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This article examines the supposed lack of “humanity” in Woolf’s short stories and novels by identifying its source in the sphere of “solid objects” and in the way these “objects” destabilize the coherence of what the western philosophical tradition typically refers to as “subject” (in the Cartesian sense). Referring to Moore’s direct realism as well as James’s and Mach’s radical empiricism, the discussion focuses on specific states of heightened perceptive intensity in which the perceiving subject stumbles on the verge of collapse and “mixes” itself with what it perceives. By considering these limit cases, this paper tries to demonstrate the way in which Woolf’s fiction might in fact be understood as illustrative of the process of de-humanizing de-centralization and dispersion of the already fluid consciousness and its blending with the impersonal material objects, resulting in a complete loss of one idea of “the human” (an idea based on the intellectual autonomy and sovereignty of a unified subject) and pointing towards a post-human and post-modern condition in which human becomes defined by the ever-widening circle of its own outside

Background: Patients with ankylosing spondylitis (AS) experience abnormal spinopelvic motion due to chronic inflammation of the axial skeleton, predisposing them to impingement and dislocation. The purpose of this study was to evaluate total hip arthroplasty (THA) dislocation rates in AS patients and evaluate the effects of age and gender on dislocation risk., Methods: Patients who underwent primary THA from 2005 to 2014 were identified using the PearlDiver database. AS patients were compared to age- and gender-matched controls without AS. Patients with a history of spine pathology or spine surgery were excluded. Univariate analyses were performed based on age and sex to evaluate dislocation rates at 90 days, 6 months, 1 year, and 5 years postoperatively., Results: A total of 2792 THA patients (59.6% male) with AS were identified and compared to an age- and gender-matched control group of 5582 THA patients (59.5% male) without AS or known spine pathology. At final follow-up, there were 96 dislocations (3.4%) in the AS group and 138 (2.5%) dislocations in the control group (OR 1.40; 95% CI, 1.08-1.83; p  = 0.0118). AS patients ⩾70 years old had higher dislocation rates at all time points (OR range, 1.75-2.09; p  < 0.05) compared to controls. At 5-year follow-up, dislocation-free survivorship was 95.7% (95% CI, 94.5-96.9%) for AS patients ⩾70 years old compared to 97.3% (95% CI, 96.6-98.0%) for patients ⩾70 years old without AS., Conclusions: Older AS patients have higher dislocation rates following THA. This effect is likely related to decreased spinopelvic motion in the sagittal plane, predisposing patients to impinge and dislocate., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RJH: Paid consultant for: Nuvasive.JCW: Receives royalties from: Biomet, Synthes, Seaspine, Bone Biologics; owns stock/stock options in: Pearldiver, Electrocore, Surgitech; receives Fellowship funding from: AO Foundation (paid to institution).NDH: Paid consultant for: Intellijoint Surgical, MicroPort Orthopedics.

