A fine balance and a shared learning journey: Exploring healthcare engagement through the experiences of youth with neuromuscular disorders

BACKGROUND: Youth with Neuromuscular Disorders (NMD) who are wheelchair users can now survive well into adulthood if their multisystem comorbidities are prudently managed. Uptake of health behaviors may optimize their health outcomes. OBJECTIVE: To explore youths’ perceptions of health, health behaviors and healthcare engagement. METHODS: This qualitative study purposefully recruited 11 youth with NMD from a concurrent, population-based study for variability of age, gender, type of NMD and their ratings of motivation and engagement. Interview data were analyzed and synthesized by thematic content. RESULTS: Participants perceived healthcare engagement as being given tools (knowledge and responsibility) and using them to maintain their finely balanced health. Nested in adequate social, emotional and physical support, they took responsibility for creatively integrating health behaviors they felt were informed by credible knowledge, gained primarily through personal experience. CONCLUSION: Cognizant of their compromised health, youth with NMD in this study were motivated to maintain their physical health. Limited NMD condition specific knowledge challenged youths’ uptake of health behaviors. They valued a learning partnership with their healthcare professionals. By embracing the youth’s experience based knowledge and through facilitating supportive relationships, healthcare professionals co-construct youth’s healthcare engagement that may optimize health behaviors and outcomes

High strain rate properties of a near equi-atomic NiTi shape memory alloy

The effects of strain rate and testing temperature on the mechanical response of a near equi-atomic NiTi alloy have been investigated. All experiments have been conducted in compression, at testing temperatures of room .temperature (-20°C), 30°C, 40°C and 50°C. Quasi-static experiments were performed using a Hounsfield HK50 universal testing machine, and high strain rate measurements were obtained using the split Hopkinson pressure bar technique. The primary differences in the behaviour of the material within these deformation rate regimes appeared to be the presence of a possible transformation inhibition mechanism that occurs for high rates of strain, which manifests itself as an accommodation of applied load after the onset of transformation, increased strain rate sensitivity at high rates, and temperature dependence not evident at low rates. Initial material characterisation was achieved' through microhardness testing, DSC, DMTA, X-ray and electron diffraction, resulting in clarification of the transformation temperatures, martensitic volume fraction and microstructure of the alloy. A post experiment X -ray investigation was also performed in order to establish the microstructural response of the material to deformation. From the stress-strain data collected, the strain rate sensitivity and entropy of transformation of the alloy have been calculated. The application of a standard Arrhenius type equation has also been attempted, in order to estimate the material parameters of activation volume, and the free energy of transformation in the absence of stress. This model was found to be reasonably representative of the response of the alloy, although the results calculated demonstrated a high degree of intrinsic error.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Towards the production of radiotherapy treatment shells on 3D printers using data derived from DICOM CT and MRI: preclinical feasibility studies

Background: Immobilisation for patients undergoing brain or head and neck radiotherapy is achieved using perspex or thermoplastic devices that require direct moulding to patient anatomy. The mould room visit can be distressing for patients and the shells do not always fit perfectly. In addition the mould room process can be time consuming. With recent developments in three-dimensional (3D) printing technologies comes the potential to generate a treatment shell directly from a computer model of a patient. Typically, a patient requiring radiotherapy treatment will have had a computed tomography (CT) scan and if a computer model of a shell could be obtained directly from the CT data it would reduce patient distress, reduce visits, obtain a close fitting shell and possibly enable the patient to start their radiotherapy treatment more quickly. Purpose: This paper focuses on the first stage of generating the front part of the shell and investigates the dosimetric properties of the materials to show the feasibility of 3D printer materials for the production of a radiotherapy treatment shell. Materials and methods: Computer algorithms are used to segment the surface of the patient’s head from CT and MRI datasets. After segmentation approaches are used to construct a 3D model suitable for printing on a 3D printer. To ensure that 3D printing is feasible the properties of a set of 3D printing materials are tested. Conclusions: The majority of the possible candidate 3D printing materials tested result in very similar attenuation of a therapeutic radiotherapy beam as the Orfit soft-drape masks currently in use in many UK radiotherapy centres. The costs involved in 3D printing are reducing and the applications to medicine are becoming more widely adopted. In this paper we show that 3D printing of bespoke radiotherapy masks is feasible and warrants further investigation

Investigating falls in adults with intellectual disability living in community settings and their experiences of post-fall care services: Protocol for a prospective observational cohort study

Background: Falls among older adults with intellectual disability (ID) are recognised as a serious health problem potentially resulting in reduced health-related quality of life and premature placement in residential care. However there are limited studies that have investigated this problem and thus falls rates among older adults with ID remain uncertain. Furthermore, people with ID rely heavily on familial and professional care support to address health problems, such as after having a fall. No studies have explored the post-fall care that people with ID receive. Method: This research will be carried out in two phases using a convergent mixed methods design. The aim of Phase 1 is to estimate the falls rate by prospectively observing a cohort of older adults (≥ 35 years) with ID (n = 90) for six months. Phase 1 will be conducted according to STROBE guidelines. In Phase 2, participants from Phase 1 who have experienced a fall(s) will be asked to participate in a semi-structured interview to explore their post-fall experience. Discussion: This study will determine the rate of falls among older adults with ID living in community based settings, which will assist to identify the extent of this problem. Data collected from the study will also aid in understanding the circumstance of falls and related falls risk factors in this cohort. This will include exploring any barriers that older adults with ID may encounter when seeking or undertaking recommended post-fall care advice. Findings from this research will potentially inform future development of falls prevention services for older adults with ID. This study has been approved by the University Human Research Ethics Committee. Trial registration: The protocol for this study is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12615000926538) on 7 September 2015. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368990&isReview=tru

Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults

Introduction: The aim of this study was to develop consensus recommendations on safety parameters for mobilizing adult, mechanically ventilated, intensive care unit (ICU) patients. Methods: A systematic literature review was followed by a meeting of 23 multidisciplinary ICU experts to seek consensus regarding the safe mobilization of mechanically ventilated patients. Results: Safety considerations were summarized in four categories: respiratory, cardiovascular, neurological and other. Consensus was achieved on all criteria for safe mobilization, with the exception being levels of vasoactive agents. Intubation via an endotracheal tube was not a contraindication to early mobilization and a fraction of inspired oxygen less than 0.6 with a percutaneous oxygen saturation more than 90% and a respiratory rate less than 30 breaths/minute were considered safe criteria for in- and out-of-bed mobilization if there were no other contraindications. At an international meeting, 94 multidisciplinary ICU clinicians concurred with the proposed recommendations. Conclusion: Consensus recommendations regarding safety criteria for mobilization of adult, mechanically ventilated patients in the ICU have the potential to guide ICU rehabilitation whilst minimizing the risk of adverse events

Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control

Journal ArticleReviewSCOPUS: re.jinfo:eu-repo/semantics/publishe

The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: a prospective cohort study

BackgroundThere are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months.MethodsIn a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM.ResultsOf 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51–70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06–13.77]; p TM utility score (MD, − 0.19 [− 0.28 to − 0.10]; p ConclusionsAt six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning

Thelypteris palustris

Pteridophyte