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How did the American War affect ideas of nationality, identity, and belonging for the widely dispersed and varied British subjects? This article addresses this question through an examination of the performances of Richard Brinsley Sheridan’s comic opera The Duenna (1775) in Kingston, Jamaica, and his comedy The School for Scandal (1777) in Calcutta, Bengal. In each of these sites, theatrical performances enabled residents to embrace both the love of alterity and the longing for home that were each endemic to colonial life. Yet the comic figures of Jewish characters in each play suggested that Britishness and otherness were not far removed from each other, as theatrical performance, almost despite itself, began to sketch in more similarities than differences dividing us from them. In a moment when metropolitan anxieties about empire and colonial engagements with otherness had become entangled with practices and peoples that seemed to put British identity at risk, Sheridan’s two comedies hint that empire could make everyone an “other,” a “them.” Sheridan then attempted to diffuse that insight in his plays, inviting the audience to laugh at itself as it engaged in the pleasures, and pains, of real and imagined identifications.

Spirituality and gratitude are associated with wellbeing. Few if any studies have examined the role of gratitude in heart failure (HF) patients or whether it is a mechanism through which spirituality may exert its beneficial effects on physical and mental health in this clinical population. This study examined associations bet ween gratitude, spiritual wellbeing, sleep, mood, fatigue, cardiac-specific self-efficacy, and inflammation in 186 men and women with Stage B asymptomatic HF (age 66.5 years ±10). In correlational analysis, gratitude was associated with better sleep (r=-.25, p

How can performance studies sharpen our modes of historical analysis and writing? This essay proposes “three theses” that demonstrate the multifold ways in which attention to performance, theatrical and social, can highlight aspects of cultural, political, and festive life in the hybrid spaces of empire that that would otherwise be ignored. Performance, for historians and critics, functions in this sense as both optic and event: a methodological lens through which meanings can be conveyed as well as an act of cultural transfer, an embodied form of creating, preserving, or transmitting knowledge, memory, and history.

Ustekinumab is the most recently approved biologic for the treatment of moderate-to-severe psoriasis. Real-world dosing patterns of ustekinumab are yet to be fully characterized.A retrospective, observational study was conducted using MarketScan Commercial and Medicare databases. A cohort of psoriasis patients treated with ustekinumab between 25 September 2009 and 31 October 2010 was evaluated. Main outcomes included ustekinumab dosing and treatment patterns. Kaplan-Meier estimates were calculated to adjust for the censoring of data. Subgroup analysis was conducted for biologic-experienced patients and biologic-naïve patients.One thousand ustekinumab patients were included, of whom 60% were biologic-experienced. The average age was 49.0 and 53.9% were male. 63.3% of patients initiated ustekinumab with a 45 mg dose and 34.5% initiated with a 90 mg dose. Mean (median) days from initial dose to second dose was 31.1 (28.0). During maintenance therapy, dose intervals spanned from 80.6 to 81.2 (84.0) days. About 81.4% of patients were persistent during the variable-length follow-up period.The majority of patients received the 45 mg ustekinumab dose. The mean dosing intervals were consistent with the US prescribing guidelines. Biologic-naïve and biologic-experienced patients had similar dosing patterns. Ustekinumab treatment achieved a persistency rate as high as 81.4% over an average of 186.5 (SD 114.2) days of follow-up.

Background: Peripheral neuropathy (PN) is a common consequence of multiple myeloma (MM) among those commonly treated with older-generation proteasome inhibitors (PIs). In this study, we evaluated the economic burden attributable to PN among MM patients in real-world practice settings in the US. Methods: Adults diagnosed with MM and first treated (index event) between 1 July 2006 and 28 February 2017 were identified from MarketScan® Commercial and Medicare claim databases. Continuous enrollment for at least 12 months without treatment and PN diagnoses were required pre-index. Patients were followed for at least 3 months until inpatient death or end of data. The International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes were used to identify PN. Propensity-score matching was applied to match every patient with PN to two MM patients without a PN diagnosis (controls). Healthcare utilization and expenditures per patient per month (PPPM) in the postindex period were estimated. Results: Of 11,851 patients meeting the study criteria, 15.5% had PN. After matching 1387 patients with PN and 2594 controls were identified. Baseline characteristics were well balanced between cohorts; mean follow up was 23–26 months. PPPM total costs were significantly higher by $1509 for patients with PN than controls, driven by higher hospitalization (PN 77.4%, controls 67.2%; p < 0.001) and emergency department rates (PN 67.8%, controls 58.4%; p < 0.001) and more outpatient hospital-based visits PPPM (PN 13.5 ± 14.7, controls 11.5 ± 18.0; p < 0.001). Conclusions: PN is a prevalent MM treatment complication associated with a significant economic burden adding to the complexity and cost of MM treatment. Highly effective novel treatments such as carfilzomib may reduce the overall disease burden.

Comment apprehender les modalites et les enjeux de la lecture qui se pratiquait au château de Fontainebleau vers 1530/1545, en partant de l’iconographie et avec la lectrice comme point de mire ? Evaluons tout d’abord le temoignage d’une enluminure de 1534, maintes fois reproduite, ou Antoine Macault lit au legendaire « roi lettre » Francois Ier sa traduction des Troys premiers livres de Diodore Sicilien (Fig. 1) . C’est peut-etre le grand physiognomoniste Jean Clouet, valet de chambre du roi,...

