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To evaluate the association between novel pre- and post-operative biomarker levels and 30-day unplanned readmission or mortality after paediatric congenital heart surgery.
Children aged 18 years or younger undergoing congenital heart surgery (n = 162) at Johns Hopkins Hospital from 2010 to 2014 were enrolled in the prospective cohort. Collected novel pre- and post-operative biomarkers include soluble suppression of tumorgenicity 2, galectin-3, N-terminal prohormone of brain natriuretic peptide, and glial fibrillary acidic protein. A model based on clinical variables from the Society of Thoracic Surgery database was developed and evaluated against two augmented models.
Unplanned readmission or mortality within 30 days of cardiac surgery occurred among 21 (13%) children. The clinical model augmented with pre-operative biomarkers demonstrated a statistically significant improvement over the clinical model alone with a receiver-operating characteristics curve of 0.754 (95% confidence interval: 0.65–0.86) compared to 0.617 (95% confidence interval: 0.47–0.76; p-value: 0.012). The clinical model augmented with pre- and post-operative biomarkers demonstrated a significant improvement over the clinical model alone, with a receiver-operating characteristics curve of 0.802 (95% confidence interval: 0.72–0.89; p-value: 0.003).
Novel biomarkers add significant predictive value when assessing the likelihood of unplanned readmission or mortality after paediatric congenital heart surgery. Further exploration of the utility of these novel biomarkers during the pre- or post-operative period to identify early risk of mortality or readmission will aid in determining the clinical utility and application of these biomarkers into routine risk assessment.
We measure the cosmic star formation history out to z = 1.3 using a sample of 918 radio-selected star-forming galaxies within the 2-deg2 COSMOS field. To increase our sample size, we combine 1.4-GHz flux densities from the VLA-COSMOS catalogue with flux densities measured from the VLA-COSMOS radio continuum image at the positions of I < 26.5 galaxies, enabling us to detect 1.4-GHz sources as faint as 40 μJy. We find that radio measurements of the cosmic star formation history are highly dependent on sample completeness and models used to extrapolate the faint end of the radio luminosity function. For our preferred model of the luminosity function, we find the star formation rate density increases from 0.017 M⊙ yr−1 Mpc−3 at z ∼ 0.225 to 0.092 M⊙ yr−1 Mpc−3 at z ∼ 1.1, which agrees to within 40% of recent UV, IR and 3-GHz measurements of the cosmic star formation history.
Global multi-stakeholder initiatives (MSIs) are important instruments that have the potential to improve the social and environmental sustainability of global supply chains. However, they often fail to comprehensively address the needs and interests of various supply-chain participants. While voluntary in nature, MSIs have most often been implemented through coercive approaches, resulting in friction among their participants and in systemic problems with decoupling. Additionally, in those cases in which deliberation was constrained between and amongst participants, collaborative approaches have often failed to materialize. Our framework focuses on two key aspects of these breakdowns: assumptions about the orientation of MSI participants, and the deliberation processes that participants use to engage with each other to create these initiatives and sustain them over time. Drawing from stakeholder and deliberation theories, we revisit the concept of MSIs and show how their deliberative capacity may be enhanced in order to encourage participants to collaborate voluntarily.
Optimising short- and long-term outcomes for children and patients with CHD depends on continued scientific discovery and translation to clinical improvements in a coordinated effort by multiple stakeholders. Several challenges remain for clinicians, researchers, administrators, patients, and families seeking continuous scientific and clinical advancements in the field. We describe a new integrated research and improvement network – Cardiac Networks United – that seeks to build upon the experience and success achieved to-date to create a new infrastructure for research and quality improvement that will serve the needs of the paediatric and congenital heart community in the future. Existing gaps in data integration and barriers to improvement are described, along with the mission and vision, organisational structure, and early objectives of Cardiac Networks United. Finally, representatives of key stakeholder groups – heart centre executives, research leaders, learning health system experts, and parent advocates – offer their perspectives on the need for this new collaborative effort.
Clostridium difficile spores play an important role in transmission and can survive in the environment for several months. Optimal methods for measuring environmental C. difficile are unknown. We sought to determine whether increased sample surface area improved detection of C. difficile from environmental samples.
