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The price of oil is trading around $77/barrel today. Oil prices are up 40% year over year while total oil demand in the U.S., the world's largest consumer of oil, was down some 7%.
click to enlarge
High unemployment and the economic contraction in the U.S. have led to a reduction in gasoline demand even in the non-discretionary driving months of January and February.
While oil prices are up 40%, the U.S. dollar index is only down around 8% year over year. Since December of 2009, the U.S. dollar has rallied nearly 10%, yet oil prices are relatively unchanged. Worldwide oil supplies are brimming and the U.S. strategic petroleum reserve is filled to capacity. Given all the bearish fundamentals, the obvious question is: why are oil prices so high?
Some people would say it's a conspiracy by oil traders, speculators, hedge funds, "big oil", or market manipulators. However, the oil market is a very liquid worldwide market by many different producers and consumers all of whom have their own best interests in mind. There are national oil company players as well as large private oil producers. Is it possible for speculative money to influence the price of oil? Absolutely. Can it alone completely explain today's high prices? My opinion is "no".
My take is this: world governments, traders, speculators, producers, consumers and investors all realize a simple basic fact: the world economy runs on oil. It is indispensable to economic growth. Currently, there are no realistic alternatives in place to the gasoline (oil) powered personal car and truck markets within the world's largest consumer market (the U.S.) and the world's second largest and fastest growing consumer market (China). Meanwhile, it is becoming very apparent worldwide oil production will have much difficulty keeping up with worldwide demand in the years ahead given a functioning and growing world economy.
A U.S. Government Gone Wrong: a Financial Crisis to Join the Oil Crisis
What has been the response by the U.S. energy policymakers to the $147/barrel oil prices in 2008, current high unemployment, the huge transfer of American wealth to oil producing nations, and the economic, environmental, and national security issues as a result of the country's 65% reliance on foreign oil? In two words: absolutely abysmal. The U.S. still has not adopted a strategic long-term comprehensive energy policy (like this for instance), the Obama administration is continuing the same failed policies of the Bush administration. The Federal Reserve continues to print dollars in an attempt to solve a commodity problem (oil) with fiscal and monetary tom-foolery.
U.S. energy policymakers continue to ignore the only domestic fuel capable of being scaled up to significantly reduce foreign oil imports: abundant, clean, and cheap natural gas. These policymakers continue to ignore the best solution to the unemployment problem: natural gas transportation and infrastructure jobs in the auto, energy, and industrial sectors. While creating good paying jobs, such an energy policy and jobs initiative would keep billions of dollars in the U.S. wealth which is now going to foreign oil producers ($365 billion in 2009, close to half a trillion dollars in 2008).
As a result of this breakdown in U.S. government "leadership", failed energy policies, and very unwise (fraudulent might be a better word….) fiscal and monetary policies, the U.S. is now awash in debt. It is growing, and there is no doubt we will be servicing such debt for generations to come. Bottom line: the U.S. now has a financial crisis in addition to its oil crisis. All the time, excellent natural gas legislation (HR 1835 for instance) remains moth-balled in Congress as well as Ron Paul's excellent proposal to audit the Federal Reserve and shed some well required light on the fraudulent un-Constitutional activities of that bureaucracy.
Let us reflect on this for a moment: the world's reserve currency of choice (the U.S. dollar) is built on the fragile foundations of foreign oil dependence and very unsound financial policies. The country printing the world's reserve currency is hemorrhaging its wealth to pay for foreign oil. The world's reserve currency is being controlled by a very small group of people who, led by Benjamin Bernanke at the Federal Reserve, in complete secrecy and without Congressional oversight, and with the assistance of a corrupt U.S. Treasury department, print fiat U.S. dollars backed by nothing by thin air. Who can be surprised when the money printed ends up in the hands of people like Lloyd Blankfein at Goldman Sachs (NYSE:GS), Robert Benmosche at AIG, and Jamie Dimond at J.P. Morgan (NYSE:JPM) as "bonuses" for their roles in causing the recent near complete financial meltdown of the entire U.S. financial system?
As a result, countries like Brazil, China, Russia, India and even allies like Germany and France have publicly called for an alternative world reserve currency. However, this will be complicated and will take time to implement due to the wide use and of the U.S. dollar in worldwide trading systems. So, what are investors to do in the meantime? Buy oil. Buy gold. In my opinion, this is exactly why oil and gold are at trading at such high levels even in the midst of the most serious economic contraction since the Great Depression.
Investment Advice:
While investors can make money in individual stocks and sectors from time-to-time, long-term investing in broad U.S. equity indexes is a losing proposition. Returns on the S&P500 over the past decade, while oil has gone from under $20 to $147 to $30 to today's $77, have been abysmal. It is clear the oil price roller coaster has not been friendly to the U.S. equity markets (which makes me wonder why those managing money at Vanguard, Fidelity, and other firms are not pounding the table for the U.S. to adopt a strategic long-term comprehensive energy policy – they must surely see the writing on the wall). So, the first step in successful investing is to simply get out of any broad based U.S. equity fund. In addition, considering the heavy debt load of U.S. Federal and State governments, high unemployment rates and a broken government, I would also recommend staying clear of bond funds and municipal "bombs" as that market is a disaster waiting to happen.
My advice is to stick with oil and gold. Buy oil companies that will pay good dividends while you wait for the next oil price spike that we all know is coming: BP (yielding 6.4%), COP (4.2%), CVX (3.8%), and Statoil (NYSE:STO) are all good buys. Statoil recently proposed a 2010 dividend of NOK 6.00 per share. This works out to $1 US per share, which means the STO ADR (NYSE) has a 4.5% yield. Statoil pays a once yearly dividend and it will be paid June 2, 2010. STO will go ex-dividend on May 20, 2010.
Meantime, look for weakness to buy gold and silver bullion in addition to the GLD and SLV ETFs. As the commercials said, if I gave you a choice between $10,000 in U.S. dollars versus $10,000 worth of U.S. gold eagles, and said you couldn't touch either for 10 years, which would you rather own a decade from now? Gold is the ultimate preserver of wealth. Increasingly, America's governmental policies are leaving U.S. investors with fewer and fewer alternatives.
Disclosure: Long BP, COP, STO, gold


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Information classification schemes are overly complex, says ISF
Chief information officers need to take a leading role in setting up formal information classification schemes to stop them over-engineering them to comply with security regulations, according to a report from the Information Security Forum (ISF).
This Article Covers
Risk management
Chief information officers need to take a leading role in setting up formal information classification schemes to stop them over-engineering them to comply with security regulations, according to a report from the Information Security Forum (ISF).
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The ISFsaid that information classification systems were overly complex. "As a result they rarely deliver business benefits and are often simply ignored," it said.
Good information classification prevents over complicating controls, it said. This cuts the costs and resources needed to protect information.
"Information classification can also help to enforce better access control policies and demonstrate compliance with data protection and privacy legislation as well as regulations such as HIPAA and Gramm-Leach Bliley," it said.
The ISF said participation was essential from HR, Legal, IT and Audit, along with board support. "Having senior managers with a shared strategic vision and understanding of information classification and the value it can deliver is critical to overcome budgetary and organisational issues. It is also vital to run a successful pilot project to show a 'quick win' to demonstrate the benefits," said Nick Frost at the ISF who wrote the report.
Frost said information classification requires a consistent process to determine the level of confidentiality of a piece of information, the development of techniques to communicate that classification, and practical measures to protect it.
