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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

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Open Journal of Anesthesiology 2018年第6期8卷 183-197页

作者： Richard Skupski Arthur Toth Michael T. McCurdy Shane Kappler James Lantry Gerson Pyran Donald Zimmer Joseph Dynako Anne Grisoli David Zimmer John Wilson Bhavesh M. Patel Hannelisa Callisen Alyssa Chapital Lovely Nathalie Colas marc Edson Augustin Nathalie Edema Enzo Del Brocco Richard Frechette Mark Thompson James Corcoran Michael Mazowiecki Mark Walsh Memorial Hospital Trauma Center South Bend IN USA University of Maryland School of Medicine Baltimore MD USA Indiana University School of Medicine South Bend Campus South Bend IN USA Mayo Clinic Rochester MN USA Mayo Clinic Phoenix AZ USA Hô spital Saint Luc Port-Au-Prince Haiti Excela Health Westmoreland Hospital Greensburg PA USA Saint Joseph Regional Medical Center Mishawaka IN USA

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 reali

关键词： Intensive Care Unit (ICU) Critical Care Mechanical Ventilation Endotracheal Ventilation Anesthesiologist Low and Moderate-Income Country Austere Environment Telemedicine

INTEGRATED DESIGN OF AN ELECTRIC POWERED UNMANNED AIR VEHICLE USING CONCURRENT SUBSPACE DESIGN

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Transactions of Nanjing University of Aeronautics and Astronautics 2000年第2期17卷 140-149页

作者：余雄庆 marcA.Stelmack StephenM.Batill 南京航空航天大学飞行器系南京210016 圣母大学航空航天与机械工程系

The concurrent subspace design (CSD) framework has been used to conduct a preliminary design optimization of an electric powered, unmanned air vehicle (EPUAV) operating at a low Reynolds number. A multidisciplinary system analysis that includes aerodynamics, weights, propulsion, performance and stability and control has been developed for this class of vehicles. The CSD framework employs artificial neural network based response surfaces to provide approximations to the design space. The EPUAV system includes 25 continuous and 4 discrete design variables. The CSD framework was able to identify feasible designs with significant weight reductions relative to any previously considered (i.e. initial database) designs. This was accomplished with a limited number of system analyses. The results also demonstrate the nature of this design framework adaptive to changes in design requirements.

关键词： aircraft design multidisciplinary design optimization unmanned air vehicle optimization

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绝非不可对比

海外英语 2010年第6期 22-22页

作者： marc Silver 高春梅（译）不详浙江工商大学

“That＇s like apples and oranges．”（这像苹果和橘子一样风马牛不相及）这个短语表达的意思是将两种完全不相干的物体或想法放在一起比较。但是苹果和橘子就真的是完全不相干吗？两者都是有籽水果。康奈尔大学的园艺家伊恩·默文... 详细信息

“That＇s like apples and oranges．”（这像苹果和橘子一样风马牛不相及）这个短语表达的意思是将两种完全不相干的物体或想法放在一起比较。但是苹果和橘子就真的是完全不相干吗？两者都是有籽水果。康奈尔大学的园艺家伊恩·默文说．“这两种水果你都可以采摘下来，咬上一口。”但两者又以“完全不同的方式”成长。

关键词：对比康奈尔大学苹果水果

偏远及农村地区卫生人力留用计划成本分析技术框架

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中国卫生政策研究 2011年第12期4卷 10-17页

作者： Pascal Zurn Marko Vujicic Christophe Lemiere Maud Juquois Laura Stormont Jim Campbell Martin Rutten Jean-marc Braichet 马达飞(翻译) 李秋霖(翻译) 李晓燕(翻译) 张光鹏(审校) 世界卫生组织瑞士日内瓦世界银行美国华盛顿世界银行塞内加尔达喀尔 DE Cooperacion社会研究所西班牙巴塞罗那雷瓦赫宁根大学荷兰海牙卫生部人才交流服务中心

