Reducing Nurses\u27 Communication Anxiety During End of Life Care

End of life (EOL) conversations are meaningful discussions pertaining to the patient’s disease trajectory, symptom management, and the patient’s goals at end of life. End of life care discussions have been associated with many benefits for the patient including: decreased healthcare costs, less aggressive treatments at EOL, and a good death. These sensitive discussions must occur over the course of several interactions or spontaneously in the moment in order to support the patient during delicate moments. This makes the nurse the prime candidate to help facilitate and harbor these discussions. However, barriers to communication exist, leading to the omission of EOL conversations, which results in inadequate patient care. Research recommends that nurses who are provided with training and adequate support are able to initiate and facilitate in EOL conversations with patients, leading to positive patient outcomes. The purpose of the project is to develop and implement an educational program about EOL discussions for hospice nursing staff at an inpatient hospice unit with the primary goal of enhancing nurses’ knowledge and understanding of EOL communication, leading to nurse empowerment and improved comfort to engage in EOL discussion. It is proposed that a two-hour, face-to-face educational program with a pre and post intervention survey be implemented in order to decrease nurses’ anxiety when participating in EOL conversations. The implications of the educational program support the use of face-to-face on-the-job training as an effective measure in teaching and enhancing nursing skills, and EOL education should be included in professional development and orientation in areas not traditionally educated in palliative and hospice care

Laminaria japonica Extract Enhances Intestinal Barrier Function by Altering Inflammatory Response and Tight Junction-Related Protein in Lipopolysaccharide-Stimulated Caco-2 Cells.

In the normal physiological state, intestinal epithelial cells act as a defensive frontline of host mucosal immunity to tolerate constant exposure to external stimuli. In this study, we investigated the potential anti-inflammatory and gut permeability protective effects of Laminaria japonica (LJ) water extract (LJE) and three types of fermented Laminaria japonica water extracts (LJE-F1, LJE-F2, and LJE-F3) in lipopolysaccharide (LPS)-stimulated Caco-2, human intestinal epithelial cells. All four extracts significantly decreased the production of nitric oxide and interleukin-6 induced by LPS stimulus. In addition, LJE and the three types of LJE-Fs also inhibited LPS-induced loss of monolayer permeability, as assessed by changes in transepithelial electrical resistance. All four LJ extracts significantly prevented the inhibition of the protein levels of occludin, whereas LJE, LJE-F1, and LJE-F3 significantly attenuated the reduction in phosphorylation of adenosine monophosphate-activated protein kinase compared with the LPS-treated group in Caco-2 cells. In conclusion, LJE and its fermented water extracts appear to have potential gut health-promoting effects by reducing inflammation and partially regulating the tight junction-related proteins in human intestinal epithelial cells. Thus, additional studies are warranted to evaluate Laminaria japonica as a therapeutic agent for inflammatory bowel diseases

Hydrogen-Bonding Network Anchors the Cyclic Form of Sugar Arylhydrazones

The “classical” challenge, raised by Emil Fischer as to why one monosaccharide arylhydrazone adopts a cyclic structure but another an acyclic structure, is answered here. The present comprehensive analysis of hexose and hexosamine arylhydrazones, based on 2D NMR spectroscopy and theoretical modeling, has established that the chain of hydrogen bonds needed for conformational selection can only be completed for D-glucosamine derivatives. Thus, D -glucosamine 4-nitrophenyl-hydrazone exclusively adopts its cyclic form, but any configurational changes imply the formation of acyclic structures. In conclusion, three criteria dominate structure selection, namely 1) an amino function at the C-2 position, 2) the “all-equatorial” substitution mode of the pyranoid ring, and 3) an electron- withdrawing group on the arylhydrazone are all needed to get the cyclic form only

Modeling Initial Participation of Diverse Communities in Competitive Swimming

This research note introduces the Initial Participation Model, which theorizes continued participation in a activity or group before individuals make commitment is a function of: enjoyment, feeling of inclusion, and/or involvement opportunities. The specific focus of this research is investigating how deficiency in enjoyment, feeling of inclusion, and involvement opportunities may discourage continuing participation in competitive swimming by underrepresented populations such as African American, Black, Hispanic, Latino, Native American, Pacific Islander and low-socioeconomic communities. Details explain how initial participation differs from other sport stages by emphasizing participation; relating to program instead of sport; and resetting each time an individual joins a new activity or group. Two examples are offered illustrating how the model may be used for identifying points of intervention that stimulate continued initial participation. Also included are specific factors constructing the model and future testing plans for validation

