Bare Arms Research Articles

Hypoechoic Halo Imaging Findings Following Femoropopliteal Artery Stent Implantation: Risk Factors and Clinical Outcomes

BackgroundHypoechoic peri-stent areas in duplex ultrasonography (DUS) (ie, “halo”) have been noted following femoropopliteal artery stenting. ObjectivesThis study sought to investigate the prevalence, risk factors, and potential safety implications of hypoechoic halos identified with DUS following stent implantation in the IMPERIAL (ELUVIA Drug-Eluting Stent Versus Zilver PTX Stent) and EMINENT (Trial Comparing ELUVIA Versus Bare Metal Stent in Treatment of Superficial Femoral and/or Proximal Popliteal Artery) trials. MethodsThe IMPERIAL and EMINENT studies of femoropopliteal artery stenting included polymer-based drug-eluting stent, nonpolymer drug-coated stent, and bare metal stent treatment arms. A dedicated DUS protocol was implemented for core laboratory assessment of halo presence at study follow-up visits. Logistic regressions were used to investigate risk factors for a halo sign and its impact on clinically driven target lesion revascularization and primary patency. ResultsDiagnostic DUS imaging from 659 patients was obtained at time points ranging from 6 months to 5 years post–stent implantation. Halo prevalence ranged from 20% to 35% of patients with diagnostic DUS and was present at all time intervals. Halos were identified surrounding all stent types. In analyses of patients with diagnostic imaging from at least 2 visits, halo presence typically persisted, with occasional cases of regression and development at later times. No statistically significant association was found for halo status (ie, halo vs no halo) on 1-year clinically driven target lesion revascularization (OR: 1.27; 95% CI: 0.70-2.30; P = 0.4240) or primary patency (OR: 0.68; 95% CI: 0.43-1.07; P = 0.0927). ConclusionsA hypoechoic halo following a femoropopliteal stent procedure is a common occurrence associated with all studied stent types. The presence of a halo appears to be benign with no associated clinical sequelae or effect on target vessel revascularization rates within 1 year of stent implantation.

Comparison of blood pressure measurements on the bare and sleeved arms - what does it uncover?

Accurate office blood pressure (BP) measurement remains crucial in diagnosing and managing hypertension. In this study, we aimed to compare BP measurements done over a bare arm versus a sleeved arm, while controlling all other possible sources of variance. We collected BP measurements of 100 hypertensive patients visiting a nephrology and hypertension clinic between January 2019 and December 2023. Measurements were taken by a single operator and according to the updated guidelines. BP measurements were performed first with one arm bare, and the other arm sleeved, with measurements taken simultaneously. Then, measurements were again taken simultaneously after exposing the arm which was first sleeved, and dressing the arm which was bare at first. A nonparametric Wilcoxon test was performed to compare each patient's measurements on each arm. No statistically significant differences were found between the sleeved and the bare arm measurements, with one exception of SBP measured on the left arm (slightly lower SBP on the bare arm). While looking at the absolute value of differences, the median difference was impressive with a 7-8 mmHg systolic difference and 5.5 mmHg diastolic difference. Our study revealed a robust and unpredicted effect of clothing on BP; in some patients, BP was increased while in others decreased. Therefore, we believe there is importance in measuring BP on bare skin, regardless of clothing or sleeve type.

COMPARISON OF BLOOD PRESSURE MEASUREMENTS ON THE BARE ARM AND THE SLEEVED ARM - WHAT DOES IT COVER?

Objective: The question of blood pressure measuring on the bare arm was debated for many years. The updated guidelines recommend measuring on the bare arm, although former studies found no significant differences between measurements taken over a rolled-down or up sleeve compared to the bare arm. We aim to compare blood pressure measurements on the same patients over a bare and a sleeved arm. Design and method: We collected blood pressure measurements of 100 patients visiting the nephrology clinic between January 2019 and December 2022. Measurements were performed with and without sleeves on each arm for each patient (total of 400 arms) and taken simultaneously on both arms (exchanging the bare and the sleeved arm in the second measurement). Since most variables were not normally distributed, we proceeded to a non-parametric Wilcoxon test to compare each patient's measurements on each arm. Results: No statistically significant differences were found between the sleeved and the bare arm measurements, with one exception of systolic blood pressure measured on the left arm (p = 0.041). Although the actual values demonstrated no statistically significant difference, the absolute values of the differences demonstrated clinically significant higher median values on the sleeved arms, both in systolic blood pressure (7 mmHg on the right arm and 8 mmHg on the left arm) and diastolic blood pressure (5.5 mmHg for both arms). As demonstrated by the wide interquartile ranges in table 1 and seen in figure 1 for all variables, the values of all variables had high variance. Conclusions: We found no statistically significant difference in blood pressure measurements between sleeved and bare arms. However, measurement of blood pressure over sleeved arms provided unpredictable results, with up to 40-50 mmHg differences in some individuals. As clinicians, we believe that in order to standardize blood pressure measurements we should measure blood pressure on the bare arms.

