Always Something of It Remains : Sexual Trauma in Ernest Hemingway’s \u3cem\u3eFor Whom the Bell Tolls\u3c/em\u3e

Following his completion of Tender is the Night in 1934, F. Scott Fitzgerald sent a copy of the manuscript to his friend, Ernest Hemingway. Hemingway replied with a long, thoughtful letter detailing the reasons he both “liked it and didn’t like it” (SL 407). He instructed Fitzgerald: “Forget your personal tragedy. We are all bitched from the start and you especially have to be hurt like hell before you can write seriously. But when you get the damned hurt use it—don’t cheat with it” (408). The often-troubled friendship between these two masters of modernism has been the subject of a number of scholarly inquiries, with Fitzgerald often cast as the sensitive/feminine/intellectual to Hemingway’s unaffected/masculine/brute. As I will demonstrate in this article, however, Hemingway possessed a keen ability to represent gradations in traumatic nuance with which he is not often credited. Hemingway did, indeed, “use the hurt” of the Spanish Civil War while he had it, and it resulted in his masterpiece, For Whom the Bell Tolls

“A Southern Expendable”: Cultural Patriarchy, Maternal Abandonment, and Narrativization in Dorothy Allison\u27s \u3cem\u3eBastard Out of Carolina\u3c/em\u3e

Bastard Out of Carolina is a remarkable text for many reasons: Allison’s unsentimental portrayal of profound poverty in the Old South; her unflinching depiction of incest; and the conclusion—devastating for character and reader alike—all contribute to the “flawless” nature of this novel. Perhaps most remarkable, though, is Allison’s ability to seamlessly weave a particularly Southern tradition of masculinity and violence into this heartbreaking tale of a daughter’s trauma and a mother’s abandonment. In this article, I will investigate Allison’s multifaceted portrayals of trauma in Bastard Out of Carolina, which—when combined with an analysis of social and economic traditions in the Old South, as well as an examination of the complex process of narrativization—leads the critical reader to conclude that the trauma ultimately most injurious to Bone is psychological, not sexual. Sadly, this investigation makes apparent that because patriarchal violence is so intrinsic to Southern culture—and particularly to the culture of this text’s era—Daddy Glen’s abuse of Bone may be horrifying and repulsive, but it is not entirely unexpected. What is unexpected, however, is Anney’s abandonment of her daughter, both symbolic and literal. As a theoretical framework layered in trauma, feminist, and psychoanalytic theories proves, it is ultimately Anney’s abandonment, and not Glen’s prolonged physical and sexual abuse, that is the source of this narrator’s most grievous trauma

Kittens in the Oven: Race Relations, Traumatic Memory, and the Search for Identity in Julia Alvarez’s \u3cem\u3eHow the García Girls Lost Their Accents\u3c/em\u3e

The search for an ever-elusive home is a thread that runs throughout much literature by authors who have immigrated to the United States. Dominican authors are particularly susceptible to this search for a home because “for many Dominicans, home is synonymous with political and/or economic repression and is all too often a point of departure on a journey of survival” (Bonilla 200). This “journey of survival” is a direct reference to the dictatorship of Rafael Leonidas Trujillo Molina, who controlled the Dominican Republic from 1930-1961. The pain and trauma that Trujillo inflicted upon virtually everyone associated with the Dominican Republic during this era is still heartbreakingly apparent, and perhaps nowhere is that trauma more thoroughly illustrated than in the literature of Julia Alvarez. Alvarez is a prime example of an author who utilizes narrative in a clear attempt to come to grips with lingering traumatic memories. After her father’s role in an attempt to overthrow the dictator is revealed, Alvarez’s family is forced to flee the Dominican Republic as political exiles, and a sense of displacement has haunted her since. Because both the Dominican Republic and the United States are extraordinary racially charged, concepts of home and identity are inextricably bound to race relations in much of Alvarez’s art. Using theoretical concepts drawn from the fields of trauma studies and Black cultural studies, this essay examines Alvarez’s debut novel in order to illustrate the myriad ways in which culture, politics, and race converge and speak through each other, largely in the form of traumas that can irreparably alter one’s sense of home, voice, and identity

Is there a feudal hierarchy amongst regulatory immune cells? More than just Tregs

Nature has provided the developing immune system with several checkpoints important for the maintenance of tolerance and the prevention of autoimmunity. The regulatory mechanisms operating in the periphery of the system are mediated by subsets of regulatory cells, now considered principal contributors to peripheral tolerance. Regulatory T cells (Tregs) have received titanic interest in the past decade, placing them at the centre of immuno-suppressive reactions. However, it has become clearer that other immune suppressive cells inhibit auto-reactivity as effectively as Tregs. The function of Tregs and other regulatory cells in rheumatoid arthritis will be discussed in this review

Analysis and Improvement of the Security Building at PG&E Diablo Canyon Nuclear Power Plant

A new Security building was recently designed and built at the Pacific Gas and Electric (PG&E) Diablo Canyon Power Plant (DCPP).This building’s staff and equipment are responsible for performing routine inspections on all personnel entering the facility in order to prevent security-related incidents from occurring at the nuclear power plant. Similar to airport security procedures, the DCPP security building routine inspections include the use of x-ray machines, metal detectors, and explosive detectors. The Power Plant periodically experiences pre-planned, preventive maintenance outages, that last 4-6 weeks. During an outage, a power plant reactor is shut down for maintenance, repair, and re-fueling. Since the new security building’s grand opening DCPP experienced its first outage. Unfortunately, the security building processes were significantly challenged during the outage. Before every outage hundreds of temporary outage workers are hired to perform outage-specific duties. The temporary workers are not as familiar with entrance security procedures as the permanent DCPP personnel, and their credentials are not as well established. Therefore, queues and delays may be caused, especially during peak times at the beginning of shifts, 5-7 am and 4-6 pm. During the outage of February/March 2014 it became evident that waiting times of the larger flow of workers through the new security building were too excessive for permanent employees and temporary outage workers. In an attempt to reduce wait times and make waiting more comfortable security personnel implemented several changes to the security process. These changes included setting up a tent for the queuing lines outside the new building, where workers waited until adequate space became available inside the building. All processing stations inside the building were operated during peak times, and increased number of security officers manned these stations and directed the employees through the security processes. These changes resulted in significant additional operating cost, as well as security staff dissatisfaction due to higher levels of overtime work. Our analysis of the security building internal layout design and processes revealed several areas for improvement, as follows. Improvement of processes Improvement of building layout and structure Improvement of training Improvement of signage and directions The team created a number of deliverables: Facility redesign model using Visio, bin optimization policy, standard operating procedures (SOP), computer animated models that simulate existing and proposed processes using Simio modeling software, instructional video, effective signage designs, and a financial report that justified the costs of the recommendations. The proposed solutions achieve multiple objectives: Decrease wasted time of employees at the security process Decrease the number of security officers Standardize the responsibilities of the security officers Optimize asset usage, including inspection equipment and bins Simplify the process via signage and video aids The cost to implement these recommendations is approximately $275,265.06 and the savings are estimated to be$701,660. Therefore, net savings exceed $400,000. In addition, DCPP employee satisfaction should drastically increase, as the waiting lines will be eliminated or drastically shortened. Job satisfaction of security officers should increase as well, as a result of lower overtime and less stressful work environment

Dissection of the differential mechanisms of apoptosis used during b cell maturation

Ligation of the B cell receptor (BCR) on B lymphocytes results in differential biological outcomes depending on the maturation state of the cell. Thus, mature B lymphocytes become activated and proliferate (clonal expansion) in response to BCR crosslinking, whilst immature B cells either become unresponsive, alter the specificity of their BCR, or undergo apoptosis (clonal deletion). Furthermore, mature B cells can be induced to undergo growth arrest and apoptosis following coligation of the BCR and Fc?Rllb by immune complexes during negative feedback of B cell responses. The precise molecular events downstream of BCR signalling that are responsible for these distinct outcomes remain to be established. This study has focused upon identifying the important signalling mechanisms linking BCR ligation with regulation of the cell cycle and induction of apoptosis in immature and mature B lymphocytes. The murine B cell line WEHI 231 is widely used as a model for clonal deletion of immature B lymphocytes. This is because it has the cell surface phenotype of an immature B lymphocyte, and as such responds to BCR ligation by undergoing growth arrest and apoptosis. Moreover, WEHI 231 cells can be rescued from BCR-mediated apoptosis by co-engagement of CD40, mimicking T cell help. Such BCR-mediated apoptosis has previously been associated with both mitochondrial translocation and activation of PLA2 and a loss of mitochondrial membrane integrity. This study extended these findings by identifying that the product of PLA2, arachidonic acid, acts as the causal metabolite in the initiation of such BCR-mediated apoptosis. Furthermore, it demonstrated that the metabolism of arachidonic acid can provide a dynamic switch from apoptotic to proliferative signalling. For example, ligation of the BCR leads to the build up of arachidonic acid which leads to disruption of the mitochondrial membrane potential (MMP) and hence apoptosis. Whereas, in contrast to this, co-engagement of CD40 leads to the induction of C0X2 and hence the metabolism of arachidonic acid to prostaglandin E2 (PGE2) which promotes proliferative signalling. Therefore arachidonic acid metabolism acts as a dynamic, molecular switch from apoptotic to proliferative signalling. This study also demonstrated that upregulation of BclXL(as induced by CD40) acts to protect from arachidonic acid-mediated loss of mitochondrial membrane integrity and apoptosis. Furthermore, co-engagement of CD40 was found to increase the association of Bak with BclXL indicating that BclXL may act to sequester the pro-apoptotic Bak and hence inhibit the opening of the mitochondrial permeability pore. These data suggest that modulation of Bcl-2 family member induction and function is integral to such BCR-mediated apoptosis and T cell-derived rescue. In addition, it has been demonstrated that upregulation of BclXL can additionally function to downmodulate BCR-induced calcium signals providing an additional mechanism for the downregulation of mPLA2 activation and hence consequent apoptotic signalling. Previous work in this laboratory had highlighted the importance of dynamic ERK signalling in both proliferation and apoptosis of immature B cells. Thus, during BCR-mediated growth arrest and apoptosis the sustained ERK signalling, found in proliferating WEHI 231 cells. Is abrogated. Therefore a causal role for such sustained ERK signalling in immature B cell proliferation was investigated by manipulating endogenous ERK activation by expressing constitutively active RasV12 constructs in WEHI 231 cells. Such RasV12 expressing WEHI 231 cells were refractory to both BCR-mediated growth arrest and apoptosis for up to 24 h emphasising the importance of the uncoupling of ERK signalling in BCR- mediated cell cycle arrest and apoptosis. In an attempt to identify key regulatory elements involved, the role of SHIP and Dok in targeting the ERKMAPK pathway was explored by expressing dominant negative constructs. However, these constructs did not provide release from BCR-mediated apoptosis. (Abstract shortened by ProQuest.)

