Facilitators & barriers and practices of early mobilization in critically ill burn patients: A survey.

BACKGROUND: Early mobilization (EM) of intensive care (IC) patients is important but complex with facilitators and barriers. Compared to general IC patients, burn IC patients are more hyper-metabolic. They have extensive wounds, lengthy wound dressing changes, and repeated surgeries that may affect possibilities of EM. This study aimed to identify facilitators and barriers of EM in burn IC patients among all disciplines involved. Additionally, we assessed EM practices, i.e. when are which patients considered suitable for EM. METHODS: A survey was sent to 139 professionals involved in EM of burn IC patients (discipline groups: Intensivists, medical doctors, registered nurses, therapists). RESULTS: Response rate was 57 %. The majority found EM very important, yet different definitions were chosen. Perceived barriers mainly concerned patient-level factors, most frequently hemodynamic instability and excessive sedation followed by skin graft surgery, fatigue, and pain management. Most frequent barriers at the provider-level were limited staffing, safety concerns, and conflicting perceptions about the suitability of EM. At the institutional-level, we found no high barriers. Interdisciplinary variation on perceived barriers, when to initiate it, and permitted maximal activity were ascertained. CONCLUSION: Skin grafts and pain management were barriers of EM specific for burn care. Opinions on frequency, dosage and duration of EM varied widely. Improving interdisciplinary communication is key.

Heterogeneous Subgreenschist Deformation in an Exhumed Sediment-Poor Mélange.

Many described subduction complexes (or mélanges) exhumed from seismogenic depths comprise thick, turbidite-dominated sequences with deformed zones containing clasts or boudins of more competent sandstone and/or basalt. In contrast, many active subduction zones have a relatively small thickness of sedimentary inputs (<2 km), turbidite sequences are commonly accreted rather than subducted, and the role of pelagic sediments and basalt (lavas and hyaloclastites) in the deforming zone near the plate interface at <20 km depth is poorly understood. Field investigation of Neoproterozoic oceanic sequences accreted in the Gwna Complex, Anglesey, UK, reveals repeated lenticular slices of variably sampled ocean plate stratigraphy (OPS) bounded by thin mélange-bearing shear zones. Mélange matrix material is derived from adjacent OPS lithologies and is either dominantly illitic, likely derived from altered siliciclastic sediment, or chloritic, likely derived from altered volcanics. In the illitic mélange, mutually cross-cutting phyllosilicate foliation and variably deformed chlorite-quartz-calcite veins suggest ductile creep was cyclically punctuated by transient, localized fluid pulses. Chlorite thermometry indicates the veins formed at 260 ± 10°C. In the chloritic mélange, recrystallized through-going calcite veins are deformed to shear strains of 4-5 within a foliated chlorite matrix, suggesting calcite veins in subducting volcanics may localize deformation in the seismogenic zone. Shear stress-strain rate curves constructed using existing empirical relationships in a simplified shear zone geometry predict that slip velocities varied depending on pore fluid pressure; models predict slow slip velocities preferentially by frictional sliding in chlorite, at pore fluid pressures greater than hydrostatic but less than lithostatic.

The degree of joint range of motion limitations after burn injuries during recovery.

INTRODUCTION: The aim of this study was to determine the degree of ROM limitations of extremities, joints and planes of motion after burns and its prevalence over time. METHOD: The database of a longitudinal multicenter cohort study in the Netherlands (2011-2012) was used. From patients with acute burns involving the neck, shoulder, elbow, wrist, hip, knee and ankle joints that had surgery, ROM of 17 planes of motion was assessed by goniometry at 3, 6 weeks, 3-6-9 and 12 months after burns and at discharge. RESULTS: At 12 months after injury, 12 out of 17 planes of motion demonstrated persistent joint limitations. The five unlimited planes of motion were all of the lower extremity. The most severely limited joints at 12 months were the neck, ankle, wrist and shoulder. The lower extremity was more severely limited in the early phase of recovery whereas at 12 months the upper extremity was more severely limited. CONCLUSION: The degree of ROM limitations and prevalence varied over time between extremities, joints and planes of motion. This study showed which joints and planes of motion should be watched specifically concerning the development of scar contracture.

