Inadvertent hypothermia after procedural sedation and analgesia in a cardiac catheterisation laboratory: A prospective observational study

Objective To identify the prevalence of and risk factors for inadvertent hypothermia after procedures performed with procedural sedation and analgesia in a cardiac catheterisation laboratory. Design Single-centre, prospective observational study. Setting Tertiary care private hospital in Australia. Participants A convenience sample of 399 patients undergoing elective procedures with procedural sedation and analgesia were included. Propofol infusions were used when an anaesthetist was present. Otherwise, bolus doses of either midazolam or fentanyl or a combination of these medications was used. Interventions None Measurements and main results Hypothermia was defined as a temperature <36.0° Celsius. Multivariate logistic regression was used to identify risk factors. Hypothermia was present after 23.3% (n=93; 95% confidence interval [CI] 19.2%-27.4%) of 399 procedures. Sedative regimens with the highest prevalence of hypothermia were any regimen that included propofol (n=35; 40.2%; 95% CI 29.9%-50.5%) and the use of fentanyl combined with midazolam (n=23; 20.3%; 95% CI 12.9%-27.7%). Difference in mean temperature from pre to post-procedure was -0.27°C (Standard deviation [SD] 0.45). Receiving propofol (odds ratio [OR] OR 4.6 95% CI 2.5-8.6), percutaneous coronary intervention (OR 3.2 95% CI 1.7-5.9), body mass index <25 (OR 2.5 95% CI 1.4-4.4) and being hypothermic prior to the procedure (OR 4.9; 95% CI 2.3-10.8) were independent predictors of post-procedural hypothermia. Conclusions A moderate prevalence of hypothermia was observed. The small absolute change in temperature observed may not be a clinically important amount. More research is needed to increase confidence in our estimates of hypothermia in sedated patients and its impact on clinical outcomes.

Somali perspectives on physical activity: PhotoVoice to address barriers and resources in San Diego

Although many immigrants enter the United States with a healthy body weight, this health advantage disappears the longer they reside in the United States. To better understand the complexities of obesity change within a cultural framework, a community-based participatory research (CBPR) approach, PhotoVoice, was used, focusing on physical activity among Muslim Somali women. The CBPR partnership was formed to identify barriers and resources to engaging in physical activity with goals of advocacy and program development. Muslim Somali women (n = 8) were recruited to participate, trained and provided cameras, and engaged in group discussions about the scenes they photographed. Participants identified several barriers, including safety concerns, minimal culturally appropriate resources, and financial constraints. Strengths included public resources and a community support system. The CBPR process identified opportunities and challenges to collaboration and dissemination processes. The findings laid the framework for subsequent program development and community engagement.

Comparison of the effects of litigation and ADR in South-East Queensland

Alternative dispute resolution (ADR) methods, such as arbitration, are often used instead of litigation to resolve construction disputes, as industry folklore considers litigation overly expensive and time-consuming. But is this actually the case? Do the people most involved in construction dispute resolution agree? What are the real advantages and disadvantages of using litigation or ADR? When, if ever, is litigation the most appropriate way of resolving construction disputes? To answer these questions, this paper first provides a review of the literature on the use of litigation and ADR for construction dispute resolution. This is followed by the results of a survey of construction and legal personnel with moderate to extensive experience of dispute resolution in the Australian South-East Queensland construction industry. The main results of this are that, in addition to litigation being more expensive in money and time than ADR methods, the nature of the existing relationship between the parties has an important effect on the resolution process, what happens after an unsuccessful ADR and, if adversarial, is more likely to lead to litigation. The results are then validated and verified by one of the most experienced practitioners in claims and disputes in the whole of Australia.

Super DNAging - New insights into DNA integrity, genome stability and telomeres in the oldest old

Reductions in DNA integrity, genome stability, and telomere length are strongly associated with the aging process, age-related diseases as well as the age-related loss of muscle mass. However, in people reaching an age far beyond their statistical life expectancy the prevalence of diseases, such as cancer, cardiovascular disease, diabetes or dementia, is much lower compared to “averagely” aged humans. These inverse observations in nonagenarians (90–99 years), centenarians (100–109 years) and super-centenarians (110 years and older) require a closer look into dynamics underlying DNA damage within the oldest old of our society. Available data indicate improved DNA repair and antioxidant defense mechanisms in “super old” humans, which are comparable with much younger cohorts. Partly as a result of these enhanced endogenous repair and protective mechanisms, the oldest old humans appear to cope better with risk factors for DNA damage over their lifetime compared to subjects whose lifespan coincides with the statistical life expectancy. This model is supported by study results demonstrating superior chromosomal stability, telomere dynamics and DNA integrity in “successful agers”. There is also compelling evidence suggesting that life-style related factors including regular physical activity, a well-balanced diet and minimized psycho-social stress can reduce DNA damage and improve chromosomal stability. The most conclusive picture that emerges from reviewing the literature is that reaching “super old” age appears to be primarily determined by hereditary/genetic factors, while a healthy lifestyle additionally contributes to achieving the individual maximum lifespan in humans. More research is required in this rapidly growing population of super old people. In particular, there is need for more comprehensive investigations including short- and long-term lifestyle interventions as well as investigations focusing on the mechanisms causing DNA damage, mutations, and telomere shortening.

