A88 UNDERSTANDING NURSE PERCEPTIONS OF CARING FOR PATIENTS WITH ALCOHOL USE DISORDER: A CROSS-SECTIONAL STUDY

Background

Alcohol Use Disorder (AUD), the problematic consumption of alcohol, affects 107 million people worldwide. AUD increases morbidity and mortality and has a substantial impact on daily functioning including quality of life, relationships and employment. AUD is particularly detrimental in patients who already have liver damage like cirrhosis. The management of AUD includes screening, brief intervention and referral to treatment for psychological and pharmacotherapy based treatment. People with AUD have frequent interactions with the healthcare system. These interactions represent opportunities to engage patients with therapy. As front-line workers who have maximal contact with patients, nurses practicing in acute care are in an ideal position to initiate AUD related discussion with patients. Prior to the design of an educational intervention to increase nursing engagement with AUD screening and brief intervention, there is a need to understand baseline knowledge, attitudes and perceptions in this group.

Aims

The aim of the present study was to explore the knowledge, attitudes and perceptions of nurses caring for patients with cirrhosis and AUD.

Methods

We conducted a cross-sectional survey using the Survey of Attitudes and Perceptions (SAP). The SAP is derived from a validated tool to assess attitudes and perceptions towards patients with AUD. Anonymous surveys were distributed on inpatient medicine units across 5 geographic zones in Alberta between September 2019-March 2020. Data were analyzed using descriptive and inferential statistics.

Results

A total of 93 nurses from 7 inpatient medicine units across Alberta participated in the study. The majority of participants were Registered Nurses (74.9%), who practiced in an urban setting (69%), and had worked in their role for an average of 9.9 years. Few (22.6%) participants reported any prior structured education on caring for patients with AUD, with the majority reporting limited knowledge of alcohol and effects of alcohol consumption. Though most reported that caring for patients with AUD was part of their professional role, only 15.7% felt motivated to work with this group of patients. Responses to individual questions or sub-domains of the survey did not significantly differ by length or time in professional role, or practice setting.

Conclusions

Our results indicate that nurses have limited knowledge on caring for patients with AUD. Given the importance of AUD in the development and progression of cirrhosis as well as the frequency of hospitalizations for patients with cirrhosis, increasing nurse knowledge of AUD is crucial to improving the quality of care for these patients. The results of this study will be used to inform the development of an educational intervention to increase nursing knowledge of caring for patients with cirrhosis and AUD.

Funding Agencies

Alberta Innovates

Filling the knowledge gap: A suspect screening study for 1310 potentially persistent and mobile chemicals with SFC- and HILIC-HRMS in two German river systems

Persistent and mobile chemicals (PM chemicals) were searched for in surface waters by hydrophilic interaction liquid chromatography (HILIC) and supercritical fluid chromatography (SFC), both coupled to high resolution mass spectrometry (HRMS). A suspect screening was performed using a newly compiled list of 1310 potential PM chemicals to the data of 11 surface water samples from two river systems. In total, 64 compounds were identified by this approach. The overlap between HILIC- and SFC-HRMS was limited (31 compounds), confirming the complementarity of the two methods used. The identified PM candidates are characterized by a high polarity (median logD -0.4 at pH 7.5), a low molecular weight (median 187 g/mol), are mostly ionic (54 compounds) and contain a large number of heteroatoms (one per four carbons on average). Among the most frequently detected novel or yet scarcely investigated water contaminants were cyanoguanidine (11/11 samples), adamantan-1-amine (10/11), trifluoromethanesulfonate (9/11), 2-acrylamido-2-methylpropanesulfonate (10/11), and the inorganic anions hexafluorophosphate (11/11) and tetrafluoroborate (10/11). 31% of the identified suspects are mainly used in ionic liquids, a chemically diverse group of industrial chemicals with numerous applications that is so far rarely studied for their occurrence in the environment. Prioritization of the findings of PM candidates is hampered by the apparent lack of toxicity data. Hence, precautionary principles and minimization approaches should be applied for the risk assessment and risk management of these substances. The large share of novel water contaminants among these findings of the suspect screening indicates that the universe of PM chemicals present in the environment has so far only scarcely been explored. Dedicated analytical methods and screening lists appear essential to close the analytical gap for PM compounds.

