Att skapa eller icke skapa : En uppgörelse med den konstnärliga blockeringens filosofi och psykologi utifrån Julia Camerons teori om konstutövning

Syftet med detta arbete är att gestalta och analysera författaren Julia Camerons teori om konstutövning, som den uttrycks i två av böckerna i hennes Artist's Way-trilogi. I synnerhet strävar jag efter att uppnå en förståelse av det vanliga fenomenet att människors konstnärliga handlingar stöter på hinder eller blockeringar i form av deras egna tanke- och beteendemönster. Ett annat viktigt syfte är att undersöka vad individen själv kan göra för att bryta sina blockerande mönster och frigöra sin konstnärliga potential. I denna forskning använder jag en hermeneutisk forskningsansats. Min studie visar att grundorsaken till konstnärliga blockeringar är kollektiva, felaktiga föreställningar om vad konst är och vem som är konstnär. Våra kulturella myter om konsten och konstnären ger upphov till en uppdelning av människor i konstnärer och ickekonstnärer, och den resulterande konstnärliga ojämlikheten får negativa konsekvenser för båda grupperna. Jag beskriver Camerons egna teser om konstens verkliga väsen och syfte samt konstnärens verkliga identitet, och utreder och analyserar den konstnärliga blockeringens olika former, uppkomst och mekanismer. Slutligen identifierar jag sex huvudsakliga strategier som varje individ kan använda för att överkomma sina blockeringar och frigöra sin fulla konstnärliga potential.The aim of this thesis is to investigate and analyze author Julia Cameron's theory on creativity, as expressed in two of her books in the Artist's Way trilogy. In particular, I strive to gain an understanding of the common phenomenon that a person's creative actions are obstructed or blocked by their own patterns of thought and behavior. Another important purpose is to investigate what actions the individual person can take to break their blocking patterns and free their creative potential. My research is conducted using a hermeneutic approach. According to my study, the primary cause of creative blocks are collective, faulty ideas about the essence of art and the identity of the artist. Our cultural mythology about art and artists causes a dichotomy between artists and non-artists, and the resulting artistic inequality becomes the cause of negative consequences for both groups. I describe Cameron's own philosophy on the actual purpose of art and the artist's actual identity, and explore and analyze the forms, causes and mechanisms of creative blockage. Ultimately, I identify six major strategies which can be adopted by any individual concerned with overcoming their artist's block and freeing their full creative potential

Intensive care unit burden is associated with increased mortality in critically ill COVID-19 patients

BACKGROUND: Traditional models to predict intensive care outcomes do not perform well in COVID-19. We undertook a comprehensive study of factors affecting mortality and functional outcome after severe COVID-19.METHODS: In this prospective multicentre cohort study, we enrolled laboratory-confirmed, critically ill COVID-19 patients at six ICUs in the Skåne Region, Sweden, between May 11, 2020, and May 10, 2021. Demographics and clinical data were collected. ICU burden was defined as the total number of ICU-treated COVID-19 patients in the region on admission. Surviving patients had a follow-up at 90 days for assessment of functional outcome using the Glasgow Outcome Scale-Extended (GOSE), an ordinal scale (1-8) with GOSE ≥5 representing a favourable outcome. The primary outcome was 90-day mortality; the secondary outcome was functional outcome at 90 days.RESULTS: Among 498 included patients, 74% were male with a median age of 66 years and a median body mass index (BMI) of 30 kg/m 2 . Invasive mechanical ventilation was employed in 72%. Mortality in the ICU, in-hospital and at 90 days was 30%, 38% and 39%, respectively. Mortality increased markedly at age 60 and older. Increasing ICU burden was independently associated with a two-fold increase in mortality. Higher BMI was not associated with increased mortality. Besides age and ICU burden, smoking status, cortisone use, P a CO 2 >7 kPa, and inflammatory markers on admission were independent factors of 90-day mortality. Lower GOSE at 90 days was associated with a longer stay in the ICU. CONCLUSION: In critically ill COVID-19 patients, the 90-day mortality was 39% and increased considerably at age 60 or older. The ICU burden was associated with mortality, whereas a high BMI was not. A longer stay in the ICU was associated with unfavourable functional outcomes at 90 days

Wood Cellulose Preparation Methods and Mass Spectrometric Analyses of δ 13 C, δ 18 O, and Nonexchangeable δ 2 H Values in Cellulose, Sugar, and Starch: An Interlaboratory Comparison

International audienc

Recent human-induced atmospheric drying across Europe unprecedented in the last 400 years

International audienc

Atmospheric drying across Europe is unprecedented in a pre-industrial context

Vapour pressure deficit (VPD) represents the desiccation strength of the atmosphere, fundamentally impacting evapotranspiration, ecosystem functioning and vegetation productivity. Its spatial patterns and long-term changes under natural versus human-induced climate change are poorly understood but are essential for predicting its future ecological and socio-economic effects, e.g., on crop yield, bioclimatic comfort or wildfires. We combine regional reconstructions of pre-industrial summer VPD variability from a European tree-ring oxygen-isotope network with excellent climate sensitivity with observations and Earth System Model simulations. We demonstrate a recent human-induced intensification of atmospheric drying across Europe that exceeds natural variability specifically in the Alps and Pyrenees, but also in western, central and southern Europe. A less distinct increase occurs in Fennoscandia. This VPD increase may cause an enhanced risk of tree mortality, forest decline and yield reductionsevenin the temperate lowland regions of Europe, particularly when considering the extreme drought events in the recent years

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days. Results: A total of 5021 patients with a median age of 84 years (IQR 81–86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807)

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries. CONCLUSIONS: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NTC03134807)