After Satan : Essays in Honour of Neil Forsyth

This volume is the result of a collective desire to pay homage to Neil Forsyth, whose work has significantly contributed to scholarship on Satan. This volume is "after" Satan in more ways than one, tracing the afterlife of both the satanic figure in literature and of Neil Forsyth's contribution to the field, particularly in his major books The Old Enemy: Satan and the Combat Myth (Princeton University Press, 1987, revised 1990) and The Satanic Epic (Princeton University Press, 2003). The essays in this volume draw on Forsyth's work as a focus for their analyses of literary encounters with evil or with the Devil himself, reflecting the richness and variety of contemporary approaches to the age-old question of how to represent evil. All the contributors acknowledge Neil Forsyth's influence in the study of both the Satan-figure and Milton's Paradise Lost. But beyond simply paying homage to Neil Forsyth, the articles collected here trace the lineage of the Satan figure through literary history, showing how evil can function as a necessary other against which a community may define itself. They chart the demonised other through biblical history and medieval chronicle, Shakespeare and Milton, to nineteenth-century fiction and the contemporary novel. Many of the contributors find that literary evil is mediated through the lens of the Satan of Paradise Lost, and their articles address the notion, raised by Neil Forsyth in The Satanic Epic, that the literary Devil-figures under consideration are particularly interested in linguistic ambivalence and the twisted texture of literary works themselves. The multiple responses to evil and the continuous reinvention of the devil figure through the centuries all reaffirm the textual presence of the Devil, his changing forms necessarily inscribed in the shifting history of western literary culture. These essays are a tribute to the work of Neil Forsyth, whose scholarship has illuminated and guided the study of the Devil in English and other literatures.

Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study.

BACKGROUND: Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. AIMS: We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients. METHODS: We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. RESULTS: The EPIC II database includes 13,796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, P < 0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, P < 0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, P < 0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (P < 0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P < 0.05). CONCLUSIONS: Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study.

OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use.

After Satan: Essays in Honour of Neil Forsyth

This volume is the result of a collective desire to pay homage to Neil Forsyth, whose work has significantly contributed to scholarship on Satan. This volume is "after" Satan in more ways than one, tracing the afterlife of both the satanic figure in literature and of Neil Forsyth's contribution to the field, particularly in his major books The Old Enemy: Satan and the Combat Myth (Princeton University Press, 1987, revised 1990) and The Satanic Epic (Princeton University Press, 2003). The essays in this volume draw on Forsyth's work as a focus for their analyses of literary encounters with evil or with the Devil himself, reflecting the richness and variety of contemporary approaches to the age-old question of how to represent evil. All the contributors acknowledge Neil Forsyth's influence in the study of both the Satan-figure and Milton's Paradise Lost. But beyond simply paying homage to Neil Forsyth, the articles collected here trace the lineage of the Satan figure through literary history, showing how evil can function as a necessary other against which a community may define itself. They chart the demonised other through biblical history and medieval chronicle, Shakespeare and Milton, to nineteenth-century fiction and the contemporary novel. Many of the contributors find that literary evil is mediated through the lens of the Satan of Paradise Lost, and their articles address the notion, raised by Neil Forsyth in The Satanic Epic, that the literary Devil-figures under consideration are particularly interested in linguistic ambivalence and the twisted texture of literary works themselves. The multiple responses to evil and the continuous reinvention of the devil figure through the centuries all reaffirm the textual presence of the Devil, his changing forms necessarily inscribed in the shifting history of western literary culture. These essays are a tribute to the work of Neil Forsyth, whose scholarship has illuminated and guided the study of the Devil in English and other literatures.

Increased prevalence of bladder and intestinal dysfunction in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is predominantly characterized by a progressive loss of motor function. While autonomic dysfunction has been described in ALS, little is known about the prevalence of lower urinary tract symptoms (LUTS) and intestinal dysfunction. We investigated disease severity, LUTS and intestinal dysfunction in 43 patients with ALS attending our outpatient department applying the ALS functional rating scale, the International Consultation on Incontinence Modular Questionnaire, the Urinary Distress Inventory and the Cleveland Clinic Incontinence Score. Results were compared to the German population of a cross-sectional study assessing LUTS in the healthy population, the EPIC study. Results showed that urinary incontinence was increased in patients with ALS aged ≥ 60 years compared to the EPIC cohort (female: 50%/19% (ALS/EPIC), p = 0.026; male: 36%/11% (ALS/EPIC), p = 0.002). No difference was seen at 40-59 years of age. Urge incontinence was the predominant presentation (73% of symptoms). A high symptom burden was stated (ICIQ-SF quality of life subscore 5.5/10). Intake of muscle relaxants and anticholinergics was associated with both urinary incontinence and severity of symptoms. Furthermore, a high prevalence of constipation (46%), but not stool incontinence (9%), was noted. In conclusion, the increased prevalence of urge incontinence and high symptom burden imply that in patients with ALS, LUTS should be increasingly investigated for.

Opposite impacts of dietary versus supplemental calcium on cardiovascular health.

Commentary on: Li K, Kaaks R, Linseisen J, et al . Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European prospective investigation into cancer and nutrition study (EPIC-Heidelberg). Heart 2012; 98 :920 - 5

Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome.

BACKGROUND: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II. METHODS: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days. RESULTS: Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤ 2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality. CONCLUSIONS: The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.

A prospective development study investigating focal irreversible electroporation in men with localised prostate cancer: Nanoknife Electroporation Ablation Trial (NEAT).

