324 research outputs found
The prevalence of hyperglycaemia and its relationship with mortality, readmissions and length of stay in an older acute surgical population : a multicentre study
Funding statement This research received no specific grant from any funding agency in the public, commercial or not-for-profit sector.Peer reviewedPostprin
Traffic Instabilities in Self-Organized Pedestrian Crowds
In human crowds as well as in many animal societies, local interactions among
individuals often give rise to self-organized collective organizations that
offer functional benefits to the group. For instance, flows of pedestrians
moving in opposite directions spontaneously segregate into lanes of uniform
walking directions. This phenomenon is often referred to as a smart collective
pattern, as it increases the traffic efficiency with no need of external
control. However, the functional benefits of this emergent organization have
never been experimentally measured, and the underlying behavioral mechanisms
are poorly understood. In this work, we have studied this phenomenon under
controlled laboratory conditions. We found that the traffic segregation
exhibits structural instabilities characterized by the alternation of organized
and disorganized states, where the lifetime of well-organized clusters of
pedestrians follow a stretched exponential relaxation process. Further analysis
show that the inter-pedestrian variability of comfortable walking speeds is a
key variable at the origin of the observed traffic perturbations. We show that
the collective benefit of the emerging pattern is maximized when all
pedestrians walk at the average speed of the group. In practice, however, local
interactions between slow- and fast-walking pedestrians trigger global
breakdowns of organization, which reduce the collective and the individual
payoff provided by the traffic segregation. This work is a step ahead toward
the understanding of traffic self-organization in crowds, which turns out to be
modulated by complex behavioral mechanisms that do not always maximize the
group's benefits. The quantitative understanding of crowd behaviors opens the
way for designing bottom-up management strategies bound to promote the
emergence of efficient collective behaviors in crowds.Comment: Article published in PLoS Computational biology. Freely available
here:
http://www.ploscompbiol.org/article/info%3Adoi%2F10.1371%2Fjournal.pcbi.100244
Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools.
BACKGROUND: There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment. METHODS: We searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach. RESULTS: We retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a 'gold standard' significantly hinders the evaluation of tools' validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations. CONCLUSIONS: There are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence
Enhanced empirical data for the fundamental diagram and the flow through bottlenecks
In recent years, several approaches for modelling pedestrian dynamics have
been proposed and applied e.g. for design of egress routes. However, so far not
much attention has been paid to their 'quantitative' validation. This
unsatisfactory situation belongs amongst others on the uncertain and
contradictory experimental data base. The fundamental diagram, i.e. the
density-dependence of the flow or velocity, is probably the most important
relation as it connects the basic parameter to describe the dynamic of crowds.
But specifications in different handbooks as well as experimental measurements
differ considerably. The same is true for the bottleneck flow. After a
comprehensive review of the experimental data base we give an survey of a
research project, including experiments with up to 250 persons performed under
well controlled laboratory conditions. The trajectories of each person are
measured in high precision to analyze the fundamental diagram and the flow
through bottlenecks. The trajectories allow to study how the way of measurement
influences the resulting relations. Surprisingly we found large deviation
amongst the methods. These may be responsible for the deviation in the
literature mentioned above. The results are of particular importance for the
comparison of experimental data gained in different contexts and for the
validation of models.Comment: A contribution to: Pedestrian and Evacuation Dynamics 2008 (Springer)
12 pages, 7 figure
Feasibility of trial procedures for a randomised controlled trial of a community based group exercise intervention for falls prevention for visually impaired older people: the VIOLET study
