Hasil untuk "American literature"

A. Mellors

Beatriz Bernava Sarinho, Inajara Rotta, Tácio de Mendonça Lima et al.

ABSTRACT Background and Aims While previous publications have briefly pointed out a few alternative therapeutic interventions for the treatment of histoplasmosis and tuberculosis coinfections in patients with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS), there are no reviews evaluating the efficacy, effectiveness, and safety of different regimens. Thus, this protocol outlines the approach for systematically reviewing and synthesizing the existing literature regarding the efficacy, effectiveness, and safety of different regimens for histoplasmosis and tuberculosis coinfection treatment in patients with HIV/AIDS. Methods A systematic search will be conducted using PubMed, Embase, and Latin American and Caribbean Health Sciences Literature (LILACS) databases. Studies will be selected in two distinct stages, and data from selected studies will be extracted. Risk of bias will be assessed using the RoB 2, ROBINS‐I, NOS, and JBI tools, depending on the type of study. Finally, the strength of the body of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Conclusions The findings of this review may positively impact public health, stimulating the implementation of evidence‐based practices and guiding the adoption of specific treatment protocols for patients with HIV/AIDS coinfected with histoplasmosis and tuberculosis in endemic regions.

Xavier Pickett

By exploring how Cone employs and emulates Black literary sources, this article argues that his theological writing can be understood as often translating and thereby making explicit the significance of the inner, emotional lives of Black folks, particularly Black rage, into Black theological thought. The argument, in other words, is that Cone’s writing is an ethical performance of rage and a literary process of reforming his rage. His performance of rage is ethical in that it is morally motivated by injustice and indifference. It is not a performance for its own sake or to simply blow off steam. The performance takes a literary form and becomes the means through which his rage is reformed. The aim of this article demonstrates how his theological writing copes with and transforms rage into ethical discourse.

Karla Resende da Costa, Luisa Davi Oliveira de Mesquita

Abstract The importance of works of science fiction to scholars of International Relations has already been established by discussions pertaining to its pedagogical value, its value as a study object and even its value as a constitutive aspect of world politics. In this article, we argue that it is equally important to give attention to works of magical realism in IR, especially because magical realism blurs the boundaries between literary and genre fiction, posing a constructive challenge to the different ways literature is either considered art or mere entertainment. By relaying the deep connection between magical realism and its birthplace, Latin America, we use One Hundred Years of Solitude, by Gabriel García Márquez, and The House of Spirits, by Isabel Allende, to illustrate how magical realist pieces can serve as reflections of Latin American sensibilities and therefore provide relevant insights for the scholar of IR.

José María Paz Gago

This article tries to unveil one of the great enigmas of Kafka studies, namely, the identity of the author of the first translation of The Metamorphosis into a foreign language. Indeed, in 1925 the Revista de Occidente published a Spanish version of Kafka’s famous novella, a translation that was 3 years ahead of the first French version and 12 years ahead of the first English version. The author of this translation, which helped to make Kafka’s work known throughout Europe and also in America, has remained unknown until now, despite the most diverse attributions, from Margarita Nelken to Jorge Luis Borges. We try to demonstrate, through solid contextual and textual arguments, that the only possible author of this pioneering translation, still valid today, is the Galician Ramón María Tenreiro.

Marie Carcassonne, Séverine Chauvel, Géraldine Farges et al.

Based on a literature review conducted in France and Spain and sixteen interviews conducted in 2017 and 2018 in three French and two Spanish universities, this article questions diversity policies in higher education in a comparative perspective. First, the article shows the influence of American and European institutions on these policies, as well as their link with notions imported from corporate policies. A comparison of the criteria used in the various measures which aim at promoting diversity in universities in France and Spain highlights, in a second part, the fluctuating nature of diversity, with variations depending on the context or the target: students or staff. In fact, diversity policies in France seem to be more focused on the international or “diverse” character of the student body from a territorial point of view – or even indirectly from a migratory point of view; in Spain, disability is given a much more central place in the measures for the diversification of the public. When these policies are directed towards staff, they are essentially based on gender equality and attention to disability in both countries. Finally, the article examines the political stakes involved in maintaining the vagueness of this notion, by looking at how it is interpreted and put into practice by those in charge of diversity policies in universities.

