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Rogers J, Reed MP, Blaine K, Manning H. Children with medical complexity: A concept analysis. Nurs Forum 2021; 56:676-683. [PMID: 33625740 DOI: 10.1111/nuf.12559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 01/01/2021] [Accepted: 01/29/2021] [Indexed: 11/27/2022]
Abstract
AIM The aim of this paper is to conduct a concept analysis on the term, "children with medical complexity." BACKGROUND Children with medical complexity (CMC) describes pediatric patients with chronic, sustained acuity; however, there is a lack of consensus in the literature regarding its exact meaning, characteristics, and implications. DESIGN This analysis relied upon the framework described by Walker and Avant. DATA SOURCE The CINAHL, MEDLINE, and PubMed databases were queried from April 2020 to December 2020 with an initial search of the literature for the keyword, "children with medical complexity" and other associated terms, such as "pediatric medical complexity" and "nursing care of children with medical complexity." REVIEW METHODS This analysis will explore the concept of CMC and its significance, attributes, antecedents, and consequences. RESULTS This investigation revealed that CMC are a growing population of pediatric patients who have one or more complex chronic conditions that affect multiple body systems, experience functional limitations, require extensive care coordination from multiple providers, and are dependent upon life-sustaining medical technology. CONCLUSIONS The findings can serve as a foundation for future work advancing the understanding of the topic of CMC.
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Affiliation(s)
- Jayne Rogers
- Medical Nursing Service, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mary P Reed
- Medical Nursing Service, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kevin Blaine
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Haylee Manning
- Medical Nursing Service, Boston Children's Hospital, Boston, Massachusetts, USA
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Leets LL, Cahill J, Sprenger AM, Thomas JS, Hartman R, Reed MEP, Manning H, Britt M, Vu CT, Kohn NW, Aguirre S, Wijesinghe S, Klaus S. Nudging Discharge Readiness With a Poster: A Sequential, Exploratory Mixed Methods Pilot Study of Patient Caregivers. J Patient Exp 2020; 7:1341-1348. [PMID: 33457585 PMCID: PMC7786666 DOI: 10.1177/2374373520968976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Many hospitals face a common challenge: limited space for a high number of patients. This has led to quick patient throughput, which can impact patient perception of discharge readiness. This study examined whether a poster highlighting tasks to complete as part of the discharge process improved caregiver perception of readiness to transition home. Using a sequential, exploratory mixed methods design, focus groups were convened to explore clinical staff perspective on the discharge process on 3 pediatric inpatient units at a large, urban, pediatric academic medical center in the United States. Analysis of this content informed the design of a poster intervention to “nudge” caregivers (eg, parents, legal guardians) toward readiness and self-efficacy that was then tested in a randomized, controlled experiment. The poster focused on practical knowledge for specific areas of transition adjustment, such as medication and care recipient recovery behaviors, barriers, and enablers. Caregivers (n = 135) completed surveys at discharge indicating their perceived readiness to transition home with their child. Analysis of covariance was used to test the effect of the poster condition (poster vs no poster) on caregiver readiness, preparedness, and confidence for discharge while controlling for previous admission history. Significant effects for poster presence were found on caregivers’ perceived readiness for discharge, F1,125 = 7.75, P = .006, Cohen’s d = 0.44; and caregivers’ perceived preparedness for the transition home, F1,121 =7.24, P = .008, Cohen’s d = 0.44. Only a marginal effect was found for poster condition on caregivers’ confidence ratings, F1,125 = 2.93, P = .090, Cohen’s d = 0.29. The results suggest that simple nudges in the patient care environment may yield measurable improvements in caregiver outcomes.
