Caddo and Pueblo responses first to the rise and fall of Cahokia and Chaco and then to Spanish colonialism in the sixteenth and seventeenth centuries reveal how the centuries of history generated by ...these Native places and people must be reckoned with in order to understand the historical trajectories that they set in motion and that still reverberated in 1492 … and 1592, and 1692. Such a project involves putting potsherds and oral traditions on an equal playing field with archival documents. And, more critically, it involves a question of time. The key here is to see “colonial America” as one point, a late point, along a much longer continuum of North American history. If we place colonialism within the greater timescale of indigenous history, we may avoid the confines of a history that all too often casts the post-1492 trajectory of American Indians as one defined by decimation and declension. A longer time depth allows us to put both destruction and regeneration in context, and it reminds us that the heritage of colonialism that reaches into our present is paralleled—and shaped—by the heritage of indigenous history.
Revising the standard narrative of European-Indian relations in America, Juliana Barr reconstructs a world in which Indians were the dominant power and Europeans were the ones forced to accommodate, ...resist, and persevere. She demonstrates that between the 1690s and 1780s, Indian peoples including Caddos, Apaches, Payayas, Karankawas, Wichitas, and Comanches formed relationships with Spaniards in Texas that refuted European claims of imperial control.Barr argues that Indians not only retained control over their territories but also imposed control over Spaniards. Instead of being defined in racial terms, as was often the case with European constructions of power, diplomatic relations between the Indians and Spaniards in the region were dictated by Indian expressions of power, grounded in gendered terms of kinship. By examining six realms of encounter--first contact, settlement and intermarriage, mission life, warfare, diplomacy, and captivity--Barr shows that native categories of gender provided the political structure of Indian-Spanish relations by defining people's identity, status, and obligations vis-a-vis others. Because native systems of kin-based social and political order predominated, argues Barr, Indian concepts of gender cut across European perceptions of racial difference.
Colonial America stretched from Quebec to Buenos Aires and from the Atlantic littoral to the Pacific coast. Although European settlers laid claim to territories they called New Spain, New England, ...and New France, the reality of living in those spaces had little to do with European kingdoms. Instead, the New World's holdings took their form and shape from the Indian territories they inhabited. These contested spaces throughout the western hemisphere were not unclaimed lands waiting to be conquered and populated but a single vast space, occupied by native communities and defined by the meeting, mingling, and clashing of peoples, creating societies unlike any that the world had seen before.Contested Spaces of Early Americabrings together some of the most distinguished historians in the field to view colonial America on the largest possible scale. Lavishly illustrated with maps, Native art, and color plates, the twelve chapters span the southern reaches of New Spain through Mexico and Navajo Country to the Dakotas and Upper Canada, and the early Indian civilizations to the ruins of the nineteenth-century West. At the heart of this volume is a search for a human geography of colonial relations:Contested Spaces of Early Americaaims to rid the historical landscape of imperial cores, frontier peripheries, and modern national borders to redefine the way scholars imagine colonial America.Contributors:Matthew Babcock, Ned Blackhawk, Chantal Cramaussel, Brian DeLay, Elizabeth Fenn, Allan Greer, Pekka Hämäläinen, Raúl José Mandrini, Cynthia Radding, Birgit Brander Rasmussen, Alan Taylor, and Samuel Truett.
To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002.
The American College of ...Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients. The task force, divided into four subcommittees, collaborated over 6 yr in person, via teleconferences, and via electronic communication. Subcommittees were responsible for developing relevant clinical questions, using the Grading of Recommendations Assessment, Development and Evaluation method (http://www.gradeworkinggroup.org) to review, evaluate, and summarize the literature, and to develop clinical statements (descriptive) and recommendations (actionable). With the help of a professional librarian and Refworks database software, they developed a Web-based electronic database of over 19,000 references extracted from eight clinical search engines, related to pain and analgesia, agitation and sedation, delirium, and related clinical outcomes in adult ICU patients. The group also used psychometric analyses to evaluate and compare pain, agitation/sedation, and delirium assessment tools. All task force members were allowed to review the literature supporting each statement and recommendation and provided feedback to the subcommittees. Group consensus was achieved for all statements and recommendations using the nominal group technique and the modified Delphi method, with anonymous voting by all task force members using E-Survey (http://www.esurvey.com). All voting was completed in December 2010. Relevant studies published after this date and prior to publication of these guidelines were referenced in the text. The quality of evidence for each statement and recommendation was ranked as high (A), moderate (B), or low/very low (C). The strength of recommendations was ranked as strong (1) or weak (2), and either in favor of (+) or against (-) an intervention. A strong recommendation (either for or against) indicated that the intervention's desirable effects either clearly outweighed its undesirable effects (risks, burdens, and costs) or it did not. For all strong recommendations, the phrase "We recommend …" is used throughout. A weak recommendation, either for or against an intervention, indicated that the trade-off between desirable and undesirable effects was less clear. For all weak recommendations, the phrase "We suggest …" is used throughout. In the absence of sufficient evidence, or when group consensus could not be achieved, no recommendation (0) was made. Consensus based on expert opinion was not used as a substitute for a lack of evidence. A consistent method for addressing potential conflict of interest was followed if task force members were coauthors of related research. The development of this guideline was independent of any industry funding.
