Minimizing Obstetric Hemorrhage

Patients undergoing cesarean deliveries are at risk for hemorrhage. In fact, hemorrhage is the leading cause of preventable maternal mortality and accounts for more than 140,000 deaths each year worldwide (O’Brien & Ulh, 2016). Hemorrhage has been associated with a number of well-established risk factors which could be recognized prior to delivery. Women who do not have these risk factors could still experience postpartum hemorrhage, but using a risk assessment tool has been shown to identify 60-85% of women who will experience hemorrhage (Shields, Goffman, & Caughey, 2017). The postpartum hemorrhage (PPH) risk assessment tool, developed by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), identifies women with PPH risk factors. The tool allows clinicians to prepare for possible interventions and close monitoring of women at increased risk of bleeding, to ultimately prevent mortality. At a metropolitan hospital PPH risk assessments were not being discussed during standard pre-procedure huddles. This quality improvement project added the PPH risk assessment tool to the pre procedure huddle sheet. This facilitated interdisciplinary team discussion of PPH risk factors for patients undergoing cesarean deliveries. There were a total of 575 mothers in the study with 297 in the pre intervention period and 278 in the post. There was a statistically significant increase in estimated blood loss (EBL) between the pre and post intervention groups. While the study tool did not result in a decrease in EBL, it increased awareness among the interdisciplinary care team by facilitating discussion about PPH

Examination of the Cumulative Risk Assessment and Nutritional Profiles among College Ballet Dancers

This study examined female collegiate ballet dancers\u27 ( = 28) Female Athlete Triad (Triad) risk via the Cumulative Risk Assessment (CRA) and nutritional profiles (macro- and micronutrients; = 26). The CRA identified Triad return to play criteria (RTP: Full Clearance, Provisional Clearance, or Restricted/Medical Disqualified) by assessing eating disorder risk, low energy availability, menstrual cycle dysfunction, and low bone mineral density. Seven-day dietary assessments identified any energy imbalances of macro- and micronutrients. Ballet dancers were identified as low, within normal, or high for each of the 19 nutrients assessed. Basic descriptive statistics assessed CRA risk classification and dietary macro- and micronutrient levels. Dancers averaged 3.5 ± 1.6 total score on the CRA. Based on these scores, the RTP outcomes revealed Full Clearance 7.1%, = 2; Provisional Clearance 82.1%, = 23; and Restricted/Medical Disqualification 10.7%, = 3. Dietary reports revealed that 96.2% ( = 25) of ballet dancers were low in carbohydrates, 92.3% ( = 24) low in protein, 19.2% ( = 5) low in fat percent, 19.2% ( = 5) exceeding saturated fats, 100% ( = 26) low in Vitamin D, and 96.2% ( = 25) low in calcium. Due to the variability in individual risks and nutrient requirements, a patient-centered approach is a critical part of early prevention, evaluation, intervention, and healthcare for the Triad and nutritional-based clinical evaluations

Crystal polymorphs and transformations of 2-iodo-4-nitroaniline

Full crystal structural characterization of three crystal polymorphs of 2-iodo-4-nitroaniline was carried out: the triclinic, orthorhombic, and a new monoclinic form. Powder X-ray diffraction, differential scanning calorimetry, and infrared data on the three of these are reported. Solvent-mediated transformations were observed on the basis of changes in crystal morphology and data from an in situ laser probe. Transformation to the monoclinic form was observed in all cases. [Published as part of a virtual special issue of selected papers presented in celebration of the 40th Anniversary Conference of the British Association for Crystal Growth (BACG), which was held at Wills Hall, Bristol, UK, September 6-8, 2009

Determinants of attitudes to carnivores : implications for mitigating human-carnivore conflict on South African farmland

Human–wildlife conflict is increasingly prevalent, particularly in relation to carnivores in non-protected areas of Africa. Quantifying the attitudes of land owners towards carnivores and understanding the factors that influence these attitudes are instrumental in conservation planning and reducing persecution-related threats to carnivores.However, information about attitudes to carnivores in Africa, and South Africa in particular, is scarce. To obtain such data we interviewed 170 commercial game and livestock farmers in two ecologically important rural areas of northern South Africa. Responses to statements about carnivore management, stock protection and predationwere generally positive. However, 62% of respondents believed carnivores to be financially damaging and 35% thought them overly abundant. Many respondents (41%) were unwilling to tolerate even low levels of predation and considered persecution of carnivores to be the cheapest form of stock protection (31%). Attitudes were significantly more positive among respondents who did not kill carnivores than among those who did. Generalized linear regression coupled with informationtheoretic analysis showed that attitudes to carnivores were determined by a combination of cultural and land-use attributes more than by economic factors such as stock holdings or predation losses. The results elucidate potential targets for mitigation activities and facilitate the development of communication, education and extension activities specifically designed to appeal to intended recipients and address prevalent motives for persecuting carnivores.Endangered Wildlife Trust, Knowsley Safari Park, the Rufford Small Grants Foundation, the University of Brighton, and the Leverhulme Trust.http://journals.cambridge.org/action/displayJournal?jid=ORXhb201

Examining Seasonal Anthrax Risk in Wildlife: Comparing Home Ranges and Site Fidelity in Sero-Positive and Sero-Negative Ungulates

