Standing alone on the frontline. The meaning of being a nurse in the archipelago-A phenomenological hermeneutical study.

AIM: The aim of this study was to illuminate the meaning of being a nurse in the archipelago. METHODOLOGICAL DESIGN AND JUSTIFICATION: A phenomenological hermeneutical design was applied, as there is a need to understand the lifeworld and the meaning of being a nurse in the archipelago. ETHICAL ISSUES AND APPROVAL: Approval was granted by the Regional Ethical Committee and local management team. All participants provided consent to participate. RESEARCH METHOD: Individual interviews were conducted with 11 nurses (Registered Nurses or primary health nurses). The interviews were transcribed, and the text was analysed by means of phenomenological hermeneutical method. RESULTS: The analyses ended in one main theme: Standing alone on the frontline, and three themes: 1. Combating sea, weather and the clock with the sub-themes: Fighting to give care to patients despite harsh conditions and Fighting against time; 2. Standing firm but wavering with the sub-themes: Embracing the unexpected and Calling out for support; and 3. Being a lifeline throughout the entire lifespan with the sub-themes: Having responsibility for the islanders and Having an intertwined private and work life. STUDY LIMITATIONS: The interviews may be considered few, but the textual data were rich and assessed suitable for the analysis. The text may be interpreted differently, but we deemed our interpretation as more probable than others. CONCLUSION: Being a nurse in the archipelago means standing alone on the frontline. Nurses, other health professionals and managers need knowledge and insight about working alone and the moral responsibilities thereof. There is a need to support the nurses in their lonely work. Traditional means of consultations and support could preferably be supplemented by modern digital technology.

The core of Katie Eriksson's caritative caring theory - a qualitative study from a postdoctoral perspective.

BACKGROUND: For about 40 years, Katie Eriksson developed the caritative caring theory at Åbo Akademi University in Finland. However, a description regarding the most substantial concepts and the relationships between these is lacking and thus needs to be explored. AIMS: The aim of the study was twofold: to explore and describe central concepts in the development of caritative caring theory from a postdoctoral perspective and to uncover and explore the relationships between the concepts. METHODOLOGY: The design of the study was qualitative with a mixed method approach. The material was collected from a postdoctoral group (n = 38) mainly through electronic questionnaires. The texts were interpreted through manifest and latent content analysis. FINDINGS: The analyses generated five main categories including subcategories. The main categories were 'Caring' 'Ethos', 'Suffering' 'Health' and 'The human being'. The relation between the main concepts compiled as 'A tentative synthesis of the main concepts and the relationships between them'. CONCLUSION: This study contributes to an understanding of the most fundamental and valuable concepts in the development of caritative theory during its first 40 years according to postdoctoral researchers' perspectives. This study also displays that the concepts ethos and caring have the strongest relationship followed by that between caring and health, indicating the inner core of ethos and love within caring which bears the potential of enhancing the patient's well-being and health.

"They Know Me and My Situation-Patients' and Spouses' Perceptions of Person-Centered Care in Hospital-at-Home Care".

Realization of person-centered care (PCC) is contextual. How is it perceived at hospital-at-home? Pairwise telephone interviews of patients (n = 27) and their spouses (n = 18) emerged in 4 themes. Care was found to be person-centered when both the principles and activities that underpin the concept PCC were realized.

Measuring in Situ Length Distributions of Polymer-Wrapped Monochiral Single-Walled Carbon Nanotubes Dispersed in Toluene with Analytical Ultracentrifugation.

The length of a carbon nanotube is an important dimension that has to be adjusted to the requirements of an experiment or application, e.g., through sorting methods. So far, atomic force microscopy (AFM) has been the method of choice for measuring length distributions, despite being an ex situ method with apparent shortcomings. In this work, we explore analytical ultracentrifugation (AUC) as an in situ method for measuring the length distribution of polymer-wrapped (7, 5) single-walled carbon nanotubes dispersed in toluene. This is an AUC study of nanotubes in nonaqueous media, the preferred media for nanotubes used in device fabrication. In AUC, the temporally and spatially dependent change in optical absorption of a sample is measured under centrifugation. The resulting sedimentation curves can be deconvoluted with a standard data processing procedure (SEDFIT), to yield the sedimentation coefficient distribution. However, the conversion of the sedimentation coefficient distribution into a length distribution is nontrivial and requires finding a suitable model for the nanotube friction coefficient. Also, since AUC is based on optical absorption, it yields a volume distribution and not a number distribution as obtained from AFM reference data. By meeting these challenges and finding a surprisingly simple empirical flexible-chain-like model to describe the sedimentation behavior of one specific chiral structure, we suggest AUC as a viable method for measuring in situ nanotube length distributions of nonaqueous dispersions.