Parliamentary Dress

Parliamentary Dress

We Have All Been Through a Lot: Use of Vulnerability and Self as a Healing Bridge.

Back to table of contents Previous article Next article Personal AccountsFull AccessWe Have All Been Through a Lot: Use of Vulnerability and Self as a Healing BridgeDiane Roston, M.D.Diane RostonSearch for more papers by this author, M.D.Published Online:13 Oct 2022https://doi.org/10.1176/appi.ps.20220431AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail “Doc, did you ever ride?” Dan asked as I walked him into my office where he had been my psychiatric patient for several years.The question caught me off guard. I usually keep my personal life outside of my office door. I noticed that he was holding something in his hand and said, “Tell me about what you brought with you today.”Dan gripped a small framed photograph between his working-man’s hands. “This is the bike I’ve been telling you about. That color isn’t pink,” he said, pointing to the front fender. “It’s fuchsia. See how fine that trim looks? It’s not pink, I’m sure of that. My dad wouldn’t have rode a pink bike. This bike is the reason I stay alive.”My late husband and I had ridden a motorcycle together once many years ago—before we were married, before my husband became severely depressed, before he gave up. What was the reason I stayed alive after my husband went into the woods with a shotgun and never came out?Over the past year, Dan had pulled through a serious episode of depression that included thoughts of suicide. There had been appointments after which I feared that Dan would not live to meet with me again.Dan continued. “When I grew up, my dad and me got real close. We rode bikes together. Got tight. When he hit 50 and got too sick to ride, I’d ride by his place on my motorcycle and stop on the porch for a beer. One day, he got serious on me. I followed him into his trailer and sat down across from him at the small table. ‘I’m not getting better,’ he told me. ‘You’ve got two choices: you can keep my bike, or you can sell it and keep the cash. That’s what you have to choose.’”Dan pointed to the photograph. “I couldn’t get rid of my dad’s Harley. It was his pride and joy.”“Nice bike.” I pointed at the lanky man with the ponytail wearing jeans and an unbuttoned shirt posing in front of the bike. “That’s your dad?”“Yes. That’s my father.” He held the photograph out from his chest and looked at it with reverence. “So when I get to thinking it’s not worth living, I look here”—he pointed to the motorcycle—“and then I have to stay alive. For my dad. I have to take care of my dad’s Harley.”I had been relieved in recent appointments to hear Dan talk about how he had replaced some of the motorcycle parts with original parts so that in the future—it was reassuring that he was planning for the future—he could restore his father’s motorcycle to its original form.As I looked at the picture, I was taken back to that ride on a June day many years ago. I remember feeling the sun warm my bare arms and holding my husband as if I would never let go of him.For a time after he died, I did not let go. I left his sandals on the mudroom floor, his reading glasses by his side of the bed, and his coveralls on the nail in his wood shop, and I waited for him to return. For months, I waited.Slowly, I learned to let go of that wish and to hold on to the love. I let go of the sandals and reading glasses and left the coveralls on the nail to remind myself of the many hours he spent building shelves for all our books.Slowly, the full force of the memory of that ride returned. How much we loved! What joy we shared! For that joy, I stayed alive. For this memory, I was grateful.Dan pulled off his cap, stroked his shaved head, and repositioned the cap just so. Again he asked, “You ever ride?”Sometimes self-disclosure feels right. At that moment, I felt that sharing something about my own experience would deepen our human connection. We had both been through a lot. “Yes,” I said. “I rode once. On the back of a motorcycle, actually. Holding tight to someone I loved. That ride took my breath away.”“That’s good, Doc. Then you know what I mean. You know just what I mean.”I smiled. Yes, I knew.Send correspondence to Dr. Roston ([email protected]). Patricia E. Deegan, Ph.D., and William C. Torrey, M.D., are editors of this column. FiguresReferencesCited byDetailsCited byNone Volume 74Issue 3 March 01, 2023Pages 324-324 Metrics KeywordsAdministration & managementPsychiatry/generalPDF download History Published online 13 October 2022 Published in print 1 March 2023

Clinical Issues-August 2022.

Use of sterile vests Key words: sterile technique, surgical attire, gown, contaminated, back. Bare arms for unscrubbed personnel Key words: long sleeves, cover jacket, disposable jacket, patient skin antisepsis, surgical site infection (SSI). Preventing thermal injury from electrosurgical devices Key words: electrosurgical unit (ESU), monopolar electrosurgical device, electrode, alternate site thermal injury, burn. Preoperative site marking for minimally invasive procedures Key words: surgical site, wrong-site surgery, alternative site marking, point of access, preprocedure verification.

