Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Textural and Compositional Changes in the Lithospheric Mantle Atop the Hawaiian Plume: Consequences for Seismic Properties

International audienceWe characterized the texture, composition, and seismic properties of the lithospheric mantle atop the Hawaiian plume by petrostructural analysis of 48 spinel peridotite xenoliths from four localities in three Hawaiian islands. Coarse-porphyroclastic peridotites with variable degrees of recrystallization, recorded by growth of strain-free neoblasts onto the deformed microstructure, predominate. Full evolution of this process produced equigranular microstructures. Some peridotites have coarse-granular microstructures. Coarse-granular and coarse-porphyroclastic peridotites have strong orthorhombic or axial-[100] olivine crystal-preferred orientations (CPOs). Recrystallization produced some dispersion and, locally, changed the olivine CPO towards axial-[010]. Enrichment in pyroxenes relative to model melting trends and pyroxenes with interstitial shapes and CPO uncorrelated with the olivine CPO imply refertilization by reactive melt percolation. The unusual spatial distribution of the recrystallized fraction, Ti enrichment, and Rare Earth Element fractionation in recrystallized, equigranular, and coarse-granular peridotites support that these microstructures are produced by static recrystallization triggered by melt percolation. However, there is no simple relation between microstructure and chemical or modal composition. This, together with marked variations in mineral chemistry among samples, implies multiple spatially heterogeneous melt-rock reaction events. We interpret the coarse-porphyroclastic microstructures and CPO as representative of the original oceanic lithosphere fabric. Annealing changed the microstructure to coarse-granular, but did not modify significantly the olivine CPO. Recrystallization produced moderate dispersion of the CPO. "Normal" oceanic lithosphere seismic anisotropy patterns are therefore preserved. Yet Fe enrichment, refertilization, and limited heating of the base of the lithosphere may reduce seismic velocities by up to 2%, partially explaining negative velocity anomalies imaged at lithospheric depths beneath Hawaii

Comparative analysis of the midgut microbiota of two natural tick vectors of Rickettsia rickettsii

Although the ticks Amblyomma sculptum and Amblyomma aureolatum are important vectors of Rickettsia rickettsii, causative agent of the life-threatening Rocky Mountain spotted fever, A. aureolatum is considerably more susceptible to infection than A. sculptum. As the microbiota can interfere with the colonization of arthropod midgut (MG) by pathogens, in the current study we analyzed the MG microbiota of both tick species. Our results revealed that the MG of A. aureolatum harbors a prominent microbiota, while A. sculptum does not. Remarkably, a significant reduction of the bacterial load was recorded in R. rickettsii-infected A. aureolatum. In addition, the taxonomy analysis of the MG bacterial community of A. aureolatum revealed a dominance of the genus Francisella, suggesting an endosymbiosis. This study is the first step in getting insights into the mechanisms underlying the interactions among Amblyomma species, their microbiota and R. rickettsii. Additional studies to better understand these mechanisms are required and may help the development of novel alternatives to block rickettsial transmission.Fil: Pavanelo, Daniel B.. Universidade Do Sao Paulo. Instituto de Ciencias Biomédicas. Departamento de Parasitología; BrasilFil: Schröder, Nicolas C.H.. Universidade Do Sao Paulo. Instituto de Ciencias Biomédicas. Departamento de Parasitología; BrasilFil: Pin Viso, Natalia Daniela. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación En Ciencias Veterinarias y Agronómicas. Instituto de Agrobiotecnología y Biología Molecular. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Agrobiotecnología y Biología Molecular; ArgentinaFil: Martins, Larissa A.. Universidade Do Sao Paulo. Instituto de Ciencias Biomédicas. Departamento de Parasitología; BrasilFil: Malossi, Camila D.. Universidade Do Sao Paulo. Instituto de Ciencias Biomédicas. Departamento de Parasitología; BrasilFil: Galletti, Maria F.B.M.. Universidade Do Sao Paulo. Instituto de Ciencias Biomédicas. Departamento de Parasitología; BrasilFil: Labruna, Marcelo B.. Universidade de Sao Paulo; BrasilFil: Daffre, Sirlei. Universidade Do Sao Paulo. Instituto de Ciencias Biomédicas. Departamento de Parasitología; BrasilFil: Farber, Marisa Diana. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación En Ciencias Veterinarias y Agronómicas. Instituto de Agrobiotecnología y Biología Molecular. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Agrobiotecnología y Biología Molecular; ArgentinaFil: Fogaça, Andréa C.. Universidade Do Sao Paulo. Instituto de Ciencias Biomédicas. Departamento de Parasitología; Brasi

Environnement et sociétés rurales en mutation

Les interactions entre sociétés humaines et environnement constituent un défi majeur pour l’avenir de la planète. Les conférences internationales (Rio, Kyoto, Johannesburg, etc.) montrent toute l’ambiguïté et tous les enjeux économiques et politiques nationaux qui s’y expriment. Dans ce contexte hautement politique, comment créer des convergences qui répondent aux besoins des populations et à une gestion environnementale appropriée ? C’est bien là toute la difficulté du développement durable. L’une des réponses qu’apporte ce livre passe par la nécessité de renouveler en profondeur les problématiques scientifiques et par l’importance de développer des études au niveau local ; car c’est là où se trouvent confrontées les stratégies des sociétés et les réponses qu’elles apportent aux multiples contraintes auxquelles elles ont à faire face. Connaître et faire connaître, dans les processus de prise de décision, les capacités d’adaptation et d’innovation des sociétés locales, cerner de nouveaux modes de régulation pour l’usage des ressources naturelles, proposer des stratégies alternatives de développement durable : tels sont les enjeux fondamentaux des études développées dans ce livre, à partir d’exemples contrastés pris dans la zone bioclimatique méditerranéenne