Behavior of pretilachlor and dimethametryn in water of flooded rice fields

In order to understand the behavior of pretilachlor, a popular rice herbicide in the world, and a synergetic active ingredient, dimethametryn, a monitoring study was conducted in 3 paddy plots in Kyushu region, Japan. The monitoring indicated different behaviors for both pesticides from those reported in the literature. Maximum concentrations of pretilachlor and dimethametryn were 1 order of magnitude lower than the values observed in previous studies. However, the dissipation rates estimated from monitoring data were in agreement with other studies in Japan. The pesticide product was tested and showed good dissolution of pretilachlor and dimethametryn in water, suggesting that another study is needed to explain the low concentrations of the two pesticides in the fields. Besides pesticide behaviors, it was observed from the monitoring that water management in paddy rice cultivation still requires more attention to reduce the environmental risk of rice pesticides.

Common variants in the region around Osterix are associated with bone mineral density and growth in childhood

Peak bone mass achieved in adolescence is a determinant of bone mass in later life. In order to identify genetic variants affecting bone mineral density (BMD), we performed a genome-wide association study of BMD and related traits in 1518 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). We compared results with a scan of 134 adults with high or low hip BMD. We identified associations with BMD in an area of chromosome 12 containing the Osterix (SP7) locus, a transcription factor responsible for regulating osteoblast differentiation (ALSPAC: P = 5.8 × 10-4; Australia: P = 3.7 × 10-4). This region has previously shown evidence of association with adult hip and lumbar spine BMD in an Icelandic population, as well as nominal association in a UK population. A meta-analysis of these existing studies revealed strong association between SNPs in the Osterix region and adult lumbar spine BMD (P = 9.9 × 10-11). In light of these findings, we genotyped a further 3692 individuals from ALSPAC who had whole body BMD and confirmed the association in children as well (P = 5.4 × 10-5). Moreover, all SNPs were related to height in ALSPAC children, but not weight or body mass index, and when height was included as a covariate in the regression equation, the association with total body BMD was attenuated. We conclude that genetic variants in the region of Osterix are associated with BMD in children and adults probably through primary effects on growth.

Impact of ethnicity upon body composition assessment in Sri Lankan Australian children

Objectives: Obesity is a disease with excess body fat where health is adversely affected. Therefore it is prudent to make the diagnosis of obesity based on the measure of percentage body fat. Body composition of a group of Australian children of Sri Lankan origin were studied to evaluate the applicability of some bedside techniques in the measurement of percentage body fat. Methods: Height (H) and weight (W) was measured and BMI (W/H2) calculated. Bioelectrical impedance analysis (BIA) was measured using tetra polar technique with an 800 μA current of 50 Hz frequency. Total body water was used as a reference method and was determined by deuterium dilution and fat free mass and hence fat mass (FM) derived using age and gender specific constants. Percentage FM was estimated using four predictive equations, which used BIA and anthropometric measurements. Results: Twenty-seven boys and 15 girls were studied with mean ages being 9.1 years and 9.6 years, respectively. Girls had a significantly higher FM compared to boys. The mean percentage FM of boys (22.9 ± 8.7%) was higher than the limit for obesity and for girls (29.0 ± 6.0%) it was just below the cut-off. BMI was comparatively low. All but BIA equation in boys under estimated the percentage FM. The impedance index and weight showed a strong association with total body water (r 2 = 0.96, P < 0.001). Except for BIA in boys all other techniques under diagnosed obesity. Conclusions: Sri Lankan Australian children appear to have a high percentage of fat with a low BMI and some of the available indirect techniques are not helpful in the assessment of body composition. Therefore ethnic and/or population specific predictive equations have to be developed for the assessment of body composition, especially in a multicultural society using indirect methods such as BIA or anthropometry.

