Common Impressions Research Articles

Pediatric Utilization of Emergency Medical Services from Outpatient Offices and Urgent Care Centers

ObjectiveNational efforts have highlighted the need for pediatric emergency readiness across all settings where children receive care. Outpatient offices and urgent care centers are frequent starting points for acutely injured and ill children, emphasizing the need to maintain pediatric readiness in these settings. We aimed to characterize emergency medical services (EMS) utilization from outpatient offices and urgent care centers to better understand pediatric readiness needs. MethodsWe performed a retrospective cross-sectional analysis of EMS encounters using the National Emergency Medical Services Information System, a nationally representative EMS registry (2019–2022). We included four years of EMS encounters of children (<18 years old) that originated from an outpatient office or urgent care center. We described characteristics, including patient demographics, prehospital clinician impression, therapies, and procedures performed. ResultsOf 179,854,336 EMS encounters during the study period, 164,387 pediatric encounters originated at an outpatient setting. Most EMS encounters originated from outpatient offices. Evening and weekend EMS encounters more frequently originated from urgent care centers. The most common impressions were respiratory distress (n = 60,716), systemic illness (n = 23,583), and psychiatric/behavioral health (n = 13,273). Ninety-four percent of EMS encounters resulted in transportation to a hospital. ConclusionsEMS encounters from outpatient settings most commonly originate from outpatient offices, relative to urgent care settings, where pediatric emergency readiness may be limited. It is important that outpatient settings and providers are ready for varied emergencies, including those occurring for a behavioral health concern, and that readiness guidelines are updated to address these needs.

Urban land patterns can moderate population exposures to climate extremes over the 21st century

Climate change and global urbanization have often been anticipated to increase future population exposure (frequency and intensity) to extreme weather over the coming decades. Here we examine how changes in urban land extent, population, and climate will respectively and collectively affect spatial patterns of future population exposures to climate extremes (including hot days, cold days, heavy rainfalls, and severe thunderstorm environments) across the continental U.S. at the end of the 21st century. Different from common impressions, we find that urban land patterns can sometimes reduce rather than increase population exposures to climate extremes, even heat extremes, and that spatial patterns instead of total quantities of urban land are more influential to population exposures. Our findings lead to preliminary suggestions for embedding long-term climate resilience in urban and regional land-use system designs, and strongly motivate searches for optimal spatial urban land patterns that can robustly moderate population exposures to climate extremes throughout the 21st century.

Does Housing Status Matter in Emergency Medical Services Administration of Naloxone? A Prehospital Cross-sectional Study.

Introduction: Persons experiencing homelessness (PEH) use emergency medical services (EMS) at disproportionately high rates relative to housed individuals due to several factors including disparate access to healthcare. Limited access to care is compounded by higher rates of substance use in PEH. Despite growing attention to the opioid epidemic and housing crisis, differences in EMS naloxone administration by housing status has not been systematically examined. Our objective in this study was to describe EMS administration of naloxone by housing status in the City of Los Angeles. Methods: This was a 12-month retrospective, cross-sectional analysis of electronic patient care reports (ePCRs) for all 9-1-1 EMS incidents attended by the Los Angeles Fire Department (LAFD), the sole EMS agency for the City of Los Angeles during the study period, January-December 2018. During this time, the City had a population of 3,949,776 with an estimated 31,825 (0.8%) PEH. We included in the study individuals to whom LAFD responders had administered naloxone. Housing status is a mandatory field on ePCRs. The primary study outcome was the incidence of EMS naloxone administration by housing status. We used descriptive statistics and logistic regression models to examine patterns by key covariates. Results: There were 345,190 EMS incidents during the study period. Naloxone was administered during 2,428 incidents. Of those incidents 608 (25%) involved PEH, and 1,820 (75%) involved housed individuals. Naloxone administration occurred at a rate of 19 per 1,000 PEH, roughly 44 times the rate of housed individuals. A logistic regression model showed that PEH remained 2.38 times more likely to receive naloxone than their housed counterparts, after adjusting for gender, age, and respiratory depression (odds ratio 2.38, 95% confidence interval 2.15-2.64). The most common impressions recorded by the EMS responders who administered naloxone were the same for both groups: overdose; altered level of consciousness; and cardiac arrest. Persons experiencing homelessness who received naloxone were more likely to be male (82% vs 67%) and younger (41.4 vs 46.2years) than housed individuals. Conclusion: In the City of Los Angeles, PEH are more likely to receive EMS-administered naloxone than their housed peers even after adjusting for other factors. Future research is needed to understand outcomes and improve care pathways for patients confronting homelessness and opioid use.

