Spinal anesthesia for cesarean delivery in a woman with neuromyelitis optica.

Neuromyelitis optica (NMO), or Devic's disease, is an idiopathic severe demyelinating disease that preferentially affects the optic nerve and spinal cord. Neuraxial anesthesia in women with multiple sclerosis is widely accepted, but reports of the use of neuraxial anesthesia in patients with NMO are scarce. We report the case of a morbidly obese primigravida undergoing a planned cesarean delivery at 32 weeks' gestation due to an acute exacerbation of NMO, managed with spinal anesthesia. Other than increased intraoperative hyperalgesia requiring inhaled nitrous oxide/oxygen, the mother experienced no apparent anesthetic-related complications.

The Performance Practice of Buddhist Baiqi in Contemporary Taiwan

The baiqi (Buddhist percussive instruments), also known as faqi (dharma instruments), are mentioned in the Chinese Buddhist scriptures under many different terms: jianzhi, jiandi, jianzhui, or jianchi. The original function of baiqi in earlier monastic life was to gather people or to call an assembly. With the completion of monasticism and monastic institutions, baiqi have become multifunctional in monasteries, and many baiqi instruments have been developed for different monastic applications. In contemporary Buddhist monasteries in Taiwan, baiqi are used, on the one hand, to mark the time throughout the day, signal the beginning and end of monastic daily activities, and regulate the monastic order; and on the other hand, baiqi are indispensable to the musical practices of all Buddhist rituals, where they are used to accompany fanbai (Buddhist liturgical chants) and to articulate the whole ritual process. This study investigates multiple facets of Buddhist baiqi in their performance practice, function, application, notation, and transmission, exploring the interaction between baiqi and fanbai, baiqi and the practitioner, baiqi and the monastic space, and baiqi and various Buddhist contexts. I draw upon ideas from performance theory as it concerns different disciplines, but I maintain a sharper focus on the musicological dimension of performance practice when analyzing, interpreting, and explaining the performance and music of baiqi in terms of the monastic lifestyle and its rituals. The study not only uncovers the musical system of baiqi, but also encapsulates various issues of performed identity, social interaction, performer/audience, associated behaviors, the musical construction of space, and transmission.

Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients in the US: insights from the National Cardiovascular Data Registry.

BACKGROUND: P2Y12 antagonist therapy improves outcomes in acute myocardial infarction (MI) patients. Novel agents in this class are now available in the US. We studied the introduction of prasugrel into contemporary MI practice to understand the appropriateness of its use and assess for changes in antiplatelet management practices. METHODS AND RESULTS: Using ACTION Registry-GWTG (Get-with-the-Guidelines), we evaluated patterns of P2Y12 antagonist use within 24 hours of admission in 100 228 ST elevation myocardial infarction (STEMI) and 158 492 Non-ST elevation myocardial infarction (NSTEMI) patients at 548 hospitals between October 2009 and September 2012. Rates of early P2Y12 antagonist use were approximately 90% among STEMI and 57% among NSTEMI patients. From 2009 to 2012, prasugrel use increased significantly from 3% to 18% (5% to 30% in STEMI; 2% to 10% in NSTEMI; P for trend <0.001 for all). During the same period, we observed a decrease in use of early but not discharge P2Y12 antagonist among NSTEMI patients. Although contraindicated, 3.0% of patients with prior stroke received prasugrel. Prasugrel was used in 1.9% of patients ≥75 years and 4.5% of patients with weight <60 kg. In both STEMI and NSTEMI, prasugrel was most frequently used in patients at the lowest predicted risk for bleeding and mortality. Despite lack of supporting evidence, prasugrel was initiated before cardiac catheterization in 18% of NSTEMI patients. CONCLUSIONS: With prasugrel as an antiplatelet treatment option, contemporary practice shows low uptake of prasugrel and delays in P2Y12 antagonist initiation among NSTEMI patients. We also note concerning evidence of inappropriate use of prasugrel, and inadequate targeting of this more potent therapy to maximize the benefit/risk ratio.

Witnessing Crisis in Contemporary and Golden Age Spain

In this volume, experts on the Spanish Golden Age from the United Kingdom, Ireland, and the United States offer analyses of contemporary works that have been influenced by the classics from the sixteenth and seventeenth centuries.

The Great War on the small screen: Representing the First World War in contemporary Britain

In Britain since the 1960s television has been the most influential medium of popular culture. Television is also the site where the Western Front of popular culture clashes with the Western Front of history. This book examines the ways in which those involved in the production of historical documentaries for this most influential media have struggled to communicate the stories of the First World War to British audiences. Documents in the BBC Written Archives Centre at Caversham, Berkshire, the Imperial War Museum, and the Liddell Hart Centre for Military Archives all inform the analysis. Interviews and correspondence with television producers, scriptwriters and production crew, as well as two First World War veterans who appeared in several recent documentaries provide new insights for the reader. Emma Hanna takes the reader behind the scenes of the making of the most influential documentaries from the landmark epic series The Great War (BBC, 1964) up to more recent controversial productions such as The Trench (BBC, 2002) and Not Forgotten: The Men Who Wouldn't Fight (BBC, 2008). By examining the production, broadcast and reception of a number of British television documentaries this book examines the difficult relationship between the war's history and its popular memory.

Hypertension - a contemporary approach to nursing care

The incidence of hypertension is increasing as the number of patients with obesity and diabetes mellitus increases. Hypertension results when the peripheral vascular resistance is increased, the blood viscosity is elevated and/or the flow of blood through the main arteries is impeded. Chronic hypertension results in enlarged heart, myocardial damage and lung and renal abnormalities. While some causative factors such as obesity can be controlled, others for example genetics are more difficult to treat because often there is more than one factor involved. This paper explores how essential and secondary factors contribute to the incidence of hypertension and the physiological changes resulting from raised blood pressure. It proposes that although traditional treatment has some success, nurse-led clinics are having better success not only in controlling raised blood pressure but also in reducing cardiac, pulmonary and renal morbidity. It is more cost-effective, staff is more productive and clients are more compliant with treatment.

Grandparents and parenting: towards a theory of grandparenthood

This paper explores the changing role of contemporary grandparents with many demonstrating a willingness and ability to take on parental responsibilities for their grandchildren, where they may face challenges and opportunities in difficult times. Three main forms of grand parenting are identified in the literature, those who have primary responsibility and are raising their grand children as their main carers perhaps in response to crisis situations, those who live in extended families and participate in care, and those who provide day care while the child’s parents work. The latter has increased because of the increasing frequency of divorce, single parenting and the lack of available or subsidised child care in the United Kingdom. When grandparents step into a troubled situation and attempt to offer stability and security for their grandchildren they may have to manage the combined responsibilities of family caregivers and parental figures. Grandparenthood is a tenuous role, lacking clear agreement on behaviour norms. In the culture of advice and parenting support, while care must be taken not to undermine parenting skills or make judgements about the ability to cope with the demands of childcare, an exploration of the impact on grandparents and children must be undertaken. Due to the complex web of interrelated factors the process and outcomes of care giving by grandparents is not well known in the literature. It is proposed therefore that it is timely for research to be undertaken to explore and develop a theory of Grandparenthood.