526 research outputs found
Ambulatory assisted living fallers at greatest risk for head injury
No full textOBJECTIVES: To determine the relationship between head injuries sustained during each fall with various known high risk health and demographic factors predictive of falls.
DESIGN: Prospective cohort study conducted over 1 year
SETTING: Assisted living and skilled nursing units of a Continuing Care Retirement Community located in the northeastern United States.
PARTICIPANTS: Sixty nine OAs who fell.
MEASUREMENTS: Age, gender, diagnosis, high risk medication, functional, cognitive, ambulation/elimination status, mode of locomotion, fall related symptoms and the position of the fall, were analyzed using General Estimating Equations among elderly fallers with and without head injury.
RESULTS: A total of 173 falls (average of 2.9 times) were observed for 62 patients who had complete injury data. Injuries were recorded in 40.5% of falls, with 41.4% being head injuries. Head injuries were more likely to be hematomas than lacerations (66.7% vs. 14.7%) and among assisted living residents (p=0.04). Head injured patients were more likely to be walking at the time of the fall (69% vs. 36.1%) and less likely to have bowel incontinence (3.5% vs. 28.5%; p=0.04). None of the high risk diagnosis or medications associated with falls risk increased risk for head injury.
CONCLUSION: Those at greatest risk for head injury were ambulatory assisted living residents. None of the known clinical conditions predictive of risk to fall were predictive of head injury. For head injury prevention to be successful we need a closer examination of resident’s mobility, shoe-wear, health behavior with respect to ability to use assistive devices, and floor surface landing area. Future health policy implications include measures to ensure standard of care practices for head injured patients are in place.This is the peer reviewed version of the following article: Gray-Miceli, D. L., Ratcliffe, S. J. and Thomasson, A. (2013), Ambulatory Assisted Living Fallers at Greatest Risk for Head Injury. Journal of the American Geriatrics Society, 61: 1817–1819, which has been published in final form at https://dx.doi.org/10.1111/jgs.12467. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Peer reviewe
Teaching Strategies for Atypical Presentation of Illness in Older Adults
No full textAtypical presentation of illness is one of those phenomena where “seeing is believing”. Expert geriatric nurses and clinicians know all to well the early signs and symptoms of this frequent masquerader of bacterial infections, pain, acute myocardial infarction, heart failure or other serious medical ailments in older adults. Students however, as novices to clinical practice, require interactive learning approaches to reflect on the client’s illness presentations, help with developing the necessary skills to analyze and synthesize clinically relevant data, and to witness resolution of an atypical presentation when found and treated. We discuss various learner-centered, interactive approaches to teach students how to recognize an atypical presentation of illness using a real-life clinical case. Outlined are teaching strategies for faculty, drawn on visual, auditory, reading and kinesthetic modes of student learning. Use of the senses to teach nurses about care of patient’s is not entirely new or innovative, as reflected on by Florence Nightingale’s (1846) earliest writings of the "rules of nursing".Peer reviewe
Use of a comprehensive postfall assessment tool to prevent falls
No full textNursing research in fall prevention should not only identify etiologic risk factors to fall, but seek to identify underlying causes, whenever possible. Few studies have investigated the use of a comprehensive post fall assessment tool (PFAT) by nurses as an intervention for the prevention of recurrent falls, especially one that prompts nurses to consider all potential causes through a categorization scheme. This study tested use of a comprehensive PFAT as an intervention, prospectively, facility-wide for 1 year by RNs using a pre-post-test design. A 29.4% reduction in the fall rate (z=3.89; p <0.001), 27.6% decline in total falls experienced by all fallers (p<0.001) and a 34.0% decline for recurrent fallers (p = 0.025) from pre-intervention to intervention year was observed when trained nurses categorized falls according to perceived causes. These declines are likely due to consistent and rigorous use by trained nursing staff, prompting their critical examination of each fall.Peer reviewe
Sicurezza e paura
No full textWorking Paper ; n.127/1999- Indice #3- Prefazione #5- 'Abitare insieme': un progetto associativo per una città migliore (A. Imeroni) #6- Introduzione #7- Parte I. La percezione del rischio criminalità (R. Miceli, R. Rosato) #9- Parte II. Bambini, città, paure (G. Giardiello) #37- Parte III. Le paure degli anziani (P. Chiambretto, P. Parra Saiani) #6
Current Approaches to Post-fall Assessment in Nursing Homes
No full textFalls in nursing homes occur among a large percentage of residents. Their onset necessitates a postfall assessment (PFA) be performed by clinical staff to determine likely etiology. The absence of an empirically validated comprehensive postfall assessment tool has led to considerable variability in the types of PFAs performed. The purpose of this study was to examine the types of PFA tools available, their content, and to compare this with national recommendations for fall assessment in geriatric practice.Peer reviewe
Improving the quality of geriatric nursing care: Enduring outcomes from the Geriatric Nursing Education Consortium