Background: The American Joint Replacement Registry (AJRR) was created to capture knee and hip arthroplasty data in the United States. The purpose of this study was to compare early reports from the AJRR to other national registries to identify topics for future analysis., Methods: Hip and knee arthroplasty data were extracted from the AJRR, Australia, New Zealand, United Kingdom, Norway, and Sweden from 2014 to 2016. Hip arthroplasty data including femoral and acetabular fixation, bearing surface, head size, dual-mobility bearings, resurfacing, and revision burden were compared. Knee arthroplasty data including polyethylene type, unicondylar arthroplasty, mobile bearings, cruciate-retaining implants, patella resurfacing, and revision burden were compared. Registry characteristics and patient demographics were reported using descriptive statistics., Results: In 2016, the AJRR captured 28% of arthroplasty procedures performed in the United States compared with 95%-98.3% among other registries. Cementless femoral fixation was 96.7% in the AJRR compared with 21.8%-63.4%. Ceramic and 36-mm heads were most common in AJRR; all other registries reported that metal and 32-mm heads were most popular. Dual-mobility articulations were used in 8% of primary and 28% of revision total hip arthroplasty procedures in the AJRR. The AJRR reported a unicondylar knee arthroplasty rate of 3.2% compared with 5.1%-13.3% in other registries, but the highest rates of posterior-stabilized total knee arthroplasties (48.5% compared to 8.2%-28.7%) and patella resurfacing (93.9% compared to 2.4%-51.6%)., Conclusion: Several differences in hip and knee arthroplasty practices exist between the United States and other countries. Future studies should focus on understanding why differences in practice trends exist and assess outcomes associated with these practices., Level of Evidence: Level III, retrospective., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Late dislocations after total hip arthroplasty (THA) are challenging for the hip surgeon because the cause is often not evident and recurrence is common. Recently, decreased spinopelvic motion has been implicated as a cause of dislocation. The purpose of this study was to assess the mechanical causes of late dislocation, including the influence of spinopelvic motion., Methods: Twenty consecutive patients were studied to identify the cause of their late dislocation. Cup inclination and anteversion were measured on standard pelvic radiographs. Lateral standing and sitting spine-pelvis-hip radiographs were used to measure pelvic motion, femoral mobility, and sagittal cup position by assessing sacral slope, pelvic-femoral angle, and cup ante-inclination. Spinopelvic motion was defined as the difference between the standing and sitting sacral slopes (Δsacral slope). A new measurement, the combined sagittal index, which measures the sagittal acetabular and femoral positions, was used to assess the functional motion of the hip joint and risk of impingement., Results: There were 9 anterior dislocations (45%) and 11 posterior dislocations (55%) at a mean of 8.3 years after a primary THA. Eight of the 9 patients with an anterior dislocation had spinopelvic abnormalities such as fixed posterior pelvic tilt when standing, increased standing femoral extension, and an increased standing combined sagittal index. Ten of the 11 patients with a posterior dislocation had abnormal spinopelvic measurements such as decreased spinopelvic motion (average Δsacral slope [and standard error] = 9.0° ± 2.4°), increased femoral flexion, and a decreased sitting combined sagittal index. For every 1° decrease in spinopelvic motion, there was an associated 0.9° increase in femoral motion and, in some patients, this resulted in osseous impingement and dislocation., Conclusions: Patients with a late dislocation have abnormal spinopelvic motion that precipitates the dislocation, especially when combined with cup malposition or soft-tissue abnormalities. Spinopelvic stiffness is associated with increased age and increased femoral motion, which may lead to impingement and dislocation. Lateral spine-pelvis-hip radiographs may predict the risk and direction of dislocation., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Oxidative stress is involved in a number of pathological conditions and the generated oxidatively modified lipids influence membrane properties and functions, including lipid-protein interactions and cellular signaling. Brewster angle microscopy demonstrated oxidatively truncated phosphatidylcholines to promote phase separation in monolayers of 1-palmitoyl-2-oleoyl-sn-glycerol-3-phosphocholine (POPC), sphingomyelin (SM) and cholesterol (Chol). More specifically, 1-palmitoyl-2-azelaoyl-sn-glycero-3-phosphocholine (PazePC), was found to increase the miscibility transition pressure of the SM/Chol-phase. Lateral diffusion of lipids is influenced by a variety of membrane properties, thus making it a sensitive parameter to observe the coexistence of different lipid phases, for instance. The dependence on lipid lateral packing of the lateral diffusion of fluorophore-containing phospholipid analogs was investigated in Langmuir monolayers composed of POPC, SM, and Chol and additionally containing oxidatively truncated phosphatidylcholines, using fluorescence correlation spectroscopy (FCS). To our knowledge, these are the first FCS results on miscibility transition in ternary lipid monolayers, confirming previous results obtained using Brewster angle microscopy on such lipid monolayers. Wide-field fluorescence microscopy was additionally employed to verify the transition, i.e. the loss and reformation of SM/Chol domains., (Copyright © 2014. Published by Elsevier B.V.)

Here, we report on a novel PCR targeting-based strategy called 'PCR duplication' that enables targeted duplications of genomic regions in the yeast genome using a simple PCR-based approach. To demonstrate its application we first duplicated the promoter of the FAR1 gene in yeast and simultaneously inserted a GFP downstream of it. This created a reporter for promoter activity while leaving the FAR1 gene fully intact. In another experiment, we used PCR duplication to increase the dosage of a gene in a discrete manner, from 1× to 2x. Using TUB4, the gene encoding for the yeast γ-tubulin, we validated that this led to corresponding increases in the levels of mRNA and protein. PCR duplication is an easy one-step procedure that can be adapted in different ways to permit rapid, disturbance-free investigation of various genomic regulatory elements without the need for ex vivo cloning.

