Ems

El manejo de la vía aérea en el ambiente prehospitalario supone un gran reto para los profesionales de la salud ya que existen muchos factores que lo dificultan o imposibilitan. El objetivo de esta investigación fue diseñar e imprimir en 3D un dispositivo supraglótico para la intubación orotraqueal a ciegas y evaluar la eficiencia en costos para su uso rutinario por los servicios de atención médica de urgencias. El diseño se hizo basándose en el dispositivo comercial “SALT” y se realizó un estudio económico prospectivo para calcular su costo total de producción. Los resultados demostraron un ahorro del 92.64% en comparación con el costo promedio de dispositivos comerciales similares.

The medical management of acute coronary syndrome (ACS) follows the recommendations of international medical societies. The call to the emergency services by the patient triggers a race against the clock in pre-hospital care. It is essential to reduce the duration of the inadequate perfusion of the heart in order to limit its consequences. An effective reperfusion strategy must be planned in advance taking into account the logistical constraints. It is crucial that the general public is educated to recognise the signs of ACS and to call the emergency services immediately (such as (15,112, 991).
La prise en charge médicale du syndrome coronarien aigu (SCA) est cadrée par les recommandations des sociétés savantes internationales. L’appel au centre 15 par le patient déclenche une course contre la montre en préhospitalier. Il faut réduire le délai de mauvaise perfusion du cœur et en limiter les conséquences. Une stratégie de reperfusion efficace doit être anticipée avec des contraintes logistiques. L’éducation des populations est primordiale dans la reconnaissance des signes de SCA, avec un appel précoce au centre 15, 112 ou 911.

A step by step guide on how to master the basics in Accounting. Whether you have just started Accounting or struggling to grasp the basic principles, this book is for you. Colourful illustrations make Accounting come alive on your iPad or device, and it is a valuable add-on in the classroom for students doing Accounting or EMS.

Downloadable in both epub and mobi (for Kindle) format on devices or computer (laptop). 368 pages.

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The organization of a emergency medical services (EMS)
must obey the reality of a country focused on the goal
of providing opportunity and quality of care to patients
who suffer an urgency, emergency and / or disaster in the
prehospital setting. Thus, the EMS in Chile into its component
subsystems private and public has responded with a system
other than American or European (mainly French /Germany),
ie, a more well organized with multiple levels of response
from resuscitations drivers, paramedics, health university
professionals non-doctors, and doctors. Besides having a
central axis that is continuing medical regulation for the
administration or management of the unique number of
health emergencies and the limited resources available to
community demand.
In the same context, the resolution of timing and quality
is achieved the key issues pointing time-dependent life-
threatening, and these trials (cardiac arrest out-hospital,
compromised airway or ventilation, compromise tissue
perfusion and confrontation with chest pain with its
highest expression is acute coronary syndrome) as well as
organizational (including the presence of some doctors in
the Prehospital (Ph) or the use of certain sensitive resources
such as rescue for helicopters).

Introduction: One of the most important components of emergency medical services (EMS) which plays a major role in reducing mortality and disability of victims is access to healthcare services. Equitable access to healthcare services requires providing essential and accessible services for all people without imposing any financial burden on them. The aim of this study was to determine and prioritize the components of access to EMS in Iran. Methods: This study is a descriptive and cross-sectional study that has done in the first half of 2010 in Iran using DEMATEL method. The data about the access components of EMS in different systems was collected using researcher-made questionnaire. Afterwards, a sample of 30 Iranian experts in EMS who were selected using purposive sampling method were asked to evaluate the suggestions and revise the collected components using their scientific, practical and visionary experience. Then, the components were identified using Delphi method. The priorit...

