A case of malpositioned Endotracheal tube with resultant left lung collapse.

BACKGROUND ENDOTRACHEAL INTUBATION IS USUALLY DONE AS A PART OF EMERGENCY MANAGEMENT OF PATIENTS WITH A THREATENED AIRWAY AND GENERAL ANAESTHSIA, IN ORDER TO ENSURE PATENCY OF THE AIRWAY AS WELL AS PROPER VENTILATION. POSITIONING AN ET TUBE CORRECTLY IS OF PARAMOUNT IMPORTANCE IN ORDER TO PREVENT HYPOVENTILATION, INAPPROPRIATE VENTILATION AND ALSO COLLAPSE OF LUNG DUE TO MALPOSITIONING OF ET TUBE. ETT POSITION IS USUALLY ASSESSED USING FRONTAL CHEST RADIOGRAPH. THE POSITION OF THE ETT IS DEPENDENT ON THE POSITION OF THE HEAD & NECK. THE MANDIBLE CAN BE USED FOR ASSESSMENT OF WHETHER THE NECK IS IN A NEUTRAL OR FLEXED OR EXTENDED POSITION. ETT POSITIONING VARIES FROM PATIENT TO PATIENT DEPENDING UPON AGE OF THE PATIENT ALSO. CASE DESCRIPTION A 1 YEAR 10 MONTHS OLD FEMALE CHILD PRESENTED WITH THE COMPLAINTS OF FEVER SINCE 2 DAYS, 2 EPISODES OF CONVULSIONS, GTCS TYPE OF SEIZURES WITH UP ROLLING OF EYES, ENTIRE EPISODE LASTING FOR 2 MINUTES, ASSOCIATED WITH POST ICTAL DROWSINESS. CHILD IS A KNOWN CASE OF GLOBAL DEVELOPMENTAL DELAY AND WAS PREVIOUSLY ADMITTED TO HOSPITAL WITH SIMILAR COMPLAINTS. ON EXAMINATION SHE WAS FOUND TO HAVE HYPOTONIA OF ALL 4 LIMBS AND DROWSINESS. CONCLUSION: ETT POSITIOING SHOULD ALWAYS BE ASSESSED USING A FRONTAL CHEST XRAY IN ORDER TO ENSURE PROPER POSITIONING AND AVOID MALPOSITION

Unique Common Fixed Point Theorem for Non-Expansive Mappings

In the present paper two theorems on non-expansive mappings have been established. The first theorem is for four mappings which satisfy R- sub weakly commuting property in pair. The result of first theorem is used to develop another theorem for q-star shaped subset of a normed space. An attempt has been made to prove one more theorem for two weakly compatible mappings on convex sets. These results are the extension and generalization of earlier results existing in the literature

Examining the Role of Emotional Labor in Mediating the Relationship Between Calling and its Outcomes

Work as calling research has clearly established the benefits of having a calling, such as, work meaningfulness and job satisfaction, and is less forthcoming in identifying the affective linkages between calling and its outcomes. We propose that because individuals with high calling find their work purposeful and significant, they are more likely to actively shape their emotions and engage in emotional regulation. This study examines the role of emotional labor in mediating the relationship between calling and its two outcomes – emotional exhaustion and job performance. The data for the study included a sample of 195 teachers from 42 daycare centers. Findings suggest that having a high calling is associated with lower emotional exhaustion and is associated with higher job performance. Also, calling is significantly associated with emotional labor, and in particular, is positively related to deep acting and negatively related to surface acting. Further, results show that both surface acting and deep acting mediate the relationship between calling and its outcomes

Comparison of left 4th and 5th intercostal space thoracotomy for open-chest cardiopulmonary resuscitation in dogs

Open-chest cardiopulmonary resuscitation (OC-CPR) is indicated in certain cardiopulmonary arrest situations such as thoracic trauma. Laboratory research and clinical studies in human medicine have established the superiority of OC-CPR compared to closed-chest cardiopulmonary resuscitation (CC-CPR) with regard to cardiac output, aortic blood pressure, blood flow, and perfusion. Despite this demonstrated superiority, the technique for OC-CPR has not been described in detail in the veterinary clinical literature. The most convenient incision for performing OC-CPR is a left intercostal thoracotomy. Literature most commonly describes a 4th or 5th intercostal space (ICS) thoracotomy for performing OC-CPR in dogs. No studies to date have been performed to compare the two approaches. The goal of this study was to evaluate whether lateral thoracotomies through the 5th ICS should be recommended over those performed through the 4th ICS for canine OC-CPR. We hypothesized that access to the heart would be more convenient through the 5th ICS, and the 4th ICS would not provide appropriate access for all the procedures involved in performing OC-CPR. Left lateral thoracotomies were performed on twelve canine cadavers, six through the 4th ICS and six through the 5th ICS. Six parameters (ease of grasping phrenicopericardial ligament, ease of pericardial incision, ease of aortic access, ease of achieving appropriate hand position, ease of application of Rumel tourniquet, and ease of proper placement of defibrillator paddles) involved in performing OC-CPR were assessed by three evaluators. The results indicated that either 4th or 5th ICS thoracotomy may provide adequate access to intrathoracic structures pertinent for performing OC-CPR in dogs weighing approximating 20 kg, but the 5th ICS was found to be better for most manipulations.Includes bibliographical reference

Language contact and sound change: Reasons for mutual unintelligibility between formal and colloquial registers of Tamil

Tamil has since its origination been diglossic, separating the formal high register from the colloquial low register. These two registers are currently mutually unintelligible (Shanmugam Pillai 1965). This analysis explores the reasons why they became unintelligible, which are proposed to be two-fold: historic language contact between Tamil and Sanskrit; and sound changes demonstrated using the Comparative Method. It has been suggested that the decline in mutual intelligibility is due to the removal of Sanskrit loanwords from the formal high register during the Tamil Purist Movement of the 20th century (Kailasapathy 1979). The earliest evidence of Tamil and Sanskrit reciprocal borrowing dates to the first Tamil literary works (Krishnamurti 2003). Where and when this language contact occurred is unclear, but it may have occurred during overlapping occupation of the Indus River Valley region by Sanskrit and Proto-Dravidian (Steever 2009). During the 20th century, the formal register replaced these loanwords with Tamil equivalents wherever possible (Kailasapathy 1979). Currently, low register Tamil is composed of 50% loanwords whereas high register Tamil is composed of only 20% loanwords (Krishnamurti 2003). It has been attested, however, that some diglossia was present before contact between Tamil and Sanskrit. Early diglossia can thus instead be explained by sound changes, which also account for current differences between the registers not attributed to loanwords. Sound changes identified in this analysis include: syncope, apocope, paragoge, stop to fricative lenition, and others. This analysis finds that language contact and sound changes contributed to the decline in intelligibility between formal and colloquial Tamil, however the nature of the language contact is still under investigation

Developing capabilities in smart city ecosystems: a multi-level approach

Smart city projects require complex coordination of resources, but research on how capabilities form at the city-ecosystem level remains scarce. This article develops a multi-level approach to capability development in smart city ecosystems through an empirical study of London’s city data. We analyse the London case to discover how two ecosystem-level capabilities – data provisioning and data insights – developed through global, configural and shared aggregation processes. We find that the emergence process changes as the smart city ecosystem develops, requiring different coordination and resource mobilisation mechanisms at various stages. We contribute to the capability development and smart city literatures by focusing on ecosystem-level capabilities linked to collective city-level outcomes rather than the capabilities of the leading city authority. Insights from the study are of value to city authorities considering how to scale up and organise smart city initiatives in support of urban development goals