Antti Malmivaara, Antti Kaipia, Heini Huhtala et al.

Objectives Basic tools that measure a hospital’s performance are required in order to benchmark or compare hospitals, but multispecialty institutional registries are rarely reported, and there is no consensus on their standard definitions and methodology. This study aimed to describe the setting up and first results of a hospital-wide surgical complication register that uses a minimal set of patient-related risk factors based on bedside data and produces outcomes data based on severity of complications.Design Cohort study.Setting Perioperative data related to all adult surgical procedures in a tertiary referral centre in Finland for 3 years (2016–2018) were included in the study. Complications were recorded according to a modified Clavien-Dindo classification, and the preoperative risk factors were compiled based on the literature and coded as numerical measures. The associations of preoperative risk factors with postoperative complications were analysed using the χ2 test or Fisher’s exact test.Results In total, 19 158 operations were performed between 2016 and 2018. Data on complications (Clavien 0–9) were recorded for 4529 surgical patients (23.6%), and 779 complications were reported (Clavien 1–9), leading to an overall complication rate of 17.2%. Of these, 4.6% were graded as major (Clavien 4–7). Patient-related risk factors with the strongest association with complications were growing American Society of Anesthesiologists Physical Status Classification System score (p<0.001), growing Charlson Index (p<0.001), poor nutritional status (Nutritional Risk Screening 2002), p=0.041) and urgency of surgery (p<0.001).Conclusions We describe an inexpensive hospital-wide surgical complication monitoring system that can produce valid numerical data for monitoring risk-adjusted surgical quality. The results showed that only a few patient-related risk factors were sufficient to account for the case mix.

M. Spencer, C. Markstrom-Adams

Anupamaa J Seshadri, Christopher P Michetti, Joseph F Rappold et al.

Venous thromboembolism (VTE) is a potential sequela of injury, surgery, and critical illness. Patients in the Trauma Intensive Care Unit are at risk for this condition, prompting daily discussions during patient care rounds and routine use of mechanical and/or pharmacologic prophylaxis measures. While VTE rightfully garners much attention in clinical patient care and in the medical literature, optimal strategies for VTE prevention are still evolving. Furthermore, trauma and surgical patients often have real or perceived contraindications to prophylaxis that affect the timing of preventive measures and the consistency with which they can be applied. In this Clinical Consensus Document, the American Association for the Surgery of Trauma Critical Care Committee addresses several practical clinical questions pertaining to specific or unique aspects of VTE prophylaxis in critically ill and injured patients.

C. Howden, R. Hunt

Asis De

To honor Nuruddin Farah’s fifty-year-long writing journey, this article explores his time in India (1966–69) and the influence it had on making him a leading postcolonial writer. My approach is largely biographical. I begin with his decision to turn down a scholarship at an American University, which some critics view as immature or even eccentric. I challenge this view of his choice instead to enroll for a degree in philosophy, literature and sociology at the Government College of Panjab University at Chandigarh in 1966 and to make what was then a country of poverty and even famine his first diasporic destination. I argue that this was a well-thought-out, politically correct and wise decision in the global context of international relationships in the 1960s. I also explore Farah’s brief association with Indian culture and the knowledge he acquired of Indian philosophy and literature to explain his decision to adopt a feminist perspective to write on injustice against women and the powerless and religious intolerance rather than focus on issues such as independence realpolitik like leading African writers at the time. His first manuscript, published in 1970 as From a Crooked Rib, was a Penguin modern classic by 2004. I argue that this novel was importantly shaped by his Indian experience. I also explore the influence of two novels on the young Farah on his personal life, ideology and writing even before he went to India: W. Somerset Maugham’s novel The Razor’s Edge (1944) and Thakazhi Sivasankara Pillai’s classic Chemmeen (1956). This is the first substantial investigation of the effect of Farah’s Indian experience.

C.M. Klugman, W.A. Nelson, L.L. Anderson-Shaw et al.

