Differential contractile response of critically ill patients to neuromuscular electrical stimulation

BACKGROUND: Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. METHODS: This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. RESULTS: One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). CONCLUSION: Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. TRIAL REGISTRATION: ISRCTN ISRCTN19392591 , registered 17 February 201

Der Pneumokoniosekomplex

Klinik und Funktionsdiagnostik sprechen mit Sicherheit dafür, dass die spezifischen Staubfibrosen nicht das Hauptproblem der Pneumokoniosen sind. Unkomplizierte Siliklosen sind symptomarm. Beschwerden, gesundheitlicher Abbau und Lungenfunktionsminderungen von Bergleuten und Staubarbeiten allgemein stehen in engeren Beziehungen zu den unspezifischen Staubreaktionen als zu den spezifischen. Von den ersteren sind am wichtigsten die asthmatischen Bronchitiden mit obstruktiven Emphysem. Zahlenmässig und klinisch liegt das Schwergewicht bei den unspezifischen Lungenreaktionen, die kausal nicht von der Silikose abhängen, sondern direkte Folgen des jahrelangen Staubreizes im Bereich der Bronchien sind. Bronchiektasen entwickeln sich nicht nur in Verbindung mit Silikose, sondern auch völlig unabhängig davon auf bronchitischer und emphysematöser Grundlage. Die Möglichkeit einer durch Staub provozierten Lungenatrophie über das physiologische Mass wird diskutiert. Eine kritische Analyse der »Staublungenkrankheit« unter Heranziehung funktionsdiagnostischer Methoden führt zu dem Schluss, dass die gesetzmässigen Lungenreaktionen vielseitig sind. Der Pneumokoniosekomplex umfasst die »spezifischen« und »unspezifischen« Lungenreaktionen auf den Staub. Erstere sind die echten Fibrosen (Silikose, Asbestose, Aluminose usw.), letztere umfassen die ungemein häufigen asthmatischen Bronchitiden mit obstruktivem Emphysem, Bronchiektasen, wahrscheinlich durch Staub provozierte Lungen-atrophien und sekundäre Herz- und Kreislaufschäden. Sämt1iche Teilfaktoren des Pneumokoniosekomplexes sind als direkte Staubwirkungen und damit als berufsbedingt anzusehen. Die asthmatische Emphysembronohitis der Bergleute ist ein echtes erworbenes physikalisch-irritatives Bronchialasthma und wird seit Jahrhunderten -Bergmannsasthma« genannt. Es sollte nicht mehr als anlagebedingt oder schicksalhaft angesehen, sondern als Berufskrankheit anerkannt werden. Damit wäre eine wirksame Prophylaxe gesichert wie bei der Silikose. In fortgeschrittenen Stadien versagen alle Therapeutica, was in gleicher Weise für Asthma und Silikose gilt.Pneumokoniozni komplek

Curriculum design as an enabler of student involvement and success in higher education

Quality assurance, promotion, and the success of students are core drivers in Higher Education. Students shifted from being receivers in the knowledge transfer process of Higher Education to active co-producers in the learning process, which makes students more involved in the quality assurance process today than they were in the past. This shift requires curriculum developers of programmes to not only understand the nature of the change in the students’ role in Higher Education but also to anticipate future changes in their role. The Mode 1, Mode 2 and Mode 3 models of knowledge production are useful systems to help curriculum designers understand this daunting task. This research conducts a theoretical exploration into students’ shift in knowledge production as they engage with the curriculum in higher education, which explores the different modes of knowledge production. The exploratory research includes practical curriculum examples that highlight the changes in the structures of control, characteristics, and practicalities of the different modes, changes in assessment strategies, changes in teacher-student relationships, and the inclusion of other role-players such as industry and society. The first mode of knowledge production is a disciplinary and homogeneity model, with the second mode shifting to a transdisciplinary, heterogeneous, transient, and more systemic model which includes industry stakeholders, with a permeable boundary. The third mode of knowledge production is situated in the fourth industrial revolution space and looks at the combined future of science, knowledge, and technology

