Caring for the autistic child: a resource manual for health care providers

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects approximately 1 in 68 children (CDC, 2014). Comorbid medical conditions and psychiatric disorders increase the likelihood that these children will require acute care services more often than their neurotypical peers (McDermott, Zhou, & Mann, 2008; Simonoff et al., 2008). The evidence suggests that most health care providers are unprepared for the complexity of the interactions with these children during an acute care episode (McGongile, Migyanka, et al., 2014; McGongile, Venkat, et al., 2014; Muskat et al., 2015). Currently, there are no formalized training programs for acute health care workers in Regina Qu’Appelle Health Region (RQHR). Purpose: The purpose of this practicum project was to use the best available evidence on the care needs of children with Autism Spectrum Disorder (ASD) and effective interaction strategies to guide development of a resource manual for acute care health workers, especially registered nurses (RNs), working in the RQHR. Methods: Initial steps involved planning for and conducting a needs assessment. The resulting database emerged from a critical review of relevant literature, an environmental scan of resources within RQHR, and informal consultations with parents and caregivers of children with ASD, acute care nurses and nurse managers and experts in the field of ASD. Following analysis and collation of all data into major themes, a draft blueprint guided development of a resource manual for health care providers interacting with and providing care to children with ASD. Results: The needs assessment data informed development of an educational resource manual appropriate for all health care providers who encounter children with ASD and their parents and/or caregivers within acute care environments. The Caring for the Autistic Child: A Guide for Health Care Providers in Acute Care provides insightful information on the disorder and associated comorbid conditions, as well as effective approaches to care delivery with this priority population. Implementation and evaluation plans will guide distribution of the resource manual within the RQHR. Conclusion: The sequential and interdependent steps taken in this practicum project led to the development of a resource manual comprised of simple, easy to implement strategies capable of assisting nurses and all healthcare providers in providing care tailored to the autistic child’s unique needs and challenges.

The transition experience for registered nurses new to case management in the community

Case management is increasingly being used within today‟s healthcare system in an effort to reduce healthcare costs while meeting the complex needs of populations within the community. Registered nurses (RNs) are often recruited for the role of case managers in the community because of their specific skill set and ability to navigate the healthcare system. There is a vast amount of literature related to the client and system benefits of case management, the roles and responsibilities of RN case managers, and job satisfaction among RN case managers. However, there is a literature gap noted in relation to the transition experience for RNs new to case management in the community setting. This research study used grounded theory methodology, guided by Glaser and Strauss (1967) to explore the process of RNs transitioning to case management in the community setting. Eleven RNs new to case management in the community were interviewed using semi-structured interviews. Data analysis was carried out using the constant comparative method. Three stages of adjusting to case management in the community were identified: slugging it out, seeing the job as it is, and finding the way. By gaining an understanding of this transition experience, recommendations for nursing practice and administration, education, and research that are based on the evidence from this study can be implemented to improve the transition experience for RNs new to case management in the community setting

Measuring Scope of Practice Enactment among Primary Care Registered Nurses in Ontario

Background: Primary care is the sector of health care in which patients first establish contact with the health system, are provided person-focused care over time for all new or common needs, and receive coordinated integrated health services provided elsewhere by other members of the health care team. Registered Nurses (RNs) in Canada provide care within this sector in varying roles. The extent to which RNs enact their full scope of practice in primary care settings in Canada is not known. The Actual Scope of Practice questionnaire (ASCOP) is a 26 item Likert scale questionnaire developed by researchers in Canada and validated in the acute care setting to measure the extent to which RNs apply the knowledge, skills and competencies of the professional full scope of practice. Similar to the acute care setting, there is a need to measure scope of practice enactment in the primary care setting. Objectives: The overall aim of this thesis was to measure scope of practice enactment in the primary care setting. Two research objectives were addressed: (1) to revise and adapt the ASCOP questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument, the ASCOP-PC. Methods: To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective a cross-sectional survey of 178 RNs working in primary care organizations in Ontario was conducted Results: The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The ASCOP-PC yielded acceptable alpha coefficients ranging from 0.66 to 0.91 and explained variances from 44.2 to 62.6. Total mean score of 5.16 suggests that RNs within these models of care almost always engage in activities reflected in the ASCOP-PC. Interpretation: Findings from this study support the use of a the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care nurses in the primary care setting.

