ORCID Profile
0000-0002-5022-8498
Current Organisations
Flinders University
,
Flinders Medical Centre
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: University of Toronto Press Inc. (UTPress)
Date: 02-2018
DOI: 10.3138/PTC.2016-61
Abstract: Purpose: We estimated the agreement of a thigh-worn accelerometer, the activPAL, used to measure activity and sedentary parameters, with observed mobility assessments of intensive care unit (ICU) survivors. Method: We prospectively compared activPAL measurements with direct observation during assessments at discharge from the ICU or acute hospital in eight participants with a median age of 56 (1st–3rd quartile 48–65) years and an Acute Physiology and Chronic Health Evaluation II score of 23 (1st–3rd quartile 17–24). Frequency of sit-to-stand transitions time spent standing, stepping, upright (standing and stepping), and sedentary (lying/sitting) and total steps were described analysis was performed using Bland–Altman plots and calculating the absolute percent error. Results: All sit-to-stand transitions were accurately detected. The mean difference on the Bland–Altman plots suggested an overestimation of standing time with the activPAL of 31 (95% CI: −9, 71) seconds and underestimation of stepping time by 25 (95% CI: −47, −3) seconds. The largest median absolute percent errors were for standing time (21.9%) and stepping time (18.7%) time spent upright (1.7%) or sedentary (0.3%) was more accurately estimated. The activPAL underestimated total steps per session, achieving the largest percent error (70.8%). Conclusion: Because it underestimated step count, the activPAL likely incorrectly recorded stepping time as standing time, so that time spent upright was the measure of activity with the smallest error. Sedentary behaviour, including frequency of transitions, was validly assessed.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Wiley
Date: 07-02-2012
Abstract: Body composition is commonly altered in response to critical illness and can be estimated at the bedside with bioelectrical impedance spectroscopy (BIS). Different electrode configurations may be used to mitigate assumptions of the technique, but the reliability of tetra-polar and octo-polar arrangements has yet to be established. This study aimed to compare both configurations, in a prospective observational study of 17 critically ill survivors and 12 healthy controls. Weight, supine body length, and BIS on both tetra-polar and octo-polar configured devices were recorded, then repeated 2 days later. Bioelectrical impedance vector analysis was subsequently performed using data from the tetra-polar device at a frequency of 50 kHz. Test-retest agreement was acceptable for the tetra-polar device (intraclass correlation coefficient range, patients: 0.876-0.988 vs controls: 0.983-0.998, P ≤ 0.001). However, lower and wider ranging test-retest intraclass correlation coefficients were obtained with the octo-polar instrument in both groups. Furthermore, there was a difference in the mass/volume of body compartments measured on each device in both patients (P ≤ .017) and controls (P ≤ .045). A change in the composition profile of critically ill males was evident between measurement occasions, which was reflected by a reduction in body weight of 1.6 (1.5) kg (P ≤ 0.001) across the s le over the same period. BIS devices should not be used interchangeably in the clinical setting. The reliability of the tetra-polar instrument was good, but daily fluctuations in body weight may have affected the results.
Publisher: Elsevier BV
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 22-11-2021
DOI: 10.1007/S12603-021-1704-5
Abstract: The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and Edmonton Frail Scale (EFS) are widely used in acute care settings to assess nutritional and frailty status, respectively. We aimed to determine whether the scored PG-SGA can identify pre-frailty and frailty status, to simultaneously evaluate malnutrition and frailty in clinical practice. Cross-sectional study. A convenience s le of 329 consecutive patients admitted to an acute medical unit in South Australia. Nutritional and frailty status were ascertained with scored PG-SGA and EFS, respectively. Optimal cut-off scores to identify pre-frailty and frailty were determined by calculating the Scored PG-SGA's sensitivity, specificity, positive and negative predictive values, Youden Index (YI), Liu index, Receiver Operator Curves (ROC) and Area Under Curve (AUC). Nutritional status and patient characteristics were analysed according to frailty categories. The optimal cut-off PG-SGA score as determined by the highest YI, to identify both pre-frailty and frailty was >3, with a sensitivity of 0.711 and specificity of 0.746. The AUC was 0.782 (95% CI 0.731-0.833). In this cohort, 64% of the patients were well-nourished, 26% were moderately malnourished and 10% were severely malnourished. Forty-three percent, 24% and 33% of the patients were classified as robust, pre-frail and frail, respectively. Bivariate analysis showed that those robust were significantly younger than those who were pre-frail (-2.8, 95% CI -5.5 to -0.1, p=0.036) or frail (-3.4, 95% CI -5.9 to -1.0, p=0.002). Robust patients had significantly lower Scored PG-SGA than those who were pre-frail (-2.5, 95%CI -3.8 to -1.1, p<0.001) or frail (-4.9, 95% CI -6.1 to -3.7, p<0.001). The Scored PG-SGA is moderately sensitive in identifying pre-frailty/frailty in older hospitalized adults and can be useful in identifying both conditions concurrently.
