Hydronephrosis Due to Bilateral Tubo-ovarian Abscess

A 27-year-old female presented to the emergency department with fevers, nausea, chills, and non-specific bilateral lower quadrant abdominal pain. A pregnancy test was negative. Computed tomography demonstrated moderate left hydronephrosis secondary to tubo-ovarian abscess. The abscess was so large it distorted local anatomy and compressed the ureters. She was prescribed meropenem and admitted for care by obstetrics/gynecology

What happened to the inventory overhang?

The large inventory buildup in the first half of 1997 led to media warnings of a substantially weaker economy by year's end. The authors examine the rationale for these warnings, and argue that inventory accumulation is an unreliable predictor of future economic strength.Inventories ; Business cycles

The Effects of Hypoxia on Chemical Toxicity in Two Model Fish Species

Hypoxia is a global and increasingly important stressor in aquatic ecosystems, with major impacts on biodiversity worldwide. Hypoxic waters are often contaminated with a wide range of chemicals but knowledge is limited about the interactions between hypoxia and chemical stressors. Therefore, during this PhD I set out to investigate how the concentration of oxygen in the water influences chemical toxicity in fish. My work focused on two groups of chemicals: toxic metals, of which copper was used as an example, and anti-androgenic chemicals. Copper is an essential metal, widespread in the aquatic environment, but it can become toxic to aquatic organisms when environmental levels become too high. Copper and hypoxia are likely to co-occur but despite this our understanding of the interactions between these two stressors is limited. To address this, I performed a series of experiments using both the zebrafish (Danio rerio) and the three-spined stickleback (Gasterosteus aculeatus) as fish models. I first investigated the effects of hypoxia on copper toxicity to zebrafish embryos during development. Copper toxicity was reduced by over 2-fold under hypoxia compared to normoxia during the first day of development, and I demonstrated that this protective effect was associated with the activation of the hypoxia inducible factor pathway. In contrast, hypoxia increased copper toxicity in hatched larvae, which was deduced to be associated with differential copper uptake. To test if the interactions between copper and low oxygen observed for the zebrafish also occurred for other fish species, exposures were conducted in a species with a lower tolerance to hypoxia, the three-spined stickleback. The results obtained showed that hypoxia suppressed copper toxicity prior to hatching, but after hatching this effect was reversed, similarly to that observed for the zebrafish. This suggests a potential conserved effect of hypoxia on copper toxicity during embryogenesis across fish species. To investigate if life stage influences the interactions between low oxygen and copper toxicity, the effects of combined exposures were assessed in the adult male three-spined stickleback. The critical oxygen level (Pcrit) was determined to allow appropriate experimental design. The combined exposures to copper and low oxygen resulted in a decreased ability to acclimate to low oxygen. Fish were able to lower their Pcrit in response to low oxygen conditions when exposed to hypoxia alone but not when exposed to hypoxia in combination with copper. Together, these datasets support the hypothesis that the life stage influences the effects of the combined exposure, as hypoxia protects from copper toxicity during early embryogenesis but increases copper toxicity in hatched embryos and in adults. I then investigated whether hypoxia can affect the toxicity of another widespread group of pollutants, anti-androgenic chemicals. Male three-spined sticklebacks were exposed to three anti-androgenic chemicals, flutamide, linuron and fenitrothion, under different air saturations. Each chemical had a unique transcriptional response alone and in combination with reduced oxygen saturation. Under both air saturations, spiggin transcription was strongly inhibited by exposure to flutamide. In contrast, exposure to fenitrothion did not result in a significant effect on spiggin transcription. Interestingly, linuron strongly inhibited spiggin under 100% air saturation, but this effect was absent under low air saturation, potentially as a result of interactions between the hypoxia inducible factor pathway and the aryl hydrocarbon receptor pathway. This work illustrates the potential mechanisms responsible for interactions between reduced oxygen and chemical toxicity, especially for aryl hydrocarbon receptor agonists, and highlights how hypoxia can modify the effects of a variety of chemicals with diverse modes of action. My research highlights the importance of considering the interactions between multiple stressors, and the need to take into account the type of chemical, life stage, and the species tolerance. Understanding these interactions is essential to facilitate the accurate prediction of the consequences of exposure to complex stressors in a rapidly changing environment.Cefa

Dissolved Nutrient Ratios and Concentrations Affect Fungal Reproduction and Community Structure Associated with Submerged Leaf Litter and Wood

