94 research outputs found

    Getting to the Point: Walking and feeling on the shorelines of Spurn

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    Spurn is a narrow sandy spit on the Holderness coast of East Yorkshire, UK, which juts out into the mouth of the Humber Estuary, and is a place of rich ecological and historical interest. Because of its position at the boundary of river and sea, Spurn is also a landscape distinguished by its liminality and unpredictability, with recent flood events rendering it largely accessible only by foot. In the body of literature produced surrounding Spurn, there are a number of authors who write of walking with the aim of reaching the tip of the spit, Spurn Point, merging their embodied experiences of the place with reflections on their emotions and uncertainties. This paper recognises Spurn as a more-than-representational landscape (Waterton 2018) and as an affective landscape (Berberich et al. 2016), in a constant state of becoming and in which bodies affect and are affected by a range of more-than-human actors and atmospheres. The paper explores how writers use the act of ‘getting to the Point’ to negotiate questions of grief, uncertainty, memory and identity. It also considers the extent to which these texts have the potential to influence how readers connect with the landscape, and how certain evocations of Spurn can affect the meanings that people associate with the place. The paper argues that such associations, developed through the intimate encounters enabled by walking, could have a significant impact on the future management of Spurn and other similarly transient places

    The Place of Trial of Contract and Tort Actions under the Montana Venue Statutes

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    The Place of Trial of Contract and Tort Actions under the Montana Venue Statute

    A List of Rotatoria Known to Occur in Ireland with Notes on Their Habitats and Distribution

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    A total of 315 species of rotifers are known to occur in Ireland. Of these 71 belong to the Bdelloidea and 244 to the Monogononta. Three species new to Ireland are now recorded and one of them is also a new record for the British Isles. A taxonomic list of the 315 species is given together with notes on ecology, where possible, and distribution. The names of recorders are included

    Functional status in ICU survivors and out of hospital outcomes: a cohort study

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    OBJECTIVES: Functional status at hospital discharge may be a risk factor for adverse events among survivors of critical illness. We sought to examine the association between functional status at hospital discharge in survivors of critical care and risk of 90-day all-cause mortality after hospital discharge. DESIGN: Single-center retrospective cohort study. SETTING: Academic Medical Center. PATIENTS: Ten thousand three hundred forty-three adults who received critical care from 1997 to 2011 and survived hospitalization. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The exposure of interest was functional status determined at hospital discharge by a licensed physical therapist and rated based on qualitative categories adapted from the Functional Independence Measure. The main outcome was 90-day post hospital discharge all-cause mortality. A categorical risk-prediction score was derived and validated based on a logistic regression model of the function grades for each assessment. In an adjusted logistic regression model, the lowest quartile of functional status at hospital discharge was associated with an increased odds of 90-day postdischarge mortality compared with patients with independent functional status (odds ratio, 7.63 [95% CI, 3.83-15.22; p < 0.001]). In patients who had at least 7 days of physical therapy treatment prior to hospital discharge (n = 2,293), the adjusted odds of 90-day postdischarge mortality in patients with marked improvement in functional status at discharge was 64% less than patients with no change in functional status (odds ratio, 0.36 [95% CI, 0.24-0.53]; p < 0.001). CONCLUSIONS: Lower functional status at hospital discharge in survivors of critical illness is associated with increased postdischarge mortality. Furthermore, patients whose functional status improves before discharge have decreased odds of postdischarge mortality.L30 TR001257 - NCATS NIH HH

    Measuring the prevalence of intradialytic hypotension in a satellite dialysis clinic: Are we too complacent?

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    Aims and objectives To measure the prevalence of symptomatic (S‐IDH) and asymptomatic intradialytic hypotension (A‐IDH) or postdialysis overhydration in a satellite haemodialysis clinic in Western Australia. Background Intradialytic hypotension is one of the most common side effects of haemodialysis caused by ultrafiltration provoking a temporary volume depletion. The prevalence of asymptomatic hypotension during dialysis has been rarely reported, but is considered to have the same negative consequences as symptomatic hypotension on various end organs like the brain and the gastrointestinal tract. Design Observational study on a retrospective 3‐month period of nursing recorded fluid‐related adverse events. Methods Data collection on the occurrence of S‐IDH and A‐IDH during a total of 2,357 haemodialysis treatments in 64 patients. Body weight of patients at the time of cessation of treatment was recorded, and patients, whose weight exceeded their ideal body weight by at least 0.5 kg, were classified as overhydrated. Data analysis was performed using spss version 24 software. Results Symptomatic intradialytic hypotension was the most common adverse event measured in this cohort, and occurred during 221 (9.4%) of all treatments, whereas asymptomatic intradialytic hypotension occurred in 88 (3.7%) of all treatments. The total occurrence of intradialytic hypotension was 13.1%, and symptomatic was observed in 30 patients, implying that nearly every second patient had at least one symptomatic episode within 3 months. Overhydration occurred in a total of 103 (4.4%) of all treatments, and involved 17 patients. Conclusions Symptomatic and asymptomatic intradialytic hypotension were the most commonly observed adverse events in this cohort; overhydration occurrence was considerably less common. Relevance to clinical practice The high occurrence of hypotension‐related events demonstrates that ultrafiltration treatment goals in satellite dialysis clinics are sometimes overestimated, resulting in regular significant symptomatic episodes for the patient. Raising the awareness of the prevalence of IDH amongst renal nurses could be an essential initial step before collectively preventative strategies in haemodialysis satellite units are implemented

    Acute kidney disease and renal recovery : consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

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    Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of > 90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD

    Strategies to Enhance Rehabilitation after Acute Kidney Injury in the Developing World

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    Acute kidney injury (AKI) is independently associated with new onset chronic kidney disease (CKD), end-stage kidney disease, cardiovascular disease, and all-cause mortality. However, only a minority of patients receive follow-up care after an episode of AKI in the developing world, and the optimal strategies to promote rehabilitation after AKI are ill-defined. On this background, a working group of the 18th Acute Dialysis Quality Initiative (ADQI) applied the consensus-building process informed by a PubMed review of English language articles to address questions related to rehabilitation after AKI. The consensus statements propose that all patients should be offered follow-up within three months of an AKI episode, with more intense follow-up (e.g., &lt; one month) considered based upon patient risk factors, characteristics of the AKI event, and the degree of kidney recovery. Patients should be monitored for renal and non-renal events post-AKI, and we suggest the minimum level of monitoring consist of an assessment of kidney function and proteinuria within three months of the AKI episode. Care should be individualized for higher risk patients, particularly patients who are still dialysis-dependent to promote renal recovery. While evidence-based treatments for survivors of AKI are lacking and some outcomes may not be modifiable, we recommend simple interventions such as lifestyle changes, medication reconciliation, blood pressure control, and education, including the documentation of AKI on the patient’s medical record. In conclusion, survivors of AKI represent a high-risk population and these consensus statements should provide clinicians with guidance on the care of patients after an episode of AKI
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