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This chapter describes the transformation in the uses of the past from the late Bronze Age dynasty of the Western Zhou to the early Warring States in the late sixth and the fifth centuries BCE. It begins with the observation, based on bronze inscriptions and transmitted poems and speeches, that the genealogical past dominated the historical imgination among the political elite of the Western Zhou. Then, it turns to a discussion of the early Warring States period, with a detailed analysis of the Confucian Analects and the Mozi. In both texts, we can observe similar departures from the genealogial focus of the Western Zhou, but divergent interpretations of the historical agency of the deliberative capacity of individuals. Both texts also presume a historical rupture between the past and the present, unlike the earlier late Bronze Age materials, and offer different remedies for its overcoming.
The Introduction describes the basic arguments and scope of the book. It gives a survey of the secondary scholarship on the subject, with the contention that scholars had focused mostly on historiographical texts and neglected to study ideas of the past across the broader corpus. Moreover, it argues that there is a culturalist bias in their readings that reduces the early Chinese engagement with the past to a matter of cultural attitude. On the basis of this survey of secondary scholarship, the Introduction describes the specific perspective and methods of this study. First, it will engage with a variety of materials, both historiographical and non-historiographical; second, it will approach early Chinese narratives about the past not as expressions of cultural beliefs but as argumentative utterances in the broader political and ethical debates.
The Epilogue summarizes the key findings of each chapter, and reflects on some of the larger implications of the basic argument of the book, namely that engagements with the past in early China were less a matter of cultural attitude than they were deliberate ideological mobilization towards various political ends.
This chapter focuses on the first decades of the Han empire, and how members of the political elite dealt with the problematic legacy of the Qin empire. In particular, I discuss two distinct attempts at rehabilitating the idea of antiquity as a meaningful thing, and reasserting the historical field as relevant to the the construction of a viable political order. First, I discuss the oeuvre of the politician Jia Yi, and how he repurposed the model for engaging with the past in the Analects and argued for the urgent need to recognize once again the great utility of the past in devising political orders. Then, in the last part of the chapter, I discuss the writings of Lu Jia, another early Han politician, specifically his essay “Foundation of the Way.” In this text, Lu Jia presents a peculiar teleological narrative of the civilizing progress from antiquity to the recent past that culminates in the composition of the Five Classics. With its commitment and subjugation of the historical field, Lu Jia evinces a complex attitude towards the legacy of the Qin that was at once sharply critical and deeply sympathetic.
This chapter studies the fortune of historical knowledge under the rise of the Qin empire from the mid-fourth century to the end of the third century BCE. It begins with a discussion of the founding of the Qin empire, and how the infamous episode of the “Burning of the Books” points to its desire to exercise dominion not just over the space but also the time of the empire. Then, it turns to a discussion of the ambivalent, problematic role that history had long played in the Legalist tradition of political thought, as seen in writings by various prominent Qin officials, especially Shang Yang and Han Feizi. Then, under the Qin empire and the First Emperor, we saw not only an inheritance and forceful application of this Legalist vision of the state, but also a willful radicalization of its key principles. The Qin empire built on the Legalist legacy and finally arrived at a vision of itself as the effective “end of history,” a supposed cessation of all material change in human history henceforth that also worked as an effective dismissal of the entire historical field as ultimatley useless and irrelevant.
In this last chapter, I focus exclusively on the monumental work of history the Shiji, by Sima Qian, the Grand Archivist at the court of Emperor Wu of the Han empire. Out of the 130 chapters of the Shiji, I focus on the two, namely the “Huozhi Liezhuan” and the “Pingzhun shu,” that primarily deal with the economic history of the entire civilized world, up to the time of the Han empire. I argue that Sima Qian mobilized historical narratives to offer a sharp critique of what he perceived to be the problems with Han imperialism as it developed under Emperor Wu. The Shiji, in this sense, was a critical deployment of the field of the past; Sima Qian engaged with the past less to advance a new political order than to deconstruct an existing one. The Shiji was a critique all the way down.
