4,627 research outputs found
The Micro-City Project: A progress Report
This is a report on social science aspects of the Micro-City Project conducted at St. John\u27s University at Collegeville, Minnesota. The program began in June, 1968, and this report covers activities which range from attitudinal survey research to mathematical models
Red Sea, White Tides, and Blue Horizons
Eric Hobsbawm, in his effort to explain the fundamental divide which produced the Second World War, convincingly argues that “the crucial lines in this civil war were not drawn between capitalism as such and communist social revolution, but between ideological families: on the one hand the descendants of the eighteenth-century Enlightenment and the great revolutions including, obviously the Russian revolution’, on the other hand, its opponents.” This thesis argues that the American Civil War was a “great revolution” that represented a crucial transformative point in the formation of these two waring factions. The struggle was especially influential on the theory of Karl Marx, who declared in the preface to the First German Edition to Capital Volume I, that “As in the 18th century, the American war of independence sounded the tocsin for the European middle class, so that in the 19th century, the American Civil War sounded it for the European working class.” The death of slavery in the United States was not a inevitability, but the result of intense political struggle that emerged from a foundational material contradiction of North American settler colonialism and subsequent capitalist development which dramatically reshaped the transnational ideological dialectic between the forces for and against the rule of the masses
Community versus local energy in a context of climate emergency
This is the author accepted manuscript. The final version is available from Nature Research via the DOI in this record.UK policy on decentralized energy has shifted from community energy to local energy. This signals reduced support for grassroots, citizen-led action in favour of institutional partnerships and company-led investments, which puts at risk the urgent, long-term social and technological transformations required in a climate emergency
Physical outcome measure for critical care patients following intensive care discharge
Introduction: The aim of this study was to evaluate the most suitable
physical outcome measures to be used with critical care patients following
discharge. ICU survivors experience physical problems
such as reduced exercise capacity and intensive care acquired
weakness. NICE guideline ‘Rehabilitation after critical illness’ (1) recommends
the use of outcome measures however does not provide
any specific guidance. A recent Cochrane review noted wide variability
in measures used following ICU discharge (2).
Methods: Discharged ICU patients attended a five week multidisciplinary
programme. Patients’ physical function was assessed during
the programme, at 6 months and 12 months post discharge. Three
outcome measures were included in the initial two cohorts. The Six
Minute Walk Test (6MWT) and the Incremental Shuttle Walk test
(ISWT) were chosen as they have been used within the critical care
follow up setting (2). The Chester Step Test (CST) is widely thought
to be a good indicator of ability to return to work (one of the programmes
primary aims). Ethics approval was waived as the
programme was part of a quality improvement initiative.
Results: Data was collected for the initial patients attending the
programme (n = 13), median age was 52 (IQR = 38-72), median ICU
LOS was 19 days (IQR = 4-91), median APACHE II was 23 (IQR = 19-41)
and 11 were men. One patient was so physically debilitated that the
CST or ISWT could not be completed however a score was achieved
using the 6MWT. Another patient almost failed to achieve level 1 of
the ISWT. Subsequent patients for this project (total n = 47) have all
therefore been tested using the 6MWT. Good inter-rater and intrarater
reliability and validity have been reported for the 6MWT (3).
Conclusions: Exercise capacity measurement is not achievable for
some patients with either the ISWT or the CST due to the severity of
their physical debilitation. Anxiety, post-traumatic stress disorder and
depression are common psychological problems post discharge (4),
therefore using a test with a bleep is not appropriate. Therefore, the 6MWT is the most appropriate physical outcome measure to be used
with critical care patients post discharge
Classification of pain and its treatment at an intensive care rehabilitation clinic
Introduction
Treatment in an Intensive Care Unit (ICU) often necessitates uncomfortable
and painful procedures for patients throughout their admission.
There is growing evidence to suggest that chronic pain is
becoming increasingly recognised as a long term problem for patients
following an ICU admission [1]. Intensive Care Syndrome: Promoting
Independence and Return to Employment (InS:PIRE) is a five
week rehabilitation programme for patients and their caregivers after
ICU discharge at Glasgow Royal Infirmary. This study investigated the
incidence and location of chronic pain in patients discharged from ICU
and classified the analgesics prescribed according to the World Health
Organization analgesic
Methods
The InS:PIRE programme involved individual sessions for patients and
their caregivers with a physiotherapist and a pharmacist along with
interventions from medical, nursing, psychology and community services.
