on 25-Oct-2016 (Tue)

2nd degree vaginal tear:
-involves perineal muscles (the muscles b/w the vagina & anus that help support the uterus, bladder & rectum)
-typically require stitches & begin to heal w/i few wks
-to ease discomfort:
-----sit on pillow/padded ring
-----pour warm water over vulva while passing urine & rinse w/ squeeze bottle afterward
-----press a clean pad firmly against wound when you bear down for bowel mvnt
-----cool wound w/ ice pack
-----take pain relievers or stool softeners as recommended by HCP

3rd degree vaginal tear
-involves perineal msc's & anal sphincter
-sometimes require repair in OR
-might take months to heal
-possible complications: fecal incontinence, painful intercourse; if these happen, talk to HCP
-to ease discomfort:
---sit on pillow/padded ring
---pour warm water over vulva during urination, rinse w/ squeeze bottle, press clean pad against wound during bowel mvnt
---cool wound w/ ice pack
---take pain relievers/stool softeners

4th degree vaginal tear:
-involve perineal msc's, anal sphincter, & tissue lining rectum
-usually require repair in OR
-might take months to heal
-possible complications: fecal incontinence, painful intercourse; if these happen talk to HCP
-evaluate recovery at post-partum check up

If bleeding pt in triage:
-make sure to ask
---where placenta is (if it's low-line)
---recent intercourse w/i 24h
-can also ask other things like falls
-call Dr if known placenta previa
-light bleeding at full term is no worry

If HTN in triage:
-do toxic work up (is it affecting kidney/liver)
-urine - check for protein
-look for reduced plt in blood (Hg is also sometimes reduced)
-LDH/AST are often elevated

If decreased fetal mvnt in triage:
-ausc fetal heart if <32wk
-FHR monitor if >32wk (NST - 20 min, min 2-3 accels by 15 beats)
-really need to check if decreased mvnt at 36-38 wks
-if everything seems good, can send home w/ paper to count baby mvnts (8-10 pm, min 6 mvnts, go to hospital if not)
---for 34+ wks

Induction
-pts overdue by 8 days (41w 1d)
-always do NST + b/w
-2 ways
---break water (+ IV oxy (Pit) if not enough to induce)
---insert prostaglandin gel (24h or 6h)

APGAR score
-appearance (skin colour)
-pulse (HR)
-grimace response (reflexes)
-activity (msc tone)
-respiration (breathing rate + effort)

en rund violett kärna med sparsamt med cytoplasma kring kärnan

Benmärgsutstryk Giemsa Ytligt betraktat liknar benmärgsutstryket ett blodutstryk med massor av erytrocyter och mogna, vita blodkroppar

A hormone is a chemical substance that is classified as a peptide, steroid, or amine.

Hormones are synthesized and secreted by endocrine cells usually found in endocrine glands.

The classical endocrine glands are the hypothala- mus, anterior and posterior lobes of the pituitary, thyroid, parathyroid, adrenal cortex, adrenal medulla, gonads, placenta, and pancreas

steroid hormones are derivatives of cholesterol

amine hormones are derivatives of tyrosine

In the nucleus, the gene for the hormone is tran- scribed into an mRNA. Generally, a single gene is responsible for directing the primary structure of each peptide hormone. (Because the genes for almost all peptide hormones have been cloned, recombinant DNA technology makes it possible to synthesize human peptide hormones.) 2. The hormone mRNA is transferred to the cytoplasm and translated on the ribosomes to the first protein pro- duct, a preprohormone. Translation of the mRNA begins with a signal peptide at the N terminus. Translation ceases, and the signal peptide attaches to receptors on the endoplasmic reticulum via “docking proteins.” Translation then continues on the endoplasmic reticulum until the entire peptide sequence is produced (i.e., the preprohormone). 3. The signal peptide is removed in the endoplasmic reticulum, converting the preprohormone to a prohormone. The prohormone contains the complete hormone sequence plus other peptide sequences, which will be removed in a final step. Some of the “other” peptide sequences in the pro- hormone are necessary for proper folding of the hormone (e.g., formation of intramolecular linkages). 4. The prohormone is transferred to the Golgi appa- ratus, where it is packaged in secretory vesicles. In the secretory vesicles, proteolytic enzymes cleave peptide sequences from the prohormone to produce the final hormone. Other functions of the Golgi apparatus include glycosylation and phosphoryla- tion of the hormone. 5. The final hormone is stored in secretory vesicles until the endocrine cell is stimulated. For example, parathyroid hormone (PTH) is synthesized and stored in vesicles in the chief cells of the parathyroid gland. The stimulus for secretion of PTH is low extracellular calcium (Ca 2+ ) concentration. When sensors on the parathyroid gland detect a low extra- cellular Ca 2+ concentration, the secretory vesicles are translocated to the cell membrane, where they extrude PTH into the blood by exocytosis. The other constituents of the secretory vesicles, including

Negative feedback is the most important and common mechanism for regu- lating hormone secretion

Steroid hormones are synthesized and secreted by the adrenal cortex, gonads, corpus luteum, and pla- centa.

The steroid hormones are cortisol, aldosterone, estradiol and estriol, progesterone, testosterone, and 1,25-dihydroxycholecalciferol

All steroid hormones are derivatives of cholesterol

The amine hormones are catecholamines and thyroid hormones

The amine hormones are derivatives of the amino acid tyrosine

In endocrine systems, negative feedback means that some  feature  of  hormone  action,  directly  or  indirectly,  inhibits further secretion of the hormone

Long-loop feedback means that the hormone feeds back all  the  way to the hypothalamic-pituitary axis

The endocrine system is responsible for homeostasis. Growth, devel- opment, reproduction, blood pressure, concentrations of ions and other substances in blood, and even behav- ior are all regulated by the endocrine system.

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Consider the case of Derrida’s missed transformative encounters with Paul, which I will explore further on. Why is it that Derrida deconstructs—or reads in what he calls a “materialist” mode—Platonic assumptions about intentionality in craft production or authorship in text production (realizing that these models so powerfully inform Platonic models of thinking itself), even as Derrida simply rejects and lampoons what he perceives to be the retrograde dualistic metaphysics of the apostle? The difference in treatment here is stunning and not without profound implications for the ongoing discursive life of cultural power: Plato’s dualistic metaphysic is worked into a model of complex material immanence, whereas Paul is simply expelled as a purveyor of a Platonism for the masses, a thinker of

One should say it clearly and brutally: Christian origins stories of the sort we begin to see in Acts always had a great deal more to do with negotiating the ideological aftermath of this colonial rebellion and its rapaciously brutal repressions than it ever did with the natural outworking of distinct and distinctly ideal identities, projects, or theologies. Such representational, idealizing tales are instead the essentially repressive fantasies of the sort we can begin to intuit already in Acts’ early narrative of Christian origins.

In this case, for example, some predominantly Gentile branches of the Jesus movement began to imagine more and more essential, representational, or ideal distinctions between themselves and the group that becomes, retroactively, “the Jews” as a suspicious name for what they themselves are not or with which they (self-protectively) do not want to be identified. The drama of Acts remains haunting, of course, and the eventual function of this canonized Western theologico-political history will end up having everything to do with the fact that “Christianity” emerges here through an agreement to participate in an economy of imagined identities within which “the Jewish question” under Roman imperial sovereignty was always really about someon

In the inflation or expansion of the intitial gestures we have begun to discuss, however, all the latter-day variations of the same ethical (and eventually ontological) problematic are repetitions made possible by such early Christian gestures of collaborationism, gestures that amount to the manufacture of identity premised on the disavowal of a “rebellious” Jewish element worthy of katechontic reprisal.

Christianity, as the designation of a founding of a new and more universal “religion,” has its point of origin in this political turmoil and social crisis, an effect of the carefully managed pressure to participate in the imperial economy. The key point here, one of the lasting cultural effects of this moment emerges in the way this questionable or not so heroic “origin” was so profoundly mirrored as a form of theological orientation indistinguishable from a form of historical narration. Roman violence against the anticolonial uprisings of Judea and Galilee became understood—again, already in Acts—as retributive divine judgment against the recalcitrance of the Jews, the necessary displacement and scapegoating that made way for an imagination o

n the ancient instance, the projection of distinct, ideal types coupled wonderfully with the brutalities of effective history in the first centuries C.E., as if this violence afforded the all-important teleological supplement (or clear interpellating experience) by which to drive forward the self-protective, self-constituting self-differentiation from “the Jews.” As the repetition of self here implies, it was with historical narration, in other words, that a populist Platonism came into its own as a force in the Christian world, one so remarkably powerful as soon to attempt to render the Jews into the Christians’ own recalcitrant shadow. The fact that Rome murdered and stole Jews en masse during the sixties and early seventies—just decades before the production of Acts, perhaps—simply provoked and bolstered the investment in an imagined ideal distinction between what would soon be referred to as two “religions.”

Nietzsche was perfectly correct to see in the emergence and spread of Christianity a kind of pop Platonism (and, like Freud, sometimes a vindictively perverse or sacrificial one at that). What Nietzsche does not recognize sufficiently, on my reading, is that it is not so much Paul as Paul’s place within an emerging Christian narrative Platonizing intervention that constitutes him as the purveyor of this, as it were, ideal or conceptual stance. In one of his remarkable analyses of Paul (which always need to be pushed just a little further to get where we need to be), this one from Daybreak, the genealogist of the material soul of the West concludes: “This [Paul] is the first Christian, the inventor of Christianness! Before him there were only a few Jewish sectarians.