Le Centre d’Enseignement des Soins d’Urgence est historiquement “l’école des SAMU“ (Services d’Aide Médicale Urgente). Le CESU contribue à la formation initiale et continue des professionnels de santé face à l'urgence. Grâce aux nouvelles techniques pédagogiques mises en œuvre, avec notament la simulation en santé, leur implantation au sein des établissements de santé est non seulement un atout pour le développement professionnel continu (DPC) mais se révèle aussi un outil indispensable à la prévention et la gestion des risques. Grâce à leur réseau créé en intra et extra hospitalier, les CESU représentent une plus value en terme de coordination des soins et probablement en terme financier. Que ce soit en France ou au Mahgreb, ils se profilent comme des acteurs potentiels de l’évaluation des pratiques professionnelles et de la recherche médicale.
[The CESU (Center for EMS Education) is historically “the school of SAMU” (Emergency Medical Services). This center contributes to the initial and continuous training and education for health professionals facing emergencies. Throughout new teaching techniques implemented, especially with simulation in healthcare, their implementation in healthcare facilities is not only an asset to the continuing professional development (CPD), but also turns out to be an essential tool for risk prevention and management. Through their network established within and outside the hospital, this “learning”
center represents an added value in terms of coordination of care and probably in financial terms as well. Whether in France or Maghreb, they are emerging as potential actors in the evaluation of professional practice and medical research.]

In this paper, a day-ahead profit-maximizing energy management scheme for a grid-tied microgrid operation is proposed. The microgrid contains various types of distributed energy resources (DERs) and an inverter-interfaced battery-bank storage system. The average of day-ahead hourly forecasted data for loads, wind speed, and solar radiation are inputted into the framework of energy management (EMF). To optimize the microgrid performance, EMF determines the hourly dispatch of reactive and active power for each DER. Also, it specifies the discharging and charging times of the energy storage system and the on-load tap changer position setting of the transformer connected to the main grid. The main aim is to maximize the revenue of microgrid meeting all technical limitations. The main grid can sell/buy reactive and active powers to/from the microgrid with a variable daily energy price of the market. A collective rule base-BAT algorithm is implemented as a solver of the energy management optimization problem for a grid-tided microgrid. Furthermore, the ability of the suggested EMF is proved in comparison with recent approaches.

Despite the growth of wilderness medicine in general, some
EMS systems, even in areas with high outdoor activity
usage, are ill-prepared to respond to wilderness emergencies.
Underfunding, jurisdictional issues, undertraining, and
lack of attention can all contribute to a meager formal
rescuer response during your next wilderness emergency.
By law all EMS personnel, whether in the front country
or backcountry, must operate under the medical oversight
of a licensed physician. However, until now there has
been no specific training for physicians to provide this
type of oversight.

After the wedding in Těšín, the accompanied newlyweds went to Salzburg, where they were festively received (so-called reception) in the presence of many invited guests and courtiers of the Archbishop of Salzburg. The entire family of Caspar of Hohenems attended the festivities; Anna Sidonia’s brother, Friedrich William, also came from Munich to greet his sister, representing his father, Adam Wenceslas, there. The newlyweds stayed at the Archbishop’s so-called New Residence in Salzburg (Neue Residenz, today the Salzburg Museum). Jacob Hannibal held the office of chief marshal in the Archbishop’s court, but he was addicted to alcohol and gambling. The great financial demands of his court led to disagreements with his uncle, Marc Sittich, who also strongly criticized Anna Sidonia’s behaviour. That is why Jacob Hannibal had to leave with his wife in the middle of 1617 to the castle of his father, Caspar, in Hohemens. After returning to Salzburg, Princess Anna Sidonia gave birth to son Marc (Hannibal) Sittich, who died after three months, and probably a daughter, Johanna Eleonora. Anna Sidonia died of smallpox in puerperium on 13 March 1619 and was buried in the St. Salvator Chapel three days later. One of the few memories of her is a life-size portrait exhibited in the Municipal Museum and Gallery in the eastern-Bohemian town of Polička.

Malaysian Small Medium-sized Enterprises (SMEs) is largest business establishment and vital component of the country’s economic development. However, limited studies were examined on their development, challenges and future green prospects, especially in service sector. Therefore this article examines the development of SMEs in Malaysia, challenges and opportunities of green practices among SMEs which is play a vital role in the nation growth. The uniqueness of this paper focuses on green practices which is important for SMEs to progress and competitive in domestically and globally. The key messages from these studies examined in this paper are that Malaysian SMEs contribute to the largest business establishment in Malaysia especially service sector and majority of them are in micro size establishment. Nevertheless, there are wide recognition in the literature about the factors hinder SMEs from expanding, this is mainly because high cost of raw materials, high initial cost of investment and shortage of skilled labour. The concept of green environment is still at infancy stage in Malaysian SMEs. Environmental management literature mostly published in the developed countries has proven that ISO 14001 Environmental Management System (EMS) implementation has a positive and significant relationship with SMEs performance. This study is important indicator to encourage other SMEs which has no green practices in place to consider joining the green bandwagon, especially SMEs service sectors. The studies focused are conditioned by the search strategy used. In addition, other key words could be including in future studies such as performance, customer satisfaction, financial performance, environmental and green supply chain management in order to expand this search. The main contribution of this paper is to identify the development of SMEs in Malaysia and future research proposals with regards to the benefit of the green practices (ISO 14001 standards) in Malaysian SMEs service sector.

