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Item Open Access Against the Grain: Reclaiming the Life I Left Behind(2015-06-12) Brill, Margaret* Designated as an Exemplary Master's Project for 2014-15*
Against the Grain revisits a period of my life long neglected: the 20 years between my graduation from London University with a BA in African history in 1964 and my professional reinvention as an academic librarian. In keeping with second wave feminism's emphasis on professional life, I had dismissed this period of my life as subservient to "patriarchy": I was the dependent wife of a Foreign Service officer. At this point in my personal and professional history I have come to recognize this was anything but a prelude to a more real existence. With the benefit of historically informed insights, I recognize that I lived for extended periods in hotspots throughout Africa and beyond in the nineteen sixties and seventies, at moments of world historical significance: Ghana, Burundi, South Africa, Bulgaria, and Zaire. Moreover, because of my relative independence I was able to develop relationships that continue to shape my understanding of this complex period in US foreign policy. In classic feminist fashion, the personal and the political were inextricable. Somewhat more against the feminist grain are the rich experiences and examined life of an adventurous, independent woman in a traditional marriage. I eventually regained my independence; when I remarried and moved to North Carolina in 1984, I put those years behind me. Viewing that part of my life in historical context has revealed that, even without a career, I led a full and rich life that has helped to shape my identity today.Item Open Access Effects of varenicline and cognitive bias modification on neural response to smoking-related cues: study protocol for a randomized controlled study.(Trials, 2014-10-07) Attwood, Angela S; Williams, Tim; Adams, Sally; McClernon, Francis J; Munafò, Marcus RBACKGROUND: Smoking-related cues can trigger drug-seeking behaviors, and computer-based interventions that reduce cognitive biases towards such cues may be efficacious and cost-effective cessation aids. In order to optimize such interventions, there needs to be better understanding of the mechanisms underlying the effects of cognitive bias modification (CBM). Here we present a protocol for an investigation of the neural effects of CBM and varenicline in non-quitting daily smokers. METHODS/DESIGN: We will recruit 72 daily smokers who report smoking at least 10 manufactured cigarettes or 15 roll-ups per day and who smoke within one hour of waking. Participants will attend two sessions approximately one week apart. At the first session participants will be screened for eligibility and randomized to receive either varenicline or a placebo over a seven-day period. On the final drug-taking day (day seven) participants will attend a second session and be further randomized to one of three CBM conditions (training towards smoking cues, training away from smoking cues, or control training). Participants will then undergo a functional magnetic resonance imaging scan during which they will view smoking-related pictorial cues. Primary outcome measures are changes in cognitive bias as measured by the visual dot-probe task, and neural responses to smoking-related cues. Secondary outcome measures will be cognitive bias as measured by a transfer task (modified Stroop test of smoking-related cognitive bias) and subjective mood and cigarette craving. DISCUSSION: This study will add to the relatively small literature examining the effects of CBM in addictions. It will address novel questions regarding the neural effects of CBM. It will also investigate whether varenicline treatment alters neural response to smoking-related cues. These findings will inform future research that can develop behavioral treatments that target relapse prevention. TRIAL REGISTRATION: Registered with Current Controlled Trials: ISRCTN65690030. Registered on 30 January 2014.Item Open Access Learning to Love(2010) Deagman, RachaelThis study examines medieval edification in all of its rich senses: moral improvement, the building up of community, and the construction of a city or edifice. Drawing from medieval literature, religious writing and architectural sources, my dissertation investigates virtue formation and explores what kinds of communities nourish or hinder those virtues. The Christian virtue of love stands at the center of my project. Drawing from the work of Alasdair MacIntyre, I show that medieval Christians learn the craft of love in a lifelong process into which they are initiated as apprentices to those who teach the craft in the Church. For parishioners in late medieval England, apprenticeship in the craft of love entails participation in sacramental practice, particularly in the sacrament of penance.
Chapter one considers Jacob's Well , a fifteenth-century penitential manual written by an anonymous author that uses architectural allegory to describes the penitential process. I argue that the author, a self-proclaimed "man of craft," apprentices the reader into sacramental practice. The author is both an exemplar to the reader and apprenticed to Christ. In chapter two, I explore the role of the narrative exempla in Jacob's Well. The exempla often resist the paradigm set forth in the allegory of the well. My chapter shows that learning to read these stories trains the reader to recognize forgiveness and sin in others and then to use this recognition to evaluate one's own story. Chapter three considers William Langland's richly complex fourteenth-century poem, Piers Plowman. The horrible failures of the sacrament of penance in this poem cause the Church to crumble. The allegorical Wille is left within this Church with the enjoinder to "learn the craft of love." For Wille to learn the craft of love means more than learning to forgive and to be forgiven - it means learning to be charitable. For Langland, a charitable Church is yet to be practiced, yet to be constructed. My last chapter examines Pearl, a late fourteenth-century apocalyptic allegory written by an anonymous poet. The poem opens with a jeweler lamenting the loss of his pearl in a garden. As the poem progresses it becomes clear that the jeweler is a father who mourns the death of his infant daughter. In a dream vision, his daughter appears to him as a Pearl Maiden, one of the 144,000 virgins from the Book of Revelations. In an inversion of the usual parent-child relationship, the Pearl Maiden teaches the jeweler to recognize that their interlocking narratives stem from the same Christian tradition, although his particular narrative is one of penitential practice and hers is one of grace. The Pearl poet's architectural allegory focuses on the completed City of New Jerusalem rather than on the upbuilding or crumbling of the Church.
