94 research outputs found
On shoplifting and tax fraud: An action-theoretic analysis of crime
No full textThe article evaluates different theories of action in the area of crime research. A narrow version of rational choice theory assumes actors to choose in an instrumental, outcome-oriented way. It hypothesises that individuals weight the costs and benefits of criminal acts with subjective probabilities. In contrast, a wide version of the theory allows individuals to derive utility directly from choosing certain actions. Previous studies either do not directly test these theories or yield inconsistent results. We show that a meaningful test of these rival rational choice explanations can only be conducted if a broader view is adopted that takes into account the interplay of moral norms and instrumental incentives. Such a view can be derived from the Model of Frame Selection (Kroneberg 2005) and the Situational Action Theory of Crime Causation (Wikström 2004). Based on these theories, we analyze the willingness to engage in shoplifting and tax fraud in a sample of 2,130 adults from Dresden, Germany. In line with our theoretical expectations, we find that only respondents who do not feel bound by moral norms consider instrumental incentives. Where norms have been strongly internalised and in the absence of neutralisation techniques which legitimise norm-breaking, instrumental incentives are irrelevant.
Resuscitative Endovascular Balloon Occlusion of the Inferior Vena Cava (REBOVC) : Experimental and clinical studies
No full textJuxtahepatic venous injuries often cause life-threatening hemorrhagic shock, the mortality is high and new management methods are needed. The aims were to explore endovascular methods for retrohepatic vascu-lar isolation, their effects on survival, hemodynamics, metabolism, end-organ damage and bleeding, and if ultrasound and anatomical land-marks could be used to guide placement of resuscitative endovascular balloon occlusion of the inferior vena cava (REBOVC). Study I ex-plored the effects of different combinations of REBOVC +/- endovascu-lar aortic balloon occlusion (REBOA) +/- the Pringle maneuver (PM) for 5 minutes in anesthetized pigs (n=9). REBOVC was found to be tol-erated hemodynamically if combined with REBOA whereas REBOVC alone or combined with PM was not. In study II, REBOA was com-pared to REBOA + REBOVC in normovolemia and in hemorrhagic shock in anesthetized pigs (n=6-7/group). REBOA + REBOVC was tol-erated for 45 minutes, but negative hemodynamic and metabolic ef-fects in hemorrhagic shock must be considered. In Study III, the effects in anesthetized pigs of different combinations of balloon occlusion (REBOA vs REBOA + REBOVC vs REBOA + infra- and suprahepatic REBOVC + portal vein occlusion) on survival, hemodynamics, retrohe-patic bleeding, metabolism, and collateral flow were compared to no occlusion. REBOA was found to most efficiently stabilize hemodynam-ics and prolong survival despite larger collateral flow and retrohepatic bleeding. The inability of venous occlusion to stabilize hemodynamics as efficiently as REBOA was probably due to a combination of arterial collateral flow combined with reduced venous return. Studies IV + V examined if ultrasound (in anesthetized pigs, n=9) and anatomical landmarks (computerized tomography images from 50 humans) could be used to position REBOVC and found that subxiphoidal ultrasound and external landmarks can be useful tools to adequately position RE-BOVC in the inferior vena cava
Resuscitative Endovascular Balloon Occlusion of the Inferior Vena Cava (REBOVC) : Experimental and clinical studies
No full textJuxtahepatic venous injuries often cause life-threatening hemorrhagic shock, the mortality is high and new management methods are needed. The aims were to explore endovascular methods for retrohepatic vascu-lar isolation, their effects on survival, hemodynamics, metabolism, end-organ damage and bleeding, and if ultrasound and anatomical land-marks could be used to guide placement of resuscitative endovascular balloon occlusion of the inferior vena cava (REBOVC). Study I ex-plored the effects of different combinations of REBOVC +/- endovascu-lar aortic balloon occlusion (REBOA) +/- the Pringle maneuver (PM) for 5 minutes in anesthetized pigs (n=9). REBOVC was found to be tol-erated hemodynamically if combined with REBOA whereas REBOVC alone or combined with PM was not. In study II, REBOA was com-pared to REBOA + REBOVC in normovolemia and in hemorrhagic shock in anesthetized pigs (n=6-7/group). REBOA + REBOVC was tol-erated for 45 minutes, but