Pressure ulcers and nutritional deficits in elderly long-term care patients: Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: (1) pressure ulcer wound healing (2) length of hospital stays, and (3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SID-12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

The role of emotional intelligence in college students' success

The purpose of this study was to determine if higher academic performance was positively correlated to higher emotional intelligence among traditional age male and female college students enrolled in an Introduction to Business course at a large multi-campus state college in Florida. The Bar-On 2004 (Emotional Quotient Inventory) EQ-i 133-item inventory was used to assess students’ emotional intelligence. Within the scope of this ex-post facto study, a quasi-experimental design was included to further determine if emotional intelligence could be increased through the inclusion of a curricular component on emotional intelligence. Four groups of students (N=111) participated in the three-phase study over two semesters. The first phase (pre-intervention) was limited to students with an established GPA and an attempted-to-completed credit hour ratio within the institution (N=82). Results showed a slight positive correlation between the two factors and the students’ emotional intelligence pretest assessment scores. The second phase of the study involved establishing a control and an experimental group in each of two semesters to compare the attainment of overall emotional intelligence scores as measured by the EQ-i. The third phase of the study examined four measures of academic success (GPA, the attempted-to-completed credit hour ratio, grade in the business course, and persistence in college) to determine if these factors were positively correlated with the students’ posttest EQ-i scores. The study also included a research question to determine if significant differences in overall EQ-i scores existed between male and female students during the three phases. Findings from the study indicated that (a) there was a slight positive correlation in the pre-intervention stage between emotional intelligence and traditional measures of academic success specifically, GPA and the attempted-to-completed credit hour ratio; (b) curricular intervention made a significant difference at the p <.05 level, with an .5 effect size, in one semester but failed to meet that threshold in the following semester with the second pair of groups; (c) at the post-intervention phase, the four measures of traditional academic success yielded a low positive correlation with the students’ emotional intelligence assessment scores, and (d) female students showed significant gains in their overall EQ-i scores.

Anarchy In The Airways

In his dialogue - Anarchy In The Airways - Joseph C. Von Kornfeld, Assistant Professor, College of Hotel Administration, University of Nevada, Las Vegas initially states: “Deregulation of the airline industry has brought about financial vulnerability for the traveling public. The author analyzes the situation since that point in time and makes recommendations for some solutions.” In this article, Assistant Professor Von Kornfeld, first defines the airline industry in its pre-regulated form. Then he goes into the ramifications and results of deregulating the industry, both in regards to the consumer, and in deregulation’s impact on the airlines themselves. “The most dramatic consequence of the pressures and turbulence of airline deregulation has been the unprecedented proliferation of airline bankruptcies,” Von Kornfeld informs. “Prior to the deregulation of the U.S. airline industry in 1978, U.S. air carriers operated in a business environment that was insulated from the normal stresses and strains of open competition. They were restricted from actively competing with fares and routings by the Civil Aeronautics Board (CAB),” Von Kornfeld says. In leveling the playing field, Von Kornfeld offers, “Each carrier was restricted to specific geographic routes, with those routes limited to two or three competing carriers. The only thing that set carriers apart in this CAB defined atmosphere was their ability to either advertise, or to enhance their level of service; or both. “…ultimately paid for by the passenger through fare increases sanctioned by the CAB,” Von Kornfeld states. “Airline service standards were unquestionably superior during the regulated environment,” Von Kornfeld renders an interesting observation. He does mention, however, that carrier safety was also considered a concern immediately prior to, and then after deregulation. “The major controversy focused on the allegation that safety and maintenance standards would be compromised due to the financial pressures brought about by an openly competitive environment,” Von Kornfeld says. Pricing, as well as labor unions are important factors in the equation, and Von Kornfeld addresses their relevance in the deregulated environment. “The primary rationalization for deregulation was to facilitate a more openly competitive environment. The increased competition was to ultimately have benefitted the consumer. Ironically, that’s not entirely the case, Von Kornfeld elaborates. In addressing some of the negative aspects of airline deregulation, Von Kornfeld suggests that some sort of federal re-regulation may be in order.