Unlike Freud’s apostle in Moses and Monotheism, Nietzsche’s Paul was himself not already split, ambivalent, or stranded within effective history in a way that signals the potential for a real transvaluation of the value or function of the figure in question. Nietzsche therefore seems to me not to do with Paul what he obviously knew one must do in relation to modern Europe’s Platonism for the masses, namely, to submit it to a properly genealogical critique. Instead Nietzsche reifies Paul, leaving his place in the archive of Western ontotheology unscathed, forcing the philosopher only to disavow, rather than to transform, the effective Pauline legacy

WE SHOULD REVIVE THE EARLY CHRISTIAN PRACTICE OF PRODUCING testimonia collections, little assemblages that effect the solicitation, repetition, and dissemination of new communal formulae, so many virtual constitutions of questionably political bodies. With the little collection above I want to flag some ways that to discover Paul floating within an underground current of a new materialism is to read in him an exemplary case of that perplexingly obtrusive enjoyment which constitutes our being—unsaved and unsafe—in the world.

described in the introduction) that Nietzsche failed to capitalize on the radicality of his critique of Paulinism precisely to the degree that he failed to become Paul. We should take the comparative problematic seriously. Mutually displaced by the elusive solicitations of an underground current of materialism, Paul and ourselves would participate in an oddly secret sharing that needs to be made clearer. As I have already begun to suggest with my little testimonia book, one way to unfold this tale is to consider Pauline klēsis or calling as a mode of Epicurean parenklisis, translated by Lucretius into Latin as clinamen, a tilt or swerve that is intimately linked to important recent efforts to imagine both the materiality of our being in the world and also the peculiarly open or contingent ground of our emancipatory hope.

Following this trajectory, Slavoj Žižek has gone further in his own early developments of these genealogical points into a political category wherein clinamen as the swerve of “enjoyment” operates as a “constitutive ontological excess,” a “pure excess” in the sense that it has “no presupposed normality.

Finally, and closely related, Derrida’s psychoanalytic commentary on Lucretius’s need for a declination, swerve, or clinamen within the otherwise orderly falling of atoms in the void could be an enlightening commentary on all of Žižek’s Lacanian work on political enjoyment:

Note that my little testimonia book weaves together all these interrelated tropes with a Pauline gloss whereby a genuinely surprising “federation” or covenanted collective emerges from “the nothings” or “the nonbeings” (ta mē onta), disparate nothings knitted together into a social experience. To say that it is only in the “weakness” of a witness believed that unites them is to say that their evental emergence or consolidation differs in no respect from the self-grounding or performative strength of what we will soon hear described as interpellation. In the clinamen or parenklisis of klēsis something emerges from nothing, and Paul’s call indicates only the mysterious forcefulness of the, as it were, uncalled for organization of new community.

In each instance of the testimonia book, therefore, it is the resolute difficulty of maintaining oneself as a singularity that solicits the “return” of the archive of Paulinism. This is important to make clear in the sense that it is not incidentally but rather precisely, specifically that the new materialism invites a genealogical association between Pauline klēsis and Epicurean parenklisis or Lucretian clinamen.

In Derrida’s peculiarly dogmatic repetition of Nietzsche on several occasions, Derrida makes of Paul the first Christian and the worst kind of pop Platonist. As I have already started to explain, as ironic as it may be, a new materialism must learn to read religion like the postfoundational materialists we claim to be rather than looking to it for indications of an idealism we want to designate as an enemy. In repeating Nietzsche, Derrida effectively leaves the real issue—the excess of phenomenal immanence that disturbs everyday life—outside his readerly frame.

The subterranean insight, ever articulated and always immediately forgotten, Althusser understands as a countermaterialism, a “completely different mode of thought” to the “various materialisms on record,” including (he tells us) that of Marx, Engels, and Lenin as these tend to be understood (167).

In fact, Althusser finds the renewal and liberation of this subterranean materialism also in Heidegger, so it is no surprise that Althusser claims that this materialism eludes “the classical criteria of every materialism” and that, in this respect, “We continue to talk about a materialism of the encounter only for the sake of convenience” (171, my emphasis).

As bearers and heralds of this subversive and subterranean “current” of thought, Althusser mentions Lucretius, Spinoza, Machiavelli, Hobbes, Rousseau, Marx, Heidegger, and Derrida.

