Nursing is a stressful occupation, which can often lead to compassion fatigue (CF) and turnover intention (TI). When their basic psychological needs (BPN) of competence, relatedness, and autonomy are not met, registered nurses (RNs) may develop a higher propensity to experience CF and TI. Amid projected nursing shortages, the loss of these health care providers may threaten the quality of patient care. Although there is research on BPN and their relationship with well-being and functioning, research is lacking on the relationship between BPN satisfaction, CF and TI among RNs. Researchers have also not examined whether RNs' BPN satisfaction moderates the relationship between CF and TI. To examine these relationships, a quantitative study based on self-determination theory was conducted. A convenience sample of 99 RNs from a nursing association in southern Arizona completed 3 online instruments: Basic Need Satisfaction at Work Scale, Turnover Intention Scale, and Professional Quality of Life Scale Version 5. Linear, correlational, multiple, and step-wise regression analyses were used for testing the study's four hypotheses. Results showed that the BPN of autonomy and competence were related to CF, and all three BPN were related to TI. Additional analysis showed that CF and TI were only marginally related. Results from multiple regression analysis revealed that only 2 predictors, competence and autonomy, significantly predicted TI. Social change implications include the potential to recognize the significance of meeting RNs' BPN, and a consequent reduction of both CF and TI, thus potentially contributing to improved patient care as well as increased productivity and morale.

In a Midwest school district, school personnel and students are concerned that the Extra School Time (EST) program student enrollment is declining. The purpose of this qualitative case study was to explore teacher, administrator, and adult age student perceptions to gain a deeper understanding of the problem leading to declining enrollment in the EST program. Using Lewin's holistic model of systemic leadership and evaluation of programs, teachers', students' and administrators' perceptions of factors, processes for support, curriculum needs, and actions to improve implementation of the EST program were explored. Using a qualitative case study, data were collected via semi-structured interviews and a survey of 9 purposefully sampled participants. Sampling criteria included being a current or former adult age student who attended the EST program, current EST teacher, and EST administrators. Data from semi-structured interviews and surveys were triangulated and analyzed using inductive and comparative coding, and a constant comparative analysis method. Emerging themes were coded using axial coding. Six themes emerged: lack of child care, transportation, work conflict with class attendance, convenience of times classes were offered, and offering courses that were relevant to the student. A 24-hour faculty professional development program was developed to educate EST faculty and staff on the issues influencing declining EST enrollment and develop strategies and actions to improve implementation of the EST program by addressing student and teacher needs. Positive social change from this study may include increased graduation rates, meaningful employment for EST participants, college entrance, and employment growth for the local community.

The purpose of this study was to compare seventh-grade students' motivation and preference toward text-based programming using Visual Basic, and graphics-based programming using Robolab. Motivation was defined by the My Class Activities questionnaire using the dimensions of interest, challenge, choice, and enjoyment. Preference was determined through team and individual student choice. This study was conducted with 122 students from three 6-week technology education classes. This study examined two hypotheses. First, middles school students will be more motivated when using a graphics-based programming language than text-based as measured by the My Class Activities survey. The second hypothesis for this study was that middle school students preferred using graphic-based programming more than using text-based programming in an introductory experience. Student preference was identified individually and within a team environment.

The COVID-19 pandemic has negatively affected everyone in the world, however the phenomenon of growth following intense suffering has been well-documented over the past few decades (e.g., Tedeschi et al., 2018). Less research has been able to explain why some experience growth from trauma while others do not. Drawing from Joseph and Linley’s (2005) Organismic Valuing Theory model of posttraumatic growth, we examined the role of the basic psychological needs of autonomy, competence, and relatedness (during the onset of the pandemic and currently) in fostering posttraumatic growth. Participants (N = 289) completed an online survey assessing the impact of the pandemic, basic psychological needs, and posttraumatic growth. We hypothesized that participants with greater satisfaction of basic psychological needs during the onset of the pandemic and currently would report greater posttraumatic growth. We found that current satisfaction of psychological needs significantly predicted posttraumatic growth (β = .42, p < .001) whereas satisfaction of psychological needs at onset did not. Secondary analyses of the impact of each need (current and at onset) on posttraumatic growth revealed that current autonomy support significantly predicted posttraumatic growth above and beyond the other needs across both time points (β = .29, p < .001). Interpretations of these results are discussed, and implications and limitations of the study are addressed. / Graduate / 2023-12-31

