This time-motion study explored the amount of time clinicians spent on wound assessments in a real-world environment using wound assessment digital application utilizing Artificial Intelligence (AI) ...vs. manual methods. The study also aimed at comparing the proportion of captured quality wound images on the first attempt by the assessment method. Clinicians practicing at Valley Wound Center who agreed to join the study were asked to record the time needed to complete wound assessment activities for patients with active wounds referred for a routine evaluation on the follow-up days at the clinic. Assessment activities included: labelling wounds, capturing images, measuring wounds, calculating surface areas, and transferring data into the patient's record. A total of 91 patients with 115 wounds were assessed. The average time to capture and access wound image with the AI digital tool was significantly faster than a standard digital camera with an average of 62 seconds (P<0.001). The digital application was significantly faster by 77% at accurately measuring and calculating the wound surface area with an average of 45.05 seconds (P<0.001). Overall, the average time to complete a wound assessment using Swift was significantly faster by 79%. Using the AI application, the staff completed all steps in about half of the time (54%) normally spent on manual wound evaluation activities. Moreover, acquiring acceptable wound image was significantly more likely to be achieved the first time using the digital tool than the manual methods (92.2% vs. 75.7%, P<0.004). Using the digital assessment tool saved significant time for clinicians in assessing wounds. It also successfully captured quality wound images at the first attempt.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides ...transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions.
We combined information on cholera incidence in sub-Saharan Africa (excluding Djibouti and Eritrea) from 2010 to 2016 from datasets from WHO, Médecins Sans Frontières, ProMED, ReliefWeb, ministries of health, and the scientific literature. We divided the study region into 20 km × 20 km grid cells and modelled annual cholera incidence in each grid cell assuming a Poisson process adjusted for covariates and spatially correlated random effects. We combined these findings with data on population distribution to estimate the number of people living in areas of high cholera incidence (>1 case per 1000 people per year). We further estimated the reduction in cholera incidence that could be achieved by targeting cholera prevention and control interventions at areas of high cholera incidence.
We included 279 datasets covering 2283 locations in our analyses. In sub-Saharan Africa (excluding Djibouti and Eritrea), a mean of 141 918 cholera cases (95% credible interval CrI 141 538–146 505) were reported per year. 4·0% (95% CrI 1·7–16·8) of districts, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), have high cholera incidence. By focusing on the highest incidence districts first, effective targeted interventions could eliminate 50% of the region's cholera by covering 35·3 million people (95% CrI 26·3 million to 62·0 million), which is less than 4% of the total population.
Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes.
The Bill & Melinda Gates Foundation.
Malnutrition is associated with poor clinical outcomes among hospitalized patients. However, studies linking malnutrition with poor clinical outcomes in the intensive care unit (ICU) often have ...conflicting findings due in part to the inappropriate diagnosis of malnutrition. We primarily aimed to determine whether malnutrition diagnosed by validated nutrition assessment tools such as the Subjective Global Assessment (SGA) or Mini Nutritional Assessment (MNA) is independently associated with poorer clinical outcomes in the ICU and if the use of nutrition screening tools demonstrate a similar association. PubMed, CINAHL, Scopus, and Cochrane Library were systematically searched for eligible studies. Search terms included were synonyms of malnutrition, nutritional status, screening, assessment, and intensive care unit. Eligible studies were case-control or cohort studies that recruited adults in the ICU; conducted the SGA, MNA, or used nutrition screening tools before or within 48 hours of ICU admission; and reported the prevalence of malnutrition and relevant clinical outcomes including mortality, length of stay (LOS), and incidence of infection (IOI). Twenty of 1168 studies were eligible. The prevalence of malnutrition ranged from 38% to 78%. Malnutrition diagnosed by nutrition assessments was independently associated with increased ICU LOS, ICU readmission, IOI, and the risk of hospital mortality. The SGA clearly had better predictive validity than the MNA. The association between malnutrition risk determined by nutrition screening was less consistent. Malnutrition is independently associated with poorer clinical outcomes in the ICU. Compared with nutrition assessment tools, the predictive validity of nutrition screening tools were less consistent.
