Tito, Dionysus and Apollo: an Examination of Tito Melema in Romola

Greek myth is significant throughout George Eliot’s work, and is especially important in the characterization of Tito Melema. A particular identification with Dionysus or Bacchus begins early in the novel when Nello, after remarking that the newcomer seems to have come “straight from Olympus: (Ch. 2, 71), later finds that he resembles a young Bacchus or an Apollo (Ch. 4, 87). Further, the term “the stranger”, a common appellation of the god in the ancient world, where he was regarded as a foreigner from over the sea, comes when this stranger in Florence is frequently so called, often by the narrator throughout the first three chapters; indeed, the very first chapter is entitled “The Shipwrecked Stranger”. Even a year later, Bernardo still thinks of him as “the young Greek stranger” (Ch. 19, 248). Early in the novel again, a Bacchic association with the Via de’Bardi, presaged through an allusion to Nonnus’s Dionysiaca (Ch.5, 94), is confirmed whim Romola, expecting this new scholar to be middle-aged or elderly, is confronted with the handsome young Tito: her surprise “could not have been greater if the stranger had worn a panther-skin and carried a thyrsus” (Ch.6 6, 105). The panther-skin and thyrsus were traditional attributes of Bacchus; and Tito is once again “the stranger”. This parallel with Dionysus is maintained by Tito’s self-identification with the god through the portrait on the triptych, through his use of a recognized epithet of Bacchus when he calls himself Romola’s “Care-Dispeller” (Ch. 20, 263) and through the purple and red tunic he wears for his betrothal, reminiscent as it is of the multi-coloured garment associated with the god, reddish-purple in particular being one of the Bacchis colours. Further, in an allusion to the yoking of a lion and a boar to a chariot during the wooing of Alcestis (Ch. 13, 186), there is a reminder of the Dionysian chariot, traditionally also drawn by wild beasts, and Bacchus is yet again recalled when Piero di Cosimo thinks of the young man as “my Bacco trionfante” (Ch. 25, 297) and when, in the Rucellai Gardens, Tito sings a Bacchic chorus (Ch. 39, 420)

Contested Meanings: Gadfly\u27 Historian Separates Civil War Fact From Myth

Alan T. Nolan is probably best known for two books, written 30 years apart. The first, The Iron Brigade, was published in 1961 and hailed as a model unit history. Three decades later, Nolan wrote Lee Considered: General Robert E. Lee and Civil War History, a much more controversial bo...

The War within the Union High Command: Politics and Generalship During the Civil War

Elite vs. amateur West Point and the Commons The study of Civil War generalship has gotten a bit stale. Many historians and buffs keep asking the same familiar questions: Did the South have better military leaders? Why did it take so long for the Union to find competent commande...

Do patients who die from an alcohol-related condition ‘drift’ into areas of greater deprivation? Alcohol-related mortality and health selection theory in Scotland

Background: Health selection has been proposed to explain the patterning of alcohol-related mortality by area deprivation. This study investigated whether persons who die from alcohol-related conditions are more likely to experience social drift than those who die from other causes. Methods: Deaths recorded in Scotland (2013, >21 years) were coded as ‘alcohol-related’ or ‘other’ and by deprivation decile of residence at death. Acute hospital admissions data from 1996 to 2012 were used to provide premortality deprivation data. χ² tests estimated the difference between observed and expected alcohol-related deaths by first Scottish Index of Multiple Deprivation (SIMD) decile and type of death. Logistic regression models were fitted using type of death as the outcome of interest and change in SIMD decile as the exposure of interest. Results: Of 47 012 deaths, 1458 were alcohol-related. Upward and downward mobility was observed for both types of death. An estimated 31 more deaths than expected were classified ‘alcohol-related’ among cases whose deprivation score decreased, while 204 more deaths than expected were classified ‘alcohol-related’ among cases whose initial deprivation ranking was in the four most deprived deciles. Becoming more deprived and first deprivation category were both associated with increased odds of type of death being alcohol-related after adjusting for confounders. Conclusion: This study suggests that health selection appears to contribute less to the deprivation gradient in alcohol-related mortality in Scotland than an individual’s initial area deprivation category

A Fatal Rectus Sheath Hematoma after a Myasthenia Crisis Case Report

Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal. Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization. Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with fluids and received one unit of packed red blood cells. A CT-angiogram of her abdomen and pelvis demonstrated a type III RSH. She underwent a percutaneous inferior epigastric artery embolization via interventional radiology. Unfortunately, she did not recover and was transitioned to hospice, dying one day after discharge. Conclusion: Although classic teaching about RSHs includes an association with systemic anticoagulation and a physical exam notable for a mass not crossing the midline, it is important to recognize a wider range of presentations including an abdominal mass that crosses the midline, as demonstrated by our patient. Other important risk factors include frailty, immunosuppression, and possibly abdominal injections (particularly heparin)

