Bed Mobility Research Articles

Recovery Pattern and Barriers to Mobilization during Acute Rehabilitation Phase in Organophosphate Poisoning Patients

Organophosphate pesticide poisoning is a common clinical problem in developing countries, bringing with it significant morbidity and mortality. There is limited evidence on the mobility status in patients who survive acute intoxication by organophosphates. The purpose of this study is to assess the mobility patterns and barriers to mobilization in organophosphate poisoning survivors in the intensive care unit. This cross-sectional study looked at 37 patients with acute intoxication from organophosphate compounds. Patients with Acute Physiology and Chronic Health Evaluation scores of less than 93 and Richmond Agitation and Sedation scores between −2 and +2 were included. Potential mobility barriers, bed mobility, functional strength, transfers, and endurance were assessed using the Perme Intensive Care Unit Mobility score on alternative days for the first ten days of intensive care unit admission. Perme scores (2.50–6.0, p ≤ 0.01) improved significantly with improvement in the subcomponents of bed mobility score (1.83 ± 0.35 to 7.23 ± 3.84), transfers (0.37 ± 0.02 to 4.78 ± 3.84), and gait (1.83 ± 0.35 to 5.23 ± 1.27) from day 2 through day 10 of hospital admission. The endotracheal tube and continuous infusion were identified as major barriers to mobilization (66.6%) using Perme scores. Perme scores improved gradually in organophosphate poisoning patients in the intensive care unit. Identification of mobility barriers may help in the modification of rehabilitation goals.

Estabilidade primária do implante dental

Primary stability derives mainly from mechanical involvement with the cortical bone and the lack of mobility in the bone bed at the insertion of the implant and depends on the quantity and quality of the bone, the surgical technique, and the design of the implant. The titles were captured in the database PubMed, Scielo, and relevant Brazilian magazines to identify the primary stability, after the insertion of the implant in the region indicated in the protocol. Tapered implants showed greater primary stability compared to cylindrical implants, when placed under bone density conditions. The geometry of the implant is an important factor in the degree of primary stability. Based on this, large threads are desirable in cases of poor bone quality. The insertion torque values are very important for the clinical determination of the levels of primary stability and the absence of micro movements whenever an immediate load is applied. The implant, used as if it were the last cutter, when correctly inserted, penetrates with pressure in the bone store if its diameter is larger than that of the cutter perforation. The implant design plays an influential role in achieving its primary stability.

Threshold of Motion Conditions Under Stokes Flow Regime and Comparison With Turbulent Flow Data

AbstractThe present study numerically investigates the effects of bed geometrical properties on particle entrainment driven by Stokes flow. We use different substrate arrangements to alter two important factors: The angle of repose, φ, and degree of exposure, e, of the test particle. The effectiveness of shear flow in mobilizing surface particles will change with e and φ, or collectively, η = e/tanφ, yielding a wide range of critical Shields parameter, θc, values. The use of η is better suited for describing local bed geometry as both e and φ values will change simultaneously during substrate rearranging processes. Furthermore, the range of θc values obtained in this study stems from the limitation of this parameter to relate the applied force variation to local flow and bed conditions. We therefore propose an effective shear ratio, α, to establish such connections between the global and local flow shear intensities. These results provide a unique perspective to examine typical θc data obtained from both Stokes and turbulence regimes. For the case of a single‐particle entrainment under given grain protrusion, Stokes flow‐based θc values are found to be 2 to 3 times larger than the counterpart turbulence data. For the case of channel bed mobility, however, the Shields curve suggests an order of magnitude difference in θc between the two regimes. In part, we attribute this significant θc variation to turbulent flow fluctuations in the first case and varied bed mobility levels in the second, given their distinct theoretical and empirical nature, respectively.

