Heterochronic Representations of the Fall : Bakhtin, Milton, DeLillo

Bakhtin argues that each literary genre codifies a particular world-view which is defined, in part, by its chronotope. That is, the spatial and temporal configurations of each genre determine in large part the kinds of action a fictional character may undertake in that given world (without being iconoclastic, a realist hero cannot slay mythical beasts, and a questing knight cannot philosophize over drinks in a café). Recent extensions of Bakhtin’s theory have sought to define the chronotopes of new and emergent genres such as the road movie, the graphic novel, and hypertext fiction. Others have challenged Bakhtin’s characterization of certain chronotopes, such as those of epic and lyric poetry, arguing that these genres (and their chronotopes) are far more dynamic and dialogic than Bakhtin’s analysis seems at first glance to allow. Rather than taking issue with Bakhtin’s characterization of particular genres here, however, I wish to argue that we should pay closer attention to the heterochrony, or interplay of different chronotopes, in individual texts and their genres. As Bakhtin’s own essay demonstrates, what makes any literary chronotope dynamic is its conflict and interplay with alternative chronotopes and world-views. Heterochrony (raznovremennost) is the spatiotemporal equivalent of linguistic heteroglossia, and if we examine any of Bakhtin’s readings of particular chronotopes closely enough, we will find evidence of heterochronic conflict. This clash of spatiotemporal configurations within a text, or family of texts, provides the ground for the dialogic inter-illumination of opposing world-views

Child protection decision-making and ethical engagement: a comparative analysis of social work practice in England and Finland

The decision to intervene in family life to protect a child necessitates weighing up ethical and legal considerations, a task shaped by the knowledge, skills and personal values of social workers and situated in organisational and local policy contexts. Recent comparative research has improved understanding of how national child protection systems operate, however less is known about how national contextual factors influence decision-making at the practice level. In view of this, this study explores how social workers in two nations, England and Finland, make child protection decisions and engage with ethical issues during this process. The qualitative study involved interviews with 30 social workers in child protection agencies across England and Finland. Participants were asked to comment on two constructed case vignettes, each of which incorporated an ethical dimension, and were interviewed about their experiences of ethical dilemmas and decision-making in practice. Similarities were observed in the English and Finnish participants’ responses to the vignettes. Ethical engagement was seen to vary at an individual level, although in general participants from both nations focused on presenting risk factors over the ethical aspects of the cases. The participants’ narratives further highlighted the significance of support networks in guiding decisions, with differences observed in the nature and extent of support provision across the samples. The findings demonstrate the importance of decision-making environments, both national and organisational, in shaping child protection decisions. The study’s comparative lens reveals how practice is supported through different mechanisms in different national contexts, yet irrespective of the child protection system in place, support structures seem to be vital in helping social workers to negotiate the ethical complexities of practice. It is argued that strengthening these support structures, while fostering a culture of discussion and reflection, may help organisations to better integrate ethical engagement into everyday work processes

Comparing child protection decision-making in England and Finland : supervised or supported judgement?

Systems for the protection of children have evolved differently across nation states. Studies have identified contrasting system ‘orientations’, related to how child protection problems are framed and how organisations respond in different contexts. In this study, the influence of national and organisational factors on practice-level decision reasoning by social workers has been compared. Interviews were conducted with 30 child protection social workers in sites across England and Finland, structured around two hypothetical case vignettes. While similarities were observed in how the social workers responded to the vignettes, there were differences in the nature and extent of managerial involvement described, with the English social workers appearing to rely on managerial input for decision-making to a greater extent than the Finnish social workers. These findings suggest evidence for two distinct organisational approaches to decision-making: ‘supervised’ and ‘supported’ judgement. Here, supervised judgement describes a hierarchical, ‘top-down’ form of decision-making, while supported judgement describes a more horizontal and shared decision-making approach. The lens of comparative methodology has revealed how these organisational factors come into play in different child protection systems. The practice implications of supervised, manager-led approaches to decision-making, as contrasted with supported, team-led approaches, are discussed

Reducing surgical site infection rates in colorectal surgery – a quality improvement approach to implementing a comprehensive bundle

Funding Information: Funding for project management time was received from the Scottish Patient Safety Programme.Peer reviewedPublisher PD

Accelerometer-measured sedentary time and cardiometabolic biomarkers:A systematic review

AbstractObjectiveWe conducted a systematic review to investigate the cross-sectional and prospective associations of accelerometer-measured total sedentary time and breaks in sedentary time with individual cardiometabolic biomarkers in adults ≥18years of age.MethodsOvid Medline, Embase, Web of Science and the Cochrane Library were searched for studies meeting the inclusion criteria. Due to inconsistencies in the measurement and analysis of sedentary time, data was synthesised and presented narratively rather than as a meta-analysis.ResultsTwenty-nine studies were included in the review; twenty-eight reported on total sedentary time and six on breaks in sedentary time. There was consistent evidence from cross-sectional data of an unfavourable association between total sedentary time and insulin sensitivity. There was also some evidence that total sedentary time was unfavourably associated with fasting insulin, insulin resistance and triglycerides. Furthermore, there was some evidence from cross-sectional data of a favourable association between breaks in sedentary time and triglycerides.ConclusionTotal sedentary time was consistently shown to be associated with poorer insulin sensitivity, even after adjusting for time spent in physical activity. This finding supports the proposed association between sedentary time and the development of Type 2 diabetes and reinforces the need to identify interventions to reduce time spent sedentary

Risk factors for severe acute lower respiratory infections in children – a systematic review and meta-analysis

Aim To identify the risk factors in children under five years of age for severe acute lower respiratory infections (ALRI), which are the leading cause of child mortality. Methods We performed a systematic review of published literature available in the public domain. We conducted a quality assessment of all eligible studies according to GRADE criteria and performed a meta-analysis to report the odds ratios for all risk factors identified in these studies. Results We identified 36 studies that investigated 19 risk factors for severe ALRI. Of these, 7 risk factors were significantly associated with severe ALRI in a consistent manner across studies, with the following meta-analysis estimates of odds ratios (with 95% confidence intervals): low birth weight 3.18 (1.02-9.90), lack of exclusive breastfeeding 2.34 (1.42-3.88), crowding – more than 7 persons per household 1.96 (1.53-2.52), exposure to indoor air pollution 1.57 (1.06-2.31), incomplete immunization 1.83 (1.32-2.52), undernutrition – weight-for-age less than 2 standard deviations 4.47 (2.10-9.49), and HIV infection 4.15 (2.57-9.74). Conclusion This study highlights the role of the above seven risk factors in the development of severe pneumonia in under-five children. In addition, it emphasizes the need for further studies investigating other potential risk factors. Since these risk factors are potentially preventable, health policies targeted at reducing their prevalence provide a basis for decreasing the burden of childhood pneumonia

Understanding the National Student Survey: investigations in languages, linguistics and area studies

This report is a summary of interviews and focus groups with around 100 students and 50 members of academic staff in departments of languages, linguistics or area studies at nine universities in the UK. In recent years, concerns have been expressed about the ambiguity of some of the statements which students are asked to respond to in the National Student Survey (NSS). This project set out to get a better understanding of how students and staff understand the questions. The interviews and focus groups were carried out by members of academic staff at the nine institutions who each then wrote an individual report of their findings. This summary is designed to enable wider distribution of these findings without identifying individual staff, institutions `or departments

Estimating global and regional morbidity from acute bacterial meningitis in children: assessment of the evidence

Aim To estimate global morbidity from acute bacterial meningitis in children. Methods We conducted a systematic review of the PubMed and Scopus databases to identify both community-based and hospital registry-based studies that could be useful in estimation of the global morbidity from bacterial meningitis in children. We were primarily interested in the availability and quality of the information on incidence rates and casefatality rates. We assessed the impact of the year of study, study design, study setting, the duration of study, and sample size on reported incidence values, and also any association between incidence and case-fatality rate. We also categorized the studies by 6 World Health Organization regions and analyzed the plausibility of estimates derived from the current evidence using median and inter-quartile range of the available reports in each region. Results We found 71 studies that met the inclusion criteria. The only two significant associations between the reported incidence and studied covariates were the negative correlation between the incidence and sample size (P < 0.001) and positive correlation between incidence and case-fatality rate (P < 0.001). The median incidence per 100 000 childyears was highest in the African region – 143.6 (interquartile range [IQR] 115.6-174.6), followed by Western Pacific region with 42.9 (12.4-83.4), the Eastern Mediterranean region with 34.3 (9.9-42.0), South East Asia with 26.8 (21.0-60.3), Europe with 20.8 (16.2-29.7), and American region with 16.6 (10.3- 33.7). The median case-fatality rate was also highest in the African region (31.3%). Globally, the median incidence for all 71 studies was 34.0 (16.0-88.0) per 100 000 child-years, with a median case-fatality rate of 14.4% (5.3%-26.2%). Conclusions Our study showed that there was now sufficient evidence to generate improved and internally consistent estimates of the global burden of acute bacterial meningitis in children. Although some of our region-specific estimates are very uncertain due to scarcity of data from the corresponding regions, the estimates of morbidity and casefatality from childhood bacterial meningitis derived from this study are consistent with mortality estimates derived from multi-cause mortality studies. Both lines of evidence imply that bacterial meningitis is a cause of 2% of all child deaths

Transformation in a changing climate: a research agenda

The concept of transformation in relation to climate and other global change is increasingly receiving attention. The concept provides important opportunities to help examine how rapid and fundamental change to address contemporary global challenges can be facilitated. This paper contributes to discussions about transformation by providing a social science, arts and humanities perspective to open up discussion and set out a research agenda about what it means to transform and the dimensions, limitations and possibilities for transformation. Key focal areas include: (1) change theories, (2) knowing whether transformation has occurred or is occurring; (3) knowledge production and use; (4), governance; (5) how dimensions of social justice inform transformation; (6) the limits of human nature; (7) the role of the utopian impulse; (8) working with the present to create new futures; and (9) human consciousness. In addition to presenting a set of research questions around these themes the paper highlights that much deeper engagement with complex social processes is required; that there are vast opportunities for social science, humanities and the arts to engage more directly with the climate challenge; that there is a need for a massive upscaling of efforts to understand and shape desired forms of change; and that, in addition to helping answer important questions about how to facilitate change, a key role of the social sciences, humanities and the arts in addressing climate change is to critique current societal patterns and to open up new thinking. Through such critique and by being more explicit about what is meant by transformation, greater opportunities will be provided for opening up a dialogue about change, possible futures and about what it means to re-shape the way in which people live