The Effect of Natural Products and Small Gtpases in Adipogenesis

Insulin signaling is one of the main initiators of adipogenesis, the conversion from pre-adipocyte to adipocyte or lipid droplet. Rab proteins are the master regulator of intracellular trafficking and endosome fusion in endocytosis, making them potential regulators of insulin signaling in adipogenesis. Pre-adipocytes 3T3-Ll cells expressing several Rab5 constructs were used to examine the effect of dehydroleucodine (DhL ), a sesquiterpene lactone isolated from aerial parts of Artemisia douglasiana Besser. The results obtained identify Rab5 deactivation as a key step for adipogenesis by forming signaling endosomes. The addition of DhL significantly inhibited the lipid droplet accumulation in a dose-dependent manner and dramatically attenuated the synthesis of adipogenic transcriptional factors, C/EBPa and PPARy. Activation of AMPKa, Erk and Akt during adipocytic differentiation was not inhibited by treatment with DhL. This data suggest that DhL has an important role in Rab5 dependent adipogenesis by regulating several transcriptional factors including PP ARy expression, which is known to play an essential role during fat formation.

Pressure ulcers and nutritional deficits in elderly long-term care patients : effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: 1) pressure ulcer wound healing 2) length of hospital stays, and 3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SD=12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

Multi-year weather data in the remote semi-arid to arid mountain region of the Saharan flank of the Atlas Mountains

In 2001, a weather and climate monitoring network was established along the temperature and aridity gradient between the sub-humid Moroccan High Atlas Mountains and the former end lake of the Middle Drâa in a pre-Saharan environment. The highest Automated Weather Stations (AWS) was installed just below the M'Goun summit at 3850 m, the lowest station Lac Iriki was at 450 m. This network of 13 AWS stations was funded and maintained by the German IMPETUS (BMBF Grant 01LW06001A, North Rhine-Westphalia Grant 313-21200200) project and since 2011 five stations were further maintained by the GERMAN DFG Fennec project (FI 786/3-1), this way some stations of the AWS network provided data for almost 12 years from 2001-2012. Standard meteorological variables such as temperature, humidity, and wind were measured at an altitude of 2 m above ground. Other meteorological variables comprise precipitation, station pressure, solar irradiance, soil temperature at different depths and for high mountain station snow water equivalent. The stations produced data summaries for 5-minute-precipitation-data, 10- or 15-minute-data and a daily summary of all other variables. This network is a unique resource of multi-year weather data in the remote semi-arid to arid mountain region of the Saharan flank of the Atlas Mountains. The network is described in Schulz et al. (2010) and its further continuation until 2012 is briefly discussed in Redl et al. (2015, doi:10.1175/MWR-D-15-0223.1) and Redl et al. (2016, doi:10.1002/2015JD024443).

Valutazione dosimetrica e aspetti tecnici di trattamenti VMAT (Volumetric Modulated Arc Therapy) in radioterapia oncologica

La VMAT (Volumetric Modulated Arc Therapy) è una delle più recenti tecniche radioterapiche, in cui, oltre alla modulazione geometrica della fluenza del campo di radiazione come avviene nell’IMRT (Intensity Modulated Radiotherapy), sono variati durante il trattamento anche la velocità del gantry e il rateo di dose. La radiazione è erogata senza interruzioni lungo uno o più archi continui della testata dell’acceleratore, così da ridurre i tempi di trattamento in modo sostanziale rispetto all’IMRT. Nelle tecniche ad intensità modulata, ed in particolare nella VMAT, il lettino porta paziente modifica la distribuzione di dose durante gli irraggiamenti posteriori, riducendo quella al target e aumentando quella superficiale. Il presente lavoro di tesi, che ha proprio l’obiettivo di valutare questi aspetti dosimetrici in un’ottica pre-clinica, è stato svolto presso il Servizio di Fisica Sanitaria del Policlinico S.Orsola–Malpighi, Azienda Ospedaliero-Universitaria di Bologna. Le misure sono state effettuate presso le U.O. Radioterapia-Morganti e Radioterapia-Frezza f.f. della medesima Azienda Sanitaria, al fine di caratterizzare dal punto di vista dosimetrico il lettino di trattamento iBEAM evo dell’acceleratore lineare Synergy Elekta. L’attenuazione misurata in caso di incidenza perpendicolare del fascio sul lettino, in buon accordo con gli articoli di riferimento, è stata: (2.81±0.06)% per fotoni di energia di 6 MV, (1.81±0.10)% a 10 MV e (1.38±0.05)% a 15 MV. L’attenuazione massima misurata con fotoni di energia di 6 MV si è avvicinata al 4% negli irraggiamenti obliqui. Infine, è stato analizzato il confronto con statistica gamma fra distribuzione di dose pianificata e misurata prima e dopo aver modellizzato le caratteristiche del lettino nel software per l’elaborazione del piano di trattamento. Solo dopo tale operazione, i due casi VMAT analizzati (tumore dell’orofaringe e prostatico) superano i criteri più restrittivi e affidabili utilizzati nella pratica clinica.