A randomized controlled trial of the effect of supervised progressive cross-continuum strength training and protein supplementation in older medical patients: the STAND-Cph trial

BackgroundDuring hospitalization, older adults (+ 65 years) are inactive, which puts them at risk of functional decline and loss of independence. Systematic strength training can prevent loss of functional performance and combining strength training with protein supplementation may enhance the response in muscle mass and strength. However, we lack knowledge about the effect of strength training commenced during hospitalization and continued after discharge in older medical patients. This assessor-blinded, randomized study investigated the effect of a simple, supervised strength training program for the lower extremities, combined with post-training protein supplementation during hospitalization and in the home setting for 4 weeks after discharge, on the effect on change in mobility in older medical patients.MethodsOlder medical patients (≥ 65 years) admitted acutely from their home to the Emergency Department were randomized to either standard care or supervised progressive strength training and an oral protein supplement during hospitalization and at home 3 days/week for 4 weeks after discharge. The primary outcome was between-group difference in change in mobility from baseline to 4 weeks after discharge assessed by the De Morton Mobility Index, which assesses bed mobility, chair mobility, static and dynamic balance, and walking. Secondary outcomes were 24-h mobility, lower extremity strength, gait speed, grip strength and activities of daily living.ResultsEighty-five patients were randomized to an intervention group (N = 43) or a control group (N = 42). In the intervention group, 43% were highly compliant with the intervention. Our intention-to-treat analysis revealed no between-group difference in mobility (mean difference in change from baseline to 4 weeks, − 4.17 (95% CI − 11.09; 2.74; p = 0.24) nor in any of the secondary outcomes. The per-protocol analysis showed that the daily number of steps taken increased significantly more in the intervention group compared to the control group (mean difference in change from baseline to 4 weeks, 1033.4 steps (95% CI 4.1; 2062.7), p = 0.049, adjusted for mobility at baseline and length of stay; 1032.8 steps (95% CI 3.6; 2061.9), p = 0.049, adjusted for mobility at baseline, length of stay, and steps at baseline).ConclusionsSimple supervised strength training for the lower extremities, combined with protein supplementation initiated during hospitalization and continued at home for 4 weeks after discharge was not superior to usual care in the effect on change in mobility at 4 weeks in older medical patients. For the secondary outcome, daily number of steps, high compliance with the intervention resulted in a greater daily number of steps. Less than half of the patients were compliant with the intervention indicating that a simpler intervention might be needed.Trial registrationClinicalTrials.gov, NCT01964482. Registered on 14 October 2013. Trial protocol PubMed ID (PMID), 27039381.

23 The Implementation of a Hospital “Buddy Walking Programme” to Improve Access to Mobility for Acute Hospital in-Patients

Abstract Background An acute hospital admission often means that patient’s mobility can decline if not maintained and encouraged throughout their inpatient stay. The “Buddy Walking Programme” is a joint initiative between the physiotherapy department, nursing department and hospital volunteers. The aim of this research was to implement a hospital “Buddy Walking Programme” within a teaching hospital in Cork to allow the provision of accompanied walking sessions by members of the hospital’s volunteer team. Methods Ward based physiotherapy staff and nursing staff identify suitable patients and add their bed number and mobility status to a list each morning. Patients are identified who are independently mobile or can safely mobilise with the supervision of one person, with or without a mobility aid and who are cognitively capable of simple commands. Physiotherapists and nursing staff are made aware of the programme at induction. Volunteers partake in an educational session and manual handling training prior to offering supervised walking sessions. Results A standard operating procedure has been developed for the “Buddy Walking Programme”. Training has been rolled out hospital wide amongst nursing staff, physiotherapy staff and hospital volunteers. Conclusion This programme will help encourage a culture of physical activity within the hospital in-patient setting and improve mobility levels. Further research is warranted to explore the beliefs and perceptions of hospital staff and volunteers regarding the initiative and to examine barriers and facilitators to the programme.

Design of fascines for riverbank protection in alpine rivers: Insight from flume experiments

We present the results of flume experiments specifically designed to investigate the conditions required for successful bank protection using fascines, considered in the early and critical stage of their installation (no developed root system), in the alpine context. A total of 145 runs were performed with erodible banks, considering different combinations of protection design (no protection, rip-raps, twigs), bed mobility (with or without bedload), discharge (from low to exceptional floods), and bend curvature radius. None of the runs showed any direct fascine grabbing by the flow observed; all destruction was the consequence of bank scouring, erosion and collapse around the structure. In all cases, most destructive effects resulted from water recirculation inside the bank. Thus, we conclude that all measures aiming to reduce water circulations during the first stage of the fascine construction and development are recommended. This include large bend curvature radii (when possible), fining of the filling material, use of antiscouring twigs, optimisation of the programming of the works with consideration of the hydrology (shape of hydrographs) and regular survey of the structure. Our experiments show that anti-scouring twigs have a real protective effect by modifying the local hydraulics and promoting sediment deposition at the bank toe.

