Effect of Early Mobilization Programs in the Intensive Care Unit (ICU). A Review of Systematic Reviews

Title: Effect of Early Mobilization Programs in the Intensive Care Unit (ICU). A Review of Systematic Reviews Authors: Nicholas C. Higa, SPT1; Stephanie J. Pelham, SPT1; Rondamarie B. Smith, SPT1; Ann Wilson, PT, M.Ed., GCS.1 Affiliation(s): 1. Physical Therapy Program, University of Puget Sound; Purpose: To determine the effect of early mobilization on reducing the side effects associated with prolonged bed rest of patients in the ICU. Materials & Methods: CINAHL, The Cochrane Library, PEDro and PubMed were searched between April 2015 to August 2015 to identify systematic reviews published from 2000 to 2015 with the keywords “ambulation,” “critical care,” “early mobilization,” “systematic review,” “ICU,” and “physical therapy.” The search resulted in the retrieval of eight potential articles. Results: The initial search yielded 187 articles with seven meeting the inclusion/exclusion criteria, published from 2009 to 2013, which were rated using the AMSTAR checklist and organized according to outcome measure. The outcome measures include: length of stay in the ICU, length of stay in the hospital, hand grip strength, mortality, functional independence, 6 minute walk test (6MWT), duration of intubation, duration of mechanical ventilation, SF-36 and health related quality of life (QOL). Conclusions: The research indicates early mobilization improves functional mobility and muscle strength, reduces the length of stay in the ICU, the duration of mechanical ventilation and decreases mortality. Keywords: Early Physical Medicine and Rehabilitation, Early Mobilization, ICU, Intensive Care Unit, Systematic Review, Critical Care, Early Mobility, Physical Therap

Hardware Assessment in Support of the Dynamic Power Convertor Development Effort

Stirling Radioisotope Power Systems (RPS) are being developed by NASA's RPS Program in collaboration with the U.S. Department of Energy (DOE). Efforts ranging from 2001 to 2015 enabled development of the Technology Demonstration Convertor (TDC) for use in the 110-watt Stirling Radioisotope Generator (SRG-110) and the Advanced Stirling Convertor (ASC) for use in the Advanced Stirling Radioisotope Generator (ASRG). The DOE selected Lockheed Martin Space Systems Company (LMSSC) as the system integration contractor for both flight development efforts. The SRG-110 housed two TDCs fabricated by Infinia and resulted in the production of 16x demonstration units and 2x engineering units. The project was redirected in 2006 to make use of a more efficient and lower mass ASCs under development by Sunpower Inc. The DOE managed the flight contract with LMSSC and subcontractor Sunpower Inc. from 2007 to 2013 to build the ASRG, with support from NASA Glenn Research Center (GRC). Sunpower Inc. held two parallel contracts to produce ASCs, one with Lockheed Martin to produce ASC-F flight units and one with GRC for the production of ASC-E3 engineering unit pathfinders that were used to refine the flight design and production processes. The DOE initiated termination of the ASRG contract in late 2013. After ASRG had ended, GRC completed characterization testing of the ASRG Engineering Unit #2 (EU2) and the GRC contract with Sunpower was also completed. The NASA RPS Program Office has recently initiated a new Dynamic Power Conversion development effort which includes the potential maturation of Stirling, Brayton, and Rankine power convertors for the next generation of RPS. The effort started with the request for proposal and review of submits. Contracts are anticipated for release in 2017 and will initially focus on a design phase prior to fabrication and testing. This new effort will focus on robustness in addition to high efficiency, specific power, and reliability. Also, some requirements introduced during the ASRG contract have also been included in the new effort, such as constant lateral loading. Due to the focus on robustness and new requirements relative to the older TDC design, the Stirling Cycle Development Project has initiated an assessment of government owned hardware to help inform requirements evolution and evaluation of future designs. While lessons learned from the ASRG flight development project have been taken into consideration, the evaluation of the TDC design had not been completed for some existing environments or relatively new requirements. To further assess the TDC design, a series of tasks were initiated to evaluate degradation for units that have operated unattended for over 105,000 hours, demonstrate robustness to a random vibration environment, characterize and evaluate performance for varying lateral load profiles. The status for each task are described

