121,914 research outputs found
Pre-operative Waterlow score and outcomes after kidney transplantation
No full textBACKGROUND: Waterlow scoring was introduced in the 1980s as a nursing tool to risk stratify for development of decubitus ulcers (pressure sores) and is commonly used in UK hospitals. Recent interest has focussed on its value as a pre-op surrogate marker for adverse surgical outcomes, but utility after kidney transplantation has never been explored. METHODS: In this single-centre observational study, data was extracted from hospital informatics systems for all kidney allograft recipients transplanted between 1(st) January 2007 and 30(th) June 2020. Waterlow scores were categorised as per national standards; 0–9 (low risk), 10–14 (at risk), 15–19 (high risk) and ≥ 20 (very high risk). Multiple imputation was used to replace missing data with substituted values. Primary outcomes of interest were post-operative length of stay, emergency re-admission within 90-days and mortality analysed by linear, logistic or Cox regression models respectively. RESULTS: Data was available for 2,041 kidney transplant patients, with baseline demographics significantly different across Waterlow categories. As a continuous variable, the median Waterlow score across the study cohort was 10 (interquartile range 8–13). As a categorical variable, Waterlow scores pre-operatively were classified as low risk (n = 557), at risk (n = 543), high risk (n = 120), very high risk (n = 27) and a large proportion of missing data (n = 794). Median length of stay in days varied significantly with pre-op Waterlow category scores, progressively getting longer with increasing severity of Waterlow category. However, no difference was observed in risk for emergency readmission within 90-days of surgery with severity of Waterlow category. Patients with ‘very high risk’ Waterlow scores had increased risk for mortality at 41.9% versus high risk (23.7%), at risk (17.4%) and low risk (13.4%). In adjusted analyses, ‘very high risk’ Waterlow group (as a categorical variable) or Waterlow score (as a continuous variable) had an independent association with increase length of stay after transplant surgery only. No association was observed between any Waterlow risk group/score with emergency 90-day readmission rates or post-transplant mortality after adjustment. CONCLUSIONS: Pre-operative Waterlow scoring is a poor surrogate marker to identify kidney transplant patients at risk of emergency readmission or death and should not be utilised outside its intended use. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-022-02902-8
Experiences and perceptions using the Waterlow pressure ulcer risk assessment tool: a community care perspective
No full textIntroduction The pressure ulcer risk assessment tool plays a pivotal role guiding a patient’s care pathway and quality of care [1]. Especially when considering, clinicians’ actions not only impact patient treatment, they profoundly influence patterns of care and allocation of resources [2]. Therefore, assessment tools need to produce the same or similar results i.e. aresensitivity accurate when different clinicians assess the same patient [3] and direct preventative and management resources appropriately. To meet the ever more complex clinical needs of patients, and the challenge of the zero pressure ulcer agenda [4], evaluation of the Trusts clinical, assessment, prevention and management strategies was undertaken. Using a qualitative human-factor focused approach, clinical practices associated with the Waterlow Pressure Ulcer Risk Assessment Tool [5] were explored.Method A purpose-designed questionnaire, hosted using an online survey administrator, was developed specifically for the evaluation. Experiences of Using the Waterlow Pressure Ulcer Risk Assessment Tool Questionnaire (EUWT-Q), comprised nine open and closed questions and invited free expression. Questions aimed to capture experiences and perceptions of clinical practice surrounding Waterlow use. A panel of Expert Healthcare Professionals employed within the Trust reviewed and piloted the EUWT-Q. A purposive sample of 79 community care clinicians employed across the Trust in varying roles, and users of Waterlow within daily clinical practice, were contacted to take part in the evaluation. Data analysis adhered principles of a six-phase recursive thematic analysis [6] with the themes developed strongly linked to language, concepts, and relationships of meaning.Results Of the 79 clinicians contacted, 59 completed the EUWT-Q (response rate 74%). Predominantly, respondents were Community Nurses 64% (n=38) and experienced using Waterlow, with 42% (n=25) having more than 15-years’ experience.Two interrelated key themes emerged: Decision-Making Confidence and Defensively Nursing. Which, to a large extent, overlap and when considered together, comprehensively reflect experiences and perceptions of clinical practice surrounding Waterlow use.Decision-Making ConfidenceSeemingly, clinician's feel little confidence that Waterlow adequately supports clinical decision-making. For some Waterlow was considered useful and “…positive for identifying the potential risk†(CN0560). However, sensitivity accuracy was criticised, and a stronger