Care Measures Research Articles

Traffic analysis of different geometries of a junction for optimization of vehicle capacity and traffic safety increase

Abstract Identifying various vehicle movement characteristics inside a network requires a careful assessment and different measurements technics, in regards to road traffic studies. These measures are influenced by a variety of variables, including the direction of traffic, changes in daily transportation demand, junction geometry and location in areal of study, style of road and also the size of the study area. Examining various geometries and arrangements of lanes with different distributions of vehicle platoons of the junction based on traffic-related elements is the goal of this essay. The analysis of the junction in regards to the speed, volume, capacity, pollution and traffic safety can give alternative solution and provide a foundation for the implementation of various political strategies in the area.

Oral And Dental Evaluation Of Bone Marrow Transplant Patients: A Retrospective Observational Study

This retrospective observational study aims to evaluate the oral and dental conditions of 100 bone marrow transplant (BMT) patients. The study assessed oral pathologies, including root canal treatments, extractions, squamous cell carcinoma cases, oral prophylaxis procedures, and restorations. The findings provide valuable insights into the oral health challenges faced by BMT patients, emphasizing the need for specialized dental care and preventive measures in this vulnerable population

Incidence of medical device-related pressure injuries and identification of risk factors in the neonatal unit

AimThis study was conducted to investigate the incidence of medical device-related pressure injuries (MDRPIs) and the risk factors influencing their occurrence in the neonatal intensive care unit (NICU). MethodThis study is a prospective, descriptive study. The research was conducted with 116 newborns between June 1, 2022, and June 1, 2023. Newborns who stayed in the neonatal intensive care unit for at least 24 h were observed daily for medical device-related pressure injuries under and around each medical device throughout their stay in the intensive care unit. The "Case Report Form," "MDRPIs Monitoring Form," "Braden Q scale for children," National Pressure Injury Advisory Panel (NPIAP) Pressure Grading, and Glasgow Coma Scale were used in the research. ResultsThe incidence of medical device-related pressure injuries is 35.3 % (41/116). It was found that 38.1 % (16/42) of medical device-related pressure injuries developed due to Near-Infrared Spectroscopy (NIRS) probes, and 33.5 % (14/42) developed due to medical devices related to the respiratory system. In terms of anatomical location, 38.1 % occurred on the forehead, and 23.8 % on the arm/leg. The difference between birth weight, gestational age, development of MDRPIs in newborns receiving sedation and inotropes was found to be statistically significant. Regression analysis identified gestational age (p = 0.040, OR = 0.795, 95%CI = [0.632–1.000]) as an independent risk factor for the occurrence of medical device-related pressure injuries. ConclusionsThe incidence of medical device-related pressure injuries in newborns was relatively high in this study, with gestational age being the most significant risk factor for MDRPIs formation. It is crucial for neonatal intensive care nurses to consider associated risk factors while providing newborn care and implement appropriate preventive measures to reduce the incidence of MDRPIs.

Environmental impact of haematology care—measurement and mitigation

Environmental impact of haematology care—measurement and mitigation

Building Capacity of Community Health Centers to Improve the Provision of Postpartum Care Services Through Data-Driven Health Information Technology and Innovation.

Maternal morbidity and mortality remain significant challenges in the United States, with substantial burden during the postpartum period. The Centers for Disease Control and Prevention, in partnership with the National Association of Community Health Centers, began an initiative to build capacity in Federally Qualified Health Centers to (1) improve the infrastructure for perinatal care measures and (2) use perinatal care measures to identify and address gaps in postpartum care. Two partner health center-controlled networks implemented strategies to integrate evidence-based recommendations into the clinic workflow and used data-driven health information technology (HIT) systems to improve data standardization for quality improvement of postpartum care services. Ten measures were created to capture recommended care and services. To support measure capture, a data cleaning algorithm was created to prioritize defining pregnancy episodes and delivery dates and address data inconsistencies. Quality improvement activities targeted postpartum care delivery tailored to patients and care teams. Data limitations, including inconsistencies in electronic health record documentation and data extraction practices, underscored the complexity of integrating HIT solutions into postpartum care workflows. Despite challenges, the project demonstrated continuous quality improvement to support data quality for perinatal care measures. Future solutions emphasize the need for standardized data elements, collaborative care team engagement, and iterative HIT implementation strategies to enhance perinatal care quality. Our findings highlight the potential of HIT-driven interventions to improve postpartum care within health centers, with a focus on the importance of addressing data interoperability and documentation challenges to optimize and monitor initiatives to improve postpartum health outcomes.

