Risk factors for heel pressure injury in cardiovascular intensive care unit patients.

This study analyzed the risk factors for heel pressure injury in cardiovascular intensive care unit patients with the aim of laying the groundwork for preventive nursing interventions. We conducted a retrospective case-control study of 92 patients who were admitted to the cardiovascular surgical or medical intensive care unit of a university hospital in South Korea between January and December 2017. Of these patients, 31 and 61 were included to the heel pressure injury group and the non-heel pressure injury group, respectively. Data on their demographic, disease-related, and intensive care unit treatment characteristics, as well as the degree of pressure injury, were collected from the hospital's electronic medical records using a standardized form. Cardiac surgery (P < .001), operation time (P = .001), use of a mechanical ventilator (P < .001), use of vasoconstrictors (P < .001), use of sedative drugs (P < .001), and extracorporeal membrane oxygenation treatment (P < .001) were identified as significant risk factors for heel pressure injury. A total of 22 patients (71%) from the heel pressure injury group developed deep tissue injury, and 16 patients (51.6%) who received extracorporeal membrane oxygenation treatment developed heel pressure injury.

Long-term and residual settlement behaviour of a multi-staged municipal solid waste landfill, Republic of Korea.

In this study, characteristics of the long-term landfill settlement are analysed and the starting date of residual settlement is deduced using the data of the landfill 1 of the Gimpo Metropolitan Landfill (GML) measured for 27 years. The landfill 1 is a multi-staged municipal solid waste landfill where dykes are constructed after landfilling for subsequent waste fills. The landfilling began in 1992 and finished in 2000, and the waste settlement measurement continued throughout this period. The older waste of the lower lift shows higher biodegradation and larger settlement than the waste of the upper lift, which acts as vertical load. Large settlement occurred in the lower lifts due to the collapse of waste voids caused by the overburden load of the upper lifts after biodegradation of waste in the lower lifts during long-term landfilling. In the conventional landfills, that is, mono-layer landfills, the time-dependent settlement generally occurs after the stress-dependent settlement. But, most of the time, this landfill showed mainly the time-dependent settlement. The duration, at which the biodegradation of organic matters is reduced and the residual settlement begins, was 8.8 years in average and the date range was from 7.6 to 11.7 years considering each disposed block in landfill 1. This date is obtained by calculating from the mid-point time of the landfilling duration.

Development and evaluation of a multimodality simulation disaster education and training program for hospital nurses.

AIM: To develop a multimodality simulation program for hospital nurses to enhance their disaster competency and evaluate the effect of the program. METHODS: The program implementation started in October 2016 and ended in December 2016. It was developed using the ADDIE model (analysis, design, development, implementation, and evaluation). Evaluation consisted of formative assessment and summative assessment. Formative assessment was performed during triage, crisis management, and problem-solving simulation programs through direct feedback and debriefing from the teacher. Summative assessment was performed using the Kirkpatrick curriculum evaluation framework. RESULTS: Needs assessment using the modified Delphi survey resulted in these competencies for hospital disaster nursing: triage, incident command, surge capacity, life-saving procedures, and special situations. Each competency was matched with the appropriate simulation modalities. A total of 40 emergency nurses participated in the study program. The evaluation of the program resulted in improvement in perception, crisis management, problem solving, and technical skills in disaster nursing. CONCLUSION: Multimodality simulation training program was developed to enhance the competency of hospital nurses in disaster response. All participants improved their disaster response competencies significantly. The program that was developed in this study could be used as a fundamental tool in future research in disaster curriculum development.

International Nursing: Needs Assessment for Training in Disaster Preparedness for Hospital Nurses: A Modified Delphi Study.

Despite high awareness of the need, opportunities for nurses to gain disaster experience or training are limited. In Korea, most disaster training is done in an undergraduate curriculum where there is very limited practice, and the educational topics are mostly focused on the field aspect of disaster events. The purpose of this study was to determine the need for such training for hospital nurses and to determine appropriate and relevant components of the training contents. A qualitative survey approach using the modified Delphi method was used to collect and analyze the data. The surveys were conducted in 3 rounds. After the results were analyzed from the third-round survey, the authors finalized the contents for a training program to prepare nurses for their roles during disasters. Through a structured needs analysis using a modified Delphi survey, the framework for the content development of disaster training curriculum for hospital nurses was developed.