No full textThe nation's aging demographics, few nursing faculty with gero-expertise, and insufficient geriatric content in nursing programs has created a national imperative to increase the supply of nurses qualified to provide care for older adults. GNEC, the Geriatric Nursing Education Consortium, a collaborative program of the John A. Hartford Foundation, the American Association of Colleges of Nursing, and the NYU Nursing Hartford Institute for Geriatric Nursing was initiated to provide faculty with the necessary skills, knowledge, and competency to implement sustainable curricular innovations in care of older adults. This article describes the background, processes, and development of GNEC evidence-based curricular materials, and the dissemination of these materials through six, two and a half day national Faculty Development Institutes (FDIs). Eight hundred eight faculty, representing 418 schools of nursing, attended an FDI. A total of 479 individuals responded to an evaluation conducted by Baruch College that showed faculty feasibility to incorporate GNEC content into courses, confidence in teaching and incorporating content, and overall high rating of the GNEC materials. The impact of GNEC is discussed along with effects on faculty participants over two years. Administrative and faculty level recommendations to sustain and expand GNEC are highlighted.Peer reviewe
Bacterial Endophytes: Unexplored Sources Of Biotechnologically Relevant Molecules
No full textEndophytes are microorganisms which colonize the internal tissues of the plants without causing any harm. Generally, endophytes are described as presenting beneficial functions to the plant host, such as plant growth promoting activity and protection against pathogens. The interaction between endophytes and plants is so close, that the term holobiont has been proposed to define the plant and its microbiome, as if they formed a unique organism. In the last decades, endophytes have gained more attention since there is growing evidence of their capacity to influence the plant’s physiology and to produce bioactive compounds. For example, it has been suggested that endophytes could synthesize compounds similar to the ones produced by the plant host, and modulate the production of plants secondary metabolites. In this context, endophytes appear as a powerful tool. On one hand, the exploration of endophytes allows to deepen our knowledge on the plant-microbiome interaction; on the other hand, the better comprehension of the holobiont can lead to a biotechnological application of endophytes.
Thus, we decided to explore bacterial endophytes from different plants, to better comprehend the structure of their communities, to explore their phenotypic features, prospecting a possible biotechnological application.
In this work, we have analyzed bacterial endophytes from medicinal plants tissues and seeds, and hyperaccumulator plants.
Bacterial communities associated to the medicinal plants Echinacea purpurea and E. angustifolia were already described in our laboratory and showed very specific communities in association to different tissues of the plants (stem/leaves, roots) and rhizosphere. Then, we decided to furtherly explore such communities, mainly focusing on the possible forces that could determine the presence of different communities in different districts of the plants. The performed analysis indicated that bacterial strains themselves could be implied in determining the structure of their own community by means of antimicrobial production, which in turn determine the colonization by adaptive phenotypes.
Endophytes exhibiting intriguing phenotypes, such as the inhibition of human opportunistic pathogens, were furtherly analyzed, by determining their genome sequences. The analysis of such sequences showed that the endophytic strains harbor many gene cluster which might be implied in inhibitory activities, confirming that endophytic bacterial strains are a promising field to investigate.
Endophytic bacterial strains were also analyzed within E. purpurea seeds. In this case, endophytes were observed within the plant’s seeds, extracted, taxonomically and phenotypically characterized.
More recently, we decided to explore endophytes which live in association with Phragmites australis plants, which are largely used in phytodepuration constructed wetlands. This part of the work was possible thanks to the collaboration with G.I.D.A. S.p.A., Gestione Impianti Depurazione Acque. The characterization of such endophytes has shown that they are able to grow in presence of critical elements for wastewater treatment, suggesting their possible application to obtain an enhancement of phytodepuration efficiency.
Overall, the analyses performed in this work increased our knowledge on bacterial endophytes from different sources, their communities structure, and interaction with the host. As a consequence, it represents the starting point to a possible biotechnological application of endophytes, in order to address issues, such as antibiotic resistance and environmental cleanup.Gli endofiti sono microrganismi che colonizzano i tessuti interni delle piante senza causare nessun danno. Generalmente, gli endofiti sono in grado di compiere funzioni come la promozione della crescita della pianta e la protezione contro patogeni. Il termine olobionte indica l’insieme costituito dalla pianta e dal suo microbiota, come se questi costituissero un unico grande organismo. Nelle ultime decadi, gli endofiti sono stati sempre più studiati, poiché è diventata sempre più evidente la loro capacità di influenzare la fisiologia della pianta e la produzione di molecole bioattive. Per esempio, è stato proposto che gli endofiti possono sintetizzare composti simili a quelli sintetizzati dalla pianta ospite e che possono modulare la produzione dei metaboliti secondari della pianta. In questo contesto, gli endofiti appaiono come strumenti di grande potenziale in campo biotecnologico.
