Leysir kreppan manneklu í hjúkrun? Hvað með starfsumhverfið?

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenNú gengur betur en áður að manna stöður hjúkrunarfræðinga á heilbrigðisstofnunum. En vandinn er ekki leystur því eftir er að takast á við orsakirnar sem búa að baki. Stórir hópar hjúkrunarfræðinga munu fara á eftirlaun á næstu árum og versnandi starfsumhverfi vegna niðurskurðar gæti haft áhrif á aðsókn í hjúkrunarnám og nýliðun í stéttinni

Use of electrical stimulation to restore standing in Paraplegics with long-term denervated degenerated muscles DDM

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenRaförvun sem meðferð við vöðvasjúkdómum og ýmsum öðrum kvillum á sér langa forsögu, má þar nefna að Galvani birti fyrstu grein sína 1791. Frá því upp úr 1970 hafa mörg kerfi, þar af mörg þeirra að verulegu leyti tölvustýrð, verið þróuð til að raförva vöðva hjá sjúklingum með skaða í miðtaugakerfi (upper motor neuron skaði) þar sem hreyfitaug frá mænu niður í vöðva er heil og raförvun taugar er möguleg. Mörg slík raförvunartæki eru til á markaðinum, oft kölluð FES raförvunartæki (FES = Functional Electrical Stimulation). Í mörgum tilvikum hefur göngugeta náðst á rannsóknarstofum og tækjakosturinn verður sífellt minni og liprari en undirbúningur fyrir raförvunina hefur hingað til verið það krefjandi, og kerfin það óþjál, að fáir eða engir hafa notað þessi kerfi daglega. Við útlæga mænuskaða með mikla taugaskerðingu og vöðvarýrnun (lower motor neuron skaði) er hreyfitaug frá mænu niður í vöðva horfin og raförvun verður að beinast beint að vöðvaþráðum. Hingað til hefur engin raförvunarmeðferð verið möguleg fyrir útlæga mænuskaða þar sem sá straumstyrkur sem leyfilegt er að nota samkvæmt núverandi stöðlum ESB virðist ekki hafa nein teljandi áhrif. Það er þó einmitt þessi sjúklingahópur sem vænta má að hefði mest gagn af raförvun þar sem fylgikvillar hjá þessum hópi eru meiri en hjá sjúklingum með hærri skaða

Burn injuries in children: admissions at Landspitali University Hospital in Iceland 2000-2008

