Imperialism Rise in Nationalism • During the French and Industrial Revolution, nationalism continued to inspire nations to increase their political and economic power. • Nationalism became the ideal force in the political, economic, and cultural life in the world, becoming the first universal ideology-organizing all people into a nation state. Nationalism Defined • The strong belief that the interest of a particular nation-state is of primary importance. o Nation-State – a state where the vast majority shares the same culture and is conscious of it. It is an ideal in which cultural boundaries match up with political ones. • As an ideology, it is based on the idea that the individual’s loyalty and devotion to the nation-state surpass other individual/group interests. • Exalting one nation’s belief above all others and placing primary emphasis on promotion of its culture and interests, excluding the interests of others. Changing the World through a Nationalistic Vision • The French Revolution significantly changed the political world and how countries govern. • The Industrial Revolution significantly changed the economic world. • The Age of Imperialism (1870-1914) dramatically changed the political, economic, and social world. What is Imperialism? • Imperialism- The policy of extending the rule of authority of an empire or nation over foreign countries, or of acquiring and holding colonies and dependencies. Power and influence are done through diplomacy or military force. Reasons for Imperialism • There are 5 main motives for empires to seek to expand their rule over other countries or territories: 1. Exploratory • Imperial nations wanted to explore territory unknown to them. • The main purpose for this exploration of new lands was for resource acquisition, medical or scientific research. o Charles Darwin • Other reasons: o Cartography (map making) o Adventure 2. Ethnocentric • Europeans acted on the concept of ethnocentrism o Ethnocentrism- the belief that one race or nation is superior to others. • Ethnocentrism developed out of Charles Darwin’s “survival of the fittest” theory. Philosophers used the theory to explain why there were superior races and inferior races. o This became known as Social Darwinism. • Most imperial nations believed that their cultural values or beliefs were superior to other nations or groups. • Believed imperial conquest would bring successful culture to inferior people. 3. Religious • Imperial expansion promoted a religious movement of people setting out to convert new members of conquered territories. • With the belief that Christianity was superior, missionaries believed it was their duty to spread Christianity to the world. • Christian missionaries established churches, and in doing so, they spread Western culture values as well. • Typically, missionaries spread the imperial nation's language through education and religious interactions. 4. Political • Patriotism and Nationalism helped spur our imperial growth, thus creating competition against other supremacies. • It was a matter of national pride, respect, and security. • Furthermore, European rivalry spurred nations for imperial conquest. Since land equaled power, the more land a country could acquire the more prestige they could wield across the globe. • Empires wanted strategic territory to ensure access for their navies and armies around the world. • The empire believed they must expand, thus they needed to be defended. 5. Economic • With the Industrial Revolution taking place during the same time, governments and private companies contributed to find ways to maximize profits. • Imperialized countries provided European factories and markets with natural resources (old and new) to manufacture products. • Trading posts were strategically placed around imperialized countries to maximize and increase profits. o Such places as the Suez Canal in Egypt which was controlled by the British provided strategic choke hold over many European powers. o Imperial powers competed over the best potential locations for resources, markets, and trade. History of Imperialism • Ancient Imperialism 600 BCE-500 CE o Roman Empire, Ancient China, Greek Empire, Persian Empire, Babylonian Empire. • Middle Age Imperialism (Age of Colonialism-1400-1800s) o Great Britain, Spain, Portugal, France, Netherlands (Dutch), Russia. • Age of Imperialism 1870-1914 o Great Britain, Spain, Portugal, France, Germany, Belgium, Italy, Japan, United States, Ottoman Empire, Russia. • Current Imperialism...? o U.S. Military intervention (i.e. Middle East) o Russia’s Invasion of Ukraine. Imperialism Colonialism • Refers to political or economic control, either legally or illegally. • Refers to where one nation assumes control over the other. • Creating an empire, expanding into neighboring regions and expanding the dominance far outside its borders. • Where a country conquers and rules over other regions for exploiting resources from the conquered country for the conqueror's benefit. • Foreign government controls/governs a territory without significant settlement. • Foreign government controls/governs the territory from within the land being colonized. • Little to no new settlement established on fresh territory. • Movement to settle to fresh territory. Age of Colonialism WHEN? • Started around the late 1400s and ended around the late 1700s/early 1800s. WHY? • Primary Reason: European countries, wished to find a direct trade route to Asia (China & India) and the East Indies. o Quicker and relatively more effective than land routes over Asia. • Secondary Reason: Empire expansion (land power) WHO? • Countries involved: Great Britain, France, Spain, the Dutch & Portugal. • Individuals’ knowns as Mercantilists believed that maintaining imperialized territory and colonizing the region could serve as a source of wealth, while personal motives by rulers, explorers, and missionaries could therefore promote their own agenda. o This agenda being “Glory, God and Gold”. Mercantilism • Mercantilism was a popular and main economic system for many European nations during the 16th to 18th centuries. • The main goal was to increase a nation’s wealth by promoting government rule of a nation’s economy for the purpose of enhancing state power at the expense of rival national power. • It