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Although mortality rates for patients with d-transposition of the great arteries remain quite low, these patients have a unique circulation that requires careful management in the peri-operative period. Despite the improved mortality for patients with common arterial trunk, the course in the intensive care unit is remarkable for significant morbidity and utilisation of significant resources. Pre-operative patient management focuses on balancing competing circulations, pulmonary and systemic, which exist in parallel rather than in series, as in the normal circulation. Post-operative patient management in both lesions focuses on optimising systemic output, respiratory status, and mitigating the effects of cardiopulmonary bypass. In this article, we review pre- and post-operative intensive care management in neonates with d-transposition of the great arteries and common arterial trunk.
To compare the microbiological efficacy of hydrogen peroxide vapor (HPV) and ultraviolet radiation (UVC) for room decontamination.
Prospective observational study.
500-bed teaching hospital.
HPV and UVC processes were performed in 15 patient rooms. Five high-touch sites were sampled before and after the processes and aerobic colony counts (ACCs) were determined. Carrier disks with ~106Clostridium difficile (CD) spores and biological indicators (BIs) with 104 and 106Geobacillus stearothermophilus spores were placed in 5 sites before decontamination. After decontamination, CD log reductions were determined and BIs were recorded as growth or no growth.
93% of ACC samples that had growth before HPV did not have growth after HPV, whereas 52% of sites that had growth before UVC did not have growth after UVC (P < .0001). The mean CD log reduction was >6 for HPV and ~2 for UVC. After HPV 100% of the 104 BIs did not grow, and 22% did not grow after UVC, with a range of 7%–53% for the 5 sites. For the 106 BIs, 99% did not grow after HPV and 0% did not grow after UVC. Sites out of direct line of sight were significantly more likely to show growth after UVC than after HPV. Mean cycle time was 153 (range, 140–177) min for HPV and 73 (range, 39–100) min for UVC (P < .0001).
Both HPV and UVC reduce bacterial contamination, including spores, in patient rooms, but HPV is significantly more effective. UVC is significantly less effective for sites that are out of direct line of sight.
To compare fluorescent markers with aerobic colony counts (ACCs) and an adenosine triphosphate (ATP) bioluminescence assay system for assessing terminal cleaning practices.
A prospective observational survey.
A 500-bed university-affiliated community teaching hospital.
In a convenience sample of 100 hospital rooms, 5 high-touch surfaces were marked with fluorescent markers before terminal cleaning and checked after cleaning to see whether the marker had been entirely or partially removed. ACC and ATP readings were performed on the same surfaces before and after terminal cleaning.
Overall, 378 (76%) of 500 surfaces were classified as having been cleaned according to fluorescent markers, compared with 384 (77%) according to ACC criteria and 225 (45%) according to ATP criteria. Of 382 surfaces classified as not clean according to ATP criteria before terminal cleaning, those with the marker removed were significantly more likely than those with the marker partially removed to be classified as clean according to ATP criteria (P = .003).
Fluorescent markers are useful in determining how frequently high-touch surfaces are wiped during terminal cleaning. However, contaminated surfaces classified as clean according to fluorescent marker criteria after terminal cleaning were significantly less likely to be classified as clean according to ACC and ATP assays.
To determine the ability of a mobile UV light unit to reduce bacterial contamination of environmental surfaces in patient rooms.
An automated mobile UV light unit that emits UV-C light was placed in 25 patient rooms after patient discharge and operated using a 1- or 2-stage procedure. Aerobic colony counts were calculated for each of 5 standardized high-touch surfaces in the rooms before and after UV light decontamination (UVLD). Clostridium difficile spore log reductions achieved were determined using a modification of the ASTM (American Society for Testing and Materials) International E2197 quantitative disk carrier test method. In-room ozone concentrations during UVLD were measured.
For the 1-stage procedure, mean aerobic colony counts for the 5 high-touch surfaces ranged from 10.6 to 98.2 colony-forming units (CFUs) per Dey/Engley (D/E) plate before UVLD and from 0.3 to 24.0 CFUs per D/E plate after UVLD, with significant reductions for all 5 surfaces (all P<.02). Surfaces in direct line of sight were significantly more likely to yield negative culture results after UVLD than before UVLD (all P<.001). Mean C. difficile spore log reductions ranged from 1.8 to 2.9. UVLD cycle times ranged from 34.2 to 100.1 minutes. For the 2-stage procedure, mean aerobic colony counts ranged from 10.0 to 89.2 CFUs per D/E plate before UVLD and were 0 CFUs per D/E plate after UVLD, with significant reductions for all 5 high-touch surfaces. UVLD cycle times ranged from 72.1 to 146.3 minutes. In-room ozone concentrations during UVLD ranged from undetectable to 0.012 ppm.
