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A road is only a simple thing at first sight, as has been previously noted (Miller 2001: 183). On second look, however, it reveals its dazzling complexity, as well as a profound and deep connection with human endeavours that it entails, for instance, with the human desire to escape from one place or to reach another. Movement, change and transformation are intrinsic to roads, to the experiencing subjects who travel along them and the environment they traverse, which they connect as much as divide. As the epitome of modernity, the road is a symbol of violence, colonialism, conquest, oppression and exploitation, as well as an icon of hope, protest and freedom.
Roads are connected to religion in manifold ways, not only in the sense that religions offer certain ‘paths’ to salvation (Sting 1997). Some of our readers and most of our authors will know what it feels like to be squeezed between narrow rows of a crowded bus in India, the vehicle coming to a sudden stop, the bus driver (or one of his team) jumping off to quickly offer a coconut at a small shrine on the side of the road, before diving back into the bus, hoping that the gods will hear him and give their blessing. Obviously, not only in India, but definitely there, roads are places of worship and of pilgrimage. They may represent ‘mythographies’ (Masquelier 2002), imaginations of an indigenised modernity which also involve ideas about the anger of those spirits whose dwellings have suffered destruction in the very construction of the road. They are also sites of reflection, a moral geography in relation to which loss of traditions and moral anomie can be contemplated (Luning 2009). They are liminal spaces and, as such, dying on the road – or rather on the path – may be considered a particularly ‘bad death’ (P. Berger 2015: 276f.). Being on the road may be associated with potential transgressions of embodied local moral orders and codes, and, as such, they may be a powerful tool restricting movement and reproducing asymmetrical relationships in terms of caste, class and gender (Miller 2001).
It is April 1999, two old men are the first to reach the shrine of Gumang or Pat Kanda, outside the Gadaba village of Gudapada. They are the sacrificer (pujari) and the ritual cook (randari), the most senior men in the village in terms of ritual status. They have followed the narrow paths out of the village and through the dry fields on the hard laterite soil that has not seen a drop of rain since the end of the monsoon in October. They climb down to wet rice fields that are constructed in the bed of the river. After balancing on the narrow earthen division separating two paddies, they climb up again on the other side and reach the most important shrine of the village, consisting merely of a small roofed structure without walls, but with thick beams supporting the roof only about a metre above the ground. Below the roof, a single stone protrudes about 30 cm out of the earth, the local representation of dorom or the sun-moon deity. Shortly afterwards, other men assemble and clear the area of dry leaves and branches. Then they take the tiles off the roof of the small shrine and repair the wooden structure before covering it again. A few of the older men only wear loincloth, but most wear a lungi or dhoti and a shirt. One young man stands out, not only because he is tall, but because he is dressed in a bright red garment (Hindi: kurta). Once the sacrificial site has been prepared, the pujari ‘sacrifices’ a coconut before two animals – a cock and a goat – are ritually killed. The man in red is given some pieces of the coconut and leaves before the animals are killed. Later, he is not to be seen among the groups eating different parts of the sacrificial animals at different places. Did the man participate in the ritual or not?
Krusna Sisa, the man dressed in red, is a member of a religious movement known locally as Olek Dormo, and called Mahima Dharma in Dhenkanal, its region of origin. Ascetics (babas) probably came to Koraput in the early 1970s to seek new adherents to their movement.
We present a rare case of incidentally diagnosed Twiddler’s syndrome in a child 7 years after implantation of a dual-chamber pacemaker system with epicardial leads. During revision, an insulation defect of the ventricular lead was evident, despite unremarkable prior pacemaker lead testing. The lead was repaired and a new generator was suture-fixated to prevent re-occurrence of generator manipulation.
Protein-losing enteropathy is an infrequent but severe condition occurring after Fontan procedure. The multifactorial pathogenesis remains unclear and no single proposed treatment strategy has proven universally successful. Therefore, we sought to describe different treatment strategies and their effect on clinical outcome and mortality.
Material and Methods:
We performed a retrospective observational study. From the total cohort of 439 Fontan patients treated in our institution during the study period 1986–2019, 30 patients (6.8%) with protein-losing enteropathy were identified. Perioperative, clinical, echocardiographic, laboratory, and invasive haemodynamic findings and treatment details were analysed.
