Indications, Complications, and Techniques for Emergent Rapid Sequence Intubation Outside the Operating Room

Airway is the initial and single most important step in any Advanced Cardiac Life Support (ACLS), airway rescue, or trauma resuscitative algorithm. Without a patent airway, further resuscitative measures are futile. Rapid sequence intubation (RSD is a technique used by Certified Registered Nurse Anesthetists (CRNA) and other appropriately trained healthcare providers to secDre the airway in an attempt to regain physiological homeostasis in ihe failing patient. This procedure, however, is associated with substantial ri sks. A.dditional l.y, those oati.ents r-ec1uirin r2: RSI are often the most ..i. J ,_. critically ill with a multitude of other injuries or pathology. A i:horough understanding of airway management, rapid sequence intubation technique, and potential compUcations of this technique must be a priority for those professionals involved in airway rescue. The purpose of this review is to explore the most common indications for rapid sequence or emergent tracheal intubations in the critical care setting, to describe the most common techniques and pharmacological agents utilized, and to discuss the complications associated with rapid sequence intubation. The expected outcome of this independent study is that there will be an increase in knowledge and awareness by CRNAs and other healthcare providers that will ultimately result in improved patient outcome A comprehensive literature review utilizing retrospective research, prospective studies and case reports regarding the indications, techniques, pharmacological agents and complications of RSI will be conducted. A power point educational presentation that includes the indications, techniques and complications of RSI will be developed and presented to CRNAs, nurse anesthesia students, and other healthcare professionals involved in airway rescue outside of the operating room. An adult learning theoretical framework will guide this stud

Potential candidates for ECPR in the catchment area of the University hospital in North Norway

Introduction: Some studies report increased survival from out of hospital cardiac arrest (OHCA) with extracorporeal cardiopulmonary resuscitation (ECPR), but the survival rates vary and heterogeneous study populations complicate comparison between studies. Aim: The purpose of this study was to find potential ECPR candidates among all OHCA cases in the catchment area of the University Hospital of North Norway (UNN). Material and methods: In a case series design, we analyzed retrospectively patient record data from the local UNN OHCA registry from January 1 2015 to December 31 2017. Patients were included in the study if they fulfilled the UNN ECPR protocol criteria: Age 80 years, witnessed OHCA with bystander CPR, no-flow time < 5 min, initial VF, VT or PEA and a refractory cardiac arrest. However, we omitted the time limitation of CPR time of maximum 40 min in order to also include the cases that theoretically would have been excluded solely due to distance from the center. Geographical position at the time of arrest was recorded and travel time to the center was estimated. Results: There were 321 cases of OHCA during the study period. Following the ECPR inclusion criteria 138 cases (43%) were included, of which 22 (7%) did not have an exclusion criterium, and were considered eligible for ECPR, but only five had actually been treated with ECPR. Conclusion: Approximately 7 % of OHCA in the UNN area fulfilled the ECPR criteria, and may theoretically have benefited from ECPR treatment. However, with the current requirements of low flow time, only nine would have access to the treatment. Integration of an OHCA-ECPR program may have a small but clinically important effect in selected patients. Our results encourage further investigation of wider application of ECPR, which in the future also should focus on options for the OHCA patients that occurred outside the current geographical limits for this therapy

Diseases of Baby Pigs

The diseases which affect baby pigs are the same as those which also affect older swine . However, when baby pigs are affected the disease is frequently much more severe. The baby pig does not have the reserve to withstand a prolonged infection and is dependent on the continuous supply of milk for energy. When this milk supply is lost by vomition or when the pig refuses to eat , then the disease rapidly gains control. Other organ isms which are usually non-infective also be gin to multiply and be cause of the weakened condition brought about by the disease the se secondary organ isms begin t o invade other organs and enhance the disease

Social Reflections on the Ecocertification process and Protected Areas of Australia

　Ecocertification in Australia began with the implementation of the world’s first National Ecotourism Accreditation Program（NEAP） in 1996 as a result of stakeholders and social pressures. It was a joint product of government, Protected Area Managers, tourism stakeholders, academics, and Australian society. Originally, a small voluntarily implemented system catering to a niche market, it is now a national $1.2 billion industry, encompassing Eco certified companies, guides, indigenous and climate change certification.\n　Recent tourism research indicates that as the generation shifts, there is a growth in conscientious travelling with an increase in volunteerism, environmentally friendly, authentic and experiential tourism. In 2012, nearly 30% of tourists indicated they would choose an eco-friendly option, and a majority of travellers（70%） expect travel companies to build sustainability into their products（CREST 2013）. The following paper looks at the sociological processes and events in the tourism industry that contributed to the development of Ecotourism ? ecologically sustainable tourism, cultural understanding, education, and accreditation

