Asleep or not asleep? Evaluation of the Quality of Patients’ Sleep in Critical Care Nursing

Sleep is important for the recovery of a critically ill patient, as lack of sleep is known to influence negatively a person’s cardiovascular system, mood, orientation, and metabolic and immune function and thus, it may prolong patients’ intensive care unit (ICU) and hospital stay. Intubated and mechanically ventilated patients suffer from fragmented and light sleep. However, it is not known well how non-intubated patients sleep. The evaluation of the patients’ sleep may be compromised by their fatigue and still position with no indication if they are asleep or not. The purpose of this study was to evaluate ICU patients’ sleep evaluation methods, the quality of non-intubated patients’ sleep, and the sleep evaluations performed by ICU nurses. The aims were to develop recommendations of patients’ sleep evaluation for ICU nurses and to provide a description of the quality of non-intubated patients’ sleep. The literature review of ICU patients’ sleep evaluation methods was extended to the end of 2014. The evaluation of the quality of patients’ sleep was conducted with four data: A) the nurses’ narrative documentations of the quality of patients’ sleep (n=114), B) the nurses’ sleep evaluations (n=21) with a structured observation instrument C) the patients’ self-evaluations (n=114) with the Richards-Campbell Sleep Questionnaire, and D) polysomnographic evaluations of the quality of patients’ sleep (n=21). The correspondence of data A with data C (collected 4–8/2011), and data B with data D (collected 5–8/2009) were analysed. Content analysis was used for the nurses’ documentations and statistical analyses for all the other data. The quality of non-intubated patients’ sleep varied between individuals. In many patients, sleep was light, awakenings were frequent, and the amount of sleep was insufficient as compared to sleep in healthy people. However, some patients were able to sleep well. The patients evaluated the quality of their sleep on average neither high nor low. Sleep depth was evaluated to be the worst and the speed of falling asleep the best aspect of sleep, on a scale 0 (poor sleep) to 100 (good sleep). Nursing care was mostly performed while the patients were awake, and thus the disturbing effect was low. The instruments available for nurses to evaluate the quality of patients’ sleep were limited and measured mainly the quantity of sleep. Nurses’ structured observatory evaluations of the quality of patients’ sleep were correct for approximately two thirds of the cases, and only regarding total sleep time. Nurses’ narrative documentations of the patients’ sleep corresponded with patients’ self-evaluations in just over half of the cases. However, nurses documented several dimensions of sleep that are not included in the present sleep evaluation instruments. They could be classified according to the components of the nursing process: needs assessment, sleep assessment, intervention, and effect of intervention. Valid, more comprehensive sleep evaluation methods for nurses are needed to evaluate, document, improve and study patients’ quality of sleep.

Physicochemical analyses indicated to the quality control of royal jelly with honey

Royal jelly (RJ) is used as a revitalizing tonic. In order to avoid rejection to its acid taste, it is added to honey. There are regulations for honey and for royal jelly separately but not for the mixture. The objective of this work is, therefore, to verify if the same methods used for pure honey quality control can be used for honey mixed with royal jelly and also the presence of RJ through 10-HDA determination. The methods used were: moisture, reducing sugars, apparent sucrose, ash, hydroxymethylfurfural, insoluble solids, diastase activity, acidity and 10-HDA. Samples were prepared by adding 0-100% of RJ in honey. The results showed that the ash method was the only suitable one to all the samples. The acidity analysis (direct titration) was suitable to 0-30%RJ samples; the reducing sugar analysis was suitable to 0-20% RJ samples. Concerning moisture analysis the refractometric method is suitable to 0-10% RJ and the Infra Red method is suggested to be used for samples with more than 10% RJ. The methods for diastase activity, HMF, apparent sucrose and insoluble solids were inadequate for all samples with RJ. The presence of RJ in the samples was confirmed by the 10-HDA analyses.