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Affiliation(s)
| | - Jennifer Cahill
- Department of Nursing, Boston Children's Hospital, Boston, MA, USA
| | | | | | | | | | - Haylee Manning
- Department of Nursing, Boston Children's Hospital, Boston, MA, USA
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Manning H. WE-EF-204-02: Murine Model Systems for Co-Clinical Trials. Med Phys 2015. [DOI: 10.1118/1.4926005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Grotzinger JP, Sumner DY, Kah LC, Stack K, Gupta S, Edgar L, Rubin D, Lewis K, Schieber J, Mangold N, Milliken R, Conrad PG, DesMarais D, Farmer J, Siebach K, Calef F, Hurowitz J, McLennan SM, Ming D, Vaniman D, Crisp J, Vasavada A, Edgett KS, Malin M, Blake D, Gellert R, Mahaffy P, Wiens RC, Maurice S, Grant JA, Wilson S, Anderson RC, Beegle L, Arvidson R, Hallet B, Sletten RS, Rice M, Bell J, Griffes J, Ehlmann B, Anderson RB, Bristow TF, Dietrich WE, Dromart G, Eigenbrode J, Fraeman A, Hardgrove C, Herkenhoff K, Jandura L, Kocurek G, Lee S, Leshin LA, Leveille R, Limonadi D, Maki J, McCloskey S, Meyer M, Minitti M, Newsom H, Oehler D, Okon A, Palucis M, Parker T, Rowland S, Schmidt M, Squyres S, Steele A, Stolper E, Summons R, Treiman A, Williams R, Yingst A, Team MS, Kemppinen O, Bridges N, Johnson JR, Cremers D, Godber A, Wadhwa M, Wellington D, McEwan I, Newman C, Richardson M, Charpentier A, Peret L, King P, Blank J, Weigle G, Li S, Robertson K, Sun V, Baker M, Edwards C, Farley K, Miller H, Newcombe M, Pilorget C, Brunet C, Hipkin V, Leveille R, Marchand G, Sanchez PS, Favot L, Cody G, Fluckiger L, Lees D, Nefian A, Martin M, Gailhanou M, Westall F, Israel G, Agard C, Baroukh J, Donny C, Gaboriaud A, Guillemot P, Lafaille V, Lorigny E, Paillet A, Perez R, Saccoccio M, Yana C, Armiens-Aparicio C, Rodriguez JC, Blazquez IC, Gomez FG, Gomez-Elvira J, Hettrich S, Malvitte AL, Jimenez MM, Martinez-Frias J, Martin-Soler J, Martin-Torres FJ, Jurado AM, Mora-Sotomayor L, Caro GM, Lopez SN, Peinado-Gonzalez V, Pla-Garcia J, Manfredi JAR, Romeral-Planello JJ, Fuentes SAS, Martinez ES, Redondo JT, Urqui-O'Callaghan R, Mier MPZ, Chipera S, Lacour JL, Mauchien P, Sirven JB, Manning H, Fairen A, Hayes A, Joseph J, Sullivan R, Thomas P, Dupont A, Lundberg A, Melikechi N, Mezzacappa A, DeMarines J, Grinspoon D, Reitz G, Prats B, Atlaskin E, Genzer M, Harri AM, Haukka H, Kahanpaa H, Kauhanen J, Paton M, Polkko J, Schmidt W, Siili T, Fabre C, Wray J, Wilhelm MB, Poitrasson F, Patel K, Gorevan S, Indyk S, Paulsen G, Bish D, Gondet B, Langevin Y, Geffroy C, Baratoux D, Berger G, Cros A, d'Uston C, Forni O, Gasnault O, Lasue J, Lee QM, Meslin PY, Pallier E, Parot Y, Pinet P, Schroder S, Toplis M, Lewin E, Brunner W, Heydari E, Achilles C, Sutter B, Cabane M, Coscia D, Szopa C, Robert F, Sautter V, Le Mouelic S, Nachon M, Buch A, Stalport F, Coll P, Francois P, Raulin F, Teinturier S, Cameron J, Clegg S, Cousin A, DeLapp D, Dingler R, Jackson RS, Johnstone S, Lanza N, Little C, Nelson T, Williams RB, Jones A, Kirkland L, Baker B, Cantor B, Caplinger M, Davis S, Duston B, Fay D, Harker D, Herrera P, Jensen E, Kennedy MR, Krezoski G, Krysak D, Lipkaman L, McCartney E, McNair S, Nixon B, Posiolova L, Ravine M, Salamon A, Saper L, Stoiber K, Supulver K, Van Beek J, Van Beek T, Zimdar R, French KL, Iagnemma K, Miller K, Goesmann F, Goetz W, Hviid S, Johnson M, Lefavor M, Lyness E, Breves E, Dyar MD, Fassett C, Edwards L, Haberle R, Hoehler T, Hollingsworth J, Kahre M, Keely L, McKay C, Bleacher L, Brinckerhoff W, Choi D, Dworkin JP, Floyd M, Freissinet C, Garvin J, Glavin D, Harpold D, Martin DK, McAdam A, Pavlov A, Raaen E, Smith MD, Stern J, Tan