The eighteenth-century navy ranged far and wide around the Atlantic Ocean, knitting together a British world between metropole, colonies, trading stations and shipping routes. This concluding chapter provides an overview of some of these activities, examining the navy from the perspectives of cultural history. Wilson reminds us that the popularity of this institution occurred through representation, as the navy became a symbol of virtuous self-sacrifice and an object of adoration for groups scattered around Britain’s expanding empire. But she also demonstrates that depictions or discussions of naval deeds did not always treat the navy or its officers with sheer adulation. And in all of these contexts, naval men came into close physical contact with all sorts, from enslaved and free coloured women to shopkeepers, merchants, planters and colonial governors: offering another reminder of how the navy helped to entwine the multifarious and deeply divided people who populated Britain’s Atlantic world.

Background— Heart failure (HF) readmission rates are primarily derived from Medicare enrollees. Given increasing public scrutiny of HF readmissions, understanding the rate and predictors in populations covered by other payers is also important, particularly among patients with systolic dysfunction, for whom most HF-specific therapies are targeted. Methods and Results— MarketScan Commercial and Medicaid Administrative Claims Databases were used to identify all first hospitalizations with an International Classification of Diseases-9 discharge diagnosis code for HF (primary position) and systolic HF (any position) between January 1, 2005, and June 30, 2008. Among 4584 unique systolic HF index admissions (mean age 55 years), 30-day crude readmission rates were higher for Medicaid than commercially insured patients: all-cause 17.4% versus 11.8%; HF-related 6.7% versus 4.0%, respectively. In unadjusted analysis, higher comorbidity and prior healthcare utilization predicted readmission; age, sex, and plan type did not. After adjustment for case mix, the odds of all-cause and HF-related readmission were 32% and 68% higher, respectively, among Medicaid than commercially insured patients ( P Conclusions— Compared with commonly cited Medicare HF readmission rates of 20% to 25%, Medicaid patients with systolic HF had lower 30-day readmission rates, and commercially insured patients had even lower rates. Even after adjustment for case mix, Medicaid patients were more likely to be readmitted than commercially insured patients, suggesting that more attention should be focused on readmissions among socioeconomically disadvantaged populations.

Descriptions of the inpatient experience for patients hospitalized with systolic heart failure (HF) are limited and lack a cross-sectional representation of the US population. While length of stay (LOS) is a primary determinant of resource use and post-discharge events, few models exist for estimating LOS.MarketScan(®) administrative claims data from 1/1/2005-6/30/2008 were used to select hospitalized patients aged ≥18 years with discharge diagnoses for both HF (primary diagnosis) and systolic HF (any diagnostic position) without prior HF hospitalization or undergoing transplantation.Among 17,597 patients with systolic HF; 4109 had commercial; 2118 had Medicaid; and 11,370 had Medicare payer type. Medicaid patients had longer mean LOS (7.1 days) than commercial (6.3 days) or Medicare (6.7 days). In-hospital mortality was highest for patients with Medicaid (2.4%), followed by Medicare (1.3%) and commercial (0.6%). Commercial patients were more likely to receive inpatient procedures. Renal failure, pressure ulcer, malnutrition, a non-circulatory index admission DRG, receipt of a coronary artery bypass procedure or cardiac catheterization, or need for mechanical ventilation during the index admission were associated with increased LOS; receipt of a pacemaker device at index was associated with shorter LOS.Selection of patients with systolic HF is limited by completeness and accuracy of medical coding, and results may not be generalizable to patients with diastolic HF or to international populations.Inpatient care, LOS, and in-hospital survival differ by payer among patients hospitalized with systolic HF, although co-morbidity and inpatient procedures consistently influence LOS across payer types. These findings may refine risk stratification, allowing for targeted intensive inpatient management and/or aggressive transitional care to improve outcomes and increase the efficiency of care.

Aim: Hypertension is related to abnormalities in autonomic nervous system (ANS) function, with increased sympathetic output and decreased parasympathetic tone. Lifestyle interventions are the first line of treatment in hypertension, and decreased blood pressure (BP) effects may be related to changes in ANS function. Using heart rate recovery (HRR) from exercise as an index of parasympathetic tone and plasma noradrenaline as an index of sympathetic tone, we investigated the effects of lifestyle interventions on ANS function in patients with elevated BP. Methods: Sedentary participants with elevated BP were randomly assigned to either an exercise only (N = 25), exercise plus dietary approaches to stop hypertension (DASH) diet (N = 12), or waitlist control (N = 15) 12-week intervention. Plasma noradrenaline was measured at rest and participants performed a peak exercise test before and after the intervention. HRR was calculated as peak heart rate (HR) minus HR at 1 min post-exercise. Results: Heart rate recovery showed a significant group by time interaction; both intervention groups showed increases in HRR from pre- to post-intervention, while waitlist showed no change. Similarly, both exercise plus diet and exercise groups, but not waitlist, showed significant reductions in BP from pre- to post-intervention. Linear regression revealed that BP post-intervention was significantly predicted by change in HRR when controlling for pre-BP, age, gender and BMI. Conclusions: Lifestyle interventions induced training-reduced BP and altered autonomic tone, indexed by HRR. This study indicates the importance of behavioural modification in hypertension and that increased parasympathetic function is associated with success in reduction of BP.

