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clinical Judgment Development: Six Steps to Establish Professional Identity and Role-Specific competencies in caring for a Sexual Assault Survivor

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Health 2022年第1期14卷 23-37页

作者： Rose Eva constantino Larissa c. Allen Vivian Hui Kelly M. Nitowski Brayden Kameg Amy S. Bowser rebecca Burkart Betty Braxter Department of Health and community Systems School of Nursing University of Pittsburgh Pittsburgh Pennsylvania USA School of Nursing University of Pittsburgh Pittsburgh Pennsylvania USA

Background: clinical judgment is a specific role that establishes a professional identity. The purpose of this paper is to prepare nursing students to make better judgments in the clinical setting and realign learning and teaching. Methods: We used six steps to arrive at a competent clinical judgment suggested by the National council State Board of Nursing (NScBN) as a clinical judgment model 1) recognizing cues, 2) analyzing cues, 3) prioritizing hypotheses, 4) generating solutions, 5) taking an action, and 6) evaluating outcomes during the head-to-toe examination of the patient. Results: The primary outcomes are stabilization of the hemodynamics of the patient and prevention of further blood loss. Fluids are being given to help keep the vascular volume from being depleted, but they cannot solve the underlying problem. continued assessment, intervention, and monitoring of vital signs through the course of the hospital stay ending with the patient’s discharge. Discussion: Survivors of sexual assault are unique for a nurse to provide care. The nurse needs to assess, intervene, monitor, and pay attention to detail of the 6 steps to clinical judgment, resulting in positive outcomes for their patient. conclusions: Forensic nursing is a field of nursing that focuses on sexual assault survivor care and works to make the aftermath of their tragic situation easier to cope with. Strengthening clinical judgment skills could remedy significant mistakes made by novice forensic nurses. critical thinking and clinical ethical reasoning are the building blocks of clinical judgment.

关键词： Analyze cues clinical Judgment Evaluate Outcomes Generate Solutions Prioritize Hypotheses Recognize cues

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Breath Biopsy^(®) to Identify Exhaled Volatile Organic compounds Biomarkers for Liver cirrhosis Detection

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Journal of clinical and Translational Hepatology 2023年第3期11卷 638-648页

作者： Giuseppe Ferrandino Giovanna De Palo Antonio Murgia Owen Birch Ahmed Tawfike Rob Smith Irene Debiram-Beecham Olga Gandelman Graham Kibble Anne Marie Lydon Alice Groves Agnieszka Smolinska Max Allsworth Billy Boyle Marc P.van der Schee Michael Allison rebecca c.Fitzgerald Matthew Hoare Victoria K.Snowdon Owlstone Medical CambridgeUK Department of Oncology University of CambridgeHutchison/MRC Research CentreCambridgeUK Department of Pharmacology and Toxicology School for Nutrition and Translational Research in Metabo-lism(NUTRIM)Maastricht University Medical Centerthe Netherlands Department of Medicine University of CambridgeAddenbrooke’s HospitalCambridgeUK Addenbrookes Hepatology and Liver Transplantation Unit Addenbrookes Hospi-talCambridgeUK MRc cancer Unit Hutchison/MRC Research CentreUniversity of CambridgeCambridgeUK cRUK cambridge Institute CambridgeUK

Background and Aims:The prevalence of chronic liver dis-ease in adults exceeds 30%in some countries and there is significant interest in developing tests and treatments to help control disease progression and reduce healthcare *** is a rich sampling matrix that offers non-invasive so-lutions suitable for early-stage detection and disease *** previously investigated targeted analysis of a single biomarker,here we investigated a multiparametric approach to breath testing that would provide more robust and reliable results for clinical ***:To identify can-didate biomarkers we compared 46 breath samples from cir-rhosis patients and 42 from *** and analysis used Breath Biopsy OMNI™,maximizing signal and contrast to background to provide high confidence biomarker detec-tion based upon gas chromatography mass spectrometry(Gc-MS).Blank samples were also analyzed to provide de-tailed information on background volatile organic compounds(VOcs)***:A set of 29 breath VOcs differed significantly between cirrhosis and controls.A classification model based on these VOcs had an area under the curve(AUc)of 0.95±0.04 in cross-validated test *** seven best performing VOcs were sufficient to maximize classifica-tion performance.A subset of 11 VOcs was correlated with blood metrics of liver function(bilirubin,albumin,prothrom-bin time)and separated patients by cirrhosis severity using principal component ***:A set of seven VOcs consisting of previously reported and novel candidates show promise as a panel for liver disease detection and mon-itoring,showing correlation to disease severity and serum biomarkers at late stage.

