Background: To avoid overexertion in critically ill patients, information on the physical demand, i.e., metabolic load, of daily care and active exercises is warranted. Objective: The objective of this study was toassess the metabolic load during morning care activities and active bed exercises in mechanically ventilated critically ill patients. Methods: This study incorporated an explorative observational study executed in a university hospital intensive care unit. Oxygen consumption (VO2) was measured in mechanically ventilated (≥48 h) critically ill patients during rest, routine morning care, and active bed exercises. We aimed to describe and compare VO2 in terms of absolute VO2 (mL) defined as the VO2 attributable to the activity and relative VO2 in mL per kilogram bodyweight, per minute (mL/kg/min). Additional outcomes achieved during the activity were perceived exertion, respiratory variables, and the highest VO2 values. Changes in VO2 and activity duration were tested using paired tests. Results: Twenty-one patients were included with a mean (standard deviation) age of 59 y (12). Median (interquartile range [IQR]) durations of morning care and active bed exercises were 26 min (21–29) and 7 min (5–12), respectively. Absolute VO2 of morning care was significantly higher than that of active bed exercises (p = 0,009). Median (IQR) relative VO2 was 2.9 (2.6–3.8) mL/kg/min during rest; 3.1 (2.8–3.7) mL/kg/min during morning care; and 3.2 (2.7–4) mL/kg/min during active bed exercises. The highest VO2 value was 4.9 (4.2–5.7) mL/kg/min during morning care and 3.7 (3.2–5.3) mL/kg/min during active bed exercises. Median (IQR) perceived exertion on the 6–20 Borg scale was 12 (10.3–14.5) during morning care (n = 8) and 13.5 (11–15) during active bed exercises (n = 6). Conclusion: Absolute VO2 in mechanically ventilated patients may be higher during morning care than during active bed exercises due to the longer duration of the activity. Intensive care unit clinicians should be aware that daily-care activities may cause intervals of high metabolic load and high ratings of perceived exertion.
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BACKGROUND: Critically ill patients receiving invasive ventilation are at risk of sputum retention. Mechanical insufflation-exsufflation (MI-E) is a technique used to mobilise sputum and optimise airway clearance. Recently, interest has increased in the use of mechanical insufflation-exsufflation for invasively ventilated critically ill adults, but evidence for the feasibility, safety and efficacy of this treatment is sparse. The aim of this scoping review is to map current and emerging evidence on the feasibility, safety and efficacy of MI-E for invasively ventilated adult patients with the aim of highlighting knowledge gaps and identifying areas for future research. Specific research questions aim to identify information informing indications and contraindications to the use of MI-E in the invasively ventilated adult, MI-E settings used, outcome measures reported within studies, adverse effects reported and perceived barriers and facilitators to using MI-E reported.METHODS: We will search electronic databases MEDLINE, EMBASE, CINAHL using the OVID platform, PROSPERO, The Cochrane Library, ISI Web of Science and the International Clinical Trials Registry Platform. Two authors will independently screen citations, extract data and evaluate risk of bias using the Mixed Methods Appraisal Tool. Studies included will present original data and describe MI-E in invasively ventilated adult patients from 1990 onwards. Our exclusion criteria are studies in a paediatric population, editorial pieces or letters and animal or bench studies. Search results will be presented in a PRISMA study flow diagram. Descriptive statistics will be used to summarise quantitative data. For qualitative data relating to barriers and facilitators, we will use content analysis and the Theoretical Domains Framework (TDF) as a conceptual framework. Additional tables and relevant figures will present data addressing our research questions.DISCUSSION: Our findings will enable us to map current and emerging evidence on the feasibility, safety and efficacy of MI-E for invasively ventilated critically ill adult patients. These data will provide description of how the technique is currently used, support healthcare professionals in their clinical decision making and highlight areas for future research in this important clinical area.
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BACKGROUND: Early mobilization has been proven effective for patients in intensive care units (ICUs) to improve functional recovery. However, early mobilization of critically ill, often mechanically ventilated, patients is cumbersome because of the attachment to tubes, drains, monitoring devices and muscle weakness. A mobile treadmill with bodyweight support may help to initiate mobilization earlier and more effectively. The aim of this study is to assess the effectiveness of weight-supported treadmill training in critically ill patients during and after ICU stay on time to independent functional ambulation. METHODS: In this randomized controlled trial, a custom-built bedside body weight-supported treadmill will be used and evaluated. Patients are included if they have been mechanically ventilated for at least 48 hours, are able to follow instructions, have quadriceps muscle strength of Medical Research Council sum-score 2 (MRC 2) or higher, can sit unsupported and meet the safety criteria for physical exercise. Exclusion criteria are language barriers, no prior walking ability, contraindications for physiotherapy or a neurological condition as reason for ICU admission. We aim to include 88 patients and randomize them into either the intervention or the control group. The intervention group will receive usual care plus bodyweight-supported treadmill training (BWSTT) daily. The BWSSTT consists of walking on a mobile treadmill while supported by a harness. The control group will receive usual care physiotherapy treatment daily consisting of progressive activities such as bed-cycling and active functional training exercises. In both groups, we will aim for a total of 40 minutes of physiotherapy treatment time every day in one or two sessions, as tolerated by the patient. The primary outcome is time to functional ambulation as measured in days, secondary outcomes include walking distance, muscle strength, status of functional mobility and symptoms of post-traumatic stress. All measurements will be done by assessors who are blinded to the intervention on the regular wards until hospital discharge. DISCUSSION: This will be the first study comparing the effects of BWSTT and conventional physiotherapy for critically ill patients during and after ICU stay. The results of this study contribute to a better understanding of the effectiveness of early physiotherapy interventions for critically ill patients. TRIAL REGISTRATION: Dutch Trial Register (NTR) ID: NL6766. Registered at 1 December 2017.
