Coat Pocket Research Articles

Lipshine #18 Champagne Gold

Lipshine #18 Champagne Gold Val Rigodon (bio) We could watch the moonrise from the pool, float on our backs, and count the silver spacecrafts puttering across the water-color sky, striping it with seafoam-colored chemtrails, but you roll your eyes. Your sharp triangle teeth pop black bubblegum, the special promotional kind they stopped making years ago but which I still find littering the bottom of your coat pockets. You shake sand out of your sneakers and break another choker. You’ve got a dozen replacements downstairs in that scallop shell you stole from your older sister. You jog out of the house: my mauve mermaid girl with feathers on her eyelashes, ears rotten from cheap silver. You sold your legs to stalk about the sandy shore, to wrap around some devil’s red roaring motorcycle. Your band of rowdy angels will be waiting for you at the new-old-revamped-reopened multiplex at the mall, where you loiter after curfew. Everyone wonders how you got your gang to plummet from the pearlescent heavens, to stuff their cotton-soft feet into beat-up sneakers and walk the speckled concrete—but me, I already know. We were from the deepest, coldest depths of the black-green sea. We were mermaid girls with diamonds in our teeth. You swam around like you owned the place, and maybe you did. But you traded it all away like bottle caps in coral reef. You sold your jellyfish hair that once streamed behind you in luminescent pink and orange, and now you stay shaved, pushing rose thorns from your head. You wanted gravity and feathers and asteroids. I had never imagined the sun; I only wanted to be your shadow. I followed you up here, but I should have known better. “Kiss me,” I begged when we were bending in the wind, scalps exposed to the ultraviolet. You turned away and stared into your yellow clamshell mirror. You had a hundred layers of waterproof eyeliner to apply. “Nah, your breath smells like fish.” [End Page 105] Then you ran, already an expert, already the lean-legged king of the forest. You took my voice with you like a piece of mint floss wrapped around a wiggly tooth and a brassy doorknob. I was always the fool. My breath never bothered you before, but up here in the air you were putting on airs. Now I sit on your bed while you’re gone and wait for you to come home, red hot and sweating and wanting comfort from the unrelenting ground. We don’t know how to swim anymore. I try on your gold lip-gloss, taste your mouth there, and stamp kisses on the back of my hand. I wrap myself in towels and sit on the roof and let the wind dry my hair until it is a salt-crusted curtain. I stare up at the sky and watch the speedcrafts weave down the nebula highway, dodging stars all by myself. I separate my tail into two long, oak-tan legs and pretend I know what roots are. I pretend that walking is the coolest, chicest thing a mermaid girl can do. And I don’t think of the savage sea, where girls like us hunt squids and crash ships and pierce our noses with stolen fishhooks and hide gold in deep, black, hot places and don’t wear lipgloss. Nah, I don’t think of those things at all. [End Page 106] Val Rigodon VAL RIGODON is a creative writer and attorney. She was a 2019 Poets House Emerging Poets Fellow and a storyteller for The Moth. You can find more of her work on the Internet and, someday, in a bookstore. She one day hopes to live in a house by the sea. I have loved fairy tales ever since I was a young child. I especially sought out revisions and retellings. My favorite stories to write and read include whimsy, magic, and love. I’ve never been able to resist adding a touch of magic to everything I write. Copyright © 2023 Wayne State University Press

White coat - is it safe?

Background: The transient contamination of medical professional’s attires including white coats is one of the major vehicles for the horizontal transmission of microorganisms in the hospital. In particular, white-coat cuffs had a higher bacterial load than the mouths of the pockets. The bacterial isolates were resistant to nearly all of the antibiotics tested. This study was conducted to determine the level and type of microbial contamination present on the white coats of medical students in order to assess the risk of transmission of pathogenic micro-organisms by this route in a hospital setting. This study was performed in tertiary care hospital to study the white coat as vehicle for bacterial dissemination and to know the way of handling, cleaning of white coat.Methods: It is observational prospective cross-sectional study conducted at tertiary care hospital. Nurses, interns, residents, technicians are included. Samples are taken from 3 sites of white coat pocket, lapel and collar.Results: We found that reason to wear white coat is dress code of the hospital. Most of the white coats were washed less than 3 days or less. Pocket was the most common site with MRCONS. Pocket (14%) is the most common contaminated site. Antibiotic sensitivity of organisms is mainly sensitive for ciprofloxacin and vancomycin.Conclusions: From the above study we confirm white coat carries microorganism hence it spreads nosocomial infection. Hand washing and multiple number white coat use should be encouraged.

Right Brain: Cogwheels and Crystals.

"Cogwheels and Crystals" is a reflection on how difficult it was to see a patient with Parkinson disease in the office as the daughter of a man with the same diagnosis. The immediate challenge was maintaining composure and professionalism, fighting the urge to stay blissfully unaware. The poem explores my feelings as I set out to perform a thorough interview similar to any other: discomfort with confronting potential future realities, reminders of the ways my father's disease limited his involvement in my childhood, and guilt for perhaps not caring for him enough as I spend my days caring for others with similar struggles.he is here today, fidgeting, can't sit still,my crystal ball.i look though i don't want to.my white coat feels stiff, rigid on my body andthe cogwheels begin cranking restlessly in my head.he is here today, hand trembling as he adjusts his glasses.i do not wish to fast-forward to The End of my father,but my crystal ball is here today.i am tasked with asking him to tell me about the things i want to hide from.i close my eyes for a moment before i begin,and i am a small child again doing homework on the kitchen table.the smell of indian spices cooking is quite strong to my sister and me, but my dad is none the wiser; something we called a quirk.and then i am in high school proud in my gown, tassel hanging.we are late because my dad is struggling to tie his shoes. he can barely get the spoon from the bowl to his mouth at the reception.and then i am back herei don't want to see how this ends.my crystal ball is here today.it feels like morbid curiosity; i ask him details,about how his medications are failing, about how he cannot move his body to eat, bathe, wear his clothes. his voice is a whisper.i wonder how long before my dad loses his voice.how long until he gets to this part?i counsel and send my crystal ball away, heart heavy,and immediately call my dad.i stick my hand in my coat pocket, it sinksand i sink into a chairi don't tell him that i've seen the end.is he talking a little softer than usual?i ask him cordial questions, about work and weatherand hang up before he realizes i am cryingabout cogwheels and crystals.

