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

Analysis of PrP genotypes in relation to reproductive and production traits in Chios sheep

The study describes the changes with time in gene and genotype frequencies of a closed Chios herd. Genomic DNA was isolated and purified from peripheral blood leucocytes using standard procedures. The identification of the allelic variants present in the DNA samples, was performed in a simple multiplex PCR reaction and melting curve analysis of the PrP gene. Only ARR/ARR female genotypes were kept for breeding, and only males of the same genotype were used following year 2 of the study. As a result of planned individual matings and selection, the susceptible ARQ/ARQ genotype was eliminated from the flock in 4 years. The gene frequency of the R allele from a low 0.056 at year 1 reached a high 0.911 at year 6 of the study. Data from first lactation ewes of known genotypes were used to examine possible associations between PrP genotypes and ewe reproductive (litter size at birth and at weaning) and production traits (litter weight at birth and at weaning and 60-day milk yield after weaning). No effects of the sire genotype (ARR/ARR and ARR/ARQ) were found for any of the traits studied. The ewe genotype was associated with performance for reproductive traits but not with total weight of lamb output at birth or at weaning. ARR/ARR ewes had a higher litter size at birth (2.09) compared to ARQ/ARQ ewes (1.79) and higher litter size at weaning (1.84) compared to ARR/ARQ ewes (1.59). 60-day milk yield after weaning was not influenced by genotype (114.8, 105.8 and 114.8 kg for ARR/ARR, ARR/ARQ and ARQ/ARQ genotypes, respectively). Birth weight and 98-day weight were not influenced by the lamb genotype. ARQ/ARQ lambs were slightly heavier (P < 0.05) than ARR/ARR lambs at weaning as a result of faster pre-weaning growth. Post weaning growth was similar for the homozygous genotypes

Middle–Late Holocene earthquake history of the Gyrtoni Fault, Central Greece: Insight from optically stimulated luminescence (OSL) dating and paleoseismology

The south-dipping Gyrtoni Fault defines the northeastern boundary of the Middle-Late Quaternary Tyrnavos Basin, Central Greece. The recognition and recent tectonic activity of the fault were previously based on mapping, remote sensing analyses and electrical resistivity tomography studies. To understand the Holocene seismotectonic behavior of the Gyrtoni Fault we excavated two paleoseismological trenches. To estimate the timing of past earthquakes using luminescence dating, we obtained twenty five fluvial-colluvial sediment and pottery samples from both the upthrown and the downthrown fault blocks. We applied the Optically Stimulated Luminescence (OSL) dating to coarse grain quartz using the single-aliquot regenerative-dose (SAR) protocol. Our investigations of luminescence characteristics using various tests confirmed the suitability of the material for OSL dating. We found that the estimated OSL ages were internally consistent and agreed well with the available stratigraphical data, archaeological evidence and radiocarbon dates. The performed paleoseismological analysis emphasized the occurrence of three surface faulting events in a time span between 1.42 ± 0.06 ka and 5.59 ± 0.13 ka. Also, we recognized an earlier faulting event (fourth) has been also recognized to be older than 5.59 ± 0.13 ka. The mean throw per event value of 0.50–0.60 m could correspond to a ca. Mw 6.5 earthquake. An average fault slip rate of 0.41 ± 0.01 mm/a and an average recurrence time of 1.39 ± 0.14 ka were also estimated. Our results suggest that the elapsed time from the most recent event (minimum age 1.42 ± 0.06 ka) is comparable with the mean return period

LCA of Barley Production: A Case Study from Cyprus

Greenhouse gas emissions (i.e., carbon dioxide, methane, nitrous oxide) produced by agriculture contribute to global warming and climate change. Various practices followed by farmers in different environmental conditions contribute to the increase in the phenomena, and there is a need for immediate measures. The current study examines the environmental impact of barley production under rain-fed conditions in Cyprus. For this, four different nutrient management scenarios were investigated in order to evaluate the environmental performance of crop production, namely: (1) Nitrogen (20%), Phosphorous (20%), Potassium (10%); (2) Nitrogen (20%), Phosphorous (20%), Potassium (10%) and manure; (3) Nitrogen (25%), Phosphorous (10%), Potassium (0%); and (4) Nitrogen (25%), Phosphorous (10%), Potassium (0%) and manure. Data were collected from two different areas of Cyprus (Nicosia and Larnaca) through on-site visits and questionnaires. Life Cycle Assessment (LCA) was used as a method to quantify environmental impacts which were categorized into six impact categories: (i) acidification potential (AP), (ii) eutrophication potential (EP), (iii) global warming potential (GWP), (iv) ozone depletion potential (ODP), (v) photochemical, ozone creation potential (POCP), and (vi) terrestrial ecotoxicity (TAETP). LCA was used with system boundaries from field to harvest and a functional unit (FU) of one bale of hay. Research results showed that the addition of manure increased values in all impact categories. Comparing scenarios without manure (1 and 3) and with manure (2 and 4), the main process which contributed to GWP was field preparation, which resulted in 3 t CO2-Eq&#8729;FU&minus;1 and 46.96 t CO2-Eq&#8729;FU&minus;1, respectively. Furthermore, the highest contribution of sub-processes to GWP (kg CO2-Eq&#8729;FU&minus;1) was machinery maintenance (scenarios 2 and 4). The potential to reduce environmental impacts from barley and moreover, to mitigate the footprint of the agriculture sector in Cyprus is proposed by changing existing practices such as decreasing fuel consumption by agricultural machinery, and monitoring fertilizing and seeding. Conclusively, the carbon footprint of barley can be decreased through the improvement of nutrient management and cropping practices

