Enhancing the Braden Scale Pressure Ulcer Risk Assessment in Long-Term Care Facilities: A Cohort Study

The development of pressure ulcers remains challenging as they are associated with overwhelming costs, pain and suffering, prolonged hospitalization, and morbidity and mortality. In the United States, the Braden scale is the most widely used risk assessment tool among all healthcare organizations to identify high-risk individuals for pressure ulcer development. The objective of risk assessment is to detect high-risk patients, implement immediate interventions, and evaluate patients not at risk who do not require intervention. The purpose of this cohort study is to determine the pressure ulcer predictability of the Braden score in comparison to the Braden score with additional predictor factors. Predictor factors explored in this research incorporate those described in current literature as pressure ulcer risk factors: age, gender, comorbidities, and history of previous pressure ulcer. This study utilized an observational cohort research design to appraise the effectiveness of an intervention based on evidence and data. Logistic regression statistical analysis was applied to establish how successful Braden total scores were in a pressure ulcer predictive model with and without the addition of additional predictor factors. A separate relative risk model was tested using only the most applicable predictor factors correlated with pressure ulcer prevalence in this model without the Braden score in an effort to cultivate the most relative model. The research was conducted solely at Symphony of Lincoln Park in Chicago, Illinois. All patient records from January 2020 through July 2020 were reviewed and identified to attain data recorded on the data collection sheet of patients who developed pressure ulcers during that time frame along with the same number of patients who did not develop pressure ulcers but were classified as at-risk as evidenced by a Braden score of 18 or less, resulting in a total of 119 adult long-term care residents. The general assumption from this analysis was that a logistic regression model of pressure ulcer development in long-term care residents indicated 9 predictors able to determine a statistically significant risk of pressure ulcer development. Specifically, the analysis suggested high risk Braden total scores (mean=15), history of pressure ulcer, anemia, limb paralysis, osteoporosis, malnutrition, incontinence, CHF, Alzheimer’s, and DM2 can be predictive of the development of pressure ulcers in long-term care residents. The analysis integrated a predictive model using binary logistic regression, which revealed that the Braden total score alone was accurately able to predict 75.6% (76.6% subjects that did develop pressure ulcers were accurately predicted and 74.5% of subjects which did not develop pressure ulcers were accurately predicted in the Braden score only model). Adding the presence of history of pressure ulcer, anemia, limb paralysis, osteoporosis, malnutrition, incontinence, CHF, Alzheimer’s, and DM2 was able to accurately predict 98.3% (96.9% with PU, 100% without PU). More research is needed to substantiate these findings and investigate contemporary risk assessment methods, with the ultimate objective of reducing the incidence of pressure ulcers

Power in partnership: How government agencies and community partners are joining forces to fight wage theft

In the face of widespread wage violations and limited resources, some labor enforcement agencies have created community enforcement programs to bolster their reach and improve effectiveness. Such programs have been implemented at the federal, state, and local levels. In these programs, worker and community-based organizations (CBOs) receive public funding to assist labor agencies in a range of functions, including most often providing education and outreach to marginalized worker communities and referring cases to enforcement agencies.This report:Explains the concept of community enforcement programsReviews the policy rationales for such programs, both for government enforcement agencies and for worker organizations/workersExplores existing and potential roles that community organizations can play in relation to labor standards enforcementIdentifies decision points for designing publicly funded community enforcement programsExplores additional methods to ensure worker input into enforcement operations and policymakingIdentifies potential public funding sources for community enforcement programsIdentifies areas for further researchProvides snapshots of a number of existing programs (Appendix A)Provides links to sample Requests for Proposals (RFPs) and other program materials from various jurisdictions (Appendix B

Prison Rape Elimination Act (PREA): Considerations for Policy Review

A policy review guide designed to assist in drafting PREA (Prison Rape Elimination Act) policies for review by the National Institute of Corrections (NIC) is provided. Sections of this document are: purpose; questions to consider -- policy organization, definitions, zero tolerance, staff/offender duty to report, prevention, and investigations (e.g., general, selection and training of investigators, protocols, and aftermath); and list of resources