An Assessment of How Nurse Practitioners Create Access to Primary Care in Canadian Residential Long-Term Care Settings

The aim of this paper is to explore the role and activities of nurse practitioners (NPs) working in long-term care (LTC) to understand concepts of access to primary care for residents. Utilizing the "FIT" framework developed by Penchanksy and Thomas, we used a directed content analysis method to analyze data from a pan-Canadian study of NPs in LTC. Individual and focus group interviews were conducted at four sites in western, central and eastern regions of Canada with 143 participants, including NPs, RNs, regulated and unregulated nursing staff, allied health professionals, physicians, administrators and directors and residents and family members. Participants emphasized how the availability and accessibility of the NP had an impact on access to primary and urgent care for residents. Understanding more about how NPs affect access in Canadian LTC will be valuable for nursing practice and healthcare planning and policy and may assist other countries in planning for the introduction of NPs in LTC settings to increase access to primary care.

Mechanismen kleiner regulatorischer RNAs in Dictyostelium discoideum: Charakterisierung und Anwendung

Die RNA-Interferenz (RNAi) ist ein in Eukaryoten weit verbreiteter Mechanismus, der die transkriptionelle oder posttranskriptionelle Stilllegung von Genen beschreibt. Die Spezifität wird dabei durch die Sequenz einer kleinen, nicht-kodierenden RNA gewährleistet. Diese RNA leitet einen Effektorkomplex, dessen Zentrum immer von einem Argonautenprotein gebildet wird, üblicherweise zu einer komplementären mRNA. In der Folge kommt es zum Abbau des Transkripts oder zur Inhibierung der Translation. Aktuelle Veröffentlichungen konnten zudem das Aktivitätsprofil der Argonautenproteine beträchtlich erweitern: Im Zellkern vorkommende Argonautenproteine wurden beispielsweise mit Spleißvorgängen, der Promotorkontrolle von Genen und der DNA-Reparatur in Verbindung gebracht. In den letzten Jahren konnten weitreichende Kenntnisse bezüglich der Kontrolle einiger transposabler Elemente durch RNAi sowie der Biogenese kleiner regulatorischer RNAs in Dictyostelium discoideum und anderen Organismen gewonnen werden. Ein Fokus dieser Arbeit lag zunächst auf der Charakterisierung des Argonautenproteins AgnB und der Identifikation von Interaktionspartnern. Es konnte gezeigt werden, dass AgnB zumindest partiell im Zellkern der Amöbe lokalisiert und dort vermutlich regulatorische Aufgaben wahrnimmt. Gestützt wurde diese Annahme durch die massenspektrometrische und Western Blot basierte Detektion nukleärer Bindungspartner. Weiterführende Analysen konnten AgnB zudem als positiven Regulator für drei entwicklungsregulierte Gene beschreiben und so die Verbindung zum Prozess der RNA activation in der Amöbe herstellen. Identifizierte posttranslationale Modifikationen könnten diesbezüglich die Aktivität des Argonauten steuern. Mit Hilfe von Crosslink-RNA-Immunopräzipitation und anschließender Hochdurchsatz-sequenzierung oder der Northern Blot basierten Auswertung konnte eine Assoziation von AgnB und der Class I RNAs gezeigt werden. Diese Klasse umfasst nicht-kodierende RNAs mit einer Länge von etwa 42 bis 65 Nukleotiden und wurde bisher nicht als Substrat für die RNAi-Maschinerie in D. discoideum angesehen. Ein weiterer Teil dieser Arbeit beschäftigte sich mit dem Einfluss von AgnA und AgnB auf die Promotorbereiche des D. discoideum Retrotransposons DIRS-1. Im Verlauf der Untersuchungen konnte beobachtet werden, dass die Anordnung entgegengesetzt operierender DIRS-1 Promotor-sequenzen für die Stilllegung eines Reportergens ausreichend war. Darauf aufbauend konnte ein DIRS-1 basiertes knockdown System etabliert werden. Mit Hilfe dieses Systems konnten die Proteinmengen ausgewählter Zielgene so effektiv reduziert werden, dass die entsprechenden Stämme den Phänotyp des korrespondierenden knockout Stammes zeigten. Darüber hinaus war es möglich die Proteinreduktion zu modulieren, um so beispielsweise dosisabhängige Effekte zu registrieren. Vorangegangene Arbeiten zur Biogenese von micro (mi)RNAs konnten das RNA-bindende Protein RbdB als eine Hauptkomponente für die Prozessierung maturer miRNAs identifizieren. Der miRNA defiziente RbdB- Stamm wurde in dieser Arbeit zur Identifikation putativer miRNA Ziele genutzt. Dazu wurde sowohl das Transkriptom des D. discoideum Wildtyps als auch des rbdB knockout Stammes in hohem Durchsatz sequenziert, um so differentiell exprimierte Gene zu detektieren. Vielversprechende Kandidaten wurden mittels qRT-PCR verifiziert. Dabei wurde unter anderem ein putativer Transkriptionsfaktor als miRNA target identifiziert, der eine Vielzahl weiterer Gene regulieren könnte. Abschließend konnte in dieser Arbeit gezeigt werden, dass RbdB ebenfalls für die Generierung von small interfering (si)RNAs aus strukturierten Loci von Bedeutung ist. Dies weist auf mindestens zwei unterschiedliche Mechanismen zur siRNA Prozessierung in D. discoideum hin.

