Evidence Collection for the Unconscious and Unconsented Patient

Forensic nurses are faced with making an ethical decision when an unconscious patient presents with signs of sexual assault. If the patient is unable to consent, the nurses need to decide whether or not to perform a forensic exam. Hospitals have policies in place regarding consent for emergency care, but not all of them consider the collection of forensic evidence. The window of opportunity for forensic collection may disappear before contacts are made or proper consent is established.\ud Ethical, legal, and policy considerations that complicate this scenario are discussed

Elder Abuse Screening Education for Emergency Department Nurses: An education intervention

Executive Summary Elder Abuse Screening and Identification for Emergency Department Nurses The Elder Abuse Screening and Identification for Emergency Department Nurses was an educational intervention. The education and training module was intended to improve the, skills and attitudes of emergency department nurses. The goal was to improve future screening and identification of elder patients presenting to the department for a healthcare encounter who may be victims of elder abuse. Problem The problem being addressed is a clinical practice issue that has multi-faceted contributing factors. Clinical practitioners receive little to no education and training on the topic of elder abuse, with exception of the fact that as licensed professionals mandated reporting is a known requirement. A knowledge deficit of emergency room nurses’ knowledge on elder abuse identification, screening, reporting and referral had been identified as an area for advancing education. Elder abuse is identified in one out of fourteen cases annually. The nursing and clinical literature is severely lacking in information of the clinical manifestations of elder abuse that can clearly be differentiated from age related changes and co-morbidities. The underreporting of elder abuse cases identified in healthcare settings, can be improved with by advancing knowledge, skills and attitudes of healthcare professionals. Emergency department nurses are key to improving identification and improved care and discharge planning as they are first responders, first line triage and are instrumental to establishing the care plan and process for patients presenting for a care encounter. Purpose The purpose of this evidence-based practice project was to improve the clinical identification by emergency department nurses in elder abuse identification by increasing the knowledge, skills and attitudes through the completion of an educational program authored by this forensic nurse specialist, DNP candidate. This project was a quality improvement initiative. Goal The goal was to design an educational intervention that focused and emphasized the clinical manifestations of elder abuse to improve the care of seniors presenting to the emergency department. The construct of the curriculum presented in the intervention addressed the three themes critical to understanding the scope, physiologic manifestations and the procedural aspects of care for a victim of elder abuse. increasing the knowledge and skill of the nurses in the identification and screening for elder abuse that may present as a symptom of a medical diagnosis, a co-morbid condition or as symptoms commonly associated with the aging process. Objectives The objectives of this project included: 1) Identify the demographics and descriptive profile of the emergency department nurses participating in the study. 2) Identify the emergency department nurses’ knowledge on clinical identification of elder abuse and associated response, referral, reporting and documentation and 3) Evaluate the effectiveness of the elder abuse educational module used in the project. Plan Identifying the change in knowledge of emergency department nurses on the topic of clinical identification of elder abuse prior to and immediately following completion of an educational intervention was planned. The content development and delivery of the education was disseminated via the on-line learning technology platform used by the hospital where the intervention took place. The project consisted of collecting demographic (descriptive of the project participants), followed by a pre-test on knowledge of elder abuse. The one-hour educational program to emergency department nurses aimed at increasing their knowledge on clinical identification of elder abuse was given and followed by a post-test survey. The effectiveness of the educational intervention was measured by using a pre-and post-test survey score difference analysis. Outcomes and Results The objectives of the project were met. Objective one achieved a descriptive profile of the nurses that participated in the intervention. Objective two and three were met and showed at the pretest that the knowledge level to be below the benchmark of 80% or 12 correct responses. The aggregate mean score of the pretest (M= 9.11, SD= 2.21) were below the 80% benchmark. The post- test aggregate mean scores met and slightly exceeded the benchmark (M= 12.53, SD 1.59). The mean scores on the post-test showed improved knowledge of the content as the result of the intervention. A statistically significant improvement in mean knowledge scores was noted in the post-intervention assessment, suggesting that the educational intervention was successful in increasing nurses’ knowledge on the topic

