Bakgrund: Varje år examineras över 4000 sjuksköterskor i Sverige. De blivande sjuksköterskorna beskriver rädsla och stress relaterat till den kommande yrkesrollen, men känner sig ändå redo för yrkeslivet. Syfte: Att beskriva nyutexaminerade sjuksköterskors upplevelser under första året som yrkesverksamma. Metod: Allmän litteraturstudie utförd på ett systematiskt sätt. Resultatet bygger på en manifest innehållsanalys baserat på tjugo vetenskapliga artiklar samt två doktorsavhandlingar. Resultat: Övergången från student till yrkesverksam upplevs ofta som traumatisk och de nyutexaminerade sjuksköterskorna känner sig dåligt förberedda för verkligheten som legitimerad sjuksköterska. De finner att ansvaret är större än de tidigare uppfattat, en konstant tidsbrist samt att det var svårt att bli socialt accepterad på avdelningen. Diskussion: De centrala fynd som diskuterades är verklighetschocken, svårigheterna med att passa in på avdelningen samt den ifrågasatta kompetensen. Slutsats: Det första året upplevdes som påfrestande och det blev tydligt för författarna att något bör göras för att underlätta övergången. / Background: Every year over 4000 new registered nurses graduates in Sweden. The nurses to-be describe fear and stress related to the upcoming role, but still they feel ready for the nursing profession. Aim: To describe new graduate nurses experiences during first year of practice. Method: Literature review done systematically. The result is based on twenty scientific articles and two dissertations and interpreted with a manifest content analysis. Result: The transition from student to registered nurse is often perceived as traumatic and the new graduated nurses feel inadequately prepared for the reality as a registered nurse. They found the responsibility to be greater then they previously had perceived, a constant lack of time and it´s hard to be socially accepted on the ward. Discussion: Central key findings that were discussed are reality shock, difficulties to fit in on the wards and the questioned competence. Conclusion: The first year was experienced as stressful and it became clearly to the authors that something should be done to facilitate the transition.

The shock compression of Reactive Particle Metal Mixtures (RPMMs) is studied at the microscale by direct numerical simulation. Mixture microstructures are rendered explicitly, providing spatial resolution of the coupled thermal, mechanical, and chemical responses at the particle level during shock compression. A polymer-bonded aluminum-iron oxide thermite system is the focus of this work; however, the computational methods developed here may be extended to other reactive particle systems. Shock waves are propagated through the mixtures in finite element simulations, where Eulerian formulations are used to handle the highly-dynamic nature of particulate shock compression. Thermo-mechano-chemical responses are computed for a set of mixture classes (20% and 50% epoxy content by weight) subjected to a range of dynamic loading conditions (particle velocities ranging from 0.300??00 km/s). Two critical sub-problems are addressed: (i) the calculation of Hugoniot data for variable mixture compositions and (ii) the prediction of sites that experience microscale reaction initiation. Hugoniot calculations are in excellent agreement with experimental data. Microscale reaction initiation sites are predicted in certain load cases for each mixture class, although such predictions cannot currently be validated by experimental methods.

The enforcement of national health insurance brings the new transition of medical service. The main purpose of this study is to investigate patients¡¦ emphasis and satisfaction on different dimension of service quality. The study referred to industrial views, related literature review and 5Qs model (Zineldin, 2006). Eventually, the practical research results are used to conduct a competitive niche strategy and a positioning plan of extracorporeal shock wave lithotripsy market to seek the unique value of medical service differentiation. According to the empirical view, the satisfaction and loyalty of those patients who had operations under the hospital treatment were significantly higher than those patients who didn¡¦t. ¡§Quality of atmosphere¡¨ and ¡§Quality of infrastructure¡¨ were the two factors which had positive impact on the satisfaction of patients. Also, ¡§Quality of medical care interaction¡¨ and ¡§Quality of atmosphere¡¨ affected the loyalty of patients greatly. Therefore, this study suggested that doctors should provide professional medical services to offer unique attributes which were valued by patients, and then achieved the influence of word-of-mouth marketing. The Competitive strategy is (1) from standardization to differentiation: creating values to patients by standard operation procedure. (2) from selfish departmentalism to patient-orientation: providing more interactions during medical service to fulfill the cognitive and emotional needs of patients. (3) from tradition to innovation: carrying out a new model which was designed by whole new ideas to supply medical service with sustainable competitive advantage. (4) from closed to open environment: emphasizing on profession and abandoning asymmetric information to develop trust relationship between doctors and patients. The strategic positioning of ESWL is to provide cordial, effective and fast integrated medical service for patients, and the establishment of ¡§Shock Wave Lithotripsy Center¡¨ is the further step of this strategy.