Molecular characterization of chemical mutagenesis induced diversity in elite maize germplasm

Three classical breeding Iowa Super Stiff Stalk (SSS) inbred lines B37, B73 and B84, one Lancaster inbred Oh43 and mutant lines obtained by chemical mutagenesis followed by mutation breeding as follows: two of B37 and four of Oh43 were selected for molecular characterization. The mutant inbred lines were chosen because in addition to the improved GCA and SCA for grain yield, proven by their predominance in the Bulgarian breeding programs, they showed shifts in the flowering time as compared to the initial inbreds. Molecular markers (micro satellites and other PCR-based DNA markers) were used for characterization of maize genotypes and determination of the induced by chemical mutagenesis genetic variability in maize germplasm. The tested nine SSR markers (umc 1001, umclO14, umcl057, umcll81, umcl0lS, umc 1029. umcl003, umc 1033 and umcl035) can discriminate between the initial classical breeding inbred lines and the originating mutant inbreds. Allelic diversity was also studied by PCR amplification with specifically de-signed primers in the coding regions and flanking sequence of two genes: dwarf8 (d&amp;: chromosome 1, 198.5 cM), and indeterminate l (id1; chromosome 1. 175.0 cM). These are considered candidate genes for variation in plant height and/or flowering time, based on mutant phenotypes and chromosomal locations near major QTLs. Single nucleotide polymorphisms and indels were detected in the region flanking the SH2 domain of dwarf8 gene in some of the mutant inbreds as a result of SSCP and sequencing analyses. However, these polymorphisms could not be associated with the observed variations in flowering time. PCR analysis of the promoter region dwarf8 showed a variant fragment of about 1 kb in the inbred line Oh43 that was not present in any other initial and mutant in-bred lines included in the study. PCR amplification of the 5' end of the Id1 coding sequence revealed polymorphic bands in the mutant lines XM535, XM521, XM250-l, XM98-8 and XM85-105, as well as in the classical breeding line B73. The data, presented here demonstrate the usefulness of chemical mutagenesis for generation of genetic diversity within the elite maize germplasm. Some of this variation may affect the major genes in the QTLs. Our initial data revealed mutagenesis induced polymorphisms in the coding sequences of two important for the determination of flowering time transcription factors. Further molecular analyses of the proposed model systems may complement the trait association efforts and will help to directly identify the major genes in the QTLs

Pacientes miológicos com defeitos extensos: opções de reconstrução. Relato de caso Cancer patients with large defects. Reconstructional options: a case study

Referimo-nos ao caso de um paciente masculino de setenta e cinco anos de idade, com um carcinoma espinocelular (SCC), que se originou na parte exterior da orelha direita há quatro anos. Sofreu uma remoção cirúrgica da parte lesionada combinada com dissecção modificada do pescoço e reconstrução com o uso de retalho peitoral maior. Além disso, teve radioterapia com 6000 rads na região temporal direita. Há dois meses o paciente mostrou urna recorrência expansiva no que diz respeito ao músculo temporal e ao osso, o osso litóide, os músculos masseter e os músculos pterigóideos, a parte direita da mandíbula, a glândula da parótida com o nervo facial, e o bulbo superior da veia jugular interna. Sofreu uma remoção cirúrgica da lesão afetada até as extremidades saudáveis e reconstrução estética e funcional com a utilização combinada de uma prótese de metal fixa do côndilo e da mandíbula direita e o uso de músculo-cutâneo trapezious flap. Apresentamos o relato de um caso sobre as opções de reconstrução que nós temos em nossos dias para proporcionar qualidade de vida a doentes que sofrem de cancro.<br>We report a case of a seventy-five years old male patient with a squamous cell carcinoma (SCC) originated from the right external ear four years ago. He was undergone surgical removal of the lesion with a combination of modified neck dissection and reconstruction with the use of pectoralis major flap. Furthermore, he had radiotherapy with 6000 rads of the right temporal region. Two months ago the patient showed an extended recurrence concerning the temporal muscle and bone, the lithoid bone, the maseter and the pterygoids muscles, the right part of the mandible, the parotid gland with the facial nerve, and the superior bulb of the internal jugular vein. He had a surgical removal of the lesion in extended healthy margins and functional and esthetic reconstruction of the defect with a combination of metal fixed prosthesis of the condyle and the right mandible and the use of myocutaneous trapezious flap. This is a case report of the reconstruction options we have nowadays to provide quality of life in cancer patients