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Two recent fiction series produced for video-on-demand (VOD) platforms show the conflict between the Roman Empire and indigenous peoples from the perspective of the latter for the first time. Thus, transforming the traditional Roman historical genre into a more diverse and multifocal space. But, in Barbarians and Britannia this new audiovisual optic manages the representation of this historical reality in completely opposite ways.

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Cuadernos de Investigación Histórica 44 (44): 281–296. doi:10.18172/brocar.4560.Vicente García, V., and S. Díaz Jiménez. 2021. “Nuevas evidencias arqueológicas en la provincia de Soria: Posibles aportaciones para el estudio de la presencia militar romana en la Submeseta Norte.” BSSA Arqueología 87: 1–29. doi:10.24197/ba.LXXXVII.0.1-29Vidal.Volken, S., and M. Volken. 2008. Les clous de chaussures, témoins du cheminement des voyageurs, 391–396. Aosta: Alpis Poenina, Grand Saint-Bernard, une Voie à Travers l’Europe.Welfare, H., and V. G. San. 1995. Roman Camps in England. The Field Archaeology. London: Royal Comission of the Historical Monuments of England.Zanier, W. 2016. Der Spätlatène und frühkaiserzeitliche Opferplatz auf dem Döttenbichl südlich von Oberammergau. München: Verlag C. H. Beck. A new Roman military site was recently detected in Galicia, Spain, an area where the army presence had been challenging to trace until date. O Penedo dos Lobos is a playing-card shaped camp with very distinctive, fortified entrances. The archaeological survey conducted on this site in the summer of 2018 allowed us to recover some elements of Roman militaria, as well as numismatic evidence dating back to late 1st c. BC, thus suggesting a connection with the Cantabrian-Asturian Wars of Augustan times. However, there is still some uncertainty regarding the specific task undertaken by the military contingent that occupied this site. Besides its historical implications, a focus will be given to the methodology applied for the archaeological survey of this site. This has shed new light on the Roman military presence in Galicia, allowing its integration into wider European debates on Roman conquest and expansion Recientemente se detectó un nuevo sitio militar romano en Galicia, un área donde la presencia del ejército había sido difícil de rastrear hasta la fecha. O Penedo dos Lobos es un campamento en forma de naipe con entradas fortificadas muy distintivas. El estudio arqueológico realizado en este sitio en el verano de 2018 nos permitió recuperar algunos elementos de militaria romana, así como pruebas numismáticas que datan de finales del siglo I a. C. que sugieren una conexión con las guerras cántabro-astures de la época de Augusto. Sin embargo, aún existe cierta incertidumbre sobre la tarea específica que llevó a cabo el contingente militar que ocupó este sitio. Además de sus implicaciones históricas y arqueológicas, nos centraremos en detalle en la metodología aplicada en el estudio de este sitio. Esto nos ha permitido arrojar nueva luz sobre la presencia militar romana en Galicia, permitiendo su integración en los debates europeos más amplios sobre la conquista y la expansión romana This work was supported by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie [grant agreement No 794048]; the postdoctoral research programme of the Regional Government of Galicia (Xunta de Galicia, Spain) [Grant agreements n. ED481B 2016/117-0 and IN606B 2016/002] SI

Presentamos en este artículo las evidencias y el contexto geográfico y arqueológico de una fortificación localizada en el municipio de Negreira (A Coruña) y que por sus características puede corresponder a un posible campamento romano. El sitio arqueológico está ubicado en una zona de gran interés para comprender la romanización del occidente de Galicia, con actividad minera, asentamientos y vías de comunicación de la época. Las nuevas tecnologías LIDAR, el acceso abierto al «vuelo americano» de 1956 y otras bases de datos de imágenes aéreas, junto con técnicas más convencionales, han propiciado el hallazgo o, más bien, la propuesta de revisión cronológica y funcional de este yacimiento. El posible campamento podría pertenecer a una fase final o inmediatamente posterior de la conquista romana. This article presents the evidence and the geographical and archaeological context of a large fortress located in the municipality of Negreira (A Coruña) and whose characteristics may correspond to a possible Roman camp. The archaeological site is located in an area of great interest (with minery, settlements and roads of those times), which help us to understand the Romanization of the western Gallaecia. New LIDAR technologies and open access to the 1956 «American flight» and other aerial imagery databases, combined with more traditional techniques have led to the discovery, or rather, to propose a chronological and functional requalification of this site. This new camp could have been built in the final phase of the Roman conquest or at the beginning of the Romanization process.

