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BACKGROUND Surgical treatment of ankle fracture is associated with significant pain and high postoperative opioid consumption. The anaesthesia method may affect early postoperative pain. The main objective of the study was to compare postoperative opioid consumption after ankle-fracture surgery between patients treated with spinal anaesthesia and general anaesthesia. METHODS We reviewed retrospectively the files of 586 adult patients with surgically treated ankle fracture in the years 2014 through 2016. The primary outcome was opioid consumption during the first 48 postoperative hours. Secondary outcomes were maximal pain scores, postoperative nausea and vomiting, the length of stay in the post-anaesthesia care unit, and opioid use in different time periods up to 48 h postoperatively. Propensity score matching was used to mitigate confounding variables. RESULTS Total opioid consumption 48 h postoperatively was significantly lower after spinal anaesthesia (propensity score-matched population: effect size -13.7 milligrams; 95% CI -18.8 to -8.5; P

An interview with artist Lea Porsager for the catalogue of the Emma Kunz Cosmos exhibition.

Background: Surgical treatment of ankle fracture is associated with significant pain and high postoperative opioid consumption. The anaesthesia method may affect early postoperative pain. The main objective of the study was to compare postoperative opioid consumption after ankle-fracture surgery between patients treated with spinal anaesthesia and general anaesthesia. Methods: We reviewed retrospectively the files of 586 adult patients with surgically treated ankle fracture in the years 2014 through 2016. The primary outcome was opioid consumption during the first 48 postoperative hours. Secondary outcomes were maximal pain scores, postoperative nausea and vomiting, the length of stay in the post-anaesthesia care unit, and opioid use in different time periods up to 48 h postoperatively. Propensity score matching was used to mitigate confounding variables. Results: Total opioid consumption 48 h postoperatively was significantly lower after spinal anaesthesia (propensity score-matched population: effect size −13.7 milligrams; 95% CI −18.8 to −8.5; P < .001). The highest pain score on the numerical rating scale in the post-anaesthesia care unit was significantly higher after general anaesthesia (propensity score-matched population: effect size 3.7 points; 95% CI 3.2-4.2; P < .001). A total of 60 patients had postoperative nausea and vomiting in the post-anaesthesia care unit, 53 (88.3%) of whom had general anaesthesia (P = .001). Conclusions: Patients with surgically treated ankle fracture whose operation was performed under general anaesthesia used significantly more opioids in the first 48 h postoperatively, predominantly in the post-anaesthesia care unit, compared with patients given spinal anaesthesia.

Little has been written on the relationship between one of the most prominent personalities of modern Western esotericism, Aleister Crowley (1875(2013)1947), and Islam. Yet, this relationship was important to Crowley and is significant for understanding his views on religions, as well as some particular aspects of the religious tradition he himself initiated, Thelema. Crowley had close contacts with various forms of Islam during his travels in India, Egypt, Algeria, and Tunisia. He often expresses admiration and fascination for Islamic culture, which he compares favorably to other religious traditions, particularly Christianity, but also Hinduism. Some of his opinions mirror ideas that were relatively widespread in Victorian Britain. This chapter starts with a comparison between Thelema and Islam. It shows the extent of the influence that Crowley(2019)s contact(2014)both direct and indirect(2014)with Islam had on the shaping of his own religious movement. It also looks at the broader cultural meaning of Crowley(2019)s views on Islam, with respect to aspects such as politics, gender, and sexuality. Particular attention is given to the influence that the British explorer and orientalist Richard Burton had on Crowley with respect to Islam. Many of the opinions Crowley expressed were clearly modelled on Burton, who had been one of his heroes since his childhood years. This chapter also looks at Crowley(2019)s interest in Sufism and compares it with the similar interest Burton had.

This chapter focuses on the presence in the history of modern art of what Marco Pasi defines as “esoteric posthumousness.” Posthumousness is the inability or unwillingness of an artist to have their artistic work promoted and recognised during their life. Posthumousness can be esoteric when the artist combines it with a deep interest in alternative spirituality, mysticism, and esoteric doctrines or practices. By focusing on a number of cases of “posthumous” artists who were deeply influenced by esoteric ideas and practices, such as Georgiana Houghton, Hilma af Klint, and Emma Kunz, this chapter shows how the relationship between posthumousness and alternative spirituality is not purely accidental, but points to some interesting patterns. The conclusion demonstrates that the projection of an artistic work into the hypothetical future of posthumousness is not a contingent aspect, but one of the factors that allows artists interested in esotericism to give full expression to their creativity.