LP (a) levels and apo (a) phenotypes in urban black South African men

CITATION: Carstens, M. E., Burgess, L. J. & Taljaard, J. J. F. 1998. LP (a) levels and apo (a) phenotypes in urban black South African men. South African Medical Journal, 88:139-142.The original publication is available at http://www.samj.org.zaObjective. To investigate the lipoprotein (a) (Lp (a)) levels and apolipoprotein (a) (apo (a)) phenotypes in a group of urban black South African men. Design. Cross-sectional design. Setting. Lead acid battery plant, East London, Eastern Cape. Participants. Blood samples from a study on the association between lead and renal failure were kindly donated for the present study and 111 of the donors participated (K Steyn - personal communication). Outcome measures. Lp (a) levels and apo (a) phenotypes. Results. Three groups were identified: those with normal ( 700 U/l) plasma Lp (a) concentrations. Nine apo (a) phenotypes and 26 combinations thereof could be discerned. Apart from the single- and double-band phenotypes described before, triple-band phenotypes were also present. As the Lp (a) values increased, the relative frequency of the single-band phenotype decreased, whereas the relative frequency of the double-band phenotype increased. The relative frequency of the triple-band phenotype was highest in the group with high Lp (a) concentrations. No correlation was evident between the size of the apo (a) isoforms and the Lp (a) concentrations. Conclusions. Raised plasma Lp (a) levels have been associated with coronary heart disease (CHD). In addition, it has been proposed that the apo (a) gene determined plasma Lp (a) concentrations. These studies were performed using plasma from white subjects. CHD is uncommon in black South Africans. The reason may be that, given the lack of relationship between the size of the apo (a) isoforms and the Lp (a) concentrations observed in the present study, factors other than the isoform size may determine the Lp (a) levels in this particular ethnic group.Publisher’s versio

Effects of urodilatin on natriuresis in cirrhosis patients with sodium retention

BACKGROUND: Sodium retention and ascites are serious clinical problems in cirrhosis. Urodilatin (URO) is a peptide with paracrine effects in decreasing sodium reabsorption in the distal nephron. Our aim was to investigate the renal potency of synthetic URO on urine sodium excretion in cirrhosis patients with sodium retention and ascites. METHODS: Seven cirrhosis patients with diuretics-resistant sodium retention received a short-term (90 min) infusion of URO in a single-blind, placebo-controlled cross-over study. In the basal state after rehydration the patients had urine sodium excretion < 50 mmol/24 h. RESULTS: URO transiently increased urine sodium excretion from 22 ± 16 μmol/min (mean ± SD) to 78 ± 41 μmol/min (P < 0.05) and there was no effect of placebo (29 ± 14 to 44 ± 32). The increase of URO's second messenger after the receptor, cGMP, was normal. URO had no effect on urine flow or on blood pressure. Most of the patients had highly elevated plasma levels of renin, angiotensin II and aldosterone and URO did not change these. CONCLUSION: The short-term low-dose URO infusion increased the sodium excretion of the patients. The increase was small but systematic and potentially clinically important for such patients. The small response contrasts the preserved responsiveness of the URO receptors. The markedly activated systemic pressor hormones in cirrhosis evidently antagonized the local tubular effects of URO

LP (a) levels and apo (a) phenotypes in urban black South African men

Objective. To investigate the lipoprotein (a) (Lp (a)) levels and apolipoprotein (a) (apo (a)) phenotypes in a group of urban black South African men.Design. Cross-sectional design.Setting. Lead acid battery plant, East London, Eastern Cape.Participants. Blood samples from a study on the association between lead and renal failure were kindly donated for the present study and 111 of the donors participated (K Steyn - personal communication).Outcome measures. Lp (a) levels and apo (a) phenotypes.Results. Three groups were identified: those with normal (&lt;300 U/I), intermediate (300 - 700 U/I) and high (&gt; 700 U/I) plasma Lp (a) concentrations. Nine apo (a) phenotypes and 26 combinations thereof could be discerned. Apart from the single- and double-band phenotypes described before, triple-band phenotypes were also present. As the Lp (a) values increased, the relative frequency of the single-band phenotype decreased, whereas the relative frequency of the double-band phenotype increased. The relative frequency of the triple-band phenotype was highest in the group with high Lp (a) concentrations. No correlation was evident between the size of the apo (a) isoforms and the Lp (a) concentrations.Conclusions. Raised plasma Lp (a) levels have been associated with coronary heart disease (CHD). In addition, it has been proposed that the apo (a) gene determined plasma Lp (a) concentrations. These studies were performed using plasma from white subjects. CHD is uncommon in black South Africans. The reason may be that, given the lack of relationship between the size of the apo (a) isoforms and the Lp (a) concentrations observed in the present study, factors other than the isoform size may determine the Lp (a) levels in this particular ethnic group

