6297 research outputs found
Sort by
The Effectiveness of a Short-term Rehabilitation Programme of Preoperative High Intensity Exercise and Inspiratory Muscle Training to Improve Postoperative Recovery in Cancer Patients Undergoing Surgical Lung Resection
Get PDFIntroduction: Patients with operable lung cancer may be elderly, frail and multimorbid, presenting with debilitating symptoms that can increase the risk of postoperative pulmonary complications and result in extended hospital length of stays. It was hypothesised that a 2-4 week preoperative rehabilitation programme consisting of high-intensity interval training (HIIT) and inspiratory muscle training (IMT) could improve preoperative pulmonary function to optimise postoperative recovery. The twice weekly face-to-face programme was supervised by a qualified physiotherapist or exercise physiologist within a community gym setting and the virtual programme consisted of recorded videos and live online exercise sessions for patients to access at home. The aim of this study was to investigate the efficacy of the two modes of preoperative rehabilitation programmes in improving patient outcomes in comparison with standard care (no rehabilitation) in patients awaiting surgical resection for lung cancer.
Methods: A case-control cohort design evaluated the effectiveness and feasibility of preoperative HIIT and IMT for lung cancer patients delivered through the expansion of an existing Cardiac Rehabilitation Service. The preoperative rehabilitation programme was delivered either face-to-face or virtually and was compared to standard care. A total sample of 444 patient records were evaluated; standard care (n=166), face-to-face rehabilitation (n=142) and virtual rehabilitation (n=136). Groups were matched on age, BMI, ASA classification and extent of surgical resection undertaken. Patient data from a 3-year period was accessed to review hospital length of stay, incidence of pulmonary complications and 12-month survival. Pre and post intervention pulmonary function tests and health-related quality of life were measured alongside patient uptake, programme completion, HIIT attainment and patient or clinician reported adverse events in both rehabilitation groups.
Results: PiMAX improved significantly pre and post virtual rehabilitation, mean increase 1.312 cmH20 (p=0.001, 95% CI 0.535-2.089cmH20) and pre and post faceto-face rehabilitation, mean increase 1.144cmH20 (p<0.001, 95% CI 0.5581.730cmH20). Face-to-face rehabilitation significantly increased preoperative FEV1, mean difference 0.064 litres (p<0.001, 95% CI 0.032-0.096 litres), percentage predicted FEV1 2.79% (p<0.001, 95% CI 1.599-3.978%) and preoperative FVC 0.083 litres (p<0.001, 95% CI 0.045-0.121 litres). Virtual rehabilitation achieved nonsignificant increases in these pulmonary function measures and significantly increased percentage predicted FVC 2.74% (p=0.021, 95% CI 0.331-3.858%). Postoperative complication severity was significantly lower with virtual rehabilitation in comparison to standard care (p=0.002) but was not statistically different to face-to-face rehabilitation. Virtual rehabilitation had a significantly lower proportion of positive radiological findings at 20.6% compared to face-toface rehabilitation 33.8% (p=0.013). Despite significant improvements in pulmonary function and some improvement in postoperative complications with rehabilitation, hospital length of stay (mean ±SD) for virtual rehabilitation (8.13 days ±6.45) or face-to-face rehabilitation (9.75 days ±9.61) was not significantly different to standard care (8.27 days ±5.47) (p=0.114). Mean length of high dependency care was also not statistically different between groups (p=0.561). Preoperative rehabilitation groups did not differ statistically from standard care for antimicrobial therapy prescription, high flow oxygen requirement, tracheostomy insertion or chest drain duration. All factors indicative of postoperative pulmonary complications were associated with significantly increased risk of mortality 12 months post-surgery; postoperative tracheostomy insertion HR 8.19 (p<0.001, 95% CI 4.25-15.77), high flow oxygen requirement HR 3.90 (p<0.001, 95% CI 2.17-7.00), positive radiological findings HR 2.62 (p<0.001, 95% CI 1.58-4.35), positive sputum culture HR 2.44 (p=0.002, 95% CI 1.41-4.25) and antimicrobial therapy prescription HR 2.33 (p=0.002, 95% CI 1.38-3.94). Virtual or face-to-face rehabilitation did not influence 12-month survival although a poorer baseline physical activity status was associated with a significantly increased risk of mortality at 12-months HR 1.92 (p=0.001, 95% CI 1.33-2.77). No serious adverse events occurred with intervention and programmes had 100% uptake and high completion rates; virtual rehabilitation 76.5% and face-to-face rehabilitation 73.2%. 43% of patients in either mode of delivery were unable to achieve 80% HRR HIIT targets in the programme. Waiting time to surgery (mean ±SD) was significantly longer in face-to-face rehabilitation (23.48 days ±11.39) in comparison to virtual rehabilitation (19.92 days ±12.12) (p=0.033, 95% CI 0.23-6.89) and standard care (18.45 days ±19.92) (p<0.001, 95% CI 2.07-7.98).