Probing the structure of giant fullerenes by high resolution trapped ion mobility spectrometry.

We present high-resolution trapped ion mobility spectrometry (TIMS) measurements for fullerene ions in molecular nitrogen. Three different charge states were studied (monocations, monoanions and dianions) with fullerenes ranging in size from C60 to C150. Ions were prepared by either electrospray ionization (ESI, for mono- and dianions) or by atmospheric pressure chemical ionization (APCI, for monocations) of a preformed fullerene soot extract solution. We demonstrate that TIMS allows to identify (and separate) constituent isomers in favorable cases. Using DFT calculations based on known condensed phase structures and trajectory method (TM) calculations we can reproduce the experimental TIMSCCSN2 for fullerenes up to C108 to within 0.5%. Using candidate structures based on quantum chemical predictions, we have also obtained structural information for fullerenes C110-C150- a size range not previously accessed in condensed phase studies. We find that soluble fullerenes in this size have near-spherical rather than tubular structures. While the TM programs presently available for CCS modelling do a remarkably good job at describing the ion mobility of high (and even giant) fullerenes we observe a slight but systematic size-dependent deviation between TIMSCCSN2 values and our best computational fits which may reflect systematic bonding changes as the cage size increases.

Working in home healthcare and suggestions for development.

In order to describe nurses' experiences of working in home health care and their suggestions for the development of this public health-care sector, interviews with 18 home health-care nurses were analyzed with qualitative thematic content analysis. The nurses perceived the working shifts either affirmative or non-affirmative, depending on the contextual and organizational factors affecting nurses' workload. The more the nurses perceived they could influence their work, the more engaged they were in patient-related nursing activities, patient-centeredness, collaboration, and forward planning. Several concrete suggestions for the development of home healthcare on the organizational, interprofessional, team and individual levels were given.

A Window Toward the World: Older Adults' Experiences of Becoming in Health and Developing as Human Beings Through Interacting With Others Using Real Video Communication.

The population in the Nordic countries, as well as globally, is increasingly becoming older. Concurrently, with an increased aging population, there is an increase in poor health and loneliness among older adults. The aim of this study was to uncover, from a caring science perspective, community-living older adults' experiences of interacting with others via real video communication. The study uses a hermeneutical approach. The material consists of interviews with older adults regarding their experiences of using real video communication. The texts were interpreted through hermeneutical reading. Study participation and data storage and handling for research purposes were approved by the participants when they provided their informed consent. Ethical permission to conduct this study was granted by a research board. The findings uncovered that welfare technology offers a metaphor-a window toward the world-that comprises the overarching core theme "Being in a movement toward becoming a unity as a human being," and 3 main themes: "Alleviating suffering through beating involuntary solitude," "Being in the world as an equal and dignified human being," and "Dedicating new perspectives and meaning in life." Welfare technology seems to be an important means to improve the quality of life for older adults living at home. Welfare technology enables older people to be in contact with other people in an easy way. Further research is needed to uncover issues of welfare technology from different perspectives.

Inner strength and its relationship to health threats in ageing-A cross-sectional study among community-dwelling older women.

AIM: To explore the relationship between inner strength and health threats among community-dwelling older women. BACKGROUND: Inner strength is described as a resource that promotes experiences of health, despite adversities. Inner strength and its dimensions (i.e. connectedness, creativity, firmness and flexibility) can be assessed using the Inner Strength Scale (ISS). Exploring attributes of weaker inner strength may yield valuable information about areas to focus on in enhancing a person's inner strength and may ultimately lead to the perception of better health. DESIGN: Cross-sectional questionnaire survey. METHODS: The study is based on responses from 1270 community-dwelling older women aged 65 years and older; these were collected in the year 2010 and describe the situation that still exists today for older women. The questionnaire included the ISS, background characteristics and explanatory variables known to be health threats in ageing. Data were analysed using descriptive and inferential statistics. RESULTS: Poorer mental health was related to weaker inner strength in total and in all the dimensions. Symptoms of depressive disorders and feeling lonely were related to three of the dimensions, except firmness and creativity respectively. Furthermore, poor physical health was associated with the dimensions firmness and flexibility. Other health threats were significantly related to only one of the dimensions, or not associated at all. CONCLUSION: Mental ill health has overall the strongest association with weaker inner strength. Longitudinal studies are recommended to confirm the results. However, the ISS does not only estimate inner strength but can also be a tool for discovering where (i.e. dimension) interventions may be most profitable.

