Cultivating Caring in Nursing Education

There has been an increase in incivility in nursing education. The uncivil behaviors that are demonstrated most frequently are anger, frustration, and disrespect toward others. The uncivil behaviors may be exhibited by nursing faculty or nursing students. The reasons for uncivil behavior are varied and are identified in studies by nurse researchers. While the problem of incivility has been difficult to resolve, it is important to address incivility because it is in fact escalating in nursing education. It is hoped that the integration of caring theories within nursing education will lead to an understanding and expression of caring behaviors, which will decrease incivility. The purposes of this phenomenological study, Cultivating Caring in Nursing Education, were to obtain personal perspectives and understandings of caring from student nurses and to enrich the nursing curriculum with a caring theory that will heighten trust, communication, and respect. The current nursing curriculum was enhanced with caring lectures and narrative story-telling. Eighteen students participated in focus groups and answered questions related to caring. The questions were: When you think about caring, what are the first words that come to your mind? What is it to care for self and others? Tell me of a caring action that you witnessed in the school environment this semester? How can you help decrease negative attitudes in school? Tell me how you can demonstrate caring behaviors with students and faculty. Data were analyzed using qualitative thematic analysis. Themes related caring included “expressing genuine interest in others, listening, being present, providing comfort, and role modeling”. Students were able to describe caring attributes and behaviors in nursing that have been exhibited while in nursing school. The nursing students felt that caring behaviors have been role-modeled by nursing faculty and that they have experienced and developed caring relationships while in school. Nursing educators will be able to promote civility in nursing education and practice by more intentionally incorporating caring in the nursing curriculum and environment

Role of NF-κB Activity in Apoptotic Response of Keratinocytes Mediated by Interferon-γ, Tumor Necrosis Factor-α, and Tumor-Necrosis-Factor-Related Apoptosis-Inducing Ligand

An important step in tumorigenesis involves loss of sensitivity to various apoptotic signals by malignant cells, imbuing them with an enhanced survival phenotype. NF-κB also regulates epidermal thickness, susceptibility to apoptosis, and tumor formation in skin. Keratinocytes were examined for their susceptibility to apoptosis using cytokines produced during an immunologic response to tumor antigens, i.e., interferon-γ and/or tumor necrosis factor-α (TNF-α). The role for NF-κB in this response was examined using a retroviral vector containing a degradation-resistant form of IκBα. Whereas interferon-γ and TNF-α either alone or in combination did not induce apoptosis in keratinocytes, after infection with the retrovirus to block NF-κB activation they became susceptible to TNF-α but not Fas-induced apoptosis. Moreover, when keratinocytes with repressed NF-κB activity were simultaneously treated with interferon-γ, there was a synergistic induction of apoptosis by TNF-α that was dependent on FADD, tumor-necrosis-factor-related apoptosis-inducing ligand (TRAIL), and caspase activation. Molecular abnormalities accompanying repressed NF-κB activity included failure to induce TNF-RII receptor together with enhanced levels of TRAIL death receptor 4. The ability of interferon-γ when combined with TNF-α to mediate keratinocyte apoptosis included induction of TRAIL coupled with diminished capacity of keratinocytes with repressed NF-κB activity to increase the TRAIL decoy receptor-1, as well as lower levels of several NF-κB-dependent antiapoptotic proteins accompanied by enhanced caspase 8 levels. These results indicate that interferon-γ and TNF-α synergistically induce keratinocyte apoptosis when concomitant induction of NF-κB is blocked. Participants in the apoptotic response mediated by NF-κB, besides cell-survival proteins, include modulation of TRAIL and both death and decoy receptors. Thus, not only does NF-κB signaling influence the intrinsic survival pathway for keratinocytes in normal skin, but it may also play a role in determining the apoptotic response to cytokines generated during an immune response via TRAIL produced by the keratinocytes themselves

Smartphone applications designed to improve older people’s chronic pain management:an integrated systematic review

(1) Background: Older people’s chronic pain is often not well managed because of fears of side-effects and under-reporting. Telehealth interventions, in the form of smartphone applications, are attracting much interest in the management of chronic diseases, with new and evolving approaches in response to current population demographics. However, the extent to which telehealth interventions may be used to promote and effect the self-management of chronic pain is not established. (2) Aim: To provide an objective review of the existing quantitative and qualitative evidence pertaining to the benefits of smartphone applications for the management of chronic pain in older people. (3) Methods: A literature search was undertaken using PubMed, Medline, CINAHL, Embase, PsychINFO, the Cochrane database, Science Direct and references of retrieved articles. The data were independently extracted by two reviewers from the original reports. (4) Results: This integrative systematic review identified 10 articles considering smartphone applications related to self-management of chronic pain among older adults. (5) Conclusions: It is important for future research to not only examine the effects of smartphone initiatives, but also to compare their safety, acceptability, efficacy and cost–benefit ratio in relation to existing treatment modalities.</p

A Randomized, Controlled, Phase 2 Study of Maralixibat in the Treatment of Itching Associated With Primary Biliary Cholangitis.

