Utilizing Anesthesiologists, Emergency and Critical Care Physicians with Telemedicine Monitoring to Develop Intubation and Ventilation Services in an Intensive Care Unit in the Austere Medical Environment: A Case Series. Expansion of the EP/CC GAS Project

Background: Significant resource constraints and critical care training gaps are responsible for the limited development of intensive care units (ICUs) in resource limited settings. We describe the implementation of an ICU in Haiti and report the successes and difficulties encountered throughout the process. We present a consecutive case series investigating an anesthesiologist, emergency, and critical care physician implemented endotracheal intubation and mechanical ventilation protocol in an austere environment with the assistance of telemedicine. Methods: A consecutive case series of fifteen patients admitted to an ICU at St. Luc Hospital located in Portau-Prince, Haiti, between the months of February 2012 to April 2014 is reported. Causes of respiratory failure and the clinical course are presented. Patients were followed to either death or discharge. Results: Fifteen patients (eight women and seven men) were included in the study with an average age of 37.7 years. The mean duration of ventilation was three days. Of the fifteen patients intubated, five patients (33.3%) survived and were discharged from the ICU. Of the five surviving patients, two were intubated for status epilepticus, one for status asthmaticus and one for hyperosmolar coma associated with intracerebral hemorrhage. Of the patients dying on the ventilator, four patients died from pneumonia, two from renal failure, and one from tetanus. The remaining three died from strokes and cardiac arrests. Conclusions: Mortality of mechanically ventilated patients in a resource-limited country is significant. Focused training in core critical care skills aimed at increasing the endotracheal intubation and ventilatory management capacity of local medical staff should be a priority in order to continue to develop ICUs in these austere environments. Collaborative educational and training efforts directed by anesthesiologists, emergency, and critical care physicians, and aided by telemedicine can facilitate realizing this goal.

ON SPACELIKE AUSTERE SUBMANIFOLDS IN PSEUDO-EUCLIDEAN SPACE

In this article, we construct some spacelike austere submanifolds in pseduoEuclidean spaces. We also get some indefinite special Lagrangian submanifolds by constructing twisted normal bundle of spacelike austere submanifolds in pseduo-Euclidean spaces.

Evaluation of Google Glass^(■) with Camera Adaptor and GoPro^(■) as Teaching Tools for Endotracheal Intubation in the Austere Medical Environment

Objective: Endotracheal intubation (ETI) is a life-saving emergency procedure, but it is a complex skill that is difficult to teach. Recent studies have shown that video laryngoscopy is effective in teaching ETI to learners at various levels of medical expertise;however, it has proven to be costly and provides images of inconsistent quality. In this educational proof of concept feasibility convenience sample pilot study, we aim to explore and compare the effectiveness of using modified Google Glass? (GG) and GoPro? (GP) technologies to visualize and teach ETI to critical care physicians in the austere medical environment of a low-income country. We propose, based on our findings, that this inexpensive technology could teach lifesaving ETI to pre-hospital providers in the austere medical environment, medical students, rural emergency physicians, critical care physicians in low-income countries, far forward military medical providers, and other learners. Methods: A case series of twenty-five patients, five in the United States (US) at Memorial Hospital in South Bend, IN and twenty at Saint Luc’s Hospital in Port Au Prince, Haiti, is presented. These patients were collected from November 1st 2015 through February 1st of 2016. The anesthesiologist and the emergency physicians in the United States utilized GG to intubate five patients in the US prior to the twenty patients intubated during two separate trips to Haiti. On the two separate trips to Haiti, the GG was trialed and modified to obtain better exposure. These adaptations resulted in the final collection of twenty patients studied with the adapted GG system and GP. Physicians graded airway visualization based on LEMON and Cormack-Lehane scores. Previously published parameters for the assessment of failed intubation risk and passage of the cords were used as data points for analysis using a Likert-Scale analysis for each parameter. The data were analyzed by averages of Likert-Scale scoring with their respective standard deviations. Results: The results show that the GP is superior to GG for assessing the LEMON scoring system until visualization of the oropharynx, while the GG is markedly superior for calculation of Cormack-Lehane score (cord visualization) and passing of the endotracheal tube. Conclusion: A review of the twenty-five cases demonstrates that while GP allows for better visualization for the parameters that require a wider view of the patient, the modified GG allows for superior visualization in the parameters that require a more focused view of the cords. GG can serve as an effective educational tool in the ICU for physicians and other providers in the austere medical environment who require effective ETI training. In addition, we propose that these techniques can serve as an inexpensive yet effective means of teaching hands on endotracheal intubation skills to learners of varying levels of clinical experience.

