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During the eighteenth century, British publishers capitalized on a growing market for educational toys with board games aimed at teaching geography. These games used maps as game boards, encouraging children to view maps as sites of play. Yet the fixed version of the world presented in a gameboard map was often at odds both with the political realities of the period and with the rapid overturns of chance-driven gameplay. This essay analyses a series of surviving games from the period, illustrating the evolution of the geographical game from an eighteenth-century tool of nationalist propaganda to a more subversive nineteenth-century form that took advantage of board games’ inherent association with chance. In the board game, publishers found a visual form that could unite cartography with unpredictability and that could train players to read maps as stable representations of an unstable world. The mechanism of the game itself – its relationship to chance and unpredictability – ultimately came to be seen as a useful device for structuring the Romantics’ relationship to a world in flux.
Clinical decision-making in psychiatry is affected by many factors, including how best to reduce risks of harm while promoting autonomy and personal recovery. This article proposes guidance for clinical decision-making that is consistent with civil liability law. It emphasises collaboration, clarification of the available information and communication of decisions as a basis for recovery-oriented risk management.
This article examines the politics of wine making in Alsace in the two decades after the region returned to French rule in 1918. During these years Alsatian wine makers worked to transform their wines to meet the tastes of French drinkers, following five decades of producing wine for German consumption. As wine makers grappled with the question of how to secure the future of their industry, Alsatian wine became emblematic of the most contentious aspects of Alsace's reintegration into France. The introduction of new laws on viticulture raised the question of what was French about wine, the wine industry's woes symbolised the difficulties of Alsace's economic reintegration and wine became an emblem for often fierce wrangling over identity and belonging in the recovered region. This article traces this process and argues that while wine became a symbol of the complications of reintegration, its importance in understandings of French national culture equally allowed it to offer a solution to the problems that return to France caused for Alsace's wine industry in the interwar years. In this way, this case study of the politics of wine making in Alsace is suggestive of wine's broader power as a symbol of national belonging.
In 2012, the American Heart Association and the American Academy of Paediatrics released a scientific statement with guidelines for the evaluation and management of the neurodevelopmental needs of children with CHD. Decades of outcome research now highlight a range of cognitive, learning, motor, and psychosocial vulnerabilities affecting individuals with CHD across the lifespan. The number of institutions with Cardiac Neurodevelopmental Follow-Up Programmes and services for CHD is growing worldwide. This manuscript provides an expanded set of neurodevelopmental evaluation strategies and considerations for professionals working with school-age children with CHD. Recommendations begin with the referral process and access to the evaluation, the importance of considering medical risk factors (e.g., genetic disorders, neuroimaging), and the initial clinical interview with the family. The neurodevelopmental evaluation should take into account both family and patient factors, including the child/family’s primary language, country of origin, and other cultural factors, as well as critical stages in development that place the child at higher risk. Domains of assessment are reviewed with emphasis on target areas in need of evaluation based on current outcome research with CHD. Finally, current recommendations are made for assessment batteries using a brief core battery and an extended comprehensive clinical battery. Consistent use of a recommended assessment battery will increase opportunities for research collaborations, and ultimately help improve the quality of care for families and children with CHD.
Background: Many institutions have reported transmission of multidrug-resistant organisms to patients from colonized sinks. Prior data have shown that bacterial colonization of the sink drain, which can occur via biofilm from a colonized p-trap or via seeding from above, results in dispersion of bacteria in the area of the sink when water from the faucet comes in contact with the drain. Heat disruption of biofilm formation between the p-trap and sink drain is a potential strategy in preventing colonization of sink drains. Methods: In an academic center hospital, 54 tail-piece heaters were installed in 3 intensive care units and 2 acute-care units in an associated regional hospital. Half of the installed devices were sham (no heat). The devices were programmed to heat the tail piece to 72C for 1 hour every fourth hour. Rooms were randomized to heating or sham devices on a 1:1 basis within each unit. Sink drains and p-traps were sampled biweekly. Samples were assessed for semiquantitative growth of gram-negative bacteria on MacConkey agar, looking especially for Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Carbapenemase-producing Enterobacterales (CPE) was detected by broth enrichment followed by growth on Colorex KPC agar. Frontline personnel were blinded to device assignment. Results: Linear mixed modeling revealed reduced risk of detectable gram-negative bacteria (OR, 0.16; 95% CI, 0.037–0.536) and Enterobacterales (OR, 0.17; 95% CI, 0.368–0.668) in sink drains with a heating device (Fig. 1), but no difference in risk of detectable P. aeruginosa or S. maltophilia (Table 1). We detected a trend toward reduction in CPE that did not reach statistical significance, and there was no difference in risk for detection of any bacteria in the p-trap between heating and sham devices. Audits of devices demonstrated that few reached the target heating temperature of 72C (median, 65.9C; range, 50.1–73.7C). Conclusions: Disruption of biofilm between the p-trap and the sink drain is a promising strategy for the prevention of sink-drain colonization with clinically important bacteria. The presence of a heating device was associated with reduced risk of detectable gram-negative organisms, specifically Enterobacterales, in sink drains. The limitations of this study included low overall rates of positivity for certain pathogens, including CPE, and suboptimal, inconsistent performance across heating devices. Further work with a larger sample size and more consistent heating devices is warranted, as are data regarding patient outcomes as a result of such interventions.
Background:Staphylococcus aureus (S. aureus) is the second most common cause of healthcare-acquired infections in neonates. S. aureus colonization is a known risk factor for invasive disease. Aside from healthcare workers (HCWs), recent data suggest that parents are important reservoirs of S. aureus in the neonatal intensive care unit (NICU). S. aureus typically colonizes the nares, but it can also colonize other anatomic locations such as the throat. Objective: Our objectives were to identify and compare S. aureus colonization among HCWs and parents and to identify and compare different sites of S. aureus colonization. Methods: Between April 2015 and July 2016, we performed 4 point-prevalence surveys and collected nares and throat swabs from HCWs (nurses, respiratory therapists, nurse practitioners, and physicians) at a quaternary-care NICU. During an overlapping period, we screened parents of neonates in the NICU for S. aureus colonization using nares, throat, groin, and perianal cultures as a part of an ongoing randomized control trial. Cultures from both studies were collected using standardized methods. ESwabs were used to collect samples, which were inoculated into broth for enrichment and subsequently cultured onto chromogenic agar to differentiate between MSSA and MRSA. Results: The prevalence of methicillin susceptible S. aureus (MSSA) colonization was 46% (105/226) in HCWs and 28% (239/842) in parents. The prevalence of methicillin resistant S. aureus (MRSA) colonization was 2.2% (5/226) in HCWs and 2.2% (19/842) in parents. Of those who were colonized with S. aureus, 35% (79/226) of HCWs and 46.5% (160/344) of parents had nares and throat colonization while 11.5% (26/226) of HCWs and 12.2% (42/344) of parents had only throat colonization but not nares colonization. Of those who were MRSA colonized, 1.3% (3/226) of HCWs and 1.8% (15/842) of parents had a positive nares and throat culture as compared to 0.9% (2/226) of HCWs and 0.2% (2/842) of parents had only positive throat cultures. Additionally, 68% (175/257) were colonized with S. aureus at any swabbed site including nares, throat, groin, or perinanal areas. However, only 30% (77/257) of parents had only nares colonization as compared to 58.8% (151/257) had throat and nares colonization, 38.1% (98/257) had nares and groin colonization, and 37.4% (96/257) had nares and perianal colonization. Conclusions: HCWs had greater prevalence of S. aureus colonization compared to parents. As expected, the nares was the most common site of MSSA and MRSA, but a large proportion of S. aureus colonized HCWs and parents had only throat colonization. Given the prevalence of S. aureus in non-nares sites of HCWs and parents in the NICU, further studies should examine the role of non-nares carriers in the transmission of S. aureus in this population.
Disclosures: Aaron Milstone reports consultancy with Becton Dickinson.
There is increasing evidence of a strong association between sleep and mental health in both adolescents and adults. CBT for insomnia is being applied to good effect with adults with mental health difficulties but there are few studies examining its applicability to adolescents within mental health services.
