Knowing People and Interpretive Practice

This paper is my response to the statement “All nursing is interpretive.” Using an exemplar from my experience as an outreach nurse with the homeless population, I provide my perspective on how nursing is not only interpretive, but how interpretation is an integral component of nursing practice across practice settings. It is demonstrated that interpretation not only helps us to know people, but can also help us navigate our settings and at times keep us safe. It is written in the first person from the perspective of the first author

Enfermedad respiratoria en vacas Holstein alimentadas con silaje de maíz: reporte de caso

An outbreak of respiratory distress was observed in Holstein cows immediately after consuming a new batch of corn-silage, presumably due to the presence of pneumotoxic gases. Signs were observed in 10% of the cows, and characterized as tachypnea, orthopneic position, cough and notable anxiety a few minutes after offering the silage. No deaths were recorded. Mild leucocytosis was observed in the hemogram. Nutritional analysis and nitrate determination of the corn-silage revealed usual values. Nitrous oxide and methane concentration were evaluated by gas chromatography and nitrogen oxides concentration directly with a portable device, resulting in acceptable values. Although high concentrations of toxic gases could not be evidenced in the air sampled on farm, the clinical signs observed coincide with those reported in cases of exposure to gases formed during corn silage processes. A greater emphasis is required in the evaluation of the corn to be ensiled, given the possible existence of factors that can generate the accumulation of potentially toxic gases for cattle that affect negatively their health and productivity.Se describe un brote de enfermedad respiratoria en vacas Holando Argentino, inmediatamente luego del consumo de un nuevo silaje de planta entera de maíz, presuntamente con presencia de gases neumotóxicos. Se observaron signos en el 10% de las vacas, caracterizados como taquipnea, posición ortopnéica, episodios de tos y ansiedad, unos minutos luego del ofrecimiento del silaje. No se registraron muertes. En el hemograma se observó leucocitosis leve. El análisis de calidad nutricional del alimento y la concentración de nitratos en el silaje de maíz resultó con los valores habituales. Se evaluó la concentración de óxido nitroso y metano en una muestra de silaje de maíz recolectada herméticamente por cromatografía gaseosa, así como la concentración de óxidos de nitrógeno in situ con un instrumento portátil, resultando en valores aceptables. Aunque no se pudieron evidenciar concentraciones de gases elevadas en el aire del silaje muestreado en el tambo, los signos clínicos observados coinciden con los casos reportados de exposición a gases que se forman durante la fermentación del ensilado. Se debería tener en cuenta la evaluación del maíz a ser ensilado, dadas las posibilidades de que se genere la acumulación de gases potencialmente tóxicos para el ganado, que puedan afectar negativamente su salud y productividad

Individualized Prediction of Drug Resistance in People with Post-Stroke Epilepsy: A Retrospective Study

Background: The study aimed to develop a model and build a nomogram to predict the probability of drug resistance in people with post-stroke epilepsy (PSE). Methods: Subjects with epilepsy secondary to ischemic stroke or spontaneous intracerebral hemorrhage were included. The study outcome was the occurrence of drug-resistant epilepsy defined according to International League Against Epilepsy criteria. Results: One hundred and sixty-four subjects with PSE were included and 32 (19.5%) were found to be drug-resistant. Five variables were identified as independent predictors of drug resistance and were included in the nomogram: age at stroke onset (odds ratio (OR): 0.941, 95% confidence interval (CI) 0.907–0.977), intracerebral hemorrhage (OR: 6.292, 95% CI 1.957–20.233), severe stroke (OR: 4.727, 95% CI 1.573–14.203), latency of PSE (>12 months, reference; 7–12 months, OR: 4.509, 95% CI 1.335–15.228; 0–6 months, OR: 99.099, 95% CI 14.873–660.272), and status epilepticus at epilepsy onset (OR: 14.127, 95% CI 2.540–78.564). The area under the receiver operating characteristic curve of the nomogram was 0.893 (95% CI: 0.832–0.956). Conclusions: Great variability exists in the risk of drug resistance in people with PSE. A nomogram based on a set of readily available clinical variables may represent a practical tool for an individualized prediction of drug-resistant PSE

