Inadvertent severe hypercapnia during general anesthesia: drop-in oxygen saturation or electrocardiography changes; which one warns us earlier?

Background During general anesthesia especially when the nurse or anesthesiologist forgets to change manual to controlled mode after successful endotracheal intubation, capnography shows End-tidal Co2 above 20 mmHg after checking the place of the tracheal tube and will remain on the screen permanently. In this scenario, the patient receives a high concentration of oxygen, and Spo2 (oxygen saturation) does not drop for a long time which is too late to intervene. It has been all-time questionable which one of the cardiac dysrhythmias or Spo2 dropping occurs earlier. Results Medical records of seven deceased patients reviewed. All of them had electrocardiogram changes including premature ventricular contraction or bradycardia as a first warning sign. Oxygen saturation remains above 95% even with cardiac dysrhythmia. Conclusions Bradycardia and premature ventricular contraction were the first warning findings for severe hypercapnia during general anesthesia and occurred earlier than dropping oxygen saturation. Furthermore, the normal capnography waveform is more reliable than the End-tidal Co2 number for monitoring.

Burnout Syndrome in public school teachers in Sorocaba, São Paulo, Brazil

Objective: To identify the prevalence of Burnout Syndrome (BS) in a sample of 107 elementary school teachers (cycle II and high school) in Sorocaba/SP and analyze possible associations of psychosocial and organizational factors at work with the dimensions of burnout. Methods: Cross-sectional epidemiological study, conducted through a selection of a convenience sample, which included 107 teachers from state schools in Sorocaba using the following criteria: having entered the public teaching career for at least one year and working predominantly as a teacher, that is, not having more hours in administrative positions. Data collection was conducted in eight schools in the city, and two forms were used, the “Maslach Burnout Inventarie-Educators Survey” (MBI-ES) and a biopsychosocial form. Pearson's chi-square test and logistic regression analysis were performed for data analysis, adopting a significance level of 5%. Results: There was a prevalence of BS in 4.7% of teachers, with 29% of teachers showing high Emotional Exhaustion, 33.6% high Depersonalization and 18.7% low Professional Fulfillment. Positive associations were found between factors such as lack of recognition, dissatisfaction with work and situations of harassment with the dimensions of the BS. Conclusion: The results suggest a warning sign for illness characterized by burnout in the sample of teachers studied.

Is a Left-to-Right >2.2°C Difference a Valid Measurement to Predict Diabetic Foot Ulceration in People with Diabetes and a History of Diabetic Foot Ulceration?

Monitoring foot skin temperatures at home have been shown to be effective at preventing the occurrence of diabetic foot ulcers. In this study, the construct validity of using >2.2°C difference between contralateral areas on the foot as a warning sign of imminent ulceration is explored. Thirty participants with diabetes at high risk of ulceration (loss of protective sensation and previous ulceration and/or amputation) monitored their foot temperatures at six sites, four times a day for six days using a handheld infrared thermometer. Walking activity, time of day, and environmental temperature were also monitored and correlated with foot temperatures. We found that contralateral mean skin temperature difference was 0.78°C at baseline. At single sites, left-to-right temperature differences exceeding the threshold were found in 9.6% of measurements ( n = 365), which reduced to 0.4% when individually corrected and confirmed the next day. No correlation was found between contralateral temperature differences and activity, time of day, and environmental temperature. We conclude that using a >2.2°C difference is invalid as a single measurement in people at high risk of ulceration, but the construct validity is appropriate if both individual corrections and next day confirmation are applied.

Forecast of Economic Growth in Armenia

The article presents the development of methods for forecasting economic growth. Since the 1950s, researchers have paid more attention to economic growth research. Many analysts and economists have focused on methods of forecasting economic growth and have tried to find the principal methods that influenced it. In the 2000s, economists found out that more than 500 exogenous or indigenous factors affect economic growth. Every national economy has its specifications which makes the forecast of its economic growth uncorrelated with the others. Some of them are heavily affected by oil and gas production, the others – by financial or customer service and a dozen of national economies are affected by the production in agriculture [3]. The economy of Armenia is not an exception. The author showed dynamics of Armenian economic growth, by which factors it has been affected, brought some comparisons with the region's countries. The authors used various econometric models to predict economic growth. The tiniest model, which the author constructed based on the ordinary least squares method, showed that Armenia's economic growth is mainly affected by four factors: Foreign Direct Investments, exports, national savings, and the amount of provided loans in Armenia. The quality of the model was 98% which is very high. The most considerable affection have foreign direct investments (FDI). If the FDI increases by 1 billion dollars, gross domestic product (GDP) will rise by 4.52 billion dollars, 36% of Armenia's GDP in 2019. The affection of Exports is not low either. If the amount of Exports increases by 1 billion dollars, that would raise gross domestic product (GDP) by 1.58 billion dollars which is 13.6% of Armenia's GDP in 2019. The author also tried to predict the economic growth of Armenia for ten years, from 2020-2029. The author used both ARIMA and SARIMA models to forecast economic growth. The results were interesting because they showed the economic crisis of 2020 due to the COVID-19 pandemic and the need for change in fiscal and monetary policies. It can be a warning sign to the ministry of Finances, Central Bank of Armenia, to consider critical changes in these policies.