St. Francis, and: Arctic Palimpsest, and: Nocturne at Midnight

St. Francis, and: Arctic Palimpsest, and: Nocturne at Midnight Mary Lee (bio) In my dreams, St. Francisspeaks in the field of me, and his sparrows gather nearto listen. St. Francis of pain’s unfadingcenter, what brightly hums as a thrummed pulse of bees,I know how it turns a mouth silent. Muted,the mouth’s O most adjacent to the blottediris-ring found on poppies. The aperture of lack’s taste,language made inadequate. Is it true that there is a soundto speech leaving you. To be still and knowthe morning with its choir of trees alive in me, hiddenbetween grasses, lilies, wordless stones in the passingof hours as somewhere I can hear the face of the impossible moonfalling clear over pools of water. [End Page 37] Arctic Palimpsest When God painted my doe face,he must have added a dab of rougeand a streak of oblivion. How could Ihave known the exact shape of my lifeobscured by leaves, capable as any eye’s flicker?In the forest, I was another absence—a doe wanting to turn real in the shade,always a little lost in the landscape.My breath left no consequence in the air.Despair was the larger animal I couldn’t see,readying awake while I remained sleeping.And when despair, the animal, rearedits restless head—a remnant of its kisslike a thorn lodged into the side of my flesh.Then I saw what seemed like the wrist of God,his back retreating into the shadows,and briefly, the light was a stillness in medrawn over the face of the world. ________ In the mind of a doe, more and more snow.Across endless snow, a mind blank to fill.Sometimes it beckons and withoutquestion I follow its uncertain forms—like the footprints of a doe leading me furtherand further out across snow until I am the snow.Or were the footprints my own? Was I the doewith a mind sewn closed by the cold,unable to see the cold as separatefrom myself? Sometimes in the privacyof my own sadness I feel like a thing hunted.Sometimes when I imagine the sadness,I think the sadness imagines me. [End Page 38] ________ The deer are braver in the cold than youcould ever be, their hooves kissing the whitelandscape in a lattice. Alreadythe fresh snow comes to fill those markswhere their weight pressed in. You can imaginetheir deer lungs calming as they watch the sundisappear inside the growing dark,their heads nodding awake at dawn,ears twitching as the hares stiramong the nearby grasses. Some of the deer,startled, bound past the trees,their glassy eyes quivering,traces of a dream. And the ones fallen over,sides opened and ears splayedon the ground, their blood spilling outas they listen to ice expanding below,loud cracks echoing like the soundof a troop of whales coming to save them—Their breath hangs there for a while.You can almost see it there still. [End Page 39] Nocturne at Midnight Maybe a stone had pierced the glass, a boy’s stoneof hatred or love puncturing the window in an ordinary arc—Or maybe the sharp end of a nearby branchhad been driven into the glass during a storm,fractures spreading out like veinsaround the point where it struck. Whatever it wasmade no difference. There was the windowwith a hole the size of her eye that might fit a key,a small opening for her to peer through, to see,on the other side, the yard’s lengthening shadows.Only night, that dark pitch of wine, like some brutalsweetness filling one’s animal mouth in a thicketof blackberries. As if, in the middle of the night, too muchpours into the mind, assembles as a nocturne of starlings—But there was light, wasn’t there? There was a candleheld up against the panes, and her mind to transformthe overwhelm of night. To imagine night blossomingalong the bare arms of trees that could...

Reuse of Disposable Isolation Gowns in Rodent Facilities during a Pandemic.

Reuse of disposable personal protective equipment is traditionally discouraged, yet in times of heightened medical applications such as the SARS CoV-2 pandemic, it can be difficult to obtain. In this article we examine the reuse of disposable gowns with respect to still providing personnel protection. XR7, a fluorescent powder, was used to track contamination of gowns after manipulation of rodent cages. Mouse cages were treated with XR7 prior to manipulations. Disposable gowns were labeled for single person use and hung in common procedure spaces within the vivarium between usages. A simulated rack change of 140 cages was completed using XR7-treated cages. One individual changed all cages with a break occurring after the first 70 cages, requiring the gown to be removed and reused once. To simulate research activities, 5 individuals accessed 3 XR7-treated cages daily for 5 d. Each mouse in the XR7-treated cages was manipulated at least once before returning cages to the housing room. Disposable gowns were reused 5 times per individual. Gowns, gloves, clothing, bare arms, and hands were scanned for fluorescence before and after removing PPE. Fluorescence was localized to gloves and gown sleeves in closest contact with animals and caging. No fluorescence was detected on underlying clothing, or bare arms and hands after removing PPE. Fluorescence was not detected in procedure spaces where gowns were hung. The lack of fluorescence on personnel or surfaces indicate that gowns can be reused 1 time for routine husbandry tasks and up to 5 times for research personnel. A method for decontamination of used gowns using Vaporized Hydrogen Peroxide (VHP) was also validated for use in areas where animals are considered high risk such as quarantine, or for fragile immunocompromised rodent colonies.