negative hemodynamic and metabolic ef-fects in hemorrhagic shock must be considered. In Study III, the effects in anesthetized pigs of different combinations of balloon occlusion (REBOA vs REBOA + REBOVC vs REBOA + infra- and suprahepatic REBOVC + portal vein occlusion) on survival, hemodynamics, retrohe-patic bleeding, metabolism, and collateral flow were compared to no occlusion. REBOA was found to most efficiently stabilize hemodynam-ics and prolong survival despite larger collateral flow and retrohepatic bleeding. The inability of venous occlusion to stabilize hemodynamics as efficiently as REBOA was probably due to a combination of arterial collateral flow combined with reduced venous return. Studies IV + V examined if ultrasound (in anesthetized pigs, n=9) and anatomical landmarks (computerized tomography images from 50 humans) could be used to position REBOVC and found that subxiphoidal ultrasound and external landmarks can be useful tools to adequately position RE-BOVC in the inferior vena cava
Interactive Interventions can Improve Hand Hygiene and Aseptic Techniques During Perioperative Care – Experience From the “Safe Hands” Project
No full textPurpose: This paper evaluates a theory-driven, interactive hand hygiene (HH) intervention, the Safe Hands project, based on theories of organizational learning and culture including leadership support, dialogue and co-creation. Design: This prospective quasi-experimental study used unobtrusive overt observations to evaluate adherence to HH recommendations after implementing an infection-prevention intervention. Methods: The primary outcome was differences in HH practices “Before aseptic/clean procedure” (WHO moment 2), “After body fluid exposure risk” (WHO moment 3) and performance of aseptic techniques. One operating room (OR) department served as the study hospital and the other as the control hospital, both at Swedish university hospitals. Adherence to HH guidelines was measured 4 times during 2015 to 2017. Findings: The intervention site displayed a significant improvement in adherence to HH guidelines and aseptic techniques. WHO 2; from 23.8% to 36.2%, (P = .014), WHO 3; from 22.2% to 42.3%, (P = .002), and aseptic techniques; from 17.5% to 31.6%, (P = .003). No changes in adherence were identified at the control site. The use of contaminated gloves decreased post intervention at the study operating department. Conclusions: This study shows that implementing tailored interventions that are underpinned by theories from organizational learning and culture can improve adherence to hand hygiene in a complex setting as the OR up to 6 months post-intervention. The interprofessional co-creation of standards operating procedures addressing specific care procedures and emphasizing the importance of aseptic techniques can be an acceptable and feasible way to reduce the risks of contaminating medical devices and patients during perioperative care
A influência da tecnologia em unidade de terapia intensiva: a percepção da equipe
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Florianópolis, 2014.Estudo com metodologia qualitativa e inspiração fenomenológica, embasado em leituras da filosofia da tecnologia, com objetivo compreender quais são os processos pelos quais a tecnologia é incorporada por profissionais da saúde que atuam em unidade de terapia intensiva (UTI). Participaram do estudo quatro pessoas: um médico, uma enfermeira, um técnico de enfermagem e uma fisioterapeuta, membros da equipe de saúde da UTI de um hospital escola público, situado em Florianópolis, Brasil. Os informantes deram consentimento por escrito e verbal. A confidencialidade e o anonimato foram assegurados pela utilização do nome da profissão dos funcionários. O Comitê de Ética em pesquisa com Seres Humanos da Universidade Federal de Santa Catarina aprovou o protocolo do estudo por meio do parecer número 270.900. A entrevista semi-estruturada e a observação foram as técnicas de coletas de dados utilizadas. Foram realizadas duas entrevistas por informante. A primeira entrevista foi iniciada com a questão "Como tem sido sua experiência com a tecnologia existente na UTI?", seguida de outras questões a fim de aprofundar a temática. As entrevistas foram gravadas e transcritas com auxílio de software f4 ®. Posteriormente foi feita análise temática, a qual revelou quatro temas principais: tipologia da tecnologia, sentimentos, valoração do artificial, e tecnoconhecimento. Nesta dissertação foram trabalhados dois: tipologia da tecnologia e tecnoconhecimento. Durante a observação foram observadas características