Toward an in-depth understanding of cardiovascular interventional nursing : a qualitative study into nursing within the cardiac catheterisation laboratory setting

Introduction: Nursing in the cardiac catheterisation laboratory (CCL) varies globally in terms of scope and deployment. In the US, all allied staff are cross-trained into all CCL roles. The Australian and New Zealand experience has legislative frameworks that reserves specific functions to nurses. Yet, the nursing role within the CCL is poorly researched and defined. Aim: This study sought to gain deeper understanding of the perceived role of CCL nurses in Australia and New Zealand. Method: A descriptive qualitative study using semi-structured in-depth interviews was used. A cross-sectional sample of 23 senior clinical nurses or nursing managers representing 16 CCLs across Australia and New Zealand was obtained. Data were digitally recorded and transcribed verbatim prior to analysis by three researchers. Results: Five major themes emerged from the data. These themes were: 1. The CCL is a unique environment; 2. CCL nursing is a unique and advanced cardiac nursing discipline; 3. The recruitment attributes for CCL nurses are advanced; 4. Education needs to be standardised; and 5. The evidence to support practice is poor. Discussion: The CCL environment is a dynamic, deeply interdisciplinary setting with CCL nursing seen to be a unique advanced practice role. Yet the time has come for a scope of practice, educational standards, guidelines and competencies was expressed by the participants. Conclusion: Nursing in the CCL is an advanced practice role working within a complex interdisciplinary environment. Further work is required to define the role of CCL nurses together with the evidence-base for their practice.

The Duet between the Author and the Translator: An Analysis of Style through Shifts in Literary Translation

The study proposes a method for identifying the personal imprint of literary translators in translated works of fiction. The initial assumption was that the style of a target text is not determined solely by the literary style of the author but also by features of its translator s idiolect. A method was developed for identifying the idiolectal features of individual translators, which were then used to describe personal translation styles. The method is not restricted to a particular language pair. To test the method and to establish the nature of the proposed personal imprint empirically, extracts from four English-language literary source texts (two novels by James Joyce and two by Ernest Hemingway) were first compared with their translations into Finnish (by four different translators) in order to identify changes, or shifts, that had taken place at the formal linguistic level in the translation process. To allow individual propensities to manifest themselves, only optional shifts in which the translators had a range of choices available to them were included in the study. In the second phase, extracts by different authors rendered into Finnish by the same translator were compared in order to gauge the extent of the potential impact of the author's style on the translator's work. In-depth analysis of the types of shifts made most frequently by the individual translators revealed further intersubjective differences, and the shifts were used to construct translation profiles for each of the translators. In order to determine the potential effects of frequently occurring shifts on the target text, some central concepts of narratology were adapted and used to establish an intermediate link between microlevel choices and macrolevel effects. In this way the propensity of an individual translator to opt for certain types of shift could be linked with the overall artistic effect of the target text.

Proteomic analysis of circulating immune complexes in juvenile idiopathic arthritis reveals disease-associated proteins

Juvenile idiopathic arthritis reflects a group of clinically heterogeneous arthritides hallmarked by elevated concentrations of circulating immune complexes. In this study, the circulating immune complex proteome was examined to elucidate disease-associated proteins that are overexpressed in patients with an aggressive, and at times destructive, disease phenotype. To solve this proteome, circulating immune complexes were isolated from the sera of patients with chronic, erosive or early-onset, aggressive disease and from patients in medical remission or healthy controls subsequent to protein separation by 2-DE. Thirty-seven protein spots were overexpressed in the circulating immune complexes of the aggressive disease groups as compared to controls, 28 of which have been confidently identified to date. Proteolytic fragments of glyceraldehyde-3-phosphate dehydrogenase, serotransferrin, and a-1-antitrypsin have been identified among others. In total, these 28 putative disease-associated proteins most definitely contribute to immune complex formation and likely have a significant role in disease etiology and pathogenesis. Moreover, these proteins represent markers of aggressive disease, which could aid in diagnosis and management strategies, and potential therapeutic targets to prevent or control disease outcome. This is the first in-depth analysis of the circulating immune complex proteome in juvenile idiopathic arthritis.