Frost said, "Information exists in many different forms, from paper documents and verbal communications to the masses of electronic data stored, transmitted and processed. Although introducing an effective enterprise-wide scheme is daunting, organisations can no longer afford to ignore its importance if embarrassing data losses (such as the HM Revenue & Customs incident) are to be avoided."
The ISF recently published an upgraded Standard of Good Practice for Information Security, which is available free to non-members at the ISF Standard website.
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Security Think Tank: Allocate maintenance processes to each piece of key software
Security Think Tank: Using vulnerability management to support the patching process
Lancaster and Newcastle researchers tackle Met Police email challenge
InfoSec Europe 2012: A look at IT security skills in the current climate
Tim Wilson, deputy head of ICT at NHS City & Hackney, on ISO 27000 compliance
Input from the business vital to risk management in infosec, says CISO for Steria UK


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The 2011 Cove Shocker features a 1.5″ headtube that you can also modify by using different headset cups. It has a 64 degree headtube angle and replaceable dropouts. The frame is handmade in Canada and also is equipped with a finely tuned customized Elka Shock (Stage 5 damper).
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Pioneer hosts annual Science and Art Fair
ARLINGTON — Pioneer Elementary's annual Science and Art Fair on Friday, May 17, turned STEM into STEAM by debuting a new theme this year, "STEAM into Science."
According to Kari Pendray, a member of the Advisory Council for Education for Pioneer Elementary, the school's students added an A for art to the STEM acronym of science, technology, engineering and math.
"The idea is that much of STEM requires the use of art in design, problem-solving and creative thinking, all of which are highly sought-after skills needed in current and future employment markets," Pendray said.
The Pioneer Elementary Science and Art Fair has increased its participants from 80 in 2010 to 250 in 2013.
"The fair continues to grow in size, likely because of the momentum in science that has been building over the last three years," Pendray said. "You can't miss the enormous smiles you see on the students' faces, as they beam with delight when they bring in their science experiments. Kids are learning by doing, and the work is fun because they get to do hands-on experiments in the process."
From iguana studies to creating energy from pickles, the fair's subjects are limited only by the imaginations of the kindergarten through fifth-grade students.
"It's really great to see how what we're teaching is actually applied in their projects," said Molly Ahrens, a fifth-grade teacher at Pioneer Elementary who graded the students' projects.
One Pioneer Elementary student, Angela Gotera, found herself moved by more than mere scientific inquiry. Her project sought to measure "How Horses Keep Warm," by considering the circulation of air and how the direction a horse faces against the wind keeps their body temperature warm.
"The Science and Art Fair inspired me to ponder harder about the world, and made me want to be a doctor when I grow up," Gotera said.
Pendray noted that parental involvement is a key ingredient of the fair, since students not only learn the science in school, but also do their projects at home.
"The trick is finding the right balance between project guidance and allowing children enough independence at their age level," Pendray said. "The more that parents, teachers and the community can gently guide children in the direction of their interests, the more momentum children can gain towards reaching their dreams."
"Every Science and Art Fair poses both a challenge and an opportunity for our children to think and learn," said Chie Gotera, Angela's mom. "That is a great thing."
Another newly added feature this year included community participants. This year's fair enhanced participation from community members through the Arlington Apple Early Childhood Education and Assistance Program, which created hands-on science investigations for students using magnets, colored water tubs and sparkle clay to show the "science of play," as well as the Arlington-based Aerospace Manufacturing Technologies, which created a display to show how airplane parts are made.
"Community partners show students what science looks like in the real world, and send a message that we care about what the students are doing," said Brian Gross, project manager at AMT.
"I truly want to thank the Science and Art Fair Committee for their vision and continual facilitation of this wonderful event, as well as our teachers, parents and community members," said Karl Olson, principal of Pioneer Elementary. "By combining the arts with science, we can highlight the wonderful work and creativity of so many of our students. The best part is that these experiences will spark future directions for many students, and encourage them to strive for careers and activities in these areas. Each year, this event grows larger, more families attend and students get to show off what they've learned."
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Primary Care Doctor, Family Practitioner
38 years of experience
38 years of experience
Mountain Creek
7500 W Camp Wisdom Rd
Dallas, TX 75236 Phone number & directions
7500 W Camp Wisdom Rd
Dallas, TX 75236 Phone number & directions
License & Identifications
A medical license is required for a doctor to practice medicine in a particular state. Requirements vary by state but most require, at a minimum, post-graduate training in the doctor's specific specialty. An NPI number is a national identifier unique to an individual health care provider and is managed by the Center for Medicare & Medicaid Services (CMS).
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Dr. Gordon Whitney, MD is board certified in Family Medicine.
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Dr. Whitney graduated from University of Washington, Seattle.
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Dr. Gordon Whitney practices Family Medicine near Dallas, TX.
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Topic: open graph
Google Offers Social Sign-In Alternative to Facebook
Pits two companies as rivals for online identities
By Tim Peterson on Feb. 26, 2013 - 2:15 PM EST
Facebook has pretty much become the Social Security Administration when it comes to unified online identities, thanks to Facebook Connect. Sure, not everyone or every publisher or every app developer…
How Facebook's Open Graph Impacted 'USA Today's Super Bowl Ad Meter
Led to 200,000 more videos viewed
By Tim Peterson on May. 21, 2012 - 9:00 AM EDT
This year marked the first time USA Today digitized its 23-year-old Super Bowl Ad Meter by rolling it out to Facebook in app form. You know lots of love weigh…
ESPN.com Enables Facebook's Automated Sharing
Publisher the latest to sign on for Open Graph, with some restrictions
By Mike Shields on Mar. 29, 2012 - 12:37 PM EDT
Publishers are warming to Facebook's Open Graph—with some reservations. For example, ESPN.com last week began rolling out Facebook's social sharing product on select news pages. Users who opt in will automatically…


text: May the Best Name Win! Babble Editors Baby showers can be a great time to brainstorm baby names with your friends. Moms share favorite baby shower games that may help you settle on a baby-name. Balloon Pop 1 of 6 Share "At my cousin's shower they put random baby names in balloons and the right baby name in one balloon. Each guest picked a balloon and then everyone popped their balloon. The person with the right name won a prize!"—Julie J. Letter Scramble 2 of 6 Share "I went to a baby shower where the mom did not have a name for her baby yet. For fun, we were asked to take the mom's first name and the dad's first name plus their last name and come up with as many baby names as we could create with those letters."—Kathy K. Who Wrote That? 3 of 6 Share "Have everyone write down a bizarre (or serious) baby name. Have the mom-to-be try to match up the made-up baby name with the person who wrote it."—Sandra Spell It 4 of 6 Share "If the parents have already picked out the baby's name, you can play a spelling game. Take the baby's full name and try to make as many words as possible with the letters from the... By the Letter 5 of 6 Share "We played a game where we used the letter she desired the baby's name to begin with to come up with as many names as we could in one minute. Duplicate names got scratched off as each player read their list and the person with the largest number of remaining names won a prize. The bonus was that our expectant mom had the chance to hear potential names for her precious little one!"—Monica Letter Grab Bag 6 of 6 Share "Depending on the amount of people attending the shower, put them in teams of four five or six then put some letters in a bag every one pick a letter out then work as a team a make up a name."—Jackie L. Article Posted 5 years Ago Share this article $icon_label $icon_label $icon_label $icon_label See Comments What do you think? Share this article $icon_label $icon_label $icon_label $icon_label See Comments What do you think? What do you think? Use a Facebook account to add a comment, subject to Facebook's Terms of Service and Privacy Policy. Your Facebook name, profile photo and other personal information you make public on Facebook (e.g., school, work, current city, age) will appear with your comment. Learn More Close comments


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Grizzly G0703 - 1-1/2 HP 2 Stage Cyclone Dust Collector
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220V Operation: 220V operation requires installation of a 220V conversion kit. For your own safety, all wiring procedures MUST be completed by an electrician or other qualified service personnel. See Owner's Manual for details. For new machines (or those made since March, 2011) order item #P0703P088. For machines made prior to March, 2011, order item #P0703088. The manufacture date is provided on the main product label of the machine.
