No second chance: the experiences of junior neonatal nurses in providing end-of-life care for babies and families in the NNU

Background

An infant’s death is acutely stressful for parents and professionals. Little is known about junior nurses’ experiences providing end-of-life care in Neonatal Units (NNU).

Objectives

To better understand junior nurses’ experiences providing end-of-life care in NNU, the study explored the challenges and opportunities inherent in their practice relating to providing such care to babies and their families.

Methods

Neonatal nurses (n=12) with less than 3 years’ experience who were undergoing a neonatal education programme participated. Two focus groups were convened each with 6 nurses. The Ethics Committee at the relevant University approved the study. Nominal Group Technique (NGT) was used in the focus groups to build consensus around the challenges faced by junior nurses, alongside suggested developments in improving future care provision. Primary analysis involved successive rounds of ranking and decision making whilst secondary analysis involved thematic analysis.

Results

The study identified the pressures these nurses felt in having only one chance to ‘get it right’ for the infants and their families. They perceived the need for further ‘education and training’ highlighting that improved education provision would include both additional courses and internal training sessions. Greater ‘support’ from mentors themselves more experienced in this aspect of care within the NNU was identified as important in addressing issues around confidence building and skill development.

Conclusions

The results highlight junior nurses’ need for specific education and mentorship around end-of-life care for babies. This presentation will outline the implications for practice, education and further research.

Structure and lipid interactions of membrane-associated glycosyltransferases : Cationic patches and anionic lipids regulate biomembrane binding of both GT-A and GT-B enzymes

This thesis concerns work on structure and membrane interactions of enzymes involved in lipid synthesis, biomembrane and cell wall regulation and cell defense processes. These proteins, known as glycosyltransferases (GTs), are involved in the transfer of sugar moieties from nucleotide sugars to lipids or chitin polymers. Glycosyltransferases from three types of organisms have been investigated; one is responsible for vital lipid synthesis in Arabidopsis thaliana (atDGD2) and adjusts the lipid content in biomembranes if the plant experiences stressful growth conditions. This enzyme shares many structural features with another GT found in gram-negative bacteria (WaaG). WaaG is however continuously active and involved in synthesis of the protective lipopolysaccharide layer in the cell walls of Escherichia coli. The third type of enzymes investigated here are chitin synthases (ChS) coupled to filamentous growth in the oomycete Saprolegnia monoica. I have investigated two ChS-derived MIT domains that may be involved in membrane interactions within the endosomal pathway. From analysis of the three-dimensional structure and the amino-acid sequence, some important regions of these very large proteins were selected for in vitro studies. By the use of an array of biophysical methods (e.g. Nuclear Magnetic Resonance, Fluorescence and Circular Dichroism spectroscopy) and directed sequence analyses it was possible to shed light on some important details regarding the structure and membrane-interacting properties of the GTs. The importance of basic amino-acid residues and hydrophobic anchoring segments, both generally and for the abovementioned proteins specifically, is discussed. Also, the topology and amino-acid sequence of GT-B enzymes of the GT4 family are analyzed with emphasis on their biomembrane association modes. The results presented herein regarding the structural and lipid-interacting properties of GTs aid in the general understanding of glycosyltransferase activity. Since GTs are involved in a high number of biochemical processes in vivo it is of outmost importance to understand the underlying processes responsible for their activity, structure and interaction events. The results are likely to be useful for many applications and future experimental design within life sciences and biomedicine.

Child anxiety, resiliency, and the FRIENDS for Life program

Anxiety disorders are the most commonly diagnosed group of mental disorders in children (Kessler et al., 2012). Resiliency, defined as a child’s ability to successfully overcome an adverse event (Newland, 2014) is believed to be comprised of protective factors such as self-esteem and positive coping strategies (Rutter, 1987). These protective factors are related to child anxiety in that their presence or absence may augment or hinder a child’s resiliency towards anxiety-provoking events and situations (Lo Casico, Guzzo, & Pace, 2013; Thorne, Andrews, & Nordstokke, 2013). The FRIENDS for Life (FFL) program is a school-based anxiety prevention program which aims to decrease anxiety and increase resiliency in 8- to 11-year-old children (Barrett & Sonderegger, 2003). Previous studies have shown FFL to be an effective tool in decreasing anxiety and increasing resiliency; however, not all previous studies have utilized control or comparison groups (Brownlee et al., 2013; Neil & Christensen 2007; Stopa, Barrett, & Golingi, 2011). Moreover, existing FRIENDS literature has not previously considered the potential role of parent anxiety in child outcomes. The present study aimed to evaluate child anxiety, resiliency, and parent anxiety in relation to the FFL program while including a no-treatment control group. It was hypothesized that child anxiety would decrease and child resiliency would increase following FFL. Results obtained from a non-identified school-based sample were not entirely consistent with predictions, such that decreases in anxiety and increases in resiliency were observed in both the experimental and control groups.

