Relação entre lesão por pressão e estado nutricional em pacientes hospitalizados: Revisão de literatura

The aim of this study was to review the main scientific evidence about pressure ulcer and nutritional status in adult patients admitted to a hospital. This is a literature review. A search was carried out in online scientific databases such as: SciELO, PubMed and LILACS. The keywords used were “pressure ulcer” AND “hospital” AND “malnutrition”. The search in the databases resulted in 129 studies in which eight met the inclusion criteria and made up the present review. The analysis showed that nutritional status (malnutrition) is one of the most important risk factors associated with the development and severity of pressure injuries in hospitalized patients. Nutritional intervention for patients at high risk of developing pressure injuries has proved to be a cost-effective approach compared to standard nutritional care in preventing pressure injuries.El objetivo de este estudio fue revisar la evidencia científica principal sobre la lesión por presión y el estado nutricional en pacientes adultos ingresados ​​en un hospital. Esta es una revisión de la literatura. Se realizó una búsqueda en bases de datos científicas en línea como: SciELO, PubMed y LILACS. Las palabras clave utilizadas fueron "úlcera por presión" Y "hospital" Y "desnutrición". La búsqueda en las bases de datos dio como resultado 129 estudios y, de estos, ocho cumplieron los criterios de inclusión y constituyeron la presente revisión. El análisis mostró que el estado nutricional de la desnutrición es uno de los factores de riesgo más importantes asociados con el desarrollo y la gravedad de las lesiones por presión en pacientes hospitalizados. La intervención nutricional para pacientes con alto riesgo de desarrollar lesiones por presión ha demostrado ser un enfoque rentable en comparación con la atención nutricional estándar para prevenir lesiones por presión.O objetivo deste estudo foi revisar as principais evidências científicas sobre a lesão por pressão e o estado nutricional em pacientes adultos internados em hospital. Trata-se de uma revisão de literatura. Foi realizada uma busca em bases de dados científicas online como: SciELO, PubMed e LILACS. Os descritores utilizados foram “pressure ulcer” AND “hospital” AND “malnutrition”. A busca nas bases de dados resultou em 129 estudos e, destes, oito atenderam aos critérios de inclusão e compuseram a presente revisão. A análise mostrou que o estado nutricional de desnutrição é um dos fatores de risco mais importantes associados ao desenvolvimento e gravidade da lesão por pressão em pacientes hospitalizados. A intervenção nutricional para pacientes em alto risco de desenvolver lesão por pressão mostrou-se uma abordagem custo-efetiva em comparação com cuidados nutricionais padrão na prevenção de lesão por pressão

DADA: data assimilation for the detection and attribution of weather and climate-related events

A new nudging method for data assimilation, delay‐coordinate nudging, is presented. Delay‐coordinate nudging makes explicit use of present and past observations in the formulation of the forcing driving the model evolution at each time step. Numerical experiments with a low‐order chaotic system show that the new method systematically outperforms standard nudging in different model and observational scenarios, also when using an unoptimized formulation of the delay‐nudging coefficients. A connection between the optimal delay and the dominant Lyapunov exponent of the dynamics is found based on heuristic arguments and is confirmed by the numerical results, providing a guideline for the practical implementation of the algorithm. Delay‐coordinate nudging preserves the easiness of implementation, the intuitive functioning and the reduced computational cost of the standard nudging, making it a potential alternative especially in the field of seasonal‐to‐decadal predictions with large Earth system models that limit the use of more sophisticated data assimilation procedures

The pathogenesis of low pathogenicity H7 avian influenza viruses in chickens, ducks and turkeys