Purpose: Excessive day time sleepiness, sleep disorders and neurobehavior changes are common clinical observations in the patients with epilepsy. From literature review, they were highly related with epilepsy risk characteristics (age of onset, types or numbers of drugs, seizure frequency), co-morbidities or neuronal network changes. The serological biomarkers have been reported to reflect the phenomenon of seizure, while their correlations with neurobehavior changes were still not concluded. There were two purposes of this thesis. (1) To understand the relationship between sleep disturbance with day time performances (2) To understand the relationships between serological biomarkers, neurobehavior performances and neuronal networks in patients with temporal lobe epilepsy. Material and Methods: The study enrolled patients from epilepsy outpatient clinic. By using self-appreciated questionnaire (The Pittsburgh Sleep Quality Index, The Epworth Sleepiness Scale, Euroqol Quality of Life Scale-5D), we collected the characteristics of sleep related behavior and life quality changes and explored the relationship with epilepsy risk characteristics. In patients with temporal lobe epilepsy, we assessed the neurobehavior performances, measured the serological biomarkers (heat shock protein 70, S100£]protein, neuron specific enolase, brain derived neurotrophic factor, plasma and mitochondrial DNA) and brain magnetic resonance imaging. In statistical analysis, we compared the differences with age matched controls or performed correlation analysis among the parameters Result: One hundred and seventeen patients with epilepsy completed the sleep quality questionnaires. The results showed that 20 percent of patients had day time sleepiness, while the sleep disorder was prolong sleep latency and impaired sleep efficiency. In epilepsy characteristics, patients with complex partial seizure, intractable seizure or with multi-pharmacy were related with poor sleep quality. A total of 34 patients completed the serological, neurobehavior and brain magnetic resonance analysis. The results showed that patients with temporal lobe epilepsy had higher heat shock protein 70 and S100£]protein levels, while those with attacks more than twice per month had significant higher heat shock protein 70, S100£]protein and neuron specific enolase levels. Compared with the matched controls, the regions showing atrophy included hippocampus and parahippocampus, putamen, thalamus and supplementary motor areas. In correlation study, only heat shock protein 70 showed an inverse correlation with hippocampal volume (R square = 0.22, p = 0.007) after controlling for the effect of age. Conclusion: The study suggested that epilepsy risk characteristics, serological biomarkers, brain atrophic regions were important factors for day time sleepiness, sleep disturbances and neurobehavior changes in patients with epilepsy.