Analisis Simbolisme Jepang dalam Seragam Sekolah Menengah Pertama

The symbols on junior high school uniforms in Japan have different meanings. The purpose of this study is to describe the meaning of semiotics (denotative, connotative, and myth) in junior high school uniforms in Japan using Roland Barthes' semiotic theory. This research is a qualitative descriptive study research with literature study data collection techniques. The results of the analysis show six symbols whose meanings can be known, namely the school uniform was not only clothes worn by certain groups, but there are several semiotic meanings contained in parts of the school uniform. In addition, school coats are required to be in a dark color, which is a tradition in Japan where students are prohibited from wearing brightly colored coats. They wear a suit collar with a standard collar shape which is the best collar to use in any occasion, the symbol in the middle of the coat buttons means an identifier of the origin of the uniform, the coat pocket is decorative and is used to place an item. Then the purpose of using ties is for the student to be more confident and learn to dress neatly, white school shirts like school shirts in general symbolize cleanliness and innocence which makes students look formal when attending school, and school skirts that cover part or all of their legs part to show the feminist side of female students.

Comparison of four handheld point-of-care ultrasound devices by expert users

BackgroundPoint-of-care ultrasound (POCUS) is rapidly becoming ubiquitous across healthcare specialties. This is due to several factors including its portability, immediacy of results to guide clinical decision-making, and lack of radiation exposure to patients. The recent growth of handheld ultrasound devices has improved access to ultrasound for many clinicians. Few studies have directly compared different handheld ultrasound devices among themselves or to cart-based ultrasound machines. We conducted a prospective observational study comparing four common handheld ultrasound devices for ease of use, image quality, and overall satisfaction. Twenty-four POCUS experts utilized four handheld devices (Butterfly iQ+™ by Butterfly Network Inc., Kosmos™ by EchoNous, Vscan Air™ by General Electric, and Lumify™ by Philips Healthcare) to obtain three ultrasound views on the same standardized patients using high- and low-frequency probes.ResultsData were collected from 24 POCUS experts using all 4 handheld devices. No single ultrasound device was superior in all categories. For overall ease of use, the Vscan Air™ was rated highest, followed by the Lumify™. For overall image quality, Lumify™ was rated highest, followed by Kosmos™. The Lumify™ device was rated highest for overall satisfaction, while the Vscan Air™ was rated as the most likely to be purchased personally and carried in one’s coat pocket. The top 5 characteristics of handheld ultrasound devices rated as being “very important” were image quality, ease of use, portability, total costs, and availability of different probes.ConclusionsIn a comparison of four common handheld ultrasound devices in the United States, no single handheld ultrasound device was perceived to have all desired characteristics. POCUS experts rated the Lumify™ highest for image quality and Vscan Air™ highest for ease of use. Overall satisfaction was highest with the Lumify™ device, while the most likely to be purchased as a pocket device was the Vscan Air™. Image quality was felt to be the most important characteristic in evaluating handheld ultrasound devices.

Zizou's Voice

Zizou's Voice Ghassan Zeineddine (bio) Zizou never thought he'd make a living off his voice or return to reading the Qur'an, but both things happened after he was fired from his job in the winter of 2003. He had been a night watchman at an assisted living facility on Ford Road in Dearborn, Michigan. The night hours had attracted him to the position; during his shift most residents were asleep, giving him the quiet and peace of mind to write his fantasy novel, "The Lands of Sarabia," at the front desk. Aside from his rounds of the hallways of each floor and the occasional glance at the CCTV monitors to make sure a resident hadn't left their room, he wrote his story on a legal pad, his inky scrawl wide across the page, to the distant whoosh of cars and trucks on the freeway. Once he finished a chapter, he would type it up at home on his desktop computer. The novel was set in an Arab fantasy world. There were no dragons or bearded wizards, no elves or slobbering goblins. Instead of Arthurian swords there were scimitars inscribed with Arabic calligraphy; instead of blonde maidens there were raven-haired princesses. And there were plenty of jinns, perhaps too many. Ten years after starting the book during his senior year of university, he wasn't anywhere near the end. The novel kept growing and spiraling in labyrinthine directions, leaving Zizou distressed and anguished. The more he worked on it the more he believed he had wasted his time, that he was a failed writer, a failed human. Even his breath, he thought, stank of defeat. One night, frustrated by his writing, Zizou put on his coat and left the front desk and stepped outside into the frigid cold to clear his mind. He walked down the gravel driveway to Ford Road, where he stood on the curb of the sidewalk, dangerously close to leaning into the freeway. When a pickup came speeding down the road, he was tempted to step in front of it. Stop being dramatic, he chastised himself. Or was drama the natural inclination of an artist? But was he an artist? He was thirty-two years old [End Page 20] with one publication to his name: a fantastical story that had appeared in his university's student literary journal about the misadventures of Abdelrahman Abu Fawaz, a melancholic Phoenician sailor who suffered from incurable insomnia. Zizou was stuck at a pivotal moment in his novel where the main characters, who hailed from distant lands in his imagined world of Sarabia, were about to cross paths. Only Zizou didn't know how to pull this all off. He stood back from the curb and paced up and down the sidewalk, his head bent, hands deep in his coat pockets. The icy wind lashed at him; his eyes watered. Not for the first time did he contemplate whether he should give up the pen. He couldn't rely anymore on the excuse of being young and exploring different career paths. According to his parents, at his age he was supposed to be married with children, own a decent-sized house with a finished basement, and drive a good car. Zizou was single, lived in a studio that overlooked a carwash, and drove a 1992 Chevrolet Corsica with a dented bumper. Zizou's younger brother, Fareed, was a real estate agent—one of the big sharks, Fareed often boasted—whose smiling face adorned a billboard on Ford Road. Every evening on his way to work, Zizou saw Fareed's slicked black hair and bright white teeth, lit up by spotlights. "When will I get to see your face on a billboard?" his mother often asked him. In Dearborn, the successful Arabs advertised their businesses on billboards all around town. Zizou imagined seeing his portrait on the back flap of his book. He didn't have Fareed's good looks or physique—Fareed wore tight-fitting suits to show off his muscles—and his hairline had started to recede. But what Zizou did have was an arresting, sonorous voice—a movie preview voice, his high school classmates...

