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Introduction: Medical transport services are essential in the regionalization of trauma care. Given the limited number of designated trauma centers, transport times can be prolonged, with patient care managed by paramedics for the duration of their transfer. Pain management is a paramount component, but oligoanalgesia can occur. The primary objective of this study was to evaluate pain management practices during transport of trauma patients by air. Methods: We conducted a 12-month review of ORNGE electronic paramedic records. ORNGE is the exclusive provider of air and land transport in Ontario, Canada. Cases from 1 January 2015 to 31 December 2015 were screened. Patients were identified according to inclusion (≥18 years old requiring transportation to designated trauma center) and exclusion criteria (GCS<14; intubation; accompanied by a nurse or physician). Information was collected in a standardized, piloted data form used by a single trained data extractor. Demographics, injury description, and transportation parameters were recorded. Outcomes included pain assessment according to changes on a 10-point numeric rating scale (NRS), patterns of analgesia administration, and analgesia-related adverse events (AEs). Results were reported as mean, (standard deviation), [range], or percentage. Results: Of 600 potential records, 372 patients met our inclusion criteria with the following characteristics: age 47.0 [19-92] years; 70.4% male; 97.0% blunt injury. Duration of transport was 82.4 (46.3) minutes. Pain was initially assessed in 90.0% of patients. Overall, NRS at baseline was 4.9 (2.8). Of the 62.4% who received analgesia, NRS at baseline was 5.9 (2.5). Fentanyl was most commonly administered (78.5%) at 44.3 [25-60] mcg. NRS after the first dose of analgesia decreased by 1.1 (1.6) points. A total of 73.7% of patients received further analgesia, equal to 2.4 [1-19] additional doses. While 23.4% of patients had no change in NRS after the first dose of analgesia, subsequent doses resulted in no change in NRS in over 65% [65.4-71.3] of patients. A total of 43 AEs (6.7%) were recorded after 638 doses of analgesia, and the most common AE was nausea (39.5%). Conclusion: The majority of patients were assessed for pain. Although the first analgesia administration had minimal effect on NRS, subsequent doses appeared to have even less of an impact. AEs were infrequent.
Cathars have long been regarded as posing the most organised challenge to orthodox Catholicism in the medieval West, even as a "counter-Church" to orthodoxy in southern France and northern Italy. Their beliefs, understood to be inspired by Balkan dualism, are often seen as the most radical among medieval heresies. However, recent work has fiercely challenged this paradigm, arguing instead that "Catharism" was a construct of its persecutors, mis-named and mis-represented by generations of subsequent scholarship, and its supposedly radical views were a fantastical projection of the fears of orthodox commentators. This volume brings together a wide range of views from some of the most distinguished international scholars in the field, in order to address the debate directly while also opening up new areas for research. Focussing on dualism and anti-materialist beliefs in southern France, Italy and the Balkans, it considers a number of crucial issues. These include: what constitutes popular belief; how (and to what extent) societies of the past were based on the persecution of dissidents; and whether heresy can be seen as an invention of orthodoxy. At the same time, the essays shed new light on some key aspects of the political, cultural, religious and economic relationships between the Balkans and more western regions of Europe in the Middle Ages.
Antonio Sennis isSenior Lecturer in Medieval History at University College London Contributors: John H. Arnold, Peter Biller, Caterina Bruschi, David d'Avray, Jörg Feuchter, Bernard Hamilton, Robert I. Moore, MarkGregory Pegg, Rebecca Rist, Lucy Sackville, Antonio Sennis, Claire Taylor, Julien Théry-Astruc, Yuri Stoyanov
The 2013 conference at University College London aimed to undertake, in the words of the preliminary announcement, a reassessment of the phenomenon traditionally known as ‘Catharism’ through a debate in a non-confrontational spirit, with the aim of reconsidering without assumptions the strength of the evidence for dualist beliefs and for an organized movement of adherents to them. Eighteen months on the predominant recollection of a quite exceptionally stimulating and enjoyable occasion is that it left among its participants a surprising degree of agreement on such facts as are capable of being established – and at least as profound a disagreement as before on what they mean, for there was little, either then or since, to suggest that any mind has been much changed. It was ever thus. It is hardly news that differences in reading small pieces of evidence may lead to widely divergent conclusions. Nevertheless, that despite the best efforts of all the participants discussion focused with ever sharper intensity on ever diminishing detail reinforces the suspicion that there is more at stake in the disagreement about the nature and origins of ‘Catharism’ than a straightforward difference of scholarly opinion. Peter Biller's comment, in his introductory remarks, that the passions run much higher in this debate than in its counterpart over early Waldensianism, even though on the face of it the issues are very much the same, has been amply fulfilled. This chapter, however, eschewing wider issues, will attempt to clarify the methodological differences which still put us at cross purposes, and in particular the implications of the difference between looking forward to the crucial period in debate from an earlier standpoint, or back from a later one.
In respect of the facts divergence on the main question was not great. It was agreed that clear evidence of the presence of organized dualism in Europe, and a fortiori between the Rhone and the Garonne, before the Albigensian crusade is very slight at best, and that after 1250 it is both abundant and substantial. The traditionalists attached considerable weight to the following: a donation of revenues in 1189 to a woman who had joined the heretici;
In general modern writers on popular heresy in the high middle ages have shared the opinion of contemporary observers that the capacity of dissident preachers to attract a popular following, stimulate sentiments of intense devotion and loyalty, and canalise resentment of clerical exaction and abuse, constituted a significant threat to the authority of the Church. Hence, more or less explicitly, the extension of the theory and practice of coercion in the twelfth and thirteenth centuries has been seen as a defensive reaction designed (with the emphasis according to the preference of the historian) to protect clerical privilege and spiritual authority. There are, however, distinguished exceptions. In one of the few passages in his writings where religious persecution is discussed, Southern accounts for it thus:
… those who bore authority in the church were agents with very limited powers of initiative. They were not free agents. Doubtless they were responsible for some terrible acts of violence and cruelty, among which the Albigensian Crusade holds a particular horror. But on the whole the holders of ecclesiastical authority were less prone to violence, even against unbelievers, than the people whom they ruled.