Condomínios fechados: a produção habitacional contemporânea e a auto-exclusão dos ricos no espaço urbano de Natal RN (1995 2003)

The present work analyzes the fast evolution of gated communities in Natal-RN´s urban space. Characterized by the occupation of large areas, providing private security and utilities, this kind of real estate use arises a long list of questions and issues from society and scholars, due to privatization of urban space, bending of law constraints and the lack of an integrated planning of the cities where they are built. The reasons for its fast growth in Brazil s urban areas are analyzed, considering the impact on formal urban planning and municipal services and on the identification of urbanistic, architectural pattern and constraints, as well as legal, social and economic issues. This study is based on the detailed analysis of the first three units of gated communities built in the urban space in Natal, between 1995 and 2003, including their evolution throughout time and the specific social and economic reasons for its present widespread adoption in Brazilian real estate market and, particulary, in our city. The main objective of this piece of work is to answer the why s and how s these phenomena evolved, setting a basis for the definition of adequate public policies and regulation of this kind of urban land use

Cannabinoids impact on pregnancy: effects in trophoblast cells

Cannabinoids (CBs) can be classified as: phytocannabinoids, the constituents of the Cannabis sativa plant; synthetic cannabinoids lab-synthesized and the endocannabinoids that are endogenous lipid mediators. Cannabinoid compounds activate cannabinoid receptors – CB1 and CB2. The most prevalent psychoactive phytocannabinoid is Δ9tetrahydrocannabinol (THC), but more than 60 different CBs were already identified in the plant. The best characterized endocannabinoids (eCBs) are anandamide (AEA) and 2arachidonoylglycerol (2-AG), that are involved in several physiological processes including synaptic plasticity, pain modulation, energy homeostasis and reproduction. On the other hand, some synthetic cannabinoids that were initially designed for medical research, are now used as drugs of abuse. During the period of placental development, highly dynamic processes of remodeling occur, involving proliferation, apoptosis, differentiation and invasion of trophoblasts. It is known that a tight control of eCBs levels is required for normal pregnancy progression and that eCBs are involved in trophoblast cells turnover. Therefore, by sharing activation of the same receptors, exposure to exocannabinoids either by recreational or medicinal use may lead to alterations in the eCBs levels and in the endocannabinoid system homeostasis In this work, it was studied the impact of CBs in BeWo trophoblastic cells and in primary cultures of human cytotrophoblasts. Cells were treated for 24 hours with different concentrations of THC, the synthetic cannabinoid WIN‐55,212 (WIN) and 2-AG. Treatment with THC did not affect BeWo cells viability while WIN and 2-AG caused a dose-dependent viability loss. Morphological studies together with biochemical markers indicate that 2-AG is able to induce apoptosis in cytotrophoblasts. On