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BackgroundThe acid-base status of infants around birth can provide information about their past, current and future condition. Although umbilical cord blood pH <7.0 or base deficit ≥12 mmol/L is associated with increased risk of adverse outcome, there is uncertainty about the prognostic value of degree of acidosis as previous studies have used different variables, thresholds, outcomes and populations.MethodsRetrospective review of routinely collected clinical data in all live-born inborn infants of 35 weeks gestation or more delivered between January 2005 and December 2013 at the Simpson Centre for Reproductive Health, Edinburgh, UK. Infants were included if their lowest recorded pH was <7 and/or highest base deficit ≥12 mmol/L on either umbilical cord blood and/or neonatal blood gas within 1 hour of birth. Neurodevelopmental outcome of the infants with encephalopathy was collected from the targeted follow-up database.Results56 574 infants were eligible. 506 infants (0.9%) met inclusion criteria. Poor condition at birth and all adverse outcomes increased with worsening acidosis. Combined outcome of death or cerebral palsy was 3%, 10% and 40% at lowest pH of 6.9–6.99, 6.8–6.89 and <6.8, respectively, and 8%, 14% and 59% at a base deficit of 12–15.9, 16–19.9 and 20 mmol/L or more, respectively.ConclusionsThere is a dose-dependent relationship between the degree of acidosis within an hour of delivery, and the likelihood of adverse neonatal and later neurodevelopmental outcome in infants born at 35 weeks gestation or more.

Urine drug testing is frequently used in clinical, employment, educational, and legal settings and misinterpretation of test results can result in significant adverse consequences for the individual who is being tested. Advances in drug testing technology combined with a rise in the number of novel misused substances present challenges to clinicians to appropriately interpret urine drug test results. Authors searched PubMed and Google Scholar to identify published literature written in English between 1946 and 2016, using urine drug test, screen, false-positive, false-negative, abuse,and individual drugs of abuse as key words. Cited references were also used to identify the relevant literature. In this report, we review technical information related to detection methods of urine drug tests that are commonly used and provide an overview of false-positive/false-negative data for commonly misused substances in the following categories: cannabinoids, central nervous system (CNS) depressants, CNS stimulants, hallucinogens, designer drugs, and herbal drugs of abuse. We also present brief discussions of alcohol and tricyclic antidepressants as related to urine drug tests, for completeness. The goal of this review was to provide a useful tool for clinicians when interpreting urine drug test results and making appropriate clinical decisions on the basis of the information presented.

This study examined the relationship between blood pressure, peripheral blood flow (PBF), and peripheral fractional oxygen extraction (FOE). Variables that may influence PBF and peripheral FOE were also measured. Measurements of PBF by near infrared spectroscopy and fractional shortening by echocardiography were made within 12 h of birth in 24 infants less than 32 wk gestation. Blood gases, Hb, temperature, and blood pressure were also measured. PBF was significantly correlated with fractional shortening (r0.56, p0.005), Po2(r−0.5, p0.01), and peripheral temperature (r0.52, p0.01). Peripheral FOE was significantly correlated with fractional shortening (r−0.48, p0.02), Po2(r0.52, p0.02), and Pco2(r−0.53, p0.008), but not with peripheral temperature. There was no significant correlation between blood pressure and either PBF or peripheral FOE. These results indicate the importance of several physiologic variables, but not blood pressure, in determining peripheral tissue oxygen delivery in sick preterm infants receiving intensive care. It adds weight to the idea that blood pressure should not be considered a surrogate for peripheral blood flow and oxygen delivery.

