BACKGROUND: Chest physiotherapy is widely used in people with cystic fibrosis in order to clear mucus from the airways.OBJECTIVES: To determine the effectiveness and acceptability of chest physiotherapy compared to no treatment or spontaneous cough alone to improve mucus clearance in cystic fibrosis.SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Date of the most recent search of the Group's Cystic Fibrosis Trials Register: 04 February 2013.SELECTION CRITERIA: Randomised or quasi-randomised clinical studies in which a form of chest physiotherapy (airway clearance technique) were taken for consideration in people with cystic fibrosis compared with either no physiotherapy treatment or spontaneous cough alone.DATA COLLECTION AND ANALYSIS: Both authors independently assessed study eligibility, extracted data and assessed study quality. There was heterogeneity in the published outcomes, with variable reporting which meant pooling of the data for meta-analysis was not possible.MAIN RESULTS: The searches identified 144 studies, of which eight cross-over studies (data from 96 participants) met the inclusion criteria. There were differences between studies in the way that interventions were delivered, with several of the intervention groups combining more than one treatment modality. One included study looked at autogenic drainage, six considered conventional chest physiotherapy, three considered oscillating positive expiratory pressure, seven considered positive expiratory pressure and one considered high pressure positive expiratory pressure. Of the eight studies, six were single-treatment studies and in two, the treatment intervention was performed over two consecutive days (once daily in one, twice daily in the other). This enormous heterogeneity in the treatment interventions prevented any meta-analyses from being performed.Four studies, involving 28 participants, reported a higher amount of expectorated secretions during chest physiotherapy as compared to a control. One study, involving 18 participants, reported no significant differences in sputum weight. In five studies radioactive tracer clearance was used as an outcome variable. In three of these (28 participants) it was reported that chest physiotherapy, including coughing, increased radioactive tracer clearance as compared to the control period. One study (12 participants) reported increased radioactive tracer clearance associated with all interventions compared to control, although this was only reported to have reached significance for postural drainage with percussion and vibrations; and the remaining study (eight participants) reported no significant difference in radioactive tracer clearance between chest physiotherapy, without coughing, compared to the control period. Three studies, involving 42 participants reported no significant effect on pulmonary function variables following intervention; but one further study did report significant improvement in pulmonary function following the intervention in some of the treatment groups.AUTHORS' CONCLUSIONS: The results of this review show that airway clearance techniques have short-term effects in the terms of increasing mucus transport. No evidence was found on which to draw conclusions concerning the long-term effects.
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This chapter will focus on the deep evolutionary history of the cognitive capacities underlying linguistic iconicity. The complex capacity for linguistic iconicity has roots in a more general cross-modal ability present throughout the animal kingdom, cross-modal transfer. Cross-modal transfer is the ability to make basic inferences about sensory properties of an object in multiple modalities based on experience from only one. This situates iconicity as a fundamentally cross-modal phenomenon; part of a broader, uniquely human cross-modal cognitive suite which includes relatively rare phenomena like synesthesia, alongside more ubiquitous phenomena like sensory metaphor and cross-modal correspondences. Evidence suggests the evolutionarily deep capacity for cross-modal transfer was honed into more sophisticated capacities underlying iconicity by an evolutionary ratchet of increased prosociality during human self-domestication. This period provided strong selective pressures for increasingly complex cross-sensory communication, and eventually, the predominantly arbitrary symbolic systems that underpin modern human language. This is a peer-reviewed preprint of the work below.Cuskley, Christine and Kees Sommer (forthcoming). The evolution of linguistic iconicity and the cross-modal cognitive suite. To appear in Olga Fisher, Kimi Akita, and Pamela Perniss (eds.), Oxford Handbook of Iconicity in Language. Oxford University Press: Oxford, UK.
Background: Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive care units (ICUs). Objectives: The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients. Methods: This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed. Findings: Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: “professional barriers”, “external factors”, and “patient barriers”. Conclusions: Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice.
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Aanleiding: Automatisering kan leiden tot beter gebruik van materialen en afval reduceren. Dit brengt verbeteringen met zich mee voor 'people, planet and profit' (PPP) - mensen, het milieu en de winst. Een specifieke vorm van automatisering, de ontwikkeling van zelfrijdende auto's en vrachtauto's, gaat snel. Maar om zelfrijdende voertuigen beschikbaar te maken is er nog veel onderzoek en ontwikkeling nodig op verschillende gebieden. Er zijn nog veel vragen te beantwoorden op het gebied van onder andere truckontwerp, betrouwbare software, aansprakelijkheid, trajectplanning en logistiek. Doelstelling Het doel van het Intralog-project is om voor de maatschappij en de private sector een significante bijdrage te leveren aan de mogelijkheden van zelfrijdende voertuigen in de commerciële transportsector. Het Intralog-project onderzoekt de toegevoegde waarde voor PPP van 'automated guided trucks' (AGT's) aan logistieke operaties bij distributiecentra en interterminal/intermodal traffic hubs. Dit gebeurt in twee stappen: 1) het identificeren van het potentieel met betrekking tot de vraag vanuit de logistieke omgeving; 2. het ontwerpen, realiseren, testen en valideren van mogelijke strategieën voor het implementeren van AGT's in een logistiek scenario. Beoogde resultaten Het concrete resultaat van het project bestaat uit onderzoekstools en hardware- en softwaremodellen voor Intralog. Deze bieden een goede mogelijkheid om de opgedane kennis te verspreiden. De projectdeelnemers zullen bijdragen aan workshops, tentoonstellingen en in Nederland georganiseerde symposia. De onderzoeksresultaten verspreiden ze op conferenties en door middel van publicaties in technische vakbladen. De uiteindelijke Intralog-resultaten worden gepresenteerd op een afsluitend congres. De resultaten zullen worden samengevat in een boekje.
