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

Dynamic Anchor: A Feature-Guided Anchor Strategy for Object Detection

The majority of modern object detectors rely on a set of pre-defined anchor boxes, which enhances detection performance dramatically. Nevertheless, the pre-defined anchor strategy suffers some drawbacks, especially the complex hyper-parameters of anchors, seriously affecting detection performance. In this paper, we propose a feature-guided anchor generation method named dynamic anchor. Dynamic anchor mainly includes two structures: the anchor generator and the feature enhancement module. The anchor generator leverages semantic features to predict optimized anchor shapes at the locations where the objects are likely to exist in the feature maps; by converting the predicted shape maps into location offsets, the feature enhancement module uses the high-quality anchors to improve detection performance. Compared with the hand-designed anchor scheme, dynamic anchor discards all pre-defined boxes and avoids complex hyper-parameters. In addition, only one anchor box is predicted for each location, which dramatically reduces calculation. With ResNet-50 and ResNet-101 as the backbone of the one-stage detector RetinaNet, dynamic anchor achieved 2.1 AP and 1.0 AP gains, respectively. The proposed dynamic anchor strategy can be easily integrated into the anchor-based detectors to replace the traditional pre-defined anchor scheme

Dynamic Anchor: A Feature-Guided Anchor Strategy for Object Detection

The majority of modern object detectors rely on a set of pre-defined anchor boxes, which enhances detection performance dramatically. Nevertheless, the pre-defined anchor strategy suffers some drawbacks, especially the complex hyper-parameters of anchors, seriously affecting detection performance. In this paper, we propose a feature-guided anchor generation method named dynamic anchor. Dynamic anchor mainly includes two structures: the anchor generator and the feature enhancement module. The anchor generator leverages semantic features to predict optimized anchor shapes at the locations where the objects are likely to exist in the feature maps; by converting the predicted shape maps into location offsets, the feature enhancement module uses the high-quality anchors to improve detection performance. Compared with the hand-designed anchor scheme, dynamic anchor discards all pre-defined boxes and avoids complex hyper-parameters. In addition, only one anchor box is predicted for each location, which dramatically reduces calculation. With ResNet-50 and ResNet-101 as the backbone of the one-stage detector RetinaNet, dynamic anchor achieved 2.1 AP and 1.0 AP gains, respectively. The proposed dynamic anchor strategy can be easily integrated into the anchor-based detectors to replace the traditional pre-defined anchor scheme

Analytic RF design of a linear accelerator with a SLED-I type RF pulse compressor

This study presents the RF design of a linear accelerator (linac) operated in single-bunch mode. The accelerator is powered by a compressed RF pulse produced from a SLED-I type RF pulse compressor. The compressed RF pulse has an unflattened shape with a gradient distribution which varies over the structure cells. An analytical study to optimize the accelerating structure together with the RF pulse compressor is performed. The optimization aims to maximize the efficiency by minimizing the required RF power from the generator for a given average accelerating gradient. The study shows that, owing to the compressed RF pulse shape, the constant-impedance structure has a similar efficiency to the optimal structure using varying iris apertures. The constant-impedance structure is easily fabricated and is favorable for the design of a linac with a pulse compressor. We utilize these findings to optimize the RF design of a X-band linac using the constant-impedance accelerating structure for the Tsinghua Thomson X-ray source facility

Effects of habitat alteration on lizard community and food web structure in a desert steppe ecosystem

Habitat alteration has major impacts on biodiversity, but we do not fully understand how changes in vegetation structure alter community interactions among vertebrate predators and their prey. Desertification is a major threat to degraded steppe habitats, prompting re-vegetation efforts to slow wind erosion. These processes alter both the structure and composition of the vegetation, and thus could influence predator and prey abundances, and their interactions. We investigated how habitat structure (degraded [sparse], natural [intermediate], or re-vegetated [dense]) influences lizard species richness, abundance, and diversity, and the interactions between these predators and invertebrate prey in the arid desert steppe. Structurally sparse and dense vegetation supported higher lizard abundances than natural habitats, with Phrynocephalus frontalis and Eremias argus dominating sparse and dense habitats respectively, and P. frontalis and E. multiocellata co-dominating natural habitats. Habitats that were structurally dense also supported the most complex trophic interactions among predators and prey, whereas structurally sparse habitats had low interaction diversity and interaction evenness, with most energy flowing along few trophic pathways. Steppe degradation therefore simplifies community trophic interactions, and restoration through enhanced protection of natural steppe habitat structure may play an important role in the conservation of healthy predator–prey communities. Desertification is a pressing issue throughout most of the arid steppe; revegetation efforts resulted in robust communities, in addition to promoting persistence of E. argus, which is endemic and threatened. Maintaining a heterogenous structural landscape thus may be the most promising way to combat desertification while at the same time restoring predator–prey community composition