These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.
The acute respiratory distress syndrome (ARDS) has multiple causes and is characterized by acute lung inflammation and increased pulmonary vascular permeability, leading to hypoxemic respiratory ...failure and bilateral pulmonary radiographic opacities. The acute respiratory distress syndrome is associated with substantial morbidity and mortality, and effective treatment strategies are limited. This review presents the current state of the literature regarding the etiology, pathogenesis, and management strategies for ARDS.
OBJECTIVE:To develop clinical practice guidelines for the support of the patient and family in the adult, pediatric, or neonatal patient-centered ICU.
PARTICIPANTS:A multidisciplinary task force of ...experts in critical care practice was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM) to include representation from adult, pediatric, and neonatal intensive care units.
EVIDENCE:The task force members reviewed the published literature. The Cochrane library, Cinahl, and MedLine were queried for articles published between 1980 and 2003. Studies were scored according to Cochrane methodology. Where evidence did not exist or was of a low level, consensus was derived from expert opinion.
CONSENSUS PROCESS:The topic was divided into subheadingsdecision making, family coping, staff stress related to family interactions, cultural support, spiritual/religious support, family visitation, family presence on rounds, family presence at resuscitation, family environment of care, and palliative care. Each section was led by one task force member. Each section draft was reviewed by the group and debated until consensus was achieved. The draft document was reviewed by a committee of the Board of Regents of the ACCM. After steering committee approval, the draft was approved by the SCCM Council and was again subjected to peer review by this journal.
CONCLUSIONS:More than 300 related studies were reviewed. However, the level of evidence in most cases is at Cochrane level 4 or 5, indicating the need for further research. Forty-three recommendations are presented that include, but are not limited to, endorsement of a shared decision-making model, early and repeated care conferencing to reduce family stress and improve consistency in communication, honoring culturally appropriate requests for truth-telling and informed refusal, spiritual support, staff education and debriefing to minimize the impact of family interactions on staff health, family presence at both rounds and resuscitation, open flexible visitation, way-finding and family-friendly signage, and family support before, during, and after a death.
This article revisits the question of how American Indians are faring at the hands of colonial historians, which I first considered in the January 1989 issue of theWilliam and Mary Quarterly. It ...argues that, despite the wealth of scholarship being done on Native peoples and the growing awareness of that work in the wider field of early American studies, understanding of the Indians’ experience, of their place in early America—and therefore of early America itself—is still handicapped by historians’ use of an archaic, Eurocentric vocabulary. A look at some of the scholarship published since the turn of the millennium suggests how pervasive and pernicious this biased terminology remains, and how it stands in the way of efforts to fathom that strange place conventionally called “early America.”
ABSTRACTLactic acidosis occurs commonly and can be a marker of significant physiologic derangements. However what an elevated lactate level and acidemia connotes and what should be done about it is ...subject to inconsistent interpretations. This review examines the varied etiologies of lactic acidosis, the physiologic consequences, and the known effects of its treatment with sodium bicarbonate. Lactic acidosis is often assumed to be a marker of hypoperfusion, but it can also result from medications, organ dysfunction, and sepsis even in the absence of malperfusion. Acidemia causes deleterious effects in almost every organ system, but it can also have positive effects, increasing localized blood flow and oxygen delivery, as well as providing protection against hypoxic cellular injury. The use of sodium bicarbonate to correct severe acidemia may be tempting to clinicians, but previous studies have failed to show improved patient outcomes following bicarbonate administration. Bicarbonate use is known to decrease vasomotor tone, decrease myocardial contractility, and induce intracellular acidosis. This suggests that mild to moderate acidemia does not require correction. Most recently, a randomized control trial found a survival benefit in a subgroup of critically ill patients with serum pH levels <7.2 with concomitant acute kidney injury. There is no known benefit of correcting serum pH levels ≥ 7.2, and sparse evidence supports bicarbonate use <7.2. If administered, bicarbonate is best given as a slow IV infusion in the setting of adequate ventilation and calcium replacement to mitigate its untoward effects.
