| 1. |
- Kattge, Jens, et al.
(författare)
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TRY plant trait database - enhanced coverage and open access
- 2020
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Ingår i: Global Change Biology. - : Wiley-Blackwell. - 1354-1013 .- 1365-2486. ; 26:1, s. 119-188
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Tidskriftsartikel (refereegranskat)abstract
- Plant traits-the morphological, anatomical, physiological, biochemical and phenological characteristics of plants-determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait-based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits-almost complete coverage for 'plant growth form'. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait-environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives.
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| 2. |
- Beeckman, Dimitri, et al.
(författare)
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EPUAP classification system for pressure ulcers : european reliability study
- 2007
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Ingår i: Journal of Advanced Nursing. - 0309-2402 .- 1365-2648. - 0309-2402 ; 60:6, s. 682-691
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper is a report of a study of the inter-observer reliability of the European Pressure Ulcer Advisory Panel pressure ulcer classification system and of the differential diagnosis between moisture lesions and pressure ulcers. Background. Pressure ulcer classification is a valuable tool to provide a common description of ulcer severity for the purposes of clinical practice, audit and research. Despite everyday use of the European Pressure Ulcer Advisory Panel system, its reliability has been evaluated in only a limited number of studies. Methods. A survey was carried out between September 2005 and February 2006 with a convenience sample of 1452 nurses from five European countries. Respondents classified 20 validated photographs as normal skin, blanchable erythema, pressure ulcers (four grades), moisture lesion or combined lesion. The nurses were familiar with the use of the European Pressure Ulcer Advisory Panel classification scale. Results. Pressure ulcers were often classified erroneously (kappa = 0.33) and only a minority of nurses reached a substantial level of agreement. Grade 3 lesions were regularly classified as grade 2. Non-blanchable erythema was frequently assessed incorrectly as blanchable erythema. Furthermore, the differential diagnosis between moisture lesions and pressure ulcers appeared to be complicated. Conclusion. Inter-observer reliability of the European Pressure Ulcer Advisory Panel classification system was low. Evaluation thus needs to focus on both the clarity and complexity of the system. Definitions and unambiguous descriptions of pressure ulcer grades and the distinction between moisture lesions will probably enhance clarity. To simplify the current classification system, a reduction in the number of grades is suggested.
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| 3. |
- Fobelets, M., et al.
(författare)
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Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section
- 2019
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Ingår i: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 126:8, s. 1043-1051
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care. Design: Economic analysis alongside the cluster-randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care). Setting: Fifteen maternity units in three European countries – Germany (five), Ireland (five), and Italy (five) – with relatively low VBAC rates. Population: Pregnant women with a history of one previous lower-segment caesarean section; sites were randomised (3:2) to intervention or control. Methods: A cost–utility analysis from both societal and health-services perspectives, using a decision tree. Main outcome measures: Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost–utility ratios were calculated per country. Results: The mean difference in costs per quality-adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95%CI €258–268) and 0.008QALYs (95%CI 0.008–0.009QALYs) for Germany, €456 (95%CI €448–464) and 0.052QALYs (95%CI 0.051–0.053QALYs) for Ireland, and €1174 (95%CI €1170–1178) and 0.006QALYs (95%CI 0.005–0.007 QALYs) for Italy. The incremental cost–utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost-effective for Germany, 92% for Ireland, and 15% for Italy. Conclusion: The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany. Tweetable abstract: The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland. © 2019 Royal College of Obstetricians and Gynaecologists
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| 4. |
- Fobelets, M., et al.