Book Reviews

Book Reviews

Imagined Histories

Imagined Histories

Vitriol throwing in Victorian America

ABSTRACT This article focuses on the late nineteenth and early twentieth centuries when caustic and corrosive substances such as concentrated sulphuric acid or carbolic acid were easily available. Acid was extremely portable, as bottles and syringes could be successfully concealed in coat and skirt pockets. Throwing, squirting, spraying, or pouring acid was a fairly accurate means of harming specific areas of the body or damaging clothing. Vitriol throwers often deliberately aimed at their victim’s face and eyes to ensure permanent facial disfigurement. Most American acid assaults were by lone operators with a very specific target and motivation, and the woman consumed by jealousy and bent on revenge dominated popular understandings of acid crime. Vitriol throwing was a very specific form of female vigilantism in this period, but it was not an exclusively female practice. Most news and crime reports centred on attacks on public streets and in public institutions, which generated intense fear and anxiety and recurring moral panics over public safety in urban-industrial America, particularly when male serial “Jacks” were at large. Overall, the public, press, and courts demonstrated considered antipathy and ambivalence toward vitriol offences, offenders, and victims as illustrated by the controversial Petrie-Rozelle case in 1880s California.

Sōseki: Modern Japan's Greatest Novelist by John Nathan

Reviewed by: Sōseki: Modern Japan's Greatest Novelist by John Nathan Jonathan Zwicker (bio) Sōseki: Modern Japan's Greatest Novelist By John Nathan. Columbia University Press, New York, 2018. xiv, 327 pages. $37.00, cloth; $22.00, paper; $21.99, E-book. Among the short episodes that comprise Akutagawa Ryūnosuke's autobiographical "The Life of a Stupid Man" ("Aru ahō no issho"), there is a haunting passage in which he recalls the death of his mentor, Natsume Sōseki, in 1916: In the wind after the rain, he walked down the platform of the new station. The sky was still dark. … He left his cigarette unlit and felt a pain close to joy. "Master near death," read the telegram he had thrust into his coat pocket. Just then the 6:00 a.m. Tokyo-bound train began to snake its way toward the station, rounding a pine-covered hill in the distance and trailing a wisp of smoke.1 What makes this scene so evocative is an uncanny resonance of which Akutagawa was himself surely aware: Akutagawa's memory is an eerie pantomime of the ending of the first half of Sōseki's most famous novel, Kokoro, as the I-narrator boards a train to Tokyo to try to see his own mentor, Sensei, before his death. Kokoro seems to hover over Akutagawa's own relationship with Sōseki, whom he refers to throughout his late writings simply as Sensei, as if the novel had come to structure how Akutagawa understood his own life and his memories of that rainy morning in December 1916. Much in Akutagawa's late work, especially "The Life of a Stupid Man" and "Spinning Gears" ("Haguruma") is concerned with the intersection of books and life, how the experience of life is informed by books as much as, perhaps more than, books are informed by the stuff of life. "The Life of a Stupid Man" is autobiographical but hardly an autobiography in any recognizable sense: it is fragmentary and episodic, the vignettes of a life gathered in no discernible order, narrated in the third person. The fragmentary modernism of Akutagawa's late work may seem a long way from the novels of his mentor, but a through-line that connects late Akutagawa with late Sōseki is a concern for the fractured nature of the self and a skepticism over the possibility of narrating a life. It is in this stance that we can see Akutagawa's greatest debt to Sōseki. When Akutagawa writes that "With the last of his strength, he tried to write his autobiography, but it did not [End Page 266] come together as easily as he had hoped,"2 he was not just explaining the strange nature of the manuscript he would leave behind to his friend Kume Masao at the time of his suicide, he was also expressing a deep skepticism about the very ease with which the classical I-novel had posited a relationship between life and writing. In this context, Akutagawa's evoking of Kokoro is especially suggestive for it is a novel centrally concerned with the struggle to express, in writing, the basic stuff of a life. There is, in Sōseki's novel, a distrust of the written word, of its capacity to make sense of and to transmit an individual's experiences. Indeed, as John Nathan eloquently writes in his recent biography, Sōseki: Modern Japan's Greatest Novelist, Kokoro is, at its base, an extended meditation on this subject, that "one man cannot learn from another; the impossibility of understanding another coupled with our need to assert ourselves guarantees that what awaits us is the agony experienced by … the sensei who cannot teach in Kokoro, a life of isolation and loneliness" (p. 225). For a biographer, then, Sōseki's life presents an interesting problem, one that surely shaped Nathan's approach to his subject in Sōseki: Modern Japan's Greatest Novelist, that is, how to write about an author who was himself profoundly skeptical of the possibility of the transmission of a life in writing, even while recognizing that it is only through this medium that a life...

