The Role of Modern-Era Echocardiography in Identification of Cardiac Risk Factors for Infective Endocarditis

This chapter provides an updated overview of the scientific literature on cardiac pathology predisposing to infective endocarditis and the estimated risk associated with selected lesion-specific abnormalities, in an era of changing epidemiology and advanced echocardiographic imaging. Importantly, with the evolution of modern-era echo, subtle changes in valve structure and function are now easily detectable and a proportion of cases of apparently ‘normal’ valves involved with IE, may in fact have subtle pre-existing pathological and/or haemodynamic abnormalities. The chapter will have a clinical focus with an aim to provide the Physician with up-to-date and practical information on cardiac risk factor identification for infective endocarditis

Advanced Echocardiography for the Diagnosis and Management of Infective Endocarditis

Echocardiography is fundamental for the management of infective endocarditis (IE) across all stages of the illness including diagnosis, surveillance during medical therapy, identification of prognostic markers, planning perioperative intervention, postoperative assessment, and follow-up after completion of definitive therapy. Modern era echocardiography (echo) offers outstanding temporal and spatial image resolution, providing the opportunity for early diagnosis of this life-threatening infection. Emerging imaging modalities, such as real-time three-dimensional (3D) echocardiography, offer a novel way of readily visualizing the extent of intracardiac infection and the relationship of pathology to adjacent cardiac structures, well before surgical intervention, without radiation exposure or significant risk to the patient. Echocardiography can have a positive impact on the management of every stage of this disease, with the opportunity to improve outcomes

Family-inclusive practice in a psychiatric intensive care unit

Aims and Method: The National Institute for Health and Care Excellence recommends involving the families of patients admitted to psychiatric hospital care, without specific guidance on how to do it. To improve family involvement in a National Health Service psychiatric intensive care unit, a relatives’ and carers’ clinic was set up. Fifty family members attended and completed questionnaires. Nine went on to take part in interviews, the results of which were analysed using thematic analysis. Results: Families felt more informed and found the increased access to information useful. They felt that the process showed respect for them and their family member, and that their contribution was valued. Running throughout the interviews was the contrast with previous experiences; families reported feeling heard and understood and attributed this in part to timing and environment. Clinical implications: The clinic was viewed positively by families and met the trust’s commitment to including carers, as well as national guidance which suggests it should be part of routine practice

Fitting high-energy Littlest Seesaw parameters using low-energy neutrino data and leptogenesis

We show that the four high-energy Littlest Seesaw parameters in the flavour basis,namely two real Yukawa couplings plus the two right-handed neutrino masses, can be determined by an excellent fit to the seven currently constrained observables of low-energy neutrino data and leptogenesis. Taking into account renormalisation group corrections, we estimate $\chi^2 \simeq 1.5-2.6$ for the three d.o.f., depending on the high-energy scale and the type of non supersymmetric Littlest Seesaw model. We extract allowed ranges of neutrino parameters from our fit data, including the approximate mu-tau symmetric predictions $\theta_{23}=45^o\pm 1^o$ and $\delta = -90^o \pm 5^o$, which, together with a normal mass ordering with $m_1=0$, will enable Littlest Seesaw models to be tested in future neutrino experiments.Comment: Typos corrected, references added. 25 pages, 20 figure

Theory and simulation of gelation, arrest and yielding in attracting colloids

We present some recent theory and simulation results addressing the phenomena of colloidal gelation at both high and low volume fractions, in the presence of short-range attractive interactions. We discuss the ability of mode-coupling theory and its adaptations to address situations with strong heterogeneity in density and/or dynamics. We include a discussion of the effect of attractions on the shear-thinning and yield behaviour under flow.Comment: 17 pages, 6 figure