Pemasaran Hijau Yang Semakin Menjadi Kebutuhan Dalam Dunia Bisnis

Green marketing is a type of marketing where a company sells a product that is envi-ronmentally friendly. In the concept of green marketing, a company has done greenmarketing since the beginning of the production process which transform raw materi-als into environmentally friendly finished product, called green product. The growingglobal warming make the green marketing is a major issue in today\u27s business world.Green marketing has become a necessity for both producers and consumers for thecreation of a healthy environment. A company can do green marketing that matchesto the company\u27s business. Implementation of green marketing can cover many ac-tivities depending on what the company wants to do. Automotive manufacturers arean example of a company that must implement a comprehensive green marketingbecause its products could potentially damage the environment due to pollution fromvehicle fumes

Parallel and I/O-efficient randomisation of massive networks using global curveball trades

Graph randomisation is a crucial task in the analysis and synthesis of networks. It is typically implemented as an edge switching process (ESMC) repeatedly swapping the nodes of random edge pairs while maintaining the degrees involved [23]. Curveball is a novel approach that instead considers the whole neighbourhoods of randomly drawn node pairs. Its Markov chain converges to a uniform distribution, and experiments suggest that it requires less steps than the established ESMC [6]. Since trades however are more expensive, we study Curveball’s practical runtime by introducing the first efficient Curveball algorithms: the I/O-efficient EM-CB for simple undirected graphs and its internal memory pendant IM-CB. Further, we investigate global trades [6] processing every node in a single super step, and show that undirected global trades converge to a uniform distribution and perform superior in practice. We then discuss EM-GCB and EMPGCB for global trades and give experimental evidence that EM-PGCB achieves the quality of the state-of-the-art ESMC algorithm EM-ES [15] nearly one order of magnitude faster

Aspekte van nasionale en kulturele identiteit van 'n verenigende Europa sedert 1958 : enkele gevallestudies

