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

Children’s social communication skills and electronic screen exposure, perinatal, and other risk factors

Aim: To explore if exposure to electronic screen media (ESM) can increase the risk of poor social communication skills in children. Subjects and methods: Using the stratified, random cluster sampling method, 81,282 children aged 3–12 years from seven districts in Shanghai were investigated in 2014. The children’s social communication skills were measured by the social communication questionnaire (SCQ). Results: More television viewing time every day was positively associated with the positive SCQ group (p ≤ 0.001). There was a dose–effect relationship between television screen time and its associated odds ratios (ORs). However, weekly time spent online or playing games for 3 h or less was negatively associated with the positive SCQ group (p < 0.05) by a multivariable logistic regression model. Other child and family characteristics were also found to impact SCQ performance. Conclusion: Significant associations of child and family characteristics with poor SCQ status were revealed in the Chinese children, which may be crucial for early intervention. To assess effects on children’s social development, screen time and multiple patterns of screen use should be considered for future guidelines and policies.</p

Abnormal body mass index may be related to poor social function of female children by a propensity score matching analysis

This study sought to estimate the association of children’s body mass index (BMI) with their social function in Shanghai China. A large population-based cross-sectional study based on a propensity score matching (PSM) analysis was conducted. BMI was compared according to social communication questionnaire (SCQ) classification, and then SCQ score was compared in terms of BMI grouping before and after PSM. A positive SCQ was considered to indicate poor social communication and a negative SCQ was then supposed to be normal. After 1:3 matching, a total of 7563 children aged 3–12 years were included in analysis. There were statistically significant positive correlation of BMI with SCQ scores for obese females of school age (R2 = 0.043, p 2 = 0.047, p = 0.027). In conclusion, BMI may be characterized as one of predictive factor for poor social function of these children.</p

Diurnal and seasonal variations of soil respiration rate under different row-spacing in a Panicum virgatum L. field on semi-arid Loess Plateau of China

px; &quot;&gt; &lt;Soil respiration (SR) in crop field is affected by environmental factors, agronomic practices and crop types. To clarify how planting density affects the SR dynamics in switchgrass (Panicum virgatum L.) field on the semi-arid Loess Plateau, this research investigated diurnal and seasonal changes of soil respiration rate (RS) under three different row-spacing treatments (20, 40 and 60 cm) in the fourth growing year of switchgrass. Results showed that RS presented a pronounced seasonality under all row-spacing treatments. The highest daily average RS values appeared in August, while the lowest (P&lt;0.05) were in September for each row-spacing. Diurnal variations of RS exhibited single-peak curves in each month. Daily average RS increased significantly as row-spacing enlarged during May and August but there was no significant difference among row-spacing treatments in September. Soil water storage in the depth of 0&ndash;100 cm had no significant difference (P&gt;0.05) among the row-spacing treatments, and similar results were found for soil temperature in 0&ndash;15 cm soil depth. Soil respiration temperature sensitivity (Q10) values were 1.0&ndash;3.7 during the growing months, which were strongly correlated with air temperature in May and June and the soil temperature at 15 cm depth in August. Higher aboveground biomass production and lower RS in most growth months indicated that 20 cm row-spacing treatment was beneficial for increasing the carbon fixation in switchgrass field. Results also implied that it is necessary to take into account the influence of phenology and root growth of switchgrass on soil respiration for accurately evaluating the carbon cycle in the region.</span

Does precipitation keep pace with temperature in the marginal double-cropping area of northern China?

Northern China is the major grain-production region in the country. To adapt to climate change and ensure food security with a fixed area of arable land, utilizing a multiple cropping frequency each year is regarded as an efficient method of offsetting the projected negative yield impacts on staple crops. Given that climate warming prolongs the potential growing season and benefits the expansion of multi-cropping systems, this research investigated whether changes in precipitation will keep pace with temperature in the marginal double-cropping area of northern China under two scenarios (RCP4.5 and RCP8.5). Our results indicated that northern China will experience consistent warming, which will cause the limits of the double-cropping system to move remarkably towards the northeast and northwest in this century. However, the increased precipitation may not be sufficient to alleviate the water deficiency in the double-crop rotation and support the realisation of double-cropping benefits due to increasing heat resources. Although the potential yield will be considerable in the marginal double-cropping area after future expansion, the instability of rain-fed yields will gradually increase with the decrease in precipitation in the marginal region unless supplemental irrigation is applied. The insufficient precipitation was projected to negatively affect the potential yield in this area by 56–67 %. Moreover, the coefficient of variation of yield was great due to the large spatial distribution difference in the cumulated precipitation. After adopting limited irrigation in key wheat growth periods, this negative effect was predicted to be alleviated by approximately 10–12 %. In the entire marginal region, the northeast faces the lowest risk of precipitation deficiency during double-cropping system expansion. It was concluded that the double-cropping system is an efficient adaptation strategy worth encouraging in the context of climate change; however, this approach should be considered only after considering the local cumulative precipitation and the condition of the water supply

Data Poisoning Attack Using Hybrid Particle Swarm Optimization in Connected and Autonomous Vehicles