Publisher: Springer Science and Business Media LLC
Date: 16-02-2017
DOI: 10.1007/S00134-017-4685-4
Abstract: To identify, evaluate and synthesise studies examining the barriers and enablers for survivors of critical illness to participate in physical activity in the ICU and post-ICU settings from the perspective of patients, caregivers and healthcare providers. Systematic review of articles using five electronic databases: MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus. Quantitative and qualitative studies that were published in English in a peer-reviewed journal and assessed barriers or enablers for survivors of critical illness to perform physical activity were included. Prospero ID: CRD42016035454. Eighty-nine papers were included. Five major themes and 28 sub-themes were identified, encompassing: (1) patient physical and psychological capability to perform physical activity, including delirium, sedation, illness severity, comorbidities, weakness, anxiety, confidence and motivation (2) safety influences, including physiological stability and concern for lines, e.g. risk of dislodgement (3) culture and team influences, including leadership, interprofessional communication, administrative buy-in, clinician expertise and knowledge (4) motivation and beliefs regarding the benefits/risks and (5) environmental influences, including funding, access to rehabilitation programs, staffing and equipment. The main barriers identified were patient physical and psychological capability to perform physical activity, safety concerns, lack of leadership and ICU culture of mobility, lack of interprofessional communication, expertise and knowledge, and lack of staffing/equipment and funding to provide rehabilitation programs. Barriers and enablers are multidimensional and span erse factors. The majority of these barriers are modifiable and can be targeted in future clinical practice.
Publisher: American Geophysical Union (AGU)
Date: 02-04-2016
DOI: 10.1002/2015GL067448
Publisher: Elsevier BV
Date: 04-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-01-2023
DOI: 10.1097/CCM.0000000000005739
Abstract: Significant variations exist in the use of respiratory muscle ultrasound in intensive care with no society-level consensus on the optimal methodology. This systematic review aims to evaluate, synthesize, and compare the clinimetric properties of different image acquisition and analysis methodologies. Systematic search of five databases up to November 24, 2021. Studies were included if they enrolled at least 50 adult ICU patients, reported respiratory muscle (diaphragm or intercostal) ultrasound measuring either echotexture, muscle thickness, thickening fraction, or excursion, and evaluated at least one clinimetric property. Two independent reviewers assessed titles, abstracts, and full text against eligibility. Study demographics, ultrasound methodologies, and clinimetric data. Sixty studies, including 5,025 patients, were included with 39 studies contributing to meta-analyses. Most commonly measured was diaphragm thickness (DT) or diaphragm thickening fraction (DTF) using a linear transducer in B-mode, or diaphragm excursion (DE) using a curvilinear transducer in M-mode. There are significant variations in imaging methodology and acquisition across all studies. Inter- and intrarater measurement reliabilities were generally excellent, with the highest reliability reported for DT (ICC, 0.98 95% CI, 0.94–0.99). Pooled data demonstrated acceptable to excellent accuracy for DT, DTF, and DE to predicting weaning outcome after 48 to 72 hours postextubation (DTF AUC, 0.79 95% CI, 0.73–0.85). DT imaging was responsive to change over time. Only three eligible studies were available for intercostal muscles. Intercostal thickening fraction was shown to have excellent accuracy of predicting weaning outcome after 48-hour postextubation (AUC, 0.84 95% CI, 0.78–0.91). Diaphragm muscle ultrasound is reliable, valid, and responsive in ICU patients, but significant variation exists in the imaging acquisition and analysis methodologies. Future work should focus on developing standardized protocols for ultrasound imaging and consider further research into the role of intercostal muscle imaging.
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Springer Science and Business Media LLC
Date: 24-03-2023
DOI: 10.1186/S12966-023-01431-3
Abstract: Toward development of a core outcome set for randomized controlled trials (RCTs) of physical activity (PA) interventions for older adults, the purpose of this study was to identify outcome domains and subdomains (‘what’ was measured) in previously published RCTs of PA for older adults. We conducted a rapid review and searched Ovid MEDLINE for recently- published (2015-2021), English-language, RCTs of PA interventions for older adults (mean age 60+ yrs). We limited to articles published in Web of Science top-10 journals in general and internal medicine, geriatrics and gerontology, rehabilitation, and sports science. Two reviewers independently completed eligibility screening two other reviewers abstracted trial descriptors and study outcomes. We classified study outcomes according to the standard outcome classification taxonomy endorsed by the Core Outcome Measures in Effectiveness Trials Initiative. Our search yielded 548 articles 67 articles were eligible to be included. Of these, 82% were efficacy/effectiveness trials, 85% included both male and female participants, and 84% recruited community-dwelling older adults. Forty percent of articles reported on interventions that involved a combination of group and in idual PAs, and 60% involved a combination of PA modes (e.g., aerobic, resistance). Trial s le size ranged from 14 to 2157 participants, with median (IQR) of 94 (57-517) 28,649 participants were included across all trials. We identified 21 unique outcome domains, spanning 4/5 possible core areas (physiological/clinical life impact resource use adverse events). The five most commonly reported outcome domains were physical functioning (included in n =51 articles), musculoskeletal and connective tissue ( n =30), general ( n =26), cognitive functioning ( n =16), and emotional functioning/wellbeing ( n =14). Under these five outcome domains, we further identified 10 unique outcome subdomains (e.g., fall-related body composition quality of life). No outcome domains or subdomains were reported consistently in all RCTs. We found extensive variability in outcome domains and subdomains used in RCTs of PA for older adults, reflecting the broad range of potential health benefits derived from PA and also investigator interest to monitor a range of safety parameters related to adverse events. This study will inform development of a core outcome set to improve outcome reporting consistency and evidence quality.