Gradually, increasing environmental awareness has increased the demand for goods and services. These manufactured goods and services are made in compliance with environmental standards to protect and enhance environmental assets and natural resources as important competitive factors. Numerous standards and legal legislations have been developed to guide businesses on environmental issues. Therefore, various businesses sectors are more inclined to develop and implement environmental policies these days. Many of these policies are developed with the guidance of ISO 4001-Environmental Management Systems (EMSs). The businesses which have adopted the standards of the EMSs have to protect the environment and ensure its continuity. Thus, businesses require the reflection of environmental management activities on businesses performance evaluation in terms of price competitiveness and cost effectiveness. To this end, this research aims to study Turkish businesses which have adopted and got EMS certification and accordingly analyze the development and implementation of EMS and how its implementation in turn affects environmental performance. Descriptive Statistics, Correlation, and Linear Regression Analyses were used to assess the association between EMS implementation and environmental performance. The results revealed that EMS implementation has a significant positive impact on environmental performance.

It the article is present the model of costs of environmental management system as a tool to help for cities in estimating costs connected with this system and also to undertaking decision regarding initiating ISO 14001. Thanks to this model city can qualify the real costs referring to different groups on which city have referring and with have influence on natural environment.

An experiment was conducted at Horticulture farm, Sher-e-Bangla Agricultural University, Bangladesh to create EMS induced new variants of tomato through TILLING for point mutations. Mutation induction is considered as an effective way to enrich plant genetic variation. Seeds of two tomato lines (LINE-1 and LINE-2) were treated with different concentrations (0.0%, 0.1%, 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7% and 1.0%) of chemical mutagen EMS. Tomato plants showed wide range of variation concerning their studied characters. Among 216 plants 27 plants were selected having variations in traits concerning crop duration, yield contributing characters and shelf life the requirement of the farmer’s yield and customer choice. Number of fruit, individual fruit weight, yield/plant and shelf life of the 27 plants ranged from 51.0-104, 41.0-80.4 g, 2.1-4.5 kg and 8.0-31.0 days respectively.

The software available to implement and carry out efficiency analysis is crucial for the diffusion of efficiency frontier techniques among applied researchers and policy makers. The implementation of up‐to‐date productivity and efficiency analysis is indeed important to advance our knowledge in many fields, ranging from the public and regulated sectors to the private ones. This contribution fills a gap in the existing literature and surveys the currently available options to estimate a variety of frontier methodologies using either general or dedicated programs. We outline directions for future research.

Con el fin de evitar la contaminación de amplias superficies a causa de una mala disposición de la basura, se consiguió aprovechar el cabello humano que se elimina en salones de belleza, como materia prima para la obtención de compost además se inocularon microorganismos para acelerar este proceso, el compost es un abono orgánico que se utiliza como fertilizante edáfico, puede contribuir al desarrollo del sector agrícola, y a la conservación del ambiente.
El proceso tecnológico inicio con la recolección de la materia prima, que fue sometida al proceso de compostaje, por un espacio de 16 semanas, se empleó un Diseño completamente al azar con 9 tratamientos y 3 repeticiones, cada unidad experimental estuvo conformada con 50kg de materia orgánica a compostar, se utilizaron dos dosis de cabello humano: de 5 y 10%, dos grupos diferentes de microorganismos: microorganismos eficientes (EM) y Trichoderma spp, conjuntamente con estiércol y pasto. Se comprobó que la formulación del tratamiento T2 (2% Microorganismos Eficientes + 10% Cabello humano + 24% Estiércol de cuy. + 64% Poda de pasto) fue la más adecuada para obtener una concentración óptima de macronutrientes, elementos secundarios y micronutrientes con valores de: 0,12% de Nitrógeno, 0,028% de Fósforo, 0,60% de Potasio, 0,56% de Calcio, 0,085% de Azufre, 0,059% de Magnesio, 6,01 ppm de Boro, 4,11 ppm de Cobre, 127,13 ppm de Hierro, 56 ppm de Manganeso y 22,29 ppm de Zinc. Además alcanzó un pH ligeramente ácido de 6,27, una conductividad eléctrica de 12,91 mS/cm que se traduce en un compost con una concentración salina fuerte, el rendimiento fue del 65% y el costo de producción por kilogramo de compost mereció un valor de 0,07 USD.