The mobile UV-C light unit significantly reduced aerobic colony counts and C. difficile spores on contaminated surfaces in patient rooms.
Given the elusive subject – or, better, the object – of the speaker's prayer in Shelley's “Hymn to Intellectual Beauty,” it is entirely appropriate that the first appearance of the poem in print was delayed several months because Leigh Hunt had lost the manuscript. During late 1816, several notices in The Examiner announced the imminent publication of a poem by a writer signing himself the “Elfin Knight.” After Shelley pulled together another copy from his draft notebooks, the poem finally appeared on January 19, 1817. “The following Ode,” the editor notes, “originally announced under the signature of the Elfin Knight, we have since found to be from the pen of the Author … mentioned, among others a week or two back in an article entitled ‘Young Poets.’” At the end of the poem appears the name of that young poet, “Percy B. Shelley.” Right below his name, filling the rest of the right column and continuing on the next page, is an article titled “Reform,” reporting “A select meeting of Independent Gentlemen, friends of economy, public order, and reform,” who had met to discuss “a constitutional Reform in the Commons House of Parliament,” a practical attempt to “free / This world from its dark slavery” (“Hymn,” ll. 71–2).
Shelley's drafts and notebooks, which have recently been published for the first time, are very revealing about the creative processes behind his poems, and show - through illustrations and doodles - an unexpectedly vivid visual imagination which contributed greatly to the effect of his poetry. Shelley's Visual Imagination analyzes both verbal script and visual sketches in his manuscripts to interpret the lively personifications of concepts such as 'Liberty', 'Anarchy', or 'Life' in his completed poems. Challenging the persistent assumption that Shelley's poetry in particular, and Romantic poetry more generally, reject the visual for expressive voice or music, this first full-length study of the drafts and notebooks combines criticism with a focus upon bibliographic codes and iconic pages. The product of years of close examination of these remarkable texts, this much-anticipated book will be of great value for all students of Shelley and all those interested in the Romantic process of creation.
Laon and Cythna; or, The Revolution of the Golden City: a Vision of the Nineteenth Century is a long narrative showing how poet–prophets might work “to free the world from its dark slavery,” to free it from all coercive political and intellectual power even in the face of reasserted tyranny. In Queen Mab, the ruins of ancient civilizations are haunting memories of tyrannies overthrown and yet resurgent in new territories, with the exception of “the ghost of Liberty” haunting a now-ruined classical Athens. In Laon and Cythna a cultural inheritance of once-active liberty, manifested in the visible ruins of Greece, educates Laon and Cythna as children, and the framing narrator remembers the same inheritance as he attempts to revive cast-down hopes for the failed French Revolution. No single, central visionary energy figured as a named allegorical personification guides the characters or narrators as in “Intellectual Beauty.” Nor are the many personifications that work in the poem voiced from above, abstracted from events, like those of Queen Mab as she critiques mass ideological enchantment and envisions reform. Instead, the most striking aspect of personification in Laon and Cythna is that the characters, more or less realistic historical agents within the visionary narrative frame, themselves develop the personifications – some positive, some negative. They do this with deliberate self-consciousness, well aware of the fictional, yet persuasive rhetorical properties of their figures, both verbal and visual.
Like Epipsychidion, Adonais uses allegorical personification not to unleash the agency of a central, structuring concept but instead to encircle, enshroud, and transform an actual historical person. As in Epipsychidion, the narrator bears a close but complex relationship to the scribal hand which sketches and drafts and to the actual, historical Percy Shelley. The earlier poem creates a fiction of a highly subjective expression of love; Adonais employs two highly conventional fictions for expressing grief, a grief that mourns both for a person and for his vocation. Although conventional, those fictional devices – the sub-genre of the pastoral elegy “spoken” by a grieving fellow shepherd and that shepherd's description of a figure resembling the actual Shelley – push the reader toward a belief in the writer's subjective encounter with loss. Earl Wasserman and, following him, Peter Sacks, argue powerfully that the published poem moves through the mourning rituals of the traditional elegy with a figurative language that generates its own level of healing transformations. While Wasserman briefly notes biographical readings, Sacks argues that this formal process of mourning also expresses Shelley's own grief and anxieties about Keats' death. I locate this autobiographical, psychological work, instead, in his manuscript drafts. The “successions” of his revisionary process create a consoling artifice of mourning that can discover within its own figurations a skeptic's hypotheses of immortality.
