PEN International and its Republic of Letters, 1921-1970

In 1921 a circle of writers formed a dinner club in London to welcome foreign writers visiting from abroad. Punningly dubbed the "P.E.N."--for the poets, playwrights, essayists and novelists invited into its fold--the group argued that writers above all could best promote communication and civility across national lines. Over the years, PEN survived a series of onslaughts that undermined this humanistic idea: fascist infiltration, yet another World War, revelations of Holocaust, the shock of atomic warfare, and CIA meddling. By 1970 PEN had become global, transforming from a British club into an organization devoted to protecting freedom of expression and facilitating communication worldwide. In doing so, its members strove to create an institutionalized form of the Republic of Letters, a federation that aimed to model cultural civility to the wider world. PEN survived challenges to its existence because it molded itself to evolving contexts while insisting on the stability of its core values. PEN justified its existence by arguing that its definition of literary values were universal. Yet PEN's ideals needed to be protected and promoted by an institution precisely because they were neither universally accepted nor secure. PEN promoted a distinctly liberal, humanistic, and aesthetically middlebrow definition of literature and its social role. By claiming its values were universal, giving them institutional expression, and attracting the attention of funders and competing governments during the Cold War, PEN helped make liberal humanism seem synonymous with internationalism

Using Project ECHO to deliver a tele-mentoring and teaching program on palliative care in South Asia:Interpretive description of participants' experiences with a community of practice for learning

Objectives To explore the learning experiences of participants (learners and teachers), in a yearlong tele-teaching and mentoring program on pediatric palliative care, which was conducted using the Project ECHO (Extension for Community Healthcare Outcomes) model and consisted of 27 teaching and clinical case discussion sessions for palliative medicine residents in India and Bangladesh. The goal of the study is to explore how participation and learning is motivated and sustained for both residents and teachers, including the motivators and challenges to participation and learning in a novel online format. Methods Qualitative interviews with ECHO participants, including learners and teachers were conducted. Interviews were recorded and transcribed. Thematic analysis of interview data was conducted within an interpretive description approach. Results Eleven physicians (6 residents, 5 teachers) participated in interviews. Key elements of the ECHO program which participants identified as supporting learning and participation include small group discussions, a flipped classroom, and asynchronous interactions through social media. Individual learner characteristics including effective self-reflection and personal circumstances impact learning. Providing opportunities for a diverse group of learners and teachers, to interact in communities of practice (COP) enhances learning. Three major themes and 6 subthemes describing learning processes were identified. Themes included (1) ECHO program structure, (2) learner characteristics, and (3) COP. Subthemes included flipped classroom, breakout rooms, learning resources, personal circumstances, self-awareness of learning needs, and community interactions. Significance of results Project ECHO suggests a novel model to train health providers, which is effective in low- and middle-income countries. Online learning programs can lead to learning through community of practice when learners and teachers are able to interact and engage in peer support and reflective practice. Educators should consider incorporating small group discussions, a flipped classroom design, and opportunities for asynchronous interactions to enhance learning for participants in online learning programs.</p

Exploring the expansion of planner’s engagement capabilities via accessing the data from a building information model for public consultation

