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  • The maximal metabolic steady state: redefining the ‘gold standard’

    Jones, Andrew M; Burnley, Mark; Black, Matthew I; Poole, David C; Vanhatalo, Anni (Wiley, 2019-05-23)
    The maximal lactate steady state (MLSS) and the critical power (CP) are two widely used indices of the highest oxidative metabolic rate that can be sustained during continuous exercise and are often considered to be synonymous. However, while perhaps having similarities in principle, methodological differences in the assessment of these parameters typically result in MLSS occurring at a somewhat lower power output or running speed and exercise at CP being sustainable for no more than approximately 20–30 min. This has led to the view that CP overestimates the ‘actual’ maximal metabolic steady state and that MLSS should be considered the ‘gold standard’ metric for the evaluation of endurance exercise capacity. In this article we will present evidence consistent with the contrary conclusion: i.e., that (1) as presently defined, MLSS naturally underestimates the actual maximal metabolic steady state; and (2) CP alone represents the boundary between discrete exercise intensity domains within which the dynamic cardiorespiratory and muscle metabolic responses to exercise differ profoundly. While both MLSS and CP may have relevance for athletic training and performance, we urge that the distinction between the two concepts/metrics be better appreciated and that comparisons between MLSS and CP, undertaken in the mistaken belief that they are theoretically synonymous, is discontinued. CP represents the genuine boundary separating exercise in which physiological homeostasis can be maintained from exercise in which it cannot, and should be considered the gold standard when the goal is to determine the maximal metabolic steady state.
  • Physiological evidence that the critical torque is a phase transition, not a threshold

    Pethick, Jamie; Winter, Samantha L; Burnley, Mark (Lippincott, Williams & Wilkins, 2020-11-30)
    Introduction Distinct physiological responses to exercise occur in the heavy- and severe-intensity domains, which are separated by the critical power or critical torque (CT). However, how the transition between these intensity domains actually occurs is not known. We tested the hypothesis that CT is a sudden threshold, with no gradual transition from heavy- to severe-intensity behavior within the confidence limits associated with the CT. Methods Twelve healthy participants performed four exhaustive severe-intensity trials for the determination of CT, and four 30-min trials in close proximity to CT (one or two SE above or below each participant’s CT estimate; CT − 2, CT − 1, CT + 1, CT + 2). Muscle O2 uptake, rectified electromyogram, and torque variability and complexity were monitored throughout each trial, and maximal voluntary contractions (MVC) with femoral nerve stimulation were performed before and after each trial to determine central and peripheral fatigue responses. Results The rates of change in fatigue-related variables, muscle O2 uptake, electromyogram amplitude, and torque complexity were significantly faster in the severe trials compared with CT − 2. For example, the fall in MVC torque was −1.5 ± 0.8 N·m·min−1 in CT − 2 versus –7.9 ± 2.5 N·m·min−1 in the lowest severe-intensity trial (P < 0.05). Individual analyses showed a low frequency of severe responses even in the circa-CT trials ostensibly above the CT, but also the rare appearance of severe-intensity responses in all circa-CT trials. Conclusions These data demonstrate that the transition between heavy- and severe-intensity exercise occurs gradually rather than suddenly.
  • Prolonged depression of knee-extensor torque complexity following eccentric exercise

    Pethick, Jamie; Whiteaway, Katherine; Winter, Samantha L; Burnley, Mark; Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, UK. (Wiley, 2018-11-28)
    Neuromuscular fatigue reduces the temporal structure, or complexity, of muscle torque output. Exercise-induced muscle damage reduces muscle torque output for considerably longer than high-intensity fatiguing contractions. We hypothesized that muscle-damaging eccentric exercise would lead to a persistent decrease in torque complexity, whereas fatiguing exercise would not. Ten healthy participants performed five isometric contractions (6 s contraction, 4 s rest) at 50% maximal voluntary contraction (MVC) before, immediately after and 10, 30 and 60 min and 24 h after eccentric (muscle-damaging) and isometric (fatiguing) exercise. These contractions were also repeated 48 h and 1 week after eccentric exercise. Torque and surface EMG signals were sampled throughout each test. Complexity and fractal scaling were quantified using approximate entropy (ApEn) and the detrended fluctuation analysis α exponent (DFA α). Global, central and peripheral perturbations were quantified using MVCs with femoral nerve stimulation. Complexity decreased after both eccentric [ApEn, mean (SD), from 0.39 (0.10) to 0.20 (0.12), P < 0.001] and isometric exercise [from 0.41 (0.13) to 0.09 (0.04); P < 0.001]. After eccentric exercise, ApEn and DFA α required 24 h to recover to baseline levels, but after isometric exercise they required only 10 min. The MVC torque remained reduced [from 233.6 (74.2) to 187.5 (64.7) N m] 48 h after eccentric exercise, with such changes evident only up to 60 min after isometric exercise [MVC torque, from 246.1 (77.2) to 217.9 (71.8) N m]. The prolonged depression in maximal muscle torque output is therefore accompanied by a prolonged reduction in torque complexity.
  • Conceptualising the surveillance of teachers

