4,518 research outputs found

    Birthing change: an ethnographic study of the Alaska Family Health & Birth Center in Fairbanks, Alaska

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    Thesis (M.A.) University of Alaska Fairbanks, 2013This study examines the practices of the Alaska Family Health & Birth Center in order to understand how midwives help clients navigate the process of pregnancy, birth, and the postpartum period with a high rate of success, as defined by a low cesarean rate, low mortality and morbidity, and high maternal satisfaction. How do the midwives prepare mothers to navigate the transformation and how do they address failure to progress during birth? This study analyzes birth as a rite of passage, which incorporates a culture's worldview and its practices. These outcomes are achieved by employing a positive, holistic view of the natural, physiological process, by using practices that support the physiological process and minimize intervention, and by keeping the space in which out-of hospital birth takes place. The fact that parents are choosing an alternative ritual for birth at an increasing rate nationwide reflects a change happening in American culture.Chapter 1. Introduction -- 1.1. The Alaska Family Health & Birth Center (AFH & BC) -- 1.2. Controversy in American maternity care -- 1.3. Pregnancy and birth at AFH & BC as a rite of passage: research questions, hypothesis, and analysis -- 1.4. Rites of passage -- 1.5. Methods and methodology -- 1.6. Execution of research -- 1.7. Chapter summaries -- Chapter 2: The Alaska context -- 2.1. Geography, environment, and culture -- 2.2. Costs and insurance -- 2.3. Alaska native birthing traditions -- Chapter 3. The Alaska Family Health & Birth Center setting -- 3.1. The midwifery model of care -- 3.2. Different types of birth attendants -- 3.3. The legal context -- 3.4. Participant demographics -- 3.5. Study participants and what brought them to AFH & BC -- 3.6. AFH & BC statistics, legal status, and funding -- 3.7. Out-of-hospital and AFH & BC demographics -- Chapter 4. Prenatal care -- 4.1. A prenatal care appointment with Sienna -- 4.2. The childbirth preparation class with Deb -- 4.3. Additional notes on prenatal care -- 4.4. Conclusions about preparation for birth -- Chapter 5. Birth stories -- 5.1. Participant birth stories -- 5.2. Postpartum care -- 5.3. Conclusions about intrapartum care -- Chapter 6. The physiological process -- 6.1. Emotions and hormones -- 6.2. "Going deep within" -- 6.3. Authoritative knowledge: the knowledge -- 6.4. Conclusion -- Chapter 7. Failure to progress -- 7.1. Preventing failure to progress -- 7.2. Defining progress -- 7.3. Authoritative knowledge: the authority -- 7.4. Conclusion -- Chapter 8. AFH & BC and Fairbanks Memorial Hospital -- 8.1. Jane's birth story -- 8.2. The relationship between AFH & BC and Fairbanks Memorial Hospital -- 8.3. Crisis as normal -- Chapter 9. The role of the midwife -- 9.1. Guardians of birth -- 9.1.1. Holding the physical space by maintaining infrastructure -- 9.1.2. Holding the external space during birth -- 9.1.3. Holding the political space -- 9.2. Empowerment -- Chapter 10. Conclusion -- 10.1. Summary of findings -- 10.2. Epilogue -- References -- Participant interviews

    One-pot near-ambient temperature syntheses of aryl(difluoroenol) derivatives from trifluoroethanol

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    Difluoroalkenylzinc reagents prepared from 1-(2’-methoxy-ethoxymethoxy)-2,2,2-trifluoroethane and 1-(N,N-diethylcarbamoyloxy)-2,2,2-trifluoroethane at ice bath temperatures, underwent Negishi coupling with a range of aryl halides in a convenient one pot procedure. While significant differences between the enol acetal and carbamate reagents were revealed, the Negishi protocol compared very favourably with alternative coupling procedures in terms of overall yields from trifluoroethanol