Publisher: American Geophysical Union (AGU)
Date: 28-05-2018
DOI: 10.1029/2018GL078430
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.JCRC.2012.03.001
Abstract: Dynamometry is an objective tool for volitional strength evaluation that may overcome the limited sensitivity of the Medical Research Council scale for manual muscle tests, particularly at grades 4 and 5. The primary aims of this study were to investigate the reliability, minimal detectable change, and time to peak muscle force, measured with portable dynamometry, in critically ill patients. Isometric hand grip, elbow flexion, and knee extension were measured with portable dynamometry. Interrater consistency (intraclass correlation coefficient [95% confidence interval]) (0.782 [0.321-0.930] to 0.946 [0.840-0.982]) and test-retest agreement (0.819 [0.390-0.943] to 0.918 [0.779-0.970]) were acceptable for all dynamometry forces, with the exception of left elbow flexion. Despite generally good reliability, a mean change (upper 95% confidence interval) of 2.8 (7.8) kg, 1.9 (5.2) kg, and 2.6 (7.1) kg may be required from a patient's baseline force measurement of right grip, elbow flexion, and knee extension to reflect real force changes. There was also a delay in the time for critically ill patients to generate peak muscle forces, compared with healthy controls (P ≤ .001). Dynamometry can provide reliable measurements in alert critically ill patients, but moderate changes in strength may be required to overcome measurement error, during the acute recovery period. Deficits in force timing may reflect impaired neuromuscular control.
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/MF12194
Abstract: The tagging of aquatic and semi-aquatic animals with acoustic transmitters and their detection by passive underwater receivers has gained huge popularity over the past decade. This technology offers researchers the opportunity to monitor the finite- to broad-scale movements of multiple in iduals over many years however, the sheer scale and spatial complexity of these datasets are often beyond the capabilities of routine database and spread-sheet applications. In the present paper, we describe software (V-Track) that greatly facilitates the assimilation, analysis and synthesis of animal-location data collected by underwater passive acoustic receivers. The principal features within V-Track are the behavioural event qualifier (BEQ) and the receiver-distance matrix (RDM) calculator. The BEQ identifies and catalogues horizontal movements from receiver detection data, or vertical movements from transmitter sensor data (depth or temperature). The RDM is generated from the geographical location of the acoustic receivers and is utilised by V-Track to illustrate the behavioural event information in a spatial context. V-Track is a package written within the R-programming language, and a graphical user interface is also provided. Here, we feature two case studies to demonstrate software functionality for defining and quantifying behaviour in acoustically tagged marine and freshwater vertebrates.
Publisher: Wiley
Date: 03-10-2019
DOI: 10.1002/JPEN.1719
Abstract: The potential for bioimpedance spectroscopy (BIS) to identify muscle weakness and functional limitations in critical illness is unknown this study aimed to determine association of BIS with strength/function and differences between 3 intensive care units (ICUs). A retrospective post hoc analysis of BIS, strength, and functional data from adults who required ≥48 hours of mechanical ventilation was conducted. Measures of body composition included the proportion (%) of total body water (TBW), fat mass (FM), and fat-free mass (FFM). The Medical Research Council sum score (MRC-ss) and Physical Function in ICU Test-Scored (PFIT-s) were used for strength and functional assessments. Nonparametric cross-sectional analyses were done at enrollment (≤48 hours of admission: site-A, site-C) and awakening from sedation (site-A, site-B). Raw impedance variables including 50-kHz phase angle (PA) and impedance ratio (IR) were available from site-A and site-B. Participants were 135 adults (site-A n=59, site-B n=33, site-C n=44), with a median (interquartile range) age of 59 (50-69) years. At enrollment, TBW%, FM%, and FFM% were similar between site-A and site-C (P>.05) pooled data were not associated with MRC-ss at awakening or MRC-ss/PFIT-s at ICU discharge. At awakening, there was less TBW%, less FFM%, and greater FM% at site-B vs site-A (P≤.001) but no associations with MRC-ss/PFIT-s when using pooled data. Trends with pooled data of a lower PA and higher IR being associated with awakening MRC-ss were confirmed within site-B (PA ρ=0.70, P≤.001 IR ρ=-0.79, P≤.001). Site-by-site data suggest that raw impedance variables might be useful for screening weakness and poor function.