(författare)
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Preference of birth mode and postnatal health related quality of life after one previous caesarean section in three European countries
- 2019
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 79
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Women who have had a caesarean section may have a preference for birth mode during their subsequent pregnancy, either ‘vaginal birth after caesarean’ (VBAC) or ‘elective repeat caesarean section’ (ERCS). A mismatch between the preferred and actual birth mode may result in an impaired postnatal Health Related Quality of Life (HRQoL). This study examined the associations between antenatal birth mode preferences, the actual birth mode and postnatal HRQoL in women with one previous caesarean section in three European countries. Design: Prospective longitudinal survey, as a part of a cluster randomised trial (OptiBIRTH) Setting: Fifteen maternity units in three European countries: Germany (5), Ireland (5) and Italy (5). Participants: Women (≥ aged 18 years) living in Germany, Ireland and Italy with one previous caesarean section. The sample consisted of 862 women with complete antenatal and postpartum data. Measurements: Women's preference for birth mode after one previous caesarean section was assessed at inclusion to the trial, and HRQoL was assessed antenatally and at three months postpartum using the Short-Form Six-Dimension health survey. Based on women's preferences and actual birth mode six groups were determined: “match VBAC-VBAC” (preference for vaginal birth, actual mode of birth vaginal birth), “match ERCS-ERCS” (preference for caesarean section, actual mode of birth elective repeat caesarean section), “match ERCS-EMCS” (preference for caesarean section, actual mode of birth emergency repeat caesarean section), “mismatch VBAC-ERCS” (preference for vaginal birth, actual mode of birth elective repeat caesarean section), “mismatch VBAC-EMCS” (preference for vaginal birth, actual mode of birth emergency repeat caesarean section) and “no preference”. Associations between the preferred and actual birth mode were examined using univariate and multivariate analyses. Findings: Women with preference for vaginal birth but who gave birth by elective repeat caesarean section (mismatch VBAC-ERCS) had a lower postnatal HRQoL compared to women with a preference for vaginal birth who actually had a birth vaginally (match VBAC-VBAC, p = 0.02). Poor antenatal HRQoL scores (p < 0.01) and maternal readmission postpartum (p = 0.03) are cofounding factors for poorer postnatal HRQoL scores. Key conclusions: The results show that women with a preference for a vaginal birth who gave birth by an elective repeat caesarean section had a significantly lower HRQoL at three months postnatal. The long-term consequences and psychological health of women who do not achieve a vaginal birth after caesarean require further consideration and research. Implications for practice: Attention should be given to the long-term impact of a mismatch in preferred and actual mode on the psychological health of women. © 2019 Elsevier Ltd
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| 5. |
- Beeckman, D., et al.
(författare)
-
EPUAP classification system for pressure ulcers : European reliability study
- 2007
-
Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 60:6, s. 682-691
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper is a report of a study of the inter-observer reliability of the European Pressure Ulcer Advisory Panel pressure ulcer classification system and of the differential diagnosis between moisture lesions and pressure ulcers. BACKGROUND: Pressure ulcer classification is a valuable tool to provide a common description of ulcer severity for the purposes of clinical practice, audit and research. Despite everyday use of the European Pressure Ulcer Advisory Panel system, its reliability has been evaluated in only a limited number of studies. METHODS: A survey was carried out between September 2005 and February 2006 with a convenience sample of 1452 nurses from five European countries. Respondents classified 20 validated photographs as normal skin, blanchable erythema, pressure ulcers (four grades), moisture lesion or combined lesion. The nurses were familiar with the use of the European Pressure Ulcer Advisory Panel classification scale. RESULTS: Pressure ulcers were often classified erroneously (kappa = 0.33) and only a minority of nurses reached a substantial level of agreement. Grade 3 lesions were regularly classified as grade 2. Non-blanchable erythema was frequently assessed incorrectly as blanchable erythema. Furthermore, the differential diagnosis between moisture lesions and pressure ulcers appeared to be complicated. CONCLUSION: Inter-observer reliability of the European Pressure Ulcer Advisory Panel classification system was low. Evaluation thus needs to focus on both the clarity and complexity of the system. Definitions and unambiguous descriptions of pressure ulcer grades and the distinction between moisture lesions will probably enhance clarity. To simplify the current classification system, a reduction in the number of grades is suggested.
