691 research outputs found
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Early in-bed cycling versus usual care in the ICU on muscle atrophy and mobility: A randomized trial
Combatting electoral traces: the Dutch tempest discussion and beyond
In the Dutch e-voting debate, the crucial issue leading to the abandonment of all electronic voting machines was compromising radiation, or tempest. Other countries, however, do not seem to be bothered by this risk. In this paper, we use actor-network theory to analyse the socio-technical origins of the Dutch tempest issue in e-voting, and its consequences for e-voting beyond the Netherlands. We introduce the term electoral traces to denote any physical, digital or social evidence of a voter's choices in an election. From this perspective, we provide guidelines for risk analysis as well as an overview of countermeasures
The golden circle: A way of arguing and acting about technology in the London ambulance service
This paper analyses the way in which the London Ambulance Service recovered from the events of October 1992, when it implemented a computer-aided despatch system (LASCAD) that remained in service for less than two weeks. It examines the enactment of a programme of long-term organizational change, focusing on the implementation of an alternative computer system in 1996. The analysis in this paper is informed by actor-network theory, both by an early statement of this approach developed by Callon in the sociology of translation, and also by concepts and ideas from Latour’s more recent restatement of his own position. The paper examines how alternative interests emerged and were stabilized over time, in a way of arguing and acting among key players in the change programme, christened the Golden Circle. The story traces four years in the history of the London Ambulance Service, from the aftermath of October 1992 through the birth of the Golden Circle to the achievement of National Health Service (NHS) trust status. LASCAD was the beginning of the story, this is the middle, an end lies in the future, when the remaining elements of the change programme are enacted beyond the Golden Circle
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Exercise is delayed in critically ill patients: a five year observational study in an Australian tertiary intensive care unit
Duration of bed rest among critically ill patients in ICU has been associated with development of persistent weakness that can last for more than five years. Commencing early exercise interventions in ICU is likely to reduce critically ill patients’ physical dysfunction. However, critically ill patients often experience prolonged periods of bed rest and inactivity.
This study examined the timing of commencement of exercise interventions, including sitting out of bed and upright mobilisation, following physiological stability in critically ill patients and describes key clinical outcomes.
Participants included consecutive patients admitted for >48 hours to a 25-bed Australian mixed medical and surgical adult ICU between July 2009 and June 2014. Time taken for patients to achieve neurological, cardiorespiratory and cardiovascular (physiological) stability was calculated and timing of initial sitting out of bed and upright mobilisation was recorded.
A small number of patients (n=206, 6.0%) did not achieve physiological stability. A substantial proportion of patients (n=1377, 40.1%) did not complete any mobilisation or sitting activities. For patients (n=1851, 53.9%) who did undertake mobilisation or sitting activities, activity commenced a median (IQR) of 3.6 (2.0, 7.7) days after ICU admission. This represented a median (IQR) delay after physiological stability of 2.3 (1.3, 4.4) days for mobilisation and 2.7 (1.5, 5.7) days for sitting. In-hospital mortality was 14.3% (n=491) for patients who did not participate in exercise interventions, compared to 2.6% (n=89) for patients who exercised whilst in ICU
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Critical Care Cycling Study (CYCLIST) trial protocol: a randomised controlled trial of usual care plus additional in-bed cycling sessions versus usual care in the critically ill
Introduction
In-bed cycling with patients with critical illness has been shown to be safe and feasible, and improves physical function outcomes at hospital discharge. The effects of early in-bed cycling on reducing the rate of skeletal muscle atrophy, and associations with physical and cognitive function are unknown.
Methods and analysis
A single-centre randomised controlled trial in a mixed medical-surgical intensive care unit (ICU) will be conducted. Adult patients (n=68) who are expected to be mechanically ventilated for more than 48 hours and remain in ICU for a further 48 hours from recruitment will be randomly allocated into either (1) a usual care group or (2) a group that receives usual care and additional in-bed cycling sessions. The primary outcome is change in rectus femoris cross-sectional area at day 10 in comparison to baseline measured by blinded assessors. Secondary outcome measures include muscle strength, incidence of ICU-acquired weakness, handgrip strength, time to achieve functional milestones (sitting out of bed, walking), Functional Status Score in ICU, ICU Mobility Scale, 6 min walk test 1week postICU discharge, incidence of delirium and quality of life (EuroQol Five Dimensions questionnaire Five Levels scale). Quality of life assessments will be conducted post-ICU admission at day 10, 3 and 6 months after acute hospital discharge. Participants in the intervention group will complete an acceptability of intervention questionnaire.
