Deciding not to resuscitate: nurses’ and physicians’ perspectives

Press Releases   •   Nov 15, 2018 10:37 GMT

When deciding not to resuscitate patients in cardiac arrest, ethical issues arise. Nurses and physicians conflicting perspectives often cause frustration. In a new doctoral thesis from Uppsala University, Mona Pettersson examines clinical and ethical perspectives on “DNR orders” in cancer care.

Sometimes, when a patient is so ill that performing cardiopulmonary rescue (CPR) would do more harm than good, a DNR order is issued. Sometimes they are issued very late, perhaps even after CPR has been initiated. Sometimes they are unclear, and sometimes contradictory. Performing CPR on a patient at the end of their cancer can also be experienced by caregivers as the opposite of good caregiving. This can cause stress among the medical staff.

From a physician’s perspective, there is often hope for the patient’s survival even when the cancer has progressed very far. The physicians sometimes choose not to inform the patient that a DNR order has been issued. Often with the patient’s best interest in mind. They do not want them to lose hope. If the decision is made close to the cardiac arrest, this can make it harder to inform the patient.

Nurses have close and daily contact with their patients. If the patient, and perhaps also their family, is informed about the DNR order, nurses can support them and answer their questions. Some nurses wish physicians would make DNR decisions sooner, for them to be able to do so.

According to the Swedish Patient’s Act, patients have the right to take part and be informed in their treatment. But both the Patient’s Act and the National Board of Health and Welfare’s recommendations underline the importance of adapting the information to the individual. Physicians and nurses have a responsibility to handle decisions and information with the patient’s best interest in mind. This could mean not to inform, if it could do more harm than good. Guidelines from the Swedish Society of Medicine, the Swedish Society of Nursing and the Swedish Resuscitation Council support this. 

The difficulty lies in assessing whether the information does more harm than good for patients and their families. This is where nurses and physicians have different perspectives.

At many haematology and oncology wards, there are experiences of DNR orders and the frustration they can cause. A majority of the nurses and physicians who took part in Mona Pettersson’s research express that it is important for patients and their next-of-kin to be involved in or informed about decisions made. But few of them think this can become the reality of their workplace.

Mona Pettersson’s thesis shows that it is important for nurses and physicians to understand each other’s perspectives. To avoid conflicts between them, communication and ethical competence is crucial.

“Nurses and physicians share the responsibility of communicating with one another. For a common understanding they need insight into each other’s perspectives on DNR orders”, says Mona Pettersson.

She hopes her research will lead to such an understanding between nurses and physicians, to patients receiving the same information from all parties and to safer end-of-life care.

For more information, contact Mona Pettersson, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics, phone: +4670-95324446, e-mail: mona.pettersson@pubcare.uu.se

COMPETENCE AND COMMUNICATION: Do Not Resuscitate Decisions in Cancer Care, Uppsala: Acta Universitatis Upsaliensis, 2018

Uppsala University -- quality, knowledge, and creativity since 1477
World-class research and outstanding education of global benefit to society, business, and culture.
Uppsala University is one of northern Europe's highest ranked academic institutions. www.uu.se

When deciding not to resuscitate patients in cardiac arrest, ethical issues arise. Nurses and physicians conflicting perspectives often cause frustration. In a new doctoral thesis from Uppsala University, Mona Pettersson examines clinical and ethical perspectives on “DNR orders” in cancer care.

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The unintended consequences of dams and reservoirs

Press Releases   •   Nov 13, 2018 16:54 GMT

An international team of drought scientists show that while many dams and reservoirs are built, or expanded, to alleviate droughts and water shortages, they can paradoxically contribute to make them worse. The study is published in Nature Sustainability.

Researchers capture in-action images of photosynthetic protein complex splitting water

Press Releases   •   Nov 07, 2018 18:00 GMT

In a new article published in Nature an international research team presents high-resolution images of photosystem II, the protein complex that splits water into hydrogen ions and oxygen during photosynthesis. The images will help researchers better understand this complex mechanism, possibly opening up the door to developing cheap and efficient solar fuel devices.