In eukaryotic cells, most proteins in the cytosol and nucleus are degraded via the ubiquitin-proteasome pathway. Ubiquitin is best known for its role in targeting proteins for degradation by the proteasome. Ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) is found specifically in central and peripheral neurons, and is responsible for the removal of small peptide fragments from the ubiquitin chain and for co-translational processing of ubiquitin gene products to generate free monomeric ubiquitin. In response to extreme conditions, cells exhibit an up-regulation of heat shock protein (HSP) expression, which contributes to repair and protective mechanisms. Within the HSP family, HSP70 is the major inducible member that protects against cell death. Based on the pharmacologic property of organophosphates as an inhibitor of cholinesterase, it is generally contended that manifestations of organophosphate poisoning, including secretion and muscle fasciculation, stupor, cardiopulmonary collapse, respiratory failure, coma or death, result from accumulation of, and over-stimulation by acetylcholine at peripheral of central synapses. One approach in furthering our understanding on organophosphate poisoning is delineation of its potential protective mechanisms. In this regard, the information on the cellular and molecular mechanisms that underlie organophosphate poisoning has received attention. Our laboratory demonstrated previously that a crucial brain site via which mevinphos (Mev), an organophosphate insecticide of the P=O type, acts is the rostral ventrolateral medulla (RVLM), the medullary origin of premotor sympathetic neurons that are responsible for the maintenance of vasomotor tone. The phasic changes in cardiovascular events over the course of acute Mev intoxication also parallel fluctuations of the ¡§life-and-death¡¨ signals that emanate form the RVLM. Based on a rat model of organophosphate poisoning that provides continuous information on cellular and molecular mechanisms in the RVLM, the present study was undertaken to evaluate whether changes in protein level of UCH-L1 or HSP70 are associated with death arising from Mev intoxication. We also evaluated the efficacy of both of them in the neuroprotection against fatality during Mev intoxication. The first part of this study investigated whether UCH-L1 plays a neuroprotective role at the RVLM, where Mev acts to elicit cardiovascular toxicity. In Sprague-Dawley rats maintained under propofol anesthesia, Mev (960 µg/kg, i.v.) induced a parallel and progressive augmentation in UCH-L1 or ubiquitin expression at the ventrolateral medulla during the course of Mev intoxication. The increase in UCH-L1 level was significantly blunted on pretreatment with microinjection bilaterally into the RVLM of a transcription inhibitor, actinomycin D (5 nmol) or a translation inhibitor, cycloheximide (20 nmol). Compared to artificial cerebrospinal fluid (aCSF) or sense uch-L1 oligonucleotide (100 pmol) pretreatment, microinjection of an antisense uch-L1 oligonucleotide (100 pmol) bilaterally into the RVLM significantly increased mortality, reduced the duration of the phase I (¡§pro- life¡¨ phase), blunted the increase in ubiquitin expression in ventrolateral medulla, and augmented the induced hypotension in rats that received Mev. The second part of this study investigated whether HSP70 plays a neuroprotective role at the RVLM. Intravenous administration of Mev (960

Chaperonins (Hsp60 chaperones) comprise a class of oligomeric, high-molecular-weight chaperones that have the unique ability to fold some proteins that cannot be folded by simpler chaperone systems. The term &ldquo / thermosome&rdquo / is used for molecular chaperonins from Archaeal organisms since they accumulate to high levels upon heat-shock. In this study first time, we have cloned and sequenced two Hsp60 subunit genes (&amp / #945 / and &amp / #946 / ) from a thermoacidophilic archaeon Thermoplasma volcanium. For cloning we have followed a PCR based strategy. Amplification of Hsp60 &amp / #945 / gene from chromosomal DNA of T. volcanium yielded a product of 1939 bp amplicon and that of Hsp60 &amp / #946 / gene yielded a product of 1921 bp amplicon. After ligation of the PCR fragments to pDrive vector, recombinant plasmids were transferred into E. coli TG-1 competent cells and recombinant colonies were selected by blue/white screening. The cloning of two subunit genes were confirmed by restriction mapping and by sequencing. Both subunit genes were then subcloned to pUC18 vector consequtively to construct a co-expression vector. Both subunit genes were expressed under control of their own promoters leading to production of active Hsp60 chaperonin (thermosome). Chaperone activity of the recombinant thermosome was shown by using pig citrate synthase enzyme as substrate. Thermosome induced refolding was observed when renaturation was carried out at 50&deg / C for 2,5 h. Under this condition, citrate synthase activities associated with control and test were &amp / #61508 / mA412/min:19.0 and &amp / #61508 / mA412/min:24.0 respectively. Clustal W Version 1.82 was used for multiple sequence alignments of Hsp60 &amp / #61537 / and Hsp60 &amp / #61538 / proteins of T. volcanium and other Hsp60 proteins from various eukaryotes, bacteria and archaea. The highest sequence similarity was found between &amp / #945 / subunit proteins of T. volcanium and T. acidophilum (94%) and &amp / #946 / subunit proteins of T. volcanium and T. acidophilum (93%). Clusters of orthologous groups and conserved domain database searches revealed the phylogenetic relationships between Hsp60 &amp / #61537 / and Hsp60 &amp / #61538 / subunits of T. volcanium thermosome and other Hsp60 proteins from various eukaryotes, bacteria and archaea. Induction of both subunit genes under heat shock (65&deg / C, 70&deg / C and 75&deg / C for 2h) and under oxidative stress (imposed by 0,008 mM, 0,01 mM, 0,02 mM, 0,03 mM and 0,05 mM H2O2) conditions was studied by Real-Time PCR technique and amplified cDNA band density analysis.

