Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs

Background. Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested. Aims and objectives. The purpose of this paper is to examine the inter-rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs.Design. Survey was among pressure ulcer experts.Methods. Fifty-six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter-rater reliability was calculated.Results. The multirater-Kappa for the entire group of experts was 0.80 (P < 0.001).Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers).Conclusions. The inter-rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear.Relevance to clinical practice. The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer Classification software package has been developed to facilitate learning

Environmental Electrokinetics for a sustainable subsurface

International audienceSoil and groundwater are key components in the sustainable management of the subsurface environment. Source contamination is one of its main threats and is commonly addressed using established remediation techniques such as in-situ chemical oxidation (ISCO), in-situ chemical reduction (ISCR; most notably using zero-valent iron [ZVI]), enhanced in-situ bioremediation (EISB), phytoremediation, soil-washing, pump-and-treat, soil vapour extraction (SVE), thermal treatment, and excavation and disposal. Decades of field applications have shown that these techniques can successfully treat or control contaminants in higher permeability subsurface materials such as sands, but achieve only limited success at sites where low permeability soils, such as silts and clays, prevail. Electrokinetics (EK), a soil remediation technique mostly recognized in in-situ treatment of low permeability soils, has, for the last decade, been combined with more conventional techniques and can significantly enhance the performance of several of these remediation technologies, including ISCO, ISCR, EISB and phytoremediation. Herein, we discuss the use of emerging EK techniques in tandem with conventional remediation techniques, to achieve improved remediation performance. Furthermore, we highlight new EK applications that may come to play a role in the sustainable treatment of the contaminated subsurface

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans – anteaters, sloths, and armadillos – have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data-paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards to sloth species, Bradypus variegatus has the most records (n=962), and Bradypus pygmaeus has the fewest (n=12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other datasets of Neotropical Series which will become available very soon (i.e. Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans dataset

Demonstration of an automated mass flow control system for condensable propellant Hall-effect thrusters

An automated mass flow control system for condensable propellant thrusters was demonstrated. The control system has the ability to arrest thermal runaway in a direct-evaporation feed system and stabilize the discharge current during voltage-limited operation of a magnesium-fueled Hall-effect thruster. The system supplemented plasma discharge heating at the evaporative anode with a resistive heater located behind the anode. Steady- state operation at constant voltage with discharge current variations less than 0.35 A was demonstrated for 60 minutes. A thrust of 44 mN was measured at a discharge voltage of 300 volts at 6 Amps, yielding a thrust-to-power of 24.4 mN/kW. A thrust of 50 mN was measured at a discharge voltage of 300 volts at 7 Amps, also yielding a thrust-to-power of 23.8 mN/kW. For a thruster operating at 2.1 kW, the steady-state supplemental heater power was 136 watts representing only 6% of the total system power. © 2012 by Mark A. Hopkins

Implication of dipeptidylpeptidase IV activity in human bronchial inflammation and in bronchoconstriction evaluated in anesthetized rabbits.

BACKGROUND: Decreased dipeptidylpeptidase IV (DPPIV) activity within the human nasal mucosa has previously been shown to contribute to the severity of chronic inflammatory rhinosinusitis. OBJECTIVE: To investigate and correlate the role of DPPIV activity with regard to bronchial inflammation. METHODS: DPPIV/CD26 activity/concentration was investigated in the bronchial tissue of human subjects suffering from chronic bronchial inflammation. In addition, the effect of a recombinant Aspergillus fumigatus DPPIV (fuDPPIV) was investigated on histamine-induced bronchoconstriction in anesthetized rabbits. RESULTS AND CONCLUSIONS: DPPIV/CD26 was present in submucosal seromucous glands, in leukocytes and to a very low degree in endothelial cells of human bronchi. DPPIV activity was correlated with tissue CD26 content measured by immunoassay. As previously reported for the nasal mucosa, DPPIV/CD26 activity was inversely correlated with the degree of airway inflammation. Systemic pretreatment with recombinant fuDPPIV markedly reduced the increase in histamine-induced airway resistance in rabbits. In conclusion, DPPIV activity modulates lower airway tone by degrading unknown peptidic substrates released by histamine in response to an allergen. Contrasting with our observations in the nose, this modulation is apparently not mediated via a neurokinin (NK1) receptor

Formation of patterned ground and sublimation till over Miocene glacier ice in Beacon Valley, southern Victoria Land, Antarctica

A thin glacial diamicton, informally termed Granite drift, occupies the floor of central Beacon Valley in southern Victoria Land, Antarctica. This drift is 25% striated clasts in the >16 mm fraction and a weathered, clast-supported diamicton with varnished and wind-faceted gravels and cobbles. The weathered facies is a coarse-grained lag of Granite drift that occurs at the base of polygon troughs and in lenses within the nonweathered facies. The concentration of cosmogenic 3He in dolerite cobbles from two profiles through the nonweathered drift facies exhibits steadily decreasing values and shows the drift to have formed by sublimation of underlying ice. These profile patterns and the 3He surface-exposure ages of 1.18 ± 0.08 Ma and 0.18 ± 0.01 Ma atop these profiles indicate that churning of clasts by cryoturbation has not occurred at these sites in at least the past 105 and 106 yr. Although Granite drift is stable at polygon centers, low-frequency slump events occur at the margin of active polygons. Slumping, together with weathering of surface clasts, creates the large range of cosmogenic-nuclide surface-exposure ages observed for Granite drift. Maximum rates of sublimation near active thermal-contraction cracks, calculated by using the two 3He depth profiles, range from 5 m/m.y. to 90 m/m.y. Sublimation rates are likely highest immediately following major slump events and decrease thereafter to values well below our maximum estimates. Nevertheless, these rates are orders of magnitude lower than those computed on theoretical grounds. During eruptions of the nearby McMurdo Group volcanic centers, ash-fall debris collects at the surface of Granite drift, either in open thermal-contraction cracks or in deep troughs that lie above contraction cracks; these deposits subsequently lower passively as the underlying glacier ice sublimes. The fact that some regions of Granite drift have escaped modification by patterned ground for at least 8.1 Ma indicates long-term geomorphic stability of individual polygons. Once established, polygon toughs likely persist for as long as 105–106 yr. Our model of patterned-ground formation, which applies to the hyperarid, cold-desert, polar climate of Antarctica, may also apply to similar-sized polygons on Mars that occur over buried ice in Utopia Planitia.10 figures; 3 tables.info:eu-repo/semantics/publishe