Joseph Adler

Purpose: The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety. Methods: We searched the electronic databases of PubMed, CINAHL, Medline (Ovid), and The Cochrane Library for a period spanning 2000-2011. Articles used in this review included randomized and nonrandomized clinical trials, prospective and retrospective analyses, and case series in peerreviewed journals. Sackett's Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported. Results: Fifteen studies met inclusion criteria and were reviewed. According to Sackett's Levels of Evidence, 9 studies were level 4 evidence, one study was level 3, 4 studies were level 2, and one study was level one evidence. Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories. Conclusion: A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit. However, literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes.

PURPOSE: The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety. METHODS: We searched the electronic databases of PubMed, CINAHL, Medline (Ovid), and The Cochrane Library for a period spanning 2000-2011. Articles used in this review included randomized and nonrandomized clinical trials, prospective and retrospective analyses, and case series in peer-reviewed journals. Sackett's Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported. RESULTS: Fifteen studies met inclusion criteria and were reviewed. According to Sackett's Levels of Evidence, 9 studies were level 4 evidence, one study was level 3, 4 studies were level 2, and one study was level one evidence. Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories. CONCLUSION: A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit. However, literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes.

Early reliable, valid screening, diagnosis, and treatment improve peripheral arterial disease outcomes, yet screening and diagnostic practices vary across settings and specialties. A scoping literature review described reliability and validity of peripheral ischaemia diagnosis or screening tools. Clinical studies in the PUBMED database January 1, 1970, to August 13, 2018, were reviewed summarising ranges of reliability and validity of peripheral ischaemia diagnostic and screening tools for patients with non-neuropathic lower leg ischaemia. Peripheral ischaemia screening and diagnostic practices varied in parameters measured such as timing, frequency, setting, ordering clinicians, degree of invasiveness, costs, definitions, and cut-off points informing clinical and referral decisions. Traditional ankle/brachial systolic blood pressure index <0.9 was a reliable, valid lower leg ischaemia screening test to trigger specialist referral for detailed diagnosis. For patients with advanced peripheral ischaemia or calcified arteries, toe-brachial index, claudication, or invasive angiographic imaging techniques that can have complications were reliable, valid screening, and diagnostic tools to inform management decisions. Ankle/brachial index testing is sufficiently reliable and valid for use during routine examinations to improve timing and consistency of peripheral ischaemia screening, triggering prompt specialist referral for more reliable, accurate Doppler, or other diagnosis to inform treatment decisions.

Frequency stability of resonators used in low noise oscillators is typically achieved by encasing the resonator or the complete oscillator in a temperature-controlled oven. This method is preferred over electrically pulling the resonator which results in a lower loaded Q. The oven approach introduces long warm-up time, increased size, and adds considerably to the total power dissipation of the oscillator. The objective is to develop an oven structure which drastically reduces both warm-up time and power dissipation.

Of the approximately 20 million public employees in the United States, more than eight million are either members of or represented by labor unions—a penetration rate of just over 40 percent. What is remarkable about this phenomenal growth is that most of the expansion of union activity in government has occurred within the last 40 years, and almost mirrors the decline of union strength in the private sector. The rise and fall of labor in the private sector is a backdrop to the growth of public sector collective bargaining. Explanations for the dramatic increase in government union activity can be explored from a number of different perspectives. Current public policy efforts to reform civil service and allow managers greater flexibility are seen by some researchers as having the potential to impact the ability of public sector unions to represent their members effectively. The recent split within the AFL-CIO may also have consequences affecting public sector union activity. Costly and self defeating jurisdictional disputes can arise and subsequently lead to a decline in membership strength. On the other hand, increased competition can serve to reinvigorate the entire labor movement in much the same way that the original split between the AFL and CIO resulted in massive private sector organizing efforts and dramatic, if temporary membership gains.