Challenges Faced by Nurses in Pressure Ulcers Prevention in Healthcare settings : a Literature review

Context: Pressure ulcers, this problem sounds like a common but serious issue in healthcare settings, especially elderly, less mobile patients and chronically ill. Pressure ulcer prevention not only increases the quality-of-life patients but also reduces the cost of care and treatment. Nurses play a vital role in preventing these ulcers, but they often face difficulties in doing so. The review is based Imogene King`s Theory of goal Attainment, which emphasized the importance of the nurse-patient relationship, goals setting, and having support systems in place for effective care. Aim: The study aims to explore the challenges faced by nurses in preventing pressure ulcers in health care settings. Methods: A literature review was conducted in this study to answer the following research question. What are the nurse's challenges in preventing pressure ulcers in healthcare setting? 4 electronic databases were used for literature search. The inductive content analysis method was used to examine a total of eighteen research articles. Finding: The finding indicates key challenges, including staff shortages, time limitations, lack of training and prevention protocols and inadequate resources. Nurses also reported gaps in knowledge related to pressure ulcer prevention. Furthermore, Nurses expressed stress and frustration because of these structural obstacles. Conclusions: The study reveals that nurses encounter multiple challenges when it comes to preventing pressure ulcers, these factors not only make it tough to effective prevention care but also lead to frustration and stress among nurses. Addressing these barriers with better education, training and consistent protocols to help support both nurses and the patients

Dynamics of Nonlinear Random Walks on Complex Networks

In this paper we study the dynamics of nonlinear random walks. While typical random walks on networks consist of standard Markov chains whose static transition probabilities dictate the flow of random walkers through the network, nonlinear random walks consist of nonlinear Markov chains whose transition probabilities change in time depending on the current state of the system. This framework allows us to model more complex flows through networks that may depend on the current system state. For instance, under humanitarian or capitalistic direction, resource flow between institutions may be diverted preferentially to poorer or wealthier institutions, respectively. Importantly, the nonlinearity in this framework gives rise to richer dynamical behavior than occurs in linear random walks. Here we study these dynamics that arise in weakly and strongly nonlinear regimes in a family of nonlinear random walks where random walkers are biased either towards (positive bias) or away from (negative bias) nodes that currently have more random walkers. In the weakly nonlinear regime we prove the existence and uniqueness of a stable stationary state fixed point provided that the network structure is primitive that is analogous to the stationary distribution of a typical (linear) random walk. We also present an asymptotic analysis that allows us to approximate the stationary state fixed point in the weakly nonlinear regime. We then turn our attention to the strongly nonlinear regime. For negative bias we characterize a period-doubling bifurcation where the stationary state fixed point loses stability and gives rise to a periodic orbit below a critical value. For positive bias we investigate the emergence of multistability of several stable stationary state fixed points

Synchronization of phase oscillators on complex hypergraphs

We study the effect of structured higher-order interactions on the collective behavior of coupled phase oscillators. By combining a hypergraph generative model with dimensionality reduction techniques, we obtain a reduced system of differential equations for the system's order parameters. We illustrate our framework with the example of a hypergraph with hyperedges of sizes 2 (links) and 3 (triangles). For this case, we obtain a set of 2 coupled nonlinear algebraic equations for the order parameters. For strong values of coupling via triangles, the system exhibits bistability and explosive synchronization transitions. We find conditions that lead to bistability in terms of hypergraph properties and validate our predictions with numerical simulations. Our results provide a general framework to study synchronization of phase oscillators in hypergraphs, and they can be extended to hypergraphs with hyperedges of arbitrary sizes, dynamic-structural correlations, and other features.Comment: 8 pages, 5 figure

A comparative study between the use of the combination of trichloroacetic acid peeling with hydroquinone and hydroquinone alone in patients with melasma

Background: Melasma is a common acquired pigmentary disorder that is aesthetically displeasing. Kligman’s and Modified Kligman’s formula using topical steroids, hydroquinone and retinoids, and various other depigmenting agents is being widely used all over for melasma with varying results. Chemical peeling is newly added to the therapeutic armamentarium and is showing encouraging results worldwide in patients with melasma. However, comparative studies are lacking in abundance in our part of the world. Aims and Objectives: To determine if serial trichloroacetic acid peels provide additional benefits when combined with time-tested topical therapy with hydroquinone 4% in patients with melasma. Materials and Methods: Fifty melasma patients were divided into two groups of 25 each. One group received serial trichloroacetic acid peel combined with topical hydroquinone 4%. The other group only received topical hydroquinone 4% cream. The results were evaluated by a clinical investigator both subjectively and with photographs taken at baseline, 12 weeks, and 21 weeks. For clinical evaluation, the melasma area and severity index (MASI) was used. Results: A significant decrease in MASI score from baseline to 21 weeks was observed in both groups (P<0.001). The group receiving the trichloroacetic acid peel 20% showed a trend toward more rapid and greater improvement, with statistically significant results (P<0.001). Only a few side effects were observed in the peel group. Conclusion: This study demonstrates that serial trichloroacetic acid peels provide an additional effect to a topical regimen of 4% hydroquinone cream for treating melasma in Fitzpatrick skin types III and above if used judiciously and under supervision. It demonstrates that superficial chemical peels can be used as an adjunct with better efficacy to treat patients with melasma

