Pregnancy-Related Hypertension in North Dakota: Incidence, Outcomes, and Nursing Care Practices

Preeclampsia and pregnancy-induced hypertension complicate 6 to 7% of all pregnancies in the United States with the incidence varying among different regions, counties, and states. For improved perinatal outcomes in high-risk pregnancies there must be adequate care given in a timely and appropriate manner. Very little has been written on the incidence and trends in rural America and even less is known about incidence and trends in the rural Native American population. It is unknown how effective small rural hospitals are in the nursing care of the hypertensive pregnant women they encounter. This project was an epidemiological retrospective cohort study of pregnancy- related hypertension (PRH) which also included a descriptive analysis of nursing care practices for hypertensive pregnant women in North Dakota hospitals. It encompassed all births to North Dakota residents from 1989 through 1997 who were Caucasian and Native American. The epidemiological data was extracted from the North Dakota Health Department birth records. A survey was sent to all North Dakota hospitals offering delivery services to obtain data on nursing care practices. Of the 87,737 births analyzed, the overall incidence of PRH was 3.8%, lower than the national average. The Caucasian population with an overall incidence of 3.8% is slightly more at risk than the Native American population, with overall incidence of 3.6%. Plurality of births posed the greatest relative risk with 1995 showing a high of 3.34, with a 95% confidence interval of (2.40, 4.64). The relative risk for infants of hypertensive pregnancies to be of low birth weight ranged from 2.51 to 4.13, and prematurity of gestation was also a great risk at 3.09. Consistently throughout the nine years smoking was a protective factor against preeclampsia. The risk of having PRH and a low birth weight infant were higher in the nonsmoking groups than the smoking groups. Maternal outcomes include an increased risk of being transferred to a referral hospital and delivery by cesarean section. The survey of nursing care practices revealed that the hypertensive pregnant woman is being effectively cared for, overall, and appropriately transferred when necessary. The greatest concerns expressed by nursing staff in caring for mothers with PRH are lack of experience and fears of inability to handle seizures and other emergency situations. There is a great need for providing education to nurses in these small rural communities. Astute nursing surveillance is essential during the antepartum and intrapartum periods to mitigate the effects of PRH and decrease perinatal morbidity and mortality. Future studies need to focus on the paradoxical effects of smoking and pregnancy, and what makes it protective for preeclampsia. Nursing research is needed on the effectiveness of activity restriction with preeclampsia, and whether controlling the environment actually makes a difference in illness experiences and the outcomes for mothers and infants

AMATC: Sustainable Solutions for Humanitarian Mine Action

Kabul’s Afghan Mine Action Technology Center employs disabled deminers to create demining products. AMATC donates part of its revenue to local physical rehabilitation and treatment facilities, and now employs 11 disabled employees full time

Learning About Ethical Outdoor Leadership

Outdoor adventure programming has responded to changing societal and individ­ual needs by enlarging the goals and objec­tives of programs beyond the boundaries of the outdoor trip. Program missions, goals and objectives regularly include integrating people with and without disabilities, rein­forcing appropriate school and societal be­haviour in youth at risk, enhancing the self­ esteem of young people, teaching environ­mentally sound behaviour, and enhancing restorative healing for women survivors of abuse and people with terminal illness. These broader goals and objectives place different demands upon the outdoor leader and situate an outdoor trip within a larger context. This larger context connects out­door leadership with such concepts as power, social change, vision, ethics, and values. This research project used an ad­vanced university class on ethical outdoor leadership to explore the intersection of the scholarship about ethical leadership,the practices of outdoor leaders, and the context of the outdoors

Organoids as a model for colorectal cancer

Modelling human diseases in in vitro systems is undisputedly an invaluable research tool, yet there are many limitations. Some of those limitations have been overcome through the introduction of organoid culture systems, which have revolutionised colorectal cancer research and enabled an array of new experimental techniques. This 3D system models the physiology, shape, dynamics and cell make-up of the intestinal epithelium producing a relevant and highly adaptable model system. The increased functional relevance of this model compared to the use of 2D cancer cell lines makes it an invaluable tool for both basic and translational research. As the limitations of this system are being overcome to make high-throughput assays possible, it is clear that organoids are becoming a mainstay of colorectal cancer research. This review aims to explore the advantages and limitations of this system and discusses the future directions enabled by this model