In this study, possible involvement of the small heat shock proteins (sHsps) from a thermoacidophilic archaeon, Thermoplasma (Tp) volcanium in the stress response was investigated. Our results showed that heterologous, high level expression of TVN0775/sHsp gene in E.coli increased its thermotolerance at 53&deg / C for two hours. But, the second sHsp of the Tp. volcanium, TVN0984/sHsp was not effective in improvement of the thermal resistance of the mesophilic bacterium (i. e., E.coli). The expression of the TVN0775/sHsp and TVN0984/sHsp genes increased about 3 fold after heat-shock at 65&deg / C, as revealed by Real-Time PCR analysis. Although expression of the both genes was induced at 70&deg / C, TVN0984/sHsp gene expression was increased higher (about 5 fold) than that of the TVN0775/sHsp gene expression (about 1.5 fold). Tp. volcanium cells were exposed to high pH (pH: 3.5, pH: 4.0, pH: 4.5, pH: 5.0), and the change in the sHsp genes&rsquo / expression profile were analyzed. The results showed that TVN0775/sHsp gene expression was more sensitive to increased pH than TVN0984/sHsp gene expression. The TVN0775/sHsp gene transcription induced at most 2.5 fold at pH 4.0 and the gene expression either reduced or did not change at higher pH values (i.e., pH 4.5 and 5.0). On the other hand, TVN0984/sHsp gene expression did not change at pH 4.0 but significantly reduced at higher pH values. The effect of oxidative stress on the expression of TVN0775 and TVN0984 genes was investigated by treatment of Tp. volcanium cells with 0.01 mM, 0.02 mM, 0,03 mM and 0.05 mM H2O2. For both sHsp genes, transcription was induced at lower concentrations of H2O2 (0.01 mM and 0.02 mM). At higher concentrations of H2O2 expression of both genes&rsquo / transcription either did not changed or down regulated. Lastly, in this study we have purified the recombinant TVN0775/sHsp, as an Nterminal 6x his-tag fusion to homogeneity on Ni-NTA affinity column. Purified protein samples were used in the chaperone activity assays using bovine glutamate dehydrogenase enzyme (boGDH) as substrate. We have found that the recovery of glutamate dehydrogenase activity at 45&deg / C, 50&deg / C and 53&deg / C in the presence of the Tp. volcanium sHsps was higher than that of spontaneous refolding. Also, TVN0775/sHsp increased the recovery of the boGDH enzyme that was denatured at 2.5 M GdnHCl concentrations for 30 min.

(理学療法基礎系7, 第42回日本理学療法学術大会)

No description available.

The generalized theory of thermoelasticity was employed to characterize the coupled thermal and mechanical wave propagation in high performance microelectronic packages. Application of a Gaussian heat source of spectral profile similar to high performance devices was shown to induce rapid thermal and mechanical transient phenomena. The stresses and temporal gradient of stresses (power density) induced by the thermal and mechanical disturbances were analyzed using the Gabor Wavelet Transform (GWT). The arrival time of frequency components and their magnitude was studied at various locations in the package. Comparison of the results from the classical thermoelasticity theory and generalized theory was also conducted. It was found that the two theories predict vastly different results in the vicinity of the heat source but that the differences diminish within a larger time window. Results from both theories indicate that the rapid thermal-mechanical waves cause high frequency, broadband stress waves to propagate through the package for a very short period of time. The power density associated with these stress waves was found to be of significant magnitude indicating that even though the effect, titled short time scale effect, is short lived, it could have significant impact on package reliability. The high frequency and high power density associated with the stress waves indicate that the probability of sub-micron cracking and/or delamination due to short time scale effect is high. The findings demonstrate that in processes involving rapid thermal transients, there is a non-negligible transient phenomenon worthy of further investigation.