The Mg/Ca–temperature relationship in brachiopod shells: calibrating a potential palaeoseasonality proxy

Brachiopods are long-lived, long-ranging, extant organisms, of which some groups precipitate a relatively diagenetically stable low magnesium calcite shell. Previous work has suggested that the incorporation of Mg into brachiopod calcite may be controlled by temperature (Brand et al., 2013). Here we build upon this work by using laser ablation sampling to define the intra-shell variations in two modern brachiopod species,Terebratulina retusa (Linnaeus, 1758) and Liothyrella neozelanica (Thomson, 1918). We studied three T. retusa shells collected live from the Firth of Lorne, Scotland, which witnessed annual temperature variations on the order of 7 °C, in addition to four L. neozelanica shells, which were dredged from a water depth transect (168–1488 m) off the north coast of New Zealand. The comparison of intra-shell Mg/Ca profiles with shell δ<sup>18</sup>O confirms a temperature control on brachiopod Mg/Ca and supports the use of brachiopod Mg/Ca as a palaeoseasonality indicator. Our preliminary temperature calibrations are Mg/Ca = 1.76 ± 0.27 e<sup>(0.16 ± 0.03)T</sup>, R<sup>2</sup> = 0.75, for T. retusa and Mg/Ca = 0.49 ± 1.27 e<sup>(0.2 ± 0.11)T</sup>, R<sup>2</sup> = 0.32, for L. neozelanica (errors are 95% confidence intervals)

General practitioner views of an electronic high-risk medicine proforma to facilitate information transfer.

Background The potential of warfarin related harm is increased if clinicians lack the full patient specific information to make informed decisions—an e-proforma has been developed to communicate this information on hospital discharge. Objective To determine the views of general practitioners (GPs) on a warfarin discharge e-proforma. Method A cross-sectional survey of all GPs (n=272) within the Raigmore Hospital catchment area of NHS Highland, Scotland. Results The response rate was 39.3% (107/272). 84 (78.5%) noticed recent changes to information supplied on discharge for warfarin patients. 64 (59.8%) respondents thought this would result in more informed prescribing with regards to dosing, while 65 (60.7%) felt this would improve safety. Accurate completion, timely receipt of the e-proforma and a realistic date for subsequent INR tests were considered important by GPs. Conclusion This study suggests the use of an e-proforma to communicate information about a high-risk medication, warfarin, to GPs on discharge optimises safe, informed prescribing and monitoring in primary care. The development of a discharge e-proforma for other high-risk medication as a patient safety improvement measure should be explored

Pain Management in Cancer Center Inpatients:A Cluster Randomized Trial to Evaluate a Systematic Integrated Approach—The Edinburgh Pain Assessment and Management Tool

Purpose Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes. Patients and Methods In a two-arm, parallel group, cluster randomized (1:1) trial, we observed pain outcomes in 19 cancer centers in the United Kingdom and then randomly assigned the centers to either implement EPAT or to continue UC. The primary outcome was change in the percentage of study participants in each center with a clinically significant (≥ 2 point) improvement in worst pain (using the Brief Pain Inventory Short Form) from admission to 3 to 5 days after admission. Secondary outcomes included quality of analgesic prescribing and opioid-related adverse effects. Results Ten centers were randomly assigned to EPAT, and nine were assigned to UC. We enrolled 1,921 patients and obtained outcome data from 93% (n = 1,795). Participants (mean age, 60 years; 49% women) had a variety of cancer types. For centers randomly assigned to EPAT, the percentage of participants with a clinically significant improvement in worst pain increased from 47.7% to 54.1%, and for those randomly assigned to continue UC, this percentage decreased from 50.6% to 46.4%. The absolute difference was 10.7% (95% CI, 0.2% to 21.1%; P = .046) and it increased to 15.4% (95% CI, 5.8% to 25.0%; P = .004) when two centers that failed to implement EPAT were excluded. EPAT centers had greater improvements in prescribing practice and in the Brief Pain Inventory Short Form pain subscale score. Other pain and distress outcomes and opioid adverse effects did not differ between EPAT and UC. Conclusion A systematic integrated approach improves pain outcomes for inpatients in cancer centers without increasing opioid adverse effects