Fuel types misrepresent forest structure and composition in interior British Columbia: a way forward.

Background: A clear understanding of the connectivity, structure, and composition of wildland fuels is essential for effective wildfire management. However, fuel typing and mapping are challenging owing to a broad diversity of fuel conditions and their spatial and temporal heterogeneity. In Canada, fuel types and potential fire behavior are characterized using the Fire Behavior Prediction (FBP) System, which uses an association approach to categorize vegetation into 16 fuel types based on stand structure and composition. In British Columbia (BC), provincial and national FBP System fuel type maps are derived from remotely sensed forest inventory data and are widely used for wildfire operations, fuel management, and scientific research. Despite their widespread usage, the accuracy and applicability of these fuel type maps have not been formally assessed. To address this knowledge gap, we quantified the agreement between on-site assessments and provincial and national fuel type maps in interior BC. Results: We consistently found poor correspondence between field assessment data and both provincial and national fuel types. Mismatches were particularly frequent for (i) dry interior ecosystems, (ii) mixedwood and deciduous fuel types, and (iii) post-harvesting conditions. For 58% of field plots, there was no suitable match to the extant fuel structure and composition. Mismatches were driven by the accuracy and availability of forest inventory data and low applicability of the Canadian FBP System to interior BC fuels. Conclusions: The fuel typing mismatches we identified can limit scientific research, but also challenge wildfire operations and fuel management decisions. Improving fuel typing accuracy will require a significant effort in fuel inventory data and system upgrades to adequately represent the diversity of extant fuels. To more effectively link conditions to expected fire behavior outcomes, we recommend a fuel classification approach and emphasis on observed fuels and measured fire behavior data for the systems we seek to represent. Supplementary Information: The online version contains supplementary material available at 10.1186/s42408-024-00249-z.

Antecedentes: Un entendimiento claro sobre la conectividad, estructura, y composición de los combustibles vegetales es esencial para un manejo efectivo de los incendios de vegetación. Sin embargo, la tipificación y mapeo de los combustibles son aspectos desafiantes debido a la amplia diversidad de las condiciones de los combustibles y su variabilidad espacial y temporal. En Canadá, los tipos de combustibles y el comportamiento potencial del fuego están caracterizados por el uso del Sistema de Predicción del Comportamiento del Fuego (Fire Behavior Prediction System, FBP), el cual usa una "aproximación asociada" para categorizar la vegetación en 16 tipos de combustibles basados en la estructura y composición de los rodales. En la Columbia Británica (BC) los mapas del sistema provincial y nacional de FBP son derivados de datos de inventarios tomados mediante sensores remotos, que son ampliamente usados para operaciones de incendios de vegetación, manejo de combustibles, e investigación científica. A pesar de su amplio uso, la exactitud y aplicabilidad de esos mapas de tipos de combustibles no han sido adecuadamente comprobadas. Para determinar este vacío en el conocimiento, cuantificamos la concordancia entre las determinaciones in situ y los mapas de combustibles provinciales y nacionales en el interior de BC. Resultados: Encontramos consistentemente una pobre correspondencia entre las determinaciones de los datos de campo y los tipos de combustibles provinciales y nacionales. Los desfasajes fueron particularmente frecuentes para: i) los ecosistemas secos del interior, ii) bosques mixtos y tipos de combustibles en bosques deciduos, y iii) condiciones de postcosecha. Para el 58% de las parcelas a campo, no hubo una concordancia adecuada entre la estructura y composición existentes. Estos desajustes fueron derivados de la exactitud y disponibilidad de datos del inventario forestal, y la baja aplicabilidad del Sistema FBP a los combustibles del interior de la Columba Británica. Conclusiones: Los desajustes en la determinación de los tipos de combustibles que nosotros identificamos pueden limitar la investigación científica, pero también es un desafío para las decisiones en las operaciones de incendios y en el manejo de los combustibles. El mejoramiento de la exactitud en la determinación de tipos de combustibles requerirá de un esfuerzo significativo en el inventario de datos y sistemas mejorados para representar adecuadamente la diversidad de los combustibles existentes. Para ligar más efectivamente las condiciones a los resultados del comportamiento, recomendamos una aproximación a la clasificación de los combustibles y énfasis en datos de los combustibles observados y del comportamiento medido para los sistemas que pretendemos representar.

Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19 / Nursing care plan for the prevention of pressure ulcers secondary to prone positioning in COVID-19 patients

Introducción: La posición prono (PP) es una alternativa terapéutica ampliamente recomendada e implementada en los pacientes con COVID-19. Sin embargo, aunque es un procedimiento no invasivo, es complejo y se asocia con eventos adversos como las úlceras por presión (UPP). Nuestro objetivo es proponer un plan de cuidados de enfermería basado en el lenguaje estandarizado NANDA-I, NIC, NOC para la prevención de las UPP secundarias a la PP en la enfermedad de COVID-19. Síntesis del contenido: En los pacientes con COVID-19, además de factores de riesgo propios del paciente como la edad avanzada y la presencia de comorbilidades, la PP contribuye a la presencia de los diagnósticos de enfermería de riesgo de úlcera por presión [00249], de deterioro de la integridad cutánea [00047] y tisular [00248]. Por su parte, la intervención de enfermería prevención de úlceras por presión [3540], es clave para minimizar el desarrollo de esta complicación, mejorar la calidad de la atención y el pronóstico en este tipo de pacientes. Finalmente, para determinar la efectividad del cuidado de enfermería se proponen los resultados NOC consecuencias de la inmovilidad: fisiológicas [0204] e integridad tisular: piel y membranas mucosas [1101]. Conclusión: La PP es una terapia coadyuvante recomendada para el manejo de los pacientes con COVID-19 críticamente enfermos, debido a que optimiza la función pulmonar, sin embargo está asociada a eventos adversos como las UPP. Este artículo presenta recomendaciones basadas en una revisión narrativa para facilitar la implementación de cuidados de enfermería preventivos que reduzcan su frecuencia en esta población.

Introduction: Prone position (PP) is a therapeutic alternative widely used and recommended in patients with COVID-19. Although PP is a non-invasive procedure, it is complex and could be associated with complications such as the development of pressure ulcers (PU). We aimed to propose a standardized nursing care plan in terms of NANDA-International, NIC (Nursing Interventions Classification) and NOC (Nursing Outcomes Classification) to prevent PU secondary to the PP in people with COVID-19.Content synthesis: In patients with COVID-19, in addition to risk factors such as advanced age and the presence of comorbidities, PP contributes to the presence of pressure ulcer risk nursing diagnoses [00249], of deterioration of skin [00047] and tissue [00248] integrity. On the other hand, the nursing intervention for the prevention of pressure ulcers [3540], due to the specificity and scientific basis of its activities, is key to minimize the development of this complication, improve the quality of care and the prognosis in this type of patients. Finally, to evaluate the effectiveness of nursing care, we propose the nursing results (NOC): consequences of immobility: physiological [0204] and tissue integrity: skin and mucous membranes [1101]. Conclusion: PP is a recommended adjunctive therapy for the management of critically ill COVID-19 patients due to its benefits to improve lung function. However, it is associated with adverse effects such as PU. This article presents recommendations based on a narrative review for a better implementation of preventive nursing care that reduces the frequency of PU in this population.