Metal Oxide Semiconductors for Solar Energy Harvesting

The correlation between energy consumption and human development illustrates the importance of this societal resource. We will consume more energy in the future. In light of issues with the status quo, such as climate change, long-term supply and security, solar energy is an attractive source. It is plentiful, virtually inexhaustible, and can provide more than enough energy to power society. However, the issue with producing electricity and fuels from solar energy is that it is expensive, primarily from the materials: silicon) used in building the cells. Metal oxide semiconductors are an attractive class of materials that are extremely low cost and can be produced at the scale needed to meet widespread demand. An industrially attractive thin film synthesis process based on aerosol deposition was developed that relies on self-assembly to afford rational control over critical materials parameters such as film morphology and nanostructure. The film morphology and nanostructure were found to have dramatic effects on the performance of TiO2-based photovoltaic dye-sensitized solar cells. Taking a cue from nature, to overcome the spatial and temporal mismatch between the supply of sunlight and demand for energy consumption, it is desirable to produce solar fuels such as hydrogen from photoelectrochemical water splitting. The source of water is important -- seawater is attractive. The fundamental reaction mechanism for TiO2-based cells is discussed in the context of seawater splitting. There are two primary issues with producing hydrogen by photoelectrochemical water splitting using metal-oxide semiconductors: visible light activity and spontaneous activity. To address the light absorption issue, a combined theory-experiment approach was taken to understand the fundamental role of chemical composition in determining the visible light absorption properties of mixed metal-oxide semiconductors. To address the spontaneous activity issue, self-biasing all oxide p/n bulk-heterojunctions were synthesized and the nanostructure was systematically varied to understand the fundamental role of various characteristic length scales in the nanostructured region of the device on performance. The conclusion of this work is that solar energy harvesting by metal oxide semiconductors is highly promising. All of the scientific concepts have been proven, and steady gains in efficiency are being achieved as researchers continue to tackle the problem

Die Expression von EpCAM (CD 326) in Kraniopharyngeomen und Zysten der Rathkeschen Tasche und der mögliche Einsatz als neuer diagnostischer Marker

