Capacity building in low- and middle-income countries: The essentials of sustainable education programs.

ABSTRACT: NPs are an essential resource in the organization and creation of capacity-building efforts to improve healthcare across the globe. There are limited data to guide the creation of effective supplementary education projects. Recent evidence highlights the essential components of sustainability, curriculum development, and program evaluation.

A Policy Analysis of Preparedness for Hurricane Evacuations in the United States, 1990 to 2019: Implementation in Coastal States.

Hurricane or typhoon evacuations in the United States are typically managed by state, territorial, or tribal emergency management officials with federal, state, and local agency operational support. The evacuation process may involve issuing mandatory or "voluntary" evacuation orders to alert the community and mitigate loss of life and injury. We conducted an analysis of state and local hurricane evacuation policies identified through a literature review (January 1990 to June 2019) and key informant interviews with state public health and emergency management officials in Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Texas in October and November 2019. Findings from the literature review show that most gaps in hurricane evacuation preparedness-based on 44 policy-related publications identified in the review-could be categorized into 4 themes: shelters, evacuation decisionmaking, at-risk populations, and transportation. Findings from key informant interviews for 7 states revealed that coastal states have been able to address most of these gaps since Hurricane Katrina in 2005. However, an important remaining gap in preparedness is providing timely warnings to at-risk populations during hurricane evacuations.

Development and implementation of a trauma team education program in Georgetown, Guyana.

ABSTRACT: Trauma teams without structured team training demonstrate impaired team dynamics, which can cause delays in patient care, leading to poor patient outcomes. Improving team dynamics leads to better communication, reduced errors, and enhanced patient care. Evidence-based trauma team training was implemented and delivered within a resource-restricted ED.

Unique factors to the implementation of a disaster preparedness plan at Georgetown Public Hospital in Guyana.

ABSTRACT: Disaster planning in developing countries is largely ineffective despite these countries being more likely to suffer from catastrophic events. This article aims to identify strengths, educational needs, practice improvement opportunities, and local factors that may contribute to the development/implementation of a disaster preparedness plan at Georgetown Public Hospital in Guyana.

Maximizing Success With Rapid Sequence Intubations.

Within emergency care settings, rapid sequence intubation (RSI) is frequently used to secure a definitive airway (i.e., endotracheal tube) to provide optimal oxygenation and ventilation in critically ill patients of all ages. For providers in these settings, a deeper understanding of the indications, associated medications, and adjunctive techniques may maximize success with this common procedure. Identification of difficult airways, using mnemonics and standardized criteria prior to the procedure allows, the clinician additional time for assimilation of additional resources and tools to increase the likelihood of first-pass success with intubation. This article describes tools for the procedure of RSI, including the "7 Ps" checklist of intubation.

An 8-year-old boy with altered mental status.

Management of an acutely ill pediatric patient with undifferentiated altered mental status is a common challenge facing air medical crewmembers. The transport team is often the vital link between the referring agency and a tertiary care center; it is incumbent upon the team to be able to meet the challenges of patient management including airway management, providing hemodynamic support, and addressing presenting symptoms. This case presents a child with altered mental status and seizure activity requiring advanced interventions and support. His hospital course is described and reveals an encephalopathy caused by the Bartonella henselae bacterium also known as cat-scratch disease. This case shows the pathology, symptomology, and management along with the importance of proper management and interventions by air medical crewmembers to maximize outcomes.

Impairments in site-specific AS160 phosphorylation and effects of exercise training.

The purpose of this study was to determine if site-specific phosphorylation at the level of Akt substrate of 160 kDa (AS160) is altered in skeletal muscle from sedentary humans across a wide range of the adult life span (18-84 years of age) and if endurance- and/or strength-oriented exercise training could rescue decrements in insulin action and skeletal muscle AS160 phosphorylation. A euglycemic-hyperinsulinemic clamp and skeletal muscle biopsies were performed in 73 individuals encompassing a wide age range (18-84 years of age), and insulin-stimulated AS160 phosphorylation was determined. Decrements in whole-body insulin action were associated with impairments in insulin-induced phosphorylation of skeletal muscle AS160 on sites Ser-588, Thr-642, Ser-666, and phospho-Akt substrate, but not Ser-318 or Ser-751. Twelve weeks of endurance- or strength-oriented exercise training increased whole-body insulin action and reversed impairments in AS160 phosphorylation evident in insulin-resistant aged individuals. These findings suggest that a dampening of insulin-induced phosphorylation of AS160 on specific sites in skeletal muscle contributes to the insulin resistance evident in a sedentary aging population and that exercise training is an effective intervention for treating these impairments.

Comparison of a field-based test to estimate functional threshold power and power output at lactate threshold.

It has been proposed that field-based tests (FT) used to estimate functional threshold power (FTP) result in power output (PO) equivalent to PO at lactate threshold (LT). However, anecdotal evidence from regional cycling teams tested for LT in our laboratory suggested that PO at LT underestimated FTP. It was hypothesized that estimated FTP is not equivalent to PO at LT. The LT and estimated FTP were measured in 7 trained male competitive cyclists (VO2max = 65.3 ± 1.6 ml O2·kg(-1)·min(-1)). The FTP was estimated from an 8-minute FT and compared with PO at LT using 2 methods; LT(Δ1), a 1 mmol·L(-1) or greater rise in blood lactate in response to an increase in workload and LT(4.0), blood lactate of 4.0 mmol·L(-1). The estimated FTP was equivalent to PO at LT(4.0) and greater than PO at LT(Δ1). VO2max explained 93% of the variance in individual PO during the 8-minute FT. When the 8-minute FT PO was expressed relative to maximal PO from the VO2max test (individual exercise performance), VO2max explained 64% of the variance in individual exercise performance. The PO at LT was not related to 8-minute FT PO. In conclusion, FTP estimated from an 8-minute FT is equivalent to PO at LT if LT(4.0) is used but is not equivalent for all methods of LT determination including LT(Δ1).