Kartonkikoneen tuoreveden käytön vähentäminen kemiallisesti puhdistettua jätevesikirkastetta hyödyntäen

Tämän diplomityön tarkoituksena oli tutkia mahdollisuutta hyödyntää kemiallisesti puh-distettua jätevettä prosessivetenä. Vedensäästöpotentiaalin perusteella tutkimuskohteeksi valittiin kartonkikone 4. Tutkimuksen tavoite oli tuoreveden käytön ja jätevesipäästöjen vähentäminen Stora Enso Imatran tehtailla. Työn kirjallisuusosa keskittyy kemialliseen jätevedenkäsittelyyn, kartonkikoneen veden käyttöön ja prosessiveden laatuun vaikuttaviin tekijöihin. Työn kokeellisessa osassa laa-dittiin vesitase tuoreveden käyttökohteiden ja veden tarpeen määrittämiseksi. Kemialli-sesti puhdistetun jäteveden ja prosessiveden ominaisuudet määritettiin, jotta saatiin sel-ville ne ominaisuudet, jotka voisivat estää jätevesikirkasteen hyötykäytön. Laboratoriomääritykset osoittivat, että hyötykäytön esteenä ovat jätevesikirkasteen kiin-toaine-, sulfaatti- ja karbonaattipitoisuus sekä mikrobitaso ja väri. Metallien ja suolaionien haittavaikutusten selvittäminen vaatii lisätutkimusta. Lisäpuhdistusmenetelmien avulla, kuten käänteisosmoosi, jätevesikirkasteen laatu saataisiin vastaamaan prosessiveden tasoa ja hyötykäyttö olisi mahdollista myös kartonkikone 4:n ulkopuolella.

Sensory profile and drivers of liking for grape nectar among smoker and nonsmoker consumers

Decreased gustatory and olfactory capacity is one of the problems caused by tobacco use. The objectives of this study were to determine the sensory profile of six grape nectar samples sweetened with different sweeteners and to verify the drivers of liking in two distinct consumer groups: smokers and nonsmokers. The sensory profile was constructed by twelve trained panelists using quantitative descriptive analysis (QDA). Consumer tests were performed with 112 smokers and 112 nonsmokers. Partial least squares regression analyses was used to identify the drivers of acceptance and rejection of the grape nectars among the two consumer groups. According to the QDA, the samples differed regarding six of the nineteen attributes generated. The absolute averages of the affective test were lower in the group of smokers; possibly because smoking influences acceptance and eating preferences, especially with regard to sweet foods. The results showed that the grape flavor was the major driver of preference for acceptance of the nectar, while astringency, wine aroma, bitterness and sweetness, and bitter aftertaste were drivers of rejection in the two groups of consumers, with some differences between the groups.

Peroxidase activity and sensory quality of ready to cook mixed vegetables for soup: combined effect of biopreservatives and refrigerated storage

Enzymatic senescence processes and browning of fresh cut vegetables negatively affect their sensory properties and nutritional value and finally result in the rejection of affected products by consumers. In order to prevent quality decay, the combined effects of natural antioxidants and storage temperature on peroxidase activity and sensory attributes (overall visual quality, browning and odor) of individual and mixed vegetables for soup (butternut squash, leek and celery) were evaluated. Fresh cut vegetables were treated with antioxidant solutions as tea tree essential oil (15 μl/mL), propolis extract (15 μl/mL) and gallic acid (2 mg/mL) and stored at optimal (5 °C) and abusive (15 °C) temperature for a maximum of 14 days. The application of natural preservatives, plus optimal storage conditions, exerted significant inhibitory effects in peroxidase activity of squash, celery and mixed vegetables throughout the storage. Furthermore, propolis treatment applied on mixed vegetables retarded browning appearance and preserved the visual quality for a longer period when compared to untreated product.

Acceptance of a food of animal origin obtained through genetic modification and cloning in South America: a comparative study among university students and working adults

AbstractWith the aim of comparing the acceptance of milk obtained from cloned, genetically modified (GM) and conventionally bred cows among working adults and university students, and identifying and characterizing typologies among both subsamples in terms of their preferences, a survey was applied to 400 people in southern Chile, distributed using a simple allocation among the subsamples. Using a conjoint analysis, it was found that consumers preferred milk from a conventional cow. Using a cluster analysis, in both subsamples two segments sensitive to production technology were identified. Rejection of cloning was greatest among university students, whereas a higher proportion of working adults rejected GM. The segments differed in terms of area of residence, knowledge about GM, and milk consumption habits. Contrary to what was expected, no differences were found according to education, gender or degree of satisfaction with food-related life.