<p>Abstract</p> <p>Background</p> <p>Avian influenza (AI) viruses infect numerous avian species, and low pathogenicity (LP) AI viruses of the H7 subtype are typically reported to produce mild or subclinical infections in both wild aquatic birds and domestic poultry. However relatively little work has been done to compare LPAI viruses from different avian species for their ability to cause disease in domestic poultry under the same conditions. In this study twelve H7 LPAI virus isolates from North America were each evaluated for their comparative pathogenesis in chickens, ducks, and turkeys.</p> <p>Results</p> <p>All 12 isolates were able to infect all three species at a dose of 10⁶50% egg infectious doses based on seroconversion, although not all animals seroconverted with each isolate-species combination. The severity of disease varied among isolate and species combinations, but there was a consistent trend for clinical disease to be most severe in turkeys where all 12 isolates induced disease, and mortality was observed in turkeys exposed to 9 of the 12 viruses. Turkeys also shed virus by the oral and cloacal routes at significantly higher titers than either ducks or chickens at numerous time points. Only 3 isolates induced observable clinical disease in ducks and only 6 isolates induced disease in chickens, which was generally very mild and did not result in mortality. Full genome sequence was completed for all 12 isolates and some isolates did have features consistent with adaptation to poultry (e.g. NA stalk deletions), however none of these features correlated with disease severity.</p> <p>Conclusions</p> <p>The data suggests that turkeys may be more susceptible to clinical disease from the H7 LPAI viruses included in this study than either chickens or ducks. However the severity of disease and degree of virus shed was not clearly correlated with any isolate or group of isolates, but relied on specific species and isolate combinations.</p

Imbibition in Disordered Media

The physics of liquids in porous media gives rise to many interesting phenomena, including imbibition where a viscous fluid displaces a less viscous one. Here we discuss the theoretical and experimental progress made in recent years in this field. The emphasis is on an interfacial description, akin to the focus of a statistical physics approach. Coarse-grained equations of motion have been recently presented in the literature. These contain terms that take into account the pertinent features of imbibition: non-locality and the quenched noise that arises from the random environment, fluctuations of the fluid flow and capillary forces. The theoretical progress has highlighted the presence of intrinsic length-scales that invalidate scale invariance often assumed to be present in kinetic roughening processes such as that of a two-phase boundary in liquid penetration. Another important fact is that the macroscopic fluid flow, the kinetic roughening properties, and the effective noise in the problem are all coupled. Many possible deviations from simple scaling behaviour exist, and we outline the experimental evidence. Finally, prospects for further work, both theoretical and experimental, are discussed.Comment: Review article, to appear in Advances in Physics, 53 pages LaTe

The density and peculiar velocity fields of nearby galaxies

We review the quantitative science that can be and has been done with redshift and peculiar velocity surveys of galaxies in the nearby universe. After a brief background setting the cosmological context for this work, the first part of this review focuses on redshift surveys. The practical issues of how redshift surveys are carried out, and how one turns a distribution of galaxies into a smoothed density field, are discussed. Then follows a description of major redshift surveys that have been done, and the local cosmography out to 8,000 km/s that they have mapped. We then discuss in some detail the various quantitative cosmological tests that can be carried out with redshift data. The second half of this review concentrates on peculiar velocity studies, beginning with a thorough review of existing techniques. After discussing the various biases which plague peculiar velocity work, we survey quantitative analyses done with peculiar velocity surveys alone, and finally with the combination of data from both redshift and peculiar velocity surveys. The data presented rule out the standard Cold Dark Matter model, although several variants of Cold Dark Matter with more power on large scales fare better. All the data are consistent with the hypothesis that the initial density field had a Gaussian distribution, although one cannot rule out broad classes of non-Gaussian models. Comparison of the peculiar velocity and density fields constrains the Cosmological Density Parameter. The results here are consistent with a flat universe with mild biasing of the galaxies relative to dark matter, although open universe models are by no means ruled out.Comment: In press, Physics Reports. 153 pages. gzip'ed postscript of text plus 20 embedded figures. Also available via anonymous ftp at ftp://eku.ias.edu/pub/strauss/review/physrep.p

Physician–Patient Communication About Prescription Medication Nonadherence: A 50-state Study of America’s Seniors

CONTEXT: Understanding and improving the quality of medication management is particularly important in the context of the Medicare prescription drug benefit that took effect last January 2006. OBJECTIVE: To determine the prevalence of physician–patient dialogue about medication cost and medication adherence among elderly adults nationwide. DESIGN: Cross-sectional survey. PARTICIPANTS: National stratified random sample of community-dwelling Medicare beneficiaries aged 65 and older. MAIN OUTCOME MEASURES: Rates of physician–patient dialogue about nonadherence and cost-related medication switching. RESULTS: Forty-one percent of seniors reported taking five or more prescription medications, and more than half has 2 or more prescribing physicians. Thirty-two percent overall and 24% of those with 3 or more chronic conditions reported not having talked with their doctor about all their different medicines in the last 12 months. Of seniors reporting skipping doses or stopping a medication because of side effects or perceived nonefficacy, 27% had not talked with a physician about it. Of those reporting cost-related nonadherence, 39% had not talked with a physician about it. Thirty-eight percent of those with cost-related nonadherence reported switching to a lower priced drug, and in a multivariable model, having had a discussion about drug cost was significantly associated with this switch (odds ratio [OR] 5.04, 95% confidence interval [CI] 4.28–5.93, P < .001). CONCLUSIONS: We show that there is a communication gap between seniors and their physicians around prescription medications. This communication problem is an important quality and safety issue, and takes on added salience as physicians and patients confront new challenges associated with coverage under new Medicare prescription drug plans. Meeting these challenges will require that more attention be devoted to medication management during all clinical encounters

