Purpose: Pressure ulcers are a high cost, high volume issue for health and medical care providers, having a detrimental effect on patients and relatives. Pressure ulcer prevention is widely covered in the literature, but little has been published regarding the risk to patients in the radiographical setting. Thisreview of the current literature is to identify findings relevant to radiographical context.Methods: Literature searching was performed using Science Direct and Medline databases. The search was limited to articles published in the last ten years to remain current and excluded studies containing participants less than 17 years of age. In total 14 studies were acquired; three were excluded as they were not relevant. The remaining 11 studies were compared and reviewed.Discussion: Eight of the studies used ‘healthy’ participants and three used symptomatic participants. Nine studies explored interface pressure with a range of pressure mat technologies, two studies measured shear (MRI finite element modelling, and a non-invasive instrument), and one looked at blood flow and haemoglobin oxygenation. A range of surfaces were considered from trauma, nursing and surgical backgrounds for their ability to reduce pressure including standard mattresses, high specification mattresses, rigid and soft layer spine boards, various overlays (gel, air filled, foam).Conclusion: The current literature is not appropriate for the radiographic patient and cannot be extrapolated to a radiologic context. Sufficient evidence is presented in this review to support the need for further work specific to radiography in order to minimise the development of PU in at risk patients.
Musicians often play under circumstances in which pressure may lead to anxiety and performance deterioration. Theories suggest that a drop in performance is due to a shift in focus of attention towards task-irrelevant information. In this study, we asked music students to report what they think and where they focus attention in three situations: when they play under pressure (Study 1; n = 81), the moment just before choking under pressure and when they try to recover after a mistake (Study 2; n = 25). Focus of attention was examined using retrospective verbal reports and point-spread distributions. Besides a notable focus on music-related information (36.9%), music students reported a considerable number of worries and disturbing thoughts (26.1%) during playing under pressure (Study 1). Just before choking, they showed even more worries and disturbing thoughts (46.4%) at the cost of music-related focus (21.1%) (Study 2), as also confirmed by the point-spread distributions. During recovery after a mistake, attention was mainly focused on music-related information (53.0%) and less on thoughts that give confidence (18.5%) and physical aspects (16.6%). It is advisable to help music students with improving their performance, for example, by attentional control training or providing training with elevated levels of anxiety.
Objective. In this study an experimental set-up for measuring skin microvascular responses of the footsole to changes in externally applied pressure was analysed. Design. A clinical study. Skin microvascular blood flow was measured in healthy volunteers, during and after external mechanical pressure of different magnitudes. Background. During standing and walking the footsole is commonly exposed to high static and dynamic mechanical pressure, resulting in changes in the microcirculation of the footsole. In diabetic patients a disturbed interaction between externally applied pressure and skin microvascular response seems to be involved in the development of a foot ulcer. Methods. Eleven volunteers participated in the study. Static loads were applied to the heel part of the footsole with the person in a supine position. Contact pressure and skin blood flux, based on the laser Doppler technique, were simultaneously monitored. The pressure used was varied in five discrete steps between 10 and 160 kPa and applied during a period of 5 min each. The microcirculation was measured during as well as after pressure loading. Results. Pressures of 40 kPa and higher do stop the blood flow in the skin micro-circulation. Releasing the applied pressure resulted in a hyperaemic response. This response appears to increase in amplitude at increasing pressures up to 800% of the baseline laser Doppler fluxmetry level. Beyond a pressure level of 80 kPa the hyperaemic response seems not to be influenced by the pressure level. The time needed to achieve the maximal laser Doppler fluxmetry level decreased when the pressure was raised from 10 to 80 kPa, but increased again when higher pressures were applied (P = 0.051). An intra-individual variation of 11-50% was observed for the parameters describing the blood flux before, during, and after pressure application. Conclusion. Simultaneously measuring changes in contact pressure and laser Doppler flux of the footsole is a useful method to study the interaction of external mechanical pressure and skin microvascular reactions. Pressures above 40 kPa stop skin microvascular blood flow. Releasing the applied pressure results in a hyperaemic response, which increases when the applied pressure increases from 40 to 80 kPa. Higher pressures do not influence the amplitude in skin microvascular response, but result in a longer delay to maximal hyperaemia.
