Was können Pflegende zur Reduktion unnötiger Kathetertage beitragen : Eine Analyse pflegegeleiteter Strategien zur Verhinderung unnötiger Kathetertage und den damit verbundenen katheterassoziierten harnwegsinfektionen bei Erwachsenen im Akutspital

Hintergrund: In der Schweiz erhält jede(r) vierte Patient(in) während des Spitalaufenthaltes einen Dauerkatheter (DK). Trotz bestmöglicher DK-Pflege erhöht jeder zusätzliche Kathetertag das Risiko einer katheterassoziierten Harnwegs-infektion (CAUTI) um 3-10%. Ziel: Anhand der Fragestellung soll herausgefunden werden, welche pflegerischen Interventionen bei Erwachsenen im Akutspital unnötige Kathetertage verhindern und damit verbundene katheterassoziierte Harnwegsinfektionen (CAUTIs) reduzieren können. In dieser Arbeit werden pflegerische Strategien zur Evaluation der DK-Notwendigkeit aufgelistet und miteinander verglichen. Methode: Es wurde eine Literaturrecherche in den Datenbanken CINAHL, Medline, Pubmed und Cochrane Library durchgeführt. Die relevante Literatur wurde analysiert und bezüglich ihrer Güte eingeschätzt. Ergebnisse: Die Evidenz zeigt einen positiven Effekt verschiedener pflegerischer Strategien zur Evaluation der DK-Notwendigkeit auf die Reduktion von Kathetertagen, von einer CAUTI-Reduktion wird teilweise berichtet. Schlussfolgerungen: In der Literatur wird empfohlen, Pflegende in die Evaluation der DK-Notwendigkeit miteinzubeziehen, um den DK-Gebrauch zu reduzieren. Es sollte im Akutspital eine pflegerische Strategie verfolgt werden, um das Bewusstsein bezüglich DK-Gebrauchs zu erhöhen. Die Auseinandersetzung mit der Literatur zeigt, dass eine Kombination mehrerer pflegerischer Strategien zur DK-Evaluation sinnvoll wäre. So beispielsweise ein pflegegeleitetes DK-Protokoll in Kombination mit Edukation

PERSONNEL

1023.1. EMS agency medical director. 1023.2. Medical command physician. 1023.3. Medical command facility medical director. 1023.4. Regional EMS medical director. 1023.5. Commonwealth EMS Medical Director. § 1023.1. EMS agency medical director. (a) Roles and responsibilities. An EMS agency medical director is responsible for: (1) Providing medical guidance and advice to the EMS agency, including: (i) Reviewing the Statewide EMS protocols and Department-approved regional EMS protocols that are applicable to the EMS agency and ensuring that its EMS providers and other relevant personnel are familiar with the protocols applicable to the EMS agency. (ii) Performing medical audits of EMS provided by the EMS agency’s EMS providers

A General Geometric Fourier Transform

The increasing demand for Fourier transforms on geometric algebras has resulted in a large variety. Here we introduce one single straight forward definition of a general geometric Fourier transform covering most versions in the literature. We show which constraints are additionally necessary to obtain certain features like linearity or a shift theorem. As a result, we provide guidelines for the target-oriented design of yet unconsidered transforms that fulfill requirements in a specific application context. Furthermore, the standard theorems do not need to be shown in a slightly different form every time a new geometric Fourier transform is developed since they are proved here once and for all.Comment: First presented in Proc. of The 9th Int. Conf. on Clifford Algebras and their Applications, (2011

Cryo-Electron Tomography Elucidates the Molecular Architecture of Treponema pallidum, the Syphilis Spirochete

Cryo-electron tomography (CET) was used to examine the native cellular organization of Treponema pallidum, the syphilis spirochete. T. pallidum cells appeared to form flat waves, did not contain an outer coat and, except for bulges over the basal bodies and widening in the vicinity of flagellar filaments, displayed a uniform periplasmic space. Although the outer membrane (OM) generally was smooth in contour, OM extrusions and blebs frequently were observed, highlighting the structure’s fluidity and lack of attachment to underlying periplasmic constituents. Cytoplasmic filaments converged from their attachment points opposite the basal bodies to form arrays that ran roughly parallel to the flagellar filaments along the inner surface of the cytoplasmic membrane (CM). Motile treponemes stably attached to rabbit epithelial cells predominantly via their tips. CET revealed that T. pallidum cell ends have a complex morphology and assume at least four distinct morphotypes. Images of dividing treponemes and organisms shedding cell envelope-derived blebs provided evidence for the spirochete’s complex membrane biology. In the regions without flagellar filaments, peptidoglycan (PG) was visualized as a thin layer that divided the periplasmic space into zones of higher and lower electron densities adjacent to the CM and OM, respectively. Flagellar filaments were observed overlying the PG layer, while image modeling placed the PG-basal body contact site in the vicinity of the stator–P-collar junction. Bioinformatics and homology modeling indicated that the MotB proteins of T. pallidum, Treponema denticola, and Borrelia burgdorferi have membrane topologies and PG binding sites highly similar to those of their well-characterized Escherichia coli and Helicobacter pylori orthologs. Collectively, our results help to clarify fundamental differences in cell envelope ultrastructure between spirochetes and gram-negative bacteria. They also confirm that PG stabilizes the flagellar motor and enable us to propose that in most spirochetes motility results from rotation of the flagellar filaments against the PG

