973 resultados para mouth ulcer


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Routine activities that many of us are used to performing in person like paying bills, purchases and bookings are now done online. With more people buying irregularly bought products online, more consumers are relying on professional, amateur and user reviews to inform them of the quality of their intended purchase. Little known about how consumers use these reviews. Less is known about how these reviews influence buying behavior. This article outlines a research framework that can provide insight into these areas.

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Observations of departing Siberian-breeding Red Knots Calidris canutus canutus from their central staging site during northward migration, the Schleswig-Holstein Wadden Sea, Germany, in early June 2008, challenge the established notion that departing long-distance migrating waders only leave around sunset. During four days we scanned several thousand Red Knots for colour-ringed individuals and found a total of 20 different individuals that were previously ringed at either their main wintering site, the Banc d'Arguin in Mauritania, or at stopover sites on the Atlantic coast of France. Body masses of captured Red Knots in Schleswig-Holstein were higher than 200 g and hematocrite values showed an average of 58%, clearly indicating that they were ready for take-off. On all except one evening, we noted impressive departure movements during the incoming tide. On that exceptional evening a cold front thunderstorm passed over the area. Late the next morning, thousands of Red Knots departed during the incoming tide. We assume that the birds avoided taking off in adverse weather conditions and elaborate why Red Knots presumably traded off advantages from departing during twilight. We suggest that during spring migration, schedules are so tight that further delays decrease fitness, either because it would cause another full day of exposure to high predation risk by falcons, or because of conditions upon arrival on the tundra.

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The state of global freshwater ecosystems is increasingly parlous with water resource development degrading high-conservation wetlands. Rehabilitation is challenging because necessary increases in environmental flows have concomitant social impacts, complicated because many rivers flow between jurisdictions or countries. Australia's MurrayDarling Basin is a large river basin with such problems encapsulated in the crisis of its Ramsar-listed terminal wetland, the Coorong, Lower Lakes and Murray Mouth. Prolonged drought and upstream diversion of water dropped water levels in the Lakes below sea level (20092010), exposing hazardous acid sulfate soils. Salinities increased dramatically (e.g. South Lagoon of Coorong>200gL-1, cf. modelled natural 80gL-1), reducing populations of waterbirds, fish, macroinvertebrates and littoral plants. Calcareous masses of estuarine tubeworms (Ficopomatus enigmaticus) killed freshwater turtles (Chelidae) and other fauna. Management primarily focussed on treating symptoms (e.g. acidification), rather than reduced flows, at considerable expense (≥AU$2 billion). We modelled a scenario that increased annual flows during low-flow periods from current levels up to one-third of what the natural flow would have been, potentially delivering substantial environmental benefits and avoiding future crises. Realisation of this outcome depends on increasing environmental flows and implementing sophisticated river management during dry periods, both highly contentious options.

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Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P < 0·001). Audits between 2003 and 2011 of 4368 patient medical records identified compliance with pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital.