Standing on their own two feet. The role of nursing education in the life stories of nurse teachers from Bangladesh

[eng] The nursing profession in Bangladesh has undergone substantial development over recent decades but still faces significant challenges. A remarkable gap has been described between the institutionally-accepted image of nursing as the provision of hands-on care and the small amount of time that nurses allocate to it, especially in government hospitals. The reasons for this contradiction have shown a complex interaction between historical, socioeconomic and cultural factors. These are mainly related to the conflict between the British-inherited curriculum, with a strong emphasis on basic care activities, social and gender norms, and longstanding discrimination against nurses in their institutional settings and society. This research aims to provide a theoretical analysis of the ways in which structural factors intersect with the professional and social experiences of a group of nurse teachers. The objectives of the thesis are to describe nurses’ views about nursing care and their profession, to discuss to what extent nursing education has been an empowering tool, and to analyse how the nurses’ socioeconomic background, personal experiences and life events have influenced their professional careers and their conceptualisation of nursing and care. A critical phenomenological analysis of the nurses’ life stories has been used, relating the stories to the broader history and political economy of nursing in Bangladesh. Twenty-two nurses were selected and interviewed over an eight-month fieldwork period, of which seven were selected as key informants. The discussion is mainly based on theoretical contributions from anthropology, practice theory, feminism and a critical analysis of nursing knowledge. A common rhetoric was found among the nurses: namely that nursing care has ‘deteriorated’. They tended to emphasise hands-on care and the ‘old’ apprenticeship model, while also approving moves towards a more professional model. Nursing care activities were understood as a mixture of service and management of the wards and patients, linked to a wish to ‘utilise’ the knowledge that they were continuously acquiring. Therefore, nursing education was broadly empowering in terms of knowledge, independence, and self-realization. Nevertheless, at some moments social and institutional discrimination made the m feel disempowered, frustrated and vulnerable. Even so, the nurses interviewed have achieved successful professional careers, together with a significant amount of social recognition. Without ignoring their outstanding individual capacities, the role that key people and institutions had in supporting them in their eagerness to learn has to be considered. Finally, the act of caring itself and the knowledge that it produces may also be a source of personal and collective agency. However, work is needed in order to create and maintain the necessary conditions for the caring experience to be empowering. This responsibility falls beyond the nursing field, as it involves structural changes, especially in terms of gender and class inequalities.[cat] La professió infermera a Bangladesh ha experimentat importants avenços en les últimes dècades, tot i que encara presenta reptes considerables. La imatge institucionalment acceptada de la infermeria com la provisió de cures i contacte continuat amb els pacients contrasta amb la poca dedicació de moltes infermeres a aquestes activitats, especialment en els hospitals públics. Aquesta contradicció s’explica per una complexa interacció entre factors històrics, socioeconòmics i culturals. Existeix un conflicte entre un pla d’estudis heretat de l’època colonial Britànica, amb un fort èmfasi en les activitats de cures bàsiques, les normes socials i de gènere, i la històrica discriminació de les infermeres en els seus entorns institucionals i socials. Aquesta tesi pretén teoritzar sobre les formes en què els factors estructurals s’interseccionen amb les experiències professionals i socials d’un grup de professores d’infermeria. Els objectius de la tesi són: descriure les visions de les infermeres sobre el concepte de cura i sobre la seva professió; discutir fins a quin punt l’educació en infermeria ha estat una eina empoderadora, i analitzar de quina manera el context socioeconòmic, experiències personals i esdeveniments vitals de les professores han influït en la seva carrera professional i en la seva conceptualització de les cures infermeres. La recerca ha realitzat una anàlisi fenomenològica crítica de les històries de vida de les professores d’infermeria, relacionant-les amb la història i economia política de la infermeria a Bangladesh. Vint infermeres van ser entrevistades durant un període de vuit mesos, entre les quals set professores van ser escollides com a informants clau. La discussió es basa principalment en les aportacions teòriques de l'antropologia, la teoria de la pràctica, el feminisme i l’anàlisi crítica del coneixement infermer. Les infermeres entrevistades sostenien, en general, que les cures d'infermeria s’havien ‘deteriorat’. Les seves narratives tendien a emfatitzar el ‘vell’ model d’aprenentatge pràctic, alhora que es valorava l’evolució cap a un model més professional. Les infermeres conceptualitzaven la cura com una barreja entre les nocions de servei i de gestió de les sales i dels pacients, juntament amb un desig d’utilitzar els coneixements que constantment adquiriren. Per tant, l’educació en infermeria ha estat en general empoderadora quant a coneixements, independència i sentit d’auto-realització. Tot i així, en certs moments, la discriminació social i institucional viscuda, els va fer sentir impotents, frustrades i vulnerables. Malgrat les dificultats, però, les infermeres d’aquesta tesi han aconseguit un exitós desenvolupament professional, així com un grau de reconeixement social considerable. Sense ignorar les seves notables capacitats individuals, cal considerar també el suport rebut per part de diferents persones i institucions en el seu constant desig de formar-se i aprendre. Finalment, l’acte de tenir cura i el coneixement que se’n deriva, són en si mateixos una font d’agència personal i col·lectiva. No obstant això, cal treballar per crear i mantenir les condicions necessàries perquè l’experiència cura sigui empoderadora. Aquesta és una responsabilitat que excedeix l’àmbit infermer, ja que implica canvis estructurals, especialment en relació a les desigualtats de gènere i classe

Additional file 1: of Newly recognized cerebral infarctions on postmortem imaging: a report of three cases with systemic infectious disease

Timeline of Case 1. (DOCX 20 kb

Purine Analog-Like Properties of Bendamustine Underlie Rapid Activation of DNA Damage Response and Synergistic Effects with Pyrimidine Analogues in Lymphoid Malignancies

