Consumer Credit in America: Past, Present, and Future

In September 2016, in conjunction with Law & Contemporary Problems at Duke University School of Law, we organized a symposium on Consumer Credit in America. We sought to assess the state of consumer credit in America — to review and examine its recent history, to consider arguments for and against regulation, and to discuss the potential for future innovation. This is the introduction to the volume of articles coming out of that symposium

The Role Of Advanced Nurse Practitioner In Health Promotion And Disease Prevention Of Obesity In Children

Obesity is one of the most serious health problems facing the youth of the United States. Evidence suggests that the problem is getting worse rapidly. Obesity is now the most prevalent physiological and psychological disease of children and adolescents. Many people; i.e., governmental authorities and national leaders in the health care system perceived that obesity will impact health care in the United States, as well as in the world, now and in the future; specifically, increased cost, increased individual and community health infractions, problems, and quality of life. Many people think it is a cosmetic problem only, but in reality, it is linked to multiple health problems; such as, but not limited to, diabetes, hypertension, dyslipidemia, and psychosocial dilemmas. Advanced nurse practitioners are in the greatest position to help individuals and families, due to their extensive theoretical and practice background. For the advanced nurse practitioner, the process of dealing with the problem of obesity can be overwhelming to address thoroughly. Primary prevention has emerged as the best intervention, rather than dealing with secondary and tertiary repercussions. The purpose of this Evidence Based Practice (EBP) study was to impute in the Advanced Nurse Practitioner, the importance of primary prevention, and management, should this become necessary, regarding the monumental issue of childhood obesity

Starch-thickened acidic foodstuffs and method of preparation

Starch-thickened acidic foodstuffs are provided in which the starch used as a thickener comprises sugary-2 starch obtaining from sugary-2 genotype maize seeds. Sugary-2 starch can be effectively used as a thickener in foodstuffs having a pH of 2.0 to 5.5

Cardiovascular pressures in the human fetus

The technique of ultrasound guided fetal blood sampling has been adapted, as herein described, to permit measurement of intra amniotic, intra umbilical vascular and intra cardiac pressures in the human fetus in utero during indicated procedures. 246 pregnancies have been investigated and reference ranges for these pressures established. The effects of fetal disease on these pressures has been examined. Intra amniotic pressure in the presence of a normal liquor volume is unaffected by fetal abnormality, and increases with gestation. Measurement of intra amniotic pressure in abnormal liquor volumes provides widely varying results and has no proven clinical value. Umbilical venous pressure does not increase with gestation and is not affected by fetal abnormality unless this involves the fetal heart. In nonimmune hydrops, there is a significant relationship between umbilical venous pressure and cardiac size, providing for the first time direct evidence of intrauterine cardiac failure in some cases of hydrops. Elevation of venous pressure also occurs in congenital heart disease if cardiomegaly is present, and congenital diaphragmatic hernia with associated left ventricular compression. Umbilical arterial pressure increases with gestation, and is elevated in the presence of abnormal umbilical artery Doppler blood flow studies and fetal hypoxia. Left and right atrial pressures do not increase with gestation. Although the pressure in the right atrium is higher than the left, this is not statistically significant. Elevation of atrial pressure occurs in nonimmune hydrops with associated cardiomegaly. Left and right ventricular pressures are equal and both systolic and end diastolic pressures increase with gestation. The pressure waveforms are similar to those obtained in postnatal investigations. Abnormalities of pressure waveforms and actual values occur in cases of left and right ventricular outflow obstruction, and these measurements provide additional diagnostic and prognostic information. This study provides new data on umbilical venous pressure in the presence of fetal abnormality and intrauterine cardiac failure. It also provides the results of the first direct measurements of human fetal cardiac pressures in normal and abnormal hearts

Contextualizing Teacher Professionalism: Findings from a Cross-Case Analysis of Union Active Teachers