Techno-economic assessment at full scale of a biogas refinery plant receiving nitrogen rich feedstock and producing renewable energy and biobased fertilisers

Anaerobic digestion of nitrogen (N) rich substrates might be hindered when ammonia (NH₃) formation reaches toxic levels for methanogenic microorganisms. One possible strategy to avoid inhibiting conditions is the removal of NH₃ from digestate by stripping and scrubbing technology and by recirculating N depleted digestate back to the digester. This study aimed to i) monitor the performance (mass and energy balances) of a full scale digestate processing cascade that includes an innovative vacuum side stream NH₃stripping and scrubbing system, ii) assess the production cost of ammonium sulphate (AS) solution and iii) evaluate its fertiliser quality. The use of gypsum to recover NH₃ in the scrubbing unit, instead of the more common sulphuric acid, results in the generation of AS and a fertilising liming substrate. Mass and nutrient balances indicated that 57% and 7.5% of ammonium N contained in digestate was recovered in the form of a 22% AS and liming substrate, respectively. The energy balance showed that about 3.8 kWh_el and 59 kWh_th were necessary to recover 1 kg of N in the form of AS. Furthermore, the production cost of AS, including both capital and operational costs, resulted to be 5.8 € t^-1 of digestate processed. According to the fertiliser quality assessment, this technology allows for the recovery of NH₃in the form of salt solutions that can be utilised as a substitute for synthetic mineral nitrogen fertilisers.

Bright correlated twin-beam generation and radiation shaping in high-gain parametric down-conversion with anisotropy

Uniaxial anisotropy in nonlinear birefringent crystals limits the efficiency of nonlinear optical interactions and breaks the spatial symmetry of light generated in the parametric down-conversion (PDC) process. Therefore, this effect is usually undesirable and must be compensated for. However, high gain may be used to overcome the destructive role of anisotropy in order to generate bright two-mode correlated twin-beams. In this work, we provide a rigorous theoretical description of the spatial properties of bright squeezed light in the presence of strong anisotropy. We investigate a single crystal and a system of two crystals with an air gap (corresponding to a nonlinear SU(1,1) interferometer) and demonstrate the generation of bright correlated twin-beams in such configurations at high gain due to anisotropy. We explore the mode structure of the generated light and show how anisotropy, together with crystal spacing, can be used for radiation shaping.

A rapid method for quantification of persistent and mobile organic substances in water using supercritical fluid chromatography coupled to high-resolution mass spectrometry

Persistent and mobile organic substances (PM substances) are a threat to the quality of our water resources. While screening studies revealed widespread occurrence of many PM substances, rapid trace analytical methods for their quantification in large sample sets are missing. We developed a quick and generic analytical method for highly mobile analytes in surface water, groundwater, and drinking water samples based on enrichment through azeotrope evaporation (4 mL water and 21 mL acetonitrile), supercritical fluid chromatography (SFC) coupled to high-resolution mass spectrometry (HRMS), and quantification using a compound-specific correction factor for apparent recovery. The method was validated using 17 PM substances. Sample preparation recoveries were between 60 and 110% for the vast majority of PM substances. Strong matrix effects (most commonly suppressive) were observed, necessitating a correction for apparent recoveries in quantification. Apparent recoveries were neither concentration dependent nor dependent on the water matrix (surface or drinking water). Method detection and quantification limits were in the single- to double-digit ng L⁻¹ ranges, precision expressed as relative standard deviation of quadruplicate quantifications was on average < 10%, and trueness experiments showed quantitative results within ± 30% of the theoretical value in 77% of quantifications. Application of the method to surface water, groundwater, raw water, and finished drinking water revealed the presence of acesulfame and trifluoromethanesulfonic acid up to 70 and 19 μg L⁻¹, respectively. Melamine, diphenylguanidine, p-dimethylbenzenesulfonic acid, and 4-hydroxy-1-(2-hydroxyethyl)-2,2,6,6-tetramethylpiperidine were found in high ng L⁻¹ concentrations.