picture surrounding completion difficulties emerged. Confusion surrounding interpretation of ‘grey area’s’ [8] or ambiguously interpretable risk factors were widely perceived as problematic. As a result, clinicians had lost decision-making confidence and sought peer support surrounding interpretation of risk factors.Clinicians also perceived the use of Waterlow to have evolved into one of constrained dictation, rather than part of an assessment process. Particularly surrounding, perceptions of a propensity for Waterlow, to over predict risk and trigger inappropriate or unnecessary equipment prescription. In turn, this impacted and influenced the socio-political working culture, eroding clinical decision-making confidence, and creating barriers surrounding the freedom/autonomy to act in accordance with one’s professional knowledgebase. Thus, established patterns of defensive nursing.Defensively NursingClinician’s narratives exposed incongruence between professional philosophy’s and actions. This revealed frustration, with the development of diminished confidence and professional disempowerment surrounding use of Waterlow. A fearful, consciously led, move toward defensive, care strategies, where, clinicians focus on the score rather than the needs of the patient (NS1112) rather than, foremost, in the interest of the patient, had seemingly developed as a self-protective response to Trust imposed ramifications, should patients develop pressure ulcers. As such, a perception of pressure to prescribe pressure relieving equipment had developed. Therefore, more, and higher-grade equipment was being prescribed even when contradicting clinical judgement. Clinicians were aware their clinical strategies were counterintuitive and directly linked to defensive nursing. As such, there were outright requests to please replace it as soon as possible (NS1558).It seems counter-intuitive that a defensive nursing strategy built on risk overestimation and over prescription of pressure relieving equipment has not resulted in the elimination of avoidable pressure ulcers. The solution to eradicating avoidable pressure ulcers is, therefore, more complex than one of more pressure preventative equipment. From an economic perspective, a propensity for risk over-prediction with some patients is a serious and expensive limitation. Particularly considering the working practices that have developed. Conclusion Findings indicate that clinicians do perceive the use of Waterlow as assisting identification of risk factors. However, the use of Waterlow has seemingly influenced costly working practices. Costly in terms of diminishing workforce confidence, and costly in terms of the funds potentially being allocated to forms of pressure ulcer management that are not necessarily appropriate at the time of prescription. As such, the findings are strongly relevant to clinical practice, highlighting there is potential for cost savings through improved allocation of resources and providing evidence to support quality improvement innovation.</p
Experiences and perceptions using the Waterlow pressure ulcer risk assessment tool: a community care perspective
No full textIntroduction The pressure ulcer risk assessment tool plays a pivotal role guiding a patient’s care pathway and quality of care [1]. Especially when considering, clinicians’ actions not only impact patient treatment, they profoundly influence patterns of care and allocation of resources [2]. Therefore, assessment tools need to produce the same or similar results i.e. aresensitivity accurate when different clinicians assess the same patient [3] and direct preventative and management resources appropriately. To meet the ever more complex clinical needs of patients, and the challenge of the zero pressure ulcer agenda [4], evaluation of the Trusts clinical, assessment, prevention and management strategies was undertaken. Using a qualitative human-factor focused approach, clinical practices associated with the Waterlow Pressure Ulcer Risk Assessment Tool [5] were explored.Method A purpose-designed questionnaire, hosted using an online survey administrator, was developed specifically for the evaluation. Experiences of Using the Waterlow Pressure Ulcer Risk Assessment Tool Questionnaire (EUWT-Q), comprised nine open and closed questions and invited free expression. Questions aimed to capture experiences and perceptions of clinical practice surrounding Waterlow use. A panel of Expert Healthcare Professionals employed within the Trust reviewed and piloted the EUWT-Q. A purposive sample of 79 community care clinicians employed across the Trust in varying roles, and users of Waterlow within daily clinical practice, were contacted to take part in the evaluation. Data analysis adhered principles of a six-phase recursive thematic analysis [6] with the themes developed strongly linked to language, concepts, and relationships of meaning.Results Of the 79 clinicians contacted, 59 completed the EUWT-Q (response rate 74%). Predominantly, respondents were Community Nurses 64% (n=38) and experienced using Waterlow, with 42% (n=25) having more than 15-years’ experience.Two interrelated key themes emerged: Decision-Making Confidence and Defensively Nursing. Which, to a large extent, overlap and