Transcriptome analysis of a parasitic clade V nematode:comparative analysis of potential molecular anthelmintic targets in Cylicostephanus goldi

Clade V nematodes comprise several parasitic species that include the cyathostomins, primary helminth pathogens of horses. Next generation transcriptome datasets are available for eight parasitic clade V nematodes, although no equine parasites are included in this group. Here, we report next generation transcriptome sequencing analysis for the common cyathostomin species, Cylicostephanus goldi. A cDNA library was generated from RNA extracted from 17 C. goldi male and female adult parasites. Following sequencing using a 454 GS FLX pyrosequencer, a total of 475,215 sequencing reads were generated, which were assembled into 26,910 contigs. Using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes databases, 27% of the transcriptome was annotated. Further in-depth analysis was carried out by comparing the C. goldi dataset with the next generation transcriptomes and genomes of other clade V nematodes, with the Oesophagostomum dentatum transcriptome and the Haemonchus contortus genome showing the highest levels of sequence identity with the cyathostomin dataset (45%). The C. goldi transcriptome was mined for genes associated with anthelmintic mode of action and/or resistance. Sequences encoding proteins previously associated with the three major anthelmintic classes used in horses were identified, with the exception of the P-glycoprotein group. Targeted resequencing of the glutamate gated chloride channel α4 subunit (glc-3), one of the primary targets of the macrocyclic lactone anthelmintics, was performed for several cyathostomin species. We believe this study reports the first transcriptome dataset for an equine helminth parasite, providing the opportunity for in-depth analysis of these important parasites at the molecular level. Sequences encoding enzymes involved in key processes and genes associated with levamisole/pyrantel and macrocyclic lactone resistance, in particular the glutamate gated chloride channels, were identified. This novel data will inform cyathostomin biology and anthelmintic resistance studies in future.

A comparison analysis of the marketing strategy of Lufthansa and Emirates in Germany

The objective of this paper is to perform an analysis of the marketing strategy of Lufthansa and Emirates in Germany. Since both airlines use a similar approach to increase brand awareness an in-depth analysis is implemented in order to identify potential differences. Hereby, consumer insights about the perception and expectation travellers have in common will be analyzed and assessed with quantitative data. Both airlines are well positioned in terms of their marketing strategy, but when Emirates is strengthen its marketing campaign with that pace, the Gulf carrier will certainly make use of its economic strength and can become a frightening threat for the Lufthansa Group on long-haul destinations. Finally, recommendations for future marketing activities for both airlines will be given.

The DPRK in China's post-cold war foreign policy - a neoclassical realist analysis

Avec l’échec des négociations entre les États-Unis et la Corée du Nord, menées depuis le début des années 1990, sur la question du nucléaire, le problème est devenu graduellement l’affaire des pays voisins, tous soucieux de l’avenir de la région du sud-est asiatique. Présentée comme le seul allié de la Corée du Nord, la China a été invitée à participer à des négociations à trois, à quatre (1997-1998), et à six (2003-2007), dans l’espoir de faire entendre raison au régime isolé, mais jusqu’à maintenant, aucune des tentatives n’est parvenue à satisfaire chacun des membres à la table. Alors que la tension monte et que la politique américaine se fait de moins en moins flexible, la Chine quant à elle, continue d’encourager le retour des négociations à six (Six-Party Talks) dans l’optique de dénucléariser la péninsule coréenne, tout en travaillant à maintenir ses liens avec la Corée du Nord. Le fil conducteur de cette présente recherche est d’abord d’essayer de comprendre pourquoi la Chine continue de soutenir la Corée du Nord, fournissant dons alimentaires et financiers. L’idée est donc d’analyser, selon les principes du réalisme néoclassique, la politique étrangère de la Chine. L’hypothèse principale de cette théorie renvoie à l’idée que la distribution du pouvoir dans le système international influence la politique étrangère des États, mais que des variables au niveau de l’état et/ou de l’individu interviennent dans la formulation et l’application de celle-ci. Il est proposé ici que le lien entre l’unipolarité du système international et la politique nord-coréenne de la Chine, est façonné par des variables intermédiaires telles que : a) la perception des leaders de la distribution du pouvoir et de leur place dans le système international; b) l’idéologie du régime politique, et; c) le type d’unité responsable de la prise de décision en politique étrangère. L’analyse de chacune des variables permettra de faire la lumière sur les intérêts politiques et économiques de la Chine dans l’entretien de cette relation avec la Corée du Nord.