Comparison of waste settlement characteristics for two landfills disposed in long sequential periods.

Changes in waste management policy affect the settlement characteristics of waste landfills in which the waste disposal is operated for decades. In this study, the waste settlements were calculated by using the data measured in two multi-staged landfills for 27 years. The relationship between the changes in waste management policies and settlement characteristics is analyzed. Sequentially launched waste management policies reduced the organic matters in municipal solid waste (MSW) of the landfill. This change in turn influenced the engineering properties of landfill waste, e.g. water content, unit weight, and initial void ratio, etc. Due to the reduction of food waste in landfills, the water content decreased and the unit weight increased. The initial void ratio declined by the decrease of water content and the increase of unit weight. The annual primary and secondary compression indices, Cc and Cα, of each lift also increased/decreased due to the change in waste composition. The Cc of Phase #1 increased from an average of 0.34 to an average of 0.51 because the percentage of coal ash in MSW drastically decreased and the percentage of food, paper, and plastic, which are highly compressible, increased. On the other hand, the Cc of Phase #2 declined from an average of 0.15 to an average of 0.025 due to the decrease of the waste compressibility from the reduction of organic matters. The Cα of Phase #1 and #2 decreased by the reduction of organic matter and moisture which are needed for biodegradation of wastes in the landfill.

Development and Effects of a Transition Nursing Program for Patients and Family Caregivers at a Neurological ICU in Korea.

The purpose of this study was to develop a transition nursing program for patients and family caregivers in neurological intensive care units (ICUs) and to evaluate the effects of the program. A literature review, focus group interviews, analysis of medical records, confirmation of validity, and clinical applicability were used to develop the program, which was tested using a pre- and post-test quasi-experimental design. Participants were recruited in 2011. The experimental group (46 patients and their family caregivers) received the developed program before transferring from the neurological ICU to a ward, whereas the control group (48 patients and their family caregivers) received routine care. The results showed that patients and family caregivers in the experimental group had significantly higher transition readiness and satisfaction with transition nursing and lower transition anxiety and transition stress, and family caregivers in the experimental group had a significantly lower burden of caregiving.

Overexpression of MMP-9 and HIF-1α in Breast Cancer Cells under Hypoxic Conditions.

PURPOSE: Hypoxia, which is a loss of oxygen in tissues, is a common condition in solid tumors due to the tumor outgrowing existing vasculature. Under hypoxic conditions, hypoxia-inducible factor (HIF)-1α rapidly accumulates and transactivates hundreds of genes, such as matrix metalloproteinases (MMPs). MMPs contribute to invasion and metastasis of tumor cells by degrading the surrounding basement membrane and extracellular matrix barriers, which enables the easy migration and spread of cancer cells. We examined whether hypoxia increases tumor cell invasion, and whether increased invasiveness was due to HIF-1α and MMP-9 expression. METHODS: Transwell invasion assays were performed to demonstrate whether hypoxia enhance tumor invasion by use of MDA-MB-231 breast cancer cells. An immunofluorescence assay was used to demonstrate expression of HIF-1α and MMP-9 under hypoxic conditions. Luciferase and ChiP assays were performed to demonstrate that MMP-9 promoter activity was regulated by HIF-1α. RESULTS: HIF-1α was stabilized under hypoxic conditions and stimulated MMP-9 expression, which affected the tumor invasiveness of breast cancer cells. HIF-1α transactivated the MMP-9 promoter by forming a transcriptional unit with p300, thus increasing expression of MMP-9 transcripts. Zymography indicated that MMP-9 had more gelatinase activity under hypoxic conditions than normoxic conditions. Furthermore, the small GTPase Ras was also activated in response to hypoxia, which then aids stabilization of HIF-1α, and in turn upregulates MMP-9 expression. We also demonstrate that MMP-9 is upregulated concurrently with HIF-1α in tumor tissues from patients with breast cancer. CONCLUSION: These results suggest that HIF-1α promotes cell invasion through a MMP-9-dependent mechanism and that future antitumor agents could be used to target HIF-1α and MMP-9.