Functional management of ankle sprains: what volume and intensity of walking is undertaken in the first week

BACKGROUND:
Acute ankle sprains are usually managed functionally, with advice to undertake progressive weight-bearing and walking. Mechanical loading is an important modular of tissue repair; therefore, the clinical effectiveness of walking after ankle sprain may be dose dependent. The intensity, magnitude and duration of load associated with current functional treatments for ankle sprain are unclear.
AIM:
To describe physical activity (PA) in the first week after ankle sprain and to compare results with a healthy control group.
METHODS:
Participants (16-65 years) with an acute ankle sprain were randomised into two groups (standard or exercise). Both groups were advised to apply ice and compression, and walk within the limits of pain. The exercise group undertook additional therapeutic exercises. PA was measured using an activPAL accelerometer, worn for 7 days after injury. Comparisons were made with a non-injured control group.
RESULTS:
The standard group were significantly less active (1.2 ± 0.4 h activity/day; 5621 ± 2294 steps/day) than the exercise (1.7 ± 0 .7 h/day, p=0.04; 7886 ± 3075 steps/day, p=0.03) and non-injured control groups (1.7 ± 0.4 h/day, p=0.02; 8844 ± 2185 steps/day, p=0.002). Also, compared with the non-injured control group, the standard and exercise groups spent less time in moderate (38.3 ± 12.7 min/day vs 14.5 ± 11.4 min/day, p=0.001 and 22.5 ± 15.9 min/day, p=0.003) and high-intensity activity (4.1 ± 6.9 min/day vs 0.1 ± 0.1 min/day, p=0.001 and 0.62 ± 1.0 min/day p=0.005).
CONCLUSION:
PA patterns are reduced in the first week after ankle sprain, which is partly ameliorated with addition of therapeutic exercises. This study represents the first step towards developing evidence-based walking prescription after acute ankle sprain.

Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis

Background

It is unknown whether a conservative approach to fluid administration or deresuscitation (active removal of fluid using diuretics or renal replacement therapy) is beneficial following haemodynamic stabilisation of critically ill patients.

Purpose

To evaluate the efficacy and safety of conservative or deresuscitative fluid strategies in adults and children with acute respiratory distress syndrome (ARDS), sepsis or systemic inflammatory response syndrome (SIRS) in the post-resuscitation phase of critical illness.

Methods

We searched Medline, EMBASE and the Cochrane central register of controlled trials from 1980 to June 2016, and manually reviewed relevant conference proceedings from 2009 to the present. Two reviewers independently assessed search results for inclusion and undertook data extraction and quality appraisal. We included randomised trials comparing fluid regimens with differing fluid balances between groups, and observational studies investigating the relationship between fluid balance and clinical outcomes.

Results

Forty-nine studies met the inclusion criteria. Marked clinical heterogeneity was evident. In a meta-analysis of 11 randomised trials (2051 patients) using a random-effects model, we found no significant difference in mortality with conservative or deresuscitative strategies compared with a liberal strategy or usual care [pooled risk ratio (RR) 0.92, 95 % confidence interval (CI) 0.82–1.02, I2 = 0 %]. A conservative or deresuscitative strategy resulted in increased ventilator-free days (mean difference 1.82 days, 95 % CI 0.53–3.10, I2 = 9 %) and reduced length of ICU stay (mean difference −1.88 days, 95 % CI −0.12 to −3.64, I2 = 75 %) compared with a liberal strategy or standard care.

Conclusions

In adults and children with ARDS, sepsis or SIRS, a conservative or deresuscitative fluid strategy results in an increased number of ventilator-free days and a decreased length of ICU stay compared with a liberal strategy or standard care. The effect on mortality remains uncertain. Large randomised trials are needed to determine optimal fluid strategies in critical illness.

Growth and Public Transportation Investments: Growth Management Strategies to Reduce Transportation Capital Costs In and Near Midwestern Urban Areas, 1995

Transportation and land-use are independent, inter-active systems. Land-use patterns shape local transportation demand, but transportation systems in turn influence land-use patterns. In attempting to satisfy transportation demand created by existing land-use patterns, transportation planners directly, if not always consciously or intentionally, influence future land-use patterns. This study examines that complex relationship. The purpose of the study was threefold: to compile the body of knowledge already existing; to apply this body of knowledge to the context of midsize cities in the Midwest; and, to make the knowledge accessible both to transportation planners and to public officials who make key decisions about land use.

Confluent Learning: Using a Design Approach to Develop Cognitive Abilities and Enhance Affective Capacities Through Change Management Curriculum

Purpose The aim of the study is to explore the role of confluent learning in supporting the development of change management knowledge, skills and attitudes and to inform the creation of a conceptual model based upon a priori and a posteriori knowledge gained from literature and the research. Design/methodology/approach The research adopts qualitative approach based on reflective inquiry methodology. There are two primary data sources, interviews with learners and the researchers’ reflective journals on learners’ opinions. Findings The confluent learning approach helped to stimulate affective states (e.g. interest and appreciation) to further reinforce cognitive gains (e.g. retention of knowledge) as a number of higher order thinking skills were further developed. The instructional design premised upon confluent learning enabled learners to further appreciate the complexities of change management. Research implications/ limitations The confluent learning approach offers another explanation to how learning takes place, contingent upon the use of a problem solving framework, instructional design and active learning in developing inter- and trans-disciplinary competencies. Practical implications This study not only explains how effective learning takes place but is also instructive to learning and teaching, and human resource development (HRD) professionals in curriculum design and the potential benefits of confluent learning. Social implications The adoption of a confluent learning approach helps to re-naturalise learning that appeals to learners affect. Originality/value This research is one of the few studies that provide an in-depth exploration of the use of confluent learning and how this approach co-develops cognitive abilities and affective capacity in the creation of a conceptual model.

Indigenous Māori values and perspectives to inform freshwater management in Aotearoa-New Zealand

In response to widespread water quality and quantity issues, the New Zealand Government has recently embarked on a number of comprehensive freshwater management reforms, developing a raft of national discussion and policy documents such as “Freshwater Reform 2013 and Beyond” and a National Policy Statement for freshwater management (NPS-FM 2014). Recent resource management reforms and amendments (RMA 2014), based on previous overarching resource management legislation (RMA 1991), set out a new approach and pathway to manage freshwater nationwide. Internationally, there is an increasing trend to engage with indigenous communities for research and collaboration, including indigenous groups as active participants in resource management decision making. What is driving this change toward more engagement and collaboration with indigenous communities is different for each country, and we document the progress and innovation made in this area in New Zealand. The indigenous rights of Māori in New Zealand are stated in the 1840 Treaty of Waitangi and in many forms of New Zealand's legislation. Local and central governments are eager to include local indigenous Māori groups (iwi/hapū) in freshwater management planning processes through meaningful engagement and collaboration. Key to the success of collaborative planning processes for Māori are enduring relationships between local government and Māori, along with adequate resourcing for all partners contributing to the collaborative process. A large number of shared governance and management models for natural resource management have emerged in New Zealand over the past 20 years, and some recent examples are reviewed. We provide some discussion to improve understanding and use of the terms used in these management models such as cogovernance, comanagement, and coplanning, and describe some of the more important frameworks and tools being developed with Māori groups (e.g., iwi/hapū), to strengthen Māori capacity in freshwater management and to support good collaborative process and planning.

Towards balanced exploitation and management of the fishery resources of Uganda

A casual study of the hydrological map of Uganda would convince every serious fisherman and fisheater that he is most favoured to be in Uganda. The extent and distribution of the country's aquatic system plus the rich variety of fish species there is promises a fishery potential of considerable magnitude: The open waterways comprised by the Uganda portions of Lakes Victoria, Albert and Edward; and Lakes Kyoga, George plus minor lakes Wamala, Kijanebarora, mutanda, etc. occupy about 15% of the total surface area (91,000 m2; Depart. Land Survey, 1962). Most of the nation's fish supplies are currontly from this source. 1.2. A rich network of permanent and seasonal rivers and streams filling and/or emptying various water systems covers most of Uganda. This aquatic network is associated with a fish fauna whose immense significance as a source of protein is perhaps better appreciated by the local subsistance fisherman and consumer than by the fisheries scientist and manager in this country. Many species of this fish fauna have strong affinities with the open water systems while some are typically riverine. 1.3. Then there are wetlands composed mainly of expanses of swamp, but including some areas of bog. These cover about 2% of the country. While the variety of fish fauna found here is limited by the rather hostile nature of the environment (comparatively de-oxygenated under a canopy of dense stands of emergont vegetation) several specialised fishes e.g. Clarias spp. and Protpterus aethiopicus (Kamongo) occur here. Availability of permanent and seasonal sources of water, well distributed throughout most areas of Uganda, opens up immense potential for a variety of aquaculture practices. However, while active exploitation of much of these fishery resources is currently underway, important questions regarding the magnitudes of the various resource potentials and dynamics, and about suitable levels and modes of exploitation, are yet unanswered. These gaps in knowledge go about the fishery resources of Uganda would hinder formulation of adequate development and management schemes. This short paper examines some of the above problems and suggests some approaches towards balanced oxploitation and management of the fisheries of Uganda.

