[Influence of working conditions and salary on temporary agency work for intermediate care and intensive care units : Partial results of a nationwide survey]. / Einfluss der Arbeitsbedingungen und des Gehalts auf die Leiharbeit für Intermediate-Care- und Intensivstationen : Teilergebnisse einer bundesweiten Umfrage.

BACKGROUND: Agency nursing is used as a form of labour to counter vacant staff positions in hospitals. Stakeholders and nurses might view this critically for different reasons. AIM: The aim of this study was to evaluate what individual net income nurses in German intensive care units and intermediate care units consider "fair and acceptable" for their work. Furthermore, what influence does salary have on the willingness to change to agency nursing or back to a permanent position. METHODS: From September-October 2020, an anonymous online survey was performed among nurses of intermediate care units, intensive care units and special care units in German-speaking countries. The results were evaluated using descriptive statistics. RESULT: Of 1203 participants, 1036 (86%) of those working in Germany could be evaluated. The question about the individual net income was answered by 1032 (99%) participants. The majority of respondents (n = 522) stated that they had an individual net income of 2000-2999 €/month. The higher the level of the net income, the lower the willingness to switch to agency work. The participants in permanent employment only perceive a net income of 3200 €/month (median 3200 €; interquartile range [IQR] 2800-3800 €) as acceptable and fair for their work. In all, 142 agency nurses stated that an individual net income of 3200 €/month (median 3200 €; IQR 3000-3950 €) would be sufficient to move from agency nursing back into permanent employment. CONCLUSION: The intensive care nurses in this survey consider a salary of 3200 €/month as acceptable and fair for their work. The salary level can be a parameter for the decision to go into agency work, but also to move back to permanent employment. Regardless of the salary, better working conditions were indicated as an essential element in terms of job satisfaction for all respondent groups.

Influence of working conditions and salary on agency work for intermediate and intensive care units : Part 2: Partial results of a nationwide survey.

BACKGROUND: Agency work in nursing is used as a form of labor to counter vacant staff positions in hospitals. Both hospital owners and nurses view this critically for different reasons. AIM: The aim of this study was to assess what personal net income nurses in German intensive care units and intermediate care units consider "fair and sufficient" for their work (addressed in Part 1 of the survey) and what influence-aside from the salary-the working conditions have on the willingness to change to temporary work or back to a permanent position. METHODS: From September to October 2020, an anonymous online survey was conducted among nurses of intermediate care units, intensive care units, and special care units in German-speaking countries. Descriptive statistics were used for the analysis. RESULT: Of 1203 participants, 86% (n = 1036) could be evaluated. None of the job satisfaction factors queried received four or five stars (maximum five stars) from those participating in the survey. The most unsatisfied group proved to be regularly employed nurses with an additional part-time job. Key job satisfaction factors differed markedly between the groups, with regular employees favoring consistency and stability. Agency workers prefer gaining experience in a broader range of tasks. Unreliable duty rosters and poor nurse to patient ratios were common points of criticism. CONCLUSION: For job satisfaction, making nurses feel appreciated and respected is essential. This includes a guaranteed nurse to patient ratio and reliable duty rosters that also include tasks outside direct patient care. In order for nurses to leave agency work, it is necessary to take into account the differences in interests in terms of the focus of activity.

Diagnostic value of the electrocardiogram in the assessment of prior myocardial infarction.

BACKGROUND: The best available imaging technique for the detection of prior myocardial infarction (MI) is cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Although the electrocardiogram (ECG) still plays a major role in the diagnosis of prior MI, the diagnostic value of the ECG remains uncertain. This study evaluates the diagnostic value of the ECG in the assessment of prior MI. METHODS: In this retrospective study, data from electronic patient files were collected of 1033 patients who had undergone CMR with LGE between January 2014 and December 2017. After the exclusion of 59 patients, the data of 974 patients were analysed. Twelve-lead ECGs were blinded and evaluated for signs of prior MI by two cardiologists separately. Disagreement in interpretation was resolved by the judgement of a third cardiologist. Outcomes of CMR with LGE were used as the gold standard. RESULTS: The sensitivity of the ECG in the detection of MI was 38.0% with a 95% confidence interval (CI) of 31.6-44.8%. The specificity was 86.9% (95% CI 84.4-89.1%). The positive and negative predictive value were 43.6% (95% CI 36.4-50.9%) and 84.0% (95% CI 81.4-86.5%) respectively. In 170 ECGs (17.5%), the two cardiologists disagreed on the presence or absence of MI. Inter-rater variability was moderate (κ 0.51, 95% CI 0.45-0.58, p < 0.001). CONCLUSION: The ECG has a low diagnostic value in the detection of prior MI. However, if the ECG shows no signs of prior MI, the absence of MI is likely. This study confirms that a history of MI should not be based solely on an ECG.