The development of connected and autonomous vehicles (CAV s) relies heavily on deep learning technology, which has been widely applied to perform a variety of tasks in CAYs. On the other hand, deep learning faces some security concerns. Data poisoning attack, as one of the security threats, can compromise the deep learning models by injecting poisoned training samples. The poisoned models may make more false predictions, and may cause fatal accidents of CA V s in the worst case. Therefore, the principles of poisoning attacks are worth studying in order to propose counter measures. In this work, we propose a black-box and clean-label data poisoning attack method that uses hybrid particle swarm optimization with simulated annealing to generate perturbations for poisoning. The attacking method is evaluated by experiments on the deep learning models of traffic sign recognition systems on CA V s, and the results show that the classification accuracies of the target deep learning models are obviously downgraded using our method, with a small portion of poisoned data samples in GTSRB dataset

Table_1_Diagnostic performance of elastosonography in the differential diagnosis of benign and malignant salivary gland tumors: A meta-analysis.doc

PurposeThe clinical practice of elastosonography for the detection of salivary gland tumors is still a controversial issue. The objective of this meta-analysis was to evaluate the effect of elastosonography for the diagnosis of salivary gland tumors and to compare the diagnostic value of elastosonography and conventional ultrasound in the diagnosis of salivary gland tumors.MethodsA comprehensive literature search through PubMed, EMBASE, and Cochrane Library was carried out from inception to November 2021. Two researchers independently extracted the data from the enrolled papers using a standard data extraction form. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to evaluate the diagnostic performance of elastosonography. The Quality Assessment of Diagnostic Accuracy Studies—2 (QUADAS-2) tool was utilized to evaluate the quality of each included study. Meta-DiSc version 1.4, Review Manager 5.3, and StataSE 15 were used.ResultsSixteen studies with a total of 1105 patients with 1146 lesions were included in this meta-analysis. The pooled sensitivity, specificity, PLR, NLR, and DOR of elastosonography for the differentiation between benign and malignant salivary gland tumors were 0.73 (95%CI, 0.66–0.78), 0.64 (95%CI, 0.61–0.67), 2.83 (95%CI, 1.97–4.07), 0.45 (95%CI, 0.32–0.62), and 9.86 (95%CI, 4.49–21.62), respectively, with an AUC of 0.82. Four studies provided data regarding the conventional ultrasound for the differentiation between benign and malignant salivary gland tumors. The pooled sensitivity, specificity, and DOR were 0.62 (95%CI, 0.50–0.73), 0.93 (95%CI, 0.90–0.96), and 25.07 (95%CI, 4.28–146.65), respectively. The meta-regression and subgroup analyses found that assessment methods were associated with significant heterogeneity, and quantitative or semiquantitative elastosonography performed better than the qualitative one.ConclusionsElastosonography showed a limited value for diagnosing malignant salivary gland tumors; it could be considered as a supplementary diagnostic technology to conventional ultrasound, and quantitative or semiquantitative elastosonography was superior to the qualitative one.</p

Table_2_Diagnostic performance of elastosonography in the differential diagnosis of benign and malignant salivary gland tumors: A meta-analysis.doc

PurposeThe clinical practice of elastosonography for the detection of salivary gland tumors is still a controversial issue. The objective of this meta-analysis was to evaluate the effect of elastosonography for the diagnosis of salivary gland tumors and to compare the diagnostic value of elastosonography and conventional ultrasound in the diagnosis of salivary gland tumors.MethodsA comprehensive literature search through PubMed, EMBASE, and Cochrane Library was carried out from inception to November 2021. Two researchers independently extracted the data from the enrolled papers using a standard data extraction form. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to evaluate the diagnostic performance of elastosonography. The Quality Assessment of Diagnostic Accuracy Studies—2 (QUADAS-2) tool was utilized to evaluate the quality of each included study. Meta-DiSc version 1.4, Review Manager 5.3, and StataSE 15 were used.ResultsSixteen studies with a total of 1105 patients with 1146 lesions were included in this meta-analysis. The pooled sensitivity, specificity, PLR, NLR, and DOR of elastosonography for the differentiation between benign and malignant salivary gland tumors were 0.73 (95%CI, 0.66–0.78), 0.64 (95%CI, 0.61–0.67), 2.83 (95%CI, 1.97–4.07), 0.45 (95%CI, 0.32–0.62), and 9.86 (95%CI, 4.49–21.62), respectively, with an AUC of 0.82. Four studies provided data regarding the conventional ultrasound for the differentiation between benign and malignant salivary gland tumors. The pooled sensitivity, specificity, and DOR were 0.62 (95%CI, 0.50–0.73), 0.93 (95%CI, 0.90–0.96), and 25.07 (95%CI, 4.28–146.65), respectively. The meta-regression and subgroup analyses found that assessment methods were associated with significant heterogeneity, and quantitative or semiquantitative elastosonography performed better than the qualitative one.ConclusionsElastosonography showed a limited value for diagnosing malignant salivary gland tumors; it could be considered as a supplementary diagnostic technology to conventional ultrasound, and quantitative or semiquantitative elastosonography was superior to the qualitative one.</p