Fleuve glauque : les départements de la Seine, banlieue des romans « Spécial Police » de Frédéric Dard

This paper studies the representation of suburbs as a place of anguish in the “Special Police” novels (Fleuve Noir publisher, Paris) by Frédéric Dard. This anxiety, it is argued, is what lends this collection of 25 novels some of their essential qualities, their unhealthy climate and absolute darkness. Dard’s suburbs fit into the traditions of realism; but the atmosphere, characters and plots owe to the American hardboiled school and like in film noir, space is stylized and dramatized, and often used to express a judgment of moral nature. Spatial representations in these novels are part of a critique of civilization and constitute a comment on the social modernization and public intervention in the development of the French territory in the postwar period. The novels written by Frédéric Dard from the mid-1950s to mid-1960s offer a profoundly original representation of suburban angst and what was not yet known at the time as the suburban malaise. Avoiding clichés and excessively connoted referential spaces, Dard anchor these noir novels he called “novels of the night” in landscapes that are both biographical and intertextual. The West Suburbs of Paris and what was
to become the Yvelines department are at the centre of Dard’s novelistic geography, turning into a mythical and deadly space in which is negotiated an acculturation in France of the evil and ruined world described in American noir.

Development of a Short Stay Unit in an Emergency Department

In 2009, the Royal Victoria Hospital, Belfast, established a nine-bed, short-stay unit in its emergency department. This article explains the rationale for the model of care delivery adopted, and the importance of developing and working with integrated care pathways. It also discusses four areas essential to the effective running of the unit: interdisciplinary collaboration, training for clinical nurse leaders, management of change and leadership.

Genomovar diversity amongst Burkholderia cepacia complex isolates from an Australian adult cystic fibrosis unit

In this study, a combination of recA-based PCR assays and 16S rDNA restriction fragment length polymorphism (RFLP) analysis was used to determine the genomovar diversity of clinical Burkholderia cepacia complex isolates. Twenty-eight isolates were prospectively collected from patients attending a large Australian adult cystic fibrosis (CF) unit, 22 isolates were referred from other Australian CF units and a further eight isolates originated from patients without CF. The 28 prospectively collected isolates were distributed amongst the following genomovars: Burkholderia cepacia genomovar I (28.6%), Burkholderia multivorans (21.4%), Burkholderia cepacia genomovar III (39.3%), Burkholderia vietnamiensis(3.6%) and Burkholderia ambifaria (7.1%). The results of this study highlight the usefulness of 16S rDNA RFLP typing for the identification of other Burkholderia spp. and non-fermenting gram-negative bacteria.

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness

Background: Skeletal muscle wasting and weakness are significant complications of critical illness, associated with the degree of illness severity and periods of reduced mobility during mechanical ventilation. They contribute to the profound physical and functional deficits observed in survivors. These impairments may persist for many years following discharge from the intensive care unit (ICU) and may markedly influence health-related quality of life. Rehabilitation is a key strategy in the recovery of patients following critical illness. Exercise based interventions are aimed at targeting this muscle wasting and weakness. Physical rehabilitation delivered during ICU admission has been systematically evaluated and shown to be beneficial. However its effectiveness when initiated after ICU discharge has yet to be established. Objectives: To assess the effectiveness of exercise rehabilitation programmes, initiated after ICU discharge, on functional exercise capacity and health-related quality of life in adult ICU survivors who have been mechanically ventilated for more than 24 hours. Search methods:We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), OvidSP MEDLINE, Ovid SP EMBASE, and CINAHL via EBSCO host to 15th May 2014. We used a specific search strategy for each database. This included synonyms for ICU and critical illness, exercise training and rehabilitation. We searched the reference lists of included studies and contacted primary authors to obtain further information regarding potentially eligible studies. We also searched major clinical trials registries (Clinical Trials and Current Controlled Trials) and the personal libraries of the review authors. We applied no language or publication restriction. We reran the search in February 2015. We will deal with any studies of interest when we update the review.  Selection criteria:We included randomized controlled trials (RCTs), quasi-RCTs, and controlled clinical trials (CCTs) that compared an exercise interventioninitiated after ICU discharge to any other intervention or a control or ‘usual care’ programme in adult (≥18years) survivors ofcritical illness. Data collection and analysis:We used standard methodological procedures expected by The Cochrane Collaboration. Main results:We included six trials (483 adult ICU participants). Exercise-based interventions were delivered on the ward in two studies; both onthe ward and in the community in one study; and in the community in three studies. The duration of the intervention varied according to the length of stay in hospital following ICU discharge (up to a fixed duration of 12 weeks).Risk of bias was variable for all domains across all trials. High risk of bias was evident in all studies for performance bias, although blinding of participants and personnel in therapeutic rehabilitation trials can be pragmatically challenging. Low risk of bias was at least 50% for all other domains across all trials, although high risk of bias was present in one study for random sequence generation (selection bias), incomplete outcome data (attrition bias) and other sources. Risk of bias was unclear for remaining studies across the domains.All six studies measured effect on the primary outcome of functional exercise capacity, although there was wide variability in natureof intervention, outcome measures and associated metrics, and data reporting. Overall quality of the evidence was very low. Only two studies using the same outcome measure for functional exercise capacity, had the potential for pooling of data and assessment of heterogeneity. On statistical advice, this was considered inappropriate to perform this analysis and study findings were therefore qualitatively described. Individually, three studies reported positive results in favour of the intervention. A small benefit (versus. control)was evident in anaerobic threshold in one study (mean difference, MD (95% confidence interval, CI), 1.8 mlO2/kg/min (0.4 to 3.2),P value = 0.02), although this effect was short-term, and in a second study, both incremental (MD 4.7 (95% CI 1.69 to 7.75) Watts, P value = 0.003) and endurance (MD 4.12 (95% CI 0.68 to 7.56) minutes, P value = 0.021) exercise testing demonstrated improvement.Finally self-reported physical function increased significantly following a rehabilitation manual (P value = 0.006). Remaining studies found no effect of the intervention.Similar variability in with regard findings for the primary outcome of health-related quality of life were also evident. Only two studies evaluated this outcome. Following statistical advice, these data again were considered inappropriate for pooling to determine overall effect and assessment of heterogeneity. Qualitative description of findings was therefore undertaken. Individually, neither study reported differences between intervention and control groups for health-related quality of life as a result of the intervention. Overall quality of the evidence was very low.Mortality was reported by all studies, ranging from 0% to 18.8%. Only one non-mortality adverse event was reported across all patients in all studies (a minor musculoskeletal injury). Withdrawals, reported in four studies, ranged from 0% to 26.5% in control groups,and 8.2% to 27.6% in intervention groups. Loss to follow-up, reported in all studies, ranged from 0% to 14% in control groups, and 0% to 12.5% in intervention groups. Authors’ conclusions:We are unable, at this time, to determine an overall effect on functional exercise capacity, or health-related quality of life, of an exercise based intervention initiated after ICU discharge in survivors of critical illness. Meta-analysis of findings was not appropriate. This was due to insufficient study number and data. Individual study findings were inconsistent. Some studies reported a beneficial effect of the intervention on functional exercise capacity, and others not. No effect was reported on health-related quality of life. Methodological rigour was lacking across a number of domains influencing quality of the evidence. There was also wide variability in the characteristics of interventions, outcome measures and associated metrics, and data reporting.If further trials are identified, we may be able to determine the effect of exercise-based interventions following ICU discharge, on functional exercise capacity and health-related quality of life in survivors of critical illness.

Revising Partial Pre-Orders with Partial Pre-Orders: A Unit-Based Revision Framework

Belief revision studies strategies about how agents revise their belief states when receiving new evidence. Both in classical belief revision and in epistemic revision, a new input is either in the form of a (weighted) propositional formula or a total
pre-order (where the total pre-order is considered as a whole).
However, in some real-world applications, a new input can be a partial pre-order where each unit that constitutes the partial pre-order is important and should be considered individually. To address this issue, in this paper, we study how a partial preorder representing the prior epistemic state can be revised by another partial pre-order (the new input) from a different perspective, where the revision is conducted recursively on the individual units of partial pre-orders. We propose different revision operators (rules), dubbed the extension, match, inner and outer revision operators, from different revision points of view. We also analyze several properties for these operators.

Aspirin therapy in patients with acute respiratory distress syndrome (ARDS) is associated with reduced intensive care unit mortality: a prospective analysis

INTRODUCTION: Acute respiratory distress syndrome (ARDS) is a common clinical syndrome with high mortality and long-term morbidity. To date there is no effective pharmacological therapy. Aspirin therapy has recently been shown to reduce the risk of developing ARDS, but the effect of aspirin on established ARDS is unknown.

METHODS: In a single large regional medical and surgical ICU between December 2010 and July 2012, all patients with ARDS were prospectively identified and demographic, clinical, and laboratory variables were recorded retrospectively. Aspirin usage, both pre-hospital and during intensive care unit (ICU) stay, was included. The primary outcome was ICU mortality. We used univariate and multivariate logistic regression analyses to assess the impact of these variables on ICU mortality.

RESULTS: In total, 202 patients with ARDS were included; 56 (28%) of these received aspirin either pre-hospital, in the ICU, or both. Using multivariate logistic regression analysis, aspirin therapy, given either before or during hospital stay, was associated with a reduction in ICU mortality (odds ratio (OR) 0.38 (0.15 to 0.96) P = 0.04). Additional factors that predicted ICU mortality for patients with ARDS were vasopressor use (OR 2.09 (1.05 to 4.18) P = 0.04) and APACHE II score (OR 1.07 (1.02 to 1.13) P = 0.01). There was no effect upon ICU length of stay or hospital mortality.

CONCLUSION: Aspirin therapy was associated with a reduced risk of ICU mortality. These data are the first to demonstrate a potential protective role for aspirin in patients with ARDS. Clinical trials to evaluate the role of aspirin as a pharmacological intervention for ARDS are needed.

Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention

Blood culture contamination (BCC) has been associated with unnecessary antibiotic use, additional laboratory tests and increased length of hospital stay thus incurring significant extra hospital costs. We set out to assess the impact of a staff educational intervention programme on decreasing intensive care unit (ICU) BCC rates to <3% (American Society for Microbiology standard). BCC rates during the pre-intervention period (January 2006-May 2011) were compared with the intervention period (June 2011-December 2012) using run chart and regression analysis. Monthly ICU BCC rates during the intervention period were reduced to a mean of 3·7%, compared to 9·5% during the baseline period (P < 0·001) with an estimated potential annual cost savings of about £250 100. The approach used was simple in design, flexible in delivery and efficient in outcomes, and may encourage its translation into clinical practice in different healthcare settings.

Towards an Improved Phasor Measurement Unit Data Communications Framework

This paper discusses a proposed new communications framework for phasor measurement units (PMU) optimized for use on wide area networks. Traditional PMU telecoms have been optimized for use in environments where bandwidth is restricted. The new method takes the reliability of the telecommunications medium into account and provides guaranteed delivery of data whilst optimizing for realtime delivery of the most current data. Other important aspects, such as security, are also considered.

Spectacles of military urbanism in online representations of the Elite Squad of the military police of Rio de Janeiro: a multimodal approach

This paper presents a multimodal analysis of online self-representations of the Elite Squad of the military police of Rio de Janeiro, the Special Police Operations Battalion BOPE. The analysis is placed within the wider context of a “new military urbanism”, which is evidenced in the ongoing “Pacification” of many of the city’s favelas, in which BOPE plays an active interventionist as well as a symbolic role, and is a kind of solution which clearly fails to address the root causes of violence which lie in poverty and social inequality. The paper first provides a sociocultural account of BOPE’s role in Rio’s public security and then looks at some of the mainly visual mediated discourses the Squad employs in constructing a public image of itself as a modern and efficient, yet at the same time “magical” police force.

Historical Dialogue and Memory in Organisational Transition: the case of the Police in Northern Ireland

During Northern Ireland’s transition towards peace the role of the police as an actor in the conflict has been a key point of contention. As such, the reform of policing has been central to conflict transformation. Within this process, the role of dialogue about what policing had been and could be in the future has been vital. Such institutional post violence change processes have been hugely significant in illustrating both organisational resistance to change and the need for transitions to be powerfully manoeuvred through complex, political, organisational and cultural processes (Buchanan and Badham 1999; Pettigrew 2012). The radical and reforming nature of policing transition (Murphy 2013) has been both organisationally challenging (requiring significant transformational leadership, resourcing and external engagement from wider civic society) and politically unusual. Indeed, in a society emerging from violence the NI police are the only public sector organisation to have engaged structurally and culturally in understanding the point at which their core roles intersected with the ‘management’ of the conflict in NI generally. This paper presents an analysis of the role of historical dialogue in organisational change process, using the RUC / PSNI case. It proposes that historical dialogue is not just an external, societal process but also an internal organisational process and as such, has implications for managing institutional change in societies emerging from conflict. In doing so, it builds theoretical links between literature on conflict transformation and that on organisational memory and empirically explores messaging internal to the RUC before and during the four main periods of organisational change (Murphy 2013), with dialogue aimed at an external audience. It offers an analysis of how historical dialogue itself impacts on and is impacted by the organisational realities of change itself.