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We implemented a guideline for appropriate acid suppressant use in hematology-oncology patients. This intervention resulted in a sustained reduction in proton pump inhibitor (PPI) use without an increase in rates of gastrointestinal bleeding. Practice guidelines are effective in reducing PPI use, which is associated with risk of Clostridioides difficile infection.
This research investigates two factors influencing the ability of tree-ring data to provide accurate 14C calibration information: the fitness and rigor of the statistical model used to combine the data into a curve; and the accuracy, precision and reproducibility of the component 14C data sets. It presents a new Bayesian spline method for calibration curve construction and tests it on extant and new Southern Hemisphere (SH) data sets (also examining their dendrochronology and pretreatment) for the post-Little Ice Age (LIA) interval AD 1500–1950. The new method of construction allows calculation of component data offsets, permitting identification of laboratory and geographic biases. Application of the new method to the 10 suitable SH 14C data sets suggests that individual offset ranges for component data sets appear to be in the region of ± 10 yr. Data sets with individual offsets larger than this need to be carefully assessed before selection for calibration purposes. We identify a potential geographical offset associated with the Southern Ocean (high latitude) Campbell Island data. We test the new methodology for wiggle-matching short tree-ring sequences and use an OxCal simulation to assess the likely precision obtainable by wiggle-matching in the post-LIA interval.
The novel Volumetric Image Matching Environment for Radiotherapy (VIMER) was developed to allow users to view both computed tomography (CT) and cone-beam CT (CBCT) datasets within the same 3D model in virtual reality (VR) space. Stereoscopic visualisation of both datasets combined with custom slicing tools and complete freedom in motion enables alternative inspection and matching of the datasets for image-guided radiotherapy (IGRT).
Material and methods:
A qualitative study was conducted to explore the challenges and benefits of VIMER with respect to image registration. Following training and use of the software, an interview session was conducted with a sample group of six university staff members with clinical experience in image matching.
User discomfort and frustration stemmed from unfamiliarity with the drastically different input tools and matching interface. As the primary advantage, the users reported match inspection efficiency when presented with the 3D volumetric renderings of the planning and secondary CBCT datasets.
This study provided initial evidence for the achievable benefits and limitations to consider when implementing a 3D voxel-based dataset comparison VR tool including a need for extensive training and the minimal interruption to IGRT workflow. Key advantages include efficient 3D anatomical interpretation and the capability for volumetric matching.
Qualitative inorganic analysis is required for the identification of unknowns, the classification of type, and sometimes to decide what subsequent quantitative analysis is needed. The traditional way of performing qualitative XRF analysis on unknown materials is by subjecting the sample to a full spectral scan. This takes time and an experienced operator to interpret the spectra. Classifying the elements detected as major, minor or trace can also be person dependent. Round robin tests have confirmed this by showing considerable variation in results between laboratories.
Current developments in the recently introduced method of HgI2 crystal platelet growth by polymer assisted vapor transport are described. Crystal parameters are evaluated by making electrical measurements on x-ray detectors fabricated from HgI2 platelets, Selection for detector fabrication is on the basis of size and apparent crystalline perfection. Detectors have been fabricated with active areas averaging 2 to 3 mm2 and thicknesses ranging from 20 to 400 µm. Values of electron mobility and mobility-lifetime product measured for HgI2 platelet material are among the highest ever observed for HgI2.
The combination of low leakage current and good electron transport makes HgI2 platelets suitable for room-temperature x-ray spectrometry. An energy resolution of 370 eV (FWHM) for the 5.9 KeV Mn Kα line has been obtained, and representative low-energy x-ray fluorescence spectra are presented.
The mouth may be presented and understood in different ways, be subject to judgement by others and, as we age, may intrude on everyday life due to problems that affect oral health. However, research that considers older people's experiences concerning their mouths and teeth is limited. This paper reports on qualitative research with 43 people in England and Scotland, aged 65–91, exploring the significance of the mouth over the lifecourse. It uses the concept of ‘mouth talk’ to explore narratives of maintaining, losing and replacing teeth. Participants engaged in ‘mouth talk’ to downplay the impact of the mouth, demonstrate socially appropriate ageing, and distance themselves from ‘real’ old age by retaining a moral identity and sense of self. They also found means to challenge dominant discourses of ageing in how they spoke about missing teeth. Referring to Leder's notion of ‘dys-appearance’ and Gilleard and Higgs’ work on the social imaginary of the fourth age, the study illustrates the ways in which ‘mouth talk’ can contribute to sustaining a sense of self in later life, presenting the ageing mouth, with and without teeth, as an absent presence. It also argues for the importance of listening to stories of the mouth in order to expand understanding of people's approaches to oral health in older age.
