Buildings provide tremendous insights into the character of imperialism, not least in the manner in which Western forms were spread across the globe. They reveal the projection of power and authority ...in colonised landscapes, as well the economic ambitions and social and cultural needs of colonial peoples in all types of colonies. They also represent a colonial order of social classes and racial divisions, together with the ways in which these were inflected through domestic living space, places of work and various aspects of cultural relations. They illuminate the desires of Europeans to indulge in cultural and religious proselytisation, encouraging indigenous peoples to adopt western norms. But the resistance of the supposedly subordinate people led to the invasion, adoption and adaptation of such buildings for a post-colonial world. The book will be vital reading for all students and scholars interested in the widest aspects of material culture.Buildings provide tremendous insights into the character of imperialism, not least in the manner in which Western forms were spread across the globe. They reveal the projection of power and authority in colonised landscapes, as well the economic ambitions and social and cultural needs of colonial peoples in all types of colonies. They also represent a colonial order of social classes and racial divisions, together with the ways in which these were inflected through domestic living space, places of work and various aspects of cultural relations. They illuminate the desires of Europeans to indulge in cultural and religious proselytisation, encouraging indigenous peoples to adopt western norms. But the resistance of the supposedly subordinate people led to the invasion, adoption and adaptation of such buildings for a post-colonial world. The book will be vital reading for all students and scholars interested in the widest aspects of material culture.
Imperial history in general received very little attention in British universities until the 1950s. Until that time, such history was treated in highly ethnocentric ways, often with a specific focus ...on imperial rule from above. Most significantly, British domestic history was largely taught without any reference to its imperial dimension, except in a few restricted economic areas. When the revolution in the writing and teaching of history began to take place in the 1960s, the emphasis changed into aspects of resistance, notably the rise of nationalism and the study of instances of revolt within the empire. Yet there was a great deal of evidence for the material presence of empire within Britain, as well as the many examples of the visuality and cultural presence of imperialism. Indeed, these visual and cultural dimensions of imperial history seemed to offer an entirely different route into the history of the relationship between Britain, the British people and empire. The text, and the many documents in archives appeared to obscure as much as they illuminated. Such an approach soon produced negative responses. Bernard Porter famously argued that the British were indeed ‘absent-minded imperialists’ because they took very little interest in empire, with the imperial influence on British culture being essentially minimal. Andrew Porter similarly argued that missionaries were essentially anti-imperial and should be absolved from any guilt surrounding the processes of empire. However, the development of a great range of studies of cultural aspects of empire seemed to contradict both these approaches. Studies of the theatre, of film, exhibitions, museum displays, advertising, ephemera, heroic popular biographies and novels, as well as emigration propaganda seemed to indicate the pervasiveness of the imperial presence in British culture. Missionaries while often critical of specific events seemed to be swept up in this all-embracing culture. It became obvious that imperial images and ideas were used by so many companies and agencies that they had to be regarded as having a positive resonance among the population. Moreover, local studies of the material presence of cities and of the press (together with the cross-over from the presentation of fact into fiction) seemed to suggest the ubiquity of the imperial presence in British culture.
Surgical site infection following correction of pediatric scoliosis is well described. However, we are aware of no recent multicenter study describing the rates of surgical site infection, and ...associated pathogens, among patients with different etiologies for scoliosis.
A multicenter, retrospective review of surgical site infections among pediatric patients undergoing spinal instrumentation to correct scoliosis was performed at three children's hospitals in the United States. Study subjects included all patients undergoing posterior spinal instrumentation from January 2006 to December 2008. Surgical site infections were defined according to the Centers for Disease Control and Prevention's National Healthcare Safety Network case definition, with infections occurring within one year after surgery.
Following the analysis of 1347 procedures performed in 946 patients, surgical site infection rates varied among procedures performed in patients with different scoliosis etiologies. Procedures performed in patients with neuromuscular scoliosis had the highest surgical site infection rates (9.2%), followed by those performed in patients with syndromic scoliosis (8.8%), those performed in patients with other scoliosis (8.4%), those performed in patients with congenital scoliosis (3.9%), and those performed in patients with idiopathic scoliosis (2.6%). Surgical site infection rates varied among procedures in patients undergoing primary spinal arthrodesis based on etiology, ranging from 1.2% (95% confidence interval, 0.1% to 1.3%) in patients with idiopathic scoliosis to 13.1% (95% confidence interval, 8.4% to 17.8%) in patients with neuromuscular scoliosis. Surgical site infection rates following primary and revision procedures were similar among patients with different etiologies. In distraction-based growing constructs, rates were significantly lower for lengthening procedures than for revision procedures (p = 0.012). Multivariate analysis demonstrated that non-idiopathic scoliosis and extension of instrumentation to the pelvis were risk factors for surgical site infections. The three most common pathogens were Staphylococcus aureus (25.0% 95% confidence interval, 17.8% to 32.2%), coagulase-negative staphylococci (17.1% 95% confidence interval, 10.9% to 23.3%), and Pseudomonas aeruginosa (10.7% 95% confidence interval, 5.6% to 15.8%). Overall, 46.5% (95% confidence interval, 35.5% to 57.5%) of surgical site infections contained at least one gram-negative organism; 97.0% (95% confidence interval, 90.8% to 100.0%) of these infections were in patients with non-idiopathic scoliosis.
