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     

Learning from animation enabled by collaboration

Animated graphics are extensively used in multimedia instructions explaining how natural or artificial dynamic systems work. As animation directly depicts spatial changes over time, it is legitimate to believe that animated graphics will improve comprehension over static graphics. However, the research failed to find clear evidence in favour of animation. Animation may also be used to promote interactions in computer-supported collaborative learning. In this setting as well, the empirical studies have not confirmed the benefits that one could intuitively expect from the use of animation. One explanation is that multimedia, including animated graphics, challenges human processing capacities, and in particular imposes a substantial working memory load. We designed an experimental study involving three between-subjects factors: the type of multimedia instruction (with static or animated graphics), the presence of snapshots of critical steps of the system (with or without snapshots) and the learning setting (individual or collaborative). The findings indicate that animation was overall beneficial to retention, while for transfer, only learners studying collaboratively benefited from animated over static graphics. Contrary to our expectations, the snapshots were marginally beneficial to learners studying individually and significantly detrimental to learners studying in dyads. The results are discussed within the multimedia comprehension framework in order to propose the conditions under which animation can benefit to learning.     

Managing time,workload and costs in distance education: findings from a literature review of Distances et Médiations des Savoirs (formerly Distances et Savoirs)

The purpose of this review, spanning over 12 years of publication of Distances et Médiations des Savoirs (DMS), formerly Distance et Savoirs (DMS) (2003–2014), is guided by the question why and how French-speaking researchers addressed the issues of time, workload and costs in distance learning, and how this was affected by the increasing influence of information and communication technologies.     

Évaluation-sondage dans le premier cycle (12–16 ans)

Sans résuméI.R.E.M. de Rouen     

教练员在培养优秀运运员过程中的作用

在过去的20年里,体育科研工作者努力探讨运动员如何才能成为最优秀的选手.他们认为,教练员在运动员发展过程中的作用不可忽视.     

In search of good citizenship education: A normative analysis of the International Civic and Citizenship Education Study (ICCS)

In the last two decades, calls to place citizenship education (CE) at the top of national and European educational policy and research agendas have been gaining in prominence. Large‐scale comparative studies, such as the International Civic and Citizenship Education Study (ICCS), are often considered the main evidence base for setting these agendas and improving CE policies and practices. This article therefore considers the ICCS study as an inherent part of the process of translating general, educational aims into curricular policies and practices of CE. However, while critical voices about comparative educational studies have become paramount, a detailed analysis of their contents, of what and how they measure and what they promote as the aims of education is often lacking. This article aims to fill this gap by analysing the main research documents, design and items of the 2009 ICCS study. To find out what ICCS promotes as the goals of citizenship education, we examined its normative assumptions in terms of qualification, socialisation and/or subjectification. Our analysis shows that the qualification and socialisation functions are dominantly validated in all aspects of the study, whilst there is only marginal attention to subjectification. This implies that ICCS misses an important potential to document and/or promote pupils becoming autonomous and critical democratic citizens, whilst this is often considered a central aim of citizenship education by policymakers, practitioners and teachers.     

Changes in mechanical properties of sprinting during repeated sprint in elite rugby sevens athletes

This study aimed to analyse fatigue-induced changes in mechanical sprinting properties during a specific repeated-sprint test in elite rugby sevens athletes. Twenty elite rugby sevens players performed ten 40?m sprints on a 30?s cycle with participant’s running back and forth in a marked lane. Radar was used to assess maximal overground sprint performance over each 40?m. Macroscopic mechanical properties (maximal horizontal force (F₀), maximal horizontal power (P_max), maximal ratio of horizontal force (RF_peak), decrease in the ratio of horizontal-to-total force (D_RF), total force and maximal sprinting velocity (v₀)) were drawn from horizontal force velocity relationships, using a validated method applied to the speed–time data. Fatigue-induced changes were analysed comparing the first sprint to an average of 2^nd-4^th, 5^th-7^th and 8^th-10^th. Repeated-sprint ability (RSA) testing induced substantial changes in the maximal velocity component, with a decrease (–15%) in v₀ (effect size (ES)?=?–2.46 to –4.98), and to a lower extent (–5.9%) in the maximal force component F₀ (ES?=?–0.59). D_RF moderately decreased (14%; ES=–0.76–1.11), and RF_peak largely decreased in the later sprints (ES?=?–0.32 to –1.27). Fatigue observed in this RSA test appeared to have a greater effect on the technical ability to produce horizontal force at high velocities, likely due to an alteration in the ability to maintain horizontally oriented force application when velocity increases rather than during the initial acceleration phase, but also the overall force production capacity. The ability to maintain forward-oriented force at high velocities is of central importance for identifying fatigue and monitoring load.