F, Trainer M, Posner A, Voytek M, Aubrey A, Behar A, Blaney D, Brinza D, Christensen L, DeFlores L, Feldman J, Feldman S, Flesch G, Jun I, Keymeulen D, Mischna M, Morookian JM, Pavri B, Schoppers M, Sengstacken A, Simmonds JJ, Spanovich N, Juarez MDLT, Webster CR, Yen A, Archer PD, Cucinotta F, Jones JH, Morris RV, Niles P, Rampe E, Nolan T, Fisk M, Radziemski L, Barraclough B, Bender S, Berman D, Dobrea EN, Tokar R, Cleghorn T, Huntress W, Manhes G, Hudgins J, Olson T, Stewart N, Sarrazin P, Vicenzi E, Bullock M, Ehresmann B, Hamilton V, Hassler D, Peterson J, Rafkin S, Zeitlin C, Fedosov F, Golovin D, Karpushkina N, Kozyrev A, Litvak M, Malakhov A, Mitrofanov I, Mokrousov M, Nikiforov S, Prokhorov V, Sanin A, Tretyakov V, Varenikov A, Vostrukhin A, Kuzmin R, Clark B, Wolff M, Botta O, Drake D, Bean K, Lemmon M, Schwenzer SP, Lee EM, Sucharski R, Hernandez MADP, Avalos JJB, Ramos M, Kim MH, Malespin C, Plante I, Muller JP, Navarro-Gonzalez R, Ewing R, Boynton W, Downs R, Fitzgibbon M, Harshman K, Morrison S, Kortmann O, Williams A, Lugmair G, Wilson MA, Jakosky B, Balic-Zunic T, Frydenvang J, Jensen JK, Kinch K, Koefoed A, Madsen MB, Stipp SLS, Boyd N, Campbell JL, Perrett G, Pradler I, VanBommel S, Jacob S, Owen T, Savijarvi H, Boehm E, Bottcher S, Burmeister S, Guo J, Kohler J, Garcia CM, Mueller-Mellin R, Wimmer-Schweingruber R, Bridges JC, McConnochie T, Benna M, Franz H, Bower H, Brunner A, Blau H, Boucher T, Carmosino M, Atreya S, Elliott H, Halleaux D, Renno N, Wong M, Pepin R, Elliott B, Spray J, Thompson L, Gordon S, Ollila A, Williams J, Vasconcelos P, Bentz J, Nealson K, Popa R, Moersch J, Tate C, Day M, Francis R, McCullough E, Cloutis E, ten Kate IL, Scholes D, Slavney S, Stein T, Ward J, Berger J, Moores JE. A Habitable Fluvio-Lacustrine Environment at Yellowknife Bay, Gale Crater, Mars. Science 2013; 343:1242777. [DOI: 10.1126/science.1242777] [Citation(s) in RCA: 578] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Vaniman DT, Bish DL, Ming DW, Bristow TF, Morris RV, Blake DF, Chipera SJ, Morrison SM, Treiman AH, Rampe EB, Rice M, Achilles CN, Grotzinger JP, McLennan SM, Williams J, Bell JF, Newsom HE, Downs RT, Maurice S, Sarrazin P, Yen AS, Morookian JM, Farmer JD, Stack K, Milliken RE, Ehlmann BL, Sumner DY, Berger G, Crisp JA, Hurowitz JA, Anderson R, Des Marais DJ, Stolper EM, Edgett KS, Gupta S, Spanovich N, Agard C, Alves Verdasca JA, Anderson R, Archer D, Armiens-Aparicio C, Arvidson R, Atlaskin E, Atreya S, Aubrey A, Baker B, Baker M, Balic-Zunic T, Baratoux D, Baroukh J, Barraclough B, Bean K, Beegle L, Behar A, Bender S, Benna M, Bentz J, Berger J, Berman D, Blanco Avalos JJ, Blaney D, Blank J, Blau H, Bleacher L, Boehm E, Botta O, Bottcher S, Boucher T, Bower H, Boyd N, Boynton B, Breves E, Bridges J, Bridges N, Brinckerhoff W, Brinza D, Brunet C, Brunner A, Brunner W, Buch A, Bullock M, Burmeister S, Cabane M, Calef F, Cameron J, Campbell JI, Cantor B, Caplinger M, Caride Rodriguez J, Carmosino M, Carrasco Blazquez I, Charpentier A, Choi D, Clark B, Clegg S, Cleghorn T, Cloutis E, Cody G, Coll P, Conrad P, Coscia D, Cousin A, Cremers D, Cros A, Cucinotta F, d'Uston C, Davis S, Day MK, de la Torre Juarez M, DeFlores L, DeLapp D, DeMarines J, Dietrich W, Dingler R, Donny C, Drake D, Dromart G, Dupont A, Duston B, Dworkin J, Dyar MD, Edgar L, Edwards C, Edwards L, Ehresmann B, Eigenbrode J, Elliott B, Elliott H, Ewing R, Fabre C, Fairen A, Farley K, Fassett C, Favot L, Fay D, Fedosov F, Feldman J, Feldman S, Fisk M, Fitzgibbon M, Flesch G, Floyd M, Fluckiger L, Forni O, Fraeman A, Francis R, Francois P, Franz H, Freissinet C, French KL, Frydenvang J, Gaboriaud A, Gailhanou M, Garvin J, Gasnault O, Geffroy C, Gellert R, Genzer M, Glavin D, Godber A, Goesmann F, Goetz W, Golovin D, Gomez Gomez F, Gomez-Elvira J, Gondet B, Gordon S, Gorevan S, Grant J, Griffes J, Grinspoon D, Guillemot P, Guo J, Guzewich S, Haberle R, Halleaux D, Hallet B, Hamilton V, Hardgrove C, Harker D, Harpold D, Harri AM, Harshman K, Hassler