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Airway management is a controversial topic in modern Emergency Medical Services (EMS) systems. Among many concerns regarding endotracheal intubation (ETI), unrecognized esophageal intubation and observations of unfavorable neurologic outcomes in some studies raise the question of whether alternative airway techniques should be first-line in EMS airway management protocols. Supraglottic airway devices (SADs) are simpler to use, provide reliable oxygenation and ventilation, and may thus be an alternative first-line airway device for paramedics. In 2019, Alachua County Fire Rescue (ACFR; Alachua, Florida USA) introduced a novel protocol for advanced airway management emphasizing first-line use of a second-generation SAD (i-gel) for patients requiring medication-facilitated airway management (referred to as “rapid sequence airway” [RSA] protocol).
This was a one-year quality assurance review of care provided under the RSA protocol looking at compliance and first-pass success rate of first-line SAD use.
Records were obtained from the agency’s electronic medical record (EMR), searching for the use of the RSA protocol, advanced airway devices, or either ketamine or rocuronium. If available, hospital follow-up data regarding patient condition and emergency department (ED) airway exchange were obtained.
During the first year, 33 advanced airway attempts were made under the protocol by 23 paramedics. Overall, compliance with the airway device sequence as specified in the protocol was 72.7%. When ETI was non-compliantly used as first-line airway device, the first-pass success rate was 44.4% compared to 87.5% with adherence to first-line SAD use. All prehospital SADs were exchanged in the ED in a delayed fashion and almost exclusively per physician preference alone. In no case was the SAD exchanged for suspected dislodgement evidenced by lack of capnography.
First-line use of a SAD was associated with a high first-pass attempt success rate in a real-life cohort of prehospital advanced airway encounters. No SAD required emergent exchange upon hospital arrival.
Tracheal intubation and mechanical ventilation provide essential support for patients with respiratory failure, but the course of mechanical ventilation may be complicated by adverse ventilator-associated events (VAEs), which may or may not be associated with infection. We sought to understand how the frequency of subglottic suction, an indicator of the quantity of sputum produced by ventilated patients, relates to the onset of all VAEs and infection-associated VAEs.
We performed a case-crossover study including 87 patients with VAEs, and we evaluated 848 days in the pre-VAE period at risk for a VAE.
Setting and participants:
Critically ill patients were recruited from the medical intensive care unit of an academic medical center.
We used the number of as-needed subglottic suctioning events performed per calendar day to quantify sputum production, and we compared the immediate pre-VAE period to the preceding period. We used CDC surveillance definitions for VAE and to categorize whether events were infection associated or not.
Sputum quantity measured by subglottic suction frequency is greater in the period immediately prior to VAE than in the preceding period. However, it does not discriminate well between infection-associated VAEs and VAEs without associated infection.
Subglottic suction frequency may serve as a valuable marker of sputum quantity, and it is associated with risk of a VAE. However, our results require validation in a broader population of mechanically ventilated patients and intensive care settings.
The centenary commemorations of the 1916 rebellion, heavily scripted by the official state policies of 2016, has, mainly through the uncritical recycling of pious commonplaces, fixed a specific interpretation of the event in the public memory: a Rising timed to coincide with that of Christ, involving Pearse reading out a proclamation from the GPO steps and canonized by Yeats’s poem as to its utterly transformative effect. This chapter deconstructs these commonplaces and traces their banal-nationalistic effect on the public commemorations.
Brain circuits are highly interconnected three-dimensional structures fabricated from components ranging vastly in size; from cell bodies to individual synapses. While neuronal activity can be visualized with advanced light microscopy (LM) techniques, the resolution of electron microscopy (EM) is critical for identifying synaptic connections between neurons. Here, we combine these two techniques, affording the advantage of each and allowing for measurements to be made of the same neural features across imaging platforms. We established an EM-label-free workflow utilizing inherent structural features to correlate in vivo two-photon LM and volumetric scanning EM (SEM) in the ferret visual cortex. By optimizing the volume SEM sample preparation protocol, imaging with the OnPoint detector, and utilizing the focal charge compensation device during serial block-face imaging, we achieved sufficient resolution and signal-to-noise ratio to analyze synaptic ultrastructure for hundreds of synapses within sample volumes. Our novel workflow provides a reliable method for quantitatively characterizing synaptic ultrastructure in functionally imaged neurons, providing new insights into neuronal circuit organization.
Readers of this collection of scholarly studies on migration do not need to be told of Eric's unsurpassed mastery of the widely neglected English diaspora, his seemingly effortless intellectual sweep, or his adroitness in juxtaposing general findings with telling individual narratives. These qualities were all evident at the conference in his honour that gave rise to this book, followed so soon by his shocking and sudden death in London. I could not attend, being gravely ill myself, but was later able to watch the proceedings on video. I imagined that I was there with Eric and exchanging glances with him in the lecture room, along with so many of his friends and mine. It never occurred to me that September that it would be my lot to bid Eric farewell.