[Drug-induced angioedema : Focus on bradykinin]

On a pathophysiological level, angioedema can be differentiated into histamine- and bradykinin-mediated types. The prototype drug-associated, bradykinin-mediated form of angioedema is angiotensin-converting enzyme (ACE) inhibitor-induced angioedema. The hypothesized cause is a decrease in bradykinin degradation via ACE inhibition. In this scenario, other bradykinin-degrading enzymes assume major importance. When the effect of these enzymes is also diminished, e. g., due to genetic variants or external factors, compensation for the inhibition of ACE may be insufficient. An increased risk of angioedema has also been reported for other drugs, particularly when prescribed in combination with ACE inhibitors. Here, the suspected cause also relates to the degradation of bradykinin. When angioedema arises within the context of concomitant ACE inhibitor use, additive bradykinin degradation effects may be implicated.

Nonlinearity-induced localization in a periodically driven semidiscrete system

We demonstrate that nonlinearity plays a constructive role in supporting the robustness of dynamical localization in a system which is discrete in one dimension and continuous in the orthogonal one. In the linear regime, time-periodic modulation of the gradient strength along the discrete axis leads to the usual rapid spread of an initially confined wave packet. Addition of the cubic nonlinearity makes the dynamics drastically different, inducing robust localization of moving wave packets. Similar nonlinearity-induced effects are also produced in the presence of a combination of static and oscillating linear potentials. The predicted dynamical localization in the nonlinear medium can be realized in photonic lattices and Bose-Einstein condensates.

Bloch oscillations sustained by nonlinearity

We demonstrate that nonlinearity may play a constructive role in supporting Bloch oscillations in a model which is discrete, in one dimension and continuous in the orthogonal one. The model can be experimentally realized in several fields of physics such as optics and Bose-Einstein condensates. We demonstrate that designing an optimal relation between the nonlinearity and the linear gradient strength provides extremely long-lived Bloch oscillations with little degradation. Such robust oscillations can be observed for a broad range of parameters and even for moderate nonlinearities and large enough values of linear potential. We also present an approximate analytical description of the wave packet’s evolution featuring a hybrid Bloch oscillating wave-soliton behavior that excellently corresponds to the direct numerical simulations.

Photochemically Induced Bound Residue Formation of Carbamazepine with Dissolved Organic Matter

More than 400 new nitrogen containing products were detected upon experimental sunlight photolysis of the pharmaceutical carbamazepine (CBZ) in the presence of dissolved organic matter (DOM) by Fourier transform ion cyclotron resonance mass spectrometry (FTICR-MS). These products were presumably formed through covalent binding of CBZ phototransformation products with DOM molecules. About 50% of these newly formed bound residues contained one nitrogen atom and had a molecular mass between 375 and 525 Da, which was 150 to 200 Da higher than for an average DOM molecule. In addition, a previously unknown CBZ phototransformation product, 3-quinolinecarboxylic acid (3-QCA), was identified by liquid chromatography high resolution tandem mass spectrometry (LC-HRMS/MS). 3-QCA was likely formed through oxidative ring cleavage and subsequent decarboxylation of acridine, a well-known phototransformation product of CBZ. Collision induced dissociation experiments and Kendrick mass defect analyses corroborated that about 160 of the new products were formed via covalent binding of 3-QCA with DOM molecules of above-average O/C and H/C ratios. Experiments at lower CBZ concentration suggested that the importance of bound residue formation increases with increasing DOM/CBZ ratios. Photochemically induced bound residue formation of polar contaminants with DOM in the aqueous phase is thus a disregarded pathway along which contaminants can be transformed in the environment. The method presented here offers a new possibility to study the formation of bound residues, which may be of relevance also for other transformation processes in natural waters where radical intermediates are generated.

Global Burden of Sugar-Related Dental Diseases in 168 Countries and Corresponding Health Care Costs

