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Shared Decision-Making after Implementation of the Chronic Care Model (CCM)—An Evaluative Approach

Open Journal of Nursing 2014年第12期4卷 824-835页

作者： Anne Lise holm Anne Lyberg Ingela Berggren Elisabeth Severinsson The Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud & Vestfold University College Kongsberg Norway The Department of Nursing Health and Culture University West Trollh&#228ttan Sweden

Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.

关键词： Chronic Care Model Decision-Making Depressive Ill Health Focus Group Interviews Participation Team

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Depressed Older Patients’ Need for and Expectations of Improved Health Services—An Evaluative Approach to the Chronic Care Model

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Open Journal of Nursing 2015年第4期5卷 376-386页

作者： Anne Lyberg Ingela Berggren Anne Lise holm Elisabeth Severinsson Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud and Vestfold University College Kongsberg Norway Department of Nursing Health and Culture University West Trollh&aumlttan Sweden Department of Health Science Stord/Haugesund University College Stord Norway

Depression in later life is an underrepresented yet important research area. The aim of the study was to explore depressed older persons’ need for and expectations of improved health services one year after implementation of the Chronic Care Model (CCM). A qualitative evaluative design was used. Data were collected through individual interviews with older persons living in Norway. The qualitative content analysis revealed two themes: The need to be safeguarded and Expectation of being considered valuable and capable. Evaluation of the improvement in care with focus on the CCM components showed that the most important components for improving the depressed older person’s daily life were: delivery system re-design, self-management support, productive interaction and a well-informed active patient. The findings highlight the need for a health services designed for persons suffering from chronic ill-health, where the CCM could serve as a framework for policy change and support the redesign of the existing healthcare system. We conclude that older persons with depression need attention, especially those who have been suffering for many years. The identified components may have implications for health professionals in the promotion of mental healthcare.

关键词： Chronic Care Model Depression Expectations Health Services Needs Older Persons

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Improved cryopreservation of human hepatocytes using a new xeno free cryoprotectant solution

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World Journal of Hepatology 2012年第5期4卷 176-183页

作者： Mohammed Saliem Frida holm Rosita Bergstrm Tengzelius Carl Jorns Lisa-Mari Nilsson Bo-Gran Ericzon Ewa Ellis Outi Hovatta Division of Obstetrics and Gynecology Department of Clinical ScienceIntervention and TechnologyKarolinska Institute141 86 StockholmSweden Division of Transplantation Surgery Department of Clinical ScienceIntervention and TechnologyKarolinska Institute141 86 StockholmSweden Division of Pediatrics Department of Clinical ScienceIntervention and TechnologyKarolinska Institute141 86 StockholmSweden

AIM:To optimize a xeno-free cryopreservation protocol for primary human ***:The demand for cryopreserved hepatocytes is increasing for both clinical and research *** several hepatocyte cryopreservation protocols being available,improvements are urgently *** first compared controlled rate freezing to polystyrene box freezing and did not find any significant change between the *** the polystyrene box freezing,we compared two xeno-free freezing solutions for freezing of primary human hepatocytes:a new medium(STEM-CELLBANKER,CB),which contains dimethylsulphoxide(DMSO) and anhydrous dextrose,both permeating and non-permeating cryoprotectants,and the frequently used DMSO-University of Wisconsin(DMSOUW) *** viability of the hepatocytes was assessed by the trypan blue exclusion method as well as a calcein-esterase based live-dead assay before and after *** function of the hepatocytes was evaluated before and after cryopreservation by assessing enzymatic activity of 6 major cytochrome P450 isoforms(CYPs):CYP1A2,CYP2C9,CYP2C19,CYP2D6,CYP3A4 and ***:The new cryoprotectant combination preserved hepatocyte viability significantly better than the standard DMSO-UW protocol(P < 0.01).There was no significant difference in viability estimation between both the trypan blue(TB) and the Live-Dead Assay *** was a correlation between viability of fresh hepatocytes and the difference in cell viability between CB and DMSO protocols(r 2 = 0.69) using the TB ***,due to high within-group variability in the activities of the major CYPs,any statistical between-group differences were *** of human hepatocytes using the cryoprotectant combination was a simple and xeno-free procedure yielding better hepatocyte ***,it may be a better alternative to the standard DMSO-UW *** CYP activities did not seem to be a relevant way to compare hepatocyte function

关键词： Human hepatocytes Viability Cytochrome P540 Dimethylsulphoxide Cryoprotectant Cryopreservation

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Synthesis of W-Fe-S clusters with heteroligated core toward structural mimicking of nitrogenaseFeMo cofactor

Synthesis of W-Fe-S clusters with heteroligated core toward ...