was the economic counterpart of political absolutism. Why did mercantilists want colonies? • Mercantilists believed that a country must have an excess of exports over imports. • By colonizing territory, it provided the nation with indispensable wealth of precious raw materials. • Therefore, the claimed territory served as a market and supplier of raw materials for the mother country. Which, in time, provided an excess of exports for the nation and thus created wealth. o Development of Trading Companies to support this economic system. Hudson Bay Company – (1670). Controlled primarily North America. o Dutch East Indie Trading Company (1682) o East Indian Trading Company (1600) o Royal African Trade Company (1672) WHERE? • European nations begun to colonize the America, India and the East Indies to create a direct trade route. • Great Britain was the leading power in India, Australia and North America, South Africa. • Spain colonized central and South America. • French held Louisiana, coastal land of Africa and French Guinea. • The Dutch built an empire in the East Indies. • The Portuguese was able to take control of present-day Brazil and the southern tip of South America and Japan. Age of Colonialism • As countries started to imperialize these regions, eventually the concept of colonization took hold: • This is what makes the Age of Colonialism extremely different! End of Colonialism • By 1800, colonialism became less popular • Why? o Revolutions (Spain, France & American) o The Napoleonic Wars o Struggle for nationalism and democracy. o Exhausted all money and energy to supervise their colonies. Waiting to wake again • Imperialism would stay quiet for close to 50 years before Great Britain and France’s economies revitalized. • The outbreak of the Industrial Revolution only encouraged and revitalized European nations to begin their conquest for new territory and resources. Age of Imperialism THE SCRAMBLE FOR AFRICA 1870-1914 Conditions Prior to Imperialism of Africa  European interest in exploiting Africa was minimal.  Their economic interests & profit in Africa primarily came through coastal trade that took place during the 1500-1700s.  The slave trade became the main source of European profit.  Furthermore, disease, political instability, lack of transportation and unpredictable climate all discouraged Europeans from seeking territory. Slave Trade & the Trans-Atlantic Slave Voyages  Forced labor was not uncommon during the 13-17th Centuries. Africans and Europeans had been trading goods and people across the Mediteranea for centuries.  This all changed from 1526 to 1867, as a new system of slavery was introduced that became highly “commercialized, racialized and inherited”  By 1690, the America and West Indies saw approximately 30,000 African people shipped from Africa. A century later, that number grew to 85,000 people per year.  By 1867, approximately 12.5 million people (about twice the population of Arizona) left Africa in a slave ship. What Changed? 1. End of the Slave Trade- Left a need for trade between Europe and Africa. 2. Innovation in technology- The steam engine and iron hulled boats allowed Europe 3. Discovery of new raw materials- Explorers located vast raw materials and resources and this only spurred imperialism with Europe in the wake of the Industrial Revolution. 4. Politics- Unification of Germany and Italy left little room to expand in Europe. Germany and Italy both needed raw materials to “catch up” with Britain and France so they looked to Africa. The Scramble for Africa  The scramble started in 1870.  Although some coastal land had previously been acquired before 1870, the need for territory quickly accelerated as European countries looked t get deeper into Africa.  Within 20 years, nearly all continents were placed under imperialistic rule. Who was Involved?  Great Britain  France  Germany  Italy  Portugal  Belgium  Spain (kind) Violent Affairs  Violence broke out multiple times when European nations looked to claim the same territory.  Germ Chancellor. Otto van Bismarck. Attempted to avert the possibility of violence against the European powers.  In 1884, Bismarck organized a conference in Berlin for the European nations. The Berlin Conference (1884-85)  The conference looked to set ground rules for future annexation of African territory by European Nations.  Annexation is the forcible acquisition and assertion of legal title over one state’s territory by another state, usually following military occupation of the territory.  From a distant perspective, it looked like it would reduce tensions among European nations and avert war.  At the heart of the meeting, these European countries negotiated their claims to African territory, made it official and then mapped their regions.  Furthermore, the leaders agreed to allow free trade among imperialized territory and some homework for negotiating future European claims in Africa was established. Further Path  After the conference, european powers continued to expand their claims in Africa so that by 1900. 90% of the African territory had been claimed. A Turn towards Colonization?  Upon the imperialization of African territory, European nations and little interest in African land unless it produced economic wealth.  Therefore, European governments put little effort and expertise into these imperialized regions.  In most cases, this emat a form of indirect rule. Thus, governing the natin without sufficient settlement and government from within the mother country. Some Exceptions  There were some exemptions through in Africa as colonization was a necessary for some regions i n Africa.  Some regions where diamonds and gold were present. Government looked to protectorate the regions and establish rule and settlement in the regions.  Protectorates: A state controlled and protected by another state for defense against aggression and other law violations. Would  Some examples include South Africa, Botswana, Zimbabwe and Congo. Conclusion  Although it may appear that the Berlin Conference averted war amid the African Scramble, imperialism eventually brought the world into worldwide conflict.  With the continued desire to create an empire by European nations. World War 1 would break out which can be linked to this quest at imperialism.