关键词： Breath Biopsy Non-invasive Biomarker cirrhosis Liver function test.

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Assessing Post-Storm Forest Dynamics in the Pyrenees Using High-Resolution LIDAR Data and Aerial Photographs

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Journal of Mountain Science 2015年第4期12卷 841-853页

作者： ángela BLáZQUEZ-cASADO José R.GONZáLEZ-OLABARRIA Santiago MARTíN-ALcóN Ariadna JUST Mariló cABRé Lluís coll Forest Sciences center of catalonia (cTFc) Institut cartogràfic i Geològic de catalunya (IcGc)

We evaluated how historical storm events have shaped the current forest landscape in three Pyrenean subalpine forests(NE Spain).For this purpose we related forest damage estimations obtained from multi-temporal aerial photographic comparisons to the current forest typology generated from airborne Li DAR data, and we examined the role of past natural disturbance on the current spatial distribution of forest structural *** found six forest structural types in the landscape: early regeneration(T1 and T2), young even-aged stands(T3), uneven-aged stands(T4) and adult stands(T5and T6).All of the types were related to the timing and severity of past storms, with early-regeneration structures being found in areas markedly affected in recent times, and adult stands predominating in those areas that had suffered lowest damage levels within the study *** general, landscapes where high or medium levels of damage were recurrent also presented higher levels of spatial heterogeneity,whereas the opposite pattern was found in the less markedly affected landscape, characterized by thepresence of large regular *** results show the critical role that storm regimes in terms of timing and severity of past storms can play in shaping current forest structure and future dynamics in subalpine *** knowledge gained could be used to help define alternative forest management strategies oriented toward the enhancement of landscape heterogeneity as a measure to face future environmental uncertainty.

关键词：森林景观风暴动态评价雷达数据高分辨率亚高山森林照片航拍

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T cells from induced and spontaneous models of SLE recognize a common T cell epitope on β2-glycoprotein Ⅰ

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cellular & Molecular Immunology 2019年第8期16卷 685-693页

作者： David Salem rebecca Subang Masataka Kuwana Jerrold S.Levine Joyce Rauch Division of Rheumatology Department of MedicineResearch Institute of the McGill University Health CentreMontrealQCCanada Department of Allergy and Rheumatology Nippon Medical SchoolGraduate School of MedicineTokyoJapan Section of Nephrology Department of MedicineUniversity of Illinois at ChicagoChicagoILUSA Section of Nephrology Department of MedicineJesse Brown Veterans Affairs Medical CenterChicago IL USA

Systemic lupus erythematosus is a prototypic model for B-cell epitope spread in *** to numerous molecularly distinct self-antigens emerge in a sequential manner over several years,leading to disease *** the earliest autoantibodies to appear are those targeting phospholipid-binding proteins,particularlyβ2-glycoprotein Ⅰ.Notably,mice immunized with β2-glycoprotein Ⅰ and lipopolysaccharide develop a strong T cell response to β2-glycoprotein Ⅰ that is associated with autoantibody production and renal disease,similar to that seen in human *** we hypothesized that mice with murine systemic lupus erythematosus,whether induced or spontaneous,should have T cells that recognizeβ2-glycoprotein *** evaluated the response of splenic T cells from mice with induced(c57BL/6 and c3H/HeN)and spontaneous(MRL/lpr)systemic lupus erythematosus to peptides spanning the entire sequence of humanβ*** found that mice with induced and spontaneous systemic lupus erythematosus recognize a common T cell epitope(peptide 31;LYRDTAVFEcLPQHAMFG)in domain Ⅲ ofβ2-glycoprotein I.β2GPI-reactive cD4^(+)T cells from the two models differed primarily in cytokine production:T cells from mice with induced SLE expressed IFN-γ,while T cells from MRL/lpr mice expressed both IL-17 and IFN-γ,indicating that IL-17-expressing T cells are not necessary for generating aβ2GPI-reactive T cell *** data suggest that the generation of aβ2-glycoprotein Ireactive T cell response is shared by both induced and spontaneous models of systemic lupus erythematosus and that this T cell response may mediate epitope spread to autoantibodies in both models.

