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We evaluated the safety and feasibility of high-intensity interval training via a novel telemedicine ergometer (MedBIKE™) in children with Fontan physiology.
The MedBIKE™ is a custom telemedicine ergometer, incorporating a video game platform and live feed of patient video/audio, electrocardiography, pulse oximetry, and power output, for remote medical supervision and modulation of work. There were three study phases: (I) exercise workload comparison between the MedBIKE™ and a standard cardiopulmonary exercise ergometer in 10 healthy adults. (II) In-hospital safety, feasibility, and user experience (via questionnaire) assessment of a MedBIKE™ high-intensity interval training protocol in children with Fontan physiology. (III) Eight-week home-based high-intensity interval trial programme in two participants with Fontan physiology.
There was good agreement in oxygen consumption during graded exercise at matched work rates between the cardiopulmonary exercise ergometer and MedBIKE™ (1.1 ± 0.5 L/minute versus 1.1 ± 0.5 L/minute, p = 0.44). Ten youth with Fontan physiology (11.5 ± 1.8 years old) completed a MedBIKE™ high-intensity interval training session with no adverse events. The participants found the MedBIKE™ to be enjoyable and easy to navigate. In two participants, the 8-week home-based protocol was tolerated well with completion of 23/24 (96%) and 24/24 (100%) of sessions, respectively, and no adverse events across the 47 sessions in total.
The MedBIKE™ resulted in similar physiological responses as compared to a cardiopulmonary exercise test ergometer and the high-intensity interval training protocol was safe, feasible, and enjoyable in youth with Fontan physiology. A randomised-controlled trial of a home-based high-intensity interval training exercise intervention using the MedBIKE™ will next be undertaken.
The temporal structures of provincial realist novels set in extraction landscapes convey the new understanding of futurity that attended the nineteenth-century rise of an industrial system powered by a nonrenewable, diminishing stock of underground resources. Focusing on Joseph Conrad's Nostromo (1904), George Eliot's The Mill on the Floss (1860), and Fanny Mayne's Jane Rutherford; Or, the Miners' Strike (1853), this article demonstrates how these works adapt the provincial realist novel's emphasis on social renewal by way of marriage, reproduction, and inheritance to the extraction-based society of industrial Britain, undergirded by a trajectory of depletion and exhaustion rather than renewal. These works' deviation from novelistic chrononormativity expresses a new understanding of an extraction-based present that is claimed at the expense of future generations.
This essay recasts the central locale of The Mill on the Floss in order to show how the geography and society of George Eliot's novel function together as a conjoined ecological system. I show that the port at St. Ogg's is set on an estuary, and from this observation, I claim that the entanglement of multiple estuarial waters provides a formal model for the overall ecology of the novel. Referring to this system as “ecological form,” the essay shows how the characters’ misunderstanding of the estuarial nature of the St. Ogg's hydrography is the primary source of the communal divisions with which the novel is so famously riven. In so doing, this essay makes two methodological interventions, one local, and one slightly more global. In the first, I show how unsticking the progression of our criticism from that of a novel's plot—especially one with such a catastrophically strong telos as Mill’s—can allow us to view form and, particularly, geography as newly vital to literary history. This leads to the second intervention, in which I suggest that reading practices in an age of environmental collapse should look beyond disaster itself and toward affected communities’ systemic ties to those extraneous systems—economic, legal, imperial—that aid and abet disasters elsewhere and even ignore the potential for catastrophic reoccurrence in the near future. In other words, reading for water readily yields a wide-ranging map of global capitalism perhaps unexpectedly centered on a small town in Lincolnshire.
This article explores the ecology of form presented in George Eliot's novel Silas Marner. Though many have read the novel as a tight-knit account of an organic society, this author reads a more disorienting, emergent, and conflicted study of the coproduction of lives and environment. George Henry Lewes's account of physiology, particularly his discussion of epigenesis, is foundational to this disorganizing turn in Eliot's fiction. Finally, the author explores how the contingent relation between Eppie and Silas Marner underlines the recent convergence between discussions of queer futurity and the agential turn in ecocriticism.
This article traces the rise of modern oil culture to interlocking innovations in British fiction, political economy, natural science, and colonial capitalism. It advances a method called “transitive reading” to understand those innovations and to show how writers first conceived of oil in relation to established energy inputs such as coal. The article then reads Joseph Conrad's late masterpiece, Victory (1915), as an ambivalent artifact of the British petro-imagination. In representing the “liquidation” of overseas coal capitalism, Victory articulates a desire for freedom from carbon power, while nevertheless binding that desire to a world where petroleum or “liquid coal” was becoming increasingly constitutive of the self.