do ambiente e da equipe de saúde da UTI, das tecnologias aí presentes e de como os membros da equipe lidavam com estas tecnologias. Resultados: O tema tipologia da tecnologia resultou na construção de três categorias: Categoria 1 - características físicas; Categoria 2- características funcionais; Categoria 3- manipulação e cargas de trabalho. O tema do tecnoconhecimento foi desdobrado em três categorias: Categoria 1 - forma de receber o treinamento; Categoria 2 - necessidade de treinamento e, por fim, Categoria 3 - vantagens do treinamento. A ideia de transição permeou as falas dos informantes relativas ao tema da tipologia da tecnologia, trazendo à tona diferenças temporais entre as características das tecnologias de ontem versus as de hoje. Este estudo mostrou que as principais formas de receber treinamento são a iniciativa própria e a socialização entre colegas e que o treinamento pelos fabricantes de tecnologia tem sido escasso. Os informantes também pontuaram a percepção de falta de treinamento. Outros resultados foram: a descrição de vantagens relativas ao treinamento, que a manutenção não é descrita como parte integrante do treinamento e, por fim, mencionaram erros, riscos na manipulação e dificuldade para identificar falhas como consequências negativas da falta de treinamento. Os achados contribuem para o conhecimento relativo à temática, evidenciando a necessidade de mais pesquisas. Para outros estudos, sugere-se a realização de observação do tipo sombra com os informantes, inclusão de perguntas específicas sobre outras tecnologias e observação de algum treinamento.Abstract : This is a study with qualitative methodology and phenomenological inspiration, based on readings from the philosophy of technology, in order to understand the processes by which technology is incorporated by healthcare professionals who work in the intensive care unit (ICU). In the study four people were included: a doctor, a nurse, a practical nurse and a physiotherapist, members of the health staff in the ICU of a public teaching hospital located in Florianopolis, Brazil. Informants gave verbal and written consent. Confidentiality and anonymity were assured by the use of profession name only. The Ethics Committee on Human Research of the Federal University of Santa Catarina approved the study protocol by the opinion number 270.900. The techniques of data collection used were a semi-structured interview and observation. Two interviews were conducted by informants. The first interview started with the question "How has been your experience with the existing technology in the ICU?", followed by other questions in order to deepen the theme. The interviews were recorded and transcribed with the aid of software f4 ®. Later a thematic analysis, which revealed four main themes, was taken: typology of technology, feelings, valuation of artificial and techno-knowledge. Two of them were used in this dissertation: typology of technology and techno-knowledge. During the observation, characteristics of the environment and the health staff from the ICU, the technologies presented there and how team members dealt with these technologies were observed. Results: The theme typology of technology has resulted in the construction of three categories: Category 1 - physical features; Category 2 - functional characteristics; Category 3 - Handling and workloads. The theme of techno-knowledge was split into three categories: Category 1 - way to receive training; Category 2 - need for training and, finally, Category 3 - benefits of training. The idea of transition permeated the informants' statements about the topic of the typology of technology, bringing up temporal differences between the characteristics of yesterday's technologies versus those in use today. This study showed that the main forms of receiving training for the person?s own initiative and peer socialization. It also showed that training by technology manufacturers have been scarce. Informants also noted the lack of training. Other results were: the description of advantages related to the training, equipment maintenance is not described as an integral part of training and finally they mentioned errors, risks in handling and difficulty to identify failures and negative consequences of lack of training. The findings contribute to knowledge concerning on the subject, highlighting the need for more research. For other studies, it is suggested to conduct a shadow type observation with informants, including specific questions about other technologies and watching some training
