Successful endotracheal intubation following a failed first attempt during aeromedical retrieval

2020 ◽  
pp. emermed-2019-208425
Author(s):  
John Glasheen ◽  
Jeff Hooper ◽  
Andrew Donohue ◽  
Emmeline Finn ◽  
Bronwyn Murray-Smith ◽  
...  
Keyword(s):  
Descriptive Statistics ◽  
Intubation Attempt ◽  
Quality And Safety ◽  
Electronic Database ◽  
Failed Intubation ◽  
Intubation Technique ◽  
The Third ◽  
Successful Attempt ◽  
Intubation Success ◽  
Made In

IntroductionFirst attempt intubation success is used by many prehospital services as a marker of quality and safety. An increasing complication rate is associated with repeated intubation attempts. The aim of this study was to identify changes to intubation technique following a failed intubation attempt.MethodsLifeFlight Retrieval Medicine provides aeromedical retrieval services in Queensland, Australia. This retrospective study identified cases of failed intubation attempts from an electronic database registry over a 41-month period from March 2015 to July 2018. These data were analysed using descriptive statistics.ResultsOf the 762 patients who required intubation 758 (99.5%) were successfully intubated, with 684 intubated at the first attempt (89.8%; 95% CI: 0.87 to 0.92). There was no difference in first attempt success between direct and video laryngoscopy (511/563 (90.8%) vs 172/194 (88.6%) p=0.38), trauma or medical (374/419 (89.3%) vs 310/343 (90.4%), p=0.61), primary or interhospital missions (329/370 (88.7%) vs 355/392 (90.8%), p=0.33). 78 cases of failed first attempt intubations were identified. In 65 of these cases, intubation was successful at the second attempt. A single change was made to the intubation procedure prior to a second successful attempt in 28/78 cases (35.9%), and more than one change was made in 41/78 (52.6%). The changes included the operator, intubation device, patient position, intubating aid and external laryngeal manipulation. No change between attempts was recorded in 9/78 (11.5%). 9 cases were successfully intubated at the third attempt, and changes prior to the third attempt included operator, device and intubating aid.ConclusionAlthough a high overall intubation success was found, one in ten patients who were intubated had a failed first attempt. The majority of successful subsequent attempts were preceded by at least one change to intubating technique. Intubating clinicians need the ability to identify and correct issues leading to a failed first attempt.

KERCH STRAIT IN KAMYSH-BURUN SPIT AREA: HIGH-RESOLUTION SEISMOACOUSTIC APPROACH

2018 ◽  
Author(s):  
В. Зинько ◽  
V. Zin'ko ◽  
А. Зверев ◽  
A. Zverev ◽  
М. Федин ◽  
...  
Keyword(s):  
High Resolution ◽  
Fracture Zone ◽  
Sedimentary Cover ◽  
Sedimentary Rocks ◽  
The West ◽  
Early Generation ◽  
The Third ◽  
Azov Sea ◽  
Kerch Strait ◽  
Made In

The seismoacoustical investigations was made in the western part of the Kerch strait (Azov sea) near Kamysh-Burun spit. The fracture zone with dislocated sedimentary rocks layers and buried erosional surface was revealed to the west of spit. Three seismofacial units was revealed to the east of spit. The first unit was modern sedimentary cover. The second ones has cross-bedding features and was, probably, the part of early generation of Kamysh-Burun spit, which lied to the east of its modern position. The lower border of the second unit is the erosional surface supposed of phanagorian age. The third unit is screened by acoustic shedows in large part.