Conclusion: A 2-4 week combined HIIT and IMT programme as a preoperative rehabilitation strategy can improve pulmonary function for patients awaiting surgical lung resection but improvements may not influence hospital length of stay, incidence of postoperative pulmonary complications or 12-month survival. Virtual rehabilitation appears to be a superior mode of delivery to influence clinical severity of postoperative complications and provide timely intervention in comparison to face-to-face rehabilitation. Cardiac Rehabilitation programmes could be a viable referral pathway for lung cancer patients to access rehabilitation programmes in the future but further research is needed to establish the cost effectiveness of these interventions prior to implementation
Collaboration, Engagement, and Tradition in Contemporary and Electronic Music: NoiseFloor Perspectives
No full textCollaboration, Engagement, and Tradition in Contemporary and Electronic Music: NoiseFloor Perspectives offers insights into practices at the forefront of modern music making and is built on a rich collection of concerts and talks, representing over a decade of artistic insight and creative practice showcased at the annual NoiseFloor event.
Exploring the themes of collaboration, engagement and tradition, this cutting-edge collection offers chapters on a range of pressing issues, including AI in music, audiovisual composition, environmental sound, and interactive sound systems. NoiseFloor’s aim is to showcase research and original works by international music composers and performers and has attracted prolific artists in a wide range of related fields - many of whom have contributed to this volume. This book provides a timely snapshot of new and emerging developments in the broad field of contemporary music-making.
Collaboration, Engagement, and Tradition in Contemporary and Electronic Music will be of interest to postgraduates and advanced undergraduates working in the areas of contemporary music, electronic music, and music technology. This book is also ideal for composers, artists, and researchers investigating theoretical concepts and compositional practices in contemporary music
The enhanced paper grip test can substantially improve community screening for the risk of falling
Get PDFBackground
Lower-limb strength measures can enhance falls risk assessment but due to the lack of clinically applicable methods, such measures are not included in current screening. The enhanced paper grip test (EPGT) is a simple-to-use and cost-effective test that could fill this gap. However, its outcome measure (EPGT force) has not yet been directly linked to the risk of falling.
Research question
Is the EPGT a good candidate for falls risk screening in older people in the community?
Methods
Seventy-one older people living independently in the community were recruited for this prospective observational study (median age 69 y, range 65y-79y). Lower-limb and whole-body strength were assessed at baseline using the EPGT and a standardised hand-grip method respectively. Incident falls were recorded monthly for a year through follow-up telephone conversations. The capacity of individual strength measures to predict falls and to enhance an established falls risk assessment tool (FRAT) commonly used by UK’s national health service (NHS) was assessed using binomial logistic regression. The analysis was repeated for the subset of participants without history of falling at baseline (prediction of first-ever falls).
Results
Increased EPGT force and increased symmetry in strength between limbs were significantly associated with reduced risk of falling. Compared to the NHS-FRAT, the EPGT correctly classified more people (73% vs 69%), it achieved higher sensitivity (56% vs 26%) and higher negative predictive value (76% vs 68%). Complementing the NHS-FRAT with the EPGT produced a more comprehensive model that correctly classified 91% of participants and achieved 98% specificity, 81% sensitivity, 89% negative and 96% positive predictive value. Replacing the EPGT with hand-grip strength consistently undermined prediction accuracy. The EPGT remained highly accurate when focused on the prediction of first-ever falls.
Significance
The EPGT can substantially enhance falls screening in the community. These results can also inform effective personalised strength exercise interventions
Sdn And Nfv: A New Dimension To Virtualization
No full textSoftware-defined network (SDN) and network function virtualization (NFV) are two technology trends that have revolutionized network management, particularly in highly distributed networks that are used in public, private, or hybrid cloud services. SDN and NFV technologies, when combined, simplify the deployment of network resources, lower capital and operating expenses, and offer greater network flexibility. The increasing usage of NFV is one of the primary factors that make SDN adoption attractive. The integration of these two technologies; SDN and NFV, offer a complementary service, with NFV delivering many of the real services controlled in an SDN. While SDN is focused on the control plane, NFV optimizes the actual network services that manage the data flows. Devices such as routers, firewalls, and VPN terminators are replaced with virtual devices that run on commodity hardware in NFV physical networking. This resembles the 'as-a-service' typical model of cloud services in many aspects. These virtual devices can be accessed on-demand by communication, network, or data center providers.
This book illustrates the fundamentals and evolution of SDN and NFV and highlights how these two technologies can be integrated to solve traditional networking problems. In addition, it will focus on the utilization of SDN and NFV to enhance network security, which will open ways to integrate them with current technologies such as IoT, edge computing and blockchain, SDN-based network programmability, and current network orchestration technologies. The basics of SDN and NFV and associated issues, challenges, technological advancements along with advantages and risks of shifting networking paradigm towards SDN are also discussed. Detailed exercises within the book and corresponding solutions are available online as accompanying supplementary material
The Rwanda Asylum Plan: Investigating the Impact of International Law on the UK Government’s Recent Policies on the Refugees
No full textThe UK has a long history of responding to global displacements through resettlement and integration. However, its recent policies and initiatives have critically impacted the refugee protection regime which goes against the UK’s perennial commitment to international refugee law and human rights principles. Taking instances from the Rwanda Asylum Plan, this paper investigates the impact of international law on the UK Government’s recent policies on the refugees. It argues that the impact of international law on such policy is somehow weaker as reflected in its recent refugee-related moves. It also argues that these policies are less than satisfactory, even though strictly they are not against international law. Two examples are used to substantiate these arguments: 1) the latest plan for immigration (2021) and the Nationality and Borders Act (2022), and 2) the absence of more equal treatment across schemes (Ukrainian and Afghan schemes). The significance of this paper lies in exploring the intricacies associated with the UK legal regime, insular national politics, and recent policies for the refugees so that they could better align with international law and respond more humanely to the refugee crisis as the consequences otherwise could create an unsafe global society where the dignity and moral claims of refugees are subordinated to legalisms
Nationality, statelessness, and human rights: Does ‘everyone’ really have the right to nationality under Article 15 of the UDHR?
