Severe preterm preeclampsia - associated posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome which causes non-specific neurological symptoms such as visual impairment (cortical blindness, diplopia, hemianopia), acute headaches, seizures (focal or general tonic-clonic), vomiting, altered mental status, focal neurologic deficit as a complication of preeclampsia. Preeclampsia is a serious complication specific for pregnancy, characterized by hypertension (systolic > 140 mm Hg and/or diastolic > 90 mm Hg) and proteinuria (> 300 mg u 24-h urine sample , > 1 +) at or after 20th week of gestation. It is one of the leading causes of perinatal morbidity and mortality. We present a 38-year-old pregnant woman, gravida 1 para 0 with PRES which was manifested on the second day after delivery by Cesarean section at 32 weeks of gestation with aphasia and blindness caused by severe preeclampsia. We confirmed the diagnosis by MRI which revealed white matter edema in the posterior cerebral area in a symmetric fashion, hyper intense cortical foci in the right occipital lobe and punctiform lesions in the bilateral occipital lobe. We treated her promptly in the intensive care unit (ICU) with antihypertensive and anticonvulsant therapy after which she fully recovered. PRES should always be kept in mind when a patient in the postpartum period develops one of the above symptoms. If timely recognized and promptly treated, full recover usually follows

On the Black Book as Durational: Noah Purifoy’s Desert Library

What happens to a library in the desert? How does it transform as a material object under these pressures, and what might these transformations tell us about its capacity for bearing and registering history? This article considers these questions in relation to the artist Noah Purifoy’s found-object installation Library of Congress, one of approximately thirty works that make up the ten-acre space of the Noah Purifoy Desert Art Museum of Assemblage Art in Joshua Tree, California. The museum consists of a wide range of found-object sculptures, all deeply enmeshed within the space of the desert. The museum, and indeed Purifoy’s work as a whole, are deeply invested in a complex social and political dialogue with assemblage and thing theory of the sort popularized by Bill Brown and Jane Bennett, constellating objects within space as a way of mapping the shape of postwar Blackness. Library in particular consciously asks what happens to the racial stakes of assemblage when the things in question are books and the site in question is a library. (Included in the issue section Beyond the Book

The normal distribution, an epistemological view

The role of the normal distribution in the realm of statistical inference and science is considered from epistemological viewpoint. Quantifiable knowledge is usually embodied in mathematical models. History and emergence of the normal distribution is presented in a close relationship to those models. Furthermore, the role of the normal distribution in estimation of model parameters, starting with Laplace’s Central Limit Theorem, through maximum likelihood theory leading to Bronstein von Mises and Convolution Theorems, is discussed. The paper concludes with the claim that our knowledge on the effects of variables in models or laws of nature has a mathematical structure which is identical to the normal distribution. The epistemological consequences of the latter claim are also considered

Management of fetal supraventricular tachyarrhythmia - case report

The conduction system of the fetal heart is defined by the16th week of gestation when it matures and normally produces a regular rhythm and rate between 110 and 160 beats per minute (bpm) for the remainder of the pregnancy. Deviations from these parameters are fetal arrhythmias. They are diagnosed in 2% of unselected pregnancies. They are mostly benign and transient but some of them are persistent and associated with structural defects or can cause heart failure, fetal hydrops and intrauterine death. Routine prenatal care includes screening for fetal arrhythmias in the second and third trimester with fetal ultrasound examinations which include a view of the four cardiac chambers and both ventricular outflow tracts. The fetal outcomes are improved upon appropriate antepartum diagnosis and care. Here we present a pregnancy and multidisciplinary management, prenatal evaluation and intervention with maternal transplacental treatment of a 28-year-old female, gravida II, para II, in 28+5 weeks of gestation with fetal arrhythmia, in tertiary university hospital. She had a history of previous caesarean section, in the 40th week of gestation due to an infection of the synus pylonidalis. We confirmed suspected fetal arrhythmia as supraventricular tachyarrhythmia without fetal hydrops, based on the ultrasound doppler M mode imaging, and started transplacental administration of antiarrhythmyc agent, digoxin. It has been considered the first line agent for treatment of fetal supraventricular tachycardia but higher maternal doses are required to maintain a therapeutic serum level. We converted fetal heartbeat into normal sinus rhythm after three days of administration of digoxin. We continued to monitor the fetus once a week with controlling levels of digoxin and electrolytes in maternal blood until the end of the pregnancy at 38+6 weeks of gestation

Informed consent and secondary data:reflections on the use of mothers' blogs in social media research

