Pressure Ulcer Risk and Prevention: Examining the Inter-Rater Reliability of the National Database of Nursing Quality Indicators® (NDNQI)

ABSTRACT Measuring and reporting performance have become the norm. The purpose of this descriptive multi-site (N = 36 NDNQI-participating hospitals) study was to examine the reliability of the National Database of Nursing Quality Indicators® (NDNQI®) pressure ulcer (PrU) risk and prevention measures. This is the first known study to examine the inter-rater reliability of these measures. Data for Part 1 of this two-part study were extracted from 1,637 patient records by 120 raters. One rater at each hospital was considered the "expert". Agreement between the expert and non-expert raters was calculated for the risk measures. Among the patients, 530 were "at risk" for PrU, and included in calculations of agreement for the prevention measures. In Part 2, raters completed an online survey about the methods they use to collect these data. Cohen's kappa values varied widely within and across hospitals. Because most patients were assessed for PrU risk, and those at risk received prevention, the prevalence of a "Yes" response was high suggesting prevalence-adjusted kappa (PAK) may be a better estimate of inter-rater reliability than Cohen's kappa. PAK values for: Skin assessment, PAK = .977, 95% CI [.966 - .989]; Risk assessment, PAK = .978, 95% CI [.964 -.993]; Time since last risk assessment, PAK = .790, 95% CI [.729 - .852]; Risk assessment scale, PAK = .997, 95% CI [.991 - 1.0]; Risk status, PAK = .877, 95% CI [.838 - .917]; Any prevention, PAK = .856, 95% [.769 - .943]; Skin assessment documented, PAK = .956, 95% CI [.904 - 1.0]; and Pressure-redistribution surface use, PAK = .839, 95% CI [.763 - .916] indicated substantial to near perfect agreement. PAK values for: Routine repositioning, PAK = .577, 95% CI [.494 - .661]; Nutritional support, PAK = .500, 95% CI [.418 - .581]; and Moisture management, PAK = .556, 95% CI [.469 - .643] indicated moderate agreement. Results provide support for the reliability of all (5) PrU risk measures, and three of six prevention measures. Areas of disagreement between the expert and non-expert raters should direct education to improve reliability. Results of the online survey suggest raters need further training on the NDNQI guidelines for PrU data collection

O prostornoj razdiobi normiranog diferencijalnog vegetacijskog indeksa nad Indijom i njegova veza s oborinom, temperaturom zraka, dostatnošću vlažnosti tla i ENSO pojavom

The changes in spatial distribution of Advanced Very High Resolution Radiometer (AVHRR) Normalized Difference Vegetation Index (NDVI) are stud¬ied for different seasons in India for the period 1982 to 2000. The inter-annual variability of All India NDVI (AINDVI) has been studied and related to rainfall, air temperature, soil moisture adequacy, Southern Oscillation Index (SOI) and Nino 3 Sea Surface Temperature (Nino 3 SST) to understand the influence of these variables on vegetal cover. The results show that the NDVI is high during the south-west (June to September) monsoon and retreat (October and November) seasons where in major crop seasons Kharif and Rabi take place over India. The trend of AINDVI is increasing and displayed higher values during La Niña and lower in El Niño episodes. The correlation between rainfall and NDVI of All India is not significant on monthly basis (+0.13) but it is more prominent when the cumulative annual amounts of rainfall are involved (+0.61). NDVI responded very well to the variations of soil moisture adequacy (SAD) which enumerates the strongest correlation (+0.73) of crop performance with NDVI. This significant strong correlation inferred that SAD can be taken as the indicator for the NDVI variations rather rainfall. The linear regression analysis of AINDVI and the ENSO indices revealed the strong impact of sea surface temperatures than SOI on vegetation pattern over India.Promjene prostorne raspodjele normiranog diferencijalnog vegetacijskog indeksa (NDVI) dobivenog na temelju mjerenja radiometrom vrlo visoke rezolucije (AVHRR) proučavane su za različite sezone na području Indije tijekom razdoblja od 1982. do 2000. godine. Promatrana je međugodišnja promjenjivost NDVI-a izračunatog za cijelo područje Indije (AINDVI) te njegova povezanost s oborinom, temperaturom zraka, dostatnošću vlažnosti tla, indeksom Južne oscilacije (SOI) te Niño 3 površinskom temperaturom mora (Niño 3 SST) kako bi se utvrdila povezanost tih varijabli i vegetacijskog pokrova. Rezultati pokazuju da NDVI poprima visoke vrijednosti tijekom sezone jugozapadnih monsuna (od lipnja do rujna) te tijekom prijelazne sezone povlačenja monsuna (listopad i studeni) što se uglavnom podudara sa žetvenim sezonama Kharif i Rabi. NDVI ima pozitivan trend te poprima više vrijednosti tijekom La Niña, a niže vrijednosti tijekom El Niño događaja. Iako korelacija između mjesečnih vrijednosti oborine i NDVI-a za cijelo područje Indije nije signifikantna (+0,13), ona je značajno veća ukoliko se promatraju kumulativne godišnje vrijednosti oborine (+0,61). Varijabilnost NDVI-a je u skladu s promjenama dostatnosti vlažnosti tla (SAD) što rezultira značajnim koeficijentom korelacije između indeksa NDVI i prinosa usjeva (+0,73). Ova signifikantna i jaka povezanost ukazuje da se SAD može koristiti kao uspješniji pokazatelj promjenjivosti NDVI-a nego sama oborina. Linearna regresija između AINDVI i ENSO indeksa pokazala je da su površinske temperature mora (Niño 3 SST) bolje korelirane s vegetacijskim pokrovom Indije nego indeks SOI