OBJECTIVE:In 2006, the American College of Critical Care Medicine assembled a 20-member task force to revise the 2002 guidelines for sedation and analgesia in critically ill adults. This article ...describes the methodological approach used to develop the American College of Critical Care Medicine’s 2013 ICU Pain, Agitation, and Delirium Clinical Practice Guidelines.
DESIGN:Review article.
SETTING:Multispecialty critical care units.
PATIENTS:Adult ICU patients.
INTERVENTIONS:The task force was divided into four subcommittees, focusing on pain, sedation, delirium, and related outcomes. Unique aspects of this approach included the use of1) the Grading of Recommendations Assessment, Development and Evaluation method to evaluate the literature; 2) a librarian to conduct literature searches and to create and maintain the pain, agitation, and delirium database; 3) creation of a single web-based database; 4) rigorous psychometric analyses of pain, sedation, and delirium assessment tools; 5) the use of anonymous electronic polling; and 6) creation of an ICU pain, agitation, and delirium care bundle.
RESULTS:The pain, agitation, and delirium database includes over 19,000 references. With the help of psychometric experts, members developed a scoring system and analyzed the psychometric properties of 6 behavioral pain scales, 10 sedation/agitation scales, and 5 delirium monitoring tools. A meta-analysis was performed to assess the overall impact of benzodiazepine versus nonbenzodiazepine sedation on ICU outcomes. The pain, agitation, and delirium guidelines include 54 evidence-based statements and recommendations. The quality of evidence and strength for each statement and recommendation was ranked. In the absence of sufficient evidence or group consensus, no recommendations were made. An ICU pain, agitation, and delirium care bundle was created to facilitate adoption of the pain, agitation, and delirium guidelines. It focuses on taking an integrated approach to assessing, treating, and preventing pain, agitation/sedation, and delirium in critically ill patients, and it links pain, agitation, and delirium management to spontaneous awakening trials, spontaneous breathing trials, and ICU early mobility and sleep hygiene programs in order to achieve synergistic benefits to ICU patient outcomes.
CONCLUSIONS:The 2013 ICU pain, agitation, and delirium guidelines provide critical care providers with an evidence-based, integrated, and interdisciplinary approach to managing pain, agitation/sedation, and delirium. The methodological approach used to develop the guidelines ensures that they are rigorous, evidence-based, and transparent. Implementation of the ICU pain, agitation, and delirium care bundle is expected to have a significant beneficial impact on ICU outcomes and costs.
OBJECTIVE:To describe and analyze the development and psychometric properties of subjective sedation scales developed for critically ill adult patients.
DATA SOURCES:PubMed, MEDLINE, Cochrane ...Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, ISI Web of Science, and the International Pharmaceutical Abstracts.
STUDY SELECTION:English-only publications through December 2012 with at least 30 patients older than 18 years, which included the key words of adult, critically ill, subjective sedation scale, sedation scale, validity, and reliability.
DATA EXTRACTION:Two independent reviewers evaluated the psychometric properties using a standardized sedation scale psychometric scoring system.
DATA SYNTHESIS:Among the 19,000+ citations extracted for the 2013 Society of Critical Care Medicine’s Clinical Practice Guidelines for the Management of Pain, Agitation and Delirium and from December 2010 to 2012, 36 articles were identified compassing 11 sedation scales. The scale development process, psychometric properties, feasibility, and implementation of sedation scales were analyzed using a 0–20 scoring system. Two scales demonstrated scores indicating “very good” published psychometric propertiesRichmond Agitation-Sedation Scale (19.5) and the Sedation-Agitation Scale (19). Scores with “moderate” properties include the Vancouver Interaction and Calmness Scale (14.3), Adaptation to the Intensive Care Environment (13.7), Ramsay Sedation Scale (13.2), Minnesota Sedation Assessment Tool (13), and the Nursing Instrument for the Communication of Sedation (12.8). Scales with “low” properties included the Motor Activity Assessment Scale (11.5) and the Sedation Intensive Care Score (10.5). The New Sheffield Sedation Scale (8.5) and the Observer’s Assessment of Alertness/Sedation Scale (3.7) demonstrated “very low” published properties.
CONCLUSIONS:Based on the current literature, and using a predetermined psychometric scoring system, the Richmond Agitation-Sedation Scale and the Sedation-Agitation Scale are the most valid and reliable subjective sedation scales for use in critically ill adult patients.
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