Failures in childbirth care

The study, first published in 2003, looks at the root causes of adverse events and near misses in obstetrics at seven hospital maternity units by interviewing 93 members of staff, identifying the areas of mismanagement in each case and thematically analysing them

Labour ward incidents and potential claims - Lessons learned from research

This paper provides an insight into the underlying factors involved in potential cerebral palsy and/or shoulder dystocia claims. The research was undertaken to identify the root causes of 37 cases of birth asphyxia in term infants severe enough to warrant admission to neonatal care units in the north-west of England between 2001 and 2002. All available staff (n ¼ 93) providing care during critical periods were interviewed by the author using the cognitive interviewing technique. These included 81 midwives, two consultant obstetricians, eight registrars and two senior house officers. An expert panel consisting of consultant obstetricians, midwives, a consultant neonatologist and the researcher applied the Bolam test to identify instances where care had been substandard and injury caused as a result. Although the cases were often complex, covering more than one shift and over more than one stage of labour, the most dangerous time appeared to be during the night shift (19 cases, 51%), followed by the evening shift (13 cases, 35%) and then the day shift (five cases, 14%). The main problems include: failure to respond appropriately to signs of fetal hypoxia (26 cases, 70%); undiagnosed obstruction (22 cases, 59%), which was broken down into failure to identify cephalopelvic disproportion (13 cases, 35%); and shoulder dystocia (nine cases, 24%). Delayed resuscitation of the infant occurred in 26 cases (80%), and in 18 cases (49%) there was excessive and inappropriate use of Syntocinon. All cases involved human error, either through a delay or failure to take action, or taking inappropriate action. However, these were all underpinned and perpetuated by system and cultural errors present in the labour wards, such as allowing unsupported and inexperienced personnel to work in a position for which they lacked the necessary skill and experience. This was perpetuated by the customary practice of using unsupervised junior medical staff in a first on-call position for complications, and also of failing to sustain safe midwifery staffing levels. This in turn prevented support for more inexperienced staff. Consequently, when inexperienced midwives and obstetricians were left unsupervised in charge of complicated cases, it created accidents waiting to happen. When unsupervised and inexperienced paediatricians attended the birth of an asphyxiated infant, the child’s condition deteriorated further when they were unable to resuscitate it. If such system and cultural errors as these are not rectified, the current high rate of damaged babies is likely to continue

Borders, Bordering, and the Transnation

The hope for a better life that drives increasing numbers of refugees to seek shelter has corresponded to an increasingly hysterical sealing of national borders around the world. Whatever the world would look like without borders, refugees have been reduced to the condition of homo sacer–bare life–in what Giorgio Agamben calls a state of exception outside the law. This article considers the oxymoronic conditions by which the nation-state produces ‘states of exception’, not only to record the sinister development of the incarceration of asylum seekers, but also to emphasize the tenacious and innovative nature of the processes and techniques by which subjects inhabit borders of all kinds. Despite the powerful structural effects of the state—particularly its effects on transnational mobility— individual subjects inhabit the borders of nations in ways that demonstrate their political mobility, constituting what I call the ‘transnation’. While the transnation—the outside of the state that begins within the nation—may or may not engage in physical travel, it reveals the utopian possibilities offered by the actual proliferation of national subjects. The article considers the function of literature in the transnation, particularly the utopian possibilities it offers to move between the structures of the state

The Sacred in the Secular: Francis Webb’s Incarnational Poetry

Francis Webb’s poetry places the significance of Jesus firmly in the miracle of the incarnation, a moment that symbolises the presence of Christ in all creation, a presence summed up in the lines ‘The tiny not the immense/Will teach our groping eyes’. Drawing energy out of the Thomist tradition and the Ignatian Spiritual Exercises, Webb demonstrates a belief in the presence of Jesus in the quotidian, proximate aspects of existence, a belief he shares with other Australian writers such as Patrick White and Les Murray. Mentored in his early years by Norman Lindsay and Douglas Stewart, Webb’s maturing sense of the presence of Christ in creation required a severing of ties with their stridently anti-religious position. Consequently, his poetry is driven by the metaphor of the journey, specifically a journey towards the revelation of Jesus, a journey to the ‘Centre’—both the centre of Australia and the spiritual centre of life. But such a journey demands the apprehension of the divine in the proximate, material aspects of existence. In this way the poetry demonstrates that revelation lies in the journey, not at its end. Jesus is to be appre-hended in every moment

Amplitude-mode dynamics of polariton condensates

We study the stability of collective amplitude excitations in non-equilibrium polariton condensates. These excitations correspond to renormalized upper polaritons and to the collective amplitude modes of atomic gases and superconductors. They would be present following a quantum quench or could be created directly by resonant excitation. We show that uniform amplitude excitations are unstable to the production of excitations at finite wavevectors, leading to the formation of density-modulated phases. The physical processes causing the instabilities can be understood by analogy to optical parametric oscillators and the atomic Bose supernova.Comment: 4 pages, 2 figure

Fast field-cycling NMR of cartilage : a way toward molecular imaging

Peer reviewedPublisher PD

Universal features of Thermopower in High Tc systems and Quantum Criticality

In high Tc superconductors a wide ranging connection between the doping dependence of the transition temperature Tc and the room temperature thermopower Q has been observed. A "universal correlation" between these two quantities exists with the thermopower vanishing at optimum doping as noted by OCTHH (Obertelli, Cooper, Tallon, Honma and Hor). In this work we provide an interpretation of this OCTHH universality in terms of a possible underlying quantum critical point (QCP) at Tc. Central to our viewpoint is the recently noted Kelvin formula relating the thermopower to the density derivative of the entropy. Perspective on this formula is gained through a model calculation of the various Kubo formulas in an exactly solved 1-dimensional model with various limiting procedures of wave vector and frequency.Comment: 12 pages, 8 figure