294 resultados para Enhanced recovery


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Climate change is predicted to increase the frequency and severity of extreme weather events which pose significant challenges to the ability of government and other relief agencies to plan for, cope with and respond to disasters. Consequently, it is important that communities in climate sensitive and potential disaster prone areas strengthen their resilience to natural disasters in order to expeditiously recover from potential disruptions and damage caused by disasters. Building self reliance and, particularly in the immediate aftermath of a disaster, can facilitate short-term and long-term community recovery. To build stronger and more resilient communities, it is essential to have a better understanding of their current resilience capabilities by assessing areas of strength, risks and vulnerabilities so that their strengths can be enhanced and the risks and vulnerability can be appropriately addressed and mitigated through capacity building programs. While a number of conceptual frameworks currently exist to assess the resilience level of communities to disasters, they have tended to differ on their emphasis, scope and definition of what constitutes community resilience and how community resilience can be most effectively and accurately assessed. These limitations are attributed to the common approach of viewing community resilience through a mono-disciplinary lens. To overcome this, this paper proposes an integrated conceptual framework that takes into account the complex interplay of environmental, social, governance, infrastructure and economic attributes associated with community resilience. The framework can be operationalised using a range of resilience indicators to suit the nature of a disaster and the specific characteristics of a study region.

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Cardiovascular diseases are a leading cause of death throughout the developed world. With the demand for donor hearts far exceeding the supply, a bridge-to-transplant or permanent solution is required. This is currently achieved with ventricular assist devices (VADs), which can be used to assist the left ventricle (LVAD), right ventricle (RVAD), or both ventricles simultaneously (BiVAD). Earlier generation VADs were large, volume-displacement devices designed for temporary support until a donor heart was found. The latest generation of VADs use rotary blood pump technology which improves device lifetime and the quality of life for end stage heart failure patients. VADs are connected to the heart and greater vessels of the patient through specially designed tubes called cannulae. The inflow cannulae, which supply blood to the VAD, are usually attached to the left atrium or ventricle for LVAD support, and the right atrium or ventricle for RVAD support. Few studies have characterized the haemodynamic difference between the two cannulation sites, particularly with respect to rotary RVAD support. Inflow cannulae are usually made of metal or a semi-rigid polymer to prevent collapse with negative pressures. However suction, and subsequent collapse, of the cannulated heart chamber can be a frequent occurrence, particularly with the relatively preload insensitive rotary blood pumps. Suction events may be associated with endocardial damage, pump flow stoppages and ventricular arrhythmias. While several VAD control strategies are under development, these usually rely on potentially inaccurate sensors or somewhat unreliable inferred data to estimate preload. Fixation of the inflow cannula is usually achieved through suturing the cannula, often via a felt sewing ring, to the cannulated chamber. This technique extends the time on cardiopulmonary bypass which is associated with several postoperative complications. The overall objective of this thesis was to improve the placement and design of rotary LVAD and RVAD inflow cannulae to achieve enhanced haemodynamic performance, reduced incidence of suction events, reduced levels of postoperative bleeding and a faster implantation procedure. Specific objectives were: * in-vitro evaluation of LVAD and RVAD inflow cannula placement, * design and in-vitro evaluation of a passive mechanism to reduce the potential for heart chamber suction, * design and in-vitro evaluation of a novel suture-less cannula fixation device. In order to complete in-vitro evaluation of VAD inflow cannulae, a mock circulation loop (MCL) was developed to accurately replicate the haemodynamics in the human systemic and pulmonary circulations. Validation of the MCL’s haemodynamic performance, including the form and magnitude of pressure, flow and volume traces was completed through comparisons of patient data and the literature. The MCL was capable of reproducing almost any healthy or pathological condition, and provided a useful tool to evaluate VAD cannulation and other cardiovascular devices. The MCL was used to evaluate inflow cannula placement for rotary VAD support. Left and right atrial and ventricular cannulation sites were evaluated under conditions of mild and severe heart failure. With a view to long term LVAD support in the severe left heart failure condition, left ventricular inflow cannulation was preferred due to improved LVAD efficiency and reduced potential for thrombus formation. In the mild left heart failure condition, left atrial cannulation was preferred to provide an improved platform for myocardial recovery. Similar trends were observed with RVAD support, however to a lesser degree due to a smaller difference in right atrial and ventricular pressures. A compliant inflow cannula to prevent suction events was then developed and evaluated in the MCL. As rotary LVAD or RVAD preload was reduced, suction events occurred in all instances with a rigid inflow cannula. Addition of the compliant segment eliminated suction events in all instances. This was due to passive restriction of the compliant segment as preload dropped, thus increasing the VAD circuit resistance and decreasing the VAD flow rate. Therefore, the compliant inflow cannula acted as a passive flow control / anti-suction system in LVAD and RVAD support. A novel suture-less inflow cannula fixation device was then developed to reduce implantation time and postoperative bleeding. The fixation device was evaluated for LVAD and RVAD support in cadaveric animal and human hearts attached to a MCL. LVAD inflow cannulation was achieved in under two minutes with the suture-less fixation device. No leakage through the suture-less fixation device – myocardial interface was noted. Continued development and in-vivo evaluation of this device may result in an improved inflow cannulation technique with the potential for off-bypass insertion. Continued development of this research, in particular the compliant inflow cannula and suture-less inflow cannulation device, will result in improved postoperative outcomes, life span and quality of life for end-stage heart failure patients.

