Improving Outcomes for Pregnant Women with Severe Hypertension

Background: In 2019, a large hospital in Alaska joined the Alaska Perinatal Quality Collaborative (PQC). The first project was the AIM Hypertension Project. The goals of the project were to reduce severe maternal morbidity among preeclampsia cases by 20% and Increase the timely treatment of hypertension to 80%. Other process and structure measures included education, simulation, clinical debriefs, and follow-up visits. Methods/Approach: The PQC used monthly educational sessions, data collection and review of every case with severe hypertension, and Plan-Do-Study-Act cycles. Data collection occurred over an 18-month period. Cases were identified by the Washington State Hospital Association database and reviewed for timely treatment of severe hypertension. Timely treatment is defined as either a systolic BP of equal to or greater than 160mmHg or diastolic equal or greater than 120mmHg that persists for greater than 15 minutes. The patient must be treated with an anti-hypertensive within 60 minutes of the first blood pressure. Results: Data collection occurred from July 2019-December 2020. A total of 225 cases were reviewed. The 2020 rate of timely treatment of severe hypertension increased to 81.3% (Goal of 80%). The project was able to reduce the variation in practice. There were three months with 100% timely treatment. In measuring the Severe Maternal Morbidity from Pre-eclampsia cases, the 2019 rate was 8.4%. The2020 rate was 6.9% (Goal 6.72%). The PSJH overall rate was 8.7%. Conclusions: This project was able to standardize the processes around the management of severe hypertension through order sets, standards of work, education, simulation, and EPIC alerts. This large hospital implemented bedside debriefs and quarterly case reviews of cases that resulted in severe maternal morbidity. Implications for Practice: This project demonstrated the power of working collaboratively with the statewide PQC to improve patient outcomes. There were significant challenges with COVID-19 priorities and distractions. Overall, both nurses and physicians are committed to timely treatment and the reduction of severe maternal morbidity.https://digitalcommons.psjhealth.org/prov_rn_conf_all/1032/thumbnail.jp

Opiate Use Disorder Pathway in the Perinatal Period

https://digitalcommons.psjhealth.org/summit_all/1043/thumbnail.jp

Choruses in Octavo Form

Collection of four octavo choruses. This set of sheet music includes Jacob H. Schloeder\u27s The Divine Praises, uncredited arrangements of the Lord\u27s Prayer ( Our Father ) and Hail Mary, and Ignaz Franz\u27s Holy God, We Praise Thy Name (uncredited here, and under the title Sancte Deus, Laudamus Te and with the English lyrics of Clarence A. Walworth). The music is arranged for chorus of four voice parts.https://ecommons.udayton.edu/imri_sheetmusic/1098/thumbnail.jp

The architecture of the Mystical Body. How to build churches after the Second Vatican Council

[Resumen] El tema genérico de este congreso es la arquitectura religiosa contemporánea. Y el tema específico nos pide considerar la arquitectura sacra contemporánea dentro de un marco dialéctico entre el concepto y la identidad. Para mí, el término clave es contemporánea: de nuestra época. Esto parece presuponer una particular consciencia histórica: de lo que entendemos —o al menos de lo que creemos— que nuestro lugar concreto en la historia exige u obtiene: un modo de pensar sobre la arquitectura sacra que sea respetuoso con nuestra situación contemporánea. Esto también sugiere que nuestra respuesta actual bien pudiera ser diferente de la de épocas pasadas. Pero cada época es contemporánea. Y todo lo que podemos hacer es arquitectura contemporánea. Simplemente no podemos pensar en arquitectura excepto como contemporáneos de nuestra propia época. Ya no podemos transformar la piedra en escultura con la visión y la mente de un cantero medieval. Ni estamos ya ocupados con las polémicas de la Contrarreforma que conformaron las magníficas iglesias barrocas. Ya no estamos involucrados en los debates cristológicos que influenciaron las arquitecturas de las iglesias en la época de Justiniano. Ni el movimiento del Gothic Revival se entiende como una interpretación moderna de un auténtico edificio medieval. Ni el clasicismo renacentista puede ser ya confundido con el de un antiguo templo griego o romano, así como ninguna de esas iglesias contemporáneas neoclásicas se podría confundir con la obra de un genio del Renacimiento, como Paladio, Bramante o Alberti. Así que yo creo que la fascinación por el concepto contemporáneo es problemática. A pesar de todo, esta cuestión de la arquitectura sacra contemporánea parece ser el núcleo dialéctico en el que se han enzarzado los arquitectos y liturgistas durante los últimos cien años, más o menos. He de señalar que necesitamos respetar las particularidades de nuestra época, y que es útil examinar en qué grado deberían influir en nuestra toma de decisiones, y qué valores se están introduciendo en nuestra aproximación a la arquitectura sacra. Pero el grado hasta el que podrían influenciar nuestra aproximación a la arquitectura sacra es mucho más limitado

