Protocol for a mixed-methods exploratory investigation of care following intensive care discharge: the REFLECT study

© Author(s) 2019. Re-use permitted under CC BY. Published by BMJ.INTRODUCTION: A substantial number of patients discharged from intensive care units (ICUs) subsequently die without leaving hospital. It is unclear how many of these deaths are preventable. Ward-based management following discharge from ICU is an area that patients and healthcare staff are concerned about. The primary aim of REFLECT (Recovery Following Intensive Care Treatment) is to develop an intervention plan to reduce in-hospital mortality rates in patients who have been discharged from ICU. METHODS AND ANALYSIS: REFLECT is a multicentre mixed-methods exploratory study examining ward care delivery to adult patients discharged from ICU. The study will be made up of four substudies. Medical notes of patients who were discharged from ICU and subsequently died will be examined using a retrospective case records review (RCRR) technique. Patients and their relatives will be interviewed about their post-ICU care, including relatives of patients who died in hospital following ICU discharge. Staff involved in the care of patients post-ICU discharge will be interviewed about the care of this patient group. The medical records of patients who survived their post-ICU stay will also be reviewed using the RCRR technique. The analyses of the substudies will be both descriptive and use a modified grounded theory approach to identify emerging themes. The evidence generated in these four substudies will form the basis of the intervention development, which will take place through stakeholder and clinical expert meetings. ETHICS AND DISSEMINATION: Ethical approval has been obtained through the Wales Research and Ethics Committee 4 (17/WA/0107). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER: ISRCTN14658054.Peer reviewedFinal Published versio

Paroles gelées

The transmission of Occitan lyric corpus was strongly mediated by the concerns of the compilers of troubadour lyric manuscripts. This hermeneutic framing, in which the prose biographies known as vidas and razos played a significant role, aimed to create a tradition of written authority for the vernacular language of the songs. In this article, I look at how the troubadour biographies construct an impersonal voice of written commentary around the performative voice of troubadour song, inviting contemporary and future readers to validate the cultural project of authorising the vernacular.La conception que nous avons de la lyrique occitane doit beaucoup aux compilateurs et commentateurs des chansons des troubadours, et les textes biographiques que l’on appelle vidas et razos revêtent une importance particulière pour l’orientation de la culture troubadouresque. En effet, les auteurs de ces textes ont créé un cadre herméneutique qui visait la création d’une écriture vernaculaire placée sous le signe de l’auctoritas. Dans cet article, nous analysons les procédés de cette démarche, en prêtant attention au sort subi dans les biographies par la voix performative de la chanson troubadouresque, qui se retrouve effacée au profit de la voix impersonnelle du commentateur, ancrée dans l’espace de l’écriture. Le manuscrit s’ouvre ainsi à la postérité, en demandant au lecteur à venir de participer à “l’auctorisation” de la langue vernaculaire

Paroles gelées

The transmission of Occitan lyric corpus was strongly mediated by the concerns of the compilers of troubadour lyric manuscripts. This hermeneutic framing, in which the prose biographies known as vidas and razos played a significant role, aimed to create a tradition of written authority for the vernacular language of the songs. In this article, I look at how the troubadour biographies construct an impersonal voice of written commentary around the performative voice of troubadour song, inviting contemporary and future readers to validate the cultural project of authorising the vernacular.La conception que nous avons de la lyrique occitane doit beaucoup aux compilateurs et commentateurs des chansons des troubadours, et les textes biographiques que l’on appelle vidas et razos revêtent une importance particulière pour l’orientation de la culture troubadouresque. En effet, les auteurs de ces textes ont créé un cadre herméneutique qui visait la création d’une écriture vernaculaire placée sous le signe de l’auctoritas. Dans cet article, nous analysons les procédés de cette démarche, en prêtant attention au sort subi dans les biographies par la voix performative de la chanson troubadouresque, qui se retrouve effacée au profit de la voix impersonnelle du commentateur, ancrée dans l’espace de l’écriture. Le manuscrit s’ouvre ainsi à la postérité, en demandant au lecteur à venir de participer à “l’auctorisation” de la langue vernaculaire

How Powerful Was the National Policy? The Lesson of the Cotton Mills

Historians have claimed that Canadian manufacturing grew in the nineteenth century largely because of the National Policy tariff. In the case of the cotton textile sector,  our findings cast serious doubt on the long-standing idea that the National Policy was indispensable to the growth of Canadian manufacturing before WWI