Publisher: Mark Allen Group
Date: 09-2006
DOI: 10.12968/IJTR.2006.13.9.21783
Abstract: The evaluation of patients' functional outcome and mobility status is of critical importance to all physiotherapists, including those practising in acute care. However, the difficulty in attributing aspects of improvement to physiotherapy intervention has made outcome measurement a complex process. Furthermore, a general literature search failed to identify an immediately appropriate evaluative outcome measure to guide physiotherapists' reasoning or monitor patients' in the acute care setting. Without adequate instruments to measure intervention efficacy for clinical and research purposes, it is difficult to implement evidence-based practice. Part two of this article series presents findings on outcome measurement derived from the focused ethnography in-depth interview methodology described in part one. Recommendations to improve physiotherapists' functional outcome evaluation in acute care are discussed. The use of in idualized atient-specific measures of either items of impairment or activity limitation are suggested, as scored from the physiotherapists' perspective.
Publisher: American Geophysical Union (AGU)
Date: 17-03-2020
DOI: 10.1029/2019GL086259
Publisher: Mark Allen Group
Date: 02-08-2006
DOI: 10.12968/IJTR.2006.13.8.343
Abstract: In the current health care climate physiotherapists working in acute hospitals are not exempt from evidence-based practice pressures. Clinicians are required to incorporate clinical expertise with patient values and the best available evidence. As physiotherapists are ideally placed to intervene in the management of acutely ill inpatients, who are at a high-risk of complications, the decision-making process for the commonly performed task of mobilization requires understanding. Presented in part one of this series are the indicators expert Australian acute care physiotherapists' used in decision-making to determine patient capacity for mobilization. Part two presents and applies study findings to functional outcome evaluation. A focused ethnography using an in-depth interview with 12 acute care physiotherapists was employed to address this. Interview transcripts were analysed thematically. No single indicator was used in participants' decision-making to determine patients' capacity for mobilization. Rather, numerous indicators were incorporated throughout a fluid, in idualized and task-specific assessment and treatment process.
Publisher: Elsevier BV
Date: 2022
Publisher: Springer Science and Business Media LLC
Date: 08-06-2020
DOI: 10.1038/S41467-020-16676-W
Abstract: The severe drought of the 1930s Dust Bowl decade coincided with record-breaking summer heatwaves that contributed to the socio-economic and ecological disaster over North America’s Great Plains. It remains unresolved to what extent these exceptional heatwaves, hotter than in historically forced coupled climate model simulations, were forced by sea surface temperatures (SSTs) and exacerbated through human-induced deterioration of land cover. Here we show, using an atmospheric-only model, that anomalously warm North Atlantic SSTs enhance heatwave activity through an association with drier spring conditions resulting from weaker moisture transport. Model devegetation simulations, that represent the wide-spread exposure of bare soil in the 1930s, suggest human activity fueled stronger and more frequent heatwaves through greater evaporative drying in the warmer months. This study highlights the potential for the lification of naturally occurring extreme events like droughts by vegetation feedbacks to create more extreme heatwaves in a warmer world.
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2022-060973
Abstract: To determine what, how, for whom and under what conditions in idual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals. This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme. A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive–behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions’ interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience. These findings provide realistic and reliable reporting of outcomes to better support implementation within the ‘real world’. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.
Publisher: Elsevier BV
Date: 2019
Publisher: Public Library of Science (PLoS)
Date: 27-04-2023
DOI: 10.1371/JOURNAL.PONE.0285038
Abstract: Critical care healthcare professionals are at high risk in developing burnout and mental health disorders including depression, anxiety, and post-traumatic stress disorder. High demands and the lack of resources lead to decreased job performance and organizational commitment, low work engagement, and increases emotional exhaustion and feelings of loneliness. Peer support and problem-solving approaches demonstrate promising evidence as it targets workplace loneliness, emotional exhaustion, promotes work engagement, and supports adaptive coping behaviors. Tailoring of interventions have also shown to be effective in influencing attitudes and behavior changes, attending to the in idual experience and specific needs of end-users. The purpose of this study is to assess the feasibility and user-perceived acceptability of a combined intervention (In idualized Management Plan (IMP) and Professional Problem-Solving Peer (PPSP) debrief) in critical care healthcare professionals. This protocol was registered in the Australian and New Zealand Clinical Trials Registry (ACTRN12622000749707p). A two-arm randomized controlled trial, with pre-post-follow-up repeated measures intergroup design with 1:1 allocation ratio to either 1) treatment group–IMP and PPSP debrief, or 2) active control group–informal peer debrief. The primary outcomes will be conducted by assessing the recruitment process enrolment, intervention delivery, data collection, completion of assessment measures, user engagement and satisfaction. The secondary outcomes will explore preliminary effectiveness of the intervention using self-reported questionnaire instruments from baseline to 3-months. This study will provide the interventions’ feasibility and acceptability data for critical care healthcare professionals and will be used to inform a future, large-scale trial testing efficacy.