Samples were collected from 12 patient rooms in a tertiary-care hospital in Toronto, Canada.
Samples represented small surface-area and large surface-area floor and bedrail pairs from single-bed rooms of patients with low (without prior antibiotics), medium (with prior antibiotics), and high (C. difficile infected) shedding risk. Presence of C. difficile in samples was measured using quantitative polymerase chain reaction (qPCR) with targets on the 16S rRNA and toxin B genes and using enrichment culture.
Of the 48 samples, 64·6% were positive by 16S qPCR (geometric mean, 13·8 spores); 39·6% were positive by toxin B qPCR (geometric mean, 1·9 spores); and 43·8% were positive by enrichment culture. By 16S qPCR, each 10-fold increase in sample surface area yielded 6·6 times (95% CI, 3·2–13) more spores. Floor surfaces yielded 27 times (95% CI, 4·9–181) more spores than bedrails, and rooms of C. difficile–positive patients yielded 11 times (95% CI, 0·55–164) more spores than those of patients without prior antibiotics. Toxin B qPCR and enrichment culture returned analogous findings.
Clostridium difficile spores were identified in most floor and bedrail samples, and increased surface area improved detection. Future research aiming to understand the role of environmental C. difficile in transmission should prefer samples with large surface areas.
Across the British empire, public worship was important for sustaining a sense of community and connectedness. This was most evident in special acts of worship, when the peoples of imperial territories, and sometimes of the whole empire, were asked at times of crisis and celebration to join together in special days or prayers of petition or thanksgiving to God. These occasions, ordered by a variety of civil and ecclesiastical authorities, were an enduring feature of all colonial societies from the seventeenth to the mid-twentieth centuries. Although these special acts of worship have considerable potential for deepening our understanding of various themes in the history of the British empire, they have yet to receive sustained analysis from scholars. This article is concerned with the fundamental task of considering why and how special prayers and days of fasting, humiliation, intercession and thanksgiving were appointed across the empire. By focusing on the causes of, and orders for, these occasions, it indicates reasons for the longevity of this practice, as well as its varied and changing purposes.
On a visit to Malta in 1838, Queen Adelaide expressed severe disappointment that the British colony did not possess a purpose-built Anglican place of worship. She determined to fund the building of one at her personal expense and within six years the grandiose neoclassical church of St Paul's, Valletta, was completed. This imposing structure occupied an ambiguous position in a colony where the British government was pledged to maintain Roman Catholicism. St Paul's was ostensibly intended for the existing Anglican population in Malta. However, the church was perceived by both evangelicals and Roman Catholics as a potential instrument of propagating Protestantism. In examining the basis for these perceptions, this article suggests that St Paul's was part of a larger effort, driven by high church clergy connected with the Society for Promoting Christian Knowledge (SPCK), to influence the Maltese towards greater sympathy with the Anglican tradition, while avoiding overt proselytizing. The concomitant establishment of the diocese of Gibraltar in 1842 was, it is argued, key to this enterprise. The analysis advanced here has important implications for our understanding of Anglicanism in an imperial context, the contribution of royal patronage to this process and the conflict between religious and governmental imperatives.
This article examines the Society in Scotland for Propagating Christian Knowledge (SSPCK) and its missions in the Highlands and Britain's American colonies. Constituted in 1709 and operating as an auxiliary arm of the Church of Scotland, the SSPCK aimed to extend Christianity in ‘Popish and Infidel parts of the world’. It founded numerous Highland charity schools, and from 1729 sponsored missions to Native Americans in New England and Georgia. Missions were increasingly important in British overseas expansion; consequently, historians have viewed the society as a civilizing agency, which deployed religious instruction to assimilate ‘savage’ heathens into the fold of Britain's empire. This article suggests that the SSPCK was equally concerned with Christianization: missionaries focused on spiritual edification for the salvation of souls, indicating a disjuncture between the society's objectives and the priorities of imperial expansion. It also challenges the parity assumed by historians between the SSPCK's domestic and foreign missions, arguing that the society increasingly prioritized colonial endeavours in an attempt to recover providential favour. In doing so, it sheds new light on Scottish ideas of mission during the first half of the eighteenth century, and reassesses the Scottish Church's role in Britain's emerging empire.
