Predictive mapping of the global power system using open data.

Limited data on global power infrastructure makes it difficult to respond to challenges in electricity access and climate change. Although high-voltage data on transmission networks are often available, medium- and low-voltage data are often non-existent or unavailable. This presents a challenge for practitioners working on the electricity access agenda, power sector resilience or climate change adaptation. Using state-of-the-art algorithms in geospatial data analysis, we create a first composite map of the global power system with an open license. We find that 97% of the global population lives within 10 km of a MV line, but with large variations between regions and income levels. We show an accuracy of 75% across our validation set of 14 countries, and we demonstrate the value of these data at both a national and regional level. The results from this study pave the way for improved efforts in electricity modelling and planning and are an important step in tackling the Sustainable Development Goals.

A global multi-hazard risk analysis of road and railway infrastructure assets.

Transport infrastructure is exposed to natural hazards all around the world. Here we present the first global estimates of multi-hazard exposure and risk to road and rail infrastructure. Results reveal that ~27% of all global road and railway assets are exposed to at least one hazard and ~7.5% of all assets are exposed to a 1/100 year flood event. Global Expected Annual Damages (EAD) due to direct damage to road and railway assets range from 3.1 to 22 billion US dollars, of which ~73% is caused by surface and river flooding. Global EAD are small relative to global GDP (~0.02%). However, in some countries EAD reach 0.5 to 1% of GDP annually, which is the same order of magnitude as national transport infrastructure budgets. A cost-benefit analysis suggests that increasing flood protection would have positive returns on ~60% of roads exposed to a 1/100 year flood event.

Motivation of student radiographers in learning situations based on role-play simulation: A multicentric approach involving trainers and students.

INTRODUCTION: Role-play simulation is implemented in different radiography institutions. This tool develops Knowledge, Skills and Competences (KSC) in students. The aim of this study was to identify the strategies implemented by trainers in order to encourage student motivational dynamics and to find those that resonate with students. METHODS: Three role-play simulation sessions using a grid were observed in two different radiography institutions that have a simulation centre (two French institutions and one Swiss). In order to identify explicitly or implicitly the motivational strategies used, four interviews with trainers were conducted. To understand students' opinions about these strategies, seven interviews with radiography students were done. RESULTS: Defining motivation was not easy. The trainers used various strategies to motivate students, not all of which were verbalized in interviews. Although students said they were stressed prior to participating in role-play simulation, this study shows that such simulation sessions are effective to develop high motivational dynamics for students. CONCLUSION: This study has identified three main areas of improvement: exploring students' expectations, give importance to patients briefing so that they can fully perform their role and improving the authenticity of the environment. The latter issue can only be addressed through access to up-to-date equipment in training institutions.

A systematic review on the effectiveness of medical training therapy for subacute and chronic low back pain.

Medical training therapy (MTT) to improve muscular strength and endurance follows evidence based guidelines and is increasingly recommended to patients suffering from subacute and chronic back pain (LBP). This study investigated whether MTT was effective in reducing pain and improving function in patients with subacute or chronic LBP. Data sources were MEDLINE, EMBASE, CINAHL, Pedro, Cochrane Central Register of Controlled Trials. We included RCTs that examined exercise or MTT in adult patients with LBP compared to placebo, no intervention or other interventions. Study outcomes had to include at least one of the following: pain intensity; functional status, absenteeism. Two independent reviewers performed quality assessment. Visual analogue scale ratings ranging from 0-10 MTT quantified the MTT aspects of the intervention. Studies with rating scores >7.5 were included. We identified only 2 studies that examined the effectiveness of MTT. Both trials, one was of high quality, found MTT to decrease pain and improve function significantly better than therapy of uncertain effectiveness. There is moderate evidence that would support the effectiveness of MTT in the treatment chronic LBP. Future high quality RCT will have to clarify whether MTT is effective and would be superior to other forms of therapeutic exercise.

[Loss of visual acuity after treatment with pipamperone]. / Visusminderung nach Pipamperon-Therapie.

The butyrophenone derivative pipamperone is a neuroleptic agent administered to reduce psychomotor agitation and psychotic conditions in schizophrenic psychoses. Among other things it blocks D2 receptors in the dopamine pathways of the mesolimbic system and therefore reduces excess release of dopamine in the area thought to control psychotic experiences. Dopamine also takes part in signal transduction in the visual process. Loss of visual acuity, color vision, scotoma and electrophysiological alterations were observed under treatment with different groups of neuroleptics which interfere with dopamine metabolism but have not yet been observed after therapy with pipamperone. We present the case of a young women suffering from unilateral loss of visual acuity after treatment with pipamperone.