Biological membranes are under significant oxidative stress caused by reactive oxygen species mostly originating during cellular respiration. Double bonds of the unsaturated lipids are most prone to oxidation, which might lead to shortening of the oxidized chain and inserting of terminal either aldehyde or carboxylic group. Structural rearrangement of oxidized lipids, addressed already, is mainly associated with looping back of the hydrophilic terminal group. This contribution utilizing dual-focus fluorescence correlation spectroscopy and electron paramagnetic resonance as well as atomistic molecular dynamics simulations focuses on the overall changes of the membrane structural and dynamical properties once it becomes oxidized. Particularly, attention is paid to cholesterol rearrangement in the oxidized membrane revealing its preferable interaction with carbonyls of the oxidized chains. In this view cholesterol seems to have a tendency to repair, rather than condense, the bilayer., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Understanding of cellular regulatory pathways that involve lipid membranes requires the detailed knowledge of their physical state and structure. However, mapping the viscosity and diffusion in the membranes of complex composition is currently a non-trivial technical challenge. We report fluorescence lifetime spectroscopy and imaging (FLIM) of a meso-substituted BODIPY molecular rotor localised in the leaflet of model membranes of various lipid compositions. We prepare large and giant unilamellar vesicles (LUVs and GUVs) containing phosphatidylcholine (PC) lipids and demonstrate that recording the fluorescence lifetime of the rotor allows us to directly detect the viscosity of the membrane leaflet and to monitor the influence of cholesterol on membrane viscosity in binary and ternary lipid mixtures. In phase-separated 1,2-dioleoyl-sn-glycero-3-phosphocholine-cholesterol-sphingomyelin GUVs we visualise individual liquid ordered (Lo) and liquid disordered (Ld) domains using FLIM and assign specific microscopic viscosities to each domain. Our study showcases the power of FLIM with molecular rotors to image microviscosity of heterogeneous microenvironments in complex biological systems, including membrane-localised lipid rafts.

Even though superresolution microscopy indicates that size of plasma membrane rafts is <20 nm, those structures have never been observed. Förster resonance energy transfer (FRET) is therefore still the most powerful optical method for characterization of such domains. In this letter we investigate relation between nanodomain affinity of a donor-acceptor (D/A) pair and the detectable nanodomain size/area. We show that probes with high affinity to the liquid-ordered (L(o)) phase are required for detecting domain sizes of a few nanometers, and/or domains that occupy a few percent of the bilayer area. A combination of donors and acceptors that prefer different phases is the more favorable approach. For instance, a D/A pair with the distribution constant of donors K(D) = 5 and acceptors K(A) = 0.01 can resolve a broad spectrum of nanodomain sizes. On the other hand, currently available donors and acceptors that prefer the same phase, either the liquid-disordered (L(d)) or L(o) phase, are not so convenient for determining domain sizes <20 nm. Here the detection limits of FRET experiments employing several commonly used D/A pairs have been investigated., (Copyright © 2011 Biophysical Society. Published by Elsevier Inc. All rights reserved.)

This article outlines how one community's academic-practice partnership evolved over time as it sought to address the community's needs for a qualified competent nursing workforce. Both organization and system changes were essential in the establishment of formal structures to address nursing workforce shortage needs. Both practice and education leaders were actively engaged in setting the strategic priorities at multiple system levels in the creation of these formal structures. We anticipate that the formation of these new formal structures will advance and sustain our academic-practice partnerships. Five key lessons were learned: (a) change is inevitable, (b) leadership matters at all levels, (c) succession planning is essential, (d) persistence toward established goals is necessary, and (e) relationships are the glue to sustain forward movement., (Copyright © 2011. Published by Elsevier Inc.)