Oral diseases such as dental caries, edentulism (tooth loss), periodontal disease (PD), and oral cancer currently constitute an increased major public health burden across the globe, with significant differences between countries. One of the main drivers of caries, edentulism, and PD is the excessive intake of sugars. Here, we aimed to quantify the global sugar-related dental health and cost burden in the year 2010. This study used a health-econometrical model to calculate the disease burden as well as the direct and indirect costs attributable to the intake of free sugars (mono- and disaccharides [MDS]). To this end, several databases from the Institute for Health Metrics and Evaluation (IHME), Organisation for Economic Co-operation and Development (OECD), Food and Agriculture Organization (FAO), and World Bank were used. In total, the corresponding disease burden in 168 countries and economic burden in 31 OECD countries were quantified. In 2010, the consumption of MDS was associated with a global dental disease burden of 4.1 million disability-adjusted life years (DALYs; 95% uncertainty interval [UI]: 2.1 to 7.4 million DALYs), with 2.7 million DALYs from MDS-related caries and 1.4 million DALYs from PD. In terms of economic costs, MDS-related dental diseases were associated with a global financial burden of 172 billion US dollars (USD; 95% UI: 91 to 295 billion USD), the largest share of which (151 billion USD) was incurred in OECD countries. Overall, 26.3% (95% UI: 13.3% to 47.5%) of the total global oral disease burden was attributed to the consumption of MDS. The present study emphasizes the need to further address the role of free sugars in oral health and nutrition policy. Although the largest share of the economic burden was accounted for by OECD countries, emerging economies should address this challenge early on in national public health policies if they are to avoid disease and the prospect of increased cost burdens.

Dynamics of dipoles and vortices in nonlinearly coupled three-dimensional field oscillators

The dynamics of a pair of harmonic oscillators represented by three-dimensional fields coupled with a repulsive cubic nonlinearity is investigated through direct simulations of the respective field equations and with the help of the finite-mode Galerkin approximation (GA), which represents the two interacting fields by a superposition of 3+3 harmonic-oscillator p-wave eigenfunctions with orbital and magnetic quantum numbers l=1 and m=1, 0, -1. The system can be implemented in binary Bose-Einstein condensates, demonstrating the potential of the atomic condensates to emulate various complex modes predicted by classical field theories. First, the GA very accurately predicts a broadly degenerate set of the system's ground states in the p-wave manifold, in the form of complexes built of a dipole coaxial with another dipole or vortex, as well as complexes built of mutually orthogonal dipoles. Next, pairs of noncoaxial vortices and/or dipoles, including pairs of mutually perpendicular vortices, develop remarkably stable dynamical regimes, which feature periodic exchange of the angular momentum and periodic switching between dipoles and vortices. For a moderately strong nonlinearity, simulations of the coupled-field equations agree very well with results produced by the GA, demonstrating that the dynamics is accurately spanned by the set of six modes limited to l=1.

Precession and nutation dynamics of nonlinearly coupled non-coaxial three-dimensional matter wave vortices

Nonlinearity is the driving force for numerous important effects in nature typically showing transitions between different regimes, regular, chaotic or catastrophic behavior. Localized nonlinear modes have been the focus of intense research in areas such as fluid and gas dynamics, photonics, atomic and solid state physics etc. Due to the richness of the behavior of nonlinear systems and due to the severe numerical demands of accurate three-dimensional (3D) numerical simulations presently only little knowledge is available on the dynamics of complex nonlinear modes in 3D. Here, we investigate the dynamics of 3D non-coaxial matter wave vortices that are trapped in a parabolic potential and interact via a repulsive nonlinearity. Our numerical simulations demonstrate the existence of an unexpected and fascinating nonlinear regime that starts immediately when the nonlinearity is switched-on and is characterized by a smooth dynamics representing torque-free precession with nutations. The reported motion is proven to be robust regarding various effects such as the number of particles, dissipation and trap deformations and thus should be observable in suitably designed experiments. Since our theoretical approach, i.e., coupled nonlinear Schrödinger equations, is quite generic, we expect that the obtained novel dynamical behavior should also exist in other nonlinear systems.

High-sensitivity NMR beyond 200,000 atmospheres of pressure

Pressure-induced changes in the chemical or electronic structure of solids require pressures well into the Giga-Pascal (GPa) range due to the strong bonding. Anvil cell designs can reach such pressures, but their small and mostly inaccessible sample chamber has severely hampered NMR experiments in the past. With a new cell design that has a radio frequency (RF) micro-coil in the high pressure chamber, NMR experiments beyond 20 Giga-Pascal are reported for the first time. (1)H NMR of water shows sensitivity and resolution obtained with the cells, and (63)Cu NMR on a cuprate superconductor (YBa2Cu3O7-δ) demonstrates that single-crystals can be investigated, as well. (115)In NMR of the ternary chalcogenide AgInTe2 discovers an insulator-metal transition with shift and relaxation measurements. The pressure cells can be mounted easily on standard NMR probes that fit commercial wide-bore magnets with regular cryostats for field- and temperature-dependent measurements ready for many applications in physics and chemistry.

