Fluid resuscitation practice patterns in intensive care units of the USA: a cross-sectional survey of critical care physicians.

BACKGROUND: Fluid resuscitation is a cornerstone of intensive care treatment, yet there is a lack of agreement on how various types of fluids should be used in critically ill patients with different disease states. Therefore, our goal was to investigate the practice patterns of fluid utilization for resuscitation of adult patients in intensive care units (ICUs) within the USA. METHODS: We conducted a cross-sectional online survey of 502 physicians practicing in medical and surgical ICUs. Survey questions were designed to assess clinical decision-making processes for 3 types of patients who need volume expansion: (1) not bleeding and not septic, (2) bleeding but not septic, (3) requiring resuscitation for sepsis. First-choice fluid used in fluid boluses for these 3 patient types was requested from the respondents. Descriptive statistics were performed using a Kruskal-Wallis test to evaluate differences among the physician groups. Follow-up tests, including t tests, were conducted to evaluate differences between ICU types, hospital settings, and bolus volume. RESULTS: Fluid resuscitation varied with respect to preferences for the factors to determine volume status and preferences for fluid types. The 3 most frequently preferred volume indicators were blood pressure, urine output, and central venous pressure. Regardless of the patient type, the most preferred fluid type was crystalloid, followed by 5 % albumin and then 6 % hydroxyethyl starches (HES) 450/0.70 and 6 % HES 600/0.75. Surprisingly, up to 10 % of physicians still chose HES as the first choice of fluid for resuscitation in sepsis. The clinical specialty and the practice setting of the treating physicians also influenced fluid choices. CONCLUSIONS: Practice patterns of fluid resuscitation varied in the USA, depending on patient characteristics, clinical specialties, and practice settings of the treating physicians.

Social paranoia and absurdist fiction in Cold War America and Soviet Russia: a comparative study

This thesis explores the theme of social paranoia as depicted in the Absurdist fiction of Cold War America and Soviet Russia. The central hypothesis informing this research maintains that, despite the ideology of moral and cultural “Otherness” constructed and reinforced by both nations throughout much of twentieth century, the US and the Soviet Union more often than not functioned as mirror images of paranoia and suspicion. Much of the fiction produced in Russia from the Revolution onwards and in the US during the Cold War period highlights how these two ostensibly irreconcilable nations were consumed by similar fears and gripped by an equally pervasive paranoia. These parallel conditions of anxiety and mistrust led to a surprising congruity of literary responses, which transcended the ideological divide between capitalism and communism and, as such, underscored the homogeny of fear which lay beneath the façade of constructed difference. I contend that, because Soviet Russia and the America of the Cold War period were nations consumed by fear and suspicion, authors living in both countries became preoccupied by the mechanics of such deeply paranoid societies. Consequently, much of the fiction of the US and the Soviet Union during this period was preoccupied with the themes of paranoia, conspiracy, intensive bureaucracy and the politicisation of science, which resulted in the terror of the Nuclear Age. This thesis explores how these central themes unite apparently diverse literary texts and illustrate the uniformity of terror which transcended both the physical and ideological boundaries separating the United States and the Soviet Union. In doing so, this research focuses primarily on the multi-faceted manifestations of paranoia in selected works by Soviet authors Mikhail Bulgakov, Daniil Kharms and Yuli Daniel, and American authors Joseph Heller, Thomas Pynchon and Kurt Vonnegut. Focusing on key works by each author, this research considers these texts as products of two culturally diverse, yet equally paranoid societies and explores their preoccupation with issues of spying, infiltration and conspiracy. This thesis thus emphasises how these authors counter simplistic notions of Cold War Otherness by revealing two nations possessed by a similar sense of vulnerability and insecurity. Furthermore, this thesis examines how this social anxiety is reinforced by the way in which these authors position issues such as the mechanics of the bureaucratic system and clandestine scientific experimentation as the focal point of the paranoid imagination. Ultimately, by examining the concordance of paranoiac representation in America and the Soviet Union during this period, I demonstrate that these ostensibly divergent nations harboured similar fears and insecurities.