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| 6. |
- Beeckman, Dimitri, Visiting Professor, 1982-, et al.
(författare)
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Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers : a pragmatic non-commercial multicentre randomised open label parallel group medical device trial
- 2021
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Ingår i: British Journal of Dermatology. - : Blackwell Science Ltd.. - 0007-0963 .- 1365-2133. ; 185:1, s. 52-61
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Silicone adhesive multilayer foam dressings are used as adjuvant therapy to prevent hospital-acquired pressure ulcers (PUs).OBJECTIVES: Determine if silicone foam dressings in addition to standard prevention reduce PU incidence category 2 or worse compared to standard prevention alone.METHODS: Multicentre, randomised controlled, medical device trial conducted in eight Belgian hospitals. At risk adult patients were centrally randomised (n=1633) to study groups based on a 1:1:1 allocation: experimental group 1 (n=542) and 2 (n=545) - pooled as the treatment group - and the control group (n=546). Experimental groups received PU prevention according to hospital protocol, and a silicone foam dressing on these body sites. The control group received standard of care. The primary endpoint was the incidence of a new PU category 2 or worse at these body sites.RESULTS: In the intention-to-treat population (n=1605); 4.0% of patients developed PUs category 2 or worse in the treatment group and 6.3% in the control group (RR=0.64, 95% CI 0.41 to 0.99, P=0.04). Sacral PUs were observed in 2.8% and 4.8% of the patients in the treatment group and the control group, respectively (RR=0.59, 95% CI 0.35 to 0.98, P=0.04). Heel PUs occurred in 1.4% and 1.9% of patients in the treatment and control group respectively (RR=0.76, 95% CI 0.34 to 1.68, P=0.49).CONCLUSIONS: Silicone foam dressings reduce the incidence of PUs category 2 or worse in hospitalised at-risk patients when used in addition to standard of care. Results show a decrease for sacrum, but no statistical difference for heel/trochanter areas.
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| 7. |
- Boerjan, W., et al.
(författare)
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Superroot, a recessive mutation in Arabidopsis, confers auxin overproduction
- 1995
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Ingår i: The Plant Cell. - : JSTOR. - 1040-4651 .- 1532-298X. ; 7:9, s. 1405-1419
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Tidskriftsartikel (refereegranskat)abstract
- We have isolated seven allelic recessive Arabidopsis mutants, designated superroot (sur1-1 to sur1-7), displaying several abnormalities reminiscent of auxin effects. These characteristics include small and epinastic cotyledons, an elongated hypocotyl in which the connection between the stele and cortical and epidermal cells disintegrates, the development of excess adventitious and lateral roots, a reduced number of leaves, and the absence of an inflorescence. When germinated in the dark, sur1 mutants did not develop the apical hook characteristic of etiolated seedlings, We were able to phenocopy the Sur1(-) phenotype by supplying auxin to wild-type seedlings, to propagate sur7 explants on phytohormone-deficient medium, and to regenerate shoots from these explants by the addition of cytokinins alone to the culture medium. Analysis by gas chromatography coupled to mass spectrometry indicated increased levels of both free and conjugated indole-3-acetic acid. sur1 was crossed to the mutant axr2 and the altered-auxin response mutant ctr1. The phenotype of both double mutants was additive. The sur1 gene was mapped on chromosome 2 at 0.5 centimorgans from the gene encoding phytochrome B.
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| 8. |
- Cuni-Sanchez, Aida, et al.