IF THE VOCABULARY of medieval English is anything to go by, birds were a conspicuous and abundant presence in the lives of medieval people. In Old English alone, one might talk of a fughel-dæg ‘bird-day’; of being a fugel-bana ‘bird-killer’ gone fugelung ‘fowling’ with a fugel-net ‘bird-net’ somewhere fugel-wylle ‘abounding in birds’; or of a fugel-hælsere ‘bird-diviner’ observing fugel-cynn ‘birdkind’; or perhaps of feðer-cræt ‘feather-embroidering’ or a feðer-bed. Raucously and richly vocal, feathered and flying, birds impressed and enriched, sustained and enabled the bodily and cognitive experiences of daily living. As much as their mammalian fellows, birds were participants in rural and urban living in a time, as one historian goes so far as to say, in which ‘animals and humans shared space, food, famines, work, and weather conditions more intensely’ than any other historical age except human prehistory. As the Old English terms above suggest, birds were often of practical interest. The most proximate, everyday species were domestic poultry: chickens were an important and protected resource, enjoyed by almost every social stratum, and geese, a more labour-intensive poultry species, not only provided meat and eggs, but their feathers, plucked from living or dead birds, were a crucial resource for arrows and quills. Tamed birds of prey were highly prized among the nobility, nurtured and flown by falconers who knew intimately the birds’ idiosyncratic habits and moulting patterns. All these birds could occupy less prosaic roles, too. Raptors had powerful semiotic value as emblems on escutcheons, or through the projection of ‘shared’ courtly values in literary realms, and even the humble chicken could, in cockerel form, function as a symbol of Christian light and hope, or the hen feature as an encrypted marvel in an Old English riddle, or a reminder of God's divine wisdom in bestiary sources.
Recent interest in human-nonhuman relations has emphasised this eclecticism of animal meaning in pre-modern living, but particularly nonhuman physicality, reminding us that these creatures existed within a network of relations and interactions with human subjects who were well acquainted with the origins and husbandries of those natural sources that provided foods and technologies.
This indoors flying makes it seem absurd, Although it itches and nags and flutters and yearns, To postulate any other life than now.
(Louis MacNeice, ‘Dark Age Glosses’, 15–17)
What came first, the seabird's cry or the soul Imagined in the dawn cold when it cried?
(Seamus Heaney, ‘Small Fantasia for W.B.’, 3–4)
LOUIS MACNEICE's poem reminds us of how well endures one specific association of a very well-known sparrow with a central Anglo-Saxon ‘image-complex’: fire-lit hall and raging storm, transience and eternity. The purported moment in Bede's Historia ecclesiastica when one king and his people reject their pagan beliefs for a promised Christian eternity pivots on a fictional augury in which a flying bird is entwined with the morphosis and fate of the human soul. Bede's sparrow is allegorical: like man's journey from the unknown to human existence on earth, and then again to the unknown, the bird flies in from the cold, through the banqueting hall and back out again into the tempestuous night, subject to the ineluctable transience of mortal life. The passer, or spearwa in Old English, becomes responsible for a seminal moment in the history of the English people, assigned a significant rhetorical function in a pagan representation of life without Christ that simultaneously contemplates what that life might look like after conversion. It resonates with and consolidates a scriptural legacy which designates birds a special status in thinking through this key theological anxiety and inquiry, a legacy which locates birds as ideal creatures to articulate the Christian pilgrim journey by aligning avian flight with the metaphorical peregrinations of the faithful who must ‘soar to the unchangeable substance of God’. The bird appears in Saint Augustine's lengthy exegesis of Psalm 83, for instance, where it is compared to the human heart or soul. Psalm 124.7 includes the neodspearuwa ‘needful sparrow’ that Ælfric alludes to elsewhere: Ute sawl is ahred of grine swa swa spearwa ‘Our soul is freed from the snare just like the sparrow’.
BIRDS IN THE EXETER BOOK RIDDLES are an important subject of wonder, the various and unique transformations of particular species described in a scheme of nearly one hundred riddles that marvel at nonhuman phenomena, both animate and inanimate. Anglo-Saxon riddles as a whole had serious, didactic purposes and, despite their unique characteristics, the Old English riddles’ clear connections to the Anglo-Latin examples make it likely that they also served some form of pedagogic role in a monastic environment. Certainly their formulaic injunctions, instructing that we frige ‘ask’ or saga ‘say’ hwæt ‘what’ or hu ‘how’ something is or comes to be, fit with the intellectual lines of inquiry evident in the Latin riddles. Superficially, then, birds feature on one level in the ‘catalogue of diversity’ to be pondered, guessed and classified by naming a solution. As scholars of the Exeter Riddles have long known, however, their unique form of vernacular riddling presents audiences with sophisticated, often divergent forms of learning and hermeneutics in their own right, and in this chapter I explore how birds’ peculiarities become part of the collection's self-reflexive pedagogic aims and strategies.