Las heridas ocupan un porcentaje elevado en las demandas de los servicios de urgencias, tanto hospitalario como extrahospitalario. Son lesiones producidas por el efecto de un agente externo que actúa de manera brusca sobre una parte de nuestro organismo, provocando una rotura de la superficie cutánea o mucosa, una discontinuidad en el epitelio que lo reviste. En este artículo queremos abordar la importancia que tiene una valoración inicial de la herida de forma integral, el mecanismo causal que la provocó, así como el tiempo que ha transcurrido desde que se ha producido, factores todos ellos de gran importancia; así como poderla clasificar de forma adecuada para, posteriormente, iniciar los cuidados correctos en función de las características de cada paciente y de la propia herida. Muchos son los elementos que cobran importancia en el proceso de cicatrización de la propia herida, además de una serie de factores que van a hacer que este proceso de reparación se vea mermado por múltiples razones.

We are at the beginning of a new industrial revolution, the fourth industrial revolution, which means the total connectivity with support of mobility and a revolution in resources. This allows real-time decision making, in the lines where the action is performed, to gain efficiency, speed and adjustment to local conditions and a centralized control with structures in which the power of approximation is centralized, forming ecosystems with a dynamic orientated to project actions in real time with a shared and accepted criteria. The new IT and telecommunication technologies have made possible the MANAGEMENT INFORMATION SYSTEM in REAL TIME, supporting the network of connections that identifies who are the participants and they do, decide and access the information only in an authorized manner thanks to Cybersecurity models. This concept has more obstacles than technological ones; those are the mindset of the participants and especially deciders, due to their lack of knowledge or experience to understand an interconnected globally with disruption. The speed will change the nature of the business when the velocity of change be enough, the nature of the business will be completely changed. These changes will happen due to a single factor: The digital information flow and its availability in real time. Digital transformation means disruption, not only to optimize process, but also to focus on new solutions, products and resources, giving a globally net with worldwide connectivity. But not all are good news, the digital transformation also means risks and dangers, (remembering Escila and Caribdis, being between two dangers, avoiding one could be in the grasp of the other). One wrong vision could change strengths into weaknesses and in our connected era the reversion works with such devastating velocity that a Company could be led from a quiet equilibrium to the chaos instantly. The attractive idea than connection means liberation is not only a mistake because it could mean also get trapped to a strong dynamic net with many difficulties to get liberated from. At the same time who is not connected has not value at all. In order to avoid digital risks it is necessary to take very complex measures due to the complexity of the systems, such as: Designing a Strategic Information System with control and firewalls under responsibility of a Chief Technical Officer (CTO), protecting Data Bases, blocking data security encrypted, fragmentation and other mechanisms to assure impossible to be robbed or manipulated, with “Web Doorkeepers” watching the net and the interconnectivity of all the ecosystems where the Company is and to implant Internet of Things (IoT) avoiding security leaks, with controls in process, input and output to avoid manipulations with the trust of all the people involved. But trust is what every company needs to be in a competitive environment, knowing that nobody can reject progress. Developing one trustworthy environment inside and outside the Company giving confidence to owners, employees, customers, suppliers, and financial and official institutions. At the same time act firmly (dare to know) and never interrupt the progress.

The feasibility of cybermedia and the business models that underpin them are now a classic theme of academic and professional literature within broadcast journalism. We believe it is important to examine revenue strategies aimed at the consumer of Spanish cybermedia in a context of maturity at digital journalism that contrasts with the sharp economic crisis this country is currently going through. The insights of our study highlight the coexistence of two diametrically opposed business models between the most popular and reference cybermedia in Spain and the establishment of ‘value-added’ strategies in those cybermedia that have established pay per view systems.