ABORDAGEM AS MULHERES VÍTIMAS DE VIOLÊNCIA POR ENFERMEIRAS E ENFERMEIROS

Introduction: violence against women is a matter of public interest that transcends geographical, cultural, and socioeconomic boundaries. It is understood as any act or conduct that violates human rights, based on gender, that causes death, harm, or physical, sexual, psychological, or patrimonial suffering to women. Primary health care is the individual’s gateway to the network, thus the nurse must be trained to recognize possible cases of violence and effectively welcome women, to establish measures for prevention, promotion, and care for victims. Objective: To analyze the effectiveness of the approach taken by nurses in primary care to women victims of violence, seeking to identify practices and strategies that can be improved to offer comprehensive and welcoming care, to contribute to health promotion and coping with gender violence. Method: a study of a qualitative methodological approach, with an explanatory descriptive character, through an integrative review of the literature on national and international publications in representative journals in the field of nursing, indexed in the virtual database PubMed, LILACS e Medline, within the period delimited for this research, in the years 2019 to 2024. Discussion: the analyses highlighted the different types of violence against women, the need for primary care nurses to be trained to identify and welcome victims, as well as the obstacles encountered by the health class. Conclusion: the attributions of the Primary Health Care nurse are essential for the reception of women who are victims of violence, considering that they are the first professional to have contact with the victim and build a bond, which is essential for the victim to remain in the care network and disassociate themselves from the abuser.

Clinical and Pathoanatomical Characteristics of Hypoplastic Left Heart Syndrome a Clinical Case

Hypoplastic left heart syndrome (HLHS) is a common congenital heart defect, accounting for 4 to 16% of cases, and is one of the most prognostically unfavorable, involving single-­ventricle hemodynamics. HLHS involves hypoplasia of the left ventricle, often in combination with atresia and/or stenosis of the aortic and/or mitral valves, as well as hypoplasia of various parts of the aorta. Intrauterine reduction in blood flow to the left heart structures at early stages of fetal development subsequently leads to severe changes in cardiac structures, often not amenable to surgical correction. Objective. To study the clinical and morphological features of HLHS using a clinical case as an example. Materials and Methods. The patient was a child from the first pregnancy, which was complicated by anemia and first-­trimester preeclampsia. The defect was diagnosed prenatally at 23/24 weeks. At 39 weeks, labor was induced, and the infant was hospitalized in the intensive care unit with symptoms of cardiac and respiratory failure. On the 6th day of life, surgical treatment was performed — a Norwood operation, which is a single-­ventricle hemodynamic surgical correction of the defect. Despite intensive care measures, multiple organ failure progressed, leading to the development of disseminated intravascular coagulation (DIC) and subsequent death on the 10th day of life. Results. Autopsy, including staining of the myocardium with Masson’s trichrome and hematoxylin and eosin, showed pronounced plethora of the microcirculatory vessels with formation of erythrocyte thrombi. Pronounced perivascular edema and fraying of muscle fibers were detected. Fibroelastosis of the endocardium of the left ventricle was observed, characterized by pronounced sclerotic thickening due to significant proliferation of fibrous tissue, with the spread of connective tissue strands into the myocardium. Endocardial fibroelastosis is a component of HLHS and one of the determining factors in the outcome of cardiac surgery. Conclusion. The results of this work indicate the complexity of HLHS as a developmental defect, the severity of its clinical manifestations, and the limited prospects of currently existing surgical treatment methods. These patients may require heart transplantation in the first days of life. A potential alternative to early postnatal heart transplantation may be the development of methods for intrauterine correction of the existing developmental defect.