As in Chapter One, we are never far from the mysterious qualities of birds’ foreignness, and this compelling avian aspect will ultimately concern us more with how the Riddles’ strategies reveal ignorance as much as enlightenment. I see avian quiddities as particularly apt in this dialogic game, because the lives and behaviours of these proximate strangers exemplify well the distinctive interplay of the known and unknown in riddling discourses; in being both nameable and anonymous they suit riddles’ tendencies to obfuscate and disambiguate concurrently. Birds are a significant element in the miscellany, that is, because they enact a series of diverse transformations that redouble their participation in the Riddles’ preoccupations with wondering. As subjects of wonder, they naturally perform a bewildering range of perpetual sleights and shifts that transgress species and territory boundaries, making their diversity excellent riddle material. Within riddling frameworks, however, this unpredictable diversity achieves a heightened focus because it meets with further transformations imposed by metaphor and paradox.
THE BIRDS THAT FLY AND SING through my five chapters have enacted, provoked and evaded transformations. Metaphor – indeed, all forms of human translation – is repeatedly at stake, empowered and limited through its various and tangled involvements with the avian real. In Chapter One, birds mobilised a paradoxical metaphor, aiding those transfigurations most desired in orthodox Christian doctrine. In Chapter Two they mystified scholastic attempts to decode their diversity of kinds that ‘be not distinguyd in certayne’, escaping or thwarting human transformative designs upon the natural world. Elsewhere, they managed curious frictions between biological and cultural species traits with comic aplomb, manipulating and resisting their assigned roles in literary modes to reverse or redirect humanised taxonomies of species and voice. In the final chapter, we ended with the most substantial and dramatic of all avian transformations, simultaneously dispersive and integrative mutations that ‘bringen forth of briddes kinde’ (CA, IV.3119).
Studies of the sort I offer here run an unavoidable risk. Those who consciously and rigorously attempt to write about the nonhuman are paradoxically forced to recognise that they always do write about the human. As Erica Fudge comments, in these cases ‘we read humans writing about animals’, and (even if we do claim to address the animal purely as itself) we must process these writings through our own human faculties. To borrow the words of another writer on birds, there is a ‘sense in which a book like this on birds is really about ourselves’. I do not intend, however, that the title of this book should be misleading. I maintain that birds are, in fact, my proper focus because their materiality is always evident and deeply relevant. Their presence reveals intertwined human–avian histories and existences that can and do suggest an interdependence or compatibility that makes the bird integral, not marginal, to our self-conceptions. It would be entirely false, of course, to suggest that the birds I discuss are not symbolic, metaphoric or anthropomorphic, or that medieval people were not users of birds in the traditional sense.
[Tell me now, you wretched creature: is there any other purpose to you, other than that you have a shrill voice? You mean nothing to any other being … What good do you do among mankind?]
Heruore hit is þat me þe shuneþ
An þe totorue & tobuneþ
[So it is that people shun you, and pelt and beat you to pieces.]
(The Owl and the Nightingale, 556–63 and 1165–6)
THE OWL's VITRIOLIC WORDS in the first epigraph above remind us of the central theme of this poem's ‘plaiding suþe stronge’ [very strong debate (12)] – an owl and a nightingale contend aggressively on the usefulness of their voices, apologists for their own, and lambasters of the other's. In one respect, this is a generic feature, a recognisable component from a number of the possible Latin or Anglo-Norman debate-poems which are likely sources for The Owl and the Nightingale: people, abstractions or creatures debate their individual merits, or those of another whom they represent. On this simple basis, Neil Cartlidge comments, the poem certainly qualifies as a debate-poem, and the adept treatment the author makes of so-called debate-poetry characteristics in itself may point out an important aim for a text whose exact purpose has famously baffled scholars: ‘it could reasonably be described both as a self-conscious summation, and a self-conscious surpassing, of received literary possibilities’. In this skilled ‘summation’, however, we are alerted to how those ‘received literary possibilities’ mesh with other medieval literary discourses in which being useful bears significance. The cut and thrust of disputatio, dealt with more simply or superficially in The Owl and the Nightingale's sources, does not exist as a frivolous display of wit, or even just as a comment on rhetoric itself, but to press debating the subject of nonhuman worth to much more provocative ends.