Why did the past matter so greatly in ancient China? How did it matter and to whom? This is an innovative study of how the past was implicated in the long transition of power in early China, as embodied by the decline of the late Bronze Age aristocracy and the rise of empires over the first millenium BCE. Engaging with a wide array of historical materials, including inscriptional records, excavated manuscripts, and transmitted texts, Vincent S. Leung moves beyond the historiographical canon and explores how the past was mobilized as powerful ideological capital in diverse political debate and ethical dialogue. Appeals to the past in early China were more than a matter of cultural attitude, Leung argues, but were rather deliberate ways of articulating political thought and challenging ethical debates during periods of crisis. Significant power lies in the retelling of the past.
This chapter studies voices that were skeptical or even inimical towards the supposed utility of historical knowledge for the construction and functioning of a proper political order. In particular, I focus the discussion on the Guodian Laozi and the Mengzi, as representative examples of, respectively, the cosmogonic and bioethical literatures of the late Warring States period that were part of this broader antihistorical current. In the Laozi, we see the delineation of a cosmogonic history, a type of deep history that was mobilized to question and undermine the meaningfulness and relevance of all other historical narratives. In the Mengzi, we see a purposeful distancing from and subjugation of historical knowledge as an authoritative source towards the proper cultivation of one’s ethical potential. The cultivated skepticism or even hostility towards the authority of the past in these two different texts points to the contentiousness of the field of the past in the latter half of the Warring States period.
The Pain Catastrophizing Scale (PCS) measures three aspects of catastrophic cognitions about pain—rumination, magnification, and helplessness. To facilitate assessment and clinical application, we aimed to (a) develop a short version on the basis of its factorial structure and the items’ correlations with key pain-related outcomes, and (b) identify the threshold on the short form indicative of risk for depression.
Social centers for older people.
664 Chinese older adults with chronic pain.
Besides the PCS, pain intensity, pain disability, and depressive symptoms were assessed.
For the full scale, confirmatory factor analysis showed that the hypothesized 3-factor model fit the data moderately well. On the basis of the factor loadings, two items were selected from each of the three dimensions. An additional item significantly associated with pain disability and depressive symptoms, over and above these six items, was identified through regression analyses. A short-PCS composed of seven items was formed, which correlated at r=0.97 with the full scale. Subsequently, receiver operating characteristic (ROC) curves were plotted against clinically significant depressive symptoms, defined as a score of ≥12 on a 10-item version of the Center for Epidemiologic Studies-Depression Scale. This analysis showed a score of ≥7 to be the optimal cutoff for the short-PCS, with sensitivity = 81.6% and specificity = 78.3% when predicting clinically significant depressive symptoms.
The short-PCS may be used in lieu of the full scale and as a brief screen to identify individuals with serious catastrophizing.
Background: Spinal Muscular Atrophy (SMA) is an autosomal recessive neurodegenerative disease. In June 2017, Health Canada approved Nusinersen, currently the only available drug for SMA. Since 2016, patients in Ontario have been treated clinically with Nusinersen through different access programs. Methods: Retrospective case series of patients with SMA treated clinically with Nusinersen in Ontario, describing clinical characteristics and logistics of intrathecal Nusinersen administration. Results: Twenty patients have been treated across four centres. To date, we have reviewed 8 cases at one centre (seven SMA Type I, one SMA Type II). Age at first dose ranged from 3-156 months and disease duration 9-166 months. Patients had received 4-7 doses at last evaluation. Three patients with scoliosis (2 with spinal rods) required fluoroscopy-guided radiologist administration, and 4 required general anesthesia. No complications/adverse events were reported. At last follow up, 5/8 families reported improved daily activities. Of 5 patients with baseline and follow up motor function testing, 3 demonstrated improved scores. One patient died due to respiratory decline at age 9 months, despite improved motor outcome scores. Conclusions: We describe the first Canadian post-marketing experience with Nusinersen. Timely dissemination of this information is needed to guide clinicians, hospital administrators, and policy-makers.
