Patient Care Advocacy Through Electronic Communication

Patient advocacy is a primary role of the Certified Registered Nurse Anesthetist (CRNA). While engaged in the legislative process, CRNAs have failed to materialize significant gains in political potency on a national scale. This project involved the development of prototype software for mobile communication devices to augment the CRNA community’s ability to advocate for patients in the healthcare policy arenas. After a demonstration of the software to key leaders of the American Association of Nurse Anesthetists (AANA), an anonymous survey was distributed to the AANA executive administrators. All six executives in attendance for the demonstration of the software completed and returned a qualitative survey. The survey was designed for a critique of the developed software. The results of the survey conveyed a strong interest in the prototype and a plan for further development of the software. Several functions of the software were regarded by the AANA executives as essentials for future iterations of the application

A new model for mixing by double-diffusive convection (semi-convection): I. The conditions for layer formation

The process referred to as "semi-convection" in astrophysics and "double-diffusive convection in the diffusive regime" in Earth and planetary sciences, occurs in stellar and planetary interiors in regions which are stable according to the Ledoux criterion but unstable according to the Schwarzschild criterion. In this series of papers, we analyze the results of an extensive suite of 3D numerical simulations of the process, and ultimately propose a new 1D prescription for heat and compositional transport in this regime which can be used in stellar or planetary structure and evolution models. In a preliminary study of the phenomenon, Rosenblum et al. (2011) showed that, after saturation of the primary instability, a system can evolve in one of two possible ways: the induced turbulence either remains homogeneous, with very weak transport properties, or transitions into a thermo-compositional staircase where the transport rate is much larger (albeit still smaller than in standard convection). In this paper, we show that this dichotomous behavior is a robust property of semi-convection across a wide region of parameter space. We propose a simple semi-analytical criterion to determine whether layer formation is expected or not, and at what rate it proceeds, as a function of the background stratification and of the diffusion parameters (viscosity, thermal diffusivity and compositional diffusivity) only. The theoretical criterion matches the outcome of our numerical simulations very adequately in the numerically accessible "planetary" parameter regime, and can easily be extrapolated to the stellar parameter regime. Subsequent papers will address more specifically the question of quantifying transport in the layered case and in the non-layered case.Comment: Submitted to Ap

NASA newsletters for the Weber Student Shuttle Involvement Project

Biweekly reports generated for the Weber Student Shuttle Involvement Project (SSIP) are discussed. The reports document the evolution of science, hardware, and logistics for this Shuttle project aboard the eleventh flight of the Space Transportation System (STS-41B), launched from Kennedy Space Center on February 3, 1984, and returned to KSC 8 days later. The reports were intended to keep all members of the team aware of progress in the project and to avoid redundancy and misunderstanding. Since the Weber SSIP was NASA's first orbital rat project, documentation of all actions was essential to assure the success of this complex project. Eleven reports were generated: October 3, 17 and 31; November 14 and 28; and December 12 and 17, 1983; and January 3, 16, and 23; and May 1, 1984. A subject index of the reports is included. The final report of the project is included as an appendix

Association of clusterin with the BRI2-derived amyloid molecules ABri and ADan

Familial British and Danish dementias (FBD and FDD) share striking neuropathological similarities with Alzheimer's disease (AD), including intraneuronal neurofibrillary tangles as well as parenchymal and vascular amyloid deposits. Multiple amyloid associated proteins with still controversial role in amyloidogenesis colocalize with the structurally different amyloid peptides ABri in FBD, ADan in FDD, and Aβ in AD. Genetic variants and plasma levels of one of these associated proteins, clusterin, have been identified as risk factors for AD. Clusterin is known to bind soluble Aβ in biological fluids, facilitate its brain clearance, and prevent its aggregation. The current work identifies clusterin as the major ABri- and ADan-binding protein and provides insight into the biochemical mechanisms leading to the association of clusterin with ABri and ADan deposits. Mirroring findings in AD, the studies corroborate clusterin co-localization with cerebral parenchymal and vascular amyloid deposits in both disorders. Ligand affinity chromatography with downstream Western blot and amino acid sequence analyses unequivocally identified clusterin as the major ABri- and ADan-binding plasma protein. ELISA highlighted a specific saturable binding of clusterin to ABri and ADan with low nanomolar Kd values within the same range as those previously demonstrated for the clusterin-Aβ interaction. Consistent with its chaperone activity, thioflavin T binding assays clearly showed a modulatory effect of clusterin on ABri and ADan aggregation/fibrillization properties. Our findings, together with the known multifunctional activity of clusterin and its modulatory activity on the complex cellular pathways leading to oxidative stress, mitochondrial dysfunction, and the induction of cell death mechanisms – all known pathogenic features of these protein folding disorders – suggests the likelihood of a more complex role and a translational potential for the apolipoprotein in the amelioration/prevention of these pathogenic mechanisms

