As digital technologies are integrated into medical environments, they continue to transform the experience of contemporary health care. Importantly, medicine is increasingly visual. In the history of sonography, visibility has played an important role in accessing fetal bodies for diagnostic and entertainment purposes. With the advent of three-dimensional rendering, sonography presents the fetus visually as already a child. The aesthetics of this process and the resulting imagery, made possible in digital networks, discloses important changes in the relationship between (...) technology and biology, reproductive health and political debates, and biotechnology and culture. (shrink)

Feminist scholars have long argued that the pregnant body is erased – both literally and discursively – from mainstream foetal representations. Janemaree Maher argues that the placenta, as point of distinction and connection between pregnant women and foetuses, has the radical potential to refigure understandings of pregnant embodiment and subjectivity, and offer ‘a way to begin thinking through the impasse of pregnant representation’. Drawing on Maher's notion of the ‘placental body’, this article will examine the place of the placenta in (...) the practice of non-diagnostic 4D ultrasound scanning. The analysis seeks to connect Maher's theoretical perspective, and the rich feminist literature around foetal imaging, with observational data from my study of 4D scans. I will argue that the capacity of 3- and 4D sonography to image the placenta and umbilical cord in a way that is newly intelligible to lay viewers might present an opportunity for thinking differently about the interconnections – material and social – between pregnant women and foetuses and to relocate women as the subjects of their pregnancies. (shrink)

BackgroundSonographic mesenteric pattern in celiac disease (CD) suggests a hyperdynamic circulation. Despite the well-known CD-related neurological involvement, no study has systematically explored the cerebral hemodynamics to transcranial Doppler sonography.Materials and methodsMontreal Cognitive Assessment (MoCA) and 17-item Hamilton Depression Rating Scale (HDRS) were assessed in 15 newly diagnosed subjects with CD and 15 age-, sex-, and education-matched healthy controls. Cerebral blood flow (CBF) velocities and indices of resistivity (RI) and pulsatility (PI) from the middle cerebral artery (MCA), bilaterally, and the (...) basilar artery (BA) were recorded. We also assessed cerebral vasomotor reactivity (CVR) through the breath-holding test (BHT).ResultsWorse scores of MoCA and HDRS were found in patients compared to controls. Although patients showed higher values of CBF velocity from MCA bilaterally compared to controls, both at rest and after BHT, no comparison reached a statistical significance, whereas after BHT both RI and PI from BA were significantly higher in patients. A significant negative correlation between both indices from BA and MoCA score were also noted.ConclusionThese treatment-naïve CD patients may show some subtle CVR changes in posterior circulation, thus possibly expanding the spectrum of pathomechanisms underlying neuroceliac disease and in particular gluten ataxia. Subclinical identification of cerebrovascular pathology in CD may help adequate prevention and early management of neurological involvement. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sweating the Small StuffTim CunninghamAs an emergency nurse, I often do not notice the small stressors as compared to the loads of intense physical and emotional suffering I witness while working at a level–one–trauma center. The horrendous deaths and injuries caused by gun violence, motorized vehicles, people in emotional distress and those suffering from chronic diseases build up on the mind as a veritable ‘scrapbook of nightmares.’ Emergency providers (...) know, in taking on this profession, that this is ‘all in a day’s work.’ Consequently, we put our selves at risk for emotional burnout as we bear witness to profound suffering while trying to improve lives.I see the traumas, the end–of–life decision making thrust upon families amidst a medical crisis and the other aspects of emergent suffering as bails of hay, against which I tried to build coping mechanisms in order to experience them but also be able to let go. For the most part I am confident to report that I have been able to work through major traumatic situations without belaboring the emotional residue. What I have failed to notice though are not the bails of hay, but individual straws of which they are made.A straw that nearly broke my back came to my pediatric emergency room as a 9–year–old girl who was involved in a low speed motor vehicle collision. She was restrained in the passenger seat; and although she was walking at the scene and crying, she was backboarded by EMS and placed in a cervical spine brace. On arrival to our emergency department she presented with normal vital signs and mutation. Her only complaint was diffuse abdominal pain. We preformed a FAST (Focused Assessment with Sonography for Trauma) exam, which was negative for free abdominal blood. Despite our efforts to make the patient comfortable, we were unable to ease her pain. The patient reported that her pain decreased after we took her off the backboard, but she still did not feel herself.Our attending and resident physicians decided that this child should have an abdominal computed tomography scan (CT) to rule out organ damage with subsequent bleeding. According to hospital protocol, this decision was within our standards of care. I stood by the family when the physician team discussed the plan of care and noticed the parents’ collective body language, which was troubled. I left the room with the physicians but not long after, the family subtly requested that I speak with them.The family was concerned about the radiation to which their child would be exposed. At the same time, they too were concerned about her abdominal pain and understood that a CT could confirm serious abdominal injury. They knew the gravity of the worst–case scenario and wanted to do what was best for their child.The mother asked me if this girl were my child what would I do.My first thought was: No CT, go home, watch her and return if symptoms worsen. My second thought conflicted with the first as I realized this was instruction that fell out of protocol differing from the opinions of the physician team. I paused before responding and found myself sputtering some pointless information about CT scans and mechanisms of injuries sustained from car accidents—I [End Page E9] was filling space, avoiding their question as I pondered the best answer.The girl’s parents told me that one was leaning towards the CT and the other against, they wanted my advice to make a decision. They pressed me saying, “What would you do.” Although I felt an uneasiness and nausea in that moment, I told them my truth, which was that I would go home without the CT.The family appeared relieved and I felt the sensation of stress leaving my body as if I had just taken a deep breath. Contented, but a daughter still with abdominal pain, the family left that evening with specific instructions to watch for adverse symptoms.In that moment, I felt like I had done the right thing but by the end of my shift I left work questioning my choice. I lost sleep that night because of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 2. © 2015 by Feminist Studies, Inc. 335 Rachel Lumsden “The Music Between Us”: Ethel Smyth, Emmeline Pankhurst, and “Possession” But limelight is bad for me: the light in which I work best is twilight. —Virginia Woolf to Ethel Smyth1 There are few composers who seemed to seek the glow of public limelight more than Dame Ethel Smyth (1858–1944). Smyth fearlessly forged a career for (...) herself as a professional composer in Britain during a time when female musicians were largely regarded as inferior to male musicians and lacked equal educational and professional opportunities. Smyth’s brazen personality was evident from her early years; as a teenager, she battled for two years to gain her father’s approval to travel to Leipzig to further her musical studies. Smyth’s struggle for acceptance as a composer continued throughout her career; she composed large-scale works—including six operas—at a time when women were expected to write “feminine,” small-scale compositions (such as solo piano pieces and songs), and she fought unrelentingly to have her music performed. Throughout her career Smyth faced a barrage of sexist criticism, in which she was consistently referred to as a “lady composer” and alternatively praised and derided for writing “masculine” music: if a 1. Virginia Woolf, letter to Ethel Smyth (August 21, 1932), in The Letters of Virginia Woolf, ed. Nigel Nicolson and Joanne Trautmann (New York: Harcourt Brace Jovanovich, 1979), 5: 97. 