The development of burn scar contractures and impact on joint function, disability and quality of life in low- and middle-income countries: A prospective cohort study with one-year follow-up.

OBJECTIVE: The aim of this study was to assess the development of burn scar contractures and their impact on joint function, disability and quality of life in a low-income country. METHODS: Patients with severe burns were eligible. Passive range of motion (ROM) was assessed using lateral goniometry. To assess the development of contractures, the measured ROM was compared to the normal ROM. To determine joint function, the normal ROM was compared to the functional ROM. In addition, disability and quality of life (QoL) were assessed. Assessments were from admission up to 12 months after injury. RESULTS: Thirty-six patients were enrolled, with a total of 124 affected joints. The follow-up rate was 83%. Limited ROM compared to normal ROM values was observed in 26/104 joints (25%) at 12 months. Limited functional ROM was observed in 55/115 joints (48%) at discharge and decreased to 22/98 joints (22%) at 12 months. Patients who had a contracture at 12 months reported more disability and lower QoL, compared to patients without a contracture (median disability 0.28 versus 0.17 (p = 0.01); QoL median 0.60 versus 0.76 (p = 0.001)). Significant predictors of developing joint contractures were patient delay and the percentage of TBSA deep burns. CONCLUSION: The prevalence of burn scar contractures was high in a low-income country. The joints with burn scar contracture were frequently limited in function. Patients who developed a contracture reported significantly more disability and lower QoL. To limit the development of burn scar contractures, timely access to safe burn care should be improved in low-income countries.

Microphysical Modeling of Carbonate Fault Friction at Slip Rates Spanning the Full Seismic Cycle.

Laboratory studies suggest that seismogenic rupture on faults in carbonate terrains can be explained by a transition from high friction, at low sliding velocities (V), to low friction due to rapid dynamic weakening as seismic slip velocities are approached. However, consensus on the controlling physical processes is lacking. We previously proposed a microphysically based model (the "Chen-Niemeijer-Spiers" [CNS] model) that accounts for the (rate-and-state) frictional behavior of carbonate fault gouges seen at low velocities characteristic of rupture nucleation. In the present study, we extend the CNS model to high velocities (1 mm/s ≤ V ≤ 10 m/s) by introducing multiple grain-scale deformation mechanisms activated by frictional heating. As velocity and hence temperature increase, the model predicts a continuous transition in dominant deformation mechanisms, from frictional granular flow with partial accommodation by plasticity at low velocities and temperatures, to grain boundary sliding with increasing accommodation by solid-state diffusion at high velocities and temperatures. Assuming that slip occurs in a localized shear band, within which grain size decreases with increasing velocity, the model results capture the main mechanical trends seen in high-velocity friction experiments on room-dry calcite-rich rocks, including steady-state and transient aspects, with reasonable quantitative agreement and without the need to invoke thermal decomposition or fluid pressurization effects. The extended CNS model covers the full spectrum of slip velocities from earthquake nucleation to seismic slip rates. Since it is based on realistic fault structure, measurable microstructural state variables, and established deformation mechanisms, it may offer an improved basis for extrapolating lab-derived friction data to natural fault conditions.

Surprising impact of stromal TIL's on immunotherapy efficacy in a real-world lung cancer study.