​New infrastructure for medieval literature launched

Press Releases   •   Oct 31, 2018 15:23 GMT

Norse World is a new database which will make it easier for researchers to study perceptions of the surrounding world in Medieval Scandinavian literature. The new tool is a digital resource aimed at researchers in fields such as language history and philology, comparative literature, manuscript studies and digital humanities. It will be freely available to both researchers and the public.

​Molecular details of protein evolution investigated

Press Releases   •   Oct 24, 2018 19:00 BST

Proteins govern the biology of the cell. Through random mutation the sequences of our proteins slowly change over time, usually without affecting function. But sometimes new functions will be invented in this process. Scientists at Uppsala University have studied such a case in molecular detail: the emergence and optimisation of an interaction between two proteins. The results are published in Science Advances and show how several factors conspire to shape a plastic protein-protein interaction.

In a previous study the team reconstructed two interacting proteins from extinct organisms. One of these organisms was the ancestor of most of present day animals that lived sometime around 600 million years ago. The other one was an ancestor to present day fishes present 440 million years ago. Proteins from these animals were resurrected in the laboratory and analysed using different methods. Now the team has used nuclear magnetic resonance (NMR) to study in molecular detail the interaction of these ancient proteins and compared it to that of the corresponding modern human proteins.

"We observe how the oldest proteins interact weaker and that this is due to a combination of differences in structure (what the protein looks like) and dynamics (how they move) compared to younger variants," says Celestine Chi who lead the study together with Per Jemth, both at the department of Medical Biochemistry and Microbiology, Uppsala University.

The two proteins, denoted CBP/p300 and NCOA, are so-called transcriptional coactivators, which means that they facilitate the cellular process of transcription where DNA is used as template to make a messenger RNA which in turn is used by the ribosome to make proteins. The scientists speculate that mutations in one of the two proteins resulted in a weak interaction some 600 million years ago that slightly improved transcription. Subsequent mutations further shaped structure and dynamics to optimise the interaction and consolidate their function.

We are interested in how evolution shapes proteins and how new functions arise. There are still many unanswered questions regarding protein evolution on a molecular level," says Per Jemth. "We will investigate the evolution of other protein-protein interactions and look for general patterns.

The study is a collaboration between Uppsala University, ETH in Zürich, University of Buenos Aires and Stockholm University.

Jemth P, et al: Structure and dynamics conspire in the evolution of affinity between intrinsically disordered proteins, Science Advanced 2018, DOI10.1126/sciadv.aau4130

Contact:

Per Jemth, Department of Medical Biochemistry and Microbiology, Uppsala University;
phone: 018-4714557; e-mail: per.jemth@imbim.uu.se

Celestine Chi, Department of Medical Biochemistry and Microbiology, Uppsala University;
e-mail: celestine.chi@imbim.uu.se

Uppsala University -- quality, knowledge, and creativity since 1477
World-class research and outstanding education of global benefit to society, business, and culture.
Uppsala University is one of northern Europe's highest ranked academic institutions. www.uu.se

Through random mutation the sequences of our proteins slowly change over time, usually without affecting function. But sometimes new functions will be invented in this process. Scientists at Uppsala University have studied such a case in molecular detail. The results are published in Science Advances and show how several factors conspire to shape a plastic protein-protein interaction.

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Unravelling the genetics of fungal fratricide

Press Releases   •   Oct 15, 2018 12:38 BST

Selfish genes are genes that are passed on to the next generation but confer no advantage on the individual as a whole, and may sometimes be harmful. Researchers at Uppsala University have, for the first time, sequenced (or charted) two selfish genes in the fungus Neurospora intermedia that cause fungal spores to kill their siblings.

New knowledge about retrovirus-host coevolution

Press Releases   •   Oct 08, 2018 20:00 BST

Retroviruses have colonised vertebrate hosts for millions of years by inserting their genes into host genomes, enabling their inheritance through generations as endogenous retroviruses (ERVs). Researchers from Uppsala University now provide new knowledge about the long-term associations of retroviruses and their hosts by studying ERV variation and segregation in wild and domestic rabbit populations. The findings are being published in Proceedings of the National Academy of Sciences (PNAS).