The epithelial cell adhesion molecule (EpCAM) is a type I glycoprotein located on the surface of epithelial cells. It is strongly expressed in many neoplasms and already used in the diagnosis and distinction of various tumour subtypes. Comparative studies about EpCAM expression in cystic sellar lesions are lacking. Therefore, we analysed its distribution pattern in adamantinomatous (aCP) and papillary (pCP) craniopharyngiomas (CP) and Rathke’s Cleft Cysts (RCC) using immunohistochemistry and gene expression profiling. Whereas the protein was not detectable in pCP (n = 10), all aCP (n = 64) showed distinct staining patterns. The vast majority of RCC (n = 10) also appeared positive, but these displayed notably lower labeling scores. Additionally, significantly higher mRNA levels were detectable in aCP (n = 19) when compared to pCP (n = 10) (p = 9.985^−8). Furthermore, pediatric aCP cases, in general, exhibited stronger EpCAM staining levels compared to adult ones (p = 0.015). However, we were not able to verify this result on mRNA level. In summary, our findings demonstrate that EpCAM can be used as an additional distinction-marker for cystic lesions of the sellar region. Its unknown function in aCP and the presence of an approved monoclonal bispecific trifunctional antibody for cancer therapy are interesting starting points for further studies.Hintergrund und Ziele: EpCAM (Epithelial Cell Adhesion Molecule, CD326) ist ein auf der Zelloberfläche lokalisiertes Typ I Glykoprotein, das neben seiner Adhäsionsfunktion zwischen benachbarten Zellen auch eine wichtige Rolle in der zellulären Signaltransduktion und der Zellentwicklung einnimmt. Das Protein wird vor allem von epithelialen Geweben und sich daraus entwickelnden Tumoren exprimiert und kann als diagnostischer Marker für unterschiedliche Tumorentitäten genutzt werden. Die Sellaregion mit der Hirnanhangsdrüse (Hypophyse) ist zentral im Kopf gelegen und befindet sich in direkter Nachbarschaft zu wichtigen Strukturen, wie dem Hypothalamus, der Sehbahnkreuzung und den beiden inneren Halsschlagadern (A. carotis interna dextra et sinistra). Neben endokrinen Tumoren innerhalb des Hypophysenvorderlappens (Adenohypophyse) können hier zahlreiche andere, nicht-neuroepitheliale, teils zystische Raumforderungen wie z.B. Kraniopharyngeome (CP) und Rathke-Taschen-Zysten (RCC) entstehen. Obwohl diese Läsionen selten sind und als histologisch gutartig gelten, stellen sie wegen ihrer Lage sowohl klinisch als auch therapeutisch eine große Herausforderung dar. Aufgrund unterschiedlicher Therapiestrategien und Prognosen ist es von großer Bedeutung die einzelnen Entitäten anhand von Gewebeproben histologisch sicher differenzieren zu können, was hinsichtlich der Ähnlichkeit im mikroskopischen Bild aber nicht immer eindeutig möglich ist. Ziel dieser Arbeit war es, das Verteilungsmuster von EpCAM innerhalb adamantinöser und papillärer CP-Varianten sowie RCC zu analysieren und dadurch zu überprüfen, ob das Protein zukünftig als möglicher diagnostischer Differenzierungsmarker genutzt werden kann. Methoden (Patienten, Material und Untersuchungsmethoden): Im Rahmen meiner Doktorarbeit untersuchte ich zunächst die Expression von EpCAM mittels immunhistochemischer Färbungen (monoklonaler EpCAM-Antikörper, Klon: MOC-31, Cell Marque) an einem Kollektiv histologischer Gewebeproben von 64 adamantinösen CP (aCP), 10 papillären CP (pCP) sowie 10 RCC. Anhand der mikroskopischen Befunde wurden spezifische Expressionsgruppen (TIS 1-4) erhoben und diese wiederum in drei Bewertungsgruppen (S1-3) eingeteilt. Die Ergebnisse wurden danach unter Berücksichtigung verschiedener klinischer Charakteristika (z.B. Geschlecht, Alter) unter Zuhilfenahme des χ2-Tests und des Exakten Tests nach Fischer statistisch verglichen (IBM SPSS Statistics 23). Zusätzlich wurde exemplarisch in Serienschnitten eines aCP das Verteilungsmuster von EpCAM im Vergleich zu β-catenin analysiert und ergänzend das EpCAM-Genexpressionsprofil mittels mRNA-Extraktion und - Aufreinigung (RNeasy® Extraction kit und column, Qiagen) sowie Mikroarray-Analyse (Affymetrix U133 Plus2.0 expression array) an einem Kollektiv von 19 aCP und 10 pCP untersucht. Die statistische Evaluation der log2-Genexpressionswerte erfolgte mittels Mann- Whitney-Test (IBM SPSS Statistics 23). Ergebnisse und Beobachtungen: Während EpCAM in keiner der pCP (n=10) nachweisbar war, zeigten alle aCP (n=64) eine deutliche immunhistochemische Färbung variabler Intensität. Die Mehrzahl der RCC (8 von 10; 80%) zeigte ebenfalls positive Färbeergebnisse, welche allerdings signifikant schwächer ausgeprägt waren als in aCP (α ≤ 0.01; p = 0.0096). In Übereinstimmung mit diesen Ergebnissen konnten in aCP signifikant höhere EpCAM mRNA-Level als in pCP (n=10) nachgewiesen werden (α ≤ 0. 01; p = 9.985-8). Interessanterweise zeigten aCP im Kindesalter generell ein stärkeres EpCAM Färbemuster als entsprechende Fälle erwachsener Patienten [χ2: p= 0.007; Exakter Test nach Fischer (zweiseitig): p= 0.015]. Auch bei invasiven Tumoren konnte eine Tendenz zu höheren Expressionsraten festgestellt werden, ohne allerdings eine statistische Signifikanz zu erreichen. Eine weitere interessante Entdeckung war, dass in Zellen mit nukleärer β-catenin-Akkumulation, welche eine wichtige Rolle in der Entstehung und dem Wachstum von aCP spielen, keine EpCAM Expression nachweisbar war. Schlussfolgerungen: Die Ergebnisse der Arbeit zeigen, dass EpCAM zukünftig als wichtiger diagnostischer Marker in der Unterscheidung zystischer Raumforderungen der Sellaregion eingesetzt werden kann, da zwar alle aCP (100%) jedoch keines der pCP eine Expression aufwiesen. Die fehlende Co- Expression von EpCAM und β-catenin ist ein weiteres interessantes Ergebnis dieser Studie, weil in anderen Tumorentitäten der Einfluss von EpCAM auf die Aktivierung des Wnt-Signalweges, die Zelladhäsion und die Tumorausbreitung bereits detailliert untersucht wurde. Diese Zusammenhänge und die gesteigerte EpCAM Expression bei kindlichen im Vergleich zu erwachsenen Patienten stellen interessante Ansatzpunkte für Folgestudien dar. Da bereits etablierte Antikörper für die zielgerichtete Tumortherapie erhältlich sind, ist der Nachweis einer EpCAM Expression in aCP zudem eine interessante Grundlage für zukünftige Therapiestudien