Unmasking Chaotic Attributes in Time Series of Living Cell Populations

. Such complicated dynamics are generally the result of a combination of stochastic events and deterministic regulation. Assessing the role, if any, of chaotic regulation is difficult. However, unmasking chaotic dynamics is essential for analysis of cellular processes related to proliferation rate, including metabolic activity, telomere homeostasis, gene expression, and tumor growth.Using a simple, original, nonlinear method based on return maps, we previously found a geometrical deterministic structure coordinating such fluctuations in populations of various cell types. However, nonlinearity and determinism are only necessary conditions for chaos; they do not by themselves constitute a proof of chaotic dynamics. Therefore, we used the same analytical method to analyze the oscillations of four well-known, low-dimensional, chaotic oscillators, originally designed in diverse settings and all possibly well-adapted to model the fluctuations of cell populations: the Lorenz, Rössler, Verhulst and Duffing oscillators. All four systems also display this geometrical structure, coordinating the oscillations of one or two variables of the oscillator. No such structure could be observed in periodic or stochastic fluctuations.Theoretical models predict various cell population dynamics, from stable through periodically oscillating to a chaotic regime. Periodic and stochastic fluctuations were first described long ago in various mammalian cells, but by contrast, chaotic regulation had not previously been evidenced. The findings with our nonlinear geometrical approach are entirely consistent with the notion that fluctuations of cell populations can be chaotically controlled

About disposition of energy levels

The unique properties of central potential of the form $-\beta e^{-r}r^{\gamma}$ were studied using the recently developed critical parameter technique. The particular cases of $\gamma=0$ and $\gamma=-1$ yield, respectively, the exponential and Yukawa potentials widely used in the atomic, molecular and nuclear physics. We found different behavior of the energy levels of this potential for three different ranges of the value of $\gamma$. For $\gamma\geq0$ it was found that the energy of bound states with the same principal quantum number $N$ decreases with increasing angular momentum $\ell$. The Gaussian and Woods-Saxon potentials also show this behavior. On the contrary, for $-2\leq\gamma\leq-1$ increasing $\ell$ gives a higher energy, resembling the Hulthen potential. However, a potential with $-1<\gamma<0$ possesses mixed properties, which give rise to several interesting results. For one, the order of energy levels with different quantum numbers is not preserved when varying the parameter $\beta$. This leads to a quantum degeneracy of the states, and in fact, for a given value of $\gamma$ we can find the values $\beta_{thr}$ for which two energy levels with different quantum numbers coincide. Another interesting phenomena is the possibility, for some values of $\gamma$ in this range, for two new energy levels with different quantum numbers to appear simultaneously when $\beta$ reaches their common critical value.Comment: 10 pages, 3 table

Olhares cruzados: contributo da Arte no ensino-aprendizagem do Português e do Espanhol

Relatório de Estágio apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Ensino de Português e das Línguas Clássicas no 3º Ciclo do Ensino Básico e Secundário ou de Língua Estrangeira (Espanhol) nos Ensinos Básico e SecundárioNo contexto da sociedade contemporânea, convém reconhecer, refletir e aferir o contributo da arte no processo de ensino-aprendizagem, tendo em conta que a pintura, a poesia, a música, favorecem a comunicação e a discussão. Na presente reflexão pretendo abordar o contributo do diálogo entre as artes: pintura, poesia e música como suporte didático-pedagógico para o ensino do Português, no 10.º ano do Ensino Secundário e para o ensino do Espanhol, no 7º ano do 3º Ciclo, tendo como base não apenas a investigação teórica, mas também o trabalho desenvolvido ao longo da minha Prática de Ensino Supervisionada, realizado na Escola Secundária Quinta do Marquês, em Oeiras, no ano letivo 2012-2013. A análise teórica e a reflexão prática apontam para a necessidade de apostar na transversalidade dos saberes recorrendo a estratégias de ensino que motivem os alunos e que se conciliem com as suas expectativas