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Edinburgh, United Kingdom

Smith F.,Napier University
The Cochrane database of systematic reviews

Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue will expedite wound healing. There are numerous methods available but no consensus on which one is most effective for surgical wounds. To determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds. In March 2013, for this third update, we searched the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We included randomised controlled trials (RCTs) with outcomes including at least one of the following: time to complete debridement or time to complete healing. Two review authors independently reviewed the abstracts and titles obtained from the search, extracted data independently using a standardised extraction sheet and independently assessed methodological quality. One review author was involved in all stages of the data collection and extraction process, thus ensuring continuity. Five RCTs (159 participants) were eligible for inclusion; all compared treatments for infected surgical wounds and reported time required to achieve a clean wound bed (complete debridement). One trial compared an enzymatic agent (streptokinase/streptodornase) with saline-soaked dressings. Four trials compared the effectiveness of dextranomer beads or paste with other products (different comparator in each trial) to achieve complete debridement. Meta-analysis was not possible due to the unique comparisons within each trial. One trial reported that dextranomer achieved a clean wound bed significantly more quickly than Eusol, and one trial comparing enzymatic debridement with saline-soaked dressings reported that the enzyme-treated wounds were cleaned more quickly. However, methodological quality was poor in these two trials. There is a lack of large, high-quality published RCTs evaluating debridement per se, or comparing different methods of debridement for surgical wounds, to guide clinical decision-making. Source

Psycharakis S.G.,Napier University
Journal of sports sciences

In this article, we present a critical review of the swimming literature on body roll, for the purposes of summarizing and highlighting existing knowledge, identifying the gaps and limitations, and stimulating further research. The main research findings can be summarized as follows: swimmers roll their shoulders significantly more than their hips; swimmers increase hip roll but maintain shoulder roll when fatigued; faster swimmers roll their shoulders less than slower swimmers during a 200-m swim; roll asymmetries, temporal differences in shoulder roll and hip roll, and shoulder roll side dominance exist in front crawl swimming, but there is no evidence to suggest that they affect swimming performance; and buoyancy contributes strongly to generating body roll in front crawl swimming. Based on and stimulated by current knowledge, future research should focus on the following areas: calculation of body roll for female swimmers and for backstroke swimming; differences in body roll between breathing and non-breathing cycles; causes of body roll asymmetries and their relation to motor laterality; body roll analysis across a wide range of velocities and swimming distances; exploration of the association between body roll and the magnitude and direction of propulsive/resistive forces developed during the stroke cycle; and the influence of kicking actions on the generation of body roll. Source

Nebulizers and metered dose inhalers (MDI) have both been adapted for delivering aerosol bronchodilation to mechanically ventilated patients, but there is incomplete knowledge as to the most effective method of delivery. To compare the effectiveness of nebulizers and MDIs for bronchodilator delivery in invasively ventilated, critically ill adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5); Ovid MEDLINE (1950 to Week 19 2012); Ovid EMBASE (1980 to Week 19 2012); CINAHL via EBSCOhost (1982 to Week 19 2012) and reference lists of articles. We searched conference proceedings and reference lists of articles. We also contacted manufacturers and researchers in this field. There were no constraints based on language or publication status. Randomized controlled trials (RCTs), including randomized cross-over trials where the order of the intervention was randomized, comparing the nebulizer and MDI for aerosol bronchodilation in mechanically ventilated adult patients in critical care units. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information where required. We collected information about adverse effects from the trials. This review included three trials, two addressing the primary outcome measure of a reduction of airway resistance (measured as a reduction in interrupter and additional airway resistance) with a total of 28 patients (n =10, n =18) and two addressing adverse changes to haemodynamic observations with a total of 36 patients (n =18, n =18). Limitations in data availability and reporting in the included trials precluded meta-analysis and therefore the present review consisted of a descriptive analysis. Risk of bias in the included trials was judged as low or of unknown risk across the majority of items in the 'Risk of bias' tool.Cautious interpretation of the included study results suggests that nebulizers could be a more effective method of bronchodilator administration than MDI in terms of a change in resistance. No apparent changes to haemodynamic observations (measured as an increase in heart rate) were associated with either mode of delivery. Due to missing data issues, meta analyses were not possible. Additionally, small sample sizes and variability between the studies with regards to patient diagnoses, bronchodilator agent and administration technique mean that it would be speculative to infer definitive recommendations based on these results at this time. This is insufficient evidence to determine which is the most effective delivery system between nebuliser and MDI for aerosol bronchodilation in adult patients receiving mechanical ventilation. Existing randomized controlled trials, including randomized cross-over trials where the order of the intervention was randomized, comparing nebulizer and MDI for aerosol bronchodilation in mechanically ventilated adult patients do not provide sufficient evidence to support either delivery method at this time. Source

Lombardi D.,Napier University | Bhattacharya S.,University of Surrey
Earthquake Engineering and Structural Dynamics

The purpose of this paper is to investigate the effects of liquefaction on modal parameters (frequency and damping) of pile-supported structures. Four physical models, consisting of two single piles and two 2×2 pile groups, were tested in a shaking table where the soil surrounding the pile liquefied because of seismic shaking. The experimental results showed that the natural frequency of pile-supported structures may decrease considerably owing to the loss of lateral support offered by the soil to the pile. On the other hand, the damping ratio of structure may increase to values in excess of 20%. These findings have important design consequences: (a) for low-period structures, substantial reduction of spectral acceleration is expected; (b) during and after liquefaction, the response of the system may be dictated by the interactions of multiple loadings, that is, horizontal, axial and overturning moment, which were negligible prior to liquefaction; and (c) with the onset of liquefaction due to increased flexibility of pile-supported structure, larger spectral displacement may be expected, which in turn may enhance P-delta effects and consequently amplification of overturning moment. Practical implications for pile design are discussed. © 2013 John Wiley & Sons, Ltd. Source

Psycharakis S.G.,Napier University
Journal of Strength and Conditioning Research

The purpose of this study was to examine longitudinally the reliability and validity of ratings of perceived exertion (RPE) for monitoring exercise intensity in elite swimmers, with the percentage of maximum heart rate (%HR max) and the blood lactate concentration (La) being the criterion measures. Moreover, the purpose was to examine whether an adjustment of HRmax, as previously suggested for recreational/university swimmers, is required for subsequent calculations of %HRmax for elite swimmers. Seventeen swimmers competing at international level performed a 7 x 200 m incremental swim test at their specialty stroke 4 times during a period of 6 months. The RPE validity was examined with the use of correlation and with repeated measures analysis of variance (ANOVA) of the z-transformed values. The RPE reliability was examined with a factorial ANOVA, with %HRmax and La being the dependent variables and test (4 levels) and RPE stage (7 levels) the fixed factors. The RPE was found to be a valid method for monitoring exercise intensity, with the correlation coefficients with %HRmax and La being 0.85 and 0.82, respectively. There was a strong correspondence between RPE and %HRmax scores and a weaker correspondence between RPE and La scores, suggesting that that RPE reflects accurately the HR levels of elite swimmers. The longitudinal intertest reliability was high as no significant differences were found in the values of %HRmax or La between the 4 tests. The good validity and reliability of RPE suggest that it can be used in elite swimmers' training for the purpose of monitoring exercise intensity. Contrary to previous recommendations for recreational/university swimmers, when prescribing intensity for elite swimmers, the predicted HRmax value used for subsequent calculations should not be adjusted because such an adjustment would appear to underestimate HRmax. © 2011 National Strength and Conditioning Association. Source

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