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Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Recent US disasters highlight the current imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. We examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves.
A mixed methods design included evaluation of insurance pharmacy benefits, focus group interviews with patients, and key informant interviews with physicians, pharmacists, and insurers.
Results and Discussion
Most prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days. For patients to acquire 14- to 30-day disaster medication reserves, health professionals interviewed supported 60- to 100-day dispensing units. Barriers included restrictive insurance benefits, patients’ resistance to mail order, and higher copay-ments. Physicians, pharmacists, and insurers also varied widely in their preparedness planning and collective mutual-aid plans, and most believed pharmacists had the primary responsibility for patients’ medication continuity during a disaster.
To strengthen prescription drug continuity in disasters, recommendations include the following: (1) creating flexible drug-dispensing policies to help patients build reserves, (2) training professionals to inform patients about disaster planning, and (3) building collaborative partnerships among system stakeholders. (Disaster Med Public Health Preparedness. 2013;7:257-265)
Over the past fifty years the scanning electron microscope (SEM) has established itself as the most versatile and productive tool for imaging and microanalysis in many areas of science and technology, and some seventy-thousand instruments generate millions of micrographs every day. Scanning electron microscopes do, however, have one fundamental limitation in that the only experimental variable available to the operator is the choice of the accelerating voltage. Although the ability to vary beam energy is both necessary and important, it is an unfortunate fact that changing the beam energy also alters many aspects of performance: imaging resolution, relative strength of different signal components, depth of beam penetration, capabilities of the various analytical systems, and the severity of charging and beam-induced damage. This makes it difficult or impossible to optimize the interaction of interest.
Because the ability to perform some form of chemical microanalysis has become an essential feature for any microscope, it is necessary to investigate what options are available in the new “ORION” helium ion microscope (HIM). The HIM has the ability to visualize local variations in specimen chemistry in both the ion induced secondary electron and the Rutherford backscattered imaging modes, but this provides only limited and qualitative information. Quantitative, elementally specific, microanalysis could be performed in the HIM using secondary electron spectroscopy, Rutherford backscattered ion spectroscopy, or secondary ion mass spectroscopy, but while each of these options has promise, none of them can presently guarantee either reliable element identification or quantitative analysis across the periodic table.
In many semiconductor materials problems, structural characterizations must be achieved in both the lateral and vertical dimensions. Although a combination of cross-sectional and planar transmission electron microscopy can provide this information, the sample preparation time is demanding and only relatively small volumes of material are examined. We describe here an alternative approach in which the charge collection (‘CCM’) imaging mode of the scanning electron microscope (SEM) is used. It is shown that, by varying the incident electron beam energy, electricallly active defects at different positions beneath the entrance surface of the material can be imaged and their depth estimated.
In this paper we will present recent experimental results, using electron holography and electron interferometry, of studies of ferroelectric domain walls in BaTiO3 thin films. Unlike conventional TEM diffraction contrast imaging of ferroelectrics, the new technique that we have developed not only allows direct visualization of ferroelectric domain walls and electrostatic field distributions in the vicinity of the domain wall, but also enables quantitative measurement of domain wall width and local polarization. We have measured 90° domain wall width to be between 20 to 50 Å for a BaTiO3 thin specimen. The variation of polarization across the domain wall will be shown to be close to that predicted by the Zhirnov model. The value of the measured spontaneous polarization is about 1.5×10−5 C/cm2, which is closed to the bulk macroscopically measured value.
The scanning electron microscope (SEM) is the most widely used, as well as the most versatile, of electron-optical instruments. In all of the imaging modes of the instrument it is now possible to achieve a spatial resolution on the nanometer scale from a bulk specimen, provided that the electron-optical performance of the instrument is of the necessary quality. In practice this means that a field emission gun (FEG) as well as a highly excited probe forming lens must be used. With state-of-the-art instrumentation, image resolutions as good as 4 - 5 nm at lkeV, and lnm at 20keV, are now achievable. This paper outlines the design criteria for a high resolution FEG SEM and discusses the type of image information available. The performance achieved is compared to that of other types of microscope that offer similar capabilities.
The theory of imaging crystallographic defects in solid specimens through the use of electron channeling contrast is reviewed and the necessary conditions for observation are deduced. It is shown that current high performance field emission scanning electron microscopes can meet these requirements and produce dislocation images from suitable materials.
Palestine in the 1st Century CE was subject to colonial rule, leading to the marginalisation of the native people and the victimisation of the poor. Mark and its Subalterns offers a fresh appraisal of the identity and involvement of subalterns in Mark's Gospel, arguing that the presence of subalterns in Mark provides a hermeneutical tool for re-reading the Bible in a postcolonial context. Drawing on liberation and feminist readings of Scripture, the book examines postcolonial biblical interpretations that failed to take native peoples into account. The book presents a postcolonial reading of the Gospel of Mark - highlighting key issues of gender, race, hybridity, class, nationalism, purity and the representation of the poor - and uses this analysis to construct a framework for understanding religion in contemporary India.
This chapter provides a conclusion to this study, its implications in the postcolonial context of India, the limitations of the findings and some suggestions for further research in this line. The result of this study can be summarized in the following way along with some major hermeneutical issues emerging from the deliberations of this thesis. This thesis has considered the Gospel of Mark afresh from a postcolonial perspective. The contributions of past interpreters have been reviewed, focusing on three main areas, namely Markan interpreters, Indian hermeneuts and postcolonial readers of the text. In the light of the contributions of the past interpreters of Mark from various angles of their interpretation, this study has focused more attention on a postcolonial viewpoint. The introduction of the study raised five major questions concerning the identity of the subalterns in Mark, the nature of Roman oppression in Galilee, the Markan milieu, postcolonial dimensions of the text and a possible hermeneutical paradigm for India
Part I, Hermeneutics: General Methodological Considerations paved the way for a creative discussion on Mark and its hermeneuts in the rest of the study. Further, this section dealt with the issue of the spread of Christianity and missionary attempts at biblical interpretation. This part of the study clearly showed that they did not take the issues related to the sociopolitical and religiocultural life of the natives into account when interpreting the Bible. However, there were native voices which stood for indigenization and local systems of religious order.
In the light of the findings of the previous chapter, which placed the Gospel of Mark in the Roman colonial milieu, this chapter will investigate the sociopolitical, literary and religious origins and dimensions of the Gospel of Mark. By presenting and placing Mark in its real sociopolitical and religiocultural context, it is proposed by this author to offer a hermeneutical challenge based on the rebel and subaltern voices in Mark. Many scholars strongly advocate that Mark had access to some historical and biographical documents which were perhaps shaped immediately after the death of Jesus by the possible eyewitnesses of the ministry of Jesus (Trocme, 1975: 32). This chapter will also study the nature of the Jerusalem authorities and their influence on the Jesus movement. In the same way, on the basis of these investigations it is anticipated that there will be an exploration of the movements of resistance, including the identity and implications of the marginalized and subalterns in the Gospel of Mark.
The Identity of the Author of Mark
A section on the identity of the author of Mark is necessary to understand the sociopolitical and ideological compulsions behind the formation of the Gospel. Despite the existence of many theories about the context and origin of the Gospel, this author would like to place Mark in a “post-Nero/pre-70 Roman setting” (Senior, 1987: 11) as this is ideologically and socially convincing.