Background and Objectives Even with the introduction of specific risk-reduction strategies, transfusion-related acute lung injury (TRALI) continues to be a leading cause of transfusion-related morbidity and mortality. Existing small animal models have not yet investigated TRALI resulting from the infusion of heat-treated supernatant from whole blood platelet concentrates. In this study, our objective was the development of a novel in vivo two-event model of TRALI in sheep. Materials and Methods Lipopolysaccharide (LPS; 15 μg/kg) as a first event, modelled clinical infection. Transfusion (estimated at 10% of total blood volume) of heat-treated pooled supernatant from date-of-expiry human whole blood platelet concentrates (d5-PLT-S/N) was used as a second event. TRALI was defined by both hypoxaemia that developed either during the transfusion or within two hours of its completion and post-mortem histological evidence of pulmonary oedema. Results LPS infusion did not cause lung injury itself, but did result in decreased circulating levels of lymphocytes and neutrophils with evidence of the latter becoming sequestered in the lungs. Sheep that received LPS (first event) followed by d5-PLT-S/N (second event) displayed decreased pulmonary compliance, decreased end tidal CO2 and increased arterial partial pressure of CO2 relative to control sheep, and 80% of these sheep developed TRALI. Conclusions This novel ovine two-event TRALI model presents a new tool for the investigation of TRALI pathogenesis. It represents the first description of an in vivo large animal model of TRALI and the first description of TRALI caused by transfusion with heat-treated pooled supernatant from human whole blood platelet concentrates.

OBJECTIVES: The purpose of this study was to examine the real-world differences in healthcare resource utilization in chronic lymphocytic lymphoma (CLL) patients treated with either first-line ibrutinib monotherapy (IM) or first-line bendamustine + rituximab (BR) therapy using U.S. administrative claims data. METHODS: The MarketScan® Research Databases were used to identify patients aged 18 years or older with commercial or Medicare supplemental insurance plans based on their first prescription (index date) of either IM or BR therapy between 02/01/2014 and 08/30/2017. Patients were required to be diagnosed with CLL and be treatment naïve, as well as be continuously enrolled (CE) for 6 months prior to and at least 30 days following the index date. All-cause and CLL-related healthcare resource utilization (e.g., inpatient admission (IP) and emergency room (ER) visits) were evaluated during a 12-month follow-up period from the index date among the subset of patients with 12 months of continuous enrollment and were reported per-patient per-month (PPPM). Statistical differences in the distribution of IP and ER visits between the IM versus BR therapy groups were estimated using chi-squared test for categorical variables and t-test for continuous variables. RESULTS: A total of 1,886 CLL patients were identified, with 1,157 patients in the IM cohort and 729 patients in the BR cohort. The IM cohort was significantly older (mean = 69.3 years; SD = 11.6) then the BR cohort (mean age = 66.4 years; SD = 9.8). There was a similar proportion of females (IM = 36%; BR = 32%), and no significant difference in the National Cancer Institute Comorbidity Index score was observed between the two cohorts (IM=0.9 vs BR=0.8, p=0.34). The results of the comparisons between the two groups with 12 months of follow-up (IM = 589; BR = 436) are provided in Table 1. For all-cause healthcare utilization, the proportion of patients experiencing at least one IP admission and the PPPM number of admissions was significantly higher in the IM cohort compared to the BR cohort. The proportion of patients with at least one ER visit was higher in the IM than in the BR cohort, but the difference was not statistically significant. However, the PPPM number of ER visits was significantly higher in the IM cohort. A similar pattern was found for the CLL-related healthcare utilization variables with two exceptions. First, the average length of stay (ALOS) per CLL-related IP admission was significantly longer for the IM than BR cohort; whereas, ALOS per all-cause IP admission was longer for the IM cohort, but the difference was not significantly different. Second, while patients in the IM cohort experienced more CLL-related ER visits, they were not significantly higher in the IM cohort than in the BR cohort. Conclusions: The current study examined differences in healthcare utilization during a 12 month period among CLL-patients initially treated in a front-line setting with either ibrutinib or BR combination therapy. Results indicated that not only did more ibrutinib patients experience an IP admission and ER visits, both all-cause and CLL-related, but they also experienced more repeat admissions and ER visits. These real-world findings highlight the importance of considering the healthcare resource utilization of CLL patients which may be associated with their first-line therapy. Disclosures Irwin: Teva: Consultancy. Zhang:Teva: Consultancy. Wilson:Teva: Consultancy. Hoehn:Teva: Employment. Szabo:Teva: Employment. Tang:Teva: Employment.

