Theologische Hochschule Chur

Zusammenfassung In der Neudefinition für professionelle Pflege und Pflegefachpersonen des International Council of Nurses (ICN) zählt Advocacy (Fürsprache) zu den Kernaufgaben von Pflege. Im deutschsprachigen Raum gibt es hierzu eine erhebliche Forschungslücke. Die vorliegende Studie exploriert erstmals, wie deutsche Pflegefachpersonen in Akutkrankenhäusern advokatorisches Handeln verstehen, welche Motive, Situationen, Strategien und Konsequenzen damit verbunden sind. Zugleich zeigt sich, dass sich advokatorisches Pflegehandeln mit Anforderungssituationen aus den Konzepten von Lebensqualität, Spiritualität und Coping in Verbindung bringen lassen. Methode: Es wurden 15 leitfadengestützte Experteninterviews mit Pflegefachpersonen sowie 3 ergänzende Interviews mit einer Ergotherapeutin, einer Medizinstudentin und einem Assistenzarzt geführt. Die Auswertung erfolgte mittels der qualitativer Inhaltsanalyse nach Kuckartz/Rädiker ( 5 2022). Ergebnisse: Zentrale Motive advokatorischen Handelns sind die Realisierung persönlicher und berufsethischer Werte. Es konnten hilfreiche und hinderliche Faktoren identifiziert werden. Die interprofessionelle Zusammenarbeit mit dem ärztlichen Dienst ist dabei von zentraler, oft konfliktbehafteter Bedeutung. Fazit: Advokatorisches Handeln ist ein bedeutsames Element professioneller Pflege in Deutschland. Die Förderung einer advokatorischen Haltung sowie unterstützender struktureller und kultureller Rahmenbedingungen ist essenziell, um die Patientenversorgung und die Arbeitszufriedenheit des Pflegepersonals nachhaltig zu verbessern. Advokatorisches Handeln fördert die Lebensqualität, Spiritualität und Coping-Bestrebungen der anvertrauten Menschen, auch wenn die deutsche Übersetzung der Neudefinition des ICN Spiritual Care nicht als Teilaufgabe professioneller Pflege ausweist.

Invasive mechanical ventilation (MV) is often a lifesaving intervention in patients with traumatic brain injury (TBI) to optimize gas exchange and prevent secondary brain injury, thereby avoiding the deleterious effects of both hypoxia and hyperoxia, as well as hypocapnia and hypercapnia. However, MV in these patients represents a unique clinical challenge, as it must take into account multiple parameters, including cerebral autoregulation and autoregulatory reserves, brain compliance, cerebral dynamics such as intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral blood flow (CBF), as well as systemic hemodynamics and respiratory system mechanics. Moreover, the detrimental effects of MV on extracranial organs and systems are well established, with the lungs being the most vulnerable, particularly when non-protective ventilation strategies involving high tidal volumes (TV) and inspiratory pressures are applied. Currently, the optimal ventilation approach in patients with TBI, with or without LI, remains incompletely defined. While protective ventilation practices are recommended for a large number of critically ill patients, their application in individuals with acute brain injury (ABI) may adversely affect cerebral and systemic hemodynamics, as well as brain physiology, potentially leading to secondary damage and poor clinical outcomes. Because the consequences of TBI, such as secondary brain damage and lung complications, begin shortly after the primary event, the role of prehospital MV in these patients is crucial. However, existing data from the out-of-hospital setting are scarce. Thus, in the present review, we aim to summarize the available evidence on MV in patients with TBI, with an emphasis on the prehospital setting.

Large-scale language models (LLMs) have basically changed the limits of what can be achieved by natural language processing and this was the case of GPT-3 at its very first demonstration back in 2020. This study outlines in detail their journey. It goes through all the concepts of their architecture. Besides, it describes the training process. The article records the gradual increasing of their volumetry and the consequent differences of their properties along the way. Different methods of testing these models are also indicated. Besides, it refers to their application in various fields. Besides, this research work deals with the advent of multi-modal systems capable of autonomous decision-making. We have centered our work on the landmark research that has been published in the period of 2022–2024. We reckon the self-supervised pre-training, instruction tuning, preference optimization, and reasoning-directed reinforcement learning as four main areas that contributed to the development of LLMs. These approaches have converted LLMs to be no longer just the text generators but rather the most versatile AI systems that they are. Our focus is on their use in the medical field and bioinformatics. We address the challenge of explaining the functioning of large language models (LLMs). We tell the story of in-context learning. We discuss the development of LLMs-based agents. At the end, we are identifying the major limitations of the present-time and, simultaneously, suggesting a few ideas for the future in this fast-evolving area.

