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When F. Scott Fitzgerald (b. 1896) died of a heart attack at age forty-four, on December 21, 1940, in Hollywood, he left behind a novel-in-progress about the motion picture industry. A few weeks later, his companion, the Hollywood columnist Sheilah Graham, sent the author's draft materials to his editor, Maxwell Perkins, at Charles Scribner's Sons. After considering several options, including hiring another writer to complete the work following Fitzgerald's outlines and notes, Perkins enlisted the literary critic (and friend of Fitzgerald) Edmund Wilson – whom Graham had also contacted shortly after the author's death – to shape and edit the manuscript for publication. As titles, Fitzgerald had considered “Stahr: A Romance,” after the novel's central character, Monroe Stahr, a Hollywood studio executive, and “The Love of the Last Tycoon: A Western,” giving the work a different, perhaps more ironic, genre connotation. Wilson's version was published in October 1941 as The Last Tycoon: An Unfinished Novel, in a volume with The Great Gatsby and five of Fitzgerald's most important short stories.
“Unfinished works by great writers form a category as haunting as it is unsatisfactory,” the novelist Alan Hollinghurst has written. “In gratifying a curiosity about what might have been, they heighten the feeling of loss.” One certainly feels a sense of loss at Fitzgerald's early death, yet in the case of The Last Tycoon what exists in published form seems almost more of a benefaction than a cause for regret.
Purpose: Among pediatric patients, cardiopulmonary arrests account for a small, but important, percentage of responses by emergency medical services (EMS). EMS prehospital assessment of medical and traumatic arrests in the pediatric patient were compared with that of the Office of Medical Investigator (OMI) autopsy reports to assess differences and implications for EMS training and prevention in pediatric arrests.
Methods: Retrospective review of ambulance run forms from an urban EMS system with OMI autopsy correlation. Patients less than fifteen years of age and younger who were treated by prehospital personnel from November 1, 1990, to October 31, 1991, for a medical or traumatic arrest. Proportions were analyzed using chi-square analysis or Fisher's exact test and agreement was assessed using the Kappa statistic.
Results: Ambulance runs were reported for 2,586 pediatric patients. Of these, forty-two (1.6%) suffered arrests, with thirty-two (76%) medical arrests and ten (24%) traumatic arrests. Children one year of age or less accounted for 75% of the medical arrests while children greater that one year of age accounted for 80% of the traumatic arrests (p = 0.003). Overall mortality was 81%. When EMS prehospital assessment of medical and traumatic arrests were compared with OMI reports, there was good agreement (kappa = 0.70) for Sudden Infant Death Syndrome (SIDS), but poor agreement (kappa = 0.37) for child abuse.
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