1430. Novel Transmission of Burkholderia pseudomallei from a Freshwater Aquarium to a Human — Maryland, 2019

BackgroundNearly all U.S. cases of melioidosis, a potentially fatal disease caused by Burkholderia pseudomallei, are associated with travel to endemic areas. In September 2019, a patient in Maryland with no international travel history developed melioidosis and whole genome sequencing (WGS) of the patient’s clinical isolate showed it clustered most closely with isolates from Southeast Asia. CDC and Maryland Department of Health (MDH) investigated possible sources of B. pseudomallei exposure to identify the source and route of transmission and evaluate risk to others.MethodsMDH interviewed the patient and household members during October–December 2019. In consultation with CDC, MDH conducted environmental sampling of the patient’s home including drains, faucets, potted and ground soil, imported products, and two freshwater aquariums. Samples were tested for B. pseudomallei at CDC by PCR and culture. B. pseudomallei isolates underwent WGS and were analyzed along with a reference panel of geographically diverse, publicly available genomes.ResultsThree environmental samples, all from aquarium #2, were positive for B. pseudomallei. These isolates matched the patient’s clinical isolate by WGS, suggesting the aquarium was the source of exposure. According to interviews, the patient set up both aquariums in July 2019 and all the fish in aquarium #2 died in August 2019. The patient recalled reaching her bare hands and arms into the aquarium in August 2019, one month prior to illness onset.ConclusionThis investigation led to the first documentation of transmission of B. pseudomallei from a freshwater aquarium to a human. Many freshwater ornamental fish are imported from Southeast Asia, so this newly recognized transmission route may have significant implications for the freshwater aquatics trade. Further investigations are underway at the retail location that sold the fish and the commercial vendors that supplied the freshwater animals and plants imported from Southeast Asia.Disclosures All Authors: No reported disclosures

What’s that stuff? Hair removers

It’s almost summer in the Northern Hemisphere. Temperatures are rising, swimming pools are opening, and bare arms and legs are emerging from winter clothing. For some people, the start of shorts-and-swimsuit season means it’s time to get rid of body hair. These sunseekers have an array of techniques to turn to: hair removal creams, waxing and sugaring, lasers, and even a good ol’ pair of tweezers. Knowing how the various options work might help you decide which one to use. Getting rid of body hair is a billion-dollar industry and growing worldwide. But depilatories are nothing new. Evidence indicates that prehistoric cultures used stones and shark teeth as crude razors. Some ancient Egyptians removed hair with tweezers, razors, and pumice stones and ripped it out with wax or sugar pastes, leaving behind only their eyebrows. Chemical removers have ancient roots too. People living 6,000 to 7,000 years ago in what

Blood pressure measurements over thin and thick sleeves in the frail elderly.

Blood pressure (BP) measurement is recommended on bare arms, but undressing the arms for BP measurements is often difficult for frail elderly individuals. We aimed to assess the accuracy of BP measurements over arms with thin and thick clothing among the frail elderly. This is a cross-sectional study. Individuals aged 65 years or older were recruited from three long-term care facilities in Japan between April and May 2016. The main outcome measures were BP measurements (a) on a bare arm, (b) over a thin shirt, (c) over a thin shirt and a cardigan, and (d) over the sleeve of a thin shirt and a cardigan rolled up to the elbow. BP was compared across measurements using the paired t-test and multiple analysis of variance adjusting for sex and treatments for hypertension. Of 147 participants, 23.8% were men. The mean age of the participants was 87.2 years (SD: 7.8). The mean (SD) BP on a bare arm, over a shirt, over a shirt and a cardigan, and over a rolled-up sleeve were 128.8 (20.0)/69.3 (13.2), 131.0 (22.2)/73.9 (15.2), 136.9 (22.2)/78.9 (15.8), and 136.4 (26.0)/80.7 (15.9) mmHg, respectively. BP measurements over clothed arms were significantly higher than bare arm measurements. BP differences were significant when measured over a cardigan after adjusting for sex and treatments for hypertension. In the elderly, clothing has a significant effect on BP measurements. The arms should be undressed as much as possible for BP measurements in the elderly.