Helping the Parents of Middle School Students Communicate Biblical Truths of Sexuality at the First Baptist Church of Lenoir, North Carolina

An educational program was developed to discover the role of the church in promoting healthy parent/child communication about sexuality. Believing scripture affirms sexuality as a blessing from God, parents and middle school youth were recruited and led through the study. Surveys measured attitudes, opinions, and understanding of biblical knowledge, anatomy, and communication levels. After the program the families were given two months to observe parent/child communication. Final surveys indicated that the church can play an active role in promoting parent child communication about sexuality, and participants reflected a positive outcome by recommending the continuation of this program as a part of the on-going youth ministry of the church. Detail

Evidence for shape coexistence in 98^{98}Mo

A $\gamma\gamma$ angular correlation experiment has been performed to investigate the low-energy states of the nucleus $^{98}$Mo. The new data, including spin assignments, multipole mixing ratios and lifetimes reveal evidence for shape coexistence and mixing in $^{98}$Mo, arising from a proton intruder configuration. This result is reproduced by a theoretical calculation within the proton-neutron interacting boson model with configuration mixing, based on microscopic energy density functional theory. The microscopic calculation indicates the importance of the proton particle-hole excitation across the Z=40 sub-shell closure and the subsequent mixing between spherical vibrational and the $\gamma$-soft equilibrium shapes in $^{98}$Mo.Comment: 6 pages, 5 figures, 3 tables; published in Phys. Rev.

Multi-Level Effects of Low Dose Rate Ionizing Radiation on Southern Toad, \u3cem\u3eAnaxyrus [Bufo] terrestris\u3c/em\u3e

Despite their potential vulnerability to contaminants from exposure at multiple life stages, amphibians are one of the least studied groups of vertebrates in ecotoxicology, and research on radiation effects in amphibians is scarce. We used multiple endpoints to assess the radiosensitivity of the southern toad (Anaxyrus [Bufo] terrestris) during its pre-terrestrial stages of development -embryonic, larval, and metamorphic. Toads were exposed, from several hours after oviposition through metamorphosis (up to 77 days later), to four low dose rates of 137Cs at 0.13, 2.4, 21, and 222 mGy d-1, resulting in total doses up to 15.8 Gy. Radiation treatments did not affect hatching success of embryos, larval survival, or the length of the larval period. The individual family variation in hatching success of embryos was larger than the radiation response. In contrast, newly metamorphosed individuals from the higher dose-rate treatments had higher mass and mass/length body indices, a measure which may relate to higher post-metamorphic survival. The increased mass and index at higher dose rates may indicate that the chronic, low dose rate radiation exposures triggered secondary responses. Additionally, the increases in growth were linked to a decrease in DNA damage (as measured by the Comet Assay) in red blood cells at a dose rate of 21 mGy d-1 and a total dose of 1.1 Gy. In conclusion, the complex effects of low dose rates of ionizing radiation may trigger growth and cellular repair mechanisms in amphibian larvae

A Real-time Impedance-Based Screening Assay for Drug-Induced Vascular Leakage

Vascular leakage is a serious side effect of therapies based on monoclonal antibodies or cytokines which may lead to life-threatening situations. With the steady increase of new drug development programs for large molecules, there is an urgent need for reliable tools to assess this potential liability of new medicines in a rapid and cost-effective manner. Using human umbilical vein endothelial cells (HUVECs) as a model for endothelium, we established an impedance-based assay measuring the integrity of the endothelial cell monolayer in real time. We could demonstrate that the HUVEC monolayer in our system was a relevant model as cells expressed major junctional proteins known to be responsible for maintaining tightness as well as receptors targeted by molecules known to induce vascular leakage in vivo. We assessed the time-dependent loss of barrier function using impedance and confirmed that signals obtained corresponded well to those from standard transwell assays. We assayed a series of reference molecules which led to the expected change of barrier integrity. A nonspecific cytotoxic effect could be excluded by using human fibroblasts as a nonresponder cell line. Finally, we could show reversibility of vascular permeability induced by histamine, IL-1β, or TNF-α by coincubation with established antagonists, further demonstrating relevance of this new model. Taken together, our results suggest that impedance in combination with HUVECs as a specific model can be applied to assess clinically relevant vascular leakage on an in vitro leve