Physical rehabilitation interventions for adult intensive care patients across the continuum of recovery (i.e. within the intensive care unit (ICU) and following ICU and hospital discharge): an overview of systematic reviews

Background
Patients admitted to the intensive care unit with critical illness often experience significant physical impairments, which typically persist for many years following resolution of the original illness. Physical rehabilitation interventions that enhance restoration of physical function have been evaluated across the continuum of recovery following critical illness including within the intensive care unit, following discharge to the ward and beyond hospital discharge. Multiple systematic reviews have been published appraising the expanding evidence investigating these physical rehabilitation interventions, although there appears to be variability in review methodology and quality. We aim to conduct an overview of existing systematic reviews of physical rehabilitation interventions for adult intensive care patients across the continuum of recovery.

Methods/design
This protocol has been developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. We will search the Cochrane Systematic Review Database, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, MEDLINE, Excerpta Medica Database and Cumulative Index to Nursing and Allied Health Literature databases. We will include systematic reviews of randomised controlled trials of adult patients, admitted to the intensive care unit and who have received physical rehabilitation interventions at any time point during their recovery. Data extraction will include systematic review aims and rationale, study types, populations, interventions, comparators, outcomes and quality appraisal method. Primary outcomes of interest will focus on findings reflecting recovery of physical function. Quality of reporting and methodological quality will be appraised using the PRISMA checklist and the Assessment of Multiple Systematic Reviews tool.

Discussion
We anticipate the findings from this novel overview of systematic reviews will contribute to the synthesis and interpretation of existing evidence regarding physical rehabilitation interventions and physical recovery in post-critical illness patients across the continuum of recovery.

Impaired orthostatic blood pressure recovery and cognitive performance at two-year follow up in older adults: The Irish Longitudinal Study on Ageing

Background: Prospective investigations of the association between impaired orthostatic blood pressure (BP) regulation and cognitive decline in older adults are limited, and findings to-date have been mixed. The aim of this study was to determine whether impaired recovery of orthostatic BP was associated with change in cognitive function over a 2-year period, in a population based sample of community dwelling older adults. 

Methods: Data from the first two waves of the Irish Longitudinal Study on Ageing were analysed. Orthostatic BP was measured during a lying to standing orthostatic stress protocol at wave 1 using beat-to-beat digital plethysmography, and impaired recovery of BP at 40 s post stand was investigated. Cognitive function was assessed at wave 1 and wave 2 (2 years later) using the Mini-Mental State Exam (MMSE), verbal fluency and word recall tasks. 

Results: After adjustment for measured, potential confounders, and multiple imputation for missing data, the change in the number of errors between waves on the MMSE was 10 % higher [IRR (95 % CI) = 1.10 (0.96, 1.26)] in those with impaired recovery at 40 s. However, this was not statistically significant (p = 0.17). Impaired BP recovery was not associated with change in performance on any of the other cognitive measures. 

Conclusions: There was no clear evidence for an association between impaired recovery of orthostatic BP and change in cognition over a 2-year period in this nationally representative cohort of older adults. Longer follow-up and more detailed cognitive testing would be advantageous to further investigate the relationship between orthostatic BP and cognitive decline.

