A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial.

Background: increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause on going disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). Methods: the intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development. Results: the final construct for the complex intervention involved a dedicated GRA trained to pre-defined competencies across multiple rehabilitation domains (physiotherapy, dietetics, occupational therapy, and speech/language therapy), with specific training in post-critical illness issues. The intervention was from ICU discharge to 3 months post-discharge, including inpatient and post-hospital discharge elements. Clear strategies to provide information to patients/families were included. A detailed taxonomy was developed to define and describe the processes undertaken, and capture them during the trial. The detailed process measure description, together with a range of patient, health service, and economic outcomes were successfully mapped on to the modified CONSORT recommendations for reporting non-pharmacologic trial interventions. Conclusions: the MRC complex intervention framework was an effective guide to developing a novel post-ICU rehabilitation intervention. Combining a clearly defined new healthcare role with a detailed taxonomy of process and activity enabled the intervention to be clearly described for the purpose of trial delivery and reporting. These data will be useful when interpreting the results of the randomised trial, will increase internal and external trial validity, and help others implement the intervention if the intervention proves clinically and cost effective.

Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: the RECOVER randomized clinical trial.

Importance: critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. Objective: to evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post–intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. Design, Setting, and Participants: a parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. Interventions: during the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. Main Outcomes and Measures: the Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). Results: median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, −0.2 [95% CI, −1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, −0.1 [95% CI, −3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, −3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. Conclusions and Relevance: post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.

French good practice guidelines for medical and occupational surveillance of the low back pain risk among workers exposed to manual handling of loads

International audience

Chronic low back pain, chronic disability at work, chronic management issues.

International audience

Physical Design Methodologies for Low Power and Reliable 3D ICs

As the semiconductor industry struggles to maintain its momentum down the path following the Moore's Law, three dimensional integrated circuit (3D IC) technology has emerged as a promising solution to achieve higher integration density, better performance, and lower power consumption. However, despite its significant improvement in electrical performance, 3D IC presents several serious physical design challenges. In this dissertation, we investigate physical design methodologies for 3D ICs with primary focus on two areas: low power 3D clock tree design, and reliability degradation modeling and management. Clock trees are essential parts for digital system which dissipate a large amount of power due to high capacitive loads. The majority of existing 3D clock tree designs focus on minimizing the total wire length, which produces sub-optimal results for power optimization. In this dissertation, we formulate a 3D clock tree design flow which directly optimizes for clock power. Besides, we also investigate the design methodology for clock gating a 3D clock tree, which uses shutdown gates to selectively turn off unnecessary clock activities. Different from the common assumption in 2D ICs that shutdown gates are cheap thus can be applied at every clock node, shutdown gates in 3D ICs introduce additional control TSVs, which compete with clock TSVs for placement resources. We explore the design methodologies to produce the optimal allocation and placement for clock and control TSVs so that the clock power is minimized. We show that the proposed synthesis flow saves significant clock power while accounting for available TSV placement area. Vertical integration also brings new reliability challenges including TSV's electromigration (EM) and several other reliability loss mechanisms caused by TSV-induced stress. These reliability loss models involve complex inter-dependencies between electrical and thermal conditions, which have not been investigated in the past. In this dissertation we set up an electrical/thermal/reliability co-simulation framework to capture the transient of reliability loss in 3D ICs. We further derive and validate an analytical reliability objective function that can be integrated into the 3D placement design flow. The reliability aware placement scheme enables co-design and co-optimization of both the electrical and reliability property, thus improves both the circuit's performance and its lifetime. Our electrical/reliability co-design scheme avoids unnecessary design cycles or application of ad-hoc fixes that lead to sub-optimal performance. Vertical integration also enables stacking DRAM on top of CPU, providing high bandwidth and short latency. However, non-uniform voltage fluctuation and local thermal hotspot in CPU layers are coupled into DRAM layers, causing a non-uniform bit-cell leakage (thereby bit flip) distribution. We propose a performance-power-resilience simulation framework to capture DRAM soft error in 3D multi-core CPU systems. In addition, a dynamic resilience management (DRM) scheme is investigated, which adaptively tunes CPU's operating points to adjust DRAM's voltage noise and thermal condition during runtime. The DRM uses dynamic frequency scaling to achieve a resilience borrow-in strategy, which effectively enhances DRAM's resilience without sacrificing performance. The proposed physical design methodologies should act as important building blocks for 3D ICs and push 3D ICs toward mainstream acceptance in the near future.

