IntroductionThe driving pressure (ΔP) has an independent association with outcome in patients with acute respiratory distress syndrome (ARDS). INTELLiVENT-Adaptive Support Ventilation (ASV) is a closed-loop mode of ventilation that targets the lowest work and force of breathing.AimTo compare transpulmonary and respiratory system ΔP between closed-loop ventilation and conventional pressure controlled ventilation in patients with moderate-to-severe ARDS.MethodsSingle-center randomized cross-over clinical trial in patients in the early phase of ARDS. Patients were randomly assigned to start with a 4-h period of closed-loop ventilation or conventional ventilation, after which the alternate ventilation mode was selected. The primary outcome was the transpulmonary ΔP; secondary outcomes included respiratory system ΔP, and other key parameters of ventilation.ResultsThirteen patients were included, and all had fully analyzable data sets. Compared to conventional ventilation, with closed-loop ventilation the median transpulmonary ΔP with was lower (7.0 [5.0–10.0] vs. 10.0 [8.0–11.0] cmH2O, mean difference − 2.5 [95% CI − 2.6 to − 2.1] cmH2O; P = 0.0001). Inspiratory transpulmonary pressure and the respiratory rate were also lower. Tidal volume, however, was higher with closed-loop ventilation, but stayed below generally accepted safety cutoffs in the majority of patients.ConclusionsIn this small physiological study, when compared to conventional pressure controlled ventilation INTELLiVENT-ASV reduced the transpulmonary ΔP in patients in the early phase of moderate-to-severe ARDS. This closed-loop ventilation mode also led to a lower inspiratory transpulmonary pressure and a lower respiratory rate, thereby reducing the intensity of ventilation.Trial registration Clinicaltrials.gov, NCT03211494, July 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03211494?term=airdrop&draw=2&rank=1.
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The literature on how organizations respond to institutional pressure has shown that the individual decision-makers’ interpretation of institutional pressure played an important role in developing organizational responses. However, it has paid less attention to how this interpretation ultimately contributes to their range of organizational decisions when responding to the same institutional pressure. We address this gap by interviewing board members of U.S. and Dutch hospitals involved in adopting best practices regarding board evaluation. We found four qualitatively different cognitive frames that board members relied on to interpret institutional pressure, and which shaped their organizational response. We contribute to the literature on organizational response to institutional pressure by empirically investigating how decision-makers interpret institutional pressure, by suggesting prior experience and role definition as moderating factors of multidimensional cognitive frames, and by showing how these cognitive frames influence board members’ response to the same institutional pressure.
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Background: The transformation in global demography and the shortage of health care workers require innovation and efficiency in the field of health care. Digital technology can help improve the efficiency of health care. The Mercury Advance SMARTcare solution is an example of digital technology. The system is connected to a hybrid mattress and is able to detect patient movement, based on which the air pump either starts automatically or sends a notification to the app. Barriers to the adoption of the system are unknown, and it is unclear if the solution will be able to support health care workers in their work. Objective: This study aims to gain insight into health care workers’ expectations of factors that could either hamper or support the adoption of the Mercury Advance SMARTcare unit connected to a Mercury Advance mattress to help prevent patients from developing pressure injuries in hospitals and long-term care facilities. Methods: We conducted a generic qualitative study from February to December 2022. Interviews were conducted, and a focus group was established using an interview guide of health care workers from both the United Kingdom and the Netherlands. Thematic analysis was performed by 2 independent researchers. Results: A total of 14 participants took part in the study: 6 (43%) participants joined the focus group, and 8 (57%) participants took part in the individual interviews. We identified 13 factors based on four themes: (1) factors specifically related to SMARTresponse, (2) vision on innovation, (3) match with health care activities, and (4) materials and resources involved. Signaling function, SMARTresponse as prevention, patient category, representatives, and implementation strategy were identified as facilitators. Perception of patient repositioning, accessibility to pressure injury aids, and connectivity were identified as barriers. Conclusions: Several conditions must be met to enhance the adoption of the Mercury Advance SMARTcare solution, including the engagement of representatives during training and a reliable wireless network. The identified factors can be used to facilitate the implementation process. JMIR Nursing 2024;7:e47992
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The hospitality industry contributes significantly to global climate change through its high resource consumption and emissions due to travel. As public pressure for hotels to develop sustainability initiatives to mitigate their footprint grows, a lack of understanding of green behavior and consumption of hotel guests hinders the adoption of effective programs. Most tourism research thus far has focused on the ecotourism segment, rather than the general population of travelers, and while research in consumer behavior shows that locus of control (LOC) and guilt can influence guests’ environmental behavior, those factors have not been tested with consideration of the subjective norm to measure their interaction and effect on recycling behavior. This study first examines the importance of internal and external LOC on factors for selecting hotel accommodation and the extent of agreement about hotel practices and, second, examines the differences in recycling behavior among guests with internal versus external LOC under levels of positive versus negative subjective norms and feelings of low versus high guilt.