Primary biliary cholangitis (PBC) is typically associated with elevated serum bile acid levels and pruritus, but pruritus is often refractory to treatment with existing therapies. This phase 2 study assessed the efficacy and safety of maralixibat, a selective, ileal, apical, sodium-dependent, bile acid transporter inhibitor, in adults with PBC and pruritus. Adults with PBC and pruritus who had received ursodeoxycholic acid (UDCA) for ≥6 months or were intolerant to UDCA were randomized 2:1 to maralixibat (10 or 20 mg/day) or placebo for 13 weeks in combination with UDCA (when tolerated). The primary outcome was change in Adult Itch Reported Outcome (ItchRO™) average weekly sum score (0, no itching; 70, maximum itching) from baseline to week 13/early termination (ET). The study enrolled 66 patients (maralixibat [both doses combined], n = 42; placebo, n = 24). Mean ItchRO™ weekly sum scores decreased from baseline to week 13/ET with maralixibat (-26.5; 95% confidence interval [CI], -31.8, -21.2) and placebo (-23.4; 95% CI, -30.3, -16.4). The difference between groups was not significant (P = 0.48). In the maralixibat and placebo groups, adverse events (AEs) were reported in 97.6% and 70.8% of patients, respectively. Gastrointestinal disorders were the most frequently reported AEs (maralixibat, 78.6%; placebo, 50.0%). Conclusion: Reductions in pruritus did not differ significantly between maralixibat and placebo. However, a large placebo effect may have confounded assessment of pruritus. Lessons learned from this rigorously designed and executed trial are indispensable for understanding how to approach trials assessing pruritus as the primary endpoint and the therapeutic window of bile acid uptake inhibition as a therapeutic strategy in PBC

Space based astronomy: Teacher's guide with activities

This curriculum guide uses hands-on activities to help students and teachers understand the significance of space-based astronomy - astronomical observations made from outer space. The guide contains few of the traditional activities found in many astronomy guides such as constellation studies, lunar phases, and planetary orbits. Instead, it tells the story of why it is important to observe celestial objects from outer space and how to study the entire electromagnetic spectrum. The guide begins with a survey of astronomy related NASA spacecraft. This is followed by a collection of activities in four units: (1) the atmospheric filter; (2) the electromagnetic spectrum; (3) collecting electromagnetic radiation; and (4) down to Earth. A curriculum index identifies the curriculum areas each activity addresses. The guide concludes with a glossary, reference list, a NASA Resources list, and an evaluation card. It is designed for students in grades 5 through 8

Advanced EFL learners' beliefs about language learning and teaching: a comparison between grammar, pronunciation, and vocabulary

This paper reports on the results of a study exploring learners’ beliefs on the learning and teaching of English grammar, pronunciation and vocabulary at tertiary level. While the importance of learners’ beliefs on the acquisition process is generally recognized, few studies have focussed on and compared learners’ views on different components of the language system. A questionnaire containing semantic scale and Likert scale items probing learners’ views on grammar, pronunciation and vocabulary was designed and completed by 117 native speakers of Dutch in Flanders, who were studying English at university. The analysis of the responses revealed that (i) vocabulary was considered to be different from grammar and pronunciation, both in the extent to which an incorrect use could lead to communication breakdown and with respect to the learners’ language learning strategies, (ii) learners believed in the feasibility of achieving a native-like proficiency in all three components, and (iii) in-class grammar, pronunciation and vocabulary exercises were considered to be useful, even at tertiary level. The results are discussed in light of pedagogical approaches to language teaching

Weighing the Giants - I. Weak-lensing masses for 51 massive galaxy clusters: project overview, data analysis methods and cluster images