Formulação de massas cerâmicas para porcelanas elétricas utilizando resíduos oriundos de corpos de fusíveis

The power industry generates as waste ceramic bodies of electrical fuses that are discarded after use. The formulation of ceramic bodies for porcelain electrical insulators using waste from the bodies fuse allocation promotes environmentally appropriate, through the reuse of the material. This work evaluated the technical feasibility of using waste for use in electrical porcelains with formulations containing the residue, feldspar and kaolinite. The raw materials were processed through grinding and sieving to 200 mesh. The ceramic material obtained from the proposed formulations with 25%, 30%, 34% and 40% of the residue went through a vibratory mill for grinding and homogenization, and then were sieved at 325 mesh. The samples were shaped in a uniaxial press, with the application of 25 MPa and sintered at 1100° C, 1150°C, 1200°C, 1225°C and 1250°C, at levels of 20 and 45 minutes. Were also developed bodies of evidence with reference formulations obtained without residue, to establish a comparison on physical, mechanical and electrical. The tests were conducted and technology: linear shrinkage, porosity, water absorption, resistance to bending to three points, measuring insulation resistance electrical resistivity of the material, X-ray diffraction and X-ray fluorescence Waste characterizations pointed to the existence of two phases: mullite and quartz phases are of great importance in the microstructure of the ceramic and this fact reveals a possibility for reuse in electrical porcelains. The mullite is an important constituent because it is a phase that makes it possible to increase the mechanical strength in addition to the body allows the use at high temperatures. The use of ceramic bodies residue fuses, proved feasible for application in electrical porcelain and the most significant results were obtained by the formulations with 25% waste and sintering at 1200°C

Aplicação da metodologia de planejamento de experimentos para formulação de massas cerâmicas para telhas

Rio Grande do Norte State stands out as one great producer of structural clay of the brazilian northeastern. The Valley Assu ceramic tiles production stands out obtained from ilitics ball clays that abound in the region under study. Ceramics formulation and the design of experiments with mixture approach, has been applied for researchers, come as an important aid to decrease the number of experiments necessary to the optimization. In this context, the objective of this work is to evaluate the effects of the formulation, temperature and heating rate in the physical-mechanical properties of the red ceramic body used for roofing tile fabrication of the Valley Assu, using design of mixture experiments. Four clays samples used in two ceramics industry of the region were use as raw material and characterized by X-ray diffraction, chemical composition, differential thermal analysis (DTA), thermogravimetric analysis (TGA), particle size distribution analysis and plasticity techniques. Afterwards, they were defined initial molded bodies and made specimens were then prepared by uniaxial pressing at 25 MPa before firing at 850, 950 and 1050 ºC in a laboratory furnace, with heating rate in the proportions of 5, 10 e 15 ºC/min. The following tecnologicals properties were evaluated: linear firing shrinkage, water absorption and flexural strength. Results show that the temperature 1050 ºC and heating rate of 5 ºC/min was the best condition, therefore presented significance in all physical-mechanical properties. The model was accepted as valid based of the production of three new formulations with fractions mass diferents of the initial molded bodies and heated with temperature at 1050 ºC and heating rate of 5 ºC/min. Considering the formulation, temperature and heating rate as variables of the equations, another model was suggested, where from the aplication of design of experiments with mixtures was possible to get a best formulation, whose experimental error is the minor in relation to the too much formulations

Effect on the disability index of adult patients with benign paroxysmal positional vertigo using vestibular rehabilitation and human movement

Objective: determine the effect on the disability index of adult patients with benign paroxysmal positional vertigo (BPPV) using vestibular rehabilitation therapy (VRT) and human movement. Subjects: six subjects with an average age of 49.5 ± 14.22 years who have been diagnosed with benign paroxysmal positional vertigo by an otolaryngologist. Instruments: the Dizziness Handicap Inventory and a questionnaire to determine impact on the quality of life of patients with this pathology (Ceballos and Vargas, 2004). Procedure: subjects underwent vestibular therapy for four weeks together with habituation and balance exercises in a semi-supervised manner. Two measurements were performed, one before and one after the vestibular therapy and researchers determined if there was any improvement in the physical, functional, and emotional dimensions. Statistical analysis: descriptive statistics and Student’s t-test of repeated measures were applied to analyze results obtained. Results: significant statistical differences were found in the physical dimension between the pre-test (19.33 ± 4.67 points) and post-test (13 ± 7.24 points) (t = 2.65; p < 0.05).  In contrast, no significant statistical differences were found in the functional (t = 2.44; p>0.05), emotional (t = 2.37; p>0.05) or general dimensions (t = 2.55; p>0.05). Conclusion: vestibular therapy with a semi-supervised human movement program improved the index of disability due to vertigo (physical dimension) in BPPV subjects.