Development of a chatbot for depression: adolescent perceptions and recommendations.

Chatbots are a relatively new technology that has shown promising outcomes for mental health symptoms in adults; however, few studies have been done with adolescents or reported adolescent user experiences and recommendations for chatbot development. Twenty three participants ages 13-18 (Mage =14.96) engaged in user testing of a chatbot developed to psychoeducate adolescents on depression, teach behavioral activation, and change negative thoughts. Thematic analysis was conducted of participants' responses to user experience questions, impressions, and recommendations. Over half (56.5%) of the sample completed the full intervention and provided user experience feedback online. The average NPS score was 6.04 (SD=2.18), and 64.3% (n=9) said they would use the chatbot in the future. Of all user experience responses, 54.5% were positive. The most common impressions were related to symptom improvement (61.1%) and availability (52.8%) The most frequent recommendations were related to solving technical problems (66%). Chatbots for mental health are acceptable to some adolescents, a population that tends to be reluctant to engage with traditional mental health services. Most participants reported positive experiences with the chatbot, believing that it could help with symptom improvement and is highly available. Adolescents highlighted some technical and stylistic problems that developers should consider. More pilot and user testing is needed to develop mental health chatbots that are appealing and relevant to adolescents.

Evaluation of clinical characteristics and pre-biopsy impressions of primary Merkel cell carcinoma of the skin.

Merkel cell carcinoma is an aggressive carcinoma of the skin notable for protean presentation on physical exam. A retrospective cohort of 232 patients with primary cutaneous Merkel cell carcinoma was reviewed for availability of data on pre-biopsy clinical differential diagnosis based on clinical exam. Data was available for 192 patients (83%). The three most common impressions were cyst (33.3%), basal cell carcinoma (31.8%), and squamous cell carcinoma (19.8%). Merkel cell carcinoma was correctly suspected in only 13 cases (6.8%). A greater proportion of lesions that were less than or equal to 2 cm in diameter (10.2%) or carried BCC as a co-diagnosis (11.5%) were correctly suspected as Merkel cell carcinoma prior to biopsy, versus lesions greater than 2 cm in diameter (1.6%) or carrying SCC as a co-diagnosis (2.6%), suggesting that clinicians may be anchoring on the well-publicized concept of Merkel cell carcinoma as a small, pearly papule in real-world practice.

Different Spatiotemporal Patterns in Global Human Population and Built‐Up Land

AbstractPopulation concentration and built‐up land expansion are two prominent features of contemporary urbanization. Existing literature on the population aspect of urbanization has mostly focused on national and regional aggregates, and literature on the land development aspect has often relied on spatial case studies of individual cities or their meta‐analyses. Using newly‐available data, here we conduct the first global‐coverage, spatial analysis of the relationship between (changes in) population and built‐up land at multiple spatial scales, and compare to existing common beliefs about urbanization based on individual city studies. We find that population and built‐up land show distinctly different spatial and temporal patterns (with a global correlation coefficient around 0.6). Contrary to common impressions, our results show that during recent decades, developed and developing regions across the world experienced comparable amounts of built‐up land expansion. While meta‐analyses have reported that built‐up land in urban areas expands globally on average twice as fast as population grows, our results show the global change rates of built‐up land and population are similar. Also, most global population, including what national statistics agencies call urban population, reside in areas with low land development levels (which are frequently less than 5% built up). These changes in perspective suggest that urbanization's potential large‐scale impacts may need to be re‐evaluated, and lead to best‐practice recommendations for urbanization modeling and analysis. Especially, the common practice in large‐scale earth system modeling of assuming demographically‐defined urban population resides in areas with medium to high built‐up land development levels should change.

Construction of virtual intercuspal occlusion: Considering tooth displacement.

