Zoekresultaten

The challenges of evidence-based prehabilitation in a real-life context for patients preparing for colorectal surgery - a cohort study and multiple case analysis

Background: Multimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.Methods: In this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.Results: Fifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33-84 days). Adherence was high (84-100%) in five and moderate (72-73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.Conclusion: Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.

How Operators Design Their Human-Cobot Interdependencies

Problem solving and Program design using the TI-92

This textbook is intended for a basic course in problem solving and program design needed by scientists and engineers using the TI-92. The TI-92 is an extremely powerful problem solving tool that can help you manage complicated problems quickly. We assume no prior knowledge of computers or programming, and for most of its material, high school algebra is sufficient mathematica background. It is advised that you have basic skills in using the TI-92. After the course you will become familiar with many of the programming commands and functions of the TI-92. The connection between good problem solving skills and an effective program design method, is used and applied consistently to most examples and problems in the text. We also introduce many of the programming commands and functions of the TI-92 needed to solve these problems. Each chapter ends with a number of practica problems that require analysis of programs as well as short programming exercises.

Switching modalities in a sentence verification task : ERP evidence for embodied language processing

In an event related potential (ERP) experiment using written language materials only, we investigated a potential modulation of the N400 by the modality switch effect. The modality switch effect occurs when a first sentence, describing a fact grounded in one modality, is followed by a second sentence describing a second fact grounded in a different modality. For example, "A cellar is dark" (visual), was preceded by either another visual property "Ham is pink" or by a tactile property "A mitten is soft." We also investigated whether the modality switch effect occurs for false sentences ("A cellar is light"). We found that, for true sentences, the ERP at the critical word "dark" elicited a significantly greater frontal, early N400-like effect (270-370 ms) when there was a modality mismatch than when there was a modality-match. This pattern was not found for the critical word "light" in false sentences. Results similar to the frontal negativity were obtained in a late time window (500-700 ms). The obtained ERP effect is similar to one previously obtained for pictures. We conclude that in this paradigm we obtained fast access to conceptual properties for modality-matched pairs, which leads to embodiment effects similar to those previously obtained with pictorial stimuli.

The dynamics of power in disaster response networks

A major challenge for disaster scholars and policymakers is to understand the power dimension in response networks, particularly relating to collaboration and coordination. We propose a conceptual framework to study interests and negotiations in and between various civic and professional, response networks drawing on the concepts of “programming” and “switching” proposed by Manuel Castells in his work on the network society. Programming in disaster response refers to the ability to constitute response networks and to program/reprogram them in terms of the goals assigned to the network. Switching is the ability to connect different net-works by sharing common goals and combining resources. We employ these concepts to understand how the US Federal Emergency Management Agency organized its response in the aftermath of Hurricanes Katrina and Sandy. Our conceptual framework can be used both by disaster scholars and policymakers to understand how networked power is constructed and utilized.

Switching Power Supplies in DC Grids

The Smart Current Limiter is a switching DC to DC converter that provides a digitally pre-set input current control for inrush limiting and power management. Being able to digitally adjust the current level in combination with external feedback can be used for control systems like temperature control in high power DC appliances. Traditionally inrush current limiting is done using a passive resistance whose resistance changes depending on the current level. Bypassing this inrush limiting resister with a Mosfet improves efficiency and controllability, but footprint and losses remain large. A switched current mode controlled inrush limiter can limit inrush currents and even control the amount of current passing to the application. This enables power management and inrush current limitation in a single device. To reduce footprint and costs a balance between losses and cost-price on one side and electromagnetic interference on the other side is sought and an optimum switching frequency is chosen. To reduce cost and copper usage, switching happens on a high frequency of 300kHz. This increases the switching losses but greatly reduces the inductor size and cost compared to switching supplies running on lower frequencies. Additional filter circuits like snubbers are necessary to keep the control signals and therefore the output current stable.