(författare)
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High aboveground carbon stock of African tropical montane forests
- 2021
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 596:7873, s. 536-542
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Tidskriftsartikel (refereegranskat)abstract
- Tropical forests store 40–50per cent of terrestrial vegetation carbon. However, spatial variations in aboveground live tree biomass carbon (AGC) stocks remain poorly understood, in particular in tropical montane forests. Owing to climatic and soil changes with increasing elevation, AGC stocks are lower in tropical montane forests compared with lowland forests. Here we assemble and analyse a dataset of structurally intact old-growth forests (AfriMont) spanning 44 montane sites in 12 African countries. We find that montane sites in the AfriMont plot network have a mean AGC stock of 149.4megagrams of carbon per hectare (95% confidence interval 137.1–164.2), which is comparable to lowland forests in the African Tropical Rainforest Observation Network4 and about 70per cent and 32per cent higher than averages from plot networks in montane and lowland forests in the Neotropics, respectively. Notably, our results are two-thirds higher than the Intergovernmental Panel on Climate Change default values for these forests in Africa8. We find that the low stem density and high abundance of large trees of African lowland forests is mirrored in the montane forests sampled. This carbon store is endangered: we estimate that 0.8 million hectares of old-growth African montane forest have been lost since 2000. We provide country-specific montane forest AGC stock estimates modelled from our plot network to helpto guide forest conservation and reforestation interventions. Our findings highlight the need for conserving these biodiverse and carbon-rich ecosystems.
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| 9. |
- Daly, D., et al.
(författare)
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How much synthetic oxytocin is infused during labour? A review and analysis of regimens used in 12 countries
- 2020
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:7
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare synthetic oxytocin infusion regimens used during labour, calculate the International Units (IU) escalation rate and total amount of IU infused over eight hours. Design Observational study Setting Twelve countries, eleven European and South Africa. Sample National, regional or institutional-level regimens on oxytocin for induction and augmentation labour Methods Data on oxytocin IU dose, infusion fluid amount, start dose, escalation rate and maximum dose were collected. Values for each regimen were converted to IU in 1000ml diluent. One IU corresponded to 1.67 mu g for doses provided in grams/micrograms. IU hourly dose increase rates were based on escalation frequency. Cumulative doses and total IU amount infused were calculated by adding the dose administered for each previous hour. Main Outcome Measures Oxytocin IU dose infused Results Data were obtained on 21 regimens used in 12 countries. Details on the start dose, escalation interval, escalation rate and maximum dose infused were available from 16 regimens. Starting rates varied from 0.06 IU/hour to 0.90 IU/hour, and the maximum dose rate varied from 0.90 IU/hour to 3.60 IU/hour. The total amount of IU oxytocin infused, estimated over eight hours, ranged from 2.38 IU to 27.00 IU, a variation of 24.62 IU and an 11-fold difference. Conclusion Current variations in oxytocin regimens for induction and augmentation of labour are inexplicable. It is crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used. Estimating the total amount of oxytocin IU received by labouring women, alongside the institution's mode of birth and neonatal outcomes, may deepen our understanding and be the way forward to identifying the optimal infusion regimen.
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| 10. |
- De Meyer, D., et al.
(författare)
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PROTECT - Trial : A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance
- 2019
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Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 75:5, s. 1085-1098
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To study the effectiveness of tailored repositioning and a turning and repositioning system on: (1) nurses' compliance to repositioning frequencies; (2) body posture of patients after repositioning; (3) incidence of pressure ulcers and incontinence-associated dermatitis; (4) nurses' and patients' preferences, comfort and acceptability; and (5) budget impact.BACKGROUND: Patient-tailored systematic repositioning is key in pressure ulcer prevention. To date, a clinical decision-making tool is lacking and compliance to pressure ulcer prevention guidelines is low. Research concerning commercially available turning and repositioning systems is lacking.DESIGN: Multicentre, cluster, three-arm, randomised, controlled pragmatic trial.METHODS: Two hundred twenty-seven patients at risk of pressure ulcer development were recruited at 29 wards in 16 hospitals between February 2016 - December 2017. Wards were randomly assigned to two experimental groups and one control group.RESULTS: Nurses' compliance to repositioning frequencies increased significantly in the experimental groups when patients were cared for in bed (94.6% versus 69% and 84.9% versus 71.4%). Applying the turning and repositioning system was associated with significantly more correctly positioned patients (30-45° tilted side-lying position) (69.6% versus 34.6%). Few pressure ulcers and incontinence-associated dermatitis incidents occurred. Both patients and nurses were positive about the intervention. Higher labour costs related to repositioning in bed were found in the control group.CONCLUSION: This was the first study investigating the effect of tailored repositioning and the use of a repositioning aid to increase nurses' compliance to repositioning. The results were in favour of the interventions yet demonstrating the importance of follow-up and education.
