Background and Objectives
Extended vertical rectus abdominis myocutaneous (eVRAM) flap has been proposed for reconstruction of large pelviperineal defects where traditional VRAM flap is insufficient. ...We present our experience with eVRAM flap for pelviperineal reconstruction following oncologic resection.
Methods
A retrospective study was conducted, including all the patients who underwent reconstruction with eVRAM flap after complex pelvic resection, between 2012 and 2020. EVRAM flap was indicated when traditional VRAM was considered deficient to cover or reach the skin defect or to fill the dead space.
Results
Forty‐four patients were included in the study. Successful reconstruction with eVRAM flap was achieved in 40 patients. There were three flap failures, and one patient died in the second postoperative day because of multiple organ failure. Perineal wound complications occurred in 17 patients (38.6%), eight of them requiring surgical reoperation. Donor site problems were present in five patients (11.4%), and only one patient required surgical closure because of a major dehiscence.
Conclusions
The authors found the eVRAM flap to be a useful and reliable flap for reconstruction of complex pelviperineal wounds, with a low rate of donor site morbidity.
Reduced‐order models are essential tools to deal with parametric problems in the context of optimization, uncertainty quantification, or control and inverse problems. The set of parametric solutions ...lies in a low‐dimensional manifold (with dimension equal to the number of independent parameters) embedded in a large‐dimensional space (dimension equal to the number of degrees of freedom of the full‐order discrete model). A posteriori model reduction is based on constructing a basis from a family of snapshots (solutions of the full‐order model computed offline), and then use this new basis to solve the subsequent instances online. Proper orthogonal decomposition (POD) reduces the problem into a linear subspace of lower dimension, eliminating redundancies in the family of snapshots. The strategy proposed here is to use a nonlinear dimensionality reduction technique, namely, the kernel principal component analysis (kPCA), in order to find a nonlinear manifold, with an expected much lower dimension, and to solve the problem in this low‐dimensional manifold. Guided by this paradigm, the methodology devised here introduces different novel ideas, namely, 1) characterizing the nonlinear manifold using local tangent spaces, where the reduced‐order problem is linear and based on the neighboring snapshots, 2) the approximation space is enriched with the cross‐products of the snapshots, introducing a quadratic description, 3) the kernel for kPCA is defined ad hoc, based on physical considerations, and 4) the iterations in the reduced‐dimensional space are performed using an algorithm based on a Delaunay tessellation of the cloud of snapshots in the reduced space. The resulting computational strategy is performing outstandingly in the numerical tests, alleviating many of the problems associated with POD and improving the numerical accuracy.
•Spatial mismatches between ecosystem services supply and demand increase over time due to urban sprawl and population growth.•Maps of supply-demand mismatches provide insights for land-use planning ...beyond administrative boundaries.•High-resolution quantitative methods of ecosystem services mapping facilitate multiscale land-use planning.
Global trends in land-use changes, including urbanization and abandonment of rural areas, have important repercussions for the supply and demand of ecosystem services (ES). In this study, we assessed and mapped the supply and demand of three ES (water provision, climate regulation, and outdoor recreation) along an urban-rural gradient in the Madrid region (Spain) from 1990 to 2012. We mapped ES supply, based on land use/land cover (LULC) data, using InVEST models and complementary methods, and ES demand, using population density and demand indicators. Then, we explored spatial supply-demand mismatches at a municipality spatial scale. Despite an increase in ES supply in some areas, a general increase in ES demand led to increasing dependence by the Madrid metropolitan area on outlying areas. We found that the number of municipalities that exhibited mismatches between the supply and demand in ES increased throughout the study period, due mainly to urban sprawl. Our results suggest the need for comprehensive land-use planning at the regional scale, taking into account that many ES flows reach beyond municipality boundaries. Finally, we discuss the utility of analyzing spatial mismatches in the supply and demand of ES for land-use planning and decision-making.
Nurse managers’ competencies: A scoping review González‐García, Alberto; Pinto‐Carral, Arrate; Pérez‐González, Silvia ...
Journal of nursing management,
September 2021, Letnik:
29, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Aim
To describe and synthesize scientific literature on nurse managers’ competencies.
Background
The key strategy for the success of health organisations currently resides in the capacity of the ...nurse manager to develop advanced competencies in management. However, there is a lack of systematic reviews that synthesize knowledge about nurse managers’ competencies.
Evaluation
A scoping review was conducted using electronic databases including Web of Science, Scopus, PubMed and Cumulative Index to Nursing and Allied Health Literature.
Key issues
After the first analysis, 392 competencies were observed from 76 studies. Finally, 53 competencies were grouped according to their characteristics. The two most‐cited competencies were communication and finance.