Per questi motivi, abbiamo deciso di analizzare batteri endofiti da piante diverse, allo scopo di capire meglio la struttura delle loro comunità e di esplorare le loro caratteristiche fenotipiche, prospettando così una possibile applicazione in campo biotecnologico.
In questo lavoro, sono state analizzati batteri endofiti da piante medicinali, da semi di piante medicinali e da piante iperaccumulatrici di sostanze tossiche.
Recentemente, comunità batteriche associate alle piante medicinali Echinacea purpurea and E. angustifolia sono state analizzate nel nostro laboratorio e hanno mostrato una struttura e composizione molto specifica nei vari tessuti delle piante (foglie/stelo, radici) e nella rizosfera. Successivamente, abbiamo deciso di studiare in modo più approfondito tali comunità, concentrandoci soprattutto nei fattori che potrebbero determinare la presenza di comunità così specifiche in diversi compartimenti delle piante. Le analisi effettuate hanno mostrato che le comunità batteriche stesse potrebbero prendere parte nella strutturazione delle proprie comunità, attraverso la produzione di molecule antimicrobiche, che determinano a loro volta la colonizzazione da parte di ceppi resistenti.
Inoltre, alcuni ceppi batterici estratti da Echinacea purpurea e E. angustifolia sono stati ulteriormente analizzati dal punto di vista genetico, attraverso il sequenziamento dei loro genomi. Lo studio delle sequenze ha mostrato che i ceppi endofiti presentano diversi cluster genici presumibilmente coinvolti in attività antibiotica, confermando che tali ceppi potrebbero trovare un’applicazione in campo biotecnologico.
Ceppi batterici endofiti sono stati analizzati anche all’interno di semi di E. purpurea. In questo caso, oltre ad osservare la presenza di endofiti all’interno dei semi, endofiti batterici sono stati estratti dai semi e caratterizzati dal punto di vista tassonomico e fenotipico.
Recentemente, la nostra analisi degli endofiti si è estesa verso le piante iperaccumulatrici. Sono stati analizzati batteri endofiti in associazione alle piante di Phragmites australis, largamente utilizzate in impianti di fitodepurazione. Questa parte del lavoro è stata possibile grazie alla collaborazione con G.I.D.A. S.p.A, Gestione Impianti Depurazione Acque. La caratterizzazione di tali endofiti ha evidenziato la loro capacità di crescita in presenza di elementi, quali ferro, boro e selenio, che sono critici nel processo di depurazione delle acque. Queste evidenze rendono possibile ipotizzare l’applicazione di tali ceppi per un incremento dell’efficienza depurativa.
In conclusione, le analisi effettuate in questo lavoro di tesi hanno permesso di appronfondire le nostre conoscenze riguardo batteri endofiti provenienti da diverse fonti. Questo lavoro rappresenta, inoltre, il punto d’inizio per un possibile utilizzo di tali batteri in campo biotecnologico, al fine di rispondere a precise richieste, quali la resistenza agli antibiotici e la necessità di diminuire l’inquinamento ambientale
Dynamic thermal rating for overhead lines: Self-adaptive protection device
No full textThe increase in the consumption of electricity, the stringent environmental restrictions and the need to keep costs, make ever more meaningful the need for a flexible operation of existing overhead lines. This paper studies the possibility to use a dynamic thermal rating for overhead line starting from the analysis of the mathematical model and the ability of the latter to reflect the temperature of an overhead conductor in different ambient condition; then it simulates the thermal behaviour of a conductor both in steady state and dynamic one. Finally the paper shows a method for a self-adaptive thermal protection syste
A Stepwise Approach to a Comprehensive Post-Fall Assessment
No full textPost-fall assessment is an essential component of any fall prevention intervention. Typically, clinical practice recommendations for fall assessment are left to the discretion of each practitioner and miss many of the associated symptoms, situational contexts and pertinent elements required to reveal likely underlying determinants of a fall event. In order to elicit a comprehensive evaluation of a recent fall, a 5-step organizational approach is presented which allows for the consistent gathering of key information needed to determine possible underlying fall etiology while also addressing the patient’s perception of their fall. Several cases will be used to illustrate this comprehensive approach to fall assessment.Peer reviewe
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