Three Poems

22 WLT SUMMER 2021 a POETRY Three Poems by Yoo Heekyung father inside my coat it is only after i lose my wallet that i find father inside my coat. he is holding a long and slender cigarette between his teeth. dear father inside my coat like wet feet, how do we make sense of this strangeness? i put my hands in my empty coat pockets and look back at father. birds fly up from the shadows. i am certain i saw them, the faint traces. father inside my coat is still cold, and i am at a loss. father. yes? are you happy? why would i be happy? then why did you do it? that’s a question i should ask. i raised my head in the direction that was disappearing. leaves trembled between the streetlights and the trees on the avenue. but it seems we must continue arguing, even inside the same coat. 驛 [yeok] (station) this place is a passage of worn-out people. they usher their frayed legs up the stairs. the train has not even once arrived on time. accordingly, clocks are as useless as the train schedules here. those who departed early in the morning return past dusk. occasionally, those who arrive late into the night walk with an increasingly tattered gait. the passage remembers one man’s passing. his causa mortis: winter. when he was buried in the frozen earth, his wife wept with sorrow. like a train that was about to arrive. memory is nothing but mere memory. similar to my hesitation to write when something comes to mind, the station does not move. no, the station trembles a little each time a train departs. slowly at first, and then faster and faster, the station disappears. 23:24. yet another train will arrive from the city. the passengers preparing to disembark remain out of sight. no one is waiting to board. snowfall just barely, the old people walk on the streets blanketed in snow. on this disquiet night, i grill beef intestines while reading a letter a young man had written after he had spent the night with his first love. the man gets weepy over past moments, and above the butchered memories, the steam collects into a fog believe it or not, but while coughing, i think of the musical notes i clutch in my frozen hands. this bent present, all of this, is like a song to me. the outside is, as always, the things swallowed and spat out by the winter of my youth. how shiny it still seems within this time, the haggard name that is “us.” this night shrouded in snow resembles only a vast cave. but to stay quiet and to face my burning face, abruptly, the next day, i ache with the fallen snow Translations from the Korean By Stine Su Yon An Editorial note: Stine Su Yon An was a mentee in the American Literary Translators Association’s 2020 Emerging Translator Mentorship Program. These excerpts are from Oneul achim daneo (Today’s morning vocabulary) (Moonji Books, 2011). Yoo Heekyung 유희경 is a South Korean poet and playwright. He is the author of Oneul achim daneo (2011), Dangsinui jari – namuro jaraneun bangbeop (2013), Uriege jamsi sinieotdeon (2018), and other collections. He is a playwright with the theater company 독 (dock) and a member of the poetry collective 작란 (作亂) (jaknan). In 2019 Yoo was awarded the Hyundae Munhak Sang (Contemporary Literature Award) for his poetry. He runs ,wit n cynical, a series of poetry bookstores and project spaces in Seoul. Stine Su Yon An is a poet and translator based in New York City. Her work has appeared in Electric Literature, Black Warrior Review, Waxwing, Pleiades, and elsewhere. She holds an MFA in literary arts from Brown University. PHOTO BY OWTANA ON UNSPLASH ...

Book Reviews

Heath D. Avid Reader Press/Simon & Schuster; 2020. Hardback; 320 pages.This title could not have been more timely given the coronavirus disease 2019 (COVID-19) crisis we are dealing with in health care. Heath puts forward the premise that certain processes can help mitigate the development of problems; that is, rather than being reactive once a problem occurs, we should be looking “upstream” for solutions. This thinking focuses on determining factors that contribute to the problem and addressing those issues. One example from health care is the use of infant car seats. A pediatrician noticed that car accidents frequently resulted in infant deaths. He founded the movement to implement and require the use of car seats for infants and children, with the outcome of decreased pediatric deaths from this cause. Rather than focusing his actions on managing the trauma care for infants and children, his goal was to implement a solution upstream to prevent the injuries. Because of this pediatrician’s early and ongoing efforts, use of car seats became the law.According to Heath, circumstances should be studied and considered when developing solutions. We do not have to accept common outcomes as normal. Another example in the book is the acceptance that sports injuries are inevitable as an outcome of playing sports. But if the mechanics of movement are studied and analyzed, athletes can be trained in specific ways to mitigate potential injury. This way of thinking will promote individualized training according to the particular weaknesses identified. Similarly, when we are faced with a problematic situation in our lives, we can avoid the one-size-fits-all approach and accept ownership for helping to develop upstream solutions.Upstream is divided into 3 sections: The Three Barriers to Upstream Thinking, Seven Questions for Upstream Leaders, and Far Upstream. This book is a quick read, even for those who underline and annotate. Heath offers real-world examples to illustrate salient points, helping the reader to understand the connections and context.Upstream is a must read for every leader in the health care setting. Consider the COVID-19 crisis and critical problems for both patient care and health care worker safety. For example, how might upstream thinking for supply chain management ensure everyone has the equipment they need in the future?Lundsberg JW. Elsevier; 2018. Paperback; 384 pages.Small enough to fit in a laboratory coat pocket, Manual for Pulmonary and Critical Care Medicine is a reference for health care providers, but could also be valuable for advanced bedside clinicians. This book does not cover content on neurological or cardiac emergencies. Lundsberg provides the pathophysiology, case studies, and algorithms for patient management and decision-making. Purchase of this book includes access to the Elsevier ExpertConsult online portal.Polit DF, Beck CT. Wolters Kluwer; 2017. Hardback; 814 pages.Nursing Research is a textbook and is not likely of interest to the casual reader. However, this book is a valuable reference on processes and tools for development and analysis of research to support evidence-based practice. Those who have not recently taken research or statistics classes may want to consider this book as an addition to their library as a resource on updated research methods and analysis.McBride AB. Springer Publishing; 2020. Paperback; 314 pages.The Growth and Development of Nurse Leaders is appropriate for any nurse who wants to develop or hone leadership skills. McBride focuses on the areas of personal, organizational, and transformational leadership development. The text is dense, without many figures or tables; however, the content topics are important for any current or prospective leader. Purchase of this book includes access to the Springer Publishing Digital Access online additional content.