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We have developed an explanation for ultra trace detection found when using Au/Ag SERS nanoparticles linked to biochemical affinity tags, e.g. antibodies. The nanoparticle structure is not as usually assumed and the aggregated nanoparticles constitute hot spots that are indispensable for these very low levels of analyte detection, even more so when using a direct detection method.

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The nature and characteristics of how learners learn today are changing. As technology use in learning and teaching continues to grow, its integration to facilitate deep learning and critical thinking becomes a primary consideration. The implications for learner use, implementation strategies, design of integration frameworks and evaluation of their effectiveness in learning environments cannot be overlooked. This study specifically looked at the impact that technology-enhanced learning environments have on different learners’ critical thinking in relation to eductive ability, technological self-efficacy, and approaches to learning and motivation in collaborative groups. These were explored within an instructional design framework called CoLeCTTE (collaborative learning and critical thinking in technology-enhanced environments) which was proposed, revised and used across three cases. The field of investigation was restricted to three key questions: 1) Do learner skill bases (learning approach and eductive ability) influence critical thinking within the proposed CoLeCTTE framework? If so, how?; 2) Do learning technologies influence the facilitation of deep learning and critical thinking within the proposed CoLeCTTE framework? If so, how?; and 3) How might learning be designed to facilitate the acquisition of deep learning and critical thinking within a technology-enabled collaborative environment? The rationale, assumptions and method of research for using a mixed method and naturalistic case study approach are discussed; and three cases are explored and analysed. The study was conducted at the tertiary level (undergraduate and postgraduate) where participants were engaged in critical technical discourse within their own disciplines. Group behaviour was observed and coded, attributes or skill bases were measured, and participants interviewed to acquire deeper insights into their experiences. A progressive case study approach was used, allowing case investigation to be implemented in a "ladder-like" manner. Cases 1 and 2 used the proposed CoLeCTTE framework with more in-depth analysis conducted for Case 2 resulting in a revision of the CoLeCTTE framework. Case 3 used the revised CoLeCTTE framework and in-depth analysis was conducted. The findings led to the final version of the framework. In Cases 1, 2 and 3, content analysis of group work was conducted to determine critical thinking performance. Thus, the researcher used three small groups where learner skill bases of eductive ability, technological self-efficacy, and approaches to learning and motivation were measured. Cases 2 and 3 participants were interviewed and observations provided more in-depth analysis. The main outcome of this study is analysis of the nature of critical thinking within collaborative groups and technology-enhanced environments positioned in a theoretical instructional design framework called CoLeCTTE. The findings of the study revealed the importance of the Achieving Motive dimension of a student’s learning approach and how direct intervention and strategies can positively influence critical thinking performance. The findings also identified factors that can adversely affect critical thinking performance and include poor learning skills, frustration, stress and poor self-confidence, prioritisations over learning; and inadequate appropriation of group role and tasks. These findings are set out as instructional design guidelines for the judicious integration of learning technologies into learning and teaching practice for higher education that will support deep learning and critical thinking in collaborative groups. These guidelines are presented in two key areas: technology and tools; and activity design, monitoring, control and feedback.