INTRODUCTION: Focal therapy may reduce the toxicity of current radical treatments while maintaining the oncological benefit. Irreversible electroporation (IRE) has been proposed to be tissue selective and so might have favourable characteristics compared to the currently used prostate ablative technologies. The aim of this trial is to determine the adverse events, genito-urinary side effects and early histological outcomes of focal IRE in men with localised prostate cancer. METHODS: This is a single centre prospective development (stage 2a) study following the IDEAL recommendations for evaluating new surgical procedures. Twenty men who have MRI-visible disease localised in the anterior part of the prostate will be recruited. The sample size permits a precision estimate around key functional outcomes. Inclusion criteria include PSA ≤ 15 ng/ml, Gleason score ≤ 4 + 3, stage T2N0M0 and absence of clinically significant disease outside the treatment area. Treatment delivery will be changed in an adaptive iterative manner so as to allow optimisation of the IRE protocol. After focal IRE, men will be followed during 12 months using validated patient reported outcome measures (IPSS, IIEF-15, UCLA-EPIC, EQ-5D, FACT-P, MAX-PC). Early disease control will be evaluated by mpMRI and targeted transperineal biopsy of the treated area at 6 months. DISCUSSION: The NEAT trial will assess the early functional and disease control outcome of focal IRE using an adaptive design. Our protocol can provide guidance for designing an adaptive trial to assess new surgical technologies in the challenging landscape of health technology assessment in prostate cancer treatment.

Prospective study of insulin-like growth factor-I, insulin-like growth factor-binding protein 3, genetic variants in the IGF1 and IGFBP3 genes and risk of coronary artery disease.

Although experimental studies have suggested that insulin-like growth factor I (IGF-I) and its binding protein IGFBP-3 might have a role in the aetiology of coronary artery disease (CAD), the relevance of circulating IGFs and their binding proteins in the development of CAD in human populations is unclear. We conducted a nested case-control study, with a mean follow-up of six years, within the EPIC-Norfolk cohort to assess the association between circulating levels of IGF-I and IGFBP-3 and risk of CAD in up to 1,013 cases and 2,055 controls matched for age, sex and study enrolment date. After adjustment for cardiovascular risk factors, we found no association between circulating levels of IGF-I or IGFBP-3 and risk of CAD (odds ratio: 0.98 (95% Cl 0.90-1.06) per 1 SD increase in circulating IGF-I; odds ratio: 1.02 (95% Cl 0.94-1.12) for IGFBP-3). We examined associations between tagging single nucleotide polymorphisms (tSNPs) at the IGF1 and IGFBP3 loci and circulating IGF-I and IGFBP-3 levels in up to 1,133 cases and 2,223 controls and identified three tSNPs (rs1520220, rs3730204, rs2132571) that showed independent association with either circulating IGF-I or IGFBP-3 levels. In an assessment of 31 SNPs spanning the IGF1 or IGFBP3 loci, none were associated with risk of CAD in a meta-analysis that included EPIC-Norfolk and eight additional studies comprising up to 9,319 cases and 19,964 controls. Our results indicate that IGF-I and IGFBP-3 are unlikely to be importantly involved in the aetiology of CAD in human populations.

ePortfolio as a tool for reflexivity and skills' communication : learn how to communicate skills

This paper aims to present an ePortfolio project led for two years in a multilingual and interdisciplinary Master's program in public discourse and communication analysis offered by the Faculty of Arts of the University of Lausanne (Switzerland). Globally, the project - named Learn to communicate skills - offers a reflection about academic skills and their transferability to the professional world. More precisely, the aim of the project is to make students aware of the importance of reflexive learning to make their skills transferable to other contexts.

The Sanskrit epics' representation of Vedic myths

Abstract: This book studies several mythical motifs, found in the Veda (especially in the Ùgveda) on the one hand and in one or both Sanskrit epics on the other: Agni's hiding, the theft of the Soma, Indra's rape of Ahalyå, Upamanyu's salvation by the Aßvins, and finally the representation of the Great War of the Mahåbhårata as a sacrifice. While it is often said that the subsequent Indian literature only paid "lipservice" to the Vedas without really knowing and even less understanding these texts, the present study not only shows that many Vedic myths are still kept alive in the Epics, but more importantly that their deep underlying meaning was perfectly understood by the epic mythmakers, and reactualized to fit the changed religious conditions of epic times. Résumé: Descriptif du livre Ce livre étudie plusieur motifs mythologiques qui se trouvent à la fois dans les Vedas (et spécialement dans le Ùgveda), et dans l'une ou l'autre des grandes épopées sanskrites, le Mahåbhårata et le Råmåyana. Ces motifs sont: la disparition d'Agni, le rapt du Soma, le viol d'Ahalyå par Indra, le sauvetage d'Upamanyu par les Aßvins, et enfin, la représentation de la grande guerre du Mahåbhårata comme un rite sacrificiel. On maintient souvent que la littérature plus tardive ne fait référence aux Vedas que pour la forme, sans pour autant réellement connaître et encore moins comprendre ces textes. Mais la présente étude montre tout au contraire que non seulement beaucoup de mythes védiques se retrouvent dans les épopées, mais encore ? ce qui est plus important ? que les mythographes de l'épopée avaient parfaitement compris leur sens profond, et l'avaient réactualisé pour répondre aux changements religieux de l'époque épique.