Facing Austere Situations Persisting in Upgrading

Recently, the Press Center of China National Textile &Apparel Council issued the information about the economicoperation of the textile industry in the first quarter. It couldbe seen from the main economic indexes that, since

Book Review of Bloodbath Nation

Published in January 2023, illustrated by photographer Spencer Ostrander, Bloodbath Nation is the latest non-fiction work by Paul Auster. This paper makes a review of Bloodbath Nation, including its structure, content, author’s writing style and features of cover and illustrations, and gives a brief evaluation of this work.

New construction of special Lagrangian submanifolds in T~*R^n equipped with the standard metric

A class of twisted special Lagrangian submanifolds in T＊R^n and a kind of austere submanifold from conormal bundle of minimal surface of R^3 are constructed.

Burnout and Its Association with Working Conditions among Greek Hospital Nurses in a Time of Financial Crisis

The recent global economic recession has affected nursing working conditions in terms of salary reductions, increased workload and staff shortages. Poor nursing working conditions are associated with higher levels of burnout. However in Greece this association has not yet been studied. The aim of this study was to explore financial crisis related changes in nurses’ working conditions and their associations with burnout. A cross-sectional quantitative survey was conducted and data were collected through self-reported questionnaires from 299 Greek nurses from two Public Hospitals in 2012. Multiple linear regression analyses were used in order to find independent factors associated with burnout. The results showed that Greek nurses had high levels of burnout. Satisfaction from the job, quality of care and feeling equivalent with other professionals were independent predictors of lower emotional exhaustion. Workload increase and willingness to change career and work department were independent predictors of higher emotional exhaustion. Job satisfaction and satisfaction from care quality were independent predictors of lower depersonalization. Changes in working relationships and willingness to change career were independent predictors of higher depersonalization. Higher personal accomplishments were independently associated with more years in nursing, satisfaction from the salary prior to reductions, better quality of care, feeling suitable for the job and being anxious about future career. Influence on nurse efficiency by income reduction was an independent predictor of lower personal accomplishments. In conclusion, Greek nurses were suffering from high levels of burnout which was independently associated with crisis related working conditions. Interventions are needed in order to reduce the burden of burnout among Greek nurses.

The Racial Prejudice in City in Paul Auster’s Novels

In Auster’s novels,the racial prejudice occupies a vital part;the whites presently take a majority privileged position in the mainstream culture;both the blacks and Jews become the target of racial prejudice which is vividly embodied in City of Glass:The Graphic Novel,Ghosts,Man in the Dark,In the Country of Last Things.

On Submanifolds Whose Tubular Hypersurfaces Have Constant Higher Order Mean Curvatures

Motivated by the theory of isoparametric hypersurfaces,we study submanifolds whose tubular hypersurfaces have some constant higher order mean curvatures.Here a k-th order mean curvature Q_k^v（k ≥ 1） of a submanifold M^n-is defined as the k-th power sum of the principal curvatures,or equivalently,of the shape operator with respect to the unit normal vector v.We show that if all nearby tubular hypersurfaces of M have some constant higher order mean curvatures,then the submanifold M itself has some constant higher order mean curvatures Q_k^v independent of the choice of v.Many identities involving higher order mean curvatures and Jacobi operators on such submanifolds are also obtained.In particular,we generalize several classical results in isoparametric theory given by E.Cartan,K.Nomizu,H.F.Miinzner,Q.M.Wang,et al.As an application,we finally get a geometrical filtration for the focal submanifolds of isoparametric functions on a complete Riemannian manifold.