Objective: To report a case of neuroleptic malignant syndrome (NMS) secondary to quetiapine in which the patient developed extrapyramidal symptoms (EPS).Case Summary: A 34-year-old male with a history of severe brain damage, mental retardation, and seizures was admitted to the hospital with changes in mental status, development of tremors, and a temperature of 39.9 °C. Initial differentia) diagnoses included seizure, aspiration, stroke, and infection. Once these were excluded, NMS was considered. The patient exhibited other characteristics of NMS during hospitalization, including lead pipe rigidity, tachycardia, and high creatine kinase level (up to 12,654 IU/L). Drug therapy on presentation included quetiapine 200 mg 3 times per day, guanfacine 2 mg/day. carbamazepine 400 mg every 12 hours, valproic acid 500 mg twice daily, and lorazepam 2 mg (unknown schedule). He reportedly had received these medications for at least a month before admission. On hospital day 2, quetiapine was discontinued. The patient received traditional treatment (or NMS, which included bromocriptine, dantrolene, intravenous fluids, and supportive care. The NMS resolved in 7 days.Discussion: In cases of NMS, clinicians previously believed that the risk for developing severe adverse effects such as EPS was lower with atypical versus typical antipsychotics. We identified 13 cases of NMS secondary to quetiapine in the literature via a search of MEDLINE/PubMed (1950–2008), and Iowa Drug Information Service (1966–2008). Seventy-five percent of previous reports of NMS secondary to quetiapine had reactions that included EPS, Common patient characteristics in our report and others included male sex, history of mental retardation, and treatment modalities used in NMS. Unique characteristics in this case included length of therapy without dosage change or titration and no known history of drug-related EPS. The Naranjo probability scale indicated a probable relationship between the development of NMS and quetiapine.Conclusions: NMS with associated EPS has been previously associated with quetiapine. Clinicians should be aware that NMS with EPS can occur with quetiapine at steady state doses without recent dosage adjustments or titration.

Each of the four protagonists in The exploded view (2004) attempts to negotiate the field of post-apartheid signs, material objects and ideological possibilities and limits. In this article we analyse the limited capacity of each protagonist to make sense of the transforming world he inhabits. We characterize this limited capacity to make meaning by relating the four narratives comprising the novel to certain theoretical moves in the work of Michel de Certeau and Pierre Bourdieu respectively. We conclude that Vladislavic develops a sense of the ineluctably contingent nature of the quotidian based in a secular epistemology. That is, his protagonists experience simultaneously the failed promise of transcendence and their agency as dramatically qualified in the postcolonial context in which they live.

Andre Brink's An instant in the wind (1976) is most commonly interpreted as presenting a Utopian alternative to apartheid's politics of race. This alternative is constructed as an Edenic allegory in which Elizabeth Larsson, who is abandoned in the interior of South Africa, and Adam Mantoor, an escaped slave, discover a genuinely liberated libidinal mutuality unconstrained by colonial ideology. We are concerned to investigate Brink's presentation of the failure of this allegorical escape, and the reintroduction of the two castaways into colonial social history, represented in the text as “the Cape”. The novel's self-referential enquiry into the possibility of extrication from the social and political suggests that it might be read as a metafictional interrogation of particular practices of representation. In order to come to terms with these practices, we place An instant in the wind in the context of the genre of shipwreck and castaway narrative, and then consider the basis of Karl Marx's criticism of the use of this genre in attempts to explain social, economic and historical realities.

AbstractThis study examined older Americans' use of food labels as a tool to moderate dietary risk factors for heart disease. Data from the USDA's Continuing Survey of Food Intakes by Individual (CSFII) 1994-96 and the Diet and Health Knowledge Survey (DHKS) from 2,846 respondents aged 51 years and older was used. Indices were constructed to measure and correlate dietary intake, label use and understanding, and health status data. Understanding and use of food labels was lower among older age groups, while heart-related health problems increased. Use of food labels and percent energy intake from fat were inversely related (P< 0.01). Older Americans would benefit from education on food label use and interpretation to decrease their dietary risk factors for heart disease.

Fluctuations in cerebral hemodynamics have been implicated in the pathogenesis of acquired brain damage in babies born prematurely. This study examined the changes in cerebral fractional oxygen extraction (FOE) over the first 3 d after birth in 25 very-low-birth-weight preterm infants. Twelve infants had no major cerebral injury and 13 had acquired brain injury; cystic periventricular leukomalacia (PVL) was present in 4 and intraventricular hemorrhage (IVH) in 9, of whom 2 also had hemorrhagic parenchymal infarction (HPI). Normal values (median, 5th–95thcentiles) for cerebral FOE in very-low-birth-weight infants with no cerebral injury were 0.38 (0.23–0.53) on d 1, 0.31 (0.18–0.45) on d 2, and 0.28 (0.17–0.38) on d 3. Infants who developed cystic PVL had no significant change in cerebral FOE during the first 3 d after birth. By contrast, cerebral FOE fluctuated in infants with IVH over the 3 d of measurement, decreasing from d 1 to d 2 (p0.03) and increasing from d 2 to d 3 (p0.02). The highest cerebral FOE values were seen in the two infants with HPI. The different patterns of change in cerebral FOE with HPI and cystic PVL provide additional evidence that the pathogenesis of these two conditions is different. Because high cerebral FOE is likely to be a consequence of low cerebral oxygen delivery, probably because of low cerebral blood flow, our results indicate that fluctuations in cerebral blood flow may occur when there is IVH or HPI.