'A piece of fine meshwork': the intertwining fiction of Philip Roth and Edna O'Brien

This thesis comprises a comparative analysis of the works the Irish author Edna O’Brien and her contemporary and friend, the Jewish-American author Philip Roth. It investigates the striking biographical, textual and stylistic symmetries between two writers from very different cultures and literary traditions. The thesis begins with the, until now, undetected intertextual nexuses between Roth’s fiction and O’Brien’s. These allusions significantly alter the readings of a number of their novels, while at the same time indicating wider transatlantic frames of reference now apparent in their work. O’Brien has, since the beginning of her career, been in frequent correspondence with all of the pre-eminent Jewish-American authors of her time, and her work conducts a dialogue with key Jewish-American texts. Conversely, Roth’s fiction—like O’Brien’s, obviously indebted to Joyce—has frequently alluded to other seminal Irish authors. The literary and personal relationship of Roth and O’Brien symbolize myriad links between Jewish and Irish literary cultures. In O’Brien’s (and wider Irish) fiction, the Jew is often positioned as an exotic but dangerous “Other”. Equally, throughout the Jewish canon Irish Catholics are frequently employed as foils. Roth and O’Brien investigate difference by depicting relationships that cross these boundaries. Through understanding the complex interrelations at play between the fiction of Roth and O’Brien, and between their work and that of a wider pantheon of Irish and American writers, this thesis will reposition both as transnational authors while developing a culturally sensitive, textually nuanced account of their transatlantic literary relations.

La vérité polyphonique : la problématisation théorique et pratique de la dichotomie entre fiction et documentaire, précédé du film YT Remix

La création cinématographique de l’étudiante qui accompagne ce mémoire sous la forme d’un DVD est disponible à la Médiathèque de la Bibliothèque des lettres et sciences humaines sous le titre : YT Remix (documentaire) ; Sonorisation d'un extrait de L'homme à la caméra (D. Vertov).(http://atrium.umontreal.ca/notice/UM-ALEPH002370775)

Expérience précaire du monde et représentation de la poésie dans La fissure de la fiction et Désâmé de Patrice Desbiens

Diverses œuvres de poésie moderne et contemporaine mettent en scène le rapport à l’écriture d’un sujet lyrique. Une telle problématique trouve une incarnation particulièrement intéressante dans l’œuvre de Patrice Desbiens, notamment dans certains de ses textes des années 1990 et 2000, où elle apparaît avec plus d’acuité. Pourtant, sa pratique auto-réflexive a fait l’objet de très peu de recherches. Afin d’éclairer le rapport qu’entretient Patrice Desbiens avec l’écriture et avec la poésie, ce mémoire s’intéresse à deux de ses textes, soit La fissure de la fiction (1997) et Désâmé, (2005) en accordant davantage d’espace au premier, que je considère comme un texte-charnière dans la production poétique de Desbiens. Dans un premier temps, mon travail présente ainsi la précarité qui caractérise le protagoniste de La fissure de la fiction et, sous un autre angle, le sujet lyrique de Désâmé. Dans cette optique, la figure du poète est étudiée dans La fissure de la fiction à la lumière de la reprise ironique du mythe de la malédiction littéraire et du sens que la réactualisation de ce mythe confère au personnage dans ce récit poétique. Dans un second temps, ce mémoire s’attache à montrer que la cohérence et la vraisemblance des univers mis en scène dans La fissure de la fiction et Désâmé sont minées. C’est à l’aune de ces analyses que peut ensuite être envisagé le rôle d’une poésie qui, en dernière instance, comporte malgré tout un caractère consolateur, en dépit ou en raison de l’esthétique du grotesque, tantôt comique, tantôt tragique, dans laquelle elle s’inscrit et que nous tâcherons de mettre en lumière.

Alienated Selfhood and Heroism: A Poststructuralist Reading of John le Carré’s Spy Fiction Novels

John le Carré’s novels “The Spy Who Came in From the Cold” (1963), “Tinker, Tailor, Soldier, Spy” (1974), and “The Tailor of Panama” (1997), focus on how the main characters reflect the somber reality of working in the British intelligence service. Through a broad post-structuralist analysis, I will identify the dichotomies - good/evil in “The Spy Who Came in From the Cold,” past/future in “Tinker, Tailor, Soldier, Spy,” and institution/individual in “The Tailor of Panama” - that frame the role of the protagonists. Each character is defined by his ambiguity and swinging moral compass, transforming him into a hybrid creation of morality and adaptability during transitional time periods in history, mainly during the Cold War. Le Carré’s novels reject the notion of spies standing above a group being celebrated. Instead, he portrays spies as characters who trade off individualism and social belonging for a false sense of heroism, loneliness, and even death.