Retroviruses, such as HIV in humans, must become part of the host cell’s nuclear DNA to produce new viruses. Over timescales of millions of years, retroviral infiltrations of germ cells have been inherited by the host’s offspring as ERVs, which make up large parts of vertebrate genomes today.

The researchers used recent technological advances for population-based analyses of whole genomes derived from wild and domestic hosts, which offer new insights into ERV-host genome variation. As a model, the researchers studied European rabbits, which diverged into two subspecies on the Iberian Peninsula about one million years ago and were domesticated in southern France about 1,000 years ago.

“By studying whole genome sequences from related host populations compared to the genome of a single individual, we can identify new ERVs to better understand retrovirus-host coevolution,” says Daniel Rivas, lead author of the study.

Using data from hundreds of individuals from many rabbit populations, the researchers were able to identify previously unknown retroviral insertions, as well as determine the spread of those that existed in the reference genome. The ERV diversity mostly follows rabbit divergence and the results indicate substantial variation across ERV insertions in different rabbit populations. This new knowledge sheds light on how ERVs spread in host populations, and how that spread correlates with the evolution of the host species.

“The abundance and segregating variation we uncover from host populations demonstrate the genomic ERV record as a remarkable source for an evolutionary perspective on retrovirus-host associations,” says Patric Jern, who headed the study.

Rivas Carillo S.D., Pettersson M.E., Rubin C.J. and Jern P. (2018) Whole-genome comparison of endogenous retrovirus segregation across wild and domestic host species populations. Proceedings of the National Academy of Sciences (USA), DOI: 10.1073/pnas.1815056115

For more information please contact:

Patric Jern, Science for Life Laboratory, Department of Medical Biochemistry and Microbiology,
e-mail: Patric.Jern@imbim.uu.se

Uppsala University -- quality, knowledge, and creativity since 1477
World-class research and outstanding education of global benefit to society, business, and culture.
Uppsala University is one of northern Europe's highest ranked academic institutions. www.uu.se

Retroviruses have colonised vertebrate hosts for millions of years by inserting their genes into host genomes, enabling their inheritance through generations as endogenous retroviruses (ERVs). Researchers from Uppsala University now provide new knowledge about the long-term associations of retroviruses and their hosts by studying ERV variation and segregation in wild and domestic rabbits.

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Artificial enzymes convert solar energy into hydrogen gas

Press Releases   •   Oct 04, 2018 10:02 BST

In a new scientific article, researchers at Uppsala University describe how, using a completely new method, they have synthesised an artificial enzyme that functions in the metabolism of living cells. These enzymes can utilize the cell’s own energy, and thereby enable hydrogen gas to be produced from solar energy.

Hydrogen gas has long been noted as a promising energy carrier, but its production is still dependent on fossil raw materials. Renewable hydrogen gas can be extracted from water, but as yet the systems for doing so have limitations.

In the new article, published in the journal Energy and Environmental Science, an interdisciplinary European research group led by Uppsala University scientists describe how artificial enzymes convert solar energy into hydrogen gas. This entirely new method has been developed at the University in the past few years. The technique is based on photosynthetic microorganisms with genetically inserted enzymes that are combined with synthetic compounds produced in the laboratory. Synthetic biology has been combined with synthetic chemistry to design and create custom artificial enzymes inside living organisms.

“We’ve now been able to use the method we developed to produce enzymes that use the cell’s own energy to produce hydrogen gas,” says Adam Wegelius, a PhD student at the Department of Chemistry – Ångström Laboratory, Uppsala University.

Senior Lecturer Gustav Berggren and Professor Peter Lindblad of the same department have been jointly leading the research.

“Evolution has already developed and refined a tool for capturing sunlight through photosynthesis. And by introducing our artificial enzyme into photosynthetic cyanobacteria we can directly benefit from this efficient process, thus producing hydrogen gas from solar energy. We’ve developed a completely new method, which allows us to go beyond the solutions offered by evolution and nature, in our development of artificial enzymes” Berggren says.

The article, “Generation of a functional, semisynthetic [FeFe]-hydrogenase in a photosynthetic microorganism”, was published in Energy and Environmental Science and is available at dx.doi.org/10.1039/C8EE01975D.