Thesis (MA)--University of Stellenbosch, 2003.ENGLISH ABSTRACT: In a globalizing world it follows that the identity of individuals will come under scrutiny as borders between states fade. It is exactly for this reason that so many people feel uncomfortable within themselves and become involved in a desperate search for new terms of reference and value systems. By virtue of this, history is utilized to explore the problem by tracing circumstances on a continent where the issue is currently very topical. Certain facets of Europe, which was the axis of the catastrophic Second World War but simultaneously the cradle of an Eurocentrism which has evolved gradually over centuries, is carefully scrutinized in order to determine what tendencies are becoming noticeable. This investigation cannot ignore the demise of the Soviet Empire and the burgeoning nation states of Eastern Europe since it represents an important divide in the European history of the twentieth century. A unifying Europe is embodied in various institutions which have sprung up since the Second World War, partially due to efforts of Europeans to organise themselves or alternatively, as a consequence of the Atlantic allies' attempts to present a united front to Soviet Russia. With the demise of the Soviet Republic in 1989, the concept underwent a further change when the Eastern European countries joined the institutional structures of a unifying nature such as the Council of Europe. It is exactly because of this that the identity issue came to the fore. The only realistic and pragmatic yardstick to measure national and cultural identity within the defined period is by employing the sovereignty of the nation state. Concurrently with this yardstick is the realisation that the protection or loss of sovereignty occurs within the upper constitutional or political levels where the public is seldom involved, but ultimately as a consequence affected. This reflects a democratic deficit. Seen from the angle of the early protagonists of Eurocentrism as well as the USA, there were conflicting views on the protection or loss of sovereignty, but an admission that greater unity could lead to the loss of some sovereignty. Britain, without publicly acknowledging it, had indeed surrendered some of its sovereignty during the 1970's when it became a member of the European Economic Community, by subjecting itself to the ruling that European Union legislation would be superior to that of Britain in the event of a conflict. Britain had thus, with regard to national and cultural identity, already proceeded to a new relationship. This new relationship was reinforced by Britain's under-writing of the principle of subsidiarity which ultimately promotes a dual identity of being British and European. The same tendency was noticeable in the institutional arrangements and programmes of the Council of Europe and the European Union. On investigating the viewpoints and role which Belgium, as one of the founder members of the European Economic Community, and simultaneously a small nation, this tendency also becomes very apparent, but possibly with greater emphasis of the regional role as a result of strong identity forming influences. In conclusion, it is thus apparent that being a European, and British or Flemish simultaneously, is currently becoming the vogue. However, being European is currently of a consumer-goods nature. It does not embrace a vibrant European identity particularly as a consequence of the language difference which limit the Europeanisation of national and cultural identities. Attempts to resolve the problem through adages such as "unity in diversity" has not produced the expected results.AFRIKAANSE OPSOMMING: In 'n globaliserende wêreld volg dit dat die identiteit van individue onder druk sal kom omdat die grense tussen state neig om te vervaag. Dit is juis as gevolg hiervan dat soveel mense ongemaklik voel met hulself en betrokke raak by 'n desperate soeke na nuwe punte van verwysing en nuwe waardestelsels. Gedagtig hieraan word die geskiedenis ingespan om die problematiek te verken deur ondersoek in te stel na die verloop van omstandighede op 'n kontinent waar die kwessie inderdaad tans uiters aktueel is. Sekere aspekte van Europa, wat die spilpunt van die katastrofale Tweede Wêreld Oorlog was, maar terselfdertyd ook die bakermat van 'n Eurosentrisme wat geleidelik oor eeue ontluik het, word onder die vergrootglas geplaas ten einde te bepaal watter neigings te bespeur is. Hierdie ondersoek kon ook nie die val van die Sowjet-ryk en die opkomende nasiestate in Oos-Europa ignoreer nie, omdat dit 'n belangrike breuklyn in die Europese geskiedenis van die twintigste eeu verteenwoord ig. 'n Verenigende Europa word vergestalt in verskeie organisasies wat sedert die Tweede Wêreld Oorlog ontstaan het enersyds vanweë pogings van Europeërs om hulself te orden, of andersyds, vanweë pogings van die Atlantiese bondgenote om 'n verenigende front jeens Sowjet-Rusland te vorm. Met die val van die Sowjet-Republiek in 1989, het die begrip 'n verdere verandering ondergaan toe Oos-Europese lande aangesluit het by institusionele strukture van 'n verenigende aard soos die Raad van Europa. Juis as gevolg hiervan het die identiteitskwessie sterker na vore getree. Die enigste realistiese en pragmatiese norm om dit te meet binne die gegewe tydsgewrig was aan die hand van die soewereiniteit van die nasiestate. Die meting gaan egter gepaard met die wete dat soewereiniteitsbeskerming of -verlies plaasvind op hoë politieke of konstitusionele vlakke waarby die algemene publiek selde betrek, maar inderdaad as uitvloeisel, geaffekteer word. Dit lei dus tot 'n gebrekkige demokratiseringsproses. Gesien vanuit die oogpunt van die vroeër denkers van Europeanisering asook die VSA, was daar botsende menings oor die verlies of beskerming van soewereiniteit, maar 'n erkenning dat groter eenheid tog tot "n mate van soewereiniteitsverlies kon lei. Brittanje het inderdaad, sonder om dit openlik te erken, reeds met sy aansluiting in die 1970's afstand gedoen van "n gedeelte van haar soewereiniteit deur die aanvaarding van die toetredingsvoorwaarde dat, waar Britse en Europese Ekonomiese Gemeenskap wetgewing bots, laasgenoemde sou oorheers. Gedagtig hieraan, is dit dus duidelik dat wat nasionale en kulturele identiteit betref, Brittanje reeds haarself begeef het in "n nuwe verhouding. Die nuwe verhouding versterk deur Brittanje se onderskrywing van die beginsel van subsidiariteit, kom eintlik daarop neer dat "n persoon terselfdertyd Brits en Europeër kan wees. Dieselfde tendens is te bespeur in die institusionele reëlings en programme van die Raad van Europa asook die Europese Unie. Wanneer die standpunte en rol van België as een van die stigterlande van die Europese Ekonomiese Gemeenskap, maar terselfdertyd "n kleinstaat, ondersoek word, kom die verskynselook sterk na vore, moontlik egter met nog meer beklemtoning van die streeksrolle van gebiede as gevolg van sterk identiteitsvormende invloede. Ten laaste word dit dus duidelik dat "n gelyktydige Europees-wees asook Brits-wees, of Vlaams-wees, nou aan die orde van die dag begin kom. Die Europees-wees is egter nog van "n verbruikersgoedere aard. Dit omvat nog nie "n lewenskragtige Europese identiteit nie veral as gevolg van die taalverskille wat belemmerend inwerk op die Europeanisering van nasionale en kulturele identiteite. Pogings om die probleem op te los deur slagspreuke soos "eenheid in diversiteit" werp nog nie die nodige vrugte af nie