Introdução: A posição prona (PP) é uma alternativa terapéutica amplamente recomendada e implementada em pacientes com COVID-19. No entanto, embora seja um procedimento não invasivo, é complexo e está associado a eventos adversos, como úlceras por pressão (UP). Nosso objetivo é propor um plano de cuidados de enfermagem baseado na linguagem padronizada NANDA-I, NIC, NOC para a prevenção de UP secundárias à PP na doença COVID-19.Síntese de conteúdo: Em pacientes com COVID-19, além dos próprios fatores de risco do paciente, como idade avançada e presença de comorbidades, a PP contribui para a presença de diagnósticos de enfermagem de risco de úlcera por pressão [00249], de deterioração da pele [00047] e do tecido Integridade. Por sua vez, a intervenção de enfermagem na prevenção de úlceras por pressão [3540] é fundamental para minimizar o desenvolvimento desta complicação, melhorar a qualidade da assistência e o prognóstico neste tipo de paciente. Por fim, para determinar a eficácia da assistência de enfermagem, são propostos os resultados da NOC, consequências da imobilidade: fisiológicas [0204] e integridade do tecido: pele e mucosas [1101]. Conclusão: PP é uma terapia adjuvante recomendada para o tratamento de pacientes graves com COVID-19, pois otimiza a função pulmonar, porém está associada a eventos adversos, como UP. Este artigo apresenta recomendações baseadas em revisão narrativa para facilitar a implementação de cuidados preventivos de enfermagem que reduzam sua frequência nesta população.

Adherencia y potenciales eventos adversos prevenidos durante la administración de medicamentos endovenosos empleando bombas de infusión inteligentes en cuatro unidades de cuidados intensivos en Colombia / Adherence and potential adverse events prevented during the administration of intravenous medications using Smart infusion pump in four intensive care units in Colombia

Resumen Introducción: Las bombas de infusión inteligentes, constituyen una herramienta útil para la administración segura de medicamentos endovenosos dado que permiten prevenir potenciales eventos adversos. Objetivo: Evaluar la adherencia y los potenciales eventos adversos prevenidos, durante la administración de medicamentos endovenosos empleando bombas de infusión inteligentes. Metodología: Estudio observacional, realizado en cuatro unidades de cuidados intensivos usando datos del software Hospira MedNetTM. Un análisis descriptivo fue llevado a cabo junto con un análisis bivariado empleando una prueba U de Mann-Whitney, una prueba de Kruskal-Wallis y un test de Bonferroni para evaluar la adherencia y los potenciales eventos adversos prevenidos por año y servicio. Resultados: La adherencia fue del 74,0%, se presentaron 78.299 alertas de seguridad y se previnieron 4,54% (n=16.288) potenciales eventos adversos. Se encontraron diferencias entre el primer y segundo año en la adherencia [Mediana: 69,15 (Q1:64,2-Q3:75,5) Vs Mediana: 84,2(Q1:72,15-Q3:89,05), p<0.001], adherencia a la seguridad [Mediana: 87,1% (Q1:83,05-Q3:91,2) Vs Mediana: 94,05 (Q1:89,95-Q3:96,2), p<0.001] y las ediciones de alertas de limite relativo [Mediana:17,0 (Q1:8,5-Q3:24,5) Vs Mediana: 12,0 (Q1:7,0-Q3:17,5), p=0.013]. La solución salina, la norepinefrina, el lactato de ringer, la piperacilina-tazobactam, la nitroglicerina y la heparina presentaron el mayor número de alertas de seguridad. Conclusión: Se encontró una buena adherencia (uso de la farmacoteca) y adherencia a la seguridad (indicador de uso de la bomba), con una reducción de los potenciales eventos adversos; así el uso de bombas inteligentes podría contribuir en la prevención de potenciales errores durante la administración de medicamentos endovenosos en la unidad de cuidados intensivos.