Objective: Very preterm neonates are prone to brain injury if cerebral blood flow fluctuates. Partial liquid ventilation (PLV) may benefit any lung disease but giving 30 mL/kg of perfluorocarbon when starting PLV increases cortical cerebral blood flow velocity. We aimed to determine if varying the initial dose of perfluorocarbon alters the effect on cerebral blood flow velocity when starting PLV. Methods: In this randomised, controlled trial with historical comparison 24 preterm lambs received one of three loading doses of intratracheal perfluorocarbon liquid over 20 min when starting PLV: 20, 30 or 40 mL/kg. Data on respiratory mechanics, haemodynamics and cerebral blood flow velocity, measured with laser Doppler, were collected continuously for 30 min from the start of dosing. Results: Cortical cerebral blood flow velocity increased over time in all three groups (two-way ANOVA, P= 0.007). There was no difference between groups (two-way ANOVA, P= 0.26). There was no difference between groups in cortical cerebral blood flow velocity variability (P= 0.68), blood pressure (P= 0.96) or heart rate (P= 0.46). The was no statistically significant difference in PaCO2 between groups measured at baseline and at 30 min after starting PLV (P= 0.51). Conclusions: Cortical cerebral blood flow velocity and its variability are not affected by varying doses of tracheal perfluorocarbon (20, 30 or 40 mL/kg) at the start of PLV in preterm lambs.

This study represents early scholarship into crowdsourcing which is defined as outsourcing work to a large, undefined crowd through an open call. The study attempts to answer scholarly calls for re...

Objective To review the evidence and provide recommendations for the counselling and management of obese parturients. Outcomes Outcomes evaluated include the impact of maternal obesity on the provision of antenatal and intrapartum care, maternal morbidity and mortality, and perinatal morbidity and mortality. Evidence Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to April 2009. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values The evidence obtained was reviewed and evaluated by the Maternal Fetal Medicine and Clinical Practice Obstetric Committees of the SOGC under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. Benefits, Harms, and Costs Implementation of the recommendations in this guideline should increase recognition of the issues clinicians need to be aware of when managing obese women in pregnancy, improve communication and consultation amongst the obstetrical care team, and encourage federal and provincial agencies to educate Canadians about the values of entering pregnancy with as healthy a weight as possible.

Resume Objectif Analyser les donnees et formuler des recommandations en ce qui concerne le counseling et la prise en charge des parturientes obeses. Issues Parmi les issues evaluees, on trouve les effets de l’obesite maternelle sur l’offre de soins prenatals et intrapartum, ainsi que sur la morbidite et la mortalite maternelles et perinatales. Resultats Des recherches ont ete menees aupres de Statistique Canada, de Medline et de The Cochrane Library en vue d’en tirer la litterature portant sur les effets de l’obesite pendant la grossesse sur les soins prenatals et intrapartum, la morbidite et la mortalite maternelles, l’anesthesie obstetricale, et la morbidite et la mortalite perinatales. Les resultats ont ete restreints aux analyses systematiques, aux essais comparatifs randomises / essais cliniques comparatifs et aux etudes observationnelles. Aucune restriction en fonction de la date ou de la langue n’a ete mise en œuvre. Les recherches ont ete regulierement mises a jour et leurs resultats ont ete incorpores a la directive clinique jusqu’en avril 2009. La litterature grise (non publiee) a ete identifiee par l’intermediaire de recherches menees dans les sites Web d’organismes s’interessant a l’evaluation des technologies dans le domaine de la sante et d’organismes connexes, dans des collections de directives cliniques, dans des registres d’essais cliniques et aupres de societes de specialite medicale nationales et internationales. Valeurs Les resultats cumules ont ete analyses et evalues par le comite de medecine fœto-maternelle et le comite de pratique clinique-obstetrique de la SOGC, sous la gouverne des auteurs principaux, et les recommandations ont ete formulees conformement aux lignes directrices elaborees par le Groupe d’etude canadien sur les soins de sante preventifs. Avantages, desavantages et couts :La mise en œuvre des recommandations formulees dans la presente directive clinique devraient sensibiliser davantage les cliniciens aux aspects qui doivent etre pris en consideration dans le cadre de la prise en charge des femmes obeses pendant la grossesse, ameliorer la communication et la consultation au sein de l’equipe de soins obstetricaux, et inciter les organismes federaux et provinciaux a sensibiliser les Canadiennes aux bienfaits du maintien d’un poids aussi sante que possible avant la grossesse. Recommandations 1. Les examens de sante periodiques et les autres consultations de nature gynecologique se deroulant avant la grossesse constituent des occasions ideales d’aborder le sujet de la perte de poids avant la conception. Les femmes devraient etre incitees a presenter, avant la grossesse, un IMC 2 et, idealement, 2 . (III-B) 2. L’IMC devrait etre calcule en fonction de la taille et du poids pregrossesses. Les femmes qui presentent un IMC pregrossesse > 30 kg/m 2 sont considerees comme etant obeses. Ce renseignement peut s’averer utile dans le cadre du counseling visant les risques pour la grossesse qui sont associes a l’obesite. (II-2B) 3. Les femmes enceintes obeses devraient se voir offrir des services de counseling au sujet du gain ponderal, de la nutrition et des choix alimentaires. (II-2B) 4. Les femmes obeses devraient etre avisees qu’elles sont exposees a des risques de complications medicales telles que les maladies cardiaques, les maladies pulmonaires, l’hypertension gestationnelle, le diabete gestationnel et l’apnee obstructive du sommeil. La pratique reguliere d’exercices pendant la grossesse peut contribuer a attenuer certains de ces risques. (II-2B) 5. Les femmes obeses devraient etre avisees que leur fœtus est expose a un risque accru d’anomalies congenitales; un depistage approprie devrait etre mis en œuvre. (II-2B) 6. Les fournisseurs de soins obstetricaux devraient tenir compte de l’IMC au moment de prendre des dispositions en vue de la tenue d’une evaluation anatomique fœtale au cours du deuxieme trimestre. Une evaluation anatomique menee a 20–22 semaines pourrait s’averer mieux indiquee pour ce qui est des patientes enceintes obeses. (II-2B) 7. Les femmes enceintes obeses courent un risque accru de subir une cesarienne; de plus, leur taux de reussite en ce qui concerne l’accouchement vaginal a la suite d’une cesarienne connait une baisse. (II-2B) 8. Le tenue d’une consultation prenatale aupres d’un anesthesiste devrait etre envisagee, afin de passer en revue les options en matiere d’analgesie et de s’assurer de la mise en place d’un plan de prise en charge lorsque l’option de l’anesthesie regionale est retenue. (III-B) 9. Le risque de thromboembolie veineuse de chaque femme obese devrait etre evalue. Dans certaines situations cliniques, le fait d’envisager une thromboprophylaxie devrait etre personnalise. (III-B)