Median follow-up after disease onset was 13.1 years [interquartile range 10.6]. Twenty-five patients received surgical or interventional treatment for haemodynamic restrictions. Medical treatment, predominantly pulmonary vasodilator and/or systemic anti-inflammatory therapy with budesonide, was initiated in 28 patients. In 15 patients, a stable remission could be achieved by medical or surgical procedures (n = 3 each), by combined multimodal therapy (n = 8), or ultimately by cardiac transplantation (n = 1). Phrenic palsy, bradyarrhythmia, Fontan pathway stenosis, and absence of a fenestration were significantly associated with development of protein-losing enteropathy (p = 0.001–0.48). Ten patients (33.3%) died during follow-up; 5-year survival estimate was 96.1%. In unadjusted analysis, medical therapy with budesonide and pulmonary vasodilator therapy in combination was associated with improved survival.
Protein-losing enteropathy is a serious condition limiting survival after the Fontan procedure. Comprehensive assessment and individual treatment strategies are mandatory to achieve best possible outcome. Nevertheless, relapse is frequent and long-term mortality substantial. Cardiac transplantation should be considered early as treatment option.
Dynamics of conversion and religious change more generally are extremely complex, yet it is crucial for contemporary societies to understand them. This volume contributes to this understanding by focussing on the processes and modalities of conversion within, between and across various religious traditions (Hinduism, Islamic Reformism, Christianity, indigenous religions) from a multi-disciplinary perspective, including anthropology, sociology, religious studies, history and theology. While the book deals with Indian case studies, the introduction, preface (by Piers Vitebsky) and afterword (by Aparecida Vilaça) also offer a comparative perspective linking the Indian situation to contexts of conversion in other parts of the world. The introduction not only provides an overview of important research on conversion in India, it also intends to advance the general theoretical reflection on conversion, considers analytical tools for further research and discusses the work of important theorists such as Pierre Bourdieu, Joel Robbins and Marshall Sahlins who are not generally referred to in debates on conversion in India.
We developed the Long-term Early Development Research (LEADER) project to investigate the development of children with CHD and/or after cardiopulmonary resuscitation. Both populations are at risk for delays in motor, cognitive, and language development. However, few studies to date have investigated the longitudinal development in these children.
To establish a clinical research unit, we planned three studies: a cross-sectional study in children after cardiopulmonary resuscitation (LEADER-REA Pilot Study), a longitudinal study in children after cardiopulmonary resuscitation, with a focus on evaluating various biomarkers as predictors for developmental outcome (LEADER-CPR study), and a longitudinal study in children with ventricular septal defect, tetralogy of Fallot, or transposition of the great arteries after cardiac surgery (LEADER-CHD study).
Implementation of all three LEADER studies was successful and study protocols were conducted as planned. Findings from the LEADER-REA Pilot study have been recently published and data collection for both prospective trials is ongoing. Descriptive analysis of the first 20 assessments of the LEADER-CHD study showed no severe deficits in overall cognitive, motor, and language developments in the children.
Children with CHD and/or after cardiopulmonary resuscitation are at risk for developmental delay. Therefore, a detailed developmental assessment is necessary as a pre-requisite for individual developmental support. Our LEADER project has been shown to be feasible in a clinical setting and is the first step towards the establishment of a clinical research unit in our clinic with a focus on longitudinal research.
With the ongoing expansion of palliative care services throughout the United States, meeting the needs of socioeconomically marginalized populations, as in all domains of healthcare, continues to be a challenge. Our specific aim here was to help meet some of these needs through expanding delivery of pain and palliative care services by establishing a new clinic for underserved patients and collecting descriptive data about its operation.
In November of 2014, the National Institutes of Health Clinical Center's Pain and Palliative Care Service (PPCS) launched a bimonthly offsite pain and palliative care outpatient clinic in collaboration with Mobile Medical Care Inc. (MobileMed), a private not-for-profit primary care provider in Montgomery County, Maryland, serving underserved area residents since 1968. Staffed by NIH hospice and palliative medicine clinical fellows and faculty, the clinic provides specialty pain and palliative care consultation services to patients referred by their primary care healthcare providers. A patient log was maintained, charts reviewed, and referring providers surveyed on their satisfaction with the service.