Trace gas emissions from savanna fires in northern Australia

We present analyses of near‐infrared ground‐based Fourier transform infrared solar absorption spectra recorded from a site in Darwin, Northern Territory, Australia (12.4°S, 130.9°E) from August 2005 to June 2008. Total column amounts of carbon monoxide derived from these spectra show a very clear annual cycle, with evidence of transported pollution from Indonesian fires in 2006. Aerosol optical depth measurements from the same site show a similar annual cycle but without exceptional values in 2006, suggesting significant loss of aerosol loading in the transported and aged smoke. In addition, we report the first ever measurements by remote sensing solar Fourier transform infrared of emission ratios with respect to carbon monoxide for formaldehyde (0.022 ± 0.007), acetylene (0.0024 ± 0.0003), ethane (0.0020 ± 0.0003), and hydrogen cyanide (0.0018 ± 0.0003) from Australian savanna fires. These are derived from mid‐infrared spectra recorded through smoke plumes over Darwin on 20 separate days. The only previous measurements of emission ratios for formaldehyde and hydrogen cyanide from Australian savanna fires involved cryogenic trapping and storage of samples that were gathered in very fresh smoke. The results reported here are nearly an order of magnitude higher (but in agreement with laboratory studies), suggesting losses in the collection, storage, or transfer of the gases in the earlier measurements and/or chemical production of these reactive gases within the smoke plumes. Emission ratios for acetylene and ethane from this work are in broad agreement with other literature values

Extended Operation Testing of Stirling Convertors in Support of Stirling Radioisotope Power System Development

100 We class Stirling convertors began extended operation testing at NASA Glenn Research Center (GRC) in 2003 with a pair of Technology Demonstration Convertors (TDCs) operating in air. Currently, the number of convertors on extended operation test has grown to 12, including both TDCs and Advanced Stirling Convertors (ASCs) operating both in air and in thermal vacuum. Additional convertors and an electrically heated radioisotope generator will be put on test in the near future. This testing has provided data to support life and reliability estimates and the quality improvements and design changes that have been made to the convertor. The convertors operated 24/7 at the nominal amplitude and power levels. Performance data were recorded on an hourly basis. Techniques to monitor the convertors for change in internal operation included gas analysis, vibration measurements, and acoustic emission measurements. This data provided a baseline for future comparison. This paper summarizes the results of over 145,000 hr of TDC testing and 40,000 hr of ASC testing and discusses trends in the data. Data shows the importance of improved materials, hermetic sealing, and quality processes in maintaining convertor performance over long life

A core outcome set for seamless, standardized evaluation of innovative surgical procedures and devices (COHESIVE):a patient and professional stakeholder consensus study

To develop a COS, an agreed minimum set of outcomes to measure and report in all studies evaluating the introduction and evaluation of novel surgical techniques. SUMMARY OF BACKGROUND DATA: Agreement on the key outcomes to measure and report for safe and efficient surgical innovation is lacking, hindering transparency and risking patient harm. METHODS: (I) Generation of a list of outcome domains from published innovation-specific literature, policy/regulatory body documents, and surgeon interviews; (II) Prioritization of identified outcome domains using an international, multi-stakeholder Delphi survey; (III) Consensus meeting to agree the final COS. Participants were international stakeholders, including patients/public, surgeons, device manufacturers, regulators, trialists, methodologists, and journal editors. RESULTS: A total of 7972 verbatim outcomes were identified, categorized into 32 domains, and formatted into survey items/questions. Four hundred ten international participants (220 professionals, 190 patients/public) completed at least one round 1 survey item, of which 153 (69.5%) professionals and 116 (61.1%) patients completed at least one round 2 item. Twelve outcomes were scored “consensus in” (“very important” by ≥70% of patients and professionals) and 20 “no consensus.” A consensus meeting, involving context: modifications, unexpected disadvantages, device problems, technical procedure completion success, patients’ experience relating to the procedure being innovative, surgeons’/operators’ experience. Other domains relate to intended benefits, whether the overall desired effect was achieved and expected disadvantages. CONCLUSIONS: The COS is recommended for use in all studies before definitive randomized controlled trial evaluation to promote safe, transparent, and efficient surgical innovation