Perceived Barriers of Early Mobilization in the Intensive Care Unit

Purpose Early mobilization of Intensive Care Unit (ICU) patients can improve patient outcomes but also includes barriers to implementation. Nebraska Medicine has continued to have ongoing quality improvement initiatives like the ABCDEF liberation bundles and early mobilization that have been attempted but have never fully come to fruition. This project surveys Nebraska Medicines ICUs staff to better understand attitudes, knowledge and behavior regarding early mobilization using a validated tool. The aim was to identify barriers, so the organization could better understand the needs of ICU staff for future implementations of early mobility and related assessment tools. Materials and Methods A systematic literature was conducted in MEDLINE, EMBASE, and CINHAL for systematic reviews, meta-analysis, and randomized control trials (RCTs) related to early mobilization of ICU patients. The literature review included data on interventions, improved outcomes, mobility tools used, and surveys to identify existing barriers. A survey created by Johns Hopkins Medicine, Patient Mobilization Attitudes and Beliefs in the ICU (PMABS-ICU) was selected for this project. An invitation to participate in this survey was sent out through email to ICU register nurses (RNs) and patient care technicians (PCTs) in all five ICUs at Nebraska Medicine. Additionally, informational fliers were posted throughout each unit. The survey included 27 questions and an open-ended free text portion for comments. Using SPSS 28.0, the survey results were examined for total score and subscales of knowledge, attitudes, and behaviors. Differences in scores by years of work experience and assigned ICU were examined. Results The survey had a response rate of 18.5% (70/378). Of the 70 respondents, 61 were RNs and 9 were PCTs. The survey showed validity and internal consistency with Cronbach α of 0.845 for the total score and subscales being 0.610 for the knowledge subscale, 0.752 for attitudes, and 0.713 for behaviors. One-way ANOVA testing revealed no significant difference in total or any subscale score based on years of experience. There were no significant differences in knowledge subscale scores between units. However, there were significant differences for total score, attitude, and behavioral subscale scores when responses were grouped by unit. The Bonferroni Post Hoc test showed there was no difference between the total scores and subscales in the Cardiovascular Intensive Care Unit (CVICU) and Werner Intensive Care Unit (WICU), whereas Medical Intensive Care Unit (MICU), Neuroscience Intensive Care Unit (NSICU), and Surgical Intensive Care Unit (SICU) had no difference from one another in the total scores nor in the subscales. Both CVICU and WICU were significantly different when each was compared to MICU, NSICU or SICU for attitude subscale scores. The common themes from the qualitative responses include patient safety concerns, staffing constraints, and time and complexity of patients. Conclusion The survey results can be summed up into 3 different themes: Concerns about patient safety, staffing, and time needed with the complexity of ICU patients. Each unit has its own identity, expectations, and challenges. The results of the survey indicate that there was no difference between units when it comes to knowledge, but prior to implementing an early mobility protocol, the units need to address potential barriers related to attitudes and behaviors as well as the specific barriers identified in free text comments. Addressing perceived barriers now with evidence-based strategies will facilitate implementation of the early mobilization protocols in ICUs

Drumming in time is easy: social bonding effects of synchrony arise from reduced cognitive load

The synchrony-bonding effect has often been observed, but the mechanisms behind it remain poorly understood. Numerous possible mechanisms have been proposed, however simple perceptual processing explanations have been largely ignored. The present study tested a theory based on processing fluency across two controlled experiments. In the first study, 104 participants completed a drumming task in a within-subjects design in which they also completed a secondary visual attention task. We found that when drumming in non-synchrony, performance was worse on the secondary task, indicating increased cognitive load. In the second study, 82 participants performed a similar drumming task, however instead of the secondary task they were asked to self- report how difficult they found the tapping task and how much they liked the person they were drumming with. Participants reported that drumming in synchrony felt easier and produced greater feelings of social connection than drumming out of synchrony. Taken together, these studies suggest that synchrony may promote processing fluency, which in turn leads to prosocial effects