Post-fire vegetation regeneration in Portugal : implications for management

This thesis aims at improving the knowledge on the post-fire vegetation regeneration. For that, forests and shrublands were studied, after forest fires and experimental fires. Maritime Pine (Pinus pinaster) recruitment after fire was studied. Fire severity was evidenced as a major effect on this process. High crown fire severity can combust the pines, destroying the seed bank and impeding post fire pine recruitment. However, crown combustion also influences the post-fire conditions on the soil surface, since high crown combustion (HCC) will decrease the postfire needle cast. After low crown combustion (LCC) (scorched rather than torched crowns), a considerable needle cover was observed, along with a higher density of pine seedlings. The overall trends of post-fire recruitment among LCC and HCC areas could be significantly attributed to cover by needles, as well by the estimation of fire severity using the diameters of the burned twigs (TSI). Fire increased the germination from the soil seed bank of a Pinus pinaster forest, and the effects were also related with fire severity. The densities of seedlings of the dominant taxa (genus Erica and Calluna vulgaris) were contrastingly affected in relation to the unburned situation, depending on fire severity, as estimated from the degree of fire-induced crown damage (LCC/HCC), as well as using a severity index based on the diameters of remaining twigs (TSI). Low severity patches had an increase in germination density relatively to the control, while high severity patches suffered a reduction. After an experimental fire in a heathland dominated by Pterospartum tridentatum, Erica australis and E. umbellata, no net differences in seedling emergence were observed, in relation to the pre-fire situation. However, rather than having no effect, the heterogeneity of temperatures caused by fire promoted caused divergent effects over the burned plot in terms of Erica australis germination – a progressive increased was observed in the plots were maximum temperature recorded ranged from 29 to 42.5ºC and decreased in plots with maximum temperature ranging from 51.5 to 74.5ºC. In this heathland, the seed density of two of the main species (E. australis and E. umbellata) was higher under their canopies, but the same was not true for P. tridentatum. The understory regeneration in pine and eucalypt stands, 5 to 6 years post fire, has been strongly associated with post-fire management practices. The effect of forest type was, comparatively, insignificant. Soil tilling, tree harvesting and shrub clearance, were linked to lower soil cover percentages. However, while all these management operations negatively affected the cover of resprouters, seeders were not affected by soil tilling. A strong influence of biogeographic region was identified, suggesting that more vulnerable regions may suffer higher effects of management, even under comparatively lower management pressure than more productive regions. This emphasizes the need to adequate post-fire management techniques to the target regions.

Temperatura e luz na germinação do endemismo algarvio Tuberaria major

Dissertação mest., Gestão Sustentável de Espaços Rurais, Universidade do Algarve, 2009

Preoperative education and its influence on perception of recovery for clients awaiting total hip and total knee replacement surgery /

The puqjose of this study was to examine the manner in which an inviting approach to a preoperative teaching and learning educational experience influenced the perception and subsequent recovery of clients who were awaiting total hip and total knee replacement surgery. An in-depth review of the internal and external factors that shape client perceptions was undertaken in this study. In addition, this study also explored whether or not the Prehab Program was preparing clients physically, socially, and psychologically for surgery. Data for this qualitative case study research were collected through preoperative interviews with 4 participants awaiting total hip replacement surgery and 1 participant awaiting total knee replacement surgery. Four postoperative interviews were conducted with the participants who had received total hip replacement surgery. The occupational therapist and physical therapist who were the coleaders of the Prehab Program at the time of this study were also interviewed. The results of this study suggest that while individuals may receive similar educational experiences, their perceptions of the manner in which they benefited from these experiences varied. This is illustrated in the research findings, which concluded that while clients benefited physically from the inviting approach used during the practical teaching session, not all clients perceived the psychological benefits of this practice session, especially clients with preexisting high levels of anxiety. In addition to increasing the understanding of the internal as well as external factors that influence the perceptions of clients, this study has also served as an opportunity for reflection on practice for the Prehab therapists and other healthcare educators.

The identification, distribution and persistence of oxamyl and its degradation products in planted corn seed, seedling root and soil from oxamyl-treated corn seeds

A simple method was developed for treating corn seeds with oxamyl. It involved soaking the seeds to ensure oxamyl uptake, centrifugation to draw off excess solution, and drying under a stream of air to prevent the formation of fungus. The seeds were found to have an even distribution of oxamyl. Seeds remained fungus-free even 12 months after treatment. The highest nonphytotoxic treatment level was obtained by using a 4.00 mg/mL oxamyl solution. Extraction methods for the determination of oxamyl (methyl-N'N'-dimethyl-N-[(methylcarbamoyl)oxy]-l-thiooxamimidate), its oxime (methyl-N',N'-dimethyl-N-hydroxy-1-thiooxamimidate), and DMCF (N,N-dimethyl-1-cyanoformanade) in seed" root, and soil were developed. Seeds were processed by homogenizing, then shaking in methanol. Significantly more oxamyl was extracted from hydrated seeds as opposed to dry seeds. Soils were extracted by tumbling in methanol; recoveries range~ from 86 - 87% for oxamyl. Root was extracted to 93% efficiency for oxamyl by homogenizing the tissue in methanol. NucharAttaclay column cleanup afforded suitable extracts for analysis by RP-HPLC on a C18 column and UV detection at 254 nm. In the degradation study, oxamyl was found to dissipate from the seed down into the soil. It was also detected in the root. Oxime was detected in both the seed and soil, but not in the root. DMCF was detected in small amounts only in the seed.

