Pressure ulcer related pain in community populations: a prevalence survey.

BACKGROUND: Pressure ulcers are costly to the healthcare provider and can have a major impact on patient's quality of life. One of the most distressing symptoms reported is pain. There is very little published data on the prevalence and details of pain experienced by patients with pressure ulcers, particularly in community populations. The study was conducted in two community NHS sites in the North of England. METHODS: The aim was to estimate the prevalence of pressure area related pain within a community population. We also explored the type and severity of the pain and its association with pressure ulcer classification. A cross-sectional survey was performed of community nurses caseloads to identify adult patients with pressure ulcers and associated pain. Consenting patients then had a full pain assessment and verification of pressure ulcer grade. RESULTS: A total of 287 patients were identified with pressure ulcers (0.51 per 1000 adult population). Of the 176 patients who were asked, 133 (75.6%) reported pain. 37 patients consented to a detailed pain assessment. Painful pressure ulcers of all grades and on nearly all body sites were identified. Pain intensity was not related to number or severity of pressure ulcer. Both inflammatory and neuropathic pain were reported at all body sites however the proportion of neuropathic pain was greater in pressure ulcers on lower limbs. CONCLUSIONS: This study has identified the extent and type of pain suffered by community patients with pressure ulcers and indicates the need for systematic and regular pain assessment and treatment

Methane Fluxes from a High Intensity Seep Area west of Crimea, Black Sea

Methane seepage is a wide-spread phenomenon in the Black Sea with an increase in density and intensity west of the Crimea in the Paleo Dnepr area between 70 and 250m water depth. Within the EU funded project CRIMEA we studied the impact of high intensity seeps on the methane distribution in the water column and its possible transport into the atmosphere. Here we present data which allow flux calculations of free methane from an area of 1 by 1.23 miles between 80 and 95m water depth. Our calculations are based on direct and hydroacoustic flux measurements of single seeps or small-scaled seep areas (several m2); the spatial extrapolation of these fluxes use the very strong correlation between the bubble seep occurrence and a high backscattering seafloor; the temporal variability of bubble release was detected via the lander-based hydroacoustic system GasQuant.More than 1000 bubbling seep sites were identified during two cruises in 2003 and 2004 by hydroacoustic water column surveys. The hydroacoustic detection of bubbles uses the strong backscattering of the free gas phase caused by the great impedance difference of bubbles in water (equivalent to the detection of fish and their swim bladder). In echograms, bubble streams or even single bubbles can be detected, traced and used for special analyses such as bubble rising speed, bubble size and shrinking rates. Because of the flare-like appearance of bubble streams in echograms we call these features ’flares’.Parallel multi beam mapping allowed the detection of the seafloor morphology together with the spatial backscatter intensity of the seafloor. The combination of flare occurrences with high backscatter areas provided a very good correlation. Normalized, the backscatter ranged from -12.5 to 7.1 dB for an area of 4.23 km2. All seep positions plott in areas with more than -2.7 dB, which is almost the entire area of investigation (95.8 %). However, 75% of the flares occur within only 20.1% of the area, half of the flares occur in only 9.2% and 25% even occur in only 3.8% of the area with backscattering values above 2.4 dB. This correlation allows to predict and extrapolate active bubble seeps even without direct or hydroacoustic observations.One reason for the high backscattering seafloor are patches of carbonate cemented seafloor (formed via AOM) which typically occurs just below bright white Beggiatoa mats. In addition, high resolution seismic studies with a 5kHz sub-bottom profiler clearly show a shallow gas front in normally 3m sediment depth. In those areas where strong gas front reflectors dome up and reach the seafloor surface the backscatter values and flare density are the highest. This clearly shows that the bubbles released are fed from shallow gas which also might have an impact on the physical properties of the seafloor and its backscatter behaviour. Seeps in lower or even very low backscatter areas possibly indicate a rather young or weak activity which did not (so far) cause a remarkable carbonate cementation detectable during multi beam surveys.However, the backscatter data are the base for our spatial flux calculations which use direct bubble trapping to distinguish the flux rate from one single seep hole and hydroacoustic methods for small seep areas of several m2. Direct bubble flux measurements were performed with the submersible JAGO by trapping the bubbles with a funnel. Fluxes vary between 0.55 and 1.44 ml/s (or 1.98 to 5.18 l/h at in situ volume; or 0.24 to 0.64 mmol/s). Subsequent GC-based gas analyses onboard confirmed that the gas phase consists exclusively of methane. Visual observations by JAGO and towed camera systems showed bubble diameters between 1 and 15mm with typical sizes between 3 and 7mm. Together with bubble rising speeds of typically 25cm/s both attributes are in very good agreement with detailed hydroacoustic measurements using a dual frequency scientific echo sounder EK500 (120 and 38kHz). Flux estimat