In 2010, the World Health Organization (WHO) released Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention: Global Policy Recommendations, a report on strategies for increasing and retaining health care workers in rural regions. The report states that while 50 percent of the world’s population lives in rural areas, only 38% of the nursing and less than 25% of the physician workforce serves these regions. For the United States, the WHO states that 20% of the population lives in rural regions and only 9% of registered physicians practice in such areas. Among the solutions the WHO offers is contextualizing medical education. In other words, medical students should be drawn from rural populations, trained through rural community experiences, and taught using rural health specific situations: “Revise undergraduate and postgraduate curricula to include rural health topics so as to enhance the competencies of health professionals working in rural areas, thereby increase their job satisfaction and retention” (WHO 2010, 3; Barrett, Lipsky, and Lutfiyya 2011). This, strategy suggests physician success and satisfaction in rural practice requires training using rural-specific cases, knowledge, and experience. In parallel to the need to increase rural clinical experience, there is a need to better understand the unique ethical issues that arise in the rural environment. A growing rural ethics literature points to an emerging awareness of the special ethical considerations inherent to clinical practice in these closely-knit, tightly interdependent small communities, as well as the need to develop ethical resources for these providers. According to Nelson, et. al. the “rural context significantly impacts the common health care ethical conflicts including confidentiality, boundary issues, shared decision-making, professional-patient relationship, and allocation of resources for a significant portion of our population” (Nelson et al. 2006, 45). For example, there may be unique challenges to patient privacy when patients are also the physician’s neighbors, friends, children’s teachers, and relatives (Klugman and Dalinis 2008; Nelson 2010; Nelson 2010; Nelson, Greene, and West 2010; Nelson and Schmidek 2008). In the Encyclopedia of Bioethics, Dan Callahan wrote that bioethics has evolved into four areas of general inquiry including what he calls cultural bioethics, which, “refers to the effort systematically to relate bioethics to the historical, ideological, culture and social context in which it is expressed” (Callahan 2004). John Hardwig has also asserted that mainstream bioethics is focused on urban issues (Hardwig 2006). In the last decade, a cultural bioethics subfield of “urban bioethics” has emerged that proposes “life-density, diversity, and disparity” create unique ethical challenges (Fleischman, Levin, and Meekin 2001),(Blustein and Fleischman 2004).  In recognizing that there exists an urban bioethics that focuses on problems of population density, then there must also exist a correlative cultural bioethics of rurality that reflects a low-density population, agricultural culture, and a lack of needed health care resources. “To date, there exists a limited focus on rural healthcare ethics shown by the scarcity of rural healthcare ethics literature, rural ethics committees, rural focused ethics training and research on rural ethics issues” (Nelson et al. 2007). For instance, a national study noted that 40% of critical access hospitals do not have ethics committees to assist rural clinicians with ethics conflicts compared to almost 100% of hospitals with over 400 beds (Fox, Myers, and Pearlman 2007; Nelson et al. 2010). While Nelson et. al. have made a call for increased training in ethical issues in rural contexts, there is no information available regarding whether physician education programs currently teach in this area (Nelson et al. 2007). To empirically assess the prevalence of rural medical and ethics education for medical and osteopathic students, the researchers constructed a comprehensive survey. Methods The Rural Medical Ethics Information Survey employed yes/no, multiple choice, and fill-in-the-blank questions drawn from the literature and from recommendations by the Rural Health Care Ethics Working Group – a group of rural medical educators and ethicists. The University of Texas Health Science Center San Antonio Institutional Review Board determined the survey to be exempt in June 2010. In Fall 2010, the researchers sent a recruitment email to all 133 U.S. member schools of the Association of American Medical Colleges (AAMC), and all 26 members of the American Association of Colleges of Osteopathic Medicine (AACOM). The emails were directed to the senior medical/osteopathic education official at each institution, asking them to either complete a survey on SurveyMonkey or to forward the survey link to someone within the organization who could appropriately respond (SurveyMonkey 2011). For schools that did not complete the survey, an email reminder was sent 3 weeks later. For schools that still did not complete the survey, a third email reminder was sent 4 weeks after that. The researchers asked whether the school had a required or elective rural experience