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Recent years have seen a global rise in the failure of tailings dams. Studies investigating the causes of slope failure often recognise high intensity rainfall events to significantly contribute to liquefaction, erosion and overtopping. This study aims to investigate the influence of alternative physical and geohydrological processes that, under tension saturation conditions, contribute to slope instability in tailings dams. It has been suggested that the generation of transient pressure wave mechanisms by high intensity rainfall events, surface ponding and wetting front advancement result in the formation of an induced pressure head that triggers the mobilization of pre-event water. In order to quantify these physical processes, this study included the analysis of rapid transmission conditions in a silica fines mix, with similar physical and hydraulic characteristics as platinum tailings. A tall leak-proof soil column, containing the soil sample compacted to in-situ dry bulk density, was fitted with seven observation ports. Each port consisted of a pore air pressure probe, a mini tensiometer and a time domain reflectometry probe. After set-up and initial stabilisation, three separate artificial high intensity rainfall events were applied to the surface. Monitoring of hydraulic state variables was recorded at thirty second intervals by automatic logging, thereby enabling the analysis of measured outcomes. Observations showed instant spikes in pore air pressure ahead of the wetting front, as well as a number of delayed responses. The interpretation of lab results led to the conclusion that pressure diffusion mechanisms throughout the porous medium, could result in the rapid release and mobilisation of previously stagnant antecedent moisture, thereby enabling phreatic levels to rising rapidly and in excess to the amount of surface infiltration. Also, since an increase in pore water pressure is likely to cause a reduction in shear strength, it is suggested that these physical and geohydrological processes could have an adverse impact on the stability of tailings dams.
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Nixon and Metiary argue that the notion of protest needs to be included in the global education system as a distinct activity. It needs to take its place alongside other social sciences and humanities courses in the school curricula. They stress that the ability to impact society, to incite societal change, to participate through more means than voting, needs to be taught. It needs to be implemented into the global education system.
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While there has been a growing body of research focused on corporate social responsibility (CSR) practices in developing economies, few studies have examined the factors shaping the CSR agenda in sub-Saharan countries. Using qualitative data obtained through semi-structured interviews with management and stakeholders, this paper examines the drivers of the CSR agenda pursued by Paladin (Africa), a subsidiary of an Australian multinational mining company (MNC) operating the first uranium mine in Malawi. The findings suggest that the CSR agenda in the mining industry in Malawi is strongly influenced by externally generated pressures such as civil society organisation activism and community expectations; although it is clear that other drivers such as public and private regulations and pressure from financial markets also played a role in pressurising Paladin to adopt a CSR agenda.
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INTRODUCTION: While prone positioning (PP) has been shown to improve patient survival in moderate to severe acute respiratory distress syndrome (ARDS) patients, the rate of application of PP in clinical practice still appears low.AIM: This study aimed to determine the prevalence of use of PP in ARDS patients (primary endpoint), the physiological effects of PP, and the reasons for not using it (secondary endpoints).METHODS: The APRONET study was a prospective international 1-day prevalence study performed four times in April, July, and October 2016 and January 2017. On each study day, investigators in each ICU had to screen every patient. For patients with ARDS, use of PP, gas exchange, ventilator settings and plateau pressure (Pplat) were recorded before and at the end of the PP session. Complications of PP and reasons for not using PP were also documented. Values are presented as median (1st-3rd quartiles).RESULTS: Over the study period, 6723 patients were screened in 141 ICUs from 20 countries (77% of the ICUs were European), of whom 735 had ARDS and were analyzed. Overall 101 ARDS patients had at least one session of PP (13.7%), with no differences among the 4 study days. The rate of PP use was 5.9% (11/187), 10.3% (41/399) and 32.9% (49/149) in mild, moderate and severe ARDS, respectively (P = 0.0001). The duration of the first PP session was 18 (16-23) hours. Measured with the patient in the supine position before and at the end of the first PP session, PaO2/FIO2 increased from 101 (76-136) to 171 (118-220) mmHg (P = 0.0001) driving pressure decreased from 14 [11-17] to 13 [10-16] cmH2O (P = 0.001), and Pplat decreased from 26 [23-29] to 25 [23-28] cmH2O (P = 0.04). The most prevalent reason for not using PP (64.3%) was that hypoxemia was not considered sufficiently severe. Complications were reported in 12 patients (11.9%) in whom PP was used (pressure sores in five, hypoxemia in two, endotracheal tube-related in two ocular in two, and a transient increase in intracranial pressure in one).CONCLUSIONS: In conclusion, this prospective international prevalence study found that PP was used in 32.9% of patients with severe ARDS, and was associated with low complication rates, significant increase in oxygenation and a significant decrease in driving pressure.
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In dit rapport worden de maatschappelijke kosten en baten onderzocht van waterstof-elektrisch rijden voor vrachtverkeer. De keten van elektriciteitproductie, conversie naar waterstof, opslag en transport van waterstof, waterstoftankstation en waterstofvrachtwagen is gemodelleerd. De total cost of ownerschip en ook de levelised cost of driving van waterstof-elektrisch rijden zijn hoger dan de alternatieven diesel en batterijelektrisch rijden. Ten opzichte van batterijelektrisch rijden kent waterstof wel enkele operationele voordelen zoals de kortere tanktijd en het hogere bereik. Ook niet-monetaire effecten zijn geanalyseerd.
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