The PASCAL Visual Object Classes Challenge

The formation of SCFA is the result of a complex interplay between diet and the gut microbiota within the gut lumen environment. The discovery of receptors, across a range of cell and tissue types for which short chain fatty acids SCFA appear to be the natural ligands, has led to increased interest in SCFA as signaling molecules between the gut microbiota and the host. SCFA represent the major carbon flux from the diet through the gut microbiota to the host and evidence is emerging for a regulatory role of SCFA in local, intermediary and peripheral metabolism. However, a lack of well-designed and controlled human studies has hampered our understanding of the significance of SCFA in human metabolic health. This review aims to pull together recent findings on the role of SCFA in human metabolism to highlight the multi-faceted role of SCFA on different metabolic systems.

https://www.tandfonline.com/doi/pdf/10.1080/19490976.2015.1134082

Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism

Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly-if at all. Diffusion of innovations is a major challenge in all industries including health care. This article examines the theory and research on the dissemination of innovations and suggests applications of that theory to health care. It explores in detail 3 clusters of influence on the rate of diffusion of innovations within an organization: the perceptions of the innovation, the characteristics of the individuals who may adopt the change, and contextual and managerial factors within the organization. This theory makes plausible at least 7 recommendations for health care executives who want to accelerate the rate of diffusion of innovations within their organizations: find sound innovations, find and support "innovators," invest in "early adopters," make early adopter activity observable, trust and enable reinvention, create slack for change, and lead by example.

/pdf/disseminating-innovations-in-health-care-5edel562ka.pdf

Disseminating Innovations in Health Care

Обнаружение транспортных средств на изображениях загородных шоссе на основе метода Single shot multibox Detector

https://www.naspghan.org/files/documents/pdfs/training/curriculum-resources/biliary-disease/aasld-guidelines/EASL_Cholestatic_Dz.pdf

EASL Clinical Practice Guidelines: management of cholestatic liver diseases

The Braden Scale for Predicting Pressure Sore Risk was developed to foster early identification of patients at risk for forming pressure sores. The scale is composed of six subscales that reflect sensory perception, skin moisture, activity, mobility, friction and shear, and nutritional status. Content and construct validity were established by expert opinion and empirical testing. Three studies of reliability are reported here, using raters who varied in level of educational preparation and geographic region. Two prospective studies of predictive validity were completed to determine the scale's sensitivity and specificity. Reliability ranged from r = .83 to r = .94 for nurses' aides and licensed practical nurses; when used by registered nurses, the reliability increased to r = .99. Predictive validity was calculated for each cut-off point of the scale. Using a cut-off point of 16, sensitivity was 100% in both studies. Specificity ranged from 64% to 90%. This instrument has highly satisfactory reliability when used by RNs, and greater sensitivity and specificity than instruments previously reported.

The Braden Scale for Predicting Pressure Sore Risk.

The Braden Scale for Predicting Pressure Sore Risk was developed to foster early identification of patients at risk for forming pressure sores. The scale is composed of six subscales that reflect sensory perception, skin moisture, activity, mobility, friction and shear, and nutritional status. Content and construct validity were established by expert opinion and empirical testing. Three studies of reliability are reported here, using raters who varied in level of educational preparation and geographic region. Two prospective studies of predictive validity were completed to determine the scale's sensitivity and specificity. Reliability ranged from r = .83 to r = .94 for nurses' aides and licensed practical nurses; when used by registered nurses, the reliability increased to r = .99. Predictive validity was calculated for each cut-off point of the scale. Using a cutoff point of 16, sensitivity was 100% in both studies. Specificity ranged from 64% to 90%. This instrument has highly satisfactory reliability when used by RNs, and greater sensitivity and specificity than instruments previously reported.

The Braden Scale for predicting pressure sore risk. Nursing Research, 36 (4), 205-210

Studies related to the treatment of pressure sores have appeared in the literature. Questions remain regarding both the etiology and treatment. This article presents a conceptual schema within which current knowledge can be organized and examined and further study facilitated. The critical determinants of pressure sores are primarily the intensity and duration of pressure. A second critical concept, the tolerance of the tissue for pressure, is also discussed. Conditions contributing to prolonged and intense pressure are included within the concepts of mobility, activity, and sensory perception. Tissue tolerance for pressure is influenced by both extrinsic and intrinsic factors. Extrinsic factors such as moisture, friction, and shear impinge on the skin and underlying tissues, while the multiple influences of nutrition, the physiologic effects of stress, aging, and alterations in cellular respiration are intrinsic factors which influence the architecture and integrity of the skin and supporting structures. The schema provides broad categories capable of organizing existing knowledge and new findings.

