An Interventional Study on the Effects of Pressure Ulcer Education on Jordanian Registered Nurses’ Knowledge and Practice

AbstractBACKGROUND: Pressure ulcers (PUs) are health problems that resulted in human suffering, pain, disfigurement, loss of productive time, and financial burden. Despite the fact that PU is largely preventable (Elliott, McKinley & Fox, 2008) and recent advances in health care, PU rates are significantly increased in health care facilities (EPUAP, 2009). PURPOSE: The current study examined the effects of pressure ulcer education program on nurses’ knowledge, practices, attitudes and intentions towards PU prevention and treatment. METHODS: Interventional approach using before-after test design was used. Two hundred and twenty nurses were randomly selected from eight hospitals in Jordan. Nurses’ knowledge and practice about PU was measured by PU knowledge and practice test based on EPUAP guidelines and Beeckman et al. (2011), while attitudes and intentions were measured using scales. RESULTS: The study revealed that nurses’ knowledge, practices, attitudes and intentions were improved towards PU prevention and treatment. Demographic variables such as gender and years of experience were influential in relation to nurses’ knowledge, practices, attitudes and intentions towards PU prevention and treatment. Results also showed lack of accurate information about PU management among nurses and positive nurses’ attitudes toward PU prevention and treatment. CONCLUSION: A PU education program is a powerful tool for nurses. It provides an opportunity to improve understanding of PU, keep abreast of current knowledge on PU, and eliminate patient's suffering. Additionally, PU education programs can help nurses to acquire professional attitudes that will enable them to improve quality of nursing care

Adoption of Fragrant Rice Farming: The Case of Paddy Farmers in the East Coast Malaysia

AbstractAnnually, Malaysia has to import approximately 30% of rice, including fragrant rice (Basmati and Jasmine type) to meet the shortage of domestic demand. The import of this specialty rice shows an up surging trend every year with a value of RM500 million. Mas Wangi or MRQ74 that has special characteristics and 80% similar attributes to Basmati type has been officially released in year 2005. The special characteristics such as long and slender grain shape, non- sticky and aromatic rice makes it preferred by Malaysian consumers and enabling it to tap the higher-end rice market, compared to normal white rice. The fragrant rice farming is one of the government initiatives to produce fragrant rice in large areas and needs full commitment from the farmers in non-granary areas. This study seeks to determine factors that influence new rice variety, MRQ74 adoption among paddy farmers in East Coast, Malaysia including the adoption behaviour. The study involved 28 farmers in non-granary areas in two districts; Pasir Mas and Tanah Merah, Kelantan via an in-depth interview approach. The results revealed that apart from the technology characteristics, there are other significant aspects that influence the adoption decision-making of the farmers such as extension services, capital resources, social influences, and institutional factor

Zeta Function Zeros, Powers of Primes, and Quantum Chaos

We present a numerical study of Riemann's formula for the oscillating part of the density of the primes and their powers. The formula is comprised of an infinite series of oscillatory terms, one for each zero of the zeta function on the critical line and was derived by Riemann in his paper on primes assuming the Riemann hypothesis. We show that high resolution spectral lines can be generated by the truncated series at all powers of primes and demonstrate explicitly that the relative line intensities are correct. We then derive a Gaussian sum rule for Riemann's formula. This is used to analyze the numerical convergence of the truncated series. The connections to quantum chaos and semiclassical physics are discussed

Gendered perceptions and adaptation practices of smallholder cocoa farmers to climate variability in the Central Region of Ghana