Wildfires are a dominant disturbance to boreal forests, and in North America, they typically cause widespread tree mortality. Forest fire burn severity is often measured at a plot scale using the ...Composite Burn Index (CBI), which was originally developed as a means of assigning severity levels to the Normalized Burn Ratio (NBR) computed from Landsat satellite imagery. Our study investigated the potential to map biophysical indicators of burn severity (residual green vegetation and charred organic surface) at very high (3 cm) resolution, using color orthomosaics and vegetation height models derived from UAV-based photographic surveys and Structure from Motion methods. These indicators were scaled to 30 m resolution Landsat pixel footprints and compared to the post-burn NBR (post-NBR) and differenced NBR (dNBR) ratios computed from pre- and post-fire Landsat imagery. The post-NBR showed the strongest relationship to both the fraction of charred surface (exponential R2 = 0.79) and the fraction of green crown vegetation above 5 m (exponential R2 = 0.81), while the dNBR was more closely related to the total green vegetation fraction (exponential R2 = 0.69). Additionally, the UAV green fraction and Landsat indices could individually explain more than 50% of the variance in the overall CBI measured in 39 plots. These results provide a proof-of-concept for using low-cost UAV photogrammetric mapping to quantify key measures of boreal burn severity at landscape scales, which could be used to calibrate and assign a biophysical meaning to Landsat spectral indices for mapping severity at regional scales.
Unmanned Aerial Vehicle (UAV) systems, sensors, and photogrammetric processing techniques have enabled timely and highly detailed three-dimensional surface reconstructions at a scale that bridges the ...gap between conventional remote-sensing and field-scale observations. In this work 29 rotary and fixed-wing UAV surveys were conducted during multiple field campaigns, totaling 47 flights and over 14.3 km2, to document permafrost thaw subsidence impacts on or close to road infrastructure in the Northwest Territories, Canada. This paper provides four case studies: (1) terrain models and orthomosaic time series revealed the morphology and daily to annual dynamics of thaw-driven mass wasting phenomenon (retrogressive thaw slumps; RTS). Scar zone cut volume estimates ranged between 3.2 × 103 and 5.9 × 106 m3. The annual net erosion of RTS surveyed ranged between 0.35 × 103 and 0.39 × 106 m3. The largest RTS produced a long debris tongue with an estimated volume of 1.9 × 106 m3. Downslope transport of scar zone and embankment fill materials was visualized using flow vectors, while thermal imaging revealed areas of exposed ground ice and mobile lobes of saturated, thawed materials. (2) Stratigraphic models were developed for RTS headwalls, delineating ground-ice bodies and stratigraphic unconformities. (3) In poorly drained areas along road embankments, UAV surveys detected seasonal terrain uplift and settlement of up to 0.5 m (>1700 m2 in extent) as a result of injection ice development. (4) Time series of terrain models highlighted the thaw-driven evolution of a borrow pit (6.4 × 105 m3 cut volume) constructed in permafrost terrain, whereby fluvial and thaw-driven sediment transfer (1.1 and 3.9 × 103 m3 a−1 respectively) was observed and annual slope profile reconfiguration was monitored to gain management insights concerning site stabilization. Elevation model vertical accuracies were also assessed as part of the case studies and ranged between 0.02 and 0.13 m Root Mean Square Error. Photogrammetric models processed with Post-processed Kinematic image solutions achieved similar accuracies without ground control points over much larger and complex areas than previously reported. The high resolution of UAV surveys, and the capacity to derive quantitative time series provides novel insights into permafrost processes that are otherwise challenging to study. The timely emergence of these tools bridges field-based research and applied studies with broad-scale remote-sensing approaches during a period when climate change is transforming permafrost environments.
Background
Early detection and removal of precursor lesions reduce colorectal cancer morbidity and mortality. Sessile serrated adenomas/polyps (SSP) are a recognized precursor of cancer, but there ...are limited studies on whether current screening techniques detect this pathology.
Aims
To investigate the sensitivity of fecal immunochemical tests (FIT) and epigenetic biomarkers in blood for detection of SSP.