This essay reads Gerard Manley Hopkins's poetry for its “ecological perception”: a perceptual modality involving the dynamic interaction between human bodies and environmental givens or potentialities. Linking Hopkins's syncretic ideas about perception to the psychologist J. J. Gibson's account of our sensitivity to environmental “affordances,” the essay assesses three scales of ecological perception in Hopkins (arboreal, atmospheric, apocalyptic) and stresses the particular relevance of the intermediate (atmospheric) scale for our experience of environmental crisis. In “The Blessed Virgin compared to the Air we Breathe,” Hopkins recognizes the “teleconnections” bridging global systems and specific sites without remaining rooted to the local or bioregional (arboreal) or rushing to a vantage beyond planetary confines (apocalyptic).
Taking a long view of mycological history, this essay considers how studies of fungal life have modeled fugitive, cryptic, and queer forms of belonging that open the body and the body politic to modes of collectivity that trouble the equation of ecology with holistic closure. Turning to Arthur Machen's The Hill of Dreams, this essay shows how the geographies of desire and belonging created through fungal intimacies make it impossible to speak of either the self-contained individual or ecology in the singular. Open and plural, selves and worlds proliferate, contaminate, and interpenetrate through the infectious touch of fungal relations.
This essay presents an ecocritical analysis of Hannah Crafts's The Bondwoman's Narrative, the 1850s manuscript novel by a formerly-enslaved African American woman that was recovered by Henry Louis Gates in 2001. Examining Crafts's extensive engagement with Charles Dickens's Bleak House, it argues that Crafts's fictionalized narrative of enslavement and self-emancipation re-imagines a Victorian politics of environmental health as a critique of environmental racism. Showing how Crafts presents the material ecology of the plantation South as a site and vector of violence, it reads The Bondwoman's Narrative as resisting nineteenth-century scientific discourses of racialized immunity that sought to legitimize the systemic neglect of enslaved people in the antebellum United States.
This essay returns to the early nineteenth-century prehistory of ecology to argue that the anthropocentrism of Victorian social novels should be understood as a deliberate, pragmatic response to the ethical dilemmas of ecological entanglement—dilemmas visible by the late eighteenth century. Interspecies entanglement and its discontents provided the cornerstone of Malthus's infamous arguments about overpopulation in the Essay on the Principle of Population (1798). Inspired by Malthus's proto-ecological vision of endless interconnection, Harriet Martineau adopted it as the plot structure of her Illustrations of Political Economy (1832–34), some of the earliest and most influential examples of industrial fiction. Later social novelists borrowed Martineau's narrative technique of disclosing community by tracing material interdependence, but they excluded relations that crossed the species barrier. Those exclusions arose not from arrogance or ignorance of humanity's dependence on other species but from the decision to bracket often unanswerable questions arising from interspecies collectivity to foreground the practical importance of attending to the urgent needs of human beings.
This collection of essays turns to the nineteenth century in order to weigh the legacy of its holistic conception of systems and to resurrect alternative discourses of openness, permeability, and indeterminate relation. If modern ecocriticism has sometimes been hobbled by a restrictively organic, harmonious conception of how ecologies work, we wager that a return to Victorian interrogations of natural and social collectives can furnish more open, less integrated models for how assemblages operate. The nineteenth century saw both the first acceleration of anthropogenic climate change and the birth of a host of sciences-economic, social, geological, energetic, and (yes) ecological-that now struggle to address the planetary implications of that acceleration. Our growing awareness that we are now living in the long tail of this conjuncture and at the birth of the Anthropocene has prompted a re-evaluation of what we think we know about how nature and society work, and how they might work together.
Studies of symbiosis have been instrumental in recent thinking about bodies and ecologies as open systems. But even before the invention of symbiosis toward the end of the nineteenth century, parasitism helped scientists conceive of open ecologies marked by complex, interdependent intimacies. This essay shows how the invention of symbiosis as an umbrella term for “true parasitisms” and “non-parasitisms” helped to close off previously existing (if precarious) possibilities for reciprocality within the older concept, and suggests that the time has come for a revitalization of parasitism as a conceptual tool in the face of social and ecological crisis
This article argues that Mayhew's London Labour and the London Poor articulates a mid-nineteenth-century urban ecology that resonates with the “open” and “unfinished” form of midcentury London and Mayhew's London Labour itself. Mayhew's extensive elaboration of midcentury recycling, repurposing, and reusing practices is put into dialogue with the volumes’ print innovations and, in particular, print recycling practices. Drawing on the passage in which Mayhew describes his ecological vision most compactly—itself recycled from an earlier work—it illustrates how these volumes unite “the ragpicker” and the writer in the production of open and usable forms generative of social change.