Initial building investigations at Aberdeen Proving Ground, Maryland: Objectives and methodology

As part of an environmental-contamination source-definition program at Aberdeen Proving Ground, detailed internal and external inspections of 23 potentially contaminated buildings are being conducted to describe and characterize the state of each building as it currently exists and to identify areas potentially contaminated with toxic or other hazardous substances. In addition, a detailed geophysical investigation is being conducted in the vicinity of each target building to locate and identify subsurface structures, associated with former building operations, that are potential sources of contamination. This report describes the objectives of the initial building inspections, including the geophysical investigations, and discusses the methodology that has been developed to achieve these objectives

Improving Democracy Education. A Book Review of \u3ci\u3eEducation for Democracy: A Renewed Approach to Civic Inquiries for Social Justice\u3c/i\u3e

In their book Education for Democracy: A Renewed Approach to Civic Inquiries for Social Justice, authors Steven P. Camicia and Ryan Knowles (2021) offer a timely recipe for addressing the lack of civic competence in America, which is facing a great threat to democracy. Their student-centered model for democracy education in the classroom aims to bring a critical approach to teaching students in a manner that is authentic and that promotes multiculturalism. While we believe their contribution is well thought out, we contend the authors needed to explain more fully how the theoretical model connects to desired outcomes and also offer readers a clearer path to implementation. Likewise, we wanted to see a more explicit reference to philosopher and progressive educator John Dewey, whose writings nearly a century ago presaged the approach in this work. That being said, Education for Democracy ought to become an inspiration and a reference manual for those educators who care deeply about democracy education

Effect of microstructures on the electron-phonon interaction in the disordered metals Pd60_{60}Ag40_{40}

Using the weak-localization method, we have measured the electron-phonon scattering times $\tau_{ep}$ in Pd$_{60}$Ag$_{40}$ thick films prepared by DC- and RF-sputtering deposition techniques. In both series of samples, we find an anomalous $1/\tau_{ep} \propto T^2\ell$ temperature and disorder dependence, where $\ell$ is the electron elastic mean free path. This anomalous behavior cannot be explained in terms of the current concepts for the electron-phonon interaction in impure conductors. Our result also reveals that the strength of the electron-phonon coupling is much stronger in the DC than RF sputtered films, suggesting that the electron-phonon interaction not only is sensitive to the total level of disorder but also is sensitive to the microscopic quality of the disorder.Comment: accepted for publication in Phys. Rev.