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Case Citation Simple Examples
A selection of articles related to case citation simple examples.
Original articles from our library related to the Case Citation Simple Examples. See Table of Contents for further available material (downloadable resources) on Case Citation Simple Examples.
- The Case of Ted Owens (The PK Man)
- The principal concern of most readers will be whether the evidence in the Ted Owens case, as presented by Dr. Mishlove, is true beyond a reasonable doubt. Were this case the only case open to investigation it might well be considered beyond the pale of...
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- Waking Paralysis Related Case Histories: #1: Ms. E: Ms. E. I had another spontaneous, unwanted, OBE a few days ago. I was sitting in for a Maths lecture to take a nap (I don't take Mathematics) and was feeling very cold, rather hungry and miserable as I...
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- Survivalists' Guide for the New Millennium: Chapter 6
- AS THE WORM TURNS Health and well being are part of the natural birthright of the human being. With all of its organs intact, the right diet, exercise and mental focus, a human body can overcome any disease. Even so, the effects of living in this...
Philosophy >> Survivalists Guide for the New Millennium
- Serveral Simple But Useful Meditations
- MEDITATIONS Before you start any kind of meditation, here are a few tips: Pick a place where you will not be disturbed. If you want, you may put on some relaxing music or nature sounds to keep you from possible distractions. Get into an upright position...
Mind >> Meditation
- A Treatise on Astral Projection, Part 4: More Rope Techniques
- ROPE is a very effective projection technique, but it still has to be learned to be effective. I would like to elaborate on a couple of points about the technique, inspired by the feedback I have received so far. There is NO visualization required - AT ALL -...
Parapsychology >> Astral Projection
- A Few Simple Stretches
- Here are a few simple Yoga stretches for those days when life gets you in the neck, in the back, in the shoulder or for the dreaded internetitis rigor mortis. Always work within your comfort level, it is meant to relax and stretch the muscles not to force...
Body Mysteries >> Yoga
- A Simple Cleansing Meditation
- Make sure that you have a comfortable chair where you can sit with your feet firmly flat on the ground. Loosen any tight clothing and rest your hands in your lap. Relax and breathe deeply and rhythmically. In. Out. Each time you breathe in, envision yourself...
Mind >> Meditation
Case Citation Simple Examples is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, Case Citation Simple Examples books and related discussion.
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- Of course, there have been episodes when religious ideas or politics have got in the way of scientific advance (such as the Galileo case). ... But it's not that simple.
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- Most cited "cases" are opinions of appellate courts; however, trial court rulings ... section 3-200 provides both basic examples and sample case citations from all ...
- www.law.cornell.edu
- Basic Legal Citation (2015)
- EXAMPLES – CITATIONS OF . ... Introduction to Basic Legal Citation (online ed.
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- Law Library. BASIC LEGAL CITATION ... A case citation usually has the following components: 1 ...
- www.asl.edu
- Chapter 2 HOW TO READ A LEGAL CITATION - AALL
- One basic format of a legal citation includes the ... The citation in our example above begins with the case name, which includes the plaintiff/appellant's last ...
- www.aallnet.org
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text:
Lunchbox Biscuits
2 cups + 2 Tbsp. whole wheat flour 1 Tbsp. baking powder 1/2 tsp. salt 1/2 cup vegetable shortening 1 cup unsweetened plain soy milk mixed with 1/2 Tbsp. apple cider vinegar Water
•Preheat the oven to 375°F. •In a large bowl, combine the flour, baking powder, and salt. •Cut the vegetable shortening into the dry mixture and combine until the dough is crumbly. •Stir in the mixture of soy milk and vinegar until a ball of dough starts to form. •Knead the dough a couple of times, dusting your hands with the extra 2 tablespoonfuls of flour as needed. If the dough is dry, add small amounts of water (about a tablespoonful at a time) to moisten it. •Dust your hands lightly with the remaining flour, then grab handfuls of dough and shape them into biscuits. •Line a baking sheet with parchment paper and add the biscuits, spaced approximately 1 inch apart. Bake for about 10 minutes, or until the bottoms start to brown. Makes 10 biscuits
Commenting is closed.
These look awesome! I wonder if almond milk will work as well, though? Looks like I get to experiment!


text:
i was asked to do this cake by a friend for niece...apparently the nan had seen my previous present stacked cake and liked the colours. now i think the colours arent quite right for a 21st...it looks a bit 'babyish' but they were pleased with the result so thats all that matters!
CakeCentral.com is the world's largest cake community for cake decorating professionals and enthusiasts.
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text:
Most Cited Intensive and Critical Care Nursing Articles
The most cited articles published since 2011, extracted from Scopus.
The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic studyVeronika Karlsson | Ingegerd Bergbom | Anna Forsberg
Volume 28, Issue 1, February 2012, Pages 6-15
Aim: The aim of this study was to illuminate the lived experience of patients who were conscious during mechanical ventilation in an intensive care unit (ICU). Method: Interviews with 12 patients assessed as being conscious during mechanical ventilation were conducted approximately one week after discharge from an ICU. The text was analysed using a phenomenological-hermeneutic method inspired by Ricoeur. Results: Apart from breathlessness, voicelessness was considered the worst experience. The discomfort and pain caused by the tracheal tube was considerable. A feeling of being helpless, deserted and powerless because of their serious physical condition and inability to talk prompted the patients to strive for independence and recovery and made them willing to 'flow with' the treatment and care. Comments from the patients suggest that their suffering can be alleviated by communication, participation in care activities and companionship. Conclusion: A patient's endurance whilst conscious during mechanical ventilation seems to be facilitated by the presence of nurses, who mediate hope and belief in recovery, strengthening the patient's will to fight for recovery and survival. © 2011 Elsevier Ltd.
Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patients-Findings from 250 interviewsK. A M Samuelson
Volume 27, Issue 2, April 2011, Pages 76-84
Aim: In order to improve the patients' comfort and well-being during and after a stay in the intensive care unit (ICU), the patients' perspective on the intensive care experience in terms of memories is essential. The aim of this study was to describe unpleasant and pleasant memories of the ICU stay in adult mechanically ventilated patients. Method: Mechanically ventilated adults admitted for more than 24. hours from two Swedish general ICUs were included and interviewed 5 days after ICU discharge using two open-ended questions. The data were analysed exploring the manifest content. Findings: Of the 250 patients interviewed, 81% remembered the ICU stay, 71% described unpleasant memories and 59% pleasant. Ten categories emerged from the content analyses (five from unpleasant and five from pleasant memories), contrasting with each other: physical distress and relief of physical distress, emotional distress and emotional well-being, perceptual distress and perceptual well-being, environmental distress and environmental comfort, and stress-inducing care and caring service. Conclusion: Most critical care patients have both unpleasant and pleasant memories of their ICU stay. Pleasant memories such as support and caring service are important to relief the stress and may balance the impact of the distressing memories of the ICU stay. © 2011 Elsevier Ltd.