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)BACKGROUND: Causes of burn injuries in children are universally associated with social and environmental factors. Epidemiological studies are therefore important in identifying risk factors and for planning preventive interventions. METHODS: Children younger than 18 years with skin burns who were treated as inpatients at Landspitali University Hospital over a 9-year period, 2000 and 2008, were included in this retrospective descriptive study. Data was collected from medical records. RESULTS: Of 149 children included in the study 41.6% were four years old or younger. The average annual incidence of hospital admissions was 21/100,000. Cold water as first aid was applied in 78% of cases. Half of the accidents occurred in the home where a close family member was the caretaker. Risk factors were identified in 11.4% of the accidents and abuse or neglect was suspected in 3.4% of cases. Scalds were the most common type of burn injury (50.3%) followed by burns caused by fire (20.4%) including gas or petrol (14.9%) and fireworks (17.6%). The most common source of scalds was exposure to hot water from hot water mains (12,9%) and heated water (12,9%). The mean time from emergency room admission to the paediatric ward was two hours and 22 minutes. The mean length of stay was 13 days; median 9 days (range 1-97). CONCLUSION: Incidence of hospital admissions for burn injury has decreased when compared with earlier Icelandic studies. Children four years and younger and boys between 13-16 years old are most at risk for burn injuries. Stronger preventive measures as well as better documentation of burn accidents are imperative.Tilgangur: Að afla upplýsinga um brunaslys barna sem lögðust inn á Landspítala á níu ára tímabili, meta hvort efla þurfi forvarnir og endurskoða ákveðna þætti í meðferð. Aðferðir: Í þessari afturskyggnu lýsandi rannsókn var upplýsingum safnað úr sjúkraskrám um börn yngri en átján ára sem dvöldu lengur en≥ sólarhring á Landspítala vegna brunaáverka á húð á árunum 2000-2008. Niðurstöður: Af 149 börnum voru 108 drengir og 41 stúlka. Meðalfjöldi innlagna á ári var 16,5 eða 21/100 000. Brunaslys voru algengust hjá fjögurra ára og yngri (41,6%) og í aldurshópnum 13-16 ára (45,7%). Hjá meirihlutanum (81%) var útbreiðsla áverka £10% af líkamsyfirborði. Helmingur slysa varð inni á heimili. Sár voru kæld á vettvangi í 78% tilvika. Áhættuþættir voru til staðar hjá 11,4% barna og hjá 3,4% barna var grunur um vanrækslu eða ofbeldi. Helstu brunavaldar voru heitt vatn og aðrir heitir vökvar (50,3%), þar af neysluvatn í 12,9% tilvika, eldur í 20,4% tilvika, þar af gas eða bensín hjá 14,9% barna, og skoteldar (17,6%). Meðaltími frá komu á bráðamóttöku að innlögn á barnadeild var 142 mínútur, (25-333). Meðallegutími var 13 dagar, miðgildið níu dagar (1-97) að meðtöldum sex dögum á gjörgæsludeild, miðgildið tveir dagar (1- 48) . Ályktun:Innlögnum vegna brunaáverka hefur fækkað. Algengustu brunavaldar eru heitt vatn, heitir vökvar, eldur og skoteldar. Flest eru slysin hjá börnum ≤yngri en fjögurra ára og hjá drengjum 13-16 ára. Mikilvægt er að auka öryggi barna á heimilum og beina forvörnum að áhættuhópum. Vanda þarf fyrsta mat á útbreiðslu sára og greina þætti sem hafa áhrif á dvalartíma á bráðamóttöku og legudeild. Bæta þarf skráningu í sjúkraskrá

Future challenges of Kalmar City

Sea level rise has steadily increased and is anticipated to rise further by the end of the century and beyond 2100. Low-lying coastal areas are affected by rising sea levels as they will be more susceptible to flooding and land loss. The main objective of this thesis is to design a holistic future proposal for Barlastholmen and Sylvanderparken in Kalmar City, Sweden. That considers adaptation to rising sea levels and emphasises green and public spaces. The thesis aims to explore how Flexmark coastal adaptation strategy could be utilised in coastal urban areas to adapt to rising sea levels and whether additional strategies would be needed. This is done using the Research by Design method and interactive processes; the work is based on a literature review and a site analysis. The literature review examines coastal adaptation strategies and their principles and structures. The site analysis investigates the current conditions and the identity of the selected areas for future values. The findings from the Literature Review chapter and Site Analysis chapter are the basis for the proposal. The project results show a holistic design proposal for the selected site in 2123. It shows how Barlastholmen and Sylvanderparken could be adapted to sea level rise and how it can create inviting and attractive green and public spaces. The results conclude that the Flexmark strategy can be utilised in the areas designated for recreation, where the site may be susceptible to flooding. However, the result shows that additional strategies are required as the Flexmark strategy was not suitable for the entire selected area. Therefore, additional strategies have been selected as they sufficiently protect specific structures and areas from flooding. The results show a comprehensive proposal combining research with a design to adapt to sea level rise

Comparison of Models for Calculation of the Thermodynamic Properties of NH3-CO2-H2O Mixture