Publisher: Elsevier BV
Date: 04-2020
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-040146
Abstract: To determine the effectiveness of combined exercise-nutrition interventions in prefrail/frail hospitalised older adults on frailty, frailty-related indicators, quality of life (QoL), falls and its cost-effectiveness. Randomised controlled trials (RCTs) of combined exercise-nutrition interventions on hospitalised prefrail/frail older adults ≥65 years were collated from MEDLINE, Emcare, CINAHL, Ageline, Scopus, Cochrane and PEDro on 10 October 2019. The methodological quality was appraised, and data were summarised descriptively or by meta-analysis using a fixed effects model. The standardised mean difference (SMD) or difference of means (MD) with 95% CIs was calculated. Twenty articles from 11 RCTs experimenting exercise-nutrition interventions on hospitalised older adults were included. Seven articles were suitable for the meta-analyses. One study had low risk of bias and found improvements in physical performance and frailty-related biomarkers. Exercise interventions were mostly supervised by a physiotherapist, focusing on strength, ranging 2–5 times/week, of 20–90 min duration. Most nutrition interventions involved counselling and supplementation but had dietitian supervision in only three studies. The meta-analyses suggest that participants who received exercise-nutrition intervention had greater reduction in frailty scores (n=3, SMD 0.25 95% CI 0.03 to 0.46 p=0.02) and improvement in short physical performance battery (SPPB) scores (n=3, MD 0.48 95% CI 0.12 to 0.84 p=0.008) compared with standard care. Only the chair-stand test (n=3) out of the three SPPB components was significantly improved (MD 0.26 95% CI 0.09 to 0.43 p=0.003). Patients were more independent in activities of daily living in intervention groups, but high heterogeneity was observed (I 2 =96%, p .001). The pooled effect for handgrip (n=3)±knee extension muscle strength (n=4) was not statistically significant. Nutritional status, cognition, biomarkers, QoL, falls and cost-effectiveness were summarised descriptively due to insufficient data. There is evidence, albeit weak, showing that exercise-nutrition interventions are effective to improve frailty and frailty-related indicators in hospitalised older adults.
Publisher: American Geophysical Union (AGU)
Date: 27-10-2021
DOI: 10.1029/2021EF002274
Abstract: Recent climate change is characterized by rapid global warming, but the goal of the Paris Agreement is to achieve a stable climate where global temperatures remain well below 2°C above pre‐industrial levels. Inferences about conditions at or below 2°C are usually made based on transient climate projections. To better understand climate change impacts on natural and human systems under the Paris Agreement, we must understand how a stable climate may differ from transient conditions at the same warming level. Here we examine differences between transient and quasi‐equilibrium climates using a statistical framework applied to greenhouse gas‐only model simulations. This allows us to infer climate change patterns at 1.5°C and 2°C global warming in both transient and quasi‐equilibrium climate states. We find substantial local differences between seasonal‐average temperatures dependent on the rate of global warming, with mid‐latitude land regions in boreal summer considerably warmer in a transient climate than a quasi‐equilibrium state at both 1.5°C and 2°C global warming. In a rapidly warming world, such locations may experience a temporary emergence of a local climate change signal that weakens if the global climate stabilizes and the Paris Agreement goals are met. Our research demonstrates that the rate of global warming must be considered in regional projections.
Publisher: IOP Publishing
Date: 12-03-2021
Abstract: Atmospheric rivers (ARs) are narrow and elongated regions of enhanced horizontal water vapour transport. Considerable research on understanding Northern Hemisphere ARs and their relationship with extreme precipitation has shown that ARs have a strong association with heavy rainfall and flooding. While there has been very little work on ARs in the Southern Hemisphere, global climatologies suggest that ARs are equally as common in both hemispheres. New Zealand in particular is located in a region of high AR frequency. This study aims to test the hypothesis that ARs play a significant role in heavy precipitation and flooding events in New Zealand. We used a recently developed AR identification method and daily station data across New Zealand to test for the concurrence of ARs and extreme rainfall. We found that, at each of the eleven stations analysed, at least seven to all ten of the top ten heaviest precipitation days between 1980 and 2018 were associated with AR conditions. Nine of the ten most damaging floods in New Zealand between 2007 and 2017 occurred during AR events. These results have important implications for understanding extreme rainfall in New Zealand, and ultimately for predicting some of the most hazardous events in the region. This work also highlights that more research on ARs in New Zealand is needed.