Integrated cytokine and metabolic analysis of pathological responses to parasite exposure in rodents

Parasitic infections cause a myriad of responses in their mammalian hosts, on immune as well as on metabolic level. A multiplex panel of cytokines and metabolites derived from four parasite-rodent models, namely, Plasmodium berghei-mouse, Trypanosoma brucei brucei-mouse, Schistosoma mansoni-mouse, and Fasciola hepatica-rat were statistically coanalyzed. 1H NMR spectroscopy and multivariate statistical analysis were used to characterize the urine and plasma metabolite profiles in infected and noninfected animals. Each parasite generated a unique metabolic signature in the host. Plasma cytokine concentrations were obtained using the ‘Meso Scale Discovery’ multi cytokine assay platform. Multivariate data integration methods were subsequently used to elucidate the component of the metabolic signature which is associated with inflammation and to determine specific metabolic correlates with parasite-induced changes in plasma cytokine levels. For example, the relative levels of acetyl glycoproteins extracted from the plasma metabolite profile in the P. berghei-infected mice were statistically correlated with IFN-γ, whereas the same cytokine was anticorrelated with glucose levels. Both the metabolic and the cytokine data showed a similar spatial distribution in principal component analysis scores plots constructed for the combined murine data, with samples from all infected animals clustering according to the parasite species and whereby the protozoan infections (P. berghei and T. b. brucei) grouped separately from the helminth infection (S. mansoni). For S. mansoni, the main infection-responsive cytokines were IL-4 and IL-5, which covaried with lactate, choline, and D-3-hydroxybutyrate. This study demonstrates that the inherently differential immune response to single and multicellular parasites not only manifests in the cytokine expression, but also consequently imprints on the metabolic signature, and calls for in-depth analysis to further explore direct links between immune features and biochemical pathways.

Medical students are afraid to include abortion in their future practices : in-depth interviews in Maharastra, India

BACKGROUND: Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education. METHOD: We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach. RESULTS: The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future. CONCLUSIONS: To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.

The reduced modulus in the analysis of sharp instrumented indentation tests

In the analysis of instrumented indentation data, it is common practice to incorporate the combined moduli of the indenter (E-i) and the specimen (E) in the so-called reduced modulus (E-r) to account for indenter deformation. Although indenter systems with rigid or elastic tips are considered as equivalent if E-r is the same, the validity of this practice has been questioned over the years. The present work uses systematic finite element simulations to examine the role of the elastic deformation of the indenter tip in instrumented indentation measurements and the validity of the concept of the reduced modulus in conical and pyramidal (Berkovich) indentations. It is found that the apical angle increases as a result of the indenter deformation, which influences in the analysis of the results. Based upon the inaccuracies introduced by the reduced modulus approximation in the analysis of the unloading segment of instrumented indentation applied load (P)-penetration depth (delta) curves, a detailed examination is then conducted on the role of indenter deformation upon the dimensionless functions describing the loading stages of such curves. Consequences of the present results in the extraction of the uniaxial stress-strain characteristics of the indented material through such dimensional analyses are finally illustrated. It is found that large overestimations in the assessment of the strain hardening behavior result by neglecting tip compliance. Guidelines are given in the paper to reduce such overestimations.