Hydro-Physical Characterization of Media Used in Agricultural Systems to Develop the Best Management Practices for operation of an Environmentally Sustainable Agricultural Enterprise

Florida is the second leading horticulture state in the United States with a total annual industry sale of over $12 Billion. Due to its competitive nature, agricultural plant production represents an extremely intensive practice with large amounts of water and fertilizer usage. Agrochemical and water management are vital for efficient functioning of any agricultural enterprise, and the subsequent nutrient loading from such agricultural practices has been a concern for environmentalists. A thorough understanding of the agrochemical and the soil amendments used in these agricultural systems is of special interest as contamination of soils can cause surface and groundwater pollution leading to ecosystem toxicity. The presence of fragile ecosystems such as the Everglades, Biscayne Bay and Big Cypress near enterprises that use such agricultural systems makes the whole issue even more imminent. Although significant research has been conducted with soils and soil mix, there is no acceptable method for determining the hydraulic properties of mixtures that have been subjected to organic and inorganic soil amendments. Hydro-physical characterization of such mixtures can facilitate the understanding of water retention and permeation characteristics of the commonly used mix which can further allow modeling of soil water interactions. The objective of this study was to characterize some of the locally and commercially available plant growth mixtures for their hydro-physical properties and develop mathematical models to correlate these acquired basic properties to the hydraulic conductivity of the mixture. The objective was also to model the response patterns of soil amendments present in those mixtures to different water and fertilizer use scenarios using the characterized hydro-physical properties with the help of Everglades-Agro-Hydrology Model. The presence of organic amendments helps the mixtures retain more water while the inorganic amendments tend to adsorb more nutrients due to their high surface area. The results of these types of characterization can provide a scientific basis for understanding the non-point source water pollution from horticulture production systems and assist in the development of the best management practices for the operation of environmentally sustainable agricultural enterprise

Meshfree Method for Prediction of Thermal Properties of Porous Ceramic Materials

In the presented thesis work, meshfree method with distance fields is applied to create a novel computational approach which enables inclusion of the realistic geometric models of the microstructure and liberates Finite Element Analysis(FEA) from thedependance on and limitations of meshing of fine microstructural feature such as splats and porosity.Manufacturing processes of ceramics produce materials with complex porosity microstructure.Geometry of pores, their size and location substantially affect macro scale physical properties of the material. Complex structure and geometry of the pores severely limit application of modern Finite Element Analysis methods because they require construction of spatial grids (meshes) that conform to the geometric shape of the structure. As a result, there are virtually no effective tools available for predicting overall mechanical and thermal properties of porous materials based on their microstructure. This thesis is a separate handling and controls of geometric and physical computational models that are seamlessly combined at solution run time. Using the proposedapproach we will determine the effective thermal conductivity tensor of real porous ceramic materials featuring both isotropic and anisotropic thermal properties. This work involved development and implementation of numerical algorithms, data structure, and software.

Examining Levels of Automation in the Wood Processing Industry - A case study

Companies operating in the wood processing industry need to increase their productivity by implementing automation technologies in their production systems. An increasing global competition and rising raw material prizes challenge their competitiveness. Yet, too extensive automation brings risks such as a deterioration in situation awareness and operator deskilling. The concept of Levels of Automation is generally seen as means to achieve a balanced task allocation between the operators’ skills and competences and the need for automation technology relieving the humans from repetitive or hazardous work activities. The aim of this thesis was to examine to what extent existing methods for assessing Levels of Automation in production processes are applicable in the wood processing industry when focusing on an improved competitiveness of production systems. This was done by answering the following research questions (RQ): RQ1: What method is most appropriate to be applied with measuring Levels of Automation in the wood processing industry? RQ2: How can the measurement of Levels of Automation contribute to an improved competitiveness of the wood processing industry’s production processes? Literature reviews were used to identify the main characteristics of the wood processing industry affecting its automation potential and appropriate assessment methods for Levels of Automation in order to answer RQ1. When selecting the most suitable method, factors like the relevance to the target industry, application complexity or operational level the method is penetrating were important. The DYNAMO++ method, which covers both a rather quantitative technical-physical and a more qualitative social-cognitive dimension, was seen as most appropriate when taking into account these factors. To answer RQ 2, a case study was undertaken at a major Swedish manufacturer of interior wood products to point out paths how the measurement of Levels of Automation contributes to an improved competitiveness of the wood processing industry. The focus was on the task level on shop floor and concrete improvement suggestions were elaborated after applying the measurement method for Levels of Automation. Main aspects considered for generalization were enhancements regarding ergonomics in process design and cognitive support tools for shop-floor personnel through task standardization. Furthermore, difficulties regarding the automation of grading and sorting processes due to the heterogeneous material properties of wood argue for a suitable arrangement of human intervention options in terms of work task allocation.  The application of a modified version of DYNAMO++ reveals its pros and cons during a case study which covers a high operator involvement in the improvement process and the distinct predisposition of DYNAMO++ to be applied in an assembly system.