Exploring the validity of the bispectral index, the Critical-Care Pain Observation Tool and vital signs for the detection of pain in sedated and mechanically ventilated critically ill adults: A pilot studyCéline Gélinas | Yannick Tousignant-Laflamme | Andréanne Tanguay | Patricia Bourgault
Volume 27, Issue 1, February 2011, Pages 46-52
This pilot study aimed to explore the validity of the bispectral (BIS) index, the Critical-Care Pain Observation Tool (CPOT) score, and vital signs (mean arterial pressure, heart rate) during rest and painful procedures in sedated and mechanically ventilated ICU adults. A convenience sample of nine patients with various diagnoses participated in this observational repeated measures study. Patients were observed during 2. minute periods at rest (baseline), and during procedures known to be painful: turning and endotracheal suctioning. Both the BIS index and the CPOT score were found to increase when patients were exposed to procedures compared with rest, and were found to be more sensitive to procedures compared with vital signs. Indeed, vital signs remained quite stable during procedures in this sample. Results from this study support the recommendation that behavioural indicators (i.e. in this case, the use of a behavioural pain scale called the CPOT) be used for the detection of pain in nonverbal ICU patients. However, in some situations (e.g. deep sedation, use of blocking agents), behavioural indicators may no longer be observable, and all that is left are physiologic signs. The BIS seems to be an interesting technique and further research is required in order to establish if it could be used to guide clinicians for the detection of pain in this vulnerable population. © 2010 Elsevier Ltd.
Integrating a multidisciplinary mobility programme into intensive care practice (IMMPTP): A multicentre collaborativeRick D. Bassett | Kathleen M. Vollman | Leona Brandwene | Theresa Murray
Volume 28, Issue 2, April 2012, Pages 88-97
Background: ICU immobility can contribute to physical deconditioning, increased ICU and hospital length of stay and complications post discharge. Despite evidence of the beneficial outcomes of early mobility, many ICUs and providers lack necessary processes and resources to effectively integrate early mobility into their daily practice. Objective: To create a progressive mobility initiative that will help ICU teams to address key cultural, process and resource opportunities in order to integrate early mobility into daily care practices. Methods: An initiative to integrate the latest evidence on mobility practice into current ICU culture in 13 ICUs in eight hospitals within the US was launched. A user-friendly, physiologically grounded evidence-based mobility continuum was designed and implemented. Appropriate education and targeted messaging was used to engage stakeholders. To support and sustain the implementation process, mechanisms including coaching calls and various change interventions were offered to modify staffs' practice behaviour. Qualitative data was collected at two time points to assess cultural and process issues around mobility and provided feedback to the stakeholders to support change. Quantitative date on ventilator days and timing of physical therapy consultation was measured. Results: Qualitative reports of the mobility programme participants suggest that the methods used in the collaborative approach improved both the culture and team focus on the process of mobility. There were no significant differences demonstrated in any of the mobility intervention group measurement however, a reduction in ventilator days (3.0. days pre vs. 2.1 days post) approached significance (. p=. 0.06). Conclusion: This multi-centre, ICU collaborative has shown that improvements in team culture, communication and resources can improve adoption of early mobility in ICU patients. © 2011 Elsevier Ltd.
Visiting policies in the adult intensive care units: A complete survey of Dutch ICUsAfien E. Spreen | Marieke J. Schuurmans
Volume 27, Issue 1, February 2011, Pages 27-30
Objectives: Treatment in an intensive care unit (ICU) is not only very stressful for the patient but also for the family as well. An open visiting policy, defined as a policy that imposes no restrictions on visiting hours, duration of visits and/or number of visitors, seems to fit very well both patient and family needs. The purpose of this article is to give an overview of the current situation of Dutch ICUs visiting policies. Design: Nationwide, telephone-based questionnaire survey. Participants: (Head)nurses of all ICUs. Results: The results of this study show that none of the ICUs have an open visiting policy, defined as a policy that imposes no restrictions on visiting time, duration of visits and/or number of visitors. The majority of the Dutch ICUs (85.7%) has restricted visiting policies. Responses were obtained from 100% of the ICUs. Conclusion: Despite several international guidelines, research and literature about unrestricted visiting hours on the ICUs, none of the ICUs in this study operates with such a visiting policy. If we take these results into account then the question rises if ICUs are aware of these patients and family needs on the ICUs. © 2010 Elsevier Ltd.
Examining the positive effects of exercise in intubated adults in ICU: A prospective repeated measures clinical studyChris Winkelman | Kimberly D. Johnson | Rana Hejal | Nahida H. Gordon | James Rowbottom | Janis Daly | Karen Peereboom | Alan D. Levine
Volume 28, Issue 6, December 2012, Pages 307-318
Background: Determining the optimal timing and progression of mobility exercise has the potential to affect functional recovery of critically ill adults. This study compared standard care with care delivered using a mobility protocol. We examined the effects of exercise on vital signs and inflammatory biomarkers and the effects of the nurse-initiated mobility protocol on outcomes. Methods: Prospective, repeated measures study with a control (standard care) and intervention (protocol) period. Results: 75 heterogeneous subjects admitted to a Medical or Surgical intensive care unit (ICU) were enrolled. In <5% of exercise periods, there was a concerning alteration in respiratory rate or peripheral oxygen saturation; no other adverse events occurred. Findings suggested the use of a protocol with one 20. minute episode of exercise daily for 2 or more days reduced ICU length of stay. Duration of exercise was linked to increased IL-10, suggesting brief episodes of low intensity exercise positively altered inflammatory dysregulation in this sample. Conclusion: A growing body of evidence demonstrates that early, progressive exercise has significant benefits to intubated adults. These results should encourage clinicians to add mobility protocols to the care of ICU adults and lead to future studies to determine optimal " dosing" of exercise in ICU patients. © 2012 Elsevier Ltd.
The sound environment in an ICU patient room-A content analysis of sound levels and patient experiencesLotta Johansson | Ingegerd Bergbom | Kerstin Persson Waye | Erica Ryherd | Berit Lindahl
Volume 28, Issue 5, October 2012, Pages 269-279
This study had two aims: first to describe, using both descriptive statistics and quantitative content analysis, the noise environment in an ICU patient room over one day, a patient's physical status during the same day and early signs of ICU delirium; second, to describe, using qualitative content analysis, patients' recall of the noise environment in the ICU patient room. The final study group comprised 13 patients. General patient health status data, ICU delirium observations and sound-level data were collected for each patient over a 24-hour period. Finally, interviews were conducted following discharge from the ICU. The sound levels in the patient room were higher than desirable and the LAF max levels exceed 55. dB 70-90% of the time. Most patients remembered some sounds from their stay in the ICU and whilst many were aware of the sounds they were not disturbing to them. However, some also experienced feelings of fear related to sounds emanating from treatments and investigations of the patient beside them. In this small sample, no statistical connection between early signs of ICU delirium and high sound levels was seen, but more research will be needed to clarify whether or not a correlation does exist between these two factors. © 2012 Elsevier Ltd.