Objective To provide an update on rubella and pregnancy so that health professionals remain aware of the potentially devastating effects on the developing fetus. Outcomes Rubella vaccination has been effective in virtually eliminating congenital rubella syndrome in Canada. Evidence Medline, PubMed, and Cochrane Database were searched for articles published between 1985 and 2007. Values The quality of evidence was rated using the criteria described in the report of the Canadian Task Force on Preventive Health Care. Sponsor The Society of Obstetricians and Gynaecologists of Canada. Recommendations 1.Since the effects of congenital rubella syndrome vary with the gestational age at the time of infection, accurate gestational dating should be established, as it is critical to counselling. (II-3A) 2.The diagnosis of primary maternal infection should be made by serological testing. (II-2A) 3.In a pregnant woman who is exposed to rubella or who develops signs or symptoms of rubella, serological testing should be performed to determine immune status and risk of congenital rubella syndrome (III-A) 4.Rubella immunization should not be administered in pregnancy but may be safely given post partum. (III-B) 5.Women who have been inadvertently vaccinated in early pregnancy or who become pregnant immediately following vaccination can be reassured that there have been no cases of congenital rubella syndrome documented in theses situations. (III-B) 6.Women wishing to conceive should be counselled and encouraged to have their antibody status determined and undergo rubella vaccination if needed. (I-A)

Resume Objectif Offrir une mise a jour sur la rubeole au cours de la grossesse, de facon a permettre aux professionnels de la sante de demeurer sensibles aux effets potentiellement devastateurs de cette maladie sur le foetus en developpement. Issues La vaccination anti-rubeole a permis de pratiquement eliminer l'embryopathie rubeolique au Canada. Resultats Des recherches ont ete menees dans Medline, PubMed et la base de donnees Cochrane en vue d'en tirer des articles publies entre 1985 et 2007. Valeurs La qualite des resultats a ete etablie au moyen des criteres decrits dans le rapport du Groupe d'etude canadien sur les soins de sante preventifs. Commanditaire La Societe des obstetriciens et gynecologues du Canada. Recommandations 1.Les effets de l'embryopathie rubeolique varient en fonction de l'âge gestationnel au moment de l'infection; ainsi, une attention particuliere devrait etre accordee a la precision de la datation gestationnelle puisque celle-ci s'avere d'une importance cruciale en matiere de prise en charge. (II-3A) 2.Le diagnostic d'infection primaire maternelle devrait etre etabli au moyen d'un test serologique. (II-2A) 3.Chez les femmes enceintes qui sont exposees a la rubeole ou qui presentent des symptomes de rubeole, des tests serologiques devraient etre effectues afin de determiner l'etat immunitaire et le risque d'embryopathie rubeolique. (III-A) 4.L'immunisation contre la rubeole ne devrait pas etre administree au cours de la grossesse; elle peut toutefois l'etre, en toute surete, pendant la periode postpartum. (III-B) 5.Les femmes ayant ete vaccinees par inadvertance au cours des premiers mois de la grossesse ou celles qui sont devenues enceintes immediatement a la suite de la vaccination peuvent etre rassurees, puisque aucun cas d'embryopathie rubeolique n'a ete documente dans de telles circonstances. (III-B) 6.Les femmes souhaitant devenir enceintes devraient etre conseillees et incitees a se soumettre a la verification de leur etat immunitaire et a une vaccination contre la rubeole, au besoin. (I-A)

