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"Light, Richard"
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Game sense : pedagogy for performance, participation and enjoyment
\"Game Sense is an exciting and innovative approach to coaching and physical education that places the game at the heart of the session. It encourages the player to develop skills in a realistic context, to become more tactically aware, to make better decisions, and to have more fun. Game Sense is a comprehensive, research-informed introduction to the Game Sense approach that defines and explores key concepts and essential pedagogical theory, and that offers an extensive series of practical examples and plans for using Game Sense in real teaching and coaching situations.The first section of the book helps the reader to understand how learning occurs and how this informs player-centred pedagogy, and explains the relationship between Game Sense and other approaches to Teaching Games for Understanding. The second section of the book demonstrates how the theory can be applied in practice, providing a detailed, step-by-step guide to using Game Sense in eleven sports, including soccer, basketball, field hockey and softball. No other book explores the Game Sense approach in such depth, or combines both the theory and innovative practical techniques. Game Sense is invaluable reading for all students of physical education or sports coaching, any in-service physical education teacher, or any sports coach working with children or young people. \"-- Provided by publisher.
Book
A Simple Method for Differentiating Complicated Parapneumonic Effusion/Empyema from Parapneumonic Effusion Using the Split Pleura Sign and the Amount of Pleural Effusion on Thoracic CT
Pleural separation, the \"split pleura\" sign, has been reported in patients with empyema. However, the diagnostic yield of the split pleura sign for complicated parapneumonic effusion (CPPE)/empyema and its utility for differentiating CPPE/empyema from parapneumonic effusion (PPE) remains unclear. This differentiation is important because CPPE/empyema patients need thoracic drainage. In this regard, the aim of this study was to develop a simple method to distinguish CPPE/empyema from PPE using computed tomography (CT) focusing on the split pleura sign, fluid attenuation values (HU: Hounsfield units), and amount of fluid collection measured on thoracic CT prior to diagnostic thoracentesis.
A total of 83 consecutive patients who underwent chest CT and were diagnosed with CPPE (n=18)/empyema (n=18) or PPE (n=47) based on the diagnostic thoracentesis were retrospectively analyzed.
On univariate analysis, the split pleura sign (odds ratio (OR), 12.1; p<0.001), total amount of pleural effusion (≥30 mm) (OR, 6.13; p<0.001), HU value≥10 (OR, 5.94; p=0.001), and the presence of septum (OR, 6.43; p=0.018), atelectasis (OR, 6.83; p=0.002), or air (OR, 9.90; p=0.002) in pleural fluid were significantly higher in the CPPE/empyema group than in the PPE group. On multivariate analysis, only the split pleura sign (hazard ratio (HR), 6.70; 95% confidence interval (CI), 1.91-23.5; p=0.003) and total amount of pleural effusion (≥30 mm) on thoracic CT (HR, 7.48; 95%CI, 1.76-31.8; p=0.006) were risk factors for empyema. Sensitivity, specificity, positive predictive value, and negative predictive value of the presence of both split pleura sign and total amount of pleural effusion (≥30 mm) on thoracic CT for CPPE/empyema were 79.4%, 80.9%, 75%, and 84.4%, respectively, with an area under the curve of 0.801 on receiver operating characteristic curve analysis.
This study showed a high diagnostic yield of the split pleura sign and total amount of pleural fluid (≥30 mm) on thoracic CT that is useful and simple for discriminating between CPPE/empyema and PPE prior to diagnostic thoracentesis.
Journal Article
Pleural Effusion
A 70-year-old man with an 80-pack-year history of smoking and a history of congestive heart failure presents with increasing shortness of breath. He also has aching chest pain on the right side that worsens with deep inspiration. He is afebrile. The chest radiograph reveals asymmetrical bilateral pleural effusions, with more fluid on the right. How should this patient be evaluated?
Foreword
This
Journal
feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.
Stage
A 70-year-old man with an 80-pack-year history of smoking and a history of congestive heart failure presents with increasing shortness of breath. He also has aching chest pain on the right side that worsens with deep inspiration. He is afebrile. The chest radiograph reveals bilateral pleural effusions, with more pleural fluid on the right than on the left. How should this patient be evaluated?
The Clinical Problem
Although many different diseases may cause a pleural effusion (Table 1), the most common causes in the United States are congestive heart failure, pneumonia, and cancer. The diagnostic workup of a patient . . .
Journal Article
Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial
Abstract
Rationale
Patients with malignant pleural effusions have significant dyspnea and shortened life expectancy. Indwelling pleural catheters allow patients to drain pleural fluid at home and can lead to autopleurodesis. The optimal drainage frequency to achieve autopleurodesis and freedom from catheter has not been determined.
Objectives
To determine whether an aggressive daily drainage strategy is superior to the current standard every other day drainage of pleural fluid in achieving autopleurodesis.
Methods
Patients were randomized to either an aggressive drainage (daily drainage; n = 73) or standard drainage (every other day drainage; n = 76) of pleural fluid via a tunneled pleural catheter.