The background impact in HEI math lectures: an experience in math in the 1st year of Accounting and Management Degree

It is a fact, and far from being a new one, that students have been entering Higher Education courses with many different backgrounds in terms of secondary school programs they attended. The impact of these basic skills is a general and worldwide challenge, fundamentally when facing some specific “constructive” subjects like foreign languages and Mathematics. Working with students with an extensive variety of Math qualifications is an outrageous challenge when they enter an advanced Math course, leading to an almost generalized expectations’ failure - from students enrolled in course and from their teachers, who feel powerless in trying to monitor knowledge construction from completely different “starting points”. If teachers’ "haste" is average, more than half of the students do not “go along” and give up, even before experiencing any kind of evaluation procedure. On the contrary, if the “speed” is too low, others are discouraged (feeling not progressing at all) and the teacher runs the risk of not meeting the minimum objectives (general and specific) of its course, which may have a negative impact on students’ future training development. Failure in Mathematics, despite being a recurrent and global issue, does not have any “magical solution”, however, in general, teachers in this area seem untiring, searching, investigating, trying and implementing new and old “recipes” to tackle and demystify this subject. In this article we describe a project developed in a Math course, with the first year students from an Accounting and Management bachelor degree, and its outcomes since it was brought to practice, revealing its impact in students’ success, from approval to dropout rates, in this course. We will shortly describe students’ differentiated Math backgrounds, their results in a pre-assessment analysis and how we try to deal with these differences and level them up, having in mind the same “finish line”. One should never forget that all these students where officially accepted in higher education institutions, so they are ones’ reality, the reality of institutions whose name one should value and strive to defend.

Weathering crises on social media – Theory and practices from social media active organizations operating in Finland

Thesis compiles findings from previous research to produce guidelines on addressing crises on social media. These guidelines extracted from previous research are compared qualitatively with empirical evidence from 12 organizations by examining whether organizations apply practices recommended in previous research. Much of guidelines gain support from practitioners with few exceptions. Findings stemming from theory and practice combine to shed light on how controversies are born on social media, how crises can be prevented on social media and how organizations may manage crisis situations on social media. The majority of the resulting guidelines focus on how to address negative information and communicate during a crisis but other means of crisis management are also presented. Previous research had voiced that the field of public relations was very fractured, crisis management was lacking qualitative research and provided very little information on what organizations should do before a crisis. Thesis collects a comprehensive amount of previous research from various fields of PR in an effort to unite findings and guidelines, gathers and analyzes empirical data in a qualitative manner and includes a pre-crisis paradigm. One of the challenges in the field of crisis management still remains the absence of universally agreed definition of a crisis and the lack of means to quantify and compare the magnitude of crises.

The importance of organizational commitment to knowledge management

In recent years, Knowledge Management (KM) has assumed great importance in the literature on business and management. However, we still have so little understanding of the human issues in KM processes. Thus, this research aims to contribute to analysing the importance of Organizational Commitment (OC) to KM. First, we used the Cardoso (2003) Knowledge Management Questionnaire (QGC) that embraces all organizational activities around knowledge processes and distinguishes four dimensions of KM. Secondly we applied the Quijano, Masip, Navarro and Aubert (1997) questionnaire (ASH-ICI) that distinguishes two types of commitment (personal and instrumental) into four dimensions. These two questionnaires were applied with 300 employees in the Portuguese industrial ceramics sector. Through multiple regression analysis we found that levels of organizational commitment are statistically important to KM dimensions. Furthermore, our analysis indicates that personal commitment is more important than need commitment. These results are discussed and Organizational Behaviour specialists and Work and Organizational psychologists are challenged to assume more responsibility and an active role in KM studies and practices and to explore human issues in this field.

