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Early identification of diabetic ketoacidosis (DKA) may improve clinical outcomes. Prior studies suggest exhaled end tidal carbon dioxide (ETCO2) provides a non-invasive, real-time method to screen for DKA in the emergency department (ED).
This a retrospective cohort study among patients who activated Emergency Medical Services (EMS) during a one-year period. Initial out-of-hospital vital signs documented by EMS personnel, including ETCO2 and first recorded blood glucose level (BGL), as well as in-hospital records, including laboratory values and diagnosis, were collected. The main outcome was the association between ETCO2 and the diagnosis of DKA.
Of the 118 patients transported with hyperglycemia (defined by BGL >200), six (5%) were diagnosed with DKA. The mean level of ETCO2 in those without DKA was 35mmHg (95% CI, 33-38mmHg) compared to mean levels of 15mmHg (95% CI, 8-21mmHg) in those with DKA (P <.001). The Area Under the Receiver Operating Characteristics (ROC) Curve (AUC) for ETCO2 identifying DKA was 0.96 (95% CI, 0.92-1.00). The correlation coefficient between ETCO2 and serum bicarbonate (HCO3) was 0.436 (P <.001) and the correlation coefficient between ETCO2 and anion gap was -0.397 (P <.001).
Among patients with hyperglycemia, prehospital levels of ETCO2 were significantly lower in patients with DKA compared to those without and were predictive of the diagnosis of DKA. Furthermore, out-of-hospital ETCO2 was significantly correlated with measures of metabolic acidosis.
The sixth chapter, “Gray Modernism,” argues that modernist experimentation with narrative form draws theoretical and disciplinary inspiration from the invention of gerontology and geriatrics as a science. During the twentieth century, aging becomes the subject of clinical interest, a temporal pathology detachable from the body it affects. Similarly, for modernist novels like Virginia Woolf’s Orlando, duration becomes separable from the highly charged aesthetic moments it contains. Though Orlando lives through many centuries, she does not grow old; instead, her greatest transformation occurs when her gender instantaneously switches from male to female. The novel creates a divide between the systems of duration and aging on the one hand, and the momentariness and constructedness of identity on the other. By breaking with the conventions that link duration and objective, shared time, Woolf situates aging in an ironic temporality that disrupts the forward press of years.
Alice Dunbar Nelson’s early short stories about New Orleans’s downriver, working-class neighborhoods focus, in particular, on the way the men in this environment can suffer forms of alienation sufficiently extreme to constitute social death. In two of these stories, a literal death comes to highlight the ways the main characters are already, from the standpoint of social relations, dead, and as such highlight the problems faced by the working poor in the distinctive environment of the final years of the nineteenth century in New Orleans. These stories, however, gave Dunbar Nelson a means of escaping this world, as, soon after they were published, she left for New York and became a prominent figure in the Harlem Renaissance.