Risk resistance: constructing home birth as morally responsible on an online discussion group

In hegemonic risk discourses, hospital obstetric units are represented as the safest and best birth settings; however, a minority of women in England and Wales (2.3% in 2014) still opt for home birth. In this article, I analyse pro-home birth discourses on a UK-based online discussion group for pregnant women covering the period 2010–2015 and collected in March 2016, to identify how individuals making pro-home birth posts on the site represented home birth as a morally responsible choice. Using Foucauldian discourse analysis, I identify three main themes: home births as a normal process, representing an intimate, existential life moment which meets women’s needs for care and personal autonomy, and is convenient and relatively safe, in contrast to hospital births which are characterised as risky; home births as morally legitimate and justified by discourses of evidence-based risk assessment, woman centredness and empowerment; and home birth as not risky and the mothers who opt for it were not taking unnecessary risks but were acting responsibly. In this article, I examine the ways in which the online setting can be used to resist dominant risk discourses. I show how the participants in the online discussion group in my study used available discursive resources to challenge hegemonic risk discourses regarding birth setting, making resistance to dominant risk discourses possible, as pro-home birth discourses legitimised ‘nonconformist’ decisions regarding birth setting. The focus on the ‘risk-takers’ in this article is valuable for healthcare practitioners seeking to improve their communication about birth setting choices with pregnant women.     

Characteristics of antibiotic resistance and sequence type of Acinetobacter baumannii clinical isolates in Japan and the antibacterial activity of DS-8587

DS-8587 is a novel broad-spectrum fluoroquinolone with extended antimicrobial activity against both Gram-positive and Gram-negative pathogens. In this study, we evaluated the antibacterial activity and mechanism of DS-8587 in 31 quinolone-resistant Acinetobacter baumannii clinical isolates. Efflux pump and qnr genes, mutations in quinolone resistance-determining regions of target enzymes, and sequence types determined by multilocus sequence typing were analyzed. Forty-two quinolone-susceptible clinical isolates were analyzed for comparison. For susceptibility testing, DS-8587 exhibited more effective antibacterial activity when compared with ciprofloxacin and levofloxacin. When combined with the efflux pump inhibitor 1-(1-napthylmethyl)-piperazine, the MIC of DS-8587 was less affected when compared with the MIC exhibited by combined ciprofloxacin and 1-(1-napthylmethyl)-piperazine. The efflux pump genes adeA/adeB/adeC and regulatory elements adeR/adeS were detected in 23 of 31 quinolone-resistant isolates. The qnrA/qnrB/qnrS genes were not detected in any A. baumannii isolates analyzed. Mutations in quinolone resistance-determining regions were observed in all 31 quinolone-resistant isolates. Multilocus sequence typing analyses revealed that 22 of 31 quinolone-resistant isolates belonged to ST-2, corresponding to international clonal lineage II. In conclusion, DS-8587 exhibits potent antibacterial activity against quinolone-resistant A. baumannii isolates that harbor mutations in quinolone resistance-determining regions. In the presence of the efflux pump inhibitor 1-(1-napthylmethyl)-piperazine, no significant changes were observed in the MIC for DS-8587. DS-8587 should be considered as a treatment option for A. baumannii including ST-2 strains that are predominant among the quinolone-resistant A. baumannii isolates found in Japan.     

THE AUSTRALIAN FURNITURE INDUSTRY

Collections of cores and discs from trees were used to identify species and methods best suited for dendrochronological studies in Australia. Three Tasmanien species, Phyllocladus aspleniifolius, Athrotaxis cupressoides, and A. selaginoides, offer excellent potential, having clear rings that can be accurately dated, ages over 500 years, and variations in ring width that can be related to climatic factors. Nothofagus gunnii occasionally can be dated, although ages over 300 years are unlikely. Dacrydium franklinii, the oldest of Australian conifers, has clear annual rings but little year-to-year variability. Crossdating in Callitris is hindered in many areas by false rings, but has been successful at 2 sites near Perth. Growth rings are of varying quality in different Eucalyptus species, but may be crossdated in some areas.     