Charles Freer Andrews (1871–1940) was a close friend of Mohandas K. Gandhi and played a celebrated role in the Indian struggle for independence within the British empire. This article makes the case for understanding Andrews as a pioneering example of the evolution from nineteenth-century Christian Socialism to twentieth-century global ‘social Anglicanism’, as Andrews's career fits a form better recognized in later campaigners. The article draws attention to three beliefs or principles discernible in Andrews's life as a Christian Socialist in the 1890s: the incarnation as a doctrine revealing the brotherhood of humanity; the Church's need to recognize and minister to the poor; and the Church's call to send out its adherents to end ‘social abuses’ and achieve ‘moral victories’. These three core Christian Socialist beliefs were applied in Andrews's thought and achievements during the second half of his life, in the colonial contexts of India, South Africa and Fiji. By comparing his thought and activity with perceptions of empire traceable among contemporary Anglican Christian Socialists, Andrews's colonial career is found to have enabled Anglican social thought to take on a global frame of reference, presaging proponents of an Anglican global social conscience later in the century.
This article explores the links between the assertion of British imperial identities and the anti-Catholic discourse and practices of a network of evangelical societies which existed and flourished in Britain and in the dominions from the halcyon days of the empire to the late 1920s. These bodies shared a broad evangelical definition of Protestantism and defended the notion that religious beliefs and their political implications formed the basis of a common British heritage and identity. Those who identified themselves as Britons in Britain and in the dominions brought forward arguments combining a mixture of pessimistic interpretations of British history since the passing of the Catholic Emancipation Act with anxieties about ongoing Irish Catholic immigration and an alleged global papist plot. They were convinced that Protestantism was key to all civil liberties enjoyed by Britons. Inspired by John Wolffe's pioneering work, the article examines constitutional, theologico-political and socio-national anti-Catholicism across Britain and its dominions.
In early fifth-century Roman Africa, Augustine faced pagan opponents who thought that the Roman empire was at risk because Christian emperors banned the worship of its gods, and that Christian ethics were no way to run an empire. He also faced Christian opponents who held that theirs was the true Church, and that the Roman empire was the oppressive power of Babylon. For Augustine, Church and empire consist of people. Everyone belongs either to the heavenly city, the community of all who love God even to disregard of themselves, or to the earthly city, the community of all who love themselves even to disregard of God. The two cities are intermixed until the final judgement shows that some who share Christian sacraments belong to the earthly city, and some officers of empire belong to the heavenly city. Empire manifests the earthly city's desire to dominate, but imperium, the acknowledged right to give orders, is necessary to avoid permanent conflict. Empire, like everything else, is given or permitted by God, for purposes we do not know.
Modern historians have long argued that the early medieval Franks thought themselves to be the chosen people or new Israel, especially as they gained a great empire under the Carolingian dynasty in the late eighth century. The Opus Caroli of Bishop Theodulf of Orléans has often been cited as one of the clearest expressions of this self-conception as God's elect. A massive work attacking the legitimacy of the Byzantine empire in the context of the iconoclasm dispute during the early 790s, it does indeed contest the Byzantine claim to be the Christian empire. But Theodulf's repeated statement that ‘We are the spiritual Israel’ is best understood not as an assertion of ethnic election, but as a reference to the Christian tradition of Scripture exegesis which should (he argues) underpin both the Frankish and the Byzantine understanding of images. The Carolingian claim to empire rested on the Frankish championing of the universal Church, and its traditions of orthodoxy and correct biblical interpretation.
Papal relations with monarchs in the later eleventh and twelfth centuries have often been characterized as ‘feudal’, as indicative of some sort of papal dominium mundi, or as an effort to advance papal ‘empire’ over the kingdoms of Christendom. More recent scholarship has drawn a distinction between ‘protection’ and ‘feudal’ relationships with kings. However, the supposed distinction between the papacy's temporal overlordship of rulers and its spiritual protection may have obscured more than it has revealed. It was only after the disputes over lay investiture of bishops in the period 1078–1122 that a distinctive protective relationship began to emerge. Previously, rulers had been willing to ‘accept their kingdom from the pope's hand’ or to participate in ceremonies of investiture. In the twelfth century these relationships became more codified and any suggestion that the papacy actually gave kingdoms to kings faded. Thus, the nature of papal ‘empire’ – or, at least, temporal authority over kings – changed markedly during this period.