Hvordan trener supermosjonister som hevder seg på regionalt nivå? En deskriptiv studie av treningsfrekvens, treningsvolum og treningsintensitet blant vinnere av Saltenregionens mosjonsløp

Bakgrunn: Veldig få studier har tatt for seg treningen til godt trente mosjonister, eller såkalte supermosjonister, som hevder seg helt i toppen i regionale mosjonistløp. Det finnes ikke mange studier som beskriver faktorene treningsfrekvens, treningsvolum eller treningsintensiteten blant disse. Mål: Formålet med studien er å belyse problemstillingen: Hvordan trener supermosjonister som hevder seg i konkurranser på regionalt nivå i distanseløp – slik at vi kan fremme mer viten om hva som skal til for å hevde seg i disse løpene. Metode: Det ble rekruttert flere supermosjonister som hevder seg i konkurranser på regionalt og lokalt nivå. Treningen til utøverne ble loggført, hvor frekvens, volum og intensitet ble registrert. For å beskrive nivået og samtidig se hvilken effekt treningen ga ble det foretatt fysiologiske tester av det maksimale oksygenopptaket og hastighet ved anaerob terskel. I tillegg ble det sett på hva forskningslitteraturen sier om eliteløpere og deres trening - dette for å sammenligne treningen på tvers av nivåene. Resultater: Funnene i denne studien viser at de som hevder seg i toppen i regionale konkurranser i Saltenregionen løper mellom 59,6 og 67,2 km i uken (menn), og mellom 54,8 og 60,8 km i uken (kvinner). I snitt bruker mennene mellom 4,8 timer og 5,3 timer på løpetrening i uken, mens kvinnene bruker mellom 5,2 og 6 timer pr. uke på løpetrening. Gruppen som helhet gjør mellom 4,5 og 5,5 løpeøkter i snitt pr. uke. Totalt med all utholdenhetstrening trenes det mellom 6,3 og 10,4 timer utholdenhetstrening pr. uke. Intensiteten i treningen varierer mellom supermosjonistene fra 59-81 % lavintensiv løpetrening, mens tallet for all utholdenhetstrening samlet varierer mellom 57-87 % lavintensiv trening. Ser vi på prosentvis fordeling av all utholdenhetstrening gjort i sone 3 kan vi se at dette varierer mellom 5,8 % og 20,39 %. Tid i sone 4 og sone 5 varierer fra 5,6 % til 15,9 %. Vi ser også at utøverne har et Vo2max-nivå på 67,3 – 69,1 ml x kg x min (menn) og 49,4 – 54,6 ml x kg x min (kvinner), samt en terskelfart på 16,6 – 17,3 km/t (menn) og 14,7 – 15, 1 km/t (kvinner), ved sine beste målinger. Konklusjon: Resultatene viser at supermosjonistene i studien som hevder seg i regionale mosjonsløp løper mellom 54,8 og 67,2 km i uken, og at de bruker mellom 4,8 og 6 timer i uken på dette, fordelt mellom 4,5 og 5,5 ukentlig løpeøkter. Gjennomsnittlig totalt ukentlig treningsvolum varierer fra 6,3 timer og opp til 10,4 timer. Intensitetsfordelingen varierer blant supermosjonistene, men alle har det til felles at det meste av treningen gjøres i sone 1 og 2. I tillegg til denne lavintensive treningen så gjøres det typisk 2 intervalløkter i uken med høyere intensitet. Vo2max blant alle supermosjonistene er mellom 49,4 og 69,1 ml x kg x min og terskelfarten mellom 14,7 og 17,3 km/t

Effects of a Vitamin and Mineral Bolus on Beef Heifer Feedlot Performance, Feeding Behavior, Carcass Characteristics, and Liver Mineral Concentrations