A conceptual schema for the study of the etiology of pressure sores.

Objective To determine if dietary intake, nutritional status, and other physical markers are risk factors for the development of pressure sores in the elderly. Design Cohort study. Setting 250-bed skilled nursing facility with 90 extended care beds in which the average length of stay is 28 days. Patients Two hundred newly admitted residents (70% female, 95% Caucasian) who were over age 65, estimated to stay greater than 10 days, at risk for pressure sore development (Braden Scale score less than or equal to 17) but free of existing pressure sores were studied for 12 weeks or until discharge. Measures Skin assessment, Braden Scale score, blood pressure, body temperature, anthropometrics, and dietary intake were studied weekly. CBC, serum albumin, serum total protein, serum iron, iron binding capacity, serum zinc and copper, and serum vitamin C were studied weekly for 4 weeks and biweekly for 8 weeks. Main outcome measures Presence/absence and stage of pressure sores. Main results Stage I pressure sores developed in 70 (35%) and Stage 2 or worse in 77 (38.5%) residents. Subjects who developed pressure sores were older (P less than 0.001) and had lower systolic and diastolic blood pressure (P less than 0.001) and higher body temperature (P less than 0.001) than those without pressure sores. Dietary intake of all nutrients was lower among subjects who developed pressure sores. Using logistic regression, the best predictors or pressure sore development were the Braden Scale score, diastolic blood pressure, temperature, dietary protein intake, and age. Conclusions Risk assessment is recommended upon admission to a nursing home and weekly for the first month. Risk status can be effectively predicted by using the Braden Scale in combination with knowledge of age, blood pressure, temperature, and dietary protein intake.

A prospective study of pressure sore risk among institutionalized elderly.

Background There have been no studies that have tested the Braden Scale for predictive validity and established cutoff points for assessing risk specific to different settings. Objectives To evaluate the predictive validity of the Braden Scale in a variety of settings (tertiary care hospitals, Veterans Administration Medical Centers [VAMCs], and skilled nursing facilities [SNFs]). To determine the critical cutoff point for classifying risk in these settings and whether this cutoff point differs between settings. To determine the optimal timing for assessing risk across settings. Method Randomly selected subjects (N= 843) older than 19 years of age from a variety of care settings who did not have pressure ulcers on admission were included. Subjects were 63% men, 79% Caucasian, and had a mean age of 63 (+/-16) years. Subjects were assessed for pressure ulcers using the Braden Scale every 48 to 72 hours for 1 to 4 weeks. The Braden Scale score and skin assessment were independently rated, and the data collectors were blind to the findings of the other measures. Results One hundred eight of 843 (12.8%) subjects developed pressure ulcers. The incidence was 8.5%, 7.4%, and 23.9% in tertiary care hospitals, VAMCs, and SNFs, respectively. Subjects who developed pressure ulcers were older and more likely to be female than those who did not develop ulcers. Braden Scale scores were significantly (p = .0001) lower in those who developed ulcers than in those who did not develop ulcers. Overall, the critical cutoff score for predicting risk was 18. Risk assessment on admission is highly predictive of pressure ulcer development in all settings but not as predictive as the assessment completed 48 to 72 hours after admission. Conclusions Risk assessment on admission is important for timely planning of preventive strategies. Ongoing assessment in SNFs and VAMCs improves prediction and permits fine-tuning of the risk-based prevention protocols. In tertiary care the most accurate prediction occurs at 48 to 72 hours after admission and at this time the care plan can be refined.

Barbara Braden

Papers

The Braden Scale for Predicting Pressure Sore Risk.

The Braden Scale for predicting pressure sore risk. Nursing Research, 36 (4), 205-210

A conceptual schema for the study of the etiology of pressure sores.

A prospective study of pressure sore risk among institutionalized elderly.

Predicting pressure ulcer risk: a multisite study of the predictive validity of the Braden Scale