Couple of models have been developed to calculate thermodynamic properties of NH3-CO2-H2O systems. These models are typically an equation of state for the vapor phase and an activity coefficient model for the liquid phase (Que & Chen, 2011). The activity coefficient models can be divided into three groups based on previous studies, Pitzer model, electrolyte Non Random Two Liquid (e-NRTL) model and extended UNIQUAC model. Que & Chen (2011) deem the e-NRTL model the model the most suitable for process modelling and simulations since it requires only binary interaction parameters and makes use of mole fraction concentration scale consistently for both the short range local compositions interactions and the long range Debey-Huckel expression. Darde (2011) compared the built in e-NRTL model from Aspen Plus to an upgraded version of the extended UNIQUAC model developed by Thomsen et al. (1996). His findings were that the extended UNIQUAC model is significantly more accurate than the e-NRTL model from Aspen. He does mention that if the binary interaction parameters were better fitted to experimental data for NH3-CO2-H2O mixture, the e-NRTL model might become more competitive with the extended UNIQUAC model. Since then the e-NRTL model has been modified in this way by couple of authors, included Que & Chen (2011) and Niu et al. (2013). Both of their adjusted models have then been used by other authors for process modelling, for example Zhang & Guo (2014) used the model with adjusted parameters from Niu et al. (2013) and Liu et al. (2015) used the modified model from Que & Chen (2011). In this paper the extended UNIQUAC model is compared with the e-NRTL thermodynamic model that is built into the most recent version of Aspen Plus, and two modified e-NRTL models; the one developed by Que and Chen (2011) and a new fit. This is done to confirm if the modified models can reach similar accuracy as the extended UNIQUAC model and how much more accurate they are compared to the built in model in Aspen Plus

Guiding in a nature destination

As nature attracts most travellers to Iceland, nature conservation is central in sustainable tourism development in the destination. A competent guide can turn a tour into an enjoyable, engaging and educational nature experience, whereas a less competent guide may simply execute the logistics of taking tourists from one point of interest to another. This is a mixed-method study where data were collected through participant observation, semi-structured interviews and desk research. Our findings were that nature conservation was not a theme the guiding, informing and managing of tour groups observed. Nature conservation was not a topic present in the information tour companies supply the guides with, and it was not a prominent theme in the curricula of guide education. Guiding on nature phenomena consisted mainly of information about geology and geoformations. Guiding was mostly verbal, without much attention to experience design. Our conclusions are that more emphasis should be placed on facilitating experience and that an important opportunity for promoting tourism sustainability is missed as nature conservation is neglected. The implication is that these topics should be emphasized more in professional guide education, in the professional community of guides and by tour operators.acceptedVersio

Wig-1: A p53 target that regulates the mRNA of p53 and Myc - and more?

Wig-1 is a transcriptional target of the tumor suppressor p53. p53 is activated by cellular stress and can induce a wide variety of responses. Some like apoptosis follow upon severe damage, while milder damage results in outcomes such as cell cycle arrest and DNA repair. Yet other p53 functions rely on physiological p53 levels. p53 mainly exerts its functions through inducing the transcription of target genes, hence in order to understand the function of p53 one must understand the function of these targets. Wig-1 was identified as a p53 target more than ten years ago, and was found to be a double stranded RNA binding protein. Apart from that, however, its function has remained elusive. In this work we demonstrate that Wig-1 regulates mRNA stability through binding to so-called AU-rich elements in 3 UTRs, and we identify p53 as well as N- and c-Myc as its targets. We also report that Wig-1 knockout causes early embryonic lethality in mice, probably due to dysregulation of Wig-1 targets such as Myc. Thus we show that p53, through Wig-1, can activate Myc and possibly other prosurvival targets. This activation may represent a way of facilitating for cells to recommence cycling after a repaired damage. Simultaneously, increased Wig-1 sensitizes the cell to any remaining damage by also stabilizing the p53 mRNA. In conclusion, we have found that the p53 target Wig-1 regulates mRNA stability through AU-rich elements. We propose a novel mechanism by which p53, through Wig-1, can tweak the cell milieu toward survival

Data-driven approach to health care : applications using claims data

Thesis (Ph. D.)--Massachusetts Institute of Technology, Sloan School of Management, Operations Research Center, 2008.Includes bibliographical references (p. 123-130).Large population health insurance claims databases together with operations research and data mining methods have the potential of significantly impacting health care management. In this thesis we research how claims data can be utilized in three important areas of health care and medicine and apply our methods to a real claims database containing information of over two million health plan members. First, we develop forecasting models for health care costs that outperform previous results. Secondly, through examples we demonstrate how large-scale databases and advanced clustering algorithms can lead to discovery of medical knowledge. Lastly, we build a mathematical framework for a real-time drug surveillance system, and demonstrate with real data that side effects can be discovered faster than with the current post-marketing surveillance system.by Margrét Vilborg Bjarnadóttir.Ph.D

The syndrome of central hypothyroidism and macroorchidism: IGSF1 controls TRHR and FSHB expression by differential modulation of pituitary TGFβ and Activin pathways