Crossbred beef heifers (n = 23; initial body weight [BW] = 370 ± 12 kg) housed at the North Dakota State University Beef Cattle Research Complex in Fargo, North Dakota, were used to evaluate the effects of a 250-d slow-release vitamin and mineral bolus on feedlot performance, feeding behavior, carcass characteristics, and liver mineral concentrations. Heifers were assigned to one of two treatments: 1) received no supplemental mineral or vitamin (CON, n = 12 or 2) received two boluses on day 0 (minimum of 3,740 mg Ca, 16,456 mg Mg, 112 mg Na, 11,220 mg Cu, 2,995 mg I, 2,805 mg Mn, 505 mg Se, 48,620 mg Zn, 468 mg Co, 824,296 IU vitamin A, 173,102 IU vitamin D3, and 4,121 IU vitamin E bases on company analysis; Reloader 250 Mineral Bolus, Cargill Inc., Minneapolis, MN; MIN, n = 11). Heifers were fed a total mixed ration containing corn silage, grass hay, dried distillers grains with solubles, and dry-rolled corn (16.05% crude protein, 1.44 Mcal/kg NEg) with no added vitamin or mineral supplement. Feed intake and number and time of visits were recorded for each heifer using the Insentec feeding system (Hokofarm Group B.V., the Netherlands) during the feeding period. Liver biopsies were collected from heifers on days 0, 69, and 134 of the feeding period for analysis of mineral concentrations and analyzed as repeated measures. Heifers were slaughtered after 150 or 169 d on feed, and carcass characteristics were determined. Final BW, average daily gain, dry matter index, gain:feed, and carcass characteristics were not influenced (P \u3e 0.19) by treatment. Control heifers visited feeders more but spent less time per visit and ate less per visit compared with MIN heifers (P \u3c 0.03). No differences (P \u3e 0.06) in liver mineral concentrations were observed between treatments, and concentrations of Se, Cu, Mo, Mn, and Co decreased (P \u3c 0.05) over the feeding period. In this experiment, the slow-release vitamin and mineral bolus evaluated failed to increase liver mineral concentrations during the finishing period or influence heifer performance and carcass characteristics

Utilizing an Electronic Feeder to Measure Mineral and Energy Supplement Intake in Beef Heifers Grazing Native Range

Introduction Grasslands in the Northern Plains provide the primary forage source for ruminants throughout much of the year (Schauer et al., 2004). Supplementation practices are often necessary to maintain production and offset forage nutritive decline throughout the grazing season (Schauer et al., 2004; Cline et al., 2009). Typically, to maintain a targeted production level, energy and protein supplementations are used for grazing livestock (Caton and Dhuyvetter, 1997). For developing heifers consuming low-quality forages, inclusion of energy ingredients into supplements may be beneficial for growth and reproductive performance (Schillo et al., 1992; Ciccioli et al., 2005; Cappellozza et al., 2014). In addition, the use of corn and distillers grains supplement has been compared to evaluate performance responses (Loy et al., 2007) but the influence of these strategies on intake and feeding behavior on pasture are lacking. Moreover, supplementing mineral to cattle grazing poor-quality range vegetation can improve forage utilization and animal performance (Köster et al., 1996; Caton and Dhuyvetter, 1997). An issue with providing mineral supplements to cattle, however, is the degree of variability in intake, with some cattle over consuming or under consuming supplements (Tait and Fisher, 1996; Cockwill et al., 2000; Greene, 2000). However, providing supplements to pasture-based cattle does not allow measurements of individual animal mineral and supplement intake; as a result, mineral and supplement intake is measured on a group basis. The use of electronic monitoring systems in the beef industry has been limited to systems primarily used in research settings to examine the effects on feed intake in relation to cattle growth performance (Islas et al., 2014), daily intake of salt-limited supplements (Reuter et al., 2017), health status (Wolfger et al., 2015), or animal movement in extensive pasture settings (Schauer et al., 2005). These technologies could be adapted easily for the use in beef cattle production systems to monitor activity, feeding or drinking behavior, or as tools for monitoring inventories in intensive or extensive production systems. Therefore, our objectives were to examine the relationship between mineral and energy supplementations provided via an electronic feeder on intake, liver mineral concentrations, and metabolites in heifers being managed on native range

A meta-analysis of gender differences in leadership effectiveness

Despite years of evidence showing that men are typically considered to be more appropriate and effective in leadership positions than women, a recent debate has emerged over the potential existence of a female leadership advantage in certain contexts (Eagly &amp; Carli, 2003a; Vecchio, 2003; Eagly &amp; Carli, 2003b). This meta-analysis aims to contribute to this debate in the literature by quantitatively summarizing gender differences in leadership effectiveness using 99 independent samples from 95 studies. Results show that when all leadership contexts are considered together there is a non- significant gender difference in leadership effectiveness. Additionally, this study examines the influence of contextual moderators developed from role congruity theory (Eagly &amp; Karau, 2002) and some competing theoretical frameworks. Overall, the findings support the core tenets of role congruity theory—that prejudice against female leaders can vary depending on a variety of features of the leadership context and characteristics of the perceivers of the leader’s effectiveness. However, some of the hypotheses proposed by role congruity theory were only partially supported. The results of this meta- analysis point to ways in which the theory can be updated and expanded by taking into account findings supported by other theories presented in the literature on gender and leadership. Finally, this meta-analysis provides important practical implications for reducing the barriers women may face throughout the leadership labyrinth as they pursue the most elite leadership positions