Communication and patient safety in gynecology and obstetrics - study protocol of an intervention study.

BACKGROUND: Patient safety is a key target in public health, health services and medicine. Communication between all parties involved in gynecology and obstetrics (clinical staff/professionals, expectant mothers/patients and their partners, close relatives or friends providing social support) should be improved to ensure patient safety, including the avoidance of preventable adverse events (pAEs). Therefore, interventions including an app will be developed in this project through a participatory approach integrating two theoretical models. The interventions will be designed to support participants in their communication with each other and to overcome difficulties in everyday hospital life. The aim is to foster effective communication in order to reduce the frequency of pAEs. If communication is improved, clinical staff should show an increase in work satisfaction and patients should show an increase in patient satisfaction. METHODS: The study will take place in two maternity clinics in Germany. In line with previous studies of complex interventions, it is divided into three interdependent phases. Each phase provides its own methods and data. Phase 1: Needs assessment and a training for staff (n = 140) tested in a pre-experimental study with a pre/post-design. Phase 2: Assessment of communication training for patients and their social support providers (n = 423) in a randomized controlled study. Phase 3: Assessment of an app supporting the communication between staff, patients, and their social support providers (n = 423) in a case-control study. The primary outcome is improvement of communication competencies. A range of other implementation outcomes will also be assessed (i.e. pAEs, patient/treatment satisfaction, work satisfaction, safety culture, training-related outcomes). DISCUSSION: This is the first large intervention study on communication and patient safety in gynecology and obstetrics integrating two theoretical models that have not been applied to this setting. It is expected that the interventions, including the app, will improve communication practice which is linked to a lower probability of pAEs. The app will offer an effective and inexpensive way to promote effective communication independent of users' motivation. Insights gained from this study can inform other patient safety interventions and health policy developments. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03855735; date of registration: February 27, 2019

Plastidial NAD-Dependent Malate Dehydrogenase: A Moonlighting Protein Involved in Early Chloroplast Development through Its Interaction with an FtsH12-FtsHi Protease Complex

Malate dehydrogenases (MDHs) convert malate to oxaloacetate using NAD(H) or NADP(H) as a cofactor. mutants lacking plastidial NAD-dependent MDH () are embryo-lethal, and constitutive silencing (1) causes a pale, dwarfed phenotype. The reason for these severe phenotypes is unknown. Here, we rescued the embryo lethality of via embryo-specific expression of pdNAD-MDH. Rescued seedlings developed white leaves with aberrant chloroplasts and failed to reproduce. Inducible silencing of pdNAD-MDH at the rosette stage also resulted in white newly emerging leaves. These data suggest that pdNAD-MDH is important for early plastid development, which is consistent with the reductions in major plastidial galactolipid, carotenoid, and protochlorophyllide levels in 1 seedlings. Surprisingly, the targeting of other NAD-dependent MDH isoforms to the plastid did not complement the embryo lethality of , while expression of enzymatically inactive pdNAD-MDH did. These complemented plants grew indistinguishably from the wild type. Both active and inactive forms of pdNAD-MDH interact with a heteromeric AAA-ATPase complex at the inner membrane of the chloroplast envelope. Silencing the expression of FtsH12, a key member of this complex, resulted in a phenotype that strongly resembles 1. We propose that pdNAD-MDH is essential for chloroplast development due to its moonlighting role in stabilizing FtsH12, distinct from its enzymatic function

‘The Rest is Silence’:Psychogeography, Soundscape and Nostalgia in Pat Collins’ Silence

Guy Debord defines the term psychogeography as 'the study of the precise laws and specific effects of the geographical environment, consciously organised or not, on the emotions and behaviour of individuals' (Debord 1955: 23). Similar to the belief of psychogeographers that the geography of an environment has a psychological effect on the human mind, proponents of acoustic ecology such as R. Murray Schafer hold that humans are affected by the sound of the environment in which they find themselves. Further to this, they examine the extent to which soundscapes can be shaped by human behaviour. Recently a body of Irish films has emerged that directly engages with the Irish soundscape and landscape on a psychogeographical level. Rather than using landscape as a physical space for the locus of action, these representations of the Irish landscape allow for an engagement with the aesthetic effects of the geographical landscape as a reflection of the psychological states of the protagonists. Bearing this in mind, this article examines how Silence (Collins 2012) arguably demonstrates the most overt and conscious incursion into this area to date. It specifically interrogates how the filmic representation of the psychogeography and soundscape of the Irish rural landscape can serve to express emotion, alienation and nostalgia, thus confronting both the Irish landscape and the weight of its associated history

Polymorphisms of genes coding for ghrelin and its receptor in relation to colorectal cancer risk: a two-step gene-wide case-control study

<p>Abstract</p> <p>Background</p> <p>Ghrelin, an endogenous ligand for the growth hormone secretagogue receptor (GHSR), has two major functions: the stimulation of the growth hormone production and the stimulation of food intake. Accumulating evidence also indicates a role of ghrelin in cancer development.</p> <p>Methods</p> <p>We conducted a case-control study to examine the association of common genetic variants in the genes coding for ghrelin (GHRL) and its receptor (GHSR) with colorectal cancer risk. Pairwise tagging was used to select the 11 polymorphisms included in the study. The selected polymorphisms were genotyped in 680 cases and 593 controls from the Czech Republic.</p> <p>Results</p> <p>We found two SNPs associated with lower risk of colorectal cancer, namely SNPs rs27647 and rs35683. We replicated the two hits, in additional 569 cases and 726 controls from Germany.</p> <p>Conclusion</p> <p>A joint analysis of the two populations indicated that the T allele of rs27647 SNP exerted a protective borderline effect (P_trend= 0.004).</p

Historicising black rhino in Namibia: colonial-era hunting, conservation custodianship, and plural values

The black rhinoceros (Diceros bicornis) is a threatened species of which the south-western subspecies (D. bicornis bicornis, synonym D. bicornis occidentalis) persists on communal land and elsewhere in Namibia. It does so despite its clearance from most of the animal’s former range due to the expansion of colonial-era hunting with firearms, and the concentration of marginalised Namibians alongside this high-value species in the challenging landscapes of north-west Namibia in particular. We trace what is known about the patterns and impacts of colonial-era hunting of rhino in the territory that is now the modern state of Namibia, introducing an online map of documented historical encounters with rhino in Namibia and the pressures on them from late 1700s. This map of historical encounters is currently complementing baseline information on the past distribution of black rhino in Namibia held by the Ministry of Environment, Forestry and Tourism (MEFT) in support of its collaborative Black Rhino Custodianship Programme (BRCP). We outline contemporary pressures on black rhino and conservation responses to these circumstances, tracing the emergence of a novel approach to rhino conservation in Namibia that recruits people living under different kinds of land tenure as ‘custodians’ of these animals, so as to support the reintroduction of both black and white rhino throughout their former range. We focus in on proactive rhino conservation work in communal-area conservancies of west Namibia which combines the translocation of black rhino to areas of its former range with an array of endeavours to pluralise the animal’s contemporary value, including rhino tourism, the recruit of local ‘rhino rangers’, and ‘rhino pride’ initiatives. In this context, and differently to custodians on freehold land, a vulnerable, large-bodied, space-requiring and sometimes dangerous mammal with very high international conservation value, simultaneously lives alongside peoples impoverished historically and with their own ambitions towards self-determination. This custodianship model of rhino conservation can be understood in part as a creative species conservation response to the very challenging structural circumstances effected by both past impacts on rhino and present inequality in land distribution and tenure, both of which add heat to questions of access to land and resources, including wildlife