    Page, Damien (Taylor & Francis, 2016-09-06)
    Schools are risky places: the risk of a poor Ofsted report, the risk of sliding down league tables, the risk of teachers abusing children, the risk of teachers being falsely accused of abuse. As a result of risk anxiety and the ever-increasing sophistication of technology, the surveillance of teachers has proliferated, becoming a future-oriented pursuit to manage this risk. Drawing on the surveillance studies literature, this article attempts to theorise the surveillance of teachers. Firstly the article argues that there are three types of teacher surveillance: the vertical perpetuated by Ofsted and senior school leaders such as teaching observations and learning walks, but also students recording their teachers on mobile phones; horizontal surveillance enacted by peers in terms of concertive control, but also parental surveillance via online and offline networks; and, finally, intrapersonal surveillance embracing reflective practice, data reporting and self-policing proximity from children. The article then concludes by arguing that while surveillance in schools embraces the themes of modern surveillance in general, by doggedly retaining the proximal and the interpersonal, it should be considered a hybrid form between traditional and modern forms of surveillance.
  • The surveillance of teachers and the simulation of teaching

    Page, Damien (Taylor & Francis, 2016-07-15)
    Just as surveillance in general has become more sophisticated, penetrative and ubiquitous, so has the surveillance of teachers. Enacted through an assemblage of strategies such as learning walks, parental networks, student voice and management information systems, the surveillance of teachers has proliferated as a means of managing the risks of school life, driven forward by neoliberal notions of quality and competition. However, where once the surveillance of teachers was panoptic, a means of detecting the truth of teaching behind fabrications, this article argues that surveillance within schools has become a simulation in Baudrillard’s terms, using models and codes such as the Teachers’ Standards and the Schools Inspection Handbook as predictors of future outcomes, simulating practice as a means of managing risk. And if surveillance in schools has become a simulation, then so perhaps has teaching itself, moving beyond a preoccupation with an essentialist truth of teaching to the hyperreality of normalised visibility and the simulation of teaching. This article argues that surveillance – including external agencies such as Ofsted – no longer exists to find the truth of teaching, the surveillance of teachers exists only to test the accuracy of the models and codes upon which the simulation is based.
  • Conspicuous practice: self-surveillance and commodification in English education

    Page, Damien (2017-10-23)
    Teachers in England have always been watched; only more recently have they been surveilled, with senior leaders, peers, students and stakeholders all collecting performance data. Yet surveillance in schools and colleges increasingly relies on watching the self, with teachers voluntarily participating in their own surveillance, making their practice visible for easy consumption by interested parties. This article builds on previous work on the surveillance of teachers to argue that this ‘conspicuous practice’ represents a convergence of surveillance and consumerism, with teachers being recreated as commodities and their own marketing agent, embodying the entrepreneurial self to maximise employability. Through social media such as Twitter and LinkedIn to exploiting open plan learning spaces, teachers engage in conspicuous practice for three main reasons: from fear, to avoid sanction; as a result of acculturation into commodified environments; as a means of routine resistance, employing the dramaturgical self for personal gain, to avoid work or re-appropriate professionalism.
  • Whiteliness and institutional racism: hiding behind (un)conscious bias

