Search

The high number of patients infected with the SARS-CoV-2 virus requiring care for ARDS puts sedation in the critical care unit (CCU) to the edge. Depth of sedation has evolved over the last 40 years (no-sedation, deep sedation, daily emergence, minimal sedation, etc.). Most guidelines now recommend determining the depth of sedation and minimizing the use of benzodiazepines and opioids. The broader use of alpha-2 adrenergic agonists (‘alpha-2 agonists’) led to sedation regimens beginning at admission to the CCU that contrast with hypnotics+opioids (“conventional“ sedation), with major consequences for cognition, ventilation and circulatory performance. The same doses of alpha-2 agonists used for ‘cooperative’ sedation (ataraxia, analgognosia) elicit no respiratory depression but modify the autonomic nervous system (cardiac parasympathetic activation, attenuation of excessive cardiac and vasomotor sympathetic activity). Alpha-2 agonists should be selected only in patients who benefit from their effects (‘personalized’ indications, as opposed to a ‘one size fits all’ approach). Then, titration to effect is required, especially in the setting of systemic hypotension and/or hypovolemia. Since no general guidelines exist for the use of alpha-2 agonists for CCU sedation, our clinical experience is summarized for the benefit of physicians in clinical situations in which a recommendation might never exist (refractory delirium tremens; unstable, hypovolemic, hypotensive patients, etc.). Because the physiology of alpha-2 receptors and the pharmacology of alpha-2 agonists lead to personalized indications, some details are offered. Since interactions between conventional sedatives and alpha-2 agonists have received little attention, these interactions are addressed. Within the existing guidelines for CCU sedation, this article could facilitate the use of alpha-2 agonists as effective and safe sedation while awaiting large, multicentre trials and more evidence-based medicine.

Spatial orientation defines our natural ability to maintain our body orientation and/or posture in relation to the surrounding environment (physical space) at rest and during motion. Humans are genetically designed to maintain spatial orientation on ground but it is difficult to achieve in flight. Because of this, normal flight may be impacted by vehicle movement and external forces (hazard or disturbance), causing poor situational awareness (distraction), spatial disorientation (SD), and mode confusion, resulting in abnormal attitudes, abnormal trajectory, and loss of aircraft control, for example, a stall. Sense of balance or equilibrioception is one of the physiological senses related to balance and for spatial orientation. Navigating by sensory input alone during flight can be misleading: sensory input does not always accurately reflect the movement of the aircraft, causing sensory illusions. These sensory illusions include: the leans, the graveyard spin and spiral, and the Coriolis illusion. Recent studies in the issue of SD in terms of its prevalence and contribution to accidents show that SD accounts for some six percent to 32% of major accidents, and some 15% to 69% of fatal accidents. To detect spatial disorientation, we use a non-invasive brainwave monitoring helmet to create a hybrid map of data points of EEG and deep brain/3D brain mapping which will be used as a trigger to detect a possible disorientation in the pilot. The input from the pilot will be analyzed with predictive algorithms to predict when the pilot may experience disorientation. We have utilized a similar approach to develop a pilot in loop system to detect, identify, and mitigate spatial disorientation in pilots. Additional sensors and microprocessors can be used to not only detect spatial disorientation but also to monitor pilot health and fitness, improve performance and operational readiness, and develop fail-safes.

Principals play a vital role in setting the direction for successful schools. With the emphasis on preparing highly qualified school leaders for the 21st century, this article investigated aspiring school leaders’ and their perception of preparedness to serve as instructional leaders, talent and organizational system managers. Particularly, the findings explore how various factors are associated with improving future school leaders’ readiness to effectively carryout critical leadership responsibilities. The article concludes with recommendations for developing a well-designed educational leadership training program that prepares and supports future school leaders for an ever changing world

