Laboratory study using a repeated measures design. The aim of this study was to determine if ankle proprioception is targeted in exercises on unstable surfaces. Lateral ankle sprain (LAS) has recurrence rates over 70%, which are believed to be due to a reduced accuracy of proprioceptive signals from the ankle. Proprioceptive exercises in rehabilitation of LAS mostly consist of balancing activities on an unstable surface. The methods include 100 healthy adults stood barefoot on a solid surface and a foam pad over a force plate, with occluded vision. Mechanical vibration was used to stimulate proprioceptive output of muscle spindles of triceps surae and lumbar paraspinal musculature. Each trial lasted for 60 s; vibration was applied from the 15th till the 30th second. Changes in mean velocity and mean position of the center of pressure (CoP) as a result of muscle vibration were calculated. Results show that on foam, the effect of triceps surae vibration on mean CoP velocity was significantly smaller than on a solid surface, while for paraspinal musculature vibration the effect was bigger on foam than on solid surface. Similar effects were seen for mean CoP displacement as outcome. Exercises on unstable surfaces appear not to target peripheral ankle proprioception. Exercises on an unstable surface may challenge the capacity of the central nervous system to shift the weighting of sources of proprioceptive signals on balance.
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PURPOSE: We investigated changes in ARDS severity and associations with outcome in COVID-19 ARDS patients.METHODS: We compared outcomes in patients with ARDS classified as 'mild', 'moderate' or 'severe' at calendar day 1, and after reclassification at calendar day 2. The primary endpoint was 28-day mortality. We also identified which ventilatory parameters had an association with presence of severe ARDS at day 2. We repeated the analysis for reclassification at calendar day 4.RESULTS: Of 895 patients, 8.5%, 60.1% and 31.4% had mild, moderate and severe ARDS at day 1. These proportions were 13.5%, 72.6% and 13.9% at day 2. 28-day mortality was 25.3%, 31.3% and 32.0% in patients with mild, moderate and severe ARDS at day 1 (p = 0.537), compared to 28.6%, 29.2% and 44.3% in patients reclassified at day 2 (p = 0.005). No ventilatory parameter had an independent association with presence of severe ARDS at day 2. Findings were not different reclassifying at day 4.CONCLUSIONS: In this cohort of COVID-19 patients, ARDS severity and mortality between severity classes changed substantially over the first 4 days of ventilation. These findings are important, as reclassification could help identify target patients that may benefit from alternative approaches.
MULTIFILE
In recent years, both scientists and the general population gained awareness of the deep entanglement between finances, health, and well-being. People cannot be reduced to a set of problems to be tackled independently, thinking that somehow these solutions add up to solve the problem as a whole.4 Researchers pay increasing attention to how problems are related, and many lessons have been learned over time. Policy-makers and practitioners who understand the complex relationship between financial, physical, and mental well-being find themselves in the unique position to use these insights in how they design their programs. This paper provides an overview of academic and grey literature and the lessons we can learn from these studies.
In the coming four years, the Hedwige-Prosperpolder in the Schelde estuary will be reopened for nature restoration. This creates opportunities, within a binational Dutch-Belgian consortium, to experiment with the existing dike and to perform targeted dike breach experiments and breach monitoring. We will exploit this opportunity to investigate a newly described, potentially valuable contribution of vegetated foreshores to flood safety: the restriction of dike breach extent, and thus of flooding volume, in the case of failure of the dike. Fostering marsh development in front of realigned dikes could improve safety more than hitherto thought. Not only does it reduce dike failure probabilities, it may also restrict the consequences of failures. Even though this is not the primary goal of the HPP realignment, in this Living Lab we will study how management realignment can be used as a nature-based solution for flood safety. We will model the contribution of vegetated foreshores to breach development, calculate its contribution to reduction of risks, and validate the model using the breach experiment. We will also study the conditions for, and rates of, vegetation and soil strength development in front of realigned dikes. We will explore novel designs and maintenance schemes for realigned dikes connected to a vegetated foreshore. Finally, we will study how people experience physical changes in the landscape in terms of place attachment: will they be reconnected to the changed landscape when properly informed on the new role of this landscape in ecosystem development and safety enhancement? The project consortium is composed of engineers, ecologists and social scientists with a strong track record in multidisciplinary co-operation. It is externally supported by national and regional water authorities, contractors and engineering companies. It is ideally situated to translate new knowledge into operational procedures, and incorporate this into the education of future coastal professionals.