Effect of garment on the arm under the auscultatory manometer cuff among primigravidae

Context: Although Perinatal guidelines recommend blood pressure (BP) should be measured on bare arms among pregnant women, BP is measured over garments in primary health care settings among prenatal women. Aim: To identify the discrepancies in BP measurements with garments under the manometer cuff versus bare arm among normotensive primigravidae. Setting and Design: An exploratory study was conducted among n = 95 normal low risk normotensive primigravidae at mid trimester attending antenatal clinic at rural PHC. Materials and Methods: With the auscultatory sphygmomanometer, BP were measured thrice with garments versus bare arms to rule out differences. Results were compared with Paired t-test and SPSS version 20 was used for analysis. Results: There were insignificant differences in mean systolic BP and diastolic BP between the garments covered versus bare arm. The mean garments thickness was less than 5 mm and it was not a significant predictor for mean differences of BP in garments vs bare on arm. Conclusions: Measuring blood pressure on arms with garments violates long-established perinatal guidelines and the decision to measure accurate BP with sleeves on among pregnant women depends on the discretion of the clients and the professionals.

Wearing long sleeves while prepping a patient in the operating room decreases airborne contaminants

The use of long sleeves by nonscrubbed personnel in the operating room has been called into question. We hypothesized that wearing long sleeves and gloves, compared with having bare arms without gloves, while applying the skin preparation solution would decrease particulate and microbial contamination. A mock patient skin prep was performed in 3 different operating rooms. A long-sleeved gown and gloves, or bare arms, were used to perform the procedure. Particle counters were used to assess airborne particulate contamination, and active and passive microbial assessment was achieved through air samplers and settle plate analysis. Data were compared with Student's t-test or Mann-Whitney U, and P < .05 was considered to be significant. Operating room B demonstrated decreased 5.0- µm particle sizes with the use of sleeves, while operating rooms A and C showed decreased total microbes only with the use of sleeves. Despite there being no difference in the average number of total microbes for all operating rooms assessed, the use of sleeves specifically appeared to decrease the shed of Micrococcus. The use of long sleeves and gloves while applying the skin preparation solution decreased particulate and microbial shedding in several of the operating rooms tested. Although long sleeves may not be necessary for all operating room personnel, they may decrease airborne contamination while the skin prep is applied, which may lead to decreased surgical site infections.

RECORDINGS IN REVIEW

1 9 2 Y R E C O R D I N G S I N R E V I E W J A Y N O R D L I N G E R At any moment, there is a crop of young pianists, eager to show what they have. And as we get older, I think, our concept of ‘‘young’’ slides upward. Yuja Wang was born in 1987 and is therefore still in the under-thirty category. She has recorded the Ravel piano concertos with the Tonhalle Orchestra of Zurich, led by its chief conductor, Lionel Bringuier (Deutsche Grammophon B0023931-02). Bringuier is a touch older than Wang, born in 1986. I first reviewed him in 2007, when he was twenty. I wrote, ‘‘It’s always risky to say that someone, in any field, is can’t-miss, but it’s not so risky in this case.’’ It was not. The two Ravel piano concertos are the one in G major, for your standard two hands, and the one in D major, for the left hand alone. They are obviously a familiar pairing. But on LPs and CDs, they have often needed a filler, usually an additional French piece. When Alicia de Larrocha recorded the concertos in the mid-1970s, she added Fauré’s Fantasy in G for piano and orchestra. Wang, too, adds Fauré, but not the Fantasy and not a piano and orchestra piece at all: she plays the Ballade in F-sharp major. It so happens that Fauré made a piano and orchestra version of this piece, but Wang elects to go solo. 1 9 3 R Leaving Fauré aside for a moment, Wang is virtually made for Ravel. Among her qualities are nimbleness, clarity, agility, and color. Much of what she plays sounds like Ravel, or Debussy, even when it shouldn’t: the Liszt Sonata, for example. She seldom makes a fat, lush sound, going deep into the keys. But that is seldom called for in Ravel or Debussy. On her new CD, she begins with the G-major concerto, to which she imparts a nice sense of jazz. This reminds me that she is quite good in the big Gershwin pieces: Rhapsody in Blue and the Concerto in F. In Ravel’s middle movement, she is wisely matter-of-fact, or straightforward. And from both her and the orchestra, the music builds beautifully and excitingly. This movement ends with a famous long trill. I like it slower and sultrier than Wang plays it, but she is entitled to her choice. And the last movement, a kind of toccata, Wang hammers elegantly, just as Ravel wants. Again, she is virtually made for this music. She next turns to the Fauré Ballade, which she plays competently , needless to say. But one can imagine more seamlessness or fluidity in it. At the same time, the piece expresses its uncomplicated charm. Wang ends her CD with the left-hand concerto, in which she is superb. Bringuier and the Tonhalle Orchestra do their part, too. The concerto has what it needs, including beauty, bite, sensuality, glitter, blues, a sense of architecture – and, from the soloist, staggering virtuosity. By the way, I had a thought when I was a kid: Do pianists cheat when they record the left-hand concerto in a studio? That is, do they bring the right hand in, when two hands would be an advantage? Who would know? The conductor , orchestra, and engineers would, so I imagine the pianist’s pride and vanity would prevent cheating. In any field, there are people who are special targets of envy and resentment. Yuja Wang is one such target, and we might guess at the reasons: she is young and indecently talented; she enjoys tremendous PR and fame; and on the stage she tends to dress as skimpily as possible. Her latest CD cover is comparatively tame, but it does allow for bare arms and midri√. Lang Lang is a target of envy and resentment too. This pianist, like Yuja Wang, was born in China, though five years earlier: in 1982. He too is young, indecently talented, and famous, and though he does not dress provocatively, he has...

Should blood pressure be measured with the cuff on a bare arm?

To establish whether the results of blood pressure (BP) measurements are affected by wearing clothing underneath the BP cuff during measurement. Normotensive and hypertensive patients (n=133; 65 men) of an outpatient clinic participated in this study. BP was measured according to a rigorous protocol with a validated oscillometric device under three conditions: with one layer of own clothing (OC) underneath the cuff, with one layer of standardized clothing (SC) underneath the cuff, and with the cuff on a bare arm (BA), in a randomized order. Patients were seated on a chair with their right arm on the table and their feet flat on the floor during BP measurement. The mean BP values (±SEM) measured during BA, OC, and SC were, respectively, 132.8±1.3, 132.3±1.4, and 133.2±1.4 mmHg for systolic blood pressure (SBP), 78.3±0.9, 78.3±0.9, and 78.5±0.9 mmHg for diastolic blood pressure (DBP), and 90.3±1.0, 90.0±1.0, and 91.5±1.0 mmHg for mean arterial blood pressure (MAP). The differences in SBP, DBP, and MAP between BA, OC, and SC measurements were not statistically significant, but there was considerable intraindividual variation in SBP deviations of more than 5 mmHg between BA versus OC and SC. There was no significant order effect of the three conditions. The absence of differences between BA, OC, and SC was not determined by age, sex, BMI, and arm circumference. We could not find differences in MAP, SBP, and DBP between the bare and clothed arms, but intraindividual variation of SBP between the three conditions is not negligible. Despite this caveat, these data suggest that in an outpatient clinic, BP can be measured reliably with one layer of clothing underneath the cuff. This is timesaving and more comfortable for patients.

Demonstrating Peace Countertopographically: Women in Black’s Solidarity at a Distance

Demonstrating Peace Countertopographically:Women in Black’s Solidarity at a Distance Elizabeth Currans (bio) Just before 5:30 p.m. on a sunny Wednesday afternoon, five women gathered outside the central Manhattan Public Library where Forty-First Street meets Fifth Avenue. All wore black, some head to toe, some with bare shoulders and arms. They formed a silent line facing rush hour pedestrian and automobile traffic holding a large black banner reading, “Women in Black Against War.” At one edge of the small group a woman handed fliers to passersby. The first lines of the handout asserted, “Women in Black New York stand in silent vigil to protest war, rape as a tool of war, ethnic cleansing and human rights abuses all over the world. We are silent because mere words cannot express the tragedy that wars and hatred bring. We refuse to add to the cacophony of empty statements that are spoken with the best intentions yet may be erased or go unheard under the sound of a passing ambulance or a bomb exploding nearby.” Over the course of an hour a few more women joined the group. At one point the group numbered eight—all participants over thirty, most over fifty, and all white save for one Black woman appearing to be in her fifties. Most onlookers were also silent. Some took fliers. Others nodded in agreement. Many kept walking, some giving the silent women a quick glimpse. One younger woman en route to somewhere else spontaneously stopped and stood for a few minutes. Passengers on commuter buses observed the vigil from the comfort of air-conditioned seats. A few people verbally asserted their support. Still fewer made disparaging comments. This small group transformed a tiny section of concrete in Manhattan’s vast urban landscape into a site for quiet contemplation in the midst of [End Page 103] late afternoon busyness. Their attire marked them as separate from locals in business suits and fashionable black, and tourists in summer tank tops and shorts. Together, their silence, immobility, and monotonic black outfits, along with the seriousness of their demeanor, lent a ritualistic tone to their presence. Despite the surrounding bustle, they stood, rupturing the ordinary chaos around them and demonstrating solidarity with people far away. From a wealthy city in a prosperous and militarily aggressive nation, they silently used their gazes and bodies to evoke faraway events and refuse complicity with war-making. By reworking the silence expected of them as women in a male-dominated society, they sought to transform socially prescribed passivity into an active refusal to support or engage in violence. I approach this Women in Black (hereafter WiB) vigil, and another I discuss below, from a feminist perspective that emphasizes the transgressive potential of public disidentification, in José Esteban Muñoz’s sense of the term, with patriarchal expectations of women. For Muñoz, disidentification inhabits something differently, in ways that maximize the potential for reworking toxic ideals, such as those that see politics as masculine and women as passive supporters of war-making (Muñoz 1999). WiB’s strategic deployment of silence demonstrates their astute analysis of gendered spatial conventions and their awareness of the limits of loud, often angry chanting to demonstrate a political position. Given the gravity of the situations they vigil to remember and contest, these public enactments are necessarily limited; nonetheless their limitations do not obliterate their possibility for intervention. On the contrary, their public performance of their solidaristic feelings demonstrates the shared humanity of participants and those suffering and dying during war and occupation. Using theoretical approaches to solidarity from Sandra Lee Bartky, Jodi Dean, Carol Gould, and Chandra Mohanty, this essay explores how WiB groups in the United States and United Kingdom express, in Barkty’s terms, their “feeling-with” others, especially other women, experiencing war and occupation. In exploring one type of feeling-with, Bartky explains that “emotional infection as a builder of solidarity is promiscuous; its utility rests precisely in its capacity to unite feeling persons from a very wide spectrum of social locations” (2002, 76). While her focus is on mass gatherings, including demonstrations, emotional infection can stem from a variety of sources, including watching...

