Imperial Eyes. Van Dycks Porträtmalerei als globale Technologie

Zu Beginn des 17. Jahrhunderts hatte sich die Malerei in Antwerpen vor allem durch Rubens als Medium einer zunehmend global verbundenen Welt etabliert. Doch auch zahlreiche von Van Dycks Porträts sind Zeugnisse eines oft hochgradig ambivalenten Kosmopolitismus. Neben Gemälden von international agierenden Antwerpener Händlern und Gelehrten fertigte der Künstler auch in Genua und England Porträts der adligen Elite an, in welchen sich deren globale Erfahrungen und Ambitionen spiegelten. Van Dyck reagierte in der Inszenierung der Marchesa Elena Grimaldi Cattaneo, mit einem schwarzen Sklaven, wie in der des Earl of Denbigh, zwischen einheimischen und exotischen Elementen, auf spezifische Anforderungen an das repräsentative Porträt im Zeitalter des disenclavement. Diese Anforderungen werden besonders deutlich in dem für eine geplante Expedition nach Madagaskar entstandenen Porträt des Earls of Arundel und dessen Frau Alethea Talbot. Das Gemälde verbindet Elemente herrschaftlicher, merkantilistischer und intellektueller Selbststilisierung mit einer Reduktion auf wenige, innovative Elemente. Die majestätische Inszenierung des Paars ist nur in einem globalen Kontext zu erklären, so dass sich die Frage nach der Funktion des in mehreren Werkstattkopien erhaltenen Gemäldes stellt. Hatte Van Dyck in seiner Komposition eine Lösung gefunden, die im Kontext des englischen Hofes, möglicherweise als Teil eines Festes, wie auch für potentielle Investoren, sowie die verarmte Landbevölkerung, die in der Indentur ihre einzige Hoffnung sah, gleichermaßen überzeugend wirkte? Die Hybris in dem überlebensgroßen Porträts des Paares, das mit leuchtend heller Haut, in kostbar glänzende Stoffe gekleidet und mit modernen Messinstrumenten in den Händen dargestellt ist, lässt es als ideales Medium der globalen Ambitionen des Paars erscheinen.

Alendronate with and without cholecalciferol for osteoporosis: results of a 15-week randomized controlled trial

OBJECTIVE: Many osteoporosis patients have low 25-hydroxyvitamin D (25OHD) and do not take recommended vitamin D amounts. A single tablet containing both cholecalciferol (vitamin D3) and alendronate would improve vitamin D status concurrently, with a drug shown to reduce fracture risk. This study assessed the efficacy, safety, and tolerability of a once-weekly tablet containing alendronate 70 mg and cholecalciferol 70 microg (2800 IU) (ALN + D) versus alendronate 70 mg alone (ALN). METHODS: This 15-week, randomized, double-blind, multi-center, active-controlled study was conducted during a season when 25OHD levels are declining, and patients were required to avoid sunlight and vitamin D supplements for the duration of the study. Men (n = 35) and postmenopausal women (n = 682) with osteoporosis and 25OHD >or= 9 ng/mL were randomized to ALN + D (n = 360) or ALN (n = 357). MAIN OUTCOME MEASURES: Serum 25OHD, parathyroid hormone, bone-specific alkaline phosphatase (BSAP), and urinary N-telopeptide collagen cross-links (NTX). RESULTS: Serum 25OHD declined from 22.2 to 18.6 ng/mL with ALN (adjusted mean change = -3.4; 95% confidence interval [CI]: -4.0 to -2.8), and increased from 22.1 to 23.1 ng/mL with ALN + D (adjusted mean change = 1.2; 95% CI: 0.6 to 1.8). At 15 weeks, adjusted mean 25OHD was 26% higher (p < 0.001, ALN + D versus ALN), the adjusted relative risk (RR) of 25OHD < 15 ng/mL (primary endpoint) was reduced by 64% (incidence 11% vs. 32%; RR = 0.36; 95% CI: 0.27 to 0.48 [p < 0.001]), and the RR of 25OHD < 9 ng/mL (a secondary endpoint) was reduced by 91% (1% vs. 13%; RR = 0.09; 95% CI: 0.03 to 0.23 [p < 0.001]). Antiresorptive efficacy was unaltered, as measured by reduction in bone turnover (BSAP and NTX). CONCLUSION: In osteoporosis patients who avoided sunlight and vitamin D supplements, this once-weekly tablet containing alendronate and cholecalciferol provided equivalent antiresorptive efficacy, reduced the risk of low serum 25OHD, improved vitamin D status over 15 weeks, and was not associated with hypercalcemia, hypercalciuria or other adverse findings, versus alendronate alone.

Does point of care prothrombin time measurement reduce the transfusion of fresh frozen plasma in patients undergoing major surgery? The POC-OP randomized-controlled trial

BACKGROUND: Bleeding is a frequent complication during surgery. The intraoperative administration of blood products, including packed red blood cells, platelets and fresh frozen plasma (FFP), is often live saving. Complications of blood transfusions contribute considerably to perioperative costs and blood product resources are limited. Consequently, strategies to optimize the decision to transfuse are needed. Bleeding during surgery is a dynamic process and may result in major blood loss and coagulopathy due to dilution and consumption. The indication for transfusion should be based on reliable coagulation studies. While hemoglobin levels and platelet counts are available within 15 minutes, standard coagulation studies require one hour. Therefore, the decision to administer FFP has to be made in the absence of any data. Point of care testing of prothrombin time ensures that one major parameter of coagulation is available in the operation theatre within minutes. It is fast, easy to perform, inexpensive and may enable physicians to rationally determine the need for FFP. METHODS/DESIGN: The objective of the POC-OP trial is to determine the effectiveness of point of care prothrombin time testing to reduce the administration of FFP. It is a patient and assessor blind, single center randomized controlled parallel group trial in 220 patients aged between 18 and 90 years undergoing major surgery (any type, except cardiac surgery and liver transplantation) with an estimated blood loss during surgery exceeding 20% of the calculated total blood volume or a requirement of FFP according to the judgment of the physicians in charge. Patients are randomized to usual care plus point of care prothrombin time testing or usual care alone without point of care testing. The primary outcome is the relative risk to receive any FFP perioperatively. The inclusion of 110 patients per group will yield more than 80% power to detect a clinically relevant relative risk of 0.60 to receive FFP of the experimental as compared with the control group. DISCUSSION: Point of care prothrombin time testing in the operation theatre may reduce the administration of FFP considerably, which in turn may decrease costs and complications usually associated with the administration of blood products. TRIAL REGISTRATION: NCT00656396.