<div><p>Bendamustine has shown considerable clinical activity against indolent lymphoid malignancies as a single agent or in combination with rituximab, but combination with additional anti-cancer drugs may be required for refractory and/or relapsed cases as well as other intractable tumors. In this study, we attempted to determine suitable anti-cancer drugs to be combined with bendamustine for the treatment of mantle cell lymphoma, diffuse large B-cell lymphoma, aggressive lymphomas and multiple myeloma, all of which are relatively resistant to this drug, and investigated the mechanisms underlying synergism. Isobologram analysis revealed that bendamustine had synergistic effects with alkylating agents (4-hydroperoxy-cyclophosphamide, chlorambucil and melphalan) and pyrimidine analogues (cytosine arabinoside, gemcitabine and decitabine) in HBL-2, B104, Namalwa and U266 cell lines, which represent the above entities respectively. In cell cycle analysis, bendamustine induced late S-phase arrest, which was enhanced by 4-hydroperoxy-cyclophosphamide, and potentiated early S-phase arrest by cytosine arabinoside (Ara-C), followed by a robust increase in the size of sub-G1 fractions. Bendamustine was able to elicit DNA damage response and subsequent apoptosis faster and with shorter exposure than other alkylating agents due to rapid intracellular incorporation via equilibrative nucleoside transporters (ENTs). Furthermore, bendamustine increased the expression of ENT1 at both mRNA and protein levels and enhanced the uptake of Ara-C and subsequent increase in Ara-C triphosphate (Ara-CTP) in HBL-2 cells to an extent comparable with the purine analog fludarabine. These purine analog-like properties of bendamustine may underlie favorable combinations with other alkylators and pyrimidine analogues. Our findings may provide a theoretical basis for the development of more effective bendamustine-based combination therapies.</p></div

Bendamustine induces apoptosis faster than other alkylating agents but does not exert sufficient cytotoxicity against all tumors.

<p>A) We cultured the indicated cell lines with various concentrations of bendamustine and measured cell proliferation with the MTT reduction assay after 72 hours. IC50 and IC80 values are defined as the concentrations of drugs that produce 50 and 80% inhibition of cell growth, respectively. The means ± S.D. (bars) of three independent experiments are shown. B) HBL-2 cells were cultured in the absence (−) or presence (+) of the IC50 value of bendamustine (BDM), harvested at the indicated time points, and stained with propidium iodide in preparation for cell cycle analysis. C) HBL-2 cells were cultured in the absence (None) or presence of IC50 values of 4-OHCY or chlorambucil (CB), harvested at the indicated time points, and stained with propidium iodide in preparation for cell cycle analysis. Columns indicate the quantification of cells in each phase of the cell cycle obtained with the ModFitLT 2.0 program. The means ± S.D. (bars) of three independent experiments are shown. <i>P</i>-values were calculated by one-way ANOVA with the Student-Newman-Keuls multiple comparisons test. Asterisks denote <i>p</i><0.05 against the untreated control.</p

Cell cycle effects of the combination of bendamustine with 4-OHCY or cytosine arabinoside.

<p>(A) HBL-2 cells were cultured with bendamustine alone, cytosine arabinoside alone or their combination for 48 hours. (B) HBL-2 cells were cultured with bendamustine alone, 4-OHCY alone or their combination for 48 hours. Cell cycle profiles were obtained by flow cytometry as described in Materials and Methods. The size of the sub-G1 fraction was calculated by analyzing DNA histograms with the ModFitLT 2.0 program. The data shown are representative of multiple independent experiments with various concentrations of the drugs.</p

Quantitative analysis of the combination of bendamustine and other drugs in lymphoid malignancies.

<p>*Mean values of observed data (S.D. not shown).</p><p>**Mean values of the predicted minimum values for an additive effect (S.D. not shown).</p><p>***Mean values of the predicted maximum values for an additive effect (S.D. not shown).</p>#<p>Overall effect of drug combination (see Materials and Methods for the method of evaluation).</p

The selection of suitable drugs to be combined with bendamustine using isobologram.

<p>Cells were cultured with various concentrations of bendamustine in combination with (A) 4-hydroperoxy-cyclophosphamide (4-HC), (B) cytosine arabinoside (araC), (C) doxorubicin (DOX) and (D) methotrexate (MTX) for 4 days (Namalwa and HBL-2) or 7 days (U266). Isobolograms were generated from dose-response curves of each combination as described previously <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0090675#pone.0090675-Furukawa1" target="_blank">[31]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0090675#pone.0090675-Koyama1" target="_blank">[32]</a>. The results of data quantification and statistical analysis are shown in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0090675#pone-0090675-t001" target="_blank">Table 1</a>.</p

Purine analog-like properties of bendamustine.

<p>(A) Effects of dilazep (left panel) and NBTI (right panel) on cytotoxicity of the indicated drugs at IC50 against HBL-2 (upper panel) and Namalwa (lower panel) cells. (B) <i>ENT1</i> mRNA expression in HBL-2 and Namalwa cells treated with the indicated drugs. The y-axes indicate relative gene expression against the expression levels of the untreated control being set at 1.0. The means ± S.D. (bars) of three independent experiments are shown. <i>P</i>-values were calculated by one-way ANOVA with the Student-Newman-Keuls multiple comparisons test. Asterisks denote <i>p</i><0.05 against the untreated control. (C) HBL-2 and Namalwa cells were cultured in the absence (Control) or presence of IC50 values of the indicated drugs. Whole cell lysates were isolated after 48 hours and subjected to immunoblot analysis for the expression of ENT1, ENT2 and GAPDH (internal control). The data shown are representative of multiple independent experiments.</p