Person centred discharge education following coronary artery bypass graft : a critical review

Aims and objectives: This critical review examines the extent that individualised education helps reduce depression, anxiety and improves self-care for people who have undergone Coronary Artery Bypass Graft surgery (CABG). Background: Individualised discharge planning is increasingly important following cardiac surgery due to recurrent admissions as well as the issue of anxiety and depression, often due to lack of preparation. The hospital to home transition is fundamental in the recovery process. Individualised education and person centred care ensures that patients’ educational needs are met. This empowers patients, increasing self-efficacy or confidence, resulting in autonomy, a smoother discharge process and avoiding post discharge problems and rehospitalisation. Design: A critical review of published peer-reviewed literature was conducted. Methods: Electronic databases searched included MEDLINE, CINAHL, the Cochrane Library and PsychInfo 2009-2015.Data was selected and extracted by three reviewers based on PRISMA guidelines (Moher et al 2009). Results: Eight articles were identified for review, and a CASP framework was used to determine the quality of the papers, all of the papers focussed on CABG. The designs were typically experimental or quasi-experimental with two reviews. Conclusion: A greater understanding of the patients’ needs allows tailored education to be provided which promotes self-care management. This level of patient empowerment increases confidence and ultimately minimise anxiety and depression. Despite the varying teaching and learning methods associated with individualised education, patient centred education has the potential to assist cardiac nurses in adequately preparing patients for discharge following their CABG. Relevance to clinical practice: Development of individualised education programmes is crucial in preparing patients for discharge. The reduction in readmission to hospital has a significant effect on already stretched resources, and the reduction in post-operative complications during the recovery period linked with depression and anxiety will have a positive effect on the individuals’ ability to self-care, health and wellbeing

Structure-mechanics relationships of collagen fibrils in the Osteogenesis Imperfecta Mouse model

The collagen molecule, which is the building block of collagen fibrils, is a triple helix of two α1(I) chains and one α2(I) chain. However, in the severe mouse model of osteogenesis imperfecta (OIM), deletion of the COL1A2 gene results in the substitution of the α2(I) chain by one α1(I) chain. As this substitution severely impairs the structure and mechanics of collagen-rich tissues at the tissue and organ level, the main aim of this study was to investigate how the structure and mechanics are altered in OIM collagen fibrils. Comparing results from atomic force microscopy imaging and cantilever-based nanoindentation on collagen fibrils from OIM and wild-type (WT) animals, we found a 33% lower indentation modulus in OIM when air-dried (bound water present) and an almost fivefold higher indentation modulus in OIM collagen fibrils when fully hydrated (bound and unbound water present) in phosphate-buffered saline solution (PBS) compared with WT collagen fibrils. These mechanical changes were accompanied by an impaired swelling upon hydration within PBS. Our experimental and atomistic simulation results show how the structure and mechanics are altered at the individual collagen fibril level as a result of collagen gene mutation in OIM. We envisage that the combination of experimental and modelling approaches could allow mechanical phenotyping at the collagen fibril level of virtually any alteration of collagen structure or chemistry.United States. Dept. of Defense. Presidential Early Career Award for Scientists and EngineersNational Science Foundation (U.S.) (CAREER Award

Terminal Velocities for a Large Sample of O Stars, B Supergiants, and Wolf-Rayet Stars

It is argued that easily measured, reliable estimates of terminal velocities for early-type stars are provided by the central velocity asymptotically approached by narrow absorption features and by the violet limit of zero residual intensity in saturated P Cygni profiles. These estimators are used to determine terminal velocities, v(infinity), for 181 O stars, 70 early B supergiants, and 35 Wolf-Rayet stars. For OB stars, the values are typically 15-20 percent smaller than the extreme violet edge velocities, v(edge), while for WR stars v(infinity) = 0.76 v(edge) on average. New mass-loss rates for WR stars which are thermal radio emitters are given, taking into account the new terminal velocities and recent revisions to estimates of distances and to the mean nuclear mass per electron. The relationships between v(infinity), the surface escape velocities, and effective temperatures are examined

