Activity and Circadian Rhythm of Sepsis Patients in the Intensive Care Unit

Early mobilization of critically ill patients in the Intensive Care Unit (ICU) can prevent adverse outcomes such as delirium and post-discharge physical impairment. To date, no studies have characterized activity of sepsis patients in the ICU using granular actigraphy data. This study characterizes the activity of sepsis patients in the ICU to aid in future mobility interventions. We have compared the actigraphy features of 24 patients in four groups: Chronic Critical Illness (CCI) sepsis patients in the ICU, Rapid Recovery (RR) sepsis patients in the ICU, non-sepsis ICU patients (control-ICU), and healthy subjects. We used several statistical and circadian rhythm features extracted from the patients' actigraphy data collected over a five-day period. Our results show that the four groups are significantly different in terms of activity features. In addition, we observed that the CCI and control-ICU patients show less regularity in their circadian rhythm compared to the RR patients. These results show the potential of using actigraphy data for guiding mobilization practices, classifying sepsis recovery subtype, as well as for tracking patients' recovery.Comment: 4 pages, IEEE Biomedical and Health Informatics (BHI) 201

Prognostic value of NT-proBNP levels in the acute phase of sepsis on lower long-term physical function and muscle strength in sepsis survivors

Background: Sepsis survivors often develop chronic critical illness (CCI) and demonstrate the persistent inflammation, immunosuppression, and catabolism syndrome predisposing them to long-term functional limitations and higher mortality. There is a need to identify biomarkers that can predict long-term worsening of physical function to be able to act early and prevent mobility loss. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-accepted biomarker of cardiac overload, but it has also been shown to be associated with long-term physical function decline. We explored whether NT-proBNP blood levels in the acute phase of sepsis are associated with physical function and muscle strength impairment at 6 and 12 months after sepsis onset. Methods: This is a retrospective analysis conducted in 196 sepsis patients (aged 18-86 years old) as part of the University of Florida (UF) Sepsis and Critical Illness Research Center (SCIRC) who consented to participate in the 12-month follow-up study. NT-proBNP was measured at 24 h after sepsis onset. Patients were followed to determine physical function by short physical performance battery (SPPB) test score (scale 0 to12-higher score corresponds with better physical function) and upper limb muscle strength by hand grip strength test (kilograms) at 6 and 12 months. We used a multivariate linear regression model to test an association between NT-proBNP levels, SPPB, and hand grip strength scores. Missing follow-up data or absence due to death was accounted for by using inverse probability weighting based on concurrent health performance status scores. Statistical significance was set at p ≤ 0.05. Results: After adjusting for covariates (age, gender, race, Charlson comorbidity index, APACHE II score, and presence of CCI condition), higher levels of NT-proBNP at 24 h after sepsis onset were associated with lower SPPB scores at 12 months (p < 0.05) and lower hand grip strength at 6-month (p < 0.001) and 12-month follow-up (p < 0.05). Conclusions: NT-proBNP levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors

Automated global water mapping based on wide-swath orbital synthetic-aperture radar

This paper presents an automated technique which ingests orbital synthetic-aperture radar (SAR) imagery and outputs surface water maps in near real time and on a global scale. The service anticipates future open data dissemination of water extent information using the European Space Agency's Sentinel-1 data. The classification methods used are innovative and practical and automatically calibrated to local conditions per 1 × 1° tile. For each tile, a probability distribution function in the range between being covered with water or being dry is established based on a long-term SAR training dataset. These probability distributions are conditional on the backscatter and the incidence angle. In classification mode, the probability of water coverage per pixel of 1 km × 1 km is calculated with the input of the current backscatter – incidence angle combination. The overlap between the probability distributions of a pixel being wet or dry is used as a proxy for the quality of our classification. The service has multiple uses, e.g. for water body dynamics in times of drought or for urgent inundation extent determination during floods. The service generates data systematically: it is not an on-demand service activated only for emergency response, but instead is always up-to-date and available. We validate its use in flood situations using Envisat ASAR information during the 2011 Thailand floods and the Pakistan 2010 floods and perform a first merge with a NASA near real time water product based on MODIS optical satellite imagery. This merge shows good agreement between these independent satellite-based water products

Overlapping but disparate inflammatory and immunosuppressive responses to SARS-CoV-2 and bacterial sepsis: An immunological time course analysis

Both severe SARS-CoV-2 infections and bacterial sepsis exhibit an immunological dyscrasia and propensity for secondary infections. The nature of the immunological dyscrasias for these differing etiologies and their time course remain unclear. In this study, thirty hospitalized patients with SARS-CoV-2 infection were compared with ten critically ill patients with bacterial sepsis over 21 days, as well as ten healthy control subjects. Blood was sampled between days 1 and 21 after admission for targeted plasma biomarker analysis, cellular phenotyping, and leukocyte functional analysi