Summary Background Respiratory mortality and morbidity remain major consequences of extreme prematurity. Percutaneous transfer of oxygen and carbon dioxide is possible in the newborn human. Perfluorocarbon (PFC) liquids have excellent oxygen and carbon dioxide carrying capacity. Animals can breath immersed in perfluorocarbon liquids and maintain adequate gas exchange. Our hypothesis is that the combination of spontaneous tidal perfluorocarbon breathing and respiration through the skin immersed in perfluorocarbon will allow adequate gas exchange in the preterm newborn. In this pilot study we aimed to observe the effects of immersion in FC-77 perfluorocarbon liquid on the preterm lamb. Pilot data Four preterm lambs at 100–115 days gestation were delivered using a modified EXIT procedure. Immediately after complete delivery, the catheterised lamb was immersed in warm, oxygenated FC-77 perfluorocarbon liquid. Physiological monitoring was done for up to 60 min. All lambs were warmed adequately and seemed to have centrally intact circulation initially. All had little or no respiratory effort and there was no appreciable lung expansion. All had severe respiratory acidosis. Discussion For the provision of immediate ex utero care to the ‘fetus’ there are three requirements: adequate gas exchange surfaces and sufficient oxygen and carbon dioxide gradients, a functioning circulation, and an environment capable of keeping the lamb warm (thus minimising metabolic demand, oxygen consumption and carbon dioxide production). In this pilot study the greatest initial problem was the severe and rapidly worsening respiratory acidosis. The major problem was a lack of respiratory drive. No lung expansion from the outset would yield zero contribution to gas exchange from the lungs. An intact central circulation does not necessarily mean that the pulmonary circulation, respiratory drive and/or the skin circulation are adequate. For adequate gas exchange to occur it will require a ‘breathing’ animal with expanded alveoli. If the transition from the normal in utero state to immersion in PFC was immediate, and lung expansion was achieved, it could still be possible to achieve adequate gas exchange through the skin and lungs of the extremely preterm newborn. Hypothesis Given the potential for gas exchange across the skin of the extremely preterm infant we hypothesise that the immersion of extremely preterm infants in PFC liquid will allow optimal percutaneous gas exchange to occur. Given some lung gas exchange with less injurious liquid ventilation (spontaneous or mechanical) we hypothesise that the combination of skin and lung gas exchange will provide sufficient gas exchange to support life.

British women’s participation in public life expanded significantly in the period of the French Revolutionary and Napoleonic wars, when women served as crucial actors in the home front’s battles of ideas and political loyalties. But as war with Revolutionary France escalated, and British women were enjoined by conservatives to refrain from politics, some responded by enacting a ‘female masculinity’ that demonstrated that neither patriotism nor masculine values were ever solely the product of male bodies and their effects. The impact of this ‘female masculinity’ on perceptions of gender is traced in popular political culture and in attitudes towards Admiral Horatio Nelson and Lady Emma Hamilton, two controversial figures of the day. Their unconventional gender performances and their representation illuminated a larger shift in the valences of body politics, from the universal and neo-classical forms of the eighteenth-century public sphere to the fragmented and individuated images of nineteenth-century modernity.

This article explores the relationships between social, physical, and sociodemographic characteristics and the health status of individuals within four contrasting neighbourhoods in Hamilton, Ontario, using a cross-sectional design. Using data from a telephone survey conducted in 2001 and 2002 of a random sample of adults (1504 respondents, response rate = 60%), path analysis was used to estimate direct and indirect effects of neighbourhood location and satisfaction on health; specifically, the effect of income, coping skills, and neighbourhood satisfaction on self-rated health. Coping was found to be an important mediator between several lifestyle and neighbourhood characteristics and health outcomes. Income and other measures of wealth such as housing tenure, employment, money worries, and lack of money/food bank use were found significant in all health outcomes as well as daily coping ability. Since coping ability was found to be more important for health status than income, policy implications include a greater emphasis on social programmes to assist individuals to manage stress, as well as income support.

Resume Objectif Resumer les donnees disponibles en ce qui a trait a la planification du renvoi a domicile des meres et des nouveau-nes. Issue Evaluation du lien entre la duree de l'hospitalisation et la morbidite et la mortalite maternelles et neonatales. Resultats Des recherches ont ete menees dans la base de donnees Medline, au moyen des mots cles early postpartum discharge , afin d'en tirer les articles publies entre janvier 1995 et decembre 2004 a ce sujet. Recommandations 1.Le renvoi precoce a domicile a la suite de l'accouchement entraine une hausse du risque de mortalite et de morbidite neonatales. Les programmes de suivi devraient tenir compte de cette situation. (II-2B) 2.Le bien-etre physique, psychologique et social de la mere et du nouveau-ne doit etre evalue au moment de la planification du renvoi a domicile. Les jeunes femmes primipares et monoparentales sont celles qui sont le plus susceptibles de retourner en salle d'urgence en compagnie de leur nouveau-ne. (II-2A) 3.Les programmes existants de soins post-partum au sein de la communaute sont bien utilises et apprecies. L'ajout de programmes communautaires pourrait entrainer une baisse de la mortalite, de la morbidite et des rehospitalisations neonatales. (II-2) Validation La presente declaration de principe a ete approuvee par le comite de pratique clinique-Obstetrique et par le comite executif de la Societe des obstetriciens et gynecologues du Canada.