336 Rachel Lumsden critic liked her work, it would be lauded for its “masculine strength,” and if a critic didn’t like her work, it would be admonished for exceeding the bounds of female propriety.2 Yet Smyth rarely flinched from battles. A defiant and prolific writer, Smyth also published an exhaustive array of books and memoirs: Impressions that Remained (1919), Streaks of Life (1921), A Three-Legged Tour in Greece (1927), A Final Burning of Boats (1928), Female Pipings in Eden (1933), Beecham and Pharaoh (1935), As Time Went On (1936), Inordinate (?) Affection (1936), Maurice Baring (1938), and What Happened Next (1940), using her literary works as a means of bringing her own experiences into the limelight. By chronicling the oppression and discrimination she consistently faced, she sought not only to draw attention to herself as a composer—whose works, in her mind, had been consistently and unjustly neglected by the public—but also to highlight the plight of female musicians in general. Smyth’s literary works are wide-ranging and cover a host of different subjects, including recollections about her own life, biographical portraits of close friends, excerpts from letters, reviews of her musical compositions, and her forthright opinions about women’s rights. A number of scholars have explored these different aspects of Ethel Smyth’s fascinating artistic career; however, most research on Smyth has focused either on her literary endeavors or her compositions. What is missing is a thoroughgoing analysis of the connections between the two. One exception is Elizabeth Wood, who has brilliantly discussed Smyth’s writings and music; however, many details of Smyth’s vast array of musical works still remain largely unexplored.3 This article examines 2. Smyth’s operas include Fantasio (1892–1894), Der Wald (1899–1901), The Wreckers (1902–1904), The Boatswain’s Mate (1913–1914), Fête Galante (1921– 1922), and Entente Cordiale (1923–1924). For more information about Smyth and the status of female musicians in Britain during this era, see Jane A. Bernstein, “‘Shout, Shout, Up with Your Song!’ Dame Ethel Smyth and the Changing Role of the British Woman Composer,” in Women Making Music: The Western Art Tradition, 1150–1950, ed. Jane Bowers and Judith Tick (Urbana: University of Illinois Press, 1986), 304–24; and Eugene Gates, “Damned If You Do and Damned If You Don’t: Sexual Aesthetics and the Music of Dame Ethel Smyth,” Journal of Aesthetic Education 31, no. 1 (Spring 1997): 63–71. 3. See Elizabeth Wood, “Performing Rights: A Sonography of Women’s Suffrage,” The Musical Quarterly 79, no. 4 (Winter 1995): 606–43; and Elizabeth Rachel Lumsden 337 a small, specific slice of Smyth’s oeuvre: her 1913 song “Possession,” dedicated to Emmeline Pankhurst (“E.P”), her friend and leader of... (shrink)

Iris Marion Young’s classic paper on the phenomenology of pregnancy chronicles the alienating tendencies of technology-ridden maternal care, as the mother’s subjective knowledge of the pregnancy gets overridden by the objective knowledge provided by medical personnel and technological apparatuses. Following Fredrik Svenaeus, the authors argue that maternal care is not necessarily alienating by looking specifically at the proper attention paid by sonographers in maternal care when performing ultrasound examinations. Using Martin Heidegger’s philosophy as a theoretical lens, the authors argue that (...) sonographers who cultivate technical mastery, build patient rapport, explain the process and significance of the ultrasound, and understand the patient’s world are able to provide excellent patient care. The authors utilize Hans-Georg Gadamer’s hermeneutics to show how sonographers can frame the ultrasound in a way that acknowledges both the subjective knowledge of the mother and the objective data obtained by the sonographer through the use of technology. Ultimately, the authors argue that the common practice of framing the ultrasound as the chance to “meet the baby” is inappropriate, as it exacerbates the tendency to regard objective knowledge as the only legitimate knowledge in medical contexts. They recommend a more balanced approach that elicits a fusion of horizons between the patient’s subjective knowledge and the objective data that is obtained by the sonographer via the ultrasound, thus respecting and bolstering patient autonomy. (shrink)

Hospital waiting lists are a feature ofpublicly funded health services that resultswhen demand appears to exceed supply. Whilemuch has been written about hospital waitinglists, little is known about the dynamics ofdiagnostic waiting lists, or more generally whyhospital waiting lists behave in perverse andoften counter-intuitive ways. This paperattempts to address this gap by applying arecent development in critical systems thinkingcalled boundary critique to understand how aparticular ultrasound waiting list was managed.A new waiting list metaphor based on waitinglists as ritual forms is (...) proposed. (shrink)