Almost fifty years ago, Daniel Hughes argued that the apparent formlessness of Shelley's poetry was a deliberate artistic choice, the representation of the mind's process in the act of creation. “I would suggest,” Hughes writes, “a method of reading Shelley, and particularly Epipsychidion, which sees calculated coherence and calculated collapse, the whole to mirror in its progress the process of mind as it creates the poem.” Hughes argues that these collapses are deliberate and artistically controlled for thematic purposes. The theme, he says, is to show the mind – Shelley's own mind, yet also all minds, considered more universally – in the process of creation. Using Epipsychidion as Hughes did, in this chapter I will pursue the relationship, sometimes a gap or abyss, between rhetoric and history in the poem. Using the draft notebooks as well as the final printed text, I will argue that Shelley's conversion of Teresa Viviani from an actual person to a rhetorical personification, a process that he represents as his discovery that the actual person fulfils his dreamed-of ideal, leads in the draft notebooks not only to the insufficiency of the speaker's language to represent, but also to the power of the writer's metaphor to create. I will also argue that the drafts redefine what we might call compositional impasses, collapses in the actual writing process, as several different kinds of rhetorical collapses.
In contrast to the more traditional iconographic methods of The Mask of Anarchy, the “Ode to Liberty” at first seems to return to the sort of iconoclasm Shelley developed for his “Hymn to Intellectual Beauty” in 1816. Like Intellectual Beauty, the elusive and barely humanized power evoked in the “Hymn,” Liberty in his 1820 Ode has almost no physical or anthropomorphic characteristics even when she is reported present. Though both personifications balance between concept and quasi-human figure brought alive through the poet's apostrophe, this lack of visual representation is particularly striking in the ode. Once Shelley had decided to write an “Ode to Liberty” in the spring of 1820, his address to that figure would have called up to his readers the very material history of the preceding three decades, not only the acting-out of revolutionary freedom in France, interpreted by the anti-Jacobins as “Anarchy,” but also the concrete, visual, and plastic representations of Liberty as a human figure, usually a woman, surrounded by emblems of her power.
For though James Thomson in the mid eighteenth century could repudiate the Phrygian cap once worn by freed Roman slaves to declare his goddess Liberty wreathed in British oak leaves, Shelley in 1820 works against a far stronger and increasingly contested array of public images. If the height of this public, visual representation occurred in the early 1790s, it persisted through Britain's mass demonstrations for governmental reform of the franchise in 1819 and – at least in cartoons – through the whole of the Queen Caroline affair in 1820.
CHALLENGING ROMANTIC ICONOPHOBIA: THE CASE OF SHELLEY
In Act ii of Prometheus Unbound, Shelley's oracular character Demogorgon responds to Asia's questions about a supreme deity by asserting with skeptical conciseness that, “A voice / Is wanting, the deep truth is imageless.” A brilliant revision of Milton's account of Death and Burke's praise of that account as a model of verbal sublimity, Demogorgon's own voice emerges from the “deep” of his volcanic cave while Asia and her sister can see only a “mighty Darkness,” “Ungazed upon and shapeless,” a darkness possessing “neither limb / Nor form nor outline.” Shelley thus tempts critics into making the second half of Demogorgon's utterance a guide for interpreting not only this lyrical drama, but all of his poetry, as a skeptical attack upon both the aesthetic medium and the philosophic implications of visuality. Further, Romanticists have repeatedly invoked that phrase, “the deep truth is imageless,” to characterize Romantic poetry more generally as a turning away from the “mirror” or mimesis of an objective world or its transcendent structures to the voice or music of an expressive subject.
So pervasive has been this focus upon the second half of Demogorgon's assertion that W. J. T. Mitchell quotes it to characterize what he calls the “iconophobic” or anti-visual tendency of Romanticism.