Aspects of \u27Indefiniteness\u27 in George Eliot\u27s Middlemarch

In this article I will be teasing out the significance of the various uses and senses of \u27indefiniteness\u27 in Middlemarch. Whether it is in relationships between other characters, or between Dorothea and other characters, or between Dorothea and herself, or indeed between Dorothea and the novel or the reader, it will be seen that indefiniteness often stands in for unfavourable conceptions of abstraction and externality, and that all contribute to disharmony in Eliot\u27s rendering. This disharmony is resolved by the end of the novel, and it seems to me that this particular resolution is one of the novel\u27s main themes. Let us start with the Prelude. In his review of Middlemarch Henry James laments the fact that there a \u27definite subject\u27 is established, the centrality of Dorothea and her story, but that then the novel fails structurally in diffusing the centrality of this main character.\u27 He is complaining of a resulting diffuseness in the novel, a lack of sufficient symmetry and neatness; he thinks it rambles. Barbara Hardy has argued against such a criticism in her formal analysis of contrast and correspondence in Middlemarch. She claims that these contrasts and correspondences are such a glaring feature of the novel that they are in effect \u27a reading direction\u27, that they are just as much a part of the reader\u27s enjoyment and experience of the novel, if, as I would suggest, at a second order level. And, this being so, these formal or structural attributes \u27concentrate\u27 the novel.2 So even if Dorothea fades out as the central concern of the novel, the structural properties of its resulting multiplicity prevent it from becoming diffuse or indefinite (to use the opposite term to James\u27s choice of word). If we look at the Prelude and the parallel drawn between St Theresa and Dorothea, and consider it in relation to the ensuing novel, we realize that Dorothea cannot become another St Theresa because of the limits to individuality in Middlemarch society; her indefinite spiritual ardour (the equivalent of St Theresa\u27s \u27illimitable satisfaction\u27) must be realistically checked by her concrete situation, her \u27domestic reality\u27. This is why the novel veers away from Dorothea after Book One

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

DESIGN AND VISCOELASTOPLASTIC CHARACTERIZATION OF A LIME-DUNE SAND-ASPHALT MIX (REPLACING AGGREGATE, MATERIAL LAWS, CREEP COMPLIANCE, RUTTING).

Viscoelastic and viscoelastoplastic characterization of pavement materials by means of simple testing and simple equipment is of great concern to pavement technologists. Another area of great concern is the replacement of premium aggregates by local materials after improving the engineering properties of the local materials. Such replacement is for the avoidance of the high costs of hauling the well-graded aggregates whose resources are also being depleted. These two research areas were combined in this study. A uniformly graded dune sand which is abundant in desert-like areas was upgraded with hydrated lime and stabilized with asphalt to improve its engineering properties. By variation of some of the mix design variables, a mix that complied with Marshall and Hveem stability criteria was produced. The effect of lime on the engineering properties of the mix was studied, and substantial improvements due to the addition of lime were observed. A mix that contained 10% Type S lime was found to have engineering properties that were comparable with those of conventional asphaltic concrete. Also, the effect of lime on the thermorheological, thermal, and elastic properties of bituminous mixes in general was studied. In addition to complying with the above-mentioned stability criteria, the lime-sand-asphalt mix was characterized by creep compliance, over wide ranges of time and temperature, so that the mix is available for thickness design by both the empirical and the theoretical methods of pavement design. New, simple equipment by which repeated as well as constant load creep tests can be easily performed was introduced and used to develop a viscoelastic-plastic constitutive law of the designed lime-sand-asphalt mix. Both the equipment and the testing are simple and gave repeatable measurements. Models for the elastic, plastic, viscoelastic and viscoplastic responses of the designed mix were derived from measurements taken by this equipment and by using computerized regression analysis techniques. Generalized models for the viscoelastic strain during the N-th loading and the N-th recovery period were developed. A FORTRAN computer program was written for computing the four strain components mentioned above separately, and for computing the total strain component for large numbers of load repetitions

RuuviTag and Embedded Systems: Environment Monitoring in Technical Facilities

The purpose of this thesis was to highlight the importance and performance aspects of Embedded System devices, focusing on the RuuviTag system in Industrial Automation environments. The RuuviTag is a wireless sensor beacon developed by Ruuvi Ltd (RuuviTag Technical Specifications 2023). The study was aimed to explore the benefits and potential disadvantages of using standardized and open-source Embedded Systems in technical environments, and to evaluate the future developments of these systems based on the RuuviTag. The research methodology involved both theoretical and practical applications. Providing a comprehensive literature review that was conducted to establish a theoretical foundation. This was followed by the practical implementation of the RuuviTag system within an industrial setting, specifically focusing on its implementation with a Raspberry Pi 3B+ to function as an Edge Gateway. The data collected from the RuuviTag was then transmitted and visualized using ThingsBoard, an open-source Internet of Things (IoT) platform for device management. The stages of the study included system setup, hardware and software configuration, data collection, and analysis of the system's performance in real-time environments. The study found that the RuuviTag system, when implemented with a Raspberry Pi 3B+, effectively collected and transmitted environmental data with high accuracy and reliability. The implementation demonstrated significant improvements in data acquisition and real-time monitoring capabilities. Additionally, the use of ThingsBoard allowed for efficient data visualization and analysis, providing valuable insights into the system's performance and potential areas for optimization. The findings highlight the potential of open-source sensor devices like the RuuviTag to enhance industrial automation processes. The study concludes that such systems offer considerable benefits in terms of cost efficiency, flexibility, and scalability. The successful integration of the RuuviTag with existing industrial systems suggests promising applications for larger implementations in various technical environments. This research contributes to the understanding of how Embedded Systems can be utilized to improve operational efficiency and supports the case for further development and deployment of these technologies in industrial settings