Note

Studied by 11 people

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Chapter 14 - Amniotic Fluid

Physiology

Function

Amniotic fluid is present in the amnion, a membranous sac that surrounds the fetus.
It acts as a cushion for the fetus, allows fetal movement, stablizes the temperature, permits proper lung development and allows exchanges of water and chemicals to take place between the fluid, the fetus and the maternal circulation (intramembranous flow).

Volume

Amniotic fluid volume is regulated by a balance between the production of fetal urine and lung fluid and the absorption from fetal swallowing and intramembranous flow.
The amount of amniotic fluid increases throughout pregnancy.
- During the first trimester, approximately 35 mL of amniotic fluid is derived primarily from the maternal circulation.
- After the first trimester, fetal urine is the major contributor to the amniotic fluid volume and it is regulated by fetal swallowing.
- Failure to swallow results in accumulation (polyhydramnios) and is an indication of fetal distress.
  - It is often associated with neural tube disorders, fetal structural anomalies, cardiac arrhythmias, congenital infections or chromosomal abnormalities.
- Increased fetal swallowing, urinary tract deformities and membrane leakage are possible causes of decreased amniotic fluid (oligohydramnios).
  - Oligohydramnios may be associated with umbilical cord compression, resulting in decelerated heart rate and fetal death.
- During the latter third to half of pregnancy, the fetus secretes a volume of lung liquid necessary to expand the lungs with growth.
- During each episode of fetal breathing movement, secreted lung liquid enters the amniotic fluid, as evidenced by lung surfactants that serve as an index of fetal lung maturity.
- During the third trimester, amniotic fluid reaches a peak volume of 1 L.

Chemical Composition

Amniotic fluid has a composition similar to that of the maternal plasma and contains a small amount of sloughed fetal cells from the skin, the digestive system and the urinary tract.
The fluid also contains biochemical substances that are produced by the fetus, such as bilirubin, lipids, enzymes, electrolytes, nitrogenous compounds and proteins.
The chemical composition of the amniotic fluid changes when fetal urine production begins.
- The concentrations of creatinine, urea and uric acid increase, whereas glucose and protein concentrations decrease.
- Concentrations of electrolytes, enzymes, hormones, and metabolic end products also vary but are of little clinical significance.