Methods
A prospective study offered FIT and a blood test (Colvera for methylated
BCAT1
and
IKZF1
) to adults referred for colonoscopy. Sensitivity of FIT and the blood test were determined for four types of pathology: low-risk conventional adenoma, high-risk adenoma, SSP, and absence of neoplasia. Comparisons were made for FIT positivity at 10 and 20 μg hemoglobin (Hb)/g feces.
Results
One thousand eight hundred and eighty-two subjects completed FIT and underwent colonoscopy. One thousand four hundred and three were also tested for methylated
BCAT1/IKZF1
. The sensitivity of FIT (20 μg Hb/g feces) for SSP was 16.3%. This was lower than the sensitivity for high-risk adenomas (28.7%,
p
< 0.05), but no different to that for low-risk adenomas (13.1%) or no neoplasia (8.4%). A positive FIT result for SSP was not associated with demographics, morphology, concurrent pathology or intake of medications that increase bleeding risk. FIT sensitivity for SSP did not significantly increase through lowering the positivity threshold to 10 μg Hb/g feces (20.4%,
p
> 0.05). Sensitivity of the blood test for SSP was 8.8%, and 26.5% when combined with FIT.
Conclusions
Both FIT and blood-based markers of DNA hypermethylation have low sensitivity for detection of SSP. Further development of sensitive screening tests is warranted.
Several remote sensing studies have documented widespread thermokarst lake expansion in continuous permafrost regions of North America over the past few decades. Other studies have found no long-term ...trends in water body extents, but large intra- and inter-annual changes driven by precipitation. These differences could be due to geographic variability in physical conditions (geology, climate, permafrost and hydrology) or in the data and methods used to extract water bodies. This study tested water extraction methods over the Tuktoyaktuk Coastal Plain, Northwest Territories (NWT), Canada, based on the Landsat 5 shortwave infrared (SWIR) channel and validated them using water extents obtained from 0.5m resolution orthophoto imagery. Methods included applying thresholds to generate binary land/water classifications, as well as deriving 30m water fractions from both linear unmixing and a new histogram breakpoint method. Results indicated that the histogram breakpoint method outperformed other methods, underestimating overall water fraction by 0.26% and overestimating the number of pure 30m water pixels by 0.66% compared to water fractions calculated from orthophotos. The breakpoint method was then applied to a stack of 17 near peak-of-season Landsat 5 and Landsat 7 images acquired between July 4 and August 18 from 1985 to 2011 to create a water fraction time-series for examining both trends and inter-annual variation in water extent. Results showed an overall expansion of lake area along margins by 55km2 with isolated lakes experiencing rapid drainage totalling 15km2, leading to a net water area increase of 40km2 over the 26-year period.
•A new Landsat water extraction technique outperforms traditional methods.•Trends in Landsat water are computed from 1985 to 2011 over the Tuktoyaktuk Plain.•Results show expansion for most lakes, while few lakes exhibited rapid drainage.•The net result of expansion and drainage is an overall increase in lake area.•Results are consistent with previous studies, but not with a study of the same region.
Strong evidence for a pan-Arctic expansion of upright shrubs comes from analysis of satellite imagery, historical photographs, vegetation plots, and growth rings. However, there are still ...uncertainties related to local-scale patterns of shrub growth, resulting interactions among vegetation functional groups, and the relative roles of disturbance and climate as drivers of observed change. Here, we present evidence that widespread and rapid shrub expansion and lichen declines over a 15,000 km² area of the western Canadian Arctic have been driven by regional increases in temperature. Using 30 m resolution Landsat satellite imagery and high resolution repeat color-infrared aerial photographs, we show that 85% of the land surface has a positive 1985-2011 trend (P < 0.05) in NDVI, making this one of the most intensely greening regions in the Arctic. Strong positive trends (> 0.03 NDVI/decade) occurred consistently across all landscape positions and most vegetation types. Comparison of 208, 1:2,000 scale vertical air photo pairs from 1980 and 2013 clearly shows that this greening was driven by increased canopy cover of erect dwarf and tall shrubs, with declines in terricolous lichen cover. Disturbances caused by wildfires, exploratory gas wells, and drained lakes all produced strong, yet localized increases in NDVI due to shrub growth. Our analysis also shows that a 4°C winter temperature increase over the past 30 years, leading to warmer soils and enhanced nutrient mineralization provides the best explanation for observed vegetation change. These observations thus provide early corroboration for modeling studies predicting large-scale vegetation shifts in low-Arctic ecosystems from climate change.