Geographic map and evolution of primary Helicobacter pylori resistance to antibacterial agents

Antibiotic resistance in Helicobacter pylori is the major cause of eradication failure. Primary H. pylori susceptibility patterns, however, are becoming less predictable. Currently, high (≥20%) clarithromycin resistance rates have been observed in the USA and in developed countries in Europe and Asia, while the highest (≥80%) metronidazole-resistance rates have been reported in Africa, Asia and South America. Primary quinolone-resistance rates of 10% or more have already been reported in developed countries in Europe and Asia. Primary amoxicillin resistance has been low (0 to <2%) in Europe but higher (6–59%) in Africa, Asia and South America. Similarly, tetracycline resistance has been absent or low (<5%) in most countries and higher (9–27%) in Asia and South America. The increasing clarithromycin and quinolone resistance, and multidrug resistance detected in 0 to less than 5% in Europe and more often (14.2%) in Brazil are worrying. Growing resistance often parallels national antibiotic consumption and may vary within patient groups according to the geographic region, patient’s age and sex, type of disease, birthplace, other infections and other factors. The geographic map and evolution of primary H. pylori resistance are clinically important, should be considered when choosing eradication regimens, and should be monitored constantly at national and global levels in an attempt to reach the recently recommended goal of eradication of more than 95%.     

Central and Regional Hemodynamics During the Acute Onset of Renal Hypertension in Rats

The purpose of this study was to quantitate the regional changes in flow and resistance which occur during the acute onset of two-kidney, one clip renal hypertension. Anesthetized rats were implanted with a Doppler flow probe and balloon occluder on one renal artery. To produce acute hypertension, the occluder was inflated to reduce renal flow velocity by 50%. After 90 minutes, mean arterial pressure increased 25% above the prestenosis control period value as a result of a 22% increase in peripheral resistance. Regional flows and resistances were determined prior to and 90 minutes after renal artery stenosis by Injection of labelled microspheres into the left ventricle. Our major findings were that: 1) the regional hemodynamic changes in flow and resistance are unevenly distributed among individual organs; and 2) the major site of increased resistance resides in the splanchnic circulation with the largest increases occurring in the small intestine.     

Higher Metabolic Syndrome in Obese Asthmatic Compared to Obese Nonasthmatic Adolescent Males

The relationship between asthma and obesity has been documented in children and adolescents; however, few studies on metabolic syndrome and asthma have been performed. Objective. To determine the prevalence of metabolic syndrome in adolescents among the following groups: obese with asthma (OA), obese without asthma (ONA), nonobese with asthma (NOA), and nonobese without asthma (NONA). Patients and Methods. The authors measured anthropometric (height, weight, waist circumference, body mass index, and waist-hip ratio), clinical (Tanner stage, blood pressure, fat and muscle reserve, and exercise), and biochemical parameters (basal and load glucose, cholesterol, triglycerides, high-density lipoproteins, uric acid, and insulin) in 500 Mexican adolescents. Results. A total of 111 OA, 198 ONA, 63 NOA, and 71 NONA adolescents completed the study. There were no differences in age, height, Tanner stage, high-density lipoproteins, or basal glucose among groups. Cholesterol, triglycerides, uric acid, basal insulin, and homeostasis model assessment (HOMA)-IR were significantly higher among the obese than nonobese groups but were similar between the OA and ONA groups. The prevalence of impaired fasting glucose was significantly higher among ONA versus OA males. The prevalence of metabolic syndrome (define as ≥3 abnormal cardiometabolic risk factors by de Ferranti, Cook, and International Diabetes Federation [IDF] criteria) was higher among OA teens than in the ONA group; however, this association was significant only among males. Adolescents from the ONA group were able to perform significantly more vigorous exercise than the other groups. Conclusion. Adolescent males who were obese and also had mild persistent asthma had a significantly higher prevalence of metabolic syndrome than obese males without asthma. However, overall, asthma seems to confer a protective effect against the prediabetes condition in males.     

Atazanavir: improving the HIV protease inhibitor class

Protease inhibitors are potent agents against HIV but their use is constrained by poor pharmacokinetics, cross-resistance and metabolic toxicities. Atazanavir [Reyataz?] is a new protease inhibitors with once-daily dosing and minimal lipid and glycemic effects. Resistance studies of clinical isolates reveal a mutational pattern distinctive from that of other protease inhibitors. Atazanavir selects for the I50L mutation in HIV protease that confers increased susceptibility to other protease inhibitors in vitro. Clinical trials have shown comparable efficacy to nelfinavir (Viracept^®) and efavirenz (Sustiva^®) in treatment-naive patients, and in preliminary studies, ritonavir-boosted atazanavir is effective in patients failing previous protease inhibitor-containing regimens. Reversible elevations in bilirubin occur in some patients but are not associated with hepatic injury. Atazanavir improves upon aspects of currently-available protease inhibitors and appears useful for initial and possibly subsequent HIV therapy.