Effect of pulse repetition rate and number of pulses in the analysis of polypropylene and high density polyethylene by nanosecond infrared laser induced breakdown spectroscopy

Pulse repetition rates and the number of laser pulses are among the most important parameters that do affect the analysis of solid materials by laser induced breakdown spectroscopy, and the knowledge of their effects is of fundamental importance for suggesting analytical strategies when dealing with laser ablation processes of polymers. In this contribution, the influence of these parameters in the ablated mass and in the features of craters was evaluated in polypropylene and high density polyethylene plates containing pigment-based PbCrO4. Surface characterization and craters profile were carried out by perfilometry and scanning electron microscopy. Area, volume and profile of craters were obtained using Taylor Map software. A laser induced breakdown spectroscopy system consisted of a Q-Switched Nd:YAG laser (1064 nm, 5 ns) and an Echelle spectrometer equipped with ICCD detector were used. The evaluated operating conditions consisted of 10, 25 and 50 laser pulses at 1, 5 and 10 Hz, 250 mJ/pulse (85 J cm(-2)), 2 mu s delay time and 6 mu s integration time gate. Differences in the topographical features among craters of both polymers were observed. The decrease in the repetition rate resulted in irregular craters and formation of edges, especially in polypropylene sample. The differences in the topographical features and ablated masses were attributed to the influence of the degree of crystallinity, crystalline melting temperature and glass transition temperature in the ablation process of the high density polyethylene and polypropylene. It was also observed that the intensities of chromium and lead emission signals obtained at 10 Hz were two times higher than at 5 Hz by keeping the number of laser pulses constant. (C) 2011 Elsevier B. V. All rights reserved.

Learning from experience: Analysis of the civil litigation regarding building structures on the court of bologna in the years 2011/2012

The present work is aimed to the study and the analysis of the defects detected in the civil structure and that are object of civil litigation in order to create an instruments capable of helping the different actor involved in the building process. It is divided in three main sections. The first part is focused on the collection of the data related to the civil proceeding of the 2012 and the development of in depth analysis of the main aspects regarding the defects on existing buildings. The research center “Osservatorio Claudio Ceccoli” developed a system for the collection of the information coming from the civil proceedings of the Court of Bologna. Statistical analysis are been performed and the results are been shown and discussed in the first chapters.The second part analyzes the main issues emerged during the study of the real cases, related to the activities of the technical consultant. The idea is to create documents, called “focus”, addressed to clarify and codify specific problems in order to develop guidelines that help the technician editing of the technical advice.The third part is centered on the estimation of the methods used for the collection of data. The first results show that these are not efficient. The critical analysis of the database, the result and the experience and throughout, allowed the implementation of the collection system for the data.

An Analysis of Capacities, Moral Hierarchies, and the Moral Status of Non-Human Animals in Contemporary Animal Rights Work

The primary objective of this thesis is to demonstrate the pernicious impact that moral hierarchies have on our perception and subsequent treatment of non-human animals. Moral hierarchies in general are characterized by a dynamic in which one group is considered to be fundamentally superior to a lesser group. This thesis focuses specifically on the moral hierarchies that arise when humans are assumed to be superior to non-human animals in virtue of their advanced mental capabilities. The operative hypothesis of this thesis is essentially that moral hierarchies thwart the provision of justice to non-human animals in that they function as a justification for otherwise impermissible actions. When humans are assumed to be fundamentally superior to non-human animals then it becomes morally permissible for humans to kill non-human animals and utilize them as mere instrumentalities. This thesis is driven primarily by an in-depth analysis of the approaches to animal rights that are provided by Peter Singer, Tom Regan, and Gary Francione. Each of these thinkers claim that they overcome anthropocentrism and provide approaches that preclude the establishment of a moral hierarchy. One of the major findings of this thesis, however, is that Singer and Regan offer approaches that remain highly anthropocentric despite the fact that each thinker claims that they have overcome anthropocentrism. The anthropocentrism persists in these respective approaches in that each thinkers gives humans Regan and Singer have different conceptions of the criteria that are required to afford a being moral worth, but they both give preference to beings that have the cognitive ability to form desires regarding the future.. As a result, a moral hierarchy emerges in which humans are regarded to be fundamentally superior. Francione, however, provides an approach that does not foster a moral hierarchy. Francione creates such an approach by applying the principle of equal consideration of interests in a consistent manner. Moreover, Francione argues that mere sentience is both a necessary and sufficient condition for being eligible and subsequently receiving moral consideration. The upshot of this thesis is essentially that the moral treatment of animals is not compatible with the presence of a moral hierarchy. As a result, this thesis demonstrates that future approaches to animal rights must avoid the establishment of moral hierarchies. The research and analysis within this thesis demonstrates that this is not a possibility, however, unless all theories of justice that are to accommodate animals abandon the notion that cognition matters morally.