The characterisation of workloads and nursing staff allocation in intensive care units: A descriptive study using the Nursing Activities Score for the first time in NorwaySiv K. Stafseth | Diana Solms | Inger Schou Bredal
Volume 27, Issue 5, October 2011, Pages 290-294
Objective: This study compares the Nine Equivalents of Nursing Manpower Use Score (NEMS) to the Nursing Activities Score (NAS) in terms of characterising the nursing workload by examining and calculating the per-nurse NAS% over a 24-h period. Method: The sample consisted of 235 patients from four volunteered for the study multidisciplinary ICUs in Norway. The daily NEMS, NAS and number of nurses who were involved in patient care per ICU were measured over one month from 2008 to 2009. Results: The average length of stay for the included patients was 5 days, and the mean patient age was 52.8 years. The mean NEMS was 32.7 points (S.D., 8.98 points), and the mean NAS was 96.24% (S.D., 22.35%). Several nurses exhibited mean NEMS points that ranged from 16 to 39.7 per ICU per day. The correlation between the NEMS and NAS could only be separately determined for each ICU. The correlation was r=0.16-0.40 [significant at the 0.01 level (2-tailed)] per unit. Depending on which unit was investigated, each nurse was observed to perform of capacity with a NAS as high as 75-90%. Conclusion: The study suggests that the actual numbers of nurses might explain the calculated NAS of 75-90% per nurse. © 2011 Elsevier Ltd.
Consensus based clinical guideline for oral hygiene in the critically illAngela M. Berry | Patricia M. Davidson | Lisa Nicholson | Carmel Pasqualotto | Kaye Rolls
Volume 27, Issue 4, August 2011, Pages 180-185
Objectives: Oropharyngeal colonisation has been identified as a factor contributing to ventilator associated pneumonia (VAP) in the Intensive Care Unit (ICU). We sought to develop a clinical practice guideline for providing oral hygiene in the critically ill. Research methodology: Following a systematic literature review a prospectively derived consensus development conference was convened and sponsored by a clinical governance unit. Results: The consensus development conference generated 12 recommendations for tools and solutions; frequency and duration of cleaning; oral assessment tools and oral hygiene protocols. These recommendations underwent a validation process. Conclusions: In light of sparse high level evidence to inform guidelines, further research is needed inform clinical practice. Oral hygiene is a critical element of nursing care and a standardised approach has the potential to improve clinical outcomes. © 2011 Elsevier Ltd.
Relatives' involvement in nursing care: A qualitative study describing critical care nurses' experiencesBirgitta Engström | Andreas Uusitalo | Åsa Engström
Volume 27, Issue 1, February 2011, Pages 1-9
Objectives: When patients become critically ill it also affects their relatives. The aim of this study was to describe critical care nurses' experience of relatives' involvement in the nursing care of patients in an intensive care unit. Method: Semi-structured personal interviews with eight critical care nurses in an intensive care unit in the northern part of Sweden were conducted during 2010. The interview texts were subjected to qualitative content analysis which resulted in the formulation of two main categories and five sub-categories. Findings: The findings showed that relatives' involvement was appreciated and seen as great resource for both patients and critical care nurses. Protecting the integrity of patients was one reason for limiting their involvement. The environment and lack of time were experienced as other obstacles to the involvement of relatives. Conclusion: Aligning the needs of the relatives to be involved in the care with the needs of the patient and the work situation of the nurses requires open communication between all three parties. © 2010 Elsevier Ltd.
Intensive care nurses' knowledge of critical care family needsPatricia Buckley | Tom Andrews
Volume 27, Issue 5, October 2011, Pages 263-272
Aims: To explore nurses' knowledge of family needs and to describe their current practices in meeting those needs. Background: Accurately assessing and responding to family needs of critically ill patients is significant in reducing the negative impact of stress; strengthens the ability to interact positively; increases family satisfaction with care and promotes trust and confidence. Inadequate attention to complex family needs can result in care fragmentation, family alienation, and the development of adversarial relationships between families and care givers. Methods: A descriptive correlational quantitative design was utilised for this study, with data collected over a three-month period from nurses working within an Intensive Care Unit. Results: The majority of respondents (n=44) scored above 70% in their knowledge of the needs of family members, indicating an excellent knowledge of those needs but only 4.2% (n=2) were able to rank family needs in order of importance. Whilst nurses reported very good practices in relation to caring for relatives there was no significant statistical relationship found between knowledge scores and self-reported practice indicating that whilst they had the knowledge it is not necessarily translated into clinical practice. But 71.4% (n=34) of respondents claimed their knowledge came from clinical work in ICU and continuing education courses (42%). Conclusion: Nurses demonstrated a very good knowledge of the needs of relatives and reported effective nursing interventions in supporting those needs, but knowledge is not necessarily translated into practice. © 2011 Elsevier Ltd.
Nurses' perceptions of communication training in the ICUJill V. Radtke | Judith A. Tate | Mary Beth Happ
Volume 28, Issue 1, February 2012, Pages 16-25
Objective: To describe the experience and perceptions of nurse study participants regarding a communication intervention (training and communication tools) for use with nonspeaking, critically ill patients. Research methodology/design: Small focus groups and an individual interview were conducted with six critical care nurses. Transcripts were analysed using qualitative content analysis and constant comparison. Setting: Two ICUs within a large, metropolitan medical centre in western Pennsylvania, United States of America. Main outcome measures: Critical care nurses' evaluations of (1) a basic communication skills training programme (BCST) and (2) augmentative and alternative communication strategies (AAC) introduced during their study participation. Results: Six main categories were identified in the data: (1) communication value/perceived competence; (2) communication intention; (3) benefits of training; (4) barriers to implementation; (5) preferences/utilisation of strategies; and 6) leading-following. Perceived value of and individual competence in communication with nonspeaking patients varied. Nurses prioritised communication about physical needs, but recognised complexity of other intended patient messages. Nurses evaluated the BCST as helpful in reinforcing basic communication strategies and found several new strategies effective. Advanced strategies received mixed reviews. Primary barriers to practise integration included patients' mental status, time constraints, and the small proportion of nurses trained or knowledgeable about best patient communication practices in the ICU. Conclusions: The results suggest that the communication skills training programme could be valuable in reinforcing basic/intuitive communication strategies, assisting in the acquisition of new skills and ensuring communication supply availability. Practice integration will most likely require unit-wide interdisciplinary dissemination, expert modelling and reinforcement. © 2011 Elsevier Ltd.
ICU-recovery in Scandinavia: A comparative study of intensive care follow-up in Denmark, Norway and SwedenIngrid Egerod | Signe S. Risom | Thordis Thomsen | Sissel L. Storli | Ragne S. Eskerud | Anny N. Holme | Karin A M Samuelson
Volume 29, Issue 2, April 2013, Pages 103-111
Objectives: The aim of our study was to describe and compare models of intensive care follow-up in Denmark, Norway and Sweden to help inform clinicians regarding the establishment and continuation of ICU aftercare programmes. Methods: Our study had a multi-centre comparative qualitative design with triangulation of sources, methods and investigators. We combined prospective data from semi-structured key-informant telephone interviews and unreported data from a precursory investigation. Results: Four basic models of follow-up were identified representing nurse-led or multidisciplinary programmes with or without the provision of patient diaries. A conceptual model was constructed including a catalogue of interventions related to the illness trajectory. We identified three temporal areas for follow-up directed towards the past, present or future. Conclusions: ICU follow-up programmes in the Scandinavian countries have evolved as bottom-up initiatives conducted on a semi-voluntary basis. We suggest reframing follow-up as an integral part of patient therapy. The Scandinavian programmes focus on the human experience of critical illness, with more attention to understanding the past than looking towards the future. We recommend harmonization of programmes with clear goals enabling programme assessment, while moving towards a paradigm of empowerment, enabling patient and family to take an active role in their recovery and wellbeing. © 2012 Elsevier Ltd.