[Spectral domain OCT in patients with unclear uveitis]. / Spectral-domain-OCT bei unklarer Uveitis.

Presented here are two cases of patients with unclear visual loss. A diagnostic assessment with spectral domain optical coherence tomography (Sd-OCT), fluorescein angiography (FLA) and blood analyses was performed due to vitreous clouding. Characteristic FLA findings for papillitis and vasculitis and as yet undescribed morphological Sd-OCT changes in the photoreceptor layer and in the pigment epithelium were found. During the treatment of the diagnosed lues these changes were resolved. The Sd-OCT technique seems to be a useful and effective diagnostic tool for uveitis diagnostics.

Whole grain in children's diet: intake, food sources and trends.

OBJECTIVE: To quantify the intake of grain and whole grain, and their food sources, as well as to investigate the age and time trends over the last decade in a sample of German children and adolescents. METHODS: Dietary records from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study were used for conducting this work. A total of 5067 3-day weighed dietary records of 821 2- to 18-year-old children and adolescents collected between 1997 and 2008 were analysed using linear mixed-effect models, in which the means of the data and the covariance structure (children of the family, repeated measurements) were modelled. RESULTS: Mean whole-grain intake was between 20 and 33 g/day in the sample and highest in 13-18 year olds. No whole grain intake was recorded in 19% of all dietary records. Total grain intake increased significantly with age (P<0.0001), even after adjustment for energy intake. Whole-grain intake (g/day) increased significantly with age in the unadjusted model (P<0.0001). This increase disappeared after adjustment for energy intake (P>0.05) and became a negative trend after adjustment for grain intake (P<0.01). There were no significant time trends during the study period. Bread had the highest effect on grain intake in the total sample (50%), followed by rice/pasta (21%), cake (13%), grain (9%), RTECs (5%) and muesli (2%). CONCLUSIONS: The whole-grain intake in this sample of German children and adolescents was far below the FBDG. The decreasing percentage of whole grain per grain intake with age contradicts the common concept of stable dietary habits during childhood and adolescents.

Multimodal tumor therapy in a 31-year-old pregnant woman with Wilms tumor.

Wilms tumor, or nephroblastoma, is the most common malignant tumor of the urinary tract in children, but is rarely found in adults. Here, we report the first case of a female patient with a Wilms tumor, diagnosed during pregnancy, who underwent radical nephrectomy and adjuvant chemotherapy before and after delivering a healthy child. Generally, treatment should follow the guidelines established for the pediatric setting.

[Management of erectile dysfunction after radical prostatectomy. Urologists' assessment vs patient survey responses]. / Versorgung der erektilen Dysfunktion nach radikaler Prostatektomie in Deutschland. Einschätzung durch den Urologen vs. Patientenbefragung.

INTRODUCTION: The aim of this national study was to evaluate ED management after RPX (without any postoperative adjuvant therapy or tumor relapse) from the patient's view compared to the urologist's view. MATERIAL AND METHODS: In May 2003 we queried 1063 urologists and 801 patients following radical prostatectomy without adjuvant therapy. They were asked about preserved potency without erectile aid, existing wish for ED therapy, recommended or tested erectile aid (oral, transurethral, intracorporal, vacuum constriction device[VCD], penile implant) as well as the long-term use. Return rate: patients 80.1%, urologists 26.7%. RESULTS: According to the urologists' view 9.1% of their affected patients were potent postoperatively without a device, but according to the polled patients only 4.7%. The wish to be treated for erectile dysfunction existed in the urologists' opinion in 46.1% of their patients, while they considered that 44.8% had no wish for treatment. On the other hand, 59.3% of the patients would like to be treated and only 28.5% did not want any kind of treatment. Regarding the long-term use of therapy for ED, the urologists thought that 26.1% of their patients did not receive therapy for the problem, and 69.7% of the patients stated they received no long-term therapy. Only 30.3% of the patients confirmed long-term therapy, while the urologists thought that 73.9% of the patients used an erectile aid. Definite therapy in the urologists' opinion involved: oral medication in 38.4%, MUSE in 3.6%, (SKAT) in 37.3%, VCD in 20.4%, and a prosthesis in 0.3%. Indeed 19.8% of the patients used oral medication, 1.7% MUSE, 26.7% SKAT, 50.9% VCD, and 0.9% penile implant. Considering the satisfaction of patients, urologists thought that 46.2% of the patients were satisfied with their treatment of ED, but only 28.9% of the patients were actually satisfied themselves. CONCLUSIONS: The comparison of patients' and urologists' views shows a clearly different description of the ED situation after RPX. The proportion of patients with a wish for treatment and the proportion of dissatisfied patients are much higher from the patients' view. This demonstrates an undertreatment of ED patients after RPX, which should also be taken into account under the current changes in the German health care system.