Simulated Transfer of Liquids and Powders from Hands and Clothing to the Mouth

A series of laboratory experiments was carried out to assess transfer of liquids (vinegar) and powders (calcium acetate and magnesium carbonate) from hands, arms, gloves, respirators, clothing, and pens to the oral cavity or the perioral area (the area surrounding the mouth). Experiments were carried out with four volunteers. The donor area (the hands, arms, gloves, and so on) was loaded with a known mass of the test substance and was then brought into contact the receiver area (the oral cavity or the perioral area). The percentage of the substance on the donor that transferred to the receiver (the transfer efficiency or TE) was assessed using saliva samples and gauze wipes of the perioral area. Magnesium carbonate was measured on gauze and in saliva using inductively coupled plasma/atomic emission spectrometry. Calcium acetate and vinegar were measured using ion chromatography/electrochemical detection. Average transfer efficiencies were calculated for each substance and transfer scenario; these were compared using ANOVA and Kruskal-Wallis tests. Overall, direct transfer from the hands to the oral cavity was significantly higher (mean TE = 51.6) than indirect transfer from the hands to the oral cavity via the perioral area by licking the lips (mean TE = 11.5). The results suggested higher TEs for liquids than for solids and that hand-to-mouth TEs may increase with water solubility. Transfer from bare arms to the perioral area was higher than from arms covered by cotton sleeves for both liquids and powders. Although TE data are often required by models estimating exposure by inadvertent ingestion, relatively few published data are available. This study has provided evidence of some factors that may influence transfer of chemicals from hands or objects to the mouth (physical form, use of clothing, and so on) and has provided data that are essential for the development of predictive exposure models of inadvertent ingestion exposure.