and the form of that experience. The officials were also queried as to whether they offered training specifically in rural health care ethics. Other information collected included demographics such as number of students in the student body, percentage of students originally from rural areas, the zip code of the school, and its self-identified distance from an urban center (i.e. the “rurality” of the location). The mainly descriptive statistical analysis was performed with exploratory tests of association. Binary responses (yes/no items) were summarized by proportions, and their 95% confidence intervals (CIs) were constructed with the exact binomial method. These CIs can be constructed when there is no variation in the response (All yes or all no) and are conservative for small sample sizes especially in the finite population setting. The CIs for differences in proportion were based upon asymptotic assumptions. Non-responses were considered to be “no.” Associations between binary and unordered categorical responses were tested using Fisher’s exact method. Associations with ordered categorical responses (Distance to Urban) were tested using a permutation-based method (H. and C. 1999). Associations between binary outcomes and continuous variables (% Rural Residency) were tested using logistic regression. Correlations between continuous variables were tested with the Spearman Rank correlation test. The level of significance was chosen to be P = .05 with 2-sided alternatives. We conducted the analysis with the R statistical software(R Development Core Team 2006) and the “coin” R package (Hothorn et al. 2008). The authors created the summary tables with SAS software (SAS Institute Inc 2008). Results Of the 159 schools surveyed, 124 completed the questionnaire (70.4% response rate). Of those, 16 identified as osteopathic schools (DO), 62 as allopathic (MD) and 46 did not offer a disciplinary identity. The researchers asked schools to classify their geographic location. Fifty-nine (47.6 %) indicated an urban location (0-5 miles from urban core), 3 (2.4 %) as suburban (6-20 miles from urban core), 3 (2.4 %) as exurban (21-50 miles from urban core), 8 (6.5 %) as rural (51 or more miles from urban core) and 51 (41.0 %) did not respond to this question. Since 73 schools also reported their zip code, this information was used to identify the schools Rural Urban Commuting Area Code (RUCA) classification (United States Department of Agriculture Economic Research Service 2005). Of these 73 schools, the mean RUCA code was 1.1 with a standard deviation of 0.5, meaning high-density development. As Table 1 demonstrates, the researchers asked schools if they require a rural experience of all students. Thirty-two schools (29.4%) indicated that they had such a requirement. Additionally, many schools offer rural education tracks that may be required only of a specific subset of students. Some of these specialty tracks only accept students from rural areas while other tracks are intended for students who plan to practice in rural regions. Six schools (12.5%) require a rural experience only for students in these specialty programs. Sixty-two schools (61.4%) offer some form of an elective rural experience for their students. Schools that had required a rural educational experience for all or some of their students often also offer a rural elective experience, thus the categories are not mutually exclusive. Only 7 (21.9%) of the 32 schools that require a rural experience for all students also teach rural health care ethics. Table 2 indicates that only 25 of the 32 schools with required rural experience answered this question. In the 6 schools with a rural specialty track, 4 (66.7%) teach rural health care ethics. In regards to the 64 schools with a rural elective, only 24 responded to the question, “Does your elective program in rural medicine include rural-focused ethical issues?” Eleven of those 24 (45.8%) indicated that they teach rural health care ethics. Discussion Less than 1/3 of schools require a rural experience of all students. Of those, only 1 in 5 offer a rural ethics curriculum. Of the 61.4% of schools that offer a rural elective, 17.7% of those offer training in rural ethics issues. However, in schools where a rural experience was required of a subset of students, 61.4% of those schools required rural health care ethics. Thus, schools that require ethics experiences of a subset of students may be more likely to have rural ethics training because of their focused mission. Or since these schools have a larger draw from rural areas, those students may demand the rural ethics focus in their training. In looking at the effect of geographic location on rural ethics teaching, the authors initially planned to rely on RUCA codes, which are created by the federal government to map areas of urbanity and rurality. However, although 8 schools self-identified as rural (defined on the survey as more than 50 miles from an urban center), the median 1.1 RUCA code for all schools shows that the self-report and the RUCA codes did not always match. For example, The Geisel Medical School at Dartmouth is located 125 miles from Boston in a pastoral area of New Hampshire. The population density for the town