Introduction

2018 ◽  
Author(s):  
Nora Goldschmidt ◽  
Barbara Graziosi
Keyword(s):  
Material Culture ◽  
The Body ◽  
Specific Site ◽  
Entire Volume ◽  
The Third ◽  
Religious Significance ◽  
Classical Poetry ◽  
Life Of The Mind ◽  
The Mind ◽  
Made In

The Introduction sheds light on the reception of classical poetry by focusing on the materiality of the poets’ bodies and their tombs. It outlines four sets of issues, or commonplaces, that govern the organization of the entire volume. The first concerns the opposition between literature and material culture, the life of the mind vs the apprehensions of the body—which fails to acknowledge that poetry emerges from and is attended to by the mortal body. The second concerns the religious significance of the tomb and its location in a mythical landscape which is shaped, in part, by poetry. The third investigates the literary graveyard as a place where poets’ bodies and poetic corpora are collected. Finally, the alleged ‘tomb of Virgil’ provides a specific site where the major claims made in this volume can be most easily be tested.

The Hydraulic Operation of Lathes for the Production of Shells

1944 ◽  
Vol 151 (1) ◽  
pp. 70-86
Author(s):  
W. Littlejohn Philip
Keyword(s):  
Machine Tools ◽  
Hydraulic Power ◽  
The Third ◽  
Hydraulic Machine ◽  
Hydraulic Machinery ◽  
Simple Machines ◽  
High Level ◽  
Shell Production ◽  
Hydraulic Operation ◽  
Made In

The paper is limited to the application of hydraulic power to lathes designed for shell making although, in the author's opinion, there is an immense field for the application of the same principles in other directions. Self-contained hydraulic machine tools have been dealt with by Mr. H. C. Town,† but in the system to be described all the machines are operated from a central hydraulic plant. Three complete installations on this principle have been established by the author, and the present paper contains an account of this work from the first experiments in 1915 until about four years ago. The first plant was constructed in 1915 for the production of 3·29-inch shells, known as “18-pounders”, from the solid bar. The output was 2,000 shells per week of 135 hours, with girl operators working on three shifts. The second plant was put down in 1916–17 for an output of 500 9·2-inch howitzer shells per week of 135 hours, also with girls working on three shifts. The third plant is of recent design. It was started in 1938 for the production of 3·45-inch shells, known as “25-pounders”; and was laid out for an output of 1,000 shells per week of 47 hours. This plant included four types of hydraulic lathes which the author was engaged to design for the War Office. Soon after the commencement of the last war in 1914 it became evident that shell production would have to be greatly increased, and engineering firms were pressed to take up shell manufacture. The author, on behalf of his firm, undertook to help in the movement, and he at once set about the construction of some simple machines for the job. These conformed on general lines to the practice of the period as regards design and operation. He soon realized, however, that drastic changes would have to be made if production was to reach the high level that circumstances demanded. Although quite familiar with hydraulic machinery of various types and of many applications in presses and certain types of heavy tools, he was not aware of any instance in which hydraulic power had been applied to the movements of a lathe. It appeared to him, nevertheless, that it would be possible to construct a very useful machine on these lines, and he accordingly started immediately to carry out experiments and to prepare designs. It was considered essential that machines for the duty which the author had in mind should be much heavier and more rigid than the ordinary machines of the time, so that they should be free from vibration and “chatter” or spring with the heaviest possible cutting. The standard of rigidity aimed at was that which would permit a half-crown coin to remain balanced on edge on the moving saddle or turret while the tools were making the heaviest cuts. This object was achieved, and the demonstration was frequently made in the presence of those who came to see the lathes at work.

(Re)Made in America: Survivorship after the Shoah

2021 ◽  
Vol 24 (1) ◽  
pp. 28-44
Author(s):  
Alyson Cole
Keyword(s):  
Public Discourse ◽  
The United States ◽  
Moral Authority ◽  
Crimes Against Humanity ◽  
Rape Victims ◽  
The Third ◽  
United States Today ◽  
Negative Attributes ◽  
Made In ◽  
The Welfare State