Common impressions cannot accurately duplicate the dental occlusion under occlusal force due to tooth displacement and mandibular deformation. To establish new methods to construct virtual intercuspal occlusion and assess their construction accuracy. The intraoral occlusal contacts of posterior teeth of 15 subjects were recorded with 8μm and 100μm articulating paper, respectively, and the marked teeth and buccal bite data were scanned with an intraoral scanner. The virtual dental occlusions were separately determined by buccal bite registration (BBR) method, and 3 new methods, namely segmented tooth registration (STR), occlusal contact areas (marked by 8μm articulating paper) registration (OCR) and mixing registration (MR) methods. With the intraoral contact areas marked by 100μm articulating paper set as reference and contact areas of the 4 virtual occlusions as tests, sensitivity, positive predictive value (PPV) and the ratio of overlapping areas were calculated. Kruskal-Wallis test or 1-way ANOVA was used to analyse the difference among groups. The sensitivity ranged from 0.69 to 0.94 and the PPV from 0.67 to 0.90. Sensitivity of OCR group and PPV of STR and OCR groups were different from that of BBR group at overlapping threshold of 50% (P=.028, .028 and .006). There was statistical difference of the ratio of overlapping areas over reference areas, and the values of STR and OCR groups were higher than that of BBR group (P=.045 and .021). The ability of STR and OCR methods to construct virtual intercuspal occlusion was better than BBR method.

Modeling perceptions using common impressions: Perceptual “authenticity,” “luxury,” and “quaintness” for leather

Genuine leather has numerous applications, such as car interiors and clothing, owing to its excellent quality. However, due to the high cost of genuine leather, animal rights issues, and environmental effects of leather processing, artificial leather has increasingly replaced genuine leather. The materials and processing methods used for artificial and genuine leathers are different, resulting in a variety of impressions and shitsukan, that is, the sense of quality of the object. In this study, we focused on the perceptual “authenticity,” “luxury,” and “quaintness,” which are important components needed to achieve the shitsukan of leather used in various products and examined the quantification of qualitative shitsukan using a perception model. We hypothesized that shitsukan can be recognized from the common potential impressions perceived from the properties of a material. Therefore, we developed a method for evaluating shitsukan using representative words for impressions that we perceive in objects and measured their image properties. The physical and psychophysical properties were obtained using several measurements. Multi-angle measuring devices were developed for the measurement experiments. Moreover, several subjective evaluation experiments were conducted to estimate the representative impressions that were potentially perceived in leather. Subsequently, we estimated two independent impressions, “surface shape” and “impression of stateliness” from the properties of leather. In addition, “authenticity,” “luxury,” and “quaintness,” were quantified using simple equations basis the impressions.

Abstract 35: Dispatcher Impression of Stroke: Concordance With Paramedic Identification and Effect on Allocation of Standard Ambulances and Mobile Stroke Units

Background: EMS 911 dispatchers must rapidly assess patient calls and allocate appropriate responding resources including, for stroke, advanced (rather than basic) life support standard ambulances and, in an increasing number of regions, specialty Mobile Stroke Units. While dispatcher accuracy in distinguishing stroke from other high risk conditions is not crucial for selecting ALS rather than BLS response, specialized MSU response necessitates a higher level of accuracy. Methods: We analyzed all transports between January 2018-August 2019 identified as stroke by dispatchers at sendout or by paramedics upon patient assessment in a large urban EMS system -LA County FD EMS, serving 4.1 million lives, 59 cities, 3,000 square miles, via 174 fire stations. Dispatchers are instructed to decide upon the appropriate diagnosis and responding resource within 60s of start of 911 call conversation. “Dispatcher Impression” (DI) and on scene paramedic “Provider Impression” (PI) were compared, and other care metrics analyzed. Results: In total, 12,528 runs were evaluated, of which 79.1% (9913) were dispatched as stroke and paramedics identified stroke in 47.6%. The sensitivity of dispatcher impression of stroke was 56.2% and the positive predictive value was 33.9%. The most common paramedic impressions in non-concordant patients dispatched as stroke were: generalized weakness in 24% (1587), altered mental status in 17% (1111), and syncope in 6% (403). In patients with a dispatcher impression of non-stroke but paramedic impression of stroke, the most common dispatcher impressions were: sick person in 29% (758), unconscious in 28.7% (750), and seizure in 4.6% (121). In dispatcher impressions of stroke, 100% were dispatched at ALS level; and in dispatcher impressions of non-stroke but eventual paramedic impression of stroke, 98.3% were dispatched at ALS level. Patient age over/under 40 &amp; patient sex did not modify rates of dispatcher - paramedic impression concordance. Conclusions: Dispatchers identify more than half of paramedic-identified stroke patients and allocate appropriate ALS standard ambulances in almost all stroke patients. However, for efficient attaching of specialized MSU resources, improved dispatcher identification of stroke is desirable.