Measurements and Main Results
The primary outcome was the incidence of autopleurodesis following the placement of the indwelling pleural catheters. The rate of autopleurodesis, defined as complete or partial response based on symptomatic and radiographic changes, was greater in the aggressive drainage arm than the standard drainage arm (47% vs. 24%, respectively; P = 0.003). Median time to autopleurodesis was shorter in the aggressive arm (54 d; 95% confidence interval, 34–83) as compared with the standard arm (90 d; 95% confidence interval, 70 to nonestimable). Rate of adverse events, quality of life, and patient satisfaction were not significantly different between the two arms.
Conclusions
Among patients with malignant pleural effusion, daily drainage of pleural fluid via an indwelling pleural catheter led to a higher rate of autopleurodesis and faster time to liberty from catheter.
Clinical trial registered with www.clinicaltrials.gov (NCT 00978939).
Journal Article
Shadows
\"This book looks at how shadows are created. - Test which materials block light (are opaque), let some light through (are translucent), and let most light through (are transparent). - Look at how you can make animal shadows using your hands! - You can make a sundial to explore how shadows can change depending on the position of the Sun. And much more!\"-
Book
Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial
Approaches to removal of sedation and mechanical ventilation for critically ill patients vary widely. Our aim was to assess a protocol that paired spontaneous awakening trials (SATs)—ie, daily interruption of sedatives—with spontaneous breathing trials (SBTs).
In four tertiary-care hospitals, we randomly assigned 336 mechanically ventilated patients in intensive care to management with a daily SAT followed by an SBT (intervention group; n=168) or with sedation per usual care plus a daily SBT (control group; n=168). The primary endpoint was time breathing without assistance. Data were analysed by intention to treat. This study is registered with
ClinicalTrials.gov, number
NCT00097630.
One patient in the intervention group did not begin their assigned treatment protocol because of withdrawal of consent and thus was excluded from analyses and lost to follow-up. Seven patients in the control group discontinued their assigned protocol, and two of these patients were lost to follow-up. Patients in the intervention group spent more days breathing without assistance during the 28-day study period than did those in the control group (14·7 days
vs 11·6 days; mean difference 3·1 days, 95% CI 0·7 to 5·6; p=0·02) and were discharged from intensive care (median time in intensive care 9·1 days
vs 12·9 days; p=0·01) and the hospital earlier (median time in the hospital 14·9 days
vs 19·2 days; p=0·04). More patients in the intervention group self-extubated than in the control group (16 patients
vs six patients; 6·0% difference, 95% CI 0·6% to 11·8%; p=0·03), but the number of patients who required reintubation after self-extubation was similar (five patients
vs three patients; 1·2% difference, 95% CI −5·2% to 2·5%; p=0·47), as were total reintubation rates (13·8%
vs 12·5%; 1·3% difference, 95% CI −8·6% to 6·1%; p=0·73). At any instant during the year after enrolment, patients in the intervention group were less likely to die than were patients in the control group (HR 0·68, 95% CI 0·50 to 0·92; p=0·01). For every seven patients treated with the intervention, one life was saved (number needed to treat was 7·4, 95% CI 4·2 to 35·5).
Our results suggest that a wake up and breathe protocol that pairs daily spontaneous awakening trials (ie, interruption of sedatives) with daily spontaneous breathing trials results in better outcomes for mechanically ventilated patients in intensive care than current standard approaches and should become routine practice.
Journal Article
Sources of light
\"This book looks at the different places light comes from, including natural and artificial sources. - Discover the difference between a light source and a reflective object and how you can tell which is which. - Look at our largest and most important light source - the Sun - and what happens when you take sunlight away. - Explore light technology by finding out how we use lasers and fiber optics. And much more!\"-
Book
An Observational Study Evaluating the Performance of LENT Score in the Selected Population of Malignant Pleural Effusion from Lung Adenocarcinoma in Singapore
Background: Patients with malignant pleural effusion (MPE) secondary to lung cancer have been associated with poor prognosis historically. LENT score developed to risk-stratify unselected patients with MPE predicts prognosis of < 6 months in patients with lung cancer. Objective: To assess the performance of LENT score in predicting prognosis in selected population of MPE secondary to lung adenocarcinoma alone. Methods: A retrospective observational study was conducted by reviewing the medical records of patients managed for MPE in the year 2012. Results: Seventy patients with lung adenocarcinoma presenting with MPE were studied. The median (range) LENT score at initial diagnosis was 5 (2–7), and the median survival 7.9 (0.13–40) months. Thirty-nine patients received epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKIs). The median LENT score and median survival was 4 (2–7) and 14.4 months, respectively, in this group. Those in high-risk category by LENT in this group (n = 19) had a median survival and 6-month survival of 17.4 months and 73.6%, respectively. Thirty-one patients were treated with conventional chemotherapy. The median LENT score and median survival was 5 (2–7) and 4.1 (0.13–34.3) months, respectively, in this group. The median survival and 6-month survival rate in patients in high-risk category and moderate-risk category by LENT score was 6.2 months and 52.7%, and 11.4 months and 70.5%, respectively. Conclusion: LENT score underestimates prognosis in patients having MPE secondary to lung adenocarcinoma. This disparity particularly applies to the lung adenocarcinoma patients carrying EGFR mutation. Hence, LENT score may not be applicable to, or may need modification before applying to such patients.
Journal Article