Mucoadhesive chitosan (CS) and/or hydroxypropyl-methylcellulose (HPMC) tablets for gastric drug delivery of acyclovir (ACV) have been developed in order to improve the ACV oral bioavailability. Swelling, bioadhesive and dissolution studies were carried out in two acidic media (pH 1.5 and 4) in order to determine the tablets behaviour in both fed and fasted states. All the designed tablets showed good mucoadhesive properties on gastric mucosa due to the presence of CS and/or HPMC. In vitro dissolution of ACV from tablets was influenced by the swelling behaviour of each polymer. All data release of the studied tablets fitted to Hopfenberg model, which describes drug release from tablets displaying heterogeneous erosion. HPMC and CS/HPMC tablets revealed a sustained release for 24 h, but a complete dissolution of the tablets was not produced at this time. On the contrary, tablets which contained only CS as polymer were able to release the total amount of ACV for 4 h, due to the CS imbibition and erosion processes in pH 1.5 medium. These results allowed us to conclude that CS is the excipient to be chosen to obtain gastroretentive formulations, due to its demonstrated gastric compatibility.

During the Portuguese War of Restoration (1640–1668), a series of fortifications were built along the Spanish-Portuguese border. The archaeological study of these sites combines different disciplines (landscape archaeology, archaeology of architecture, geospatial technologies, and documentary studies), with the aim of recovering the record of an ancient fortified landscape. This project revealed the construction of a number of small fortifications around the fortress of San Luís Gonzaga (Valença, Portugal), most of which disappeared after the signing of the Treaty of Lisbon in 1668. In the area of Campos (Vila Nova de Cerveira, Portugal), we were able to document what was probably a Modern Age fortification by analysing historic aerial photography, despite the recent construction of an industrial estate. It was also located inside a larger, square structure, which we identified as a possible Roman camp. In this paper, we discuss both fortifications, the methodological process that was developed in order to identify and study them, their possible interpretation, and how they interact with each other.

En los últimos años hemos asistido a un incremento exponencial del número de evidencias arqueológicas relacionadas con la presencia del ejército romano en el noroeste peninsular. En este trabajo analizamos un conjunto de recintos identificados en el oriente gallego mediante el empleo de una metodología específica que aúna técnicas de teledetección y métodos de prospección arqueológica convencional. Estos yacimientos podrían identificarse como asentamientos militares romanos, de acuerdo con sus particulares características morfo-tipológicas. En las siguientes líneas se describen las estructuras arqueológicas documentadas, se analiza su patrón de asentamiento y se estudian sus relaciones con el territorio circundante con la ayuda de diversas tecnologías de información geográfica. ENG:NEW ARCHAEOLOGICAL DATA FOR THE STUDY OF THE ROMAN MILITARY PRESENCE IN EASTERN GALICIAABSTRACTThe archaeological evidence related to the presence of the Roman army in NW Iberia has exponentially increased in recent years. In this paper, we analysed a number of sites identified in the Galician easternmost territories by using a specific methodology which combines remote sensing techniques and conventional archaeological survey methods. These enclosures could be identified as Roman military sites, according to their particular morpho-typological characteristics. The goal of this work is to describe the documented archaeological structures, but also to analyse the settlement pattern of these sites, and to study their relations with the surrounding territory, thanks to the help of various geographic information technologies. KEYWORDSArchaeology; Survey; Remote Sensing; GIS; Fortifications; Roman period; NW Iberia

La viabilidad de los cibermedios y los modelos de negocio que la sustenten son ya un tema clásico de la literatura académica y profesional en el ámbito del periodismo electrónico. Consideramos relevante examinar las estrategias de ingresos orientadas al consumidor de los cibermedios españoles en un contexto de madurez de la prensa digital que contrasta con la aguda crisis económica que vive en estos momentos el país. Las conclusiones de nuestro estudio señalan la convivencia de dos modelos de negocio diametralmente distintos entre los cibermedios más vistos y de referencia en Internet en España y el establecimiento de estrategias de ‘suma de valor’ en aquellos cibermedios que han establecido sistemas de pago por consumo de contenidos., The feasibility of cybermedia and the business models that underpin them are now a classic theme of academic and professional literature within broadcast journalism. We believe it is important to examine revenue strategies aimed at the consumer of Spanish cybermedia in a context of maturity at digital journalism that contrasts with the sharp economic crisis this country is currently going through. The insights of our study highlight the coexistence of two diametrically opposed business models between the most popular and reference cybermedia in Spain and the establishment of ‘value-­‐added’ strategies in those cybermedia that have established pay per view systems.