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| 11. |
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| 12. |
- Fobelets, M., et al.
(författare)
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Vaginal birth after caesarean versus elective repeat caesarean delivery after one previous caesarean section: a cost-effectiveness analysis in four European countries
- 2018
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 18, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: The OptiBIRTH study incorporates a multicentre cluster randomised trial in 15 hospital sites across three European countries. The trial was designed to test a complex intervention aimed at improving vaginal birth after caesarean section (VBAC) rates through increasing women's involvement in their care. Prior to developing a robust standardised model to conduct the health economic analysis, an analysis of a hypothetical cohort was performed to estimate the costs and health effects of VBAC compared to elective repeat caesarean delivery (ERCD) for low-risk women in four European countries. Methods: A decision-analytic model was developed to estimate the costs and the health effects, measured using Quality Adjusted Life Years (QALYs), of VBAC compared with ERCD. A cost-effectiveness analysis for the period from confirmation of pregnancy to 6 weeks postpartum was performed for short-term consequences and during lifetime for long-term consequences, based on a hypothetical cohort of 100,000 pregnant women in each of four different countries; Belgium, Germany, Ireland and Italy. A societal perspective was adopted. Where possible, transition probabilities, costs and health effects were adapted from national data obtained from the respective countries. Country-specific thresholds were used to determine the cost-effectiveness of VBAC compared to ERCD. Deterministic and probabilistic sensitivity analyses were conducted to examine the uncertainty of model assumptions. Results: Within a 6-week time horizon, VBAC resulted in a reduction in costs, ranging from €3,334,052 (Germany) to €66,162,379 (Ireland), and gains in QALYs ranging from 6399 (Italy) to 7561 (Germany) per 100,000 women birthing in each country. Compared to ERCD, VBAC is the dominant strategy in all four countries. Applying a lifetime horizon, VBAC is dominant compared to ERCD in all countries except for Germany (probabilistic analysis, ICER: €8609/QALY). In conclusion, compared to ERCD, VBAC remains cost-effective when using a lifetime time. Conclusions: In all four countries, VBAC was cost-effective compared to ERCD for low-risk women. This is important for health service managers, economists and policy makers concerned with maximising health benefits within limited and constrained resources.
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| 13. |
- Lechner, A., et al.
(författare)
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Outcomes for Pressure Ulcer Trials (OUTPUTs) project : review and classification of outcomes reported in pressure ulcer prevention research
- 2021
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Ingår i: British Journal of Dermatology. - : Blackwell Science Ltd.. - 0007-0963 .- 1365-2133. ; 184:4, s. 617-626
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: In order to overcome inconsistencies in the reporting of outcomes in clinical trials, core outcome sets (COS) have been developed in many clinical areas and the awareness of this concept is growing steadily. The Outcomes for Pressure Ulcer Trials (OUTPUTs) project aims to improve the quality of evidence on pressure ulcer prevention trials by developing a COS.OBJECTIVES: As an initial step in the COS process we aimed to identify and classify outcomes as well as concepts that represent potential outcomes for future trials that have been reported in pressure ulcer prevention research.METHODS: A review was conducted in twelve major databases covering the literature indexed until 2016. Outcomes and relevant concepts reported in primary studies and/or reviews on pressure ulcer prevention in adult patients were extracted as presented in the articles, and afterwards inductively grouped into outcome domains. The domains were then categorized according to the outcome domain taxonomy recently proposed by the Core Outcome Measures in Effectiveness Trials Group.RESULTS: 332 studies were included and 68 outcome domains were identified, covering multiple aspects of pressure ulcer prevention. Pressure ulcer occurrence was reported in 71% of all included studies representing the most frequent outcome, followed by costs (22% of all studies), and acceptability of intervention and comfort (18% of all studies).CONCLUSION: A plethora of different outcomes is applied in pressure ulcer prevention research and substantial variations in definitions and reporting of similar outcomes were observed. A COS for pressure ulcer prevention trials is needed to overcome the non-comparability of outcomes.
