RELATED READING/LITERATURE

For Kidney Disease Patients,

Staying Active Might Mean
Staying Alive
ScienceDaily (Oct. 12, 2009) — Getting off the couch could lead to a longer life for kidney disease
patients, according to a study appearing in an upcoming issue of the Clinical Journal of the American
Society Nephrology (CJASN). The findings indicate that, as in the general population, exercise has
significant health benefits for individuals with kidney dysfunction.

Many patients with chronic kidney disease (CKD) die prematurely,

but not from effects directly related to kidney problems. Because
physical activity has known health benefits, Srinivasan Beddhu,
MD (Salt Lake City VA Healthcare System and University of Utah),
and his colleagues researched the question of whether or not
exercise can help prolong CKD patients' lives.

The study included 15,368 adult participants (5.9% of whom had

CKD) in the National Health and Nutrition Examination Survey III,
a survey of the US population. After answering a questionnaire on
the frequency and intensity of their leisure time physical activity,
participants were divided into inactive, insufficiently active, and
active groups. On average, participants were followed for seven to
nine years.

The researchers found that 28% of individuals with CKD were inactive, compared with 13.5% of non-CKD
individuals. Active and insufficiently active CKD patients were 56% and 42% less likely to die during the
study than inactive CKD patients, respectively. Similar survival benefits associated with physical activity
were seen in individuals without CKD.

"These data suggest that increased physical activity might have a survival benefit in the CKD population.
This is particularly important as most patients with stage III CKD die before they develop end stage renal
disease," the authors wrote.

Study co-authors include Bradley Baird, Jennifer Zitterkoph, Jill Neilson, and Tom Greene, PhD
(University of Utah School of Medicine).

Article Date:
12 Oct 2009

Article Source:
 http://www.sciencedaily.com/releases/2009/10/091008171959.htm

Baby's MP3 Heart Monitor: New Safe Approach to

Fetal Heart Monitoring Could Save Lives
ScienceDaily (Aug. 30, 2009) — A new type of fetal heart monitor could save
the lives of unborn infants in complicated pregnancies, according to a study
published in the International Journal of Engineering Systems Modelling and
Simulation.

A .K. Mittra of the Department of Electronics Engineering, at the

Manoharbhai Patel Institute of Engineering & Technology, in Gondia, India,
and colleagues have developed a simple device based on a two-microphone
system that can monitor fetal heart rate during the mother's rest times and
sleep and send an alert to the woman and her physician.
During those complex pregnancies that end in preterm labor,
miscarriage, or fetal death, problems usually do not appear suddenly but
occur over periods of days. Regular ultrasound monitoring of fetal
development can spot some problems, but too frequent ultrasound
monitoring is associated with its own health risks. Moreover, it cannot
continually assess fetal heart rate.
However, disturbances in fetal heart rate, particularly regular sudden
drops in rate for up to one minute, can occur long before an underlying
problem is reflected in the form of other symptoms. A serious drop in fetal
heart rate is most likely to occur at night just before the pregnant woman
lies down to sleep. At this time, she is most relaxed and her own heart rate
drops, which leads to a lowering of her blood pressure, and in a susceptible
fetal a problematic drop in its heart rate.
"Monitoring FHR during a woman's most restful hours at home and
providing urgent medical assistance in case of abnormality will prove to be
very effective in the prevention of stillbirth and other prenatal complexities,"
the researchers say.
They have now developed a device based on two small acoustic sensors that
can easily monitor fetal heart rate and feed the information to a wave
analyzer in a bedside personal computer connected to the internet. The first
microphone is attached to the mother's abdomen to pick up the sound of the
fetus' heartbeat, the second is attached at a reasonable distance to pick up
ambient and bodily noise.
Computer software can then subtract the "noise" channel from the
fetal sound to produce a "wav" file that can be further analyzed for medical
anomalies. Should a problem be detected the wav file might be compressed
to the mp3 file format for rapid upload via the internet to the physician's
computer or to trigger a gentle warning to seek medical assistance.
The team points out that they have successfully tested their
monitoring system on several women at various stages of pregnancy. They
also emphasize that the system is a passive one, in which no energy
penetrates the mother's womb at any point. The technique is also
inexpensive, although it does rely on the mother having access to a personal
computer and an internet connection.

Article Source:

http://www.sciencedaily.com/releases/2009/08/090828103920.htm
 DABDA: Stages of Grieving

We've all experienced grief. We've all felt those intense rolling waves of emotion.
But, do we all experience the same feelings each time we lose a loved one?

What Are The Stages of Grief?

Many people have tried to explain what grief is; some have even identified certain
stages of grief.

Probably the most well-known of these might be from Elizabeth Kubler-Ross' book,
"On Death and Dying." In it, she identified five stages that a dying patient
experiences when informed of their terminal prognosis.

The stages Kubler-Ross identified are:

• Denial (this isn't happening to me!)

