Health Problems among Nurses Due to Flexible Working Conditions

Sleepiness and sleeplessness are symptoms of shift work disorder (SWD), a sleep disorder caused by a person's work schedule. Understanding the mechanisms underlying shift work-related health concerns may be necessary when scheduling shifts, establishing employment routines, providing clinical care, and selecting employees. In today's workplace, stress has become the most influential element impacting individual efficacy and satisfaction. In this environment, occupational stress is becoming increasingly prevalent in the nursing profession. Nurses in today's healthcare system encounter several obstacles. These difficulties develop as a result of issues at the organizational, state, and national levels. It is critical for nurses to first recognize and comprehend every potential difficulty they may confront to deal with them effectively. Not only should they be recognized and understood, but methods to minimize them should also be sought.

The Effects of L1 English Constraints on the Acquisition of the L2 Spanish Alveopalatal Nasal

This study examines whether L1 English/L2 Spanish learners at different proficiency levels acquire a novel L2 phoneme, the Spanish palatal nasal /ɲ/. While alveolar /n/ is part of the Spanish and English inventories, /ɲ/, which consists of a tautosyllabic palatal nasal+glide element, is not. This crosslinguistic disparity presents potential difficulty for L1 English speakers due to L1 segmental and phonotactic constraints; the closest English approximation is the heterosyllabic sequence /nj/ (e.g., “canyon” /kænjn/ ['khæn.jn], cf. Spanish cañón “canyon” /kaɲon/ [ka.'ɲon]). With these crosslinguistic differences in mind, we ask: (1a) Do L1 English learners of L2 Spanish produce acoustically distinct Spanish /n/ and /ɲ/ and (1b) Does the distinction of /n/ and /ɲ/ vary by proficiency? In the case that learners distinguish /n/ and /ɲ/, the second question investigates the acoustic quality of /ɲ/ to determine (2a) if learners' L2 representation patterns with that of an L1 Spanish representation or if learners rely on an L1 representation (here, English /nj/) and (2b) if the acoustic quality of L2 Spanish /ɲ/ varies as a function of proficiency. Beginner (n = 9) and advanced (n = 8) L1 English/L2 Spanish speakers and a comparison group of 10 L1 Spanish/L2 English speakers completed delayed repetition tasks in which disyllabic nonce words were produced in a carrier phrase. English critical items contained an intervocalic heterosyllabic /nj/ sequence (e.g., ['phan.jə]); Spanish critical items consisted of items with either intervocalic onset /ɲ/ (e.g., ['xa.ɲa]) or /n/ ['xa.na]. We measured duration and formant contours of the following vocalic portion as acoustic indices of the /n/~/ɲ/ and /ɲ/ ~/nj/ distinctions. Results show that, while L2 Spanish learners produce an acoustically distinct /n/ ~ /ɲ/ contrast even at a low level of proficiency, the beginners produce an intermediate /ɲ/ that falls acoustically between their English /nj/ and the L1 Spanish /ɲ/ while the advanced learners' Spanish /ɲ/ and English /nj/ appear to be in the process of equivalence classification. We discuss these outcomes as they relate to the robustness of L1 phonological constraints in late L2 acquisition coupled with the role of perceptual cues, functional load, and questions of intelligibility.

Democracy, Polis and Parasite in Communication

Communication, as a social activity existing in and comprising almost any human action, cannot take place but as a mediated performance, given that it consists in the triadic relation between transmitter, message and receiver. Its goal is always the transmission of a message with the highest possible coherence and, at the same time, its simultaneous comprehension with the less possible deterioration of its original meaning. A basic assumption is that a potential difficulty in everyday communication is due for the most part to the existence of one or more parasites, which could be detected either in external factors or in the message itself. The question is whether a parasite could live in the signifier of a word and thus determine or alter its signified during an act of communication. This paper aims at exploring Serres’ view on parasite and attempting to identify its existence and function within the signifier of words we use in everyday life. To that end the terms of “democracy” and “polis” will be used as examples of hosts of parasites.