when considered together, comprehensively reflect experiences and perceptions of clinical practice surrounding Waterlow use.Decision-Making ConfidenceSeemingly, clinician's feel little confidence that Waterlow adequately supports clinical decision-making. For some Waterlow was considered useful and “…positive for identifying the potential risk†(CN0560). However, sensitivity accuracy was criticised, and a stronger picture surrounding completion difficulties emerged. Confusion surrounding interpretation of ‘grey area’s’ [8] or ambiguously interpretable risk factors were widely perceived as problematic. As a result, clinicians had lost decision-making confidence and sought peer support surrounding interpretation of risk factors.Clinicians also perceived the use of Waterlow to have evolved into one of constrained dictation, rather than part of an assessment process. Particularly surrounding, perceptions of a propensity for Waterlow, to over predict risk and trigger inappropriate or unnecessary equipment prescription. In turn, this impacted and influenced the socio-political working culture, eroding clinical decision-making confidence, and creating barriers surrounding the freedom/autonomy to act in accordance with one’s professional knowledgebase. Thus, established patterns of defensive nursing.Defensively NursingClinician’s narratives exposed incongruence between professional philosophy’s and actions. This revealed frustration, with the development of diminished confidence and professional disempowerment surrounding use of Waterlow. A fearful, consciously led, move toward defensive, care strategies, where, clinicians focus on the score rather than the needs of the patient (NS1112) rather than, foremost, in the interest of the patient, had seemingly developed as a self-protective response to Trust imposed ramifications, should patients develop pressure ulcers. As such, a perception of pressure to prescribe pressure relieving equipment had developed. Therefore, more, and higher-grade equipment was being prescribed even when contradicting clinical judgement. Clinicians were aware their clinical strategies were counterintuitive and directly linked to defensive nursing. As such, there were outright requests to please replace it as soon as possible (NS1558).It seems counter-intuitive that a defensive nursing strategy built on risk overestimation and over prescription of pressure relieving equipment has not resulted in the elimination of avoidable pressure ulcers. The solution to eradicating avoidable pressure ulcers is, therefore, more complex than one of more pressure preventative equipment. From an economic perspective, a propensity for risk over-prediction with some patients is a serious and expensive limitation. Particularly considering the working practices that have developed. Conclusion Findings indicate that clinicians do perceive the use of Waterlow as assisting identification of risk factors. However, the use of Waterlow has seemingly influenced costly working practices. Costly in terms of diminishing workforce confidence, and costly in terms of the funds potentially being allocated to forms of pressure ulcer management that are not necessarily appropriate at the time of prescription. As such, the findings are strongly relevant to clinical practice, highlighting there is potential for cost savings through improved allocation of resources and providing evidence to support quality improvement innovation.</p
A Multi-Language Comparison of Influences on Author Verification using Character N-Grams
No full textWe create a new multi-language corpus for author verification based on Wikipedia talkpages, and evaluate the influence that differences in topic and time have on character n-gram author profiles. Topic alignment between two texts is found to increase author verification precision, and an authors writing style is found to change over time, but not more significantly after 3 years than after 1 year.Information ArchitectureWISElectrical Engineering, Mathematics and Computer Scienc
Appropriate Similarity Measures for Author Cocitation Analysis
No full textWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
The vanishing author in computer-generated works: a critical analysis of recent Australian case law
No full textAbstract
The use of software is ubiquitous in the creation of many copyright works, yet the requirement in copyright law that every work have a human author who engages in independent intellectual effort means that its use may prevent copyright subsistence. Several recent Australian cases have refocused attention on authorship as an essential criterion of copyright subsistence, and these cases suggest that much computer-produced output may be authorless and thus lack copyright protection. This article, the first in a two-part series, analyses how each case deals with the question of authorship of computer-produced works and why the use of software diminishes copyright protection for a significant number of computer-generated works. The article critiques the application of conventional notions of human authorship developed in the pre-computer age to modern productions and suggests alternative approaches to authorship that satisfy both the major objectives of copyright policy and the need to adapt to the computer age. The article argues that, without a broader judicial approach to authorship of computer-generated works, Parliament must remedy the lacuna in protection for these ‘authorless’ works. Possible solutions for reform are suggested. In a forthcoming article, the author comprehensively examines those reform proposals
