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Limited understanding of factors such as travel time, availability of emergency obstetric care (EmOC), and satisfaction/perceived quality of care on the utilisation of maternal health services exists in fragile and conflict-affect settings. We examined these key factors on three utilisation outcomes: at least one skilled antenatal care (ANC) visit, in-facility delivery, and bypassing the nearest public facility for childbirth in Afghanistan from 2010 to 2015. We used three-level multilevel mixed effects logistic regression models to assess the relationships between women's and their nearest public facilities' characteristics and outcomes. The nearest facility score for satisfaction/perceived quality was associated with having at least one skilled ANC visit (AOR: 2.02, 95% CI: 1.21, 3.36). Women whose nearest facility provided EmOC had a higher odds of in-facility childbirth compared to women whose nearest facility did not (AOR: 1.24, 95% CI: 1.04, 1.48). Nearest hospital travel time (AOR: 0.95, 95% CI: 0.93, 0.98) and nearest facility satisfaction/perceived quality (AOR: 0.34, 95% CI: 0.14, 0.82) were associated with lower odds of women bypassing their nearest facility. Afghanistan has made progress in expanding access to maternal healthcare services during the ongoing conflict. Addressing key barriers is essential to ensure that women have access to life-saving services. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to evaluate the compliance with a patient-safety bundle for placenta accreta spectrum (PAS) by comparing the implementation of the components of the patient-safety bundle in the pre- and post-protocol time periods as a quality improvement project.Study Design: This is a before and after retrospective cohort study as a quality improvement report examining compliance with a multidisciplinary delivery approach for patients with suspected PAS between 2007 and 2018. This bundle involved a multidisciplinary approach with maternal-fetal medicine, gynecologic oncology, intervention radiology, obstetric anesthesia, neonatology, and blood bank. The primary outcome was incorporation of all six of the components of the bundle into a PAS procedure: (1) betamethasone, (2) gynecologic oncology intraoperative consult, (3) preoperative balloon catheters, (4) cell salvage technology in the operating room, (5) vertical skin incision, and (6) fundal or high transverse hysterotomy. Demographic, delivery, and patient outcome data were also collected.Results: There were 39 patients included in the study, 17 were pre-protocol and 22 were post-protocol. Patients were more likely to have a PAS suspected in the antenatal period during post protocol period (23.5 versus 90.9%, p < .0001), as well as having a placenta previa (35.3 versus 81.8%, p = .003), and receive betamethasone prior to delivery (23.5 versus 86.3%, p < .0001). Patients were delivered at an earlier gestational age in post protocol period (36.8 ± 2.52 versus 33.87 ± 2.4, p = .001). The primary outcome, adherence to all components of the patient-safety bundle, was more likely to occur in the post protocol period (0 versus 40.9%, p < .0001). Maternal and postoperative outcomes were not significantly different between groups.Conclusions: We have successfully implemented a patient-safety bundle for PAS and have standardized the execution of multidisciplinary management for PAS at our institution. [ABSTRACT FROM AUTHOR]

This article puts local debates about settler colonialism and racialised migrants into dialogue with decoloniality with the hope of forging new critical approaches and making new political projects possible. I appeal to a global context in order to move beyond the impasse that has arisen on the national plane between settler colonialism studies which divides us into the homogenising categories of Indigenous and settler, and migrant studies which relies on a more nuanced understanding of both the transnational trajectories of migrants as well as the racialised spaces they occupy within nations. I turn to SKY Lee's landmark novel Disappearing Moon Café to think beyond the nation-state and about the intimacies of colonial identification. This essay proposes a methodology of inter-referencing as outlined by Kuan-Hsing Chen to approach the relations between diasporic and Indigenous peoples in order to conceive of decolonial projects that can transform how we approach Canada. [ABSTRACT FROM AUTHOR]

This paper proposes to use inter-Asian methodologies to reread Asian Canadian Studies. As an intellectual and political project, Asian Canadian Studies has largely been constituted through its responses to the Canadian nation-state and anti-racism alliances but has failed to seriously engage with Asia as a critical problematic. Informed by theories and practices of inter-referencing developed through Inter-Asia critique, we reconsider the specific pressures, local debates, and historical moments that have produced the field's central arguments and reframe the field as a series of localized reference points in dialogue with each other as well as with Asia. We conclude by turning to Madeleine Thien's novel Dogs at the Perimeter in order to ask what it might mean to localize Asian Canadian Studies and reposition it as part of a transpacific rather than nation-based formation. [ABSTRACT FROM AUTHOR]

Objective and Importance: To describe cases that illustrate the utility of intraoperative computed tomography (CT) in cochlear implantation of patients with difficult temporal bone anatomy.Clinical Presentation: A 2-year-old male with congenital X-linked stapes gusher syndrome and a 2-year-old female with enlarged vestibular aqueduct underwent successful cochlear implantation with the help of intraoperative CT. In the latter case, the initial intraoperative C-arm fluoroscopy suggested malposition of the electrode, however, was not able to provide details for adjustments. In both cases, intraoperative CT changed the insertion technique of the operating surgeon and allowed for improved electrode positioning. A 47-year-old female with polyostotic fibrous dysplasia and a 55-year-old male with post-meningitis near-total cochlear obliteration underwent successful cochlear implantation with confirmation of electrode position with intraoperative CT. In the former case, the image-guided navigation system was also implemented. Finally, a 72-year-old female underwent cochlear implantation during which intraoperative C-arm fluoroscopy suggested intra-cochlear insertion. However, postoperative CT showed the electrode extending into the internal auditory canal (IAC), illustrating the limitations of C-arm fluoroscopy.Intervention: Intraoperative CT imaging and image-guided navigation system.Conclusion: When faced with challenging temporal bone anatomy, intraoperative CT can provide critical details of the patient's microanatomy that allows for improved localization of the electrode and adjustments in operative techniques for successful cochlear implantation. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including colonial histories, migration, diaspora, mobility, and cultural flows by the Inter-Asia Cultural Studies (IACS).

