Franklin Square Research Articles

Impact of Surgical Resident Education and EMR Standardization in Enhancing ERAS Adherence and Outcomes in Colorectal Surgery

Our study aimed at investigating the degree of adherence to ERAS pathway at our institution and to evaluate the role of providing resident education and a standardized EMR order set in improving adherence and patient surgical outcomes. The study is prospective in nature and consists of two phases with a preintervention cohort to assess adherence to ERAS protocol and a postintervention cohort to evaluate improvement in adherence and patient outcomes. Adherence with the ERAS protocol was assessed across preoperative, intraoperative, and postoperative phases. The study took place at MedStar Franklin Square Medical Center in Baltimore, Maryland, involving inpatient care at a surgical ward. During the preintervention phase, patients undergoing elective colorectal surgery were identified over 6 months (N = 77), and their adherence to the ERAS protocol was assessed. Following the intervention of surgical resident and faculty education sessions on the ERAS protocol and the implementation of a standardized order set in the Electronic Medical Record, a postintervention cohort (N = 54) was selected for comparison over another 6 months. Among 77 patients who underwent elective colorectal surgery, the adherence rate to ERAS protocol was notably below 80% for most elements of the postoperative phase. When pre- and postintervention cohorts were compared, there were no significant differences in the baseline demographics and perioperative variables. After the implementation of our intervention, adherence rates were significantly improved in 7 out of 8 ERAS protocol elements of the postintervention phase. Among primary outcome measures, readmission rate (24.7% vs.9.4%; p = 0.022) and length of stay (7.3 ± 4.5 vs. 5.5 ± 3.6; p = 0.014) were significantly lower in the postintervention cohort. Although the rate of postoperative complications did not decrease significantly (33.8% vs. 31.5%; p = 0.284), there were fewer patients with postoperative ileus and surgical site infections. Outcomes were evaluated based on an 8-point score of postoperative ERAS elements. A significant decrease in mean length of stay and readmission rates is observed when at least 5 elements are completed, emphasizing the ERAS pathway's importance as a complementary bundle. Our study highlights the impact of resident education and electronic medical record standardization on ERAS adherence in colorectal surgery. This multidisciplinary approach improves adherence, reduces hospital stay, and enhances communication among healthcare providers for better patient outcomes.

An investigation of even ordered magic squares (4, 6, and 8): characteristic polynomials, eigenvalues, and encryption

In this paper, we discuss and mathematically compute the eigenvalues and the characteristic polynomials of special even square matrices of orders 4x4 and 8x8. Also, we introduce two 8th order compound magic squares. The computed values are verified using Maple software. First, for the 4th order square matrix, the characteristic polynomial was derived to be: λ(λ-2s)( λ²+4Θ) with the eigenvalues: 0,2 s, and two other conjugates. In further analysis, we performed numerical classification of the squares for the matrices of order 4. Second, for the 8th order magic square, the characteristic polynomial was obtained in the form: λ<sup>3</sup>(λ-4s)(λ<sup>4</sup>+Ωλ<sup>2</sup>+θ) where Ω,Θ are constants; the eigenvalues are 0,4 s, ∓√λ<sub>1</sub>, ∓√λ<sub>2</sub>; where λ<sub>1</sub>, λ<sub>2</sub> are the roots of the quadratic equation: λ<sup>2</sup>+Ωλ+Θ=0. Third, for the franklin square, we obtained the eigenvalues 0,4 s, and the roots of the equation: λ<sup>2</sup>+aλ+b. Finally, we suggested a hybrid image encryption technique based on Franklin magic square matrices and improved substitution technique. The proposed a grayscale image encryption/ decryption algorithm uses circular rotation of bits and Franklin magic squares’ properties in conjunction with substitution techniques to obtain a very secure algorithm against attacks.

Vestiges of Black Internationalism

The siege led by the Continental Army to reclaim Savannah from British forces in the fall of 1779 is remembered as one of the most disastrous battles of the American Revolutionary War. However, greater carnage was circumvented by a legion of (largely) free Black Chasseurs Volontaires recruited from the colony of Saint-Domingue (modern-day Haiti). Their role proved strategically vital, and a monument erected in Savannah’s Franklin Square today pays homage to their contributions to the American project of independence. Indeed, the beguiling mythos of independence suffuses their historic legacy. Yet although their story is remembered in African American histories from the nineteenth century to the present, they are systematically occluded, marginalized, and overlooked by the colonialist archive. This article interrogates the violence of archival erasure and demands interdisciplinary, multimodal, and collaborative modes of recreating and rehabilitating lost African Atlantic histories.