Surgical site infection rates were significantly higher following procedures in patients with non-idiopathic scoliosis (p < 0.001). Lengthening procedures had the lowest rate of surgical site infection among patients with early onset scoliosis who had undergone instrumentation with growing constructs. Gram-negative pathogens were common and were most common following procedures in patients with non-idiopathic scoliosis. These findings suggest a role for targeted perioperative antibiotic prophylaxis to prevent surgical site infection following pediatric scoliosis instrumentation procedures.
A framework for scabies control Engelman, Daniel; Marks, Michael; Steer, Andrew C ...
PLoS neglected tropical diseases,
09/2021, Letnik:
15, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ...ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals.
Dysregulation of aldosterone or cortisol production can predispose to hypertension, as seen in aldosterone-producing adenoma, a form of primary aldosteronism. We investigated the role of microRNA ...(miRNA) in their production, with particular emphasis on the CYP11B1 (11β-hydroxylase) and CYP11B2 (aldosterone synthase) genes, which produce the enzymes responsible for the final stages of cortisol and aldosterone biosynthesis, respectively. Knockdown of Dicer1, a key enzyme in miRNA maturation, significantly altered CYP11B1 and CYP11B2 expression in a human adrenocortical cell line. Screening of nondiseased human adrenal and aldosterone-producing adenoma samples yielded reproducible but distinctive miRNA expression signatures for each tissue type, with levels of certain miRNA, including microRNA-24 (miR-24), differing significantly between the 2. Bioinformatic analysis identified putative binding sites for several miRNA, including miR-24, in the 3' untranslated region of CYP11B1 and CYP11B2 mRNAs. In vitro manipulation of miR-24 confirmed its ability to modulate CYP11B1 and CYP11B2 expression, as well as cortisol and aldosterone production. This study demonstrates that Dicer-dependent miRNA, including miR-24, can post-transcriptionally regulate expression of the CYP11B1 and CYP11B2 genes. Normal adrenal tissue and aldosterone-producing adenoma differ significantly and reproducibly in their miRNA expression profiles, with miR-24 significantly downregulated in the latter. Adrenal miRNA may, therefore, be a novel and valid target for the therapeutic manipulation of corticosteroid biosynthesis.
Bleeding is the most common severe complication after endoscopic mucosal resection of large colon polyps and is associated with significant morbidity and cost. We examined whether prophylactic ...closure of the mucosal defect with hemoclips after polyp resection reduces the risk of bleeding.
We performed a multicenter, randomized trial of patients with a large nonpedunculated colon polyp (≥20 mm) at 18 medical centers in North America and Spain from April 2013 through October 2017. Patients were randomly assigned to groups that underwent endoscopic closure with a clip (clip group) or no closure (control group) and followed. The primary outcome, postprocedure bleeding, was defined as a severe bleeding event that required hospitalization, a blood transfusion, colonoscopy, surgery, or another invasive intervention within 30 days after completion of the colonoscopy. Subgroup analyses included postprocedure bleeding with polyp location, polyp size, or use of periprocedural antithrombotic medications. We also examined the risk of any serious adverse event.
A total of 919 patients were randomly assigned to groups and completed follow-up. Postprocedure bleeding occurred in 3.5% of patients in the clip group and 7.1% in the control group (absolute risk difference ARD 3.6%; 95% confidence interval CI 0.7%–6.5%). Among 615 patients (66.9%) with a proximal large polyp, the risk of bleeding in the clip group was 3.3% and in the control group was 9.6% (ARD 6.3%; 95% CI 2.5%–10.1%); among patients with a distal large polyp, the risks were 4.0% in the clip group and 1.4% in the control group (ARD –2.6%; 95% CI –6.3% to –1.1%). The effect of clip closure was independent of antithrombotic medications or polyp size. Serious adverse events occurred in 4.8% of patients in the clip group and 9.5% of patients in the control group (ARD 4.6%; 95% CI 1.3%–8.0%).
In a randomized trial, we found that endoscopic clip closure of the mucosal defect following resection of large colon polyps reduces risk of postprocedure bleeding. The protective effect appeared to be restricted to large polyps located in the proximal colon. ClinicalTrials.gov no: NCT01936948.