Therapeutic riding : learning and recovery for people with disabilities

The purpose ofthis study was to explore the process oftherapeutic riding as an experiential and holistic approach to learning and recovery for people with disabilities as perceived by the providers oftherapeutic riding. To enhance the connection between theory and practice and to suggest future research, the researcher endeavoured to develop a theory that contributed to the knowledge base oftherapeutic riding, animal-assisted therapy and education, experiential education, and experiential therapy in addition to contributing to connections among them. This topic was investigated because ofthe lack ofresearch about the process of therapeutic riding, particularly from learning and a recovery perspective. Few studies have addressed how therapeutic riding outcomes are achieved or how the therapeutic riding process actually works. This study was identified as grounded theory using qualitative data through interviews and narrative reflections with therapeutic riding providers, a researcher's journal, field notes, and written documents. Grounded theory analysis was used to analyze the qualitative data. This consisted ofdoing open, axial, and selective coding. This study provided detailed descriptions ofthe research approach, researcher's involvement, participant and site selection, data collection and analysis, methodological assumptions and limitations, credibility established, and ethical considerations. The findings ofthe data analysis revealed the theme ofrelationships as central to the learning and recovery process oftherapeutic riding for people with disabilities. The significance ofthe team relationships, the horse and rider relationship, and the providers and rider relationship was found. The essential components ofthe learning and recovery process were presented in a diagram in the selective coding phase. Goals oftherapeutic riding included psycho-education; behavioural and social; physical; and equestrian. Parts ofthe process ofhow outcomes were achieved included motivation; "opens new doors;" risk; task analysis; control; communication; and environmental factors. Outcomes of therapeutic riding included independence and mobility; confidence; and transfer abilities or skills. The implications ofthese findings for theory, practice, and further research were also. explored.

Diversité des champignons endophytes mycorhiziens et de classe II chez le pois chiche, et influence du génotype de la plante

réalisé en cotutelle avec la Faculté des Sciences de Tunis, Université Tunis El Manar.

Can salvage logging affect seed dispersal by birds into burned forests?

The recovery of vegetation in Mediterranean ecosystems after wildfire is mostly a result of direct regeneration, since the same species existing before the fire regenerate on-site by seeding or resprouting. However, the possibility of plant colonization by dispersal of seeds from unburned areas remains poorly studied. We addressed the role of the frugivorous, bird-dependent seed dispersal (seed rain) of fleshy-fruited plants in a burned and managed forest in the second winter after a fire, before on-site fruit production had begun. We also assessed the effect on seed rain of different microhabitats resulting from salvage logging (erosion barriers, standing snags, open areas), as well as the microhabitats of unlogged patches and an unburned control forest, taking account of the importance of perches as seed rain sites. We found considerable seed rain by birds in the burned area. Seeds, mostly from Olive trees Olea europaea and Evergreen pistaches Pistacia lentiscus, belonged to plants fruiting only in surrounding unburned areas. Seed rain was heterogeneous, and depended on microhabitat, with the highest seed density in the unburned control forest but closely followed by the wood piles of erosion barriers. In contrast, very low densities were found under perches of standing snags. Furthermore, frugivorous bird richness seemed to be higher in the erosion barriers than elsewhere. Our results highlight the importance of this specific post-fire management in bird-dependent seed rain and also may suggest a consequent heterogeneous distribution of fleshy-fruited plants in burned and managed areas. However, there needs to be more study of the establishment success of dispersed seeds before an accurate assessment can be made of the role of bird-mediated seed dispersal in post-fire regeneration

