Subchorionic Hemorrhage Appearing as Twin Gestation on Endovaginal Ultrasound

This case study describes a pregnant patient with vaginal bleeding who had a bedside endovaginal ultrasound in the emergency department (ED). The emergency physician identified a live intra-uterine pregnancy (IUP) with another structure that appeared to be a second gestational sac. The patient subsequently had an endovaginal ultrasound in the radiology department 46 minutes later. The attending radiologist described one live IUP and a subchorionic hemorrhage. Comparison of the ED and radiology ultrasound showed that the second structure, identified as a subchorionic hemorrhage, had significantly decreased in size. Endovaginal ultrasound in the evaluation of possible ectopic pregnancy is a useful bedside tool in the ED. We discuss a pitfall that can occur with endocavitary ultrasound when a twin gestation is presumed

Retinal Detachment Diagnosed by Bedside Ultrasound in the Emergency Department

This case study describes a patient who presented with vague visual complaints in the right eye, decreased visual acuity in the affected eye, and a difficult initial eye evaluation, including fundoscopic and slit lamp examinations, in the emergency department (ED). The preliminary finding included a darkened-appearing area of the retina on fundoscopic exam. The patient subsequently had bedside sonography of the eyes done by an emergency medicine (EM) intern which revealed a thin and serpentine strip appearing as a hyperechoic representation of the retina floating freely into the vitreous from the superior-lateral section of the posterior globe

External injuries, trauma and avoidable deaths in Agincourt, South Africa : a retrospective observational and qualitative study

Acknowledgments We thank Chodziwadziwa Kabudula (MRC/Wits Rural Public Health and Health Transitions Research Unit—School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg/Acornhoek, South Africa) for his assistance with assembling the Agincourt HDSS data set for our use. The research presented in this paper was in part funded by the Health Systems Research Initiative from the Department for International Development (DFID)/ Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/P014844/1).Peer reviewedPublisher PD

Adipocyte-specific protein tyrosine phosphatase 1B deletion increases lipogenesis, adipocyte cell size and is a minor regulator of glucose homeostasis

Peer reviewedPublisher PD

Changes in physical activity, physical fitness, self-perception and quality of life following a six-month physical activity counseling and cognitive behavioral therapy program in outpatients with binge eating disorder

The aim of the current study was to explore the associations between changes in the number of binges, physical activity participation, physical fitness, physical self-perception and quality of life following a six-month physical activity counseling and cognitive behavioral program in patients with binge eating disorder (BED). In total 34 (31 women) outpatients with BED (38.5±10.7 years) completed a six-month one-day per week group-based program. Participants completed the 36-item Short Form Health Survey, the Baecke Physical Activity questionnaire, the Physical Self Perception Profile and performed a six-minute walk test (6MWT) at baseline, after three and six months. Except for physical activity at work, physical strength and self-worth perception, all parameters significantly improved after six months. The effect sizes ranged from −0.33 for the number of binges to 1.67 for participation in sports activities. Significant increases in leisure time physical activity were associated with significant improvements in physical health related quality of life, perceived sports competence and physical fitness and in perceived body attractiveness. The significant reduction in the number of binges was associated with significant improvements in physical health related quality of life. Future research should focus on detailing which techniques can stimulate physical activity participation in patients with BED

Comparing nuclear power trajectories in Germany and the UK: from ‘regimes' to ‘democracies’ in sociotechnical transitions and Discontinuities

This paper focuses on arguably the single most striking contrast in contemporary major energy politics in Europe (and even the developed world as a whole): the starkly differing civil nuclear policies of Germany and the UK. Germany is seeking entirely to phase out nuclear power by 2022. Yet the UK advocates a ‘nuclear renaissance’, promoting the most ambitious new nuclear construction programme in Western Europe.Here,this paper poses a simple yet quite fundamental question: what are the particular divergent conditions most strongly implicated in the contrasting developments in these two countries. With nuclear playing such an iconic role in historical discussions over technological continuity and transformation, answering this may assist in wider understandings of sociotechnical incumbency and discontinuity in the burgeoning field of‘sustainability transitions’. To this end, an ‘abductive’ approach is taken: deploying nine potentially relevant criteria for understanding the different directions pursued in Germany and the UK. Together constituted by 30 parameters spanning literatures related to socio-technical regimes in general as well as nuclear technology in particular, the criteria are divided into those that are ‘internal’ and ‘external’ to the ‘focal regime configuration’ of nuclear power and associated ‘challenger technologies’ like renewables. It is ‘internal’ criteria that are emphasised in conventional sociotechnical regime theory, with ‘external’ criteria relatively less well explored. Asking under each criterion whether attempted discontinuation of nuclear power would be more likely in Germany or the UK, a clear picture emerges. ‘Internal’ criteria suggest attempted nuclear discontinuation should be more likely in the UK than in Germany– the reverse of what is occurring. ‘External’ criteria are more aligned with observed dynamics –especially those relating to military nuclear commitments and broader ‘qualities of democracy’. Despite many differences of framing concerning exactly what constitutes ‘democracy’, a rich political science literature on this point is unanimous in characterising Germany more positively than the UK. Although based only on a single case,a potentially important question is nonetheless raised as to whether sociotechnical regime theory might usefully give greater attention to the general importance of various aspects of democracy in constituting conditions for significant technological discontinuities and transformations. If so, the policy implications are significant. A number of important areas are identified for future research, including the roles of diverse understandings and specific aspects of democracy and the particular relevance of military nuclear commitments– whose under-discussion in civil nuclear policy literatures raises its own questions of democratic accountability

Heavy genealogy: mapping the currents, contraflows and conflicts of the emergent field of metal studies, 1978-2010

What is metal studies? How can we define and characterize it? How has it emerged as a body of academic enquiry? What are its dominant disciplinary strands, theoretical concepts and preferred methodologies? Which studies have claimed most attention, defined the goals of scholarship, typical research strategies and values? How has the claim for the legitimacy or symbolic value of metal scholarship been achieved (if it has): over time and through gradual acceptance or through conflict and contestation? How can this process of formation, or strategy of legitimation, be mapped, examined and interrogated and which methods of historical, institutional and cultural analysis are best suited to this task? Working with the most complete bibliography to date of published research on heavy metal, music and culture (the MSBD), this article employs Foucault’s archaeological “method” to examine the institutional, cultural and political contexts and conflicts that inform the genealogy of this scholarship. Such analysis reveals a formative, largely negative account of heavy metal to be found in the “sociology of rock”; a large volume of psychology work, examining heavy metal music preference as an indicator of youth risk, deviance and delinquency; sociological work on youth and deviancy critical of the values of this research and its links to social policy and politics; culminating in the work of Weinstein and Walser, who advocate a perspective sympathetic to the values of heavy metal fans themselves. Following Bourdieu, I interpret such symbolic strategies as claims for expertise within the academic field that are high or low in symbolic capital to the extent they can attain disciplinary autonomy. I then go on to examine the most recent strands of research, within cultural studies and ethnomusicology, concerned with the global metal music diaspora, and consider to what extent such work is constitutive of a coherent subfield of metal studies that can be distinguished from earlier work and what the implications of this might be