dan metode randomized post test only controlled group design. Penelitian ini dilaksanakan secara eksperimental pada PBMC dari tikus model sepsis dengan tujuan untuk mengetahui peran ketamin dalam menurunkan jumlah sel granulosit imatur pada tikus model sepsis. Penelitian dilakukan di laboratorium parasitologi dan patologi klinik Fakultas Kedokteran Universitas Brawijaya pada tanggal 27 Desember 2016—9 Januari 2017, menggunakan hewan coba tikus putih Rattus norvegicus dari galur wistar jenis kelamin jantan sebanyak 30 ekor. Penelitian ini menggunakan data persentase granulosit imatur sebelum dan sesudah perlakuan. Data yang diperoleh dianalisis ddengan SPSS 15 dan hubungannya diuji dengan one-way ANOVA. Hasil Penelitian Hasil penelitian memperlihatkan rerata persentase granulosit imatur pada kontrol negatif sebesar 0,48%, sedangkan pada kelompok kontrol positif terjadi peningkatan rerata menjadi 9,12%. Data hasil menunjukkan terjadi peningkatan persentase granulosit x imatur pada kelompok yang diberi perlakuan sepsis, didapatkan hubungan yang signifikan (sig = 0,000), dengan koefisien korelasi -0.610. Kesimpulan Dari hasil analisis data di atas dapat disimpulkan bahwa pada tikus model sepsis yang diinduksi dengan FIP terjadi peningkatan persentase granulosit imatur, pemberian ketamin 5 mg/ kgbb intraperitoneal pada jam ke-5 setelah FIP, dan tiap 2 jam setelah FIP (jam ke-0, 2, 4) dapat menurunkan persentase granulosit imatur pada tikus model sepsis yang diinduksi dengan FIP, tidak terdapat perbedaan persentase granulosit imatur akibat perbedaan waktu pemberian ketamin pada tikus model sepsis yang diinduksi dengan FIP, dan tidak terdapat perbedaan persentase granulosit imatur akibat perbedaan teknik pemberian ketamin (single dan intermiten) pada tikus model sepsis yang diinduksi dengan FIP