El Niño and the delayed action oscillator

We study the dynamics of the El Niño phenomenon using the mathematical model of delayedaction oscillator (DAO). Topics such as the influence of the annual cycle, global warming, stochastic influences due to weather conditions and even off-equatorial heat-sinks can all be discussed using only modest analytical and numerical resources. Thus the DAO allows for a pedagogical introduction to the science of El Niño and La Niña while at the same time avoiding the need for large-scale computing resources normally associated with much more sophisticated coupled atmosphere-ocean general circulation models. It is an approach which is ideally suited for student projects both at high school and undergraduate level

Rotational Evolution During Type I X-Ray Bursts

The rotation rates of six weakly-magnetic neutron stars accreting in low-mass X-ray binaries have most likely been measured by Type I X-ray burst observations with RXTE. The nearly coherent oscillations detected during the few seconds of thermonuclear burning are most simply understood as rotational modulation of brightness asymmetries on the neutron star surface. We show that, as suggested by Strohmayer and colleagues, the frequency changes of 1-2 Hz observed during bursts are consistent with angular momentum conservation as the burning shell hydrostatically expands and contracts. We calculate how vertical heat propagation through the radiative outer layers of the atmosphere and convection affect the coherence of the oscillation. We show that the evolution of the rotational profile depends strongly on whether the burning layers are composed of pure helium or mixed hydrogen/helium. Our results help explain the absence (presence) of oscillations from hydrogen-burning (helium-rich) bursts that was found by Muno and collaborators. We investigate angular momentum transport within the burning layers and the recoupling of the burning layers with the star. We show that the Kelvin-Helmholtz instability is quenched by the strong stratification, and that mixing between the burning fuel and underlying ashes by the baroclinic instability does not occur. However, the baroclinic instability may have time to operate within the differentially rotating burning layer, potentially bringing it into rigid rotation.Comment: To appear in The Astrophysical Journal; minor corrections made to tables and figure

Factors affecting the transfer of learning to the workplace

Training aims to respond to the needs of development of individuals and organizations (Grohmann & Kauffeld, 2013). Based on Holton model, we carried out a study seeking to identify and understand the factors involved in the process of learning transfer to the workplace from two different training actions on the design and skills. The study took place at a Portuguese organization and involved 98 participants. Former students were interviewed with the purpose to explore the factors that facilitated or hindered the learning transfer, and the Inventory of the Portuguese version of the Learning Transfer System (Holton, Bates, Seyler & Carvalho, 1997; Velada & Caetano, 2009) was applied. The results suggest that the Holton model (2005) shows that the trainees have identified important issues for learning transfer and that there are differences in relation to the transfer factor pursuant to the type of training.info:eu-repo/semantics/publishedVersio

Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired Association football (soccer) players

In retired professional Association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career and concussion history were prospectively collected. Next-of-kin consented for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer’s disease (N=6), TDP-43 (N=6), cerebral amyloid angiopathy (N=5), hippocampal sclerosis (N=2), corticobasal degeneration (N=1), dementia with Lewy bodies (N=1) and vascular pathology (N=1), all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer’s disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association Football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation including large scale case-control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies

Neuropathological features of genetically confirmed DYT1 dystonia: investigating disease-specific inclusions.

IntroductionEarly onset isolated dystonia (DYT1) is linked to a three base pair deletion (¿GAG) mutation in the TOR1A gene. Clinical manifestation includes intermittent muscle contraction leading to twisting movements or abnormal postures. Neuropathological studies on DYT1 cases are limited, most showing no significant abnormalities. In one study, brainstem intraneuronal inclusions immunoreactive for ubiquitin, torsinA and lamin A/C were described. Using the largest series reported to date comprising 7 DYT1 cases, we aimed to identify consistent neuropathological features in the disease and determine whether we would find the same intraneuronal inclusions as previously reported.ResultThe pathological changes of brainstem inclusions reported in DYT1 dystonia were not replicated in our case series. Other anatomical regions implicated in dystonia showed no disease-specific pathological intracellular inclusions or evidence of more than mild neuronal loss.ConclusionOur findings suggest that the intracellular inclusions described previously in DYT1 dystonia may not be a hallmark feature of the disorder. In isolated dystonia, DYT1 in particular, biochemical changes may be more relevant than the morphological changes