Growth hormone resistance and somatomedins in children with end-stage liver disease awaiting transplantation

Background: The success of orthotopic liver transplantation as treatment for end-stage liver disease has prompted investigation of strategies to maintain or improve nutrition and growth in children awaiting transplantation, because malnutrition is an adverse prognostic factor. The purpose of this study was to evaluate the effect of recombinant human growth hormone therapy on body composition and indices of liver function in patients awaiting transplant. Methods: The study was designed as a placebo- controlled, double-blind, crossover trial. Patients received 0.2 U/kg growth hormone, subcutaneously, or placebo daily for 28 days during two treatment periods, separated by a 2-week washout period. Ten patients (mean age, 3.06 ± 1.15 years; range, 0.51-11.65 years, five men), with extrahepatic biliary atresia (n = 8) or two with Alagille's syndrome (n = 2), with end-stage liver disease, completed the trial while awaiting orthotopic liver transplantation. Height, weight, total body potassium, total body fat, resting energy expenditure, respiratory quotient, hematologic and multiple biochemical profile, number of albumin infusions, insulin-like growth factor-1 and 1, growth hormone binding protein (GHBP), and insulin-like growth factor binding protein-1 (IGFBP-1) and insulin-like growth factor binding protein (IGFBP-3) were measured at the beginning and end of each treatment period. Results: Growth hormone treatment was associated with a significant decline in serum bilirubin (-34.6 ± 16.5 μmol/l vs. 18.2 ± 11.59 μmol/l; p < 0.02) but there was no significant effect on any anthropometric or body composition measurements, or on any biochemical or hematologic parameters. Conclusions: These children with end-stage liver disease displayed growth hormone resistance, particularly in relation to the somatomedin axis. Exogenous growth hormone administration may be of limited value in these patients

Identity, image, and sexuality in young adults with cancer

The impact of disease and treatment on a young adult's self-image and sexuality has been largely overlooked. This is surprising given that establishing social and romantic relationships is a normal occurrence in young adulthood. This article describes three female patients' cancer journeys and demonstrates how their experiences have impacted their psychosocial function and self-regard. The themes of body image, self-esteem, and identity formation are explored, in relation to implications for relationship-building and moving beyond a cancer diagnosis. This article has been written by young cancer survivors, Danielle Tindle, Kelly Denver, and Faye Lilley, in an effort to elucidate the ongoing struggle to reconcile cancer into a normal young adult's life.

Efficient designs for sampling and subsampling in fisheries research based on ranked sets

Sampling strategies are developed based on the idea of ranked set sampling (RSS) to increase efficiency and therefore to reduce the cost of sampling in fishery research. The RSS incorporates information on concomitant variables that are correlated with the variable of interest in the selection of samples. For example, estimating a monitoring survey abundance index would be more efficient if the sampling sites were selected based on the information from previous surveys or catch rates of the fishery. We use two practical fishery examples to demonstrate the approach: site selection for a fishery-independent monitoring survey in the Australian northern prawn fishery (NPF) and fish age prediction by simple linear regression modelling a short-lived tropical clupeoid. The relative efficiencies of the new designs were derived analytically and compared with the traditional simple random sampling (SRS). Optimal sampling schemes were measured by different optimality criteria. For the NPF monitoring survey, the efficiency in terms of variance or mean squared errors of the estimated mean abundance index ranged from 114 to 199% compared with the SRS. In the case of a fish ageing study for Tenualosa ilisha in Bangladesh, the efficiency of age prediction from fish body weight reached 140%.

A Literary Turn : Rethinking the Roles of Generalization and Theory in Anglo-American Moral Philosophy

This work investigates the role of narrative literature in late-20th century and contemporary Anglo-American moral philosophy. It aims to show the trend of reading narrative literature for purposes of moral philosophy from the 1970 s and early 80 s to the present day as a part of a larger movement in Anglo-American moral philosophy, and to present a view of its significance for moral philosophy overall. Chapter 1 provides some preliminaries concerning the view of narrative literature which my discussion builds on. In chapter 2 I give an outline of how narrative literature is considered in contemporary Anglo-American moral philosophy, and connect this use to the broad trend of neo-Aristotelian ethics in this context. In chapter 3 I connect the use of literature to the idea of the non-generalizability of moral perception and judgment, which is central to the neo-Aristotelian trend, as well as to a range of moral particularisms and anti-theoretical positions of late 20th century and contemporary ethics. The joint task of chapters 2 and 3 is to situate the trend of reading narrative literature for the purposes of moral philosophy in the present context of moral philosophy. In the following two chapters, 4 and 5, I move on from the particularizing power of narrative literature, which is emphasized by neo-Aristotelians and particularists alike, to a broader under-standing of the intellectual potential of narrative literature. In chapter 4 I argue that narrative literature has its own forms of generalization which are enriching for our understanding of the workings of ethical generalizations in philosophy. In chapter 5 I discuss Iris Murdoch s and Martha Nussbaum s respective ways of combining ethical generality and particularity in a philosophical framework where both systematic moral theory and narrative literature are taken seriously. In chapter 6 I analyse the controversy between contemporary anti-theoretical conceptions of ethics and Nussbaum s refutation of these. I present my suggestion for how the significance of the ethics/literature discussion for moral philosophy can be understood if one wants to overcome the limitations of both Nussbaum s theory-centred, equilibrium-seeking perspective, and the anti-theorists repudiation of theory. I call my position the inclusive approach .

