Pressure Injury Prevention in Cardiac Surgery Using Risk Factor Assessment and Standardization

Cardiac surgical patients are more susceptible to pressure injury (PI) than other surgical specialties, and little is known about PI prevention (PIP) in this population. How do PIP strategies, compared to standard care, affect the incidence of PI during the post-operative recovery among adult cardiac surgery patients? The aim was to reduce the incidence of UAPI in an adult CVSICU by 5% in six weeks. The conceptual framework chosen was The Iowa Model Revised, and the theoretical framework employed was the Theoretical Model for Lesion Development. Quality improvement, single-group pretest-posttest design. Sample consisted of 69 cardiac surgery, LVAD, ECMO patients at Johns Hopkins CVSICU. The intervention was a standardized PIP bundle provided to “highest risk” patients screened before surgery. Outcome measures were UAPI count and incidence rates. Process measures were percentage of patients screened, prophylactic sacral dressing, rental bed cost. Balancing measures were PI severity, anatomic location, and time between wounds. Baseline data consisted of historic data and intervention data consisted of weekly survey observations. Implementation consisted of staff education, daily preoperative screening, weekly wound rounds. 33% of patients screened as “highest risk” and received the PIP bundle. PI count decreased from 25 to 13 during implementation and wound stages improved. Chi Square test of 2-proportions showed a reduced PI incidence of 8.56% (Z=1.66, p= .048) and 2-sample Poisson rate showed significance in count (Z=1.95, p=.036). Location changed to nose, buttocks, and occipital locations. There was an overall cost savings of $78,660. Reducing PI lead to reduced morbidity and cost

Development of a Farm Management Tool for the Brazilian Conditions

This paper presents results of a managerial information system prototype developed for modern agriculturalists in the Brazilian Cerrado´s Region. It follows a case study approach. One medium scale (422 hectares) of operation was envisioned, archetypical accounting framework was established, aiming to provide better data and information to support farm management decisions. The system has proved to be useful in examining decision making at farm level and in ex ante evaluations of changes in farm-level input use, output and profitability in response to price, policy, and/or technology changes. Data entry was done in ACCESS for user friendliness and global availability; presentational materials were prepared in ACCESS and in EXCEL.Family farm system, Microsoft ACCESS application, managerial information, cost accounting, Farm Management,

Smoking and antidepressants pharmacokinetics: a systematic review

Despite an increasingly recognized relationship between depression and smoking, little is known about how smoking influences antidepressant response and treatment outcomes. The aim of this study was to systematically review the evidence of the impact of smoking on new-generation antidepressants with an emphasis on the pharmacokinetic perspective. METHODS: We present a systematic review of clinical trials comparing the serum levels of new-generation antidepressants in smokers and nonsmokers. Data were obtained from MEDLINE/PubMed, Embase, and other sources. Risk of bias was assessed for selection, performance, detection, attrition, and reporting of individual studies. RESULTS: Twenty-one studies met inclusion criteria; seven involved fluvoxamine, two evaluated fluoxetine, sertraline, venlafaxine, duloxetine or mirtazapine, and escitalopram, citalopram, trazodone and bupropion were the subject of a single study. No trials were found involving other common antidepressants such as paroxetine or agomelatine. Serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone were significantly higher in nonsmokers compared with smokers. CONCLUSIONS: There is evidence showing a reduction in the concentration of serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone in smoking patients as compared to nonsmokers. The evidence regarding other commonly used antidepressants is scarce. Nonetheless, smoking status should be considered when choosing an antidepressant treatment, given the risk of pharmacokinetic interactions.info:eu-repo/semantics/publishedVersio

Surgical correction of scoliosis: Numerical analysis and optimization of the procedure