What Happened to Franklin Square Park? People, Trees, and Environmental Justice

Based in Baltimore, Maryland, this project employs methods from urban forestry and community-engaged research to gain a deeper understanding of a city park’s physical quality and the meaning of park quality to neighborhood residents. In the summer of 2018, we were asked by residents living in the Franklin Square community to survey the trees in their neighborhood park and create an updated park map. Following the completion of our survey, we organized an event in the park for local elementary and middle school students and collected student reflections on the park before and after the event. Despite indications that the physical quality of the park is deteriorating through the loss of trees and other park features, our qualitative analysis of themes from student reflections and historical narratives suggests that not only park features but also experience, memory, and history shape park quality. By examining green space quality using a bottom-up approach, which includes the voices of community members and archival documents, we advance and question studies of urban green space quality that have largely relied on quantitative metrics.

Philadelphia: Beyond the Liberty Bell

Philadelphia: Beyond the Liberty Bell

Friends of the New York Seaport: Antebellum Quaker Commerce, Culture, and Concerns

Friends of the New York Seaport:Antebellum Quaker Commerce, Culture, and Concerns Mitchell Santine Gould (bio) Prior to 1860, all the great fortunes of the country had come from the sea, and so, inevitably, from the earliest days and until the glory of the American merchant marine had passed away, ships and shipping were the most conspicuous feature of New York business life, and the water front was the centre of interest. —The Bank of Manhattan, 19151 The greatest role for Friends in the triumph of the New York Seaport was the introduction of the packet-shipping scheme by English immigrant Jeremiah Thompson in 1818, an innovation so revolutionary that it helped transform Manhattan into the nation's commercial center. Shortly before the Revolution, Philadelphia was the nation's largest city, with an estimated population of 40,000, and New York was the next largest, at roughly 25,000.2 Ironically, it was Quaker merchants who were largely responsible for New York's supremacy over the "Quaker City." "To a Yorkshireman, New York owes much," wrote Robert G. Albion in 1939. "It was through his initiative that the city prospered so much from two other British projects—the inception of the transatlantic packet service, and the 'Cotton Triangle' to provide return cargoes for the packets."3 Yet even before Friends introduced fixed schedules for square-riggers, they had already taken an instrumental role in establishing the colonial port's financial and philanthropic infrastructures, as we shall see momentarily. Quaker influence on transatlantic navigation began with a far-ranging contribution to the merchant marine: the whalers' discovery of the Gulf Stream. Their findings were communicated to Benjamin Franklin by his cousin, Nantucket Quaker Timothy Folger. In 1768, while he was managing the American post office in London, Franklin learned that [End Page 25] mail packets between Falmouth and New York generally took a fortnight longer than voyages from London to Rhode Island. When Franklin expressed his skepticism that such was possible to Folger, the whaling captain replied that Rhode Island captains were acquainted with the Gulf Stream, but English captains were not. Friends informed these ships that they were fighting a current running at three miles an hour, and advised them to get out of it, but they were "too wise to be counselled by simple American fishermen," grumbled Folger. Benjamin Franklin appreciated that a vessel from Europe to North America could easily shorten her passage by avoiding the current, and a vessel from America to Europe could just as easily improve her speed by remaining inside it, using an overboard thermometer to detect the stream's Gulf warmth. Franklin then asked Folger to design a chart to benefit navigation. When this chart was first distributed, English sailors again dismissed the advice, but later, after receiving engravings of the same map from France, they reconsidered, and there began a revolution in Atlantic commerce.4 Fifty years later, there were many prosperous merchants in the Quaker quarter, near Manhattan's early Pearl Street Friends Meeting. Members of the Religious Society of Friends, recalled Rufus Wilmot Griswold in 1856, could be found as far out as Chatham Street, and the more affluent families settled as far south as Maiden Lane: "the Pearsalls, the Pryors, the Embrees, the Effinghams, the Hickses, the Hawxhursts, the Hulletts, the Havilands, the Cornells, the Kenyons, the Townsends, the Tituses, the Willetts, the Wrights."5 Pearl Street Meeting hosted worship and the concomitant social networking of Friends until its demolition in 1829.6 Eventually, the meeting's location at the intersection of Pearl, Cherry, and Dover Streets would be named Franklin Square; not, as is commonly believed, for Benjamin Franklin, but for Walter Franklin, a wealthy merchant whose magnificent gardens were originally planted at this spot. Walter Franklin was born in 1727, the eldest child of Thomas Franklin and Mary Pearsall, from whom he inherited a fortune. He invested his windfall in trade with China, Russia, and other exotic marketplaces. Upon his retirement, he lived in the "style of a nobleman," driven hither and thither in an "elegant chariot," in an era in which private coaches were still rare in the city. The Pearl Street Meeting House was...