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中国化学会第九届全国无机化学学术会议

作者： Xu-Dong Chen Richard H.holm College of Chemistry and Materials Science Nanjing Normal University Department of Chemistry and Chemical Biology Harvard University

The microbial transformation of dinitrogen to biologic available form such as ammonium is called biological nitrogen fixation（BNF）, which is mediated by nitrogenase. The Fe Mo-cofactor is believed to be the key catalytic center in the most-studied class of nitrogenase. However, structural mimicking of the Fe Mo-cofactor has long been a challenge in synthetic inorganic chemistry and bioinorganic chemistry. Introduction of the interstitial Q atom has proven to be the major obstacle in mimicking the Fe Mo-cofactor structure, since it would be extremely hard to control the insertion of Q atom into the cluster with rich sulfide content.[1]In an earlier work, we synthesized a cubane cluster with a [Fe4S3N] framework that is nearly isometric with the [Fe4S3Q] subunit of the Fe Mo cofactor.[2,3]In current work, a series of [WFe2S3X] cuboidal clusters were synthesized, with X（X = Cl, Br, Nor O） as a bridging core ligand, presenting a possible synthetic approach toward the [Mo Fe3S3Q] subunit of the Fe Mo cofactor. In the meantime, several novel W-Fe-S clusters were also synthesized, representing new members of the W-Fe-S cluster family.

关键词： Synthesis Fe Mo-cofactor W-Fe-S cluster

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Flexibility in design of large-scale methanol plants

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应用化工 2006年第Z1期35卷 228-240页

作者： Esben Lauge Sφrensen Helge holm-larsen Haldor Topsφe A/S

This paper presents a cost effective design for large-scale methanol production. It is demonstrated how recent technological progress can be utilised to design a methanol plant,which is inexpensive and easy to operate, while at the same time very robust towards variations in feed-stock composition and product specifications.

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The DNP: Knowledge and perceptions of students in an accelerated master’s program in nursing

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Open Journal of Nursing 2013年第1期3卷 138-146页

作者： Young-Me Lee Karyn holm Elizabeth Florez Megan Glauser Erin Haswell School of Nursing DePaul University Chicago USA

While the nursing community generally agrees that the Doctorate of Nursing Practice (DNP) degree will strengthen nursing as an academic discipline, there is little known about students’ perceptions of the advanced degree. Nursing students enrolled in an accelerated master’s program in nursing (N = 45) were surveyed to assess their knowledge of the DNP degree while also identifying the perceived effect a DNP might have on their careers, on nursing as a discipline, and on public perceptions of nursing practice. In this study, 51% of participants supported the transition to the DNP as the standard degree for practice nursing while 29% were opposed. The majority of participants (71%) planned to pursue an advanced practice nursing degree/certification with 81% of this group signifying that they would do so even if a DNP is required. The majority of participants agreed that the DNP will improve public perception of advanced practice nursing, but 71% thought the title of “doctor” would confuse patients. While current nursing students are generally informed of the upcoming DNP transition, there is disagreement regarding its implications for their careers and for the extent of public understanding.

关键词： Knowledge Perception DNP Nursing Students Accelerated Master’s Program in Nursing

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Social Capital and Depressive Ill-Health——An Evaluative Approach to the Implementation of the Chronic Care Model (CCM)

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Open Journal of Nursing 2014年第10期4卷 683-694页

作者： Anne Lise holm Anne Lyberg Ingela Berggren Sture Astrom Elisabeth Severinson The Centre for Women’s Family and Child HealthFaculty of Health SciencesBuskerud&Vestfold University CollegeKongsbergNorway Department of Nursing Health and CultureUniversity WestTrollhättanSweden

Background: Social capital has been described as a person’s sense of belonging as a result of the number and type of relationships she/he has, in which trust and reciprocity are especially important. Aim: To illuminate older persons’ experiences of social capital and depressive ill-health after implementation of the CCM. Methods: Data were collected from nine participants resident in two districts of Norway by means of individual in-depth interviews. A qualitative hermeneutic analysis was performed. Results: Two overall themes, desire for a guardian and a wish for independence despite being dependent, and two themes emerging from the analysis. The first theme—searching for protection was based on three sub-themes overwhelmed by the emotional pain of other people, a sense of exclusion and worries about the future, while the second theme—the need for a relationship with trustworthy persons comprised two sub-themes, namely, emotional pain was not understood and powerlessness to change the situation. The result of this study highlights the need for greater understanding on the part of healthcare professionals of how older persons manage their social relationships. Healthcare professionals require more knowledge about how negative self-beliefs held by older persons suffering from emotional pain, which can lead to reduced ability to trust other people. Another consequence is that fear of being dependent on other people can result in unwillingness to admit the need for help. Conclusion: This study highlights the lack of social capital in older persons who suffer from depressive ill-health. The implementation of the CCM does not appear to improve the situation. Older persons need to be more aware of their social needs and productive interactions in order to protect themselves and obtain support from their social network.

