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

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

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

On deciding to have a lobotomy:either lobotomies were justified or decisions under risk should not always seek to maximise expected utility

In the 1940s and 1950s thousands of lobotomies were performed on people with mental disorders. These operations were known to be dangerous, but thought to offer great hope. Nowadays, the lobotomies of the 1940s and 1950s are widely condemned. The consensus is that the practitioners who employed them were, at best, misguided enthusiasts, or, at worst, evil. In this paper I employ standard decision theory to understand and assess shifts in the evaluation of lobotomy. Textbooks of medical decision making generally recommend that decisions under risk are made so as to maximise expected utility (MEU) I show that using this procedure suggests that the 1940s and 1950s practice of psychosurgery was justifiable. In making sense of this finding we have a choice: Either we can accept that psychosurgery was justified, in which case condemnation of the lobotomists is misplaced. Or, we can conclude that the use of formal decision procedures, such as MEU, is problematic

Differential Brain Development with Low and High IQ in Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) and intelligence (IQ) are both heritable phenotypes. Overlapping genetic effects have been suggested to influence both, with neuroimaging work suggesting similar overlap in terms of morphometric properties of the brain. Together, this evidence suggests that the brain changes characteristic of ADHD may vary as a function of IQ. This study investigated this hypothesis in a sample of 108 children with ADHD and 106 typically developing controls, who participated in a cross-sectional anatomical MRI study. A subgroup of 64 children also participated in a diffusion tensor imaging scan. Brain volumes, local cortical thickness and average cerebral white matter microstructure were analyzed in relation to diagnostic group and IQ. Dimensional analyses investigated possible group differences in the relationship between anatomical measures and IQ. Second, the groups were split into above and below median IQ subgroups to investigate possible differences in the trajectories of cortical development. Dimensionally, cerebral gray matter volume and cerebral white matter microstructure were positively associated with IQ for controls, but not for ADHD. In the analyses of the below and above median IQ subgroups, we found no differences from controls in cerebral gray matter volume in ADHD with below-median IQ, but a delay of cortical development in a number of regions, including prefrontal areas. Conversely, in ADHD with above-median IQ, there were significant reductions from controls in cerebral gray matter volume, but no local differences in the trajectories of cortical development