Psychopolitics: Peter Sedgwick’s legacy for mental health movements

This paper re-considers the relevance of Peter Sedgwick's Psychopolitics (1982) for a politics of mental health. Psychopolitics offered an indictment of ‘anti-psychiatry’ the failure of which, Sedgwick argued, lay in its deconstruction of the category of ‘mental illness’, a gesture that resulted in a politics of nihilism. ‘The radical who is only a radical nihilist’, Sedgwick observed, ‘is for all practical purposes the most adamant of conservatives’. Sedgwick argued, rather, that the concept of ‘mental illness’ could be a truly critical concept if it was deployed ‘to make demands upon the health service facilities of the society in which we live’. The paper contextualizes Psychopolitics within the ‘crisis tendencies’ of its time, surveying the shifting welfare landscape of the subsequent 25 years alongside Sedgwick's continuing relevance. It considers the dilemma that the discourse of ‘mental illness’ – Sedgwick's critical concept – has fallen out of favour with radical mental health movements yet remains paradigmatic within psychiatry itself. Finally, the paper endorses a contemporary perspective that, while necessarily updating Psychopolitics, remains nonetheless ‘Sedgwickian’

The politics of in/visibility: carving out queer space in Ul'yanovsk

<p>In spite of a growing interest within sexualities studies in the concept of queer space (Oswin 2008), existing literature focuses almost exclusively on its most visible and territorialised forms, such as the gay scene, thus privileging Western metropolitan areas as hubs of queer consumer culture (Binnie 2004). While the literature has emphasised the political significance of queer space as a site of resistance to hegemonic gender and sexual norms, it has again predominantly focused on overt claims to public space embodied in Pride events, neglecting other less open forms of resistance.</p><p> This article contributes new insights to current debates about the construction and meaning of queer space by considering how city space is appropriated by an informal queer network in Ul’ianovsk. The group routinely occupied very public locations meeting and socialising on the street or in mainstream cafés in central Ul’ianovsk, although claims to these spaces as queer were mostly contingent, precarious or invisible to outsiders. The article considers how provincial location affects tactics used to carve out communal space, foregrounding the importance of local context and collective agency in shaping specific forms of resistance, and questioning ethnocentric assumptions about the empowering potential of visibility.</p&gt

Early clinical and laboratory risk factors of intensive care unit requirement during 2004–2008 dengue epidemics in Singapore: a matched case–control study

Background: Dengue infection can result in severe clinical manifestations requiring intensive care. Effective triage is critical for early clinical management to reduce morbidity and mortality. However, there is limited knowledge on early risk factors of intensive care unit (ICU) requirement. This study aims to identify early clinical and laboratory risk factors of ICU requirement at first presentation in hospital and 24 hours prior to ICU requirement. Method: A retrospective 1:4 matched case–control study was performed with 27 dengue patients who required ICU, and 108 dengue patients who did not require ICU from year 2004–2008, matched by year of dengue presentation. Univariate and multivariate conditional logistic regression were performed. Optimal predictive models were generated with statistically significant risk factors identified using stepwise forward and backward elimination method. Results: ICU dengue patients were significantly older (P=0.003) and had diabetes (P=0.031), compared with non-ICU dengue patients. There were seven deaths among ICU patients at median seven days post fever. At first presentation, the WHO 2009 classification of dengue severity was significantly associated (P<0.001) with ICU, but not the WHO 1997 classification. Early clinical risk factors at presentation associated with ICU requirement were hematocrit change ≥20% concurrent with platelet <50 K [95% confidence-interval (CI)=2.46-30.53], hypoproteinemia (95% CI=1.09-19.74), hypotension (95% CI=1.83-31.79) and severe organ involvement (95% CI=3.30-331). Early laboratory risk factors at presentation were neutrophil proportion (95% CI=1.04-1.17), serum urea (95% CI=1.02-1.56) and alanine aminotransferase level (95% CI=1.001-1.06). This predictive model has sensitivity and specificity up to 88%. Early laboratory risk factors at 24 hours prior to ICU were lymphocyte (95% CI=1.03-1.38) and monocyte proportions (95% CI=1.02-1.78), pulse rate (95% CI=1.002-1.14) and blood pressure (95% CI=0.92-0.996). This predictive model has sensitivity and specificity up to 88.9% and 78%, respectively. Conclusions: This is the first matched case–control study, to our best knowledge, that identified early clinical and laboratory risk factors of ICU requirement during hospitalization. These factors suggested differential pathophysiological background of dengue patients as early as first presentation prior to ICU requirement, which may reflect the pathogenesis of dengue severity. These risk models may facilitate clinicians in triage of patients, after validating in larger independent studies.Published versio