Reconsidering Relativism and Intentionalism in Interpretation : Donald Davidson, Hermeneutics, and Pragmatism

This study focuses on two philosophical issues related to the interpretation of art. Firstly, it considers the role of authorial intentions in interpretation. Secondly, the study raises the issue of relativism in interpretation through a discussion of the relativistic tendencies apparent in the views of three major figures of contemporary philosophy: Joseph Margolis, Hans-Georg Gadamer, and Richard Rorty. The major goal of the thesis is to develop a theory of interpretation supporting the role of authorial intentions in interpretation on the basis of Donald Davidson s late philosophy of language and the holistic account of interpretation that underlies different parts of his philosophy. It is my belief that an intentionalist view of interpretation built on Davidsonian elements manages to form the most convincing defense of that interpretive position against the skepticism present in the views of Margolis, Gadamer, and Rorty. The theoretical issues addressed in the thesis are illuminated by discussions of case-examples, most importantly Richard Wagner s The Valkyrie, Thomas Adés America: A Prophecy, and some symphonies by Dimitri Shostakovich. In chapter one, I present a critical discussion of Margolis robust relativism. While finding Margolis criticism of the self-refutive argument plausible, I, nevertheless, argue that the relativistic logic Margolis offers should not be favored in interpretation. The first parts of chapter two outline Davidsonian intentionalism by presenting a reading of Davidson s later work in philosophy of language and mind, and by indicating its relationship to Davidson s views of literature. Then, I shall compare Davidson s ideas with some recent modest forms of intentionalism found in analytic aesthetics, and argue that Davidsonian intentionalism is in many respects more satisfactory compared to them. Chapter three engages Gadamer s hermeneutics by defending E.D. Hirsch s criticism of Gadamer. Uncovering the shortcomings in the replies of Gadamer s followers to Hirsch s criticism serves as a basis for the defense of intentionalism in interpretation carried out in the chapter. That defense is then extended with a discussion of some recent hermeneutic readings of Davidson s views. Chapter four deals with the standing of intentionalism through Rorty s pragmatist approach to literature. By indicating the position of pragmatist notions of aesthetic experience and imagination in Davidsonian intentionalism, it is shown that an intentionalist approach need not be as impoverished with regard to the value Rorty attributes to literature as he assumes. The concluding chapter outlines some ways in which one can be a pluralist with regard to art and interpretation without falling into relativism.

Poetics of Subjectivity : Existence and Expressivity in Simone de Beauvoir's Philosophy

In the last thirty years, primarily feminist scholars have drawn attention to and re-evaluated the philosophy of Simone de Beauvoir (1908 1986). Her philosophical practice has been described as non-systematic, and her literary writing has been viewed as part of her non-systematic mode of philosophising. This dissertation radically deepens the question concerning Beauvoir s philosophical motivations for turning to literature as a mode to express subjectivity. It explicates the central concepts of Beauvoir s philosophy of existence, which are subjectivity, ambiguity, paradox and temporality, and their background in the modern traditions of existential philosophy and phenomenology. It also clarifies Beauvoir s main reason to turn to literature in order to express subjectivity as both singular and universal: as a specific mode of communication, literature is able to make the universality of existence manifest in the concrete, singular and temporal texture of life. In addition, the thesis gives examples of how Beauvoir s literary works contribute to an understanding of the complexity of subjectivity. I use the expression poetics of subjectivity to refer to the systematic relation between Beauvoir s existential and phenomenological notion of subjectivity and her literary works, and to her articulations of a creative mode of using language, especially in the novel. The thesis is divided into five chapters, of which the first three investigate Beauvoir s philosophy of existence at the intersection of the modern traditions of thought that began with René Descartes and Søren Kierkegaard s intuitions about subjectivity. Chapter 1 interprets Beauvoir s notion of ambiguity, as compared to paradox, and argues that both determine her notion of existence. Chapters 2 and 3 investigate the phenomenological side of Beauvoir s philosophy through a study of her response to early French interpretations of transcendental subjectivity, especially in the works of Jean-Paul Sartre and Maurice Merleau-Ponty. My analysis shows that Edmund Husserl s distinction between different levels of subjective experience is central to Beauvoir s understanding of subjectivity and to the different ego concepts she uses. Chapter 4 is a study of Beauvoir s reflections on the expression of subjective thought, and, more specifically, her philosophical conceptions of the metaphysical novel and the autobiography as two modes of indirect communication. Chapter 5, finally, compares two modes of investigating concrete subjectivity; Beauvoir s conceptual study of femininity in Le deuxième sexe and her literary expression of subjectivity in the novel L Invitée. My analysis reveals and explicates Beauvoir s original contribution to a comprehensive understanding of the becoming and paradox of human existence: the fundamental insight that these phenomena are sexed, historically as well as imaginatively.