Abstract Introduction: Smart infusion pumps have become a useful tool for the safe administration of intravenous medications, since they allow the prevention of potential adverse events. Objetive: To assess adherence and potential adverse events prevented during intravenous medication administration using smart infusion pumps. Methods: Observational study, conducted in four intensive care units using data from Hospira MedNetTM software. A descriptive analysis was carried out together with a bivariate analysis using a Mann-Whitney U test, a KruskalWallis test and a Bonferroni test to assess adherence and potential adverse events prevented by year and service. Results: Adherence was 74.0%, 78,299 safety alerts were presented and 4.54% (n = 16,288) potential adverse events were prevented. Differences were found between the first and second year in adherence [Median: 69.15 (Q1: 64.2-Q3:75.5) versus Median: 84.2 (Q1: 72.15-Q3: 89.05), p<0.001]. Likewise safety adherence [Median: 87.1% (Q1: 83.05-Q3: 91.2) versus Median: 94.05 (Q1: 89.95-Q3: 96.2), p<0.001] and the relative limit alert editions [Median: 17.0 (Q1: 8.5-Q3: 24.5) versus Median: 12.0 (Q1: 7.0-Q3: 17.5), p=0.013]. The saline solution, norepinephrine, ringer's lactate, piperacillin-tazobactam, nitroglycerin and heparin presented the highest number of safety alerts. Conclusions: Adequate adherence (use of the drug library) and safety adherence (indicator of pump use) were found, with a reduction in potential adverse events; thus, the use of smart pumps could contribute to the prevention of potential errors during the administration of intravenous medications in the intensive care unit.

Proteolytic shedding of the prion protein via activation of metallopeptidase ADAM10 reduces cellular binding and toxicity of amyloid-ß oligomers.

The cellular prion protein (PrPC) is a key neuronal receptor for ß-amyloid oligomers (AßO), mediating their neurotoxicity, which contributes to the neurodegeneration in Alzheimer's disease (AD). Similarly to the amyloid precursor protein (APP), PrPC is proteolytically cleaved from the cell surface by a disintegrin and metalloprotease, ADAM10. We hypothesized that ADAM10-modulated PrPC shedding would alter the cellular binding and cytotoxicity of AßO. Here, we found that in human neuroblastoma cells, activation of ADAM10 with the muscarinic agonist carbachol promotes PrPC shedding and reduces the binding of AßO to the cell surface, which could be blocked with an ADAM10 inhibitor. Conversely, siRNA-mediated ADAM10 knockdown reduced PrPC shedding and increased AßO binding, which was blocked by the PrPC-specific antibody 6D11. The retinoic acid receptor analog acitretin, which up-regulates ADAM10, also promoted PrPC shedding and decreased AßO binding in the neuroblastoma cells and in human induced pluripotent stem cell (iPSC)-derived cortical neurons. Pretreatment with acitretin abolished activation of Fyn kinase and prevented an increase in reactive oxygen species caused by AßO binding to PrPC Besides blocking AßO binding and toxicity, acitretin also increased the nonamyloidogenic processing of APP. However, in the iPSC-derived neurons, Aß and other amyloidogenic processing products did not exhibit a reciprocal decrease upon acitretin treatment. These results indicate that by promoting the shedding of PrPC in human neurons, ADAM10 activation prevents the binding and cytotoxicity of AßO, revealing a potential therapeutic benefit of ADAM10 activation in AD.

Strategic, value-based delivery in global health care: innovations at Harvard University and Brigham and Women's Hospital.

Investments in global health have more than doubled over the past decade, generating a cadre of new institutions. To date, most of the funded research in global health has focused on discovery, and, more recently, on the development of new tools, which has tightened the implementation bottleneck. This article introduces the concept of global health delivery and the need to catalog and analyze current implementation efforts to bridge gaps in delivery. Global health delivery is complex and context-dependent and requires an interdisciplinary effort, including the application of strategic principles. Furthermore, delivery is necessary to ensure that the investments in research, discovery, and development generate value for patients and populations. This article discusses the application of value-based delivery to global health. It provides some examples of approaches to aggregating implicit knowledge to inform practice. With global health delivery, the aim is to transform global health scale-up from a series of well-intentioned but often disconnected efforts to a value-based movement based upon 21st-century technology, standards, and efficiency.

The management of postacne scarring.