the other hand, morphological studies after acridine orange staining suggest that autophagy may take part in WIN-induced loss of cell viability. All cannabinoids caused a decrease in mitochondrial membrane potential (Δψm) but only 2-AG led to ROS/RNS generation, though no changes in glutathione levels were observed. In addition, ER-stress may be involved in the 2-AG induced-oxidative stress, as preliminary results point to an increase in CCAAT-enhancer-binding protein homologous protein (CHOP) expression. Besides the decrease in cell viability, alterations in cell cycle progression were observed. WIN treatment induced a cell cycle arrest in G0/G1 phase, whereas 2-AG induced a cell cycle arrest in G2/M phase. Here it is reinforced the relevance of cannabinoid signaling in fundamental processes of cell proliferation and cell death in trophoblast cells. Since cannabis-based drugs are the most consumed illicit drugs worldwide and some of the most consumed recreational drugs by pregnant women, this study may contribute to the understanding of the impact of such substances in human reproduction.

Propostas de gestão participativa para o desenvolvimento sustentável dos recursos naturais e biodiversidade de Santa Maria

Os Açores reúnem nove ilhas com singularidades peculiares em termos paisagísticos, arquitetónicos e riqueza dos seus recursos naturais. Este panorama levanta contudo grandes desafios de sustentabilidade, de entre eles a reorientação de estratégias, atendendo à especificidade da região (segundo os objetivos à escala nacional em sede da Estratégia Nacional Desenvolvimento Sustentável (ENDS)). No caso da Ilha de Santa Maria (SMA), pequena ilha em que as estratégias tendem a ser ignoradas, a participação da população e dos dirigentes locais é minorada por interesses económicos desvinculados do desenvolvimento sustentável (DS). Para inverter esta situação é necessário conhecer para preservar, proteger para conservar, planificar e orientar os comportamentos e atitudes visando a sustentabilidade dos recursos naturais (RN) da ilha. Aplicando uma metodologia que conjugou os métodos quantitativos e qualitativos, com uma componente prática, utilizando um método de amostragem não casual dirigida, não probabilística com um método de amostragem por clusters, agrupado em grupos (workshop, séniores e jovens), pretendeu-se descrever os conhecimentos, as práticas e as perceções sobre a gestão dos RN’s, DS e instrumentos de gestão territorial (IGT’s). Os resultados mostram que os conhecimentos, práticas e perceções dos diferentes grupos são insuficientes no que respeita ao conhecimento dos conceitos e dimensões do DS (independentemente das idades ou habilitações literárias), verificando-se contudo melhorias, por vezes significativas, após as ações de sensibilização e educação. É imperativo continuar o esforço de valorização dos RN’s, envolvendo a população nas estratégias de conservação, objetivando uma proposta orientadora e participada numa visão para sustentabilidade da Ilha (SMA). Recomenda-se uma proposta de modelo de Estratégia DS dos recursos naturais e biodiversidade para SMA e diversas propostas de ações para colocar em prática essa estratégia como desenvolvimentos futuros.