The “vicious circle” of chronic cough: The patient experience – qualitative synthesis

Aim The aim of this study was to systematically search and synthesise findings from peer-reviewed qualitative studies describing the experiences of those living with chronic cough. Methods A systematic search was conducted to identify all studies that used qualitative methodology to report on the experiences of adults living with chronic cough. A thematic synthesis of the first-hand narratives was undertaken. Key themes in relation to personal perspectives and experiences of living with chronic cough were identified and grouped into analytical themes. Results Six studies met the inclusion criteria. The thematic synthesis generated three analytical themes: 1) “It’s just a cough”; 2) “Constant cough and constant worry”; and 3) “No light at the end of the tunnel”, highlighting the biopsychosocial nature of chronic cough. The synthesis highlights chronic cough as a heterogeneous experience that may appear idiosyncratic, completely consuming the lives of those living with it. Conclusion This is to our knowledge the first qualitative synthesis reporting on the perceptions and experiences of adults living with chronic cough. Our review draws attention to the paucity of literature that utilises qualitative methodology to explore the experience of living with chronic cough. We highlight the missing voice of people living with chronic cough in the contemporary literature. There is now a requirement for research exploring the narratives of those living with chronic cough, to gain an understanding of the condition beyond simple quantification

Morbidity prevalence estimate at six months following a stroke (MORe PREcISE): protocol for a cohort study

Background: Knowledge of the prevalence of morbidity secondary to stroke is important for health care professionals, health care commissioners, third sector organizations, and stroke survivors to understand the likely progress of poststroke sequelae and to aid in commissioning decisions, planning care, and adjusting to life after stroke. Objective: The primary aim of the Morbidity PRevalence Estimate In StrokE (MORe PREcISE) study is to determine the prevalence of morbidity secondary to a stroke, predictors of morbidity, and trends in quality of life and functional status using patient-reported outcomes, cognitive and functional assessments. Methods: A total of 500 participants will be recruited across Wales and England within 14 days following an admission to a stroke unit for either an ischemic or hemorrhagic stroke as part of a multicenter cohort study. Participants are assessed at baseline ≤14 days poststroke and subsequently at 90 (± 14) days and 180 (± 14) days poststroke. At each time point, data will be collected relating to the following domains: participant demographics, routine clinical, patient reported, cognitive status, emotional well-being, and functional ability. Results: Recruitment commenced in October 2018 with 20 sites opened as of September 2019 and was closed on October 31, 2019. Conclusions: The primary outcome is the prevalence of morbidity at 6 months secondary to a stroke. Further analysis will consider temporal changes in the health-related domains to describe trends among baseline, 3-, and 6-month time points

Using eye tracking, time-to-action, heart-rate and perceived task difficulty to assess level of distraction and performance of entry-level paramedicine students in low- versus high-fidelity simulation

Introduction There is limited research investigating the usefulness of high-fidelity simulations (HFS) for early-stage students. Some argue the additional expense of HFS over low-fidelity simulation (LFS) is unnecessary as early-stage students are too easily distracted by non-relevant stimuli inhibiting student’s ability to focus on the core task. However, the extent to which this is true is yet to be empirically tested. Methods First-year paramedicine students were randomly assigned to complete either a LFS or HFS involving a collapsed patient with an obstructed airway. Level of distraction was measured via eye-tracking, arousal via heart-rate (HR), task difficulty via the NASA TLX, and clinical decision making via time-to-action. Student’s perceptions of HFS and LFS were also explored via in-depth interviews immediately following simulations. Results Proportion of time attending to non-relevant stimuli was greater for HFS than LFS students (8.1% vs. 0.9%, ppp=.001). More students from the HFS group revived the patient than the LFS group (58% vs. 30% respectively). Students from the HFS condition achieved time-to-action significantly quicker than those in the LFS condition (p=.010), a trend that remained constant when isolating those removing the obstruction (p\u3c.05). Conclusions Students in HFS suffered from greater distraction, perceived the task as being more difficult and were more aroused than students in LFS. However, HFS students outperformed LFS students with respect to clinical decision making and patient outcomes