BACKGROUND: Conflicting evidence exists on the effectiveness of routinely measured vital signs on the early detection of increased probability of adverse events.PURPOSE: To assess the clinical relevance of routinely measured vital signs in medically and surgically hospitalized patients through a systematic review.DATA SOURCES: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature, and Meta-analysen van diagnostisch onderzoek (in Dutch; MEDION) were searched to January 2013.STUDY SELECTION: Prospective studies evaluating routine vital sign measurements of hospitalized patients, in relation to mortality, septic or circulatory shock, intensive care unit admission, bleeding, reoperation, or infection.DATA EXTRACTION: Two reviewers independently assessed potential bias and extracted data to calculate likelihood ratios (LRs) and predictive values.DATA SYNTHESIS: Fifteen studies were performed in medical (n = 7), surgical (n = 4), or combined patient populations (n = 4; totaling 42,565 participants). Only three studies were relatively free from potential bias. For temperature, the positive LR (LR+) ranged from 0 to 9.88 (median 1.78; n = 9 studies); heart rate 0.82 to 6.79 (median 1.51; n = 5 studies); blood pressure 0.72 to 4.7 (median 2.97; n = 4 studies); oxygen saturation 0.65 to 6.35 (median 1.74; n = 2 studies); and respiratory rate 1.27 to 1.89 (n = 3 studies). Overall, three studies reported area under the Receiver Operator Characteristic (ROC) curve (AUC) data, ranging from 0.59 to 0.76. Two studies reported on combined vital signs, in which one study found an LR+ of 47.0, but in the other the AUC was not influenced.CONCLUSIONS: Some discriminative LR+ were found, suggesting the clinical relevance of routine vital sign measurements. However, the subject is poorly studied, and many studies have methodological flaws. Further rigorous research is needed specifically intended to investigate the clinical relevance of routinely measured vital signs.CLINICAL RELEVANCE: The results of this research are important for clinical nurses to underpin daily routine practices and clinical decision making.
Aim: The aim of this study is to explore patients' and (in)formal caregivers' perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design: This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods: Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi-structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients' medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six-step analysis of Strauss & Corbin have been used. Results: Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients' health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers' perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion: Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients' care needs and expectations should be prioritized to stimulate participation. Impact: (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients' care needs and expectations.
This paper introduces our special issue about ideologies in sign language vitality and revitalization and discusses ideologies related to the vitality of sign languages. Rather than taking for granted the notions of vitality and endangerment or developing criteria for measuring sign language vitality, the papers in this issue will provide a discursive construction of sign language endangerment. This construction in turn provides critical and historical reflection on how vitality has emerged as a concern for sign languages in specific local, national, and international contexts, the actors and institutions bringing forward this framing, and in whose interest it is to promote such discourses. The issue will survey how and by whom these ideologies are described, mobilized and legitimized, and what conceptualizations of language are emphasized and by whom.
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Currently, many novel innovative materials and manufacturing methods are developed in order to help businesses for improving their performance, developing new products, and also implement more sustainability into their current processes. For this purpose, additive manufacturing (AM) technology has been very successful in the fabrication of complex shape products, that cannot be manufactured by conventional approaches, and also using novel high-performance materials with more sustainable aspects. The application of bioplastics and biopolymers is growing fast in the 3D printing industry. Since they are good alternatives to petrochemical products that have negative impacts on environments, therefore, many research studies have been exploring and developing new biopolymers and 3D printing techniques for the fabrication of fully biobased products. In particular, 3D printing of smart biopolymers has attracted much attention due to the specific functionalities of the fabricated products. They have a unique ability to recover their original shape from a significant plastic deformation when a particular stimulus, like temperature, is applied. Therefore, the application of smart biopolymers in the 3D printing process gives an additional dimension (time) to this technology, called four-dimensional (4D) printing, and it highlights the promise for further development of 4D printing in the design and fabrication of smart structures and products. This performance in combination with specific complex designs, such as sandwich structures, allows the production of for example impact-resistant, stress-absorber panels, lightweight products for sporting goods, automotive, or many other applications. In this study, an experimental approach will be applied to fabricate a suitable biopolymer with a shape memory behavior and also investigate the impact of design and operational parameters on the functionality of 4D printed sandwich structures, especially, stress absorption rate and shape recovery behavior.
De Nederlandse overheid wil in 2050 een volledig circulaire economie bereiken. Met haar sterke rol als inkoper gaat ze diverse sectoren dwingen om producten circulair aan te bieden. De visie is om de geleerde lessen ook toe te passen in andere sectoren en zo de circulaire economie te versnellen. Kantoormeubilair is gedefinieerd als één van de eerste sectoren waarin geëxperimenteerd wordt met circulair inkopen. Levensduurverlenging door onderhoud en/of revitaliseren van bestaand meubilair staat daarbij centraal. Ahrend zet in op het revitaliseren van bestaand meubilair door het terugnemen en opwaarderen van oud meubilair. Dit meubilair is echter van oorsprong ontworpen voor lineair gebruik. Levensduurverlenging zal succesvoller zijn als daar vooraf in het ontwerp rekening mee is gehouden. Verschillende strategieën zijn samengevat in de circulariteitsladder en variëren van functieverandering tot recycling. Inzicht in de effectiviteit van designstrategieën voor circulair ontwerpen ontbreekt echter. d’Andrea&Evers is ontwerpbureau en adviseur voor circulair ondernemen. Wordlenig is een ontwerpbureau gericht op marktinnovatie. Beide zien in de ontwerppraktijk gebrek aan kennis hoe circulariteit afhangt van ontwerpkeuzes. Het is daarbij moeilijk om effecten van verschillende designstrategieën onderling te vergelijken. Met ontwerpend onderzoek gaan we in dit project daarom een kantoorstoel vanuit verschillende circulaire designstrategieën herontwerpen en vervolgens de circulaire verschillen inzichtelijk maken. Daarvoor gebruiken we milieu-impact analysen zoals LCA. Door het onderzoek uit te voeren als praktische design-casus, geven we inzicht in de uitdagingen van circulair ontwerpen voor product designers. De vraagstukken in deze sector, zijn de vraagstukken waar industrieel ontwerpers in andere sectoren later óók mee geconfronteerd worden. Het kennisverband voor circulair ondernemen, CIRCO, helpt daarom met disseminatie van de resultaten in andere sectoren. De onderzoeksvraag luidt: “Wat zijn voor industrieel ontwerpers de mogelijkheden en beperkingen van strategieën voor het circulair ontwerpen van producten en hoe kan het effect van die strategieën op de circulariteit onderling vergeleken worden?“
Our world is changing rapidly as a result of societal and technological developments that create new opportunities and challenges. Extended Realities (XR) could provide solutions for the problems the world is facing. In this project we apply these novel solutions in food and hospitality. It aims to tackle fundamental questions on how to stimulate a healthy and vital society that is based on a sustainable and innovative economy. This project aims to answer the question: How can Extended Reality (XR) technologies be integrated in the design of immersive food experiences to stimulate sustainable consumption behavior? A multidisciplinary approach, that has demonstrated its strength in the creative industry, will be applied in the hospitality and food sector. The project investigates implications and design considerations for immersion through XR technology that can stimulate sustainable consumption behavior. Based on XR prototypes, physiological data will be collected using biometric measuring devices in combination with self-reports. The effect of stimuli on sustainable consumption behavior during the immersive experience will be tested to introduce XR implementations that can motivate long-term behavioral change in food consumption. The results of the project contribute towards developing innovations in the hospitality sector that can tackle global societal challenges by exploiting the impact of new technology and understanding of consumer behavior to promote a healthy lifestyle and economy. Next to academic publications and conference contributions, the project will develop a handbook for hospitality professionals. It will outline steps and design criteria for the implementation of XR technologies to create immersive experiences that can stimulate sustainable consumption behavior. The knowledge generated in the project will contribute to the development of the curriculum at the Academy for Hotel and Facility at Breda University of Applied Sciences by introducing a technology-driven experience design approach for the course Sustainable Strategic Business Design.