Nurses' perceptions of patient safety climate in intensive care units: A cross-sectional studyRandi Ballangrud | Birgitta Hedelin | Marie Louise Hall-Lord
Volume 28, Issue 6, December 2012, Pages 344-354
Objectives: To investigate registered nurses' perceptions of the patient safety climate in intensive care units and to explore potential predictors for overall perception of safety and frequency of incident reporting. Research methodology/design: A cross-sectional design was conducted, using the questionnaire Hospital Survey on Patient Safety Culture, measuring 12 patient safety climate dimensions: seven at unit and three at hospital level, two outcomes and in addition two outcome items. Setting: Ten intensive care units (ICUs) in six hospitals in one hospital trust in Norway. Results: In total, 220 registered nurses (RNs) responded (72%). Seven of 12 dimensions achieved a RN proportion of positive scores over 55%. Five achieved a lower proportion. Significant differences in RNs' perceptions of patient safety were found between types of units and between the four hospitals. The total variance in the outcome measure explained by the model as a whole was for the outcome dimensions " overall perception of safety" 32%, and " frequency of incident reporting" 32%. The variables at the unit level made a significant contribution to the outcome. Conclusion: RNs in ICU are most positive to patient safety climate at unit level, hence improvements are needed concerning incident reporting, feedback and communication about errors and organisational learning and continuous improvement. © 2012 Elsevier Ltd.
Memories from intensive care unit persist for several years-A longitudinal prospective multi-centre studyPer Zetterlund | Kaety Plos | Ingegerd Bergbom | Mona Ringdal
Volume 28, Issue 3, June 2012, Pages 159-167
Introduction: In connection with the care received in the intensive care unit (ICU), the patient can experience discomfort and frustration. Earlier studies have shown mechanical ventilation (MV) to be a factor that increases patients' delusional memories in the ICU. The patients who need MV after a physical trauma constitute a vulnerable group who so far has attracted little attention from a long-term perspective. Aim: The aim for this study is to describe mechanically ventilated trauma patients over time regarding their memories, psychological recovery and health related quality of life (HRQoL). Methods: In a multicentre study, 41 patients who had received MV, answered a questionnaire with the SF-36, HAD and ICUM tool on two occasions about one and five years after the injury and care in the ICU. Results: The patients' memories were stable over time and significantly more patients remembered panic and anxiety. 37% remembered pain one year after the trauma and 46% five years thereafter. The majority of the patients remembered the family's presence from their ICU stay. Half of the patients had thoughts regarding why they had so few recollections. One fourth of the patients experienced clear symptoms of anxiety and the same amount had symptoms of depression one year after the injury. In seven of the patients the symptoms of probable anxiety persisted after five years. In six of the patients the symptoms of probable depression persisted after five years. Two of eight dimensions in HRQoL, the physical and emotional role functions, had improved significantly five years after the injury. Conclusions: Five years after the trauma, the memories from the ICU were still the same and the HRQoL improved in only two out of eight dimensions. A smaller group of patients had remaining symptoms of psychological ill-health. MV in connection with trauma may result in continued reduced health in the long term. © 2011.
The usefulness of bright light therapy for patients after oesophagectomyHiroshi Ono | Toyoe Taguchi | Yoshihiro Kido | Yuji Fujino | Yuichiro Doki
Volume 27, Issue 3, June 2011, Pages 158-166
Objectives: The prevention of delirium is an important issue in the field of perioperative nursing. The objective of this study was to verify the usefulness of acute-stage bright light exposure on patients following oesophagectomy. Methods: The participants were oesophagectomy patients that were removed from their ventilators the day after surgery. After extubation, we assigned the participants to either the exposure group or control group. At Day 2 after surgery, the exposure group underwent two hours of bright light exposure for four days. In both groups, we monitored physical activity and autonomic activity. In addition, we scored the participants on the NEECHAM Scale and evaluated their postoperative delirium and postoperative arrhythmia. Results: On the nights of Days 4 and 5, the amount of activity of the exposure group was significantly lower and The sympathetic nervous index was significantly lower on the night of Day 5. The level of arrhythmia was lower in the exposure group and we observed a significant difference on the night of Day 4 and the daytime of Day 5 after surgery. The occurrence rate of postoperative delirium tended to be lower in the exposure group, but there was no significant difference. None of the participants in the exposure group had NEECHAM Scale scores below the cut-off value from the night of Day 4 onwards. Conclusion: We conclude that postoperative bright light exposure adjusted the sleep-wakefulness cycle and improved the bed rest of patients. It was also indicated that bright light therapy is useful for reducing postoperative delirium. © 2011 Elsevier Ltd.
Survey of assessment and management of pain for critically ill adultsLouise Rose | Lynn Haslam | Craig Dale | Leasa Knechtel | Melanie Fraser | Ruxandra Pinto | Michael McGillion | Judy Watt-Watson
Volume 27, Issue 3, June 2011, Pages 121-128
Objective: To investigate critical care nurses' current practice and knowledge related to pain assessment and management for critically ill adults able and unable to self-report pain. Design: Cross sectional self-report survey. Results: Survey response rate was 57%. Though more respondents used formal pain assessment tools often or routinely for patients able to self-report compared to patients unable to communicate (P< 0.0001), there was no difference in perceived importance of pain assessment tools. Nurses were less confident in their ability to accurately assess pain for patients unable to self-report (P< 0.0001). Behaviours most frequently considered routinely indicative of pain were grimacing (88/140, 62.9%), vocalisation (78/140, 55.7%) and wincing (73/140, 52.1%). Haemodynamic instability, nursing workload and patient inability to communicate were the barriers considered to interfere with pain assessment and management most frequently. Enablers to effective management included pain prioritisation, and adequate prescription of analgesia. Most respondents (118/140 84.3%) had received continuing education on topics related to pain. Conclusions: Though nurses considered pain assessment equally important for patients unable and able to selfreport, formal assessment tools were used less frequently and nurses were less confident in their ability to assess pain for patients unable to self-report. © 2011 Elsevier Ltd.
Restraints in intensive care units-A mixed method studyGayle Langley | Shelley Schmollgruber | Anthony Egan
Volume 27, Issue 2, April 2011, Pages 67-75
The use of mechanical restraints is a controversial practice internationally but is common in South African Intensive Care Units (ICUs). Their use was studied in the ICUs of an academic, public hospital in Johannesburg, South Africa. Research methodology: Quantitative data were collected over two months by means of a checklist and analysed by means of descriptive statistics. The patients' length of stay, type of restraint used and duration thereof, the daily nurse patient ratios, as well as information regarding sedation and analgesia were detailed.Individual interviews with twenty medical and nursing ICU clinicians elicited their stated rationale for restraint, their experiences and perceptions of the practice and recommendations for restraint. Findings: Of a total of 219 patients in the three ICUs, 106 (48.4%) were restrained. The average number of days restrained was nine with a range of days from 1 to 53 (in one case only). In only six cases were restraints other than wrist ties used. Forty seven of the restrained patients had sedation and analgesic medication prescribed and 59 not. All participants conceded a place for physical restraint in the ICU, primarily to ensure the safety of patients but were divided as to the reason for restraining patients and disputed the benefits of restraint. Conclusion: Poor communication between the team, patients and families and diminished collaboration within the multi-disciplinary team emerged as central concepts in this study and influenced care decisions and practises regarding the use of mechanical restraints in the clinical area. © 2011 Elsevier Ltd.