How alternative urban stream channel designs influence ecohydraulic conditions

Streams draining urban catchments ubiquitously undergo negative physical and ecosystem changes, recognized to be primarily driven by frequent stormwater runoff input. The common management intervention is rehabilitation of channel morphology. Despite engineering design intentions, ecohydraulic benefits of urban channel rehabilitation are largely unknown and likely limited. This investigation uses an ecohydraulic modeling approach to investigate the performance of alternative channel design configurations intended to restore key ecosystem functioning in urban streams. Channel reconfiguration design scenarios, specified to emulate the range of channel topographic complexity often used in rehabilitation are compared against a reference ‘natural’ scenario using ecologically relevant hydraulic metrics. The results showed that the ecohydraulic conditions were incremental improved with the addition of natural oscillations to an increasing number of individual topographic variables in a degraded channel. Results showed that reconfiguration reduced excessive frequency of bed mobility, loss of habitat and hydraulic diversity particularly as more topographic variables were added. However, the results also showed that none of the design scenarios returned the ecohydraulics to their reference conditions. This indicate that channel-based restoration can offer some potential changes to hydraulic habitat conditions but are unlikely to completely mitigate the effects of hydrologic change. We suggest that while reach-scale channel modification may be beneficial to restore urban stream, addressing altered hydrology is critical to fully recover natural ecosystem processes.

Acute Rehabilitation of a 27-Year-Old Man With Failure to Thrive

Background and Purpose: Failure to thrive is a complex medical diagnosis that does not describe a single disease process, but rather a variety of symptoms associated with one or more possible underlying diseases or conditions. It is a diagnosis that is not well-documented outside pediatric or geriatric populations. The purpose of this case report is to present the physical therapy examination and treatment of a 27-year-old Hispanic man with a diagnosis of failure to thrive, a history of superior mesenteric artery syndrome, chronic malnutrition, type 1 diabetes mellitus, and osteopenia. Case Description: A 27-year-old Hispanic man, BMI of 12, admitted to the hospital for acute hypothermia, urinary tract infection, generalized weakness, hypotension, and failure to thrive. The complexity of his medical condition required nearly 2 weeks to stabilize general health prior to initiating physical therapy services. Personal and environmental factors contributed to progressive decline in physical activity prior to this hospital admission and led to increased dependence and support. Outcomes: Blood pressure increased by 18 mm Hg systolic and 20 mm Hg diastolic and stabilized within normal range; 5 repetitions in the 30-second sit-to-stand; functional balance composite score of 35 seconds; 20% reduction in subjective Numeric Pain Rating Scale; supervised bed mobility; maximum assistance stand-pivot transfer; and family to support caregiver needs upon return home. The patient was discharged home with recommendation for continued services through home health care referral. Discussion: Evidence-based literature regarding failure to thrive in the young adult or middle-aged adult population is limited. Therefore, the physical therapy plan of care necessitates the application of interventions shown to be effective in addressing the physical structure and function limitation upon examination generally applied to the geriatric and/or pediatric population. Clinical decision-making focused on improving physical activity and participation are imperative across clinical settings. Manual therapy interventions applied in this case may prove beneficial in the acute care setting to maximize muscle activation within available range of motion elicited through patterns of functional movements emphasizing existing abilities.

Reliability of the Bates-Jensen wound assessment tool for pressure injury assessment: The pressure ulcer detection study.