Maternal Urine vs Amniotic Fluid

	Maternal Urine	Amniotic Fluid
Creatinine	>3.5 mg/dL, as high as 10 mg/dL	<3.5 mg/dL
Urea	>30 mg/dL, as high as 300 mg/dL	<30 mg/dL
Glucose	negative	positive
Protein	negative	positive
Fern Test	negative	positive

In the fern test, a vaginal fluid specimen is spread on a glass slide, air-dried at room temperature, and observed microscopically for the presence of “fern-like” crystals.

Specimen Collection

Collection

Amniotic fluid is obtained by needle aspiration into the amniotic sac, a procedure called amniocentesis.
- The procedure most frequently performed is a transabdominal amniocentesis.
- Using continuous ultrasound for guidance, the physician locates the fetus and placenta to safely perform the procedure.
- A thin, hollow needle is inserted through the mother’s abdomen into the mother’s uterus and into the amniotic sac to aspirate the amniotic fluid.
- Vaginal amniocentesis may also be performed; however, this method carries a greater risk of infection.
In general, amniocentesis is a safe procedure, particularly when performed after the 14th week of gestation.
- Fluid for chromosome analysis is usually collected at approximately 16 weeks’ gestation, whereas tests for fetal distress and maturity are performed later in the third trimester.
A maximum of 30 mL of amniotic fluid is collected in sterile syringes.
- The first 2 or 3 mL collected can be contaminated by maternal blood, tissue fluid, and cells and are discarded.
- All fluid for chemical testing should be separated from cellular elements and debris using centrifugation or filtration as soon as possible to prevent distortion of chemical constituents by cellular metabolism or disintegration.
- Fluid for bilirubin analysis in cases of hemolytic disease of the newborn (HDN) are placed in amber-colored tubes or covered with a black plastic cover to protect from light.
- Fluid for fetal lung maturity (FLM) tests should be placed in ice and can be refrigerated or frozen up to 72 hours prior to testing.
- Frozen specimens should be thoroughly mixed, by vortexing, after thawing.
- Repeated freeze-thawing is not recommended.
- Filtration is recommended for FLM methods to prevent loss of the phospholipids.
- Specimens for cytogenetic studies are maintained at room temperature or body temperature (37°C incubation) prior to analysis to prolong the life of the cells needed for analysis.

Indications for Amniocentesis

Amniocentesis is recommended when blood screening tests and ultrasonography yield results that are abnormal.
Biochemical substances produced by the fetus can be analyzed by fluorescence polarization and thin-layer chromatography to evaluate the health of the fetus.
- Fetal epithelial cells in amniotic fluid indicate the genetic material of the fetus and the biochemical substances that the fetus has produced.

Indications for Performing Amniocentesis

Amniocentesis may be indicated at 15 to 18 weeks of gestation for the following conditions to determine early treatment or intervention:
- mother’s age of 35 or more at delivery
- family history of chromosome abnormalities, metabolic disorders and genetic diseases
- earlier pregnancy or child with birth defect or neural tube disorder
- elevated maternal serum alpha fetoprotein
- abnormal triple marker screening test
- three or more miscarriages
Evaluation of amniocentesis is indicated later in the pregnancy (20 to 42 weeks) to evaluate:
- fetal lung maturity
- fetal distress
- hemolytic disease of the newborn caused by Rh blood type incompatibility
- infection

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Appearance

Color	Clinical Significance
colorless	normal
slight to moderate turbidity	normal (late stage of fetal development)
blood-streaked	traumatic tap, abdominal trauma, or intra-amniotic hemorrhage
yellow	presence of bilirubin, red blood cell destruction (HDN)
dark green	presence of meconium (newborn’s first bowel movement)
dark red-brown	fetal death