A pilot study comparing the metabolic profiles of elite-level athletes from different sporting disciplines

Background: The outstanding performance of an elite athlete might be associated with changes in their blood metabolic profile. The aims of this study were to compare the blood metabolic profiles between moderate- and high-power and endurance elite athletes and to identify the potential metabolic pathways underlying these differences. Methods: Metabolic profiling of serum samples from 191 elite athletes from different sports disciplines (121 high- and 70 moderate-endurance athletes, including 44 high- and 144 moderate-power athletes), who participated in national or international sports events and tested negative for doping abuse at anti-doping laboratories, was performed using non-targeted metabolomics-based mass spectroscopy combined with ultrahigh-performance liquid chromatography. Multivariate analysis was conducted using orthogonal partial least squares discriminant analysis. Differences in metabolic levels between high- and moderate-power and endurance sports were assessed by univariate linear models. Results: Out of 743 analyzed metabolites, gamma-glutamyl amino acids were significantly reduced in both high-power and high-endurance athletes compared to moderate counterparts, indicating active glutathione cycle. High-endurance athletes exhibited significant increases in the levels of several sex hormone steroids involved in testosterone and progesterone synthesis, but decreases in diacylglycerols and ecosanoids. High-power athletes had increased levels of phospholipids and xanthine metabolites compared to moderate-power counterparts. Conclusions: This pilot data provides evidence that high-power and high-endurance athletes exhibit a distinct metabolic profile that reflects steroid biosynthesis, fatty acid metabolism, oxidative stress, and energy-related metabolites. Replication studies are warranted to confirm differences in the metabolic profiles associated with athletes’ elite performance in independent data sets, aiming ultimately for deeper understanding of the underlying biochemical processes that could be utilized as biomarkers with potential therapeutic implications

An ultra-high-resolution study of the interstellar medium towards Orion

We report ultra-high-resolution observations graphic of Na I, Ca II, K I, CH and CH+ for interstellar sightlines towards 12 bright stars in Orion. These data enable the detection of many more absorption components than previously recognized, providing a more accurate perspective on the absorbing medium. This is especially so for the line of sight to the Orion nebula, a region not previously studied at very high resolution. Model fits have been constructed for the absorption-line profiles, providing estimates for the column density, velocity dispersion and central velocity for each constituent velocity component. A comparison between the absorption occurring in sightlines with small angular separations has been used, along with comparisons with other studies, to estimate the line-of-sight velocity structures. Comparisons with earlier studies have also revealed temporal variability in the absorption-line profile of ζ Ori, highlighting the presence of small-scale spatial structure in the interstellar medium on scales of ≈10 au. Where absorption from both Na0 and K0 is observed for a particular cloud, a comparison of the velocity dispersions measured for each of these species provides rigorous limits on both the kinetic temperature and turbulent velocity prevailing in each cloud. Our results indicate the turbulent motions to be subsonic in each case. graphic abundance ratios are derived for individual clouds, providing an indication of their physical state

The application of advanced computer models to the prediction of sound in enclosed spaces

Computer modelling of acoustics in enclosures has developed into various forms, noneof which have yet demonstrated 100% accuracy. This thesis therefore details a study ofroom acoustic computer modelling. It highlights weaknesses with existing modellingtechniques and describes the development and subsequent verification of an improvedmodelling technique.The study discovers that for accurate prediction of many common room acousticparameters diffuse reflections should be accounted for in the modelling of all reflectionorders. However, many of the problems encountered in existing techniques are found tobe caused by the way these diffuse reflections are modelled.An improved modelling technique, referred to as a 'Hybrid-Markov' method, isproposed and developed that combines a conventional hybrid method with a radiantexchangeprocess to model diffuse reflections. Initial verification of the new modellingtechnique results in similar overall accuracies to existing modelling techniques but solvesmany of the specific problems discovered. It therefore provides a flexible and robustframework for the future development of computer prediction of sound in enclosedspaces