Anomalous effect of the aging degree on the ionic permeability of silica shells.

We present a systematic study on the ionic permeability and protective ability of silica shells with different aging degrees by using the acid etching of silica-coated iron oxide nanoparticles as the model reaction. Contradictory to common impressions, we found that the ionic permeability of silica shells increased rather than decreased with the increasing aging degree. This trend may be explained by the chemical nature of the sol–gel silica shell that affects the wettability and, thereby, the transportation of water molecules and hydrated ions. Our study provides novel insights into the protective ability of sol–gel derived silica, which enables us to design thin but low-permeability shells for the stability of inner nanoparticles under harsh conditions without scarifying the performance of core–shell nanostructures.

Impressions of Hazmat Suits Based on Color

Background: Commonly, skin and clothing surface contamination screening (radiation survey) is performed for residents of an area to confirm the levels of residual contamination after nuclear power disasters. Examiners for such a screening often wear white radiation hazmat suits. However, it has been reported that examinees tend to feel tension or anxiety. In this study, we focus on the color of the radiation hazmat suit as one measure to reduce residents’ tension or anxiety. This study aims to determine the common conceptions of radiation hazmat suits based on color. Methods: An anonymous self-administered questionnaire survey was conducted with a total of 262 participants consisting of nursing students, administrative staff of a university, general citizens, and mothers raising their children in the Tohoku region in Japan. The common impressions of radiation hazmat suits, which are typically white, were measured using the Multiple Affective States Scale. This scale can measure the affective state brought about by clothing. The color of white (W) was defined as a standard color commonly used for hazmat suits; in order to determine the common impressions of radiation hazmat suits based on color, the following additional colors were shown to the participants: salmon pink (P), ivory (I), and light green (G). Results: There were no sex differences regarding common impressions of radiation hazmat suits. For white radiation hazmat suits, a high score reflecting the characteristic of “capable” was obtained, while the scores for “cheerful” and “calm” were low, and those for “depressed” and “tense” were high. The colors that showed the highest score for “calm” as a positive affirmative state were I and P. W and P reflected a high “ashamed” score, and the “tense” score for G was higher for the participants in their 20s than for those in their 30s and older. Conclusions: Results show that the color of hazmat suits provokes far greater feelings of anxiety and tension on participants than previously thought. Radiation hazmat suits may be further improved based on the results of this study.

New Avian tracks from the lower to middle Eocene at Fossil Hill, King George Island, Antarctica

AbstractTrace fossils are long known to exist in the Fossil Hill Formation (lower to middle Eocene) at Fildes Peninsula, King George Island, Antarctica. During fieldwork in 2009, abundant new avian tracks were recovered, which are analysed here. Three avian ichnotaxa are distinguished. The most common impressions are tridactyls and tetradactyls with slender digit imprints II–IV and a posterior hallux. They are included in the ichnogenus Gruipeda. In addition tridactyl and tetradactyl footprints with short and thick digit impressions are conferred to Uhangrichnus. The third ichnotaxon is a tridactyl impression with broad and short digits assigned to Avipeda. The latter taxon is here documented for the first time from Antarctica. These avian tracks are preserved in volcaniclastic sediments consisting in reddish-brown layers of mudstone intercalated with coarse sandstone. The sequence represents lacustrine environments which seasonally dried and were episodically refilled.