Transboundary Programs to Quiet the Seas: Successes, Challenges, and the Road Ahead

Of all the threats facing the southern residents, reducing noise and disturbance is one area where we have made tangible progress around the Salish Sea. Public processes have led to new programs and policies - successes we can build on, and learn from. This panel will provide a transboundary perspective on programs that been implemented to manage and monitor vessel impacts by sector (i.e., large ships, small vessels), and identify high priority gaps or needs. For each program, panelists will discuss: 1.) What are the successes, so far? What are the challenges, and where are the gaps? 2.) How does your program measure its effectiveness? How will it adapt to new science and and emerging threats? 3.) What is the biggest gap or area of need for transboundary alignment and how would you propose to address it

Climate warming erodes tropical reef habitat through frequency and intensity of episodic hypoxia

Climate warming threatens marine life by increasing metabolic oxygen demand while decreasing oxygen availability. Tropical species living in warm, low oxygen environments may be most at risk, but their tolerances and exposures to these stressors remain poorly documented. We evaluated habitat restrictions for two brittle star species from Caribbean coral reefs by integrating field observations, laboratory experiments and an ecophysiological model. The absence of one species from the warmest reefs results from vital activity restrictions during episodic low oxygen extremes, even though average conditions are well within physiological tolerance limits. Over the past decade, warmer temperatures have been significantly correlated with a greater frequency and intensity of hypoxic events. Continued warming will progressively exclude hypoxia-tolerant species, even if average oxygen remains constant. A warming-driven increase in frequency or intensity of low oxygen extremes could similarly accelerate habitat loss across other marine ecosystems. -- Keywords : Oxygen ; Aquatic hypoxia ; Hypoxia ; Coral reefs ; Oxygen metabolism ; Ocean temperature ; Echinoderms ; Climate change

HIV/AIDS, declining family resources and the community safety net

Families play central roles in the HIV/AIDS pandemic, caring for both orphaned children and the ill. This extra caregiving depletes two family resources essential for supporting children: time and money. We use recent data from published studies in sub-Saharan Africa to illustrate deficits and document community responses. In Botswana, parents caring for the chronically ill had less time for their preschool children (74 versus 96 hours per month) and were almost twice as likely to leave children home alone (53% versus 27%); these children experienced greater health and academic problems. Caregiving often prevented adults from working full time or earning their previous level of income; 47% of orphan caregivers and 64% of HIV/AIDS caregivers reported financial difficulties due to caregiving. Communities can play an important role in helping families provide adequate childcare and financial support. Unfortunately, while communities commonly offer informal assistance, the value of such support is not adequate to match the magnitude of need: 75% of children's families in Malawi received assistance from their social network, but averaging only US$81 annually. We suggest communities can strengthen the capacity of families by implementing affordable quality childcare for 0–6 year olds, after-school programming for older children and youth, supportive care for ill children and parents, microlending to enhance earnings, training to increase access to quality jobs, decent working conditions, social insurance for the informal sector, and income and food transfers when families are unable to make ends meet

Predicting the Impact of Climate Change on Threatened Species in UK Waters

Global climate change is affecting the distribution of marine species and is thought to represent a threat to biodiversity. Previous studies project expansion of species range for some species and local extinction elsewhere under climate change. Such range shifts raise concern for species whose long-term persistence is already threatened by other human disturbances such as fishing. However, few studies have attempted to assess the effects of future climate change on threatened vertebrate marine species using a multi-model approach. There has also been a recent surge of interest in climate change impacts on protected areas. This study applies three species distribution models and two sets of climate model projections to explore the potential impacts of climate change on marine species by 2050. A set of species in the North Sea, including seven threatened and ten major commercial species were used as a case study. Changes in habitat suitability in selected candidate protected areas around the UK under future climatic scenarios were assessed for these species. Moreover, change in the degree of overlap between commercial and threatened species ranges was calculated as a proxy of the potential threat posed by overfishing through bycatch. The ensemble projections suggest northward shifts in species at an average rate of 27 km per decade, resulting in small average changes in range overlap between threatened and commercially exploited species. Furthermore, the adverse consequences of climate change on the habitat suitability of protected areas were projected to be small. Although the models show large variation in the predicted consequences of climate change, the multi-model approach helps identify the potential risk of increased exposure to human stressors of critically endangered species such as common skate (Dipturus batis) and angelshark (Squatina squatina)