Scaling of heavy rainy days with upper air profiles over Chennai during Northeast monsoon

This study aims to scale the heavy rainy days (rainfall > 64 mm per day) with the surface and upper-air parameters overChennai (12.80° N and 80.03° E), located on the east coast of India, during the Northeast (NE) monsoon (October toDecember) from 2001 to 2015. The daily rainfall and radiosonde observations that are available from India MeteorologicalDepartment (IMD), Outgoing Long-wave Radiation (OLR) from Very High Resolution Radiometer (VHRR) Kalpana-1Indian satellite, and Total Column Liquid Water (TCLW) and vertical velocity from ERA-Interimre analysis are used. Thestudy commences with the comparison of mean daily Integrated Water Vapor (IWV) and rainfall over Chennai. Further, thestudy proceeds ahead by analyzing the IWV, TCLW, Instantaneous Condensation Rate (ICR) and precipitation extremeefficiency during the heavy rainy days. The results are such as (i) the heavy rainy days are better scaled using IWV andTCLW than with surface air temperature and OLR (ii) ICR during the all heavy rainfall days found high at 700 mb level,and (iii) the precipitation extreme efficiency which is estimated using the ratio of precipitation extreme (obtained fromvertical velocity, specific humidity gradient) and the ICR has shown a linear relationship with the surface reaching rainfallthrough the temporal and spatial smearing of raindrops expected

Scaling of heavy rainy days with upper air profiles over Chennai during Northeast monsoon

153-161This study aims to scale the heavy rainy days (rainfall > 64 mm per day) with the surface and upper-air parameters over Chennai (12.80° N and 80.03° E), located on the east coast of India, during the Northeast (NE) monsoon (October to December) from 2001 to 2015. The daily rainfall and radiosonde observations that are available from India Meteorological Department (IMD), Outgoing Long-wave Radiation (OLR) from Very High Resolution Radiometer (VHRR) Kalpana-1 Indian satellite, and Total Column Liquid Water (TCLW) and vertical velocity from ERA-Interimre analysis are used. The study commences with the comparison of mean daily Integrated Water Vapor (IWV) and rainfall over Chennai. Further, the study proceeds ahead by analyzing the IWV, TCLW, Instantaneous Condensation Rate (ICR) and precipitation extreme efficiency during the heavy rainy days. The results are such as (i) the heavy rainy days are better scaled using IWV and TCLW than with surface air temperature and OLR (ii) ICR during the all heavy rainfall days found high at 700 mb level, and (iii) the precipitation extreme efficiency which is estimated using the ratio of precipitation extreme (obtained from vertical velocity, specific humidity gradient) and the ICR has shown a linear relationship with the surface reaching rainfall through the temporal and spatial smearing of raindrops expected

An appraisal of rainfall estimation over India using remote sensing and in situ measurements