Inner strength - associated with reduced prevalence of depression among older women.

OBJECTIVES: The aim of this study was to explore if inner strength is independently associated with a reduced prevalence of depression after controlling for other known risk factors associated with depression. METHODS: A population-based cross-sectional study was performed, where all women living in Åland, a Finnish self-govern island community in the Baltic Sea, aged 65 years or older were sent a questionnaire including the Geriatric Depression Scale and the Inner Strength Scale along with several other questions related to depression. Factors associated with depression were analyzed by means of multivariate logistic regression. RESULTS: The results showed that 11.2% of the studied women (n = 1452) were depressed and that the prevalence increased with age and was as high as 20% in the oldest age group. Non-depressed women were more likely to never or seldom feel lonely, have a strong inner strength, take fewer prescription drugs, feeling needed, being able to engage in meaningful leisure activities, as well as cohabit. CONCLUSION: Our results showed an association between stronger inner strength and being non-depressed. This can be interpreted to mean that inner strength might have a protective effect against depression. These findings are interesting from a health-promotion perspective, yet to verify these results, further longitudinal studies are required.

Psychometric properties of the Swedish version of the Self-Transcendence Scale among very old people.

BACKGROUND AND PURPOSE: This study tested the psychometric properties of a Swedish version of the Self-Transcendence Scale (STS). METHODS: Cohen's weighted kappa, agreement, absolute reliability, relative reliability, and internal consistency were calculated, and the underlying structure of the STS was established by exploratory factor analysis. There were 2 samples available: 1 including 194 people aged 85-103 years and a convenience sample of 60 people aged 21-69 years. RESULTS: Weighted kappa values ranged from .40 to .89. The intraclass correlation coefficient for the original STS was .763, and the least significant change between repeated tests was 6.25 points. CONCLUSION: The revised STS was found to have satisfactory psychometric properties, and 2 of the 4 underlying dimensions in Reed's self-transcendence theory were supported.

Psychometric properties of the Swedish version of the selection, optimization, compensation questionnaire.

BACKGROUND: The model of selection, optimization and compensation has been proposed as a model of adaptive management strategies throughout the lifespan. AIM: The aim of this study was to test the psychometric properties of a translated Swedish version of the 12-item selection, optimization, and compensation (SOC) questionnaire. METHOD: The 12-item SOC questionnaire is composed of four subscales: elective selection (ES), loss-based selection, optimization and compensation. A convenience sample of 122 Swedish-speaking people, aged 19-85, participated in a study of the validity and reliability of the SOC questionnaire. Cronbach's alpha coefficient, corrected item-total correlation and Cronbach's alpha if item deleted were used for reliability testing. Two other scales, the ways of coping questionnaire and Rosenberg's self-esteem scale, were used to test convergent validity, and the geriatric depression scale was used to test discriminant validity. Stability over time was evaluated using a test-retest model with a 2-week interval. RESULTS: The 12-item SOC questionnaire showed a Cronbach's alpha value of 0.50, and the subscales ranged from α = 0.16 to α = 0.64. Two items in the ES subscale had negative values on the corrected item-total correlation and showed substantial improvement (>0.05) in Cronbach's alpha when item deleted. When these two items that influenced internal consistency were deleted, Cronbach's alpha rose to 0.68. CONCLUSION: The Swedish version of the 12-item SOC questionnaire showed deficiencies in a test of internal consistency because of two items in the ES subscale, and these two items were deleted. A consequence of the reduction is a weakening of the ES subscale and thereby to some extent the SOC questionnaire in total. Further testing is advisable. However, the 10-item SOC questionnaire was acceptable in a test of validity and reliability.

Artificial Intelligence and Deep Learning for Advancing PET Image Reconstruction: State-of-the-Art and Future Directions.