Dual therapy strategies for COPD: the scientific rationale for LAMA + LABA

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and health care expenditure worldwide. Relaxation of airway smooth muscle with inhaled bronchodilators is the cornerstone of treatment for stable COPD, with inhaled corticosteroids reserved for those with a history of exacerbations. Tiotropium has occupied center stage in COPD treatment for over 10 years and improves lung function, quality of life, exercise endurance, and reduces the risk of COPD exacerbation. Long-acting β2-agonists (LABAs) improve lung function, reduce dynamic hyperinflation, increase exercise tolerance, health-related quality of life, and reduce acute exacerbation of COPD. The combination of long-acting muscarinic antagonists (LAMAs) and LABAs is thought to leverage different pathways to induce bronchodilation using submaximal drug doses, increasing the benefits and minimizing receptor-specific side effects. Umeclidinium/vilanterol is the first combination of LAMA/LABA to be approved for use in stable COPD in USA and Europe. Additionally, indacaterol/glycopyrronium and aclidinium/formoterol have been approved in Europe and in numerous locations outside USA. Several other agents are in the late stages of development, most of which offer once-daily dosing. The benefits of new LAMA/LABA combinations include improved pulmonary function, dyspnea, and health-related quality of life, and in some cases, reduced exacerbations. These evolving treatments will provide new opportunities and challenges in the management of COPD

Using prediction markets and Twitter to predict a swine flu pandemic

We explore the hypothesis that social media such as Twitter encodes the belief of a large number of people about some concrete statement about the world. Here, these beliefs are aggregated using a Prediction Market specifically concerning the possibility of a Swine Flu Pandemic in 2009. Using a regression framework, we are able to show that simple features extracted from Tweets can reduce the error associated with modelling these beliefs. Our approach is also shown to outperform some baseline methods based purely on time-series information from the Market.

Chronic Social Defeat Alters Brain Vascular-Associated Cell Gene Expression Patterns Leading to Vascular Dysfunction and Immune System Activation

Brain vascular integrity is critical for brain health, and its disruption is implicated in many brain pathologies, including psychiatric disorders. Brain-vascular barriers are a complex cellular landscape composed of endothelial, glial, mural, and immune cells. Yet currently, little is known about these brain vascular-associated cells (BVACs) in health and disease. Previously, we demonstrated that 14 days of chronic social defeat (CSD), a mouse paradigm that produces anxiety and depressive-like behaviors, causes cerebrovascular damage in the form of scattered microbleeds. Here, we developed a technique to isolate barrier-related cells from the mouse brain and subjected the isolated cells to single-cell RNA sequencing. Using this isolation technique, we found an enrichment in BVAC populations, including distinct subsets of endothelial and microglial cells. In CSD compared to non-stress, home-cage control, differential gene expression patterns disclosed biological pathways involving vascular dysfunction, vascular healing, and immune system activation. Overall, our work demonstrates a unique technique to study BVAC populations from fresh brain tissue and suggests that neurovascular dysfunction is a key driver of psychosocial stress-induced brain pathology

The effect of autograft type on progression of phase-specific loading asymmetries in the counter-movement jump from six to nine months post-ACLR

Hamstring tendon (HT) and bone-patellar tendon-bone autografts are associated with different strength and jump impulse asymmetries after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate graft-specific effects on changes in isokinetic strength and bilateral countermovement jump (CMJ) phase-specific impulse asymmetries during late-stage rehabilitation post-ACLR. Male athletes (n=44) with either a HT or BPTB autograft completed testing at 6 and 9 months post-surgery. Autograft type did not influence progression of isokinetic strength, eccentric deceleration or concentric impulse asymmetry. Asymmetries in concentric impulse, knee flexor strength and knee extensor strength decreased over the three-month period. Changes in strength asymmetry had little or no ability to explain changes in jump impulse asymmetry

Divergent trends in ecosystem services under different climate-management futures in a fire-prone forest landscape

While ecosystem services and climate change are often examined independently, quantitative assessments integrating these fields are needed to inform future land management decisions. Using climate-informed state-and-transition simulations, we examined projected trends and trade-offs for a suite of ecosystem services under four climate change scenarios and two management scenarios (active management emphasizing fuel treatments and no management other than fire suppression) in a fire-prone landscape of dry and moist mixed-conifer forests in central Oregon, USA. Focal ecosystem services included fire potential (regulating service), timber volume (provisioning service), and potential wildlife habitat (supporting service). Projections without climate change suggested active management in dry mixed-conifer forests would create more open forest structures, reduce crown fire potential, and maintain timber stocks, while in moist mixed-conifer forests, active management would reduce crown fire potential but at the expense of timber stocks. When climate change was considered, however, trends in most ecosystem services changed substantially, with large increases in wildfire area predominating broad-scale trends in outputs, regardless of management approach (e.g., strong declines in timber stocks and habitat for closed-forest wildlife species). Active management still had an influence under a changing climate, but as a moderator of the strong climate-driven trends rather than being a principal driver of ecosystem service outputs. These results suggest projections of future ecosystem services that do not consider climate change may result in unrealistic expectations of benefits