Background: Inadequate postoperative pain control is common and is associated with negative clinical outcomes. The objective is to identify preoperative predictors of poor postoperative pain control in the adult population undergoing inpatient surgery. Methods: Meta-analysis was performed according to MOOSE guidelines. Studies were included if they evaluated postoperative pain using a validated instrument in adults undergoing inpatient surgery and reported a measure of association between poor postoperative pain control and at least one preoperative predictor. Measures of association were pooled using random effects models. Results: A total of 33 studies representing 59,259 patients were included. Significant preoperative predictors of poor postoperative pain included sleeping difficulties (OR 2.32 [95% CI 1.46-3.69]), history of depressive symptoms (OR 1.71 [95% CI 1.32-2.22]), use of preoperative analgesia (OR 1.54 [95% CI 1.18-2.03]), smoking (OR 1.33 [95% CI 1.09-1.61]), -female sex (OR 1.29 [95% CI 1.17-1.43]), presence of preoperative pain (OR 1.21 [95% CI 1.10-1.32]], history of anxiety symptoms (OR 1.22 [95% CI 1.09-1.36)], younger age (OR 1.18 [95% CI 1.05-1.32)], and higher BMI (OR 1.02 [95% CI 1.01-1.03]). Conclusions: Nine significant predictors of poor postoperative pain control were identified and these should be recognized as important factors when developing pre- and peri-operative strategies to improve pain outcomes.
Introduction: Diagnosing pulmonary embolism (PE) can be challenging because the signs and symptoms are often non-specific. Studies have shown that evidence-based algorithms are not always adhered to in the Emergency Department (ED) and are often not used correctly, which leads to unnecessary CT scanning. The YEARS diagnostic algorithm, consisting of three items (clinical signs of deep vein thrombosis, hemoptysis, and whether pulmonary embolism is the most likely diagnosis) and D-dimer, is a novel and simplified way to approach suspected acute PE. The purpose of this study was to 1) evaluate the use of the YEARS algorithm in the ED and 2) to compare the rates of testing for PE if the YEARS algorithm was used. Methods: This was a health records review of ED patients investigated for PE at two emergency departments over a two-year period (April 2013-March 2015). Inclusion criteria were ED physician ordered CT pulmonary angiogram, ventilation-perfusion scan, or D-dimer for investigation of PE. Patients under the age of 18 and those without a D-dimer test were excluded. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30 days. Trained researchers extracted anonymized data. The rate of CT/VQ imaging and the false negative rate was calculated. Results: There were 1,163 patients that were tested for PE and 1,083 patients were eligible for our analysis. Of the total, 317/1,083 (29.3%; 95%CI 26.6-32.1%) had CT/VQ imaging for PE, and 41/1,083 (3.8%; 95%CI 2.8-5.1%) patients were diagnosed with PE at baseline. Three patients had a missed PE, resulting in a false negative rate of 0.4% (95%CI 0.1-1.2%). If the YEARS algorithm was used, 211/1,083 (19.5%; 95%CI 17.2-22.0%) would have required imaging for PE. Of the patients who would not have required imaging according to the YEARS algorithm, 8/872 (0.9%; 95%CI 0.5-1.8%) would have had a missed PE. Conclusion: If the YEARS algorithm was used in all patients with suspected PE, fewer patients would have required imaging with a small increase in the false negative rate.