Mechanisms Underlying Age- and Performance-related Differences in Working Memory

This study took advantage of the subsecond temporal resolution of ERPs to investigate mechanisms underlying age- and performance-related differences in working memory. Young and old subjects participated in a verbal n-back task with three levels of difficulty. Each group was divided into high and low performers based on accuracy under the 2-back condition. Both old subjects and low-performing young subjects exhibited impairments in preliminary mismatch/match detection operations (indexed by the anterior N2 component). This may have undermined the quality of information available for the subsequent decision-making process (indexed by the P3 component), necessitating the appropriation of more resources. Additional anterior and right hemisphere activity was recruited by old subjects. Neural efficiency and the capacity to allocate more resources to decision-making differed between high and low performers in both age groups. Under low demand conditions, high performers executed the task utilizing fewer resources than low performers (indexed by the P3 amplitude). As task requirements increased, high-performing young and old subjects were able to appropriate additional resources to decision-making, whereas their low-performing counterparts allocated fewer resources. Higher task demands increased utilization of processing capacity for operations other than decision-making (e.g., sustained attention) that depend upon a shared pool of limited resources. As demands increased, all groups allocated additional resources to the process of sustaining attention (indexed by the posterior slow wave). Demands appeared to have exceeded capacity in low performers, leading to a reduction of resources available to the decision-making process, which likely contributed to a decline in performance

Developing a pressure ulcer risk factor minimum data set and risk assessment framework

AIM: To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.BACKGROUND: A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.DESIGN: Consensus study.METHOD: A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011.FINDINGS: The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.CONCLUSION: The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework

QuShape: Rapid, accurate, and best-practices quantification of nucleic acid probing information, resolved by capillary electrophoresis

Chemical probing of RNA and DNA structure is a widely used and highly informative approach for examining nucleic acid structure and for evaluating interactions with protein and small-molecule ligands. Use of capillary electrophoresis to analyze chemical probing experiments yields hundreds of nucleotides of information per experiment and can be performed on automated instruments. Extraction of the information from capillary electrophoresis electropherograms is a computationally intensive multistep analytical process, and no current software provides rapid, automated, and accurate data analysis. To overcome this bottleneck, we developed a platform-independent, user-friendly software package, QuShape, that yields quantitatively accurate nucleotide reactivity information with minimal user supervision. QuShape incorporates newly developed algorithms for signal decay correction, alignment of time-varying signals within and across capillaries and relative to the RNA nucleotide sequence, and signal scaling across channels or experiments. An analysis-by-reference option enables multiple, related experiments to be fully analyzed in minutes. We illustrate the usefulness and robustness of QuShape by analysis of RNA SHAPE (selective 2′-hydroxyl acylation analyzed by primer extension) experiments

CSI 2264: Accretion process in classical T Tauri stars in the young cluster NGC 2264

Context. NGC 2264 is a young stellar cluster (~3 Myr) with hundreds of low-mass accreting stars that allow a detailed analysis of the accretion process taking place in the pre-main sequence. Aims. Our goal is to relate the photometric and spectroscopic variability of classical T Tauri stars to the physical processes acting in the stellar and circumstellar environment, within a few stellar radii from the star. Methods. NGC 2264 was the target of a multiwavelength observational campaign with CoRoT, MOST, Spitzer, and Chandra satellites and photometric and spectroscopic observations from the ground. We classified the CoRoT light curves of accreting systems according to their morphology and compared our classification to several accretion diagnostics and disk parameters. Results. The morphology of the CoRoT light curve reflects the evolution of the accretion process and of the inner disk region. Accretion burst stars present high mass-accretion rates and optically thick inner disks. AA Tau-like systems, whose light curves are dominated by circumstellar dust obscuration, show intermediate mass-accretion rates and are located in the transition of thick to anemic disks. Classical T Tauri stars with spot-like light curves correspond mostly to systems with a low mass-accretion rate and low mid-IR excess. About 30% of the classical T Tauri stars observed in the 2008 and 2011 CoRoT runs changed their light-curve morphology. Transitions from AA Tau-like and spot-like to aperiodic light curves and vice versa were common. The analysis of the Hα emission line variability of 58 accreting stars showed that 8 presented a periodicity that in a few cases was coincident with the photometric period. The blue and red wings of the Hα line profiles often do not correlate with each other, indicating that they are strongly influenced by different physical processes. Classical T Tauri stars have a dynamic stellar and circumstellar environment that can be explained by magnetospheric accretion and outflow models, including variations from stable to unstable accretion regimes on timescales of a few years