In this article, I engage with the intense fascination with National Basketball Association (NBA) basketball star Jeremy Lin and read Linsanity (as it has been dubbed by the North American media) as a flashpoint for a complex set of racialised histories and discourses. The illegibility of Lin as an Asian American athlete raises provocative questions about how racial logics and representations tend to rely on the visual as a site and set of metaphors. I then introduce the possibility of thinking about race, social intimacy and the Asian in terms of smell in an effort to complicate the way that we conceptualise race and imagine publics. [ABSTRACT FROM AUTHOR]

This essay uses work by Vancouver-based artist David Khang to think about the complex formations of publics, particularly for racialized participants, and how we are able to feel for and within them. I route this discussion of postcolonial intimacies and the problem of ‘Asia’ as a site of alterity through these art projects because they speak to the geopolitics of feeling and the local and global structures that shape memory. Moreover, I see the levels, scales and styles that Mom's Crutch and Wrong Places use to address their publics as underscoring the need to spatialize our discussions of postcolonial intimacies and affect if we are to understand how imperial knowledges continue to shape global politics and possibilities. My goal in this essay is quite simply to begin thinking about what representations of Asia reveal about the likelihood of postcolonial intimacy, despite or perhaps because of comparable the historical and ongoing experiences of imperial practices that colonize public imaginations. Wrong Places and Mom's Crutch draw attention to the relative paucity of Korean War representations and the excess of 9/11 representations within the North American imagination, and ask us to consider how these competing representations of war and suffering shape publics. [ABSTRACT FROM AUTHOR]

The politics of Supreme Court nominations present a case in which gender issues from abortion to diversity are highly salient on the bench. However, confirmation politics are also tightly constrained by institutional pressure for party loyalty. In the battle to replace Sandra Day O'Connor, we find that gender had a limited impact on senators' votes on the Roberts and Alito nominations. Republicans uniformly supported the president's nominees and the most liberal Democrats opposed them. However, gender did impact the votes of more moderate and conservative Democrats. Analysis of the explanations senators offer to justify their votes and build trust with constituents demonstrates that women—particularly Democratic women—place greater emphasis on women's rights in their floor statements, supporting the contention that female senators prioritize women as a constituency and bring a different perspective to policy deliberations. [ABSTRACT FROM PUBLISHER]

Caribou kidney is a major source of cadmium (Cd) in the traditional diets of many aboriginal communities in the Arctic. In order to characterize the risk of Cd exposure, we studied the speciation of Cd in caribou kidneys and how it can be affected by food preparation. Cd in caribou kidneys was bound to metallothionein (MT) (40%), high molecular weight proteins (50-500 kDa) (30%) and existed as free ions (10%). There was no change in Cd concentrations after the samples were baked at 350°C for 30min but the MT level was significantly decreased. Food preparation also denatured the high molecular weight proteins, resulting in a significant increase of free Cd. The toxicokinetics of Cd in caribou kidney was studied using a rodent model. Four groups (n = 6) of adult Sprague-Dawley rats were fed with rat chow with the addition of one of the following: 10% veal kidney with 0 µg/g Cd, 10% veal kidney spiked with CdCl to make up to 66 µg/g Cd; 2 10% caribou kidney containing 20 µg/g Cd and 10% caribou kidney containing 66 µg/g Cd. After 14 days, Cd accumulation increased with dose but less than 1% of the dosed Cd accumulated in the liver and kidney of rats. The percentage of Cd accumulated in the liver was higher in the group fed with caribou kidney than that dosed with spiked veal kidney. Our results suggest that caribou kidney is a major source of Cd exposure among the Arctic populations but moderate consumption may be considered unavoidable. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to evaluate the compliance with a patient-safety bundle for placenta accreta spectrum (PAS) by comparing the implementation of the components of the patient-safety bundle in the pre- and post-protocol time periods as a quality improvement project.Study Design: This is a before and after retrospective cohort study as a quality improvement report examining compliance with a multidisciplinary delivery approach for patients with suspected PAS between 2007 and 2018. This bundle involved a multidisciplinary approach with maternal-fetal medicine, gynecologic oncology, intervention radiology, obstetric anesthesia, neonatology, and blood bank. The primary outcome was incorporation of all six of the components of the bundle into a PAS procedure: (1) betamethasone, (2) gynecologic oncology intraoperative consult, (3) preoperative balloon catheters, (4) cell salvage technology in the operating room, (5) vertical skin incision, and (6) fundal or high transverse hysterotomy. Demographic, delivery, and patient outcome data were also collected.Results: There were 39 patients included in the study, 17 were pre-protocol and 22 were post-protocol. Patients were more likely to have a PAS suspected in the antenatal period during post protocol period (23.5 versus 90.9%, p < .0001), as well as having a placenta previa (35.3 versus 81.8%, p = .003), and receive betamethasone prior to delivery (23.5 versus 86.3%, p < .0001). Patients were delivered at an earlier gestational age in post protocol period (36.8 ± 2.52 versus 33.87 ± 2.4, p = .001). The primary outcome, adherence to all components of the patient-safety bundle, was more likely to occur in the post protocol period (0 versus 40.9%, p < .0001). Maternal and postoperative outcomes were not significantly different between groups.Conclusions: We have successfully implemented a patient-safety bundle for PAS and have standardized the execution of multidisciplinary management for PAS at our institution. [ABSTRACT FROM AUTHOR]