Enforcement Mechanisms in International Law and International Environmental Law

This essay aims to launch the proceedings of international law on a high note, and to suggest that many common impressions of it are wrong in general, and particularly wrong in the context of international environmental law. Even more particularly, multilateral environmental agreements (MEAs) illustrate the maturation and sophistication of international environmental law. If anything, the diversity and flexibility of compliance approaches under MEAs highlight the limited purchase of simple dichotomies such as “binding vs. non-binding” or “enforcement vs. ineffectiveness”. The essay begins by exploring the concept of “enforcement” in international law in general. It suggests that a concept of enforcement as imposition of legal sanctions, or penalties, is unduly narrow. The essay then canvasses some of the main theoretical assumptions about international law and compliance. An exploration of this theoretical context illuminates the reasons underlying common misconceptions about international law and its enforcement, and helps put in perspective the evolution of approaches to compliance in international environmental law. Finally, against the backdrop of these general considerations, the author examines key features of the approaches to compliance and enforcement in international environmental law and MEAs. The aim is to provide a ‘bigger picture’, a context for the detailed discussions of compliance mechanisms that make up the bulk of the conference proceedings.

On William Stafford: The Worth of Local Things ed. by Tom Andrews

378 WesternAmerican Literature for two more years, elsewhere within the state. The present work, a bargain in hard or soft cover, brings together most of the original exhibit along with many photographs that did not make the initial cut; it also includes beautifully produced relief maps, charts, engravings, and text vignettes. Some of the images—for example, a portfolio of early photographs that suggest the charac­ ter of the all but extinct native American valley residents and reveal their genetic homogeneity—are illuminating, unforgettable. Others, such as the reproductions of brilliantly colored fruit box labels, are Warhol-delightful. Still others are evocative, harrowing, eerie, self-consciously artistic, documentary. Inclusiveness and variety have been the principles for selection here, with the result that the graphics convey only a few common impressions—space, pleni­ tude, the often unlovely human imprint, ethnic diversity. The photographs in the original exhibit were arranged in two core group­ ings, one “historical,” the other subdivided according to the words on an illuminated welcoming sign that spans Highway 99 in a rainbow arc at the edge of Modesto: Water, Wealth, Contentment, Health. But in The Great Central Valley the images have been rearranged to complement a text, eight chapters by Gerald Haslam that sketch the valley’s history, sublocales, events, and person­ ages, touch on major issues confronting the region, and speculate about its future. LikeJohnson, Haslam makes a virtue of multifacetedness. He writes as a crossdisciplinary purveyor of specialized lore and statistics, as recounter of interviews, as arbiter of valley residents’ conflicting views, and, throughout, as man of letters.Joaquin Miller, Mary Austin, Richard Rodriguez, Maxine Hong Kingston, and many other writers of and from the valley make their brief appearances. Haslam is rich with local information that is good to know, the sort of person you’d like tojoin on a leisurely tour of the area. Although a splendid and on the whole successful publication, the book is underedited (we learn three times on two consecutive pages that its page layout is byJohnson, using a Macintosh) and too busily designed. It’s a challenge to maintain one’s mental focus as the format keeps varying from page to page, presenting ever new arrangements of material that invite special attention yet again. And the faint gray ink used for captions, headers, and page numbers was a disastrous choice. WAYNE KIME Fairmont State College On William Stafford: The Worth ofLocal Things. Edited by Tom Andrews. (Ann Arbor: University of Michigan Press, 1993. 281 pages, $39.50.) The recent death ofWilliam Stafford gives this critical anthology a particu­ lar interest and poignancy. It offers rich materials for a retrospective look at Stafford’s work, and the very full bibliography will be useful for serious critics. Reviews 379 Stafford’s poetry doesn’t always attract close textual criticism, and it is interest­ ing to consider the extent to which the critics see the poems as products of character and sensibility. Thomas Hardy comes to mind, though Hardy was a more self-conscious craftsman. It seems difficult to write an essay on Stafford without calling him “quiet,” a term that seems accurate enough in an impres­ sionistic way but doesn’t take us far into the art of the poems. They have their own rhetoric for all their naturalness. Two critics in this volume who are not sympathetic with Stafford’s poetics, Robert Creeley and Bob Perelman, have done us a service by noting that there is a rhetoric at work. If it is the height of art to conceal art, as Larochefoucauld said, then Stafford’s art is high indeed, Andrews has divided his book into three sections: book reviews, general studies, and studies of individual poems. The volume is rather heavy on book reviews. Some of these might have been sacrificed in order to reprint some of the longer articles on Stafford listed in the bibliography, like John Lauber’s “The World’s Guest—William Stafford” and George S. Lensing’s “William Stafford, Mythmaker.” Among the best of the longer articles is Jeff Gundy’s previously unpublished essay on Down in My Heart, Stafford’s account of his experiences as a conscientious objector. The essays on individual poems are...