    Tate, Shirley Anne; Page, Damien (Routledge, 2018-02-01)
    ‘Unconscious bias happens by our brains making incredibly quick judgements and assessments without us realising. Biases are influenced by background, cultural environment and experiences and we may not be aware of these views and opinions, or of their full impact and implications. This article opposes this point of view by arguing that bias is not unconscious but is (un)conscious and linked to Charles Mills’ ‘Racial Contract’ and its ‘epistemologies of ignorance’. These epistemologies emerge from what the Equality Challenge Unit (ECU) calls ‘our background, cultural environment and personal experience’. Asserting that racism stems from ‘unconscious bias’ diminishes white supremacy and maintains white innocence as a ‘will to forget’ institutional racism. In equality and diversity training ‘unconscious bias’ has become a performative act to move beyond racism through training to participate in a constructed ‘post-racial’ reality. The article argues that through decolonizing ‘unconscious bias’, ‘white fragility’ and ‘self-forgiveness’ we can begin to see hidden institutional whiteliness at the base of (un)conscious bias.
  • The academic as consumed and consumer

    Page, Damien (Taylor & Francis, 2019-03-29)
    In an increasingly competitive environment that positions students as consumers, universities have become ever more marketised, responding to policy contexts that foreground value for money, consumer choice and competition. The intensity of marketisation is argued to have profoundly affected the nature of academic work and scholars themselves, recreating academics as commodities to be weighed and measured, becoming corporatised, alienated and inauthentic in their practice. Yet with the majority of accounts of the commodification of higher education focusing on students, the actual process of how academics become consumed is under-theorised. This article therefore begins with a discussion of the historical context, providing evidence of the familiar indices of marketisation such as rampant self-promotion, the scramble for external funding and intense competition. It argues that this commodified DNA of the university provides the context for the seduction of the modern academic within the consumer society, a movement from the gratification of needs to the perpetual frustration of desires through the ‘Diderot Effect’ of policy shifts. It concludes with an examination of how contemporary academic work can be viewed through the lens of consumerism and how academics themselves have become consumers.
  • Family engagement in alternative provision

    Page, Damien (Wiley, 2020-11-06)
    This article presents findings from research focusing on family engagement within alternative provision. With the existing literature on alternative provision scant, this article analyses the extensive assemblage of family engagement within settings as practitioners navigate complex family environments often characterised by poverty, crime and substance abuse. While settings create formalised structures of family engagement that prioritise a collaborative approach to children’s development—such as family learning days and daily positive phone calls—equally they work to attenuate the isolation and loneliness of families who feel as excluded as their child. Yet as important as structured engagement is, practitioners within alternative provision also engage in the improvised pragmatism of micro-work—the work that other agencies won’t or can’t do, such as escorting parents to medical appointments, sourcing furniture to fill empty houses or talking a child out from under their bed. The article argues that family engagement in alternative provision is cyclical, with families informing staff of behavioural incidents or learning opportunities, information that rapidly personalises communicative and pedagogical strategies within schools. In return, teachers update parents at the end of the day, offering ideas for home learning or approaches to managing challenging behaviours. The article concludes by identifying six domains of family engagement—behavioural, emotional, safeguarding, functional, pedagogic and capacity building—that can be used within alternative provision settings to ensure a holistic approach that provides deep support to families to maximise the successful re-engagement of children.
  • Relationship between muscle metabolic rate and muscle torque complexity during fatiguing intermittent isometric contractions in humans

    Pethick, Jamie; Winter, Samantha L; Burnley, Mark; Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Canterbury, United Kingdom. (Wiley, 2019-09-25)
    To test the hypothesis that a system's metabolic rate and the complexity of fluctuations in the output of that system are related, thirteen healthy participants performed intermittent isometric knee extensor contractions at intensities where a rise in metabolic rate would (40% maximal voluntary contraction, MVC) and would not (20% MVC) be expected. The contractions had a 60% duty factor (6 sec contraction, 4 sec rest) and were performed until task failure or for 30 min, whichever occurred sooner. Torque and surface EMG signals were sampled continuously. Complexity and fractal scaling of torque were quantified using approximate entropy (ApEn) and the detrended fluctuation analysis (DFA) α scaling exponent. Muscle metabolic rate was determined using near-infrared spectroscopy. At 40% MVC, task failure occurred after (mean ± SD) 11.5 ± 5.2 min, whereas all participants completed 30 min of contractions at 20% MVC. Muscle metabolic rate increased significantly after 2 min at 40% MVC (2.70 ± 1.48 to 4.04 ± 1.23 %·s-1 , P < 0.001), but not at 20% MVC. Similarly, complexity decreased significantly at 40% MVC (ApEn, 0.53 ± 0.19 to 0.15 ± 0.09; DFA α, 1.37 ± 0.08 to 1.60 ± 0.09; both P < 0.001), but not at 20% MVC. The rates of change of torque complexity and muscle metabolic rate at 40% MVC were significantly correlated (ApEn, ρ = -0.63, P = 0.022; DFA, ρ = 0.58, P = 0.037). This study demonstrated that an inverse relationship exists between muscle torque complexity and metabolic rate during high-intensity contractions.
  • Family engagement and compassion fatigue in alternative provision

    Page, Damien (Taylor & Francis, 2021-06-09)
    In a sector largely ignored in policy and the public imagination, Alternative Provision works to care for and educate children for whom mainstream schooling does not work. Central to their mission is the engagement of families, often seen as both the cause of their child’s difficulties and the solution to their successful educational re-engagement. Practitioners within Alternative Provision work within sophisticated strategies of family engagement, from regular communication to the more intensive interventions of home visits, supporting families with everything from filling in forms to cleaning, from managing outbursts to sourcing furniture. With the majority of families living within contexts of deprivation, many have life histories containing trauma, trauma that Alternative Provision Practitioners listen to, confront and, often, internalise, risking ‘compassion fatigue’. This article focuses on the potential for compassion fatigue within family engagement in Alternative Provision, beginning with the impact on practitioners. It then discusses the role of leadership in building an assemblage of organisation interventions to both mitigate compassion fatigue and maximise ‘compassion satisfaction’, the fulfilment that comes from empathic work. Finally, it examines how compassion satisfaction could mitigate the deleterious impact of vicarious trauma.
  • Atmospheres, spaces and job crafting: home visits in alternative provision

    Page, Damien (Informa UK Limited, 2021-08-04)
    Neglected in policy and the public consciousness, Alternative Provision is the expanding putty of the education sector, working within the gaps left by other agencies to re-engage children. Yet to engage children, Alternative Provision must first engage families and home visits are crucial to this process. Often triggered by absences or safeguarding concerns, homes visits are inherently risky both to the safety of practitioners but also to the fragile trust that is built with families. Rather than being purely objective practices, home visits are deeply embodied, sensuous experiences: from the apprehension and neighbour-scrutiny of the doorstep to inside homes that are sometimes sealed, sometimes permeable, practitioners engage in ‘way-finding’ through room and histories, spaces of affective atmospheres made and unmade, crafted and destroyed through the interaction of people, artefacts and light. And here, improvising, practitioners craft their jobs as equally as they craft engagement.
  • Power and resistance in further education: findings from a study of first-tier managers

    Page, Damien (SAGE, 2010-01-01)
    This article presents findings from a study of first-tier managers in four further education colleges as they attempt to manage perpetual change within a context of performativity and mistrust. It begins with a discussion of power in the sector before presenting findings of routine resistance against ever increasing control and surveillance within colleges. First-tier managers were found to be primarily the audience for routine resistance rather than the target and so faced the dilemma of colluding with resistance to maintain cooperation, or challenging the behaviours. The article concludes that despite the demonisation of critical opinions in the lifelong learning sector, resistance in further education, far from contravening the principles of academic citizenship, is a form of educational fundamentalism and an attempt to prioritise learners in the face of financial and managerial imperatives.
  • The effect of hyperarticulation on speech comprehension under adverse listening conditions

    Kangatharan, Jayanthiny; Uther, Maria; Gobet, Fernand (Springer, 2021-12-31)
    Comprehension assesses a listener’s ability to construe the meaning of an acoustic signal in order to be able to answer questions about its contents, while intelligibility indicates the extent to which a listener can precisely retrieve the acoustic signal. Previous comprehension studies asking listeners for sentence-level information or narrative-level information used native listeners as participants. This is the first study to look at whether clear speech properties (e.g. expanded vowel space) produce a clear speech benefit at the word level for L2 learners for speech produced in naturalistic settings. This study explored whether hyperarticulated speech was more comprehensible than non-hyperarticulated speech for both L1 British English speakers and early and late L2 British English learners in quiet and in noise. Sixteen British English listeners, 16 native Mandarin Chinese listeners as early learners of L2 and 16 native Mandarin Chinese listeners as late learners of L2 rated hyperarticulated samples versus non-hyperarticulated samples in form of words for comprehension under four listening conditions of varying white noise level (quiet or SNR levels of +16dB, +12dB or +8dB) (3x2x4 mixed design). Mean ratings showed all three groups found hyperarticulated speech samples easier to understand than non-hyperarticulated speech at all listening conditions. Results are discussed in terms of other findings (Uther et al., 2012) that suggest that hyperarticulation may generally improve speech processing for all language groups.
  • Game mechanics for digital learning