The Bates-Jensen Wound Assessment Tool (BWAT) is used to assess wound healing in clinical practice. The purpose of this study was to evaluate BWAT use among nursing home residents with pressure injury. Findings and reliability estimates from the BWAT related to pressure injury characteristics (stage, anatomic location) and natural history (resolved, persisted) among 142 ethnically and racially diverse residents are reported. In this prospective 16-week study, 305 pressure injuries among 142 participants (34% prevalence) are described by stage, anatomic location, and BWAT scores. Visual and subepidermal moisture assessments were obtained from sacrum, buttock, ischial, and heel ulcers weekly. Participants were 14% Asian, 28% Black, 18% Hispanic, 40% White with a mean age of 78 ± 14 years, and were 62% female; 80% functionally dependent (bed mobility extensive/total assistance) and at risk (Braden Scale score 14 ± 2.7). The reliability coefficient for BWAT score (all participants, all anatomic locations) was high (r = 0.90; p < 0.0001; n = 1,161 observations). Weighted Kappas for characteristics ranging from 0.46 (skin color surrounding wound) to 0.79 (undermining) were consistent for all participants. BWAT scores showed strongest agreement coefficients for stage 4 pressure injury (r = 0.69), pressure injuries among Asian and White ethnicity/racial groups (r = 0.89, and r = 0.91, respectively), and sacrum anatomic location (r = 0.92) indicating scores are better correlated to fair skin tones. Lower agreement coefficients were demonstrated for stage 2 pressure injury (r = 0.38) and pressure injuries among African American and Hispanic ethnicity/racial groups (r = 0.88 and 0.87, respectively). BWAT scores were significantly different by pressure injury stage (F = 496.7, df = 6, p < 0.001) and anatomic location (F = 33.76, df = 8, p < 0.001). BWAT score correlated with pressure injury natural history (ulcer resolved 18.4 ± 7.4, ulcer persisted 24.9 ± 10.0; F = 70.11, df = 2, p < 0.001), but not with comorbidities. The BWAT provides reliable, objective data for assessing pressure injury healing progress.

Highly conservative behaviour of bed sediment‐associated metals following extreme flooding

AbstractOn December 26, 2015 (Boxing Day), an exceptional flood event occurred in the Irwell catchment, United Kingdom, when the neighbouring Mersey catchment experienced a much more typical winter run‐off event. This provided an opportunity to examine the influence of high‐magnitude hydrological processes on the behaviour of fine‐grained metal‐contaminated bed sediments. Forty sites across the two catchments were sampled for channel bed fine sediment storage and sediment‐associated metal(loid) concentrations prior to, and following, the flooding. Sediments were analysed for total As, Cr, Cu, Pb, and Zn and then subjected to a five‐step sequential extraction procedure. Despite a significant reorganisation of fine‐grained (&lt;63 μm) sediment storage, metal(loid) concentrations demonstrated markedly conservative behaviour with no significant difference observed between pre‐flooding and post‐flooding values across both catchments. Estimates of the channel bed storage of sediment‐associated metal(loid)s also showed minimal change as a result of the flooding. The metal partitioning data reveal only minor changes in the mobility of bed sediment‐associated metal(loid)s, indicating that such flood events do not increase the availability of sorbed contaminants in these catchments. Post‐flooding bed sediment metal(loid) loadings remain high, indicating persistent and long‐lasting sources of contamination within the Irwell and upper Mersey fluvial network.

Abstract WP496: Early Mobility in the Neurosurgical Intensive Care Unit: A Quality Improvement Project

Bed rest is prevalent among patients in neurosurgical intensive care units (NSICU). The most common conditions that contribute to bed rest are acute ischemic or hemorrhagic strokes, neuromuscular weaknesses, spinal instability, post endovascular interventions, neurobehavioral disturbances, and mechanical ventilation. The immobility of bed rest causes numerous complications including critical illness myopathy, deep venous thrombosis (DVT), pressure ulcers, pulmonary dysfunction, bone demineralization, alterations in peripheral muscle mass, joint contractures, and general deconditioning. The purpose of this evidence-based quality improvement (QI) project was to evaluate the effectiveness of a practice change, which was the implementation of an early mobility program in the NSICU. The study design for this project was a retrospective analysis of a previous practice change. The algorithm for the practice change was specially designed for patients with neurological illnesses in the ICU. The number of days during which patients had mobility interventions, the frequency of mobility interventions, Functional Status Score for ICU (FSS-ICU), NSICU Length of Stay (LOS), the incidence of ICU delirium, and ventilator days were compared pre and post intervention. This QI project was conducted in an academic neuroscience hospital with 146 beds and receives referral patients from all over the nation. The principal investigator (PI) anticipated an increase in the physical activity, thereby improving the functional and cognitive outcomes of critically ill patients admitted to the NSICU through this QI project. The outcomes of this QI project were assessed and the results revealed a statistically significant improvement in the frequency of out of bed mobility activities (number of days patients had mobility interventions, p = 0.03; frequency of mobility steps, p = 0.002). The difference in mean LOS ( p = 0.5), FSS-ICU ( p = 0.7), and ICU delirium ( p = 0.99) did not prove any statistical significance. The intervention of early mobilization in the NSICU is safe and feasible to implement, providing a structured plan for increasing the activity level of neurologically injured patients.