Althusser is repeatedly at pains to suggest that “religion” is precisely the mode of thought which is rendered inoperable by a materialism of the encounter. 12 T

I will return shortly to some of the comparisons to be discerned between Breton’s Paul and the late Althusser. But, for the moment I want to repeat very directly that it is a materialism of the encounter itself which, on its own terms, cannot allow either “religion” or Paulinism to remain unscathed or self-enclosed as the idealism they might even think themselves to be.

This only do I want to know: were you interpellated when you lived like the Jerusalem community or when we lived as we do in Galatia where we heard and believed? We the believing, we’re the real kids of Abraham. —cf. Paul to the Galatians (3:2, 7

One of the important things about Derrida’s genealogy of Epicurean clinamen in “My Chances/Mes Chances: A Rendezvous with Some Epicurean Stereophonies” is the way it inflects and avows the materialism of his early and career-making doctrines about writing and dissemination

Derrida writes: “Of course, I still dream of resurrection. But the resurrection I dream of, for my part, at the ends of the verdict, the resurrection I’m stretched out toward, would no longer have to be a miracle, but the reality of the real, quite simply, if it’s possible, ordinary reality finally rendered, beyond fantasy or hallucination” (87). The beatific conjuring of the final act of this dialogue, then, is one in which the textual persona of the philosopher, so wearied with the weaving and unweaving of discourses of truth as unveiling (cf. 39f.), finds himself happy in the everyday, not tormented by desire either to veil or to unveil but contented in the everyday as a “new finitude” (87, emphasis added).

Put differently, why is Derrida’s essay so docile in the face of Paul’s texts, even if this docility functions in the service of criticizing Paulinism as a discourse of (both) veiling and unveiling which—precisely —must be eluded as part the old epoch of “truth as onto-logical revelation” (83)? Derrida’s is here the same laziness or dogmatism we noted in Althusser’s text, a laziness or dogmatism—we should never forget—which is simply the obverse of the (initially) self- protective gesture of Breton as ecclesiastical gatekeeper of Paulinism

can be anybody’s birthday? What, can the identical day that has once occurred recur again and again [Quid? idemne potest esse dies saepius qui semel fuit?]? It is definitely not possible [Certe non potest]…. Is a person’s birthday to be observed when he is dead [etiamne post mortem coletur]? Such a provision ill became one whose “intellect had roamed” over unnumbered worlds and realms of infinite space, without shores or circumference [innumerabiles mundos infinitasque regiones, quarum nulla esset ora, nulla extremitas]. —Cicero, On Ends, 101 (II.xxxi

As you may recall, in a foreshadowing of Pierre Hadot, the later Michel Foucault, and Peter Sloterdijk, the young Marx takes up Hellenistic philosophy for its significance as an indication of the “subjective form” (rather than “metaphysical content”) of the philosophical enterprise. For Marx, as for the later thinkers, this period of philosophy becomes important, above all, for its indications of—one might say—spiritual exercises.

Marx finds in the philosophical archive pointers about the possibility of thought as a disciplined “way” of life in practice, practicing at life. Indeed, it is this aspect of the practice of philosophy that, Marx argues, constitutes the often elided chasm of difference between the philosophical systems of Democritus and Epicurus. In Marx’s genealogy, Democritus thinks that subjective appearance is mere appearance, a merely subjective effect of causal structures that constitute a systematic whole in their own right. Radically different, according to Marx, is the Epicurean view that the subjective is itself grounded without reserve in the movement of atoms in a way that precludes any dualism of the phenomena, quilting together more primordially natural ground and phenomenal perspective on the same

Cicero and Aquinas alike must not be given Roman instrumental control over these celebratory sessions. Serres summarizes the point by reference to the simulacra numinum of Lucretius, those simulations or images which cut across vectors of space and time like so many nomads, rogue wanderers (recall, precisely, Cicero’s joking sarcasm about Epicurus’s mind) along fragments of time. 32 Such ghosts, such simulacra, are as real, as material, as anything (and everything)

Why are there celebratory banquets for the undead rather than nothing? To understand, we will need a new model of myth that will have nothing to do with the need of the critics of “ontotheology” always and ever to imagine religion as wanting to be thought of as a stable doubling structure of the world in another one. Rather, as Serres writes, these stochastic emergences “are brought back to zero by deterioration, ruin and death. But, temporarily, they form” (22). Indeed, and so did Paulinism, for a while until its expectations and desires faded and his curators therefore pretended as though he had been teaching the stabilities of a pop Platonic universe

Breton once said about Christianity, something I think we should affirm in relationship to materialism as well: “We consequently relinquish the image of a simple body that the dream of a new alchemy would disengage under the sign of critique at the end of its effort. Authentic Christianity [sic] is not behind us: it is in front of us.”