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

Measurements of magnetic circuit characteristics for comprehension of intrinsic magnetic properties of materials from surface inspection

A transfer function is presented for calculating magnetic field and flux density inside a test material as a result of surface measurement. By considering flux leakage, we introduce a parameter η, called the leakage coefficient, which can be experimentally determined. It is introduced into the equations to make the transfer function more practical. The distribution of field inside a test material is then discussed in accordance with a surfacemagnetic charge model

Breather turbulence versus soliton turbulence: Rogue waves, probability density functions, and spectral features

10 págs.; 12 figs.Turbulence in integrable systems exhibits a noticeable scientific advantage: it can be expressed in terms of the nonlinear modes of these systems. Whether the majority of the excitations in the system are breathers or solitons defines the properties of the turbulent state. In the two extreme cases we can call such states >breather turbulence> or >soliton turbulence.> The number of rogue waves, the probability density functions of the chaotic wave fields, and their physical spectra are all specific for each of these two situations. Understanding these extreme cases also helps in studies of mixed turbulent states when the wave field contains both solitons and breathers, thus revealing intermediate characteristics. ©2016 American Physical SocietyThe authors acknowledge the support from the Volkswagen Stiftung. The work of JMSC was also supported by MINECO under Contract No. TEC2015-71127-C2-1-R, and by C.A.M. under Contract No. S2013/MIT-2790. N.D. and N.A. acknowledge support of the Australian Research Council (Discovery Project No. DP140100265).Peer Reviewe

Does tiny-scale atomic structure exist in the interstellar medium ?

We report on preliminary results from the recent multi-epoch neutral hydrogen absorption measurements toward three pulsars, B0823+26, B1133+16 and B2016+28, using the Arecibo telescope. We do not find significant variations in optical depth profiles over periods of 0.3 and 9--10 yr, or on spatial scales of 10--20 and 70--85 AU. The large number of non detections of the tiny scale atomic structure suggests that the AU-sized structure is not ubiquitous in the interstellar medium and could be quite a rare phenomenon.Comment: Accepted by ApJ Letters, 5 pages, 2 figure

Ibuprofen Ameliorates Fatigue- And Depressive-Like Behavior in Tumor-Bearing Mice

Aims: Cancer-related fatigue (CRF) is often accompanied by depressed mood, both of which reduce functional status and quality of life. Research suggests that increased expression of pro-inflammatory cytokines is associated with skeletal muscle wasting and depressive- and fatigue-like behaviors in rodents and cancer patients. We have previously shown that treatment with ibuprofen, a nonsteroidal anti-inflammatory drug, preserved muscle mass in tumor-bearing mice. Therefore, the purpose of the present study was to determine the behavioral effects of ibuprofen in a mouse model of CRF. Main methods: Mice were injected with colon-26 adenocarcinoma cells and treated with ibuprofen (10 mg/kg) in the drinking water. Depressive-like behavior was determined using the forced swim test (FST). Fatigue-like behaviors were determined using voluntary wheel running activity (VWRA) and grip strength. The hippocampus, gastrocnemius muscle, and serum were collected for cytokine analysis. Key findings: Tumor-bearing mice showed depressive-like behavior in the FST, which was not observed in mice treated with ibuprofen. VWRA and grip strength declined in tumor-bearing mice, and ibuprofen attenuated this decline. Tumor-bearing mice had decreased gastrocnemius muscle mass and increased expression of IL-6, MAFBx and MuRF mRNA, biomarkers of protein degradation, in the muscle. Expression of IL-1β and IL-6 was also increased in the hippocampus. Treatment with ibuprofen improved muscle mass and reduced cytokine expression in both the muscle and hippocampus of tumor-bearing mice. Significance: Ibuprofen treatment reduced skeletal muscle wasting, inflammation in the brain, and fatigue- and depressive-like behavior in tumor-bearing mice. Therefore, ibuprofen warrants evaluation as an adjuvant treatment for CRF