of Hanover, NH is 1,792 people per square mile meaning that the RUCA code is 1, or urban, while the average density for New Hampshire is 146.8 (RUCA codes 7 to 10). The presence of a medical school requires a certain density of people that may give the area an urban RUCA code even though the setting is rural. Therefore, RUCA codes were not useful in looking at geographic location of a medical school and the researchers relied more on self-reports, a less objective measure. The authors note several limitations and insights regarding this study. Many schools skipped large sections of the survey. For instance, nearly 41% of all respondents did not indicate their zip code. The survey may have been too detailed, requiring too much time for a senior education officer to complete. Additionally, few schools answered questions about hours of instruction, percent of students hailing from rural areas, and percent of graduates who go to residency in rural regions. Those that did answer often indicated they were making guesses, raising questions of the validity of those responses and thus they were excluded from analysis. Conclusion The survey results provide an enhanced understanding of the limited rural focused medical training programs in the United States. The survey results also indicate how rural ethics issues do not receive a great deal of attention in medical education. Both of these may contribute to the minority of graduating students choosing to practice in rural settings. The authors believe that following the World Health Organization’s goal of increasing rural health care workforce requires medical training experiences in rural settings including attending to the ethical challenges faced by physicians practicing in such geographic locations and cultural spaces. Drawing on Callahan’s perception of the importance of cultural bioethics, rural bioethics should be part of rural practice experience and medical school curricula, to give students the information and skills needed in rural settings.  PDF References: Barrett, F. A., M. S. Lipsky, and M. N. Lutfiyya. 2011. The impact of rural training experiences on medical students: a critical review. Academic medicine : journal of the Association of American Medical Colleges 86 (2):259-63. Blustein, J., and A. R. Fleischman. 2004. Urban bioethics: adapting bioethics to the urban context. Academic medicine : journal of the Association of American Medical Colleges 79 (12):1198-202. Callaghan, Daniel. 2004. Bioethics. In Encyclopedia of Bioethics, edited by S. G. Post. New York: Macmillan Reference. Fleischman, A. R., B. W. Levin, and S. A. Meekin. 2001. Bioethics in the urban context. Journal of urban health : bulletin of the New York Academy of Medicine 78 (1):2-6. Fox, E., S. Myers, and R. A. Pearlman. 2007. Ethics consultation in United States hospitals: a national survey. The American journal of bioethics : AJOB 7 (2):13-25. H., Strasser, and Weber C. 1999. On the Asymptotic Theory of Permutation Statistics. Mathematical Methods of Statistics 8:220-250. Hardwig, J. 2006. Rural health care ethics: what assumptions and attitudes should drive the research? The American journal of bioethics : AJOB 6 (2):53-4. Hothorn, Torsten, Kurt Hornik, Mark A. van de Wiel, and Achim Zeileis. 2008. Implementing a Class of Permutation Tests: The coin Package. Journal of Statistical Software 28 (8):1-23. Klugman, Craig M., and Pamela M. Dalinis, eds. 2008. Ethical Issues in Rural Health Care. Baltimore: The Johns Hopkins University Press. Nelson, W. A. 2010. Health care ethics and rural life. Stigma, privacy, boundary conflicts raise concerns. Health progress 91 (5):50-4. Nelson, W. A., M. A. Greene, and A. West. 2010. Rural Health Care Ethics: No Longer the Forgotten Quarter of Medical Ethics. Cambridge Quarterly for Healthcare Ethics 19 (4):510-517. Nelson, W. A., M. C. Rosenberg, T. Mackenzie, and W. B. Weeks. 2010. The presence of ethics programs in critical access hospitals. Health Care Ethics Committee Forum 22 (4):267-74. Nelson, W. A., and J. M. Schmidek. 2008. 'Rural Health Care Ethics. In The Cambridge Textbook of Bioethics, edited by P. A. Singer. Cambridge, UK: Cambridge University Press. Nelson, W., G. Lushkov, A. Pomerantz, and W. B. Weeks. 2006. Rural health care ethics: is there a literature? The American journal of bioethics : AJOB 6 (2):44-50. Nelson, W., A. Pomerantz, K. Howard, and A. Bushy. 2007. A proposed rural healthcare ethics agenda. Journal of medical ethics 33 (3):136-9. Nelson, William A., ed. 2010. Handbook for Rural Health Care Ethics: a Practical Guide for Professional. Hanover, NH: Dartmouth College Press. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. SAS for Windows 9.2. SAS Institute Inc, Cary, NC http://www.surveymonkey.com. SurveyMonkey, Palo Alto, CA. United States Department of Agriculture Economic Research Service. 2011. Measuring Rurality: Rural-Urban Commuting Area Codes. U.S. Department of Agriculture 2005 [cited December 7 2011]. Available from http://www.ers.usda.gov/briefing/rurality/ruralurbancommutingareas/. WHO. 2010. Increasing access to health workers in remote and rural areas through improved retention: Global policy recommendations. Geneva, Switzerland: World Health Organization.