Characterization of pulmonary function in Duchenne Muscular Dystrophy

Decline in pulmonary function in Duchenne Muscular Dystrophy (DMD) contributes to significant morbidity and reduced longevity. Spirometry is a widely used and fairly easily performed technique to assess lung function, and in particular lung volume; however, the acceptability criteria from the American Thoracic Society (ATS) may be overly restrictive and inappropriate for patients with neuromuscular disease. We examined prospective spirometry data (Forced Vital Capacity [FVC] and peak expiratory flow [PEF]) from 60 DMD patients enrolled in a natural history cohort study (median age 10.3 years, range 5-24 years). Expiratory flow-volume curves were examined by a pulmonologist and the data were evaluated for acceptability using ATS criteria modified based on the capabilities of patients with neuromuscular disease. Data were then analyzed for change with age, ambulation status, and glucocorticoid use. At least one acceptable study was obtained in 44 subjects (73%), and 81 of the 131 studies (62%) were acceptable. The FVC and PEF showed similar relative changes in absolute values with increasing age, i.e., an increase through 10 years, relative stabilization from 10-18 years, and then a decrease at an older age. The percent predicted, FVC and PEF showed a near linear decline of approximately 5% points/year from ages 5 to 24. Surprisingly, no difference was observed in FVC or PEF by ambulation or steroid treatment. Acceptable spirometry can be performed on DMD patients over a broad range of ages. Using modified ATS criteria, curated spirometry data, excluding technically unacceptable data, may provide a more reliable means of determining change in lung function over time.

Coupled Airy breathers

The dynamics of two component-coupled vectorial Airy beams is investigated. In the linear propagation regime, a complete analytic solution describes the breather-like propagation of two components that feature nondiffracting self-accelerating Airy behavior. The superposition of two beams with different input properties opens the possibility of designing more complex nondiffracting propagation scenarios. In the strongly nonlinear regime, the dynamics remain qualitatively robust as is revealed by direct numerical simulations. Because of the Kerr effect, the two beams emit solitonic breathers whose coupling period is compatible with the remaining Airy-like beams. The results of this study are relevant for the description of photonic and plasmonic beams that propagate in coupled planar waveguides, as well as for birefrigent or multiwavelength beams.

Length-dependent thermal transport along molecular chains

We present heat-transport measurements conducted with a vacuum-operated scanning thermal microscope to study the thermal conductance of monolayers of nine different alkane thiols self-assembled on Au(111) surfaces as a function of their length (2 to 18 methylene units). The molecular thermal conductance is probed in a confined area with a diameter below 10 nm in the contact between a silicon tip and the self-assembled monolayer. This yields a pWK(-1) sensitivity per molecule at a tip temperature of 200-300 °C versus the gold at room temperature. We found a conductance variance of up to a factor of 3 as a function of alkane chain length, with maximum conductance for a chain length of four carbon atoms.

Constraints on cosmic strings from the LIGO-Virgo gravitational-wave detectors

Cosmic strings can give rise to a large variety of interesting astrophysical phenomena. Among them, powerful bursts of gravitational waves (GWs) produced by cusps are a promising observational signature. In this Letter we present a search for GWs from cosmic string cusps in data collected by the LIGO and Virgo gravitational wave detectors between 2005 and 2010, with over 625 days of live time. We find no evidence of GW signals from cosmic strings. From this result, we derive new constraints on cosmic string parameters, which complement and improve existing limits from previous searches for a stochastic background of GWs from cosmic microwave background measurements and pulsar timing data. In particular, if the size of loops is given by the gravitational backreaction scale, we place upper limits on the string tension Gμ below 10(-8) in some regions of the cosmic string parameter space.

Impact of PEEP during laparoscopic surgery on early postoperative ventilation distribution visualized by electrical impedance tomography

BACKGROUND

General anesthesia, mechanical ventilation and pneumoperitoneum affect ventilation distribution at different extent. It should be clarified if an intraoperative positive end-expiratory pressure (PEEP) level of 10 cmH2O influences early postoperative ventilation. Electrical impedance tomography (EIT) was used to assess changes in regional ventilation.