This study examined the relationships between cerebral fractional oxygen extraction (FOE), mean arterial blood pressure (MABP), left ventricular output (LVO), blood gases, and other physiologic variables in 36 very-low-birth-weight preterm infants during the first 3 d after birth. There was a decrease in cerebral FOE (p0.008), and rises in LVO (p< 0.0001) and MABP (p0.02) during the 3 d. Between d 1 and 2, cerebral FOE decreased (p0.007) and LVO increased (p< 0.0001). There was no relationship between MABP and cerebral FOE. LVO correlated negatively with cerebral FOE on d 1 (p0.01), but not on d 2 (p0.07). On d 1, median pressure of arterial CO2was lower in infants with low LVO (<5thcentile) and high cerebral FOE (>95thcentile) than in infants with low LVO (<5thcentile) but normal cerebral FOE (5th–95thcentile) (p0.03). These findings suggest that cerebral FOE was increased only when LVO was low and there was hypocarbia. MABP had no demonstrable effect. It is likely that increased cerebral FOE is a normal physiologic response to maintain an adequate oxygen supply to the cerebral tissues when LVO is low and hypocarbia has caused vasoconstriction. It is possible that the cerebral hemispheres are low-priority vascular beds in the preterm infant, and that the high cerebral FOE is a result of reduced hemispheric blood flow to maintain MABP in the presence of low LVO.

This article considers the use of black Atlantic music in Seitlhamo Motsapi's volume of verse, earthstepper/the ocean is very shallow. In his poetry, Motsapi constructs a critique of the popular music industry while heralding the therapeutic potential of various dissonant musical modes, central among which is free improvisational jazz. We are concerned to appraise whether this musical genre, which by its own insistent definition resists representation, is adequate to the poetic and intellectual role Motsapi requires it to fulfil. This allows for an examination of the relationship between modernist aesthetic solutions and, what we might term, the black diasporan imaginary. Our tentative conclusion is that inscribing a dissonant practice, based in the right to deny and defy, can lead poetry to turn on a constitutive absence. In the case of earthstepper/the ocean is very shallow, we argue that this absence both indicates the complexities of a “transformational poetics” and casts doubt on the very therapeutic turn the verse describes

A significant proportion of patients with hematologic malignancies who are exposed to multiple transfusions will develop alloantibodies to platelet human leukocyte antigens (HLA), resulting in poor responses to subsequent platelet transfusions. Transfusion of HLA-identical platelets is an effective method of platelet support in these patients, but perfectly HLA-matched platelets are often not available. In this paper, we review the recent literature on platelet transfusion support in alloimmunized individuals and illustrate alternative management strategies with cases from our own practice.

The quantity of bone marrow collected for allogeneic bone marrow transplantation is based on collecting 10 to 15 cc of bone marrow/kg of recipient weight. We hypothesized that the percentage of CD34+ cells collected during a bone marrow harvest decreased at the end of the harvest because of increasing amounts of peripheral blood contamination. We performed a prospective, blinded study in which we measured CD34+ percentages and cell counts at 200-cc intervals during bone marrow harvests from 11 consecutive human leukocyte antigen (HLA)-matched sibling bone marrow donors. We observed that the percentage of CD34+ cells in aspirated bone marrow did not vary significantly from the start to the end of the bone marrow harvest, and the total number of CD34+ cells/kg increased in a linear fashion, thus disproving our original hypothesis. In conclusion, the percentage of CD34+ cells in aspirated bone marrow will remain constant throughout a bone marrow harvest.

AbstractThis article argues that curriculum planners should incorporate into literary syllabi works which challenge the ethos of contemporary liberal multicultural values. It suggests that such works are a stimulus to educational debate within an inherently cultural conflictual context. It also emphasises that since literature is a form of linguistic representation and such representation is semantically unstable, teachers can exploit ambiguity and interpretative alternatives to challenge texts that offend contemporary norms. These abstract issues are explored in a critical assessment of Achebe's negative evaluation of Conrad's Heart of Darkness to provide a concrete example of how issues in cultural studies and philosophy of language can inform and enhance classroom teaching.