Positron emission tomography (PET) is vital for diagnosing diseases and monitoring treatments. Conventional image reconstruction (IR) techniques like filtered backprojection and iterative algorithms are powerful but face limitations. PET IR can be seen as an image-to-image translation. Artificial intelligence (AI) and deep learning (DL) using multilayer neural networks enable a new approach to this computer vision task. This review aims to provide mutual understanding for nuclear medicine professionals and AI researchers. We outline fundamentals of PET imaging as well as state-of-the-art in AI-based PET IR with its typical algorithms and DL architectures. Advances improve resolution and contrast recovery, reduce noise, and remove artifacts via inferred attenuation and scatter correction, sinogram inpainting, denoising, and super-resolution refinement. Kernel-priors support list-mode reconstruction, motion correction, and parametric imaging. Hybrid approaches combine AI with conventional IR. Challenges of AI-assisted PET IR include availability of training data, cross-scanner compatibility, and the risk of hallucinated lesions. The need for rigorous evaluations, including quantitative phantom validation and visual comparison of diagnostic accuracy against conventional IR, is highlighted along with regulatory issues. First approved AI-based applications are clinically available, and its impact is foreseeable. Emerging trends, such as the integration of multimodal imaging and the use of data from previous imaging visits, highlight future potentials. Continued collaborative research promises significant improvements in image quality, quantitative accuracy, and diagnostic performance, ultimately leading to the integration of AI-based IR into routine PET imaging protocols.

Enhancing Interoperability and Harmonisation of Nuclear Medicine Image Data and Associated Clinical Data.

Nuclear imaging techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) in combination with computed tomography (CT) are established imaging modalities in clinical practice, particularly for oncological problems. Due to a multitude of manufacturers, different measurement protocols, local demographic or clinical workflow variations as well as various available reconstruction and analysis software, very heterogeneous datasets are generated. This review article examines the current state of interoperability and harmonisation of image data and related clinical data in the field of nuclear medicine. Various approaches and standards to improve data compatibility and integration are discussed. These include, for example, structured clinical history, standardisation of image acquisition and reconstruction as well as standardised preparation of image data for evaluation. Approaches to improve data acquisition, storage and analysis will be presented. Furthermore, approaches are presented to prepare the datasets in such a way that they become usable for projects applying artificial intelligence (AI) (machine learning, deep learning, etc.). This review article concludes with an outlook on future developments and trends related to AI in nuclear medicine, including a brief research of commercial solutions.

The Medical Informatics Initiative and the Network University Medicine - Perspectives for Nuclear Medicine.

Digitization in the healthcare sector and the support of clinical workflows with artificial intelligence (AI), including AI-supported image analysis, represent a great challenge and equally a promising perspective for preclinical and clinical nuclear medicine. In Germany, the Medical Informatics Initiative (MII) and the Network University Medicine (NUM) are of central importance for this transformation. This review article outlines these structures and highlights their future role in enabling privacy-preserving federated multi-center analyses with interoperable data structures harmonized between site-specific IT infrastructures. The newly founded working group "Digitization and AI" in the German Society of Nuclear Medicine (DGN) as well as the Fach- und Organspezifische Arbeitsgruppe (FOSA, specialty- and organ-specific working group) founded for the field of nuclear medicine (FOSA Nuklearmedizin) within the NUM aim to initiate and coordinate measures in the context of digital medicine and (image-)data-driven analyses for the DGN.

Inner strength in relation to functional status, disease, living arrangements, and social relationships among people aged 85 years and older.

Inner strength is described as an important resource that promotes well-being. We used data from a sample of 185 people in the Umeå 85+ cohort study to relate inner strength and its attributes to objective health variables. The Resilience, Sense of Coherence, Purpose in Life, and Self-Transcendence scales were used to assess aspects of inner strength, and strong correlations between the scales were found. Prevalence of heart failure, chronic obstructive pulmonary disorder, osteoporosis, or diagnosed depression was associated with low inner strength. Significant relationships were also found between high inner strength and various measures of social relationships. Participants with a higher degree of inner strength had better physical health and more satisfying social relationships. The promotion of inner strength should be a major aim of geriatric nursing.

Clinical challenges and ongoing role changes for primary health-care nurses.

OBJECTIVE: To investigate the perceptions of primary health-care nurses (PHNs) about clinical demands and future challenges. METHOD: Qualitative content-analysis of open questions from a questionnaire. A total of 121 PHNs from health-care districts in northern Sweden filled in a questionnaire during a mandatory educational day. RESULTS: Key issues that were raised included: defending the specific professional role of the PHNs; strengthening their self-governance and authority; and ensuring adequate care in the future through education that focuses more on nursing practice than on academic work. CONCLUSION: To ensure that the role of the PHN continues to develop, it is necessary to enable them to articulate, discuss, and evaluate their profession and to learn, in concrete forms, how to implement science in clinical practice.

