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Mr S[elby]. […] Adsheart! we shall have a double marriage, as sure as two and two make four. […]
The Curtain Falls – Jane Austen, Sir Charles Grandison or The Happy Man: A Comedy in Five Acts (written 1799)
Written just after Austen had completed her first draft of Pride and Prejudice, this sentence attests to what remains the same in the novel genre as it is transformed towards the end of the eighteenth century into a vehicle for psychological realism. Clearly, Austen had figured out by the time she co-authored this dramatic adaptation of Richardson's novel that good marriages make good novels, just as they end comic plays. The satisfaction is not simply aesthetic. An ending via double marriage ensures that two and two make four; it conserves or perhaps even creates cultural rationality, the kinds of reasoning that a particular social order recognizes as indisputable. John Stevenson reminds us that, in Northrop Frye's generic theory, the distinctive feature of ‘comedy’ in the broadest sense of the term is ‘that a concluding marriage offers its audience an image of restored social order’, containing the anarchic sexual energies that had threatened its dissolution.
Austen's contemporaries, the ‘female Jacobin’ authors Mary Hays and Mary Wollstonecraft, of course much lamented the social order. If marriage is a way of rejoining and reaffirming the world as currently constituted, it offers no solution to their demand for change.
To describe the epidemiology of a cluster of vancomycin-resistant Enterococcus faecium (VAREC) in a cardiothoracic surgery intensive care unit.
A case series of patients identified through review of surveillance data on nosocomial infections, review of microbiologic records, and culture survey of patients in the unit.
Six patients in the cardiothoracic surgery intensive care unit had VAREC with identical antimicrobic susceptibility patterns over a 6-month period. Four patients were identified with VAREC through prospective surveillance and 2 through retrospective review. Prior vancomycin use was seen more commonly in patients with VAREC (6/6,100%) than in those without VAREC (3/12, 25%) (Fisher’s exact test, p= .01). Six of the 7 patients with prior infection developed VAREC (85.7%). A prior nosocomial infection and prior exposure to vancomycin were found to be important variables in a logistic regression analysis. VAREC also was isolated from the environment. Acombination of cohorting of patients and staff, and modifications of standard contact isolation practices eliminated the presence of VAREC from the cardiothoracic surgery intensive care unit.
The results suggest that prior administration of vancomycin, especially in the patient who develops nosocomial infection, can influence the acquisition of vancomycin-resistant enterococci and that VAREC may be transmitted from patient to patient. Using a modification of the standard infection control practice of isolation, we were able to control the spread of this resistant strain of E faecium.
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