A three arm cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the SMART work & life intervention for reducing daily sitting time in office workers : study protocol

Background:Office-based workers typically spend 70-85% of working hours, and a large proportion of leisure time, sitting. High levels of sitting have been linked to poor health. There is a need for fully powered randomised controlled trials (RCTs) with long-term follow-up to test the effectiveness of interventions to reduce sitting. This paper describes the methodology of a three-arm cluster RCT designed to determine the effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable desk, for reducing daily sitting. Methods/Design:A three-arm cluster RCT of 33 clusters (660 council workers) will be conducted in three areas in England (Leicester; Manchester; Liverpool). Office groups (clusters) will be randomised to the SMART Work & Life intervention delivered with (group 1) or without (group 2) a height-adjustable desk or a control group (group 3). SMART Work & Life includes organisational (e.g., management buy-in, provision/support for standing meetings), environmental (e.g., relocating waste bins, printers), and group/individual (education, action planning, goal setting, addressing barriers, coaching, self-monitoring, social support) level behaviour change strategies, with strategies driven by workplace champions. Baseline, 3, 12 and 24 month measures will be taken. Objectively measured daily sitting time (activPAL3). objectively measured sitting, standing, stepping, prolonged sitting and moderate-to-vigorous physical activity time and number of steps at work and daily; objectively measured sleep (wrist accelerometry). Adiposity, blood pressure, fasting glucose, glycated haemoglobin, cholesterol (total, HDL, LDL) and triglycerides will be assessed from capillary blood samples. Questionnaires will examine dietary intake, fatigue, musculoskeletal issues, job performance and satisfaction, work engagement, occupational and general fatigue, stress, presenteeism, anxiety and depression and sickness absence (organisational records). Quality of life and resources used (e.g. GP visits, outpatient attendances) will also be assessed. We will conduct a full process evaluation and cost-effectiveness analysis. Discussion:The results of this RCT will 1) help to understand how effective an important simple, yet relatively expensive environmental change is for reducing sitting, 2) provide evidence on changing behaviour across all waking hours, and 3) provide evidence for policy guidelines around population and workplace health and well-being. Trial registration: ISRCTN11618007 . Registered on 21 January 2018

What Do Workers Do to Reduce Their Sitting Time? The Relationships of Strategy Use and Workplace Support With Desk-Based Workers' Behavior Changes in a Workplace-Delivered Sitting-Reduction and Activity-Promoting Intervention

OBJECTIVE: To explore workers' sitting-reduction and activity-promoting strategy use following an intervention targeting these changes, and whether strategy use and perceived workplace support impacted on 3-month sitting and activity outcomes. METHODS: This secondary analysis in desk-based workers (n?=?83) utilized data collected on questionnaire-derived strategy use and workplace support, and activPAL3-derived sitting (total; prolonged, =30?minutes) and activity (standing; stepping) at work. RESULTS: Fourteen strategies were commonly used during the intervention. Increased usage of some strategies were significantly (P?<?0.05) associated with beneficial changes in prolonged sitting or stepping only. Workplace support was significantly beneficially associated with changes in sitting, prolonged sitting, and stepping; these associations were largely independent of strategy use changes. CONCLUSIONS: Strategies were highly used, with increased use associated with some behavioral improvements. Workplace support appears essential for improving sitting and activity in the workplace

Australian employee perceptions of an organizational-level intervention to reduce sitting.

Stand Up Lendlease-a cluster-randomized trial targeting reductions in sitting time in Australian office workers (n?=?153, 18 manager-led teams, 1 organization)-effectively reduced sitting time during work hours and across the day after 12?months. The trial included two arms: organizational-support strategies (e.g. manager support, emails) with or without an activity tracker. The current study aimed to examine participant perceptions of the intervention, and perceived barriers and facilitators for reducing sitting time. Telephone interviews (n?=?50 participants; conducted at 6-10?months) and three focus groups (n?=?21 participants; conducted at 16?months) evaluated the intervention with qualitative data analysed thematically. Several consistent themes emerged across both short and long-term time points and intervention groups. Support and role modelling of desired behaviours from important organization personnel and receiving feedback on sitting levels were key drivers of change. Improvements in awareness about sitting, and workplace culture changes supporting active work practices were positive impacts of the intervention, but some participants also reported that initial cultural effects had dissipated and the intervention needed 'reinvigoration'. Participants desired additional 'tools' to maintain sitting less and being active, such as sit-stand desks, standing meeting tables and activity trackers. In summary, the intervention raised awareness and initiated cultural changes towards active work practices, however, additional support may be required to maintain changes in organizational culture long term. Practical tools to support sitting changes, organizational and management support and role modelling, as well as ongoing 'reinvigoration' are key strategies for short and long-term intervention success in office workplaces