Anthrax is frequently reported from wildlife and livestock in the US.  While useful in reducing risk in livestock, vaccination, the primary method of prevention, is untenable for free-ranging wildlife. Because of this, accurate surveillance and carcass clean-up are the most efficacious control measures for wildlife.  However, surveillance is expensive and requires significant personnel across large landscapes. Likewise, the transmission pathways are poorly understood in most species. Wildlife telemetry improves our understanding of movement patterns during risk periods. At the same time, serological surveys provide data on host exposure. Such data allow us to test hypotheses about host/pathogen interactions on the landscape. Starting in 2010, we initiated GPS telemetry and sero-prevalence studies for managed bison, Bison bison bison, and free-range elk (Cervus elaphus) in Montana. Here we will evaluate summertime home ranges in bulls from both species in western Montana. We compared home ranges and site fidelity metrics in sero-positive and sero-negative animals. Serological tests indicated that ~30% of bull elk and ~27% of unvaccinated bison were sero-positive for anthrax exposure, suggesting that low-level exposure is frequent on this landscape. Seasonal ranges can be useful for defining areas where animals may have increased likelihood of anthrax, comparing ranges to niche-based estimates of B. anthracis. Fidelity metrics suggest both species spent considerable time in niche-based high risk areas. Inter-annual data from elk suggest long-term range fidelity and overlap with high risk areas. These data can be used to prioritize surveillance efforts in those areas to maximize disease control, while managing search costs

Study experiences and the post-study intentions of female international undergraduate students

The number of female international students is increasing exponentially, and whilst international study may engender many benefits and challenges, little is known about their intentions once they complete their studies. This article reviews the literature on female international students with specific focus on exploring post-study intentions. A scoping review of four electronic databases was completed. After applying criteria to determine suitability, 30 publications were included in the final review. Analysis revealed three key foci: (1) the rationale for studying internationally; (2) the study experience; and (3) post-study intentions. The literature illustrates that an international study experience has the potential to be a powerful transformative opportunity if positive experiences outweigh the negatives. The findings also indicate that the post-study intentions of female international students are under-researched. The article contends that attention should be given to supporting the needs of this group, with a view to maximizing post-study opportunities

Examination of the Cumulative Risk Assessment and Nutritional Profiles among College Ballet Dancers

This study examined female collegiate ballet dancers’ (n = 28) Female Athlete Triad (Triad) risk via the Cumulative Risk Assessment (CRA) and nutritional profiles (macro- and micronutrients; n = 26). The CRA identified Triad return to play criteria (RTP: Full Clearance, Provisional Clearance, or Restricted/Medical Disqualified) by assessing eating disorder risk, low energy availability, menstrual cycle dysfunction, and low bone mineral density. Seven-day dietary assessments identified any energy imbalances of macro- and micronutrients. Ballet dancers were identified as low, within normal, or high for each of the 19 nutrients assessed. Basic descriptive statistics assessed CRA risk classification and dietary macro- and micronutrient levels. Dancers averaged 3.5 ± 1.6 total score on the CRA. Based on these scores, the RTP outcomes revealed Full Clearance 7.1%, n = 2; Provisional Clearance 82.1%, n = 23; and Restricted/Medical Disqualification 10.7%, n = 3. Dietary reports revealed that 96.2% (n = 25) of ballet dancers were low in carbohydrates, 92.3% (n = 24) low in protein, 19.2% (n = 5) low in fat percent, 19.2% (n = 5) exceeding saturated fats, 100% (n = 26) low in Vitamin D, and 96.2% (n = 25) low in calcium. Due to the variability in individual risks and nutrient requirements, a patient-centered approach is a critical part of early prevention, evaluation, intervention, and healthcare for the Triad and nutritional-based clinical evaluations

Gastrointestinal Cell Injury and Percieved Symptoms after Running the Boston Marathon

Gastrointestinal (GI) disturbances are a prevalent cause of marathon related complaints, and in extreme cases can promote life-threatening conditions such as exertional heat stroke. PURPOSE: Our aim was to study intestinal cell injury (via intestinal fatty acid binding protein [I-FABP]) and perceived GI distress symptoms among marathon runners. Potential risk factors (e.g., inadequate sleep) that could exacerbate GI disturbances in healthy, trained endurance runners were also examined. METHODS: A parallel mixed-methods study design was utilized. 2019 Boston Marathon participants were recruited via email. Before the race subjects completed surveys describing demographics and training history. Immediately pre-race, post-race, and 24-hours post-race participants completed a GI questionnaire to assess presence and severity of symptoms, a survey regarding risk factors (e.g., recent illness, medications) that could promote GI disturbances, and provided a urine sample. Due to weather, blood samples were only collected immediately and 24-hours post-race. RESULTS: A total of 40 runners (males: n = 19, age = 44.9 ± 10.8 years; females: n = 21, age = 44.8 ± 10.6 years) completed this study. I-FABP significantly decreased from post-race (3367.5 ± 2633.5 pg/ml) to 24-hours post-race (1657.3 ± 950.7 pg/ml, t(39) = -4.228, p \u3c .001, d = -.669). A significant difference in overall GI symptom scores across the three time points occurred (F(2, 39) = 41.37, p \u3c .001). Compared to pre-race (.09 ± .12) and 24-hour post-race (.44 ± .28), the highest average score occurred post-race (.84 ± .68). Post-race I-FABP (r = .31, p = .048) and post-race urine specific gravity (r = .33, p = .041) were significantly correlated with post-race GI symptom scores. CONCLUSION: Our study further supports the individualized presentation of GI disturbances, with participants experiencing a wide range of risk factors that can influence the extent of GI damage and perceived symptoms during and after exercise