Transcriptoma diferencial entre células-tronco mesenquimais humanas jovens e senescentes

Human mesenchymal stem cells (MSC) are powerful sources for cell therapy in regenerative medicine. The long time cultivation can result in replicative senescence or can be related to the emergence of chromosomal alterations responsible for the acquisition of tumorigenesis features in vitro. In this study, for the first time, the expression profile of MSC with a paracentric chromosomal inversion (MSC/inv) was compared to normal karyotype (MSC/n) in early and late passages. Furthermore, we compared the transcriptome of each MSC in early passages with late passages. MSC used in this study were obtained from the umbilical vein of three donors, two MSC/n and one MSC/inv. After their cryopreservation, they have been expanded in vitro until reached senescence. Total RNA was extracted using the RNeasy mini kit (Qiagen) and marked with the GeneChip ® 3 IVT Express Kit (Affymetrix Inc.). Subsequently, the fragmented aRNA was hybridized on the microarranjo Affymetrix Human Genome U133 Plus 2.0 arrays (Affymetrix Inc.). The statistical analysis of differential gene expression was performed between groups MSC by the Partek Genomic Suite software, version 6.4 (Partek Inc.). Was considered statistically significant differences in expression to p-value Bonferroni correction ˂.01. Only signals with fold change ˃ 3.0 were included in the list of differentially expressed. Differences in gene expression data obtained from microarrays were confirmed by Real Time RT-PCR. For the interpretation of biological expression data were used: IPA (Ingenuity Systems) for analysis enrichment functions, the STRING 9.0 for construction of network interactions; Cytoscape 2.8 to the network visualization and analysis bottlenecks with the aid of the GraphPad Prism 5.0 software. BiNGO Cytoscape pluggin was used to access overrepresentation of Gene Ontology categories in Biological Networks. The comparison between senescent and young at each group of MSC has shown that there is a difference in the expression parttern, being higher in the senescent MSC/inv group. The results also showed difference in expression profiles between the MSC/inv versus MSC/n, being greater when they are senescent. New networks were identified for genes related to the response of two of MSC over cultivation time. Were also identified genes that can coordinate functional categories over represented at networks, such as CXCL12, SFRP1, xvi EGF, SPP1, MMP1 e THBS1. The biological interpretation of these data suggests that the population of MSC/inv has different constitutional characteristics, related to their potential for differentiation, proliferation and response to stimuli, responsible for a distinct process of replicative senescence in MSC/inv compared to MSC/n. The genes identified in this study are candidates for biomarkers of cellular senescence in MSC, but their functional relevance in this process should be evaluated in additional in vitro and/or in vivo assays

Condomínios fechados: a produção habitacional contemporânea e a auto-exclusão dos ricos no espaço urbano de Natal RN (1995 2003)

The present work analyzes the fast evolution of gated communities in Natal-RN´s urban space. Characterized by the occupation of large areas, providing private security and utilities, this kind of real estate use arises a long list of questions and issues from society and scholars, due to privatization of urban space, bending of law constraints and the lack of an integrated planning of the cities where they are built. The reasons for its fast growth in Brazil s urban areas are analyzed, considering the impact on formal urban planning and municipal services and on the identification of urbanistic, architectural pattern and constraints, as well as legal, social and economic issues. This study is based on the detailed analysis of the first three units of gated communities built in the urban space in Natal, between 1995 and 2003, including their evolution throughout time and the specific social and economic reasons for its present widespread adoption in Brazilian real estate market and, particulary, in our city. The main objective of this piece of work is to answer the why s and how s these phenomena evolved, setting a basis for the definition of adequate public policies and regulation of this kind of urban land use

Natural plant polyphenols for alleviating oxidative damage in man: Current status and future perspectives

