Exposures: Exploring Selves and Landscapes in the Chernobyl Exclusion Zone

This thesis contributes to understandings of tourism and landscape by detailing how embodied tourist subjects are active producers of knowledge and place, rather than passive consumers. However tourists are not understood as the sole producers and this thesis details a world of active agencies in negotiation and mutual re-configuration. It is based upon an ethnographic study through participant observation of 25 day-trip tours to the Chernobyl Exclusion Zone in Ukraine. The participant observation was undertaken as researcher, visitor and tour guide and offers a range of perspectives and accounts. The thesis offers an account of embodied subjectivity and landscape as mutually implicated and in a co-becoming, but a mutuality that is fraught, negotiated and uncertain rather than a given vitality. The thesis is presented as five 'cuts' through this ethnographic material, each broaching specific theoretical and empirical concerns. First, the Chernobyl Exclusion Zone is argued to be a site of post-apocalypse in a manner which re-purposes a post-apocalyptic imaginary as a salient political narrative that holds a fidelity to events, pasts and futures and in contrast to Hollywood spectacle and certain climate change prophecies. Secondly the thesis examines practices of meaning-making in the ruins of Pripyat, drawing on theories that highlight material, embodied practices of making-sense through encounters with vestiges of other lives. Thirdly it presents a post-phenomenological account of embodied subjectivity. Merleau-Ponty's philosophy of the flesh is examined and, through the work of Luce Irigaray, a re conceptualisation is presented that asserts a necessary passivity of exposure as the predicate for all action and that offers a radical account of the reversibility of the flesh that de-centres the embodied subject. Fourthly the map that accompanies this thesis is presented as a means of examining networks of negotiation with the resistant, wilful, trickster agencies of radiation. Drawing on the work of Bruno Latour and Donna Haraway the thesis focuses on the Geiger counter as a key mediator in practices which assert a topographical account of networked practices in contrast to topological accounts associated with actor-network theory. Finally, the thesis offers a conception of difference and boundary-making practices as performative re-configurations where difference is understood not only as produced, rather than given through a priori assumptions of bodily and worldly boundaries, but also as actively productive. The thesis contributes to debates on subjectivity, landscape and knowledge production

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Phenotypic expansion of CACNA1C-associated disorders to include isolated neurological manifestations

International audiencePurpose:CACNA1C encodes the alpha-1-subunit of a voltage-dependent L-type calcium channel expressed in human heart and brain. Heterozygous variants in CACNA1C have previously been reported in association with Timothy syndrome and long QT syndrome. Several case reports have suggested that CACNA1C variation may also be associated with a primarily neurological phenotype.Methods:We describe 25 individuals from 22 families with heterozygous variants in CACNA1C, who present with predominantly neurological manifestations.Results:Fourteen individuals have de novo, nontruncating variants and present variably with developmental delays, intellectual disability, autism, hypotonia, ataxia, and epilepsy. Functional studies of a subgroup of missense variants via patch clamp experiments demonstrated differential effects on channel function in vitro, including loss of function (p.Leu1408Val), neutral effect (p.Leu614Arg), and gain of function (p.Leu657Phe, p.Leu614Pro). The remaining 11 individuals from eight families have truncating variants in CACNA1C. The majority of these individuals have expressive language deficits, and half have autism.Conclusion:We expand the phenotype associated with CACNA1C variants to include neurodevelopmental abnormalities and epilepsy, in the absence of classic features of Timothy syndrome or long QT syndrome