The case for reverse mortgages in Australia : applying the USA experience

In the USA, reverse mortgages have been promoted as a means of accessing equity locked up in a residence, especially after the owner/s has retired. Although there have been some teething problems, the concept of mortgaging the family home after achieving freehold ownership has many merits. Often an asset-rich household must survive on relatively small regular income, and is unable to access the increasing wealth of the family home. A reverse mortgage overcomes this hurdle.The largest asset for many ageing households is their primary place of residence, the traditional house and suburban land parcel. Recently, the Australian housing market has witnessed substantial growth in the value of its capital city housing, especially on the east coast of Australia. This can be attributed to factors such as owner-occupiers trading up to a better class of dwelling, and the continuing gentrification process for owners choosing not to relocate. At the same time, demographic changes have placed pressure on the regular income of retirees, many of whom have no superannuation fund. For example, life expectancy rates continue to rise and there are an increasing proportion of single person households in society. This has placed additional pressure on financial resources of retirees, especially those with a substantial investment in their family home and a relatively small pension.This paper visits the reverse mortgage scenario in the USA and considers potential implications for the Australian market. Strengths and weaknesses of this product are contemplated, and the viability of reverse mortgages is discussed. Although there are obvious benefits for certain segments of society, reverse mortgages are a unique product and caution should be exercised to ensure the public is fully knowledgeable from the outset.<br /

Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility

Context: The Ober and Thomas tests are subjective and involve a "negative" or "positive" assessment, making them difficult to apply within the paradigm of evidence-based medicine. No authors have combined the subjective clinical assessment with an objective measurement for these special tests. Objective: To compare the subjective assessment of iliotibial band and iliopsoas flexibility with the objective measurement of a digital inclinometer, to establish normative values, and to provide an evidence-based critical criterion for determining tissue tightness. Design: Cross-sectional study. Setting: Clinical research laboratory. Patients or Other Participants: Three hundred recreational athletes (125 men, 175 women; 250 in injured group, 50 in control group). Main Outcome Measure(s): Iliotibial band and iliopsoas muscle flexibility were determined subjectively using the modified Ober and Thomas tests, respectively. Using a digital inclinometer, we objectively measured limb position. lnterrater reliability for the subjective assessment was compared between 2 clinicians for a random sample of 100 injured participants, who were classified subjectively as either negative or positive for iliotibial band and iliopsoas tightness. Percentage of agreement indicated interrater reliability for the subjective assessment. Results: For iliotibial band flexibility, the average inclinometer angle was -24.59 degrees +/- 7.27 degrees. A total of 432 limbs were subjectively assessed as negative (-27.13 degrees +/- 5.53 degrees) and 168 as positive (-16.29 degrees +/- 6.87 degrees). For iliopsoas flexibility, the average inclinometer angle was -10.60 degrees +/- 9.61 degrees. A total of 392 limbs were subjectively assessed as negative (-15.51 degrees +/- 5.82 degrees) and 208 as positive (0.34 degrees +/- 7.00 degrees). The critical criteria for iliotibial band and iliopsoas flexibility were determined to be -23.16 degrees and -9.69 degrees, respectively. Between-clinicians agreement was very good, ranging from 95.0% to 97.6% for the Thomas and Ober tests, respectively. Conclusions: Subjective assessments and instrumented measurements were combined to establish normative values and critical criterions for tissue flexibility for the modified Ober and Thomas tests

Physician Decision-Making: Evaluaton of Data Used in a Computerized ICU

journal articleBiomedical Informatic

Optimizing the Electrocardiogram and Pressure Monitoring

journal articleBiomedical Informatic

Technical Note: Evaluation of a Crucible Furnace Retort for Laboratory Torrefactions of Wood Chips

Torrefaction is a thermal process that improves biomass performance as a fuel by property enhancements such as decreased moisture uptake and increased carbon density. Most studies to date have used very small amounts of finely ground biomass. This study reports the testing of a crucible furnace retort that was fabricated to produce intermediate quantities of torrefied material and to allow processing of wood chips. Yields ranging from 51 to 96% were impacted to a greater extent by differences in temperature than time of treatment. Although temperature-control issues (gradients, slow heating) were experienced with the crucible furnace retort, this equipment proved to be useful for its intended purpose