Mechanism of the second stage of human parturition

The mechanism of the second stage of human parturition has already been the subject of numerous works, and on many aspects of the problem the treatment has been exhaustive. There are matters, however which still call for inquiry. Further evidence seems desirable relative to the form of the dilated pelvic canal; the direction of uterine pressure may be said to be unknown: given a variable direction of pressure proof is awanting of its influence, or otherwise, on the mechanism; the known effect of a uniform pressure on a curved surface needs application to the mechanism of labour: it is worth while to attempt to unravel the congeries of movements which go by the names of flexion and extension; the difficult problem bf lateral obliquities of the fetal head remains where it was forty years ago; the development of the mechanism at the vulvar outlet may be capable of modification in a manner favourable to easier birth. These and other matters are gone over in the pages that follow.A definition of what is meant by the second stage is not easy if regard is had to every possibility/ possibility. In most labours the second stage comprehends the period which elapses after the os uteri is fully dilated and the membranes are ruptured until the child is completely born. It is obvious, however, that the mechanical phenomena cf the second stage are able to be developed before the os is wide open, and after full dilation before the membranes are ruptured, at any rate until a late period of the second staged The "expulsïve period" of the Germans also is not sufficiently general at least in its clinical manifestations, for the evidence - abdominal action - may be awantingd Nor is it adequate to maintain that the passage of the individual segments of the fetus through the vaginal and vulvar canals constitutes the second stage. For the present purpose the second stage is defined as a period which begins when the fetus is compelled to exercise an uncertain quantity of pressure upon the upper part of the vaginal wall and which lasts until, the child is entirely born.The present thesis is divided into six sections and two appendices. The first section deals with the form of the pelvic canal, the second treats of the direction of uterine and abdominal pressure, in the third the mechanism of flexion is considered in the fourth lateral obliquity of the fetal head, the fifth is devoted to internal rotation; while the sixth is concerned with the mechanism of extension and the protection of the perineum. In the first appendix a number of simple experiments is described, and in the second are set forth tables of angular distances derived from the published reproductions of frozen sections. Finally a short summary is given of the results embodied in the thesis

How to Create American Manufacturing Jobs

In An Inquiry into the Nature and Causes of the Wealth of Nations, Adam Smith wrote that a nation\u27s prosperity depends upon the skill, dexterity, and judgment with which its labour is generally applied, and upon the proportion of the population employed in useful labor. Economists watch measures of productivity and employment closely. The unemployment rate is today the single most prominent measure of economic health. By these basic criteria, the incarcerated, approximately 2.24 million able-bodied Americans, more idle prisoners than any other nation, constitute a gigantic drain on the economy. Very few prisoners produce marketable goods or services.4 Most inmate labor is simply prison housework (i.e. helping operate the correctional institution) or the making of selected goods for the government; only a small fraction of prisoners work in factories or on farms, ranches, or roads. Very low employment and productivity in federal and state prisons is invariably proven by dividing total annual correctional industry revenue by the particular prison population. Prison industries often operate at a loss and inefficiently utilize prison labor. What prisoners might be earning under full employment in the private sector equals or exceeds the direct costs of maintaining more than two million prisoners

Non-aboriginal teachers' perspectives on teaching native studies

Since the mid-1980s, the Saskatchewan Department of Education has approved the instruction of Native Studies courses in provincial high schools. In hope of enhancing the instruction of these courses, this study focused on the perspectives of Non-Aboriginal teachers who were assigned to teach Native Studies. Through a questionnaire, personal interviews, and a focus group, nine Non-Aboriginal high-school teachers examined the following aspects of the courses: formal and informal training of instructors , goals of the courses, key content and pedagogical methodologies, major challenges, and recommendations for improving the delivery of the classes.The literary context for the research was based upon three major areas: Non-Aboriginal teachers' perspectives on teaching Aboriginal students, preparing teachers to teach Native Studies, and preparing teachers to instruct Native Studies to Aboriginal students. Due to the 'single-group' nature of Native Studies curricula, considerable literature examination was focused on multicultural education models. The research data of the study revealed that the majority of interviewees have minimal formal education experience with Aboriginal content or epistemology. In addition, most of the study participants indicated little, if any, informal cultural contact with Aboriginal peoples. Study participants generally acknowledged the limitations of their scant academic and experiential interaction with Aboriginal cultures, and recommended means of various education stakeholders improving the situation.The study also exposed a variety of teacher perspectives about the goals of the courses. While there was unanimity regarding the efficacy of the courses, most teachers believed the goals of Native Studies varied depending on the cultural composition of the class. In addition, a couple of teachers inferred that a major objective of Native Studies courses is the promotion of an anti-establishment' political message. Some teachers also indicated a quandary regarding whether the course curricula required them to "teach Aboriginal culture, or teach about Aboriginal culture."In terms of course content and teaching methodologies, there were numerous opinions on `what was important'. All the interviewees viewed history as a significant ingredient to a `good' Native Studies class, but some of the teachers expressed a reluctance to delve into such issues as Aboriginal spirituality, racism, and 'white-privilege'. There was also hesitation amongst many of the respondents to incorporate traditional Aboriginal epistemologies into course methodologies because they wanted to personalize instruction, not base it upon cultural generalizations.In addition to the aforementioned issues and corresponding challenges associated with the background training for the courses, the goals of the courses, and the content and methodology of the courses, the study participants highlighted other concerns with the teaching of Native Studies: irrelevant curricula, lack of materials, poor course funding, student absenteeism, student perception that the courses are for 'non-academics', lack of flexible timetabling for experiential learning, and lack of staff knowledge and appreciation of Aboriginal cultures. All administrative levels of the education system were identified by the interviewees as influential in helping to mitigate the difficulties associated with the instruction of Native Studies

Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya

Background Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are available on the incidence and clinical characteristics of severe group A rotavirus disease. Advocacy for vaccine intervention and interpretation of effectiveness following implementation will benefit from accurate base-line estimates of the incidence and severity of rotavirus paediatric admissions in relevant populations. The study objective was to accurately define the incidence and severity of group A rotavirus disease in a resource-poor setting necessary to make informed decisions on the need for vaccine prevention. Methods and Findings Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus infection at Kilifi District Hospital in coastal Kenya. Children < 13 y of age were eligible as "cases" if admitted with diarrhoea, and "controls" if admitted without diarrhoea. We calculated the incidence of hospital admission with group A rotavirus using data from a demographic surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296 (22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%) were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95% confidence interval [CI] 1.9–4.7) were rotavirus positive. The annual incidence (per 100,000 children) of rotavirus-positive admissions was 1,431 (95% CI 1,275–1,600) in infants and 478 (437–521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9% among rotavirus-negative children. Conclusions In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first 5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is associated with acute life-threatening metabolic derangement in otherwise healthy children. Although mortality is low in this clinical research setting this may not be generally true in African hospitals lacking rapid and appropriate management

Measuring differential attainment:a longitudinal analysis of assessment results for 1,512 medical students at four Scottish medical schools

Funding The Scottish Medical Education Research Consortium (SMERC) provided funding to allow the research project to take place. The funding was used to pay for administrator and researcher time to collate and analyse the data. The funder had no direct input into the analyses chosen or the reporting of the results. The researchers were independent from the funder, and all researchers had access to the data and can take responsibility for the integrity of the data and the accuracy of the data analysis.Peer reviewedPublisher PD

Economic development, human development, and the pursuit of happiness, April 1, 2, and 3, 2004

This repository item contains a single issue of the Pardee Conference Series, a publication series that began publishing in 2006 by the Boston University Frederick S. Pardee Center for the Study of the Longer-Range Future. This was the Center's spring conference, which took place during April 1, 2, and 3, 2004.The conference asks the questions, how can we make sure that the benefits of economic growth flow into health, education, welfare, and other aspects of human development; and what is the relationship between human development and economic development? Speakers and participants discuss the role that culture, legal and political institutions, the UN Developmental Goals, the level of decision-making, and ethics, play in development