We were friends and collaborators for over 30 years, brought together by our obsessive desire to make sense of ‘mass’ migration and find some way of sifting through that mass and recovering its individuality, with all the consequent quirks and aberrations. We were particularly interested in looking at unfamiliar sub-strands to set beside the trans-Atlantic diaspora, and (along with Richard Reid) initiated a series of slim volumes entitled Visible Immigrants to uncover neglected sources for migration to Australia. This required me (I was far from reluctant) to make many brief visits to the Australian National University (ANU) and Flinders University so that we could plan and execute our next moves in the struggle for scholarly enlightenment. The small workshops generating that series have continued intermittently and did much to revive interest in the field.
We began with the thorny challenge of emigrant letters, so rich individually yet so hazardous to use as the basis of generalizations about the migratory experience. Eric was a devotee of Charlotte Erickson's classic Invisible Immigrants, which stood alone for so long in British diaspora studies in its incisive use of personal testimony. We amassed vast quantities of letters throughxiv appeals in Australia, abstracting and transcribing many of them during my longest spell at the ANU in 1990–91. Eric was always the sceptic, I the optimist intent on converting a non-sample into a sample by some magic formula.
Statistical analysis of about 500 passport applications by naturalised Americans (or their relatives) who were born in Leitrim. Though useful only for a brief period, this offers the only systematic documentation of ‘returned Yanks’ intending to make short visits, most of whom came back without children and therefore cannot be identified in the Irish census. Many applications are collated with Irish census returns to establish the origins of applicants from Leitrim, generating a profile similar to that presented in the . In addition to biographical variables, the applications permit analysis of the height and appearance of visitors, which in the case of height may be compared with measurements of the home population (Leitrim female visitors in particular were unusually tall). Comparisons are made with the findings and measurements of Harvard ethnographers who surveyed Leitrim in the mid-1930s.
Discussion of complexities of Irish migration from the Great Famine to the First World War, qualifying crude models of irreversible long-distance emigration: evidence concerning internal, circular, and reverse migration is analysed. Published official returns for Irish reverse migration just before 1914 indicate much higher levels than generally alleged. Much of the chapter is adapted from my four contributions to A New History of Ireland, vols 4, 5. Additional information is given on transatlantic shipping, indicating growing demand for eastward passages and increasing provision by major shipping lines around 1900.
Statistical analysis of information on persons born outside Ireland derived from published census reports, supplemented by additional data and information on individual incomers from digital index for 1901–11. This traces steady increase in foreign, colonial, and British presence, and examines differences between national sub-groups. The most conspicuous expansion was in the presence of Americans, whose profile differed sharply from that of all other groups. The American profile provides context for the following four chapters.
Statistical analysis of census returns for about 1,000 Americans and Canadians in ‘élite’ occupations, designed to show the diversity of human emissaries of ‘Americanisation’ with whom home population came in contact. The selected occupational groups, which exclude agriculturists, labourers, domestic servants, shopkeepers, and merchants, mainly represent ‘service providers’ such as clerks, officials, and professionals. Three idiosyncratic and conspicuous groups not easily fitted into traditional census categories are examined in detail in Chapter 5.
The same data are used to classify the stated objects of those seeking to travel outside the United States, who were overwhelmingly bound for Ireland. The great majority wished to visit relatives, particularly mothers, allowing analysis of the age of specified parents using Irish census returns. The second overlapping motive was the need to attend to property at home, an object often indistinguishable from the wish to visit relatives. Very few Leitrimonians were applying solely as business travellers or tourists.
The same approach is applied, with more documentary contextualisation, to those without occupations but of ‘independent’ or ‘private’ means, and to performers and others involved in the creative arts. Special attention is given to musicians and variety artists, using press reports naming some of the visitors. A special study of Mormon missionaries concludes this chapter.
This pictorial essay with a commentary displays seventy-eight photographs of passport applicants born in Leitrim, arranged according to thirteen themes each occupying one page. These images are set against photographs of eight men from Leitrim who were selected by the Harvard ethnographers to represent Irish racial types. The commentary identifies each applicant by name with some biographical information, and explains the attributes of each type as defined by the ethnographers.
In rural Ireland, which proportionately housed most of the American-born, almost no incomers belonged to the elite. This chapter collates all family returns, including an American, allowing identification and statistical analysis of accompanying parents born in Leitrim (‘returned Yanks’) as well as the American-born. Leitrim was the county with the highest component of American incomers by 1911 and, at several periods, the highest intensity of outward migration. Virtually all Leitrim Americans and their parents were enumerated in thatched dwellings on farms. Most American incomers were children, often fostered with relatives in poor and remote districts and houses. It follows that the Americans actually observed in rural Ireland typically suggested economic failure and continued reliance of assistance from Irish kinship networks.