The architecture of the Mystical Body: How to build churches after the Second Vatican Council

El tema genérico de este congreso es la arquitectura religiosa contemporánea. Y el tema específico nos pide considerar la arquitectura sacra contemporánea dentro de un marco dialéctico entre el concepto y la identidad. Para mí, el término clave es contemporánea: de nuestra época. Esto parece presuponer una particular consciencia histórica: de lo que entendemos —o al menos de lo que creemos— que nuestro lugar concreto en la historia exige u obtiene: un modo de pensar sobre la arquitectura sacra que sea respetuoso con nuestra situación contemporánea. Esto también sugiere que nuestra respuesta actual bien pudiera ser diferente de la de épocas pasadas. Pero cada época es contemporánea. Y todo lo que podemos hacer es arquitectura contemporánea. Simplemente no podemos pensar en arquitectura excepto como contemporáneos de nuestra propia época. Ya no podemos transformar la piedra en escultura con la visión y la mente de un cantero medieval. Ni estamos ya ocupados con las polémicas de la Contrarreforma que conformaron las magníficas iglesias barrocas. Ya no estamos involucrados en los debates cristológicos que influenciaron las arquitecturas de las iglesias en la época de Justiniano. Ni el movimiento del Gothic Revival se entiende como una interpretación moderna de un auténtico edificio medieval. Ni el clasicismo renacentista puede ser ya confundido con el de un antiguo templo griego o romano, así como ninguna de esas iglesias contemporáneas neoclásicas se podría confundir con la obra de un genio del Renacimiento, como Paladio, Bramante o Alberti. Así que yo creo que la fascinación por el concepto contemporáneo es problemática. A pesar de todo, esta cuestión de la arquitectura sacra contemporánea parece ser el núcleo dialéctico en el que se han enzarzado los arquitectos y liturgistas durante los últimos cien años, más o menos. He de señalar que necesitamos respetar las particularidades de nuestra época, y que es útil examinar en qué grado deberían influir en nuestra toma de decisiones, y qué valores se están introduciendo en nuestra aproximación a la arquitectura sacra. Pero el grado hasta el que podrían influenciar nuestra aproximación a la arquitectura sacra es mucho más limitado.The generic theme of this congress is contemporary religious architecture. And the specific issue asks us to consider contemporary sacred architecture within a dialectical framework between concept and identity. For me, the key term is contemporary: of our time. This seems to presuppose a particular historical consciousness: of what we understand - or at least of what we believe - that our specific place in history demands or obtains: a way of thinking about sacred architecture that is respectful of our contemporary situation. This also suggests that our current response may well be different from that of past eras. But each era is contemporary. And all we can do is contemporary architecture. We simply can not think of architecture except as contemporaries of our own time. We can no longer transform stone into sculpture with the vision and mind of a medieval stonemason. Nor are we already occupied with the controversies of the Counter-Reformation that made up the magnificent Baroque churches. We are no longer involved in the Christological debates that influenced the architectures of the churches in the time of Justinian. Neither the movement of the Gothic Revival is understood as a modern interpretation of an authentic medieval building. Neither Renaissance classicism can be confused with that of an ancient Greek or Roman temple, just as none of these contemporary neo-classical churches could be confused with the work of a Renaissance genius, such as Palladio, Bramante or Alberti. So I think the fascination with the contemporary concept is problematic. In spite of everything, this question of contemporary sacred architecture seems to be the dialectical nucleus in which architects and liturgists have been engaged for the last hundred years, more or less. I must point out that we need to respect the particularities of our time, and that it is useful to examine to what extent they should influence our decision-making, and what values ​​are being introduced in our approach to sacred architecture. But the degree to which they could influence our approach to sacred architecture is much more limited