D, Haukka H, Hayes A, Herkenhoff K, Herrera P, Hettrich S, Heydari E, Hipkin V, Hoehler T, Hollingsworth J, Hudgins J, Huntress W, Hviid S, Iagnemma K, Indyk S, Israel G, Jackson R, Jacob S, Jakosky B, Jensen E, Jensen JK, Johnson J, Johnson M, Johnstone S, Jones A, Jones J, Joseph J, Jun I, Kah L, Kahanpaa H, Kahre M, Karpushkina N, Kasprzak W, Kauhanen J, Keely L, Kemppinen O, Keymeulen D, Kim MH, Kinch K, King P, Kirkland L, Kocurek G, Koefoed A, Kohler J, Kortmann O, Kozyrev A, Krezoski J, Krysak D, Kuzmin R, Lacour JL, Lafaille V, Langevin Y, Lanza N, Lasue J, Le Mouelic S, Lee EM, Lee QM, Lees D, Lefavor M, Lemmon M, Malvitte AL, Leshin L, Leveille R, Lewin-Carpintier E, Lewis K, Li S, Lipkaman L, Little C, Litvak M, Lorigny E, Lugmair G, Lundberg A, Lyness E, Madsen M, Mahaffy P, Maki J, Malakhov A, Malespin C, Malin M, Mangold N, Manhes G, Manning H, Marchand G, Marin Jimenez M, Martin Garcia C, Martin D, Martin M, Martinez-Frias J, Martin-Soler J, Martin-Torres FJ, Mauchien P, McAdam A, McCartney E, McConnochie T, McCullough E, McEwan I, McKay C, McNair S, Melikechi N, Meslin PY, Meyer M, Mezzacappa A, Miller H, Miller K, Minitti M, Mischna M, Mitrofanov I, Moersch J, Mokrousov M, Molina Jurado A, Moores J, Mora-Sotomayor L, Mueller-Mellin R, Muller JP, Munoz Caro G, Nachon M, Navarro Lopez S, Navarro-Gonzalez R, Nealson K, Nefian A, Nelson T, Newcombe M, Newman C, Nikiforov S, Niles P, Nixon B, Noe Dobrea E, Nolan T, Oehler D, Ollila A, Olson T, Owen T, de Pablo Hernandez MA, Paillet A, Pallier E, Palucis M, Parker T, Parot Y, Patel K, Paton M, Paulsen G, Pavlov A, Pavri B, Peinado-Gonzalez V, Pepin R, Peret L, Perez R, Perrett G, Peterson J, Pilorget C, Pinet P, Pla-Garcia J, Plante I, Poitrasson F, Polkko J, Popa R, Posiolova L, Posner A, Pradler I, Prats B, Prokhorov V, Purdy SW, Raaen E, Radziemski L, Rafkin S, Ramos M, Raulin F, Ravine M, Reitz G, Renno N, Richardson M, Robert F, Robertson K, Rodriguez Manfredi JA, Romeral-Planello JJ, Rowland S, Rubin D, Saccoccio M, Salamon A, Sandoval J, Sanin A, Sans Fuentes SA, Saper L, Sautter V, Savijarvi H, Schieber J, Schmidt M, Schmidt W, Scholes DD, Schoppers M, Schroder S, Schwenzer S, Sebastian Martinez E, Sengstacken A, Shterts R, Siebach K, Siili T, Simmonds J, Sirven JB, Slavney S, Sletten R, Smith M, Sobron Sanchez P, Spray J, Squyres S, Stalport F, Steele A, Stein T, Stern J, Stewart N, Stipp SLS, Stoiber K, Sucharski B, Sullivan R, Summons R, Sun V, Supulver K, Sutter B, Szopa C, Tan F, Tate C, Teinturier S, ten Kate I, Thomas P, Thompson L, Tokar R, Toplis M, Torres Redondo J, Trainer M, Tretyakov V, Urqui-O'Callaghan R, Van Beek J, Van Beek T, VanBommel S, Varenikov A, Vasavada A, Vasconcelos P, Vicenzi E, Vostrukhin A, Voytek M, Wadhwa M, Ward J, Webster C, Weigle E, Wellington D, Westall F, Wiens RC, Wilhelm MB, Williams A, Williams R, Williams RBM, Wilson M, Wimmer-Schweingruber R, Wolff M, Wong M, Wray J, Wu M, Yana C, Yingst A, Zeitlin C, Zimdar R, Zorzano Mier MP. Mineralogy of a Mudstone at Yellowknife Bay, Gale Crater, Mars. Science 2013; 343:1243480. [DOI: 10.1126/science.1243480] [Citation(s) in RCA: 433] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Leshin LA, Mahaffy PR, Webster CR, Cabane M, Coll P, Conrad PG, Archer PD, Atreya SK, Brunner AE, Buch A, Eigenbrode JL, Flesch GJ, Franz HB, Freissinet C, Glavin DP, McAdam AC, Miller KE, Ming DW, Morris RV, Navarro-Gonzalez R, Niles PB, Owen T, Pepin RO, Squyres S, Steele A, Stern JC, Summons RE, Sumner DY, Sutter B, Szopa C, Teinturier S, Trainer MG, Wray JJ, Grotzinger JP, Kemppinen O, Bridges N, Johnson JR, Minitti M, Cremers D, Bell JF, Edgar L, Farmer J, Godber A, Wadhwa M, Wellington D, McEwan I, Newman C, Richardson M, Charpentier A, Peret L, King P, Blank J, Weigle G, Schmidt M, Li S, Milliken R, Robertson K, Sun V, Baker M, Edwards C, Ehlmann B, Farley K, Griffes J, Miller H, Newcombe M, Pilorget C, Rice M, Siebach K, Stack K, Stolper E, Brunet C, Hipkin V, Leveille R, Marchand G, Sanchez PS, Favot