Item Open Access More Than a Feeling: How the Nineteenth-Century British Novel Reformed the Passions(2020) Rogers, Hannah LeeBy the time of David Hume and Adam Smith, as A.O. Hirschman famously tells us, the early modern passions had been rehabilitated as a creative force, one driven by economic interest. From the turn of the nineteenth century onward, however, the passions returned with a vengeance — as indicated by the works of Jeremy Bentham, Thomas Malthus, and the Brontë sisters. What we now call “the emotions” had suddenly slipped out from under the control of individual reason and become a force of nature. As such, they could be held responsible both for keeping the individual alive and for the species’ ability to prosper and expand in number. Michel Foucault has offered perhaps the clearest articulation of how the century that followed developed new forms of government that both taught individuals to manage themselves by observing disciplinary regimens and regulated the unruliness of entire populations by means of biopolitical policies. But while, like Hirschman, Foucault links the redefinition of sexuality and how behaviors and effects were classified and managed directly to the emergence of industrial capitalism, neither he nor Hirschman consider the novel instrumental in their respective accounts of the passions. Novels, as the self-anointed discourse of personal experience, were ideally positioned to respond both critically and creatively to the disruptions of daily life that began in the late eighteenth century. In the decades that followed, I will show, the novel successively updated the causes and effects of emotional experience to accommodate the transition to an industrial society from an agrarian way of life supported by commerce and early colonization.
From Jane Eyre to Daniel Deronda, the novel features a protagonist whose biographical destiny depends on a form of yearning well in excess of the prevailing social classification system. This unnamable sense of belonging elsewhere is indeed so in excess of then existing codes of conduct and self-expression that it escapes the confines of the individual and pervades each habitat it enters with a sense of lack and constriction. The natural principles Charles Darwin first discovered during his landmark Voyage of the Beagle gave him the grounds, by 1872, to conclude that just as any species, man or animal, must physically adapt to its environment, so too must its feelings. Darwin understood that these affects — a term I use for feelings that have not been codified as one of the then recognized emotions — allow the species to develop new relations among themselves to enable survival. Over the century, the novel followed this same principle perhaps more so than any other form of writing, as it sought to alter the basis of human feeling to accommodate the material conditions of existence. My introduction explains how the novel carried out this project by capturing and reforming feelings in excess of accepted social roles and reworked both feelings and roles to form emotional ties capable of sustaining domestic life: first, during the early decades of the nineteenth century as inherited land lost its status as the coin of the realm, then in the economic crisis called the Hungry Forties, and finally during the period when England’s economy shifted from the English countryside to the imperial metropole.
Item Open Access Race and Conversion in Late Medieval England(2009) Whitaker, Cord J.Despite general consensus among scholars that race in the West is an early modern phenomenon that dates to the seventeenth and eighteenth centuries, late medieval English texts of the fourteenth and fifteenth centuries expend no small amount of effort depicting the differences between people—individuals and groups—and categorizing those people accordingly. The contexts for the English literary concern with human difference were the Crusades and associated economic expansion and travel into Eastern Europe, the Middle East, and North Africa. Scholars who have argued that race is present in medieval texts have generally claimed that race is subordinate to religion, the dominant cultural force in medieval Europe. In “Race and Conversion in Late Medieval England,” I argue that race is not necessarily subordinate to religion. Rather, racial and religious discourses compete with one another for ideological dominance. I examine three texts, juxtaposed in only one extant manuscript, London, British Library, MS Cotton Vespasian E.16; the Three Kings of Cologne, the Siege of Jerusalem, and the physiognomy portion of the Secretum Secretorum together narrate competition between race and religion as community–forming ideologies in England through their treatments of religious identity and physical characteristics. In addition, I study Chaucer’s Man of Law's Tale, which distills down questions of religious difference to genealogy and the interpretation of blood. “Race and Conversion in Late Medieval England” argues that racial ideology emerges from and competes with religion in late medieval English literature as a means of consolidating power in crusading Western Europe, even as the ever present possibility of Christian conversion threatens to undermine the essentializing work of race.