Ethics and dissemination
Appropriate ethical approval from Metro South Health Human Research Ethics Committee has been attained. Results will be published in peer-reviewed publications and presented at scientific conferences to assist planning of future multicentre randomised controlled trials (if indicated) that will test in-bed cycling as an intervention to improve the physical, cognitive and health-related quality of life outcomes of patients with critical illness
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In-bed Cycling with Critically Ill Patients: Practical Lessons From a Randomised Trial
Introduction: In-bed cycling for critically ill patients is a rehabilitative exercise that may help improve patients’ functional status at hospital discharge. In-bed cycling is not currently implemented early during a patients’ critical illness. Objectives: To identify if early in-bed cycling could be safely implemented following a patients’ admission to ICU and to identify the barriers and facilitators to implementation of in-bed cycling within ICU. Methods: A randomised controlled trial comparing usual care physio-therapy with additional in-bed cycling within a tertiary mixed medical, surgical, trauma ICU was conducted. Number of sessions of in-bed cycling planned, conducted, distance and duration cycled, haemodynamic parameters and occurrence of pre-defined adverse events were recorded. A diary of intervention implementation processes and outcomes was kept to identify barriers and facilitators to implementation of in-bed cycling. Results: Thirty-seven participants completed 276 of 304 (90.8%) planned in-bed cycling interventions. Participants completed a median (IQR) of 6 (4,8) in-bed cycling sessions. Participants commenced in-bed cycling a median (IQR) of 2.3 (1.8,3.1) days following ICU admission. Participants cycled a mean (SD) 27.7 (5.2) minutes per session and mean (SD) 3.23km (1.63km) per session and maintained haemodynamic stability. Two minor adverse events (0.7% of sessions) occurred that required clinician intervention (increased respiratory rate and oxygen desaturation). These events required adjustment to ventilator settings without any long-term consequences. The main barriers to the implementation of in-bed cycling sessions were patient fatigue (n = 9), delirium (n = 5) and haemodynamic instability (n = 4). Timing of initiation of the intervention following morning chest x-ray round with independent implementation by a physiotherapist were identified as the main facilitators to the in-bed cycling intervention. Conclusions: In-bed cycling commencing within 2 to 3 days of a patients’ ICU admission was both safe and feasible. Adverse events were rare and the main barrier to implementation of in-bed cycling sessions was patient fatigue.<br/
The molybdenum isotopic composition of the modern ocean
Natural variations in the isotopic composition of molybdenum (Mo) are showing increasing potential as a tool in geochemistry. Although the ocean is an important reservoir of Mo, data on the isotopic composition of Mo in seawater are scarce. We have recently developed a new method for the precise determination of Mo isotope ratios on the basis of preconcentration using a chelating resin and measurement by multiple-collector inductively coupled plasma mass spectrometry (MC-ICP-MS), which allows us to measure every stable Mo isotope. In this study, 172 seawater samples obtained from 9 stations in the Pacific, Atlantic, and Southern Oceans were analyzed, giving global coverage and the first full depth-profiles. The average isotope composition in δA/95Mo (relative to a Johnson Matthey Mo standard solution) was as follows: δ92/95Mo = –2.54 ± 0.16‰ (2SD), δ94/95Mo = –0.73 ± 0.19‰, δ96/95Mo = 0.85 ± 0.07‰, δ97/95Mo = 1.68 ± 0.08‰, δ98/95Mo = 2.48 ± 0.10‰, and δ100/95Mo = 4.07 ± 0.18‰. The δ values showed an excellent linear correlation with atomic mass of AMo (R2 = 0.999). Three-isotope plots for the Mo isotopes were fitted with straight lines whose slopes agreed with theoretical values for mass-dependent isotope fractionation. These results demonstrate that Mo isotopes are both uniformly distributed and follow a mass-dependent fractionation law in the modern oxic ocean. A common Mo standard is urgently required for the precise comparison of Mo isotopic compositions measured in different laboratories. On the other hand, our results strongly support the possibility of seawater as an international reference material for Mo isotopic composition
A Proposal of Business Model Design Parameters for Future Internet Carriers
Future Internet evolution requires innovative strategic stances and the design of original business models from actors involved in the ecosystem. The study focuses on Internet Carriers, recently striving to make their business sustainable, and proposes to enclose in a single reference framework all the critical levers, either consolidated or innovative, such actors can employ in order to design their value proposition, value network integration, and financial configuration. The framework grounds its findings on multiple case studies, and, by presenting an insightful list of business model parameters for Carriers, sheds light on key emerging strategic and tactical trends in the Internet interconnections market
Carbon dioxide and ocean acidification observations in UK waters. Synthesis report with a focus on 2010–2015
Key messages: 1.1 The process of ocean acidification is now relatively well-documented at the global scale as a long-term trend in the open ocean. However, short-term and spatial variability can be high. 1.2 New datasets made available since Charting Progress 2 make it possible to greatly improve the characterisation of CO2 and ocean acidification in UK waters. 3.1 Recent UK cruise data contribute to large gaps in national and global datasets. 3.2 The new UK measurements confirm that pH is highly variable, therefore it is important to measure consistently to determine any long term trends. 3.3 Over the past 30 years, North Sea pH has decreased at 0.0035±0.0014 pH units per year. 3.4 Upper ocean pH values are highest in spring, lowest in autumn. These changes reflect the seasonal cycles in photosynthesis, respiration (decomposition) and water mixing. 3.5 Carbonate saturation states are minimal in the winter, and lower in 7 more northerly, colder waters. This temperature-dependence could have implications for future warming of the seas. 3.6 Over the annual cycle, North-west European seas are net sinks of CO2. However, during late summer to autumn months, some coastal waters may be significant sources. 3.7 In seasonally-stratified waters, sea-floor organisms naturally experience lower pH and saturation states; they may therefore be more vulnerable to threshold changes. 3.8 Large pH changes (0.5 - 1.0 units) can occur in the top 1 cm of sediment; however, such effects are not well-documented. 3.9 A coupled forecast model estimates the decrease in pH trend within the North Sea to be -0.0036±0.00034 pH units per year, under a high greenhouse gas emissions scenario (RCP 8.5). 3.10 Seasonal estimates from the forecast model demonstrate areas of the North Sea that are particularly vulnerable to aragonite undersaturation
Software development cultures and cooperation problems: a field study of the early stages of development of software for a scientific community
In earlier work, I identified a particular class of end-user developers, who include scientists and whom I term 'professional end-user developers', as being of especial interest. Here, I extend this work by articulating a culture of professional end-user development, and illustrating by means of a field-study how the influence of this culture causes cooperation problems in an inter-disciplinary team developing a software system for a scientific community. My analysis of the field study data is informed by some recent literature on multi-national work cultures. Whilst acknowledging that viewing a scientific development through a lens of software development culture does not give a full picture, I argue that it nonetheless provides deep insights
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