167-177The most important meteorological parameter Rainfall, shows high variability in space and time, particularly over Tropics / Monsoon region. Many new observational and analysis methods to observe / analyse them by remote sensing techniques (Satellites, Doppler Weather Radars) have emerged over the decades, besides the dense network of in situ rain gauges, Automatic Weather Stations (AWS) etc on ground. The scales of observations being vastly different for in situ and remote sensing methods, large discrepancies between different techniques are inherent. These problems have been brought out through various validation studies by many groups in the country. Even on the daily all India spatial scale, basically only the peaks and troughs from satellite estimates match reasonably well with in situ data. Results of a case study during an intense and long-lasting rain event over Chennai, from DWR, with different satellite products and ground truth are presented. The importance of DWR rainfall data in significantly improving the integrated products is emphasised. A simple two-way approach to establish Z – R relationship for the DWRs in the country is also suggested. A well-coordinated integrated programme to study the inter comparability of precipitation at various spatio- temporal scales in the context of our water resources, model validation, extreme rainfall events, Climate change, etc., is called for. The desired accuracies from satellite data vis a vis IMD gridded data for different applications have been summarised

Synthesis of N-(3-arylprop-2-ynyl)substituted olanzapine derivatives as potential inhibitors of PDE4B

The linkage between dopamine D2 receptors and PDE activity via cAMP prompted us to design a series of novel N-(3-arylprop-2-ynyl)substituted olanzapine derivatives as potential inhibitors of PDE4B. The target compounds were conveniently prepared by using a simple and inexpensive method involving Pd/C-mediated CC bond forming reaction under Sonogashira conditions. A number of compounds were synthesized by using this strategy in good yields. Some of the compounds showed promising inhibition of PDE4B when tested in vitro that was supported by the docking studies

A systematic analysis of host factors reveals a Med23-interferon-λ regulatory axis against herpes simplex virus type 1 replication

Herpes simplex virus type 1 (HSV-1) is a neurotropic virus causing vesicular oral or genital skin lesions, meningitis and other diseases particularly harmful in immunocompromised individuals. To comprehensively investigate the complex interaction between HSV-1 and its host we combined two genome-scale screens for host factors (HFs) involved in virus replication. A yeast two-hybrid screen for protein interactions and a RNA interference (RNAi) screen with a druggable genome small interfering RNA (siRNA) library confirmed existing and identified novel HFs which functionally influence HSV-1 infection. Bioinformatic analyses found the 358 HFs were enriched for several pathways and multi-protein complexes. Of particular interest was the identification of Med23 as a strongly anti-viral component of the largely pro-viral Mediator complex, which links specific transcription factors to RNA polymerase II. The anti-viral effect of Med23 on HSV-1 replication was confirmed in gain-of-function gene overexpression experiments, and this inhibitory effect was specific to HSV-1, as a range of other viruses including Vaccinia virus and Semliki Forest virus were unaffected by Med23 depletion. We found Med23 significantly upregulated expression of the type III interferon family (IFN-λ) at the mRNA and protein level by directly interacting with the transcription factor IRF7. The synergistic effect of Med23 and IRF7 on IFN-λ induction suggests this is the major transcription factor for IFN-λ expression. Genotypic analysis of patients suffering recurrent orofacial HSV-1 outbreaks, previously shown to be deficient in IFN-λ secretion, found a significant correlation with a single nucleotide polymorphism in the IFN-λ3 (IL28b) promoter strongly linked to Hepatitis C disease and treatment outcome. This paper describes a link between Med23 and IFN-λ, provides evidence for the crucial role of IFN-λ in HSV-1 immune control, and highlights the power of integrative genome-scale approaches to identify HFs critical for disease progression and outcome

Bycatch in Indian trawl fisheries and some suggestions for trawl bycatch mitigation

Globally, trawl is the major fishing gear used in marine fisheries and in India, it contributes to more than onethird of the marine fish production. Trawl fishing has been critically evaluated from a sustainability perspective, especially analysing its bycatch composition. Most of the bycatch from trawlers contains valuable edible species with high market demand. However, a portion of the bycatch which does not have such demand in the edible fish market, known as low-value bycatch (LVB), continues to be a matter of concern from an ecological and economic perspective. During 2017–19, 30–60% of trawl landing in India was constituted by LVB, which was mainly used for fishmeal preparation. To enhance the value and utility of LVB, this study explores the possibility of converting waste from LVB into edible resources using pufferfish and triggerfish. It also highlights the positive impact of efforts by different Government agencies for bycatch mitigation like the implementation of minimum legal size in reducing the juvenile component in bycatch, with a social survey-based account of fisher’s perceptions and suggestions on successful bycatch mitigation