Pathogenesis of distal renal tubular acidosis

Distal renal tubular acidosis (RTA) is a syndrome characterized by hyperchloremic metabolic acidosis and an inappropriately high urine pH relative to the degree of acidosis. The clinical presentation is frequently complicated by nephrocalcinosis, hypercalciuria, and nephrolithiasis. Less frequent presenting manifestations include hypokalemia and osteomalacia (for review of clinical features, see Refs. 1–4). Initially, all cases of renal tubular acidosis were considered to have similar pathophysiologic mechanisms, but subsequent studies have subdivided the group into abnormalities of bicarbonate reabsorption (proximal RTA), disorders of net acid excretion (distal or classical), and defects of ammonium production. In the present review, we will limit our discussion to the pathogenesis of distal RTA

Design and Preliminary Performance Testing of Electronegative Gas Plasma Thruster

In classical gridded electrostatic ion thrusters, positively charged ions are generated from a plasma discharge of noble gas propellant and accelerated to provide thrust. To maintain overall charge balance on the propulsion system, a separate electron source is required to neutralize the ion beam as it exits the thruster. However, if high-electronegativity propellant gases (e.g., sulfur hexafluoride) are instead used, a plasma discharge can result consisting of both positively and negatively charged ions. Extracting such electronegative plasma species for thrust generation (e.g., with time-varying, bipolar ion optics) would eliminate the need for a separate neutralizer cathode subsystem. In addition for thrusters utilizing a RF plasma discharge, further simplification of the ion thruster power system may be possible by also using the RF power supply to bias the ion optics. Recently, the PEGASES (Plasma propulsion with Electronegative gases) thruster prototype successfully demonstrated proof-of-concept operations in alternatively accelerating positively and negatively charged ions from a RF discharge of a mixture of argon and sulfur hexafluoride.i In collaboration with NASA Marshall Space Flight Center (MSFC), the Georgia Institute of Technology High-Power Electric Propulsion Laboratory (HPEPL) is applying the lessons learned from PEGASES design and testing to develop a new thruster prototype. This prototype will incorporate design improvements and undergo gridless operational testing and diagnostics checkout at HPEPL in April 2014. Performance mapping with ion optics will be conducted at NASA MSFC starting in May 2014. The proposed paper discusses the design and preliminary performance testing of this electronegative gas plasma thruster prototype

Initial Thrust Measurements of Marshall's Ion-ioN Thruster

Electronegative ion thrusters are a variation of tradition gridded ion thruster technology differentiated by the production and acceleration of both positive and negative ions. Benefits of electronegative ion thrusters include the elimination of lifetime-limiting cathodes from the thruster architecture and the ability to generate appreciable thrust from both charge species. Following the continued development of electronegative ion thruster technology as exhibited by the PEGASES (Plasma Propulsion with Electronegative GASES) thruster, direct thrust measurements are required to push interest in electronegative ion thruster technology forward. For this work, direct thrust measurements of the MINT (Marshall's Ion-ioN Thruster) will be taken on a hanging pendulum thrust stand for propellant mixtures of Sulfur Hexafluoride and Argon at volumetric flow rates of 5-25 sccm at radio frequency power levels of 100-600 watts at a radio frequency of 13.56 MHz. Acceleration grid operation is operated using a square waveform bias of +/-300 volts at a frequency of 25 kHz

HIFI spectroscopy of low-level water transitions in M82

We present observations of the rotational ortho-water ground transition, the two lowest para-water transitions, and the ground transition of ionised ortho-water in the archetypal starburst galaxy M82, performed with the HIFI instrument on the Herschel Space Observatory. These observations are the first detections of the para-H2O(111-000) (1113\,GHz) and ortho-H2O+(111-000) (1115\,GHz) lines in an extragalactic source. All three water lines show different spectral line profiles, underlining the need for high spectral resolution in interpreting line formation processes. Using the line shape of the para-H2O(111-000) and ortho-H2O+(111-000) absorption profile in conjunction with high spatial resolution CO observations, we show that the (ionised) water absorption arises from a ~2000 pc^2 region within the HIFI beam located about ~50 pc east of the dynamical centre of the galaxy. This region does not coincide with any of the known line emission peaks that have been identified in other molecular tracers, with the exception of HCO. Our data suggest that water and ionised water within this region have high (up to 75%) area-covering factors of the underlying continuum. This indicates that water is not associated with small, dense cores within the ISM of M82 but arises from a more widespread diffuse gas component.Comment: 5 pages, 4 figures. Accepted for publication in A&