Understanding gendered adaptation practices among smallholder cocoa farmers is crucial to ensuring sustainable cocoa production in Ghana. This study examined the gendered perceptions and adaptation practices of smallholder cocoa farmers to climate variability in three selected communities (Breman Ayipey, Breman Baako and Breman Kuntanase) in the Asikuma-Odoben-Brakwa District of the Central Region, Ghana. The study adopted a mixed-methods approach including household surveys and focus group discussions with 10 participants in each community. Mann-Kendall trend test was used to determine the rainfall and temperature changes in the study district from 2000 to 2015. Results indicated that there was no significant difference between male and female farmers’ perceptions of climate variability (p > 0.05). Both male and female farmers perceived an increasing temperature, rainfall, windstorms and flooding for the past 15 years. The Mann-Kendall trend test showed that annual rainfall and temperature had increased over the study period although the trends were not statistically significant (p > 0.05). Both male and female farmers had resorted to the use of different adaptation practices to reduce the threats of climate variability. There was a substantial difference between adaptation practices used by male and female farmers such as changing planting dates, use of drought tolerant hybrids, shade management, livestock rearing and income from sale of properties (p < 0.05). The study recommends policy formulations that incorporate gender perspectives into climate change adaptation practices among smallholder cocoa farmers in Ghana

The IMPACT study: A clustered randomized controlled trial to assess the effect of a referral algorithm for axial spondyloarthritis

BACKGROUND: A substantial number of patients with chronic low back pain (CLBP) have axial spondyloarthritis (axSpA), but early recognition of these patients is difficult for general practitioners (GPs). The Case Finding Axial Spondyloarthritis (CaFaSpA) referral strategy has shown to be able to identify patients with CLBP at risk for axSpA, but its impact on clinical daily practice is yet unknown. OBJECTIVE: To assess the effect of the CaFaSpA referral strategy on pain caused by disability in primary care patients with CLBP. METHODS: Within this clustered randomized controlled trial 93 general practices were randomized to either the CaFaSpA referral model (intervention) or usual primary care (control). In each group primary care patients between 18 and 45 years with CLBP were included. The primary outcome was disability caused by CLBP, measured with the Roland Morris Disability Questionnaire (RMDQ) at baseline and four months. Secondary outcome was the frequency of new axSpA diagnosis. Descriptive analyses were performed, and a linear mixed-effects model was used. RESULTS: In total 679 CLBP patients were included of which 333 patients were allocated to the intervention group and 346 to the control group. Sixty-four percent were female and mean age was 36.2 years. The mean RMDQ score at baseline was 8.39 in the intervention group and 8.61 in the control group. At four months mean RMDQ score was 7.65 in the intervention group and 8.15 in the control group. This difference was not statistically significant (p = 0.50). Six (8%) out of the 75 finally referred patients, were diagnosed with axSpA by their rheumatologist. CONCLUSIONS: The CaFaSpA referral strategy for axSpA did not have an effect on disability after four months caused by CLBP. However, the strategy is able to detect the axSpA patient within the large CLBP population sufficiently. Trial registration number: NCT01944163, Clinicaltrials.gov

Effective decoupling of seebeck coefficient and the electrical conductivity through isovalent substitution of erbium in bismuth selenide thermoelectric material

Recognizing high thermoelectric performance in semiconducting materials is a challenging task. This is because the Seebeck coefficient and electrical conductivity which constitute the thermoelectric power factor are unfavourably coupled. This means decoupling the transport properties of thermoelectric materials to enhance the power factor without compromising the thermal conductivity is essential. Herein we report that the substitution of erbium (Er) within bismuth selenide (Bi2Se3) results in a simultaneous enhancement in Seebeck coefficient and electrical conductivity via effective mass and Fermi energy optimization. The Er-Substitution in Bi2Se3 does not only promote a simultaneous increase in Seebeck coefficient and electrical conductivity but also decreases the thermal conductivity through an enhancement in phonon scattering. Consequently, the optimum composition is found for the Bi1·85Er0·15Se3 sample instigating that, minimal substitution amount is required to optimize the thermoelectric performance. Our numerical calculation also shows that Er substitution alters the Fermi energy of the Bi2Se3 TE materials, thereby enhancing the effective mass. Through Raman and XPS characterization, we also elucidate that Er substitution does not change the chemical structure and chemical bonding of the pristine material appreciably. It thus leads to improvement in the Seebeck coefficient and electrical conductivity via effective mass optimization. This unique work presents a facile, scalable, cost-effective, and controllable synthesis of nanostructured Bi2Se3 toward realizing high-performance thermoelectric devices