Needs of American relatives of intensive care patients: Perceptions of relatives, physicians and nursesJanice L. Hinkle | Eleanor Fitzpatrick
Volume 27, Issue 4, August 2011, Pages 218-225
Objectives: This study investigated differences between the perceptions of American relatives, physicians and nurses concerning the needs of relatives visiting intensive care patients. Design and participants: This was a prospective descriptive study. Perceived needs were measured using the 45 item Critical Care Family Needs Inventory (CCFNI) with 101 relatives visiting as well as 28 physicians and 109 nurses working with the same group of patients. Setting: Data were collected using a convenience sample of patients, their relatives visiting, as well as the physicians and nurses working with the same patients in six adult intensive care units in a large American tertiary acute care medical centre with over a 900 bed capacity. Results and conclusions: There were significant correlations (p< 0.05) between the relatives, physicians and nurses on eight of the 45 individual items on the CCFNI. Subscale (Information, Proximity, Assurance, Comfort and Support) scores for the needs perceived by relatives, physicians and nurses were calculated and there were significant differences in the three groups on Information (F = 5.90, df = 2, p = .0005), Support (F = 4.12, df = 2, p= .022) and Comfort (F = 5.01, df = 2, p= .010). Relatives and nurses made multiple comments on the surveys. This is important information for all health care workers to consider in setting visiting policies in adult ICUs and developing approaches such as family centred care. © 2011 Elsevier Ltd.
Screening and treatment of problems after intensive care: A descriptive study of multidisciplinary follow-upAnna R. Schandl | Olof R. Brattström | Anna Svensson-Raskh | Elisabeth M. Hellgren | Magnus D. Falkenhav | Peter V. Sackey
Volume 27, Issue 2, April 2011, Pages 94-101
Objectives: To describe a multidisciplinary intensive care follow-up and the methods used for identifying and managing physical and psychological problems in ICU survivors. Methods: Patients treated > four days in an intensive care unit (ICU) were invited three, six and 12 months after intensive care for screening of physical problems with function tests and psychological problems with the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS). Results: 40 of 61 patients had clinically impaired physical function, with no ongoing physical rehabilitation at three months. Twenty-two patients received specific training instructions and 18 patients were referred for physiotherapy. 34 of 61 patients had symptoms of moderate to severe posttraumatic stress and/or symptoms of clinically significant anxiety or depression. Twelve patients accepted referral for psychiatric evaluation and treatment. Conclusion: Multidisciplinary follow-up after intensive care can be of value in identifying untreated physical and psychological problems in ICU survivors. Liaison with specialists enables referral for identified problems. Patients screened and treated in the first six months appear to have little need for further follow-up after intensive care. © 2011 Elsevier Ltd.
A qualitative interpretive study exploring parents' perception of the parental role in the paediatric intensive care unitKaitlin E. Ames | Janet E. Rennick | Sophie Baillargeon
Volume 27, Issue 3, June 2011, Pages 143-150
Objectives: The purpose of this study was to explore parents' perception of the parental role in a tertiary care Canadian university affiliated hospital's paediatric intensive care unit (PICU). Research methodology: A descriptive interpretive design was used with a purposive heterogeneous sample to reflect the range of children and parents normally admitted to the PICU. Semi-structured interviews were conducted with seven parents. Interview data were collected and analysed using the constant comparative method. Findings: Three main themes emerged: (1) being present and participating in the child's care; (2) forming a partnership of trust with the PICU health care team; and (3) being informed of the child's progress and treatment plan as the person who " knows" the child best. Conclusion: Enhanced understanding of the parental role in the PICU from the perspective of parents can help guide the development of strategies to more effectively support parents and promote parenting during this extremely stressful time. © 2011 Elsevier Ltd.
Re-building life after ICU: A qualitative study of the patients' perspectiveKate S. Deacon
Volume 28, Issue 2, April 2012, Pages 114-122
Objective: To explore former ICU patients' views on what the key components of a post ICU rehabilitation programme should be. Research methodology: Thirty five participants completed an online questionnaire accessed via a link to the study from two support groups' websites. Adults (>18. years) who had been patients in ICU were invited to take part. Participants were asked open questions about their ICU experience and their views on ICU rehabilitation. Participants were: aged from 22 to 70. years; from the USA (22), the UK (8), Canada (2), Australia (1) and other (2); 30 female and five male. Findings were analysed using a thematic approach. Findings: Three themes were identified: 'Information and education', 'Personal support' and 'Assessment and therapy'. Analysis suggested that for participants the aspects of rehabilitation covered by each of the themes were of equal importance. Conclusion: Healthcare professionals in ICU, acute ward and community settings need to be aware of the broad array of physical and psychological challenges faced by patients who have been critically ill. Healthcare professionals need to ensure a holistic approach is implemented to coordinate and facilitate rehabilitation, to address identified patients' needs. © 2011 Elsevier Ltd.
Struggling for independence: A grounded theory study on convalescence of ICU survivors 12 months post ICU dischargeA. S. Ågård | I. Egerod | E. Tønnesen | K. Lomborg
Volume 28, Issue 2, April 2012, Pages 105-113
Objectives: To explore and explain the challenges, concerns, and coping modalities in ICU-survivors living with a partner or spouse during the first 12 months post ICU discharge. Design: Qualitative, longitudinal grounded theory study. Settings: Five ICUs in Denmark, four general, one neurosurgical. Methods: Thirty-five interviews with patients and their partners at three and 12 months post ICU discharge plus two group interviews with patients only and two with partners only. Findings: The ICU survivors struggled for independence and focussed chiefly on 'recovering physical strength', 'regaining functional capacity', and 'resuming domestic roles'. The first year of recovery evolved in three phases characterised by training, perseverance and continued hope for recovery. The ICU survivors did not seem to worry about traumatic experiences. Rather, their focus was on a wide range of other aspects of getting well. Conclusion: The study offers new insight into post-ICU convalescence emphasising patients' motivation for training to recover. The findings may contribute to defining the best supportive measures and timing of rehabilitation interventions in ICU and post ICU that may help ICU-survivors in their struggle for independence throughout recovery. © 2012 Elsevier Ltd.
The lived ICU experience of nurses, patients and family members: A phenomenological study with Merleau-Pontian perspectiveBrigitte S. Cypress
Volume 27, Issue 5, October 2011, Pages 273-280
Aim: To describe and understand the lived intensive care unit experience of nurses, patients and family members during critical illness. Background: There is a paucity of research studies in the literature conducted on the triad of nurses, patients and family members looking at the experience of critical illness and their perspective of each, from the other. Methodology: A phenomenological approach and Merleau-Ponty's existentials of corporeality, temporality, relationality and spatiality was used for this study. In-depth, open-ended interviews were, conducted and analysed using van Manen's wholistic, selective and detailed line-by-line approach. Results: Five common themes (a) and three specific themes (b) emerged from the data: (a) family as a, unit, physical care/comfort, physiological care, psychosocial support and transformation; and, (b) advocacy, uncertainty and confidence in the nurse and the healthcare team. Conclusion: Examining embodied experience of corporeality, temporality, spatiality and relationality, opens new ways for coping amongst patients and their families, as well as care giving possibilities for the, nurses. This study affirms the mutual influence amongst the family, patient and nurses during a critical, illness experience and supports the tenets of family-centred care, which mandates the purposeful, inclusion of the family in all aspects of their loved one's care. © 2011 Elsevier Ltd.