From Anatomy to Functional and Molecular Biomarker Imaging and Therapy: Ultrasound Is Safe, Ultrafast, Portable, and Inexpensive.

Ultrasound is the most widely used medical imaging modality worldwide. It is abundant, extremely safe, portable, and inexpensive. In this review, we consider some of the current development trends for ultrasound imaging, which build upon its current strength and the popularity it experiences among medical imaging professional users.Ultrasound has rapidly expanded beyond traditional radiology departments and cardiology practices. Computing power and data processing capabilities of commonly available electronics put ultrasound systems in a lab coat pocket or on a user's mobile phone. Taking advantage of new contributions and discoveries in ultrasound physics, signal processing algorithms, and electronics, the performance of ultrasound systems and transducers have progressed in terms of them becoming smaller, with higher imaging performance, and having lower cost. Ultrasound operates in real time, now at ultrafast speeds; kilohertz frame rates are already achieved by many systems.Ultrasound has progressed beyond anatomical imaging and monitoring blood flow in large vessels. With clinical approval of ultrasound contrast agents (gas-filled microbubbles) that are administered in the bloodstream, tissue perfusion studies are now routine. Through the use of modern ultrasound pulse sequences, individual microbubbles, with subpicogram mass, can be detected and observed in real time, many centimeters deep in the body. Ultrasound imaging has broken the wavelength barrier; by tracking positions of microbubbles within the vasculature, superresolution imaging has been made possible. Ultrasound can now trace the smallest vessels and capillaries, and obtain blood velocity data in those vessels.Molecular ultrasound imaging has now moved closer to clinic; the use of microbubbles with a specific affinity to endothelial biomarkers allows selective accumulation and retention of ultrasound contrast in the areas of ischemic injury, inflammation, or neoangiogenesis. This will aid in noninvasive molecular imaging and may provide additional help with real-time guidance of biopsy, surgery, and ablation procedures.The ultrasound field can be tightly focused inside the body, many centimeters deep, with millimeter precision, and ablate lesions by energy deposition, with thermal or mechanical bioeffects. Some of such treatments are already in clinical use, with more indications progressing through the clinical trial stage. In conjunction with intravascular microbubbles, focused ultrasound can be used for tissue-specific drug delivery; localized triggered release of sequestered drugs from particles in the bloodstream may take time to get to clinic. A combination of intravascular microbubbles with circulating drug and low-power ultrasound allows transient opening of vascular endothelial barriers, including blood-brain barrier; this approach has reached clinical trial stage. Therefore, the drugs that normally would not be getting to the target tissue in the brain will now have an opportunity to produce therapeutic efficacy.Overall, medical ultrasound is developing at a brisk rate, even in an environment where other imaging modalities are also advancing rapidly and may be considered more lucrative. With all the current advances that we discuss, and many more to come, ultrasound may help solve many problems that modern medicine is facing.

Point of care ultrasound in thoracic malignancy.

Ultrasonography is a safe, efficient and cost-effective mode of imaging that can assist clinicians with important treatment decisions and provide procedural guidance. Today, point of care ultrasound plays an essential role in the assessment of benign and malignant conditions of chest, both in the outpatient and inpatient setting. Small, ultra-portable, affordable units can now be carried in the coat pocket. Advanced lung cancer, metastatic diseases to the lungs or thoracic malignancies can present with pleural effusion, pulmonary edema, post-obstructive pneumonia, or ascites that can be assessed by the clinician with ultrasound. It can be used to evaluate the extent of thoracic tumors beyond the parenchyma to the parietal pleura or chest wall, assess cervical, supraclavicular lymphadenopathy prior to fine needle aspiration or to determine venous thromboembolism (VTE) associated with malignancy. Thoracic ultrasound is currently being practiced by the pulmonologists, thoracic surgeons and intensivists to provide guidance during placement of pleural catheters, chest tubes or to evaluate the pleural cavity before thoracoscopy. Point of care ultrasound can improve efficiency in procedures by decreasing complications, increasing success and reducing financial strain on the health care system.