    Mount Elgon\u27s Elephants Are in Peril

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    The elephants at Mount Elgon National Park (MENP) are unique and exceptional. They are the only elephants known to excavate for salt in underground caves. Data on the ecology of elephants at MENP were collected over a period of seven years with a total of 130 days of field observations. Methods employed included: direct observations, spoor, photographs, and sound recording. Elephants visited the caves singly or in groups of up to 19 individuals; visits lasted up to 6 hours in Kitum and Makingeny Caves. Most visits began around dusk, but occasionally they entered in daytime or later at night. The frequency of visits by elephants to the caves seemed to increase as the rainfall decreased. Also observed at the caves were bats, ungulates, monkeys, rodents, carnivores, birds, and insects. Plants, rocks, and water samples are being analyzed. It appears that the formation of these caves resulted from the combined efforts of salt mining and/or eating activities over millions of years by elephants and other animals and also by pastoral African tribes. In the early 1970\u27s the elephant population in MENP was estimated to be 1,200 ± 100; today perhaps only 50-130 are left. This decline of 10- to 26-fold is mostly due to ivory poaching, which increased dramatically since 1986. If this trend continues, Mount Elgon\u27s already depleted elephant population will become extinct. This would also mean the end of the unprecedented mining behavior - a potential tourist attraction comparable to Rwanda\u27s mountain gorillas in its appeal to tourists. Recommendations and proposals for action include publicity and fund-raising in order to better equip and enlarge anti-poacher patrols, to encourage controlled tourism, and to define research and conservation work related to Mount Elgon\u27s ecosystem

    Fungal infections of the central nervous system: A review of fungal pathogens and treatment

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    Multiple factors influence the outcome of fungal infection of the central nervous system (CNS). The host and the pathogen in concert with drug delivery across the blood-brain barrier and drug activity are key factors in outcome. Drug costs can be prohibitively expensive. Drug toxicity with standard antifungal agents such as amphotericin B (infusion rate toxicity) can be reduced using simple techniques such as slower infusion and appropriate saline loading. Continuous infusion can allow relatively large doses of amphotericin B (up to 2 mg/kg/day, remaining below 0.08 mg/kg/hour) to be given with toxicity profiles comparable to expensive lipid formulations of amphotericin B. Dedicated peripherally inserted central catheters can remain in situ for weeks to months and are safe and relatively inexpensive. Correction of metabolic pathology in the case of mucormycosis and resolution of neutropenia are essential to effective treatment of filamentous fungal infections such as Mucor, Aspergillus and Scedosporium. The pharmacology and pharmacokinetics of the current major antifungal agents used to treat fungal infections of the CNS are reviewed. Tables that provide information about achievable CNS drug levels, antifungal susceptibilities and the likelihood of intrinsic drug resistance of significant fungal pathogens have been included to help the clinician with therapy. Treatment recommendations for Cryptococcal and Candida meningitis and for rhinocerebral infection with Mucor and Aspergillus have been included

    Upper Dimension and Bases of Zero-Divisor Graphs of Commutative Rings

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    For a commutative ring R with non-zero zero divisor set Z∗(R), the zero divisor graph of R is Γ(R) with vertex set Z∗(R), where two distinct vertices x and y are adjacent if and only if x y = 0. The upper dimension and the resolving number of a zero divisor graph Γ(R) of some rings are determined. We provide certain classes of rings which have the same upper dimension and metric dimension and give an example of a ring for which these values do not coincide. Further, we obtain some bounds for the upper dimension in zero divisor graphs of commutative rings and provide a subset of vertices which cannot be excluded from any resolving set

    Analytic perturbation theory in QCD and Schwinger's connection between the beta-function and the spectral density

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    We argue that a technique called analytic perturbation theory leads to a well-defined method for analytically continuing the running coupling constant from the spacelike to the timelike region, which allows us to give a self-consistent definition of the running coupling constant for timelike momentum. The corresponding ÎČ\beta-function is proportional to the spectral density, which confirms a hypothesis due to Schwinger.Comment: 11 pages, 2 figure

    Recovery Following Acute Pontine Hemorrhage

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    Massive pontine hemorrhage does not always carry a fatal prognosis. A case report is presented in which many of the features usually associated with a fatal outcome were seen: severe disturbance of consciousness with early onset of coma, decerebrate posturing, systolic BP ranging from 200 mm Hg to 250 mm Hg, and hypopnea. Intensive supportive therapy was instituted during the critical phase, and the patient recovered. Electrophysiological studies helped to define the neurological deficit
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