This article provides an account of Hayden White's claim that historiographical difference can be explained in terms of the varying narrative forms in which historical depictions are presented, rather than in terms of the data or evidence on which historical representation are based. Narrative form is constructed around particular organising categories, which assemble and present the content (data/evidence) of particular historical portrayals, to provide us with knowledge about the past. White's contention is illustrated through its application to the liberal and revisionist schools of South African historiography. White defines irony as a recognition and deployment of the mutable and protean characteristic of any linguistic articulation and representation, historical or otherwise. This paper argues that curriculum developers and history teachers in post-Apartheid South Africa would benefit from the adoption of irony as a concept of objectivity, because this would liberate them from the futile task of ascertaining which school of South African historiography embodies the Truth about South Africa's past. History teaching would consequently embrace the different perspectives, fostering a new understanding of the relationship between historical concepts and historical data, and encouraging an appreciation of how the process of historical representation situates different people in their relationship to their pasts.

Andreas M. Krafft, Pasqualina Perrig-Chiello, Andreas M. Walker, Hope for a Good Life: Results of the Hope-Barometer International Research Programme. Switzerland: Springer, 2018, 215 pp. (Hbk). ISBN 978-3-319-78469-4, £79.

Laura E. Shay, Exploring Hope in Spiritual Care: A Practical Theological Guide for Chaplains. London: Jessica Kingsley, 2019, 104 pp. (pbk). ISBN: 978-1-78592-576-4, £13.99.

BackgroundLarge population data including that of the EPICE consortium has shown high variation in implementation of evidence based practices (EBP) among units, and this can explain some of the variation in outcomes observed between units.AimsTo measure the rate of four EBPs in our preterm population and compare performance with large population data from the EPICE cohort.SettingLevel 3 NICU with approximately 8000 births per annum, with 100 births of <1500 g.PopulationAll live born babies 23+0and 31+6weeks gestation receiving neonatal intensive care, born between 1 st Jan 2014 and 31 st December 2016.ExclusionsBabies born prior to arrival at hospital and babies who did not survive to NICU admission.Four EBPs were; Born in an appropriate level neonatal unit for gestation of baby (all babies); Any antenatal steroids prior to delivery (inborn babies); Avoidance of hypothermia, measured by admission temperature ≥36°C (inborn babies); Early CPAP or intubation and surfactant within first 2 hours of life (If gestation <28 weeks, inborn babies).Abstract G209(P) Table 1Comparison of demographic and EBP dataOur centreEPICEDemographicsBirthweight, mean, g 1217 1224 Gestational age at birth, mean 28+528+5Evidence-based practicesBorn in right place,% 91.4 88.2 Any antenatal steroids prior to delivery,% 91.8 89.2 Admission temperature≥36°C,% 99.4 74.4 Appropriate respiratory management if GA<28 w,% 100 83 All evidence-based practices eligible,% 88.8 58.3 EPICE- Effective Perinatal Intensive Care in Europe data published population data in 2016MethodsEthical approval was not sought, as this was a retrospective audit of practice. Data was collected from the electronic medical records system.ResultsThere were a total of 396 babies admitted between 2014 and 2016, and 333 were inborn. Across all domains, in house practice was higher than that of EPICE, and infants receiving all EBPs were 88.8% vs 55.3% (table 1).ConclusionBenchmarking against large population data can be valuable in assessing performance and identifying areas for continuous quality improvement.

Peter Wells, ed., Treating Body and Soul: A Clinicians’ Guide to Supporting the Physical Mental and Spiritual Needs of their Patients. London: Jessica Kingsley Publishers, 2017, 208 pp. (Pbk). ISBN: 978-1-78592-148-3, £19.99.

Sam Guglani, Histories. London: Riverrun, 2018, 128 pp. (Pbk). ISBN: 978-1-78648-381-2, £8.99.

Bent Falk, Honest Dialogue. London: Jessica Kingsley Publishers, 2018, 120 pp. (Pbk). ISBN: 978-1-78592-353-1, £8.99.

Laura E. Shay, Exploring Hope in Spiritual Care: A Practical Theological Guide for Chaplains. London: Jessica Kingsley, 2019, 104 pp. (pbk). ISBN: 978-1-78592-576-4, £13.99.