Clinical and pathological correlations of C4d immunostaining and its infl uence on the outcome of kidney transplant recipients

INTRODUCTION: C4d is a marker of antibody-mediated rejection (ABMR) in kidney allografts, although cellular rejection also have C4d deposits. OBJECTIVE: To correlate C4d expression with clinico-pathological parameters and graft outcomes at three years. METHODS: One hundred forty six renal transplantation recipients with graft biopsies by indication were included. C4d staining was performed by paraffin-immunohistochemistry. Graft function and survival were measured, and predictive variables of the outcome were determined by multivariate Cox regression. RESULTS: C4d staining was detected in 48 (31%) biopsies, of which 23 (14.7%) had diffuse and 25 (16%) focal distribution. Pre-transplantation panel reactive antibodies (%PRA) class I and II were significantly higher in C4d positive patients as compared to those C4d negative. Both glomerulitis and pericapillaritis were associated to C4d (p = 0.002 and p < 0.001, respectively). The presence of C4d in biopsies diagnosed as no rejection (NR), acute cellular rejection (ACR) or interstitial fibrosis/ tubular atrophy (IF/TA) did not impact graft function or survival. Compared to NR, ACR and IF/TA C4d-, patients with ABMR C4d+ had the worst graft survival over 3 years (p = 0.034), but there was no difference between ABMR versus NR, ACR and IF/TA that were C4d positive (p = 0.10). In Cox regression, graft function at biopsy and high %PRA levels were predictors of graft loss. CONCLUSIONS: This study confirmed that C4d staining in kidney graft biopsies is a clinically useful marker of ABMR, with well defined clinical and pathological correlations. The impact of C4d deposition in other histologic diagnoses deserves further investigation.

Histopathological analysis of pre-implantation donor kidney biopsies: association with graft survival and function in one year post-transplantation

Introduction: Pre-implantation kidney biopsy is a decision-making tool when considering the use of grafts from deceased donors with expanded criteria, implanting one or two kidneys and comparing this to post-transplantation biopsies. The role of histopathological alterations in kidney compartments as a prognostic factor in graft survival and function has had conflicting results. Objective: This study evaluated the prevalence of chronic alterations in pre-implant biopsies of kidney grafts and the association of findings with graft function and survival in one year post-transplant. Methods: 110 biopsies were analyzed between 2006 and 2009 at Santa Casa de Porto Alegre, including live donors, ideal deceased donors and those with expanded criteria. The score was computed according to criteria suggested by Remuzzi. The glomerular filtration rate (GFR) was calculated using the abbreviated MDRD formula. Results: No statistical difference was found in the survival of donors stratified according to Remuzzi criteria. The GFR was significantly associated with the total scores in the groups with mild and moderate alterations, and in the kidney compartments alone, by univariate analysis. The multivariate model found an association with the presence of arteriosclerosis, glomerulosclerosis, acute rejection and delayed graft function. Conclusion: Pre-transplant chronic kidney alterations did not influence the post-transplantation one-year graft survival, but arteriosclerosis and glomerulosclerosis is predictive of a worse GFR. Delayed graft function and acute rejection are independent prognostic factors.