Mansureh Kebritchi, Atsusi Hirumi

T. Boyer, Z. Haskal

Rohan Ghatage

This essay establishes a philosophical connection between James Baldwin and the philosopher William James by investigating how the pragmatist protocol against “vicious intellectualism” offers Baldwin a key resource for thinking through how anti-black racism might be dismantled. While Richard Wright had earlier denounced pragmatism for privileging experience over knowledge, and thereby offering the black subject no means for redressing America’s constitutive hierarchies, uncovering the current of Jamesian thought that runs through Baldwin’s essays brings into view his attempt to move beyond epistemology as the primary framework for inaugurating a future unburdened by the problem of the color line. Although Baldwin indicts contemporaneous arrangements of knowledge for producing the most dehumanizing forms of racism, he does not simply attempt to rewrite the enervating meanings to which black subjects are given. Articulating a pragmatist sensibility at various stages of his career, Baldwin repeatedly suggests that the imagining and creation of a better world is predicated upon rethinking the normative value accorded to knowledge in the practice of politics. The provocative challenge that Baldwin issues for his reader is to cease the well-established privileging of knowledge, and to instead stage the struggle for freedom within an aesthetic, rather than epistemological, paradigm.

B. Hollis, C. Wagner

Concerns about vitamin D have resurfaced in medical and scientific literature because the prevalence of vitamin D deficiency in the United States, particularly among darkly pigmented persons, has increased. The primary goals of this review were to discuss past and current literature and to reassess the dietary reference intake for vitamin D in adults, with particular focus on women during pregnancy and lactation. The appropriate dose of vitamin D during pregnancy and lactation is unknown, although it appears to be greater than the current dietary reference intake of 200-400 IU/d (5-10 microg/d). Doses of 90 ng/mL, whereas doses < 1000 IU/d appear, in many cases, to be inadequate for maintaining normal circulating 25-hydroxyvitamin D concentrations of between 15 and 80 ng/mL. Vitamin D plays no etiologic role in cardiac valvular disease, such as that observed in Williams syndrome, and, as such, animal models involving vitamin D intoxication that show an effect on cardiac disease are flawed and offer no insight into normal human physiology. Higher doses of vitamin D are necessary for a large segment of Americans to achieve concentrations equivalent to those in persons who live and work in sun-rich environments. Further studies are necessary to determine optimal vitamin D intakes for pregnant and lactating women as a function of latitude and race.

S. Godwin, J. Burton, C. Gerardo et al.

Sanaa Ashour

In responding to the growing global demand for education, transnational education (TNE) plays a fundamental role in the current debate on the internationalisation and globalisation of higher education. Through conducting a systematic literature review, this paper examines the unique features of German transnational education, which has little in common with the American, Australian and British models, the reasons for its limited presence in the Gulf and its potential for having a stronger footprint. The Gulf Region is the largest importer of foreign education, and yet German TNE is only represented by one university compared to the relatively large number of USA, UK and Australian higher education institutions. Although the Gulf Region is considered as a lucrative and attractive market for foreign education, the lack of engagement of German TNE there could be interpreted through public policy-related reasons. Since Germany has already established its footprint in creating a unique brand of TNE, the paper recommends building upon the country’s expertise in low-risk option in order to invest in the Gulf. For this to materialise, Germany must build awareness of its unique brand to stand out among the competition.

E. Wolf

C. Jablecki