关键词： β2-glycoprotein I T cells systemic lupus erythematosus autoantibodies MHc class II haplotypes

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Interferon-Free Treatments for chronic Hepatitis c Genotype 1 Infection

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Journal of clinical and Translational Hepatology 2016年第2期4卷 97-112页

作者： Alireza FakhriRavari Mazyar Malakouti rebecca Brady Department of Pharmacy Practice University of the Incarnate Word Feik School of PharmacySan AntonioTexasUSA University of Texas Health Science center San AntonioTexasUSA

Hepatitis c virus (HcV) infection affects as many as 185 million people globally,many of whom are chronically infected and progress over time to cirrhosis,decompensated liver disease,hepatocellular carcinoma,and eventually death without a liver *** the United States,HcV genotype 1 constitutes about 75% of all *** interferon and ribavirin therapy was the cornerstone of treatment for many years,interferon-free treatments have become the standard of care with the emergence of new direct-acting agents,resulting in more effective treatment,shorter duration of therapy,better tolerability,lower pill burden,and ultimately better *** review will summarize the evidence for the currently available combination therapies as well as emerging therapies in phase 3 trials for treatment of HcV genotype 1.

关键词： Hepatitis c HcV Genotype 1 Direct acting antiretroviral agents

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Next generation patient-derived prostate cancer xenograft models

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Asian Journal of Andrology 2014年第3期16卷 407-412页

作者： Dong Lin Hui Xue Yuwei Wang rebecca Wu Akira Watahiki Xin Dong Hongwei cheng Alexander W Wyatt colin c collins Peter W Gout Yuzhuo Wang The Vancouver Prostate centre Vancouver Genera Hospital Vancouver Department of Experimental Therapeutics British Columbia Cancer Agency Vancouver Department of Urologic Sciences Faculty of Medicine University of British Columbia Vancouver. British Columbia. Canada.

There is a critical need for more effective therapeutic approaches for prostate cancer. Research in this area, however, has been seriously hampered by a lack of clinically relevant, experimental in vivo models of the disease. This review particularly focuses on the development of prostate cancer xenograft models based on subrenal capsule grafting of patients＇ tumor tissue into nonobese diabetic/ severe combined immunodeficient （NOD/ ScID） mice. This technique allows successful development of transplantable, patient-derived cancer tissue xenograft lines not only from aggressive metastatic, but also from localized prostate cancer tissues. The xenografts have been found to retain key biological properties of the original malignancies, including histopathological and molecular characteristics, tumor heterogeneity, response to androgen ablation and metastatic ability. As such, they are highly clinically relevant and provide valuable tools for studies of prostate cancer progression at cellular and molecular levels, drug screening for personalized cancer therapy and preclinical drug efficacy testing; especially when a panel of models is used to cover a broader spectrum of the disease. These xenograft models could therefore be viewed as next-generation models of prostate cancer.

关键词： effective therapeutic patient-derived xenograft

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Small Ubiquitin-Like Modifier conjugating Enzyme with Active Site Mutation Acts as Dominant Negative Inhibitor of SUMO conjugation in Arabidopsis

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Journal of Integrative Plant Biology 2013年第1期55卷 75-82页

作者： Konstantin Tomanov christian Hardtke Ruchika Budhiraja rebecca Hermkes George coupland Andreas Bachmair Department of Biochemistry and cell Biology Max F. Perutz Laboratories Center for Molecular Biology University of Vienna Department of Plant Molecular Biology University of Lausanne Department of Plant Developmental Biology Max Planck Institute for Plant Breeding Research

Small ubiquitin-like modifier （SUMO） conjugation affects a broad range of processes in plants, including growth, flower initiation, pathogen defense, and responses to abiotic stress. Here, we investigate in vivo and in vitro a SUMO conjugating enzyme with a cys to Ser change in the active site, and show that it has a dominant negative effect. In planta expression significantly perturbs normal development, leading to growth retardation, early flowering and gene expression changes. We suggest that the mutant protein can serve as a probe to investigate sumoylation, also in plants for which poor genetic infrastructure precludes analysis via loss-of-function mutants.

关键词： Agroinfection conjugating enzyme dominant-negative active site mutation small ubiquitin-like modifier conjugation small ubiquitin-like modifier.

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chemical peels.