BACKGROUND: Therapeutic intervention for postacne scarring has historically been limited by the considerable morbidity of most treatments for only marginal disease improvement. Within the past decade, however, a greater understanding of the pathogenesis of acne scarring has led to the development of techniques that offer more favorable risk-benefit profiles. OBJECTIVE: The aims of this article are to highlight a number of newer techniques and to assign their appropriateness to particular grades of acne scarring. MATERIALS AND METHODS: Current modalities are discussed as they relate to disease process and specific acne scar types. Techniques are presented in order of most effectual therapeutic interventions for defined grades of acne scarring. Acne scarring grades have been described previously in terms of disease load, severity, and lesion morphologies. RESULTS: A comprehensive discussion of updated therapeutic techniques and their biologic rationales in the treatment of acne scarring is presented. These include targeted interventions of inflammatory and postinflammatory processes, angiogenesis, immunologic processes, dermal and subcutaneous fibrosis, hypertrophy, and keloid scarring. DISCUSSION: A requirement for developing successful treatments for postacne scarring is a greater understanding of its pathogenesis, variability among afflicted individuals, and the inflammatory mediators and immunology of the scarring process. Many innovative techniques introduced in the past decade attempt to counteract these pathologic processes while keeping the procedural and postoperative risks to a minimum.

Postacne scarring--a quantitative global scarring grading system.

BACKGROUND: There is no global quantitative grading system for assessing the disease load and global severity of disease in a patient with postacne scarring. AIMS: The purpose of this article is to provide a quantitative grading system that would allow more objective communication between practitioners of a patient's global disease severity and between investigators, educators, and proceduralists of the efficacy of grade-specific operative interventions or therapies. PATIENTS/METHODS: We describe a global scoring system that we have found clinically useful to assess disease load and severity of acne scarring and illustrate the reproducibility of this system in a small prospective study. Photographs of 21 patients were assessed independently by four observers, two of whom were physicians and the other two nurses. RESULTS: A quantitative global acne scarring grading system is presented. No substantial difference among acne scarring scores was seen between observers, with inter-rater agreement within four score points in 19 of the 21 patient-photos assessed. CONCLUSIONS: A global acne scarring grading system is presented that would allow investigators, educators, and proceduralists to compare their cases more accurately and to have a more objective discussion of the efficacy of operative interventions or therapies. This scoring system is shown to be reproducible among observers independent of medical background, suggesting that patients can be assigned scores equally by physicians and nurses.

Postacne scarring: a qualitative global scarring grading system.

BACKGROUND: There is no global qualitative grading system for assessing the disease load and global severity of disease in a patient with postacne scarring. OBJECTIVE: The purpose of this article is to provide a simple qualitative grading system that would allow better communication between practitioners of a patient's global disease severity and the most appropriate corresponding therapy for that degree of acne scarring. METHODS: Four grades of postacne scarring are described, and appropriate therapeutic interventions are presented for each. Grade assignment is made by lesion morphologies and disease load as indicated by patient perception of severity (i.e., whether or not an individual can easily disguise his or her disease at social distances). RESULTS: A simple qualitative global acne scarring grading system is presented. LIMITATIONS: The determination of disease load in terms of patient perception of severity is intrinsically imperfect due to varying subjectivity among individuals. CONCLUSION: A global acne scarring grading system is presented that is simple to use and may optimize therapeutic intervention. This system would also allow investigators, educators, and proceduralists to compare their cases more accurately and to have a more objective discussion of the efficacy of operative interventions or therapies.

Management of nevi in transplant patients.

Immunosuppression is known to be an independent risk factor for melanoma. As allograft-sparing therapies have improved in the past two decades and transplant recipients have longer survival rates, the numbers of patients at increased risk for cutaneous malignancies, including melanoma, have dramatically grown. For a majority of transplant recipients, the first opportunity for skin cancer screening and patient education does not begin prior to transplantation, nor does it involve a dermatologist. Dermatologists detect thinner melanomas when compared to those detected by other physicians, including other specialists. A dermatology consultation for assessment of individual risk and a baseline physical examination should be done as part of a pretransplant evaluation for every patient. The authors review the known risk factors for cutaneous melanoma and melanocytic nevi in both immunocompetent and immunosuppressed populations and current methods of examination and management of pigmented lesions, including brief discussions of a multidisciplinary approach, and when to consider decreasing or stopping immunosuppressive therapy.