INTRODUCTION: Immune checkpoint inhibitors (ICI), such as anti-PD-1 agents, have become part of the standard of care treatment of advanced non-small cell lung cancer (NSCLC). Predictive biomarkers are needed to identify patients that benefit from anti-PD-1 treatments. Tumor infiltrating lymphocytes (TILs) and PD-L1 are major players in the ICI mechanism of action. In this study, we assess the impact of real-world clinicopathological variables, including TILs and PD-L1, on anti-PD-1 efficacy. METHODS: We performed a monocenter retrospective study in advanced NSCLC treated with nivolumab or pembrolizumab between January 2015 and February 2019. The impact of baseline clinical and pathological variables was assessed by univariate and multivariate models. TILs, defined as CD8+T-cells, and PD-L1 were scored in tumor and stroma, and correlated with progression free survival (PFS) and overall survival (OS). RESULTS: We included 366 patients of whom 141 were assessed for tumor and stromal TILs. The median follow-up time was 487 days. In the whole cohort, PFS was associated with high tumor PD-L1, high albumin and good performance. OS was associated with low LDH, high albumin, good performance and 'first-line treatment'. In the TILs subcohort, stromal TILs had the strongest impact on PFS and OS. Stromal TILs were a stronger marker for PFS and OS than tumoral TILs, tumoral PD-L1 or stromal PD-L1. Remaining factors for PFS and OS were albumin and albumin with LDH, respectively. CONCLUSIONS: This real-world study on clinicopathological features shows that stromal CD8 + TILs were the strongest predictor for PFS and OS in patients with advanced NSCLC on anti-PD-1 therapy. Other predictors for PFS and OS included albumin and albumin together with LDH, respectively. This study highlights the pivotal role of the stromal compartment in the mechanisms of action of ICI, and the need for further studies aiming to overcome this stromal firewall.

Burn scar contracture release surgery effectively improves functional range of motion, disability and quality of life: A pre/post cohort study with long-term follow-up in a Low- and Middle-Income Country.

OBJECTIVE: Burn scar contractures limit range of motion (ROM) of joints and have substantial impact on disability and the quality of life (QoL) of patients, particularly in a Low- and Middle-Income Country (LMIC) setting. Studies on the long-term outcome are lacking globally; this study describes the long-term impact of contracture release surgery performed in an LMIC. METHODS: This is a pre-post cohort study, conducted in a referral hospital in Tanzania. Patients who underwent burn scar contracture release surgery in 2017-2018 were eligible. ROM (goniometry), disability (WHODAS 2.0) and QoL (EQ-5D) were assessed. The ROM data were compared to the ROM that is required to perform activities of daily living without compensation, i.e. functional ROM. Assessments were performed preoperatively and at 1, 3, 6 and 12 months postoperatively. RESULTS: In total, 44 patients underwent surgery on 115 affected joints. At 12 months, the follow-up rate was 86%. The mean preoperative ROM was 37.3% of functional ROM (SD 31.2). This improved up to 108.7% at 12 months postoperatively (SD 42.0, p < 0.001). Disability-free survival improved from 55% preoperatively to 97% at 12 months (p < 0.001) postoperatively. QoL improved from 0.69 preoperatively, to 0.93 (max 1.0) at 12 months postoperatively (p < 0.001). Patients who regained functional ROM in all affected joints reported significantly less disability (p < 0.001) and higher QoL (p < 0.001) compared to patients without functional ROM. CONCLUSIONS: Contracture release surgery performed in an LMIC significantly improved functional ROM, disability and QoL. Results showed that regaining a functional joint is associated with less disability and higher QoL.

Flow-to-Friction Transition in Simulated Calcite Gouge: Experiments and Microphysical Modeling.

A (micro)physical understanding of the transition from frictional sliding to plastic or viscous flow has long been a challenge for earthquake cycle modeling. We have conducted ring-shear deformation experiments on layers of simulated calcite fault gouge under conditions close to the frictional-to-viscous transition previously established in this material. Constant velocity (v) and v-stepping tests were performed, at 550°C, employing slip rates covering almost 6 orders of magnitude (0.001-300 µm/s). Steady-state sliding transitioned from (strong) v-strengthening, flow-like behavior to v-weakening, frictional behavior, at an apparent "critical" velocity (v cr ) of ~0.1 µm/s. Velocity-stepping tests using v < v cr showed "semi-brittle" flow behavior, characterized by high stress sensitivity ("n-value") and a transient response resembling classical frictional deformation. For v ≥ v cr , gouge deformation is localized in a boundary shear band, while for v < v cr , the gouge is well-compacted, displaying a progressively homogeneous structure as the slip rate decreases. Using mechanical data and post-mortem microstructural observations as a basis, we deduced the controlling shear deformation mechanisms and quantitatively reproduced the steady-state shear strength-velocity profile using an existing micromechanical model. The same model also reproduces the observed transient responses to v-steps within both the flow-like and frictional deformation regimes. We suggest that the flow-to-friction transition strongly relies on fault (micro)structure and constitutes a net opening of transient microporosity with increasing shear strain rate at v < v cr , under normal stress-dependent or "semi-brittle" flow conditions. Our findings shed new insights into the microphysics of earthquake rupture nucleation and dynamic propagation in the brittle-to-ductile transition zone.