The clinic had 27 patient encounters with 10 patients (6 males, 4 females, aged 23–67) during its first 7 months of operation. The reason for referral for all but one patient was chronic pain of multiple etiologies. Patients had numerous psychosocial stressors and comorbidities. All primary care providers who returned surveys (n = 4) rated their level of satisfaction with the consultation service as “very satisfied” or “extremely satisfied.”
Significance of Results:
This brief descriptive report outlines the steps taken and logistical issues addressed to launch and continue the clinic, the characteristics of patients treated, and the results of quality-improvement projects. Lessons learned are highlighted and future directions suggested for the clinic and others that may come along like it.
In patients with CHD, cardiac MRI is often indicated for functional and anatomical assessment. With the recent introduction of MRI-conditional pacemaker systems, cardiac MRI has become accessible for patients with pacemakers. The present clinical study aims to evaluate safety, susceptibility artefacts, and image reading of cardiac MRI in patients with CHD and MRI-conditional pacemaker systems.
Material and methods
CHD patients with MRI-conditional pacemaker systems and a clinical need for cardiac MRI were examined with a 1.5-T MRI system. Lead function was tested before and after MRI. Artefacts and image readings were evaluated using a four-point grading scale.
A total of nine patients with CHD (mean age 34.0 years, range 19.5–53.6 years) received a total of 11 cardiac MRI examinations. Owing to clinical indications, seven patients had previously been converted from conventional to MRI-conditional pacemaker systems. All MRI examinations were completed without adverse effects. Device testing immediately after MRI and at follow-up showed no alteration of pacemaker device and lead function. Clinical questions could be addressed and answered in all patients.
Cardiac MRI can be performed safely with high certainty of diagnosis in CHD patients with MRI-conditional pacemaker systems. In case of clinically indicated lead and box changing, CHD patients with non-MRI-conditional pacemaker systems should be considered for complete conversion to MRI-conditional systems.
Objective: Temporary pacing wires play a crucial role in the diagnosis and therapy of post-operative arrhythmia after surgery for congenital heart disease. At present, bipolar pacing wires are used in most institutions. In case of functional failure of these wires, a unipolar mode of stimulation and sensing should be theoretically possible as a rescue procedure. Methods: We tested the feasibility of the customised unipolar mode in 18 post-operative patients with congenital heart disease (age 9.2 ± 13.9 months, weight 6.3 ± 3.8 kg, and cardiopulmonary bypass time 70 ± 29 minutes). As there are two possible unipolar configurations, there are twice the number of testing parameters; of those, we compared sensing (mV) and pacing thresholds (V at 0.5 ms). Results: Atrial sensing was significantly better in the unipolar modes (p < 0.001, p < 0.003). The ventricular unipolar sensing did not differ significantly in the “better” of the two possible configurations from the bipolar values (p = 0.363). For the unipolar pacing thresholds, only the “better” unipolar configuration did not differ significantly from the bipolar measurements (atrial: p = 0.058, ventricular: p = 0.138). There was no exit block or undersensing. Conclusion: The results demonstrate that unipolar stimulation and sensing using bipolar epicardial temporary pacing wires is feasible. In the case of failure of bipolar temporary pacing wires, this modality represents an easy rescue measure that in such cases should always be considered.
Damascening, defined in this context as the inlay of one metal into a different metal base, is a rare decorative technique in the Early Bronze Age, known only from seven bronze artefacts found north of the Alps. This paper reports on the first thorough scientific examination of one such find, the axe from Thun-Renzenbühl grave no. 1. This interdisciplinary project involving several institutions in Germany and Switzerland investigated the axe by means of neutron radiographic imaging and X-ray microprobe methods, supported by microscopic examination. The result is an attempt to reconstruct the fabrication and decoration process and to reconsider the enigmatic question of the origins of the damascene technique north of the Alps.