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This paper proposes a practical prediction procedure for vertical displacement of a Rotarywing Unmanned Aerial Vehicle (RUAV) landing deck in the presence of stochastic sea state disturbances. A proper time series model tending to capture characteristics of the dynamic relationship between an observer and a landing deck is constructed, with model orders determined by a novel principle based on Bayes Information Criterion (BIC) and coefficients identified using the Forgetting Factor Recursive Least Square (FFRLS) method. In addition, a fast-converging online multi-step predictor is developed, which can be implemented more rapidly than the Auto-Regressive (AR) predictor as it requires less memory allocations when updating coefficients. Simulation results demonstrate that the proposed prediction approach exhibits satisfactory prediction performance, making it suitable for integration into ship-helicopter approach and landing guidance systems in consideration of computational capacity of the flight computer.

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Evolutionary computation is an effective tool for solving optimization problems. However, its significant computational demand has limited its real-time and on-line applications, especially in embedded systems with limited computing resources, e.g., mobile robots. Heuristic methods such as the genetic algorithm (GA) based approaches have been investigated for robot path planning in dynamic environments. However, research on the simulated annealing (SA) algorithm, another popular evolutionary computation algorithm, for dynamic path planning is still limited mainly due to its high computational demand. An enhanced SA approach, which integrates two additional mathematical operators and initial path selection heuristics into the standard SA, is developed in this work for robot path planning in dynamic environments with both static and dynamic obstacles. It improves the computing performance of the standard SA significantly while giving an optimal or near-optimal robot path solution, making its real-time and on-line applications possible. Using the classic and deterministic Dijkstra algorithm as a benchmark, comprehensive case studies are carried out to demonstrate the performance of the enhanced SA and other SA algorithms in various dynamic path planning scenarios.

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This paper describes the work being conducted in the baseline rail level crossing project, supported by the Australian rail industry and the Cooperative Research Centre for Rail Innovation. The paper discusses the limitations of near-miss data for analysis obtained using current level crossing occurrence reporting practices. The project is addressing these limitations through the development of a data collection and analysis system with an underlying level crossing accident causation model. An overview of the methodology and improved data recording process are described. The paper concludes with a brief discussion of benefits this project is expected to provide the Australian rail industry.

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A new bioluminescent creatine kinase (CK) assay using purified luciferase was used to analyse CK activity in serum samples dried on filter paper. Enzyme activity was preserved for over 1 wk on paper stored at room temperature. At 60°C, CK activity in liquid serum samples was rapidly inactivated, but the activity of enzyme stored on paper was preserved for at least 2 days.

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Between mid 2010 and early 2013, Queensland road related infrastructures were devastated by flood and cyclone related natural disasters. Responding to these recent events and in preparing for more regular and intense climate-change induced events in future, the Queensland Government is now reviewing how post-disaster road infrastructure recovery projects are planned and delivered. In particular, there is awareness that rebuilding such infrastructure need sustainable strategies across economic, environmental and social dimensions. A comprehensive sustainability assessment framework for pre and post disaster situations can minimize negative impact on our communities, economy and environment. This research is underway to develop a comprehensive sustainability element frame work for post disaster management in road infrastructures in Queensland, Australia. Analyzing the implications of disruption to transport network and associated services is an important part of preparing local and regional responses to the impacts of natural disasters. This research can contribute to strategic planning, management leading to safe, efficient and integrated transport system that supports sustainable economic, social and environmental outcomes in Queensland. Within this context, this paper provides an overview of the qualitative mixed-method research approach involving literature reviews and case studies to explore and evaluate a number of sustainability elements with a view to develop operational strategies for disaster recovery road projects.

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Since the pioneering work of Hough in 1902 (1) the term ‘delayed onset muscle soreness (DOMS)’ has dominated the field of athletic recovery. DOMS typically occurs after exercise induced muscle damage (EIMD), particularly if the exercise is unaccustomed or involves a large amount of eccentric (muscle lengthening) contractions. The symptoms of EIMD manifest as a temporary reduction in muscle force, disturbed proprioceptive acuity, increases in inflammatory markers both within the injured muscle and in the blood as well as increased muscle soreness, stiffness and swelling. The intensity of discomfort and soreness associated with DOMS increases within the first 24 hours, peaks between 24 and 72 hours, before subsiding and eventually disappearing 5-7 days after the exercise. Consequently, DOMS may interfere with athletic training or competition and several recovery interventions have been utilised by athletes and coaches in an attempt to offset the negative effects...