Cultured bovine aortic endothelial (BAE) cells were found to synthesize and secrete heparan sulfate proteoglycans (HSPG), which bound basic fibrobalst growth factor (bFGF). bFGF is a known mitogen for vascular smooth muscle cells, and is indicated to have a role in some proliferative vascular disorders. In the present study, we have purified proteoglycans from BAE cells conditioned media (BAE PG), and further separated the PG into two fractions, PG-I and PG-II, by ion exchange chromatography on a Q-Sepharose column using a linear salt gradient (0.15 M to 1.2 M). PG-I and PG-II elute at 0.85M salt and 0.1M salt respectively. BAE PG is primarily composed of heparan sulfate, which is accessible to the digestion of Heparinase I/III and nitrous acid treatment; and a small amount of chondroitin sulfate, which can be digested by Chondroitinase ABC. Gel filtration chromatography (Sepharose CL-2B and CL-4B columns) showed that BAE PG consisted of two different sized peaks, and had an average molecular weight of approximately 5 x 10⁵ Da. SDS-PAGE with silver staining indicated that BAE PG had two core proteins with estimated sizes of 300kDa and 320kDa, which corresponded to the core protein of PG-I and PG-II respectively. Western blotting with anti-perlecan primary antibody recognized the core proteins of BAE PG. Size exclusion chromatography (Sepharose CL-6B column) following β-elimination showed that BAE PG had GAG chains with an estimated size less than 2 x 10⁵ Da. A protocol to investigate the cell free binding of bFGF with purified BAE PG was established using the BioRad Bio-Dot apparatus - the cationic filtration assay (CAFAS). Using a simple monovalent binding model, we obtained values for the equilibrium dissociation constant, K_D, of (1.6 ± 0.8) x 10⁻¹⁰ M; the dissociation rate constant, k_r, of 0.01 min⁻¹; the association rate constant, k_f, of 6.2 x 10⁷ M⁻¹min⁻¹ and the total binding sites of the proteoglycan, R_T, of 0.1~0.2 (# of site)/(molecule of PG). The comparison of experimental data with model predictions indicates that when the number of binding sites provided by the PG is similar or greater than that of bFGF, the monovalent binding model is valid. When the number of binding sites is less than that of bFGF, one possibility is that the binding might not be the described simple monovalent reaction, and bFGF might bind to the PG as dimers or oligomers. In addition, a model is proposed for BAE PG, in which 5 ~ 10 BAE PG molecules form a high affinity binding site for bFGF. Experimentally we find that exogenous heparan sulfate competes with BAE PG for binding with bFGF, while chondroitin sulfate seems to facilitate the binding. This result may be a useful consideration when we want to design possible pharmaceutical compounds. / Master of Science

京都大学 / 0048 / 新制・課程博士 / 博士(農学) / 甲第20430号 / 農博第2215号 / 新制||農||1048(附属図書館) / 学位論文||H29||N5051(農学部図書室) / 京都大学大学院農学研究科食品生物科学専攻 / (主査)教授 谷 史人, 教授 安達 修二, 教授 松村 康生 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