This paper seeks to extend debate on the use of blogs as qualitative data, specifically focusing on the issue of consent in research that uses publicly available but personal content. Typically the argument has been made for the need to protect individual writers and engage with these documents in a considered manner that recognises the inherent vulnerability of amateur authors. This paper will argue that a framing of these writers that foregrounds their potential vulnerability, naivety and even ignorance is in fact highly paternalistic, and therefore counter to an ethical approach to research. In seeking to protect authors from harm, we deny their agency and diminish the act of online publication. Further, this approach, prevalent in academia, is at odds with the legal position, and arguably, the weight of social understanding. A reframing of amateur online authors as informed agents not only increases the accessibility of these data to researchers and subsequently policy makers, but also alludes to a need to credit the contribution of authors without the need to seek permission. Ultimately, this paper argues for a presumption of accountability, unless otherwise proven, and an approach to the use of self‐published online material that mirrors the use of other sorts of secondary data with perceived “professional” authors, such as magazine articles, newspaper columns or organisational literature

Multidisciplinary approach in the management of pregnancy with placenta accreta spectrum disorder - Case report

From the histopathologic perspective Placenta accreta spectrum (PAS) shows the absence of the normal intervening decidua and invasion of the placenta into the myometrium. There is placenta accreta with the chorionic villi attach directly to the surface of the myometrium in the absence of the decidual layer and placenta increta when the chorionic villi penetrate deeply into the myometrium reaching the external layer. There is also placenta percreta where the invasive chorionic villi reach and penetrate through the myometrium to uterine serosa and it is nowadays the most common reason for peripartum hysterectomy (1). Drawing the line between these subtypes is not always easy, especially in the clinical situations when the invasiveness of the placenta is not known before the delivery (2). The maternal and fetal outcomes are improved upon appropriate antepartum diagnosis and care by multidisciplinary experts with experience in PAS treatment (3). Here we present a pregnancy and multidisciplinary delivery management of a 40-year-old female, gravida V, para IV, with history of the three cesarean sections, in 36+2 weeks of gestation in a tertiary academic teaching hospital. We confirmed suspected PAS antenatally based on ultrasound and magnetic resonance imaging (MRI). Preoperative preparation included the ensuring of blood products availability, the use of arterial occlusion balloons to reduce hemorrhage, and the use of double JJ stent to prevent ureteral injuries. We performed a cesarean section with immediate uterine amputation due to severe bleeding, after which the patient fully recovered. If PAS timely suspected and confirmed intraoperatively, the best maternal and neonatal outcome is achieved by the multidisciplinary approach that enables adequate elective procedure

Discussing Nature, ‘Doing’ Nature:for an emancipatory approach to conceptualizing young people's access to outdoor green space

Across the social sciences there is an extensive literature exploring the complex relationships between society and nature, increasingly concerned with, and critiquing, the notion of a unique relationship between children and green space. However, a nature/culture dichotomy remains central to socio-political discourse presenting a crisis of detachment. This nature/culture division can also be seen through practices surrounding children’s access to ‘nature’. This paper explores the conflict between academic and societal approaches to the nature/culture divide through the perceptions and experiences of learning disabled young people, aged 11–16. The findings illustrate the importance of allowing (learning disabled) young people the opportunity for embodied engagement in ‘nature’ spaces. Through activity the young people developed nuanced and hybrid understandings of nature that contest widely held dichotomies of nature and culture. This conceptualisation of complexity and non-dichotomy in the relationship between culture and nature may underpin exploration of the specific facets of nature that provide wellbeing benefits, potentially increasing the accessibility of the recognised benefits of ‘nature’ interaction for those who experience challenges in reaching environments understood as ‘nature’-full. As such, this paper presents a call for academics to communicate hybrid geographies in a way that is accessible beyond the ivory tower

Development of hydro impulse turbines and new opportunities

Hydro impulse turbines are often referred to as a mature technology having been invented around 100 years ago with many of the old design guidelines producing machines of a high efficiency. However with recent advances in Computational Fluid Dynamics (CFD) it is now possible to simulate these highly turbulent multiphase flows with good accuracy and in reasonable timescales. This has opened up an avenue for further development and understanding of these machines which has not been possible through traditional analyses and experimental testing. This paper explores some of the more recent developments of Pelton and Turgo Impulse turbines and highlights the opportunities for future development

Research relationships and responsibilities:‘Doing’ research with ‘vulnerable’ participants: introduction to the special edition

For some decades now, human geography has sought to engage with the narratives of those deemed least powerful in society. This interest in the experiences of those who have traditionally been sidelined from political agendas has been part of move towards an increasingly critical approach to the social sciences, and ultimately as a way of using the academy as a tool for social justice. Researching the experiences of socially, politically and economically marginalised groups of people, is no longer a new endeavour. What is new, however, is the rapidity in the growth of interest of researchers seeking to engage with these populations, and the variety of the toolkit of methods, for research and analysis, available to support this engagement. Whilst this special edition seeks to draw out and explore a variety of novel approaches to research methods and practice, the particularly unique contribution presented by this publication is a candid exploration of the ethical challenges of engaging with populations identified as ‘vulnerable’ as expressed through the discussion of first-hand fieldwork experience.</p