Nonalcoholic fatty liver disease and increased risk of 1-year all-cause and cardiac hospital readmissions in elderly patients admitted for acute heart failure

Nonalcoholic fatty liver disease (NAFLD) is an emerging risk factor for heart failure (HF). Although some progress has been made in improving survival among patients admitted for HF, the rates of hospital readmissions and the related costs continue to rise dramatically. We sought to examine whether NAFLD and its severity (diagnosed at hospital admission) was independently associated with a higher risk of 1-year all-cause and cardiac re-hospitalization in patients admitted for acute HF. We studied 212 elderly patients who were consecutively admitted with acute HF to the Hospital of Negrar (Verona) over a 1-year period. Diagnosis of NAFLD was based on ultrasonography, whereas the severity of advanced NAFLD fibrosis was based on the fibrosis (FIB)-4 score and other non-invasive fibrosis scores. Patients with acute myocardial infarction, severe valvular heart diseases, endstage renal disease, cancer, known liver diseases or decompensated cirrhosis were excluded. Cox regression was used to estimate hazard ratios (HR) for the associations between NAFLD and the outcome(s) of interest. The cumulative rate of 1-year all-cause re-hospitalizations was 46.7% (n = 99, mainly due to cardiac causes). Patients with NAFLD (n = 109; 51.4%) had remarkably higher 1-year all-cause and cardiac re-hospitalization rates compared with their counterparts without NAFLD. Both event rates were particularly increased in those with advanced NAFLD fibrosis. NAFLD was associated with a 5-fold increased risk of 1-year all-cause re-hospitalization (adjusted-hazard ratio 5.05, 95% confidence intervals 2.78-9.10, p<0.0001) after adjustment for established risk factors and potential confounders. Similar results were found for 1-year cardiac re-hospitalization (adjusted-hazard ratio 8.05, 95% confidence intervals 3.77-15.8, p<0.0001). In conclusion, NAFLD and its severity were strongly and independently associated with an increased risk of 1-year all-cause and cardiac re-hospitalization in elderly patients admitted with acute HF

Integrated Detector Control and Calibration Processing at the European XFEL

The European X-ray Free Electron Laser is a high-intensity X-ray light source currently being constructed in the area of Hamburg, that will provide spatially coherent X-rays in the energy range between $0.25\,\mathrm{keV}$ and $25\,\mathrm{keV}$. The machine will deliver $10\,\mathrm{trains/s}$, consisting of up to $2700\,\mathrm{pulses}$, with a $4.5\,\mathrm{MHz}$ repetition rate. The LPD, DSSC and AGIPD detectors are being developed to provide high dynamic-range Mpixel imaging capabilities at the mentioned repetition rates. A consequence of these detector characteristics is that they generate raw data volumes of up to $15\,\mathrm{Gbyte/s}$. In addition the detector's on-sensor memory-cell and multi-/non-linear gain architectures pose unique challenges in data correction and calibration, requiring online access to operating conditions and control settings. We present how these challenges are addressed within XFEL's control and analysis framework Karabo, which integrates access to hardware conditions, acquisition settings (also using macros) and distributed computing. Implementation of control and calibration software is mainly in Python, using self-optimizing (py) CUDA code, numpy and iPython parallels to achieve near-real time performance for calibration application.Comment: Proceeding ICALEPS 201

Clinical phenotype and functional characterization of CASQ2 mutations associated with Catecholaminergic Polymorphic Ventricular Tachycardia