A VOICE OF THEIR OWN: MUSIC AND SOCIAL COHESION IN TURKISH ALEVI LIFE

This dissertation examines the role that music has played in the expression of identity and revitalization of culture of the Alevis in Turkey, since the start of their sociocultural revival movement in the late 1980s. Music is central to Alevi claims of ethnic and religious difference—singing and playing the bağlama (Turkish folk lute) constitutes an expressive practice in worship and everyday life. Based on research conducted from 2012 to 2014, I investigate and present Alevi music through the lens of discourses on the construction of identity as a social and musical process. Alevi musicians perform a revived repertoire of the ritual music and folk songs of Anatolian bards and dervish-lodge poets that developed over several centuries. Contemporary media and performance contexts have blurred former distinctions between sacred and secular, yet have provided new avenues to build community in an urban setting. I compare music performances in the worship services of urban and small-town areas, and other community events such as devotional meetings, concerts, clubs, and broadcast and social media to illustrate the ways that participation—both performing and listening—reinforces identity and solidarity. I also examine the influence of these different contexts on performers’ musical choices, and the power of music to evoke a range of responses and emotional feelings in the participants. Through my investigation I argue that the Alevi music repertoire is not only a cultural practice but also a symbol of power and collective action in their struggle for human rights and self-determination. As Alevis have faced a redefined Turkish nationalism that incorporates Sunni Muslim piety, this music has gained even greater potency in their resistance to misrecognition as a folkloric, rather than a living, tradition.

Energy harvesting for monitoring bridges over their operational life

The use of energy harvesting materials for large infrastructure is a promising and growing field. In this regard, the use of such harvesters for the purpose of structural health monitoring of bridges has been proposed in recent times as one of the feasible options since the deployment of them can remove the necessity of an external power source. This paper addresses the performance issue of such monitors over the life-cycle of a bridge as it deteriorates and the live load on the structure increases. In this regard, a Lead Zirconate Titanate (PZT) material is considered as the energy harvesting material and a comparison is carried out over the operational life of a reinforced concrete bridge. The evolution of annual average daily traffic (AADT) is taken into consideration, as is the degradation of the structure over time, due to the effects of corrosion. Evolution of such harvested energy is estimated over the life-cycle of the bridge and the sensitivity of harvested energy is investigated for varying rates of degradation and changes in AADT. The study allows for designing and understanding the potential of energy harvesters as a health monitor for bridges. This paper also illustrates how the natural growth of traffic on a bridge over time can accentuate the identification of damage, which is desirable for an ageing structure. The paper also assesses the impact and effects of deployment of harvesters in a bridge as a part of its design process, considering performance over the entire life-cycle versus a deployment at a certain age of the structure.

Refugium for surface life on Snowball Earth in a nearly enclosed sea? A numerical solution for sea-glacier invation through a narrow strait

Abstract Where photosynthetic eukaryotic organisms survived during the Snowball Earth events of the Neoproterozoic remains unclear. Our previous research tested whether a narrow arm of the ocean, similar to the modern Red Sea, could have been a refugium for photosynthetic eukaryotes during the Snowball Earth. Using an analytical ice-flow model, we demonstrated that a limited range of climate conditions could restrict sea-glacier flow sufficiently to allow an arm of the sea to remain partially free from sea-glacier penetration, a necessary condition for it to act as a refugium. Here we expand on the previous study, using a numerical ice-flow model, with the ability to capture additional physics, to calculate sea-glacier penetration, and to explore the effect of a channel with a narrow entrance. The climatic conditions are made selfconsistent by linking sublimation rate to surface temperature. As expected, the narrow entrance allows parts of the nearly enclosed sea to remain safe from sea-glacier penetration for a wider range of climate conditions.

