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The global distribution of cowrie shells (Monetaria annulus and Monetaria moneta) attests to their exchange over long distances and their value in diverse cultural contexts. In addition to their commodification, cowries functioned as adornment, ritual, art and in the elaboration of both living and ancestral beings in many settings through time. Examining the circulation and usage of cowries in these different contexts facilitates an exploration of the ways in which a global commodity may carry, lose and acquire value. An ethnographic review of cowrie use in the hitherto overlooked context of southern Africa suggests that particular qualities of the shell imbued it with culturally specific value. It is suggested that cowries, as part of divination sets, were active in divination because of their white colour and their origin in the (maritime) ancestral realm that anchored divination in notions of ancestry, fertility and healing. Furthermore, in certain contexts, cowries were conceived of as animate objects, metonymically active in ‘cooling’ and healing. These observations, set within a broader discussion relating to archaeological approaches to the accumulation of value, indicate the importance of exploring alternative ontologies in the biographies of global commodities, and reveal the potential of a biographical ontology of the ‘ancestral’.
Diaphragm dysfunction following surgery for congenital heart disease is a known complication leading to delays in recovery and increased post-operative morbidity and mortality. We aimed to determine the incidence of and risk factors associated with diaphragm plication in children undergoing cardiac surgery and evaluate timing to repair and effects on hospital cost and length of stay.
We conducted a multi-institutional retrospective observational cohort study. Forty-three hospitals from the Pediatric Health Information System database were included, and a total of 112,110 patients admitted between January 2004 and December 2014 were analysed.
Patients less than 18 years of age who underwent cardiac surgery were included. Risk Adjustment for Congenital Heart Surgery was utilized to determine procedure complexity. The overall incidence of diaphragm dysfunction was 2.2% (n = 2513 out of 112,110). Of these, 24.0% (603 patients) underwent diaphragm plication. Higher complexity cardiac surgery (Risk Adjustment for Congenital Heart Surgery 5–6) and age less than 4 weeks were associated with a higher likelihood of diaphragm plication (p-value < 0.01). Diaphragmatic plication was associated with increased hospital length of stay (p-value < 0.01) and increased medical cost.
Diaphragm plication after surgery for congenital heart disease is associated with longer hospital length of stay and increased cost. There is a strong correlation of prolonged time to plication with increased length of stay and medical cost. The likelihood of plication increases with younger age and higher procedure complexity. Methods to improve early recognition and treatment of diaphragm dysfunction should be developed.
We have observed the G23 field of the Galaxy AndMass Assembly (GAMA) survey using the Australian Square Kilometre Array Pathfinder (ASKAP) in its commissioning phase to validate the performance of the telescope and to characterise the detected galaxy populations. This observation covers ~48 deg2 with synthesised beam of 32.7 arcsec by 17.8 arcsec at 936MHz, and ~39 deg2 with synthesised beam of 15.8 arcsec by 12.0 arcsec at 1320MHz. At both frequencies, the root-mean-square (r.m.s.) noise is ~0.1 mJy/beam. We combine these radio observations with the GAMA galaxy data, which includes spectroscopy of galaxies that are i-band selected with a magnitude limit of 19.2. Wide-field Infrared Survey Explorer (WISE) infrared (IR) photometry is used to determine which galaxies host an active galactic nucleus (AGN). In properties including source counts, mass distributions, and IR versus radio luminosity relation, the ASKAP-detected radio sources behave as expected. Radio galaxies have higher stellar mass and luminosity in IR, optical, and UV than other galaxies. We apply optical and IR AGN diagnostics and find that they disagree for ~30% of the galaxies in our sample. We suggest possible causes for the disagreement. Some cases can be explained by optical extinction of the AGN, but for more than half of the cases we do not find a clear explanation. Radio sources aremore likely (~6%) to have an AGN than radio quiet galaxies (~1%), but the majority of AGN are not detected in radio at this sensitivity.
Transitional justice emerged after the Second World War as a set of discrete measures, such as trials, truth commissions or reparations, to address the atrocities of a past regime and to transition societies away from the recurrence of atrocities. Since the 1990s there has been an increasing emphasis on the need for multifaceted, comprehensive transitional justice measures to effectively deal with impunity and the consequences of mass violence. It is no longer considered effective to pigeonhole discrete transitional justice mechanisms. Instead there is increasing discussion of a comprehensive package of measures that complement each other. Each of the areas of transitional justice – truth, justice, reparations, amnesties, guarantees of non-recurrence and, to a certain extent, demobilisation, disarmament and reintegration (DDR) – have their own particular focus, benefits and limitations. Although such measures can be complementary, there can also be overlap and tension between them, such as when trying to carry out prosecutions while at the same time seeking to secure truth, which requires careful crafting of social, political, economic and legal factors to avoid derailing the transition itself.
Given that the focus of this chapter is on truth commissions and reparations, it will mainly address the connection between these two measures. Truth commissions and reparations, to a certain extent, have a symbiotic relationship through which they can complement and reinforce one another's goals in acknowledging the atrocities of the past, building social inclusion and trying to vindicate victims's uffering. The first part of this chapter explores the bond between these two mechanisms, drawing upon different examples of how recommendations for reparations are constructed by truth commissions and their justification. The second part of this chapter analyses the implementation of reparation recommendations, finding that in most cases states fail to follow through, or only do so where they are forced by civil society through legal and political pressure. The third part of this chapter briefly discusses transitional societies where reparations are made without a truth commission and their impact on the transition, before reaching a conclusion. As such, it is more likely than not that truth commissions can facilitate the implementation of reparations. That said, transitional societies are complex and fragile, and cannot be easily socially engineered; the past is Often still contested and fought through political and legal forums.
At a 1984 meeting of Johnsonians, David Perkins argued for the importance of Johnson and his peers to the Modernist poets, especially T. S. Eliot. “Praise of the Augustans in Modernist criticism,” he contended, “is ordinarily combined with an attack on Romanticism. The Augustan mode is presented as a possible deliverance from error, yet a deliverance that only the strong-minded can receive.” In Perkins's model, the Augustan poets offer the Modernists an alternative approach to poetry not centered in the emotional life of the speaker, as associated with Romantics poetics. Instead it is a more cerebral and intellectually demanding method, as one finds in Pope or Johnson. Perkins shows how Pound helped Eliot edit the early lines in The Waste Land that aspired to Augustan verse but were not successful. He says little about Pound's own work, however. In efforts such as The Spirit of Romance (1910), ABC of Reading (1934), and The Guideto Kulchur (1938), Pound identified the literature and ideas he felt most worthy of preservation and study. His writing on poets was almost always polemical, and his statements on Johnson are accordingly complicated.
Part of this conflict can be understood by thinking about the immense pressure associated with poetic influence. One of the best known and longest enduring models for assessing a later writer's grappling with his influences is Harold Bloom's “anxiety of influence.” This is not to say that Bloom's model escapes criticism or that it is without its problems. Aside from blind spots with regard to gender and sexual orientation, Bloom's theory presents a metanarrative of literary transmission, and metanarratives have long been an object of postmodernist thinkers’ critique. Nevertheless, Bloom's ideas offer a useful heuristic if not an infallible model, and they shed light on the writers under study here. Bloom famously contends that “the anxiety of influence comes outof a complex act of strong misreading, a creative interpretation that I call ‘poetic misprision.’” He believes that this is a universal issue: “influence-anxieties are embedded in the agonistic basis of all imaginative literature.” Indeed, he goes so far as to argue that “The largest truth of literary influence is that it is an irresistible anxiety.”
Following the arrival of the MV Ocean Lady in 2009, four men were charged with human smuggling under s. 117 of the Immigration and Refugee Protection Act for having helped Sri Lankan asylum seekers reach Canada. Section 117 made it a criminal offence to aid and abet the unauthorized entry of asylum seekers, including when this was done for humanitarian reasons, to help family members, or as a matter of mutual aid. The case made its way to the Supreme Court and, in 2015, the court ruled in R v Appulonappa that s. 117 was too broad, potentially criminalizing humanitarian workers and family members who help transport asylum seekers, and should be interpreted in a strict manner. This article draws from pragmatic sociology to study the regimes of justification mobilized by various actors involved in, and around, R v Appulonappa between 2009 and 2015. It focuses on two sites of contestation that crystalized around divergent conceptions of fairness and safety, discussing how competing regimes of justification were used to advance stakeholder’s positions.
Haemodynamically unstable patients can experience potentially hazardous changes in vital signs related to the exchange of depleted syringes of epinephrine to full syringes. The purpose was to determine the measured effects of epinephrine syringe exchanges on the magnitude, duration, and frequency of haemodynamic disturbances in the hour after an exchange event (study) relative to the hours before (control).
Materials and methods
Beat-to-beat vital signs recorded every 2 seconds from bedside monitors for patients admitted to the paediatric cardiovascular ICU of Texas Children’s Hospital were collected between 1 January, 2013 and 30 June, 2015. Epinephrine syringe exchanges without dose/flow change were obtained from electronic records. Time, magnitude, and duration of changes in systolic blood pressure and heart rate were characterised using Matlab. Significant haemodynamic events were identified and compared with control data.
In all, 1042 syringe exchange events were found and 850 (81.6%) had uncorrupted data for analysis. A total of 744 (87.5%) exchanges had at least 1 associated haemodynamic perturbation including 2958 systolic blood pressure and 1747 heart-rate changes. Heart-rate perturbations occurred 37% before exchange and 63% after exchange, and 37% of systolic blood pressure perturbations happened before syringe exchange, whereas 63% occurred after syringe exchange with significant differences found in systolic blood pressure frequency (p<0.001), duration (p<0.001), and amplitude (p<0.001) compared with control data.
This novel data collection and signal processing analysis showed a significant increase in frequency, duration, and magnitude of systolic blood pressure perturbations surrounding epinephrine syringe exchange events.
Few data are available regarding the use of metolazone in infants in cardiac intensive care. Researchers need to carry out further evaluation to characterise the effects of this treatment in this population.
This is a descriptive, retrospective study carried out in patients less than a year old. These infants had received metolazone over a 2-year period in the paediatric cardiac intensive care unit at our institution. The primary goal was to measure the change in urine output from 24 hours before the start of metolazone therapy to 24 hours after. Patient demographic variables, laboratory data, and fluid-balance data were analysed.
The study identified 97 infants with a mean age of 0.32±0.25 years. Their mean weight was 4.9±1.5 kg, and 58% of the participants were male. An overall 63% of them had undergone cardiovascular surgery. The baseline estimated creatinine clearance was 93±37 ml/minute/1.73 m2. Initially, the participants had received a metolazone dose of 0.27±0.10 mg/kg/day, the maximum dose being 0.43 mg/kg/day. They had also received other diuretics during metolazone initiation, such as furosemide (87.6%), spironolactone (58.8%), acetazolamide (11.3%), bumetanide (7.2%), and ethacrynic acid (1%). The median change in urine output after metolazone was 0.9 ml/kg/hour (interquartile range 0.15–1.9). The study categorised a total of 66 patients (68.0%) as responders. Multivariable analysis identified acetazolamide use (p=0.002) and increased fluid input in the 24 hours after metolazone initiation (p<0.001) as being significant for increased urine output. Changes in urine output were not associated with the dose of metolazone (p>0.05).
Metolazone increased urine output in a select group of patients. Efficacy can be maximised by strategic selection of patients.
The excavated evidence of the building on the middle terrace of Site C at Tintagel Castle, in Cornwall, indicates that in the post-Roman period it had been the focus of activity involving the reuse of imported amphorae in conjunction with secondary stone stoppers made at Tintagel. This paper considers the nature of that activity and suggests that mead (fermented honey water) was being made in the building in the fifth and sixth centuries ad and stored in reused amphorae. The role of alcohol and feasting in power structures of the period and in the development of the site’s defences is also discussed.
In southern Africa, there has been a long-standing but unsubstantiated assumption that the site of Khami evolved out of Great Zimbabwe's demise around ad 1450. The study of local ceramics from the two sites indicate that the respective ceramic traditions are clearly different across the entire sequence, pointing towards different cultural affiliations in their origins. Furthermore, there are tangible typological differences between and within their related dry-stone architecture. Finally, absolute and relative chronologies of the two sites suggest that Khami flourished as a major centre from the late fourteenth/early fifteenth century, long before Great Zimbabwe's decline. Great Zimbabwe also continued to be occupied into the late seventeenth and perhaps eighteenth centuries, after the decline of Khami. Consequently, the combined significance of these observations contradicts the parent-offspring relationship implied in traditional frameworks. Instead, as chronologically overlapping entities, the relationship between Khami and Great Zimbabwe, was heterarchical. However, within the individual polities, malleable hierarchies of control and situational heterarchies were a common feature. This is in tune with historically documented political relations in related pre-colonial southern Zambezian states, and motivates for contextual approaches to imagining power relations in pre-colonial African contexts.
Sequential nephron blockade using intravenous chlorothiazide is often used to enhance urine output in patients with inadequate response to loop diuretics. A few data exist to support this practice in critically ill infants.
We included 100 consecutive patients <1 year of age who were administered intravenous chlorothiazide while receiving furosemide therapy in the cardiac ICU in our study. The primary end point was change in urine output 24 hours after chlorothiazide administration, and patients were considered to be responders if an increase in urine output of 0.5 ml/kg/hour was documented. Data on demographic, clinical, fluid intake/output, and furosemide and chlorothiazide dosing were collected. Multivariable regression analyses were performed to determine variables significant for increase in urine output after chlorothiazide administration.
The study population was 48% male, with a mean weight of 4.9±1.8 kg, and 69% had undergone previous cardiovascular surgery. Intravenous chlorothiazide was initiated at 89 days (interquartile range 20–127 days) of life at a dose of 4.6±2.7 mg/kg/day (maximum 12 mg/kg/day). Baseline estimated creatinine clearance was 83±42 ml/minute/1.73 m2. Furosemide dose before chlorothiazide administration was 2.8±1.4 mg/kg/day and 3.3±1.5 mg/kg/day after administration. A total of 43% of patients were categorised as responders, and increase in furosemide dose was the only variable significant for increase in urine output on multivariable analysis (p<0.05). No graphical trends were noted for change in urine output and dose of chlorothiazide.
Sequential nephron blockade with intravenous chlorothiazide was not consistently associated with improved urine output in critically ill infants.
Images of oil-covered seabirds or radioactive fallout from nuclear disasters easily evoke concerns over the risks to personal integrity and environmental degradation. The energy-extraction industry, like others, is profit-driven – a competitive enterprise, with little regard for the social impact of its activities beyond corporate social responsibility (CSR) rhetoric. CSR is neither a precautionary measure nor a remedial framework. Outsider stakeholder influence from government is limited and CSR is written on companies’ terms. What emerges is a distortion between companies’ responsibility and accountability for breaches. We propose a hybrid form of accountability that incorporates public international law to ensure the state, as a guardian of society, plays a more definitive role. This will require more binding obligations on states and companies beyond the current soft-law principles, to curtail jurisdictional constraints and forum shopping of large corporations, through an international court of reparations to guarantee effective remedies for victims.
Serum digoxin levels have limited utility for determining digoxin toxicity in adults. Paediatric data assessing the utility of monitoring serum digoxin concentration are scarce. We sought to determine whether serum digoxin concentrations are associated with signs and symptoms of digoxin toxicity in children.
We carried out a retrospective review of patients <19 years of age who received digoxin and had serum digoxin concentrations assessed between January, 2007 and June, 2013. Data collection included patient demographics, digoxin indication, serum digoxin concentrations, signs and symptoms of digoxin toxicity, electrocardiograms, and co-morbidities. Reviewers performing chart review and electrocardiogram analysis were blinded to digoxin levels. Descriptive statistical methods were used and comparisons were made between patients with and without toxic serum digoxin concentrations (>2 ng/ml).
There were 87 patients who met study criteria (male 46%, mean age 8.4 years). CHD was present in 67.8% and electrocardiograms were performed in 72.4% of the patients. The most common indication for digoxin toxicity was heart failure symptoms (61.5%). Toxic serum digoxin concentrations were present in 6.9% of patients (mean 2.6 ng/ml). Symptoms associated with digoxin toxicity occurred in 48.4%, with nausea/vomiting as the most common symptom (36.4%), followed by tachycardia (29.5%). Compared with those without toxic serum digoxin concentrations, significantly more patients with toxic serum digoxin concentrations were female (p=0.02). The presence of electrocardiogram abnormalities and/or signs and symptoms of digoxin toxicity was not significantly different between patients with and without serum digoxin concentrations (p>0.05).
Serum digoxin concentrations in children are not strongly associated with signs and symptoms of digoxin toxicity.
Introduction: Digoxin or propranolol are used as first-line enteral agents for treatment of infant supraventricular tachycardia. We used a large national database to determine whether enteral digoxin or propranolol was more effciacious as first-line infant supraventricular tachycardia therapy. Materials and Methods: The Pediatric Health Information System database was queried over 10 years for infants with supraventricular tachycardia initiated on enteral digoxin or propranolol monotherapy. Patients were excluded for Wolff–Parkinson–White, intravenous antiarrhythmics (other than adenosine), or death. Success was considered as discharge on the initiated monotherapy. Risk factors for successful monotherapy and risk factors for readmission for supraventricular tachycardia for patients discharged on monotherapy were determined. Results: A total of 374 patients (59.6% male) met the study criteria. Median length of stay was 7 days (interquartile range of 3–16 days). Patients had CHD (n=199, 53.2%) and underwent cardiac surgery (n=123, 32.9%), ICU admission (n=238, 63.6%), mechanical ventilation (n=146, 39.0%), and extracorporeal membrane oxygenation (n=3, 0.8%). Pharmacotherapy initiation was at median 37 days of life (interquartile range of 12–127 days) and 47.3% were initiated on digoxin. Success was similar between digoxin (73.1%) and propranolol (73.5%). Initial therapy with digoxin was not associated with success (odds ratio 1.01, 95% CI 0.64–1.61, p=0.93). Multivariable analysis demonstrated hospital length of stay (odds ratio 0.98, 95% CI 0.98–1.00) and involvement of a paediatric cardiologist (odds ratio 0.46, 95% CI 0.29–0.75) associated with monotherapy failure, and male gender (odds ratio 1.66, 95% CI 1.03–2.67) associated with monotherapy success. No variables were significant for readmission on multivariable analysis. Discussion: Digoxin or propranolol may be equally efficacious for inpatient treatment of infant supraventricular tachycardia.
Edited in association with
Alice Kelly, Lecturer in Modernism, Yale University,Isobel Maddison, Affiliated Lecturer, College Lecturer and Director of Studies in English, Lucy Cavendish College, University of Cambridge
In November 1919, Katherine Mansfield's critical review of Virginia Woolf's novel Night and Day was published under the title ‘A Ship Comes Into the Harbour’ in her husband John Middleton Murry's journal, the Athenaeum. Her private sentiments on the novel, expressed in letters to Murry in November of the same year, were equally negative. Well known to Mansfield scholars, these letters articulate a slightly different critique from that of the review. While her review concentrates on questions of form, specifically the very conventional novelistic structure Woolf had chosen for the novel, Mansfield's private reaction focuses upon another matter entirely: Woolf's evocation of an Edwardian setting that, to Mansfield, was tantamount to an evasion of the subject of the war altogether:
My private opinion is that it's a lie in the soul. The war never has been: that is what its message is. I don't want (G. forbid!) mobilization and the violation of Belgium, but the novel can't just leave the war out.
A defender of Woolf's novel might raise a legitimate objection to this charge. When living through a historical event as momentous as the First World War, is a past setting necessarily tantamount to an elision? And does Mansfield not leave herself open to precisely the same criticism? Mansfield never published a novel, but her longest story, ‘Prelude’ (1917), a distillation of an earlier draft entitled ‘The Aloe’, is similarly set in a historical past that predates the war. At first glance, ‘Prelude’ seems, like Night and Day, absolutely to ‘leave the war out’; however, examining the textual history of ‘Prelude’ reveals a quite different story. Unlike the work into which it would evolve, the original draft of ‘The Aloe’, primarily composed in Paris in early 1915, has a number of scenes in which echoes can be heard of the conflict that was raging less than a hundred miles away when Mansfield first wrote them. In this essay, I identify and analyse these moments in ‘The Aloe’, and link them both to Mansfield's experiences of the First World War in early 1915, and to her other writing of the period. Through the process of editing ‘Prelude’, I argue that the war moves from a metaphorical yet tangible presence in the text, to a seeming and signifying absence.
Introduction: The diagnosis of trisomy 21 in children has been associated with failed extubation after CHD surgery. Dexmedetomidine may be a useful agent to improve postoperative outcomes in these patients, such as ventilator time, ICU length of stay, or hospital length of stay. Materials and methods: The Pediatric Health Information System database was queried from January, 2008 to December, 2010 for patients with trisomy 21 who underwent CHD surgery. Patients who received dexmedetomidine were matched to patients who did not by propensity score. The primary outcome was ventilator days charged, and secondary outcomes included ICU and hospital length of stay. Results: A total of 1088 patients (544 matched pairs) met inclusion criteria. Patient characteristics were similar, with the exception of more patients in the dexmedetomidine group undergoing repair of complete atrioventricular canal and fewer undergoing mechanical valve replacement (p<0.01). More patients in the dexmedetomidine group were administered milrinone, epinephrine, vasopressin, benzodiazepines, opiates, and adjunct pain and sedative medications (p<0.01). The dexmedetomidine group had greater time on the ventilator [7 (4.5–11) versus 6 (4–10) days (median, interquartile range) p<0.01] and similar ICU length of stay, hospital length of stay, and mortality compared with controls. Mixed-effects modelling clustered on institution did not show beneficial effect of dexmedetomidine on ventilator time, ICU stay, or hospital length of stay. Conclusions: The use of dexmedetomidine was not associated with the decreased ventilatory time. Routine use of dexmedetomidine is not warranted in this patient population.
Over the centuries, a great deal of poetry has been devoted to warfare and its practitioners. While the majority has tended to celebrate the heroism of men involved in conflict, a not insignificant part has condemned the carnage and futility, a condemnation that reached its height during the First World War in the works of such writers as Wilfred Owens, Siegfried Sassoon, and Robert Service.
During the Middle Ages, martial poetry followed both strains. Much of it emphasized the glory of combat, serving as the supreme tool for recalling honor and assigning shame earned on the battlefield. This was true of the most widely-recited works of the period, the great epics and chanson de geste, including Beowulf, the Song of Roland, the Tales of King Arthur, and the Poema del mio Cid, to name only the most prominent. All centered on human conflict and extolled the heroism of their protagonists. Poets, like the great troubadour, Bertran de Born (c. 1140–c. 1215), could look on war as a spectacle complete with “proud pavilions high … squadrons of armored chivalry … trumpets and tabors, ensigns and pennants.” To Born's mind, participants were expected to spill blood and engage in butchery in their pursuit of “death or victory.”
Byzantine military events in the early fourteenth century have captured the imagination of Western scholars for well over a century, thanks to the participation of Spanish mercenaries in the Catalan Company led by the flamboyant Roger de Flor. The important contribution to this military adventure made by another company of mercenaries composed entirely of Alans has been grossly underestimated when not totally ignored by both Western and Russian historians. Since the Alans were implicated in the disastrous defeat of the Byzantines in Anatolia as well as the first historical success of the Turkish leader Osman, eponymous founder of the Ottoman state, examining the specific role of these warriors may shed light on the military debacle that the Byzantines suffered at the hands of the Turks and Catalans in the first decade of the fourteenth century. Despite its importance, the military effectiveness of this company while contributing to the defense of the empire has never been examined in detail, so that the question remains: why did a Mongol-trained division of considerable military potential fail so spectacularly?
The appearance of the Alans in Byzantine service first attracted attention because scholars in Western Europe, especially Spain, have long been fascinated by the adventures of the Catalan Company, comparing its exploits in the East with those of Cortez and Pizarro in the Americas. Although composed of Aragonese, Calabrians, and Sicilians, it is usually referred to as the Catalan Company since most of the officers and men were from Catalonia.