Conclusions
Knowing the competencies required by nurse managers can help organisations create strategies to develop competent managers. In addition, from the results we can infer what might be the core competencies, since 22 main competencies from the total number were identified.
Implications for Nursing Management
The competencies identified constitute the body of knowledge necessary for nurse managers. In addition, it is possible to generate a pathway for learning and professional development for nurses before they work at the microlevel of management. The starting point for this pathway could be the 22 core competencies.
Nurses who are capable of developing their competencies appropriately in the field of management are considered fundamental to the sustainability and improvement of health outcomes. These core ...competencies are the critical competencies to be developed in specific areas. There are different core competencies for nurse managers, but none in the Spanish health system. The objective of this research is to identify the core competencies needed for nurse managers in the Spanish health system. The research was carried out using the Delphi method to reach a consensus on the core competencies and a Principal Component Analysis (PCA) to determine construct validity, reducing the dimensionality of a dataset by finding the causes of variability in the set and organizing them by importance. A panel of 50 experts in management and healthcare engaged in a four-round Delphi study with Likert scored surveys. We identified eight core competencies from an initial list of 51: decision making, relationship management, communication skills, listening, Leadership, conflict management, ethical principles, collaboration and team management skills. PCA indicated the structural validity of the core competencies by saturation into three components (α Cronbach >0.613): communication, leadership and decision making. The research shows that eight competencies must be developed by the nursing managers in the Spanish health system. Nurse managers can use these core competencies as criteria to develop and plan their professional career. These core competencies can serve as a guideline for the design of nurse managers' development programs in Spain.
Recreation and ecotourism opportunities are significant and complex Cultural Ecosystem Services, including various ecological and socio-economic aspects. Therefore, an integrated approach is needed ...to address these service complexities to help inform recreation and tourism planning and management. This study aims to develop an integrated model to map and assess Recreation Opportunity Ecosystem Services (ROES) in the north of Iran involving various ecosystem attributes and indicators. The methodological framework followed in this study allowed us to identify the spatial distribution pattern of recreation ES supply and demand in the study area. Particularly, this study explored the spatial mismatches between the capacity of ecosystems to provide recreational services and societal needs by applying a supply-demand ratio indicator. To predict the future pattern of recreation ES provision in the study area, two scenarios were performed. The results showed that the areas with the highest ROES provision account for only a small share of the study area where there is a high ecosystem potential to fulfill human demand for recreation ES. The results of the mismatch analysis revealed that urban and rural areas showed a shortfall in supply, whereas the areas with a high degree of naturalness exhibited an excess supply than demand. The hot spot analysis performed for two current and future scenarios showed that the areas of recreation ES hot spots considerably decreased due to population growth and land use change in the study area over a 30-year period. Our findings can provide insights for decision-making and spatial planning to maintain recreation ES and the benefits delivered to users.
•Mapping and analyzing recreation ES supply and demand at a regional scale.•Identifying spatial distribution pattern of Recreation Opportunity Ecosystem Services (ROES) across the study area.•Mismatch analysis to identify relationship between recreation supply and demand.•Hot spot and cold spot analysis to generate clustered zones for inform tourism planning and management in the territory.•Providing insights for land use planning and decision-making.
Land-use changes, especially urbanization, have largely impacted the capacity of ecosystems to deliver ecosystem services (ES) on which human wellbeing depends. The current sectorial landscape and ...territorial planning approaches that separately address protected areas and urban areas have proven ineffective in conserving biodiversity. To address this important challenge, integrated territorial planning has been claimed to be able to better reconcile interests between nature conservation and urban planning, and ES supply and demand mapping may be a useful tool for such purposes. In this study, we quantitatively mapped biodiversity and the supply and demand of eight ES along an urban-rural gradient in the region of Madrid (Spain). Then, we clustered the municipalities in this gradient into four groups based on their common biodiversity and ES supply and demand characteristics. Additionally, we reviewed the urban plans from these municipalities and the management plans of three protected areas, analysed the references to ES in the plans, and searched for potential conflicts between urban and protected area planning aims. We found that municipalities with highly coupled ES supply and demand are in high altitude areas, coinciding with protected areas, while in urban areas, the ES demand exceeds the supply. Municipalities exhibiting a high demand for regulating ES usually include them in their plans, while municipalities with a high supply of regulating ES do not. Given the several conflicts between protected areas and urban planning that we detected, we discuss the utility of mapping biodiversity and ES supply and demand beyond administrative boundaries to overcome the challenge of integrating spatial planning approaches, especially in the context of urban-rural gradients and megacities. We also explore the utility of these methods for coordinating urban planning tools to achieve integrated territorial planning.