Users' ambivalent sense of security with humanoid robots in healthcare.

Humanoid robots have already been shown to be useful in healthcare. To ensure successful interactions with humanoid robots, is it essential that the factors that influence users' sense of security be understood. Ensuring patients' sense of security is considered a key principle of good caring. The aim of this study was to illuminate users' sense of security with humanoid robots in healthcare. Twelve semi-structured interviews were conducted. The participants consisted of five women and seven men aged 24-77. Before being interviewed, the participants were shown a video vignette with Pepper, a fully developed humanoid robot, used in the daily care of patients. The data material was analyzed using qualitative content analysis. Most participants perceived the use of humanoid robots in healthcare to be both positive and negative. The overarching theme was: Ambivalent sense of security with humanoid robots in healthcare. The four categories revealed were: Humanoid robots are both reliable and unreliable, Humanoid robots are both safe and unsafe, Humanoid robots are both likable and scary, and Humanoid robots are both caring and uncaring. Here we increased knowledge of whether patients perceive a sense of security with humanoid robots in healthcare, including which fears users have. This is vital information that should be taken into consideration when further developing and introducing humanoid robots into the healthcare setting.

Art making and expressive art therapy in adult health and nursing care: A scoping review.

OBJECTIVES: While receptive art engagement is known to promote health and wellbeing, active art engagement has not been fully explored in health and nursing care. This review is to describe the existing knowledge on art making and expressive art therapy in adult health and nursing care between 2010 and 2020. METHODS: Relevant studies and grey literature were searched and identified between March 17 and April 10, 2020 from EBSCO, CINAHL, Medline and ERIC databases and a general Internet search. Following data charting and extraction, the data (n = 42 papers) were summarized and reported in accordance with PRISMA-ScR guidelines. RESULTS: In the included papers, both art making and expressive art therapy were seen in different health care and nursing contexts: yet not the home care context. The emphasis of art activities were group activities for chronically or terminally ill residents, adults aged 65 years or older. A focus on personal narrative was often seen, which may explain why art activities appear to be linked to acknowledging and building new strengths and skills, making meaning of experiences, personal growth, symptom alleviation, and communication; all used to foster collaboration between patients, patients' near-ones and health care professionals. CONCLUSIONS: Art activities appear to be suitable for every context and can promote personcenteredness and the measurement of nursing outcomes, and they should be considered an essential part of health and nursing care, nursing education and care for health care personnel.

Endothelial progenitor cells in patients on extracorporeal maintenance dialysis therapy.

BACKGROUND: Chronic renal failure patients have a high cardiovascular disease burden, low numbers and impaired function of endothelial progenitor cells (EPCs). We hypothesized that enhanced uraemic toxin removal restores EPCs in haemodialysis patients. METHODS: In a prospective, randomized, cross-over trial, 18 patients were subjected to 4 weeks of each low-flux haemodialysis, high-flux haemodialysis and haemodiafiltration differing in uraemic toxin removal. EPCs were determined at baseline and at the end of each 4-week period. A cohort of 16 healthy volunteers served as control. EPCs were studied after culture on fibronectin (CFU-Hill) and collagen-1 (ECFC). RESULTS: Dialysis patients had a lower number of ECFCs than in healthy controls (P < 0.001) and a reduced fraction of vital ECFCs (P < 0.05), whereas the formation of endothelial cell colonies (ECCs) was increased (P < 0.05). Different middle molecular uraemic toxin removal had no effects on EPC numbers. The number of prototypical EPCs (CD34( +)/VEGFR2-KDR( +)/CD45( -) ECFCs) was similar between patients and controls. Correlations of plasma C-reactive protein with ECC count, CFU-Hill colony count and CD34( +)/VEGFR2-KDR( +)/CD45( -) subpopulation of both ECFC and CFU-Hill cells were observed. CONCLUSIONS: Different middle molecule removal has no effect on EPCs. Reduced vitality and enhanced ECC formation suggest growth induction of impaired EPCs in chronic renal failure and are associated with inflammation.

Feeling whole: the meaning of being consoled narrated by very old people.

Interviews with 13 people, over 85 years, with high scored Self-transcendence, were analyzed using a phenomenological hermeneutic method. The meaning of being consoled was interpreted to Feeling whole, an immediate experience of: being carried and embraced by God (Feeling connected to God), supported by the loving care and affection from others (Feeling connected to fellow beings and the world), being relaxed, peaceful and full of joy and experiencing hope (Being connected to self).