The degree to which loci promoting reproductive isolation cluster in the genome—that is, the genetic architecture of reproductive isolation—can influence the tempo and mode of speciation. Tight linkage between these loci can facilitate speciation in the face of gene flow. Pheromones play a role in reproductive isolation in many Lepidoptera species, and the role of endogenously produced compounds as secondary metabolites decreases the likelihood of pleiotropy associated with many barrier loci. Heliconius butterflies use male sex pheromones to both court females (aphrodisiac wing pheromones) and ward off male courtship (male‐transferred antiaphrodisiac genital pheromones), and it is likely that these compounds play a role in reproductive isolation between Heliconius species. Using a set of backcross hybrids between H. melpomene and H. cydno, we investigated the genetic architecture of putative male pheromone compound production. We found a set of 40 significant quantitative trait loci (QTL) representing 33 potential pheromone compounds. QTL clustered significantly on two chromosomes, chromosome 8 for genital compounds and chromosome 20 for wing compounds, and chromosome 20 was enriched for potential pheromone biosynthesis genes. There was minimal overlap between pheromone QTL and known QTL for mate choice and color pattern. Nonetheless, we did detect linkage between a QTL for wing androconial area and optix, a color pattern locus known to play a role in reproductive isolation in these species. This tight clustering of putative pheromone loci might contribute to coincident reproductive isolating barriers, facilitating speciation despite ongoing gene flow., The degree to which loci promoting reproductive isolation cluster in the genome—that is, the genetic architecture of reproductive isolation—can influence the tempo and mode of speciation. We found that QTL for wing and genital pheromone production in Heliconius butterflies, which might play a role in reproductive isolation, clustered significantly on two chromosomes, chromosome 8 for genital compounds and chromosome 20 for wing compounds, and chromosome 20 was enriched for potential pheromone biosynthesis genes. This tight clustering of putative pheromone loci might contribute to coincident reproductive isolating barriers, facilitating speciation despite ongoing gene flow.

Few fields of academic research are surrounded by so many misunderstandings and misconceptions as the study of Western esotericism. For twenty years now, the Centre for History of Hermetic Philosophy and Related Currents (University of Amsterdam) has been at the forefront of international scholarship in this domain. This anniversary volume seeks to make the modern study of Western esotericism more widely known beyond specialist circles, while addressing a range of misconceptions, biases, and prejudices that still tend to surround it. Thirty-one major scholars in the field respond to questions about a wide range of unfamiliar ideas, traditions, practices, problems, and personalities that are central to the field. By challenging many taken-for-granted assumptions about religion, science, philosophy, and the arts, this volume demonstrates why the modern study of esotericism leads us to reconsider much that we thought we knew about the story of Western culture

Il 2 settembre 1930 dal piroscafo Alcantara in rotta verso l'America del Sud sbarcano a Lisbona il noto occultista Aleister Crowley e la sua giovane compagna Hanni Jaeger. Ad aspettarli sulla banchina c'è il poeta Fernando Pessoa. Comincia così uno degli episodi più curiosi nella biografia di entrambi gli uomini. Qualche settimana più tardi, Crowley scompare nel nulla dopo avere lasciato una misteriosa lettera d'addio su una scogliera vicino a Cascais, nota come la "Bocca dell'Inferno". Crowley si era davvero suicidato come sembrava? E qual era il ruolo di Pessoa in questa strana vicenda? In questo libro vengono riuniti per la prima volta in edizione italiana i documenti relativi allo straordinario incontro tra il famigerato occultista inglese e il poeta portoghese, tra cui l'integralità della loro corrispondenza e il romanzo che Pessoa scrisse sulla vicenda, scoperto solo in anni recenti e ancora inedito in Italia. L'incontro di due figure eccezionali della cultura del Novecento, così diverse eppure per certi aspetti così vicine, non poteva che produrre una storia piena di mistero e di humour, come quella che viene raccontata in queste pagine.

Mechanisms that suppress recombination are known to help maintain species barriers by preventing the breakup of coadapted gene combinations. The sympatric butterfly species Heliconius melpomene and Heliconius cydno are separated by many strong barriers, but the species still hybridize infrequently in the wild, and around 40% of the genome is influenced by introgression. We tested the hypothesis that genetic barriers between the species are maintained by inversions or other mechanisms that reduce between‐species recombination rate. We constructed fine‐scale recombination maps for Panamanian populations of both species and their hybrids to directly measure recombination rate within and between species, and generated long sequence reads to detect inversions. We find no evidence for a systematic reduction in recombination rates in F1 hybrids, and also no evidence for inversions longer than 50 kb that might be involved in generating or maintaining species barriers. This suggests that mechanisms leading to global or local reduction in recombination do not play a significant role in the maintenance of species barriers between H. melpomene and H. cydno.

Electroencephalogram (EEG) has been clinically used to estimate the level of consciousness during anesthesia, but its physiology and biophysics are poorly understood in anesthesiological literature. The electrical sources of EEG are in cortical structures. EEG currents create closed-loops, which flow from the surface of the cortex and then return to the inside of the hemispheres. In the case of widespread synchronous activity like physiological sleep or anesthesia, the currents return through the base of brain and skull. Here we show with a typical EEG pattern of anesthesia, burst-suppression, that due to those currents EEG is recordable outside of scalp area. We also present the sensitivity field of electrodes located submentally, as well as the electrodes used for anesthesia monitoring, calculated from a realistic head model of the potential distribution and currents of EEG. Our results show that anesthesia EEG can be recorded with a pair of electrodes anywhere on the surface of head, as well as inside of head and brain, because the EEG current loops produce recordable voltage gradients in the whole head. A pair of electrodes submentally is most sensitive to basal parts of the brain. The typical electrodes used in anesthesia monitoring are most sensitive to basal surface of frontal lobes as well as frontal and mesial parts of temporal lobes.