L, Cody G, Fluckiger L, Lees D, Nefian A, Martin M, Gailhanou M, Westall F, Israel G, Agard C, Baroukh J, Donny C, Gaboriaud A, Guillemot P, Lafaille V, Lorigny E, Paillet A, Perez R, Saccoccio M, Yana C, Armiens-Aparicio C, Rodriguez JC, Blazquez IC, Gomez FG, Gomez-Elvira J, Hettrich S, Malvitte AL, Jimenez MM, Martinez-Frias J, Martin-Soler J, Martin-Torres FJ, Jurado AM, Mora-Sotomayor L, Caro GM, Lopez SN, Peinado-Gonzalez V, Pla-Garcia J, Manfredi JAR, Romeral-Planello JJ, Fuentes SAS, Martinez ES, Redondo JT, Urqui-O'Callaghan R, Mier MPZ, Chipera S, Lacour JL, Mauchien P, Sirven JB, Manning H, Fairen A, Hayes A, Joseph J, Sullivan R, Thomas P, Dupont A, Lundberg A, Melikechi N, Mezzacappa A, DeMarines J, Grinspoon D, Reitz G, Prats B, Atlaskin E, Genzer M, Harri AM, Haukka H, Kahanpaa H, Kauhanen J, Kemppinen O, Paton M, Polkko J, Schmidt W, Siili T, Fabre C, Wilhelm MB, Poitrasson F, Patel K, Gorevan S, Indyk S, Paulsen G, Gupta S, Bish D, Schieber J, Gondet B, Langevin Y, Geffroy C, Baratoux D, Berger G, Cros A, d'Uston C, Forni O, Gasnault O, Lasue J, Lee QM, Maurice S, Meslin PY, Pallier E, Parot Y, Pinet P, Schroder S, Toplis M, Lewin E, Brunner W, Heydari E, Achilles C, Oehler D, Coscia D, Israel G, Dromart G, Robert F, Sautter V, Le Mouelic S, Mangold N, Nachon M, Stalport F, Francois P, Raulin F, Cameron J, Clegg S, Cousin A, DeLapp D, Dingler R, Jackson RS, Johnstone S, Lanza N, Little C, Nelson T, Wiens RC, Williams RB, Jones A, Kirkland L, Treiman A, Baker B, Cantor B, Caplinger M, Davis S, Duston B, Edgett K, Fay D, Hardgrove C, Harker D, Herrera P, Jensen E, Kennedy MR, Krezoski G, Krysak D, Lipkaman L, Malin M, McCartney E, McNair S, Nixon B, Posiolova L, Ravine M, Salamon A, Saper L, Stoiber K, Supulver K, Van Beek J, Van Beek T, Zimdar R, French KL, Iagnemma K, Goesmann F, Goetz W, Hviid S, Johnson M, Lefavor M, Lyness E, Breves E, Dyar MD, Fassett C, Blake DF, Bristow T, DesMarais D, Edwards L, Haberle R, Hoehler T, Hollingsworth J, Kahre M, Keely L, McKay C, Wilhelm MB, Bleacher L, Brinckerhoff W, Choi D, Dworkin JP, Floyd M, Garvin J, Harpold D, Jones A, Martin DK, Pavlov A, Raaen E, Smith MD, Tan F, Meyer M, Posner A, Voytek M, Anderson RC, Aubrey A, Beegle LW, Behar A, Blaney D, Brinza D, Calef F, Christensen L, Crisp JA, DeFlores L, Ehlmann B, Feldman J, Feldman S, Hurowitz J, Jun I, Keymeulen D, Maki J, Mischna M, Morookian JM, Parker T, Pavri B, Schoppers M, Sengstacken A, Simmonds JJ, Spanovich N, Juarez MDLT, Vasavada AR, Yen A, Cucinotta F, Jones JH, Rampe E, Nolan T, Fisk M, Radziemski L, Barraclough B, Bender S, Berman D, Dobrea EN, Tokar R, Vaniman D, Williams RME, Yingst A, Lewis K, Cleghorn T, Huntress W, Manhes G, Hudgins J, Olson T, Stewart N, Sarrazin P, Grant J, Vicenzi E, Wilson SA, Bullock M, Ehresmann B, Hamilton V, Hassler D, Peterson J, Rafkin S, Zeitlin C, Fedosov F, Golovin D, Karpushkina N, Kozyrev A, Litvak M, Malakhov A, Mitrofanov I, Mokrousov M, Nikiforov S, Prokhorov V, Sanin A, Tretyakov V, Varenikov A, Vostrukhin A, Kuzmin R, Clark B, Wolff M, McLennan S, Botta O, Drake D, Bean K, Lemmon M, Schwenzer SP, Anderson RB, Herkenhoff K, Lee EM, Sucharski R, Hernandez MADP, Avalos JJB, Ramos M, Kim MH, Malespin C, Plante I, Muller JP, Ewing R, Boynton W, Downs R, Fitzgibbon M, Harshman K, Morrison S, Dietrich W, Kortmann O, Palucis M, Williams A, Lugmair G, Wilson MA, Rubin D, Jakosky B, Balic-Zunic T, Frydenvang J, Jensen JK, Kinch K, Koefoed A, Madsen MB, Stipp SLS, Boyd N, Campbell JL, Gellert R, Perrett G, Pradler I, VanBommel S, Jacob S, Rowland S, Atlaskin E, Savijarvi H, Boehm E, Bottcher S, Burmeister S, Guo J, Kohler J, Garcia CM, Mueller-Mellin R, Wimmer-Schweingruber R, Bridges JC, McConnochie T, Benna M, Bower H, Blau H, Boucher T, Carmosino M, Elliott H, Halleaux D, Renno N, Wong M, Elliott B, Spray J, Thompson L, Gordon S, Newsom H, Ollila A, Williams J, Vasconcelos P, Bentz J, Nealson K, Popa R, Kah LC, Moersch J, Tate C, Day M, Kocurek G, Hallet B, Sletten R, Francis