Until the l970s, ‘survivor’ referred predominantly to individuals who outlived others in the aftermath of disaster, or stood to inherit the remains of an estate; it was not imbued with evaluative connotations. In the United States today, however, survivorship abounds with positive meanings. This transvaluation rests on three intersecting trajectories that together transformed survivorship from denoting that one sustained or was spared a hardship to signifying a superior social status. The first trajectory follows the aftermath of the Shoah, when survivors acquired moral authority as victims of and public witnesses to a new violation, ‘crimes against humanity’. The second tracks the stigmatization of the term ‘victim’ in American public discourse. A consequence of struggles over the welfare state and other progressive policies, victimhood is now associated less with specific harms or injuries, and more with the supposed negative attributes of the victim herself. The third traces how survivorship became integral to the recuperative strategies of new therapeutic disciplines addressing the traumatized – from war veterans and rape victims to cancer patients. These three processes coalesced to create and legitimize a hierarchical opposition between ‘victims’ and ‘survivors’, transforming these terms into political categories and emblems of personal and group identity. In this essay, I argue that the victim/survivor binary constitutes one juncture where neoliberalism converges with Trump-era populism.

COMBATING TRANSNATIONAL CRIME IN AFRICA: PROBLEMS AND PERSPECTIVES

2006 ◽  
Vol 50 (2) ◽  
pp. 145-160 ◽  
Author(s):  
JOHN HATCHARD
Keyword(s):  
Transnational Crime ◽  
Environmental Crime ◽  
The Political ◽  
Political Will ◽  
The Third ◽  
Major Threat ◽  
Proceeds Of Crime ◽  
Made In

Transnational crime is a major problem for African states with corruption, trafficking of persons, drugs trafficking, environmental crime and the like posing a major threat to development and stability. This article examines three challenges that states must tackle in order to combat transnational crime effectively. The first is how to deal with criminals who operate outside the jurisdiction. The second concerns the investigation of crimes with a transnational element. The third challenge involves tracing and then recovering the proceeds of crime that have been moved out of the country where the crime occurred. Here the need for Western states to cooperate with those in Africa is highlighted. Drawing on examples from Lesotho and Nigeria in particular, it is argued that some progress is being made in meeting these challenges. However, the article notes that developing the political will to tackle transnational crime is fundamental to any lasting improvement.

Case Study Comparison: Limitations in Telehealth Relating to Poverty and Family Support

2021 ◽  
Vol 42 (02) ◽  
pp. 158-164
Author(s):  
Lindsey E. Jorgensen ◽  
Rachel E. Barrett
Keyword(s):  
Family Support ◽  
Pediatric Patients ◽  
Internet Access ◽  
Smart Devices ◽  
Internet Connection ◽  
The Third ◽  
Global Pandemic ◽  
Internet Connections ◽  
Made In

AbstractTelehealth appointments have grown in popularity due to the COVID-19 global pandemic. Three cases presented in this article show several different perspectives where telehealth was utilized. For the first patient, appointments were successfully completed via telehealth; however, the patient's family opted to continue with an unsecure internet connection at a local laundromat. For the second patient, a stable internet connection could not be obtained in his home, thus making telehealth appointments unavailable. The caregiver of this patient ended up driving to the clinic to have adjustments made in person. For the third patient, telehealth appointments were unavailable due to unstable internet connections as well as difficulty setting up video interpreting services. These cases highlight the idea that telehealth can be incredibly beneficial, when used correctly. For some, the option to attend appointments virtually gives them access to specialists that otherwise may not be available. For other patients, aspects such as access to smart devices and steady internet access must be considered to ensure a successful connection. The hope is that this article sheds light on some of the potential setbacks that can come from the use of telehealth appointments in a practice and provides discussion regarding for whom telehealth may be appropriate, even in pediatric patients. After reading this article, readers should be able to discuss ways in which there could be solutions for these barriers that may prevent some patients from utilizing these types of virtual appointments.