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| 14. |
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| 15. |
- Stael, Simon, et al.
(författare)
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Structure-function study of a Ca2+-independent metacaspase involved in lateral root emergence
- 2023
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Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : Proceedings of the National Academy of Sciences (PNAS). - 0027-8424 .- 1091-6490. ; 120
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Tidskriftsartikel (refereegranskat)abstract
- Metacaspases are part of an evolutionarily broad family of multifunctional cysteine proteases, involved in disease and normal development. As the structure-function relationship of metacaspases remains poorly understood, we solved the X-ray crystal structure of an Arabidopsis thaliana type II metacaspase (AtMCA-IIf) belonging to a particular subgroup not requiring calcium ions for activation. To study metacaspase activity in plants, we developed an in vitro chemical screen to identify small molecule metacaspase inhibitors and found several hits with a minimal thioxodihydropyrimidine-dione structure, of which some are specific AtMCA-IIf inhibitors. We provide mechanistic insight into the basis of inhibition by the TDP-containing compounds through molecular docking onto the AtMCA-IIf crystal structure. Finally, a TDP-containing compound (TDP6) effectively hampered lateral root emergence in vivo, probably through inhibition of metacaspases specifically expressed in the endodermal cells overlying developing lateral root primordia. In the future, the small compound inhibitors and crystal structure of AtMCA-IIf can be used to study metacaspases in other species, such as important human pathogens, including those causing neglected diseases.
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| 16. |
- Swarup, Kamal, et al.
(författare)
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The auxin influx carrier LAX3 promotes lateral root emergence
- 2008
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Ingår i: Nature Cell Biology. - : Nature Publishing Group. - 1465-7392 .- 1476-4679. ; 10:8, s. 946-954
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Tidskriftsartikel (refereegranskat)abstract
- Lateral roots originate deep within the parental root from a small number of founder cells at the periphery of vascular tissues and must emerge through intervening layers of tissues. We describe how the hormone auxin, which originates from the developing lateral root, acts as a local inductive signal which re-programmes adjacent cells. Auxin induces the expression of a previously uncharacterized auxin influx carrier LAX3 in cortical and epidermal cells directly overlaying new primordia. Increased LAX3 activity reinforces the auxin-dependent induction of a selection of cell-wall-remodelling enzymes, which are likely to promote cell separation in advance of developing lateral root primordia.
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| 17. |
- Van Tiggelen, H., et al.
(författare)
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Standardising the classification of skin tears : validity and reliability testing of the International Skin Tear Advisory Panel (ISTAP) Classification System in 44 countries
- 2020
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Ingår i: British Journal of Dermatology. - : Wiley-Blackwell Publishing Inc.. - 0007-0963 .- 1365-2133. ; 183:1, s. 146-154
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Skin tears are acute wounds that are frequently misdiagnosed and underreported. A standardised and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way.OBJECTIVES: To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally.METHODS: A multi-country study was set up to validate the content of the ISTAP Classification System through expert consultation in a two-round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter-rater reliability, and intra-rater reliability of the instrument.RESULTS: A definition for the concept of a "skin flap" in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0.79 (95% CI 0.79-0.80) and sensitivity ranged from 0.74 (95% CI 0.73-0.75) to 0.88 (95% CI 0.87-0.88). The inter-rater reliability was 0.57 (95% CI 0.57-0.57). The Cohen's Kappa measuring intra-rater reliability was 0.74 (95% CI 0.73-0.75).CONCLUSIONS: The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for a systematic assessment and reporting of skin tears in clinical practice and research globally.
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