The physiotherapist documented the incidence and pain location
during the assessment. The pharmacist recorded all analgesic medications
prescribed prior to admission and at their clinic visit. The patient’s
analgesic medication was classified according to the WHO pain ladder
from zero to three, zero being no pain medication and three being
treatment with a strong opioid. Data collected was part of an evaluation
of a quality improvement initiative, therefore ethics approval was
waived.
Results
Data was collected from 47 of the 48 patients who attended the rehabilitation
clinic (median age was 52 (IQR, 44-57) median ICU LOS
was 15 (IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of
the patients were men (67 %)). Prior to admission to ICU 43 % of patients
were taking analgesics and this increased to 81 % at the time
of their clinic visit. The number of patients at step two and above on
the WHO pain ladder also increased from 34 % to 56 %.
Conclusions
Of the patients seen at the InS:PIRE clinic two-thirds stated that they
had new pain since their ICU admission. Despite the increase in the
number and strength of analgesics prescribed, almost a quarter of
patients still complained of pain at their clinic visit. These results confirm
that pain continues to be a significant problem in this patient
group. Raising awareness in primary care of the incidence of chronic
pain and improving its management is essential to the recovery
process following an ICU admission
A critical and empirical analysis of the national-local ‘gap’in public responses to large-scale energy infrastructures
This is the author accepted manuscript. The final version is available from Taylor & Francis (Routledge) via the DOI in this record.A national-local ‘gap’ is often used as the starting point for analyses of public responses to large scale energy infrastructures. We critique three assumptions found in that literature: the public's positive attitudes, without further examining other type of perceptions at a national level; that local perceptions are best examined through a siting rather than place-based approach; that a gap exists between national and local responses, despite a non-correspondence in how these are examined. Survey research conducted at national and local levels about electricity transmission lines in the UK confirm these criticisms. Results do not support a gap between national and local levels; instead, both differences and similarities were found. Results show the value of adopting a place-based approach and the role of surveys to inform policy making are discussed.This research was supported by the Research Council of Norway (SusGrid Grant No. 207774) and
the Engineering and Physical Sciences Research Council (FlexNet: EP/EO4011X/1). The authors
would also like to acknowledge the beneficial comments and advice of their colleagues at the
Environment and Sustainability Research Group, Geography, University of Exeter, regarding previous
versions of this paper, as well as the helpful comments of the three anonymous reviewers that
commented on it. Thanks are also due to colleagues from the SusGrid project, specifically Audun
Ruud and Oystein Aas, and the participants in the research, for their contributions to this paper
Pharmacy intervention at an intensive care rehabilitation clinic
Introduction: During an intensive care stay, patients often have their
chronic medications withheld for a variety of reasons and new drugs
commenced [1]. As patients are often under the care of a number of
different medical teams during their admission there is potential for
these changes to be inadvertently continued [2]. Intensive Care Syndrome:
Promoting Independence and Return to Employment (InS:PIRE)
is a five week rehabilitation programme for patients and their
caregivers after ICU (Intensive Care Unit) discharge at Glasgow Royal
Infirmary. Within this programme a medication review by the critical
care pharmacist provided an opportunity to identify and resolve any
pharmaceutical care issues and also an opportunity to educate patients
and their caregivers about changes to their medication.
Methods: During the medication review we identified ongoing
pharmaceutical care issues which were communicated to the patient’s
primary care physician (GP) by letter or a telephone call. The patients
were also encouraged to discuss any issues raised with their GP. The
significance of the interventions was classified from those not likely to
be of clinical benefit to the patient, to those which prevented serious
therapeutic failure.
Results: Data was collected from 47 of the 48 patients who attended
the clinic (median age was 52 (IQR, 44-57) median ICU LOS was 15
(IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of the patients
were men (67%). The pharmacist made 69 recommendations;
including 20 relating to drugs which had been withheld and not
restarted, dose adjustments were suggested on 13 occasions and
new drug recommendations were made for 10 patients. Duration of treatment for new medications started during hospital admission
was clarified on 12 occasions. Lastly adverse drug effects were reported
on 4 occasions and the incorrect drug was prescribed on 2
occasions. Of the interventions made 58% were considered to be of
moderate to high impact.
Conclusions: The pharmacist identified pharmaceutical care issues
with 18.6% of the prescribed medications. Just over half of the patients
reported that they were not made aware of any alterations to
their prescribed medication on discharge. Therefore a pharmacy
intervention is an essential part of an intensive care rehabilitation
programme to address any medication related problems, provide
education and to ensure patients gain optimal benefit from their
medication
Cost and cost effectiveness of Herpes simplex virus-type 2 (hsv-2) suppressive therapy in HIV-1 and HSV-2 infected women in Johannesburg, South Africa
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