BackgroundHigh-flow nasal oxygen (HFNO) is increasingly used in patients with acute hypoxemic respiratory failure. It is uncertain whether a broadened Berlin definition of acute respiratory distress syndrome (ARDS), in which ARDS can be diagnosed in patients who are not receiving ventilation, results in similar groups of patients receiving HFNO as in patients receiving ventilation.MethodsWe applied a broadened definition of ARDS in a multicenter, observational study in adult critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), wherein the requirement for a minimal level of 5 cm H2O PEEP with ventilation is replaced by a minimal level of airflow rate with HFNO, and compared baseline characteristics and outcomes between patients receiving HFNO and patients receiving ventilation. The primary endpoint was ICU mortality. We also compared outcomes in risk for death groups using the PaO2/FiO2 cutoffs as used successfully in the original definition of ARDS. Secondary endpoints were hospital mortality; mortality on days 28 and 90; need for ventilation within 7 days in patients that started with HFNO; the number of days free from HFNO or ventilation; and ICU and hospital length of stay.ResultsOf 728 included patients, 229 patients started with HFNO and 499 patients with ventilation. All patients fulfilled the broadened Berlin definition of ARDS. Patients receiving HFNO had lower disease severity scores and lower PaO2/FiO2 than patients receiving ventilation. ICU mortality was lower in receiving HFNO (22.7 vs 35.6%; p = 0.001). Using PaO2/FiO2 cutoffs for mild, moderate and severe arterial hypoxemia created groups with an ICU mortality of 16.7%, 22.0%, and 23.5% (p = 0.906) versus 19.1%, 37.9% and 41.4% (p = 0.002), in patients receiving HFNO versus patients receiving ventilation, respectively.ConclusionsUsing a broadened definition of ARDS may facilitate an earlier diagnosis of ARDS in patients receiving HFNO; however, ARDS patients receiving HFNO and ARDS patients receiving ventilation have distinct baseline characteristics and mortality rates.Trial registration: The study is registered at ClinicalTrials.gov (identifier NCT04719182).
MULTIFILE
BACKGROUND AND PURPOSE: Paratonia is a motor problem that develops during the course of dementia. Definitions of paratonia used in the literature differ considerably, which has clinical implications and may lead to an undesirable heterogeneity in study populations. For this reason, we initiated a Delphi procedure with known experts in the field to establish an operational consensus definition of paratonia.METHODS: The Delphi procedure involved an anonymous and multistage approach presented as a questionnaire, with each stage building on the results of the previous one in order to reach consensus on the definition of paratonia.RESULTS: Eight of 17 experts agreed to participate in the study. After 4 rounds, the participants reached consensus on the following definition: paratonia is a form of hypertonia with an involuntary variable resistance during passive movement. The nature of paratonia may change with progression of dementia (eg, from active assistance (aka Mitgehen) to active resistance). The degree of resistance depends on the speed of movement (eg, slow > low resistance, fast > high resistance). The degree of paratonia is proportional to the amount of force applied and increases with progression of dementia. The resistance to passive movement is in any direction and there is no clasp-knife phenomenon.CONCLUSION: The Delphi procedure resulted in a comprehensive, operational definition of paratonia. Future research should focus on the reliability and validity of this definition.
DOCUMENT
High Performance Organization (HPO) characteristics indicate why an organization is able to achieve significantly better results than other organizations and these characteristics can facilitate associations to optimize employees’ work outcomes. The independent professional (IP) is an increasingly occurring phenomenon in the labor market that fulfils an organizations’ need for flexibility in knowledge productivity. This study focuses on the contribution of HPO characteristics to the knowledge productivity of IP's. It was conducted among managers and HRM professionals in various Dutch knowledge-intensive organizations that frequently enlist the services of IPs. This study found a number of HPO attributes that appeared to contribute to the IPs' knowledge productivity, namely the quality of management, an open and actionfocused organizational culture, and continual improvement and innovation. We will use these results to look ahead and consider the future consequences for professional practice. Managers and HRM professionals should strive to contribute to the incorporation of these characteristics within the organization in order to safeguard and enhance knowledge productivity of independent professionals.
DOCUMENT
Companies in the Brainport region are often characterized as high mix low volume (HMLV) production environments. These companies are distinguished by a wide range of possible products (high product variety), which are produced in low volumes. These are often customer-specific products that are produced once or incidentally. Traditionally, these companies focus on efficient use of resources, where utilisation rate and cost coverage are relevant. The increasing customer demand in the region leads to pressure on production capacity. An initial intuitive response from these companies is to further increase the utilisation rate of machines. To keep costs manageable, the company tries to avoid investing in additional capacity. An undesirable side effect is increasing pressure on timeliness (delivery, such as lead times, delivery reliability, flexibility) and quality. The apparent contradiction between costs and timeliness in these HMLV production environments is a recurring issue in practice-oriented research conducted by Fontys Industrial Engineering and Management students. This results in the following research question: Which sub-aspects may be relevant to the performance regarding Quality, Delivery, and Cost (QDC) of an HMLV production environment?