Impact of Yankee stadium bat day on blunt trauma in northern New York City

To determine the incidence of blunt trauma in northern New York City before and after the distribution of 25,000 baseball bats at Yankee Stadium. Prospective multicenter study, including ten days before and ten days after Bat Day (June 3, 1990). Ten emergency departments in the Bronx and northern Manhattan. All patients presenting to the ED with baseball bat injuries. Each hospital collected the following data for each subject: date and time of injury, patient's age and sex, extent of injury, whether a Yankee bat was used, presence of loss of consciousness, results of computed tomography scan of the brain (if performed), history source, and disposition of the patient. Average daily atmospheric temperature was recorded for each day of the study. Seventy-seven patients sustained bat injuries, 38 (49%) before and 36 (47%) after Bat Day. There were no significant differences between the two groups with respect to age, sex, time of injury, number and distribution of fractures and lacerations, incidence of loss of consciousness, source of history, or dispostion. There was a positive association between the number of cases on a given day and the average temperature that day (r = .5; P < .01). The distribution of 25,000 wooden baseball bats to attendees at Yankee Stadium did not increase the incidence of bat-related trauma in the Bronx and northern Manhattan. There was a positive correlation between daily temperature and the incidence of bat injury. The informal but common impressions of emergency clinicians about the cause-and-effect relationship between Bat Day and bat trauma were unfounded.

School, state, and society: the growth of elementary schooling in nineteenth-century France--a quantitative analysis

School, State, and Society is a comprehensive analysis of French elementary education in the nineteenth century. It begins in the decades before the Guizot law of 1833, which made the establishment of public schools in every commune France's national policy, and continues ti 1906, just after Church and state were formally separated and Catholic schools officially abolished. Grew and Harrigan base their study on the vast amount of statistical information that was systematically collected in France beginning in the 1830s. This information was put into machine-readable form for computer analysis. School, State, and Society examines several important aspects of elementary schools in France in the nineteenth century: the availability of schooling; enrollment; different types of schools (Catholic and lay, public and private); schooling for girls versus schooling for boys; elementary teachers' the elementary school as an institution and the links between elementary education and further instruction; and budgets and expenditures. The analysis revises some standard interpretations of the role of Catholic schools and of a nationally centralized system. The picture that emerges challenges some common impressions - among them that schooling in France progressed slowly and late, that it had to overcome great local resistance, and that the enrollment of girls long lagged behind that of boys.

The Inventions of Mark Twain by John Lauber, and: Mark Twain: The Bachelor Years by Margaret Sanborn