A statutory urban planning consultation is the only opportunity to address concerns of the public regarding the shared built environment. However, current methods for consulting the public on urban planning proposals are archaic. They are often uncoordinated and can potentially fail to provide an inclusive forum for all socio-demographics. Face-to-face consultations are noted as the best method to consult. However, they only provide a means for those with time and mobility to attend the discussions, workshops, and exhibitions regarding the built environment. Urban planning consultation processes are also limited by stakeholder relationships. It is not often that stakeholders acknowledge each other. This thesis focuses on approaches to stakeholder identification, management, and engagement. Stakeholders can be identified at any stage of project development and addressed as internal (who have a direct hand in changing a project) and external (who are impacted by changes.) Stakeholder management and engagement can vary in theory and practice, and this thesis will explore this. Internal stakeholders utilise their own communication methods and processes to cooperate and consider risk at each stage of the project. Building information modelling (BIM) is a collaborative tool which shares textual and image data among the building development project team. Planners implementing a consultation with the public do not use BIM, as it is software for internal stakeholders to share information for the project development in a common data environment (CDE). BIM is a technical methodology primarily used to communicate the strategy of the project (including usual details and specifications) but is limited in its further applications for encouraging communication beyond this initial scope. External stakeholders rely on planners to reach wider audiences, but without mediation from an expert to explain the technical language in layman’s terms, there remains a gap in knowledge making it difficult for the public to understand specific design decisions. This PhD study aims to understand how 3D Building Information Models (BIM) and associated data can be utilised to facilitate communication throughout each stage of the planning consultation and explores how BIM may be used to address the knowledge gap specifically through an online planning consultation platform. This is increasingly important as more digital tools are being introduced into the planning sphere and incorporating the views of the public and other stakeholders, should be central to planning consultations in the UK. This research presents mixed methods in order to identify the requirements for a digital planning portal that best presents BIM data for the use of public consultations. The visual and textual information of a BIM model is documented and validated with a case study and recommendations are made for using BIM data within a public consultation. Throughout the study, the concepts of what consultations are in currently in place are considered, in parallel to current policy and best practice. The author presents the impact digital tools and how these might be utilised within the current planning consultation process. The findings show that, with the incorporation of digital platforms in planning consultations, a greater focus on stakeholder perspectives and relationships can be established

The Most Commonly Occurring Papillary Thyroid Cancer in the United States Is Now a Microcarcinoma in a Patient Older than 45 Years

Background: The incidence of papillary thyroid cancer (PTC) is growing at a faster rate than any other malignancy. However, it is unknown what effect age is having on the changing PTC incidence rates. With the goal of understanding the role of age in thyroid cancer incidence, this study analyzes the changing demographics of patients with PTC over the past three decades. Methods: This was a retrospective evaluation of the incidence rates of PTC from 1973 to 2006 reported by the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Results: From 1973-2006 the age group most commonly found to have PTC has shifted from patients in their 30s to patients in the 40-50-year-old age group. In 1973 60% of PTC cases were found in patients younger than 45, and the majority of cases continued to occur in younger patients until 1999. After 1999 PTC became more common in patients older than 45 years, and in 2006, 61% of PTC cases were in patients older than 45 years. From 1988 to 2003 there has been an increasing incidence of all sizes of PTC in all age groups with the largest increase in tumors <1-cm in patients older than 45. Forty-three percent of tumors in patients older than 45 are now <1-cm, whereas only 34% are <1-cm in patients younger than 45. Of the nearly 20,000 thyroid cancer cases in 2003, 24% were microcarcinomas in patients over the age of 45. Conclusions: The incidence of PTC is increasing disproportionally in patients older than 45 years. The number of PTC tumors smaller than 1-cm is increasing in all age groups, and now the most commonly found PTC tumor in the United States is a microcarcinoma in a patient older than 45 years. These changing patterns relating age and incidence have important prognostic and treatment implications for patients with PTC.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90466/1/thy-2E2010-2E0137.pd

Preoperative botulinum neurotoxin A for children with bilateral cerebral palsy undergoing major hip surgery: a randomized double-blind placebo-controlled trial.

AIM: To assess whether preoperative botulinum neurotoxin A (BoNT-A) affects pain after major hip surgery for children with bilateral cerebral palsy (CP). METHOD: This was a randomized, parallel arms, placebo-contolled trial. Children with hypertonic CP aged 2 to 15 years awaiting bony hip surgery at a tertiary hospital were randomized to receive either BoNT-A or placebo injections into the muscles of the hip on a single occasion immediately before surgery. The primary outcome was the paediatric pain profile (PPP), which was assessed at baseline and weekly for 6 weeks. Treatment allocation was by minimization. Participants, clinicians, and outcome assessors were masked to group assignment. RESULTS: Twenty-seven participants (17 males, 10 females; mean 8y 8mo [SD 3y 9mo], range 3y 4mo-15y 10mo) were allocated to BoNT-A and 27 participants (14 males, 13 females; mean 8y 11mo [SD 3y 5mo], range 4y 1mo-15y 2mo) to placebo. Mean (SD) PPP at 6 weeks for the BoNT-A group (n=24 followed up) was 10.96 (7.22) and for the placebo group (n=26) was 10.04 (8.54) (p=0.69; 95% confidence interval [CI] -4.82, 3.18). There were 16 serious adverse events in total during 6 months of follow-up (n=6 in BoNT-A group). INTERPRETATION: Use of BoNT-A immediately before bony hip surgery for reducing postoperative pain for children with CP was not supported. WHAT THIS PAPER ADDS: Botulinum neurotoxin A (BoNT-A) does not reduce postoperative pain following bony hip surgery. BoNT-A also does not affect postoperative quality of life

Illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh: A cross-sectional study.