The mediating effects of minority stress experiences on cannabis consumption among 2SLGBTQ+ youth

Introduction Data suggest there are within-group variations in cannabis consumption among sexually diverse individuals. However, less is known about specific sexual orientations, such as Two-Spirit, asexual, pansexual, and queer (2SAPQ+), when compared with lesbian, gay, and bisexual people, as they often are not given an option to indicate their identities on surveys, leading them to be grouped with bisexuals. This study aimed to compare the relationship between LG and 2SAPBQ+ (including bisexual) identification and routine cannabis use, and whether it was mediated by minority stress. Methods Data were collected across two time points from 851 Two-Spirit, lesbian, gay, bisexual, queer, and questioning (2SLGBTQ+) youth participants. Structural equation modeling (SEM) was employed to analyze whether latent constructs within the minority stress framework mediated the relationship between sexual identity and cannabis use longitudinally. Results A preliminary logistic regression confirmed that 2SAPBQ + individuals were more likely to consume cannabis than LG individuals. The results suggest that the minority stress constructs accounted for a significant portion of the variance within the relationship between sexual orientation and cannabis use. Conclusion The pathway between sexual orientation and routine cannabis use was complex. Findings signal that not all sexual minority individuals should be grouped into one category and call for attention to careful measurement practices.

Environmental impacts of solar energy systems

The yearly growth in worldwide energy usage, coupled with the associated environmental problems and worries, are major factors driving the widespread adoption of sustainable and renewable energy on a global scale. Solar energy systems have garnered significant attention in the past decade, surpassing other forms of renewable energy systems. Nevertheless, renewable energies might still cause negative environmental impacts. Therefore, it is crucial to prioritise careful consideration and implement appropriate precautionary measures. This report delivers a detailed assessment of the environmental impacts of both established and innovative solar energy solutions, shedding light on their effects on the ecosystem, considering their impact on the environment at both small and large sizes. The study examines both the associated advancements and the crucial components in their systems. The strategy encompasses all steps, commencing with the designs, and progressing through the manufacture, materials, construction or installation phases, as well as the operation lifetime and decommissioning. This article explores targeted strategies for various systems, including waste reduction and recycling, as well as providing technically and ecologically beneficial suggestions for minimising their effects.

Postnatal quality of care measures for mothers and newborns at home: A scoping review.

The postnatal period is one of the most critical periods in the lives of mothers and newborns. Yet, the postnatal period remains the most neglected period along the maternal health care continuum. Globally, measures assessing quality of postnatal care (PNC) often focus on care at health facility level, the provision of home-based PNC and associated quality of care measures seem largely overlooked. This scoping review aims to give an overview of the literature on measures assessing quality of PNC for mothers and newborns in a home-based setting. This review was conducted according to the Arksey and O'Malley's methodology for scoping reviews. Three electronic bibliographic databases were searched together with a grey literature search. Two reviewers independently screened the identified articles. All data on home-based PNC measures were extracted and mapped according to the 2022 World Health Organization PNC Guideline recommendations in three categories: i) maternal care, ii) newborn care, iii) health system and health promotion interventions. Several additional quality of care domains, characterizing home-based PNC, were identified: i) social and emotional empowerment, ii) assessment of the home setting, iii) early breastfeeding, iv) health education and counseling, v) personal hygiene and prevention of infections, vi) referral to health facility when necessary, vii) thermal care, viii) parent-child relationship and ix) promote economic self-sufficiency. This review illustrates that home-based PNC has a very broad spectrum of care and plays a vital role in improving maternal and newborn health and well-being. In addition, there is a clear need for more research on the optimal timing and content of home-based care in the postnatal period for maximizing its potential.

Allogeneic hematopoietic cell transplantation from alternative donors in acute myeloid leukemia.

Allogeneic hematopoietic cell transplantation (HCT) potentially provides a cure for patients with acute myeloid leukemia (AML) who are unlikely to be cured with chemotherapy alone. Previously, human leukocyte antigen (HLA)-matched related donors were used exclusively, which made the procedure available for a limited proportion of patients. The introduction of high-resolution HLA-typing technology, innovations in immunosuppressive therapy, and improved supportive care measures have significantly changed the situation. Now, patients without a matched related donor have an ample opportunity to receive allogeneic HCT with the use of matched or mismatched unrelated donors, umbilical cord blood grafts, or haploidentical related donors. The outcomes of alternative donor transplantations have improved over the past decades, and the growth of unrelated donor registries as well as the donor diversification have enhanced the chance of finding a suitable donor. With multiple alternative donor choices available for most patients, the donor selection is becoming increasingly important. To discuss the optimal donor choice in case of unavailability of an HLA-matched related donor, this article reviews the existing literature of retrospective and prospective comparisons of different alternative donor transplantations in AML and discusses the current state-of-art modalities in allogeneic HCT using alternative donors.