Crises of In/Humanity: Posthumanism, Afrofuturism, and Science and/as Fiction

This thesis engages black critical thought on the human and its contemporary iterations in posthumanism and transhumanism. It articulates five categories of analysis: displace, interrupt, disrupt, expand, and wither. Each is meant to allude to the generative potential in different iterations of black thought that engages the human. Working through Sylvia Wynter’s theories of the rise of Man-as-human in particular, the project highlights how black thought on the human displaces the uncritical whiteness of posthumanist thought. It argues that Afrofuturism has the potential to interrupt the linear progression from human to posthuman and that Octavia Butler’s Fledgling proffers a narrative of race as a technology that disrupts the presumed post-raciality of posthumanism and transhumanism. It then contends that Katherine McKittrick’s rearticulation of the Promise of Science can be extended to incorporate the promise of science fiction. In so doing, it avers that a more curated conversation between McKittrick and Wynter, one already ongoing, and Octavia Butler, through Mind of My Mind from her Patternist series, expands our notions of the human as a category even at the risk of seeing it wither as a politic or praxis. It ends on a speculative note meant to imagine the possibilities within the promise of science fiction.

Fiction and reality in "The Kindly Ones" of Jonathan Littell

This paper studies the novel The Kindly Ones, whose main plot charts the anguished memories of a Nazi officer. The reader of this novel is plunged into the harshest atrocities of the Holocaust and WWII, as these are recounted by a perverse conscience who is unmoved by the most terrible actions. Fiction and reality are contrasted in the novel against the framework of history writing and the subsequent debates sparked by historical elaboration. This novel perceptively captures historical truth, thus calling for critical attention upon the collective responsibility which will prevent the repetition of events.

Cancer diagnosis disclosure from Portuguese physicians

OBJECTIVE: Doctor-patient communication in oncology, particularly concerning diagnostic disclosure, is a crucial factor related to the quality of the doctor-patient relationship and the psychological state of the patient. The aims of our study were to investigate physicians' opinions and practice with respect to disclosure of a cancer diagnosis and to explore potential related factors. METHOD: A self-report questionnaire developed for our study was responded to by 120 physicians from Coimbra University Hospital Centre and its primary healthcare units. RESULTS: Some 91.7% of physician respondents generally disclosed a diagnosis, and 94.2% were of the opinion that the patient knowing the truth about a diagnosis had a positive effect on the doctor-patient relationship. A need for training about communicating with oncology patients was reported by 85.8% of participants. The main factors determining what information to provide to patients were: (1) patient intellectual and cultural level, (2) patient desire to know the truth, and (3) the existence of family. SIGNIFICANCE OF RESULTS: Our results point to a paradigm shift in communication with cancer patients where disclosure of the diagnosis should be made part of general clinical practice. Nevertheless, physicians still experience difficulties in revealing cancer diagnoses to patients and often lack the skills to deal with a patient's emotional responses, which suggests that more attention needs to be focused on communication skills training programs.

Transfrontalité et perméabilité dans les genres de non-fiction : l’essai et la chronique

Partiendo de la noción de literatura de pensamiento, como conjunto heterogéneo y complejo de formas literarias con vocación argumentativa, el estudio que sigue pretende mostrar a la vez el valor paradigmático del ensayo, en el marco de estas escrituras, y la naturaleza transfronteriza de los géneros de no-ficción, entre los cuales el ensayo y la crónica periodística constituyen dos de las formas más próximas. En un primer momento, se analizan los rasgos característicos del ensayo, tal como Montaigne lo concibió, con el fin de determinar las líneas de fuerza de esta forma matricial, de la que procede hasta hoy toda una tradición de escritos asistemáticos y porosos de naturaleza personal y reflexiva. En un segundo momento, se estudian los rasgos específicos de la crónica periodística contemporánea, a la luz del modelo canónico, poniendo el énfasis en la perspectiva subjetiva de la mirada y en la noción de actualidad, como principales indicadores de la dimensión permeable e híbrida de este género.

Cancer diagnosis disclosure from Portuguese physicians

OBJECTIVE: Doctor-patient communication in oncology, particularly concerning diagnostic disclosure, is a crucial factor related to the quality of the doctor-patient relationship and the psychological state of the patient. The aims of our study were to investigate physicians' opinions and practice with respect to disclosure of a cancer diagnosis and to explore potential related factors. METHOD: A self-report questionnaire developed for our study was responded to by 120 physicians from Coimbra University Hospital Centre and its primary healthcare units. RESULTS: Some 91.7% of physician respondents generally disclosed a diagnosis, and 94.2% were of the opinion that the patient knowing the truth about a diagnosis had a positive effect on the doctor-patient relationship. A need for training about communicating with oncology patients was reported by 85.8% of participants. The main factors determining what information to provide to patients were: (1) patient intellectual and cultural level, (2) patient desire to know the truth, and (3) the existence of family. SIGNIFICANCE OF RESULTS: Our results point to a paradigm shift in communication with cancer patients where disclosure of the diagnosis should be made part of general clinical practice. Nevertheless, physicians still experience difficulties in revealing cancer diagnoses to patients and often lack the skills to deal with a patient's emotional responses, which suggests that more attention needs to be focused on communication skills training programs.