Litter-associated fungi are important intermediaries in carbon and energy flow in streams. They can obtain nitrogen (N) and phosphorus (P) from both the substrate and the water column. I tested the effects of dissolved nutrients (dissolved inorganic nitrogen (DIN) 40-975 µg/L, soluble reactive phosphorus (SRP) 2-135 µg/L, N:P ratios 2:1, 16:1, 128:1) on fungi associated with leaf litter (maple and rhododendron) and wood in streamside channels at Coweeta Long Term Ecological Research site, North Carolina. This study addressed two main questions: (1) will fungal reproduction (sporulation rate of aquatic hyphomycetes) peak at a dissolved N:P ratio similar to nutrient stoichiometry of fungal biomass, and (2) what are the effects of dissolved nutrients on fungal community structure and sporulation associated with plant litter that differs in initial N and P content (e.g., leaves vs. wood). The highest fungal sporulation rates were found at a dissolved N:P ratio of 16:1, which is comparable to the stoichiometry of fungal biomass (~10:1). Fungal sporulation rates and cumulative spore production per unit of plant litter by the end of the experiment generally showed statistically significant relationships with DIN rather than SRP. The greatest effects of dissolved nutrients were observed on wood compared to leaf litter. Very strong relationships between fungal production and sporulation rates and between cumulative spore production and plant litter decomposition rates were found for all substrates, suggesting that fungal activity is an important driver of plant litter decomposition. Finally, dissolved nutrients affected the relative abundances of dominant species in litter-associated fungal communities. Thus, dissolved inorganic nutrients affect reproductive output and community structure of aquatic fungi, which may have important consequences for plant litter decomposition and the flow of carbon, nutrients and energy in streams

Glaucoma And Quality Of Life And The Role Of The Nurse Practitioner

The purpose of this study is to further explore literature regarding the role of the nurse practitioner in health promotion and childhood obesity

The Relationship Between Creativity And Self-Esteem In Elders Living In The Community

The purpose of this study is to further explore literature regarding the role of the nurse practitioner in health promotion and childhood obesity

Demand for hospital emergency departments: a conceptual understanding

BACKGROUND: Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to infl uence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs. DATA SOURCES: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand. RESULTS: Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship. CONCLUSION: This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model

Achieving Graduate Attributes through Authentic Learning: The Case of Student Managed Funds

According to the Department of Education and Skills (2011), as cited by Murphy and Whelan (2016), there has been a growing emphasis on the importance of graduate attributes in higher education in Ireland. This not only places emphasis on the application of disciplinary specific knowledge, but also on the ‘soft skills’ highly sought by employers. By providing an authentic learning environment, higher education institutes can facilitate the development of graduate attributes while also ensuring graduates are gaining disciplinary specific knowledge. This project explores how Student Managed Funds (SMFs) represent an authentic learning experience through which students achieve a range of graduate attributes. In addition to the literature review that follows, we also provide details of the recently established Technological University Dublin (DIT) Student Managed Fund (SMF) and a step-by-by guide to the establishment of an SMF, whilst also showing how the DIT SMF learning experience maps to the DIT graduate attributes. Finally, we have developed an infographic that summarises how SMFs are authentic learning experiences that achieve graduate attributes and provide tips for practitioners wishing to set-up an SMF

Handover education improves skill and confidence

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135077/1/tct12461_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135077/2/tct12461.pd

Economic hardship and sexually transmitted diseases in Haiti's rural Artibonite Valley.

A study was conducted to determine the prevalence rate and risk factors for sexually transmitted diseases (STDs) in Haiti's rural Artibonite Valley. Women attending antenatal services at Hospital Albert Schweitzer from October to December 1996 were tested for gonorrhea, chlamydia, trichomonas, syphilis, and human immunodeficiency virus (HIV). Of the 476 women tested, 121 (25.4%) had trichomonas, 11/475 (2.3%) had gonorrhea, 51/475 (10.7%) had chlamydia, 32/474 (6.8%) were seropositive for syphilis, 20/469 (4.3%) were seropositive for HIV, and 191 (40.1%) had at least one STD. Nearly 30% of the women reported having entered a sexual relationship out of economic necessity and had increased odds of HIV infection, Odds Ratio (OR) 6.3 (P < 0.001). We postulate that due to recent economic hardship in rural Haiti, women are entering into sexual relationships out of economic necessity and that this trend is contributing to the growing HIV epidemic. We recommend STD prevention and development programs that target young people and economically disadvantaged women