Social support as a predictor exhaled nitric oxide in healthy individuals across time

Psychosocial factors such as social support and depression have long been associated with health outcomes. Elevated depressive symptoms are usually associated with worse health outcomes, whereas social support has been related to improvements in health. Nitric oxide levels are an important marker of both cardiovascular health and immune function. Research suggests that exhaled nitric oxide is affected by stress, negative affect, and depression; however, the effect of social support has not been previously explored. Thus, we sought to examine the association of social support, negative affect, and depression with exhaled nitric oxide in a group of 35 healthy individuals (10 males and 25 females) with a mean age of 20.5 years across five weekly assessments. Results showed that changes in social support within individuals were positively associated with levels of exhaled nitric oxide independent of other psychosocial factors. Further exploration of the health implications of this positive relationship between airway nitric oxide and social support is necessary.     

Six habits to enhance MET performance under stress: A discussion paper reviewing team mechanisms for improved patient outcomes

Effective team decision making has the potential to improve the quality of health care outcomes. Medical Emergency Teams (METs), a specific type of team led by either critical care nurses or physicians, must respond to and improve the outcomes of deteriorating patients. METs routinely make decisions under conditions of uncertainty and suboptimal care outcomes still occur. In response, the development and use of Shared Mental Models (SMMs), which have been shown to promote higher team performance under stress, may enhance patient outcomes. This discussion paper specifically focuses on the development and use of SMMs in the context of METs. Within this process, the psychological mechanisms promoting enhanced team performance are examined and the utility of this model is discussed through the narrative of six habits applied to MET interactions.A two stage, reciprocal model of both nonanalytic decision making within the acute care environment and analytic decision making during reflective action learning was developed. These habits are explored within the context of a MET, illustrating how applying SMMs and action learning processes may enhance team-based problem solving under stress. Based on this model, we make recommendations to enhance MET decision making under stress. It is suggested that the corresponding habits embedded within this model could be imparted to MET members and tested by health care researchers to assess the efficacy of this integrated decision making approach in respect to enhanced team performance and patient outcomes.     

Are we ready to predict late effects? A systematic review of clinically useful prediction models

BackgroundAfter completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period.PurposeTo identify and describe all models that predict the risk of late effects and could be used in clinical practice.Data sourcesWe searched Medline through April 2014.Study selectionStudies describing models that (1) predicted the absolute risk of a late effect present at least 1 year post-treatment, and (2) could be used in a clinical setting.Data extractionThree authors independently extracted data pertaining to patient characteristics, late effects, the prediction model and model evaluation.Data synthesisAcross 14 studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphoedema, psychological morbidity, cardiomyopathy or heart failure and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output.ConclusionDespite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable and serious late effects to inform the management of survivorship care.     

支持向量机在水源水化学耗氧量预测中的应用

目的应用支持向量机预测水中化学耗氧量(COD)浓度。方法基于研究地区的水质监测数据,运用支持向量机算法构建水质预测模型,并对某水厂水源水中COD月均浓度进行了预测。结果建模以后预测结果显示,训练集的均方误差MSE=0.039 4,相关系数R=0.805 4,平均相对误差MRE=4.22%;两组测试集样本的相对误差分别为8.89%和0.98%。结论该模型的预测性能良好,简便易行,可以为水质预测提供新思路。     

The experiences and perceptions of newly qualified nurses in the UK: An integrative literature review

AimThis integrative review aimed to develop an understanding of the experiences and perceptions of newly qualified nurses in the United Kingdom (UK).BackgroundIn the transitional period following registration, newly qualified nurses may feel socially isolated and overwhelmed by increases in accountability, workplace pressures and the psychological demands of the role. Despite this, the experiences and perceptions of newly qualified nurses remains an under-researched area in the UK, with much of the existing research having been conducted internationally.MethodAn integrative framework methodology was used as a basis for the literature review. The methodology comprised of five stages: problem identification, literature search, data evaluation, data analysis and presentation of the findings. 20 papers were assessed for quality and analysed thematically.ResultsData were synthesised under four themes: Preparation for real-world practice, the transition experience, growing into the role and preceptorship and support from the wider team.ConclusionThe review suggests that newly qualified nurses require on-going support post qualification. Workplace culture appears to have a significant impact on the transition experience. The review provides further evidence in relation to the experiences of newly qualified nurses in the UK context. The review may help to inform the development of strategies to support and retain newly qualified nurses in an ever-changing health care environment.     

Individual support planning with people with ID in The Netherlands: Official requirements and stakeholders’ expectations

IntroductionIndividualized support planning (ISP) has become a key aspect of supports for people with ID and is mandated in several countries. Different stakeholders develop policies and expectations regarding ISP. In this study, we report on requirements as found in Dutch official ID policy and on the results of consultations of panels of stakeholders and experts working in the field of ID. It was intended to describe, summarize and discuss these requirements for the purpose of enhancing ISP practices.MethodA combination of desk research of policy documents and consultation of two expert panels was performed.ResultsA variety of criteria on content, procedures, quality and person-centeredness of ISP is being used by different stakeholders. These criteria were described and summarized.DiscussionThe broad range of inconsistent requirements and sometimes conflicting expectations from different stakeholders hamper a clear conceptualization of ISP and affect the use of ISP in practice.     

肺炎克雷伯菌对β-内酰胺类抗生素耐药性主决定因素的研究

目的了解肺炎克雷伯菌对β-内酰胺类抗生素耐药性及耐药性特点,并探究其主决定因素。方法对临床送检的痰液、咽拭子、气管分泌物等做细菌培养,根据药敏试验结果分为敏感菌株、泛耐药菌株、多重耐药菌株3种菌株。分析菌株β-内酰胺酶活性以及细胞外膜通透性的变化。结果与敏感菌株组β-内酰胺酶活性(12±6)U/mg比较,泛耐药菌株组β-内酰胺酶活性(253±36)U/mg,多重耐药菌株组β-内酰胺酶活性均明显增多,差异显著,有统计学意义(P<0.05)。而泛耐药菌株组β-内酰胺酶活性表达最高;与敏感菌株组细胞外膜通透性比较,泛耐药菌株组细胞外膜通透性、多重耐药菌株组细胞外膜通透性具有明显的阻碍作用,差异显著,有统计学意义(P<0.05)。而泛耐药菌株组细胞外膜通透性阻碍作用最强。结论β-内酰胺酶活性和细胞外膜通透性是肺炎克雷伯菌对β-内酰胺类抗生素耐药性的主决定因素。