Dit onderzoek richt zich het filosofische vraagstuk van de relatie tussen lichamen – of ook: intercorporaliteit – in de hedendaagse danskunstpraktijk. Hoe kun je die relatie denken? Het onderzoek betreft een combinatie van fiilosofisch veldwerk, in de vorm van arts-based, narratief onderzoek, en filosofische literatuurstudie. In de conclusie wordt gesteld: intercorporaliteit in de hedendaagse danskunstpraktijk kan filosofisch begrepen worden als een diepe lichamelijk verbondenheid in beweging, in materiële en gevoelsmatige zin. Deze conclusie heeft het karakter van een nieuw filosofisch concept van ‘intercorporaliteit’ in de hedendaagse danskunstpraktijk. Het betreft een nieuw ‘denken’ van de relatie tussen lichamen in die context. Het uiteindelijk doel van het onderzoek ligt niet alleen in de academische filosofie of de danskunstpraktijk zelf, maar ook in de mogelijkheden die dans en bewegen in opvoeding en onderwijs hebben. Dans als kunstzinnige praktijk leert ons iets belangrijks over de relatie tussen mensen op het lichamelijke vlak. Dit kan betekenis krijgen voor het onderwijs, wanneer het kernthema verschuift naar: lichamelijke verbondenheid in beweging & mogelijkheden voor onderwijsinnovatie.
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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.
Effective clearance of inhaled particles requires mucus production and continuous mucus transport from the lower airways to the oropharynx. Mucus production takes place mainly in the peripheral airways. Mucus transport is achieved by the action of the ciliated cells that cover the inner surface of the airways (mucociliary transport) and by expiratory airflow. The capacity for mucociliary transport is highest in the peripheral airways, whereas the capacity for airflow transport is highest in the central airways. In patients with airways disease, mucociliary transport may be impaired and airflow transport may become the most important mucus transport mechanism.
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