This study addresses the question of why so many of the world's legislators are lawyers or law graduates. Drawing from previous studies on lawyer-legislators and electoral systems, it develops the argument that ‘first-pass-the-post’ single-member district electoral systems presume a principal-agent logic of representation and are therefore conducive to political parties selecting representatives with either occupational experience or educational training in the field of law. By contrast, proportional representation (PR) elections presume a microcosm model of representation incentivizing parties to select candidates representing diverse demographic and occupational backgrounds. This conjecture is tested by examining legislator backgrounds in three large parliaments with mixed electoral systems: Germany, Japan, and South Korea. As expected, single-member plurality elections are linked to a greater share of lawyers and law graduates in parliaments compared to those elected via PR even after controlling for several alternative explanations.
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.
Emergency physicians play an important role in providing care at the end-of-life as well as identifying patients who may benefit from a palliative approach. Several studies have shown that emergency medicine (EM) residents desire further training in palliative care. We performed a national cross-sectional survey of EM program directors. Our primary objective was to describe the number of Canadian postgraduate EM training programs with palliative and end-of-life care curricula.
A 15-question survey in English and French was sent by email to all program directors of both the Canadian College of Family Physicians emergency medicine (CCFP(EM)) and the Royal College of Physicians and Surgeons of Canada emergency medicine (RCPSC-EM) postgraduate training programs countrywide using FluidSurveys™ with a modified Dillman approach.
We received a total of 26 responses from the 36 (response rate = 72.2%) EM postgraduate programs in Canada. Ten out of 26 (38.5%) programs had a structured educational program pertaining to palliative and end-of-life care. Lectures or seminars were the exclusive choice to teach content. Clinical palliative medicine rotations were mandatory in one out of 26 (3.8%) programs. The top two barriers to implementation of palliative and end-of-life care curricula were lack of time (84.6%) and curriculum development concerns (80.8%).
Palliative and end-of-life care training within EM has been identified as an area of need. This cross-sectional survey demonstrates that a minority of Canadian EM programs have palliative and end-of-life care curricula. It will be important for all EM training programs, RCPSC-EM and CCFP(EM), in Canada, to develop an agreed upon set of competencies and to structure their curricula around them.
We review recent chondrule oxygen isotope studies by secondary ion mass spectrometry (SIMS). We discuss primary O-isotope fractionation characteristics of chondrule phases, and how they are used to garner information related to the physicochemical environment from which they formed. This includes high temperature gas–melt interactions, sampling of common precursors among different chondrite types, and how precursor compositions influenced redox states during chondrule formation. We also explore how primary O-isotope ratios of chondrule phases are disturbed by secondary alteration.
BACKGROUND: Meningiomas are the most common primary benign brain tumors in adults. Given the extended life expectancy of most meningiomas, consideration of quality of life (QOL) is important when selecting the optimal management strategy. There is currently a dearth of meningioma-specific QOL tools in the literature. OBJECTIVE: In this systematic review, we analyze the prevailing themes and propose toward building a meningioma-specific QOL assessment tool. METHODS: A systematic search was conducted, and only original studies based on adult patients were considered. QOL tools used in the various studies were analyzed for identification of prevailing themes in the qualitative analysis. The quality of the studies was also assessed. RESULTS: Sixteen articles met all inclusion criteria. Fifteen different QOL assessment tools assessed social and physical functioning, psychological, and emotional well-being. Patient perceptions and support networks had a major impact on QOL scores. Surgery negatively affected social functioning in younger patients, while radiation therapy had a variable impact. Any intervention appeared to have a greater negative impact on physical functioning compared to observation. CONCLUSION: Younger patients with meningiomas appear to be more vulnerable within social and physical functioning domains. All of these findings must be interpreted with great caution due to great clinical heterogeneity, limited generalizability, and risk of bias. For meningioma patients, the ideal QOL questionnaire would present outcomes that can be easily measured, presented, and compared across studies. Existing scales can be the foundation upon which a comprehensive, standard, and simple meningioma-specific survey can be prospectively developed and validated.