In a recent article, we described the application of phasor analysis to fluorescence intensity decay data on in vitro samples. As detailed in that article, this method provides researchers with a simple graphical method for viewing lifetime data that can be used to quantify individual components of a mixture as well as to identify excited state reactions. In the current article, we extend the use of in vitro phasor analysis to intrinsic protein fluorescence. We show how alterations in the excited state properties of tryptophan residues are easily visualized using the phasor method. Specifically, we demonstrate that protein-ligand and protein-protein interactions can result in unique shifts in the location of phasor points, indicative of protein conformational changes. Application of the method to a rapid kinetic experiment is also shown. Finally, we show that the unfolding of lysozyme with either urea or guanidine hydrochloride results in different phasor trajectories, indicative of unique denaturation pathways., (2010 Elsevier Inc. All rights reserved.)

The phasor method of treating fluorescence lifetime data provides a facile and convenient approach to characterize lifetime heterogeneity and to detect the presence of excited state reactions such as solvent relaxation and Förster resonance energy transfer. The method uses a plot of M sin(Φ) versus M cos(Φ), where M is the modulation ratio and Φ is the phase angle taken from frequency domain fluorometry. A principal advantage of the phasor method is that it provides a model-less approach to time-resolved data amenable to visual inspection. Although the phasor approach has been recently applied to fluorescence lifetime imaging microscopy, it has not been used extensively for cuvette studies. In the current study, we explore the applications of the method to in vitro samples. The phasors of binary and ternary mixtures of fluorescent dyes demonstrate the utility of the method for investigating complex mixtures. Data from excited state reactions, such as dipolar relaxation in membrane and protein systems and also energy transfer from the tryptophan residue to the chromophore in enhanced green fluorescent protein, are also presented., (2010 Elsevier Inc. All rights reserved.)

Objective: To demonstrate in a group of 26 patients with benign stenosis of the trachea the possibility to use a Palmaz stent as the method of choice., Material and Methods: The authors introduced since 1995 to patients with benign stenosis of the trachea 36 stents (1 Wallstent, 2 Z stents and 33 Palmaz stents). The operation was performed under general anaesthesia in an operating theatre under skiascopic and optic control. The stent was inserted along a guide. Before insertion of the stent they dilated the stenosis by means of a balloon dilatation catheter., Results: Respiration improved in all patients within 6 days after introduction of the stent. Within 30 days after insertion of the stent none of the patients died. Two patients (7.7%) died four weeks (Palmaz stent) and 11 months (Wallstent) after insertion of the stent. Restenosis was observed in 9 patients (34.6%) 2-16 weeks after introduction of the stent. In 5 patients restenosis developed repeatedly. At present 19 patients (73%) are free from complaints for 1 month to 4 years after insertion of the stent (average 28 months). 5 patients (19%) had a tracheostomy and insertion of the stent in these patients did not produce so far the anticipated result., Conclusion: The authors assume that the use of Palmaz stent is in patients with benign stenosis of the trachea in indicated cases the method of choice.

The authors used between October 1993 and January 1997 in 131 patients with inoperable malignant or benign stenosis of the oesophagus an expansible metal stent. In 25 patients the stenosis was in the upper third of the oesophagus, in 44 in the medium part, in 53 in the lower third of the oesophagus and in 9 patients in the area of the anastomosis. All patients suffered at the time when the stent was introduced from marked dysphagia (stage 3-4 according to the international classification). In 45 patients the authors introduced more than one stent. 112 patients suffered from malignant stenosis (67 squamous cell carcinoma, 27 adenocarcinoma, 9 pulmonary or bronchogenic carcinoma, in two instances lymphoma, in two instances leiomyosarcoma and in five patients another type of tumour). Seventeen patients suffered from benign stenosis (8 complications of reflux oesophagitis, 3 stenosis in the anastomosis, in two instances corrosion by acid, 2 cases of epidermolysis bullosa oesophagi and one post-radiation stenosis). In these patients repeatedly before introduction of the stent dilatation of the stenosis by means of a balloon dilatation catheter was attempted. In two instances the etiology of the stenosis was obscure. Complications related to the procedure proper or after insertion of the stent were recorded in 49 patients-dislocation of the stent 23x, occlusion of the stent 17x, development of a fistula 6x, ulceration 16x, haemorrhage 4x, hyperplasia of the mucosa 21x, ileus 2x, inadequate expansion of the stent 8x.

In a one-year study, thirty-two physicians' antibiotic costs decreased significantly and were lower than those in a comparison group. The quality of patient care was not adversely affected, and the hospital's overall rate of nosocomial infection decreased. The success of the program led to its being adopted throughout the hospital. The dynamics of pharmacies' implementing cost-reduction strategies with voluntary medical staffs are discussed throughout the article.

