What Are the Barriers to Mobilizing Intensive Care Patients?

Purpose

Recently there has been increased interest in early mobilization of critically ill patients. Proposed benefits include improvements in respiratory function, muscle wasting, intensive care unit (ICU), and hospital length of stay. We studied the frequency of early mobilization in our intensive care unit in order to identify barriers to early mobilization.

Methods

A 4-week prospective audit of 106 patients admitted to a mixed medical-surgical tertiary ICU (mean age 60 ± 20 years, mean APACHE II score 14.7 ± 7.8) was performed. Outcome measures included number of patient days mobilized, type of mobilization, adverse events, and reasons for inability to mobilize.

Results

Patients were mobilized on 176 (54%) of 327 patient days. Adverse events occurred in 2 of 176 mobilization episodes (1.1%). In 71 (47%) of the 151 patient days where mobilization did not occur, potentially avoidable factors were identified, including vascular access devices sited in the femoral region, timing of procedures and agitation or reduced level of consciousness.

Conclusions

Critically ill patients can be safely mobilized for much of their ICU stay. Interventions that may allow more patients to mobilize include: changing the site of vascular catheters, careful scheduling of procedures, and improved sedation management.Key Words: intensive care units, mobility, physical therapy     

The radium century

Last year, the UK Government agreed that a potentially dangerous legacy of radiation-contaminated land should be dealt with, after decades of ignorance and inaction on the part of the authorities. The cost of this could run to many hundreds of millions of pounds, assuming that the hundreds of sites potentially involved, which date from the birth of the nuclear industry, can actually be identified. This very practical problem cannot be tackled without an understanding of the lost history of the production and use of radium--a history that is now precisely a century in duration.     

South African Deaf education and the Deaf community

In a special section of the american Annals of the Deaf, Deaf education and the Deaf community in South Africa are discussed. The special section is organized into 7 segments: a historical overview to establish context, the educational context, educators and learners, postgraduate education and employment, perspectives of Deaf children and their parents, sport and the arts, and spiritual lives and mental health. Throughout the entire section, however, the central focus is on the overall foundation (or lack thereof) of education for Deaf learners in South Africa.     

Sports participation and academic performance: Evidence from the National Longitudinal Study of Adolescent Health

It has been argued that high school sports participation increases motivation and teaches teamwork and self-discipline. While several studies have shown that students who participate in athletic activities perform better in school than those who do not, it is not clear whether this association is a result of positive academic spillovers, or due to the influence of unobservables. Using data from the National Longitudinal Study of Adolescent Health and a variety of statistical techniques designed to distinguish between these hypotheses, we examine the effect of sports participation on several measures of academic performance. Our results provide only limited evidence that sports participation leads to enhanced academic performance.     

Reading and writing from multiple source documents in history: Effects of strategy instruction with low to average high school writers

This study examined the effects of historical reasoning strategy instruction on 11th-grade students. Students learned historical inquiry strategies using 20th Century American history topics ranging from the Spanish-American war to the Gulf of Tonkin incident. In addition, students learned a pre-writing strategy for composing argumentative essays related to each historical event. Results indicate that in comparison to a control group (N = 79), essays written by students who received instruction (N = 81) were longer, were rated as having significantly greater historical accuracy, were significantly more persuasive, and claims and rebuttals within each argument became more elaborated. Importantly, students in the control group read the same primary and secondary source document sets, and received feedback on written essays on the same topics.     

Decolonial pedagogy and the ethics of the global

An ethical and democratic globality, and the kind of education that would contribute to it, are only possible in the context of a recognition of the relations of power that have shaped history, and in particular the political, cultural, economic, and epistemological processes of domination that have characterized colonialism and Eurocentrism. Imagining an ethics of the global in this context means articulating a decolonial perspective. Starting from recent work in philosophy and cultural studies, this paper describes key principles of such an orientation to globality, and develops a reconceptualization of education in the context of this framework. The article proposes in particular a curriculum against domination, oriented against the epistemic and cultural violence of Eurocentrism that underlies the politics of content and knowledge in education, and a pedagogy of lovingness, committed to building global solidarity based on non-dominative principles of coexistence and kindredness.     

云南民族基础教育政策实施情况的调查及对策研究——以德宏州陇川县为例

结合云南省近些年来实施的基础教育政策,项目组对云南省德宏州5所小学的调查发现,基础教育政策的落实依然存在很多问题,表现在学校控辍保学工作难度大、学生语言学习存在障碍、教育财政资金投入不足等。因而提出相应的建议,保障基础教育政策的贯彻落实,促进民族地区的基础教育更好地发展。     

Competence-based teacher education: Illusion or reality? An assessment of the implementation status in Flanders from teachers’ and students’ points of view

Since 1998, the Flanders’ educational government in Belgium has been urging teacher education institutions by decree to implement competences in teacher training programs. Since then, years have gone by, and institutions have acted in order to achieve the competence-based goals. However, have they succeeded in implementing them? This is the research question that is central to the current study. An online survey inquiry was set up in eight elementary teacher education institutions using two questionnaires; one for final year elementary institution pre-service teachers, who were about to graduate at the time of completing the questionnaire (N = 218), the other for teacher trainers throughout the elementary teacher training program (N = 51). Ten years after the decree was issued, results show that competence-based education has become a reality in terms of its implementation. However, the process has not yet come to an end. Whereas some competences are clearly present in the institutions’ policies and practices (e.g. teacher as guide to learning and development, teacher as subject expert), others are poorly represented (e.g. teacher as partner of parents, external parties and as a member of the educational community). Moreover, teacher trainers tend to take four different approaches to the implementation of competences (1) during internship, (2) through the institution’s policy and program planning, (3) by means of their integration in both theoretical and practical components of the curriculum and finally, (4) a lack of implementation because the competences are considered insufficiently applicable by the teacher trainers. In particular, more experienced and subject expert teacher trainers tend to adopt the final approach more often than do younger colleagues and pedagogues. Student teachers’ results, on the other hand, suggest important differences between institutions concerning their understanding of competences and the integration of these competences in the curriculum; suggesting different paces of adaptation between teacher education institutions. Moreover, even within schools, the trajectory towards implementation is not always clear for all members of the teaching team, nor for the students of most teacher education institutions. Consequently, there is still important work to be done in order for successful competence-based change to occur.     

Problèmes de la pensée logique dans l'enseignement des mathématiques

Sans résumé