Retrogressive thaw slumps are one of the most active geomorphic features in permafrost terrain. This study investigated the distribution and growth of thaw slumps in the Richardson Mountains and Peel ...Plateau region, northwestern Canada, using Tasseled Cap (TC) trend analysis of a Landsat image stack. Based on the TC linear trend image, more than 212 thaw slumps were identified in the study area, of which 189 have been active since at least 1985. The surface area of the slumps ranges from 0.4 to 52ha, with 10 slumps exceeding 20ha. The thaw slumps in the region are all situated within the maximum westward extent of the Laurentide Ice Sheet. Based on relations between frequency distribution of slumps and that of terrain factors in the landscape, the slumps are more likely to occur on the ice-rich hummocky rolling moraines at elevations of 300–350m and 450–500m and along east-facing slopes (slope aspects of 15° to 180°) with gradients of 8° to 12°. Pixel-level trend analysis of the TC greenness transformation in the Landsat stack allowed calculating headwall retreat rates for 19 thaw slumps. The 20-year average retreat rates (1990–2010 period) for 19 slumps ranged from 7.2 to 26.7myr−1, with the largest slumps having higher retreat rates. At the regional scale, the 20-yr headwall retreat rates are mainly related to slope aspect, with south- and west-facing slopes exhibiting higher retreat rates, and large slumps appear to be generating feedbacks that allow them to maintain growth rates well above those of smaller slumps. Overall, the findings presented in this study allow highlighting of key sensitive landscapes and ecosystems that may be impacted by the presence and growth of thaw slumps in one of the most rapidly warming region in the Arctic.
•Below are updated highlights: More than 212 thaw slumps were identified in the study area, of which 189 are active.•All slumps are situated within the maximum westward extent of the Laurentide Ice Sheet.•Slumps are more likely to occur on the ice-rich hummocky tills at elevations of 300-500m and along east-facing slopes with gradients of 8 to 12°.•20-yr headwall retreat rates are mainly related to slope aspect.•Large slumps appear to be generating feedbacks that allow them to maintain growth rates well above those of smaller slumps.
During the initial phase of critical illness, the association between the dose of nutrition support and mortality risk may vary among patients in the intensive care unit (ICU) because the prevalence ...of malnutrition varies widely (28 to 78%), and not all ICU patients are severely ill. Therefore, we hypothesized that a prognostic model that integrates nutritional status and disease severity could accurately predict mortality risk and classify critically ill patients into low- and high-risk groups. Additionally, in critically ill patients placed on exclusive nutritional support (ENS), we hypothesized that their risk categories could modify the association between dose of nutrition support and mortality risk.
A prognostic model that predicts 28-day mortality was built from a prospective cohort study of 440 patients. The association between dose of nutrition support and mortality risk was evaluated in a subgroup of 252 mechanically ventilated patients via logistic regressions, stratified by low- and high-risk groups, and days of exclusive nutritional support (ENS) short-term (≤ 6 days) vs. longer-term (≥ 7 days). Only the first 6 days of ENS was evaluated for a fair comparison.
The prognostic model demonstrated good discrimination AUC 0.78 (95% CI 0.73-0.82), and a bias-corrected calibration curve suggested fair accuracy. In high-risk patients with short-term ENS (≤ 6 days), each 10% increase in goal energy and protein intake was associated with an increased adjusted odds (95% CI) of 28-day mortality 1.60 (1.19-2.15) and 1.47 (1.12-1.86), respectively. In contrast, each 10% increase in goal protein intake during the first 6 days of ENS in high-risk patients with longer-term ENS (≥ 7 days) was associated with a lower adjusted odds of 28-day mortality 0.75 (0.57-0.99). Despite the opposing associations, the mean predicted mortality risks and prevalence of malnutrition between short- and longer-term ENS patients were similar.
Combining baseline nutritional status and disease severity in a prognostic model could accurately predict 28-day mortality. However, the association between the dose of nutrition support during the first 6 days of ENS and 28-day mortality was independent of baseline disease severity and nutritional status.
PDF