Tuberculosis in renal transplant patients: The experience of a single center in Medellín-Colombia, 2005-2013

Introduction: Tuberculosis is a common opportunistic infection in renal transplant patients. Objective: To obtain a clinical and laboratory description of transplant patients diagnosed with tuberculosis and their response to treatment during a period ranging from 2005 to 2013 at the Pablo Tobón Uribe Hospital. Methods: Retrospective and descriptive study. Results: In 641 renal transplants, tuberculosis was confirmed in 12 cases. Of these, 25% had a history of acute rejection, and 50% had creatinine levels greater than 1.5 mg/dl prior to infection. The disease typically presented as pulmonary (50%) and disseminated (33.3%). The first phase of treatment consisted of 3 months of HZRE (isoniazid, pyrazinamide, rifampicin and ethambutol) in 75% of the cases and HZME (isoniazid, pyrazinamide, moxifloxacin and ethambutol) in 25% of the cases. During the second phase of the treatment, 75% of the cases received isoniazid and rifampicin, and 25% of the cases received isoniazid and ethambutol. The length of treatment varied between 6 and 18 months. In 41.7% of patients, hepatotoxicity was associated with the beginning of anti-tuberculosis therapy. During a year-long follow-up, renal function remained stable, and the mortality rate was 16.7%. Conclusion: Tuberculosis in the renal transplant population studied caused diverse nonspecific symptoms. Pulmonary and disseminated tuberculosis were the most frequent forms and required prolonged treatment. Antituberculosis medications had a high toxicity and mortality. This infection must be considered when patients present with a febrile syndrome of unknown origin, especially during the first year after renal transplant.

Revelações da crise: moeda fiduciária e as relações Tesouro/Banco Central

The current crisis shed a new light on issues that, previously, were not perceived as serious or important. It highlighted the close ties between fiat currency and government bonds denominated in it or, in other words, the relationship between Treasury and Central Bank. Two ill-conceived views of the "new consensus" on money that had turned into taboos were put in evidence. The first, derived from the quantitative theory, concerns the rejection of unsterilized monetary expansion; the second, directly related to the neoliberal ideology, prohibits or imposes strict limits on the role of central banks in the financing of public debts.

Building governance in the international financial system: Context and challenges

ABSTRACTThe international financial system has undergone deep changes since the 1970s and its stability cannot be reached in spite of actor's interests or the existence of countless coordination fora. Analyzing the system's incentive structure, one can note that its stability depends on the control of imbalances, which are not always harmful for States, creating, thus, a disturbing component in the quest for international financial management. Furthermore, non-state actors have acquired a disproportional share of power following financial globalization, escaping the control of States and of the international community.

An educator's perspective of Dr. Feingold's K-P (Kaiser- Permanents) elimination diet for hyperkinetic children and others

Do evaluation of the literature and a regional observational report support Dr. Feingold's claim that the K-P (Kaiser-Permanente) elimination diet improves the behaviours of hyperkinetic children, and others? Dr. Feingold suggests that some hyperkinetic children, and other children as well, are genetically predisposed to intolerance of food additives, particularly food colours and flavours. He claims that the K-P diet, that eliminates salicylates and artificial food colours and flavours, improves the hyperkinetic child's behaviour, muscle co-ordination, and scholastic performance. Public acceptance of the K-P diet has outstripped acceptance in the medical and scientific communities. Evaluation of available data and additional studies are needed to arrive at a conclusion of acceptance or rejection of the K-P diet for hyperkinetic children and others. My interest in the K-P elimination diet for hyperkinetic children is educational. My experience as an elementary school teacher in special education and in the classroom from K-8 has taught me that attentiveness is crucial to learning. Hyperkinesis appears to impair a child's ability to attend. Learning problems appear, followed by behavioural and social problems. l If we accept the possibility of a relationship between diet and attentiveness, and attentiveness and school behaviours, then the diet-behaviour link could be of lay importance. For instance, if a diet such as the K-P diet could do what is claimed, substantial benefits could accrue to the child. One could, for example, improve a child's behaviours. One could identify attending disturbances early in the child's education, possibly minimizing, or eliminating future difficulties in school. Finally, the greatest benefit may be the fulfillment of the basic goal of our Ontario schools, that the eh~ld-,lIla1p.evelop happily and competently within our educational framework. 2 This thesis reports evidence from the literature and from a regional observational investigation to determine the possibility of a link between the behaviours of children and Dr. Feingold's K-P elimination diet. The literature research examines (1) Dr. Feingold's concept of H-LD, (2) his K-P elimination diet, and (3) the response from three sectors, medicine, science, and the public. The regional investigation examines the observed behaviours of nine children in Regional Niagara during a nine-month period on the K-P diet.