Pre-eclampsia and preterm delivery : a population based case-control study

Peer reviewed

Carbon, nitrogen and lipid content and egg and pellet production of female C. hyperboreus in situ and during incubation experiments

The effects of temperature and food availability on feeding and egg production of the Arctic copepod Calanus hyperboreus were investigated in Disko Bay, western Greenland, from winter to spring 2009. The abundance of females in the near bottom layer and the egg production of C. hyperboreus prior to the spring bloom document that reproduction relies on lipid stores. The maximum in situ egg production (± SE) of 54 ± 8 eggs female/d was recorded in mid-February at chlorophyll a concentrations below 0.1 µg/l, whereas no egg production was observed in mid-April when the spring bloom developed. After reproduction, the females migrated to the surface layer to exploit the bloom and refill their lipid stores. In 2 laboratory experiments, initiated before and during the spring bloom, mature females were kept with and without food at 5 different temperatures ranging from 0 to 10°C and the fecal pellet and egg production were monitored. Food had a clear effect on fecal pellet production but no effect on egg production, while temperature did not have an effect on egg or fecal pellet production in any of the experiments. Analyses of carbon and lipid content of the females before and after the experiments did not reflect any effect of food or temperature in the pre-bloom experiment, whereas in the bloom experiment a clear positive effect of food was detected in female biochemical profiles. The lack of a temperature response suggests a future warmer ocean could be unfavorable for C. hyperboreus compared to smaller Calanus spp. which are reported to exploit minor temperature elevations for increased egg production.

Study Abroad Course Development: Pre-Departure Sessions

Study abroad is a highly encouraged component of the undergrad business program at Bella Lake University, with the large majority of undergraduate students choosing to study and live in a foreign country to expand on their international experiences. Currently, there is no learning structure or learning outcome expectation for students that will participate in the study abroad experience. This project focuses on the development of a course that supports students in the pre-departure phase of their study abroad journey and prepares them to set goals, understand the learning process and the practices of experiential learning to encourage students to achieve both personal and professional goals, and encourage the development of intercultural competence. The discourse surrounding the perceptions and efficacy of the course development is based on a self-assessment survey completed by 121 undergraduate business students that participated in the pre-departure sessions prior to leaving for study abroad in March 2016. The self-assessment results overall showed that the course achieved its aims with the majority of students rating that they were more likely to understand and engage in experiential learning, set goals for their study abroad experience and felt more prepared for study abroad after attending the pre-departure sessions. The project concludes that in order for the pre-departure course to maintain its value, the conversation with students surrounding experiential learning in study abroad needs to continue with further course development focusing on both during and post-study abroad. Further exploration can also be done to find varying ways to motivate different students to engage in the learning potential of study abroad.

Influence of chylomicron remnants on human monocyte activation in vitro

Background and aims Atherosclerosis is known to be an inflammatory disease and there is increasing evidence that chylomicron remnants (CMR), the lipoproteins which carry dietary fats in the blood, cause macrophage foam cell formation and inflammation. In early atherosclerosis the frequency of activated monocytes in the peripheral circulation is increased, and clearance of CMR from blood may be delayed, however, whether CMR contribute directly to monocyte activation and subsequent egress into the arterial wall has not been established. Here, the contribution of CMR to activation of monocyte pro-inflammatory pathways was assessed using an in vitro model. Methods and results Primary human monocytes and CMR-like particles (CRLP) were used to measure several endpoints of monocyte activation. Treatment with CRLP caused rapid and prolonged generation of reactive oxygen species by monocytes. The pro-inflammatory chemokines MCP-1 and IL-8 were secreted in nanogram quantities by the cells in the absence of CRLP. IL-8 secretion was transiently increased after CRLP treatment, and CRLP maintained secretion in the presence of pharmacological inhibitors of IL-8 production. In contrast, exposure to CRLP significantly reduced MCP-1 secretion. Chemotaxis towards MCP-1 was increased in monocytes pre-exposed to CRLP and was reversed by addition of exogenous MCP-1. Conclusion Our findings indicate that CRLP activate human monocytes and augment their migration in vitro by reducing cellular MCP-1 expression. Our data support the current hypothesis that CMR contribute to the inflammatory milieu of the arterial wall in early atherosclerosis, and suggest that this may reflect direct interaction with circulating blood monocytes.