Desórdenes muscoloesqueléticos en el trabajador avícola – intervenciones en salud

Introducción: El trabajador avícola presenta un alto riesgo de sufrir de Desórdenes Musculo esqueléticos, debido a la realización de trabajos manuales repetitivos; posición bípeda prolongada, posturas por fuera de ángulos de confort de miembros superiores Objetivo: Establecer las recomendaciones basadas en la evidencia de las intervenciones en salud para los Desórdenes Musculoesqueléticos (DME) en el trabajador avícola. Metodología: Se realizó una revisión de la literatura de los estudios primarios publicados en las bases de datos Medline, Scient Direct y Scielo desde 1990. Los artículos se clasificaron de acuerdo con: el tipo de estudio, la calidad de éste y el nivel de evidencia que aportaba. Resultados: Dentro de las recomendaciones de la evidencia disponible para el manejo integral de los pacientes de la industria avícola con riesgos o eventos asociados a DME se encuentran las siguientes: 1) incorporar un enfoque sistémico en la atención a dichos trabajadores, 2) incluir aspectos psicosociales en la identificación y explicación de los riesgos y eventos en salud, 3) permitir los descansos, microrupturas y pautas para el ejercicio, 4) facilitar la rotación y ampliación de puestos de trabajo, 5) mejorar las herramientas de trabajo - especialmente el corte de los cuchillos. Conclusiones: Las intervenciones descritas en la presente revisión, apuntan hacia el mejoramiento de la incidencia y la prevalencia de los DMS, la disminución de incapacidad temporal y definitiva por los DMS, el mejoramiento en la producción industrial y la reducción de costos tanto económicos como humanos. Sin embargo, se debe plantear la necesidad de continuar impulsando el desarrollo de investigaciones y estudios que permitan tener mayores elementos de juicio para poder realizar recomendaciones a los tipos de intervenciones propuestas. A pesar de lo anterior, las intervenciones en salud para los trabajadores de la industria avícola deben ser enfocadas desde la prestación integral de los servicios de salud.

Criterion-related validity of the short form of the international physical activity questionnaire in adults who are Deaf

Background: To implement appropriate programs for promoting physical activity (PA) in people who are Deaf, it is important to have valid instruments for assessing PA in this population. Objective: The main purpose of this study was to examine the criterion validity of the short form of the International Physical Activity Questionnaire (IPAQ-S) in Deaf adults. Method: This study included 44 adults (18e65 years) of both genders (63.6% were females) who met the inclusion criteria. Objective measures of PAwere collected using accelerometers, which were worn by each participant during one week. After using the accelerometer, the IPAQ-S was applied to assess participants’ physical activity during the last 7 days. Results: There was no significant correlation between the average time spent in moderate to vigorous physical activity (MVPA) as measured by the accelerometer (40.1 6 24.5 min/day) and by the IPAQ-S (41.3 6 57.5 min/day). The IPAQ-S significantly underestimated the time spent in sedentary behavior (7.6 6 2.7 h/day vs. 10.1 6 1.6 h/day). Sedentary behavior and MVPA as measured by the accelerometer and the IPAQ-S showed limited agreement. Conclusions: Our results show some limitations on the use of IPAQ-S for quantifying PA among adults who are Deaf. The IPAQ-S tends to overestimate the MVPA and to underestimate sedentary behavior in adults who are Deaf.

Geopolymers for tile industry

This project aims to develop energy-saving methods for manufacturing tiles by using geopolymerization as an innovative processing technique. In fact, classical ceramic tiles are usually produced by sintering at temperatures ranging between 1100-1250 °C depending on natural raw materials selected for the mixture. Geopolymers, instead, are amorphous aluminosilicate inorganic polymers obtained by mixing alkali-silicate solutions with reactive aluminosilicate precursors, and geopolymerization may occur at room temperature or at temperature lower than 150 °C, and several types of waste may be used as geopolymer precursors. The possibility to obtain geopolymer tiles with properties comparable with those of ceramic tiles is extremely challenging, but geopolymerization would represent a huge energy-saving in the consolidation process as well as in natural raw materials exploitation.

Silk Fibroin And Sodium Alginate Blend: Miscibility And Physical Characteristics.

Films of silk fibroin (SF) and sodium alginate (SA) blends were prepared by solution casting technique. The miscibility of SF and SA in those blends was evaluated and scanning electron microscopy (SEM) revealed that SF/SA 25/75 wt.% blends underwent microscopic phase separation, resulting in globular structures composed mainly of SF. X-ray diffraction indicated the amorphous nature of these blends, even after a treatment with ethanol that turned them insoluble in water. Thermal analyses of blends showed the peaks of degradation of pristine SF and SA shifted to intermediate temperatures. Water vapor permeability, swelling capacity and tensile strength of SF films could be enhanced by blending with SA. Cell viability remained between 90 and 100%, as indicated by in vitro cytotoxicity test. The SF/SA blend with self-assembled SF globules can be used to modulate structural and mechanical properties of the final material and may be used in designing high performance wound dressing.