Effects of patch size and density on flower visitation and seed set of wild plants: a pan-European approach

1. Habitat fragmentation can affect pollinator and plant population structure in terms of species composition, abundance, area covered and density of flowering plants. This, in turn, may affect pollinator visitation frequency, pollen deposition, seed set and plant fitness. 2. A reduction in the quantity of flower visits can be coupled with a reduction in the quality of pollination service and hence the plants’ overall reproductive success and long-term survival. Understanding the relationship between plant population size and⁄ or isolation and pollination limitation is of fundamental importance for plant conservation. 3. Weexamined flower visitation and seed set of 10 different plant species fromfive European countries to investigate the general effects of plant populations size and density, both within (patch level) and between populations (population level), on seed set and pollination limitation. 4. Wefound evidence that the effects of area and density of flowering plant assemblages were generally more pronounced at the patch level than at the population level. We also found that patch and population level together influenced flower visitation and seed set, and the latter increased with increasing patch area and density, but this effect was only apparent in small populations. 5. Synthesis. By using an extensive pan-European data set on flower visitation and seed set we have identified a general pattern in the interplay between the attractiveness of flowering plant patches for pollinators and density dependence of flower visitation, and also a strong plant species-specific response to habitat fragmentation effects. This can guide efforts to conserve plant–pollinator interactions, ecosystem functioning and plant fitness in fragmented habitats.

The dispersal of traditionally managed hay meadow plants via farmyard manure application

The dispersal of plants within botanically rich grassland is an important area of study if such swards are to be maintained. The application of farmyard manure provides a possible mechanism by which seeds contained within hay can be returned/introduced to grasslands. In this study, hay, dung and manure samples taken from farms with botanically rich meadows contained very limited quantities of seeds of desirable species. Digestion by cattle, and storage within a manure heap for 6 months or longer, further reduced seed germination. Samples were characterized by an abundance of the grass, Poa trivialis, with few forbs present. Confirmation of the negative effect of the digestive processes of cattle on seed viability was achieved using an in vitro laboratory experiment. However, this experiment did show that the perennial herbs, Filipendula ulmaria and Sanguisorba officinalis, were able to survive digestion at least as well as P. trivialis. The burial of known quantities of seeds in a manure heap also showed these perennial herbs to be at least as resistant to damage as P. trivialis. The results demonstrate that, given appropriate timing of the hay cut, seeds of species with high conservation value could become incorporated into manure for subsequent dispersal. However, manure dispersal would appear to be of limited value for many species desirable from a conservation viewpoint.

Seed longevity - moisture content relationships in hermetic and open storage

In seed storage research, moisture content can be maintained by providing a stable relative humidity (e.g. over saturated salt solutions) or by hermetic storage, but the two approaches provide different gaseous environments which might affect longevity. Seeds of timothy (Phleum pratense L.) and sesame (Sesamum indicum L.) were stored at 45 degrees C or 50 degrees C, respectively, with different moisture contents maintained by hermetic storage in laminated-aluminium-foil packets, or by desiccators above either saturated salt solutions or moistened silica gel. Seeds were withdrawn from storage at intervals from 1 to 28 d for up to 480 d and viability estimated. Within a species, the negative logarithmic relation between seed longevity and moisture content did not differ (P> 0.25, timothy; >0.05, sesame) between storage in desiccators over either moistened silica gel or saturated salt solutions, whereas the relation was much steeper (P< 0.005) in hermetic storage: longevity was similar at high moisture contents, but at low values much greater with hermetic storage. This effect of storage method on seed longevity's sensitivity to moisture content implies that oxygen is relatively more deleterious to seeds at lower than at greater moisture contents and confirms that hermetic storage is preferable for long-term seed storage at low moisture contents.