We carried out a case series analysis (n = 15) looking at the feasibility, accessibility and impact of a low-intensity sleep intervention for young people (14–25 years) being seen by a secondary care Youth Mental Health team in the UK. The intervention was based on cognitive behavioural therapy for insomnia (CBTi) and acceptance and commitment therapy (ACT) approaches and involved six individual sessions delivered on a weekly basis by a graduate psychologist. Routine outcome measures were used to monitor insomnia, psychological distress and functioning with assessments at baseline, session 3, session 6 and at 4 weeks after end of intervention. All participants scored in the clinical range for insomnia at the start of the study.
High uptake, attendance and measure completion rates were observed. Large effect sizes were observed for insomnia, psychological distress and functioning. Twelve of the fifteen participants (80%) no longer scored above threshold for insomnia at follow-up. All seven under-18s no longer met threshold for clinical ‘caseness’ on the Revised Child Anxiety and Depression Scale (RCADS) at follow-up.
The findings suggest that the intervention was well accepted by young people and feasible to apply within a secondary care setting. Strong effect sizes are encouraging but are probably inflated by the small sample size, uncontrolled design and unblinded assessments.
A GERMAN PROVERB PARAPHRASING an old Carolingian maxim observed, “He who has stayed at school till the age of twelve, and never ridden a horse, is fit only to be a priest.” The aphorism obliquely refers to the chief practitioners of the medieval horse culture, the secular nobility, who received rigorous instruction in horsemanship from an early age. One particularly demanding aspect of this lifelong education entailed the schooling of horse and rider in the performance of turns. These moves, in contrast to the one directional charge of set battles and jousts, demonstrate the maneuverability to perform feigned retreats as well as skirmishing and ravaging warfare, now considered the most prevalent form of medieval mounted combat. The topic requires laying extensive groundwork to make certain principles of horsemanship and horse training intelligible to the uninitiated reader, a process that involves enhancing the meaning of texts discussed previously.
Emergence of the Western European Equestrian Tradition
At either end of the chronological spectrum two treatises, Arrian's Ars Tactica of c. 136–37 CE and Federico Grisone's Ordini di Caualcare of 1550, explained equestrian maneuvers. For the intervening period in the Latin West, information on horse training is scattered in various sources. Medieval horse trainers were men of action who transmitted their knowledge through oral tradition. The best practitioners were not always the best explicators. The Histoire de Guillaume le Maréchal, has little to say about the subject. His career illustrates the tremendous upward social mobility that could be achieved in this medieval horse culture. William Marshal managed to parlay his skills as tournament champion into major governmental service, eventually becoming Regent of England. King Duarte of Portugal, the author of a treatise on horsemanship, had intended to write a complementary work on the training of war horses; unfortunately, the plague prematurely ended his life. Grisone, who acquired a reputation for brutal training methods, still set down in writing principles that represent the culmination of the medieval oral tradition, and the widespread acceptance of the work ensured its preeminence as the foundation of the European equestrian heritage.
Before the development of a public health system and before vaccinations, antibiotics and modern diagnostics became widespread, orphans were commonplace. It should come as no surprise then that the orphan figure has been a standard in children's literature since its modern inception with texts like Newbery's The History of Little Goody Two-Shoes (1765) and that orphaned children continue to be stock characters throughout modern children's literature. Although there are some ensemble casts in children's orphan stories – for instance, the two waifs at the heart of Brenda's Froggy's Little Brother (1875) – the orphan in children's literature is most often a single child outside, or teetering on the margins of, family life. Even when the child protagonist is part of an established family group they may be symbolically orphaned or isolated from the core family unit for extended periods of time. In many cases, the child protagonist removes themselves voluntarily from the family home, as Jim Hawkins does in R. L. Stevenson's Treasure Island (1883) and Huckleberry Finn does in Mark Twain's novels of 1876 to 1896, in order to experience life beyond the limits of the domestic space. In such cases, the absence of parents, or at the very least the absence of attentive, nurturing parents, is a neat narrative trick performed in the opening chapters of the book, allowing the child character unprecedented levels of freedom, increased agency and the opportunity to have meaningful adventures free from adult oversight. These adventurous orphans and pseudo-orphans are almost exclusively male and although they seem to turn aside from established social orders, their travels and experiences actually prepare them to attain a more secure position within society. Christopher Parkes has argued persuasively that ‘Treasure Island grooms its hero, Jim Hawkins, to take his place in [an] emergent class’ (332) of modern civil servants, clerks and imperial administrators. While these adventures initially appear to distance Jim from his homeland and his society, they ultimately prepare him to become even more tightly integrated within middle-class British society.