R, McCullough E, Cloutis E, ten Kate IL, Kuzmin R, Arvidson R, Fraeman A, Scholes D, Slavney S, Stein T, Ward J, Berger J, Moores JE. Volatile, Isotope, and Organic Analysis of Martian Fines with the Mars Curiosity Rover. Science 2013; 341:1238937. [DOI: 10.1126/science.1238937] [Citation(s) in RCA: 327] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Mahaffy PR, Webster CR, Atreya SK, Franz H, Wong M, Conrad PG, Harpold D, Jones JJ, Leshin LA, Manning H, Owen T, Pepin RO, Squyres S, Trainer M, Kemppinen O, Bridges N, Johnson JR, Minitti M, Cremers D, Bell JF, Edgar L, Farmer J, Godber A, Wadhwa M, Wellington D, McEwan I, Newman C, Richardson M, Charpentier A, Peret L, King P, Blank J, Weigle G, Schmidt M, Li S, Milliken R, Robertson K, Sun V, Baker M, Edwards C, Ehlmann B, Farley K, Griffes J, Grotzinger J, Miller H, Newcombe M, Pilorget C, Rice M, Siebach K, Stack K, Stolper E, Brunet C, Hipkin V, Leveille R, Marchand G, Sanchez PS, Favot L, Cody G, Steele A, Fluckiger L, Lees D, Nefian A, Martin M, Gailhanou M, Westall F, Israel G, Agard C, Baroukh J, Donny C, Gaboriaud A, Guillemot P, Lafaille V, Lorigny E, Paillet A, Perez R, Saccoccio M, Yana C, Armiens-Aparicio C, Rodriguez JC, Blazquez IC, Gomez FG, Gomez-Elvira J, Hettrich S, Malvitte AL, Jimenez MM, Martinez-Frias J, Martin-Soler J, Martin-Torres FJ, Jurado AM, Mora-Sotomayor L, Caro GM, Lopez SN, Peinado-Gonzalez V, Pla-Garcia J, Manfredi JAR, Romeral-Planello JJ, Fuentes SAS, Martinez ES, Redondo JT, Urqui-O'Callaghan R, Mier MPZ, Chipera S, Lacour JL, Mauchien P, Sirven JB, Fairen A, Hayes A, Joseph J, Sullivan R, Thomas P, Dupont A, Lundberg A, Melikechi N, Mezzacappa A, DeMarines J, Grinspoon D, Reitz G, Prats B, Atlaskin E, Genzer M, Harri AM, Haukka H, Kahanpaa H, Kauhanen J, Kemppinen O, Paton M, Polkko J, Schmidt W, Siili T, Fabre C, Wray J, Wilhelm MB, Poitrasson F, Patel K, Gorevan S, Indyk S, Paulsen G, Gupta S, Bish D, Schieber J, Gondet B, Langevin Y, Geffroy C, Baratoux D, Berger G, Cros A, d'Uston C, Forni O, Gasnault O, Lasue J, Lee QM, Maurice S, Meslin PY, Pallier E, Parot Y, Pinet P, Schroder S, Toplis M, Lewin E, Brunner W, Heydari E, Achilles C, Oehler D, Sutter B, Cabane M, Coscia D, Israel G, Szopa C, Dromart G, Robert F, Sautter V, Le Mouelic S, Mangold N, Nachon M, Buch A, Stalport F, Coll P, Francois P, Raulin F, Teinturier S, Cameron J, Clegg S, Cousin A, DeLapp D, Dingler R, Jackson RS, Johnstone S, Lanza N, Little C, Nelson T, Wiens RC, Williams RB, Jones A, Kirkland L, Treiman A, Baker B, Cantor B, Caplinger M, Davis S, Duston B, Edgett K, Fay D, Hardgrove C, Harker D, Herrera P, Jensen E, Kennedy MR, Krezoski G, Krysak D, Lipkaman L, Malin M, McCartney E, McNair S, Nixon B, Posiolova L, Ravine M, Salamon A, Saper L, Stoiber K, Supulver K, Van Beek J, Van Beek T, Zimdar R, French KL, Iagnemma K, Miller K, Summons R, Goesmann F, Goetz W, Hviid S, Johnson M, Lefavor M, Lyness E, Breves E, Dyar MD, Fassett C, Blake DF, Bristow T, DesMarais D, Edwards L, Haberle R, Hoehler T, Hollingsworth J, Kahre M, Keely L, McKay C, Wilhelm MB, Bleacher L, Brinckerhoff W, Choi D, Dworkin JP, Eigenbrode J, Floyd M, Freissinet C, Garvin J, Glavin D, Jones A, Martin DK, McAdam A, Pavlov A, Raaen E, Smith MD, Stern J, Tan F, Meyer M, Posner A, Voytek M, Anderson RC, Aubrey A, Beegle LW, Behar A, Blaney D, Brinza D, Calef F, Christensen L, Crisp JA, DeFlores L, Ehlmann B, Feldman J, Feldman S, Flesch G, Hurowitz J, Jun I, Keymeulen D, Maki J, Mischna M, Morookian JM, Parker T, Pavri B, Schoppers M, Sengstacken A, Simmonds JJ, Spanovich N, Juarez MDLT, Vasavada AR, Yen A, Archer PD, Cucinotta F, Ming D, Morris RV, Niles P, Rampe E, Nolan T, Fisk M, Radziemski L, Barraclough B, Bender S, Berman D, Dobrea EN, Tokar R, Vaniman D, Williams RME, Yingst A, Lewis K, Cleghorn T, Huntress W, Manhes G, Hudgins J, Olson T, Stewart N, Sarrazin P, Grant J, Vicenzi E, Wilson SA, Bullock M, Ehresmann B, Hamilton V, Hassler D, Peterson J, Rafkin S, Zeitlin C, Fedosov F, Golovin D, Karpushkina N, Kozyrev A, Litvak M, Malakhov A, Mitrofanov I, Mokrousov M, Nikiforov S, Prokhorov V, Sanin A, Tretyakov V, Varenikov A, Vostrukhin A, Kuzmin R, Clark B, Wolff M, McLennan S, Botta O, Drake D, Bean K, Lemmon M, Schwenzer SP, Anderson RB, Herkenhoff K, Lee EM, Sucharski R, Hernandez MADP, Avalos JJB, Ramos M, Kim MH, Malespin C, Plante I, Muller JP, Navarro-Gonzalez R, Ewing R, Boynton W, Downs R, Fitzgibbon M, Harshman K, Morrison S, Dietrich W, Kortmann O, Palucis M, Sumner DY, Williams A, Lugmair G, Wilson MA, Rubin D, Jakosky B, Balic-Zunic T, Frydenvang J, Jensen JK, Kinch K, Koefoed A, Madsen MB, Stipp SLS, Boyd N, Campbell JL, Gellert R, Perrett G, Pradler I, VanBommel S, Jacob S, Rowland S, Atlaskin E, Savijarvi H, Boehm E, Bottcher S, Burmeister S, Guo J, Kohler J, Garcia CM, Mueller-Mellin R, Wimmer-Schweingruber R, Bridges JC, McConnochie T, Benna M, Bower H, Brunner A, Blau H, Boucher T, Carmosino M, Elliott H, Halleaux D, Renno N, Elliott B, Spray J, Thompson L, Gordon S, Newsom H, Ollila A, Williams J, Vasconcelos P, Bentz J, Nealson K, Popa R, Kah LC, Moersch J, Tate C, Day M, Kocurek G, Hallet B, Sletten R, Francis R, McCullough E, Cloutis E, ten Kate IL, Kuzmin R, Arvidson R, Fraeman A, Scholes D, Slavney S, Stein T, Ward J, Berger J, Moores JE. Abundance and Isotopic Composition of Gases in the Martian Atmosphere from the Curiosity Rover. Science 2013; 341:263-6. [PMID: 23869014 DOI: 10.1126/science.1237966] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Bus SA, Waaijman R, Arts M, Manning H. The efficacy of a removable vacuum-cushioned cast replacement system in reducing plantar forefoot pressures in diabetic patients. Clin Biomech (Bristol, Avon) 2009; 24:459-64. [PMID: 19303180 DOI: 10.1016/j.clinbiomech.2009.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 02/11/2009] [Accepted: 02/13/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to determine the plantar forefoot offloading efficacy of a new prefabricated vacuum-cushioned cast replacement system designed for foot ulcer treatment in neuropathic diabetic patients. METHODS Fifteen diabetic subjects with peripheral neuropathy underwent in-shoe plantar pressure assessment while walking in five different footwear types: a standard vacuum-cushioned system with instantly moldable vacuum cushion and roller outsole, two modified vacuum-cushioned systems, one with flat surface vacuum cushion and one with flat outsole, a forefoot offloading shoe, and a control shoe. Regional peak pressures, pressure-time integrals, and inter-regional load transfers were calculated to determine the mechanical action of the footwear. Perceived walking comfort was tested using a 10-point visual analogue scale. FINDINGS Forefoot peak pressures and pressure-time integrals were significantly lower (by 41-56%) in the vacuum-cushioned system compared to control. Compared to the forefoot offloading shoe, the vacuum-cushioned system showed significantly higher metatarsal head peak pressures, similar metatarsal head pressure-time integrals, and significantly lower hallux peak pressures and pressure-time integrals. A major transfer of forefoot load to the midfoot explained the offloading efficacy of the vacuum-cushioned system. Few significant differences were present between the modified and standard vacuum-cushioned systems. Perceived walking comfort was significantly higher in the vacuum-cushioned system (score 6.6) than in the forefoot offloading shoe (score 3.4). INTERPRETATION The results showed that the vacuum-cushioned cast replacement system was effective in offloading the plantar forefoot of diabetic patients at risk for ulceration, although the contribution of the instantly moldable vacuum cushion and roller outsole were relatively small. The combined peak pressure, pressure-time integral and walking comfort results indicate that the vacuum-cushioned system may be a useful alternative for the forefoot offloading shoe in offloading the plantar diabetic forefoot.