The Kyaukphyu Special Economic Zone (KSEZ) in Myanmar is part of China’s massive international development strategy known as the Belt and Road Initiative (BRI). To advance the KSEZ, the Chinese state-owned enterprise (SOE) China International Trust and Investment Corporation (CITIC) has asserted its commitment to the principles of corporate social responsibility (CSR). In this paper, we investigate how CITIC’s CSR practices are perceived by two groups of local non-state stakeholders: Myanmar villagers and civil society organizations (CSOs). To this end, we conducted 31 qualitative interviews with non-state stakeholders in Kyaukphyu Township between March 2022 and October 2023. According to our interview results, there is a substantial though not universal local perception that CITIC’s publicly broadcast commitment to CSR has served primarily to advance the KSEZ and left the concerns of local residents largely unaddressed. By examining CITIC’s stated commitment and its actual commitment to CSR as perceived by the local non-state stakeholders, we aim in this study to deepen our understanding of the business practices of Chinese SOEs in overseas investments and to enrich the research on the BRI in Myanmar.

Đặt vấn đề : Ung thư thực quản (UTTQ) là loại ung thư phổ biến ở các nước Châu Á, thường gặp ở nam giới. Nguyên nhân của UTTQ đến nay vẫn chưa được làm rõ. Tuy nhiên có nhiều yếu tố nguy cơ của UTTQ như: thuốc lá, uống nhiều rượu, bệnh lý trào ngược dạ dày thực quản,... Việc chẩn đoán di căn xa trong UTTQ có vai trò quan trọng trong quyết định phương pháp điều trị và phẫu thuật của các nhà ngoại khoa. Do vậy, hiện nay phương pháp chọc hút tế bào bằng kim nhỏ hạch cổ di căn trong UTTQ dưới hướng dẫn của siêu âm được áp dụng rộng rãi và đóng vai trò quan trọng trong việc chẩn đoán khối u lành tính hay ác tính. Điều này giúp cho các bác sĩ lâm sàng có cơ sở vững chắc để đưa ra những chỉ định, phương pháp điều trị hợp lý .Mục tiêu: Mô tả đặc điểm hình ảnh siêu âm gợi ý ác tính và lành tính của hạch cổ di căn từ UTTQ. Khảo sát giá trị của chọc hút tế bào bằng kim nhỏ (FNA) trong hạch cổ di căn từ UTTQ.Đối tượng và phương pháp nghiên cứu: 20 bệnh nhân được chẩn đoán UTTQ và siêu âm phát hiện có hạch cổ nghi ngờ ác tính, từ tháng 4/2012 đến 6/2013. Các bệnh nhân được khảo sát siêu âm 2D Mode, tiến hành chọc hút tế bào bằng kim nhỏ vớ i khối hạch nghi ngờ (FNA), tế bào học tại Khoa Thăm Dò Chức Năng siêu âm và Khoa Giải Phẫu Bệnh Bệnh viện Trung ương Huế (BVTW Huế ). Chúng tôi phân chia kết quả chẩn đoán thành 2 nhóm: nhóm lành tính và nhóm ác tính.Kết quả : Trong 20 bệnh nhân có 8 trường hợ p được chẩn đoán hạch ác tính di căn từ UTTQ, 12 bệnh nhân còn lại được chẩn đoán hạch viêm phản ứng lành tính. Trong nghiên cứu của chúng tôi, các dấu hiệu gợi ý ác tính trên siêu âm là : giảm hồi âm, không đồng nhất, mất dấu hiệu tăng âm của mỡ ở rốn hạch, bờ không đều, kích thước khoảng 10mm đường kính (trục ngắn), hình tròn, số lượng nhiều. Độ nhạy, độ đặc hiệu và giá trị tiên đoán dương tính cao: Se= 80%, Sp= 100%, PPV= 100%, không có âm tính giả .Kết luận: Sự kết hợp giữa siêu âm FNA và GPB có giá trị trong chẩn đoán các hạch cổ nghi ngờ ác tính di căn từ UTTQ. Đây còn là một phương pháp an toàn, đơn giản cho nhưng bệnh nhân đã được chẩn đoán bệnh, đánh giá giai đoạ n và điều trị tiếp theo.

Photo-chemically induced dynamic nuclear polarization (photo-CIDNP) is a promising solution to the inherent lack of sensitivity in NMR spectroscopy. It is particularly interesting in biological systems since it operates in water, at room temperature, and it can be repeated if the bleaching of the system can be controlled. However, the photo-CIDNP signal enhancement is well below those of other hyperpolarization techniques. While DNP, PHIP, and SABRE reach polarization enhancements of 103 to 104-fold, photo-CIDNP enhancement is typically only one order of magnitude for 1H and two orders of magnitude for 13C in the amino-acids tryptophan and tyrosine. Here we report on a photo-oxidation product of tryptophan that is strongly photo-CIDNP active under continuous wave light irradiation. In conjunction with the dye Atto Thio 12, a 1H signal enhancement of 120-fold was observed on a 600 MHz spectrometer, while at 200 MHz the enhancement was 380-fold. These enhancements in signal to noise correspond to a reduction in measurement time of 14 400-fold and 144 400-fold, respectively. The enhancement for 13C is estimated to be over 1200-fold at 600 MHz which corresponds to an impressive measurement time reduction of 1 440 000-fold. This photo-CIDNP active oxidation product of tryptophan has been identified to be 3α-hydroxypyrroloindole. The reasons for its improved signal enhancement compared to tryptophan have been further investigated.