The challenges of post-bariatric surgery hypocalcaemia in pre-existing hypoparathyroidism

Summary Conventional treatment of hypoparathyroidism relies on oral calcium and calcitriol. Challenges in managing post-parathyroid- and post-thyroidectomy hypocalcaemia in patients with a history of bariatric surgery and malabsorption have been described, but postoperative management of bariatric surgery in patients with established hypoparathyroidism has not. We report the case of a 46-year-old woman who underwent elective sleeve gastrectomy on a background of post-surgical hypoparathyroidism and hypothyroidism. Multiple gastric perforations necessitated an emergency Roux-en-Y gastric bypass. She was transferred to a tertiary ICU and remained nil orally for 4 days, whereupon her ionised calcium level was 0.78 mmol/L (1.11–1.28 mmol/L). Continuous intravenous calcium infusion was required. She remained nil orally for 6 months due to abdominal sepsis and the need for multiple debridements. Intravenous calcium gluconate 4.4 mmol 8 hourly was continued and intravenous calcitriol twice weekly was added. Euthyroidism was achieved with intravenous levothyroxine. Maintaining normocalcaemia was fraught with difficulties in a patient with pre-existing surgical hypoparathyroidism, where oral replacement was impossible. The challenges in managing hypoparathyroidism in the setting of impaired enteral absorption are discussed with analysis of the cost and availability of parenteral treatments. Learning points: Management of hypoparathyroidism is complicated when gastrointestinal absorption is impaired. Careful consideration should be given before bariatric surgery in patients with pre-existing hypoparathyroidism, due to potential difficulty in managing hypocalcaemia, which is exacerbated when complications occur. While oral treatment of hypoparathyroidism is cheap and relatively simple, available parenteral options can carry significant cost and necessitate a more complicated dosing schedule. International guidelines for the management of hypoparathyroidism recommend the use of PTH analogues where large doses of calcium and calcitriol are required, including in gastrointestinal disorders with malabsorption. Approval of subcutaneous recombinant PTH for hypoparathyroidism in Australia will alter future management.

Column Classification/Characterisation of Strong Cation Exchange Phases for the Liquid Chromatographic Analysis of Small Molecular Weight Bases

A simple, rapid and robust protocol for the characterisation of strong cation exchange columns for the analysis of small molecular weight bases is described. A range of ten different phases were characterised, and the resultant selectivity and retention factors analysed using Principal Component Analysis. The score plots for the first and second principal components described 83% of the variability within the dataset. Score plots highlighted the large chromatographic differences observed between the phases, the validity of which was established using a larger range of bases. All the strong cation exchange materials demonstrated a synergistic mixed mode (i.e. ion exchange and hydrophobic) retention mechanism. Principal Component Analysis also highlighted the potential difficulty in locating suitable strong cation exchange “back-up” columns for the analysis of small molecular weight bases in that the characterised columns all displayed very different selectivities. The robustness of the protocol was confirmed by a factorial design experiment.

Teaching and Learning the Awareness of Existence in English Existential Sentences

This present study investigates the reasons that cause Chinese students’ difficulties, in learning English existential sentence, there-be structure. A set of questions are designed to examine their awareness of ‘existence’ in both languages. 609 participants attain this study. After data analysis, two findings indicate: (1) Students are used to selecting location as a subject starting an existential sentence which is similar to Chinese syntax, and there-be might be considered of using only when location is not given. (2) With the influence of Chinese syntax, the awareness between the place and the main noun forms because that a thing/object as a subject keeps have / has as its verb could change sentence construction and cannot effectively express the original existence in English. Therefore, this grammatical error stems not only from differences in awareness of existence between languages, but also from different grammar expressions about existence. In addition, in Chinese, existence (there-be) and possession (have/has), are expressed and translated by the only one Chinese character ‘有’. Most teachers normally adopt “have” idea to help interlingual translation to learn EES. However, this teaching might lead to a potential difficulty for students to be aware of existential difference between English and Chinese.