    Traxler, John (Routledge, 2021-06-23)
    Communities of professionals work in a world saturated with information and subject to constant change. They need reliable training, updating and education. This may be based on established, stable and authoritative sources, or they may have to develop it themselves as situations and circumstances evolve. They may learn with conventional educational and training technologies, but most people are familiar with a range of popular social media. This chapter explains how the familiarity with games, their rules and formats, can be incorporated and aligned with other innovative and emerging informal digital learning techniques and implemented on free and familiar systems in order to enable sustainable, flexible, responsive and collaborative digital learning communities.
  • A critical review of mobile learning: phoenix, fossil, zombie or …..?

    Traxler, John (MDPI, 2021-09-08)
    The established mobile learning paradigm is now two decades old; it grew out of the visions and resources of e-learning research communities in universities in the world’s more economically developed regions. Whilst it has clearly been able to demonstrate many practical, pedagogic and conceptual achievements, it is now running out of steam. It has failed to adapt to a world where mobile technologies are pervasive, ubiquitous and intrusive and where people and communities can now own their own learning. This paper looks at the evolution of the established mobile learning paradigm and explores the current global, demographic, social and technical environment in order to develop a new paradigm, more suited to the changed and changing realities and priorities. This is mobile learning2.0. The paper looks at the axioms and values of this paradigm and its possible tools and techniques. The treatment is discursive and critical. The paper reimagines the concepts and practices of learning with mobiles. It embraces many significant themes at a high level including inclusive and equitable education; learning theories and design; pedagogical frameworks and methodologies; digital and media literacies; social media and learning environments; online collaboration and communities; Informal and formal learning.
  • A study protocol for a clustered randomised controlled trial to evaluate the effectiveness of a peer-led school-based walking intervention on adolescent girls' physical activity: The Walking in ScHools (WISH) study

    O'Kane, SM; Carlin, A; Gallagher, AM; Lahart, IM; Jago, R; Faulkner, M; Murphy, MH; Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, University of Ulster, Jordanstown Campus, Newtownabbey, BT37 0QB, UK. (Springer, 2020-04-21)
    Background: Adolescent girls in the UK and Ireland are failing to meet current physical activity guidelines. Physical activity behaviours track from childhood to adulthood and it is important that adolescent girls are provided with opportunities to be physically active. Walking has been a central focus for physical activity promotion in adults and may effectively increase physical activity levels among younger people. Following on from a pilot feasibility trial, the purpose of this cluster randomised controlled trial (c-RCT) is to evaluate the effectiveness of a novel, low-cost, peer-led school-based walking intervention delivered across the school year at increasing physical activity levels of adolescent girls. Methods: The Walking In ScHools (WISH) Study is a school-based c-RCT conducted with girls aged 12-14 years from eighteen schools across the Border Region of Ireland / Northern Ireland. Following baseline data collection, schools will be randomly allocated to intervention or control group. In intervention schools, female pupils aged 15-18 years will be invited to train as walk leaders and will lead younger pupils in 10-15 min walks before school, at break and lunch recess. All walks will take place in school grounds and pupils will be encouraged to participate in as many walks as possible each week. The intervention will be delivered for the whole school year (minimum 20-22 weeks). The primary outcome measure is accelerometer-measured total physical activity (counts per minute) (end of intervention). Secondary outcomes will include time spent in sedentary behaviour, light, moderate and vigorous intensity physical activity, anthropometry measures, social media usage and sleep. A mixed-methods process evaluation will also be undertaken. Discussion: The WISH Study will examine the effectiveness of a low-cost, school-based, peer-led walking intervention in increasing physical activity in adolescent girls when delivered across the school year. If the intervention increases physical activity, it would benefit adolescent girls in the defined target area with potential for wider adoption by schools across the UK and Ireland. Trial registration: ISRCTN; ISRCTN12847782; Registered 2nd July 2019.
  • How should adult handgrip strength be normalized? Allometry reveals new insights and associated reference curves