This is the first in a series of papers in which we measure accurate weak-lensing masses for 51 of the most X-ray luminous galaxy clusters known at redshifts 0.15<z<0.7, in order to calibrate X-ray and other mass proxies for cosmological cluster experiments. The primary aim is to improve the absolute mass calibration of cluster observables, currently the dominant systematic uncertainty for cluster count experiments. Key elements of this work are the rigorous quantification of systematic uncertainties, high-quality data reduction and photometric calibration, and the "blind" nature of the analysis to avoid confirmation bias. Our target clusters are drawn from RASS X-ray catalogs, and provide a versatile calibration sample for many aspects of cluster cosmology. We have acquired wide-field, high-quality imaging using the Subaru and CFHT telescopes for all 51 clusters, in at least three bands per cluster. For a subset of 27 clusters, we have data in at least five bands, allowing accurate photo-z estimates of lensed galaxies. In this paper, we describe the cluster sample and observations, and detail the processing of the SuprimeCam data to yield high-quality images suitable for robust weak-lensing shape measurements and precision photometry. For each cluster, we present wide-field color optical images and maps of the weak-lensing mass distribution, the optical light distribution, and the X-ray emission, providing insights into the large-scale structure in which the clusters are embedded. We measure the offsets between X-ray centroids and Brightest Cluster Galaxies in the clusters, finding these to be small in general, with a median of 20kpc. For offsets <100kpc, weak-lensing mass measurements centered on the BCGs agree well with values determined relative to the X-ray centroids; miscentering is therefore not a significant source of systematic uncertainty for our mass measurements. [abridged]Comment: 26 pages, 19 figures (Appendix C not included). Accepted after minor revisio

Liposomal Co-Entrapment of CD40mAb Induces Enhanced IgG Responses against Bacterial Polysaccharide and Protein

Background Antibody against CD40 is effective in enhancing immune responses to vaccines when chemically conjugated to the vaccine antigen. Unfortunately the requirement for chemical conjugation presents some difficulties in vaccine production and quality control which are compounded when multivalent vaccines are required. We explore here an alternative to chemical conjugation, involving the co-encapsulation of CD40 antibody and antigens in liposomal vehicles. Methodology/Principal Findings Anti-mouse CD40 mAb or isotype control mAb were co-entrapped individually in cationic liposomal vehicles with pneumococcal polysaccharides or diphtheria and tetanus toxoids. Retention of CD40 binding activity upon liposomal entrapment was assessed by ELISA and flow cytometry. After subcutaneous immunization of BALB/c female mice, anti-polysaccharide and DT/TT responses were measured by ELISA. Simple co-encapsulation of CD40 antibody allowed for the retention of CD40 binding on the liposome surface, and also produced vaccines with enhanced imunogenicity. Antibody responses against both co-entrapped protein in the form of tetanus toxoid, and Streptococcus pneumoniae capsular polysaccharide, were enhanced by co-encapsulation with CD40 antibody. Surprisingly, liposomal encapsulation also appeared to decrease the toxicity of high doses of CD40 antibody as assessed by the degree of splenomegaly induced. Conclusions/Significance Liposomal co-encapsulation with CD40 antibody may represent a practical means of producing more immunogenic multivalent vaccines and inducing IgG responses against polysaccharides without the need for conjugation

Therapeutic recommendations in HFE hemochromatosis for p.Cys282Tyr (C282Y/C282Y) homozygous genotype

Although guidelines are available for hereditary hemochromatosis, a high percentage of the recommendations within them are not shared between the different guidelines. Our main aim is to provide an objective, simple, brief, and practical set of recommendations about therapeutic aspects of HFE hemochromatosis for p.Cys282Tyr (C282Y/C282Y) homozygous genotype, based on the published scientific studies and guidelines, in a form that is reasonably comprehensible to patients and people without medical training. This final version was approved at the Hemochromatosis International meeting on 12th May 2017 in Los Angeles

Mosaic Chromosomal alterations in Blood across ancestries Using Whole-Genome Sequencing

Megabase-scale mosaic chromosomal alterations (mCAs) in blood are prognostic markers for a host of human diseases. Here, to gain a better understanding of mCA rates in genetically diverse populations, we analyzed whole-genome sequencing data from 67,390 individuals from the National Heart, Lung, and Blood Institute Trans-Omics for Precision Medicine program. We observed higher sensitivity with whole-genome sequencing data, compared with array-based data, in uncovering mCAs at low mutant cell fractions and found that individuals of European ancestry have the highest rates of autosomal mCAs and the lowest rates of chromosome X mCAs, compared with individuals of African or Hispanic ancestry. Although further studies in diverse populations will be needed to replicate our findings, we report three loci associated with loss of chromosome X, associations between autosomal mCAs and rare variants in DCPS, ADM17, PPP1R16B and TET2 and ancestry-specific variants in ATM and MPL with mCAs in cis