First experience in quadripolar active fixation coronary sinus lead extraction: a case report

Background The Attain Stability Quadripolar 4798 lead is a relatively new quadripolar active fixation coronary sinus (CS) lead. No cases of extraction of a chronically implanted 4798 lead have been published to date. Case summary A 52-year-old man with a history of previous cardiac resynchronization therapy pacemaker (CRT-P) insertion and atrioventricular node ablation presented to our institution with a pocket infection 69 weeks after implantation. Directed intravenous antibiotic therapy was commenced and an extraction was performed the following day. Extraction of the right atrial and right ventricular leads was simple and achieved with gentle manual traction. Extraction of the CS lead was more difficult. Significant traction was required due to the formation of adhesions inside the CS but extraction of the lead was eventually successful without complication. Specialized extraction equipment was not required. A new contralateral CRT-P device was implanted, and the patient was discharged home. He remains well at 3 months of follow-up. Discussion We present the first case of extraction of a chronically implanted active fixation Attain Stability Quadripolar lead. Our experience demonstrates that this has been performed successfully without specialist tools and with preservation of the CS branch. Significant adhesion was noted at the site of active fixation, however. Potential difficulty with this lead’s extraction should therefore be considered when contemplating its use.

Applying the vaginal approach for benign ovarian cystectomy: current evidence and future applications

Vaginal ovarian cystectomy has not gained wide acceptance owing to the potential difficulty in entering the cul-de-sac. We review the current evidence on vaginal approaches to benign ovarian cysts. Outcome measures of interest included time to return to work, patient satisfaction, surgical complications and length of hospital stay. Ten studies were included in this review and involving 525 patients. Vaginal ovarian cystectomy is overall safe and feasible in appropriately selected cases with no evidence of intrapelvic adhesions or endometriosis. These findings will need to be validated in appropriately powered studies, before reliable conclusions can be drawn. Furthermore, we emphasize the importance of ultrasound both preoperatively for case selection optimization and intraoperatively, as a means of guidance during posterior culdotomy.

Differences in the Olfactory Sensitivity of Ceratitis capitata to Headspace of Some Host Plants in Relation to Sex, Mating Condition and Population

The Mediterranean fruit fly, Ceratitis capitata Wied., is among the most serious pests in horticulture worldwide, due to its high reproductive potential, difficulty of control and broad polyphagy. The aim of this study was to measure—by means of the electroantennogram recordings— the antennal olfactory sensitivity of virgin, mated, male, female, lab-reared and wild C. capitata following stimulation with fruit and leaf headspace of some host-plants: clementine, orange, prickly pear, lemon and apple. The results show that: (a) lab-reared mated males are more sensitive to host-plant fruit and leaf headspace than females, while the opposite was true for wild insects; (b) antennae of wild virgin males were more sensitive than the mated ones, while no difference was observed among lab-reared medflies; (c) lab-reared virgin females were more sensitive than mated ones, while few differences were found within wild medflies; (d) in mated insects, lab-reared males were more sensitive to both host-plant fruits and leaves than the wild ones, while the opposite was found for females. Taken together, these results show that the olfactory sensitivity to host-plant odors differs between virgin and mated and lab-reared and wild flies.

Lyα emitters in a cosmological volume II: the impact of the intergalactic medium

In the near future galaxy surveys will target Lyman alpha emitting galaxies (LAEs) to unveil the nature of dark energy. It has been suggested that the observability of LAEs is coupled to the large scale properties of the intergalactic medium. Such coupling could introduce distortions into the observed clustering of LAEs, adding a new potential difficulty to the interpretation of upcoming surveys. We present a model of LAEs that incorporates $\rm {Ly}\alpha$ radiative transfer processes in the interstellar and intergalactic medium. The model is implemented in the GALFORM semi-analytic model of galaxy of formation and evolution. We find that the radiative transfer inside galaxies produces selection effects over galaxy properties. In particular, observed LAEs tend to have low metallicities and intermediate star formation rates. At low redshift we find no evidence of a correlation between the spatial distribution of LAEs and the intergalactic medium properties. However, at high redshift the LAEs are linked to the line of sight velocity and density gradient of the intergalactic medium. The strength of the coupling depends on the outflow properties of the galaxies and redshift. This effect modifies the clustering of LAEs on large scales, adding non linear features. In particular, our model predicts modifications to the shape and position of the baryon acoustic oscillation peak. This work highlights the importance of including radiative transfer physics in the cosmological analysis of LAEs.