Morphological character evolution of Amorphophallus (Araceae) based on a combined phylogenetic analysis of trnL, rbcL, and LEAFY second intron sequences
No full textSequences of three different genes in 69 taxa of Amorphophallus were combined to reconstruct the molecular phylogeny of this species-rich Aroid genus. The data set was analyzed by three different methods, Maximum Parsimony, Maximum Likelihood and Bayesian analysis, producing slightly different tree topologies. Three major clades identified in all analyses reflect the biogeographical distribution of Amorphophallus. Some clades were supported by morphological characters such as sessile/nonsessile stigma, pollen opening mechanism, shape of the main segments of the lamina, growth cycle, and berry colour. When optimised, a nonsessile stigma may have evolved from a sessile one with several reversals. Pollen opening by connective rupturing evolved from pollen opening by pores. Unequally shaped segments of the lamina evolved from equally shaped segments. Simultaneously existing leaf and inflorescences evolved from alternating leaves and inflorescences. Blue, purple, green, and yellow berries evolved from red/orange/white ones
Invited Commentary: Vena Cava Balloon Occlusion for Traumatic Bleeding: Endovascular Method Facilitating Trauma Management
No full textRegulatory roles for long noncoding RNAs and circular RNAs in human skin wound repair
No full textHuman skin wound repair is a multiphase process, which includes inflammation, growth and remodeling, and requires the concerted communication of many cell types. During the course of healing, skin cells find themselves in a hostile environment where processes like migration, differentiation, apoptosis and proliferation must be correctly executed in order to restore the integrity of the injured tissue. These processes are tightly regulated by the interplay between signaling pathways and noncoding transcripts, which are essential for skin wound repair. When the healing phases do not progress in a timely and orderly manner, this results in healing defects like chronic skin ulcers or pathological scars. Due to the complex pathophysiology, these wound impairments are not fully understood and suffer from a lack of effective treatments.This doctoral thesis aims to investigate the regulatory roles of different classes of long noncoding RNAs (linear – lncRNAs. and circular isoforms – circRNAs) during normal skin wound healing and in chronic ulcers. For this, we recruited healthy volunteers to donate skin and wound biopsies that were collected at different healing stages, and chronic nonhealing ulcers were obtained from patients with diabetic foot ulcers or venous ulcers.In Paper I, we show that WAKMAR2 – a previously uncharacterized lncRNA – has a dynamic expression and function during wound repair. WAKMAR2 is downregulated during the early stages of healing to stimulate the production of inflammatory chemokines needed for the inflammatory phase, and later its levels increase to promote keratinocyte migration, essential for the proliferative phase. In a human ex vivo wound model, WAKMAR2 depletion delayed wound re-epithelialization, reinforcing its role in keratinocyte migration. We demonstrate that WAKMAR2 expression is directly affected by TGF-b signaling and its function is mediated by NF-kB signaling in keratinocytes. Because we find WAKMAR2 expression to be lower in keratinocytes at the wound edge of chronic wounds compared to normal wounds, we highlight its potential role in this pathology.In Paper II, we switch the focus to an underexplored class of noncoding RNAs known as circRNAs and, by using microarray profiling, we demonstrate that they are dysregulated in chronic diabetic foot ulcers compared to normal wounds. Our findings support a functional role for hsa_circ_0084443, a circRNA that was upregulated in diabetic wounds, that is related to keratinocyte motility and growth. We show that hsa_circ_0084443 has a longer half-life than linear mRNAs and is resistant to degradation by exoribonuclease R, which strengthens its therapeutic potential. We also uncover a molecular gene network that is regulated by hsa_circ_0084443 and may explain its functions.Paper III provides a robust catalogue of circRNA expression in human skin wounds at early healing stages and in nonhealing venous ulcers. By using RNA-seq on ribosomal RNAdepleted total RNA, we detected circRNAs and mRNAs in the same set of clinical samples. We show that circRNAs have dynamic expression patterns during wound healing and an aberrant signature in venous ulcers, that is largely independent from their