A previously developed model is used to numerically simulate real clinical cases of the surgical correction of scoliosis. This model consists of one-dimensional finite elements with spatial deformation in which (i) the column is represented by its axis; (ii) the vertebrae are assumed to be rigid; and (iii) the deformability of the column is concentrated in springs that connect the successive rigid elements. The metallic rods used for the surgical correction are modeled by beam elements with linear elastic behavior. To obtain the forces at the connections between the metallic rods and the vertebrae geometrically, non-linear finite element analyses are performed. The tightening sequence determines the magnitude of the forces applied to the patient column, and it is desirable to keep those forces as small as possible. In this study, a Genetic Algorithm optimization is applied to this model in order to determine the sequence that minimizes the corrective forces applied during the surgery. This amounts to find the optimal permutation of integers 1, ... , n, n being the number of vertebrae involved. As such, we are faced with a combinatorial optimization problem isomorph to the Traveling Salesman Problem. The fitness evaluation requires one computing intensive Finite Element Analysis per candidate solution and, thus, a parallel implementation of the Genetic Algorithm is developed

Verification for Everyone? An Overview of Dynamic Logic

This note, reporting the homonym keynote presented in the International Symposium on Molecular Logic and Computational Synthetic Biology 2018, traces an informal roadmap on Dynamic Logic (DL) field, focusing on its versatility and resilience to be adjusted and adopted in a wide class of application domains and computational paradigms. The exposition argues the room for developments on tagging DL to the analysis of synthetic biologic domain.publishe

OMNIgene.SPUTUM suppresses contaminants whilst maintaining Mycobacterium tuberculosis viability and obviates cold-chain transport

The study was funded by DNA Genotek Inc. Canada, the manufacturer of OMNIgene.SPUTUM (grant number SMD0-Z0B014).Tuberculosis (TB) diagnostics are centralised, requiring long-distance transportation of specimens in most resource-limited settings. We evaluated the ability of OMNIgene.SPUTUM (OM-S) to obviate cold-chain transport of TB specimens. A two-arm (same-day and after 5 days sample processing) study was conducted to assess contamination rates and Mycobacterium tuberculosis viability in OM-S-treated samples against the standard decontamination procedure (SDP) in Mozambique, using Lowenstein Jensen (LJ) and mycobacterial growth indicator tube (MGIT) culture and molecular bacterial load assay. 270 specimens were processed using OM-S and SDP in same-day and 5-day arms. Contamination was lower in OM-S-treated than SDP-treated cultures: 12% versus 15% and 2% versus 27% in the same-day and 5-day arms, respectively. M. tuberculosis recovery in OM-S-treated LJ cultures was 10% and 56% higher in the same-day and 5-day arms, respectively, than SDP-treated cultures, but lower in MGIT (52% and 28% lower in the same-day and 5-day arms, respectively). M. tuberculosis viable count was 1log estimated CFU·mL−1 lower in 5-day OM-S-treated sputa. OM-S was more effective at liquefying sputum with a shorter sample processing time: 22 min for culture. OM-S is simple to use and has demonstrated a high potency to suppress contaminants, maintenance of viability at ambient temperatures and higher M. tuberculosis recovery, particularly in the solid LJ cultures. Optimisation of OM-S to achieve higher MGIT culture positivity and shorter time to result will increase its application and utility in the clinical management of TB.Publisher PDFPeer reviewe

Comparison of Nanosized Gold-Based and Copper-Based Catalysts for the Low-Temperature Water-Gas Shift Reaction

In this paper the catalytic performances for the low-temperature water-gas shift reaction of Au/TiO(2) type A (from World Gold Council), Au/CeO(2) (developed at UPV-CSIC), CuO/Al(2)O(3) (from BASF), and CuO/ZnO/ Al(2)O(3) (from REB Research & Consulting) have been compared. The catalysts were characterized by different techniques such as Raman spectroscopy, BET surface area measurements, temperature-programmed reduction, and high-resolution transmission electron microscopy, which gave additional information on the redox properties and textural and morphological structure of the investigated samples. The performances of these catalysts were evaluated in a wide range of operating conditions in a micro packed-bed reactor. It was observed that the presence of reaction products in the feed (CO(2) and H(2)), as well as CO and H(2)O feed concentrations, have significant effects on the catalytic performances. With a typical reformate feed the Au/CeO(2) catalyst reveals the highest CO conversion at the lowest temperature investigated (150 degrees C). However, while in the long tests performed the CuO/ZnO/Al(2)O(3) catalyst showed a good stability for the entire range of temperatures tested (150-300 degrees C), the Au/CeO(2) sample clearly showed two distinct behaviors: a progressive deactivation at lower temperatures and a good stability at higher ones. The selection of the best catalytic system is therefore clearly dependent upon the range of temperatures used