    Nevill, Alan M; Tomkinson, Grant R; Lang, Justin J; Wutz, Wyatt; Myers, Tony D (Lippincott, Williams & Wilkins, 2021-08-24)
    Introduction Handgrip strength (HGS) is an important indicator of health. Because HGS is strongly associated with body size, most investigators normalize HGS for some measure of body size as a more sensitive indicator of strength within a population. We aimed to (1) identify the optimal body size dimension to remove (normalize) HGS for differences in body size among adults, and (2) generate norm-referenced centiles for HGS using the identified body size dimension. Methods Data were from the National Health and Nutrition Examination Survey (NHANES), a representative sample of the U.S. non-institutionalized civilian population. Exclusions resulted in a final sample of 8690 adults aged 20 years and older. HGS was measured using handheld dynamometry. Body size dimensions included body mass, height, and waist circumference. The most appropriate dimension(s) associated with HGS were identified using allometry. We fitted centile curves for normalized HGS using the Generalized Additive Model for Location, Scale, and Shape (GAMLSS). Results Findings suggest that neither body mass nor body mass index is appropriate to normalize HGS. Incorporating all three body size dimensions of body mass, height, and waist circumference, or the reduced sub-sets of body mass and height, or height alone, suggest that the most appropriate normalizing (body size) dimension associated with HGS should be a cross-sectional or surface area measure of an individual’s body size (i.e., L2, where L is a linear dimension of body size). Given that height was also identified as the signally best body size dimension associated with HGS, we recommend HGS be normalized by height2 (i.e., HGS/HT2). Centile curves for HGS/HT2 by age group and gender were therefore provided. Conclusion Scaling HGS by height2 may help normalize strength for population-based research.
  • ‘Grey’ exclusions matter: mapping illegal exclusionary practices and the implications for children with disabilities in England and Australia

    Done, Elizabeth J; Knowler, Helen; Armstrong, David (Wiley, 2021-08-24)
    This paper provides an outline of, and rationale for, an international research project that will identify commonalities and disparities in illegal school exclusionary practices in Australia and England. The aims here are to situate such practices within a global context and to map the events and processes through which children and young people, particularly those with ‘special’ educational needs and disabilities, are removed from school in Australia and England. The research we advocate is premised on evidence that inequitable and illegal exclusionary practices are endemic in education systems globally; hence, ‘pushout syndrome’ in the USA, ‘off rolling’ in England, facilitated ‘dropout’ in Italy and ‘grey exclusions’ in Australia. The authors argue that the repeated commissioning of research by national governments and school inspectorates, intended to accurately ascertain the scale of this problem and its impact on the life trajectories of the excluded, serves to defer meaningful action to prevent its occurrence. School exclusion, whether legal or illegal, can be conceptualized as a process rather than an event, and this paper discusses a descriptive continuum through which exclusionary practices in Australia and England can be mapped An experiential continuum is proposed that facilitates a thematic mapping of contributory factors, identified from a relevant literature, as a preliminary analytical framework for future research.
  • Balanced forced‐diuresis as a renal protective approach in cardiac surgery: Secondary outcomes of electrolyte changes

    Luckraz, Heyman; Giri, Ramesh; Wrigley, Benjamin; Nagarajan, Kumaresan; Senanayake, Eshan; Sharman, Emma; Beare, Lawrence; Nevill, Alan (Wiley, 2021-08-19)
    Objectives Forced-diuresis during cardiopulmonary bypass (CPB) can be associated with significant electrolyte shifts. This study reports on the serum electrolyte changes during balanced forced-diuresis with the RenalGuard® system (RG) during CPB. Methods Patients at risk of acute kidney injury (AKI)—(history of diabetes &/or anaemia, e-GFR 20–60 ml/min/1.73 m2, anticipated CPB time >120 min, Log EuroScore >5)—were randomized to either RG (study group) or managed as per current practice (control group). Results The use of RG reduced AKI rate (10% for RG and 20.9% in control, p = .03). Mean urine output was significantly higher in the RG group during surgery (2366 ± 877 ml vs. 765 ± 549 ml, p < .001). The serum potassium levels were maintained between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for the controls. Median potassium supplemental dose was 60 (0–220) mmol (RG group) as compared to 30 (0–190) mmol for control group over first 24 h (p < .001). On Day 1 post-op, there were no significant differences in the serum sodium, potassium, calcium, magnesium, phosphate, and chloride levels between the two groups. Otherwise, postoperative clinical recovery was also similar. Conclusions Balanced forced-diuresis with the RG reduced AKI rates after on-pump cardiac surgery compared to controls. Although the RG group required higher doses of IV potassium replacement in the postoperative period, normal serum levels of potassium were maintained by appropriate intravenous potassium supplementation and the clinical outcomes between groups were similar.

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