Quantitative response of the longevity of seed of twelve crops to temperature and moisture in hermetic storage

Seeds of 39 seed lots of a total of twelve different crops were stored hermetically in a wide range of air-dry environments (2-25% moisture content at 0-50 degrees C), viability assessed periodically, and the seed viability equation constants estimated. Within a species, estimates of the constants which quantify absolute longevity (K-E) and the relative effects on longevity of moisture content (C-W) and temperature (C-H and C-Q) did not differ (P >0.05 to P >0.25) among lots. Comparison among the 12 crops provided variant estimates of K-E and C-W (P< 0.01), but common values of C-H and C-Q (0.0322 and 0.000454, respectively, P >0.25). Maize (Zea mays) provided the greatest estimate of K-E (9.993, s.e.= 0.456), followed by sorghum (Sorghum bicolor) (9.381, s.e. 0.428), pearl millet (Pennisetum typhoides) (9.336, s.e.= 0.408), sugar beet (Beta vulgaris) (8.988, s.e.= 0.387), African rice (Oryza glaberrima) (8.786, s.e.= 0.484), wheat (Triticum aestivum) (8.498, s.e.= 0.431), foxtail millet (Setaria italica) (8.478, s.e.= 0.396), sugarcane (Saccharum sp.) (8.454, s.e.= 0.545), finger millet (Eleusine coracana) (8.288, s.e.= 0.392), kodo millet (Paspalum scrobiculatum) (8.138, s.e.= 0.418), rice (Oryza sativa) (8.096, s.e.= 0.416) and potato (Solanum tuberosum) (8.037, s.e.= 0.397). Similarly, estimates of C-W were ranked maize (5.993, s.e.= 0.392), pearl millet (5.540, s.e.= 0.348), sorghum (5.379, s.e.=0.365), potato (5.152, s.e.= 0.347), sugar beet (4.969, s.e.= 0.328), sugar cane (4.964, s.e.= 0.518), foxtail millet (4.829, s.e.= 0.339), wheat (4.836, s.e.= 0.366), African rice (4.727, s.e.= 0.416), kodo millet (4.435, s.e.= 0.360), finger millet (4.345, s.e.= 0.336) and rice (4.246, s.e.= 0.355). The application of these constants to long-term seed storage is discussed.

Comparative analysis by protocol and key of seed storage behaviour of sixty Vietnamese tree species

Seed storage behaviour of 5 1 native and 9 introduced tree species in Vietnam was investigated using a brief protocol developed to aid biodiversity conservation in circumstances where little is known about the seeds. Of the 60 species, 34 appeared to show orthodox (Acacia auriculaeformis, Adenanthera pavonina, Afzelia xylocarpa, Bauhinia purpurea, Callistemon lanceolatus, Cananga odorata, Canarium nigrum, Cassia fistula, Cassia javanica, Cassia splendida, Chukrasia tabularis, Dalbergia bariaensis, Dialium cochinchinensis, Diospyros mollis, Diospyros mun, Dracuntomelon duperreanum, Erythrophleum fordii, Khaya senegalensis, Lagerstroemia speciosa, Leucaena leucocephala, Livistona cochinchinensis, Markhamia stipulata, Melaleuca cajuputi, Millettia ichthyotona, Peltophorum pterocarpum, Peltophorum tonkinensis, Pinus khasya, Pinus massoniana, Pinus merkusii, Pterocarpus macrocarpus, Sindora siamensis, Sophora tonkinense, Sterculia foetida, Swietenia macrophylla), 13 recalcitrant (Avicennia alba, Beilschmiedia roxburghiana, Caryota mitis, Dimocarpus sp., Diospyros malabarica, Dipterocarpus chartaceus, Dypsis pinnatifrons, Hopea odorata, Lithocarpus gigantophylla, Machilus odoratissimus, Melanorrhoea laccifera, Melanorrhea usitata, Syzygium cinereum) and 13 intermediate (Anisoptera cochinchinensis, Aphanamixis polystachya, Averrhoa carambola, Carissa carandas, Chrysopylum cainito, Cinnamomum camphora, Citrofortunella microcarpa, Citrus grandis var. grandis, Elaeis guineensis, Hydnocarpus anthelmintica, Madhuca floribunda, Manilkara achras, Mimusops elengi) seed storage behaviour. A double-criteria key to estimate likely seed storage behaviour showed good agreement with the above: the key can reduce the workload of seed storage behaviour identification considerably.