“Strong Women Make Strong Nations”: Women, Literature, and Sovereignty in Paula Gunn Allen and Virginia Woolf

This essay places Virginia Woolf’s A Room of One’s Own and Three Guineas alongside Paula Gunn Allen’s The Sacred Hoop: Recovering the Feminine in American Indian Traditions. Reading these landmark texts together helps establish a transnational dialogue essential to twenty-first-century literary and feminist studies. A Room of One’s Own and The Sacred Hoop resonate with each other in striving to recuperate women’s history and literature, long denied or suppressed by patriarchal tenets and texts. A fruitful dialogic also emerges between Three Guineas and The Sacred Hoop, both of which argue for the eradication of patriarchy in favor of female-centric social structures in order to achieve individual and collective social and cultural equity. In examining the similarities as well as differences among these works, this essay also discusses the complementarities and conflicts among Indigenous and white/Western feminisms. Studying Woolf and Allen together builds a shared platform for intersectional analysis, vital to third-wave feminist concerns

Barriers to Pediatric Pain Management: A Nursing Perspective

This study describes strategies used by the Joint Clinical Practice Council of Children's Hospital of Wisconsin to identify barriers perceived as interfering with nurses' (RNs) ability to provide optimal pain management. A survey was used to ascertain how nurses described optimal pain management and how much nurses perceived potential barriers as interfering with their ability to provide that level of care. The survey, "Barriers to Optimal Pain management" (adapted from Van Hulle Vincent & Denyes, 2004), was distributed to all RNs working in all patient care settings. Two hundred seventy-two surveys were returned. The five most significant barriers identified were insufficient physician (MD) orders, insufficient MD orders before procedures, insufficient time to premedicate patients before procedures, the perception of a low priority given to pain management by medical staff, and parents' reluctance to have patients receive pain medication. Additional barriers were identified through narrative comments. Information regarding the impact of the Acute Pain Service on patient care, RNs' ability to overcome barriers, and RNs' perception of current pain management practices is included, as are several specific interventions aimed at improving or ultimately eliminating identified barriers. (C) 2011 by the American Society for Pain Management Nursin

‘I don’t belong nowhere really’: the figure of the London migrant in Dan Jacobson’s ‘A Long Way from London’ and Jean Rhys’s ‘Let Them Call It Jazz’

Publisher versionIn this article we compare and contrast the figure of the migrant, central to Dan Jacobson’s short story ‘A Long Way from London’ ([1953] 1958. A Long Way from London and other stories. London: Weidenfeld & Nicholson), and to Jean Rhys’s short story ‘Let Them Call It Jazz’ ([1962] 1987. The Collected Stories. New York: Norton), both of which are set in London in the early to mid-twentieth century. The main argument is that these figures, as migrants in London from South Africa and the Caribbean respectively, similarly occupy a liminal space despite stark differences in class, race and gender. In both stories this liminal space is described through evocations of London as a hostile diasporic space, lacking in hospitality, and experienced by the migrant figure as a place of confinement and incarceration. Also, both stories utilize the technique of silence or lacunae when it comes to issues of specific discrimination and abuse, such as racism or sexual exploitation. For the purposes of comparison, the character Manwera from ‘A Long Way from London’ and, Selina, the protagonist of ‘Let Them Call It Jazz’, are selected for analysis. Particularly, their respective responses (Manwera’s pride and dignity, and Selina’s recovery after a breakdown, and her musical talent) to the exigencies of migration are suggestive of ‘adaptive strength’ (Steve Vertovec and Robin Cohen [1999] 2001. Migration, Diasporas and Transnationalism. Cheltenham and Northampton MA: Elgar Reference Collection, xviii), a common feature in transnational literature which attempts to celebrate liminality and multiplicity as key characteristics of a transnational subjectivity. In addition, the protagonist of ‘A Long Way from London’, Arthur, offers a contrast to Manwera and Selina, not only because of race and class, but because he is depicted as having adapted to and assimilated into British culture, while being strangely detached from and ambivalent about both homeland and diasporic home. Varying forms of adaptive strength are portrayed in both stories, but they close with intimations of bleak futures for the migrant figures. The essay thus concludes with the observation that in these two stories, the figure of the London migrant is rendered as facing further grave challenges, and that all three figures ‘belong nowhere’ (Rhys [1962] 1987 Rhys, Jean. [1962] 1987. The Collected Stories. New York: Norton. [Google Scholar] , 175)

“The Reality of Becoming”: Deleuze, Woolf and the Territory of Cows

Woolf's modernist animals affected Deleuze and Guattari's animal philosophy, as they describe in A Thousand Plateaus. This essay focuses on the significance of these references to Woolf's aesthetics for Deleuzian philosophy, whilst also considering how we can better understand Woolf's broader exploration of animality (in texts including The Waves, Flush and Between the Acts) through close engagement with Deleuze's conceptual framework (in particular ‘becoming-animal’ and ‘de-’ and ‘reterritorialisation’). In mapping various appearances of one of the oldest domesticated animals, cows, in the work of both, the essay builds an argument about the shared bovine territory in their writings and the ontological and ethical implications of this. It therefore expands upon the relationship between Deleuze and Woolf at the same time as affirming the importance of their animal ontology, ethics and aesthetics for animal studies more widely

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)