Mycobacterium tuberculosis lineages in Hawaii demonstrate distinctive demographic and migration characteristics.

OBJECTIVES: The American state of Hawaii presents a tuberculosis (TB) burden more consistent with that of the Philippines and the Pacific Islands than that with the United States (US) or Europe. This study seeks to determine if the genetic families of Mycobacterium tuberculosis (Mtb) that are prevalent in Hawaii display differences in host demographics that may be of use for TB control in Hawaii and the Pacific. STUDY DESIGN: This retrospective study was conducted by analyzing data from the Hawaii State Department of Health to investigate the demographics associated with the Beijing (global lineage 2) and Manila (lineage 1) families of Mtb in Hawaii. METHODS: Deidentified records of all culture-positive TB cases reported by the Hawaii State Department of Health Tuberculosis Control Program from 2004 to 2016 were analyzed to identify lineage-specific demographic differences and trends. Patients' countries of origin, age, sex, and time in the US before TB diagnosis were included in this analysis. RESULTS: Manila family isolates were found to predominantly enter Hawaii through Filipino immigrants, whereas Beijing family isolates originated from a diverse set of countries. Both families exhibited significant differences in age and sex demographics. In addition, Manila family cases presented from patients with significantly longer average time of residence in the US than non-Manila cases, whereas Beijing family cases presented from patients with significantly shorter time of residence in the US than non-Beijing cases. CONCLUSIONS: Both the Beijing and Manila families of Mtb demonstrated demographic differences in Hawaii that may prove important for improving TB control and surveillance policy in Hawaii and throughout the Pacific. Areas with heavy Filipino immigration may benefit from directing more resources toward screening and education efforts for middle-aged men and those who have resided in the country longer, whereas other areas of the Pacific should consider a younger and more sex-balanced allocation. Specific to the US and Hawaii, effective screening of youths emigrating from the Compact of Free Association states remains vital.

[Scientific development of critical care : Position paper]. / Wissenschaftliche Weiterentwicklung in der Intensivpflege : Positionspapier.

Demographic changes in Germany means that nursing and medical care is becoming increasingly complex. This is especially true for intensive care. Despite the closure of hospitals in Germany, the number of beds in intensive care units rose between 2002 from 23,113 to 26,162 in 2010. At the same time the number of patients treated in intensive care units increased by 148,989 to 2,049,888. The increasing complexity requires specific education for nurses in intensive care based on a model of advanced nursing practice (ANP). Nursing experts who fulfill an advanced practise nursing are competent to make decisions autonomously and accountably within complex care situations. This includes decisions such as artificial ventilation, weaning, nutrition management and the management of delirium, wounds and pain. Nursing experts are responsible for specific clearly defined areas of care and initiate nurse-led services and practice. Scientific and research based evidence are transferred directly into health care practice and can be implemented directly. The DGF demands a scientific and with it academic development of critical care as advanced nursing practice based on a master level qualification. This also includes the request for expansion of competencies and roles and the assignment of decision making authority within complex health care situations and an orientation on the Competencies for European Critical Care Nurses of the European Federation of Critical Care Nursing Associations (EfCCNa).

Author Correction: Dynamics enhanced by HCl doping triggers 60% Pauling entropy release at the ice XII-XIV transition.

This corrects the article DOI: 10.1038/ncomms8349.

Dynamic signatures of the transition from stacking disordered to hexagonal ice: Dielectric and nuclear magnetic resonance studies.

Using various temperature-cycling protocols, the dynamics of ice I were studied via dielectric spectroscopy and nuclear magnetic resonance relaxometry on protonated and deuterated samples obtained by heating high-density amorphous ices as well as crystalline ice XII. Previous structural studies of ice I established that at temperatures of about 230 K, the stacking disorder of the cubic/hexagonal oxygen lattice vanishes. The present dielectric and nuclear magnetic resonance investigations of spectral changes disclose that the memory of the existence of a precursor phase is preserved in the hydrogen matrix up to 270 K. This finding of hydrogen mobility lower than that of the undoped hexagonal ice near the melting point highlights the importance of dynamical investigations of the transitions between various ice phases and sheds new light on the dynamics in ice I in general.

Atypical Cowpox Virus Infection in a Series of Cats.

