This manual is aimed at all healthcare practitioners, from novice to expert, who care for the critically ill patient, recognising that different disciplines contribute to the provision of effective care and that essential knowledge and skills are shared by all practitioners. It provides evidence-based guidelines on core critical care procedures and includes a comprehensive competency framework and specific competencies to enable practitioners to assess their abilities and expertise. Each chapter provides a comprehensive overview, beginning with basic principles and progressing to more complex ideas, to support practitioners to develop their knowledge, skills and competencies in critical care.

The provision of $8 billion for intercity passenger rail projects in the 2009 American Recovery and Reinvestment Act (ARRA; P.L. 111-5) reinvigorated efforts to expand intercity passenger rail transportation in the United States. The Obama Administration subsequently announced that it would ask Congress to provide $1 billion annually for high speed rail (HSR) projects. This initiative was reflected in the President's budgets for FY2010 through FY2013. Congress approved $2.5 billion for high speed and intercity passenger rail in FY2010 (P.L. 111-117), but zero in FY2011 (P.L. 112-10) and FY2012 (P.L. 112-55). In addition, the FY2011 appropriations act rescinded $400 million from prior year unobligated balances of program funding. There are two main approaches to building high speed rail (HSR): (1) improving existing tracks and signaling to allow trains to reach speeds of up to 110 miles per hour (mph), generally on track shared with freight trains; and (2) building new tracks dedicated exclusively to high speed passenger rail service, to allow trains to travel at speeds of 200 mph or more. The potential costs, and benefits, are relatively lower with the first approach and higher with the second approach. Much of the federal funding for HSR to date has focused on improving existing lines in five corridors: Seattle-Portland; Chicago-St. Louis; Chicago-Detroit; the Northeast Corridor (NEC); and Charlotte-Washington, DC. Most of the rest of the money is being used for a largely new system dedicated to passenger trains between San Francisco and Los Angeles, on which speeds could reach up to 220 mph. Plans for HSR in some states were shelved by political leaders opposed to the substantial risks such projects entail, particularly the capital and operating costs; the federal funds allocated to those projects were subsequently redirected to other HSR projects. Estimates of the cost of constructing HSR vary according to train speed, the topography of the corridor, the cost of right-of-way, and other factors. Few if any HSR lines anywhere in the world have earned enough revenue to cover both their construction and operating costs, even where population density is far greater than anywhere in the United States. Typically, governments have paid the construction costs, and in many cases have subsidized the operating costs as well. These subsidies are often justified by the social benefits ascribed to HSR in relieving congestion, reducing pollution, increasing energy efficiency, and contributing to employment and economic development. It is unclear whether these potential social benefits are commensurate with the likely costs of constructing and operating HSR. Lack of long-term funding represents a significant obstacle to HSR development in the United States. The federal government does not have a dedicated funding source for HSR, making projects that can take years to build vulnerable to year-to-year changes in discretionary budget allocations.

Surface transportation congestion most likely will be a major issue for Congress as it considers reauthorisation of the Safe, Accountable, Flexible, Efficient Transportation Equity Act -- A Legacy for Users (SAFETEA), P.L. 109-59, which is set to expire on 30 September 2009. By many accounts, congestion on the nation's road and railroad networks, at seaports and airports, and on some major transit systems is a significant problem for many transportation users, especially commuters, freight shippers, and carriers. Indeed, some observers believe congestion has already reached crisis proportions. Others are less worried, believing congestion to be a minor impediment to mobility, the by-product of prosperity and accessibility in economically vibrant places, or the unfortunate consequence of over reliance on cars and trucks that causes more important problems such as air pollution and urban sprawl. Trends underlying the demand for freight and passenger travel -- population and economic growth, the urban and regional distribution of homes and businesses, and international trade -- suggest that pressures on the transportation system are likely to grow substantially over the next 30 years. Although transportation congestion continues to grow and intensify, the problem is still geographically concentrated in major metropolitan areas, at international trade gateways, and on some intercity trade routes. Because of this geographical concentration, most places and people in America are not directly affected by transportation congestion. Consequently, in recent federal law, Congress, for the most-part, has allowed states and localities to decide the relative importance of congestion mitigation vis-a-vis other transportation priorities. This has been accompanied by a sizeable boost in funding for public transit and a more moderate boost in funding for traffic reduction measures as part of a patchwork of relatively modest federally directed congestion programs. Congress may decide to continue with funding flexibility in its reauthorisation of the surface transportation programs. States and localities that suffer major transportation congestion would be free to devote federal and local resources to congestion mitigation if they wish. Similarly, congestion-free locales would be able to focus on other transportation-related problems, such as connectivity, system access, safety, and economic development. Alternatively, Congress may want to more clearly establish congestion abatement as a national policy objective, given its economic development impact, and take a less flexible and, in other ways, more aggressive approach to congestion mitigation. Three basic elements that Congress may consider are (1) the overall level of transportation spending, (2) the prioritization of transportation spending, and (3) congestion pricing and other alternative ways to ration transportation resources with limited government spending. Congress also may want to consider the advantages and disadvantages of specific transportation congestion remedies. Hence, this book discusses the three basic types of congestion remedies proposed by engineers and planners: adding new capacity, operating the existing capacity more efficiently, and managing demand.