Nucleation of Stick-Slip Instability Within a Large-Scale Experimental Fault: Effects of Stress Heterogeneities Due to Loading and Gouge Layer Compaction.

Geodetic observations and large-scale laboratory experiments show that seismic instability is preceded by slow slip within a finite nucleation zone. In laboratory experiments rupture nucleation is studied mostly using bare (rock) interfaces, whereas upper crustal faults are typically filled with gouge. To investigate effects of gouge on rupture nucleation, we performed a biaxial shearing experiment on a 350 mm long saw-cut fault filled with gypsum gouge, at room temperature and a minimum horizontal stress σ 2 = 0.3-5 MPa. The gouge layer was sandwiched between polymethylmethacrylate (PMMA) plates For reference also a fault without gouge was deformed. Strain gauges and Digital Image Correlation were used to monitor the deformation field along the fault zone margins. Stick-slip behavior occurred on both the gouge-filled fault and the PMMA fault. Nucleation of instability on the PMMA fault persistently occurred from one location 2/3 to 3/4 along the fault adjacent to a slow slip zone at the fault end, but nucleation on the gouge-filled fault was more variable, nucleating at the ends and/or at approximately 2/3 along the fault, with precursory slip occurring over a large fraction of the fault. Nucleation correlated to regions of high average fault stress ratio τ/σ n , which was more variable for the gouge-filled fault due to small length scale variations in normal stress caused by heterogeneous gouge compaction. Rupture velocities and slip rates were lower for the gouge-filled fault than for the bare PMMA fault. Stick-slip persisted when σ 2 was lowered and the nucleation zone length increased, expanding from the center to the sample ends before transitioning into instability.

An investigation into the role of time-dependent cohesion in interseismic fault restrengthening.

Earthquakes typically exhibit recurrence times that far exceed time-scales attainable in a laboratory setting. To traverse the temporal gap between the laboratory and nature, the slide-hold-slide test is commonly employed as a laboratory analogue for the seismic cycle, from which the time-dependence of fault strength may be assessed. In many studies it is implicitly assumed that all fault restrengthening emanates from an increase in the internal friction coefficient, neglecting contributions from cohesion. By doing so, important information is lost that is relevant for numerical simulations of seismicity on natural faults, as well as for induced seismicity. We conduct slide-hold-slide experiments on granular halite gouge at various normal stresses to assess the time-dependence of the internal coefficient of friction, and of the cohesion, independently of one another. These experiments reveal that both the internal friction coefficient and cohesion increase over time, but that these quantities do not share a common evolution, suggesting different underlying mechanisms.

The prevalence and development of burn scar contractures: A prospective multicenter cohort study.

OBJECTIVE: The objective of this study was to identify the prevalence and development of after burn joint limitation by scar contracture. METHODS: In 2011-2012, consecutive patients were enrolled in this prospective multi center cohort study. Eligible were all patients admitted to the 2 participating Dutch Burn Centers with acute burns across or adjacent to the neck, shoulder, elbow, wrist, hip, knee and ankle. Passive range of motion was measured in week 3 and subsequently every 3 weeks until discharge, on discharge from the hospital and during follow-up at the outpatient clinic at 3-6-9-12 months after burn. RESULTS: Limited range of motion of non-operated burned joints (N = 195) was restored back to normal within 6-9 months. From the operated burned joints (N = 353), 58.6% demonstrated a limited range of motion at 3-6 weeks declining to 20.9% at 12 months. The upper part of the body was affected more often by scar contracture than the lower part. At 12 months, the shoulder was limited most often (51.3%) and the hip least often (0%). Reconstructive surgery was performed in 13.3% of the operated burned joints. CONCLUSIONS: Persistent joint limitations at 12 months were exclusively present in joints that needed skin grafting for rapid wound closure. The upper part of the body was more prone to contracture formation than the lower part, from which the shoulder was most often involved. More than half of the limited range of motion seen in the acute phase, resolved in the long term. The need for reconstructive surgery was less than expected.