152 Western American Literature The Inventions of Mark Twain. ByJohnLauber. (New York: Hill and Wang, 1990. 340 pages, $22.95.) Mark Twain: The Bachelor Years. A Biography. By Margaret Sanborn. (New York: Doubleday, 1990. 508 pages, $24.95.) The Inventions of Mark Twain offers a detailed chronicle of Twain’s life, especially during the 1880s;unfortunately, Lauber diminishes the value ofsuch detail with a great deal of superficial commentary. In his long account of Twain’s publishing venture with U.S. Grant, the biographer attributes the venture’s success to the fact that “Mark Twain was not an author like other authors; Grant was not a general like other generals. The public recognized that. . . .” Similarly, we are invited to appreciate the significance of Twain’s experience as a riverboat pilot in terms of the banal hypothesis that, “If Sam Clemens had never become a pilot... he might still have written Tom Sawyer, but not Huckleberry Finn.” There are even moments when Lauber peddles such obtuseness with what seems to be conscious conviction, as when he chal­ lenges those “Biographers [who] have argued that Mark Twain’s apparently obsessive interest in impersonators . . . arose from his own sense of playing a role . . .”:according to Lauber, it ismerely that “impersonations . .. have been the stuff of comedy from its beginnings.” Lauber’s critical disengagement is most disappointing when it comes to Mark Twain’s “inventions,” the book’s purported focus. He applies the word “invention” facilely to everything Twain made up, including novels, machines, and “lies” about his complicity in family tragedies. For Lauber, these diverse inventions are all just somany tokens of Twain’sboundless creativity. Undeni­ ably, Twain was capable of extraordinary creativity; but he was also a writer whose “borrowing” from the work of others not infrequently verged on impro­ priety (Twain once planned a book on South Africa’s diamond fields that was to be based entirely on the notes of a proxy-traveler!). Twain’s creative process was clearly more complicated than Lauber would lead us to believe. For all of Lauber’s careful research, Inventions delivers little besides a series of common impressions concerning Twain. Drawing widely on the humorist’s early notebooks and correspondence, Margaret Sanborn’s Mark Twain: The Bachelor Years describes Twain’s life from birth to marriage. Like Lauber, Sanborn does not offer a carefully developed critical perspective on her material, which is to say, her work too consists largely of impressions; but Sanborn’s impressions are both vivid and engaging. While this effect derives partly from the intrinsic interest of Twain’s bachelor years with their high adventure, Sanborn is to be credited for capital­ izing on that interest. Rather than blunting her detailed account of Twain’s life with flat-footed commentary, she draws on a broad range of general back­ ground material, including works on American costume and regional history, to give that account a suggestive context. Her attention to the physical and cultural environment of Twain’s youth, for instance, allows us to imagine the formation of his very sensorium, the matrix for the more refined, literary sensi­ bilities that he would later develop. Such contectualizing also lends The Bache- Reviews 153 lor Years considerable interest for readers who are concerned with social and cultural history, especially that of the western United States. Even readers already well acquainted with Twain’s early years will find several parts of Sanborn’s book illuminating, especially those dealing with the difficult living conditions Twain knew as a youth; Twain’s lively, sometimes even imposing, mother, Jane Lampton; and the humorist’s work as a reporter at the Nevada legislature. The biographer also vividly recreates Twain’s early lectures. Finally, Sanborn’s entire account is informed by a keen sense of both the witting and unwitting humor of Twain’slife. BRIAN COLLINS University of California, Santa Cruz The Duplicating Imagination: Twain and the Twain Papers. By Maria Ornella Marotti. (University Park: The Pennsylvania State University Press, 1990. 198 pages, $24.95.) In The Duplicating Imagination Maria Marotti applies an eclecticmix of literary criticism to published works from the Mark Twain Papers: Satires and Burlesques, Fables of Man, Which Was the Dream?, and The Mysterious Stranger...

Refused Readings: Narrative and History in "The Secret Integration"

One of the most common impressions derived from Thomas Pynchon's work is that the author has digested libraries of information. Much of this information is obviously historical, yet the depth and scope of historical detail in Pynchon's fiction almost questions the very notion of the historical event. In Gravity's Rainbow, for instance, the Second World War is made to accommodate such traditionally marginalized matters as the fate of the Hereros, the political significance of the Zoot suit, the extermination of the dodo bird, etc. These are all elements that usually' wind up on the trash heap of traditional historiography. For Pynchon however, they become the very substance of a counter-history.

Exploration of student nurses' stereotypes of patients

The ways in which nurses interact with their patients are likely to depend to a great extent upon their impressions of them (Goffman, 1959). For example, if a nurse perceives a patient as ‘unfriendly’, then she (or he) may deal with that patient in quite a different manner from that which she would employ if she perceived the patient as ‘friendly’. It seems likely that nurses as a group may share certain common impressions of patients. That is, particular stereotypes of patients may be associated with the nursing role. Such role related impressions have been discussed extensively by Goffman (1959) and by various investigators of sex role stereotypes (Vogel, Broverman, Clarkson and Rosenkrantz, 1972). The concept of stereotype appears to bear some resemblance to that of ‘construct’ as proposed by Kelly (1955), which is a cognitive-emotional aspect of a thing or person as viewed by an individual. A stereotype, then, might be considered to be made up of ‘bundles of related constructs’ associated with a typical representative of a role. This paper will describe an attempt to identify some of the major features of the patient stereotype as construed by student nurses. It follows a preliminary study (Worsley, 1976) in which 73 student nurses were asked to describe patients using any words or phrases they wished. Four hundred and thirty-seven different words and phrases were elicited. Many of these were mentioned only occasionally, but others were more popular. It was possible to categorize the responses, on an intuitive basis, into eight groupings: