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- Hård af Segerstad, Mathias, et al.
(författare)
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Inhaled prostacyclin for the prevention of increased pulmonary vascular resistance in cemented hip hemiarthroplasty—A randomised trial
- 2019
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 63:9, s. 1152-1161
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bone cementation may cause pulmonary vasoconstriction and ventilation/perfusion abnormalities in patients undergoing cemented hip hemiarthroplasty. In this randomised trial, we tested the hypothesis that intra-operative inhalation of prostacyclin could attenuate the increase in pulmonary vascular resistance index (PVRI, primary endpoint) when compared to inhaled saline in this group of patients. Methods: Twenty-two patients with displaced femoral neck fractures were allocated to receive inhaled aerosolised prostacyclin (20 ng/kg/min) (n = 11) or inhaled saline (NaCl, 9 mg/mL) (n = 11). All patients received total intravenous anaesthesia and were catheterised with radial and pulmonary artery fast response thermodilution catheters, for measurements of arterial and pulmonary arterial pressures, cardiac output, right ventricular ejection fraction and effective pulmonary arterial elastance. Haemodynamic measurements were performed after induction of anaesthesia, during surgery before and immediately after bone cementation and prosthesis insertion, 10 and 20 min after insertion and during skin closure. Results: During the surgical procedure, PVRI increased both in the saline (44%, P < 0.001) and the prostacyclin (36%, P = 0.019) groups, with a less pronounced increase in the prostacyclin group (P = 0.031). Effective pulmonary arterial elastance increased both in the saline (44%, P < 0.001) and the prostacyclin groups (29%, P = 0.032), with a trend for a less pronounced increase in the prostacyclin group (P = 0.084). Right ventricular ejection fraction decreased significantly in both groups with no difference between the groups. Conclusion: Inhalation of prostacyclin attenuates the increase in pulmonary vascular resistance in patients undergoing cemented hip hemiarthroplasty and could potentially attenuate/prevent haemodynamic instability induced by an increase in right ventricular afterload seen in this procedure. © 2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd
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- Jensen, S. S., et al.
(författare)
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ALMA observations of water deuteration: a physical diagnostic of the formation of protostars
- 2019
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Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 631
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Tidskriftsartikel (refereegranskat)abstract
- Context. How water is delivered to planetary systems is a central question in astrochemistry. The deuterium fractionation of water can serve as a tracer for the chemical and physical evolution of water during star formation and can constrain the origin of water in Solar System bodies. Aims. The aim is to determine the HDO/H20 ratio in the inner warm gas toward three low-mass Class 0 protostars selected to be in isolated cores, i.e., not associated with any cloud complexes. Previous sources for which the HDO/H20 ratio have been established were all part of larger star-forming complexes. Determining the HDO/H20 ratio toward three isolated protostars allows comparison of the water chemistry in isolated and clustered regions to determine the influence of local cloud environment. Methods. We present ALMA Band 6 observations of the HDO 31,2-22,1 and 21,1-21,2 transitions at 225.897 GHz and 241.562 GHz along with the first ALMA Band 5 observations of the H2180 31,3-22,0 transition at 203.407 GHz. The high angular resolution observations (0'.'3-1'.'3) allow the study of the inner warm envelope gas. Model-independent estimates for the HDO/H20 ratios are obtained and compared with previous determinations of the HDO/H20 ratio in the warm gas toward low-mass protostars. Results. We successfully detect the targeted water transitions toward the three sources with signal-to-noise ratio (S/N) > 5. We determine the HDO/H20 ratio toward L483, B335 and BHR71 IRS1 to be (2.2 0.4) x 10-3, (1.7 0.3) x 10-3, and (1.8 0.4) x 10-3, respectively, assuming Tex = 124 K. The degree of water deuteration of these isolated protostars are a factor of 2-4 higher relative to Class 0 protostars that are members of known nearby clustered star-forming regions. Conclusions. The results indicate that the water deuterium fractionation is influenced by the local cloud environment. This effect can be explained by variations in either collapse timescales or temperatures, which depends on local cloud dynamics and could provide a new method to decipher the history of young stars.
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- Kauffeldt, Anders, 1951-, et al.
(författare)
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Sjuksköterskors uppfattningar av klinisk handledning utifrån organisations-, kompetens- och utbildningsperspektiv
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Verksamhetsförlagda studier i sjuksköterskeprogrammen på såväl grund- som specialistnivå är att betrakta som en form av arbetsintegrerat lärande. En viktig del i detta är den kliniska handledning som studenterna möter i sin utbildning. Högskolan Väst och Västra Götalandsregionen har i samverkan utvecklat en handledningsmodell där bas- huvudhandledare och högskolans lärare tillsammans är resurser för studenterna under verksamhetsförlagda studier. I anslutning till dessa intentioner erbjuds kliniskt verksamma sjuksköterskor handledarutbildning. Syftet med denna studie var att beskriva en grupp sjuksköterskors uppfattningar av klinisk handledning utifrån organisations-, kompetens och utbildningsperspektiv. I en enkätundersökning som besvarades av 199 sjuksköterskor som genomgått handledarutbildning framkom att den föreskrivna handledarmodellen fortfarande var i en utvecklingsfas. Huvudhandledarfunktion och handledarnas akademiska kompetens var inte i fas med intentionerna i handledarmodellen. I undersökningen framkom också indikationer på att samarbetet mellan kliniska handledare och högskolans lärare behöver utvecklas. När det gällde innehåll i den kliniska handledningen beskrevs att praktiska perspektiv har en dominerande funktion i handledningen och att arbetsledning och samarbete var det område där informanterna upplevde att de hade lägst kompetens att handleda i. Överlag skattade sjuksköterskorna sin handledande kompetens som hög. Informanterna var positiva till handledarutbildningens effekter i förhållande till integration av och reflektion kring teori, etik och praktik. Utbildningen hade också stärkt självkänslan i rollen som handledare vilket också hade ett positivt samband med i vilken utsträckning man uppfattade att studenterna uppnådde kursplanernas studiemål. Med utgångspunkt från arbetsintegrerat lärande diskuteras fortsatt utveckling av den föreskrivna handledarmodellen och handledarnas kompetens. Vidare diskuteras utveckling av handledarutbildningen och möjligheter till vidareutbildning i handledning.