Whole body PD-1 and PD-L1 positron emission tomography in patients with non-small-cell lung cancer.

PD-L1 immunohistochemistry correlates only moderately with patient survival and response to PD-(L)1 treatment. Heterogeneity of tumor PD-L1 expression might limit the predictive value of small biopsies. Here we show that tumor PD-L1 and PD-1 expression can be quantified non-invasively using PET-CT in patients with non-small-cell lung cancer. Whole body PD-(L)1 PET-CT reveals significant tumor tracer uptake heterogeneity both between patients, as well as within patients between different tumor lesions.

Investigating Compaction by Intergranular Pressure Solution Using the Discrete Element Method.

Intergranular pressure solution creep is an important deformation mechanism in the Earth's crust. The phenomenon has been frequently studied and several analytical models have been proposed that describe its constitutive behavior. These models require assumptions regarding the geometry of the aggregate and the grain size distribution in order to solve for the contact stresses and often neglect shear tractions. Furthermore, analytical models tend to overestimate experimental compaction rates at low porosities, an observation for which the underlying mechanisms remain to be elucidated. Here we present a conceptually simple, 3-D discrete element method (DEM) approach for simulating intergranular pressure solution creep that explicitly models individual grains, relaxing many of the assumptions that are required by analytical models. The DEM model is validated against experiments by direct comparison of macroscopic sample compaction rates. Furthermore, the sensitivity of the overall DEM compaction rate to the grain size and applied stress is tested. The effects of the interparticle friction and of a distributed grain size on macroscopic strain rates are subsequently investigated. Overall, we find that the DEM model is capable of reproducing realistic compaction behavior, and that the strain rates produced by the model are in good agreement with uniaxial compaction experiments. Characteristic features, such as the dependence of the strain rate on grain size and applied stress, as predicted by analytical models, are also observed in the simulations. DEM results show that interparticle friction and a distributed grain size affect the compaction rates by less than half an order of magnitude.

Velocity-dependent slip weakening by the combined operation of pressure solution and foliation development.

Phyllosilicate-bearing faults are characterized by an anastomosing foliation with intervening hard clasts and are believed to be long-term weak structures. Here, I present results of sliding experiments on gouges of 80 wt% quartz and 20 wt% muscovite, sheared under hydrothermal conditions at constant velocity. The results show that significant strengthening occurs over a narrow range of sliding velocities (0.03-1 µm/s). At the lowest velocity investigated, weakness is achieved after a considerable sliding distance of over 20 mm with friction reaching a value of 0.3. Microstructural observations and the application of existing models point to the operation of frictional-viscous flow (FVF), through the serial operation of frictional sliding over a weak foliation and pressure solution of intervening clasts, resulting in low frictional strength and pronounced velocity-strengthening. At higher velocities, grain size reduction becomes dominant in a localized zone, which results in disruption of the foliation and the cessation of the FVF mechanism. In natural settings, earthquakes originating elsewhere on the fault would be rapidly arrested when encountering a foliated part of the fault deforming via FVF. Furthermore, pulses of elevated slip velocity would lead to grain size reduction which would destroy the foliation and cause a long-term strengthening of the fault.

The Role of Spirituality in Lifestyle Changing Among Patients with Chronic Cardiovascular Diseases: A Literature Review of Qualitative Studies.