Objective. To compare 3 types of silver dressing in the typical clinical conditions of a community health center, regarding the time to achieve resolution of clinical signs of local infection, and wound healing progress over 8 weeks.A prospective, comparative study involving 75 patients with infected chronic wounds who were divided into 3 treatment groups: Acticoat™ (group 1); Comfeel® Ag hydrocolloid/Biatain® Ag polyurethane foam (group 2); and Aquacel® Ag (group 3).The groups were comparable at baseline. Clinical signs of infection were resolved faster in group 1 than in the other two groups (P0.05, median: group 1 = 2 weeks; group 2 = 4 weeks; group 3 = 4 weeks. Group 1 required fewer treatments to eliminate the clinical signs of infection (median: group 1 = 6 treatments; group 2 = 12 treatments; group 3 = 12 treatments). Patients in group 1 healed faster than patients in the other 2 groups (P0.05).The treatment in group 1 was more effective than that of groups 2 and 3 in the treatment of infected, chronic wounds. Clinical signs of infection were resolved faster (P0.05) and wounds healed more quickly (P0.05) in group 1 than in the other 2 groups. .

Las úlceras en piel propias de las llamadas enfermedades del trópico se consideran como de baja prevalencia en nuestras sociedades desarrolladas. Pero la úlcera tropical o fagedénica, aquella propia de la lepra o las que se manifiestan en diferentes parasitosis, cada vez nos llaman más la atención; en parte, por la teórica influencia de la inmigración en nuestra civilización y el miedo a la enfermedad de afuera que lleva implícita, en parte por el turismo aventurero que muchas veces las incorpora como recuerdo del viaje a tierras lejanas. La realidad es que este tipo de lesiones merece, tanto por su gravedad como por su impacto en nuestra cultura, de los cuidados que hasta el día de hoy las veía como algo lejano y ajeno, un interés concreto que las defina, concretice y clasifique. En cuanto al comportamiento de la cura en ambiente húmedo de estas úlceras, poco sabemos por propia experiencia y aún menos en su uso como parte del tratamiento en países de esta zona del mundo, donde una pobreza extensiva condiciona la disponibilidad de recursos para el cuidado. Pero ponerse en sobre aviso con la información suficiente, nos permitirá casi siempre identificar precozmente estas lesiones y, de la misma forma, encauzar el tratamiento local más efectivo. The sores in skin own of the so called diseases of the tropic, they are considered like of fall prevalence in our developed societies. But the tropical sore or fagedénica, proper that one of the leprosy or those who demonstrate in different parasitosis, every time they are called us more the attention; partly for the theoretical influence of the immigration in our civilization and the fear of the disease of out that implicit ride, partly for the adventurous tourism that often incorporates them as recollection of the trip to distant lands. The reality is that this type of injuries deserves so much for his your gravity, since for his your impact in our culture of the elegant ones, that until today it saw them as something distant and foreign, a concrete interest that defines them, concretice and classifies. As for the behavior of it recovers in humid environment of these sores, little we know for proper experience and even less in his your use as report of the treatment in countries of this zone of the world, where an extensive poverty determines the availability of resources for the care. But to put in on notice with the sufficient information, it will allow us always to identify almost prematurely, these injuries and of the same form to channel the most effective local treatment.

En la actualidad y en nuestro medio, las quemaduras domésticas son una de las lesiones más habituales, y en las que mejor podemos iniciar un programa de prevención progresivo. Las más comunes son las escaldaduras -debido al contacto accidental con líquidos o gases calientes- y las producidas por la acción directa de las llamas. Las consecuencias van desde el dolor, la deshidratación, las secuelas físicas con repercusiones psíquicas hasta, en ocasiones, la muerte. Ante un paciente con quemaduras es prioritario y esencial llevar a cabo una minuciosa y adecuada valoración inicial que incluya: grado de la lesión (profundidad), extensión (porcentaje de superficie corporal total quemada), zona anatómica afectada y estado general del paciente (edad, estado inmunológico, nutricional, respiratorio, circulatorio, etc.), para así poder planificar los cuidados adecuados. En el presente trabajo describimos el caso de una mujer de 62 años que sufre quemaduras de primer grado y segundo grado superficial y profundo en cuello, ambas mamas y abdomen mientras manipulaba una olla a presión, con una extensión de un 6% de SCTA (Superficie Corporal Total Afectada). Se expone todo el proceso de valoración de la paciente y su correspondiente plan de cuidados, detallando los distintos tratamientos locales en función de la evolución de las lesiones, así como las medidas preventivas para minimizar las posibles complicaciones físicas y psíquicas derivadas de la aparición de cicatrices hipertróficas.