Publisher: Informa UK Limited
Date: 05-2023
DOI: 10.2147/CIA.S405144
Publisher: Oxford University Press (OUP)
Date: 2014
DOI: 10.2522/PTJ.20130048
Abstract: Skeletal muscle wasting and weakness are common in patients with sepsis in the intensive care unit, although less is known about deficits in diaphragm and limb muscles when mechanical ventilation also is required. The objective of this study was to concurrently investigate relative differences in both thickness and strength of respiratory and peripheral muscles during routine care. A prospective, cross-sectional study of 16 alert patients with sepsis and 16 people who were healthy (control group) was used. Assessment was made of the diaphragm, upper arm, forearm, and thigh muscle thicknesses with the use of ultrasound respiratory muscle strength by means of maximal inspiratory pressure and isometric handgrip, elbow flexion, and knee extension forces with the use of portable dynamometry. To describe relative changes, data also were normalized to fat-free body mass (FFM) measured by bioelectrical impedance spectroscopy. Patients (9 men, 7 women mean age=62 years, SD=17) were assessed after a median of 16 days (interquartile range=11–29) of intensive care unit admission. Patients' diaphragm thickness did not differ from that of the control group, even for a given FFM. When normalized to FFM, only the difference in patients' mid-thigh muscle size significantly deviated from that of the control group. Within the patient s le, all peripheral muscle groups were thinner compared with the diaphragm. Patients were significantly weaker than were the control group participants in all muscle groups, including for a given FFM. Within the critically ill group, limb weakness was greater than the already-significant respiratory muscle weakness. Volitional strength tests were applied such that successive measurements from earlier in the course of illness could not be reliably obtained. When measured at bedside, survivors of sepsis and a period of mechanical ventilation may have respiratory muscle weakness without remarkable diaphragm wasting. Furthermore, deficits in peripheral muscle strength and size may exceed those in the diaphragm.
Publisher: Wiley
Date: 13-04-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2015
Publisher: Elsevier BV
Date: 2022
Publisher: American Geophysical Union (AGU)
Date: 13-07-2018
DOI: 10.1029/2018GL078888
Publisher: American Geophysical Union (AGU)
Date: 11-11-2016
DOI: 10.1002/2016JD025602
Publisher: SAGE Publications
Date: 10-06-2020
Abstract: To identify interventions using wearable accelerometers to measure physical activity and/or sedentary behaviour in adults during hospitalization for an acute medical/surgical condition. Four databases were searched in August 2019 (MEDLINE, CINAHL, Scopus, EMBASE). Studies were selected if they described an intervention in adults with a medical/surgical condition, and concurrently reported an accelerometer-derived measure of physical activity and/or sedentary behaviour while participants were admitted. Items were screened for eligibility in duplicate. Included studies were synthesized to describe intervention types, feasibility and potential effectiveness. Twenty-two studies were included, reporting on 3357 participants (2040 with accelerometer data). Identified types of interventions were: pre-habilitation ( n = 2) exercise ( n = 3), patient behaviour change with self-monitoring ( n = 6), models of care ( n = 5), implementing system change ( n = 2), surgical technique ( n = 2) patients wearing day clothes ( n = 1) and education about activity in hospital ( n = 1). Of 16 studies that reported intervention effects on physical activity, 11 reported a favourable impact including studies of: pre-habilitation, self-monitoring (accelerometry or an activity whiteboard), physiotherapy, an early mobility bundle, minimally invasive surgery, an education booklet and by implementing system change. Of the six studies that reported intervention effects on sedentary behaviour, there was a favourable impact with an activity whiteboard, models of care and an education booklet. Accelerometer-derived measures of physical activity and/or sedentary behaviour have been used to describe s le characteristics and intervention effects in studies of hospitalized adults. Interventions may involve a range of health professionals, but less is known about sedentary behaviour in this setting.