Background Visually impaired older people (VIOP) have a higher risk of falling than their sighted peers, and are likely to avoid physical activity. The aim was to adapt the existing Falls Management Exercise (FaME) programme for VIOP, delivered in the community, and to investigate the feasibility of conducting a definitive randomised controlled trial (RCT) of this adapted intervention. Methods Two-centre randomised mixed methods pilot trial and economic evaluation of the adapted group-based FaME programme for VIOP versus usual care. A one hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle and Glasgow), delivered by third sector (voluntary and community) organisations. Participants were advised to exercise at home for an additional two hours over the week. Those randomised to the usual activities group received no intervention. Outcome measures were completed at baseline, 12 and 24 weeks. The potential primary outcome was the Short Form Falls Efficacy Scale – International (SFES-I). Participants’ adherence was assessed by reviewing attendance records and self-reported compliance to the home exercises. Adherence with the course content (fidelity) by instructors was assessed by a researcher. Adverse events were collected in a weekly phone call. Results Eighteen participants, drawn from community-living VIOP were screened; 68 met the inclusion criteria; 64 participants were randomised with 33 allocated to the intervention and 31 to the usual activities arm. 94% of participants provided data at the 12 week visit and 92% at 24 weeks. Adherence was high. The intervention was found to be safe with 76% attending nine or more classes. Median time for home exercise was 50 min per week. There was little or no evidence that fear of falling, balance and falls risk, physical activity, emotional, attitudinal or quality of life outcomes differed between trial arms at follow-up. Conclusions The intervention, FaME, was implemented successfully for VIOP and all progression criteria for a main trial were met. The lack of difference between groups on fear of falling was unsurprising given it was a pilot study but there may have been other contributory factors including suboptimal exercise dose and apparent low risk of falls in participants. These issues need addressing for a future trial
Pedestrian, Crowd, and Evacuation Dynamics
This contribution describes efforts to model the behavior of individual
pedestrians and their interactions in crowds, which generate certain kinds of
self-organized patterns of motion. Moreover, this article focusses on the
dynamics of crowds in panic or evacuation situations, methods to optimize
building designs for egress, and factors potentially causing the breakdown of
orderly motion.Comment: This is a review paper. For related work see http://www.soms.ethz.c
Characteristics of outdoor falls among older people: A qualitative study
Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people
Preoperative cardiac risk assessment in geriatric patients with hip fractures: an orthopedic surgeons’ perspective
Hip fracture is one of the most common orthopedic conditions and is associated with significant morbidity and mortality. With a progressively aging population, the annual incidence of hip fracture is expected to increase substantially. Emerging evidence suggests that early surgery (<24 h) minimizes complications secondary to immobilization, including orthostatic pneumonia and venous thromboembolism. Delayed surgical repair (>48 h) has been consistently demonstrated to be associated with an increased risk of 30-day and 1-year mortality. Nonetheless, early surgery necessitates a shorter time for preoperative medical preparation, in particular cardiac assessment. Patients who undergo emergent orthopedic surgery are therefore at greater risk of perioperative cardiac events than those who undergo elective surgery. In addition, the prompt triage system for preoperative cardiac assessment not only identifies patients at high risk of perioperative cardiac complications but also reduces unnecessary cardiac consultations for low-risk patients. We review the current recommendations for preoperative cardiac assessment adapted for patients with hip fracture and describe our current triage system for preoperative cardiac consultation
Modeling, Evaluation, and Scale on Artificial Pedestrians: A Literature Review
Modeling pedestrian dynamics and their implementation in a computer are challenging and important issues in the knowledge areas of transportation and computer simulation. The aim of this article is to provide a bibliographic outlook so that the reader may have quick access to the most relevant works related to this problem. We have used three main axes to organize the article's contents: pedestrian models, validation techniques, and multiscale approaches. The backbone of this work is the classification of existing pedestrian models; we have organized the works in the literature under five categories, according to the techniques used for implementing the operational level in each pedestrian model. Then the main existing validation methods, oriented to evaluate the behavioral quality of the simulation systems, are reviewed. Furthermore, we review the key issues that arise when facing multiscale pedestrian modeling, where we first focus on the behavioral scale (combinations of micro and macro pedestrian models) and second on the scale size (from individuals to crowds). The article begins by introducing the main characteristics of walking dynamics and its analysis tools and concludes with a discussion about the contributions that different knowledge fields can make in the near future to this exciting area
Evaluation of the safety and efficacy of pregabalin in older patients with neuropathic pain: results from a pooled analysis of 11 clinical studies
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