Mestrado em Gestão de Operações O presente trabalho pretende demonstrar que o Sistema de Produção Toyota é na sua essência um Sistema de Gestão do Conhecimento. Sendo composto pela revisão das principais características de um Sistema de Gestão do Conhecimento e verificação da sua aplicação pela Toyota, através das metodologias preconizadas pelo seu Sistema de Produção. A análise é efectuada com recurso a dados de uma multinacional da indústria automóvel, que adoptou as metodologias nipónicas nas suas operações. Procurando verificar se à medida que as áreas, definidas no modelo conceptual de elevação de gestão de conhecimento, se vão desenvolvendo existe uma correlação directa com a evolução de indicadores chaves. Indicadores de qualidade, custos, entregas e recursos humanos. ABSTRACT: This research proposes to demonstrate that the Toyota Production System has in the essence one Knowledge Management System. The approach is made though a revision of the main characteristics of one Knowledge Management System and analysing there appliance by Toyota, trough the methodologies defined in the Production System. The analysis is made with data from a worldwide supplier, of the main automotive OEM’s, that implemented the Japanese’s methodologies in the daily operation. Trying to verify that when the areas, defined in the conceptual model of elevation of the Knowledge Management, are developed there is a direct correlation with the evolution of key indicators. Indicators of quality, costs, deliveries and human resources.

Objetivos: Valorar la eficacia clínica de los productos disponibles para el tratamiento local de las úlceras por presión (UPP) basados en la cura en ambiente húmedo (CAH) así como su rentabilidad (coste-efectividad). Fuentes de datos: La búsqueda de estudios publicados se realizó en bases de datos bibliograficas: CINAHL, Cuiden Plus, Embase, LILACS y MEDLINE. También se realizó una búsqueda inversa, con recuperación secundaria. No se han incluido estudios no publicados. Métodos de revisión: Se han incluido ensayos clínicos que comparan a) productos de CAH con cura tradicional seca (CT) y b) diferentes productos de CAH entre ellos, para el tratamiento de UPP. Cada artículo fue valorado por dos revisores independientemente, mediante el CASP y además se valoró la calidad de la evidencia mediante el sistema GRADE. Se extrajeron datos generales, datos sobre efectividad clínica, datos sobre rentabilidad y datos de comportamiento del apósito. Para estimar el efecto se ha calculado el riesgo relativo (RR) con su intervalo de confianza del 95% y se ha realizado un metaanálisis (modelo de efectos aleatorios) cuando fue apropiado. Resultados: 66 estudios potencialmente relevantes de lo que 30 se eliminaron por puntuación CASP< 5 y otros 10 no se tuvieron en cuenta sus resultados por tener muy baja calidad de evidencia. Un metaanálisis muestra la ventaja del uso de hidrocoloides (HCL) frente a la CT (RR= 2,05 IC 95% 1,20-3,52). Estudios individuales que no permiten metaanálisis muestran la ventaja de otros productos de CAH frente a la CT y un metaanálisis de todos los estudios que comparan la CAH frente a la CT lo confirma (RR= 1,61 IC 95% 1,28-2,02). No hay diferencias de efectividad clínica de los HCL frente a las espumas de poliuretano (EP) (RR= 1,11 IC 95% 0,60-2,05), ni de otros productos entre sí. En cuanto a la rentabilidad distintos estudios muestran que los productos basados en la CAH (HCL y EP) son más rentables que la CT. En cuanto al confort las EP presentan una mayor capacidad de absorción del exudado y una mayor facilidad en la retirada que los HCL. Conclusiones: Existen muchos estudios con una evidencia muy baja o de muestra muy pequeña, lo que no permite considerarlos. Los productos para el tratamiento de UPP basados en CAH tienen mayor eficacia clínica y son más rentables que el tratamiento tradicional. No hay diferencias en la eficacia clínica de un tipo de productos de tratamiento en ambiente húmedo sobre los otros tipos, aunque hay datos relativos al confort y la absorción que muestran ventajas de las espumas de poliuretano frente a los hidrocoloides. Aims: To evaluate the clinical efficiency of the available products for pressure ulcers (PU) treatment which are based on moist environment treatment (MET) and their cost-effectiveness. Sources of data: The search of published studies was carried out in bibliographical databases: CINAHL, Cuiden Plus, Embase, LILACS and MEDLINE. An inverse search was also carried out, with secondary recovery. Unpublished studies were not included. Methods of review: Clinical trials comparing: a) products based on MET and traditional treatments (TT) and b) different types of products of MET, for PU treatments. Every article was assessed independently by two reviewers, using CASP and the GRADE system for assessing the quality of evidence. Data extracted were general data, data on clinical efficiency, data of cost-effectiveness and data about dressing performance. To estimate the effect we used the relative risk (RR) with a 95% confidence interval. A meta-analysis (random effects model) was carried out when appropriate. Results: 66 potentially relevant studies were identified. 30 were excluded because of scoring CASP< 5 and 10 were not considered for analysis because of a very low quality of evidence. A meta-analysis shows the advantage of the use of hydrocolloid (HCL) vs. TT (RR= 2.05 IC 95% 1.20-3.52). Individual studies that do not permit metaanalysis show the advantage of other products of MET vs. TT and a metaanalysis of all studies comparing MET vs. TT confirms it (RR= 1.61 IC 95% 1.28-2.02). There are no differences in clinical efficiency of HCL vs. polyurethane foam (PF) (RR= 1.11 IC 95% 0.60-2.05), nor between other products. Different studies show that products based on MET (HCL and PF) are more cost-effective than the TT. Foams show greater exudates absorption capacity and are removed easier than HCL. Conclusions: They are many studies with a very low quality of evidence or with too small a sample, which does not permit to consider them. Products based on MET for PU treatment have greater clinical efficiency and are more cost-effective than TT. There is no difference in the clinical efficiency between different types of MET products. Foams advantage HCL in comfort and exudates absorption.