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

The country of brand communication in the retail setting: An analysis of Italian products in China

The aim of this paper is to investigate the role of country of brand (COB) communication within the retail environment of emerging markets. Drawing from the literature on store image, we developed a framework to analyse static and dynamic elements of COB communication. By adopting an inductive approach, we analysed COB use in a sample of 20 stores of Italian fashion brands in China using the mystery shopping technique. Given the increasing growth of e-retailing in China, the in-store observation is complemented by an analysis of the use of COB within the brand's local website and e-commerce page. In order to have a multi-layered representation of the phenomenon, in-depth interviews with managers of Italian firms in fashion industry are carried out. Findings confirm that retailing represents a primary communication channel for firms operating in China; however, the results of the participant observation show that COB is a cue information utilised only by a small percentage of the sample, mainly in a textual and iconic way. Managerial implications are discussed on the extent to which COB communication in store should be managed within an effective marketing strategy in line with the country and consumer characteristics in order to enhance the brand image in a growing market like China

The evolution of non-small cell lung cancer metastases in TRACERx

Metastatic disease is responsible for the majority of cancer-related deaths. We report the longitudinal evolutionary analysis of 126 non-small cell lung cancer (NSCLC) tumours from 421 prospectively recruited patients in TRACERx who developed metastatic disease, compared with a control cohort of 144 non-metastatic tumours. In 25% of cases, metastases diverged early, before the last clonal sweep in the primary tumour, and early divergence was enriched for patients who were smokers at the time of initial diagnosis. Simulations suggested that early metastatic divergence more frequently occurred at smaller tumour diameters (less than 8 mm). Single-region primary tumour sampling resulted in 83% of late divergence cases being misclassified as early, highlighting the importance of extensive primary tumour sampling. Polyclonal dissemination, which was associated with extrathoracic disease recurrence, was found in 32% of cases. Primary lymph node disease contributed to metastatic relapse in less than 20% of cases, representing a hallmark of metastatic potential rather than a route to subsequent recurrences/disease progression. Metastasis-seeding subclones exhibited subclonal expansions within primary tumours, probably reflecting positive selection. Our findings highlight the importance of selection in metastatic clone evolution within untreated primary tumours, the distinction between monoclonal versus polyclonal seeding in dictating site of recurrence, the limitations of current radiological screening approaches for early diverging tumours and the need to develop strategies to target metastasis-seeding subclones before relapse

The evolution of lung cancer and impact of subclonal selection in TRACERx

Lung cancer is the leading cause of cancer-associated mortality worldwide. Here we analysed 1,644 tumour regions sampled at surgery or during follow-up from the first 421 patients with non-small cell lung cancer prospectively enrolled into the TRACERx study. This project aims to decipher lung cancer evolution and address the primary study endpoint: determining the relationship between intratumour heterogeneity and clinical outcome. In lung adenocarcinoma, mutations in 22 out of 40 common cancer genes were under significant subclonal selection, including classical tumour initiators such as TP53 and KRAS. We defined evolutionary dependencies between drivers, mutational processes and whole genome doubling (WGD) events. Despite patients having a history of smoking, 8% of lung adenocarcinomas lacked evidence of tobacco-induced mutagenesis. These tumours also had similar detection rates for EGFR mutations and for RET, ROS1, ALK and MET oncogenic isoforms compared with tumours in never-smokers, which suggests that they have a similar aetiology and pathogenesis. Large subclonal expansions were associated with positive subclonal selection. Patients with tumours harbouring recent subclonal expansions, on the terminus of a phylogenetic branch, had significantly shorter disease-free survival. Subclonal WGD was detected in 19% of tumours, and 10% of tumours harboured multiple subclonal WGDs in parallel. Subclonal, but not truncal, WGD was associated with shorter disease-free survival. Copy number heterogeneity was associated with extrathoracic relapse within 1 year after surgery. These data demonstrate the importance of clonal expansion, WGD and copy number instability in determining the timing and patterns of relapse in non-small cell lung cancer and provide a comprehensive clinical cancer evolutionary data resource