The nineteenth century evolution of the threshing machine in Britain

Manual farm work with the traditional flail, beating out grain from the sheaf-corn, was an arduous, labour-intensive task. In the late eighteenth and early nineteenth centuries, machines (driven by water, wind or horse-power) started to take over—firstly in Scotland and northern England, then further south. Farm workers, losing their winter-time employment with the flail, rose up in 1830 in anger against the machines. Their riots and disorder were violently repressed and threshing machine development resumed. New machines were proudly displayed at the 1851 Great Exhibition. Improvements over the following years concentrated on steam-powered machines, and on achieving better power utilisation and cleaner grain separation. Competitive trials—and careful measurements of efficiency—played a major role in machine development. The threshing machine became a widely visible symbol of technological progress in agriculture and contributed substantially to Britain’s growing agricultural engineering industry.

Ethical aspects regarding the management of patients with liver disease in the intensive care unit

Especially in terms of alcohol-related liver cirrhosis, discussions quickly arise in times of scarce resources about the justification for carrying out (prolonged) intensive care measures. The following review aims to address ethical aspects specifically in patients with liver cirrhosis in the intensive care unit. Apossible structured approach is presented. Ageneral recommendation is not possible. Ultimately, decisions remain on acase-by-case basis and have to take awide variety of perspectives into account.

Thermal conductivity of Eu-doped La2Zr2O7 transparent ceramics

The thermal conductivity of transparent ceramics can be an important design parameter when components are to be used in situations and environments with fast temperature changes. In this work the thermal conductivity of undoped and Eu3+-doped lanthanum zirconate (La2Zr2O7) pyrochlore ceramics usable as luminescent materials are determined via the laser flash technique from room temperature to 700 °C. Using careful measurement and evaluation procedures, the thermal conductivity of dense (pore-free) La2Zr2O7 ceramics has been determined to be 3.01 W·m−1·K−1 at 25 °C, followed by a decrease to values around 2 W·m−1·K−1 at 400 °C and a slight increase towards 700 °C. Below 600 °C the thermal conductivity decreases with increasing Eu3+ concentration, as expected, but at 600 °C a crossover is observed and this trend is changed to the opposite.

Quality-of-care standards in adult type 3 intestinal failure caused by benign disease: A European society of clinical nutrition and metabolism (ESPEN) position paper

BackgroundOutcomes related to chronic intestinal failure (CIF) vary significantly within and between countries. While there are extensive European Society of Clinical Nutrition and Metabolism (ESPEN) guidelines on the delivery of optimal care in CIF, there are no international consensus recommendations on the structure or resources required, nor on the process and appropriate outcome measures for delivering such quality care in CIF. AimThe aim of this position paper is therefore to devise ESPEN-endorsed, internationally agreed quality of care standards, covering the resources, systems and standards that centres should aim for in order to deliver optimal CIF care. MethodsMembers of the Home Artificial Nutrition-CIF Special Interest Group of ESPEN proposed an initial set of quality-of-care standards which was submitted to voting amongst clinicians from international CIF centres using a modified Delphi process, with participants rating each proposed statement as ‘essential’, ‘recommended’ or ‘not required’. Any statement receiving 80% of more ‘not required’ responses was excluded. ResultsAll 30 proposed standards relating to the structure, 18 relating to the process and 16 to the outcome measures of CIF care were deemed to be essential or recommended in more than 80% of respondents. ConclusionThis is the first paper to determine and describe internationally-agreed quality of care standards in CIF, which are now aimed at forming the basis for all CIF teams to develop and monitor their service, while also informing policymakers and payers on the infrastructure required for the optimal approach to multi-disciplinary team CIF care delivery. The recording of standardised outcomes should also allow internal and external benchmarking of care delivery within and between CIF centres.

Accuracy of continuous glucose monitoring in the hospital setting: an observational study.

