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Severe bleeding in complex pelvic fractures usually originates from branches of the internal iliac artery, presacral venous plexus, fractured bones, and soft tissues. Major iliac vascular injuries are encountered in about 10% of patients with severe pelvic fracture.
The abdominal aorta bifurcates into the two common iliac arteries at the L4-L5 level. The iliac veins are located posterior and to the right of the common iliac arteries. The ureter crosses over the bifurcation of the common iliac artery as it branches into the external and internal iliac arteries.
The internal iliac artery is about 4 cm long. At the level of the greater sciatic foramen, it divides into the anterior and posterior trunks. It supplies numerous splanchnic and muscular branches and terminates as the internal pudendal artery, which is a potential source of hemorrhage in anterior ring disruptions. Hemorrhage following pelvic fracture can occur from any branch.
The most commonly injured internal iliac artery branches (in decreasing order of frequency) are the superior gluteal, internal pudendal, and obturator arteries.
The superior gluteal artery is the largest branch of the internal iliac artery. It exits the pelvis through the greater sciatic foramen above the piriformis muscle. It provides blood supply to gluteus medius and minimus muscles.
The internal pudendal artery passes through the greater sciatic foramen, courses around the sciatic spine, and enters the perineum through the lesser sciatic foramen.
The obturator artery courses along the lateral pelvic wall and exits the pelvis through the obturator canal. In 30% of cases, the obturator artery is perfused from both internal and external iliac arteries, making angioembolization more complicated.
While the burden of dementia is increasing in low- and middle-income countries, there is a low rate of diagnosis and paucity of research in these regions. A major challenge to study dementia is the limited availability of standardised diagnostic tools for use in populations with linguistic and educational diversity. The objectives of the study were to develop a standardised and comprehensive neurocognitive test battery to diagnose dementia and mild cognitive impairment (MCI) due to varied etiologies, across different languages and educational levels in India, to facilitate research efforts in diverse settings.
A multidisciplinary expert group formed by Indian Council of Medical Research (ICMR) collaborated towards adapting and validating a neurocognitive test battery, that is, the ICMR Neurocognitive Tool Box (ICMR-NCTB) in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam), for illiterates and literates, to standardise diagnosis of dementia and MCI in India.
Following a review of existing international and national efforts at standardising dementia diagnosis, the ICMR-NCTB was developed and adapted to the Indian setting of sociolinguistic diversity. The battery consisted of tests of cognition, behaviour, and functional activities. A uniform protocol for diagnosis of normal cognition, MCI, and dementia due to neurodegenerative diseases and stroke was followed in six centres. A systematic plan for validating the ICMR-NCTB and establishing cut-off values in a diverse multicentric cohort was developed.
A key outcome was the development of a comprehensive diagnostic tool for diagnosis of dementia and MCI due to varied etiologies, in the diverse socio-demographic setting of India.
Patients with mechanical heart valves are at high thrombotic risk and require warfarin. Among those developing intracranial hemorrhage, limited data are available to guide clinicians with antithrombotic reinitiation. This 13-patient case series of warfarin-associated intracranial hemorrhages found the time to reinitiate antithrombotic therapy (17 days, interquartile range 21.5 days), and changes to international normalized ratio targets were variable and neither correlated with the type, location, or etiology of bleed, nor the valve and associated thromboembolic risk. The initial presentation significantly impacted prognosis, and diligent assessment and follow-up may support positive long-term outcomes.
It appears too late in the day to ask the question ‘What is “good” literature?’ It might seem even too late to argue for or against an essentialist definition of literature or literary value. Contemporary literary criticism is weighed in favour of the idea that it is contexts, institutions and discourses which decide the literariness of any piece of speech or writing. We have successfully extended the use of the term ‘literature’ on the basis of media, genre and sociological criteria to include oral literature, pulp fiction and the writings/ cultural practices of many formerly marginalized groups, respectively. It is a critical commonplace that an unconscious system of values lies behind our evaluations of literature, and that this varies from culture to culture and from person to person. For a Marxist critic, this system of values is related to class structure and the intellectual hegemony of the dominant class. For a postcolonial critic, the texts which were considered prestigious and were prescribed for academic study were so, because they were ideological tools of, and in turn received impetus from, the politico-cultural project of imperialism. Similarly, feminists challenge a male-centred canon. Indeed such endeavours have helped to set right the lopsidedness of literary history as well as contemporary priorities.
Apropos the subjective side, indeed the apprehension of literary value is partly a matter of the subject-object symmetry. If this is the case, value – I refuse to categorize it as exclusively ‘aesthetic’ because there are more aspects to value than pure aesthetic – is located neither exclusively in the reader nor in the text but at the precise point of encounter between them. But the subject is not an autonomous Cartesian one but is constituted in the collective, historically specific discourses. As such, the system of values consists of culturally acquired elements and maybe entangled in the networks of power and ideology. Further, literary values are pluralistic; there are many kinds of excellence.
Is there something called aesthetic quality? Can it be decided at all? If the answer is in the affirmative, how does one decide the quality of a literary work? Can the political be demarcated from the aesthetic?
Philosophical Meta-Reflections on Literary Studies' takes up key meta-questions in the humanities, with focus on contemporary literary studies, philosophically examines the nature of knowledge therein as well as the implications of certain popular critical approaches, and addresses the effervescent question of ‘relevance’. In contrast to usual works on literary theory, or on philosophy of literature for that matter, this book presents an integrated meta-reasoning on the foundational questions of literary studies from an interdisciplinary perspective – in a manner of intertextual informality. It endeavours to articulate a rationale for the humanities in general and literary studies in particular. It philosophically examines the implications of, and assumptions behind, three popular tendencies in contemporary literary criticism – textual deconstruction, ideological criticism and constructivism. It also introduces the reader to possibilities of non-reductive reasoning with regard to the relation between the aesthetic and the political. With his multidisciplinary background, doctoral degree on an encyclopedic author (James Joyce) and past engagements with vital issues in the humanities/literature, Jibu George is in a position to deal with foundational questions therein.
As part of the ongoing ‘transvaluation’ of established literary values, we have successfully argued and accepted that texts, authors, genres and social groups other than the canonical ones ought to be studied as part of the syllabi. In other words, we are past the phase of ‘restricted entry’, and objects of study have democratically multiplied. But there has been no corresponding rethinking, at least to the same degree, on what more can be done with the old and the new entrants. Somehow, originality in research has come to mean writing theses and books on less-canonical works. When we decide merely to study less-known works (it is an open secret that first-generation critics have certain advantages), we are mainly questioning the canon, not necessarily devising ways of dealing with texts which have hitherto been excluded, though new texts may demand new approaches.
During my initial years as a research scholar, I was asked to read up the secondary materials on a certain author – ‘a love that dare not speak its name’ – other than James Joyce, on whose works I did my doctoral research, so as to have an overview of the then current trends in practical criticism. After a year-long reading I found that three-fourths of the critical materials said one or more of the following:
Meaning is undecidable.
Literary texts are entangled in discourses of race, class and gender.
Some concept or the other is a cultural construct.
As we know, the first is a theoretical insight of deconstruction. The second comes to us from schools of ideological criticism, such as postcolonialism, Marxism and feminism. Harold Bloom terms these collectively ‘the School of Resentment’ (1995, 23). The third demonstrates constructivism, the ‘in-thing’ in academia today. Gender is a construct. So is sexuality, nation, subject, disability and what not. Heck! Literature itself is a construct. Later I learnt that these tendencies were representative of contemporary literary criticism in general. I also learnt that statements that did not say any of these three things were likely to be dismissed as ‘humanistic’.
The Humanities – An Ugly Duckling among Alma Mater's Pets
One principle dominates contemporary deliberations on curriculum planning and development in higher education: ‘social relevance’. The one reason given for poor research funding in the humanities is that its results are not immediate. What is not immediate is purportedly irrelevant! At least in Hans Christian Anderson's tale, the ugly duckling eventually reveals itself to be a swan. We are not claiming that the true identity of the humanities will be revealed only in future though this chapter contains a sort of blue print for their expansion. Nor are we saying that we should divert all the funding from stem cell studies and cancer drug research to knowledge generation in the humanities. Ours is not a plea for pre-eminence of the humanities or a plea against any other discipline or set of disciplines, say STEM (science, technology, engineering and mathematics). This is not a plea at all. No discipline needs a defence against any other discipline. As demonstrated with the later discussion of ideological criticism in Chapter 3, polemical or contestational reasoning is a necessary but insufficient phase of reasoning in the humanities. But every discipline needs to articulate a rationale for its existence. The title of this section, therefore, is not a summary but a point of departure.
Though in a very different context, some acknowledgements of limitations, or calls for such an acknowledgement, have come from within the humanities. Several years ago, philosopher (or ‘post-philosopher’) Richard Rorty proposed a modest conversational theory of knowledge. According to him, philosophy was a form of cultured conversation, not an attempted revelation of the truth of the world. Apparently, there is very less at stake here. Rorty was of the view that philosophers should give up the ambition or pretension to describe the world. As the title of his book Philosophy and the Mirror of Nature suggests, ideas do not provide a mirror of the way the world is but have consequences. The philosopher is not a ‘cultural overseer who knows everyone's common ground’ and who offers an explanatory master discourse but an ‘informed dilettante’ who sees ‘relations between various discourses as those strands in a possible conversation’ (1990, 316– 17). Rorty's was a response to what he called the ‘self-obsessed, “in-grown”, and “over-philosophized” ‘ character which the humanities had attained in the 1980s.
As students, some of us, at least during a brief phase of our education, have been part of a peer culture which cultivates belief in a disjunction between what happens inside the classroom and the life outside, except, of course, as one of the stepping stones to a career (Learning is earning!). This belief is the subversive subtext of all classroom interactions except of those which guarantee immediate ‘entertainment’. But the professional practitioner of a discipline does not have this luxury. If she/ he is asked why it should be studied at all, it does not suffice to amend Seneca, who criticized armchair philosophers, and platitudinize: Non scholae sed vitae discimus (we do not study for the school, but for life). A teacher of the assortment of traditional and contemporary texts which we continue to call literature, who is conscious of the nature of the discipline, will not be able to imagine teaching it without finding at least tentative answers to the question ‘Why is it studied/ taught?’. When a student of literature remarks that a classroom discussion ‘goes over my head’, except in cases of the ideological objection, it is not only a matter of incomprehension but also of contestable relevance. More often than not, the ‘So what?’ which seeks a rationale is often an undiscerned supplement to the ‘What?’ of incomprehension. If literary studies were to disappear from the spectrum of academic disciplines, would we really miss something? Or, would we continue to do the myriad of things we do now, even in the absence of a label? Can disciplines exist without reflecting on why they exist and how they are organized? Even if the answer is in the affirmative, literature is certainly not one among those disciplines. Literary studies are a discipline which has a rich precedent of critical self-consciousness. There is no clearer indicator of this self-consciousness than the sophisticated and effervescent debate which problematizes its very subject matter – notions of what qualifies as ‘literature’.
In any discipline, an adequate understanding of the object of study and a reflection on what exactly one can do with it determine the nature of study itself. One needs to ask if there are domain-specific canons of reasoning. If there are, must we pay heed to them, especially in the contemporary academic ambience of ‘radical doubt’?
This book takes up key meta-questions in the humanities, with a focus on contemporary literary studies, philosophically examines the nature of knowledge therein and addresses the effervescent question of ‘relevance’. Its subtitle is a variation on the title of M. H. Abrams's collection of essays and reviews Doing Things with Texts (1989), which in turn echoes J. L. Austin's influential work How to Do Things with Words (1955). Effective research and teaching in any discipline depend upon being able to understand its raison d’être and the modes of reasoning possible in it. Chapter 1 endeavours to articulate a philosophical rationale for the existence of the humanities with reference to what it calls the human world process. The purpose of theory and philosophy lies in offering a conceptual grasp on the world and a clarification of our implicit assumptions. The chapter argues that knowledge in the humanities is of a different order from that in the sciences and so is its social relevance. Humanistic knowledge has broader subjective and cultural bases and demands articulation of its connections to the ‘real’ world, to everyday life. The chapter presents a critique of the minimalist criterion of knowledge, and enunciates possibilities of crossfertilization between the academic and the experiential, making a distinction between reflective and implementational intelligence – a distinction reinforced by a fallacy of cognitive ease. Regardless of apprehensions concerning ‘grand’ concepts, the larger terrain of the humanities is the human world process and the cognitive, cultural, linguistic, interpretive and representational dynamism that endeavours to grapple with the process. The process far exceeds the cognitive, cultural, linguistic, interpretive and representational strategies that seek to capture it. As such, knowledge in the humanities, at least more so than is the case with knowledge of physical objects, is only an abstracted version of the process. Further, a characteristic of knowledge in the humanities is that they largely deal with intangible entities, and necessitate an ontology of the intangible. The humanities, having had the reputation of a ‘soft’ discipline, also evince scientistic aspirations, as demonstrated by the popularity of impersonal systems and codes in the study of literature and culture.
MD-PhD training programs train physician-scientists to pursue careers involving both clinical care and research, but decreasing numbers of physician-scientists stay engaged in clinical research. We sought to identify current clinical research training methods utilized by MD–PhD programs and to assess how effective they are in promoting self-efficacy for clinical research.
The US MD–PhD students were surveyed in April–May 2018. Students identified the clinical research training methods they participated in, and self-efficacy in clinical research was determined using a modified 12-item Clinical Research Appraisal Inventory.
Responses were received from 61 of 108 MD–PhD institutions. Responses were obtained from 647 MD–PhD students in all years of training. The primary methods of clinical research training included no clinical research training, and various combinations of didactics, mentored clinical research, and a clinical research practicum. Students with didactics plus mentored clinical research had similar self-efficacy as those with didactics plus clinical research practicum. Training activities that differentiated students who did and did not have the clinical research practicum experience and were associated with higher self-efficacy included exposure to Institutional Review Boards and participation in human subject recruitment.
A clinical research practicum was found to be an effective option for MD–PhD students conducting basic science research to gain experience in clinical research skills. Clinical research self-efficacy was correlated with the amount of clinical research training and specific clinical research tasks, which may inform curriculum development for a variety of clinical and translational research training programs, for example, MD–PhD, TL1, and KL2.
This article investigates gold smuggling in the twentieth-century western Indian Ocean. It illustrates how gold, condemned as a ‘barbarous relic’ by international monetary economists and central banks in the immediate post-war period, created an economy in the intermediate zone between a retreating empire and emerging nation-states in India and the Persian Gulf. Bombay and Dubai—connected by mercantile networks, trading dhows, migrants, and ‘smugglers’—were the principal constituencies and key drivers of this trans-regional economy. Partition and the concomitant flight of Indian mercantile capital into Dubai becomes the key to unlocking the many dimensions of smuggling, including its social organization and ethnic constitution. Looked at in such terms, gold smuggling reveals a transnational side to both partition and the post-colonial history of Bombay which has drawn little critical attention from historians. Consequently, it expands the analytic space necessary to explain how Dubai was able to capitalize on the arbitrage possibilities offered by import regulations in India, tap into the global networks of trade and finance, and chart its own course of development as a modern urban space throughout the latter half of the twentieth century.
Many institutions evaluate applications for local seed funding by recruiting peer reviewers from their own institutional community. Smaller institutions, however, often face difficulty locating qualified local reviewers who are not in conflict with the proposal. As a larger pool of reviewers may be accessed through a cross-institutional collaborative process, nine Clinical and Translational Science Award (CTSA) hubs formed a consortium in 2016 to facilitate reviewer exchanges. Data were collected to evaluate the feasibility and preliminary efficacy of the consortium.
The CTSA External Reviewer Exchange Consortium (CEREC) has been supported by a custom-built web-based application that facilitates the process and tracks the efficiency and productivity of the exchange.
All nine of the original CEREC members remain actively engaged in the exchange. Between January 2017 and May 2019, CEREC supported the review process for 23 individual calls for proposals. Out of the 412 reviews requested, 368 were received, for a fulfillment ratio of 89.3%. The yield on reviewer invitations has remained consistently high, with approximately one-third of invitations being accepted, and of the reviewers who agreed to provide a review, 88.3% submitted a complete review. Surveys of reviewers and pilot program administrators indicate high satisfaction with the process.
These data indicate that a reviewer exchange consortium is feasible, adds value to participating partners, and is sustainable over time.