Spatially-averaged flows over mobile rough beds: equations for the second-order velocity moments

ABSTRACTThe double-averaging methodology is used in this paper for deriving equations for the second-order velocity moments (i.e. turbulent and dispersive stresses) that emerge in the double-averaged momentum equation for incompressible Newtonian flows over mobile boundaries. The starting point in the derivation is the mass and momentum conservation equations for local (at a point) instantaneous variables that are up-scaled by employing temporal and spatial averaging. First, time-averaged conservation equations for mass, momentum, and turbulent stresses for mobile bed conditions are derived. Then, the double-averaged hydrodynamic equations obtained by spatial averaging the time-averaged equations are proposed. The derived second-order equations can serve as a basis for the construction of simplified mathematical and numerical models and for interpretation of experimental and simulation data when bed mobility is present. Potential applications include complex flow situations such as free-surface flows over vegetated or mobile sedimentary beds and flows through tidal and wind turbine arrays.

Effects of grain‐size distribution and shape on sediment bed stability, near‐bed flow and bed microstructure

AbstractDifferent studies investigating the stability of mixed sediment have found that the fine fraction can either stabilize or mobilize the bed. This study aims to find where the transition between these two modes occurs for sandy sediment and to identify the underlying (grain‐scale) processes. Flume experiments with bimodal sediment were used to investigate near‐bed processes of a non‐cohesive sediment bed, and in particular how the grain shape and the ratio of different grain sizes influence bed mobility. Medium sand (D50,c ≈ 400 μm) was mixed with 40 % fine material of different diameters (D50,f = 53; 111; 193 μm) and subjected to increasing flow velocities (U = 1.3–22.2 cm s‐1). The bed mobility (i.e. the change of the bed level over time), turbidity and near‐bed hydrodynamics were analysed. Selected results were compared with similar previous experiments with spherical glass beads. The findings indicate that, due to the complex grain shapes of natural sediment, a sand bed is more stable than a bed composed of glass beads. The grain‐size ratio RD = Dc /Df between the coarse and fine grain diameters controls whether the mixed bed is stabilized or mobilized by the presence of fines, with the transition between the modes occurring at RD = 4–5.5. Mixed beds with a very low RD &lt; 2 behave like a unimodal bed. The results suggest that RD and grain shape influence bed roughness, near‐bed flow, bed microstructure and the flow into and through the upper bed layers, which subsequently governs bed mobility. The interplay between all these processes can explain the transition between the stabilizing effect (high RD, small pore space) and the mobilizing effect (low RD, large pore space) of a fine fraction in a grain‐size mixture. © 2018 John Wiley &amp; Sons, Ltd.

Short Duration, Intensive Bed Mobility Training in Idiopathic Parkinson’s Patients- One Group Pre-post Test Study Design

Short Duration, Intensive Bed Mobility Training in Idiopathic Parkinson’s Patients- One Group Pre-post Test Study Design

Can catchment-scale urban stormwater management measures benefit the stream hydraulic environment?