背景:通过加强卫生人力留用以提高偏远和农村地区卫生人力的可及性,对于人口健康至关重要。然而,此类干预措施有关成本方面的信息往往零散、不全面、甚至缺失。政策措施的成本分析对于政策的选择、规划、实施和评估至关重要,但是由于缺... 详细信息

背景:通过加强卫生人力留用以提高偏远和农村地区卫生人力的可及性,对于人口健康至关重要。然而,此类干预措施有关成本方面的信息往往零散、不全面、甚至缺失。政策措施的成本分析对于政策的选择、规划、实施和评估至关重要,但是由于缺少成本分析的系统方法,为卫生政策制定和决策带来了严峻的挑战。方法:本文提出了提高偏远及农村地区卫生人力可及性政策干预措施的成本分析实施框架,旨在为卫生政策决策者提供帮助。同时,该框架也强调了确定财政的主要来源和财政资金可持续性的重要性。文章对加强边远农村地区卫生人力留用相关政策措施的成本分析进行了文献综述,为此类干预措施的成本分析提供了指导框架,并进一步调查分析了成本分析在整个卫生人力规划与管理中的角色与重要意义。结果:尽管对于人力留用相关政策措施效益的争论得到越来越多的关注,但如何对此类政策措施进行成本分析,目前仍缺乏相关的知识与证据。为了解决这个问题,文章提出了实施成本分析框架的关键要素,并对此进行讨论分析。结论:这些关键要素能够帮助决策者对政策措施有更加深入的了解,明晰与理解财政来源和运行机制,同时确保财政资金的可持续性。

关键词：卫生人力资源偏远及农村地区留用成本分析技术框架

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玻利维亚过去30年土地覆被变化

AMBIO－人类环境杂志 2007年第B11期36卷 565-571页

作者： Timothy J.Killeen Veronica Calderon Liliana Soria Belem Quezada marc K.Steininger Grady Harper Luis A.Solórzano Compton J.Tucker 田玉军马国霞生物多样性应用科学中心(CABS) 生物多样性应用科学中心摩尔基金会

利用5个时段的Landsat图像对玻利维亚东部低地所有山区树木生长线(大约3000m)以下的陆地景观的土地覆被变化进行研究,包括湿润森林、泛滥森林、季节性旱地林、云雾林及灌丛地和草地。2004年玻利维亚东部森林砍伐面积为45 411km^2,大约... 详细信息

利用5个时段的Landsat图像对玻利维亚东部低地所有山区树木生长线(大约3000m)以下的陆地景观的土地覆被变化进行研究,包括湿润森林、泛滥森林、季节性旱地林、云雾林及灌丛地和草地。2004年玻利维亚东部森林砍伐面积为45 411km^2,大约占原始森林覆盖面积的9%,另外有9042km^2的灌丛、热带稀树草原生境转为它用,占土地覆被总历史变化的17%。玻利维亚土地覆被变化速度从20世纪60年代的400km^2/a上升到2001～2004年间的大约2900km^2/a。本研究为玻利维亚提供监测未来土地覆被变化的可靠空间数据,这是建议的补偿机制,即补偿通过减少森林砍伐来降低碳排放的国家的前提。对比最近和以前各时期的土地覆被变化,发现20世纪90年代颁布的有关森林保护政策并没有对降低森林砍伐起明显的作用,在有些保护区内森林砍伐事实上增加了。全国范围内土地覆被变化的速度继续呈线性上升趋势,但是在圣克鲁斯区上升速度更快,这与该地区动农业机械化和养牛业的扩展有关。

关键词：土地覆被变化玻利维亚森林覆盖面积森林砍伐热带稀树草原上升速度补偿机制上升趋势

极轻或轻度子宫内膜异位症合并不孕患者的腹腔镜手术治疗

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世界医学杂志 1998年第12期2卷 78-78页

作者： marc.,S Mahe.,R