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This article explores a sizable and largely unknown manuscript treatise from the 1670s, “Pax et Obedientia,” which discusses the Civil Wars, trade, the origins of government, toleration, plantations (especially Jamaica), and the royal supremacy, embedding within it a distinctive engagement with Hobbes and a particular vision of imperial composite monarchy. This first analysis of what “Pax” said, who wrote it, and why he did so in the way that he did nuances the present understanding of Restoration debates over a centralizing empire; it reveals the different forms that policy makers thought that empire might take, while also capturing a moment of transition between different meanings of imperium. The anonymous author's engagement with Hobbes further suggests how questions that later fell into the realm of political economy were discussed at the time, using the language of natural jurisprudence. In demonstrating the methodological necessity of utilizing both linguistic and institutional contexts, the authors argue that the apparent incoherence of “Pax” reflects an essential although ineptly executed strategy on the part of its author. Inchoate though the manuscript is, it offers a significant opportunity to understand the intellectual world of junior members of the government and to reconsider the intersection of political thinking and political action.
Early in the COVID-19 pandemic, the World Health Organization stressed the importance of daily clinical assessments of infected patients, yet current approaches frequently consider cross-sectional timepoints, cumulative summary measures, or time-to-event analyses. Statistical methods are available that make use of the rich information content of longitudinal assessments. We demonstrate the use of a multistate transition model to assess the dynamic nature of COVID-19-associated critical illness using daily evaluations of COVID-19 patients from 9 academic hospitals. We describe the accessibility and utility of methods that consider the clinical trajectory of critically ill COVID-19 patients.
The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of Emergency Medical Services (EMS) providers to maintain personal safety during the treatment and transport of patients potentially infected. Increased rates of COVID-19 infection in EMS providers after patient care exposure, and notably after performing aerosol-generating procedures (AGPs), have been reported. With an already strained workforce seeing rising call volumes and increased risk for AGP-requiring patient presentations, development of novel devices for the protection of EMS providers is of great importance.
Based on the concept of a negative pressure room, the AerosolVE BioDome is designed to encapsulate the patient and contain aerosolized infectious particles produced during AGPs, making the cabin of an EMS vehicle safer for providers. The objective of this study was to determine the efficacy and safety of the tent in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization.
Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, an aeromedical-configured helicopter, and an aeromedical-configured jet. Sodium chloride particles were used to simulate infectious particles and particle counts were obtained in numerous locations close to the tent and around the patient compartment. Counts near the tent were compared to ambient air with and without use of AGPs (non-rebreather mask, continuous positive airway pressure [CPAP] mask, and high-flow nasal cannula [HFNC]).
For all transport platforms, with the tent fan off, the particle generator alone, and with all AGPs produced particle counts inside the tent significantly higher than ambient particle counts (P <.0001). With the tent fan powered on, particle counts near the tent, where EMS providers are expected to be located, showed no significant elevation compared to baseline ambient particle counts during the use of the particle generator alone or with use of any of the AGPs across all transport platforms.
Development of devices to improve safety for EMS providers to allow for use of all available therapies to treat patients while reducing risk of communicable respiratory disease transmission is of paramount importance. The AerosolVE BioDome demonstrated efficacy in creating a negative pressure environment and workspace around the patient and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.
The coronavirus disease 2019 (COVID-19) pandemic has created challenges in maintaining the safety of prehospital providers caring for patients. Reports have shown increased rates of Emergency Medical Services (EMS) provider infection with COVID-19 after patient care exposure, especially while utilizing aerosol-generating procedures (AGPs). Given the increased risk and rising call volumes for AGP-necessitating complaints, development of novel devices for the protection of EMS clinicians is of great importance.
Drawn from the concept of the powered air purifying respirator (PAPR), the AerosolVE helmet creates a personal negative pressure space to contain aerosolized infectious particles produced by patients, making the cabin of an EMS vehicle safer for providers. The helmet was developed initially for use in hospitals and could be of significant use in the prehospital setting. The objective of this study was to determine the efficacy and safety of the helmet in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization.
Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, a medical helicopter, and a medical jet. Sodium chloride particles were used to simulate infectious particles, and particle counts were obtained in numerous locations close to the helmet and around the patient compartment. Counts near the helmet were compared to ambient air with and without use of AGPs (non-rebreather mask [NRB], continuous positive airway pressure mask [CPAP], and high-flow nasal cannula [HFNC]).