Porous activated carbon materials from Triphala seed stones for high-performance supercapacitor applications

Porous activated carbon materials derived from biomass could be the suitable materials for high-rate performance electrochemical supercapacitors as it exhibits high surface area due to well-defined pore structure. Here, we report the novel porous activated carbon from Triphala seed stones by chemical activation with zinc chloride at different carbonization temperature (400-700 °C) under the nitrogen gas atmosphere. The activated carbon was characterized by Fourier transform-infrared (FTIR) spectroscopy, Raman scattering and scanning electron microscopy (SEM). Nitrogen adsorption-desorption measurements was used to study the surface properties (effective surface areas, pore volumes and pore size distributions). The electrochemical measurements were performed in an aqueous 1 M sulphuric acid (H2SO4) solution in a three-electrode cell set up. Triphala seed stones-derived porous carbon materials with well-defined micro- and mesopores exhibit high specific surface area ranges from 878.7 to 1233.3 m2 g-1 and total pore volume ranges from 0.439 to 0.626 cm3 g-1. The specific capacitance obtained by electrochemical measurement experiment was 208.7 F g-1 at 1 A g-1. These results indicate that the prepared nanoporous activated carbon material from Triphala seed stones would have significant possibility as supercapacitor electrode material for high-energy-storage supercapacitor applications

Porous activated carbon materials from Triphala seed stones for high-performance supercapacitor applications

Porous activated carbon materials derived from biomass could be the suitable materials for high-rate performance electrochemical supercapacitors as it exhibits high surface area due to well-defined pore structure. Here, we report the novel porous activated carbon from Triphala seed stones by chemical activation with zinc chloride at different carbonization temperature (400-700 °C) under the nitrogen gas atmosphere. The activated carbon was characterized by Fourier transform-infrared (FTIR) spectroscopy, Raman scattering and scanning electron microscopy (SEM). Nitrogen adsorption-desorption measurements was used to study the surface properties (effective surface areas, pore volumes and pore size distributions). The electrochemical measurements were performed in an aqueous 1 M sulphuric acid (H2SO4) solution in a three-electrode cell set up. Triphala seed stones-derived porous carbon materials with well-defined micro- and mesopores exhibit high specific surface area ranges from 878.7 to 1233.3 m2 g-1 and total pore volume ranges from 0.439 to 0.626 cm3 g-1. The specific capacitance obtained by electrochemical measurement experiment was 208.7 F g-1 at 1 A g-1. These results indicate that the prepared nanoporous activated carbon material from Triphala seed stones would have significant possibility as supercapacitor electrode material for high-energy-storage supercapacitor applications

CAGI, the Critical Assessment of Genome Interpretation, establishes progress and prospects for computational genetic variant interpretation methods

Background: The Critical Assessment of Genome Interpretation (CAGI) aims to advance the state-of-the-art for computational prediction of genetic variant impact, particularly where relevant to disease. The five complete editions of the CAGI community experiment comprised 50 challenges, in which participants made blind predictions of phenotypes from genetic data, and these were evaluated by independent assessors. // Results: Performance was particularly strong for clinical pathogenic variants, including some difficult-to-diagnose cases, and extends to interpretation of cancer-related variants. Missense variant interpretation methods were able to estimate biochemical effects with increasing accuracy. Assessment of methods for regulatory variants and complex trait disease risk was less definitive and indicates performance potentially suitable for auxiliary use in the clinic. // Conclusions: Results show that while current methods are imperfect, they have major utility for research and clinical applications. Emerging methods and increasingly large, robust datasets for training and assessment promise further progress ahead

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Reading tea leaves worldwide: decoupled drivers of initial litter decomposition mass‐loss rate and stabilization

The breakdown of plant material fuels soil functioning and biodiversity. Currently, process understanding of global decomposition patterns and the drivers of such patterns are hampered by the lack of coherent large‐scale datasets. We buried 36,000 individual litterbags (tea bags) worldwide and found an overall negative correlation between initial mass‐loss rates and stabilization factors of plant‐derived carbon, using the Tea Bag Index (TBI). The stabilization factor quantifies the degree to which easy‐to‐degrade components accumulate during early‐stage decomposition (e.g. by environmental limitations). However, agriculture and an interaction between moisture and temperature led to a decoupling between initial mass‐loss rates and stabilization, notably in colder locations. Using TBI improved mass‐loss estimates of natural litter compared to models that ignored stabilization. Ignoring the transformation of dead plant material to more recalcitrant substances during early‐stage decomposition, and the environmental control of this transformation, could overestimate carbon losses during early decomposition in carbon cycle models