IGSF1 (Immunoglobulin Superfamily 1) gene defects cause central hypothyroidism and macroorchidism. However, the pathogenic mechanisms of the disease remain unclear. Based on a patient with a full deletion of IGSF1 clinically followed from neonate to adulthood, we investigated a common pituitary origin for hypothyroidism and macroorchidism, and the role of IGSF1 as regulator of pituitary hormone secretion. The patient showed congenital central hypothyroidism with reduced TSH biopotency, over-secretion of FSH at neonatal minipuberty and macroorchidism from 3 years of age. His markedly elevated inhibin B was unable to inhibit FSH secretion, indicating a status of pituitary inhibin B resistance. We show here that IGSF1 is expressed both in thyrotropes and gonadotropes of the pituitary and in Leydig and germ cells in the testes, but at very low levels in Sertoli cells. Furthermore, IGSF1 stimulates transcription of the thyrotropin-releasing hormone receptor (TRHR) by negative modulation of the TGFβ1-Smad signaling pathway, and enhances the synthesis and biopotency of TSH, the hormone secreted by thyrotropes. By contrast, IGSF1 strongly down-regulates the activin-Smad pathway, leading to reduced expression of FSHB, the hormone secreted by gonadotropes. In conclusion, two relevant molecular mechanisms linked to central hypothyroidism and macroorchidism in IGSF1 deficiency are identified, revealing IGSF1 as an important regulator of TGFβ/Activin pathways in the pituitary

Categorización y análisis de programas de ejercicio en la tendinopatía del manguito rotador: Una revisión sistemática

Objetivo: La realización de una revisión sistemática para identificar un catálogo, basado en la evidencia, de los ejercicios más utilizados en el tratamiento de la tendinopatía del manguito rotador. Métodos: Se realizó una búsqueda bibliográfica en dos bases de datos (PubMed y EMBASE). Se incluyeron ECA que incluían a participantes con tendinopatía del manguito rotador de al menos 1 mes de duración y que realizaron ejercicio de forma aislada con una descripción adecuada del programa. El riesgo de sesgo se evaluó con la herramienta Cochrane y para la calidad metodológica se aplicó la escala PEDro. Resultados: Un total de ocho artículos fueron incluidos en este estudio. El riesgo de sesgo resultó ser generalmente bajo, con una calidad metodológica alta. Se realizó una síntesis de los programas de ejercicio y se identificaron siete categorías: “banda elástica”, “peso corporal con apoyos”, “mancuernas”, “poleas”, “contra la pared”, “peso corporal de pie” y “estiramientos”. Dentro de cada una aparecen descritos los ejercicios más comúnmente empleados en esta patología. Discusión: El uso de una “banda elástica” y la ayuda del “propio peso corporal” han demostrado ser el material más utilizado como resistencia. En cambio, los ejercicios “contra la pared” resultaron ser la categoría menos utilizada. Existe una gran heterogeneidad en cuanto a dosificación y número de ejercicios clasificados. No obstante, la dosis con más frecuencia utilizada fue de 3 series de 10 a 20 repeticiones.Objectives: To carry out a systematic review to identify an evidence-based catalog of the most used exercises in the treatment of rotator cuff tendinopathy. Methods: A bibliographic search was carried out in two databases (PubMed and EMBASE). We included only randomized controlled trials that included participants with rotator cuff tendinopathy of at least 1 month's duration and who performed exercise in isolation with an adequate description of the program. The risk of bias was assessed using the Cochrane tool and the PEDro scale was applied for methodological quality. Results: A total of eight articles were included in this study. The risk of bias was found to be generally low, with high methodological quality. A synthesis of the exercise programs was made and seven categories were identified: "elastic band", "body weight with supports", "dumbbells", "pulleys", "against the wall", "standing body weight" and "stretching". ”. Within each one, the exercises most commonly used in this pathology are described. Discussion: The use of an "elastic band" and the help of "own body weight" have proven to be the most used material for resistance. Instead, “against the wall” exercises turned out to be the least used category. There is great heterogeneity in terms of dosage and number of classified exercises. However, the most frequently used dose was 3 series of 10 to 20 repetitions