Display omitted
•Mapping biodiversity and ecosystem services informs integrated territorial planning.•Planning tools for urban and protected areas promote an urban-rural dichotomy.•Urban-rural dichotomies lead to environmental challenges and conflict.•Ecosystem services demand drives municipalities to incorporate them in planning tools.
Summary
The Arabidopsis thaliana transcription factor BRANCHED1 (BRC1) plays a pivotal role in the control of shoot branching as it integrates environmental and endogenous signals that influence ...axillary bud growth. Despite its remarkable activity as a growth inhibitor, the mechanisms by which BRC1 promotes bud dormancy are largely unknown.
We determined the genome‐wide BRC1 binding sites in vivo and combined these with transcriptomic data and gene co‐expression analyses to identify bona fide BRC1 direct targets. Next, we integrated multi‐omics data to infer the BRC1 gene regulatory network (GRN) and used graph theory techniques to find network motifs that control the GRN dynamics. We generated an open online tool to interrogate this network. A group of BRC1 target genes encoding transcription factors (BTFs) orchestrate this intricate transcriptional network enriched in abscisic acid‐related components.
Promoter::β‐GLUCURONIDASE transgenic lines confirmed that BTFs are expressed in axillary buds. Transient co‐expression assays and studies in planta using mutant lines validated the role of BTFs in modulating the GRN and promoting bud dormancy.
This knowledge provides access to the developmental mechanisms that regulate shoot branching and helps identify candidate genes to use as tools to adapt plant architecture and crop production to ever‐changing environmental conditions.
Background
Because of the coronavirus disease 2019 (COVID‐19) pandemic, the use of prone positioning has dramatically increased in the intensive care unit (ICU). Because this manoeuvre is related to ...several complications, it must be performed in a protocolized manner by the appropriate personnel.
Aim
To determine the prevalence of adverse events (AEs) in patients admitted to the ICU with a diagnosis of COVID‐19‐related acute respiratory distress syndrome (C‐ARDS) undergoing mechanical ventilation in prone position (PP).
Design
Descriptive ambispective study of patients admitted to the ICU diagnosed with C‐ARDS undergoing mechanical ventilation who were in the PP at least once.
The number of PP manoeuvres and the time spent in the PP were recorded for each subject. AEs proportions and frequencies were calculated, and analysis of variance was used to assess mean differences in the number of manoeuvres and total hours in PP stratified by the number of facial pressure ulcers. IBM SPSS Statistics v.25.0. and EPIDAT 4.1 software were used.
Results
Forty‐four patients were analysed, and 130 PP manoeuvres were performed. The most frequently observed AEs were facial oedema in 26 patients (80.3%) and facial pressure ulcers in 20 (60.6%). There was a significant positive association between the time spent in PP and the development of facial pressure ulcers (P < .001). Enteral nutrition was well tolerated, and no serious AEs or sentinel events were noted.
Conclusion
Despite the stressful, demanding situation during the peak of the pandemic, the large number of PP manoeuvres, and long duration spent in this position, no serious AEs occurred. This study highlights the need to implement preventive measures to avoid the development of pressure ulcers secondary to prone positioning.
Relevance to practice
Prone positioning requires a nursing protocol to prevent the occurrence of AEs that may reduce the quality of nursing care.
Eating out of home (EOH) is a common practice worldwide but research gaps have been identified. The aims of this review were (a) to find a common definition for EOH, (b) to determine the nutritional ...contribution of EOH, and (c) to analyze the relationship of EOH with health parameters in adults. Fifty-seven articles were finally selected. The definition of EOH was not harmonized between researchers and the comparison between studies was quite difficult. Restaurant and fast food were the terms most used, followed by chain restaurant, à la carte, sit-down restaurant, eating at table, full service, ready to eat, takeaway, buffet and buffet by weight, bar, cafes, and cafeterias, either alone or attached to at least one of the above. The profile of the main EOH participant was a highly educated, high-income, and unmarried young man. EOH was related to a body mass index (BMI) or being overweight in a different way depending on age, sex, or EOH frequency. A high rate of EOH led to poorer diet quality, characterized by higher intakes of energy, total and saturated fats, sugar, and sodium, as well as lower intakes of fiber, dairy, fruit, vegetables, and micronutrients. Regarding beverages, a higher intake of soft drinks, sugar-sweetened beverages, fruit juices, beer, and other alcohol was observed when EOH. There is a need for a methodological consensus for analyzing the impact of EOH on dietary intake and health to avoid bias. Additionally, measures and policies should be utilized to help consumers to make healthier choices when EOH is compatible with business regarding those running EOH establishments.
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