The pressure on the European health care system is increasing considerably: more elderly people and patients with chronic diseases in need of (rehabilitation) care, a diminishing work force and health care costs continuing to rise. Several measures to counteract this are proposed, such as reduction of the length of stay in hospitals or rehabilitation centres by improving interprofessional and person-centred collaboration between health and social care professionals. Although there is a lot of attention for interprofessional education and collaborative practice (IPECP), the consortium senses a gap between competence levels of future professionals and the levels needed in rehabilitation practice. Therefore, the transfer from tertiary education to practice concerning IPECP in rehabilitation is the central theme of the project. Regional bonds between higher education institutions and rehabilitation centres will be strengthened in order to align IPECP. On the one hand we deliver a set of basic and advanced modules on functioning according to the WHO’s International Classification of Functioning, Disability and Health and a set of (assessment) tools on interprofessional skills training. Also, applications of this theory in promising approaches, both in education and in rehabilitation practice, are regionally being piloted and adapted for use in other regions. Field visits by professionals from practice to exchange experiences is included in this work package. We aim to deliver a range of learning materials, from modules on theory to guidelines on how to set up and run a student-run interprofessional learning ward in a rehabilitation centre. All tested outputs will be published on the INPRO-website and made available to be implemented in the core curricula in tertiary education and for lifelong learning in health care practice. This will ultimately contribute to improve functioning and health outcomes and quality of life of patients in rehabilitation centres and beyond.
Due to the existing pressure for a more rational use of the water, many public managers and industries have to re-think/adapt their processes towards a more circular approach. Such pressure is even more critical in the Rio Doce region, Minas Gerais, due to the large environmental accident occurred in 2015. Cenibra (pulp mill) is an example of such industries due to the fact that it is situated in the river basin and that it has a water demanding process. The current proposal is meant as an academic and engineering study to propose possible solutions to decrease the total water consumption of the mill and, thus, decrease the total stress on the Rio Doce basin. The work will be divided in three working packages, namely: (i) evaluation (modelling) of the mill process and water balance (ii) application and operation of a pilot scale wastewater treatment plant (iii) analysis of the impacts caused by the improvement of the process. The second work package will also be conducted (in parallel) with a lab scale setup in The Netherlands to allow fast adjustments and broaden evaluation of the setup/process performance. The actions will focus on reducing the mill total water consumption in 20%.
Client: Foundation Innovation Alliance (SIA - Stichting Innovatie Alliantie) with funding from the ministry of Education, Culture and Science (OCW) Funder: RAAK (Regional Attention and Action for Knowledge circulation) The RAAK scheme is managed by the Foundation Innovation Alliance (SIA - Stichting Innovatie Alliantie) with funding from the ministry of Education, Culture and Science (OCW). Early 2013 the Centre for Sustainable Tourism and Transport started work on the RAAK-MKB project ‘Carbon management for tour operators’ (CARMATOP). Besides NHTV, eleven Dutch SME tour operators, ANVR, HZ University of Applied Sciences, Climate Neutral Group and ECEAT initially joined this 2-year project. The consortium was later extended with IT-partner iBuildings and five more tour operators. The project goal of CARMATOP was to develop and test new knowledge about the measurement of tour package carbon footprints and translate this into a simple application which allows tour operators to integrate carbon management into their daily operations. By doing this Dutch tour operators are international frontrunners.Why address the carbon footprint of tour packages?Global tourism contribution to man-made CO2 emissions is around 5%, and all scenarios point towards rapid growth of tourism emissions, whereas a reverse development is required in order to prevent climate change exceeding ‘acceptable’ boundaries. Tour packages have a high long-haul and aviation content, and the increase of this type of travel is a major factor in tourism emission growth. Dutch tour operators recognise their responsibility, and feel the need to engage in carbon management.What is Carbon management?Carbon management is the strategic management of emissions in one’s business. This is becoming more important for businesses, also in tourism, because of several economical, societal and political developments. For tour operators some of the most important factors asking for action are increasing energy costs, international aviation policy, pressure from society to become greener, increasing demand for green trips, and the wish to obtain a green image and become a frontrunner among consumers and colleagues in doing so.NetworkProject management was in the hands of the Centre for Sustainable Tourism and Transport (CSTT) of NHTV Breda University of Applied Sciences. CSTT has 10 years’ experience in measuring tourism emissions and developing strategies to mitigate emissions, and enjoys an international reputation in this field. The ICT Associate Professorship of HZ University of Applied Sciences has longstanding expertise in linking varying databases of different organisations. Its key role in CARMATOP was to create the semantic wiki for the carbon calculator, which links touroperator input with all necessary databases on carbon emissions. Web developer ibuildings created the Graphical User Interface; the front end of the semantic wiki. ANVR, the Dutch Association of Travel Agents and Tour operators, represents 180 tour operators and 1500 retail agencies in the Netherlands, and requires all its members to meet a minimum of sustainable practices through a number of criteria. ANVR’s role was in dissemination, networking and ensuring CARMATOP products will last. Climate Neutral Group’s experience with sustainable entrepreneurship and knowledge about carbon footprint (mitigation), and ECEAT’s broad sustainable tourism network, provided further essential inputs for CARMATOP. Finally, most of the eleven tour operators are sustainable tourism frontrunners in the Netherlands, and are the driving forces behind this project.