The potential for catchment-scale stormwater control measures (SCMs) to mitigate the impact of stormwater runoff issues and excess stormwater volume is increasingly recognised. There is, however, limited understanding about their potential in reducing in-channel disturbance and improving hydraulic conditions for stream ecosystem benefits. This study investigates the benefits that SCM application in a catchment have on in-stream hydraulics. To do this, a two-dimensional hydraulic model was employed to simulate the stream hydraulic response to scenarios of SCM application applied in an urban catchment to return towards pre-development hydrologic pulses. The hydraulic response analysis considered three hydraulic metrics associated with key components of stream ecosystem functions: benthic mobilization, hydraulic diversity and retentive habitat availability. The results showed that when applied intensively, the developed SCM scenarios could effectively restore the in-stream hydraulics to close to natural levels. Compared to an unmanaged urban case (no SCMs), SCM scenarios yielded channels with reduced bed mobility potential, close to natural hydraulic diversity and improvement of retentive habitat availability. This indicates that mitigating the effect of stormwater driven hydrological change could result in significant improvements in the physical environment to better support ecosystem functioning. We therefore suggest that intensive implementation of SCMs is an important action in an urbanizing catchment to maintain the flow regime and hydraulic conditions that sustain the ‘natural’ stream habitat functioning. We propose that stormwater management and protection of stream ecosystem processes should incorporate hydraulic metrics to measure the effectiveness of management strategies.

Scoured or suffocated: Urban stream ecosystems oscillate between hydrologic and dissolved oxygen extremes

AbstractHeadwater streams draining urbanized watersheds are subject to frequent and intense storm flows. These floods can disrupt metabolic processes occurring in benthic biofilms via the removal of biomass (i.e., scouring flows, bed mobilization) or light attenuation due to turbidity. Furthermore, channel incision caused by frequent hydraulic disturbance alters the geomorphology of streams, indirectly changing the flow and light regimes experienced by benthic biofilms. We measured dissolved oxygen (DO) and modeled whole‐stream metabolism for 18 months in six urban headwater streams in the North Carolina Piedmont, U.S.A. All streams were heterotrophic and had low rates of productivity despite relatively high streamwater nutrient concentrations. Light availability at the channel surface explained more of the day to day variation in gross primary productivity within each stream than did hydrologic disturbance. Yet among streams, the explanatory power of light declined with increasing hydrologic flashiness. We found a surprisingly wide range in DO regimes, which ranged from frequent hypoxia to near constant saturation. Hypoxia was more common in streams with lower channel gradients where bedrock outcroppings and culverts create rapid slope transitions between pools. We hypothesize this geomorphic change increases the susceptibility of benthic biota to perturbation during storms and the mean water residence time during baseflow. Increased water residence times together with elevated organic matter and nutrient inputs can set up ideal conditions for hypoxia at baseflows punctuated by frequent scouring storm flows. As a result, benthic biota are caught between hydrologic and chemical extremes that constrain their productivity.

Resistance Is Not Futile: Grain Resistance Controls on Observed Critical Shields Stress Variations

AbstractEstimates of the onset of sediment motion are integral for flood protection and river management but are often highly inaccurate. The critical shear stress (τ*c) for grain entrainment is often assumed constant, but measured values can vary by almost an order of magnitude between rivers. Such variations are typically explained by differences in measurement methodology, grain size distributions, or flow hydraulics, whereas grain resistance to motion is largely assumed to be constant. We demonstrate that grain resistance varies strongly with the bed structure, which is encapsulated by the particle height above surrounding sediment (protrusion, p) and intergranular friction (ϕf). We incorporate these parameters into a novel theory that correctly predicts resisting forces estimated in the laboratory, field, and a numerical model. Our theory challenges existing models, which significantly overestimate bed mobility. In our theory, small changes in p and ϕf can induce large changes in τ*c without needing to invoke variations in measurement methods or grain size. A data compilation also reveals that scatter in empirical values of τ*c can be partly explained by differences in p between rivers. Therefore, spatial and temporal variations in bed structure can partly explain the deviation of τ*c from an assumed constant value. Given that bed structure is known to vary with applied shear stresses and upstream sediment supply, we conclude that a constant τ*c is unlikely. Values of τ*c are not interchangeable between streams, or even through time in a given stream, because they are encoded with the channel history.