Chronic cardiovascular diseases (CVD) are diseases with marked morbidity. Patients are often advised to change their lifestyle to prevent complications and impairment of their diseases. Compliance, however, is influenced by multiple factors. Initial studies show that spirituality is an important aspect in health behavior and lifestyle changing, but to health professionals like nurses this is unknown. The aim of this review is to investigate and synthesize evidence about the role of spirituality in lifestyle changing in patients with chronic CVD. A comprehensive search was conducted in electronic databases Academic Search Premier, E-journals, Medline and PubMed, published between the years 2000-2015. After selection based on pre-set inclusion criteria, studies were retrieved and evaluated on quality using the criteria of the QOREC. Twelve studies with a qualitative empirical design and mixed methods were included. This review shows that spirituality, is related to the self-management of patients with chronic diseases. For instance, lifestyle changes are experienced as a continuous inner battle. Religion gives strength, but is also experienced as a struggle. Feelings of guilt and becoming a victim influence patients' experience. For effectively advising patients with CVD on lifestyle changes, nurses cannot ignore this factor but further investigation is required.

Clinical outcome of patients with self-inflicted burns.

INTRODUCTION: Patients with self-inflicted burns (SIB) are thought to have a longer length of stay compared to patients with accidental burns. However, other predictors for a longer length of stay are often not taken into account, e.g. percentage of the body surface area burned, age or comorbidities. Therefore, we wanted to study the outcome of patients with SIB at our burn center. METHODS: A retrospective, observational study was conducted. All adult patients with acute burns admitted to the burn center of the Martini Hospital Groningen, between January 1, 2009 and December 31, 2013 were included. Data on characteristics of the patient, injury, and outcome (LOS, mortality, discharge destination) were collected. In patients with SIB, suicide attempts (SA) were distinguished from self-harm without the intention to die (non-suicidal self-injury, NSSI). To evaluate differences in outcome, each patient with SIB was matched on variables and total score of the Abbreviated Burn Severity Index (ABSI) to a patient with accidental burns (AB). RESULTS: In total 29 admissions (21 SA and 8 NSSI) were due to SIB and 528 due to accidents. Overall, when compared to AB, there were significant differences with respect to mortality and LOS for SA and/or NSSI. Mortality was higher in the SA group, while the LOS was higher in both the SA and NSSI groups compared to the AB group. However, after matching on ABSI, no statistical significant differences between the SA and SA-match or the NSSI and NSSI-match group were found. CONCLUSION: With the right and timely treatment, differences in mortality rate or length of stay in hospital could all be explained by the severity of the burn and the intention of the patient.

Large-displacement, hydrothermal frictional properties of DFDP-1 fault rocks, Alpine Fault, New Zealand: Implications for deep rupture propagation.

The Alpine Fault, New Zealand, is a major plate-bounding fault that accommodates 65-75% of the total relative motion between the Australian and Pacific plates. Here we present data on the hydrothermal frictional properties of Alpine Fault rocks that surround the principal slip zones (PSZ) of the Alpine Fault and those comprising the PSZ itself. The samples were retrieved from relatively shallow depths during phase 1 of the Deep Fault Drilling Project (DFDP-1) at Gaunt Creek. Simulated fault gouges were sheared at temperatures of 25, 150, 300, 450, and 600°C in order to determine the friction coefficient as well as the velocity dependence of friction. Friction remains more or less constant with changes in temperature, but a transition from velocity-strengthening behavior to velocity-weakening behavior occurs at a temperature of T = 150°C. The transition depends on the absolute value of sliding velocity as well as temperature, with the velocity-weakening region restricted to higher velocity for higher temperatures. Friction was substantially lower for low-velocity shearing (V < 0.3 µm/s) at 600°C, but no transition to normal stress independence was observed. In the framework of rate-and-state friction, earthquake nucleation is most likely at an intermediate temperature of T = 300°C. The velocity-strengthening nature of the Alpine Fault rocks at higher temperatures may pose a barrier for rupture propagation to deeper levels, limiting the possible depth extent of large earthquakes. Our results highlight the importance of strain rate in controlling frictional behavior under conditions spanning the classical brittle-plastic transition for quartzofeldspathic compositions.

