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

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Caratterizzazione e analisi del contenuto dei post Instagram sull'integrazione sportiva

Supplementation in sports has become popular and social media plays an important role in facilitating access and speeding up the dissemination of health information to society. However, at the same time, supplements represent a significant exposure source to health misinformation, which can directly impact the health of individuals who consume this information. The objective of the study was to characterize and analyze the quality of content published on Instagram on the subject of sports supplementation. Thus, the top 10 posts on Instagram were collected from the search for key hashtags on the subject over 5 weeks, 2 times a week, and content analysis was quantitatively and qualitatively performed from the Descending Hierarchical Classification, word cloud and the DISCERN instrument. As a result, 112 posts composed the analyzed textual corpus, with mentions of 154 supplements; moreover, 39.4% of the authors were nutritionists, followed by content creators (23.2%) and nutrition students (16.9%), with greater female representation (66.9%), and the hashtag “supplementation” was responsible for 60.5% of the analyzed posts. The main themes present in the posts involve aspects of creatine supplementation, predetermining factors for supplementation, benefits and characteristics of protein supplementation. The average DISCERN score was 2.77, representing a low reliability of the posts; however, professionals and students in the nutrition area had higher averages. The results show that publications on the subject of sports supplementation have low quality of scientific reliability, but that quality may vary depending on the education level of the author of the publication.La suplementación en los deportes se ha vuelto popular y las redes sociales desempeñan un papel importante a la hora de facilitar el acceso y acelerar la difusión de información sanitaria a la sociedad. El objetivo del estudio fue caracterizar y analizar la calidad del contenido publicado en Instagram sobre el tema de la suplementación deportiva. A lo largo de 5 semanas, se recogieron las diez publicaciones principales en Instagram dos veces por semana mediante la búsqueda de hashtags clave sobre el tema y el análisis de contenido se realizó de forma cuantitativa y cualitativa utilizando la Clasificación Jerárquica Descendente, la nube de palabras y el DISCERNIR. instrumento. Ciento doce posts conformaron el corpus textual analizado, con menciones a 154 suplementos, el 39,4% de los autores fueron nutricionistas, seguidos de creadores de contenidos (23,2%) y estudiantes de nutrición (16,9%), con mayor representación femenina (66,9%) y el hashtag “suplementação”, responsable del 60,5% de las publicaciones analizadas. Los temas principales de las publicaciones involucran la suplementación con creatina, los factores predeterminados para la suplementación, los beneficios y las características de la suplementación proteica. El puntaje DISCERN promedio fue de 2,77, representando baja confiabilidad de los mensajes, sin embargo, los profesionales y estudiantes del área de nutrición tuvieron promedios más altos. Los resultados muestran que las publicaciones sobre suplementación deportiva tienen una baja calidad de fiabilidad científica, pero que esta calidad puede variar en función del nivel de formación del autor de la publicación.A suplementação no esporte vem se popularizando e as mídias sociais tem papel importante na facilitação do acesso e na velocidade da disseminação de informações em saúde para a sociedade. O objetivo do estudo foi caracterizar e analisar a qualidade dos conteúdos publicados no Instagram acerca da temática de suplementação esportiva. Ao longo de 5 semanas, 2 vezes por semana foram coletadas as dez principais postagens no Instagram a partir da busca por hashtags chaves sobre a temática e a análise do conteúdo foi realizada de forma quanti-qualitativa a partir da Classificação Hierárquica Descendente, nuvem de palavras e o instrumento DISCERN. Cento e doze postagens compuseram o corpus textual analisado, com menções a 154 suplementos, 39,4% dos autores eram nutricionistas, seguido de criadores de conteúdo (23,2%) e estudantes de nutrição (16,9%), com maior representação feminina (66,9%) e da hashtag “suplementação”, responsável por 60,5% das postagens analisadas. As principais temáticas nas postagens envolvem a suplementação da creatina, fatores predeterminantes para a suplementação, benefícios e características da suplementação de proteínas. A pontuação média do DISCERN foi de 2.77, representando uma baixa confiabilidade das postagens, porém, profissionais e estudantes da área de nutrição tiveram médias superiores. Os resultados evidenciam que as publicações sobre suplementação esportiva apresentam baixa qualidade de confiabilidade científica, mas que, essa qualidade pode sofrer variações a depender do grau de instrução do autor da publicação.A suplementação no esporte vem se popularizando e as mídias sociais tem papel importante na facilitação do acesso e na velocidade da disseminação de informações em saúde para a sociedade. O objetivo do estudo foi caracterizar e analisar a qualidade dos conteúdos publicados no Instagram acerca da temática de suplementação esportiva. Ao longo de 5 semanas, 2 vezes por semana foram coletadas as dez principais postagens no Instagram a partir da busca por hashtags chaves sobre a temática e a análise do conteúdo foi realizada de forma quanti-qualitativa a partir da Classificação Hierárquica Descendente, nuvem de palavras e o instrumento DISCERN. Cento e doze postagens compuseram o corpus textual analisado, com menções a 154 suplementos, 39,4% dos autores eram nutricionistas, seguido de criadores de conteúdo (23,2%) e estudantes de nutrição (16,9%), com maior representação feminina (66,9%) e da hashtag “suplementação”, responsável por 60,5% das postagens analisadas. As principais temáticas nas postagens envolvem a suplementação da creatina, fatores predeterminantes para a suplementação, benefícios e características da suplementação de proteínas. A pontuação média do DISCERN foi de 2.77, representando uma baixa confiabilidade das postagens, porém, profissionais e estudantes da área de nutrição tiveram médias superiores. Os resultados evidenciam que as publicações sobre suplementação esportiva apresentam baixa qualidade de confiabilidade científica, mas que, essa qualidade pode sofrer variações a depender do grau de instrução do autor da publicação.L’integrazione nello sport è diventata popolare e i social media svolgono un ruolo importante nel facilitare l’accesso e accelerare la diffusione delle informazioni sanitarie nella società. L'obiettivo dello studio era caratterizzare e analizzare la qualità dei contenuti pubblicati su Instagram sul tema dell'integrazione sportiva. Nel corso di 5 settimane, i primi dieci post su Instagram sono stati raccolti due volte a settimana ricercando gli hashtag chiave sull'argomento e l'analisi dei contenuti è stata effettuata in modo quantitativo e qualitativo utilizzando la classificazione gerarchica discendente, word cloud e il DISCERN strumento. Centododici post compongono il corpus testuale analizzato, con menzioni di 154 integratori, il 39,4% degli autori erano nutrizionisti, seguiti da creatori di contenuti (23,2%) e studenti di nutrizione (16,9%), con una maggiore rappresentanza femminile (66,9%) e l'hashtag “suplementação”, responsabile del 60,5% dei post analizzati. I temi principali nei post riguardano l'integrazione di creatina, i fattori predeterminanti per l'integrazione, i benefici e le caratteristiche dell'integrazione proteica. Il punteggio DISCERN medio è stato di 2,77, che rappresenta una bassa affidabilità dei post, tuttavia, professionisti e studenti nel settore della nutrizione hanno avuto medie più alte. I risultati mostrano che le pubblicazioni sull’integrazione sportiva hanno una bassa qualità di affidabilità scientifica, ma che tale qualità può variare a seconda del livello di istruzione dell’autore della pubblicazione

