32 research outputs found

    Encountering Berlant part 1: Concepts otherwise

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    In Part 1 of ‘Encountering Berlant’, we encounter the promise and provocation of Lauren Berlant's work. In 1000-word contributions, geographers and others stay with what Berlant's thought offers contemporary human geography. They amplify an encounter with their work, demonstrating how a concept, idea, or style disrupts something, opens up a new possibility, or simply invites thinking otherwise. The encounters range across the incredible body of work Berlant left us with, from the ‘national sentimentality’ trilogy through to recent work on negativity. Varying in form and tone, the encounters exemplify and enact the inexhaustible plenitude of Berlant's thought: fantasy, the case, love, impasse, feel tanks, slow death, ellipses, gesture, attrition, intimate public, ambivalence, style. Part 2 of ‘Encountering Berlant’ focuses on Berlant's most influential concept: ‘cruel optimism’. Across these heterogeneous encounters, Berlant's enduring concern with the tensions and possibilities of relationality and how to enact better forms of common life shine through. These enduring concerns and Berlant's commitment to the incoherence and overdetermination of phenomena are summarised in the Introduction, which also explores how Berlant's work has been engaged with in geography. The result is a repository of what an encounter with Berlant's thought makes possible

    Encountering Berlant part one: Concepts otherwise

    Get PDF
    In Part 1 of ‘Encountering Berlant’, we encounter the promise and provocation of Lauren Berlant's work. In 1000-word contributions, geographers and others stay with what Berlant's thought offers contemporary human geography. They amplify an encounter with their work, demonstrating how a concept, idea, or style disrupts something, opens up a new possibility, or simply invites thinking otherwise. The encounters range across the incredible body of work Berlant left us with, from the ‘national sentimentality’ trilogy through to recent work on negativity. Varying in form and tone, the encounters exemplify and enact the inexhaustible plenitude of Berlant's thought: fantasy, the case, love, impasse, feel tanks, slow death, ellipses, gesture, attrition, intimate public, ambivalence, style. Part 2 of ‘Encountering Berlant’ focuses on Berlant's most influential concept: ‘cruel optimism’. Across these heterogeneous encounters, Berlant's enduring concern with the tensions and possibilities of relationality and how to enact better forms of common life shine through. These enduring concerns and Berlant's commitment to the incoherence and overdetermination of phenomena are summarised in the Introduction, which also explores how Berlant's work has been engaged with in geography. The result is a repository of what an encounter with Berlant's thought makes possible. Short Abstract Part 1 of ‘Encountering Berlant’ explores the promise and provocation of Lauren Berlant's work. Contributors amplify an encounter with Berlant's concepts, tones, and styles, drawing out their implications for understanding relationality and how to invent and live better ways of being in common. The result is a repository of what Berlant's thinking offers geographers

    Encountering Berlant part 1: Concepts otherwise

    Get PDF
    In Part 1 of ‘Encountering Berlant’, we encounter the promise and provocation of Lauren Berlant's work. In 1000-word contributions, geographers and others stay with what Berlant's thought offers contemporary human geography. They amplify an encounter with their work, demonstrating how a concept, idea, or style disrupts something, opens up a new possibility, or simply invites thinking otherwise. The encounters range across the incredible body of work Berlant left us with, from the ‘national sentimentality’ trilogy through to recent work on negativity. Varying in form and tone, the encounters exemplify and enact the inexhaustible plenitude of Berlant's thought: fantasy, the case, love, impasse, feel tanks, slow death, ellipses, gesture, attrition, intimate public, ambivalence, style. Part 2 of ‘Encountering Berlant’ focuses on Berlant's most influential concept: ‘cruel optimism’. Across these heterogeneous encounters, Berlant's enduring concern with the tensions and possibilities of relationality and how to enact better forms of common life shine through. These enduring concerns and Berlant's commitment to the incoherence and overdetermination of phenomena are summarised in the Introduction, which also explores how Berlant's work has been engaged with in geography. The result is a repository of what an encounter with Berlant's thought makes possible

    Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

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    Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

    Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

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    Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

    Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

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    Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

    Birds build camouflaged nests

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    This work was supported by the Biotechnology and Biological Sciences Research Council (BBSRC) (BB/I019502/1 to S.D.H. and S.L.M.) and by Roslin Institute Strategic Grant funding from the BBSRC (to S.L.M).It is assumed that many birds attempt to conceal their nests by using camouflage. To our knowledge, however, no previous experimental studies have explicitly tested this assumption. To explore whether birds choose materials that match the background colors of nest sites to reduce the conspicuousness of their nests, we offered nest-building male Zebra Finches (Taeniopygia guttata) a choice of nest materials that either matched or did not match the color of their nest cup and the surrounding cage walls. Males chose to nest predominantly with material that matched the background color of the cage. To our knowledge, this is the first experimental evidence that birds actively select materials that camouflage their nests.Publisher PDFPeer reviewe
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