This paper draws on data collected as part of a study of the discourses of teacher professionalism amongst union active teachers in the Canadian provinces of Alberta and Ontario. Interviews revealed a triad of influences on the professionalism discourses of participants: engagement in teacher associations, the larger policy environment, and teacher agency. The manner in which this triad played out in each case, however, was unique to the particular political and organizational contexts framing the spaces in which such discourses were created. Using cross-case analysis, this paper specifically highlights the complex and contextualized nature of teachers’ conceptions of professionalism, paying particular attention to the nuanced enabling and limiting conditions identified between the cases. Cet article s’appuie sur des données recueillies dans le contexte d’une étude portant sur le discours concernant le professionnalisme des enseignants actifs dans leur syndicat et vivant dans les provinces canadiennes de l’Alberta et de l’Ontario. Les entrevues ont révélé une triade d’influences sur ce discours chez les participants : l’implication dans des associations d’enseignants, le contexte politique général et l’agentivité des enseignants. L’interaction de ces composantes s’est déroulée d’une façon distincte selon le contexte politique et organisationnel du milieu dans lequel le discours a été créé. S’appuyant sur une analyse transversale, cet article souligne la nature complexe et contextualisée des conceptions qu’ont les enseignants du professionnalisme, et se penche particulièrement sur les conditions nuancées, favorables ou restrictives, qui ont été identifiées dans chaque cas

Discourses of Teacher Professionalism: “From Within” and “From Without” or Two Sides of the Same Coin?

Drawing on data from a larger doctoral study, this paper specifically explores influences on the discourses of professionalism amongst a sample of highly engaged members of the Elementary Teachers’ Federation of Ontario (ETFO). Based on the assumption that discourse takes shape within a highly politicized system of socialization where language plays a significant role in the maintenance of particular power structures and the cultures that support them (Hilferty, 2004), the case suggests that the professionalism discourses of teachers and their unions and those of government are not necessarily as mutually exclusive as they are often presented in the literature.

Sleep and Breathing at High Altitude

This thesis describes the work carried out during four treks, each over 10-11 days, from 1400m to 5000m in the Nepal Himalaya and further work performed during several two-night sojourns at the Barcroft Laboratory at 3800m on White Mountain in California, USA. Nineteen volunteers were studied during the treks in Nepal and seven volunteers were studied at White Mountain. All subjects were normal, healthy individuals who had not travelled to altitudes higher than 1000m in the previous twelve months. The aims of this research were to examine the effects on sleep, and the ventilatory patterns during sleep, of incremental increases in altitude by employing portable polysomnography to measure and record physiological signals. A further aim of this research was to examine the relationship between the ventilatory responses to hypoxia and hypercapnia, measured at sea level, and the development of periodic breathing during sleep at high altitude. In the final part of this thesis the possibility of preventing and treating Acute Mountain Sickness with non-invasive positive pressure ventilation while sleeping at high altitude was tested. Chapter 1 describes the background information on sleep, and breathing during sleep, at high altitudes. Most of these studies were performed in hypobaric chambers to simulate various high altitudes. One study measured sleep at high altitude after trekking, but there are no studies which systematically measure sleep and breathing throughout the whole trek. Breathing during sleep at high altitude and the physiological elements of the control of breathing (under normal/sea level conditions and under the hypobaric, hypoxic conditions present at high altitude) are described in this Chapter. The occurrence of Acute Mountain Sickness (AMS) in subjects who travel form near sea level to altitudes above 3000m is common but its pathophysiology not well understood. The background research into AMS and its treatment and prevention are also covered in Chapter 1. Chapter 2 describes the equipment and methods used in this research, including the polysomnographic equipment used to record sleep and breathing at sea level and the high altitude locations, the portable blood gas analyser used in Nepal and the equipment and methodology used to measure each individual’s ventilatory response to hypoxia and hypercapnia at sea level before ascent to the high altitude locations. Chapter 3 reports the findings on the changes to sleep at high altitude, with particular focus on changes in the amounts of total sleep, the duration of each sleep stage and its percentage of total sleep, and the number and causes of arousals from sleep that occurred during sleep at increasing altitudes. The lightest stage of sleep, Stage 1 non-rapid eye movement (NREM) sleep, was increased, as expected with increases in altitude, while the deeper stages of sleep (Stages 3 and 4 NREM sleep, also called slow wave sleep), were decreased. The increase in Stage 1 NREM in this research is in agreement with all previous findings. However, slow wave sleep, although decreased, was present in most of our subjects at all altitudes in Nepal; this finding is in contrast to most previous work, which has found a very marked reduction, even absence, of slow wave sleep at high altitude. Surprisingly, unlike experimental animal studies of chronic hypoxia, REM sleep was well maintained at all altitudes. Stage 2 NREM and REM sleep, total sleep time, sleep efficiency and spontaneous arousals were maintained at near sea level values. The total arousal index was increased with increasing altitude and this was due to the increasing severity of periodic breathing as altitude increased. An interesting finding of this research was that fewer than half the periodic breathing apneas and hypopneas resulted in arousal from sleep. There was a minor degree of upper airway obstruction in some subjects at sea level but this was almost resolved by 3500m. Chapter 4 reports the findings on the effects on breathing during sleep of the progressive increase of altitude, in particular the occurrence of periodic breathing. This Chapter also reports the results of changes to arterial blood gases as subjects ascended to higher altitudes. As expected, arterial blood gases were markedly altered at even the lowest altitude in Nepal (1400m) and this change became more pronounced at each new, higher altitude. Most subjects developed periodic breathing at high altitude but there was a wide variability between subjects as well as variability in the degree of periodic breathing that individual subjects developed at different altitudes. Some subjects developed periodic breathing at even the lowest altitude and this increased with increasing altitude; other subjects developed periodic breathing at one or two altitudes, while four subjects did not develop periodic breathing at any altitude. Ventilatory responses to hypoxia and hypercapnia, measured at sea level before departure to high altitude, was not significantly related to the development of periodic breathing when the group was analysed as a whole. However, when the subjects were grouped according to the steepness of their ventilatory response slopes, there was a pattern of higher amounts of periodic breathing in subjects with steeper ventilatory responses. Chapter 5 reports the findings of an experimental study carried out in the University of California, San Diego, Barcroft Laboratory on White Mountain in California. Seven subjects drove from sea level to 3800m in one day and stayed at this altitude for two nights. On one of the nights the subjects slept using a non-invasive positive pressure device via a face mask and this was found to significantly improve the sleeping oxyhemoglobin saturation. The use of the device was also found to eliminate the symptoms of Acute Mountain Sickness, as measured by the Lake Louise scoring system. This finding appears to confirm the hypothesis that lower oxygen saturation, particularly during sleep, is strongly correlated to the development of Acute Mountain Sickness and may represent a new treatment and prevention strategy for this very common high altitude disorder

Native voices on Native science: Mohawk perspectives on the concept, practice, and meaning of a knowledge production system rooted in traditional Native thought

Community psychology is strongly committed to the value of cultural relativity and diversity. Acquiring knowledge regarding cultural differences is essential if community psychology is to realize this value. This paper provides a culture specific perspective on the form and meaning of a knowledge system rooted in traditional Mohawk thought. The academic literature regarding research on Native people reveals an ethnocentric description of native reality. My premise is that research in Native communities has been ideologically biased by virtue of the interpretation of native reality from the perspective of mainstream western scientific assumptions. The ability to obtain culturally relevant knowledge hinges on our ability to understand and come to knowledge in a culturally relevant way. Thus, there is a need for a knowledge production system that is rooted in traditional Native thought. Utilizing a qualitative and collaborative approach I obtain the perspectives of five people, who are members of the Mohawk Nation who reside in the Six Nation of the Grand River Community, on the concept of a Native science and a knowledge system rooted in traditional Mohawk thought. The results of the study indicated that there is a high degree of congruity between the generalized Native scientific concepts and practices with Mohawk specific traditional beliefs and practices. The study illuminates Mohawk specific teachings and how these teachings shape the meaning and practice of a knowledge system rooted in traditional Mohawk thought