Effects of stochastic hypoxia events on the benthic communities of transitional waters

Hypoxia is one of the most important and faster spreading threats to marine life and its occurrence has significantly increased in the last century. The effects of hypoxia on marine organisms and communities has mostly been studied in light of the intensity of the disturbance but not a lot of attention has been given to its interaction with other stressors and the timing of its appearance. In this thesis I started to explore these topics through laboratory and manipulative field experiments. I studied the interactive effects of thermal stress and hypoxia on a European native bivalve species (Cerastoderma edule; Linnaeus, 1758 ) and a non native one (Ruditapes philippinarum; Adams & Reeve, 1850) through a laboratory experiment performed in the Netherlands. The non native species displayed a greater tolerance to oxygen depletion than the native one. The first field experiment was performed in an Italian brackish coastal lagoon (Pialassa Baiona) and tested the effects of different timing regimes of hypoxia on the benthic community. It emerged that the main factor affecting the community is the duration of the hypoxia. The ability of the communities to recover after repeated hypoxic periods was explored in the second manipulative field experiment. We imposed three different timing regimes of hypoxia on sediment patches in Pialassa Baiona and we monitored the changes of both the benthic and the microbial communities after the disturbances. The preliminary analyses of the data from this last work suggest that the experimental manipulations caused limited detrimental effects on the communities. Overall this thesis work suggests that the duration of hypoxic events, their repetitive nature and the associated thermal stress are key factors in determining their effects on the communities and that management measures should point towards a reduction of the duration of the single hypoxic periods more than their frequency.

Traditional risk factors and lifetime risk of acute coronary events

Objective: To investigate the association between the four traditional coronary heart disease (CHD) risk factors (hypertension, smoking, hypercholesterolemia, and diabetes) and outcomes of first ACS. Methods: Data were drawn from the ISACS Archives. The study participants consisted of 70953 patients with first ACS, but without prior CHD. Primary outcomes were patient’ age at hospital presentation and 30-day all-cause mortality. The risk ratios for mortality among subgroups were calculated using a balancing strategy by inverse probability weighting. Trends were evaluated by Pearson's correlation coefficient (r). Results: For fatal ACS (n=6097), exposure to at least one traditional CHD-risk factor ranged from 77.6% in women to 74.5% in men. The presence of all four CHD-risk factors significantly decreased the age at time of ACS event and death by nearly half a decade compared with the absence of any traditional risk factors in both women (from 67.1±12.0 to 61.9±10.3 years; r=-0.089, P<0.001) and men (from 62.8±12.2 to 58.9±9.9 years; r=-0.096, P<0.001). By contrast, there was an inverse association between the number of traditional CHD-risk factors and 30-day mortality. The mortality rates in women ranged from 7.7% with four traditional CHD-risk factors to 16.3% with no traditional risk factors (r=0.073, P<0.001). The corresponding rates in men were 4.8% and 11.5% (r=0.078, P<0.001), respectively. The risk ratios among individuals with at least one CHD-risk factors vs. those with no traditional risk factors were 0.72 (95%CI:0.65-0.79) in women and 0.64 (95%CI:0.59-0.70) in men. This association was consistent among patient subgroups managed with guideline-recommended therapeutic options. Conclusions: The vast majority of patients who die for ACS have traditional CHD-risk factor exposure. Patients with CHD-risk factors die much earlier in life, but they have a lower relative risk of 30-day mortality than those with no traditional CHD-risk factors, even in the context of equitable evidence‐based treatments after hospital admission.

Development And Shelf-life Determination Of Pasteurized, Microfiltered, Lactose Hydrolyzed Skim Milk.

The segment of the world population showing permanent or temporary lactose intolerance is quite significant. Because milk is a widely consumed food with an high nutritional value, technological alternatives have been sought to overcome this dilemma. Microfiltration combined with pasteurization can not only extend the shelf life of milk but can also maintain the sensory, functional, and nutritional properties of the product. This studied developed a pasteurized, microfiltered, lactose hydrolyzed (delactosed) skim milk (PMLHSM). Hydrolysis was performed using β-galactosidase at a concentration of 0.4mL/L and incubation for approximately 21h at 10±1°C. During these procedures, the degree of hydrolysis obtained (>90%) was accompanied by evaluation of freezing point depression, and the remaining quantity of lactose was confirmed by HPLC. Milk was processed using a microfiltration pilot unit equipped with uniform transmembrane pressure (UTP) ceramic membranes with a mean pore size of 1.4 μm and UTP of 60 kPa. The product was submitted to physicochemical, microbiological, and sensory evaluations, and its shelf life was estimated. Microfiltration reduced the aerobic mesophilic count by more than 4 log cycles. We were able to produce high-quality PMLHSM with a shelf life of 21 to 27d when stored at 5±1°C in terms of sensory analysis and proteolysis index and a shelf life of 50d in regard to total aerobic mesophile count and titratable acidity.