Introduction: Diagnosing pulmonary embolism (PE) can be challenging because the signs and symptoms are often non-specific. Studies have shown that evidence-based algorithms are not always adhered to in the Emergency Department (ED), which leads to unnecessary CT scanning. The pulmonary embolism rule-out criteria (PERC) can identify patients who can be safely discharged from the ED without further investigation for PE. The purpose of this study is to evaluate the use of the PERC rule in the ED and to compare the rates of testing for PE if the PERC rule was used. Methods: This was a health records review of ED patients investigated for PE at two emergency departments over a two-year period (April 2013-March 2015). Inclusion criteria were ED physician ordered CT pulmonary angiogram, ventilation-perfusion scan, or D-dimer for investigation of PE. Patients under the age of 18 were excluded. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30 days. Trained researchers extracted anonymized data. The rate of CT/VQ imaging and the negative predictive value was calculated. Results: There were 1,163 patients that were tested for PE and 1,097 patients were eligible for our analysis. Of the total, 330/1,097 (30.1%; 95%CI 27.4-32.3%) had CT/VQ imaging for PE, and 48/1,097 (4.4%; 95%CI 3.3-5.8%) patients were diagnosed with PE. 806/1,097 (73.5%; 95%CI 70.8-76.0%) were PERC positive, and of these, 44 patients had a PE (5.5%; 95%CI 4.1-7.3%). Conversely, 291/1,097 (26.5%; 95%CI 24.0-29.2%) patients were PERC negative, and of these, 4 patients had a PE (1.4%; 95%CI 0.5-3.5%). Of the PERC negative patients, 291/291 (100.0%; 95%CI 98.7-100.0%) had a D-dimer test done, and 33/291 (11.3%; 95%CI 8.2-15.5%) had a CT angiogram. If PERC was used, CT/VQ imaging would have been avoided in 33/1,097 (3%; 95%CI 2.2-4.2%) patients and the D-dimer would have been avoided in 291/1,097 (26.5%; 95%CI 24.0-29.2%) patients. Conclusion: If the PERC rule was used in all patients with suspected PE, fewer patients would have further testing. The false negative rate for the PERC rule was low.
The correlation between objective and subjective nasal obstruction is poor, and dissatisfaction rates after surgery for nasal obstruction are high. Accordingly, novel assessment techniques may be required. This survey aimed to determine patient experience and preferences for the measurement of nasal obstruction.
Prospective survey of rhinology patients.
Of 72 questionnaires distributed, 60 were completed (response rate of 83 per cent). Obstruction duration (more than one year) (χ2 = 13.5, p = 0.00024), but not obstruction severity, affected willingness to spend more time being assessed. Questionnaires (48 per cent) and nasal inspiratory peak flow measurement (53 per cent) are the most commonly used assessment techniques. Forty-nine per cent of participants found their assessment unhelpful in understanding their obstruction. Eighty-two per cent agreed or strongly agreed that a visual and numerical aid would help them understand their blockage.
Many patients are dissatisfied with current assessment techniques; a novel device with visual or numerical results may help. Obstruction duration determines willingness to undergo longer assessment.
Mycobacterium marinum, a bacterium found in freshwater and saltwater, can infect persons with direct exposure to fish or aquariums. During December 2013, the New York City Department of Health and Mental Hygiene learned of four suspected or confirmed M. marinum skin or soft tissue infections (SSTIs) among persons who purchased whole fish from Chinese markets. Ninety-eight case-patients with non-tuberculous mycobacteria (NTM) SSTIs were identified with onset June 2013–March 2014. Of these, 77 (79%) were female. The median age was 62 years (range 30–91). Whole genome sequencing of clinical isolates revealed two main clusters and marked genetic diversity. Environmental samples from distributors yielded NTM though not M. marinum. We compared 56 case-patients with 185 control subjects who shopped in Chinese markets, frequency-matched by age group and sex. Risk factors for infection included skin injury to the finger or hand (odds ratio [OR]: 15·5; 95% confidence interval [CI]: 6·9–37·3), hand injury while preparing fish or seafood (OR 8·3; 95% CI 3·8–19·1), and purchasing tilapia (OR 3·6; 95% CI 1·1–13·9) or whiting (OR 2·7; 95% CI 1·1–6·6). A definitive environmental outbreak source was not identified.