Providence

100 THIRII MYO KYAW MYINT Providence  ast Bay Bike Path and the trees rise before us like a dark wave. Beyond them, there is the gazebo and the pale bodies of the vacationers ’ drowned children. The girl children we have named Veronica or Madeline. The boy children George or Richard. We park our bikes at the water’s edge and continue down the Path on foot. The night is balmy. The city sparkles in the distance and I can make out the power plant, the jewelry factories, and the strip clubs. We enter the line of trees. Our pockets are filled with bread to feed the dead children. Maya’s hair is pulled back from her temples and it falls to her shoulders in tight, dark curls. She is so beautiful it makes me sad. She look like a princess. The trees reach for our ankles as we walk because the forest is enchanted. I look up and see naked girls hanging by their hair from the highest branches. I recognize some of them. They came through the school where I teach. Some of the girls are still alive. The air is green and shiny inside the forest and I nearly trip on a creeping root. If I fall, the trees will hang me up too. I am more careful where I step. After some time, we reach the clearing, the gazebo, and the bridge to the vacationers’ house. The house is white, enormous. The moon is full. I dig my hands into my pockets for the bread and break off some pieces. Maya takes off her soft shoes and dips her toes in the water. In the moonlight, her skin is dark blue. She draws circles in the water with her toes and begins to talk of her cousin who killed himself, her white cousin, the son of her mother’s sister. He heard the voices of angels, Maya says. I toss pieces of bread into the water and watch them sink. I think I see the silver skin of the dead children beneath the water’s surface. When her cousin died, Maya says, they found his hoard of angels and demons. Little figurines that filled every drawer. He must have been collecting them for years. I sit down beside Maya on the bank and look at our reflection in the water. We sit close together. The water is very still. e 101 Maya hasn’t touched her bread at all, so I remark on this and she stops the story she was telling me of her cousin’s suicide. How he drowned himself in a frozen lake. She takes the bread out of her coat pocket and tosses the whole loaf into the water. We hear a loud splash. We wait to see if the children will wake up. The vacationers came late last spring when the city was in bloom, when the air was heavy with the scent of magnolia and wet earth. Spring is the most beautiful season in this city. The ice on the sidewalks melts in layers and for a few days I can see the colorful leaves from last fall encased under my feet. The vacationers’ house along the East Bay Bike Path is built like a castle. It stands on a rock in the water. The gazebo stands on a smaller rock closer to the path and between the house and the gazebo is a wooden bridge. The house is only accessible by boat. I imagine the vacationers built their house where they did because it is important to have privacy on a vacation, and also because they were afraid to die. There are parts of this city where people die every day. At the school where I teach remedial reading there is a poster on the front office door of all the children who have gone missing and are probably dead. Down the hall, there is another poster of all the local men who are convicted sex offenders. The staff is made to memorize the first poster, and the children the second. The East Bay Bike Path begins at India Point Park. Ships from the colonies once sailed to India from...

Caveats for the Emergence of Virtual Wallets

As smartphones have become integrated in the daily lives of citizens of developed nations, common monetary transactions that at one point in time required the consumer to search their cars, couches, and coat pockets for spare change can now be completed with the tap of a finger on their smartphone. Examples of these situations may include paying a toll or purchasing a beverage from a vending machine. One major factor considered to be a catalyst for the shift to virtual wallets is the idea that cashless transactions are more convenient [1]. Opposing ideas to this shift in commerce trends include concerns about security, and the criticisms can be translated to the fear of putting all your eggs in one basket [2]. By analyzing the pros and cons of the of strengthening relationship between the smartphone and commerce, a clearer understanding of its limitations can be achieved.

Birthright Citizens: A History of Race and Rights in Antebellum America by Martha S. Jones

Reviewed by: Birthright Citizens: A History of Race and Rights in Antebellum America by Martha S. Jones William G. Thomas III (bio) Birthright Citizens: A History of Race and Rights in Antebellum America. By Martha S. Jones. (Cambridge: Cambridge University Press, 2018. Pp. 248. Cloth, $110.00; paper, $27.99.) In the summer of 1827, William Watkins, a black minister, educator, and activist in Baltimore, paid a visit to John H. B. Latrobe, a well-connected local lawyer and philanthropist. Watkins had helped found the city’s Legal Rights Association, an organization aimed at protecting the rights of free blacks, and the mayor of Baltimore had imposed an 11 p.m. curfew on all people of color in the city. Watkins asked Latrobe to give him a legal opinion on whether such an ordinance was constitutional. We do not know [End Page 467] what position Latrobe took, but the fact that Watkins and the Legal Rights Association sought an opinion on this matter speaks volumes. In this pathbreaking study, Martha S. Jones has uncovered how black Baltimoreans used the law beginning in the 1780s to challenge second-class citizenship, protect their fundamental rights under the Constitution, and resist the racist presumptions that would eventually mark Roger B. Taney’s opinion in the Dred Scott case. Birthright Citizens is less a history of race than a history of rights. Baltimore was Taney’s home, of course, and part of Jones’s project is to revise our understanding of Dred Scott by demonstrating conclusively that black Baltimoreans exercised the “privileges and immunities of citizenship” for decades before that notorious decision. They traveled between states, sued and were sued in local courts, testified, made contracts, and had their contracts upheld through the law. Jones follows black Baltimoreans through their actions in the local courts, in a series of what she calls “disruptive vignettes” (10). These stories are pieced together from the fragments of information recorded in the dockets, minute books, and case files at the courthouse, and in Jones’s capable hands they are fashioned into a narrative that recasts our understanding of how African Americans claimed crucial elements of birthright citizenship long before the passage of the Fourteenth Amendment. Rather than conferred, birthright citizenship was asserted, defended, and to a remarkable degree secured by free blacks in everyday legal actions. The courthouse, Jones argues, was “a place of opportunity.” Even unjust black laws that required free blacks to license their guns could be used to demonstrate citizenship. Filling out the application in the courthouse, standing publicly before the court to obtain it, and coming away with a license were performances that enacted “a citizen’s bundle of rights” (106). With lawyers and judges adjudicating their claims, with court papers in their coat pockets, black Baltimoreans, Jones points out, “looked more and more like persons with rights” (70). One of the most significant and valuable aspects of Jones’s account is her analysis of how black Baltimoreans responded to the threat of forced colonization. She sets the discussion of colonization in the context of Indian removal and pinpoints 1830–32 as a pivotal moment. In these years the Legal Rights Association turned to William Wirt, the former U.S. attorney general who argued the case for the Cherokee before the Supreme Court in Cherokee Nation v. Georgia. Black Baltimoreans sought a definitive opinion from him on the “rights and citizenship of the free black” under the Constitution (44). They never received one, but every discussion with an attorney like Latrobe or Wirt was a “formative moment for the development of ideas about black citizenship” (45). [End Page 468] In the wake of the Nat Turner revolt, Maryland legislators led by Octavius Taney, Roger Taney’s brother, proposed wholesale removal of all free blacks from the state by legislatively turning them into term slaves preparatory to their removal. Jones calls this scheme “radical colonization” in part because it was to be both compulsory and total. The measure passed the state senate. The house never took it up but instead passed a series of oppressive black laws to control the mobility of free blacks in a naked attempt to drive them from the state. Maryland...