Tests for Fetal Distress

Hemolytic Disease of the Newborn

Initial exposure to foreign red cell antigens occurs during gestation and delivery of the placenta, when fetal red blood cells enter into the maternal circulation and stimulate the mother to produce antibodies to the antigen.
- These bind to the antigen on the fetal cells and destroy them, forming unconjugated bilirubin in the amniotic fluid.
The measurement of amniotic fluid bilirubin is performed by spectrophotometric analysis.
- The optical density (OD) of the fluid is measured in intervals between 365 nm and 550 nm and the readings plotted on semilogarithmic graph paper.
- In normal fluid, the OD is highest at 365 nm and decreases linearly to 550 nm, illustrated by a straight line.
- When bilirubin is present, a rise in OD is seen at 450 nm because this is the wavelength of maximum bilirubin absorption.
- The maximum absorbance of oxyhemoglobin occurs at 410 nm and can interfere with the bilirubin absorption peak, but it can be removed by extraction with chloroform if necessary.
- A control may be prepared by diluting commercial chemistry control sera 1 to 10 with normal saline and treating it in the same manner as the patient specimen.
- The difference between the OD of the theoretic baseline and the OD at 450 nm (absorbance difference ∆A450) represents the amniotic fluid bilirubin concentration, which is then plotted on a Liley graph to determine the severity of the hemolytic disease.
- Values falling in zone I indicate no more than a mildly affected fetus
- Values falling in zone II require careful monitoring.
- Values falling in zone III suggests a severely affected fetus.
  - Intervention through induction of labor or intrauterine exchange transfusion must be considered when a ∆A450 is plotted in zone III.

Neural Tube Defects

Increased levels of alpha-fetoprotein (AFP) in both the maternal circulation and the amniotic fluid can be indicative of the skin failing to close over neural tissue, causing fetal neural tube defects.
- AFP is the major protein produced by the fetal liver during early gestation (prior to 18 weeks).
Measurement of amniotic fluid AFP levels is indicated when maternal serum levels are elevated, a family history of previous neural tube defects exists, or there is a multiple pregnancy.
- Normal values are based on the week of gestational age, as the fetus produces maximal AFP between 12 and 15 weeks’ gestation, after which levels in amniotic fluid begin to decline.
- Both serum and amniotic fluid AFP levels are reported in terms of multiples of the median (MoM).
- A value two times the median value is considered abnormal (greater than two MoM) for both maternal serum and amniotic fluid.
Elevated amniotic fluid AFP levels are followed by measurement of amniotic acetylcholinesterase (AChE).
- The test is more specific for neural tube disorders than AFP.
- It should not be performed on a bloody specimen, because blood contains AChE.

Tests for Fetal Maturity

Fetal Lung Maturity

Respiratory distress syndrome (RDS) is the most frequent complication of early delivery and is a cause of morbidity and mortality in the premature infant.
- This disease is caused by a lack of lung surfactant, a substance that normally appears in mature lungs and allows the alveoli (air sacs of the lung) to remain open throughout respiration, prevent them from collapsing by decreasing surface tension and allow them to inflate with air more easily.

Lecithin-Sphingomyelin Ratio

Lecithin is the primary component of the surfactants (phospholipids, neutral lipids and proteins) that make up the alveolar lining and account for alveolar stability.
Lecithin is produced at a relatively low and constant rate until the 35th week of gestation, at which time a noticeable increase in its production occurs, resulting in the stabilization of the fetal lung alveoli.
- Sphingomyelin is also produced at a constant rate after about 26 weeks’ gestation and can serve as a control on which to base the rise in lecithin.
Prior to 35 weeks’ gestation, the L/S ratio is usually less than 1.6 because large amounts of lecithin are not being produced at this time, but It will rise to 2.0 or higher when lecithin production increases to prevent alveolar collapse.
- A preterm delivery is usually considered to be a relatively safe procedure.
- Falsely elevated results are encountered in fluid contaminated with blood or meconium as both these substances contain lecithin and sphingomyelin.
Quantitative measurement of lecithin and sphingomyelin is performed using thin-layer chromatography, but the procedure is labor intensive and subject to high coefficients of variation.
- Many have replaced it with more cost-effective procedures like phosphatidyl glycerol immunoassays, fluorescence polarization, and lamellar body density.