Visualizing current flow at the mesoscale in disordered assemblies of touching semiconductor nanocrystals

The transport of electrons through assemblies of nanocrystals is important for the performance of these materials in optoelectronic applications. The transport of electrons has primarily been studied by focusing on single nanocrystals or transitions between pairs of nanocrystals. There is a gap in knowledge of how large numbers of nanocrystals in an assembly behave collectively, and how this collective behavior manifests at the mesoscale. In this work, the transport of electrons in assemblies of touching, heavily doped ZnO nanocrystals was visualized as a function of temperature at the mesoscale theoretically using the model of Skinner, Chen and Shklovskii (SCS); and experimentally by conductive atomic force microscopy on ultrathin films only a few particle layers thick. Agreement was obtained between the model and experiments, with a few notable exceptions. The SCS model predicts that a single network within the nanocrystal assembly, comprised of sites connected by small resistances, dominates conduction - namely the well-known optimum band from variable range hopping theory. However, our experiments revealed that in addition to the optimum band, there are subnetworks that appear as additional peaks in the resistance histogram; which were not observed in the model calculations. Furthermore, the connections of these subnetworks to the optimum band changes in time. As time proceeds, some isolated subnetworks become connected to the optimum band; while some of the connected subnetworks become disconnected and then isolated from the optimum band. The subset of nanocrystals comprising the optimum band is dynamic

Corporations are Not People: Dissensual Democracy and the Movement Against Corporate Rights

This dissertation describes the way that the movement against corporate rights employs democratic ideals and media technologies to present itself as "the people" who have a more legitimate claim to sovereignty than corporations. The movement's use of rhetoric and technology demonstrate that democratic ideals do not necessarily represent actual democratic processes, but enacting them is still an effective way to produce a sense that a democratic event is occurring. Although different branches of the movement advocate different goals and use different rhetorical and technological strategies, they use similar techniques to demonstrate shared participation in the overall movement. These core shared techniques indicate that scholarship on democratic movements and their political issues has the opportunity to increase its effectiveness and relevance by integrating insights about how to produce dissensus based on studying movement techniques. Additionally, the history of the legal theoretical rhetoric of corporate rights relies on a sharp distinction between organic and technological collectives that shapes how the movement is able to selectively critique and enact democratic doxai.Doctor of Philosoph