Bu çalışma, Amerika’daki okul lider adaylarının örgütsel sistem liderliği faaliyetlerini yürütmeye ne kadar hazır olduklarını ve hangi farklı etkenlerin liderlik performansını nasıl etkilediği araştırıyor. Okullarda bulunan kaynakların etkili yönetimi ve tüm öğrencilerin akademik başarısını sağlamak için, okul liderlerine organizasyon ve kaynak yönetimi hakkında bilgi ve beceriler kazandırmak günümüzde çok önem taşımaktadır. Organizasyon sistemlerinin etkili yönetimi sayesinde eğitim ve öğretim sorunlarının daha kolay ve hızlı bir şekilde çözüldüğü gözlenmektedir. Bu çalışmada niceliksel korelasyonel araştırma yöntemi, farklı faktörlerin Amerika’da ki okul lider adaylarının kaynak ve operasyonel yönetimi ile ilgili algılamalarını nasıl etkilediğini analiz etmek için kullanılmıştır. Araştırmanın en şaşırtıcı sonuçlarından biri gelecekteki okul liderleri, güvenli ve yüksek performanslı öğrenme ortamı için organizasyonel sistemleri ve kaynakları yönetmeye hazır olduklarını belirttiler. Fakat diğer yandan, Amerika’da okul lider adaylarının önemli bir miktarı, okullarda büyük sistematik değişiklikler yapmaya ve karmaşık örgütsel problemleri çözmeye hazır olmadıklarını ifade ettiler. Sonuçlar aynı zamanda, regresyon modeline dokuz öngörücü değişken dahil edildiğinde, katılımcıların toplam örgütsel sistem liderliği skoruyla yalnızca yaş ve gelecekteki liderlik planları, arasında anlamlı bir korelasyon bulunduğunu göstermektedir, This study explores dynamics that affect aspiring school leaders’ and their readiness to perform organizational system leadership activities in the United States. The issues of resource management and properly equipping K-12 school leaders with knowledge and skills to ensure the academic success of all students is an on-gong issue. Through effective management of organizational systems the issues begins resolve itself. A quantitative correlational research design was used to analyze how well various factors predict future school leaders’ perceived readiness to implement resource and operational management tasks. One of the most staggering outcomes of the study, the future school leaders indicated that they are perform or knowledge ready to manage organizational systems and resources for a safe, high performing learning environment. On the other hand, the significant amount of aspiring school leaders reported that they are not fully confident in their abilities to solve large complex problems to make systemic changes. Results also suggest that when nine predictor variables are included in the regression model, it is noted that only two variables, age and the future leadership plan are significantly correlated with the participants’ total organizational system leadership score

This study examines the ways single Black mothers contribute to the educational success of their 11th-grade sons, despite the fact that their sons are enrolled in “failing schools.” Data from five interviews and one focus group reveal common characteristics of how single-Black mothers help their sons beat the odds.

Progress over the last 50 years has led to a decline in mortality from ≈70% to ≈20% in the best series of patients with septic shock. Nevertheless, refractory septic shock still carries a mortality close to 100%. In the best series, the mortality appears related to multiple organ failure linked to comorbidities and/or an intense inflammatory response: shortening the period that the subject is exposed to circulatory instability may further lower mortality. Treatment aims at reestablishing circulation within a “central” compartment (i.e., brain, heart, and lung) but fails to reestablish a disorganized microcirculation or an adequate response to noradrenaline, the most widely used vasopressor. Indeed, steroids, nitric oxide synthase inhibitors, or donors have not achieved overwhelming acceptance in the setting of septic shock. Counterintuitively, α2-adrenoceptor agonists were shown to reduce noradrenaline requirements in two cases of human septic shock. This has been replicated in rat and sheep models of sepsis. In addition, some data show that α2-adrenoceptor agonists lead to an improvement in the microcirculation. Evidence-based documentation of the effects of alpha-2 agonists is needed in the setting of human septic shock.

African American men’s health has at times been regarded as irrelevant to the health and well-being of the communities where they are born, grow, live, work, and age. The uniqueness of being male and of African descent calls for a critical examination and deeper understanding of the psycho-socio-historical context in which African American men have lived. There is a critical need for scholarship that better contextualizes African American Male Theory and cultural humility in terms of public health. Furthermore, the focus of much of the social determinants of health and health equity policy literature has been on advocacy, but few researchers have examined why health-related public policies have not been adopted and implemented from a political and theoretical policy analysis perspective. The purpose of this article will be to examine African American men’s health within the context of social determinants of health status, health behavior, and health inequalities—elucidating policy implications for system change and providing recommendations from the vantage point of health equity.