parental mRNAs. Based on circRNA and mRNA co-expression network analysis, we infer putative functions of circRNAs in human wounds. We present this data at a browsable web resource www.xulandenlab.com/humanwounds-circrna that can facilitate further studies. By further integrating the microRNA deregulation data, we also reveal potential circRNA-miRNAmRNA regulatory networks, pinpointing the circRNAs that may act as microRNA sponges in human wounds. We validate the expression of circRNA candidates with experimental approaches and show the functional significance of two circRNAs upregulated in VU.In Paper IV, we characterize the role of a circRNA – circGLIS3, which was identified in paper III. CircGLIS3 is transiently upregulated in the dermis during the early phases of wound healing and it shows no expression change in the epidermis. We show that circGLIS3 is important for wound fibroblasts to increase their responsiveness to TGF-b, enhance the production of extracellular matrix proteins (collagen type I and fibronectin I) and to promote their differentiation into myofibroblasts – requirements for granulation tissue formation during the early phases of repair. We demonstrate that circGLIS3 is regulated in an IL-1a-dependent manner in human wounds. We unravel a mechanism of action through which circGLIS3 interacts with PCPE-1 protein in the cytosol of fibroblasts to increase PCPE-1 stability and to cooperatively enhance the TGF-b-induced fibroblast activation. Lastly, we show that circGLIS3 knockdown in human ex vivo wound dermis reduced re-epithelialization and contracture of the wounds, reinforcing its beneficial role for wound closure.Taken together, the findings presented in this thesis shed light on the regulatory roles of long noncoding RNAs and circular RNAs in skin wound repair and provide a path forward for the development of novel treatments where wound healing is impaired.List of scientific papersI. WAKMAR2, a long noncoding RNA downregulated in human chronic wounds, modulates keratinocyte motility and production of inflammatory chemokines. Eva K. Herter, DongqingLi, Maria A. Toma, Manika Vij, Xi Li,Dani Visscher, Aoxue Wang, Tongbin Chu, Pehr Sommar, Lennart Blomqvist, David Berglund, Mona Ståhle, Jakob D. Wikström, Ning Xu Landén. Journal of Investigative Dermatology. 2019 Jun;139(6):1373-1384. https://doi.org/10.1016/j.jid.2018.11.033 II. Circular RNA hsa_circ_0084443 is upregulated in diabetic footulcers and modulates keratinocyte migration and proliferation. Aoxue Wang*, Maria A. Toma*, Jingxin Ma, Dongqing Li, Manika Vij, Tongbing Chu, Jing Wang, Xi Li, Ning Xu Landén. Advances in Wound Care (New Rochelle). 2020 Apr:1;9(4):145-160. *Co-first authors. https://doi.org/10.1089/wound.2019.0956 III. Circular RNA signatures of human healing and non-healing wounds. Maria A. Toma*, Zhuang Liu*†, Qizhang Wang, Letian Zhang, Dongqing Li, Pehr Sommar, Ning Xu Landén †. Journal of Investigative Dermatology. *Co-first authors, †Co-senior authors. [Accepted] https://doi.org/10.1016/j.mbs.2019.108270 IV. Circular RNA circGLIS3 activates dermal fibroblasts andincreases extracellular matrix production to improve wound healing. Maria A. Toma, Qizhang Wang, Manika Vij, Minna Piipponen, Zhuang Liu, Dongqing Li, Eva K. Herter, Letian Zhang,Xiaowei Bian, Aoxue Wang, Pehr Sommar†, Ning Xu Landén†. *Co-first authors, †Co-senior authors. [Manuscript]</p
Evidence-based practice for children with asthma in primary care : quality of management and effects of learning
No full textBackground: Asthma is the most common chronic disease among children in Sweden. Many school-aged (7-17 years), but also preschool (0-6 years) children with asthma are managed in primary care. Evidence-based guidelines have been developed to support the use of current best clinical evidence in practice and to ensure high quality care. However, there is a gap between the actual care provided for children with asthma and the recommendations stated in the guidelines. Aim: To investigate the evidence-based practice for children with asthma in primary care. We wanted to evaluate the potential influence of quality of management and effects of learning to apply the evidence-based guidelines in routine care. Methods: In study I register data regarding dispensed prescriptions was collected. Dispensed prescriptions were followed over 24 consecutive months for all children (0-16 years) visiting 14 primary health care centres (PHCs) and initiated on anti-asthmatic drugs during one year (n=1033). In study II physicians and nurses participated in interactive education in these