Seasonality in the cross-shelf physical structure of a temperate shelf sea and the implications for nitrate supply

We address a long-standing problem of how nutrients are transported from the shelf edge and from rivers to support regular, seasonal primary production in the interior of a wide, temperate, shelf sea. Cross-shelf sections of hydrography and nutrients, from a series of cruises between March 2014 and August 2015, along with time series of river discharge and river nutrient load are used to assess the seasonality of cross-shelf transports. Riverine nitrogen inputs are estimated to account for 30% of the nitrate available for the spring bloom on the inner shelf, and 10% in the mid- to outer-shelf. In the bottom layer in summer, high salinity, nutrient-rich waters are transported on-shelf as a result of wind-driven Ekman transport, cross-shelf pressure gradients and/or internal tidal wave Stoke’s drift. In the centre of the shelf this advection is responsible for 25% of the increase in bottom water nitrate seen between April and November 2014. The remaining nitrate increase suggests that about 50–62% of the nitrogen fixed into organic material during spring, summer and autumn phytoplankton growth is recycled in the bottom water over the 12 months between March 2014 and March 2015. In winter, when the water column is vertically mixed, there is a weak net off-shelf transport of about 1 m2 s−1, possibly driven by a reversal of the horizontal density gradient caused by excess cooling of shallower shelf waters. Overall, shelf nitrate concentrations are maintained by a combination of riverine supply, recycling of organic material, and summer on-shelf transports. We suggest that the main driver of inter-annual variability in pre-spring nitrate concentrations is variability in the depth of the winter mixed layer over the shelf slope

Terrestrial dissolved organic matter distribution in the North Sea

The flow of terrestrial carbon to rivers and inland waters is a major term in the global carbon cycle. The organic fraction of this flux may be buried, remineralized or ultimately stored in the deep ocean. The latter can only occur if terrestrial organic carbon can pass through the coastal and estuarine filter, a process of unknown efficiency. Here, data are presented on the spatial distribution of terrestrial fluorescent and chromophoric dissolved organic matter (FDOM and CDOM, respectively) throughout the North Sea, which receives organic matter from multiple distinct sources. We use FDOM and CDOM as proxies for terrestrial dissolved organic matter (tDOM) to test the hypothesis that tDOM is quantitatively transferred through the North Sea to the open North Atlantic Ocean. Excitation emission matrix fluorescence and parallel factor analysis (EEM-PARAFAC) revealed a single terrestrial humic-like class of compounds whose distribution was restricted to the coastal margins and, via an inverse salinity relationship, to major riverine inputs. Two distinct sources of fluorescent humic-like material were observed associated with the combined outflows of the Rhine, Weser and Elbe rivers in the south-eastern North Sea and the Baltic Sea outflow to the eastern central North Sea. The flux of tDOM from the North Sea to the Atlantic Ocean appears insignificant, although tDOM export may occur through Norwegian coastal waters unsampled in our study. Our analysis suggests that the bulk of tDOM exported from the Northwest European and Scandinavian landmasses is buried or remineralized internally, with potential losses to the atmosphere. This interpretation implies that the residence time in estuarine and coastal systems exerts an important control over the fate of tDOM and needs to be considered when evaluating the role of terrestrial carbon losses in the global carbon cycle

Untersuchungsvorhaben in der ökologischen Schweine- und Geflügelhaltung in Niedersachsen 2002 - 2003

Inhaltsübersicht: • Entwicklung von Konzepten für eine tiergerechte und standortangepasste Bewirtschaftung von Grünausläufen in der Geflügelhaltung (Dr. Friedhlem Deerberg) • Einsatz von 100% Öko-Komponenten im Vergleich zu einer mit D/L-Methionin ergänzten Ration und einer Standardration in der Legehennenfütterung (Prof. Dr. Robby Andersson) • Proteinträger in der Fütterung des Ökologischen Landbaus - Prüfung der Proteingehalte und der Proteinqualität in ökologisch erzeugten Futterkomponenten (Prof. Dr. Robby Andersson) • Untersuchung von drei verschiedenen Öko-Rationen in der Schweinemast(Dr. Hans-Gerd Brunken