Continuous glucose monitoring (CGM) improves glycaemic outcomes in the outpatient setting; however, there are limited data regarding CGM accuracy in hospital. We conducted a prospective, observational study comparing CGM data from blinded Dexcom G6 Pro sensors with reference point of care and laboratory glucose measurements during participants' hospitalisations. Key accuracy metrics included the proportion of CGM values within ±20% of reference glucose values >5.6 mmol/l or within ±1.1 mmol/l of reference glucose values ≤5.6 mmol/l (%20/20), the mean and median absolute relative difference between CGM and reference value (MARD and median ARD, respectively) and Clarke error grid analysis (CEGA). A retrospective calibration scheme was used to determine whether calibration improved sensor accuracy. Multivariable regression models and subgroup analyses were used to determine the impact of clinical characteristics on accuracy assessments. A total of 326 adults hospitalised on 19 medical or surgical non-intensive care hospital floors were enrolled, providing 6648 matched glucose pairs. The %20/20 was 59.5%, the MARD was 19.2% and the median ARD was 16.8%. CEGA showed that 98.2% of values were in zone A (clinically accurate) and zone B (benign). Subgroups with lower accuracy metrics included those with severe anaemia, renal dysfunction and oedema. Application of a once-daily morning calibration schedule improved accuracy (MARD 11.4%). The CGM accuracy when used in hospital may be lower than that reported in the outpatient setting, but this may be improved with appropriate patient selection and daily calibration. Further research is needed to understand the role of CGM in inpatient settings.

(Invited) Unraveling Hot Carrier Transfer Processes in Plasmonic Catalysis

In the last decade, plasmonic nanoantennas have revolutionized light manipulation and control at the nanoscale. Interestingly, generation of hot carriers in metals upon light absorption have opened new pathways for controlling photo(electro)chemical processes and engineering photocatalysts. Yet, fundamental questions remain about the microscopic details of these complex light-matter interactions.We have recently developed a well-controlled platform for micro-scale plasmonic photoelectrochemistry studies that leverages the unique properties of monocrystalline microflakes [1] as well as precise nanofabrication methods. Interestingly, the microflakes exhibit well-defined crystal facets and can bridge the properties of bulk metals with those of nanoscale plasmonic antennas, accessing ultra-thin film dimensions (sub 15-nm) that are challenging for polycrystalline films. By performing careful absorption measurements, we explore the photoelectrochemical performance of these hot carrier micro-scale photoelectrodes for inner- and outer-sphere reactions [2], concurrently comparing them to cm-scale devices [3]. This allows us to unravel the interplay of hot carrier generation and transport at metal-liquid and metal-semiconductor interfaces and identify bottlenecks for charge transfer.[1] Kiani F., Tagliabue G. - High‐Aspect Ratio Au Microflakes via Gap‐Assisted Synthesis – Chemistry of Materials 34 (3), 1278-1288, 2022[2] Kiani F. et al - Transport and Interfacial Injection of d-band Hot Holes Control Plasmonic Chemistry - ACS Energy Letters, 8 (10), 4242-4250, 2023[3] Ma J., Oh K., Tagliabue G. - Understanding Wavelength-Dependent Synergies between Morphology and Photonic Design in TiO2-Based Solar Powered Redox Cells – Journal of Physical Chemistry C, 127 (1), 11-21, 2022

Study protocol: a mixed-methods study of the implementation of doula care to address racial health equity in six state Medicaid programs