PHCs. 14 PHCs served as controls. Register data was collected regarding dispensed prescriptions and recorded diagnosis during 24 months before and after the intervention. Data was included from all children (0-17 years) (n= 114 175) listed at the 28 PHCs 2006-2012. Focus group interviews (FGIs) were used in study III to evaluate how general practitioners (GPs) approach, learn from and use evidence-based guidelines in their decision-making. Qualitative content analysis was used. 22 GPs participated. In study IV quality of care was assessed as a composite of quality indicators (CQI). Adherence to quality indicators was retrieved by scrutinising electronic health care records at 14 PHCs. By using the multivariate regression analysis orthogonal projection to latent structures (OPLS) the relationship between CQI and contextual features was evaluated. Results: In study I 54% of the school-aged children had only one prescription dispensed and 50% of them were initiated on short-acting beta2-agonist (SABA) as monotherapy. In study II 66% of the school-aged children with a recorded diagnosis of asthma were dispensed SABA as well as an anti-inflammatory anti-asthmatic drug before the intervention. There was no significant statistical difference between the intervention and control group at baseline or at follow-up. Approximately one-fourth of all children who were dispensed anti-asthmatic drugs did not have a recorded diagnosis of asthma. In study III three themes were conceptualised in the evaluation of the guidelines: Learning to use guidelines by contextualised dialogues; Learning that establishes confidence to provide high quality care; Learning by the use of relevant evidence in the decision-making process. In study IV more scheduled time for asthma care, lower age-limit for performing spirometry, lower duty-grade for GPs and higher activity at the educational seminars were the contextual features with highest influence on CQI. Conclusion: Most GPs show good adherence to evidence-based guidelines regarding pharmacological treatment in children with a recorded diagnosis of asthma. Correct diagnosis of asthma is crucial to enable use of evidence-based guidelines. To achieve this, spirometry needs to be performed more often. Contextualised dialogue, based on own experience, feedback on own results and easy access to short guidelines that were perceived as trustworthy, were important aspects for the use of the guidelines. To allocate time, interprofessional collaboration and to create an organisational structure with opportunities for engagement in asthma care, are contextual features that have the potential to facilitate evidence-based practice for children with asthma.List of scientific papersI. Ingemansson M, Wettermark B, Wikström Jonsson E, Bredgard M, Jonsson M, Hedlin G, Kiessling A. Adherence to guidelines for drug treatment of asthma in children: potential for improvement in Swedish primary care. Qual Prim Care. 2012;20(2):131-9. https://pubmed.ncbi.nlm.nih.gov/22824566II. Ingemansson M, Dahlén E, Wikström Jonsson E, Wettermark B, Kiessling A. Evidence-based management of childhood asthma in Swedish primary care: a controlled educational intervention study. [Manuscript]III. Ingemansson M, Bastholm-Rahmner P, Kiessling A. Practice guidelines in the context of primary care, learning and usability in the physicians´decision-making process – a qualitative study. BMC Fam Pract. 2014. Aug 20; 15(1):141. https://doi.org/10.1186/1471-2296-15-141 IV. Ingemansson M, Jonsson M, Henriksson P, Hedlin G, Kull I, Wikström Jonsson E, Krakau I, Kiessling A. Influence of contextual circumstances on quality of primary care in children with asthma. [Submitted]</p
Labor market time and home production: A new test for collective models of intra- household allocation
No full textThe allocation of time is a crucial decision that influences many aspects of household welfare, above all consumption, income level and home production. This paper presents a new methodology to estimate woman domestic productivity using a French time use survey, at least whenever the recursivity property for constrained utility maximization with home production applies. It provides empirical evidence not rejecting a collective model of household decision making over working time, as the sum of time spent in domestic production and market labor time. Our results show also that female domestic productivity is a relevant variable explaining intra-household distribution of resources.Collective models, home production, time- use
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