For more information, contact:
Gustav Berggren, tel.: +46 73 633 2698, email: gustav.berggren@kemi.uu.se
Peter Lindblad, tel.: +46 70 425 0498, email: peter.lindblad@kemi.uu.se
Adam Wegelius, tel.: +46 70 393 7119, email: adam.wegelius@kemi.uu.se

Uppsala University -- quality, knowledge, and creativity since 1477
World-class research and outstanding education of global benefit to society, business, and culture.
Uppsala University is one of northern Europe's highest ranked academic institutions. www.uu.se

In a new scientific article, researchers at Uppsala University describe how, using a completely new method, they have synthesised an artificial enzyme that functions in the metabolism of living cells. These enzymes can utilize the cell’s own energy, and thereby enable hydrogen gas to be produced from solar energy.

Read more »

​World speed record for polymer simulations

Press Releases   •   Oct 04, 2018 08:34 BST

Star polymers are within the most topologically entangled macromolecules. With a simulation over a hundred times faster than earlier studies, it is demonstrated that the mean square displacement scales with a power law 1/16 in time, instead of the previously assumed zero. It suggests that star polymer motion is the result of two linear relaxations coinciding in time.

New study shows cells produce specialised protein factories under stress

Press Releases   •   Oct 03, 2018 12:15 BST

Prevailing dogma in biological research holds that the cell’s protein factories, the ribosomes, function the same way in all cells and in all conditions. In an international study with participation from Weill Cornell Medicine and Uppsala University, published today in the journal Cell Reports, the researchers show that this is a truth that seems to not hold true.

Most functions in a cell are controlled by proteins. They are formed inside the cells in special protein factories called ribosomes. Different cells, i.e. in different tissues, need different sets of proteins and there are several ways that a cell can control how they are produced. However, it has long been an established “truth” that the composition and function of the ribosomes are the same in all cells and in all conditions.

This truth is now being disputed and in the present study the researchers show that E. coli bacteria can form specialised ribosomes that influence which proteins are produced.

“We exposed the bacteria to stress conditions by reducing the nutrient levels and found that a certain type of ribosome was produced in larger amounts. We could also link the increase in this type of ribosome to an activation of the cells’ general stress response,” says Theresa Vincent, group leader at the Department of Immunology, Genetics and Pathology, who participated in the study together with Professor Scott Blanchard at Weill Cornell Medicine in New York.

A ribosome consists of a large number of molecules that are all encoded by genes in the cell. In the study the researchers could show that variations in the DNA sequence in one of these genes gives rise to the specialised ribosomes.

“Our results support the finding that specialised ribosomes exist, that they are a result of natural gene variations and that they can control gene activity and the production of proteins. Since it has previously been believed that ribosomes have a passive role during the production of proteins, their importance in for instance diseases has not been investigated. But specialised ribosomes also exist in animal cells and it is warranted to study if and how the gene variations behind those ribosomes affect the function of the cells.”


Contact:
Theresa Vincent, email: theresa.vincent@igp.uu.se tel: +1-3478039171.

http://www.igp.uu.se/forskning/neuroonkologi/theresa-vincent/

Chad M. Kurylo, Matthew M. Parks, Manuel F. Juette, Boris Zinshteyn, Roger B. Altman, Jordana K. Thibado, C. Theresa Vincent, Scott C. Blanchard (2018) Endogenous rRNA Sequence Variation Can Regulate Stress Response Gene Expression and Phenotype, Cell Reports, Open Access, DOI: https://doi.org/10.1016/j.celrep.2018.08.093

Uppsala University -- quality, knowledge, and creativity since 1477
World-class research and outstanding education of global benefit to society, business, and culture.
Uppsala University is one of northern Europe's highest ranked academic institutions. www.uu.se

Prevailing dogma in biological research holds that the cell’s protein factories, the ribosomes, function the same way in all cells and in all conditions. In an international study with participation from Weill Cornell Medicine and Uppsala University, published today in the journal Cell Reports, the researchers show that this is a truth that seems to not hold true.

Read more »

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