BackgroundRacial inequities in severe maternal morbidity (SMM) and mortality constitute a public health crisis in the United States. Doula care, defined as care from birth workers who provide culturally appropriate, non-clinical support during pregnancy and postpartum, has been proposed as an intervention to help disrupt obstetric racism as a driver of adverse pregnancy outcomes in Black and other birthing persons of colour. Many state Medicaid programs are implementing doula programs to address the continued increase in SMM and mortality. Medicaid programs are poised to play a major role in addressing the needs of these populations with the goal of closing the racial gaps in SMM and mortality. This study will investigate the most effective ways that Medicaid programs can implement doula care to improve racial health equity.MethodsWe describe the protocol for a mixed-methods study to understand how variation in implementation of doula programs in Medicaid may affect racial equity in pregnancy and postpartum health. Primary study outcomes include SMM, person-reported measures of respectful obstetric care, and receipt of evidence-based care for chronic conditions that are the primary causes of postpartum mortality (cardiovascular, mental health, and substance use conditions). Our research team includes doulas, university-based investigators, and Medicaid participants from six sites (Kentucky, Maryland, Michigan, Pennsylvania, South Carolina and Virginia) in the Medicaid Outcomes Distributed Research Network (MODRN). Study data will include policy analysis of doula program implementation, longitudinal data from a cohort of doulas, cross-sectional data from Medicaid beneficiaries, and Medicaid healthcare administrative data. Qualitative analysis will examine doula and beneficiary experiences with healthcare systems and Medicaid policies. Quantitative analyses (stratified by race groups) will use matching techniques to estimate the impact of using doula care on postpartum health outcomes, and will use time-series analyses to estimate the average treatment effect of doula programs on population postpartum health outcomes.DiscussionFindings will facilitate learning opportunities among Medicaid programs, doulas and Medicaid beneficiaries. Ultimately, we seek to understand the implementation and integration of doula care programs into Medicaid and how these processes may affect racial health equity.Study registration The study is registered with the Open Science Foundation (https://doi.org/10.17605/OSF.IO/NXZUF).

Clinicodemographic Features of Plica Neuropathica: A Cross-Sectional Prospective Study

Abstract Introduction: Plica neuropathica (PN) is an acquired hair disorder characterized by sudden onset, irreversible hair matting, which seems to be a compact hair mass with irregular twists. Aim and Objective: This study aimed to evaluate the clinicodemographic features of PN. Materials and Methods: This study was a cross-sectional prospective clinical research that included patients with PN. All the included patients were subjected to a detailed medical history of clinicodemographic data and clinical with trichoscopic examinations of the affected hair and scalp. Results: This study included 18 female patients with PN, with a mean age of 23.94 ± 7.9. All the patients presented with PN had acute onset and progressive course, psychological stressful factors preceding PN, negligence of hair care, no history of hair care product use, no history of hair straightening, no previous treatment preceding PN, and no history of systemic diseases. Recurrence of PN was reported in 4 (22.2%) patients. On trichoscopic evaluation, all patients were presented with normal scalp and matting of hair shaft with honey-colored concretions mimicking the “wrangled mesh of wires” appearance. Sixteen (88.9%) patients were treated with cutting hair mass. Most of the included patients reported very large and extremely large effects on the quality of life. Conclusion: This study concluded that PN is an uncommon acquired hair matting disorder prevalent in young age females. It is associated with marked impairment of the patient’s quality of life. Psychological stressful factors and negligence of hair care are the main risk factors for PN. Regular hair care measures are essential to prevent hair matting.

Perceived Relational Empathy and Resilience in People with Spinal Cord Injury at the End of Acute Care: A Cross-Sectional Study.

In patients with spinal cord injury (SCI), patient-reported outcomes (PROMs) and experience of care measures (PREMs) are extremely relevant for the prognosis. However, there is a paucity of research on these topics. We conducted a cross-sectional study to investigate the relationships between these patient outcomes and other demographic and clinical variables in adult SCI patients discharged from the intensive care unit of an Italian tertiary rehabilitation hospital. We administered the Consultation and Relational Empathy (CARE) for perceived relational empathy, the Spinal Cord Independence Measure III self-report (SCIM-SR) for functional autonomy, the Numeric Rating Scale (NRS) for pain, and the Connor-Davidson Resilience Scale (CD-RISC-10) for resilience. Study participants consisted of 148 adults with SCI; 82.4% were male, with a mean age of 49.9 years (SD = 16.6). The lesion was traumatic in 82.4% and complete in 74.3% of cases. The median length of hospital stays was 35 days (interquartile range-IQR = 23-60). Perceived relational empathy was positively associated with resilience (r = 0.229, p = 0.005) and negatively associated with the length of the stay and lesion completeness. Resilience had a weak negative association with pain (r = -0.173, p = 0.035) and was unrelated to other variables. Clinicians should consider the routine assessment of PREMs and PROMs in order to personalize post-discharge therapeutic plans and identify appropriate measures to ensure continuity of care.