In August 1976 the remains of a substantial building were uncovered in the courtyard of the Palais de Justice at Rouen, by the street which has been called at least since 1116 the rue aux Juifs (see plate I). That it was a Jewish building is confirmed by the Hebrew graffiti on its interior walls. It can be dated firmly to the years around 1100 by its scale, style, and workmanship, which are strongly reminiscent of the so-called ‘Norman exchequer’ in the ducal castle at Caen. The quality of its masonry is as good as may be found anywhere in northern Europe at this time. The function of the building is not altogether certain. At 14.14 X 9.46 metres, with at least one storey above the ground floor, it seems too large for a private dwelling, and indeed it is bigger than any known synagogue of this date north of the Alps. Not only the graffiti, but the lions of Judah finely carved at the base of one column, and the dragon from Psalm 91 on another, strongly suggest a religious purpose. The synagogue was on this street, but it is usually thought to have been on the south side, opposite the Palais de Justice site. This has led Norman Golb, the author of a major study of the Jewish community at Rouen, to suggest that the building unveiled in 1976 was a school, which acted as a centre of advanced study, not only for the Jewry of Rouen, but for a much larger region in which educational and scholarly activity is attested throughout the twelfth century by a rich crop of surviving manuscripts and other references, including many from places like Pont-Audemer, Touques, Falaise, Evreux, and Coutances, which were by no means major urban centres at this time.
For the most part the authors of the few lurid and fragmentary accounts we have of eleventh and early twelfth-century heretics concentrated almost exclusively on their virulent denunciations of the church, its authority, its sacraments and its priests. Consequently such success as they had has generally been explained in negative terms as the exploitation of anti-clerical sentiment arising from resentment of the church’s corruption on the one hand and the extension of its claims on the other, or as the embrace of alien doctrines imported from outside western christendom. That the second explanation is no longer held to apply before the middle of the twelfth century makes it the more necessary to ask again whether the ability of extremely varied manifestations of religious dissent to attract support in many places did not imply the existence of some positive alternative to orthodoxy, some conception of what a church might be, or what its renewal should involve.
The contribution of ‘environment’ has been investigated across diverse and multiple domains related to health. However, in the context of large-scale genomic studies the focus has been on obtaining individual-level endophenotypes with environment left for future decomposition. Geo-social research has indicated that environment-level variables can be reduced, and these composites can then be used with other variables as intuitive, precise representations of environment in research.
Using a large community sample (N = 9498) from the Philadelphia area, participant addresses were linked to 2010 census and crime data. These were then factor analyzed (exploratory factor analysis; EFA) to arrive at social and criminal dimensions of participants' environments. These were used to calculate environment-level scores, which were merged with individual-level variables. We estimated an exploratory multilevel structural equation model (MSEM) exploring associations among environment- and individual-level variables in diverse communities.
The EFAs revealed that census data was best represented by two factors, one socioeconomic status and one household/language. Crime data was best represented by a single crime factor. The MSEM variables had good fit (e.g. comparative fit index = 0.98), and revealed that environment had the largest association with neurocognitive performance (β = 0.41, p < 0.0005), followed by parent education (β = 0.23, p < 0.0005).
Environment-level variables can be combined to create factor scores or composites for use in larger statistical models. Our results are consistent with literature indicating that individual-level socio-demographic characteristics (e.g. race and gender) and aspects of familial social capital (e.g. parental education) have statistical relationships with neurocognitive performance.
Many patients treated for head and neck cancer require nutritional support, which is often delivered using a gastrostomy tube. It is difficult to predict which patients will retain their gastrostomy tube in the long term. This study aimed to identify the factors which affect the duration of gastrostomy tube retention.
In this retrospective study, 151 consecutive patients from one centre were audited. All patients had a mucosal tumour of the head and neck, and underwent gastrostomy tube insertion between 2003 and 2007.
There were near-complete data sets for 132 patients. The gastrostomy tube was retained in survivors (n = 66) for a mean of 21.3 months and in non-survivors (n = 66) for 11.9 months. Univariate analysis showed that co-morbidity was the only factor which significantly increased duration of gastrostomy tube retention in survivors (p = 0.041).
Co-morbidity alone was associated with a significant increase in gastrostomy tube retention. It is suggested that co-morbidity be included as a variable in future relevant research. Co-morbidity should also be considered when counselling patients about their long-term function following cancer treatment. Gastrostomy tube retention is likely to be affected by many factors, with few single variables having importance independently.
The Magellanic System represents one of the best places to study the formation and evolution of galaxies. Photometric surveys of various depths, areas and wavelengths have had a significant impact on our understanding of the system; however, a complete picture is still lacking. VMC (the VISTA near-infrared YJKs survey of the Magellanic System) will provide new data to derive the spatially resolved star formation history and to construct a three-dimensional map of the system. These data combined with those from other ongoing and planned surveys will give us an absolutely unique view of the system opening up the doors to truly new science!