The Effect of Performance-Based Financial Incentives on Improving Patient Care Experiences: A Statewide Evaluation

Patient experience measures are central to many pay-for-performance (P4P) programs nationally, but the effect of performance-based financial incentives on improving patient care experiences has not been assessed. The study uses Clinician &amp; Group CAHPS data from commercially insured adult patients (n = 124,021) who had visits with 1,444 primary care physicians from 25 California medical groups between 2003 and 2006. Medical directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the patient experience improvement activities adopted by groups. Multilevel regression models were used to assess the relationship between performance change on patient care experience measures and medical group characteristics, financial incentives, and performance improvement activities. Over the course of the study period, physicians improved performance on the physician-patient communication (0.62 point annual increase, p &lt; 0.001), care coordination (0.48 point annual increase, p &lt; 0.001), and office staff interaction (0.22 point annual increase, p = 0.02) measures. Physicians with lower baseline performance on patient experience measures experienced larger improvements (p &lt; 0.001). Greater emphasis on clinical quality and patient experience criteria in individual physician incentive formulas was associated with larger improvements on the care coordination (p &lt; 0.01) and office staff interaction (p &lt; 0.01) measures. By contrast, greater emphasis on productivity and efficiency criteria was associated with declines in performance on the physician communication (p &lt; 0.01) and office staff interaction (p &lt; 0.001) composites. In the context of statewide measurement, reporting, and performance-based financial incentives, patient care experiences significantly improved. In order to promote patient-centered care in pay for performance and public reporting programs, the mechanisms by which program features influence performance improvement should be clarified

The extractive industries and development: The resource curse at the micro, meso and macro levels

The resource curse literature has necessarily evolved in a rather fragmented way. While economists, political economists and political scientists have largely focused on the role of mineral abundance in long-term growth with the analysis largely confined to the country (macro) or regional (meso) level, anthropologists, sociologists and other social scientists have explored the development impacts of extractive industries at the community (micro) level. While this has provided a rigorous and comprehensive exploration of extractive industries and their impacts, causal factors that bridge and/or leap-frog these levels tend not to be accounted for. In this paper we examine the evolution of the literature across disciplinary lines and different levels of scale to assess the current status of resource curse debates. In so doing, we aim to explore how an integration of the various multi-scale approaches can help address the persistent problem of the resource curse

Physical inactivity in Parkinson’s disease

Patients with Parkinson’s disease (PD) are likely to become physically inactive, because of their motor, mental, and emotional symptoms. However, specific studies on physical activity in PD are scarce, and results are conflicting. Here, we quantified daily physical activities in a large cohort of PD patients and another large cohort of matched controls. Moreover, we investigated the influence of disease-related factors on daily physical activities in PD patients. Daily physical activity data of PD patients (n = 699) were collected in the ParkinsonNet trial and of controls (n = 1,959) in the Longitudinal Aging Study Amsterdam (LASA); data were determined using the LAPAQ, a validated physical activity questionnaire. In addition, variables that may affect daily physical activities in PD were recorded, including motor symptoms, depression, disability in daily life, and comorbidity. Patients were physically less active; a reduction of 29% compared to controls (95% CI, 10–44%). Multivariate regression analyses demonstrated that greater disease severity, gait impairment, and greater disability in daily living were associated with less daily physical activity in PD (R2 = 24%). In this large study, we show that PD patients are about one-third less active compared to controls. While disease severity, gait, and disability in daily living predicted part of the inactivity, a portion of the variance remained unexplained, suggesting that additional determinants may also affect daily physical activities in PD. Because physical inactivity has many adverse consequences, work is needed to develop safe and enjoyable exercise programs for patients with PD