Estimated Disability-adjusted Life Years Averted By Long-term Provision Of Long Acting Contraceptive Methods In A Brazilian Clinic.

What is the contribution of the provision, at no cost for users, of long acting reversible contraceptive methods (LARC; copper intrauterine device [IUD], the levonorgestrel-releasing intrauterine system [LNG-IUS], contraceptive implants and depot-medroxyprogesterone [DMPA] injection) towards the disability-adjusted life years (DALY) averted through a Brazilian university-based clinic established over 30 years ago. Over the last 10 years of evaluation, provision of LARC methods and DMPA by the clinic are estimated to have contributed to DALY averted by between 37 and 60 maternal deaths, 315-424 child mortalities, 634-853 combined maternal morbidity and mortality and child mortality, and 1056-1412 unsafe abortions averted. LARC methods are associated with a high contraceptive effectiveness when compared with contraceptive methods which need frequent attention; perhaps because LARC methods are independent of individual or couple compliance. However, in general previous studies have evaluated contraceptive methods during clinical studies over a short period of time, or not more than 10 years. Furthermore, information regarding the estimation of the DALY averted is scarce. We reviewed 50 004 medical charts from women who consulted for the first time looking for a contraceptive method over the period from 2 January 1980 through 31 December 2012. Women who consulted at the Department of Obstetrics and Gynaecology, University of Campinas, Brazil were new users and users switching contraceptive, including the copper IUD (n = 13 826), the LNG-IUS (n = 1525), implants (n = 277) and DMPA (n = 9387). Estimation of the DALY averted included maternal morbidity and mortality, child mortality and unsafe abortions averted. We obtained 29 416 contraceptive segments of use including 25 009 contraceptive segments of use from 20 821 new users or switchers to any LARC method or DMPA with at least 1 year of follow-up. The mean (± SD) age of the women at first consultation ranged from 25.3 ± 5.7 (range 12-47) years in the 1980s, to 31.9 ± 7.4 (range 16-50) years in 2010-2011. The most common contraceptive chosen at the first consultation was copper IUD (48.3, 74.5 and 64.7% in the 1980s, 1990s and 2000s, respectively). For an evaluation over 20 years, the cumulative pregnancy rates (SEM) were 0.4 (0.2), 2.8 (2.1), 4.0 (0.4) and 1.3 (0.4) for the LNG-IUS, the implants, copper IUD and DMPA, respectively and cumulative continuation rates (SEM) were 15.1 (3.7), 3.9 (1.4), 14.1 (0.6) and 7.3 (1.7) for the LNG-IUS, implants, copper IUD and DMPA, respectively (P < 0.001). Over the last 10 years of evaluation, the estimation of the contribution of the clinic through the provision of LARC methods and DMPA to DALY averted was 37-60 maternal deaths; between 315 and 424 child mortalities; combined maternal morbidity and mortality and child mortality of between 634 and 853, and 1056-1412 unsafe abortions averted. The main limitations are the number of women who never returned to the clinic (overall 14% among the four methods under evaluation); consequently the pregnancy rate could be different. Other limitations include the analysis of two kinds of copper IUD and two kinds of contraceptive implants as the same IUD or implant, and the low number of users of implants. In addition, the DALY calculation relies on a number of estimates, which may vary in different parts of the world. LARC methods and DMPA are highly effective and women who were well-counselled used these methods for a long time. The benefit of averting maternal morbidity and mortality, child mortality, and unsafe abortions is an example to health policy makers to implement more family planning programmes and to offer contraceptive methods, mainly LARC and DMPA, at no cost or at affordable cost for the underprivileged population. This study received partial financial support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), grant # 2012/12810-4 and from the National Research Council (CNPq), grant #573747/2008-3. B.F.B., M.P.G., and V.M.C. were fellows from the scientific initiation programme from FAPESP. Since the year 2001, all the TCu380A IUD were donated by Injeflex, São Paulo, Brazil, and from the year 2006 all the LNG-IUS were donated by the International Contraceptive Access Foundation (ICA), Turku, Finland. Both donations are as unrestricted grants. The authors declare that there are no conflicts of interest associated with this study.

[factors Associated With Satisfaction With Life Among Elderly Caregivers And Non-caregivers].