Estimating and restoring bedload transport through a run-of-river reservoir

Weirs or run-of-river dams can disrupt bedload transfer with negative ecological effects downstream due to sediment starvation. The way and the degree to which bedload is trapped is nevertheless not straightforward and few studies have examined this topic. This study focuses on a 13-km-long reservoir of the Rhône River, France, created by a diversion dam equipped with bottom gates. Our main objective was to determine the degree of alteration of the bedload transfer downstream and to identify to which extent the implementation of Ecomorphogenic Flows (EmF), defined as environmental flows whose objective is specifically to increase bedload transfer through the reservoir to promote downstream habitat diversity, could increase bed mobility. The results show that the potential for morphological adjustments in the reservoir was already low before dam completion (1968) in response to a substantial decrease in coarse sediment supply, but that this potential was progressively reduced due to the impoundment. However, the bedload transfer continuity has been at least partially maintained since dam completion. According to numerical simulations, only particles smaller than medium gravels (d < 14 mm) could be exported downstream of the dam for relatively rare discharge (50-years return-interval flood). Implementation of EmF could neatly improve the bedload transfer since it would allow to strongly increase the competence: for a 2-years and a 50-years return-interval floods, the maximum particle size exportable downstream is respectively 9 and 4 times larger than for normal the reservoir operation.

Current Trends in Practice for Early Mobility with the Burn Population.

There is a clinical trend toward "early mobilization" of patients with burn injury, however mobility is not well defined in burn care. Burn injuries result in various extents of injury, body areas affected, and types of skin graft surgeries needed-all of which may influence the type, timing, safety, and outcome of mobilization activities. This study surveyed burn clinicians to determine current mobility practices and the influence of skin graft surgery on clinical decisions to mobilize patients. A 32-question survey was electronically distributed to burn clinicians and included questions about postoperative range of motion (ROM) and out of bed (OOB) mobility practices for various skin graft types and locations. For all types of grafts on all body locations, the average time after skin graft surgery that patients resumed ROM activities was postoperative day (POD) 3.87 (±2.04) while OOB mobility resumed on POD 2.54 (±1.38). There was significantly greater variability for OOB mobility compared to ROM (coefficient of variation [CV] 0.71 ± 0.8 vs 0.5 ± 0.05). Time to postoperative ROM was significantly different depending on the type of skin graft placed with sheet skin grafts resuming ROM the earliest. Time to OOB mobility after surgery was significantly different for different body locations with grafts placed above the waist resuming OOB mobility earliest. This study provides a summary of current mobility practices and serves as a foundation for future studies investigating the optimal timing and practical application of mobility protocols that may influence safety and outcome of burn survivors.

Restoring in‐stream habitat in urban catchments: Modify flow or the channel?

AbstractUrban streams have almost universally altered physical habitat conditions due to excess stormwater run‐off. This includes changes to in‐channel hydraulics and channel morphology. Restoration of in‐channel habitat has two main levers: address the hydrology or channel morphology. Both variables impact in‐stream habitat, but understanding the relative role of hydrologic and morphologic change remains a challenge. This study uses two‐dimensional hydraulic modelling to examine the relative roles of flow and channel morphology in setting hydraulic conditions. We investigated four test scenarios involving the combinations of urban versus natural hydrology and urban versus natural channel morphology. The analysis investigated three ecologically relevant hydraulics characteristics: bed mobilization, retentive habitat, and floodplain inundation, using Shields stress, shallow slow‐water habitat (SSWH) area, and floodplain inundation area hydraulic metrics, respectively. The results indicate substantial differences in hydraulic conditions between the two reaches. The urban reach showed increased bed mobility potential and SSWH availability plummeted as flow increased, whereas the natural channel showed a relatively stable bed with substantially more SSWH at most flows. Floodplain inundation frequency was low in the urban channel with decreased duration. Scenarios examined suggest that hydraulic conditions are highly sensitive to channel morphology relative to flow regime. This suggests that once channel form has been degraded, mitigating urbanization impacts on flow regime cannot maintain “natural” channel hydraulics. Management approaches therefore must protect channel morphology from change. Where the channel has already been fundamentally altered, opportunities for channel morphology rehabilitation need to be considered.