Predictors of prejudice perceptions and the role of group identification in international students

The purpose of the present study was first to determine what influences international students' perceptions of prejudice, and secondly to examine how perceptions of prejudice would affect international students' group identification. Variables such as stigma vulnerability and contact which have been previously linked with perceptions of prejudice and intergroup relations were re-examined (Berryman-Fink, 2006; Gilbert, 1998; Nesdale & Todd, 2000), while variables classically linked to prejudicial attitudes such as right-wing authoritarianism and openness to experience were explored in relation to perceptions of prejudice. Furthermore, the study examined how perceptions of prejudice might affect the students' identification choices, by testing two opposing models. The first model was based on the motivational nature of social identity theory (Tajfel & Turner, 1986) while the second model was based on the cognitive nature of self-categorization theory/ rejection-identification model (Turner, Hogg, Oakes, Reicher, & Wetherell, 1987; Schmitt, Spears, & Branscombe,2003). It was hypothesized that stigma vulnerability, right-wing authoritarianism, openness to experience and contact would predict both personal and group perceptions of prejudice. It was also hypothesized that perceptions of prejudice would predict group identification. If the self-categorizationlrejection-identification model was supported, international students would identify with the international students. If the social mobility strategy was supported, international students would identify with the university students group. Participants were 98 international students who filled out questionnaires on the Brock University Psychology Department Website. The first hypothesis was supported. The combination of stigma vulnerability, right-wing authoritarianism, openness to experience and contact predicted both personal and group prejudice perceptions of international students. Furthermore, the analyses supported the self-categorizationlrejectionidentification model. International identification was predicted by the combination of personal and group prejudice perceptions of international students.

Economic security & reconstruction: utility, history and practice in post-conflict environments

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999 P65 D53 2007

Utilizing a Phenomenological Approach to Examine the Experience of Sexuality for Women Concerned about Urinary Incontinence following Spinal Cord Injury

Sexuality after spinal cord injury (SCI) is a complex issue that is influenced by a number of social, psychological and physiological factors, one of which is urinary incontinence (UI). Using a phenomenological approach, seven mixed methods interviews combining both the interview guide and standardized open-ended approaches were conducted to examine the experience of sexuality for women who are concerned about UI following SCI. Sexual function was one of the top priorities for the women after SCI, and UI was one of the main concerns the women had regarding sexuality. The findings of this study demonstrate that various dimensions of intimacy and the sexual experience as a whole were affected by UI, and the women discussed both physical and psychological concerns. The main issues regarding sexuality included concerns related to relationships, frustrations with limited sexual activities and the difficulty of being sexually satisfied, the number of unanswered questions and concerns, and a fear of being hurt or injured while participating in sexual activities. The main concerns regarding UI were embarrassment, the work and inconvenience involved with the clean-up of UI, bladder infections, the lack of accessible washrooms, and the negative effects of UI medications. When examining sexuality and UI together, the major issues were the constant comparison to the way things were before SCI, as well as the new concerns that the women did not have to worry about previously, worrying about how their partner would react if UI were to occur during sexual activity, and the impact of their own feelings toward UI on sexuality, a connection between pleasurable sexual sensations and UI as well as difficulty differentiating between the sensation of UI with the sensation of UI, dealing with infected urine during sexual activity, having to discuss UI with a new potential sexual partner, and a fear of rejection. Other identified issues included those related to body image, a lack of resources, Doctors who were inadequately educated regarding SCI, and issues related to both having and raising children. There is a significant shortage of information available for women with SCI to use as a resource regarding sexual function in general, and sexual function as it relates to UI. It is necessary that future work focus on creating resources to assist in this area, and that the dissemination of those resources becomes both appropriate and effective. Addressing sexual function and UI which are among the top concerns for this population has the opportunity to greatly improve quality of life (QOL) for these individuals.