Demographic trends and budgetary constraints at many universities suggest that education will not be "business as usual" in the next several years. Academic programs in health care administration can enhance their ability to respond to these challenges by implementing stakeholder analysis as part of their strategic planning process. This article delineates the stakeholder groups which typically influence programs in health care administration and presents a systematic manner of analyzing their relationships to the program in terms of values and beliefs, power, cooperative potential, and likely issues. Actions to strengthen relationships with each stakeholder group are noted. Finally, the utility and limitations of stakeholder analysis are discussed.

A case study of the proposed development of a regional children's health care system in South Texas is described. Strategic plans for the system are overviewed and the community response to plans are presented. The political, social responsibility and fiscal viability issues raised are reviewed and the research literature base relevant to the health care needs of a key (Hispanic) market is summarized.

A large sample of patients (N = 763) with Tourette syndrome (TS) responded to a questionnaire dealing primarily with symptoms, treatment history, and associated disorders. The shrinking duration between symptom onset and diagnostic confirmation confirms that diagnostic awareness of TS is increasing. A significant proportion of the sample identified several common factors that occurred in the year before symptom onset. A significantly lower proportion of subjects whose initial symptoms included facial tics reported a positive response to haloperidol. Obsessive characteristics were associated with age and were more common in females. Patients with attention deficit disorder (ADD) had earlier age at onset of TS symptoms and were diagnosed earlier than patients without ADD. In general the data provide some support for a stress-diathesis model and also support previous suggestions about the genetics of Tourette syndrome and related conditions.

Tourette Syndrome (TS) is an uncommon developmental disability characterized by repetitive and involuntary verbal and motor tics. A survey of all known affiliates of the Tourette Syndrome Association of Ohio was conducted to document the special problems and needs of the TS student. A total of 431 questionnaires was returned, and the types and frequency of interpersonal and academic school problems were found to be pervasive. Problems did not differ by grade level, but students medicating their TS symptoms experienced more problems. In most cases, current students described similar problems to adults, suggesting that recent attempts to provide optimal educational opportunities to all handicapped children have not been successful where TS is involved. The presence of a behavioral or learning disability diagnosis indicated that substantial percentages of respondents were in need of specialized educational services, but not all those in need were receiving them. Parents were generally satisfied with their child's education, but less satisfied when specialized education was involved. Suggestions are offered for more effectively dealing with the TS child in the classroom.

This study examines the system dimensions of need, barriers to receiving services, and utilization within a single mental health service area. The gap between estimates of service need and service utilization is conceptualized as due to a set of specific barriers covering the access attributes of availability, accessibility, acceptability and affordability. Data from community telephone surveys (N = 2183) of mental health need are analyzed to determine the relationship between the system dimensions of need, barriers and utilization. Respondents were able to distinguish among different types of service barriers. Those in the service gap were potentially more influenced by barriers than the rest of the sample, as were, paradoxically, those who had utilized services within the past year. The implications of these findings for service provision and system design are discussed.

Community surveys for needs assessment purposes have gained considerable popularity in recent years, yet the prevalence estimates of psychiatric impairment or mental health need vary widely across studies. It is hypothesized that part of this variability may reflect methodological concerns, in particular the directory listing status of respondents when telephone survey methods are employed. Using data from two independent community surveys, the mental health needs of listed versus unlisted subscribers were compared on a series of mental health scales. The implications of the differences observed are discussed both for further telephone needs assessment projects, as well as for service providers.

Summer camps for juveniles with rheumatic disease are being offered increasingly as components of comprehensive treatment approaches, but the therapeutic value of these sessions is largely undetermined. This study attempted to judge the impact of a summer camping experience on two aspects of participants' psychosocial functioning, self-concept, and locus of control. Both of these constructs have been related to effective disease management. On both measures, the mean scores of 36 campers improved significantly following a week-long camp session, and these positive effects were maintained over a 6-month follow-up period. Campers who had attended previous camping sessions appeared to obtain maximal benefit, and male campers with rheumatic disease were identified as needing special attention. The study's limitations are discussed, and future research directions are outlined.