We live in the age of the "imperial turn"—not only in contemporary geo- politics but also in eighteenth-century scholarship. In this generative twist theatre has become centrally important. Literary critics, historians, and anthropologists have documented both the theatricality of eighteenth-century social relations and the complex ways that contemporary drama reflected and intervened in Britain's overseas expansion and materialized its transoceanic flows. 1 This essay will chart the travels of one play, Nicholas Rowe's The Fair Penitent (1702), from London, Jamaica, and Calcutta to the fledgling convict colony of New South Wales. Rowe's she-tragedy dealing with seduction and betrayal was not "about" empire in any straightforward sense, although, as we shall see, the play exploits a neoclassical

© 2014, Springer Science+Business Media New York.Depression adversely predicts prognosis in individuals with symptomatic heart failure. In some clinical populations, spiritual wellness is considered to be a protective factor against depressive symptoms. This study examined associations among depressive symptoms, spiritual wellbeing, sleep, fatigue, functional capacity, and inflammatory biomarkers in 132 men and women with asymptomatic stage B heart failure (age 66.5 years ± 10.5). Approximately 32 % of the patients scored ≥10 on the Beck Depression Inventory, indicating potentially clinically relevant depressive symptoms. Multiple regression analysis predicting fewer depressive symptoms included the following significant variables: a lower inflammatory score comprised of disease-relevant biomarkers (p

Overwhelming data indicate that individuals with even mildly elevated blood pressure (BP) are at great risk for developing clinical hypertension and future cardiovascular disease (CVD). There remains a lack of consensus regarding treatment strategies for mildly elevated BP, termed prehypertension, and the knowledge of pathophysiology and mechanisms of its clinical outcomes remains limited. Our primary aim was to investigate βAR-mediated inflammation control (BARIC) responses of blood monocytes to isoproterenol (Iso) in relation to BP and CVD risk factors, including obesity, depressive mood, fasting glucose, triglycerides, and cholesterol levels in the 64 prehypertensive compared to 84 individuals with normal BP. BARIC was determined by measuring the degree of inhibition in lipopolysaccharides-stimulated monocytic intracellular TNF production by ex vivo Iso treatment (10−8 M). Depressive mood was assessed by Beck Depression Inventory (BDI). Fasting metabolic and lipid panels were assessed, and plasma levels of inflammatory cytokines TNF, IL-1β, IL-6 were measured in a subset to confirm proinflammatory state of prehypertensive participants. Prehypertensive participants were older, heavier, included more men, and presented higher levels of fasting glucose, triglycerides, cholesterol, and plasma TNF compared to normotensive participants (p’s< .05). BARIC was significantly attenuated in the prehypertensive compared to normotensive group (p< .05). BARIC was negatively associated with systolic BP, diastolic BP, age, BMI, fasting glucose, triglycerides, total and low density cholesterol levels, and somatic depressive symptoms in all participants (p’s< .0001 to .05). However, among the prehypertensive individuals BARIC was positively associated with SBP even after controlling for the covariates (age, gender, race, BMI, glucose and lipid panel, somatic BDI scores) (p< .05). This differing nature of the BARIC-SBP relationship between the two BP groups may be attributed to moderating factors such as cardiorespiratory fitness or depressive symptoms that could not be clearly deciphered in this current study. Nonetheless, our findings indicate the associations between inflammation dysregulation mediated by sympathoadrenal activation and BP that is observable even among individuals with normal to mildly elevated BP. BARIC may be a useful and sensitive indicator of elevated risk for vascular inflammatory disease that can be detected even at lower BP levels, especially given its associations with traditional CVD risk factors and the critical role of monocytes in atherogenic processes.

Background and Purpose Manual hyperinflation is a physiotherapy technique that improves static compliance and mobilizes secretions, but has the potential to alter haemo-dynamic function. The aim of the present study was to investigate the effects of manual hyperinflation on haemodynamic function in a healthy animal model, without the usual confounding effects inherent in an heterogeneous intensive care population. Method The study used a within-subjects design, in an animal research theatre. Nine healthy sheep (eight Border Leicester, one Merino, mean weight 39.5 kg, standard deviation (SD) 1.6 kg) completed the study. The sheep were induced (thiopentane 15–20 ml), intubated, ventilated and surgically instrumented for an arterial line and pulmonary artery catheter. Anaesthesia was maintained by 1.5% halothane/oxygen. Manual hyperinflation was delivered for two minutes with a Mapleson C circuit, using a peak inspiratory pressure of 35cmH2O and an inspiratory:expiratory ratio of 2:1. Results Mean tidal volume during manual hyperinflation was 294% (SD 22%) of the ventilator tidal volume. A paired Student's t-test demonstrated that cardiac output (thermodilution method) decreased significantly (p

