The Development of a Legend: Stonewall Jackson as a Southern Hero

Throughout history, most individuals have lived their lives, and then faded into oblivion with little to remember them by. Relatively few receive credit for significantly affecting the course of human history and obtain appropriate remembrance in accounts of the past. For those whose memories endure, due to the unrepeatable nature of past events, history remains vulnerable to the corrupting influence of myths and legends that distort historical realities. Confederate Lieutenant General Thomas “Stonewall” Jackson (1824-1863) serves as a prime example of an historical figure, who, though deserving of his place in history, has been subsequently distorted by biographers and memory. The following discussion largely passes over the general’s already well-analyzed military career, and explores other factors that contributed to his incredible rise in fame to the exalted position of southern hero. Topics include Jackson’s well-documented eccentricities, the manner of his death, the social climate of the post-war South, and his subsequent treatment by early biographers. All will contribute to the answer of the question, “what made Jackson into a legend?

SANTA MORTE, A SANTA ESQUELÉTICA NO MÉXICO E NOS ESTADOS UNIDOS

Este artigo traz algumas considerações retiradas de uma pesquisa mais ampla sobre as razões do aumento da popularidade do culto à Santa Morte no México e nos Estados Unidos, desde o início dos anos 2000. De uma prática oculta, desconhecida de boa parte dos mexicanos, transformou-se em um crescente culto público que contabiliza milhões de devotos nos dois países. O texto analisa a evolução do culto, do período colonial hispânico até os dias atuais, e, por meio de entrevistas, mídia impressa e pesquisa de campo, explora os diferentes atributos conferidos à santa por uma grande gama de devotos, de donas de casa a traficantes, em meio a um contexto conturbado de crescente recessão econômica e violência urbana

Clinical characteristics and outcomes in patients with traumatic brain injury in China: a prospective, multicentre, longitudinal, observational study

Background Large-scale studies are required to better characterise traumatic brain injury (TBI) and to identify the most effective treatment approaches for TBI. However, evidence is scarce and mostly originates from high-income countries. We aimed to describe the existing care for patients with TBI and the outcomes in China. Methods The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) China registry is a prospective, multicentre, longitudinal, observational study done in 56 neurosurgical centres across China. We collected data of patients who were admitted to hospital with a clinical diagnosis of TBI and an indication for CT. Patients who were discharged directly from the emergency room were excluded. The primary endpoint was survival on discharge. Prognostic analyses were applied to identify predictors of mortality. Variations in mortality were compared between centres and provinces within China. Mortality was compared with expected mortality, estimated using the CRASH basic model. This study was registered with ClinicalTrials.gov, NCT02210221. Findings From Dec 22, 2014, to Aug 1, 2017, 13 627 patients with TBI from 56 centres were enrolled in the registry. Data from 13 138 patients from 52 hospitals in 22 provinces of China were analysed. Most patients were male (9782 [74%]), with a median age of 48 years (IQR 33–61). The median Glasgow Coma Scale (GCS) score was 13 (IQR 9–15), and the leading cause of injury was road-traffic incident (6548 [50%]). Overall, 637 (5%) patients died, including 552 (20%) patients with severe TBI. Age, GCS score, injury severity score, pupillary light reflex, CT findings (compressed basal cistern and midline shift ≥5 mm), presence of hypoxia, systemic hypotension, altitude higher than >500 m, and GDP per capita were significantly associated with survival in all patients with TBI. Variation in mortality existed between centres and regions. The expected 14-day mortality was 1116 (13%), but 544 (7%) deaths within 14 days were observed (observed to expected ratio 0·49 [95% CI 0·45–0·53]). Interpretation The results show differences in mortality between centres and regions across China, which indicates potential for identifying best practices through comparative effectiveness research. The risk factors identified in prognostic analyses might contribute to developing benchmarks for assessing quality of care. Funding None

WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours.

The acute phase management of patients with severe traumatic brain injury (TBI) and polytrauma represents a major challenge. Guidelines for the care of these complex patients are lacking, and worldwide variability in clinical practice has been documented in recent studies. Consequently, the World Society of Emergency Surgery (WSES) decided to organize an international consensus conference regarding the monitoring and management of severe adult TBI polytrauma patients during the first 24 hours after injury. A modified Delphi approach was adopted, with an agreement cut-off of 70%. Forty experts in this field (emergency surgeons, neurosurgeons, and intensivists) participated in the online consensus process. Sixteen recommendations were generated, with the aim of promoting rational care in this difficult setting