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Affiliation(s)
- S A Bus
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Young M, Manning H. Lack of effect of a ventilation strategy in preventing long-term lung injury. Crit Care Med 2000; 28:3575-6. [PMID: 11057827 DOI: 10.1097/00003246-200010000-00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- H Manning
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire 03756-0001, USA
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Demediuk BH, Manning H, Lilly J, Fencl V, Weinberger SE, Weiss JW, Schwartzstein RM. Dissociation between dyspnea and respiratory effort. Am Rev Respir Dis 1992; 146:1222-5. [PMID: 1443874 DOI: 10.1164/ajrccm/146.5_pt_1.1222] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Breathlessness induced by hypercapnia may be related to the sensation of respiratory effort or to the central or peripheral effects of CO2. To examine the relationship among breathlessness, respiratory effort, and hypercapnia, we studied eight normal naive subjects. By using a visual feedback system, subjects maintained a constant ventilation of 50-60 L/min. PETCO2 was held at 40 mm Hg during the first 2 min of each trial (control period), then for 4 min (test period) was either kept at 40 mm Hg or elevated to 50 mm Hg. At the end of each control and test period, subjects were asked to give separate ratings for dyspnea (an unpleasant urge to breathe) and for the sense of respiratory effort (analogous to lifting a weight) on a 50-cm visual analog scale. Hypercapnia was associated with a significant reduction in effort ratings (-7.3 +/- 6.4, mean +/- SD, p < 0.05) and a concomitant increase in dyspnea (+6.6 +/- 6.0, p < 0.05). We conclude that dyspnea associated with hypercapnia is dissociated from changes in respiratory effort, and that CO2 has a direct central effect that leads to breathlessness. Our data also suggest that the sense of effort at a given level of ventilation is less when the ventilation is the result of "reflex" stimuli to breathe rather than "voluntary" signals to the respiratory muscles.
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Affiliation(s)
- B H Demediuk
- Charles A. Dana Research Institute, Boston, Massachusetts
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Abstract
We hypothesized that, in quadriplegia, chest wall distortion would increase the energy cost of ventilation. To assess this, we measured the oxygen cost of breathing (VO2 resp) and changes in chest wall configuration during inspiratory resistive-loaded breathing tasks in five quadriplegic and five normal subjects. Each subject performed three breathing tasks that spanned a range of work rates (Wtot). Configurational changes of the abdomen and upper, lower, and transverse rib cage were assessed with magnetometers. We found that 1) in both groups, VO2resp increased linearly with Wtot over the range of tasks performed, 2) the mean slope of the regression line of VO2resp vs. Wtot was greater for quadriplegic than for normal subjects (3.7 +/- 0.8 vs. 2.0 +/- 0.7 ml O2/J, P less than 0.01), 3) efficiency of breathing (Wtot/VO2resp) was less for quadriplegic than for normal subjects (1.9 +/- 0.6 vs. 3.5 +/- 1.4%, P less than 0.001), 4) during inhalation, upper and lower rib cages behaved similarly in the two groups, but the quadriplegic subjects had a decrease in transverse rib cage and a much greater increase in abdomen than normal subjects, and 5) functional residual capacity decreased in normal but not in quadriplegic subjects during the breathing tasks. We conclude that the lesser efficiency of breathing in quadriplegia may be related to the elastic work of chest wall distortion, shorter mean operational diaphragm length, and possibly differences between normal and quadriplegic subjects in mechanical advantage of available inspiratory muscles.
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Affiliation(s)
- H Manning
- Department of Medicine, Brockton-West Roxbury Veterans Affairs Medical Center, Massachusetts 02132
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Ringler J, Basner RC, Shannon R, Schwartzstein R, Manning H, Weinberger SE, Weiss JW. Hypoxemia alone does not explain blood pressure elevations after obstructive apneas. J Appl Physiol (1985) 1990; 69:2143-8. [PMID: 2077012 DOI: 10.1152/jappl.1990.69.6.2143] [Citation(s) in RCA: 152] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In patients with obstructive sleep apnea (OSA), substantial elevations of systemic blood pressure (BP) and depressions of oxyhemoglobin saturation (SaO2) accompany apnea termination. The causes of the BP elevations, which contribute significantly to nocturnal hypertension in OSA, have not been defined precisely. To assess the relative contribution of arterial hypoxemia, we observed mean arterial pressure (MAP) changes following obstructive apneas in 11 OSA patients during non-rapid-eye-movement (NREM) sleep and then under three experimental conditions: 1) apnea with O2 supplementation; 2) hypoxemia (SaO2 80%) without apnea; and 3) arousal from sleep with neither hypoxemia nor apnea. We found that apneas recorded during O2 supplementation (SaO2 nadir 93.6% +/- 2.4; mean +/- SD) in six subjects were associated with equivalent postapneic MAP elevations compared with unsupplemented apneas (SaO2 nadir 79-82%): 18.8 +/- 7.1 vs. 21.3 +/- 9.2 mmHg (mean change MAP +/- SD); in the absence of respiratory and sleep disruption in eight subjects, hypoxemia was not associated with the BP elevations observed following apneas: -5.4 +/- 19 vs. 19.1 +/- 7.8 mmHg (P less than 0.01); and in five subjects, auditory arousal alone was associated with MAP elevation similar to that observed following apneas: 24.0 +/- 8.1 vs. 22.0 +/- 6.9 mmHg. We conclude that in NREM sleep postapneic BP elevations are not primarily attributable to arterial hypoxemia. Other factors associated with apnea termination, including arousal from sleep, reinflation of the lungs, and changes of intrathoracic pressure, may be responsible for these elevations.
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Affiliation(s)
- J Ringler
- Charles A. Dana Institute, Boston, Massachusetts
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Manning H. Service is the key to McGaw winner's success. Interview by Howard Larkin. Hospitals 1988; 62:87-8. [PMID: 3410430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Manning H. Trauma '85. Sudden death. Nurs Mirror 1985; 160:19-21. [PMID: 3846270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Manning H. Mind that child! Nurs Mirror 1980; 151:Suppl xviii-xx. [PMID: 6904013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Manning H. The problem of school arsonists. Australas Nurses J 1978; 7:9-10, 26. [PMID: 418765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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