The effects of chest wall loading on perceptions of fatigue, exercise performance, pulmonary function, and muscle perfusion.

BACKGROUND: Load carriage (LC), which directly affects the chest wall and locomotor muscles, has been suggested to alter the ventilatory and circulatory responses to exercise, leading to increased respiratory muscle work and fatigue. However, studies exploring the impact of LC on locomotion increased internal work, complicating their interpretation. To overcome this issue, we sought to determine the effect of chest wall loading with restriction (CWL + R) on cycling performance, cardiopulmonary responses, microvascular responsiveness, and perceptions of fatigue. METHODS: In a randomized crossover design, 23 young healthy males (22 \ub1 4 years) completed a 5 km cycling time trial (TT) in loaded (CWL + R; tightened vest with 10% body weight) and unloaded conditions. After baseline pulmonary function testing (PFT; forced expiratory volume in 1 s, FEV1; forced vital capacity, FVC), cardiopulmonary indices (HR, heart rate; O2 uptake, VO2; ventilation, VE; tidal volume, VT; and breathing frequency, Bf), rating of perceived exertion (RPE), lactate (BLa), and microvascular responses (oxy-, deoxy-, total hemoglobin; and tissue saturation; StO2) of the vastus lateralis using near infrared spectroscopy were collected during the TT; and PFT was repeated post-exercise. RESULTS: Pre-exercise, CWL + R reduced (p < 0.05) FVC (5.6 \ub1 0.8 versus 5.5 \ub1 0.7 L), FEV1 (4.8 \ub1 0.7 versus 4.7 \ub1 0.6 L), and FEV1/FVC (0.9 \ub1 0.1 versus 0.8 \ub1 0.1). CWL + R modified power output (PO) over time (interaction, p = 0.02), although the 5 km time (461 \ub1 24 versus 470 \ub1 27 seconds), VT (3.0 \ub1 0.3 versus 2.8 \ub1 0.8 L), Bf, VE, HR, VO2, microvascular and perceptual (visual analog scale, or VAS, and RPE) responses were unchanged (p > 0.05). CWL + R increased (p < 0.05) the average BLa (7.6 \ub1 2.6 versus 8.6 \ub1 3 mmol/L). CONCLUSIONS: Modest CWL + R negatively affects pre-exercise pulmonary function, modifies cycling power output over time, and increases lactate production during a 5 km cycling trial, although the cardiorespiratory, microvascular, and perceptual responses were unaffected

Ways to Reduce Peak Electrical Demand in South Louisiana

This study analyses alternatives for coping with the peak electrical demand of hot summer afternoons. Economic and Political aspects, as well as technical feasibility, are included. It is concluded that South Louisiana may indeed be able to trim peak demand to 5% below what is anticipated by 1980 , thus making one of the coal fired stations scheduled then unnecessary. However, the contingencies (Natural Gas Shortage, Another Oil Embargo) would make a coal-fired station very desirable

Estimating the risk of mortality attributable to recent late HIV diagnosis following admission to the intensive care unit: A single-centre observational cohort study

OBJECTIVES: Despite improvements in survival of people with HIV admitted to the intensive care unit (ICU), late diagnosis continues to contribute to in-ICU mortality. We quantify the population attributable fraction (PAF) of in-ICU mortality for recent late diagnosis among people with HIV admitted to a London ICU. METHODS: Index ICU admissions among people with HIV were considered from 2000 to 2019. Recent late diagnosis was a CD4 T-cell count < 350 cells/μL and/or AIDS-defining illness at/within 6 months prior to ICU admission. Univariate comparisons were conducted using Wilcoxon rank-sum/Cochran-Armitage/χ2 /Fisher's exact tests. We used Poisson regression (robust standard errors) to estimate unadjusted/adjusted (age, sex, calendar year of ICU admission) risk ratios (RRs) and regression standardization to estimate the PAF. RESULTS: In all, 207 index admissions were included [median (interquartile range) age: 46 (38-53) years; 72% male]; 58 (28%) had a recent late diagnosis, all of whom had a CD4 count < 350 cells/μL, and 95% had advanced HIV (CD4 count < 200 cells/μL and/or AIDS at admission) as compared with 57% of those who did not have a recent late diagnosis (p < 0.001). In-ICU mortality was 27% (55/207); 38% versus 22% in those who did and did not have a recent late diagnosis, respectively (p = 0.02). Recent late diagnosis was independently associated with increased in-ICU mortality risk (adjusted RR = 1.75) (95% confidence interval: 1.05-2.91), with 17.08% (16.04-18.12%) of deaths being attributable to this. CONCLUSIONS: There is a need for improved public health efforts focused on HIV testing and reporting of late diagnosis to better understand potentially missed opportunities for earlier HIV diagnosis in healthcare services

Rigor and Ethics in the World of Big-team Qualitative Data: Experiences From Research in International Development