New knowledge networks of small-scale farmers in Europe’s periphery

Funding for this research was provided by the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 311994, and the Scottish Government’s Strategic Research Programme (2011–2016).In this paper we assess the types of knowledge networks utilised by small-scale farmers in four case studies (located in Bulgaria, Poland, Portugal, and the United Kingdom). We focus on knowledge acquired to inform three new activities being undertaken by study participants: agricultural production, subsidy access and regulatory compliance, and farm diversification (specifically agritourism). Findings demonstrate that the new knowledge networks are dominated by different forms of expertise: formal ‘agricultural advisors’ identified in the case studies primarily offer codified managerial knowledge through centralised networks, suggesting that state-funded services for small-scale farmers are largely embedded in traditional, linear models of knowledge transfer. Production and diversification knowledge is exchanged through ‘distributed’ and ‘decentralised’ networks, where a range of actors are involved across varying geographical distances. Findings highlight issues associated with the quality and independence of both ‘free’ and paid advice, as well as the importance of combining tacit and codified knowledge for credibility. In all four cases, we found that small-scale farmers utilise formal advisory services primarily for accessing subsidies (e.g. completing application forms), rather than acquiring production knowledge. The authors argue that by utilising the state funding allocated to advisory services for small-scale farmers primarily to enable these farmers to access subsidies, important opportunities for innovation by both advisors or farmers can be lost.Publisher PDFPeer reviewe

Modelling distributions of Aedes aegypti and Aedes albopictus using climate, host density and interspecies competition.

Florida faces the challenge of repeated introduction and autochthonous transmission of arboviruses transmitted by Aedes aegypti and Aedes albopictus. Empirically-based predictive models of the spatial distribution of these species would aid surveillance and vector control efforts. To predict the occurrence and abundance of these species, we fit a mixed-effects zero-inflated negative binomial regression to a mosquito surveillance dataset with records from more than 200,000 trap days, representative of 53% of the land area and ranging from 2004 to 2018 in Florida. We found an asymmetrical competitive interaction between adult populations of Aedes aegypti and Aedes albopictus for the sampled sites. Wind speed was negatively associated with the occurrence and abundance of both vectors. Our model predictions show high accuracy (72.9% to 94.5%) in validation tests leaving out a random 10% subset of sites and data since 2017, suggesting a potential for predicting the distribution of the two Aedes vectors

Mapping genetic variations to three- dimensional protein structures to enhance variant interpretation: a proposed framework

The translation of personal genomics to precision medicine depends on the accurate interpretation of the multitude of genetic variants observed for each individual. However, even when genetic variants are predicted to modify a protein, their functional implications may be unclear. Many diseases are caused by genetic variants affecting important protein features, such as enzyme active sites or interaction interfaces. The scientific community has catalogued millions of genetic variants in genomic databases and thousands of protein structures in the Protein Data Bank. Mapping mutations onto three-dimensional (3D) structures enables atomic-level analyses of protein positions that may be important for the stability or formation of interactions; these may explain the effect of mutations and in some cases even open a path for targeted drug development. To accelerate progress in the integration of these data types, we held a two-day Gene Variation to 3D (GVto3D) workshop to report on the latest advances and to discuss unmet needs. The overarching goal of the workshop was to address the question: what can be done together as a community to advance the integration of genetic variants and 3D protein structures that could not be done by a single investigator or laboratory? Here we describe the workshop outcomes, review the state of the field, and propose the development of a framework with which to promote progress in this arena. The framework will include a set of standard formats, common ontologies, a common application programming interface to enable interoperation of the resources, and a Tool Registry to make it easy to find and apply the tools to specific analysis problems. Interoperability will enable integration of diverse data sources and tools and collaborative development of variant effect prediction methods