Prevalence, Predictors & Prevention of Motion Sickness in Zero-G Parabolic Flights

INTRODUCTION Zero-G parabolic flight reproduces the weightlessness of space for short periods of time. However motion sickness may affect some fliers. The aim was to assess the extent of this problem and to find possible predictors and modifying factors. METHODS Airbus Zero-G flights consist of 31 parabolas performed in blocks. Each parabola consisted of 20s 0g sandwiched by 20s hypergravity of 1.5-1.8g. The survey covered n=246 person-flights (193 Males 53 Females), aged (M+/-SD) 36.0+/-11.3 years. An anonymous questionnaire included motion sickness rating (1=OK to 6=Vomiting), Motion Sickness Susceptibility Questionnaire (MSSQ), anti-motion sickness medication, prior Zero-G experience, anxiety level, and other characteristics. RESULTS Participants had lower MSSQ percentile scores 27.4+/-28.0 than the population norm of 50. Motion sickness was experienced by 33% and 12% vomited. Less motion sickness was predicted by older age, greater prior Zero-G flight experience, medication with scopolamine, lower MSSQ scores, but not gender nor anxiety. Sickness ratings in fliers pre-treated with scopolamine (1.81+/-1.58) were lower than for non-medicated fliers (2.93+/-2.16), and incidence of vomiting in fliers using scopolamine treatment was reduced by half to a third. Possible confounding factors including age, sex, flight experience, MSSQ, could not account for this. CONCLUSION Motion sickness affected one third of Zero-G fliers, despite being intrinsically less motion sickness susceptible compared to the general population. Susceptible individuals probably try to avoid such a provocative environment. Risk factors for motion sickness included younger age and higher MSSQ scores. Protective factors included prior Zero-G flight experience (habituation) and anti-motion sickness medication.

El ritual en los "Textos de las Pirámides": sintaxis, texto y significado

Este trabajo pretende explorar la dimensión ritual en los Textos de las Pirámides, el corpus de literatura religiosa extensa más antiguo de la humanidad. La naturaleza variada de sus componentes textuales ha impedido que los egiptólogos comprendan en profundidad las complejidades de la colección y los contextos originales en los que estos textos (ritos) aparecieron. La aplicación de la teoría del ritual, principalmente la aproximación de la sintaxis ritual, ofrece a los investigadores un marco excelente de análisis e interpretación del corpus, su estructura y función. Sujeto a las reglas de la sintaxis ritual es posible exponer los múltiples niveles de significado en el corpus para la resurrección y salvación del difunto.

Sorting Test, Tower Test, and BRIEF-SR do not predict school performance of healthy adolescents in preuniversity education

Executive functions (EF) such as self-monitoring, planning, and organizing are known to develop through childhood and adolescence. They are of potential importance for learning and school performance. Earlier research into the relation between EF and school performance did not provide clear results possibly because confounding factors such as educational track, boy-girl differences, and parental education were not taken into account. The present study therefore investigated the relation between executive function tests and school performance in a highly controlled sample of 173 healthy adolescents aged 12–18. Only students in the pre-university educational track were used and the performance of boys was compared to that of girls. Results showed that there was no relation between the report marks obtained and the performance on executive function tests, notably the Sorting Test and the Tower Test of the Delis-Kaplan Executive Functions System (D-KEFS). Likewise, no relation was found between the report marks and the scores on the Behavior Rating Inventory of Executive Function—Self-Report Version (BRIEF-SR) after these were controlled for grade, sex, and level of parental education. The findings indicate that executive functioning as measured with widely used instruments such as the BRIEF-SR does not predict school performance of adolescents in preuniversity education any better than a student's grade, sex, and level of parental education.