Deep Underground Neutrino Experiment (DUNE), Far Detector Technical Design Report, Volume I Introduction to DUNE

International audienceThe preponderance of matter over antimatter in the early universe, the dynamics of the supernovae that produced the heavy elements necessary for life, and whether protons eventually decay—these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our universe, its current state, and its eventual fate. The Deep Underground Neutrino Experiment (DUNE) is an international world-class experiment dedicated to addressing these questions as it searches for leptonic charge-parity symmetry violation, stands ready to capture supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector technical design report (TDR) describes the DUNE physics program and the technical designs of the single- and dual-phase DUNE liquid argon TPC far detector modules. This TDR is intended to justify the technical choices for the far detector that flow down from the high-level physics goals through requirements at all levels of the Project. Volume I contains an executive summary that introduces the DUNE science program, the far detector and the strategy for its modular designs, and the organization and management of the Project. The remainder of Volume I provides more detail on the science program that drives the choice of detector technologies and on the technologies themselves. It also introduces the designs for the DUNE near detector and the DUNE computing model, for which DUNE is planning design reports. Volume II of this TDR describes DUNE's physics program in detail. Volume III describes the technical coordination required for the far detector design, construction, installation, and integration, and its organizational structure. Volume IV describes the single-phase far detector technology. A planned Volume V will describe the dual-phase technology

Deep Underground Neutrino Experiment (DUNE), Far Detector Technical Design Report, Volume II: DUNE Physics

The preponderance of matter over antimatter in the early universe, the dynamics of the supernovae that produced the heavy elements necessary for life, and whether protons eventually decay -- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our universe, its current state, and its eventual fate. DUNE is an international world-class experiment dedicated to addressing these questions as it searches for leptonic charge-parity symmetry violation, stands ready to capture supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector technical design report (TDR) describes the DUNE physics program and the technical designs of the single- and dual-phase DUNE liquid argon TPC far detector modules. Volume II of this TDR, DUNE Physics, describes the array of identified scientific opportunities and key goals. Crucially, we also report our best current understanding of the capability of DUNE to realize these goals, along with the detailed arguments and investigations on which this understanding is based. This TDR volume documents the scientific basis underlying the conception and design of the LBNF/DUNE experimental configurations. As a result, the description of DUNE's experimental capabilities constitutes the bulk of the document. Key linkages between requirements for successful execution of the physics program and primary specifications of the experimental configurations are drawn and summarized. This document also serves a wider purpose as a statement on the scientific potential of DUNE as a central component within a global program of frontier theoretical and experimental particle physics research. Thus, the presentation also aims to serve as a resource for the particle physics community at large

Highly-parallelized simulation of a pixelated LArTPC on a GPU

The rapid development of general-purpose computing on graphics processing units (GPGPU) is allowing the implementation of highly-parallelized Monte Carlo simulation chains for particle physics experiments. This technique is particularly suitable for the simulation of a pixelated charge readout for time projection chambers, given the large number of channels that this technology employs. Here we present the first implementation of a full microphysical simulator of a liquid argon time projection chamber (LArTPC) equipped with light readout and pixelated charge readout, developed for the DUNE Near Detector. The software is implemented with an end-to-end set of GPU-optimized algorithms. The algorithms have been written in Python and translated into CUDA kernels using Numba, a just-in-time compiler for a subset of Python and NumPy instructions. The GPU implementation achieves a speed up of four orders of magnitude compared with the equivalent CPU version. The simulation of the current induced on $10^3$ pixels takes around 1 ms on the GPU, compared with approximately 10 s on the CPU. The results of the simulation are compared against data from a pixel-readout LArTPC prototype