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- Martín-Merino, Elisa, et al.
(författare)
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The impact of different strategies to handle missing data on both precision and bias in a drug safety study : a multidatabase multinational population-based cohort study
- 2018
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Ingår i: Clinical Epidemiology. - 1179-1349 .- 1179-1349. ; 10, s. 643-654
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Tidskriftsartikel (refereegranskat)abstract
- Background: Missing data are often an issue in electronic medical records (EMRs) research. However, there are many ways that people deal with missing data in drug safety studies. Aim: To compare the risk estimates resulting from different strategies for the handling of missing data in the study of venous thromboembolism (VTE) risk associated with antiosteoporotic medications (AOM). Methods: New users of AOM (alendronic acid, other bisphosphonates, strontium ranelate, selective estrogen receptor modulators, teriparatide, or denosumab) aged >= 50 years during 1998-2014 were identified in two Spanish (the Base de datos para la Investigacion Farmacoepidemiologica en Atencion Primaria [BIFAP] and EpiChron cohort) and one UK (Clinical Practice Research Datalink [CPRD]) EMR. Hazard ratios (HRs) according to AOM (with alendronic acid as reference) were calculated adjusting for VTE risk factors, body mass index (that was missing in 61% of patients included in the three databases), and smoking (that was missing in 23% of patients) in the year of AOM therapy initiation. HRs and standard errors obtained using cross-sectional multiple imputation (MI) (reference method) were compared to complete case (CC) analysis - using only patients with complete data - and longitudinal MI - adding to the cross-sectional MI model the body mass index/smoking values as recorded in the year before and after therapy initiation. Results: Overall, 422/95,057 (0.4%), 19/12,688 (0.1%), and 2,051/161,202 (1.3%) VTE cases/ participants were seen in BIFAP, EpiChron, and CPRD, respectively. HRs moved from 100.00% underestimation to 40.31% overestimation in CC compared with cross-sectional MI, while longitudinal MI methods provided similar risk estimates compared with cross-sectional MI. Precision for HR improved in cross-sectional MI versus CC by up to 160.28%, while longitudinal MI improved precision (compared with cross-sectional) only minimally (up to 0.80%). Conclusion: CC may substantially affect relative risk estimation in EMR-based drug safety studies, since missing data are not often completely at random. Little improvement was seen in these data in terms of power with the inclusion of longitudinal MI compared with cross-sectional MI. The strategy for handling missing data in drug safety studies can have a large impact on both risk estimates and precision.
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- Naeve, Ambjörn, et al.
(författare)
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Learning Processes and processing learning : From Organizational Needs to Learning Designs
- 2006
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Konferensbidrag (refereegranskat)abstract
- Learning activity or learning process models represent the basic material elements of any learning event. However, the organizational learning setting requires the consideration of objectives outside the individual, and the transformation of these activities into measurable, efficient behavior. In order to process learning activities with technological tools, such characteristics must be properly modeled. This paper describes a model for such a process-oriented view on learning in organizations, and sketches how that framework could be integrated with IMS Learning Design, a language for the description of pedagogical arrangement of multi-role activities.
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- Sangiovanni, Davide, et al.
(författare)
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Effects of phase stability, lattice ordering, and electron density on plastic deformation in cubic TiWN pseudobinary transition-metal nitride alloys
- 2016
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Ingår i: Acta Materialia. - : PERGAMON-ELSEVIER SCIENCE LTD. - 1359-6454 .- 1873-2453. ; 103, s. 823-835
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Tidskriftsartikel (refereegranskat)abstract
- We carry out density functional theory calculations to compare the energetics of layer glide, as well as stress vs. strain curves, for cubic Ti0.5W0.5N pseudobinary alloys and reference B1-structure TiN. Irrespective of the degree of ordering on the metal sublattice, the hardness and stiffness of Ti0.5W0.5, as estimated by stress strain results and resistance to layer glide, are comparable to that of the parent binary TiN, while ductility is considerably enhanced. After an initial elastic response to an applied load, the pseudobinary alloy deforms plastically, thus releasing accumulated mechanical stress. In contrast, stress continues to increase linearly with strain in TiN. Layer glide in Ti0.5W0.5N is promoted by a high valence-electron concentration which enables the formation of strong metallic bonds within the slip direction upon deformation. [1111-oriented Ti0.5W0.5N layers characterized by high local metal-sublattice ordering exhibit low resistance to slip along < 110 > directions due to energetically favored formation of (111) hexagonal stacking faults. This is consistent with the positive formation energy of < 111 >-ordered Tio.5W0.5N with respect to mixing of cubic-BI TiN and hexagonal WC-structure WN. In the cubic pseudobinary alloy, slip occurs parallel, as well as orthogonal, to the resolved applied stress at the interface between layers with the lowest friction. We suggest that analogous structural metastability (mixing cubic and hexagonal TM nitride binary phases) and electronic (high valence electron concentration) effects are responsible for the enhanced toughness recently demonstrated experimentally for cubic single-crystal pseudobinary V0.5W0.5N and V0.5MocoN epitaxial layers. (c) 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.
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