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丛书名： Procedures in cosmetic dermatology

2011年

作者： Tung rebecca c.

来源：畅想之星图书光盘版（南... 评论

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Non-Detection of Dark Matter Particles: A case for Alternate Theories of Gravity

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Journal of High Energy Physics, Gravitation and cosmology 2021年第2期7卷 680-686页

作者： c. Sivaram Kenath Arun A. Prasad Louise rebecca Indian Institute of Astrophysics Bangalore India Department of Physics and Electronics CHRIST (Deemed to be University) Bangalore India Department of Physics Christ Junior College Bangalore India center for Space Plasma & Aeronomic Research The University of Alabama in Huntsville Huntsville Alabama USA

While there is overwhelming evidence for dark matter (DM) in galaxies and galaxy clusters, all searches for DM particles have so far proved negative. It is not even clear whether only one particle is involved or a combination of particles, their masses not precisely predicted. This non-detectability raises the possible relevance of modified gravity theories: MOND, MONG, etc. Here we consider a specific modification of Newtonian gravity (MONG) which involves gravitational self-energy, leading to modified equations whose solutions imply flat rotation curves and limitations of sizes of clusters. The results are consistent with current observations including that involving large spirals. This modification could also explain the current Hubble tension. We also consider the effects of dark energy (DE) in terms of a cosmological constant.

关键词： Dark Matter Dark Energy Modification of Newtonian Gravity Hubble Tension

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Estimated impact of introduction of new diagnostic criteria for gestational diabetes mellitus

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World Journal of Diabetes 2021年第6期12卷 868-882页

作者： Leon de Wit Anna B Zijlmans Doortje Rademaker christiana A Naaktgeboren J Hans DeVries Arie Franx rebecca c Painter Bas B van Rijn Department of Obstetrics and Gynaecology University Medical Center UtrechtUtrecht 3584 EANetherlands Department of Obstetrics and Gynaecology Gelderse Vallei HospitalEde 6716 RPNetherlands Department of Obstetrics and Gynaecology Amsterdam University Medical Centers-Location AMCAmsterdam 1105 AZNetherlands Department of Obstetrics and Gynaecology Amsterdam University Medical Centers–Location AMCAmsterdam 1105 AZNetherlands Department of Endocrinology Amsterdam University Medical Centers–Location AMCAmsterdam 1105 AZNetherlands Department of Obstetrics and Fetal Medicine Erasmus MC Sophia Children HospitalRotterdam 3015 GDNetherlands

BAcKGROUND Implementation of new diagnostic criteria for gestational diabetes mellitus(GDM)are still a subject of debate,mostly due to concerns regarding the effects on the number of women diagnosed with GDM and the risk profile of the women newly *** To estimate the impact of the World Health Organization(WHO)2013 criteria compared with the WHO 1999 criteria on the incidence of gestational diabetes mellitus as well as to determine the diagnostic accuracy for detecting adverse pregnancy *** We retrospectively analyzed a single center Dutch cohort of 3338 women undergoing a 75 g oral glucose tolerance test where the WHO 1999 criteria to diagnose GDM were clinically *** were categorized into four groups:non-GDM by both criteria,GDM by WHO 1999 only(excluded from GDM),GDM by WHO 2013 only(newly diagnosed)and GDM by both *** compared maternal characteristics,pregnancy outcomes and likelihood ratios for adverse pregnancy *** Retrospectively applying the WHO 2013 criteria increased the cohort incidence by 13.1%,from 19.3%to 32.4%.Discordant diagnoses occurred in 21.3%;4.1%would no longer be labelled as GDM,and 17.2%were newly *** to the non-GDM group,women newly diagnosed were older,had higher rates of obesity,higher diastolic blood pressure and higher rates of caesarean *** infants were more often delivered preterm,large-for-gestational-age and were at higher risk of a 5 min Apgar scorecluded from GDM were older and had similar pregnancy outcomes compared to the non-GDM group,except for higher rates of shoulder dystocia(4.3%vs 1.3%,P=0.015).Positive likelihood ratios for adverse outcomes in all groups were generally low,ranging from 0.54 to *** Applying the WHO 2013 criteria would result in a substantial increase in GDM *** diagnosed women are at increased risk for pregnancy adverse *** risk,however,seems to be lower than those identified by the

关键词： Diagnostic criteria Gestational diabetes Glucose tolerance test Incidence Pregnancy outcome

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