Cognitive deficits are common, long-term sequelae in children and adolescents with congenital heart disease (CHD) who have undergone surgical palliation. However, there is a lack of a validated brief cognitive screening tool appropriate for the outpatient setting for adolescents with CHD. One candidate instrument is the Montreal Cognitive Assessment (MoCA) questionnaire. The purpose of the research was to validate scores from the MoCA against the General Memory Index (GMI) of the Wide Range Assessment of Memory and Learning, 2nd Edition (WRAML2), a widely accepted measure of cognition/memory, in adolescents and young adults with CHD. We administered the MoCA and the WRAML2 to 156 adolescents and young adults ages 14-21 (80 youth with CHD and 76 healthy controls who were gender and age matched). Spearman's rank order correlations were used to assess concurrent validity. To assess construct validity, the Mann-Whitney U test was used to compare differences in scores in youth with CHD and the healthy control group. Receiver operating characteristic curves were created and area under the curve, sensitivity, specificity, positive predictive value, and negative predictive value were also calculated. The MoCA median scores in the CHD versus healthy controls were (23, range 15-29 vs. 28, range 22-30; p < .001), respectively. With the screening cutoff scores at <26 points for the MoCA and 85 for GMI (<1 SD, M = 100, SD = 15), the CHD versus healthy control groups showed sensitivity of .96 and specificity of .67 versus sensitivity of .75 and specificity of .90, respectively, in the detection of cognitive deficits. A cutoff score of 26 on the MoCA was optimal in the CHD group; a cutoff of 25 had similar properties except for a lower negative predictive value. The area under the receiver operating characteristic curve (95% CI) for the MoCA was 0.84 (95% CI [0.75, 0.93], p < .001) and 0.84 (95% CI [0.62, 1.00], p = .02) for the CHD and controls, respectively. Scores on the MoCA were valid for screening to detect cognitive deficits in adolescents and young adults aged 14-21 with CHD when a cutoff score of 26 is used to differentiate youth with and without significant cognitive impairment. Future studies are needed in other adolescent disease groups with known cognitive deficits and healthy populations to explore the generalizability of validity of MoCA scores in adolescents and young adults.

Abstract. While several studies have investigated winter-time air pollution with a wide range of concentration levels, hardly any results are available for longer time periods covering several winter-smog episodes at various locations; e.g., often only a few weeks from a single winter are investigated. Here, we present source apportionment results of winter-smog episodes from 16 air pollution monitoring stations across Switzerland from five consecutive winters. Radiocarbon (14C) analyses of the elemental (EC) and organic (OC) carbon fractions, as well as levoglucosan, major water-soluble ionic species and gas-phase pollutant measurements were used to characterize the different sources of PM10. The most important contributions to PM10 during winter-smog episodes in Switzerland were on average the secondary inorganic constituents (sum of nitrate, sulfate and ammonium = 41 ± 15%) followed by organic matter (OM) (34 ± 13%) and EC (5 ± 2%). The non-fossil fractions of OC (fNF,OC) ranged on average from 69 to 85 and 80 to 95% for stations north and south of the Alps, respectively, showing that traffic contributes on average only up to ~ 30% to OC. The non-fossil fraction of EC (fNF,EC), entirely attributable to primary wood burning, was on average 42 ± 13 and 49 ± 15% for north and south of the Alps, respectively. While a high correlation was observed between fossil EC and nitrogen oxides, both primarily emitted by traffic, these species did not significantly correlate with fossil OC (OCF), which seems to suggest that a considerable amount of OCF is secondary, from fossil precursors. Elevated fNF,EC and fNF,OC values and the high correlation of the latter with other wood burning markers, including levoglucosan and water soluble potassium (K+) indicate that residential wood burning is the major source of carbonaceous aerosols during winter-smog episodes in Switzerland. The inspection of the non-fossil OC and EC levels and the relation with levoglucosan and water-soluble K+ shows different ratios for stations north and south of the Alps (most likely because of differences in burning technologies) for these two regions in Switzerland.

Particle suspensions are ubiquitous in our daily life, but are not well understood due to their complexity. During the last twenty years, various simulation methods have been developed in order to model these systems. Due to varying properties of the solved particles and the solvents, one has to choose the simulation method properly in order to use the available compute resources most effectively with resolving the system as well as needed. Various techniques for the simulation of particle suspensions have been implemented at the Institute for Computational Physics allowing us to study the properties of clay-like systems, where Brownian motion is important, more macroscopic particles like glass spheres or fibers solved in liquids, or even the pneumatic transport of powders in pipes. In this paper we will present the various methods we applied and developed and discuss their individual advantages.

SummaryParticle suspensions are ubiquitous in our daily life, but are not well understood due to their complexity. During the last twenty years, various simulation methods have been developed in order to model these systems. Due to varying properties of the solved particles and the solvents, one has to choose the simulation method properly in order to use the available compute resources most effectively with resolving the system as well as needed. Various techniques for the simulation of particle suspensions have been implemented at the Institute for Computational Physics allowing us to study the properties of clay-like systems, where Brownian motion is important, more macroscopic particles like glass spheres or fibers solved in liquids, or even the pneumatic transport of powders in pipes. In this paper we will present the various methods we applied and developed and discuss their individual advantages.