Background: Around two thirds of the Swedish population use prescripted drugs and usage usually increases with age. Along with increasing age and more prescriptions, the risk of side effects and interactions also increases. Drug-related problems (DRP) causes suffering of inviduals and is also associated with high costs for the society. A previous study has shown that discrepancies in prescription lists are common, which can pose a significant risk of DRP. Accurate drug information increases the chance that the right medicine will be dispensed at the right time, at the right dose, to the right person and that the patient will use it correctly. Aim: The aim of this study was to investigate the presence of discrepancies in prescription lists, defined as outdated prescriptions, duplicates, incorrect dosage and uncertainty, as well as the extent to which prescriptions for current drug treatment were missing. The secondary purpose was to investigate how sure pharmacy customers felt about their medicine – what medicine to use, how to use them and why. Methods: An interview study was conducted at nine pharmacies, in six different cities in Sweden, during spring 2021. Inclusion criteria were pharmacy customers over the age of 18 who picked up medicines for themselves, spoke Swedish and had three or more prescriptions. Exclusion criteria were customer with multidose-dispensed drugs (ApoDos) or an agent. An interview guide was used together with a printing of the prescription list for pharmaceutical review. Written informed consent was obtained from the participants before the start of the interview. Result: 485 people met the inclusion criteria. The loss was 232 people (48 %). Out of 253 participants, 63,2 % had at least one discrepancy in prescription list and the number of discrepancies ranged from 1-16 per person for these. Only 36,8 % of participants had a completely correct prescription list. Out of a total of 2084 prescriptions, 463 prescriptions (22 %) had some form of discrepancy, the most common of which was “Duplicates” (n = 195) and “Outdated prescription” (n = 193), followed by “Incorrect dosage” (n = 71) and “Uncertainty” (n = 4). 86 participants (34 %) lacked a prescription for current treatment, a total of 131 prescriptions were missing. Participants felt very confident about their drug use. 83,8 % felt completely confident about which medicines to use, 95,3 % about how to use them and 88,9 % about why. Conclusions: The conclusions that can be drawn from this study are that discrepancies are quite common in the prescription lists as discrepancies were found in every fifth prescription. The most frequent discrepancies were outdated prescriptions and duplicates thus increasing the risk for medication errors and/or overdoses. Around one third of the participants were missing some prescriptions. These discrepancies in prescription lists can be a huge problem and also a safety issue if the patients rely solely on this information in the lists. Moreover, this study also showed that, in spite of the discrepancies, the patients felt very sure about which medicine to use and also how to use them and why. / Bakgrund: Två tredjedelar av den svenska befolkningen använder receptbelagda läkemedel och högst är användnignen hos de äldre. Med stigande ålder och fler recept ökar risken för biverkningar och interaktioner. Läkemedelsrelaterade problem (LRP) kostar samhället pengar och individen lidande. Tidigare studier har visat att avvikelser i receptlistor är vanliga, vilket kan utgöra risk för läkemedelsfel. Korrekt information ökar chansen att läkemedel förskrivs, expedieras och används rätt av patienten.  Syfte: Syftet med den här studien var att undersöka avvikelser i receptlistan ”Mina sparade recept” (MSR) på apotek, definierade som inaktuella recept, dubbletter, felaktig dosering och oklarhet, samt i vilken utsträckning recept saknades. Sekundärt syfte var att undersöka hur säkra apotekskunder kände sig kring sin läkemedelsanvändning – vilka läkemedel de skulle använda, hur och varför.  Metod: En intervjustudie genomfördes på nio apotek i sex städer i Sverige våren 2021. Inklusions-kriterier var apotekskunder över 18 år som hämtade läkemedel till sig själva, talade svenska och hade tre eller fler recept. Exklusionskriterier var doskunder och ombud. Deltagarna lämnade skriftligt informerat samtycke. Studien genomfördes innan Nationella läkemedelslistan (NLL) infördes.  Resultat: Totalt uppfyllde 485 personer inklusionskriterierna, bortfallet var 47,8 %. Av 253 deltagare hade 63,2 % minst en avvikelse i MSR och antalet avvikelser varierade mellan 1-16 per person för dessa. Endast 36,8 % hade en korrekt receptlista. Av totalt 2084 recept innehöll 463 recept (22,2 %) någon form av avvikelse, varav det vanligaste var ”Dubblett” (n=195) och ”Inaktuellt recept” (n=193). 34,0 % av deltagarna saknade recept och totalt saknades 131 recept. Deltagarna kände sig väldigt säkra på sin läkemedelsanvändning. 83,8 % kände sig helt och hållet säkra på vilka läkemedel de skulle använda, 95,3 % på hur de skulle använda dem och 88,9 % på varför. Slutsats: Studien visade att avvikelser fortfarande är vanligt förekommande i MSR då var femte recept utgjorde en avvikelse. Inaktuella recept och dubbletter var vanligast, vilket kan utgöra en risk för felmedicinering och överdosering. Saknade recept förekom hos en tredjedel av deltagarna. Dessa fel i MSR kan utgöra ett problem om patienter förlitar sig på denna informationskälla. Studien visade samtidigt att deltagarna kände sig väldigt säkra på vilka läkemedel de skulle använda, hur och varför.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is the seventh member of the coronavirus family distinct from MERS-CoV (Middle East respiratory syndrome). At the end of December 2019, the virus first emerged in Wuhan, China, The disease which   was named the coronavirus disease (COVID-19) by the World Health Organization. The disease has led to considerable healthcare burden, mortality and affected the world economy. The combination of cytokine release syndrome, acute respiratory distress syndrome (ARDS) and multiorgan failure can result in high mortality in COVID-19 patients. The inflammatory process and viral activity can cause pneumonia and eventually cause ARDS, which is a serious inflammatory condition. Glucocorticoids may help with COVID-19 due to their anti-inflammatory effects. Methylprednisolone (MP) and dexamethasone are  glucocorticoids suggested to reduce mortality in COVID-19 patients. Tocilizumab is a humanized monoclonal antibody against the IL-6 receptor. It acts as an immunosuppressant and interleukin inhibitor.  Aim: The study was performed to investigate whether methylprednisolone can reduce the risk of mortality in COVID -19 patients.  Material &amp; Metod: Relevant scientific clinical randomized trials were searched using the Pubmed medical database and the searches were performed with the search term "Methylprednisolone AND COVID -19" with the article type filter "Randomized Controlled Trial". The studies that were selected were between 2020- 2022. The search gave 14 articles and 4 articles were selected.  Results: The effect of methylprednisolone to reduce the risk of mortality in COVID -19 patients was investigated in the four clinical studies and the results showed a reduction in mortality at day 45 in patients treated with MP alone compared to the control group and MP plus tocilizumab. Study II also showed reduced mortality indicated in the per protocol analysis with a risk reduction of 0.42. In study III investigating the effect of 250 mg MP versus 6 mg dexamethasone, no statistically significant reduction in mortality was shown. In contrast, in study IV, less mortality (18.6%) was reported in the MP group compared to the control group receiving dexamethasone (37.5%), but the difference was not statistically significant (p=0.076). Discussion: The selected articles reported varying results regarding the effect of methylprednisolone on mortality. The majority showed that methylprednisolone can reduce the risk of mortality in COVID-19 patients, in addition, however, further clinical studies with a larger study population and a longer treatment course are needed.

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