Analysis of patient flows for orthopedic procedures using small area analysis in Switzerland

BACKGROUND: In general cantons regulate and control the Swiss health service system; patient flows within and between cantons are thereby partially disregarded. This paper develops an alternative spatial model, based upon the construction of orthopedic hospital service areas (HSAOs), and introduces indices for the analysis of patient streams in order to identify areas, irrespective of canton, with diverse characteristics, importance, needs, or demands. METHODS: HSAOs were constructed using orthopedic discharge data. Patient streams between the HSAOs were analysed by calculating three indices: the localization index (% local residents discharged locally), the netindex (the ratio of discharges of nonlocal incoming residents to outgoing local residents), and the market share index (% of local resident discharges of all discharges in local hospitals). RESULTS: The 85 orthopedic HSAOs show a median localization index of 60.8%, a market share index of 75.1%, and 30% of HSAOs have a positive netindex. Insurance class of bed, admission type, and patient age are partially but significantly associated with those indicators. A trend to more centrally provided health services can be observed not only in large urban HSAOs such as Geneva, Bern, Basel, and Zurich, but also in HSAOs in mountain sport areas such as Sion, Davos, or St.Moritz. Furthermore, elderly and emergency patients are more frequently treated locally than younger people or those having elective procedures. CONCLUSION: The division of Switzerland into HSAOs provides an alternative spatial model for analysing and describing patient streams for health service utilization. Because this small area model allows more in-depth analysis of patient streams both within and between cantons, it may improve support and planning of resource allocation of in-patient care in the Swiss healthcare system.

Transcriptome analysis reveals a classical interferon signature induced by IFNλ4 in human primary cells.

The IFNL4 gene is negatively associated with spontaneous and treatment-induced clearance of hepatitis C virus infection. The activity of IFNλ4 has an important causal role in the pathogenesis, but the molecular details are not fully understood. One possible reason for the detrimental effect of IFNλ4 could be a tissue-specific regulation of an unknown subset of genes. To address both tissue and subtype specificity in the interferon response, we treated primary human hepatocytes and airway epithelial cells with IFNα, IFNλ3 or IFNλ4 and assessed interferon mediated gene regulation using transcriptome sequencing. Our data show a surprisingly similar response to all three subtypes of interferon. We also addressed the tissue specificity of the response, and identified a subset of tissue-specific genes. However, the interferon response is robust in both tissues with the majority of the identified genes being regulated in hepatocytes as well as airway epithelial cells. Thus we provide an in-depth analysis of the liver interferon response seen over an array of interferon subtypes and compare it to the response in the lung epithelium.

Automatic identification of discourse markers in dialogues: An in-depth study of like and well

The lexical items like and well can serve as discourse markers (DMs), but can also play numerous other roles, such as verb or adverb. Identifying the occurrences that function as DMs is an important step for language understanding by computers. In this study, automatic classifiers using lexical, prosodic/positional and sociolinguistic features are trained over transcribed dialogues, manually annotated with DM information. The resulting classifiers improve state-of-the-art performance of DM identification, at about 90% recall and 79% precision for like (84.5% accuracy, κ = 0.69), and 99% recall and 98% precision for well (97.5% accuracy, κ = 0.88). Automatic feature analysis shows that lexical collocations are the most reliable indicators, followed by prosodic/positional features, while sociolinguistic features are marginally useful for the identification of DM like and not useful for well. The differentiated processing of each type of DM improves classification accuracy, suggesting that these types should be treated individually.