Practical considerations in the management of proton-pump inhibitors

Proton-pump inhibitors (PPIs) are one of the most active ingredients prescribed in Spain. In recent decades there has been an overuse of these drugs in both outpatient clinics and hospitals that has lead to a significant increase in healthcare spending and to an increase in the risk of possible side effects. It is important for health professionals to know the accepted indications and the correct doses for the use of these drugs. On the market there are different types of PPI: omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole. Omeprazole is the oldest and most used PPI, being also the cheapest. Although there are no important differences between PPIs in curing diseases, esomeprazole, a new-generation PPI, has proved to be more effective in eradicating H. pylori and in healing severe esophagitis compared to other PPIs. In recent years the use of generic drugs has spread; these drugs have the same bioavailability than the original drugs. In the case of PPIs, the few comparative studies available in the literature between original and generic drugs have shown no significant differences in clinical efficacy.

A Thermal Management Solution for Compact Power Converters

Regulated Transformer Rectifier Units contain several power electronic boards to facilitate AC to DC power conversion. As these units become smaller, the number of devices on each board increases while their distance from each other decreases, making active cooling essential to maintaining reliable operation. Although it is widely accepted that liquid is a far superior heat transfer medium to air, the latter is still capable of yielding low device operating temperatures with proper heat sink and airflow design. The purpose of this study is to describe the models and methods used to design and build the thermal management system for one of the power electronic boards in a compact, high power regulated transformer rectifier unit. Maximum device temperature, available pressure drop and manufacturability were assessed when selecting the final design for testing. Once constructed, the thermal management system’s performance was experimentally verified at three different power levels.

Gamification in Skills Management

Employees are the human capital which, to a great extent, contributes to the success and development of high-performance and sustainable organizations. In a work environment, there is a need to provide a tool for tracking and following-up on each employees' professional progress, while staying aligned with the organization’s strategic and operational goals and objectives. The research work within this Thesis aims to contribute to improve employees' selfawareness and auto-regulation; two predominant research areas are also studied and analyzed: Visual Analytics and Gamification. The Visual Analytics enables the specification of personalized dashboard interfaces with alerts and indicators to keep employees aware of their skills and to continuously monitor how to improve their expertise, promoting simultaneously behavioral change and adoption of good-practices. The study of Gamification techniques with Talent Management features enabled the design of new processes to engage, motivate, and retain highly productive employees, and to foster a competitive working environment, where employees are encouraged to be involved in new and rewarding activities, where knowledge and experience are recognized as a relevant asset. The Design Science Research was selected as the research methodology; the creation of new knowledge is therefore based on an iterative cycle addressing concepts such as design, analysis, reflection, and abstraction. By collaborating in an international project (Active@Work), funded by the Active and Assisted Living Programme, the results followed a design thinking approach regarding the specification of the structure and behavior of the Skills Development Module, namely the identification of requirements and the design of an innovative info-structure of metadata to support the user experience. A set of mockups were designed based on the user role and main concerns. Such approach enabled the conceptualization of a solution to proactively assist the management and assessment of skills in a personalized and dynamic way. The outcomes of this Thesis aims to demonstrate the existing articulation between emerging research areas such as Visual Analytics and Gamification, expecting to represent conceptual gains in these two research fields.

FOCUS : frailty management optimisation through EIPAHA commitments and utilisation of stakeholders’ input – an innovative European project in elderly care

The goal of FOCUS, which stands for Frailty Management Optimization through EIPAHA Commitments and Utilization of Stakeholders’ Input, is to reduce the burden of frailty in Europe. The partners are working on advancing knowledge of frailty detection, assessment, and management, including biological, clinical, cognitive and psychosocial markers, in order to change the paradigm of frailty care from acute intervention to prevention. FOCUS partners are working on ways to integrate the best available evidence from frailty-related screening tools, epidemiological and interventional studies into the care of frail people and their quality of life. Frail citizens in Italy, Poland and the UK and their caregivers are being called to express their views and their experiences with treatments and interventions aimed at improving quality of life. The FOCUS Consortium is developing pathways to leverage the knowledge available and to put it in the service of frail citizens. In order to reach out to the broadest audience possible, the FOCUS Platform for Knowledge Exchange and the platform for Scaling Up are being developed with the collaboration of stakeholders. The FOCUS project is a development of the work being done by the European Innovation Partnership on Active and Healthy Ageing (EIPAHA), which aims to increase the average healthy lifespan in Europe by 2020 while fostering sustainability of health/social care systems and innovation in Europe. The knowledge and tools developed by the FOCUS project, with input from stakeholders, will be deployed to all EIPAHA participants dealing with frail older citizens to support activities and optimize performance.