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Purpose Commencing selected workouts with low muscle glycogen availability augments several markers of training adaptation compared with undertaking the same sessions with normal glycogen content. However, low glycogen availability reduces the capacity to perform high-intensity (>85% of peak aerobic power (V·O2peak)) endurance exercise. We determined whether a low dose of caffeine could partially rescue the reduction in maximal self-selected power output observed when individuals commenced high-intensity interval training with low (LOW) compared with normal (NORM) glycogen availability. Methods Twelve endurance-trained cyclists/triathletes performed four experimental trials using a double-blind Latin square design. Muscle glycogen content was manipulated via exercise–diet interventions so that two experimental trials were commenced with LOW and two with NORM muscle glycogen availability. Sixty minutes before an experimental trial, subjects ingested a capsule containing anhydrous caffeine (CAFF, 3 mg-1·kg-1 body mass) or placebo (PLBO). Instantaneous power output was measured throughout high-intensity interval training (8 × 5-min bouts at maximum self-selected intensity with 1-min recovery). Results There were significant main effects for both preexercise glycogen content and caffeine ingestion on power output. LOW reduced power output by approximately 8% compared with NORM (P < 0.01), whereas caffeine increased power output by 2.8% and 3.5% for NORM and LOW, respectively, (P < 0.01). Conclusion We conclude that caffeine enhanced power output independently of muscle glycogen concentration but could not fully restore power output to levels commensurate with that when subjects commenced exercise with normal glycogen availability. However, the reported increase in power output does provide a likely performance benefit and may provide a means to further enhance the already augmented training response observed when selected sessions are commenced with reduced muscle glycogen availability. It has long been known that endurance training induces a multitude of metabolic and morphological adaptations that improve the resistance of the trained musculature to fatigue and enhance endurance capacity and/or exercise performance (13). Accumulating evidence now suggests that many of these adaptations can be modified by nutrient availability (9–11,21). Growing evidence suggests that training with reduced muscle glycogen using a “train twice every second day” compared with a more traditional “train once daily” approach can enhance the acute training response (29) and markers representative of endurance training adaptation after short-term (3–10 wk) training interventions (8,16,30). Of note is that the superior training adaptation in these previous studies was attained despite a reduction in maximal self-selected power output (16,30). The most obvious factor underlying the reduced intensity during a second training bout is the reduction in muscle glycogen availability. However, there is also the possibility that other metabolic and/or neural factors may be responsible for the power drop-off observed when two exercise bouts are performed in close proximity. Regardless of the precise mechanism(s), there remains the intriguing possibility that the magnitude of training adaptation previously reported in the face of a reduced training intensity (Hulston et al. (16) and Yeo et al.) might be further augmented, and/or other aspects of the training stimulus better preserved, if power output was not compromised. Caffeine ingestion is a possible strategy that might “rescue” the aforementioned reduction in power output that occurs when individuals commence high-intensity interval training (HIT) with low compared with normal glycogen availability. Recent evidence suggests that, at least in endurance-based events, the maximal benefits of caffeine are seen at small to moderate (2–3 mg·kg-1 body mass (BM)) doses (for reviews, see Refs. (3,24)). Accordingly, in this study, we aimed to determine the effect of a low dose of caffeine (3 mg·kg-1 BM) on maximal self-selected power output during HIT commenced with either normal (NORM) or low (LOW) muscle glycogen availability. We hypothesized that even under conditions of low glycogen availability, caffeine would increase maximal self-selected power output and thereby partially rescue the reduction in training intensity observed when individuals commence HIT with low glycogen availability.

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Quantity and timing of protein ingestion are major factors regulating myofibrillar protein synthesis (MPS). However, the effect of specific ingestion patterns on MPS throughout a 12 h period is unknown. We determined how different distributions of protein feeding during 12 h recovery after resistance exercise affects anabolic responses in skeletal muscle. Twenty-four healthy trained males were assigned to three groups (n = 8/group) and undertook a bout of resistance exercise followed by ingestion of 80 g of whey protein throughout 12 h recovery in one of the following protocols: 8 × 10 g every 1.5 h (PULSE); 4 × 20 g every 3 h (intermediate: INT); or 2 × 40 g every 6 h (BOLUS). Muscle biopsies were obtained at rest and after 1, 4, 6, 7 and 12 h post exercise. Resting and post-exercise MPS (l-[ring-(13)C6] phenylalanine), and muscle mRNA abundance and cell signalling were assessed. All ingestion protocols increased MPS above rest throughout 1-12 h recovery (88-148%, P < 0.02), but INT elicited greater MPS than PULSE and BOLUS (31-48%, P < 0.02). In general signalling showed a BOLUS>INT>PULSE hierarchy in magnitude of phosphorylation. MuRF-1 and SLC38A2 mRNA were differentially expressed with BOLUS. In conclusion, 20 g of whey protein consumed every 3 h was superior to either PULSE or BOLUS feeding patterns for stimulating MPS throughout the day. This study provides novel information on the effect of modulating the distribution of protein intake on anabolic responses in skeletal muscle and has the potential to maximize outcomes of resistance training for attaining peak muscle mass.