METHODS

Thirty-two patients (ASA physical status I/II) scheduled to undergo elective laparoscopic cholecystectomy were enrolled. The patients were randomly assigned to PEEP (10 cmH2O) or ZEEP group (0 cmH2O). EIT was performed before induction of anesthesia (T0) and after admission to the recovery room (T1-4). Ventral/dorsal and right/left lung impedance ratio (IR) and the center-of-ventilation index (COV) were calculated to investigate the differences in homogeneity of ventilation.

RESULTS

Compared to preoperative data a significant increase in PaCO2 and reduction of pH values could be found in both groups. Significant decrease of postoperative tidal impedance change (∆Z) as well as a general postoperative ventral shift of the ventilation indicated by changes of IR and COV could be found in both groups. In ZEEP group IR and COV differed significantly from baseline (T0). In PEEP group there was just significant difference in COV at T2-T4 compared to T0. In the early postoperative period (T1) there was no difference in ventilation distribution in PEEP patients.

CONCLUSION

Changes of postoperative ventilation can be imaged by EIT. Intraoperative PEEP ventilation has a positive effect on early postoperative ventilation distribution, even though not all PEEP patients benefit from mechanical PEEP ventilation the same way. Intraoperative PEEP results in a more homogeneous ventilation distribution by trend.

Electrical impedance tomography may optimize ventilation in a postpartum woman with respiratory failure

Amniotic fluid embolism is a rare peripartum complication with the sudden onset of haemodynamic instability, respiratory failure and coagulopathy during labour or soon after delivery. A 31-year-old woman with amniotic fluid embolism was treated with vasopressors, inotropes, intravenous fluid, tranexamic acid and ventilatory support. Assessment of respiratory impairment was made using conventional chest X-ray, computed tomography and electrical impedance tomography. The potential for electrical impedance tomography to improve monitoring and guide respiratory therapy is explored.

Collective effects in second-harmonic generation from split-ring-resonator arrays

Optical experiments on second-harmonic generation from split-ring-resonator square arrays show a nonmonotonic dependence of the conversion efficiency on the lattice constant. This finding is interpreted in terms of a competition between dilution effects and linewidth or near-field changes due to interactions among the individual elements in the array.

Influence of plaque volume on hemodynamic response and stress hormone release in patients undergoing carotid artery stenting

AIM

Carotid artery stenting (CAS) may cause bradycardia and hypotension due to barostimulation. The impact of periprocedural hypotension on CAS outcome remains controversial. The role of carotid plaque volume and catecholamine hormone release during CAS on hemodynamic changes has not been investigated so far. The aim of this prospective study was to evaluate if carotid artery plaque characteristics are predictive for stress hormone release or for postprocedural hemodynamic instability.

METHODS

In 26 patients undergoing CAS, carotid plaque volume and morphology were assessed by two- and three-dimensional (3D)-Duplex sonography prior to the procedure. Arterial plasma adrenaline, noradrenaline and renin concentrations were measured at the time of sheath insertion and 5 minutes after stent placement. ECG, heart rate, and invasive blood pressure were monitored throughout the procedure.

RESULTS

CAS caused no significant changes in hormone release, but increasing plaque volume was related to the degree of bradycardia following stent deployment (r=0.57; P=0.01). Plaque size was not associated with postprocedural hypotension. Plaque echogenicity (echolucent, heterogeneous or echogenic) did not correlate with changes in systolic blood pressure, heart rate or catecholamine hormone release.

CONCLUSION

CAS caused bradycardia in relation to plaque size, but did not cause catecholamine release which may indicate that the endovascular procedure is not associated with a relevant stress reaction.

Directional limits on persistent gravitational waves using LIGO S5 science data

The gravitational-wave (GW) sky may include nearby pointlike sources as well as stochastic backgrounds. We perform two directional searches for persistent GWs using data from the LIGO S5 science run: one optimized for pointlike sources and one for arbitrary extended sources. Finding no evidence to support the detection of GWs, we present 90% confidence level (C.L.) upper-limit maps of GW strain power with typical values between 2-20×10(-50)  strain(2) Hz(-1) and 5-35×10(-49)  strain(2) Hz(-1) sr(-1) for pointlike and extended sources, respectively. The latter result is the first of its kind. We also set 90% C.L. limits on the narrow-band root-mean-square GW strain from interesting targets including Sco X-1, SN 1987A and the Galactic center as low as ≈7×10(-25) in the most sensitive frequency range near 160 Hz.