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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.
This chapter is an attempt to re-read Mark 7:24–30 in the light of issues of gender, race and hybridity. These issues are crucial in Mark as a number of Markan passages besides 7:24–30 address these issues. In the first part of the chapter these issues will be defined. The place of women, racial scars and questions of hybridity in Mark will be evaluated. The question of how Mark treated issues of gender in his milieu will be discussed here. A discussion of the major insights which have emerged from both the traditional interpretations and Indian interpretations will be presented. Finally, Mark 7:24–30 will be interpreted from a postcolonial perspective. All these discussions will be framed by a postcolonial reading of 7:24–30 dealing with the issues of race, gender and hybridity/pluralism.
There may be many reasons why the marginalization of women and the subalterns took place in the textual presentation of the Markan story of Jesus. It is believed that an alternative reading from the perspective of the people of the margins will equip readers to understand the inner dynamics of the text. In the present postcolonial context, the search for these issues in the text or a re-reading of the text in the light of these issues will be a significant reading discourse.
Gender, Race and Hybridity Concerns in Mark
Defining Gender, Race and Hybridity
Racial concerns are connected with the notion of domination and imperialism. Thus it may be necessary to reconstruct history to search for definitions.
In the light of the results of the explorations of the imperial elements in Mark and of the possibility of using postcolonial hermeneutics for interpreting Mark presented in the previous chapter, it is relevant to look at some issues related to the poor in Mark and their representation in the Gospel and consequent interpretations of the Gospel of Mark. The issues of the poor, representation, economics, labour, tax, liberation and Jubilee are visible in several passages of Mark. Needless to say, many concerns visible in Mark seem to be postcolonial as the Gospel of Mark was a product of the colonial era of Roman imperialism. This study considers Mark in the light of these issues and in the living context of today as the author hails from a postcolonial situation. This section will look at the theological position of Mark as well as the theological position of the Markan interpreters on these issues. This chapter will have three main parts, namely a discussion on the issue of the poor in Mark, an exegetical study of Mark 10:17–31 and a postcolonial reading of that passage. In addition to this, there will be an evaluation of the historical-critical interpreters of the text. In the light of their interpretations of the issues of the poor in Mark, a postcolonial reading might offer some possible guidelines for constructing a hermeneutical paradigm for the postcolonial context.
New methodological shifts and trends in the current world have stimulated and provoked the reader and deconstructed the relationship between the text and reader with a new ideological and political sense. Khiok-khng Yeo argues for the influence and incorporation of cultural values in biblical hermeneutics as “culture, context and people are in constant interaction” (2004: 82). As a result of this movement, postcolonial methods have entered into the fascinating arena of hermeneutics. The presence of the Roman Empire in the Gospel was a major reason for the emergence of the subalterns in Mark. Before moving to the issue of postcolonial readings in biblical studies, it is only appropriate to present fundamental observations on liberation, feminist, postcolonial, and subaltern readings as they have stimulated the biblical hermeneuts to look into various hidden dimensions of the biblical insights which were not given sufficient attention by traditional interpreters of the Bible. In order to examine the above said methods in detail, this study will look at some scholars with a representative character.
It is understood that liberation interpretations, which began in the 1970s as a protest to the existing readings and political dominations, handled many postcolonial concerns in a general manner. A theology of resistance and protest which emerged within the frameworks of military regimes and neocolonialism during the 1960s took the shape of theological and biblical hermeneutics with the publication of Theology of Liberation in 1973 by Gustavo Gutiérrez of Peru.
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.
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.