To minimize pain when changing dressing for peripheral venous catheters, to select the adequate dressing in functions of the circumstances presented by each patient, and to utilize as references the recommendations by Centers for Disease Control and Prevention (CDCs) form the fundamental bases for this article.

Nursing professionals must know everything related to complications caused by intravenous therapy including the ways to prevent and solve these complications. We need not forget that nurses are the ones mainly responsible for the insertion, manipulation, removal and care of catheters.

This article reports on a spanish study to evaluate the effectiveness of dressings using a Technology Lipido-Colloid to treat skin lesions with "Urgotul". Has been included 18 of this 60 lesions were leg ulcers. We have decided to focus our analysis in these difficult to treat chronic wounds. This study noted better results in relation to the evolution of these lesions and in the quality of life for these patients who suffered these lesions in terms of pain control, skin deterioration or lesions in the same spot related to changing dressings, and an improvement in the skin nearby the lesion.

The authors present an observational evaluation on the effectiveness of a dressing included in the Indafoam brand for treatment of skin lesions due to different etiology which have an acute or chronic diagnosis; the authors include some very valuable information for professionals who use combined polyurethane foam and hydrogel dressings in their daily practice. Due to their composition, these dressings may be considered combined dressings having only one structure which maintains a stable temperature at the lesion site; these dressings have a high absorption capacity which prevents maceration of the skin surrounding lesions and protects lesions from contamination by exogenous germs.

Urinary incontinence is grave health problem which causes severe repercussions in the quality of life of those patients which suffer it and it is a serious risk factor in the development of pressure sores or ulcers. Urinary collecting sacks provide an option to deal with this problem even though up to present time these collecting sacks were only available for male patients. In this instrument usage article, the authors introduce a new device, VILUC, commercialized by Lauclar Laboratories in Spain, for feminine urinary incontinence as a possible alternate treatment for women affected by this problem who are incapable of maintaining a progressive and complete vesicle reeducation. The authors inform about how to install this device, its different components, how to care for it and the indications for its use in females who suffer from incontinence.

In this article, the authors describe the multiple uses a non irritating cutaneous protector has as an effective tool against the aggressions which peri-lesion skin and other at risk skins suffer when they are subject to constant and direct contact with secretions and liquids resulting from the use of dressings based on wet cures, or systems of continence related to ostomias, or in those patients who suffer mixed incontinence where diaper rash makes it difficult to maintain and care for the skin.