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Many lithographically created optical components, such as photonic crystals, require the creation of periodically repeated structures [1]. The optical properties depend critically on the consistency of the shape and periodicity of the repeated structure. At the same time, the structure and its period may be similar to, or substantially below that of the optical diffraction limit, making inspection with optical microscopy difficult. Inspection tools must be able to scan an entire wafer (300 mm diameter), and identify wafers that fail to meet specifications rapidly. However, high resolution, and high throughput are often difficult to achieve simultaneously, and a compromise must be made. TeraNova is developing an optical inspection tool that can rapidly image features on wafers. Their product relies on (a) knowledge of what the features should be, and (b) a detailed and accurate model of light diffraction from the wafer surface. This combination allows deviations from features to be identified by modifying the model of the surface features until the calculated diffraction pattern matches the observed pattern. This form of microscopy—known as Fourier microscopy—has the potential to be very rapid and highly accurate. However, the solver, which calculates the wafer features from the diffraction pattern, must be very rapid and precise. To achieve this, a hardware solver will be implemented. The hardware solver must be combined with mechatronic tracking of the absolute wafer position, requiring the automatic identification of fiduciary markers. Finally, the problem of computer obsolescence in instrumentation (resulting in security weaknesses) will also be addressed by combining the digital hardware and software into a system-on-a-chip (SoC) to provide a powerful, yet secure operating environment for the microscope software.
ALE organised an event with Parktheater Eindhoven and LSA-citizens (the Dutch umbrella organisation for active citizens). Five ALE students from the minor Imagineering and business/social innovation took responsibility for concept and actual organisation. On Jan 18th, they were supported by six other group members of the minor as volunteers. An IMEM-team of 5 students gathered materials for a video that can support the follow-up actions of the organisers. The students planned to deliver their final product on February 9th. The theatre will critically assess the result and compare it to the products often realised by students from different schools or even professional ones, like Veldkamp productions. Time will tell whether future opportunities will come up for IMEM. The collaboration of ALE and IMEM students is possible and adding value to the project.More than 180 visitors showed interest in the efforts of 30 national and local citizen initiatives presenting themselves on the market square in the theatre and the diverse speakers during the plenary session. The students created a great atmosphere using the qualities of the physical space and the hospitality of the theatre. Chair of the day, Roland Kleve, kicked off and invited a diverse group of people to the stage: Giel Pastoor, director of the theatre, used the opportunity to share his thoughts on the shifting role of theatre in our dynamic society. Petra Ligtenberg, senior project manager SDG NL https://www.sdgnederland.nl/sdgs/ gave insights to the objectives and progress of the Netherlands. Elly Rijnierse, city maker and entrepreneur from Den Haag, presented her intriguing efforts in her own neighbourhood in the city to create at once both practical and social impacts on SDG 11 (sustainable city; subgoal 3.2). Then the alderman Marcel Oosterveer informed the visitors about Eindhoven’s efforts on SDGs. The plenary ended with very personal interviews of representatives of two impressive citizen initiatives (Parkinson to beat; Stichting Ik Wil). In the two workshop rounds, ALE took responsibility for two workshops. Firstly the workshop: Beyond SDG cherrypicking: using the Economy for the common good’, in cooperation with citizen initiative Ware winst Brabant en Parktheater (including Social innovation-intern Jasper Box), secondly a panel dialogue on local partnerships (SDG 17) for the sustainable city (SDG 11) addressing inclusion (SDG 10) and the livability (SDG 3) with 11 representatives from local/provincial government, companies, third sector and, of course: citizen initiatives.
Plastic products are currently been critically reviewed due to the growing awareness on the related problems, such as the “plastic soup”. EU has introduced a ban for a number of single-use consumer products and fossil-based polymers coming in force in 2021. The list of banned products are expected to be extended, for example for single-use, non-compostable plastics in horticulture and agriculture. Therefore, it is crucial to develop sustainable, biodegradable alternatives. A significant amount of research has been performed on biobased polymers. However, plastics are made from a polymer mixed with other materials, additives, which are essential for the plastics production and performance. Development of biodegradable solutions for these additives is lacking, but is urgently needed. Biocarbon (Biochar), is a high-carbon, fine-grained residue that is produced through pyrolysis processes. This natural product is currently used to produce energy, but the recent research indicate that it has a great potential in enhancing biopolymer properties. The biocarbon-biopolymer composite could provide a much needed fully biodegradable solution. This would be especially interesting in agricultural and horticultural applications, since biocarbon has been found to be effective at retaining water and water-soluble nutrients and to increase micro-organism activity in soil. Biocarbon-biocomposite may also be used for other markets, where biodegradability is essential, including packaging and disposable consumer articles. The BioADD consortium consists of 9 industrial partners, a branch organization and 3 research partners. The partner companies form a complementary team, including biomass providers, pyrolysis technology manufacturers and companies producing products to the relevant markets of horticulture, agriculture and packaging. For each of the companies the successful result from the project will lead to concrete business opportunities. The support of Avans, University of Groningen and Eindhoven University of Technology is essential in developing the know-how and the first product development making the innovation possible.