DOCUMENT
The aim of the present study was to investigate if the presence of anterior cruciate ligament (ACL) injury risk factors depicted in the laboratory would reflect at-risk patterns in football-specific field data. Twenty-four female footballers (14.9 ± 0.9 year) performed unanticipated cutting maneuvers in a laboratory setting and on the football pitch during football-specific exercises (F-EX) and games (F-GAME). Knee joint moments were collected in the laboratory and grouped using hierarchical agglomerative clustering. The clusters were used to investigate the kinematics collected on field through wearable sensors. Three clusters emerged: Cluster 1 presented the lowest knee moments; Cluster 2 presented high knee extension but low knee abduction and rotation moments; Cluster 3 presented the highest knee abduction, extension, and external rotation moments. In F-EX, greater knee abduction angles were found in Cluster 2 and 3 compared to Cluster 1 (p = 0.007). Cluster 2 showed the lowest knee and hip flexion angles (p < 0.013). Cluster 3 showed the greatest hip external rotation angles (p = 0.006). In F-GAME, Cluster 3 presented the greatest knee external rotation and lowest knee flexion angles (p = 0.003). Clinically relevant differences towards ACL injury identified in the laboratory reflected at-risk patterns only in part when cutting on the field: in the field, low-risk players exhibited similar kinematic patterns as the high-risk players. Therefore, in-lab injury risk screening may lack ecological validity.
DOCUMENT
Objectives: The aim of this scoping review was threefold: 1. to identify existing definitions of oral frailty and similar terms in gerodontology literature; 2. to assess the oral frailty definitions and analyze whether these are well formulated on a conceptual level; and 3. in the absence of existing definitions meeting the criteria for good conceptual definitions, a new conceptual definition of oral frailty will be presented. Methods: A search was performed in electronic databases and internet search engines. Studies explaining or defining oral frailty or similar terms were of interest. A software-aided procedure was performed to screen titles and abstracts and identify definitions of oral frailty and similar terms. We used a guide to assess the quality of the oral frailty definitions on methodological, linguistic, and content-related criteria. Results: Of the 1,528 screened articles, 47 full-texts were reviewed. Thirteen of these contained seven definitions of oral frailty and ten definitions of similar terms. We found that all definitions of oral frailty contain the same or equivalent characteristics used to define the concepts of ’oral health’, ’deterioration of oral function’, and ’oral hypofunction’. Between the seven definitions, oral frailty is described with a different number and combination of characteristics, resulting in a lack of conceptual consistency. None of the definitions of oral frailty met all criteria. Conclusion: According to our analysis, the current definitions of oral frailty cannot be considered ’good’ conceptual definitions. Therefore, we proposed a new conceptual definition: Oral frailty is the age-related functional decline of orofacial structures.
DOCUMENT
The aim of the present study was to investigate if the presence of anterior cruciate ligament (ACL) injury risk factors depicted in the laboratory would reflect at-risk patterns in football-specific field data. Twenty-four female footballers (14.9 ± 0.9 year) performed unanticipated cutting maneuvers in a laboratory setting and on the football pitch during football-specific exercises (F-EX) and games (F-GAME). Knee joint moments were collected in the laboratory and grouped using hierarchical agglomerative clustering. The clusters were used to investigate the kinematics collected on field through wearable sensors. Three clusters emerged: Cluster 1 presented the lowest knee moments; Cluster 2 presented high knee extension but low knee abduction and rotation moments; Cluster 3 presented the highest knee abduction, extension, and external rotation moments. In F-EX, greater knee abduction angles were found in Cluster 2 and 3 compared to Cluster 1 (p = 0.007). Cluster 2 showed the lowest knee and hip flexion angles (p < 0.013). Cluster 3 showed the greatest hip external rotation angles (p = 0.006). In F-GAME, Cluster 3 presented the greatest knee external rotation and lowest knee flexion angles (p = 0.003). Clinically relevant differences towards ACL injury identified in the laboratory reflected at-risk patterns only in part when cutting on the field: in the field, low-risk players exhibited similar kinematic patterns as the high-risk players. Therefore, in-lab injury risk screening may lack ecological validity.
MULTIFILE
This paper presents the development and construct validation of an instrument for identification of resilient and less-resilient middle adolescents in high school. Purpose of this identification is a qualitative in-depth interview study of perceptions of resilient and less resilient middle-adolescents on their school environment. The qualitative study will function as examination of contentvalidity of the presented instrument. A 33-item Resilient Behavior Questionnaire (VVL) and a 105-item personality questionnaire NPV-J (Dutch Personality Questionnaire- Youngsters) were administered to a sample of 400 middle adolescent high school students (age range 14-16). It was hypothesized that scores on specific components in the VVL would correlate highly with relevant factors of personality in the NPV-J. Principal Component Analysis and Correlation Analysis served as methods of investigation. Results of the quantitative study reveal three components in the VVL and a high correlation between the scores on these components and the resilient personality factor perseverance and non-resilient factor inadequacy in the NPV-J. Discussion focuses on explanation of the results and implications for further development of the VVL.
DOCUMENT
In December of 2004 the Directorate General for Research and Technological Development (DG RTD) of the European Commission (EC) set up a High-Level Expert Group to propose a series of measures to stimulate the reporting of Intellectual Capital in research intensive Small and Medium-Sized Enterprises (SMEs). The Expert Group has focused on enterprises that either perform Research and Development (R&D), or use the results of R&D to innovate and has also considered the implications for the specialist R&D units of larger enterprises, dedicated Research & Technology Organizations and Universities. In this report the Expert Group presents its findings, leading to six recommendations to stimulate the reporting of Intellectual Capital in SMEs by raising awareness, improving reporting competencies, promoting the use of IC Reporting and facilitating standardization.
DOCUMENT