关键词： Chronic Care Model Experiences Depressive Ill-Health Older Persons Social Capital

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Noninvasive Assessment of Autonomic Cardiovascular Function in Patients after Arterial Switch Operation for Transposition of the Great Arteries

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Surgical Science 2015年第3期6卷 126-132页

作者： Joanna Hlebowicz Maja Rooth Sandra Lindstedt Johan holm Ulf Thilén Department of Internal Medicine Skane University Hospital Lund University Malmo Sweden Department of Cardiology Skane University Hospital Lund University Lund Sweden Lund University Malmo Sweden Department of Cardiothoracic Surgery Skane University Hospital Lund University Lund Sweden

Background: Children born with transposition of the great arteries (TGA) must undergo corrective surgery for survival, arterial switch being the standard surgical procedure. The sympathetic innervation of the heart may be damaged during the operation. This study was designed to determine whether adults who were born with TGA and who had arterial switch operation (ASO) in infancy exhibit denervation of the heart, measured as heart rate variability (HRV) with electrocardiography (ECG). Methods: Nine patients with transposition of the great arteries (four men and five women;mean age 26 ± 1 years) who underwent the ASO at a mean age of 85 ± 35 days, and nine healthy adults (five men and five women;mean age 26 ± 2) were included in the study. Cardiac autonomic nerve function was determined by the variation in RR intervals during maximal deep breathing, monitored by continuous ECG. The mean values were calculated for each group from six inspirations (I) and expirations (E), and the E:I ratios were calculated. Results: The E:I ratio did not differ between patients with an arterial switch and healthy controls (P?= 0.161). Two patients had signs of denervation of the heart up to 30 years after the arterial switch operation. Conclusions: Reinnervation of the heart?may take place in patients who have undergone the ASO in infancy, and these patients would not necessarily suffer from autonomic dysfunction. The HRV, measured by ECG, has the potential to identify arterially switched patients at risk of developing silent myocardial ischemia.

关键词： Congenital Heart Disease Transposition of the Great Arteries Arterial Switch Operation Sympathetic Innervation

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选择催化还原(SCR)脱硝技术在中国燃煤锅炉上的应用(上)

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热力发电 2007年第8期36卷 13-18页

作者： Hans Jensen-holm Nan-Yu Topsφe 崔建华托普索公司托普索公司北京代表处北京10000

针对燃煤电厂采用高尘选择催化还原(SCR)脱硝装置时可能遇到的问题进行分析,并对设计SCR反应器和选择适合的催化剂方面提出了建议。在选择催化剂时,针对中国煤要考虑催化剂活性位潜在积灰,以及飞灰中高CaO含量所引起的催化剂的失活。以... 详细信息

针对燃煤电厂采用高尘选择催化还原(SCR)脱硝装置时可能遇到的问题进行分析,并对设计SCR反应器和选择适合的催化剂方面提出了建议。在选择催化剂时,针对中国煤要考虑催化剂活性位潜在积灰,以及飞灰中高CaO含量所引起的催化剂的失活。以台山电厂600 MW机组和阳城电厂600 MW机组及美国肯塔基州Elmer Smith电站150 MW机组的SCR脱硝工程为例进行了说明。

关键词：燃煤锅炉烟气脱硝 SCR脱硝技术催化剂流场模拟计算流体力学实体模型

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通过贻贝养殖改善海水水质:瑞典社会的可盈利性方案

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AMBIO－人类环境杂志 2005年第2期34卷 128-135页

作者： Odd Lindahl Rob Hart Bodil Hernroth Sven Kollberg lars-Ove Loo lars Olrog Ann-Sofi Rehnstam-holm Jonny Svensson Susanne Svensson Ulf Syversen 许天虎瑞典皇家科学院瑞典农业科技大学SLU Kristineberg海洋研究站农村经济与农业协会瑞典气象与水文学院(SMHI) 哥德堡大学

沿海水域的富营养化是一个在全球范围内需要付出巨大社会代价的严重的环境问题。在斯卡格拉克海峡东部,富营养化的降低计划通过氮输入量的减少逐步实现,但目前还不清楚如何去减少氮的输入量。其中一个可能的方法是养殖紫贻贝等滤食性生... 详细信息

沿海水域的富营养化是一个在全球范围内需要付出巨大社会代价的严重的环境问题。在斯卡格拉克海峡东部,富营养化的降低计划通过氮输入量的减少逐步实现,但目前还不清楚如何去减少氮的输入量。其中一个可能的方法是养殖紫贻贝等滤食性生物,这种贻贝能够在生产海产品、饲料和农业肥料的同时也能够除去氮,从而将营养盐由海洋再循环到了陆地上。在瑞典西海岸的古尔马峡湾,我们对贻贝养殖可能对氮循环产生的影响进行了模拟。结果显示,该峡湾口地区氮的净输送量(溶解氮和颗粒状氮的总和)下降了20%。现有的商业贻贝养殖场已经免费提供了这种服务,但它对社会带来的利益将会远远大于这些。我们建议,不应该向贻贝饲养人支付劳动报酬,而应引入营养交换体制以提高沿海水域的状况。在这样的背景下提出了一个通过养殖贻贝来替代在吕瑟希尔社区的污水处理厂中消减氮含量的选择方案。生体毒素的聚积已被确定为瑞典的商业贻贝养殖进一步扩大方面的最大障碍,但这一问题似乎可以通过新技术和管理战略得以解决。在现有和可能的规定和支付费用的基础上,我们提出了一些可能会实现双赢的解决方案。

关键词：紫贻贝养殖场可盈利性社会瑞典海水水质富营养化沿海水域支付费用

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