There is increasing concern in Canada that the health care system is in a state of crisis. It is argued that reductions in federal government transfers to the provinces have resulted in a health care system characterized by under-funding in key areas and policy decisions based more on provincial fiscal concerns than the health needs of their constituents. Provincial governments have responded to reduced levels in federal funding by undertaking aggressive restructuring tactics such as the closure of hospitals and the deinsuring of medical services from provincial health plans. The end result of this restructuring, as argued by the media, consumer groups and indeed some health researchers, is a state of crisis' (i.e., lower levels of accessibility, long waiting lists, overcrowding in hospitals and increasing costs of medication). One crisis theme often mentioned is that fiscal decisions of various kinds are reducing economic and geographic accessibility, one of the five principles of the Canada Health Act (CHA) that defines the very essence of the Canadian health care system. Using data from the 1998-99 National Population Health Survey (NPHS), this paper explores the extent to which an accessibility crisis exists within the Canadian health care system by examining access to health care services and the barriers encountered in trying to access services in each of the ten provinces. The results show that approximately 6.0 percent of Canadians report access problems, with values ranging from 4.5 percent in Newfoundland to 8.3 percent in Manitoba. Regional variations in barriers to accessing care were also observed. In particular, geographic accessibility appears to be a main barrier to care in Atlantic Canada while economic accessibility emerges as a main barrier to care in Western Canada. We discuss these findings in the context of the current debates on the Canadian health care system ‘crisis’. De plus en plus de Canadiens s'inquietent que leur systeme de soins de sante soit en etat de crise. On defend l'idee selon laquelle la reduction des paiements de transfert aux provinces par le gouvernement federal serait responsable de l'etat d'un systeme de sante caracterise par un sous-financement dans les domaines-cles et des decisions politiques de sante basees, non pas sur les besoins des membres de la societe canadienne, mais sur la fiscalite provinciale. Les gouvernements provinciaux ont reagi a la reduction du financement federal par une tactique de restructuration agressive (fermeture d'hopitaux et retrait de services medicaux des programmes d'assurance de sante provinciaux). Selon les medias, les groupes de consommateurs et meme les chercheurs en soins de sante, cette restructuration a eu pour effet un systeme en etat de ‘crise’ (diminution de l'aeces aux services, longues fetes d'attente, hopitaux surcharges, augmentation des couts des medicaments etc). Un des themes recurrent est celui des decisions flscales de toutes sortes qui entrainent une baisse de l'accessibilite financiere et geographique. Cette accessibilite est pourtant un des cinq principes de la Loi canadienne sur la sante definissant l'essence meme du systeme de sante au Canada. Utilisant les donnees tirees de l'Enquete nationale sur la sante de la population, 1998-99 et examinant l'acces aux services de sante et les obstacles rencontres dans les 10 provinces canadiennes, cet article evalue dans quelle mesure une crise d'accessibilite existe au sein du systeme de sante canadien. Les resultats demontrent qu'environ 6.0 pour cent des Canadiens ont rencontre des problemes d'accessibilite, avec des variantes allant de 4.5 pour cent a Terre-Neuve jusqu'a 8.3 pour cent au Manitoba. On observe aussi des variantes regionales dans les obstacles rencontres. L'accessibilite geographique en particulier semble un obstacle mqjeur dans les regions de l'Atlantique, alors que l'accessibilite financiere semble etre un obstacle majeur dans l'Ouest du Canada. Ces resultats sont presentes dans le contexte des debats actuels sur l'existence dune, ‘crise’ dans le systeme de sante au Canada.

The present study examined real-world direct health care costs for metastatic colorectal cancer (mCRC) patients initiating first-line (1L) bevacizumab (BEV)- or cetuximab (CET)-containing regimen in 1L or 1L-through-second-line (1L-2L) therapy.Using a large US insurance claims database, patients with mCRC initiating 1L BEV- or 1L CET-containing regimen from January 1, 2008 to September 30, 2014 were identified. The per-patient per-month (PPPM) all-cause health care costs (2014 US dollars) were measured during 1L therapy and, for patients continuing to a 2L biologic-containing regimen, 1L-2L therapy. Multivariable regression analyses were used to compare PPPM total health care costs between patients initiating a 1L BEV- versus 1L CET-containing regimen.A total of 6095 patients initiating a 1L BEV- and 453 initiating a 1L CET-containing regimen were evaluated for 1L costs; 2218 patients initiating a 1L BEV- and 134 initiating a 1L CET-containing regimen were evaluated for 1L-2L costs. In 1L therapy, 1L CET had adjusted PPPM costs that were $3135 (95% confidence interval [CI], $1174-$5040; P .001) greater on average than 1L BEV. In 1L-2L therapy, 1L BEV-2L CET had adjusted PPPM costs that were $1402 (95% CI, $1365-$1442; P = .010) greater than those for 1L BEV-2L BEV, and 1L CET-2L BEV had adjusted PPPM costs that were $4279 (95% CI, $4167-$4400; P = .001) greater on average than those for 1L BEV-2L BEV. The adjusted PPPM cost differences for 1L BEV-2L other biologic or 1L CET-2L other biologic agent were numerically greater but statistically insignificant.PPPM total health care costs for 1L and 2L therapy tended to be greater for patients treated with 1L CET-containing regimens than for 1L BEV-containing regimens. Also, continuing treatment with BEV-containing regimens 1L-2L was less costly than switching between BEV and CET. The cost differences between BEV and CET hold important implications for treatment decisions of mCRC patients in real-world clinical practice.

Background: Echocardiography is used in humans to characterise the structure and function of the heart, yet is relatively uncommon in studies on the rat, the most commonly used model of human cardiovascular disease. The aim of this study was to show that echocardiography in rats provides useful information on cardiac changes occurring in thyroid dysfunction and can also be used to characterise cardiac abnormalities. Methods: Transthoracic echocardiography and Doppler techniques with high frequency, high frame rate imaging were used to define cardiac dimensions and function in 240 Wistar rats and cardiac abnormalities in Wistar and spontaneously hypertensive rats (SHR). Results: Echocardiographic assessment of left ventricular dimensions and function and aortic flows was technically feasible in almost all adult Wistar rats and SHR, including those with thyroid dysfunction and cardiac abnormalities. Pulsed-wave Doppler profiles of mitral inflows to estimate diastolic function were less reliably obtained. Conclusions: Echocardiography is a powerful technique for non-invasive and serial determination of cardiac structure and function in rat models of human cardiovascular disease.