An Analysis of Covid-19 Supply and Demand, and Impacts on the Post-Pandemic World

Covid-19 has impacted the world in an unprecedented way. The astounding rate that Covid-19 spreads has made it a universal and ubiquitous threat, affecting every facet of our daily life, causing changes in behavioral characteristics among individuals, communities, and governments. Accordingly, there have been drastic changes in domestic markets, governmental policies, and decision-making processes in this environment in supply and demand. This paper reviews the current market situation facing Covid 19, economic sector’s responses so far and its impact on post-pandemic era. Covid-19 has been a warning sign that we have to do better. Although the world was unprepared for this global crisis, this could be an opportunity for governments and businesses to learn from the experience and harden up to do better under abrupt challenges that could arise in the future.

Predictive Asset Analytics: The Future of Maintenance

Major Overhauls (MOH) of major Rotating Equipment is an essential activity to ensure equipment and overall plant's productivity and reliability requirements are met. This submission summarizes Maintenance cost reduction and MOH extension benefits on an integrally geared centrifugal Instrument Air (IA) compressor through a first of its kind Predictive Maintenance (PdM) solution project in ADNOC. Appropriate planning for Major Overhauls (MOH) in accordance with OEM, company standards and international best practices are crucial steps. Digitalization continues to transform the industry, with enhancements to maintenance practices a fundamental aspect. Centralized Predictive Analytics & Diagnostics (CPAD) project is a first of its kind in ADNOC as it ventures into on one of the largest predictive maintenance projects in the oil & gas industry. CPAD enables Predictive Maintenance (PdM) through Advanced Pattern Recognition (APR) and Machine Learning (ML) technologies to effectively monitor & assess equipment performance and overall healthiness. Equipment performance is continuously assessed through the developed asset management predictive analytics tool. Through this tool, models associated with the equipment were evaluated to detect performance deviation from historical normal operating behavior. Any deviation from the historical norm would be flagged to indicate condition degradation and/or performance drop. Moreover, the software is configured to alert for subtle changes in the system behavior that are often an early warning sign of failure. This allows for early troubleshooting, planning and appropriate intervention by maintenance teams. Using the predictive analytics software solution, an MOH interval extension was implemented for an integrally geared centrifugal IA compressor installed at an ADNOC Gas Processing site. The compressor was due for MOH at its traditional fixed maintenance interval of 40,000 running hours in Nov 2019. Through this approach, the actual performance and condition of the compressor was assessed. Its process and equipment parameters (i.e. casing vibrations, bearing vibrations, bearing temperatures and lube oil supply temperature/pressure, etc.) were reviewed, which did not flag any abnormality. The compressor's performance had not deviated from the historical norm; indicating that the equipment was in a healthy condition and had no signs of performance degradation. With this insight, a 15 months extension of the MOH was achieved. Furthermore, a 30% maintenance cost reduction throughout the compressor's life cycle is projected while ensuring equipment's reliability and integrity are upheld. A total of 7 days maintenance down time including work force and materials planning for the MOH activities was deferred. The equipment remained in operation until its rescheduled date for MOH. Through the deployment of predictive analytics solutions, informed decisions can be made by maintenance professionals to challenge traditional maintenance practices, increase Mean Time Between Overhauls (MBTO), realize the full potential of a plant's process & utilities machinery and optimize operational costs of plant assets.

The ASEAN “Crack”: Myanmar Conflict as The Warning Sign of Peace Stability in South East Asia Region

ASEAN currently facing a real strive to deal with their own internal humanitarian and peace stability related to the case of Myanmar conflict. This condition has put other ASEAN members in quandary to conduct a prompt and precise solution to bring back peace in Myanmar. This article examines the potential crack in the “ASEAN way” principle which is related to the various conflicts inside the region. Moreover, it also endorsed two possible proposals which can be considered to strengthen the role of ASEAN to take action towards their member states. The latest conflict inside Myanmar between military and democratic groups showed the warning sign that something is not working well within the system of ASEAN as a regional organization. This article investigates the potential crack that ASEAN has in their basic principle which harms the future peace stability within the region. The writer argues that the conflict in Myanmar has become a symptom that ASEAN must revisit their basic principle and reorganize their strategy to deal with potential conflict that might occur in the future.

Does Thermal Stress Modulate the Biochemical and Physiological Responses of Ruditapes Decussatus Exposed to the Progestin Levonorgestrel?

The combined effects of the abiotic factors such as temperature and synthetic progestins on the biochemical and physiological performances of marine clam Ruditapes decssatus under sub-chronic conditions are poorly studied. Here, we investigated the effects of levonorgestrel (1000 ng/l) alone or combined with increasing temperature of 20, 24 and 28°C on the biochemical and physiological responses and the gonad histology of the clam (Ruditapes decussatus) for 28 days. Our results revealed that, in clams treated with levonorgestrel (LNG) alone, there was an impairment of the defense against oxidative stress related to the inductions of CAT, GST and PSH, a reduction in the lysosomal membrane stability, a physiological disturbance via an increase in the level of estradiol, a decrease in the number of gonad oocytes and a reduction in vitellogenin like protein. Furthermore, exposure to heat stress of 20°C, 24°C and 28°C, alone or in combination with LNG, enhanced SOD antioxidant activity which was ineffective in preventing lipoperoxidation and altered clam’s physiological processes of reproduction via dramatic reduction of gonad oocyte numbers and of vitellogenin like protein reserves. Overall, these findings can be taken as a warning sign of temperature and levonorgestrel progestin effect that can lead to effective changes in the structure and function of target vital organs, such as the gonads of the clam Ruditapes decussatus, and this may have implications for the whole organism and populations.