No full textThe inclusion of the right to nationality in article 15 of the UDHR in 1948 was driven by the impulse to respond to the Second World War’s mass denationalisation. Since then, this article has been a polestar to guide states to address statelessness that may accrue in absence of nationality of any group or individual. But, despite that, statelessness has been a major challenge until now. This chapter investigates to what extent the right to nationality has been achieved to everyone’s right. After a critical analysis of the history, politics, and laws on the right to nationality and statelessness, it focuses on the contents and influences of article 15 at different levels. It then reveals the challenges, which intensify denationalisation, and thus, defy the main purpose of article 15 through two contemporary examples of statelessness, i.e., Rohingya, and Roma. In conclusion, a few recommendations are made so that the practices of (non)granting nationality are better aligned with human rights principles and secure ‘other’ human rights which are contingent upon having the right to a nationality
Unsettled Responsibilities: Antiquity, Resistance, and Rubble in Mandate Palestine
Get PDFThe 1927 Jericho earthquake caused widespread damage across Palestine and Transjordan, both ruled at the time by Britain. The worst-hit city was Nablus, where the Old City’s historic buildings became a field for conflict. Drawing on G. Gordillo’s differentiation between ruins and rubble and his analysis of colonial anxiety, power, and oppression, this article considers local and colonial reactions and competition over the material heritage of Nablus, particularly in the city’s Samaritan Quarter and the Crusader wall of the Great Mosque. Entangled in these are definitions of antiquity and ideas of archaeological value for the Ottoman and British rulers of Palestine. Decisions made and contested in Nablus and Jerusalem highlight the fine line between ruin and rubble, the mechanisms by which the mandatory administration sought to tame the built environment and indigenous communities of Nablus, and the way their confrontations reverberated in the city’s rebellious history and insurrectionary future
Advancing neural computation: experimental validation and optimization of dendritic learning in feedforward tree networks
Get PDFObjectives: This study aims to explore the capabilities of dendritic learning within feedforward tree networks (FFTN) in comparison to traditional synaptic plasticity models, particularly in the context of digit recognition tasks using the MNIST dataset. Methods: We employed FFTNs with nonlinear dendritic segment amplification and Hebbian learning rules to enhance computational efficiency. The MNIST dataset, consisting of 70,000 images of handwritten digits, was used for training and testing. Key performance metrics, including accuracy, precision, recall, and F1-score, were analysed. Results: The dendritic models significantly outperformed synaptic plasticity-based models across all metrics. Specifically, the dendritic learning framework achieved a test accuracy of 91%, compared to 88% for synaptic models, demonstrating superior performance in digit classification. Conclusions: Dendritic learning offers a more powerful computational framework by closely mimicking biological neural processes, providing enhanced learning efficiency and scalability. These findings have important implications for advancing both artificial intelligence systems and computational neuroscience
Death, Dying and Bereavement: New Sociological Perspectives
No full textWhile death, dying and bereavement are universal life events, the social conditions under which death takes place are fundamental in shaping how it is experienced by the individual. Bringing together contributors from around the world, this collection of chapters provides sociological insights into death, dying and bereavement.
Drawing upon a range of sociological theorists, including Émile Durkheim, Zygmunt Bauman and C. Wright Mills, the book reviews the historical contribution of sociology to the field of thanatology. In doing so, the book challenges individualistic psychological approaches to death, dying and bereavement and demonstrates how sociological approaches can shape, constrain and empower experiences by imbuing them with both collective and individual meaning. Chapter-length case studies explore a wide range of issues, from digital aspects of remembrance and memorialisation and continued threats to liberties that permit life and death decisions to discussions of the impact and likely legacy of COVID-19 and climate change.
This collection will be of interest to students and researchers in the social sciences with an interest in societal attitudes towards death and bereavement
Chor_alis _Choralis
No full textCor_alis _Choralis is a choral piece that employs the human voice to invite audiences to explore trust in the use of Artificial Intelligence in medicine. A collaboration between artists Emma O’Connor and Michael Day, and composer Michael Betteridge. Performed by Kantos Chamber Choir. Cor_alis _Choralis aims to increase understanding of AI in diagnostic medicine, staging a conversation with the viewer about the investment of trust in machine-learning
Data sources:
Access Repository Dashboard
Do you manage STORE - Staffordshire Online Repository? Access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard!