The world without outside

The world is all that there is. In the world, ontology and epistemology coincide. The thing and the perspective are part of it, scale is ingested in its multiplicity, communication stops at the world's edge. By reading together Deleuze and Guattari's plane of immanence and Niklas Luhmann's proto-global concept of Weltgesellschaft (“world society”), I suggest a conceptualisation of the world as the materiality of the multiple spaces of creation in an insular, all-inclusive immanence. Deprived of an outside, the world pushes its own understanding of circumference through, first, the expansion of its own limits through the process of worlding, and, second, the multiplication of modes of material (self-)production through its process of othering. Thus, the world swells up from the inside and expands on both the material and the semantic level, producing a multiplicity of fractal microcosms. Issues of responsibility and justice arise that are intricately linked to the materiality of the world and take place in and between the various bodies and spaces of the world but without an overarching hierarchy or principle. This approach is a way of counteracting the all-pervasive Hegelian understanding of synthesis, arguing instead for a plenitude that brims with positivity and that can never become fully complete. The world remains its own infinite process of worlding.

Nutritional Evaluation and Optimisation in Neonates: a randomized, double-blind controlled trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition

Background: Parenteral nutrition is central to the care of very immature infants. Current international recommendations favor higher amino acid intakes and fish oil–containing lipid emulsions. Objective: The aim of this trial was to compare 1) the effects of high [immediate recommended daily intake (Imm-RDI)] and low [incremental introduction of amino acids (Inc-AAs)] parenteral amino acid delivery within 24 h of birth on body composition and 2) the effect of a multicomponent lipid emulsion containing 30% soybean oil, 30% medium-chain triglycerides, 25% olive oil, and 15% fish oil (SMOF) with that of soybean oil (SO)-based lipid emulsion on intrahepatocellular lipid (IHCL) content. Design: We conducted a 2-by-2 factorial, double-blind, multicenter randomized controlled trial. Results: We randomly assigned 168 infants born at ,31 wk of gestation. We evaluated outcomes at term in 133 infants. There were no significant differences between Imm-RDI and Inc-AA groups for nonadipose mass [adjusted mean difference: 1.0 g (95% CI: 2108, 111 g; P = 0.98)] or between SMOF and SO groups for IHCL [adjusted mean SMOF:SO ratio: 1.1 (95% CI: 0.8, 1.6; P = 0.58]. SMOF does not affect IHCL content. There was a significant interaction (P = 0.05) between the 2 interventions for nonadipose mass. There were no significant interactions between group differences for either primary outcome measure after adjusting for additional confounders. Imm-RDI infants were more likely than Inc-AA infants to have blood urea nitrogen concentrations .7 mmol/L or .10 mmol/L, respectively (75% compared with 49%, P , 0.01; 49% compared with 18%, P , 0.01). Head circumference at term was smaller in the Imm-RDI group [mean difference: 20.8 cm (95% CI: 21.5, 20.1 cm; P = 0.02)]. There were no significant differences in any prespecified secondary outcomes, including adiposity, liver function tests, incidence of conjugated hyperbilirubinemia, weight, length, mortality, and brain volumes. Conclusion: Imm-RDI of parenteral amino acids does not benefit body composition or growth to term and may be harmful. This trial was registered at www.isrctn.com as ISRCTN29665319 and at eudract.ema.europa.eu as EudraCT 2009-016731-34.