Public Relations: Toward a Victorian Ideology of Service

Public Relations:Toward a Victorian Ideology of Service Eve M. Lynch (bio) Click for larger view View full resolution My Child-Wife’s Old Companion” by “Phiz” by Hablôt K. Browne. The Personal History of David Copperfield by Charles Dickens (1850). [End Page 64] In 1846, Queen Victoria commissioned what would become one of her favourite royal portraits. The painting, by Franz Xaver Winterhalter, depicts her en famille, with Prince Albert and her oldest son surrounding her while her younger children distract the infant Princess Helena. Showing Victoria seated in regal attire, her right arm extended around her heir’s shoulder and her children tumbling in the foreground, the painting presents a picture of middle-class domesticity shading into royal lineage. Victoria’s soft shoulders and her free left arm appear relaxed, covered only by the royal sash that obscures the brief, off-shoulder bodice. When, in 1847, a reporter for the Athenaeum reviewed the recent showing of the painting, “The Royal Family in 1846,” he wrote that the portraits of the Queen and the Prince were “sensual and fleshly versions” of the couple, and that the Queen’s bare arms and hands were “expressed in contours that speak more of hard work in the kitchen than of the occupations of a palace” (qtd. in Homans 23). This astonishing collapse of royal and scullery signification exaggerates and distorts the middle-class resonance of the portrait in a disturbingly daring suggestion: it recalls the common Victorian parlance of the domestic servant’s hands and arms as metonymic features of their role in rough labour. The fleshly image of the labouring hand was widely recognized as a signal of the coarse, even erotic, corporeality associated with the low servant. The Athenaeum reporter, focusing on the “sensual and fleshly” hands of the Queen, assesses Victoria as implicated in the workings below stairs, not as a middle-class mother and wife surveying the kitchen staff in detached authority but as the worker herself; the unmistakable symbolism suggested by the Athenaeum reviewer of the Queen’s bare limbs, evoking “hard work in the kitchen,” points less to the middle-class wife and more to the cook and scullery maid she employed, a seemingly preposterous juxtaposition, or doubling, for a reigning monarch. Although this seems a shocking juxtaposition, in fact, it was a relatively common comparison. Service was so permeable that it could take on even royal attributes; deploying this comparison of queen and cook, public servant and domestic servant, was never far from the Victorian novelist’s imagination. As Gabriel Betteredge, the house steward in Wilkie Collins’s novel The Moonstone (1868), claims in his annual speech in the servants’ hall: I follow the plan adopted by the Queen in opening Parliament—namely, the plan of saying much the same thing regularly every year…. When it is delivered, and turns out not to be the novelty anticipated, though they grumble a little, they look forward [End Page 65] hopefully to something newer next year. An easy people to govern, in the Parliament and in the Kitchen—that’s the moral of it. (115) The contrast of high and low politics could have great comic effect, as Collins demonstrates, but then it is Betteredge, the servant, who is made to appear absurd, here mimicking the Queen and teasing the Parliamentary flock. Yet Collins’s novel establishes a clear argument for the professionalism of the servant, with Betteredge managing the affairs of the household staff while also navigating between the moral compass of the Verinder family and the domestic servants. The plight of Rosanna Spearman, second housemaid in the Verinder household and herself caught between the identity of the public and private spheres, is sensitively observed by Betteredge as he moderates the needs of the household in crisis. As the reviewer of the Queen’s portrait suggests, a sober and more subtle, perhaps even unconscious, mirroring of domestic roles collapses even the highest wife and mother into the lowest scullery maid. Charles Dickens had earlier parsed the fine line between notions of public service and the private realm of domestic service, using the permeable division between public and private spheres as a means of establishing...

Michelle Obama’s Arms: Race, Respectability, and Class Privilege

The debate on Michelle Obama’s ‘right to bare arms’ illustrates that American cultural politics is far from ‘post-racial’. Through reading ‘Michelle O’ as a body out of place, at once exoticized, fetishized, and affective, this article shows the continuing location of the First Lady as white as well as exploring how stylization revisions the raced, gendered, and classed space of the First Lady’s body. It argues that, as a corporeal negation of the norms of both white upper/middle-class respectability and ‘the Black Venus’, Obama creates a space of resistance that enables a black First Lady to emerge through performativity.

Novel insights on HIV/AIDS and cardiac disease: shedding light on the HAART of Darkness

This editorial refers to ‘Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort’, by K. Sliwa et al. , doi:10.1093/eurheartj/ehr398 Never see him! I saw him clearly then. I shall see this eloquent phantom as long as I live, and I shall see her too, a tragic and familiar shade, resembling in this gesture another one, tragic also, and bedecked with powerless charms, stretching bare brown arms over the glitter of the infernal stream, the stream of darknessJoseph Conrad, Heart of Darkness The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic in Africa and worldwide indeed represents the heart of darkness for any practising physician, given the overwhelming implications in terms of mortality, morbidity, and resource use.1 While innumerable studies have been conducted on HIV/AIDS and more will rightfully come, the impact of this condition on cardiovascular health is still far from clear. Indeed, HIV/AIDS is only (at least apparently) 31 years old,2 and the introduction of potent drug combinations [namely highly active antiretroviral therapy (HAART)] even more recent.3 Given these ongoing improvements in our understanding and treatment of HIV/AIDS as a whole, leading to increased life expectancy in patients with HIV/AIDS, greater attention has been paid to the impact of this condition on other body organs and systems, in light of the pleomorphic manifestations of HIV infection, opportunistic diseases, and drug toxicities. The heart is now key for the prognosis of HIV/AIDS patients in developed countries, as cardiovascular disease is the most common cause of death there, toppling even AIDS itself.4 Several factors and mechanisms have been shown and suggested to be involved, including direct myocardial and coronary HIV infection, autoimmune responses, and an adverse risk factor profile ( Figure 1 ).5 …