Publisher: Elsevier BV
Date: 05-2020
DOI: 10.1016/J.AUCC.2019.10.006
Abstract: Physical function is often poor in intensive care unit (ICU) survivors, yet objective descriptions of sedentary behaviour and physical activity during acute hospitalisation are lacking. The objective of this study was to examine sedentary and activity patterns during patients' hospital-based recovery from a critical illness and associations with physical function, muscle strength, and length of stay (LOS). This was a prospective cohort study in a tertiary ICU and acute hospital wards, which recruited 40 adults who required ≥5 days of mechanical ventilation. Data were collected at awakening (T1), ICU discharge (T2), and hospital discharge (T3), which included monitoring of body posture (sedentary behaviour) using the activPAL and activity intensity using the GENEActiv. Data were reported as time spent lying/sitting and upright, with the number of sit-to-stand transitions and upright bouts. Statistical analysis was conducted using repeated-measures analysis of variance and Spearman's rho. From awakening to hospital discharge (T1-T3, n = 23), there was a mean [95% confidence interval] decrease in % time spent lying/sitting (-3.0% [-4.6% to1.4%], p ≤ 0.001) corresponding to increased time spent upright (43.0 min [19.9, 66.1], p ≤ 0.001). Sit-to-stand transitions increased (18 [11, 28], p ≤ 0.001). The number of upright bouts ≥2 and ≥ 5 min increased (both p ≤ 0.001), but only from ICU to hospital discharge (T2-T3, 5.3 [3.1, 7.6] and 2.3 [0.9, 3.8] respectively). At ICU discharge (T2), less % of time spent lying/sitting, more minutes spent upright, and more transitions were associated with better physical function (Physical Function in Intensive Care Test-scored and de Morton Mobility Index all rho ≥+/-0.730, p ≤ 0.001) and muscle strength (hand grip, Medical Research Council sum-score all rho≥+/-0.505, p ≤ 0.001). There were no associations between accelerometry and hospital LOS. ICU survivors' transition from highly sedentary behaviour to low intensity activity over their acute hospitalisation. Sedentary breaks may be not spread over the day such that modifying sedentary behaviour to break up prolonged lying/sitting may be a focus for future research. NCT02881801.
Publisher: Daedalus Enterprises
Date: 09-02-2016
Abstract: Advancements in tracheostomy tube design now provide clinicians with a range of options to facilitate communication for in iduals receiving ventilator assistance through a cuffed tube. Little is known about the impact of these modern design features on resistance to air flow. We undertook a bench model test to measure pressure-flow characteristics and resistance of a range of tubes of similar outer diameter, including those enabling subglottic suction and speech. A constant inspiratory ± expiratory air flow was generated at increasing flows up to 150 L/min through each tube (with or without optional, mandatory, or interchangeable inner cannula). Driving pressures were measured, and resistance was calculated (cm H2O/L/s). Pressures changed with increasing flow (P < .001) and tube type (P < .001), with differing patterns of pressure change according to the type of tube (P < .001) and direction of air flow. The single-lumen reference tube encountered the lowest inspiratory and expiratory pressures compared with all double-lumen tubes (P < .001) placement of an optional inner cannula increased bidirectional tube resistance by a factor of 3. For a tube with interchangeable inner cannulas, the type of cannula altered pressure and resistance differently (P < .001) the speech cannula in particular lified pressure-flow changes and increased tube resistance by more than a factor of 4. Tracheostomy tube type and inner cannula selection imposed differing pressures and resistance to air flow during inspiration and expiration. These differences may be important when selecting airway equipment or when setting parameters for monitoring, particularly for patients receiving supported ventilation or during the weaning process.
Publisher: Wiley
Date: 26-09-2011
DOI: 10.1111/J.1440-1843.2011.02005.X
Abstract: Reliable measurement of diaphragm and peripheral muscle thickness, using diagnostic ultrasound, has only been validated in the erect posture. However, in many clinical populations, including critically ill patients, the erect posture presents logistic difficulties. This study aimed to validate ultrasound measurement of diaphragm and peripheral muscle thickness in the recumbent position. An observational methodology of repeated but blind ultrasound and anthropometric measurements was applied, to assess inta-rater reliability. Thirteen healthy volunteers (aged 20-73years) participated. A pneumotachograph was used to target lung volume, as diaphragm thickness was measured from ultrasound at end-expiration, and both 25% and 50% of inspiratory capacity, while semi-recumbent. The thicknesses of the mid-upper arm, mid-forearm and mid-thigh musculature were also measured bilaterally while supine. Diaphragm thickness could be reliably measured at end-expiration (intra-class correlation coefficient (ICC)=0.990, 95% confidence interval: 0.918-0.998), 25% of inspiratory capacity (ICC=0.959 (0.870-0.988)) and 50% of inspiratory capacity (ICC=0.994 (0.980-0.998)). Peripheral muscle thickness measurements were also reliable (ICC=0.998-1.0). Supine anthropometric measurements of limb segment lengths and girths were highly reproducible. This ultrasound technique has good reliability in recumbent positions, making it useful for application to clinical populations when the erect posture is not practical.
