A Cultural Anthropological Overview of the Niobara/Missouri National Scenic Riverways

This document is a cultural anthropological overview and assessment of the Niobrara/Missouri National Scenic Riverways (NIMI). It represents the first formal planning step taken by the National Park service (NPS) to identify the different ethnic and religious groups of people that have historical and/or contemporary ties to the NIMI region. It primarily focuses on American Indian groups that used the NIMI region for various purposes in past historical times. The discussion of American Indian peoples emphasizes the three Federally-recognized tribes that reside in the NIMI region today, the Poncas, Santee Sioux, and Yankton sioux. Other groups that used the NIMI region for various purposes in the past, such as hunting, residence, or warfare, are also discussed, but to a lesser extent because they no longer are present in the NIMI region as organized tribal groups. The three tribes resident in the region today are, in a very real sense, neighbors to NIMI and for that reason receive more in-depth discussion. The overview and assessment also summarizes information about non-native peoples who resided in and near NIMI in the recent past, some of whom continue to live in the area today as organized social or ethnic groups, such as the Hutterites at the Bon Homme Bruderhof. Consequently, this document surveys Hutterites, Mormons, African Americans, Germans from Russia, Czechs, Scandinavians, and other immigrants who settled in the region during the latter part of the nineteenth century. This overview and assessment summarizes the present state of knowledge about each of these groups, including their history, lifestyle, and religious beliefs, and recommends further studies that may be desirable to complement and fill important gaps in this knowledge. Most of the information presented in this volume is drawn from published sources, though some of it comes from unpublished records and interviews with members of these groups, particularly the three Native American tribes that reside in the region today. The purpose of this overview and assessment is to provide the NPS with knowledge of the special circumstances and concerns of these various groups, so that informed and culturally sensitive decisions can be made when NPS affairs affect their existing or potential interests. The objective of the NPS is to be a good neighbor to all of these people, by managing its responsibilities for NIMI in a way that takes into consideration how its operations may affect, positively or negatively, these groups, along with other members of the public at large. Consequently, information presented in this overview and assessment should help NPS establish and maintain a long term positive relationship with American Indian and other organized ethnic/religious groups in and near NIMI, with the result that the interests of these groups will be fully considered in the NPS decision-making process. This study complements two other cultural resource studies conducted by the NPS for NIMI: 1) the compilation of archeological resource data for the region by the Midwest Archeological Center (in progress; Vawser and Osborn n.d.), and 2) the review of the region\u27s historical themes and cultural landscapes completed by the Midwest Regional Office in 1994 (Franklin et al. 1994). The cultural anthropological overview and assessment, of course, deals less with historical events and physical remains of past life than it does with the description of ethnic lifestyles and religious beliefs that persist in the NIMI region today

Utilization of coronary interventions and outcomes in weekend versus weekday admissions for stemi complicated by cardiogenic shock

Background ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) is associated with high mortality. We evaluated if there was a difference in the utilization of coronary interventions in patients who present with STEMI associated with CS. Methods The National Inpatient Sample, a publicly available database intended to represent 20% of all annual United States hospital admissions was searched for consecutive admission in patients \u3e18 years old from 2006 to 2015 who presented with STEMI and CS. A comparison of procedural interventions, use of hemodynamic monitoring, implementation of mechanical support and outcomes for weekday versus weekend admissions was recorded. Results 186,316 admissions for STEMI with CS were identified. There was no significant difference in adjusted mortality (OR 1.01, 95% CI: 0.96-1.06, p=0.72). The utilization of PCI was higher in weekend admissions (OR 1.10, 95% CI: 1.04-1.16, p=0.001) but the use of CABG (OR 0.94, 95% CI: 0.87-1.01, p=0.09), right heart catheterization (OR 0.96, 95% CI: 0.89-1.02, p=0.19), ECMO (OR 0.91, 95% CI: 0.71-1.18, p=0.48), percutaneous ventricular assist device (OR.91, 95% CI: 0.79-1.05, p=0.19) and IABP (OR 1.03, 95% CI 0.98-1.08, p=0.27) was similar in weekend versus weekday admissions. Conclusion There was no observed difference in the utilization of invasive procedures or outcomes in patients who are admitted with STEMI complicated by CS based on weekday and weekend admission