BACKGROUND:Despite recognition that palliative care is an essential component of any humanitarian response, serious illness-related suffering continues to be pervasive in these settings. There is very limited evidence about the need for palliative care and symptom relief to guide the implementation of programs to alleviate the burden of serious illness-related suffering in these settings. A basic package of essential medications and supplies can provide pain relief and palliative care; however, the practical availability of these items has not been assessed. This study aimed to describe the illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh. METHODS AND FINDINGS:Between November 20 and 24, 2017, we conducted a cross-sectional study of individuals with serious health problems (n = 156, 53% male) and caregivers (n = 155, 69% female) living in Rohingya refugee camps in Bangladesh, using convenience sampling to recruit participants at the community level (i.e., going house to house to identify eligible individuals). The serious health problems, recent healthcare experiences, need for medications and medical supplies, and basic needs of participants were explored through interviews with trained Rohingya community members, using an interview guide that had been piloted with Rohingya individuals to ensure it reflected the specificities of their refugee experience and culture. The most common diagnoses were significant physical disabilities (n = 100, 64.1%), treatment-resistant tuberculosis (TB) (n = 32, 20.5%), cancer (n = 15, 9.6%), and HIV infection (n = 3, 1.9%). Many individuals with serious health problems were experiencing significant pain (62%, n = 96), and pain treatments were largely ineffective (70%, n = 58). The average age was 44.8 years (range 2-100 years) for those with serious health problems and 34.9 years (range 8-75 years) for caregivers. Caregivers reported providing an average of 13.8 hours of care per day. Sleep difficulties (87.1%, n = 108), lack of appetite (58.1%, n = 72), and lack of pleasure in life (53.2%, n = 66) were the most commonly reported problems related to the caregiving role. The main limitations of this study were the use of convenience sampling and closed-ended interview questioning. CONCLUSIONS:In this study we found that many individuals with serious health problems experienced significant physical, emotional, and social suffering due to a lack of access to pain and symptom relief and other essential components of palliative care. Humanitarian responses should develop and incorporate palliative care and symptom relief strategies that address the needs of all people with serious illness-related suffering and their caregivers

A Neuropsychological Profile for Agenesis of the Corpus Callosum?: Cognitive, Academic, Executive, Social, and Behavioral Functioning in School-Age Children

Objectives: Agenesis of the corpus callosum (AgCC), characterized by developmental absence of the corpus callosum, is one of the most common congenital brain malformations. To date, there are limited data on the neuropsychological consequences of AgCC and factors that modulate different outcomes, especially in children. This study aimed to describe general intellectual, academic, executive, social and behavioral functioning in a cohort of school-aged children presenting for clinical services to a hospital and diagnosed with AgCC. The influences of age, social risk and neurological factors were examined. Methods: Twenty-eight school-aged children (8 to 17 years) diagnosed with AgCC completed tests of general intelligence (IQ) and academic functioning. Executive, social and behavioral functioning in daily life, and social risk, were estimated from parent and teacher rated questionnaires. MRI findings reviewed by a pediatric neurologist confirmed diagnosis and identified brain characteristics. Clinical details including the presence of epilepsy and diagnosed genetic condition were obtained from medical records. Results: In our cohort, ~50% of children experienced general intellectual, academic, executive, social and/or behavioral difficulties and ~20% were functioning at a level comparable to typically developing children. Social risk was important for understanding variability in neuropsychological outcomes. Brain anomalies and complete AgCC were associated with lower mathematics performance and poorer executive functioning. Conclusions: This is the first comprehensive report of general intellectual, academic, executive social and behavioral consequences of AgCC in school-aged children. The findings have important clinical implications, suggesting that support to families and targeted intervention could promote positive neuropsychological functioning in children with AgCC who come to clinical attention