The balance between oxidation and reduction is important for maintaining a healthy biological system. Oxidative stress results from an imbalance between excessive formation of reactive oxygen species (ROS) and/or reactive nitrogen species (RNS) and limited endogenous defense systems, and this imbalance can adversely alter lipids, proteins and DNA, causing a number of human diseases. Thus, exogenous antioxidants that can neutralize the effect of free radicals are needed to diminish the cumulative effects of oxidative damage over human life span. Current research reveals that phenolic compounds in plants possess high antioxidant activity and free radical scavenging capacity and can prevent the body from oxidative damage over human life span. This review focuses on the present understanding of free radicals and antioxidants and their importance in human health and disease. Information about the chemical features of free radicals as well as their deleterious effects on cell structures is reviewed. The chemical structure and anti-oxidative mechanisms of essential polyphenols and their potential health benefits are presented. In addition, the limitation of natural antioxidants and a perspective on likely future trends in this field are also discussed.

Test of a Smock System on CPR Primary Emergency Measures and Medical Errors During Simulated Emergencies

Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on:1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.

Exploration du travail d’une classe en réseau sur un objet partagé en situation d’arts plastiques

Cette étude s’est déroulée dans le contexte de l’École en réseau au Québec. Une classe du primaire a utilisé un espace numérique collaboratif (Knowledge Forum) pour la réalisation d’activités d’éducation artistique, soit l’appréciation d’un corpus d’oeuvres et la création d’un objet d’art. La progression du discours écrit relativement à ces deux objets de partage a été étudiée. Nos résultats montrent que les élèves ont réussi à faire progresser leurs contributions sur les deux objets partagés. En interagissant entre eux, ils ont créé des artéfacts de connaissances partagées et développé un langage artistique propre. À la suite de nos constats, des implications pédagogiques ont été formulées pour d’encourager la participation des élèves lors d’activités d’éducation artistique au moyen d’outils numériques qui soutiennent la collaboration.

Caratterizzazione fisico-chimica di una sorgente di plasma freddo per trattamento di packaging alimentare

I plasmi freddi a pressione atmosferica (CAP) generati da scariche a barriera dielettrica (DBD) sono oggetto di studio e sviluppo per una gamma sempre più ampia di applicazioni in ambito biomedico e industriale come la sanificazione di alimenti e di packaging termosensibili. La sorgente sviluppata in questo progetto di tesi viene definita PASS, Plasma Assisted Sanification System essa è composto da una sorgente di plasma sDBD (surface dielectric barrier discharge), una camera di trattamento, un sistema di raffreddamento e un generatore di alta tensione. Questo progetto si concentra sulla caratterizzazione fisico-chimica di una sorgente di plasma sDBD sviluppata dal gruppo di ricerca in Applicazioni Industriali dei Plasmi (AIP - DIN - Alma Mater Studiorum). In primo luogo è stata svolta una caratterizzazione elettrica della sorgente variando la potenza agendo direttamente sul duty cycle da 100% a 10% tramite due metodi: un metodo convenzionale e con il metodo di Lissajous inserendo una capacità monitor C0 pari a 90,95 nF . Successivamente è stata studiata la cinetica delle concentrazioni di O3 e NO2 in fase gas mediante misure OAS. È stata inoltre monitorata la temperatura all’interno della camera di trattamento per verificare l’ipotesi di assenza di effetti termici durante il trattamento. Un’altra importante applicazione della sorgente di plasma utilizzata in questo è la produzione di acqua attivata al plasma (Plasma Activated Water, PAW). Le specie reattive dell’ossigeno (Reactive Oxygen Species, ROS) e dell’azoto (Reactive Nitrogen Species, RNS), vengono assorbite dal liquido dando origine a ulteriori reazioni chimiche come NO3-, NO2-, H2O2. I RONS influenzano e controllano molti processi nelle piante e sono responsabili del miglioramento della crescita delle piante. Per ogni campione di acqua attivata (PAW) sono stati misurati pH, conducibilità confrontati con la soluzione non trattata e concentrazione di specie reattive quali: H2O2, NO2- e NO3- .