Effect and mechanism of hydrocortisone on organ function in patients with severe burns.

INTRODUCTION: In patients with severe burns, resuscitation with large volumes of fluid is needed, partly because of an increase in capillary leakage. Corticosteroids might be beneficial by diminishing capillary leakage. This study aimed to assess in severely burned nonseptic patients whether hydrocortisone (HC) improved outcome and diminished capillary leakage. METHODS: Retrospective analyses of a prospectively collected database were performed, including 39 patients (age 52 [35-62] years, 72% male). Patients were divided based on HC therapy. First, in patients in whom HC was started late, that is when deteriorating (late; 5-12 days postburn) data before and after start of HC were compared. Second, patients in whom HC was started day 0 or 1 postburn (upfront; within 48 hours) were compared with patients who did not receive HC (control). Outcome was assessed as organ dysfunction by Denver Multiple Organ Failure (MOF) score and Sequential Organ Failure Assessment (SOFA) score. As markers for capillary leakage and hydration state, proteinuria, B-type natriuretic peptide (BNP), and fluid administration were assessed. Follow-up was 20 days postburn. Possible adverse effects including mortality were recorded. Repeated measurement regression analyses were performed using MLwiN. RESULTS: In the late group, Denver MOF and SOFA scores significantly decreased after HC (P<.001). Proteinuria tended to decrease (P=.13), BNP increased on the days HC was used (P<.001), and amounts of fluids diminished (P<.001). In the upfront vs control group, Denver MOF and SOFA scores (P<.001) decreased more quickly. Proteinuria (P=.006) and administered fluids decreased more rapidly (P<.001). Mortality rate, numbers of positive blood cultures, incidence of pneumonia, and graft loss were similar in all groups. CONCLUSIONS: Hydrocortisone treatment in severe burned patients without sepsis might improve organ dysfunction possibly because of a reduction in capillary leakage, as reflected by a decrease of proteinuria, an increase of BNP, and diminished fluid resuscitation volumes.

The place of surveillance technology in residential care for people with intellectual disabilities: is there an ideal model of application.

BACKGROUND: The demand for (care) services for people with intellectual disabilities (ID) is on the rise, because of an expanding population of people with ID as resources are concurrently diminishing. As a result, service providers are increasingly turning to technology as a potential answer to this problem. However, the use and application of surveillance technology (ST) in the care for people with ID provokes conflicting reactions among ethicists and healthcare professionals, and no ethical consensus has been reached as of yet. The aim of this study was thus to provide an overview of how ST is viewed by (care) professionals and ethicists working in the field by investigating what the ideal application of ST in the residential care for people with ID might entail. METHODS: Use was made of the concept mapping method as developed by Trochim; a computer-assisted procedure consisting of five subsequent steps: brainstorming, prioritising, clustering, processing by the computer and finally analysis. Various participants (ranging from ethicists, physicians to support workers) were invited on the basis of their intended (professional) background. Prior to this study, the views of care professionals on the (ideal) application of ST in the residential care of people with dementia have been consulted and analysed using concept mapping. A comparison between the two studies has been made. RESULTS: Results show that the generated views represent six categories, varying from it being beneficial to the client; reducing restraints and it being based on a clear vision to (the need for) staff to be equipped; user friendliness and attending to the client. The results are presented in the form of a graphic chart. Both studies have produced very similar results, but there are some differences, as there appears to be more fear for ST among care professionals in the care for people with ID and views are expressed from a more developmental perspective rather than a person-centred perspective with regard to people with dementia. CONCLUSIONS: When it comes to views on using technology both in dementia care and the care for people with ID, there appears to be an inherent duality, often rooted in the moral conflict between safety versus freedom or autonomy. What is more, elaboration on abstract concepts often presumed to be self-evident, whether ethical or not, has proven to be difficult. How ST is viewed and apprehended is not so much dependent of the care setting and care needs, but rather whether it is clear to everyone affected by ST, what one wants to achieve with ST.