Writing Otherwise than Seeing : Writing and Exteriority in Maurice Blanchot

Maurice Blanchot (1907-2003), the French writer and novelist, is one of the most important figures in post-war French literature and philosophy. The main intention of this study is to figure out his position and originality in the field of phenomenology. Since this thesis concentrates on the notion of vision in Blanchot s work, its primary context is the post-war discussion of the relation between seeing and thinking in France, and particularly the discussion of the conditions of non-violent vision and language. The focus will be on the philosophical conversation between Blanchot and his contemporary philosophers. The central premise is the following: Blanchot relates the criticism of vision to the criticism of the representative model of language. In this thesis, Blanchot s definition of literary language as the refusal to reveal anything is read as a reference pointing in two directions. First, to Hegel s idea of naming as negativity which reveals Being incrementally to man, and second, to Heidegger s idea of poetry as the simultaneity of revealing and withdrawal; the aim is to prove that eventually Blanchot opposes both Hegel s idea of naming as a gradual revelation of the totality of being and Heidegger s conception of poetry as a way of revealing the truth of Being. My other central hypothesis is that for Blanchot, the criticism of the privilege of vision is always related to the problematic of the exteriority. The principal intention is to trace how Blanchot s idea of language as infinity and exteriority challenges both the Hegelian idea of naming as conceptualizing things and Heidegger s concept of language as a way to truth (as aletheia). The intention is to show how Blanchot, with his concepts of fascination, resemblance and image, both affirms and challenges the central points of Heidegger s thinking on language. Blanchot s originality in, and contribution to, the discussion about the violence of vision and language is found in his answer to the question of how to approach the other by avoiding the worst violence . I claim that by criticizing the idea of language as naming both in Hegel and Heidegger, Blanchot generates an account of language which, since it neither negates nor creates Being, is beyond the metaphysical opposition between Being and non-Being.

War and Revolution in St. Petersburg : Modernist Links in the Poetry of Edith Södergran and Anna Andreevna Akhmatova

Important modernists in their own countries, Anna Akhmatova and Edith Södergran are compared in this dissertation as poets whose poetry reflects the climactic events of the early twentieth century in Finland and Russia. A comparatist, biographical and historical approach is used to uncover the circumstances surrounding these events. First the poets’ early works are reviewed and their contemporaries are mentioned to provide a poetic context. Then a brief review of Finnish and Russian history situates them historically. Next, the rich literary diversity of St. Petersburg’s Silver Age is presented and the work of the poets is viewed in context before their poetry is compared, as the First World War, October Revolution and subsequent Finnish Civil War impact their writing. While biography is not the primary focus, it becomes important as inevitably the writers’ lives are changed by cataclysmic events and the textual analysis of the poems in Swedish, Russian and English shows the impact of war on their poetry. These two poets have not been compared before in a critical review in English and this work contributes to needed work in English. They share certain common modernist traits: attention to the word, an intimate, unconventional voice, and a concern with audience. In addition, they both reject formal traditions while they adopt new forms and use modern, outside influences such as art, architecture and philosophy as subject matter and a lens through which to focus their poetry. While it may seem that Anna Akhmatova was the most socially aware poet, because of the censorship she endured under Stalin, my research has revealed that actually Edith Södergran showed the most social consciousness. Thus, a contrast of the poets’ themes reveals these differences in their approaches. Both poets articulated a vibrant response to war and revolution becoming modernists in the process. In their final works created in the years before their deaths, they reveal the solace they found in nature as well as final mentions of the violent events of their youth. Keywords: St. Petersburg, Modernism, Symbolism, Acmeism, Silver Age, Finland-Swedish literature