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“Mental illness is a tough illness to survive, it is incurable but manageable. Living with the illness when at its full potency can disrupt your life at any moment.” Intensive care for patients experiencing acute psychiatric distress is an essential yet complex part of mental health services as a whole system. Psychiatric intensive care units remain a source of controversy; despite promising developments to health services incorporating recovery goals and processes outlined by people with a mental illness themselves. In past decades changes in the provision of mental health services have focused on the restoration of a meaningful and empowered life with choice and hope as a defining attribute of recovery. Yet, what does recovery mean and how are recovery principles accomplished in psychiatric intensive care arrangements for someone experiencing acute psychiatric distress?

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Purpose The aim of this study was to determine the early time course of exercise-induced signaling after divergent contractile activity associated with resistance and endurance exercise. Methods Sixteen male subjects were randomly assigned to either a cycling (CYC; n = 8, 60 min, 70% V?O2peak) or resistance (REX; n = 8, 8×5 leg extension, 80% one-repetition maximum, 3-min recovery) exercise group. Serial muscle biopsies were obtained from vastus lateralis at rest before, immediately after, and after 15, 30, and 60 min of passive recovery to determine early signaling responses after exercise. Results There were comparable increases from rest in AktThr308/Ser473 and mTORSer2448 phosphorylation during the postexercise time course that peaked 30-60 min after both CYC and REX (P<0.05). There were also similar patterns in p70S6K Thr389 and 4E-BP1Thr37/46 phosphorylation, but a greater magnitude of effect was observed for REX and CYC, respectively (P<0.05). However, AMPKThr172 phosphorylation was only significantly elevated after CYC (P<0.05), and we observed divergent responses for glycogen synthaseSer641 and AS160 phosphorylation that were enhanced after CYC but not REX (P<0.05). Conclusions We show a similar time course for Akt-mTOR-S6K phosphorylation during the initial 60-min recovery period after divergent contractile stimuli. Conversely, enhanced phosphorylation status of proteins that promote glucose transport and glycogen synthesis only occurred after endurance exercise. Our results indicate that endurance and resistance exercise initiate translational signaling, but high-load, low-repetition contractile activity failed to promote phosphorylation of pathways regulating glucose metabolism.

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Purpose: It is not known whether it is possible to repeatedly supercompensate muscle glycogen stores after exhaustive exercise bouts undertaken within several days. Methods: We evaluated the effect of repeated exercise-diet manipulation on muscle glycogen and triacylglycerol (IMTG) metabolism and exercise capacity in six well-trained subjects who completed an intermittent, exhaustive cycling protocol (EX) on three occasions separated by 48 h (i.e., days 1, 3, and 5) in a 5-d period. Twenty-four hours before day 1, subjects consumed a moderate (6 g·kg-1)-carbohydrate (CHO) diet, followed by 5 d of a high (12 g·kg-1·d -1)-CHO diet. Muscle biopsies were taken at rest, immediately post-EX on days 1, 3, and 5, and after 3 h of recovery on days 1 and 3. Results: Compared with day 1, resting muscle [glycogen] was elevated on day 3 but not day 5 (435 ± 57 vs 713 ± 60 vs 409 ± 40 mmol·kg -1, P < 0.001). [IMTG] was reduced by 28% (P < 0.05) after EX on day 1, but post-EX levels on days 3 and 5 were similar to rest. EX was enhanced on days 3 and 5 compared with day 1 (31.9 ± 2.5 and 35.4 ± 3.8 vs 24.1 ± 1.4 kJ·kg-1, P < 0.05). Glycogen synthase activity at rest and immediately post-EX was similar between trials. Additionally, the rates of muscle glycogen accumulation were similar during the 3-h recovery period on days 1 and 3. Conclusion: We show that well-trained men cannot repeatedly supercompensate muscle [glycogen] after glycogen-depleting exercise and 2 d of a high-CHO diet, suggesting that the mechanisms responsible for glycogen accumulation are attenuated as a consequence of successive days of glycogen-depleting exercise.