Diffusive author(s), cohesive author: Analysis of S/N (1994)
No full textThis study indicates the ways in which various aspects of the author(s) are brought forth in Dumb type’s performance art, the S/N production. Previous research has suggested a non-hierarchical organization of Dumb type and the absence of a “privileged author” in Dumb type’s collaborative work, S/N. However, the results that I have investigated from member’s interviews on the creative process of S/N along with my analysis of the recorded images of S/N, indicate a different aspect of the author(s). First, S/N was created through, so to speak, the collective ideas of the members of Dumb type. Further, S/N has at least nine quotations from previous performances, installations, and printed writings, besides the work-in-progress technique. Explicating one of the “author functions” as given by Michel Foucault, each text has plural subjects of the author. However, it has been revealed from members’ interviews that Teiji Furuhashi had a decision-making role in selecting the members’ ideas within the performance. Since then, S/N has had plural subjects of creation; however, Furuhashi is one of the subjects of creation along with the “privileged author.” S/N has plural authors (diffusive authors) yet at the same time, it has a “privileged author,” Teiji Furuhashi (cohesive author)
A study of Neanderthal physiology, engetics and behaviour
No full textThe general context of Neanderthal existence in Europe and Southwest Asia is assessed from a physiological perspective, based on studies of living populations experiencing certain roughly analogous circumstances. Various aspects of the fossil, archaeological, and paleoenvironmental records relevant to the discussion of energy balance among the Neanderthals were investigated. Within living populations exposed to cold climate, subsisting on energy deficient diets, or participating in strenuous exercise regimes, various metabolic and physiological responses are evident. These relate to an attempt to maintain energy balance under such stresses, and are mediated by the action of thyroid hormones. It is proposed that the Neanderthals, who endured similar conditions, must have adapted to a low level of circulating active thyroid hormones in the face of an energy imbalance (negative) and sacrificed linear growth (of the legs/limbs primarily) as an energy sparing mechanism, so that other more essential body functions could be maintained to enable survival. Given that the Neanderthal physique was skeletally robust and highly muscled (and that a significant degree and frequency of trauma is evident) it logical that they were engaging in very specific and stressful activity patterns. The Neanderthal physique would have prohibited certain activities but facilitated others. It is clear that modem athletes who share these attributes take part in power and speed events, involving intermittent bursts of high intensity exercise, rather than more stamina orientated ones. This information is used, in conjunction with archaeological and paleoenvironmental evidence, to develop a theory of the daily subsistence practices of the Neanderthals, involving the ambushing of game in a closed environment. Such start-stop activities in a cold environment would have had a bearing on metabolism and energy balance, but also exerted pressure on thermoregulatory mechanisms. In light of this a new theory is developed to explain the evolution of the Neanderthals' exceptional cranial capacity and morphology. The elongated and unflexed basicranium is proposed to have arisen in order to accommodate an expanded cavernous sinus at the base of the brain. This would have provided a mechanism for regulating brain temperature under oscillating periods of heavy physical exertion and rest in a cold environment. The points outlined here are made with reference to previously suggested notions of ecogeographic patterning of body morphology and differential mobility at the time of the 'transition'. Finally, the aspects of Neanderthal existence discussed are placed in a broad ecological and evolutionary context alongside the contemporaneous Early Anatomically Modem Humans (EAMH)
Dissipative Range Scaling of Higher Order Structure Functions for Velocity and Passive Scalars
No full textDifferently to Kolmogorov's second similarity hypothesis, we find that the 2n-th order velocity and scalar structure functions scale with n-th order moment of the energy dissipation and the scalar dissipation, respectively. The origins of this scaling are analyzed by the transport equations of the fourth order velocity and scalar increment moments and by direct numerical simulations
Fast implementation of iterative adaptive approach for wideband unambiguous radar detection
No full textAccepted author manuscriptMicrowave Sensing, Signals & System
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