We report the case of a 57-year-old woman found at home who received an ECG after having recovered from a seizure, without any clinical cardiac anomaly. The ECG revealed an elevation of the ST segment from the V1 to V5 leads and negative T waves from V1 to V5 leads. At her hospital admission, the emergency care unit (ECU) nurse performed another ECG. It no longer showed any repolarisation anomaly. However, the ECU nurse had put the precordial electrodes 3 cm too low, probably due to the patient’s voluminous breasts. In the end, the pathological trace reappeared after we returned the electrodes to their initial positions. Malpositioning of the electrodes caused a seemingly normal ECG result with life-threatening consequences.

Phytoremediation as a cost-effective and environmental friendly technique used to polluted soils with heavy metals contamination. The present study was aimed to evaluate the resistance and remediation of Tamarix aphylla calli affected by in vitro mutagenesis with. In the first step, optimization of callus induction and mutation in media with different concentrations of -2,4 was performed. The third experiments involved the evaluating of resistance and remeditaion rate of callus to cadmium at the concentrations of 0-40 mg L-1 in both treated and untreated explants with Ethyl methanesulfonate in medium. The highest survival and induction of callus was induced by the concentration of 1 mg L-1 2,4-D during the short time. Ethyl methanesulfonate at concentration of 0.2 percentage and 30 minutes made the maximum survival and minimum blacking phenomenon of explants. The highest accumulation of cadmium was obtained 1053.56 mg kg-1 dry weight in callus treated by 40 mg L-1 cadmium.

The study aimed to determine extract yield (%), antibacterial activity, and minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of plant extracts from dried and fresh herbal plants (Phyllanthus amarus) against Vibrio parahaemolyticus strain causing acute hepatopancreatic necrosis disease (AHPND) in white leg shrimp (L. vannamei). The result showed that the extract yields of dry and fresh herbs reached 11.50% and 2.75%, respectively and the antibacterial activity of the two extracts both are good at concentrations from 250 to 1,000 mg/mL at the same bacterial density of 106 CFU/mL. Specifically, the diameter of the inhibition zone at 250; 500; 750 and 1,000 mg/mL concentration of dried herbal extracts reached 16.75±0.96; 18.50±1.29; 20.75±0.96 and 21.25±0.50 mm, while that of fresh herbal extracts reached 14.50±1.29; 16.25±0.50; 16.75±0.50 and 17.00±0.00 mm, respectively, with a statistically significant difference p<0.05. The result also showed that MIC values of dried and fresh extracts were defined at 125 mg/mL and 250 mg/mL, respectively and that MBC values of the extracts were 500 and 1,000 mg/mL respectively. The GC-MS analysis revealed that there were 19 natural compounds in the dried extract, in which Ethyl Linoleolate (C20H36O2) compound occupied the highest ratio (22.43%), while 2.3-Dihydro-3.5-dihydroxy-6-methy-4H-pyran-4-one (C6H8O4) was the lowest (0.24%).

Neste Projeto Experimental de Viabilidade foi avaliada a aplicação de um Sistema de Gestão Ambiental (SGA) simplificado em uma empresa constituída apenas pelo Micro-Empreendedor como forma de demonstrar a aplicabilidade do mesmo em empreendimentos desse porte. Contatou-se que é possível com um investimento mínimo aplicar tópicos da norma ISO 1400 que possibilitam a esse empreendimentos ficar em acordo com as características da norma e formalizar assim para a comunidade em que estão a preocupação deles com a questão ambiental.