57,723 research outputs found

    Expert consensus for respiratory physiotherapy management of mechanically ventilated adults with community-acquired pneumonia: A Delphi study

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    Rationale and aims: Patients with community‐acquired pneumonia (CAP) are frequently admitted to an intensive care unit. Physiotherapy may be provided to optimize respiratory function; however, there is significant variability in clinical practice and limited research directing best practice for this cohort. This study aimed to determine expert consensus for best physiotherapy practice for invasively ventilated adults with CAP. Method: A modified Delphi technique involved an international expert panel completing three rounds of an online questionnaire. The initial 35‐statement questionnaire, based on a systematic literature review and survey of current clinical practice, covered physiotherapy assessment and treatment of intubated patients with CAP. Quantitative data using Likert scales determined level of agreement, with qualitative data collected through open‐ended responses. Consensus threshold was set a priori at 70%. Items not achieving consensus were modified and new items added based on themes from qualitative data. Quantitative data were analysed descriptively, with thematic analysis used on qualitative data. Results: The panel comprised 29 international clinical and academic experts in critical care physiotherapy. Response rate was more than 95% for each round. Outcome achieved was 38 consensus statements covering assessment and treatment, with 28 statements (74%) providing consensus on recommended clinical practice, two consensus disagreement statements (7%) for what practice is not recommended, and eight statements (21%) indicating which treatments may be beneficial. Conclusion: Expert consensus regarding physiotherapy for intubated adults with CAP patients provides an evidence‐based approach to guide clinical practice. The consensus statements can also be used to guide research evaluating physiotherapy interventions for patients with CAP

    Towards an extension of the two-variable model of carcinogenesis through oncogenes and tumour suppressor genes

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    Currently, carcinogenesis is considered to be the result of mal-expression of tumour suppressor genes and oncogenes, leading either way to uncontrollable and disorganized cell mitosis. Recently a novel class of genes has drawn the interest of the scientific community. These are microRNAs (miRNAs), a class of noncoding RNAs, 20–23 nucleotides in length, that can up or downregulate gene expression of downstream gene targets (including transcription factors, oncogenes, and tumour suppressor genes) at the post-transcriptional level. Some members of this new class of genes seem to have the potential to act simultaneously either as oncogenes or as tumour suppressor genes depending on the molecular microenvironment of the cell. We elaborate on this hypothesis by giving examples of miRNAs (e.g. mir-9, miR-17-92) which seem to function by the abovementioned mechanism. This could mean that the deterministic notion of carcinogenesis as a result of merely tumour suppressor genes and oncogenes deregulation could be revised to contain the fact that certain members of this novel class of genes have the potential to play both roles simultaneously

    Continuity properties of measurable group cohomology

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    A version of group cohomology for locally compact groups and Polish modules has previously been developed using a bar resolution restricted to measurable cochains. That theory was shown to enjoy analogs of most of the standard algebraic properties of group cohomology, but various analytic features of those cohomology groups were only partially understood. This paper re-examines some of those issues. At its heart is a simple dimension-shifting argument which enables one to `regularize' measurable cocycles, leading to some simplifications in the description of the cohomology groups. A range of consequences are then derived from this argument. First, we prove that for target modules that are Fr\'echet spaces, the cohomology groups agree with those defined using continuous cocycles, and hence they vanish in positive degrees when the acting group is compact. Using this, we then show that for Fr\'echet, discrete or toral modules the cohomology groups are continuous under forming inverse limits of compact base groups, and also under forming direct limits of discrete target modules. Lastly, these results together enable us to establish various circumstances under which the measurable-cochains cohomology groups coincide with others defined using sheaves on a semi-simplicial space associated to the underlying group, or sheaves on a classifying space for that group. We also prove in some cases that the natural quotient topologies on the measurable-cochains cohomology groups are Hausdorff.Comment: 52 pages. [Nov 22, 2011:] Major re-write with Calvin C. Moore as new co-author. Results from previous version strengthened and several new results added. [Nov 25, 2012:] Final version now available at springerlink.co

    Unfolding the Spatial and Temporal Neural Processing of Making Dishonest Choices

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    Framework for Promoting Women's Career Development across Career Stages in the Construction Industry

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    Despite efforts to promote gender diversity, the construction industry in Australia remains one of the most male-dominated industries. Women, compared to their male counterparts, progress more slowly and encounter major obstacles to career development in the construction industry. Existing research tends to focus on broad factors that impact women's career development in all career stages despite the fact that women's career priorities often change as they progress through different career stages. This study applied Super's career development model to investigate the influential factors on women's career development across four career stages: explore (precareer), establishment (early career), midcareer, and late career. By conducting a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this research identified influential factors related to women's career development in the construction industry, namely, attitude, capability, interest, past experiences, family responsibilities, parental influences, role models, support, culture, organizational practice, and policies and regulations. Based on the women's empowerment framework, the identified factors were coded and synthesized into three dimensions: individual, relational, and environmental. The research finds there is a significant focus on providing relational and environmental support to women in construction, and less attention is given to individual factors. The review revealed that personal interest and parental perceptions in construction influence women's career development in precareer and early career stages, while masculine culture significantly impacts women's career development in all career stages. This study also summarizes the theoretical contributions and practical implications drawn from existing research on different stages of women's career development and provides guidance for further research

    Evaluation of design recommendations for the development of wheelchair rugby sports-wear

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    Currently, wheelchair rugby athletes face the challenges of playing the sport without specifically designed sports-wear kit. A few designs and recommendations have already been proposed by researchers but none have made it to market yet. The purpose of this study was to evaluate a set of design recommendations for the development of wheelchair rugby sports-wear. This was done so that the products to be created are developed in collaboration with their potential users, responding to their particular needs and requirements. The evaluation was done through an online survey, where the athletes were presented with a visual representation of the design recommendations. The results indicate that the people questioned agree with the majority of the proposed designs and would be happy to have these improvements made to their current sports-wear. The most criticised recommendations were for the gloves, as they are the most important part of the kit, so it is important that they are adequate and allow for a good performance

    Evaluating megaprojects: from the “iron triangle” to network mapping

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    Evaluation literature has paid relatively little attention to the specific needs of evaluating large, complex industrial and infrastructure projects, often called ‘megaprojects’. The abundant megaproject governance literature, in turn, has largely focused on the so-called ‘megaproject pathologies’, i.e. the chronic budget overruns, and failure of such projects to keep to timetables and deliver the expected social and economic benefits. This article draws on these two strands of literature, identifies shortcomings, and suggests potential pathways towards an improved evaluation of megaprojects. To counterbalance the current overemphasis on relatively narrowly defined accountability as the main function of megaproject evaluation, and the narrow definition of project success in megaproject evaluation, the article argues that conceptualizing megaprojects as dynamic and evolving networks would provide a useful basis for the design of an evaluation approach better able to promote learning and to address the socio economic aspects of megaprojects. A modified version of ‘network mapping’ is suggested as a possible framework for megaproject evaluation, with the exploration of the multiple accountability relationships as a central evaluation task, designed to reconcile learning and accountability as the central evaluation functions. The article highlights the role of evaluation as an ‘emergent’ property of spontaneous megaproject ‘governing’, and explores the challenges that this poses to the role of the evaluator
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