Publisher: Frontiers Media SA
Date: 28-09-2022
DOI: 10.3389/FPSYG.2022.991946
Abstract: This study aimed to determine what, how, and under what circumstances in idual-focused interventions improve well-being and decrease burnout for critical care healthcare professionals. This realist approach, expert opinion interview, was guided by the Realist And Meta-narrative Evidence Synthesis: Evolving Standards II (RAMESES II) guidelines. Semi-structured interviews with critical care experts were conducted to ascertain current and nuanced information on a set of pre-defined in idual interventions summarized from a previous umbrella review. The data were appraised, and relationships between context, mechanisms, and outcomes were extracted, which created theory prepositions that refined the initial program theory. A total of 21 critical care experts were in idually interviewed. By understanding the complex interplay between organizational and personal factors that influenced intervention uptake, it was possible to decipher the most likely implementable intervention for critical care healthcare professionals. The expert recommendation suggested that interventions should be evidence-based, accessible, inclusive, and collaborative, and promote knowledge and skill development. Unique mechanisms were also required to achieve the positive effects of the intervention due to the presence of contextual factors within critical care settings. Mechanisms identified in this study included the facilitation of self-awareness, self-regulation, autonomy, collaboration, acceptance, and inclusion (to enable a larger reach to different social groups). This validation of a theoretical understanding of intervention that addressed well-being and burnout in critical care healthcare professionals by expert opinion demonstrated essential mechanisms and contextual factors to consider when designing and implementing interventions. Future research would benefit by piloting in idual interventions and integrating these new theoretical findings to understand better their effectiveness for future translation into the “real-world” setting.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2020
DOI: 10.1186/S12966-020-00970-3
Abstract: Immobility is major contributor to poor outcomes for older people during hospitalisation with an acute medical illness. Yet currently there is no specific mobility guidance for this population, to facilitate sustainable changes in practice. This study aimed to generate draft physical activity (PA) and sedentary behaviour (SB) recommendations for older adults’ during hospitalisation for an acute medical illness. A 4-Round online Delphi consensus survey was conducted. International researchers, medical/nursing hysiotherapy clinicians, academics from national PA/SB guideline development teams, and patients were invited to participate. Round 1 sought responses to open-ended questions. In Rounds 2–3, participants rated the importance of items using a Likert scale (1–9) consensus was defined a priori as: ≥70% of respondents rating an item as “critical” (score ≥ 7) and ≤ 15% of respondents rating an item as “not important” (score ≤ 3). Round 4 invited participants to comment on draft statements derived from responses to Rounds 1–3 Round 4 responses subsequently informed final drafting of recommendations. Forty-nine people from nine countries were invited to each Round response rates were 94, 90, 85 and 81% from Rounds 1–4 respectively. 43 concepts (items) from Rounds 2 and 3 were incorporated into 29 statements under themes of PA, SB, people and organisational factors in Round 4. Ex les of the final draft recommendations (being the revised version of statements with highest participant endorsement under each theme) were: “ some PA is better than none”, “ older adults should aim to minimise long periods of uninterrupted SB during waking hours while hospitalised”, “when encouraging PA and minimising SB, people should be culturally responsive and mindful of older adults’ physical and mental capabilities” and “opportunities for PA and minimising SB should be incorporated into the daily care of older adults with a focus on function, independence and activities of daily living”. These world-first consensus-based statements from expert and stakeholder consultation provide the starting point for recommendations to address PA and SB for older adults hospitalised with an acute medical illness. Further consultation and evidence review will enable validation of these draft recommendations with ex les to improve their specificity and translation to clinical practice.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-07-2020
DOI: 10.1097/CCM.0000000000004499
Abstract: Evaluation of physical functioning is central to patient recovery from critical illness—it may enable the ability to determine recovery trajectories, evaluate rehabilitation efficacy, and predict in iduals at highest risk of ongoing disability. The Physical Function in ICU Test-scored is one of four recommended physical functioning tools for use within the ICU however, its utility outside the ICU is poorly understood. The De Morton Mobility Index is a common geriatric mobility tool, which has had limited evaluation in the ICU population. For the field to be able to track physical functioning recovery, we need a measurement tool that can be used in the ICU and post-ICU setting to accurately measure physical recovery. Therefore, this study sought to: 1) examine the clinimetric properties of two measures (Physical Function in ICU Test-scored and De Morton Mobility Index) and 2) transform these measures into a single measure for use across the acute care continuum. Clinimetric analysis. Multicenter study across four hospitals in three countries (Australia, Singapore, and Brazil). One hundred fifty-one ICU patients. None. Physical function tests (Physical Function in ICU Test-scored and De Morton Mobility Index) were assessed at ICU awakening, ICU, and hospital discharge. A significant floor effect was observed for the De Morton Mobility Index at awakening (23%) and minimal ceiling effects across all time points (5–12%). Minimal floor effects were observed for the Physical Function in ICU Test-scored across all time points (1–7%) and a significant ceiling effect for Physical Function in ICU Test-scored at hospital discharge (27%). Both measures had strong concurrent validity, responsiveness, and were predictive of home discharge. A new measure was developed using Rasch analytical principles, which involves 10 items (scored out of 19) with minimal floor/ceiling effects. Limitations exist for Physical Function in ICU Test-scored and De Morton Mobility Index when used in isolation. A new single measure was developed for use across the acute care continuum.
No related grants have been discovered for Claire Baldwin.