This study discusses relations between the Church and the emperor in the last two centuries of the Byzantine empire's existence, in the Palaiologan period (thirteenth to fifteenth centuries). It questions the accepted view that the Church rose in importance and status as imperial power and authority declined. According to this view, expressed by Steven Runciman and accepted by historians since, a strong Church was the legacy of the Byzantine empire to the Ottomans. In this article the ceremonies of the late Byzantine court, as represented by the mid-fourteenth-century text of Pseudo-Kodinos, are examined for indications of continuity in the emperor's dominant role in the Church in this later period. Gilbert Dagron's contrary perspective is considered. It is then argued that the writings of two late Byzantine churchmen, Symeon of Thessalonike and Makarios of Antioch, who insist on a lesser role for the emperor in the selection and the making of a patriarch, provide evidence for the contemporary performance of the promotion of a patriarch as described by Pseudo-Kodinos. While the two churchmen tried to show that the emperor was subject to the Church, practice shows something different.
This article focuses on the exegetical interpretation of Luke's narrative of the census (or registration) carried out at the time of Jesus's birth (Luke 2: 1–5). After some brief remarks on the juridical institution of the census (the so-called professio census) in ancient Rome, a selection of the exegetical interpretations of this pericope developed by various ancient and medieval authors is presented. Origen, Ambrose, Orosius, Bede and Bonaventure are discussed, among others. A number of medieval authors, including Dante Alighieri and Bartolus of Saxoferrato, are also considered. The analysis argues, on the one hand, that a spiritualization of the institution of the census occurred and led to the spiritual empire of Christ being seen as replacing the temporal empire of Augustus; on the other, that reference to this institution was used to legitimize political authority in the eyes of believers. This interpretative tradition is thus shown to offer a vivid example of the close intertwining of theological and juridical concepts and practices which has characterized the relationship between the Church and empire from the former's very beginning.
In the 1840s the Church of England, through the agency of the Society for the Propagation of the Gospel (SPG) and the Society for Promoting Christian Knowledge (SPCK), established an official chaplaincy to emigrants leaving from British ports. The chaplaincy lasted throughout the rest of the nineteenth century. It was revitalized in the 1880s under the direction of the SPCK in response to a surge in emigration from Britain to the colonies. This article examines the imperial attitudes of Anglicans involved in this chaplaincy network, focusing on those of the 1880s and 1890s, the period of high imperialism in Britain. It compares these late nineteenth-century outlooks with those of Anglicans in the emigrant chaplaincy of the 1840s, in order to discern changes and continuities in Anglican imperialism in nineteenth-century Britain. It finds that, in contrast to the imperialist attitudes prevalent in Britain during the late nineteenth century, Anglicans in this chaplaincy network focused more on the ecclesiastical and pastoral dimensions of their work. Indeed, pro-imperial attitudes, though present, were remarkably scarce. It was the Church much more than the empire which mattered to these Anglicans, notwithstanding their direct involvement with the British empire.
The theme of this fifty-fourth volume of Studies in Church History is ‘The Church and Empire’, and the twenty-three articles included here explore the complex and ever-evolving relationship of ecclesiastical and imperial power within a range of historical contexts. The articles represent plenary addresses and a selection of the communications presented at two highly successful Ecclesiastical History Society conferences during my presidential year – a Summer Conference held at the University of Edinburgh in July 2016 and a Winter Meeting held at Magdalene College, Cambridge, in January 2017. Both conferences attracted a large number of speakers and participants from across the world, and reflected the considerable scholarly interest in questions concerning the relations of Church and empire. These questions include the extent to which Christianity in the Western world became linked to the political power of large imperial states, the nature and extent of the connection of Christianity to the expansion of Western imperialism in the early modern and modern periods, and the manner in which the Church often came into conflict with imperial power, especially when Christians insisted on the spiritual independence of the Church and on maintaining an independent Christian moral witness against the wars of conquest, cruelty, racism, oppression and arrogance of power that too often have been associated with imperial rule.