1142. Use of DNA Markers to Assess the Potential for Pathogen Transmission from Physicians’ White Coats

BackgroundPhysicians’ white coats are often contaminated, but seldom cleaned. A “bare below the elbows” dress code policy has been advocated as a strategy to reduce the risk for transmission of healthcare-associated pathogens by white coats. However, transfer of contamination by clothing has not been demonstrated in clinical settings and it is not known if long sleeves are the major source of transfer.MethodsWe observed physicians during routine patient encounters and characterized the frequency of direct and indirect contact between white coats and the patient or environmental surfaces. To assess transfer from white coats in clinical settings, we applied one cauliflower mosaic virus DNA marker to the sleeve cuffs and another to the coat pockets of physicians prior to routine patient encounters. Polymerase chain reaction was used to determine whether DNA markers from the clothing sites were transferred to patients or environmental surfaces.ResultsNinety percent of observed patient encounters included one or more direct or indirect contacts between a physician’s white coat and a patient or the environment. Direct contact occurred on average 1.7 times per encounter and indirect contact (i.e., physicians’ hands contacting the coat prior to touching the patient or environment) occurred on average 2.3 times per encounter. The figure shows the frequency and distribution of sites of direct and indirect contact with white coats. Of 11 patient encounters with DNA-contaminated white coats, five (45%) resulted in transfer of one or both DNA markers; there were three transfers from sleeve cuffs and three from coat pockets.ConclusionContaminated white coats may be an under-appreciated source for transmission of healthcare-associated pathogens. Our results provide support for the bare below the elbows policy, but also highlight the potential for indirect transfer of pathogens from other sites on white coats. Disclosures All authors: No reported disclosures.

Postcards

Postcards Barbara Lehman This book has a fascinating concept. It tells the tale of Hamish and Hermione, two holes who live in a chunk of Swiss Gruyère cheese in the kitchen of a royal palace. Unfortunately, a family of mice come along and eat the cheese—leaving the two holes homeless and vulnerable. In their search for a new home, they end up in the king's socks, in the queen's knickers, in her bicycle wheels, at the bottom of the king's boat, in a balloon which bursts, in a coat pocket, and in a custard jug. All these unwelcome holes cause the royals much inconvenience. Then, at the point of giving up, Hamish and Hermione meet the royal carpenter, who finds them a new home where they can feel useful and wanted. This improbable story delights, as it personifies nothingness and allows readers to fantasize about everyday situations. It also encourages experimentation with holes in the colorfully illustrated "holey" front cover. Bright's fairytale-like story is complemented by Ingman's fantasy-like illustrations, rendering remarkable even the most ordinary things. This is a book (and a pun) for adults and children to share and laugh aloud together. Penni Cotton The Hole Story Paul Bright Illus. Bruce Ingman London, UK: Andersen Press, 2016. Unpaged. ISBN: 9781783441938 (Picturebook; ages 3–7) [End Page 19] Mr. and Mrs. Hartlief have everything they desire except a baby. When Mr. Hartlief (reminiscent of Daly himself) discovers that the baby shop does not, in fact, sell babies, he arrives home with a piglet for his wife. They immediately fall in love with OtjiePotjie and raise him like a boy. Great is their disappointment when Otjie-Potjie is turned away on his first school day as Miss Frons (frown) only accepts boys and girls. Otjie-Potjie now, except for weekends, returns to a piggy life of mud and straw. While the narrative, supported by Daly's delightful digital illustrations, shows that families are what you make them, the Hartliefs keep dreaming about Otjie-Potjie being human. The story culminates with visions of OtjiePotjie's transformation into a real boy—but then Mr. Hartlief wishes on a star that they would all wake up the same the next morning. Surprise! Surprise! From flyleaf to flyleaf, from delightfully anthropomorphic depictions of Otjie-potjie to a scene of three exuberant pigs playing animatedly in the mud, this book is another example of the joie de vivre found in Niki Daly's work. Magdel Vorster Verrassing! Verrassing!/Surprise! Surprise! Niki Daly Afrikaans trans. Kobus Geldenhuys Cape Town, South Africa: Tafelberg Publishers, 2017. 32 pp. ISBN: 9780624081258 (Afrikaans edition) ISBN: 1910959995 (English edition, published by Otter-Barry Books, Hereford, UK) (Picturebook; ages 3–6) [End Page 33] After the popular Faten comes Cappuccino as the second young adult novel by this distinguished Lebanese writer, who has written and translated more than 120 books. The novel centers around two teenagers, Lina and Anas, who meet at a yoga class and develop friendship and mutual attraction. The book's beautiful style reflects the life of middle-class youth in Beirut. This Arabic-language novel, co-narrated by the two protagonists, tackles two main social problems usually hidden and rarely mentioned, even among friends. One concerns domestic violence, a taboo subject rarely addressed, of which Anas's mother is a long-time victim. The other issue, which troubles Lina's family, is Family and Inheritance Laws that undermine women's rights. The novel also deals with the identity struggles of children raised in Western countries, criticizing consumerism and the obsession of many girls with their looks—who go as far as undergoing surgery for their appearance. The book is gripping; it shrewdly reflects the dynamics of society and the struggle for change. Anas's problem is successfully solved, and Lena's is waiting for further social transformation. Jehan Helou Cappuccino Fatima Sharafeddine Cover illus. Somar Kowkabi Beirut, Lebanon: Dar al Saqi, 2017. 207 pp. ISBN: 9786144259771 (Fiction; ages 14–18) [End Page 37] Recent Cambridge School of Art graduate Shuti Liao won the Macmillan Prize for connecting text and illustration in this fun picturebook. Naively expressionistic full-page illustrations echo...

EDITORIAL: The Value of Learned Journals for Health Professionals

As we celebrate the twenty-year anniversary of the African Journal of Reproductive Health (AJRH) this year1, it is apt to consider the changing role of learned journals over the last two decades specially with increasing access to the worldwide web. A much-needed and welcome democratization in the availability of information has been accompanied regrettably by a concomitant overload from continual bombardment by email messages and postings from social media and at websites. As much of that information is not sieved, false news spread at an alarming rate with potentially detrimental effects on clinical consultations when misinformed patients query clinical decisions of health providers and demand inappropriate interventions specially drugs with supposedly miracle effects2. Whereas it is imperative to be selective in accessing information sources to avoid fake news, this approach is becoming difficult lately with the unfortunate official promotion of alternative facts in a post-truth context3. With triage becoming increasingly difficult, there is renewed interest in professional journals and textbooks which are now aimed at not only students but also health planners and development practitioners4. For journal contents, there is the delicate ‗town and gown‘ balance between service provision and academia but that gap is closing with the implementation of evidence-based care. Health journals that developed from broadsheets and newsletters of professional associations5 justifiably continue their role of mouthpiece by including items such as minutes of annual general meeting, reports from committees and administrative notices. Through ownership of a learned journal, a professional association demonstrates that it is not merely a trade union but it is also desirable for the journal editor to be given full independence free from pressure regarding both contents, specially as pertaining to standpoints of the professional association, and financial constraints necessitating advertising revenue. During the first decade of the African Journal of Reproductive Health, three leading medical journals in North America had to revoke their editors over editorial independence6. Peer review of manuscripts is an integral part of the editorial process to ensure the quality of articles published in a learned journal. Whereas guidelines exist, problems can arise in their implementation7. Having the final word, the editor should be impartial, abandon personal interests and neither give-in to pressure groups nor favor friends: a constraining situation similar to that faced by the Speaker in a Westminster-style parliament8. For service provider, policy maker or planner, it is much easier to shoot from the hip by taking decisions spontaneously on the spot as opposed to consulting the health literature for up-to-date evidence. With the electronic age, the vade-mecum in the pocket of the white coat of the clinician has often been replaced by bookmarks on personal digital devices to access reliable websites for official guidelines and online journals. Unfortunately, a substantial portion of the health literature is accessible only upon payment thereby making it largely inaccessible in developing countries where practitioners are those most in need. The decision-making process, whether at the bedside or policy desk, should ideally draw upon evidence specially from research findings9,10. Journal articles should clearly state their contribution to the existing body of knowledge. Therefore, the publication of research articles is part of a two-way process: reporting of findings to supplement existing systematic reviews which must be used to formulate subsequent research projects that will uncover new facts11. With the dearth of pertinent findings from low and middle-income countries, this issue is crucial to generate the information database for their implementation of evidence-based practices. With the current trend towards quantification of all issues, metrics are assuming more importance in assessing journals through proxy indices, such as impact factor, which have their own limitations. It should not be forgotten that, in the first place, a journal should meet the specific needs of its target readership whereas prominence on the worldwide web is desirable for generating awareness of journal contents during literature searches. Having its origins within a research centre, the African Journal of Reproductive Health has had an exemplary path as pertaining to editorial independence, quarterly periodicity of publication and quality of articles besides availability of issues at a dedicated website and inclusion in PubMed from the very beginning. Having been recognized as the leading regional journal in its field, the challenge now lies in consolidating its multidisciplinary approach, with a wide perspective on reproductive health, to promote its utilization for policy formulation in the quest for achieving the health-related sustainable development goals.