People's experiences of being mechanically ventilated in an ICU: A qualitative studyÅsa Engström | Natalie Nyström | Gunilla Sundelin | Janice Rattray
Volume 29, Issue 2, April 2013, Pages 88-95
Objectives: In previous studies people receiving mechanical ventilation treatment have described experiencing distress over their inability to speak and feelings such as anxiety. More research is needed to improve their experience in the intensive care unit and promote recovery. The aim of this study was to describe the intensive care unit experiences of people undergoing mechanical ventilation. Method: Qualitative, personal interviews were conducted during 2011 with eight people who were mechanically ventilated in an intensive care unit in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis. Findings: Two themes emerged, with four and three categories, respectively. Being dependent for survival on other people and technical medical equipment created a sense of being vulnerable in an anxious situation and a feeling of uncertainty about one's own capacity to breathe. Having lines and tubes in one's body was stressful. Being given a diary and follow-up visit to the intensive care unit after the stay were important tools for filling in the missing time, but there was also one participant who did not want to remember his stay in the intensive care unit. Conclusion: To be dependent on other people and technical medical equipment for survival creates a sense of being delivered into the hands of others, as the people being mechanically ventilated could not trust their body to function. © 2012 Elsevier Ltd.


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Welcome to Magic Bike Rüdesheim
The next Magic Bike will take place from 26. to 29.05.2016
Buddies & Bikes and the City of Rüdesheim invite you to the 16th MAGIC BIKE RÜDESHEIM from 26th to 29th of May 2016. The UNESCO World Heritage Mittelrheintal is an ideal bike region with beautiful routes along the Rhine and the hills of the Taunus and Hunsrück. Two imposing castles are the backdrop for a meeting with old and new friends.
We look forward to seeing you!
Magic Bike Rüdesheim 2016 – Official Trailer


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Most Liked Positive Review
Easy to Use with Spectacular Results
We followed a recipe given to us at Williams & Sonoma where we bought the 3-piece pasta roller & cutter set. The attachments were easy to install on our Kitchen Aid Pro...Read complete review
We followed a recipe given to us at Williams & Sonoma where we bought the 3-piece pasta roller & cutter set. The attachments were easy to install on our Kitchen Aid Pro 600 mixer, and with a little practice, we set about making 2-1/2 pounds of fettucine on our first try! Rave reviews by all six people at dinner. I even added some of the leftover noodles to my homemade chicken soup - it added just the right amount of bulk without weighing down the soup.Don't give up if the dough crackles up a bit on the first try through the roller. Just knead it a little, make it a bit smaller, and send it through on the #1 setting until it stays together. Then fold it in half, move the notch up by one, and send it through again. Continue until you reach the thickness you want. For us, #4 was perfect. I highly recommend these attachments to complete your Kitchen Aid experience!
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I expected more.
I was so excited to finally own this attachment! This, being my number one attachment on my wish list, i was ecstatic when i actually did get it! I couldn't wait to bust...Read complete review
I was so excited to finally own this attachment! This, being my number one attachment on my wish list, i was ecstatic when i actually did get it! I couldn't wait to bust it open and try that baby out! I got all the ingredients (Semolina was harder to find around here so it took a day or two) and made the dough. The dough came out fantastic and rolled perfectly with the pasta roller attachment. When it came time for the ravioli, i made sure to read all the instructions.. twice, to be sure i got it correct. Did as it said with the practice runs to "perfect the technique". I stuffed my raviolis with cheese, wanted to start out easy being the first time. The roller did not seal, not a SINGLE one. I was disappointed and tried a new technique. The second set did the same exact thing the filling was also bursting out of the unsealed pockets. I decided to re-read the instruction manual thinking that it was user error. Made a third set and turned out the same exact way. I mad sure that the pasta sheets were correctly placed on the rollers and made sure that it cover all the ends thinking that that was why my filling was leaking out and that they weren't sealing, that was not the problem. I was very disappointed. As i laid the unsealed, leaking, gooey pasta on the flour dusted wax paper to dry, it just turned into a large mush pile. I expected so much from this attachment and felt let down. I talked to a few friends and coworkers that have this same attachment and they all had the same problem, none of the raviolis sealed and ended up throwing them away. Sad that i wasted the time and ingredients for such a disaster. Hoping that kitchenaid finds the problem and fixes or comes up with a new/better attachment. I love all my kitchenaid products and I've never had any problems with any. I definitely wouldn't recommend this attachment. disappointed, to say the least.
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Work like a champ
By Sheri
from Kingston, WA
Comments about KitchenAid Pasta Cutter Set:
Works exactly as I'd expect - rolls out great sheets of pasta as well as Fettucini.
Bottom Line Yes, I would recommend this to a friend
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Worth waiting for
By One satisfied costomer
from St. Petersburg, Florida
I had put off this purchase for years. Just got back for a vacation in Italy. I could not hold off any longer. Tried it out as soon as I received it. It was so much fun to use. My first attempt at homemade pasta was a success. I have already recommended it to others!!!!
(1 of 1 customers found this review helpful)
Get 180 1 dollar bills, crumple in a pile, add fire
By Pasta Chef
from Denver
The title pretty much sums it up. Someone give them an award the worst kitchen appliance in history. I would not recomend this to anyone, ever.
Bottom Line No, I would not recommend this to a friend
Easy pasta and fun
By Unmbrat
from Albuquerque NM
Making pasta is so easy and so fun with this easy to use pasta roller set
(2 of 5 customers found this review helpful)
High Quality
By Ivory Tickler
from Central Utah
Still deciding if the price is justifiable for the number of times I'm likely to use it in a year.
(3 of 6 customers found this review helpful)
the best
By Dolores
from Timmins, On
100 percent in my life being easier
(3 of 4 customers found this review helpful)
Too good to be true!
By Luci
from Troy, Ohio
At long last I have my very own set of pasta roller & cutters!! So excited because KitchenAid is one of the last great manufacturing names that still makes a quality product that's worth the investment. Don't believe me? Just go online and search the term "planned obsolescense". The last time I made noodles, I worked every evening for a week rolling, cutting, dehydrating and vacuum sealing them in canning jars. Unfortunately, I was using a hand crank machine that broke half way through the process and I had to keep the rollers in place by using a heavy rubber band over the adjustment knob. Even before the silly thing came apart, it was backbreaking work trying to roll and cut the dough. Plus, I now have a great reason NOT to get rid of my vintage mixer. My first KitchenAid stand mixer is at least 30 years old and even though I have a shiny new red one on the kitchen counter, I can't make myself part with my old white model. Now one holds the roller attachment and the other gets to power the cutting head.
(5 of 5 customers found this review helpful)
Very disappointed
By EKR
from Hertfordshire, UK
Was really excited to get this for my birthday as well as the pasta attachment. Unlike the pasta rolling attachment this one is VERY disappointing. It's messy, the pasta crumples up and doesn't feed through nicely and I get pasta with little to no filling. I've tried 4/5 times now changing my technique each time and even watched videos online to see what I'm doing wrong. Nothing seems to work so I just end up doing it by hand. Really sad about this as it costs so much money for something that isn't fit for purpose.
(6 of 7 customers found this review helpful)
Love it!!
By StephW
from McKinney, TX
My husband got this for me for Christmas, and although it took me until JUNE to break it out.... I absolutely love it. I've made both spaghetti and fettuccine for my family using the recipes included in the box. They are fabulous.
Best purchase!
By krazikrafter02
from Trafford, PA
Received this as a wedding gift....it's one of my favorites! Having fun trying different combinations of ingredients. You never know what you're going to get at the end!
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Category:Social Democratic Party (Brazil) politicians
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These Cartoni Hooking Rubber Tripod Feet (Set of 3) can be pulled onto most Cartoni tripod models (except for Ultra-Light models) to provide non-slip contact with smooth surfaces. Each foot features a rubber strap (the "hook") that secures it in place on a corresponding nub on the tripod leg.