Assessment of a fragment of e-cadherin as a serum biomarker with predictive value for prostate cancer.

In prostate cancer, biomarkers may provide additional value above standard clinical and pathology parameters to predict outcome after specific therapy. The purpose of this study is to evaluate an 80 kDa fragment of the cell adhesion molecule e-cadherin as a serum biomarker. A broad spectrum of prostate cancer serum samples, representing different stages of prostate cancer disease, including benign prostatic hyperplasia (BPH), localised (Loc PCA) and metastatic prostate cancer (Met PCA), was examined for the cleaved product. There is a significant difference in the expression level of the 80 kDa fragment in the serum of healthy individuals vs patients with BPH and between BPH vs Loc PCA and Met PCA (P<0.001). Highest expression levels are observed in advanced metastatic disease. In the cohort of Loc PCA cases, there was no association between the 80 kDa serum concentration and clinical parameters. Interestingly, patients with an 80 kDa level of >7.9 microg l(-1) at the time of diagnosis have a 55-fold higher risk of biochemical failure after surgery compared to those with lower levels. This is the first report of the application of an 80 kDa fragment of e-cadherin as a serum biomarker in a broad spectrum of prostate cancer cases. At an optimised cutoff, high expression at the time of diagnosis is associated with a significantly increased risk of biochemical failure, potentially supporting its use for a tailored follow-up protocol for those patients.

Sodium butyrate and tributyrin induce in vivo growth inhibition and apoptosis in human prostate cancer.

Histone deacetylase inhibitors (HDACs) are known to exhibit antiproliferative effects on various carcinoma cells. In this study, the in vivo efficiency of two HDACs, sodium butyrate and tributyrin, on prostate cancer growth inhibition were investigated. To gain an insight into the possible underlying pathways, cell culture experiments were performed focusing on the expression of p21, Rb and c-myc. For in vivo testing, prostate cancer cell lines (PC3 and TSU-Pr1) were seeded on the chorioallantois membrane (CAM) and implanted in a xenograft model using nude mice. Standard Western blot analysis was performed for protein expression of p21, Rb and c-myc in HDAC-treated vs untreated prostate cancer cells. Both sodium butyrate and tributyrin had a considerable treatment effect on microtumours on the chicken egg at already very low concentrations of 0.1 mM. Tributyrin-treated tumours showed the strongest effect with 38% apoptotic nuclei in the prostate cancer cell line PC3. In the mouse model, there was almost no difference between sodium butyrate and tributyrin. In untreated animals the tumours were almost double the size 4 weeks after implantation. Tumours of the treatment groups had a significantly lower percentage of Ki-67-positive-stained nuclei. As demonstrated by Western blot analysis, these effects seem to be independent of p53 status and a pathway via p21-Rb-c-myc is possibly involved. In this study we have demonstrated a substantial in vivo treatment effect, which can be induced by the application of sodium butyrate or the orally applicable tributyrin in human prostate cancer. The given results may provide the rationale to apply these drugs in well-controlled clinical trials in patients being at high risk of recurrence after specific therapy or in patients with locally or distant advanced prostate cancer.

Synthesis of 8-chloro-benzo[c]quinolizin-3-ones as potent and selective inhibitors of human steroid 5alpha-reductase 1.

The synthesis of a series of differently substituted 8-chloro-benzo[c]quinolizin-3-ones, as potent and selective human steroid 5alpha-reductase type 1 inhibitors, has been accomplished by a four-step procedure based on the TiCl4-promoted tandem Mannich-Michael cyclization of 2-silyloxy-1,3-butadienes with N-t-Boc iminium ions from quinolin-2-ones. The presence on the benzo[c]quinolizinone nucleus of a methyl group and a double bond at positions 6 and 4-4a, respectively, as in compound 1d, gave rise to one of the most potent non-steroidal 5alphaR-1 inhibitors reported so far (IC50 = 14 nM).

Factors contributing to hope among noninstitutionalized elderly.