Without the helmet fan on, the particle generator alone and with all AGPs produced particle counts inside the helmet significantly higher than ambient particle counts. With the fan on, there was no significant difference in particle counts around the helmet compared to baseline ambient particle counts. Particle counts at the filter exit averaged less than one despite markedly higher particle counts inside the helmet.
Given the risk to EMS providers by communicable respiratory diseases, development of devices to improve safety while still enabling use of respiratory therapies is of paramount importance. The AerosolVE helmet demonstrated efficacy in creating a negative pressure environment and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.
Electronic health records (EHRs) are a significant contributor to physicians’ low satisfaction, reduced engagement and increased burnout. Yet the majority of evidence around EHR and physician harms is based on self-reported screen time, which may both over- and underreport actual exposure.
The purpose of this study was to examine how objective EHR use correlates with physician well-being and to develop preliminary recommendations for well-being-based EHR interventions.
Prior to the onset of COVID-19, psychiatry residents and attending physicians working in an out-patient clinic at an academic medical centre provided consent for access to EHR-usage logs and completed a well-being assessment made up of three scales: the Maslach Burnout Inventory, the Urecht Work Engagement Scale and the Professional Quality of Life Measure. Survey responses and objective EHR data were analysed with descriptive statistics.
Responses were obtained from 20 psychiatry residents (total eligible residents n = 27; 74% participation) and 16 clinical faculty members (total eligible faculty n = 24; 67% participation) with an overall response rate of 71% (total eligible residents and faculty n = 51 and total residents and faculty who completed survey n = 36). Moderate correlations for multiple well-being domains emerged in analysis for all participants, especially around the time spent per note and patient visits closed the same day.
EHR-usage logs represent an objective tool in the evaluation and enhancement of physician well-being. Results from our pilot study suggest that metrics for note writing efficiency and closing patient visits the same day are associated with physician well-being. These metrics will be important to study in ongoing efforts involving well-being-based EHR interventions.
This paper uses a textual decision at Iliad 9.394 to argue for irregularity as a functional and meaningful principle in the constitution of the Homeric text. In contrast to almost all recent major editions, I argue that the ‘irregular’ MSS γαμέσσεται should be preferred to the Aristarchaean conjecture γε μάσσεται. Aristarchus’ widely adopted emendation, I suggest, is the product of a drive towards standardization that is still operative in Homeric text-critical practice. This paper opposes that standardization with the evidence of ancient, perhaps pre-Alexandrian, responses to Iliad 9.394, in which the ‘irregularity’ of γαμέσσεται is embraced as an interpretive opportunity. The formal disruptions of γαμέσσεται, I propose, can be understood by locating them both within the immediate context of Iliad 9 and within the wider thematics of irregularity that mark the character of Achilles. This paper thus attempts to reframe our approach to the role of irregularity in the Iliad as an integral feature of meaning rather than grounds for suspecting the integrity of the text.
‘I have always sought to stand by myself’ Arnold announced in 1865.1 The remark is the more intriguing for its appearance in the first series of Essays in Criticism, a collection which, with its consideration of cultural tradition and the intricate relationality of writers, both affirms and denies autonomy. A poet-critic deeply interested in the legacy of the past and the influence of previous generations of writers, Arnold was very conscious of the particular challenges of pursuing a literary voice of one’s own in an age when the place and purpose of the arts was being questioned (not least by him), and with the Romantics still in living memory. The irony of Arnold’s wish ‘to stand by myself’ is that its registering of distinctness carries Byronic airs. With one eye on his present fame and one on posterity Byron had declared ‘I stood and stand alone’, sounding more sure of it than Arnold.2 Whether it was his powerful individualism and desire to go his own way, his defence of personal liberties and resistance to authority, or his estranged and egoistic heroes, Byron was the embodiment of self-determination for contemporaries and subsequent generations. Arnold admired Byron’s independent streak, and, ironically, found in it means of self-recognition as well as self-evaluation with which to carve out his own career. He sets up Byron as an example of what he wanted to be, as well as – more negatively – what he was prone to being, what he could not quite manage to live up to, or wanted to avoid becoming. Regard for Byron also enabled him to evaluate the legacy of different strands of English Romanticism and put his finger on what he felt was lacking in Victorian life and culture.
Early in Canto IV of Childe Harold’s Pilgrimage, written when Byron’s wanderings had led him at last to a more settled residence in Italy, he balances all that he has acquired in exile with a new wistfulness about England