Amniostat-FLM

The presence of another lung surface lipid, phosphatidyl glycerol, is also essential for adequate lung maturity.
The production of phosphatidyl glycerol normally parallels that of lecithin, but its production is delayed in cases of maternal diabetes.
Respiratory distress occurs in the presence of an L/S ratio of 2.0.
The immunologic agglutination test for phosphatidyl glycerol is more rapid and does not require a laboratory to be equipped to perform thin-layer chromatography.

Foam Stability

It is a mechanical screening test used to determine the presence of individual lung-surface lipid concentrations.
To perform this procedure:
1. 0.5 mL of amniotic fluid is added to tubes containing increasing amounts of 95% ethanol ranging from 0.42 to 0.55 mL in 0.01-mL increments.
2. These are vigorously shaked for 15 seconds and then left to sit undisturbed for 15 minutes.
3. If a continuous line of bubbles forms around the outside edge, it indicates a sufficient amount of phospholipid is available to reduce the surface tension of the fluid even in the presence of alcohol, an antifoaming agent.
4. A value of 47 or higher indicates FLM.
Blood and meconium cause false-negative results as they can reduce surface tension.

Microviscosity: Fluorescence Polarization Assay

The presence of phospholipids decreases the microviscosity of the amniotic fluid, and this decrease can be measured using fluorescence polarization.
The TDx/TDxFLx Fetal Lung Maturity II (FLMII) assay is a reagent system for the quantitative measurement of the ratio of surfactant to albumin in amniotic fluid for assessment of lung maturity of the fetus.
- This assay measures the polarization of a fluorescent dye that combines with both surfactants and albumin.
- Dye bound to surfactant has a longer fluorescence lifetime and exhibits low polarization, whereas dye bound to albumin has a decreased fluorescence lifetime and has high polarization.
- Albumin is used as an internal standard in the same manner as sphingomyelin because it remains at a constant level throughout gestation.
- The recorded changes in polarization produce a surfactant/albumin ratio expressed in milligrams surfactant to grams albumin that is compared with a calibration standard curve that includes phosphatidyl glycerol and ranges from 0 to 160 mg/g.
- Sample results are calculated from the stored standard curve using polarization values generated for each sample.
- A value of 55 mg surfactant per gram albumin or greater provides a conservative indicator of FLM and lower values may be considered.
- Immature results with the FLM II assay are less than or equal to 39 mg/g.
  - Sequential L/S testing is recommended in such cases.
- Results between 40 mg/g and 54 mg/g cannot be declared “mature” or “immature” and must be evaluated with caution.
- An accurate gestational age is an important consideration in interpreting the results.
The test requires at least 1.0 mL of amniotic fluid that has been filtered rather than centrifuged to prevent sedimentation of the lipids and reporting a falsely decreased result.
Specimens contaminated with blood, meconium, suspected maternal urine and visibly icteric samples should not be used.

Lamellar Bodies and Optical Density

The surfactants responsible for FLM are produced and secreted by the type II pneumocytes of the fetal lung and stored in the form of structures termed lamellar bodies at about 20 weeks of gestation.
The lamellar bodies enter the alveolar spaces to provide surfactant and also enter the amniotic fluid at about 26 weeks of gestation.
As the fetal lung matures, increased lamellar body production is proportional to the increase in amniotic fluid phospholipids and the L/S ratio.
The presence of lamellar bodies increases the OD of the amniotic fluid.
- Specimens are centrifuged at 2000 g for 10 minutes and examined at a wavelength of 650 nm.
- An OD of 0.150 has been shown to correlate well with an L/S ratio of greater than or equal to 2.0 and the presence of phosphatidyl glycerol.
Lamellar body diameter is similar to that of small platelets; therefore, lamellar body counts (LBCs) can be obtained rapidly with use of the platelet channel of hematology analyzers.
- The various instruments use different principles to identify platelets and are usually not invalidated by the presence of lysed blood, bilirubin or meconium.
- LBCs performed on amniotic fluid stored at 4°C are stable for up to 10 days.
- A count of 32,000-35,400 (depending on instrument used) or more particles per microliter represents adequate FLM.

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