Within 4 weeks, five cats with skin lesions affecting the hindlimbs and mainly consisting of oedema, hyperaemia and plaque-like alterations were presented to the same veterinary clinic. The cats were suffering from lameness, trauma, renal insufficiency or complicated tail amputation. Although the lesions seemed unusual for a poxvirus infection, microscopical examination of biopsy samples or specimens taken during necropsy examination revealed ballooning degeneration of keratinocytes with eosinophilic, cytoplasmic inclusion bodies indicative of an orthopoxvirus infection. Cowpox virus infection was verified using immunohistochemistry and virus isolation. Molecular analysis revealed identical haemagglutinin gene sequences in four cases and spatiotemporal circumstances in some cases pointed to hospital-acquired transmission. Unusual manifestations of feline cowpox may have an unexpected risk for human infection.

Dynamics enhanced by HCl doping triggers full Pauling entropy release at the ice XII-XIV transition.

The pressure-temperature phase diagram of ice displays a perplexing variety of structurally distinct phases. In the century-long history of scientific research on ice, the proton-ordered ice phases numbered XIII through XV were discovered only recently. Despite considerable effort, none of the transitions leading from the low-temperature ordered ices VIII, IX, XI, XIII, XIV and XV to their high-temperature disordered counterparts were experimentally found to display the full Pauling entropy. Here we report calorimetric measurements on suitably high-pressure-treated, hydrogen chloride-doped ice XIV that demonstrate just this at the transition to ice XII. Dielectric spectroscopy on undoped and on variously doped ice XII crystals reveals that addition of hydrogen chloride, the agent triggering complete proton order in ice XIV, enhances the precursor dynamics strongest. These discoveries provide new insights into the puzzling observation that different dopants trigger the formation of different proton-ordered ice phases.

Magnetic resonance cholangiopancreaticography as a diagnostic tool for common bile duct stones: a comparison with ERCP and clinical follow-up.

BACKGROUND/AIMS: The diagnostic potential of magnetic resonance cholangiopancreaticography (MRCP) has improved as a result of evolving technique. MRCP has the advantage of negligible morbidity and mortality in contrast to endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate MRCP as a replacement for diagnostic ERCP for the suspicion of common bile duct (CBD) stones. METHODS: From 1998 to 2001, MRCP was performed in 202 patients with a suspicion of CBD stones based on medical history (MH), cholestatic liver function tests (CL), both MH and CL or other reasons. ERCP was performed in all patients where MRCP indicated the presence of CBD stones and in those patients with a persistent strong clinical suspicion for CBD stones despite a negative MRCP. RESULTS: In 25 patients, MRCP suggested CBD stones which were proven with ERCP in 24 patients. Despite a negative MRCP, 27 patients had a subsequent ERCP. None of these patients appeared to have CBD stones. In this group, MRCP resulted in 100% sensitivity and 96% specificity in detecting CBD stones. Follow-up of all patients revealed 5 more patients with persistent clinical suspicion or cholestatic liver function values. Assuming CBD stones in these patients, MRCP had a sensitivity of 83 % and a specificity of 99% for this diagnosis. CONCLUSION: In the case of CBD stone suspicion, MRCP should be the diagnostic procedure of choice.

A Doppler ultrasonographic study of cyclic changes of ovarian perfusion in the Beagle bitch.

Changes in intraovarian arterial blood flow were monitored by means of colour-coded and pulsed Doppler ultrasonography in Beagle bitches during the normal oestrous cycle (n = 11) and pregnancy (n = 3), and at PGF(2alpha)-induced luteolysis (n = 4). The ultrasonographic findings were related to the reproductive stage of the bitch, as determined by vaginoscopical and cytological criteria, and by the concentrations of oestradiol, LH and progesterone in peripheral blood plasma. Colour-coded Doppler ultrasonography was used to visualize and estimate intraovarian vascularization, and pulsed Doppler ultrasonography was used to measure the arterial blood flow. The systolic and diastolic peak velocities, the end-diastolic velocity, and the pulsatility index and resistance index were calculated for quantitative analysis of the Doppler waveforms. Intraovarian perfusion increased gradually during pro-oestrus. A marked enhancement of intraovarian colouring and blood flow velocities, and a decline in the indices for pulsatility and resistance were observed in the preovulatory period. Maximum perfusion was observed at ovulation and during the early luteal phase. Significant differences (P < 0.05) were detected for the values of all calculated Doppler parameters 2 days before and 2 days after ovulation. Intraovarian blood flow decreased gradually in accordance with luteal regression. Treatment with PGF(2alpha) caused a distinct decline in luteal activity and a concomitant reduction in intraovarian perfusion. The values of blood flow parameters found during the luteal phase of pregnant bitches were comparable to those of the normocyclic bitches. Doppler ultrasonography of the intraovarian arteries in bitches provides complementary information about cyclic changes of ovarian function.