This article seeks to investigate associations between satisfaction with life and sociodemographic variables, health conditions, functionality, social involvement and social support among elderly caregivers and non-caregivers, as well as between satisfaction and the intensity of stress in the caregiver group. A sample of 338 caregivers was selected according to two items of the Brazilian version of the Elders Life Stress Inventory. A comparison-group of elderly non-caregivers was selected at random, with a similar gender, age and income profile. Data were derived from self-reported questionnaires and scales. Elderly caregivers with low levels of satisfaction and high levels of stress revealed more symptoms of insomnia, fatigue, diseases and worse IADL performance. Those with greater satisfaction and less stress revealed a good level of social support. Insomnia, depression and fatigue were associated with low satisfaction among caregivers, and with fatigue, depression and low social support among non-caregivers. It was considered relevant that instrumental, psychological and informative support can improve the quality of life and the quality of care provided by elderly caregivers, especially if they are affected by unfavorable health and psychosocial conditions and low satisfaction with life.

[association Between Physical And Psychosocial Impacts Of Oral Disorders And Quality Of Life Among The Elderly].

This study sought to evaluate the association between the impact of oral disorders in terms of physical/psychosocial dimensions and quality of life among the elderly. It involved a cross-sectional study conducted among the elderly (65-74 years) in 2008/2009. The social impact was assessed using the Oral Health Impact Profile (OHIP 14) and the quality of life using the SF 12 Short-Form Health Survey. Descriptive, univariate and multivariate (logistic regression) analysis was conducted with correction for the design effect, using SPSS(r)18.0 software. Of the 800 individuals approached, 736 elderly individuals participated (TR = 92%), with a mean age of 67.77 years, the majority of whom showed no impact based on the measurement of the prevalence of OHIP. The functional limitation dimension of the OHIP was associated with the physical domain of the SF12, irrespective of the other variables investigated. However, the seriousness of OHIP and its psychological discomfort and disability dimensions was associated with the mental domain of the SF12. The conclusion reached is that some impacts of oral disorders were associated with unsatisfactory quality of life in the physical and mental domains.

Screening The Life Cycle Of Schistosoma Mansoni Using High-resolution Mass Spectrometry.

Schistosomiasis is a common tropical disease caused by Schistosoma species Schistosomiasis' pathogenesis is known to vary according to the worms' strain. Moreover, high parasitical virulence is directly related to eggs release and granulomatous inflammation in the host's organs. This virulence might be influenced by different classes of molecules, such as lipids. Therefore, better understanding of the metabolic profile of these organisms is necessary, especially for an increased potential of unraveling strain virulence mechanisms and resistance to existing treatments. In this report, direct-infusion electrospray high-resolution mass spectrometry (ESI(+)-HRMS) along with the lipidomic platform were employed to rapidly characterize and differentiate two Brazilian S. mansoni strains (BH and SE) in three stages of their life cycle: eggs, miracidia and cercariae, with samples from experimental animals (Swiss/SPF mice). Furthermore, urine samples of the infected and uninfected mice were analyzed to assess the possibility of direct diagnosis. All samples were differentiated using multivariate data analysis, PCA, which helped electing markers from distinct lipid classes; phospholipids, diacylglycerols and triacylglycerols, for example, clearly presented different intensities in some stages and strains, as well as in urine samples. This indicates that biochemical characterization of S. mansoni may help narrowing-down the investigation of new therapeutic targets according to strain composition and aggressiveness of disease. Interestingly, lipid profile of infected mice urine varies when compared to control samples, indicating that direct diagnosis of schistosomiasis from urine may be feasible.

[larynx Cancer: Quality Of Life And Voice After Treatment].

Treatments for patients with laryngeal cancer often have an impact on physical, social, and psychological functions. To evaluate quality of life and voice in patients treated for advanced laryngeal cancer through surgery or exclusive chemoradiation. Retrospective cohort study with 30 patients free from disease: ten total laryngectomy patients without production of esophageal speech (ES); ten total laryngectomy patients with tracheoesophageal speech (TES), and ten with laryngeal speech. Quality of life was measured by SF-36, Voice-Related Quality of Life (V-RQOL), and Voice Handicap Index (VHI) protocols, applied on the same day. The SF-36 showed that patients who received exclusive chemoradiotherapy had better quality of life than the TES and ES groups. The V-RQOL showed that the voice-related quality of life was lower in the ES group. In the VHI, the ES group showed higher scores for overall, emotional, functional, and organic VHI. Quality of life and voice in patients treated with chemoradiotherapy was better than in patients treated surgically. The type of medical treatment used in patients with laryngeal cancer can bring changes in quality of life and voice.