1,142 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
LONTalk as a Standard Protocol For Underwater Sensor Platforms
Proceedings IEEE, Oceans 97, Halifax, Oct. 1997 IEEE CD-ROM 0-7803-4111-
Colorado Deer Hunting Experiences
Those responsible for managing environmental resources, like big game, have often posed questions regarding how best to manage and allocate the resource to “provide benefits to people.” One approach to obtaining information for answering these questions is based on consumer behavior concepts and research. Our consumer-oriented approach to deriving management information for environmental resources, particularly game and other recreational resources, rests on ideas conceptualized by Wagar (1966) and having their theoretical base in psychology’s expectancy-value theory (Lawler 1973). The general theoretical orientation we follow is described in Driver and Brown (1975). We also acknowledge a debt to the multiple satisfactions approach to game management articulated by Hendee (1974). The management orientation of this paper suggests that managers should produce opportunities for game-related recreation which recognize the multiple dimensions of the experience. It is the experience that is the important product of recreation, and quality experiences are a function of how well the consumer’s desired satisfactions are fulfilled. Within this orientation, this paper reports characteristics of the Colorado deer hunter population in terms of the kinds of satisfaction that make up deer hunting experiences. In doing so, the usefulness of cluster analytic techniques for social research in wildlife management is illustrated. The information and analytical techniques discussed in this paper have implications for resource valuation, resource allocation, user management, and related aspects of wildlife planning and management
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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 relative length of the patient and the primary care interval in patients with 28 common and rarer cancers
This is the final version. Available from the publisher via the DOI in this record.BACKGROUND: Appreciating variation in the length of pre- or post-presentation diagnostic intervals can help prioritise early diagnosis interventions with either a community or a primary care focus.METHODS: We analysed data from the first English National Audit of Cancer Diagnosis in Primary Care on 10 953 patients with any of 28 cancers. We calculated summary statistics for the length of the patient and the primary care interval and their ratio, by cancer site.RESULTS: Interval lengths varied greatly by cancer. Laryngeal and oropharyngeal cancers had the longest median patient intervals, whereas renal and bladder cancer had the shortest (34.5 and 30 compared with 3 and 2 days, respectively). Multiple myeloma and gallbladder cancer had the longest median primary care intervals, and melanoma and breast cancer had the shortest (20.5 and 20 compared with 0 and 0 days, respectively). Mean patient intervals were longer than primary care intervals for most (18 of 28) cancers, and notably so (two- to five-fold greater) for 10 cancers (breast, melanoma, testicular, vulval, cervical, endometrial, oropharyngeal, laryngeal, ovarian and thyroid).CONCLUSIONS: The findings support the continuing development and evaluation of public health interventions aimed at shortening patient intervals, particularly for cancers with long patient interval and/or high patient interval over primary care interval ratio.National Institute for Health Research (NIHR)Cancer Research UKPublic Health WalesBetsi Cadwaladr University Health Boar
The SKA Particle Array Prototype: The First Particle Detector at the Murchison Radio-astronomy Observatory
We report on the design, deployment, and first results from a scintillation
detector deployed at the Murchison Radio-astronomy Observatory (MRO). The
detector is a prototype for a larger array -- the Square Kilometre Array
Particle Array (SKAPA) -- planned to allow the radio-detection of cosmic rays
with the Murchison Widefield Array and the low-frequency component of the
Square Kilometre Array. The prototype design has been driven by stringent
limits on radio emissions at the MRO, and to ensure survivability in a desert
environment. Using data taken from Nov.\ 2018 to Feb.\ 2019, we characterize
the detector response while accounting for the effects of temperature
fluctuations, and calibrate the sensitivity of the prototype detector to
through-going muons. This verifies the feasibility of cosmic ray detection at
the MRO. We then estimate the required parameters of a planned array of eight
such detectors to be used to trigger radio observations by the Murchison
Widefield Array.Comment: 17 pages, 14 figures, 3 table
The upgraded Polaris powder diffractometer at the ISIS neutron source
This paper describes the design and operation of the Polaris time-of-flight powder neutron diffractometer at the ISIS pulsed spallation neutron source, Rutherford Appleton Laboratory, UK. Following a major upgrade to the diffractometer in 2010-2011, its detector provision now comprises five large ZnS scintillator-based banks, covering an angular range of 6\ub0 ≤ 2θ ≤ 168\ub0, with only minimal gaps between each bank. These detectors have a substantially increased solid angle coverage (ω ∼5.67 sr) compared to the previous instrument (ω ∼0.82 sr), resulting in increases in count rate of between 2
7 and 10
7, depending on 2θ angle. The benefits arising from the high count rates achieved are illustrated using selected examples of experiments studying small sample volumes and performing rapid, time-resolved investigations. In addition, the enhanced capabilities of the diffractometer in the areas of in situ studies (which are facilitated by the installation of a novel design of radial collimator around the sample position and by a complementary programme of advanced sample environment developments) and in total scattering studies (to probe the nature of short-range atomic correlations within disordered crystalline solids) are demonstrated
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