Desiccation tolerance of protoplasts isolated from pea embryos.

To facilitate studies of desiccation tolerance at the cellular level, a technique to isolate protoplasts from desiccation-tolerant pea (Pisum sativum L. cv. Alaska) embryos has been developed. Using FDA (fluorescein diacetate) as a probe, viability of the protoplasts was investigated before and after drying to determine whether the protoplasts could survive desiccation in a manner similar to the tissue from which they were isolated. Protoplasts were isolated from 12 h imbibed pea axes, suspended in several different sugar solutions, then dried to water contents less than 0.2 g H(2)O g(-1) DW. Protoplasts only survived drying if the rate was rapid (<2 h), while slow drying (24 h) was lethal. Maximal survival (75%) was obtained after drying protoplasts with a mixture of sucrose and raffinose, while pure sucrose and trehalose were somewhat less effective protectants. Low survival was obtained after drying protoplasts with monosaccharides and pure raffinose. Protoplasts isolated from germinated seedlings did not survive dehydration below 0.2 g H(2)O g(-1) DW. Transmission electron microscopy revealed that dried desiccation-tolerant protoplasts appeared shrunken, with folded membranes, while dried protoplasts from sensitive tissue had disrupted membranes. While isolated protoplasts maintained some of the desiccation tolerance of orthodox seeds, their inability to survive complete drying and their sensitivity to drying rate is similar to the behaviour of recalcitrant embryos.

[Magnetic resonance cholangiopancreatography: sensitive and specific diagnostic method for suspected choledolithiasis]. / Magnetische-resonantiecholangiopancreatografie: sensitieve en specifieke onderzoeksmethode bij vermoeden van choledocholithiasis.

OBJECTIVE: To evaluate the role of magnetic resonance pancreaticography (MRCP) in the diagnostic process of common bile duct stones. DESIGN: Retrospective. METHOD: All 27 MRCPs performed in the period December 1997-December 1998 in the Deventer Hospital, the Netherlands, were evaluated using chart examination. The group comprised 11 males and 16 females with an average age of 57 years (SD 3.2) with anamnestic or biochemical cholestasis. If at MRCP stones were diagnosed, endoscopic retrograde cholangiopancreaticography (ERCP) was performed. If MRCP was without abnormalities, no further diagnostic procedures were performed. The findings at MRCP were compared with those at ERCP and with the clinical course. The MRCP examinations were performed on a 1.5 Tesla MR unit. RESULTS: In 16 patients MRCP was performed before laparoscopic cholecystectomy and in 5 there after. In 5 MRCP was performed to rule out a biliary cause of acute pancreatitis and in 1 patient because of an elevated alkaline phophatase after laparotomy for an abdominal stab injury. There was one false-positive MRCP result and no false-negative ones. Accordingly, the sensitivity of MRCP for choledocholithiasis was 100% and the specificity 95%.

HDR brachytherapy applied to cervical carcinoma with moderate lateral expansion: modified principles of treatment.

BACKGROUND AND PURPOSE: In order to meet the deficiencies of endocavitary applications, a combined technique was introduced with the aim of achieving better target coverage for improvement of loco-regional tumour control. In high dose rate (HDR) endocavitary applications with tandem and ovoids, enlargement of the distance between the ovoids, shifting of dwell times and also optimization often fail to achieve sufficient expansion of the cervical parametrial area encompassed by the reference isodose. MATERIALS AND METHODS: The Deventer method, whereby HDR endocavitary and HDR interstitial brachytherapy are applied in the same session, was applied for tumours with a lateral expansion of 25 mm or more from the axis of the cervical canal. For the addition of HDR interstitial brachytherapy, each ovoid was provided with a channel which allowed insertion of an afterloading needle into the cervix up to a fixed depth. The dose specifications and dosimetry in neighbouring organs are presented in detail. RESULTS: Seventy-six combined applications were given to 41 patients. The follow-up averaged at 23 months, with a maximum of 59 months. No severe early or persistent late complications were observed. In stage IIB tumours, the most important evaluation of the merits of this technique, the disease-free 3-year survival determined with the Kaplan-Meier method was 75% (n=20). CONCLUSIONS: The Deventer method of HDR endocavitary and HDR interstitial brachytherapy applied in the same session is a feasible method for enlargement of the reference isodose envelope in the cervical parametrial area. The 3-year disease-free survival in stage IIB patients and the low complication rates in all stages together, justify its continuation.

Time course for cryoprotectant synthesis in the freeze-tolerant chorus frog, Pseudacris triseriata.