Item Open Access Resuscitation in hip fractures: a systematic review.(BMJ open, 2017-05) Rocos, Brett; Whitehouse, Michael R; Kelly, Michael BTo evaluate the evidence for the resuscitation of patients with hip fracture in the preoperative or perioperative phase of their treatment and its impact on mortality.Design
We searched MEDLINE, EMBASE, CENTRAL and PROSPERO databases using a systematic search strategy for randomised trials and observational studies investigating the fluid resuscitation of any patient with hip fracture. No language limits were applied to the search, which was complemented by manually screening the reference lists of appropriate studies.Outcome measures
Mortality at 1 week, 30 days and 1 year following surgery.Results
Two hundred and ninety-eight citations were identified, and 12 full manuscripts were reviewed; no studies satisfied the inclusion criteria. The background literature showed that the mortality for these patients at 30 days is approximately 8.5% and that bone cement implantation syndrome is insufficient to explain this. The literature was explored to define the need for an interventional investigation into the preoperative resuscitation of patients with hip fracture.Conclusions
Patients with hip fracture show similar physiological disturbance to major trauma patients. Nineteen per cent of patients presenting with hip fracture are hypoperfused and 50% show preoperative anaemia suggesting that under resuscitation is a common problem that has not been investigated. A properly conducted interventional trial could improve the outcome of these vulnerable patients.Item Embargo Sounding Reconstruction at St Paul's Cathedral, 1660–1714(2023) Smolenski, Nicholas“Sounding Reconstruction at St Paul’s Cathedral, 1660–1714” is a study of the sonic and musical history of St Paul’s Cathedral in London. It examines how musical and sonic signification played a role in the rebuilding after the Great Fire of 1666, led by architect Christopher Wren (1632–1723). During reconstruction the monarchy, the Church of England, and Parliament were able to implicate sounds produced both within and outside London’s St Paul’s into a narrative of institutional power. Relationships between the cathedral, the monarchy, the Anglican Church, and the people of London were redrawn, reinterpreted, and affected by sonic parameters; through noise pollution, acoustical construction, and sung liturgy, sounds at St Paul’s came to signify progress, excellence, and divine authority for London’s institutions, to the detriment of the Capital’s own citizens. I argue that sound is analogous to power within the cathedral, and that those sounds represent a microcosm of the social networks, overlapping authorities, and architectural spaces in Restoration London. This project thus contributes to a paradigmatic shift in understanding the rich complexities of sound and its broad impact on culture in the early modern period.
This study thus contributes to a paradigmatic shift in understanding the rich complexities of sound and its broad impact on culture in the early modern period. Interpreting St Paul’s as a monument, a symbol, and a metaphor is essential to clarifying its complex relationship with soundscapes, the nation’s capital, and its authoritative, political institutions.
Item Open Access Utility of bedside leucocyte esterase testing to rule out septic arthritis.(Emergency medicine journal : EMJ, 2021-09) Knapper, Thomas; Murphy, Richard J; Rocos, Brett; Fagg, James; Murray, Nick; Whitehouse, Michael RichardIntroduction
Suspected septic arthritis is a common presentation to EDs. The underlying diagnosis is often non-infective pathology. Differentiating between aetiologies is difficult. A bedside test with high negative predictive value (NPV) may allow safe discharge of patients, reduce the time in the ED, hospital admission and associated costs. This study aims to evaluate the NPV of bedside leucocyte esterase (LE) in the assessment of these patients.Methods
A prospective multicentre observational study of ED adult patients referred to orthopaedics with suspected native joint septic arthritis between October 2015 and April 2016. At three hospital sites in the Bristol region, the results of the LE test exposed to aspirated synovial fluid were recorded along with Gram stain, culture, haematinics and length of stay. A positive LE test was considered 2+ or 3+ leucocytes based on the test strip colour. Data were analysed to establish sensitivity, specificity, NPV and positive predictive value (PPV) against the gold standard 48-hour culture. We determined the potential number of inpatient bed-days that might be avoided using this bedside test.Results
Eighty patients underwent joint aspiration. Five cases had positive 48-hour culture. All (5/5) infected cases showed ≥2+ LE, sensitivity of 100% (95% CI 47.8% to 100%) while the Gram stain was positive in only one case (sensitivity 20%, 95% CI 0.51% to 71.6%). Twenty-three LE were read negative or 1+, all with negative 48-hour culture results, resulting in an NPV of 100% (95% CI 82.1% to 1.00%) for a negative LE test. Specificity of a positive LE test was 30.7% (95% CI 20.5% to 42.45%) with PPV of 8.77% (95% CI 7.64% to 10.1%). It was calculated that 57 orthopaedic bed-days could have potentially been saved by immediately discharging those with a negative LE test.Conclusions
LE point-of-care testing for suspected septic arthritis of native joints has a high NPV. Implementation of LE may facilitate more rapid discharge of patients with negative results. This test has the potential to reduce diagnostic uncertainty and costs to the healthcare system.