In the large international projects where many qualitative researchers work, generating qualitative Big Data, data sharing represents the status quo. This is rarely acknowledged, even though the ethical implications are considerable and span both process and product. I argue that big-team qualitative researchers can strengthen claims to rigor in analysis (the product) by drawing on a growing body of knowledge about how to do credible secondary analysis. Since this necessitates a full account of how the research and the analysis are done (the process), I consider the structural disincentives for providing these. Debates around credibility and rigor are not new to qualitative research in international development, but they intensify when new actors such as program evaluators and quantitative researchers use qualitative methods on a large scale. In this context, I look at the utility of guidelines used by these actors to ensure the quality of qualitative research. I ask whether these offer pragmatic suggestions to improve its quality, recognizing the common and hierarchized separation between the generation and interpretation of data, or conversely, whether they set impossible standards and fail to recognize the differences between and respective strengths of qualitative and quantitative research

Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety : assessor-blind pilot comparison

Background: There are currently no field data about the effect of implementing European Working Time Directive (EWTD)-compliant rotas in a medical setting. Surveys of doctors’ subjective opinions on shift work have not provided reliable objective data with which to evaluate its efficacy. Aim: We therefore studied the effects on patient's safety and doctors’ work-sleep patterns of implementing an EWTD-compliant 48 h work week in a single-blind intervention study carried out over a 12-week period at the University Hospitals Coventry & Warwickshire NHS Trust. We hypothesized that medical error rates would be reduced following the new rota. Methods: Nineteen junior doctors, nine studied while working an intervention schedule of <48 h per week and 10 studied while working traditional weeks of <56 h scheduled hours in medical wards. Work hours and sleep duration were recorded daily. Rate of medical errors (per 1000 patient-days), identified using an established active surveillance methodology, were compared for the Intervention and Traditional wards. Two senior physicians blinded to rota independently rated all suspected errors. Results: Average scheduled work hours were significantly lower on the intervention schedule [43.2 (SD 7.7) (range 26.0–60.0) vs. 52.4 (11.2) (30.0–77.0) h/week; P < 0.001], and there was a non-significant trend for increased total sleep time per day [7.26 (0.36) vs. 6.75 (0.40) h; P = 0.095]. During a total of 4782 patient-days involving 481 admissions, 32.7% fewer total medical errors occurred during the intervention than during the traditional rota (27.6 vs. 41.0 per 1000 patient-days, P = 0.006), including 82.6% fewer intercepted potential adverse events (1.2 vs. 6.9 per 1000 patient-days, P = 0.002) and 31.4% fewer non-intercepted potential adverse events (16.6 vs. 24.2 per 1000 patient-days, P = 0.067). Doctors reported worse educational opportunities on the intervention rota. Conclusions: Whilst concerns remain regarding reduced educational opportunities, our study supports the hypothesis that a 48 h work week coupled with targeted efforts to improve sleep hygiene improves patient safety

Bacterial distribution in the lungs of children with protracted bacterial bronchitis

OBJECTIVES: Flexible bronchoscopy with bronchoalveolar lavage (FB-BAL) is increasingly used for the microbiological confirmation of protracted bacterial bronchitis (PBB) in children with a chronic wet cough. At our centre, when performing FB-BAL for microbiological diagnosis we sample 6 lobes (including lingula) as this is known to increase the rate of culture positive procedures in children with cystic fibrosis. We investigated if this is also the case in children with PBB. METHODS: We undertook a retrospective case note review of 50 children investigated for suspected PBB between May 2011 and November 2013. RESULTS: The median (IQR) age at bronchoscopy was 2.9 (1.7-4.4) years and the median (IQR) duration of cough was 11 (8.0-14) months. Positive cultures were obtained from 41/50 (82%) and 16 (39%) of these patients isolated ≥2 organisms. The commonest organisms isolated were Haemophilus influenzae (25 patients), Moraxella catarrhalis (14 patients), Staphylococcus aureus (11 patients) and Streptococcus pneumoniae (8 patients). If only one lobe had been sampled (as per the European Respiratory Society guidance) 17 different organisms would have been missed in 15 patients, 8 of whom would have had no organism cultured at all. The FB-BAL culture results led to an antibiotic other than co-amoxiclav being prescribed in 17/41 (41%) patients. CONCLUSIONS: Bacterial distribution in the lungs of children with PBB is heterogeneous and organisms may therefore be missed if only one lobe is sampled at FB-BAL. Positive FB-BAL results are useful in children with PBB and can influence treatment

Exploring rationales for branding a university: Should we be seeking to measure branding in UK universities?

Although branding is now widespread among UK universities, the application of branding principles in the higher education sector is comparatively recent and may be controversial for internal audiences who question its suitability and efficiency. This paper seeks to investigate how and whether the effectiveness of branding activity in the higher education sector should be evaluated and measured, through exploratory interviews with those who often drive it; UK University marketing professionals. Conclusions suggest that university branding is inherently complex and therefore application of commercial approaches may be over simplistic. Whilst marketing professionals discuss challenges they do not necessarily have a consistent view of the objectives of branding activity although all were able to clearly articulate branding objectives for their university, including both qualitative and, to some extent, quantitative metrics. Some measures of the real value of branding activity are therefore suggested but a key debate is perhaps whether the objectives and role of branding in higher education needs to be clarified, and a more consistent view of appropriate metrics reached? Various challenges in implementing branding approaches are also highlighted