Expérience précaire du monde et représentation de la poésie dans La fissure de la fiction et Désâmé de Patrice Desbiens

Diverses œuvres de poésie moderne et contemporaine mettent en scène le rapport à l’écriture d’un sujet lyrique. Une telle problématique trouve une incarnation particulièrement intéressante dans l’œuvre de Patrice Desbiens, notamment dans certains de ses textes des années 1990 et 2000, où elle apparaît avec plus d’acuité. Pourtant, sa pratique auto-réflexive a fait l’objet de très peu de recherches. Afin d’éclairer le rapport qu’entretient Patrice Desbiens avec l’écriture et avec la poésie, ce mémoire s’intéresse à deux de ses textes, soit La fissure de la fiction (1997) et Désâmé, (2005) en accordant davantage d’espace au premier, que je considère comme un texte-charnière dans la production poétique de Desbiens. Dans un premier temps, mon travail présente ainsi la précarité qui caractérise le protagoniste de La fissure de la fiction et, sous un autre angle, le sujet lyrique de Désâmé. Dans cette optique, la figure du poète est étudiée dans La fissure de la fiction à la lumière de la reprise ironique du mythe de la malédiction littéraire et du sens que la réactualisation de ce mythe confère au personnage dans ce récit poétique. Dans un second temps, ce mémoire s’attache à montrer que la cohérence et la vraisemblance des univers mis en scène dans La fissure de la fiction et Désâmé sont minées. C’est à l’aune de ces analyses que peut ensuite être envisagé le rôle d’une poésie qui, en dernière instance, comporte malgré tout un caractère consolateur, en dépit ou en raison de l’esthétique du grotesque, tantôt comique, tantôt tragique, dans laquelle elle s’inscrit et que nous tâcherons de mettre en lumière.

Kapuściński non-fiction – próba analizy debaty publicznej

Artykuł stanowi próbę analizy debaty publicznej wywołanej publikacją na początku marca 2010 roku biografii Ryszarda Kapuścińskiego zatytułowanej "Kapuściński non-fiction". Debata ta była pod wieloma względami zjawiskiem bez precedensu. Jak wskazywano, być może po raz pierwszy od roku 1989 zawiodły w jej trakcie proste osie predykcji - nie był to konflikt lewica/prawica, starzy/młodzi czy III RP/IV RP. W debacie wokół książki Artura Domosławskiego głos zabrali ludzie, którzy często traktowali Ryszarda Kapuścińskiego jako swojego mistrza i guru zawodowego, koledzy i koleżanki po piórze, adepci tzw. polskiej szkoły reportażu, publicyści i dziennikarze najważniejszych tytuł prasowych oraz mediów elektronicznych, ale także pisarze, politycy oraz duchowni. Przedmiotem szczególnie wnikliwego namysłu były zwłaszcza trzy kwestie: proporcja faktów i fikcji literackiej w twórczości Kapuścińskiego, jego młodzieńcze heglowskie ukąszenie i późniejsza wieloletnia identyfikacja z Polską Ludową, oraz ewolucja ideowa po 1989 roku. W niniejszym artykule pominięto pierwszy wątek i skupiono się na dwóch kolejnych, traktując je jako szczególnie interesujące przy rozważaniu związków między polityką a kulturą.

Management of the clinical issue of constipation with abdominal complaints in adults: a national survey of Primary Care physicians and gastroenterologists

Irritable bowel syndrome and functional constipation represent a relevant and common health issue. However, real-world clinical practice includes patients with constipation who may or may not have other abdominal complaints (pain, bloating, abdominal discomfort) with variable frequency. The goal of the present study was to obtain information on the workload entailed by patients with constipation and associated abdominal complaints, predominant clinical behaviors, education needs, and potential daily practice aids both in Primary Care and gastroenterology settings. The clinical behavior of doctors is generally similar at both levels, despite differences in healthcare approach: use of empiric therapies and clinically guided diagnostic tests, with some differences in colonoscopy use (not always directly accessible from Primary Care). Regarding perceptions, general support and osmotic laxatives are most valued by PC doctors, whereas osmotic laxatives, combined laxatives, and linaclotide are most valued by GE specialists. Furthermore, over half of respondents considered differentiating both diagnoses as challenging. Finally, considerable education needs are self-acknowledged at both levels, as is a demand for guidelines and protocols to help in managing this issue in clinical practice. A strength of this study is its providing a joint photograph of the medical approach and the perceptions of constipation with abdominal discomfort from a medical standpoint. Weaknesses include self-declaration (no formal validation) and a response rate potentially biased by professional motivation.