• Anger (why is this happening to me?)
• Bargaining (I promise I'll be a better person if...)
• Depression (I don't care anymore)
• Acceptance (I'm ready for whatever comes)

Many people believe that these stages of grief are also experienced by others when
they have lost a loved one.

Personally, I think of these definitions as emotional behaviors rather than stages,

per se. I believe we may certainly experience some of these behaviors. But, I
believe just as strongly, that there is no script for grief; that we cannot expect to
feel any of our emotions in a particular set pattern. I do agree that acceptance is
probably the last emotion felt, and in some instances it may be the only one.

A lesser known definition of the stages of grief is described by Dr. Roberta Temes in
the book, "Living With An Empty Chair - a guide through grief." Temes
describes three particular types of behavior exhibited by those suffering from grief
and loss. They are:

• Numbness (mechanical functioning and social insulation)

• Disorganization (intensely painful feelings of loss)
• Reorganization (re-entry into a more 'normal' social life.)

I am better able to relate to this definition as it seems to more accurately reflect the
types of behavior I have experienced and observed. Within these types of behavior
might well be most of the feelings described in Kubler-Ross' writings as well.

Which List Is Right?

In my opinion, both of these lists, and many others that we've all seen, are all
descriptive of some of the emotions and functions we go through when we lose a
loved one.
I believe that grief, like so many other things in our complex lives, can't be reduced
to a neat list with absolute definitions, timelines, strategies, goals, and completion
dates. Would that it were so easy

Grief is as individual as those of us who feel it, and as varied as the circumstances
of death which occur.

Will I Go Through Every Stage?

If a 98-year old grandfather died in his sleep I think there would be different stages
of grief and loss experienced than if a two-year old child were run over by a car and
killed.

If a person has had a long life, death is somewhat expected as the natural scheme
of things. There will be emotions of grief and loss but they might be more for what
we will miss.

If a young life is cut short unexpectedly, there may well be feelings of denial, anger,
bargaining, depression, and in some cases acceptance.

Just as we have different emotional reactions to anything that happens in our lives,
so too, will we experience grief and loss in different ways. I think the important
thing to remember is that there is a wide range of emotions that may be
experienced; to expect to feel some of them and to know that we cannot completely
control the process.

When Will I Be Through Grieving?

Grieving used to be much more ritualistic than it is today. In generations past there
were set periods of time when certain customs must be observed:

• Widows wore all black clothing for one year and drab colors forever after.
• Mourners could not attend social gatherings for months.
• Laughter and gaiety were discouraged for weeks or months.

Today we are unfettered by these restrictions and might even be confused about
when we should be done grieving.

Actually, we'll probably never be done.

We'll never forget the person we grieve for. Our feelings may be tempered more
with good memories than sadness as time passes, but that isn't to say that waves of
raw emotion won't overcome us way after we thing we should be done.

I think the trick here is to understand that the feelings will occur, try to keep them
in perspective, try to understand why you feel a certain way, and if there are any
unresolved issues that cause particular emotional pain, forgive yourself and others
and if necessary talk with someone about it.
There is no completion date to grieving...let your emotions flow through the stages
of grief.

Dr. Martha Elizabeth Rogers

1914 – 1994
I. Biography

o Martha Elizabeth Rogers was born in Dallas, Texas on May 12,

1914, the oldest of four children in a family which strongly
valued education.
o The family moved to Knoxville, TN where she attended the
University of Tennessee in l93l taking undergraduate science
courses for 2 years.
o But then she entered nursing school at Knoxville General
Hospital, received her nursing diploma in 1936.
o She completed a BSN in Public Health Nursing from George
Peabody College (Nashville) in l937.
o She worked as a public health nurse, first in Michigan, then in
Connecticut.
o In 1945 she earned her master's degree in public health nursing
supervision from Teacher's College Columbia University.
o She was director of the Visiting Nurses Association in Phoenix,
AZ.
o She returned East in 1951 earning a M.P.H. from the Johns
Hopkins University while teaching at Catholic University.
o She continued on at Johns Hopkins and completed a Sc.D in
1954.
o She then began her long tenure with the Division of Nursing
Education at New York University. Her strong background in
sciences guided NYU to develop the nursing program as a
distinct body of scientific knowledge.
o In 1961 she published Educational Revolution in Nursing.
o In 1963 Martha edited a journal called Nursing Science.
o 1964 she published Reveille in Nursing.
o She first published her model of human interaction and the
nursing process in 1970 when she published An Introduction to
the Theoretical Basis of Nursing. This view presented a drastic
but attractive way of viewing human interaction and the nursing
process. Further information on her theory can be found in
publications and on the Internet.
o Rogers officially retired as Professor and Head of the Division of
Nursing in 1975 after 21 years of service.
o In 1979 she became Professor Emeritus and continued to have
an active role in the development of nursing until the time of her
death on March 13, 1994. She was 80 years of age.