The ‘preparatory lone adventure’ narrative is not normally available to female protagonists, who must instead attain the knowledge, agency and awareness to become meaningful players within wider society while operating within the confines of the domestic space and the family circle.
This chapter, which is divided into two parts, includes the script of the performance lecture Men in Waiting, preceded by the research on art and migration that underpins it. The project is in part a phenomenology of incarceration that studies what happens to perception when it is limited to the prison architecture used for immigration detention in the United Kingdom. It is also an artistic enactment of that subjectivity, and this text is a reflection on the time and space produced in this performative reflection. Through puppetry the performance takes place in a shadow world, not unlike that of Plato’s protagonist in the Republic who seeks to bring the people to enlightenment and is made a martyr as a result. Plato’s allegory would indicate that we all have access to the human condition of confinement in the dark with only shadows. However, the specific shadowside of the world as seen through the United Kingdom’s immigration detention centres was what this Darwin Lecture immersed the audience in. Writing and performing this play was a way to sit with the shadow, and within the shadow.
The podcasts highlight work from our partners: Indiana University, Purdue University and the University of Notre Dame.
Our goal is to expand our podcast reach to include work from at least three additional CTSAs, as well as highlighting the benefits of translational research to the public.
Aaron E. Carroll, is the director of Education and Workforce Development for the Indiana CTSI and a popular writer covering health, research, and policy for The New York Times. He is host of the Indiana CTSI-sponsored Healthcare Triage podcasts as well as the Healthcare Triage YouTube show, with 340,000 subscribers. We will leverage his audience and research expertise to grow the Indiana CTSI podcast participation and increase audience engagement.
We will eventually allow the nation-wide network of CTSAs to pitch guests and shows covering Translational Research, and invite local CTSA leadership or faculty to participate in the podcast.
Utilizing quantitative analytics, we expect to see a significant increase in podcast downloads and listeners as we expand our offering to other CTSAs, beyond Indiana
We expect that the CTSA-wide podcast will increase the nationwide level of knowledge and understanding of NCATS, translational research, and its benefits to society and healthcare.
We anticipate, through this expanded podcast offering, a growing number of community members who are informed and engaged on the topics of translational research, clinical and translational sciences and beyond.
DISCUSSION/SIGNIFICANCE OF IMPACT:
Podcasts are a convenient, portable, and efficient form of science communication.
Podcasts also make information personal and offer us an excellent and innovative communications vehicle to spread the word about translational research, as well as the excellent work happening at each of our CTSAs.
Recent evidence suggests that quitline text messaging is an effective treatment for smoking cessation, but little is known about the relative effectiveness of the message content.
A pilot study of the effects of gain-framed (GF; focused on the benefits of quitting) versus loss-framed (LF; focused on the costs of continued smoking) text messages among smokers contacting a quitline.
Participants were randomized to receive LF (N = 300) or GF (N = 300) text messages for 30 weeks. Self-reported 7-day point prevalence abstinence and number of 24 h quit attempts were assessed at week 30. Intent-to-treat (ITT) and responder analyses for smoking cessation were conducted using logistic regression.
The ITT analysis showed 17% of the GF group quit smoking compared to 15% in the LF group (P = 0.508). The responder analysis showed 44% of the GF group quit smoking compared to 35% in the LF group (P = 0.154). More participants in the GF group reported making a 24 h quit attempt compared to the LF group (98% vs. 93%, P = 0.046).
Although there were no differences in abstinence rates between groups at the week 30 follow-up, participants in the GF group made more quit attempts than those in the LF group.
To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.
A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.
Navajo Nation, USA.
Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.
The Navajo Fruit and Vegetable Prescription (FVRx) Programme.
A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.