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Up to 15% of patients with essential hypertension have inappropriate regulation of aldosterone; although only a minority have distinct adrenal tumors, recent evidence shows that mineralocorticoid ...receptor activation contributes to the age-related blood pressure rise and illustrates the importance of aldosterone in determining cardiovascular risk. Aldosterone also has a major role in progression and outcome of ischemic heart disease. These data highlight the need to understand better the regulation of aldosterone synthesis and its action.
Aldosterone effects are mediated mainly through classical nuclear receptors that alter gene transcription. In classic epithelial target tissues, signaling mechanisms are relatively well defined. However, aldosterone has major effects in nonepithelial tissues that include increased synthesis of proinflammatory molecules and reactive oxygen species; it remains unclear how these effects are controlled and how receptor specificity is maintained.
Variation in aldosterone production reflects interaction of genetic and environmental factors. Although the environmental factors are well understood, the genetic control of aldosterone synthesis is still the subject of debate. Aldosterone synthase (encoded by the CYP11B2 gene) controls conversion of deoxycorticosterone to aldosterone. Polymorphic variation in CYP11B2 is associated with increased risk of hypertension, but the molecular mechanism that accounts for this is not known. Altered 11β-hydroxylase efficiency (conversion of deoxycortisol to cortisol) as a consequence of variation in the neighboring gene (CYP11B1) may be important in contributing to altered control of aldosterone synthesis, so that the risk of hypertension may reflect a digenic effect, a concept that is discussed further. There is evidence that a long-term increase in aldosterone production from early life is determined by an interaction of genetic and environmental factors, leading to the eventual phenotypes of aldosterone-associated hypertension and cardiovascular damage in middle age and beyond.
The importance of aldosterone has generated interest in its therapeutic modulation. Disadvantages associated with spironolactone (altered libido, gynecomastia) have led to a search for alternative mineralocorticoid receptor antagonists. Of these, eplerenone has been shown to reduce cardiovascular risk after myocardial infarction. The benefits and disadvantages of this therapeutic approach are discussed.
Imperial deaths were given the status of martyrdoms in the cause of what European contemporaries considered the advance of civilisation. In many cases burials stimulated the overblown architecture of ...commemoration discovered in many places in the Indian Ocean world. There could well have been at least 1,000 cemeteries and church graveyards in South Asia, as well as grandiloquent memorials in cathedrals and churches throughout the region. While there are many examples from the eighteenth century, these practices became particularly striking in the nineteenth, which was an era in which the obsession with data produced a plethora of directories of memorial inscriptions and related lives. Some of these were officially inspired while others were produced by undertakers and those fascinated by documentation. From these we learn about imperial lives, careers, localised origins, and social and familial contexts. However, both these directories and the memorials which they documented were much more than the sentimental appropriation of colonial space. They also reflected ethnic and religious diversity, becoming indicators of the ‘four nations’ as well as of the contrasting Christian denominations of the United Kingdom. This was perhaps particularly true of Scots, whose geographical, social and religious affiliations can be charted through many examples in the Madras Presidency of South India and of the colony of Ceylon. They help to demonstrate that a full understanding of ethnic diversities can be derived from the study of the ‘deathscape’ of the imperial world.
Cerebral deoxygenation is associated with various adverse systemic outcomes. We hypothesized, by using the brain as an index organ, that interventions to improve cerebral oxygenation would have ...systemic benefits in cardiac surgical patients.
Two-hundred coronary artery bypass patients were randomized to either intraoperative cerebral regional oxygen saturation (rSO2) monitoring with active display and treatment intervention protocol (intervention, n = 100), or underwent blinded rSO2 monitoring (control, n = 100). Predefined clinical outcomes were assessed by a blinded observer.
Significantly more patients in the control group demonstrated prolonged cerebral desaturation (P = 0.014) and longer duration in the intensive care unit (P = 0.029) versus intervention patients. There was no difference in overall incidence of adverse complications, but significantly more control patients had major organ morbidity or mortality (death, ventilation >48 h, stroke, myocardial infarction, return for re-exploration) versus intervention group patients (P = 0.048). Patients experiencing major organ morbidity or mortality had lower baseline and mean rSO2, more cerebral desaturations and longer lengths of stay in the intensive care unit and postoperative hospitalization, than patients without such complications. There was a significant (r(2) = 0.29) inverse correlation between intraoperative rSO2 and duration of postoperative hospitalization in patients requiring > or =10 days postoperative length of stay.
Monitoring cerebral rSO2 in coronary artery bypass patients avoids profound cerebral desaturation and is associated with significantly fewer incidences of major organ dysfunction.
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