BACKGROUND: Four distinct mutations in the human cardiac calsequestrin gene (CASQ2) have been linked to catecholaminergic polymorphic ventricular tachycardia (CPVT). The mechanisms leading to the clinical phenotype are still poorly understood because only 1 CASQ2 mutation has been characterized in vitro. METHODS AND RESULTS: We identified a homozygous 16-bp deletion at position 339 to 354 leading to a frame shift and a stop codon after 5aa (CASQ2(G112+5X)) in a child with stress-induced ventricular tachycardia and cardiac arrest. The same deletion was also identified in association with a novel point mutation (CASQ2(L167H)) in a highly symptomatic CPVT child who is the first CPVT patient carrier of compound heterozygous CASQ2 mutations. We characterized in vitro the properties of CASQ2 mutants: CASQ2(G112+5X) did not bind Ca2+, whereas CASQ2(L167H) had normal calcium-binding properties. When expressed in rat myocytes, both mutants decreased the sarcoplasmic reticulum Ca2+-storing capacity and reduced the amplitude of I(Ca)-induced Ca2+ transients and of spontaneous Ca2+ sparks in permeabilized myocytes. Exposure of myocytes to isoproterenol caused the development of delayed afterdepolarizations in CASQ2(G112+5X). CONCLUSIONS: CASQ2(L167H) and CASQ2(G112+5X) alter CASQ2 function in cardiac myocytes, which leads to reduction of active sarcoplasmic reticulum Ca2+ release and calcium content. In addition, CASQ2(G112+5X) displays altered calcium-binding properties and leads to delayed afterdepolarizations. We conclude that the 2 CASQ2 mutations identified in CPVT create distinct abnormalities that lead to abnormal intracellular calcium regulation, thus facilitating the development of tachyarrhythmias

Beam Test of Silicon Strip Sensors for the ZEUS Micro Vertex Detector

For the HERA upgrade, the ZEUS experiment has designed and installed a high precision Micro Vertex Detector (MVD) using single sided micro-strip sensors with capacitive charge division. The sensors have a readout pitch of 120 microns, with five intermediate strips (20 micron strip pitch). An extensive test program has been carried out at the DESY-II testbeam facility. In this paper we describe the setup developed to test the ZEUS MVD sensors and the results obtained on both irradiated and non-irradiated single sided micro-strip detectors with rectangular and trapezoidal geometries. The performances of the sensors coupled to the readout electronics (HELIX chip, version 2.2) have been studied in detail, achieving a good description by a Monte Carlo simulation. Measurements of the position resolution as a function of the angle of incidence are presented, focusing in particular on the comparison between standard and newly developed reconstruction algorithms.Comment: 41 pages, 21 figures, 2 tables, accepted for publication in NIM

Search for anomalies in the neutrino sector with muon spectrometers and large LArTPC imaging detectors at CERN

A new experiment with an intense ~2 GeV neutrino beam at CERN SPS is proposed in order to definitely clarify the possible existence of additional neutrino states, as pointed out by neutrino calibration source experiments, reactor and accelerator experiments and measure the corresponding oscillation parameters. The experiment is based on two identical LAr-TPCs complemented by magnetized spectrometers detecting electron and muon neutrino events at Far and Near positions, 1600 m and 300 m from the proton target, respectively. The ICARUS T600 detector, the largest LAr-TPC ever built with a size of about 600 ton of imaging mass, now running in the LNGS underground laboratory, will be moved at the CERN Far position. An additional 1/4 of the T600 detector (T150) will be constructed and located in the Near position. Two large area spectrometers will be placed downstream of the two LAr-TPC detectors to perform charge identification and muon momentum measurements from sub-GeV to several GeV energy range, greatly complementing the physics capabilities. This experiment will offer remarkable discovery potentialities, collecting a very large number of unbiased events both in the neutrino and antineutrino channels, largely adequate to definitely settle the origin of the observed neutrino-related anomalies.Comment: Contribution to the European Strategy for Particle Physics - Open Symposium Preparatory Group, Kracow 10-12 September 201

Crescimento vegetativo de Coffea canephora conduzidos em sistemas de produção fertirrigado e sequeiro, e sua dependência com os fatores climáticos em Rondônia.

Objetivou-se avaliar o crescimento vegetativo do C. canephora no período de abril a agosto de 2017 e relacioná-lo com fatores climáticos, tendo como base o crescimento das hastes ortotrópicas em lavouras conduzidas em sistemas de produção fertirrigado e sequeiro no estado de Rondônia