The purposes of this study were to describe the level of hope and to identify predictor variables associated with hope in adults over the age of 65 years. Using a descriptive correlational design, noninstitutionalized individuals (N = 169; 67.5% female) ages 65 to 94 years (M = 75.4) were surveyed. Results showed a moderately high level of hope, suggesting that participants perceived a future that is good. A caring, health-promotion philosophy of practice, rather than an institutional philosophy of cure and treatment, may more actively support and enhance clients' hope. Social support, religious well-being, and health emerged as significant predictor variables in this study. Nursing interventions may influence these variables and, thus, enhance hope among noninstitutionalized elderly.

Religious well-being in noninstitutionalized elderly women.

Spirituality is recognized as an important component of health care practice with elderly people. Yet, discussion of the role it plays in elderly women on a day-to-day basis is minimal, and it is frequently not addressed in quality-of-life studies in this population. The purposes of this study were to describe the level of religious well-being and selected characteristics of religiosity in a sample of 114 non-institutionalized, largely rural elderly women (Mdn age = 75), as well as to identify the relationship between selected factors and the level of religious well-being. Descriptive research revealed a high level of religious well-being among the participants and significant positive correlation between religious well-being and the variables of social support and hope (p < .001). Through stepwise multiple regression, hope emerged as the single significant predictor of religious well-being (p < .001), explaining 31% of the variance in the dependent variable. The majority of respondents reported regularly participating in religious activities, highly rated the value or influence of religious beliefs in their lives, and identified that religious beliefs become increasingly important with age. Conducting a comprehensive assessment and implementing focused interventions associated with religious well-being will strengthen the scope of health care practice for elderly women.

The long-term impact on nursing students of participating in international education.

Internationalizing the nursing curriculum is essential to the education of the nurse professional prepared for the rapidly changing challenges of the 21st century. Despite recognition of this essential need, the long-term effects of international education on nursing students have not been examined. The purpose of this study was to describe the long-term impact of study abroad experiences on baccalaureate graduates. Using a descriptive survey design, data were collected from 27 alumni (88 per cent response rate) who completed the International Education Survey. Although the impact was found to decrease over time, respondents reported the highest impact in enhanced international perspective and increased personal development; lower impact was reported in the professional nurse role and intellectual development dimensions. Students who participated in longer programs (12 to 16 weeks) reported higher long-term impact than those participating in 3- to 4-week programs. Respondents' age at the time of the international education was positively correlated with personal development. No association was found between the respondents' year in college in which they participated and reported long-term impact. This study is a contribution to the efforts of those who are committed to making nursing education relevant in a global society.

An analysis of the impact of participation in an international study program on the cognitive development of senior baccalaureate nursing students.

As we move into a global society, increasing attention is being given to international and transcultural learning in higher education. The purpose of the study was to analyze the impact of participation in a 3-month international study program on the cognitive development of senior baccalaureate nursing students. Using Perry's theory of adult cognitive development as a conceptual basis and a quasi-experimental cohort design, data were collected from eight students participating in a semester abroad program in England and 20 randomly selected students not participating in the program, using the Measurement of Epistemological Reflection. The students participating in the program demonstrated significantly more cognitive growth (p = .044) and were 3.125 times as likely to advance in the Perry positions. Within a shrinking educational economy, these findings provide support for the establishment or revision of international study.

Watch your language.

Articles, papers, and other documents are the forms given to the substance of nursing knowledge. Here are some common obstacles to clear communication in written scholarship, along with some advice on how to avoid them.

The Nursing Minimum Data Set: abstraction tool for standardized, comparable, essential data.

The Nursing Minimum Data Set (NMDS) represents the first attempt to standardize the collection of essential nursing data. These minimum core data, used on a regular basis by the majority of nurses in the delivery of care across settings, can provide an accurate description of nursing diagnoses, nursing care, and nursing resources used. Collected on an ongoing basis, a standardized nursing data base will enable nurses to compare data across populations, settings, geographic areas, and time. Public health nurses will be able to evaluate and compare services. The purpose of this article is to discuss briefly the following aspects of the NMDS: background including definition, purposes, and elements; availability and reliability of the data; benefits; implications of the NMDS with emphasis on nursing research; and health policy decision making.

Survey of needs in continuing education of registered nurses in Wisconsin.

Results of a survey of continuing education (CE) needs of registered nurses in Wisconsin are presented, with a detailed description of the sampling method and instrument. Specific CE needs, levels of instruction needed, and differences in perceived needs for CE based on the educational level of the respondents are given. The two most frequently identified CE needs were legal issues in health and nursing and physical assessment. Preferred CE scheduling and reasons given by nurses for not participating in CE also are identified. The article concludes with a discussion of the study's implications.