Logics for Petri nets with propagating failures

Petri nets play a central role in the formal modelling of a wide range of complex systems and scenarios. Their ability to handle with both concurrency and resource awareness justifies their spread in the current formal development practices. On the logic side, Dynamic Logics are widely accepted as the de facto formalisms to reason about computational systems. However, as usual, the application to new situations raises new challenges and issues. The ubiquity of failures in the execution of current systems, interpreted in these models as triggered events that are not followed by the corresponding transition, entails not only the adjustment of these structures to deal with this reality, but also the introduction of new logics adequate to this emerging phenomenon. This paper contributes to this challenge by exploring a combination of two previous works of the authors, namely the Propositional Dynamic Logic for Petri Nets [1] and a parametric construction of multi-valued dynamic logics presented in [13]. This exercise results in a new family of Dynamic Logics for Petri Nets suitable to deal with firing failures.publishe

NEW SEISMIC SOURCE ZONE MODEL FOR PORTUGAL AND AZORES

The development of seismogenic source models is one of the first steps in seismic hazard assessment. In seismic hazard terminology, seismic source zones (SSZ) are polygons (or volumes) that delineate areas with homogeneous characteristics of seismicity. The importance of using knowledge on geology, seismicity and tectonics in the definition of source zones has been recognized for a long time [1]. However, the definition of SSZ tends to be subjective and controversial. Using SSZ based on broad geology, by spreading the seismicity clusters throughout the areal extent of a zone, provides a way to account for possible long-term non-stationary seismicity behavior [2,3]. This approach effectively increases seismicity rates in regions with no significant historical or instrumental seismicity, while decreasing seismicity rates in regions that display higher rates of seismicity. In contrast, the use of SSZ based on concentrations of seismicity or spatial smoothing results in stationary behavior [4]. In the FP7 Project SHARE (Seismic Hazard Harmonization in Europe), seismic hazard will be assessed with a logic tree approach that allows for three types of branches for seismicity models: a) smoothed seismicity, b) SSZ, c) SSZ and faults. In this context, a large-scale zonation model for use in the smoothed seismicity branch, and a new consensus SSZ model for Portugal and Azores have been developed. The new models were achieved with the participation of regional experts by combining and adapting existing models and incorporating new regional knowledge of the earthquake potential. The main criteria used for delineating the SSZ include distribution of seismicity, broad geological architecture, crustal characteristics (oceanic versus continental, tectonically active versus stable, etc.), historical catalogue completeness, and the characteristics of active or potentially-active faults. This model will be integrated into an Iberian model of SSZ to be used in the Project SHARE seismic hazard assessment

Parental origin of chromosomes influences crossover activity within the Kcnq1 transcriptionally imprinted domain of Mus musculus

BACKGROUND: Among the three functions of DNA, mammalian replication and transcription can be subject to epigenetic imprinting specified by the parental origin of chromosomes, and although there is suggestive indication that this is also true for meiotic recombination, no definitive evidence has yet been reported. RESULTS: We have now obtained such evidence on mouse chromosome 7 by assaying meiotic recombination as it occurs in reciprocal F1 mice. A 166 kb region near the Kcnq1 transcriptionally imprinted domain showed significantly higher recombination activity in the CAST x B6 parental direction (p \u3c 0.03). Characterizing hotspots within this domain revealed a cluster of three hotspots lying within a 100 kb span, among these hotspots, Slc22a18 showed a definitive parent of origin effect on recombination frequency (p \u3c 0.02). Comparing recombination activity in the mouse Kcnq1 and neighboring H19-Igf2 imprinted domains with their human counterparts, we found that elevated recombination activity in these domains is a consequence of their chromosomal position relative to the telomere and not an intrinsic characteristic of transcriptionally imprinted domains as has been previously suggested. CONCLUSION: Similar to replication and transcription, we demonstrate that meiotic recombination can be subjected to epigenetic imprinting and hotspot activity can be influenced by the parental origin of chromosomes. Furthermore, transcriptionally imprinted regions exhibiting elevated recombination activity are likely a consequence of their chromosomal location rather than their transcriptional characteristic