Form, meaning and genre in the Scherzo of Mahler’s Second Symphony

2009 ◽  
Vol 50 (3-4) ◽  
pp. 221-299
Author(s):  
Lóránt Péteri
Keyword(s):  
Secondary Structure ◽  
Multilevel Analysis ◽  
Primary Source ◽  
The Third ◽  
Successful Attempt ◽  
Extended Unit

This study offers a multilevel analysis of the form of the third movement of Mahler’s Second Symphony providing three frameworks (those of a sophisticated trio form, a bipartite idiosyncratic form, and an imaginary, ‘endless’ form). Conceiving of the formal dimensions of the Scherzo of Mahler’s Second Symphony as ontological models, I will contextualize these with reference to the writings of E.T.A. Hoffmann, Schopenhauer, and Nietzsche. Among the new discoveries of this investigation, I will outline the implications of three hitherto neglected circumstances: first, the movement’s first extended unit itself constitutes a self-contained symphonic scherzo movement; next, the movement can be described as two succeeding permutations of the same set of thematic materials; finally, there is a crucial recurrence suggesting the infinitude of the form. Instead of creating an ill-conceived dichotomy between form as a secondary structure and the meaningful ‘narrative’ in negotiation with formal questions, I wish to regard form as a primary source of a work’s meaning. At the same time, I wish to regard the form of the movement as an efficient means of channelling its dialogue with the genre of scherzo. Listened to as a composer’s self-positioning in the field of the masters of symphony, the movement reveals Mahler’s successful attempt at breaking away from the Brucknerian model of scherzo and, at the same time, proudly parading his virtuosity in applying some elements of that model in a different context.

2. American Retrospect

1893 ◽  
Vol 39 (167) ◽  
pp. 581-583
Author(s):  
D. Hack Tuke
Keyword(s):  
Annual Meeting ◽  
National Conference ◽  
The Third ◽  
History Of ◽  
Made In

Dr. Eugene Riggs, of St. Paul, Minn., U.S.A., the Chairman of the Committee on the History of the Treatment of the Insane, appointed by the National Conference of Corrections and Charities, read the report at its twentieth annual meeting, held June 12-18, 1893, at Chicago. The article is evidently drawn up by himself, and endorsed by the Committee. It constitutes an interesting and valuable review of the progress made in the care of the insane, the first era being that of neglect, the second that of detention more or less severe in character, and the third that in which we live, including the last twenty years. Dr. Riggs commences with the dawn of intelligence in the care of the insane in England in 1792, when the Retreat at York was founded. The period between this date and 1815 is recognized as one coincident in France with the beneficent work of Pinel, reinforced a little later by that of Esquirol. “Since that time both there and here (America) the battle for the increasingly intelligent application of that principle has been going on.”

The Treatment of Insanity

1874 ◽  
Vol 20 (90) ◽  
pp. 224-235
Keyword(s):  
The Third ◽  
Psychological Medicine ◽  
Made In

According to the promise made in our last number, we shall endeavour to give a brief abstract of the chapter on Treatment in the third edition of Drs. Bucknill and Tuke's “Psychological Medicine.” The chapter in question, as our readers are aware, is by Dr. Bucknill, and contains not only his own views, but those of various other writers on many questions connected with the treatment of the insane.

scholarly journals IX.—Researches on Heat. Third Series. § 1. On the unequally Polarizable Nature of different kinds of Heat. § 2. On the Depolarization of Heat. §; 3. On the Refrangibility of Heat

1839 ◽  
Vol 14 (1) ◽  
pp. 176-207
Author(s):  
James D. Forbes
Keyword(s):  
Refractive Indices ◽  
The Third ◽  
The Past ◽  
Made In ◽  
Past Winter

1. The following paper is divided into three sections, containing three distinct yet intimately connected investigations. The two first on the Polarizability and Depolarization of Heat have arisen immediately out of the train of investigation contained in my two former papers, and the researches of others to which they gave rise. The third is on the Refrangibility of Heat, a point of the highest importance for theory.2. The experiments on which these investigations are based have been performed almost exclusively during the past winter. Part of the experiments on Depolarization were, however, made in the winter 1836-7. The mode adopted for trying Refractive Indices I had long ago contemplated. It was not, however, put in practice until January last.

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