Increases in liver glycogen phosphorylase activity, along with inhibition of glycogen synthetase and phosphofructokinase-1, are associated with elevated cryoprotectant (glucose) levels during freezing in some freeze-tolerant anurans. In contrast, freeze-tolerant chorus frogs, Pseudacris triseriata, accumulate glucose during freezing but exhibit no increase in phosphorylase activity following 24-h freezing bouts. In the present study, chorus frogs were frozen for 5- and 30-min and 2- and 24-h durations. After freezing, glucose, glycogen, and glycogen phosphorylase and synthetase activities were measured in leg muscle and liver to determine if enzyme activities varied over shorter freezing durations, along with glucose accumulation. Liver and muscle glucose levels rose significantly (5-12-fold) during freezing. Glycogen showed no significant temporal variation in liver, but in muscle, glycogen was significantly elevated after 24 h of freezing relative to 5 and 30 min-frozen treatments. Hepatic phosphorylase a and total phosphorylase activities, as well as the percent of the enzyme in the active form, showed no significant temporal variation following freezing. Muscle phosphorylase a activity and percent active form increased significantly after 24 h of freezing, suggesting some enhancement of enzyme function following freezing in muscle. However, the significance of this enhanced activity is uncertain because of the concurrent increase in muscle glycogen with freezing. Neither glucose 6-phosphate independent (I) nor total glycogen synthetase activities were reduced in liver or muscle during freezing. Thus, chorus frogs displayed typical cryoprotectant accumulation compared with other freeze-tolerant anurans, but freezing did not significantly alter activities of hepatic enzymes associated with glycogen metabolism.

Effects of vitrified and nonvitrified sugars on phosphatidylcholine fluid-to-gel phase transitions.

DSC was used to study the ability of glass-forming sugars to affect the gel-to-fluid phase transition temperature, T(m), of several phosphatidylcholines during dehydration. In the absence of sugars, T(m) increased as the lipid dried. Sugars diminished this increase, an effect we explain using the osmotic and volumetric properties of sugars. Sugars vitrifying around fluid phase lipids lowered T(m) below the transition temperature of the fully hydrated lipid, T(o). The extent to which T(m) was lowered below T(o) ranged from 12 degrees to 57 degrees, depending on the lipids' acyl chain composition. Sugars vitrifying around gel phase lipids raised T(m) during the first heating scan in the calorimeter, then lowered it below T(o) in subsequent scans of the sample. Ultrasound measurements of the mechanical properties of a typical sugar-glass indicate that it is sufficiently rigid to hinder the lipid gel-to-fluid transition. The effects of vitrification on T(m) are explained using the two-dimensional Clausius-Clapeyron equation to model the mechanical stress in the lipid bilayer imposed by the glassy matrix. Dextran and polyvinylpyrrolidone (PVP) also vitrified but did not depress T(m) during drying. Hydration data suggest that the large molecular volumes of these polymers caused their exclusion from the interbilayer space during drying.

Electroconvulsive therapy in adolescents: experience, knowledge, and attitudes of recipients.

OBJECTIVE: To ascertain the experience, knowledge, and attitudes regarding electroconvulsive therapy (ECT) of persons who received the treatment in adolescence. METHOD: A 53-item survey was administered by telephone to persons who received ECT before the age of 19 years in the Australian state of New South Wales between 1990 and 1998. RESULTS: Twenty-six patients were interviewed. Experiences and opinions about ECT were generally positive. Fifty percent stated ECT had been helpful. Approximately three quarters believed their illness was worse than either ECT or pharmacotherapy. Frequencies of recalled side effects with ECT and medication were similar. Some patients perceived deficiencies in the consent process. A slight majority had attempted to conceal the history of ECT treatment. The vast majority considered ECT a legitimate treatment and, if medically indicated, would have ECT again and would recommend it to others. CONCLUSIONS: The findings are consistent with and complement evidence showing ECT to be an effective and safe treatment for seriously ill adolescents. The mostly favorable experiences and attitudes reported by interviewees will be reassuring to adolescent patients, their families, and treating health professionals when ECT is being considered.

Views about treatment among parents of adolescents who received electroconvulsive therapy.

The study assessed the experience, knowledge, and attitudes of parents of adolescents who had been treated with electroconvulsive therapy (ECT) about that treatment. Twenty-eight parents were interviewed. Overall, their opinions about ECT were favorable. Seventeen of 28 parents thought that ECT had been helpful. If ECT was recommended by a doctor, the vast majority of parents would support a decision for their child to have the treatment again and would advise others to consider it.