My Life in the Service: The World War II Diary of George McGovern by George S. McGovern

Reviewed by: My Life in the Service: The World War II Diary of George McGovern by George S. McGovern John E. Miller George S. McGovern, My Life in the Service: The World War II Diary of George McGovern. New York: Franklin Square Press, 2016. 157 pp. $25.95. George McGovern's exploits as a B-24 bomber pilot during World War II earned for him the most distinguished military record of any twentieth-century major-party presidential candidate not named Eisenhower. His reluctance to capitalize upon his war-time record during the 1972 campaign was a major factor in his lopsided loss that year. In 2001, Stephen Ambrose related his story in The Wild Blue: The Men and Boys Who Flew the B-24s over Germany. The publication of McGovern's wartime diary now adds additional detail to the narrative. Supplementing a facsimile copy in McGovern's own careful handwriting is a printed version of the diary. The calm, can-do spirit of the twenty-two-year-old pilot shines through his words, which also testify to his capacity as a pilot as well as to his unusual maturity and leadership skills. The more than 18,000 B-24s that filled the skies over Europe and Asia were the workhorses of the Allied air forces. At 65' long and 18' high, with a wingspan of 110' (different models varied slightly in their dimensions), the storied "Liberator" plane sported a maximum speed of 300 mph and cruised at 200 mph, with a range of 2,850 miles. By November 1944 when McGovern and his ten-man crew conducted their first bombing mission, the German Wehrmacht offered scant resistance, but withering anti-aircraft barrages and bad weather downed substantial numbers of planes on every bombing run, limiting the chances that crew members would survive the required thirty-five missions to complete their tour of duty. Flying out of a base near Cerignola, Italy, McGovern, who had been shy as a kid and terrified of flying when he began, overcame the airman's natural fear of death, completing his final mission on April 25, 1945, just two weeks before Germany surrendered. The South Dakotan's diary entries were expansive early on, describing train travel, housing facilities, fellow recruits, rifle training, bayonet practice, gas mask drills, guard duty, weather, and food. As his training continued in several different places in 1943 and 1944, the entries became shorter and less descriptive. Once in combat, McGovern recorded almost every flight in plain, straightforward language, omitting heroics and seldom referring to feelings and emotions or offering comments on the ultimate meaning of it all. Readers get a good sense of the seriousness, sense of purpose, and [End Page 99] matter-of-fact dedication that American aviators like him brought to the task. McGovern's crew and his fellow pilots admired and even revered his steadiness, composure, and skill as a pilot, and the responsibility he readily assumed for the safety of his men. The diary reveals that while in Italy he decided to become a college history professor. We hear about his admiration for his father when he was informed of his death, and we can picture him spending many hours in between bombing runs reading history. Other sources indicate that it was Charles and Mary Beards' 1,700-page The Rise of American Civilization that he was reading, that he had gotten married in October 1943, how he felt when during flight training he witnessed the first accident in which a pilot got killed, the impression made on him by ill-nourished kids who swarmed around him and his compatriots begging for food when their ship landed at Naples, or the devastating impact on him of seeing a bomb that had accidentally fallen out of his plane land directly on an Italian farm house at noon. McGovern feared, mistakenly, that they had just wiped out an innocent family. Read this account, supplementing it with other sources to obtain the full story of George McGovern's wartime experience, a record that won for him the Distinguished Flying Cross. John E. Miller South Dakota State University Brookings, SD Copyright © 2018 Paul Mokrzycki Renfro

Benjamin Franklin and the dissectible capacitor: his observations might surprise you

Although he is best known as an American statesman, Benjamin Franklin also made important contributions to electrical science in the mid-18th century. At the time, the Leyden jar, the first capacitor, had just been invented, and Franklin performed experiments to determine the source of the spark and shock that occurred on discharge of the jar. In these experiments, he used Leyden jars and Franklin squares (parallel-plate capacitors) that could be disassembled and reassembled. These devices later became known as dissectible capacitors. One of the more interesting results Franklin obtained was that an electrified capacitor containing a dielectric could be disassembled, the electrodes discharged, and the capacitor reassembled without sacrificing its ability to produce a spark and shock. This result is contrary to what one expects from today’s theory for capacitors involving ideal dielectrics (those possessing polarization and no other special properties such as surface effects): all charge is on the electrodes, and once they are discharged the capacitor is no longer electrified. During the years since Franklin’s observations, additional experiments have been performed and various explanations offered for the cause of Franklin’s results. In this paper, we first review the details for Franklin’s experiments, and then we describe a very simple experiment that can be performed today with a parallel-plate capacitor that gives results similar to Franklin’s. Next we discuss the experiments of Addenbrooke and Zeleny, performed in the first half of the 20th century, which provide plausible explanations for Franklin’s observations. Finally we describe the relationship of Franklin’s dissectible parallel-plate capacitor to another important 18th century invention—Volta’s generator of static electricity, the electrophorus.

AGS Clinician of the Year Brings International Perspective to Elder Care, Teaching

AGS Clinician of the Year Brings International Perspective to Elder Care, Teaching

Demystifying Benjamin Franklin’s Other 8-Square

Abstract In this article, we reveal how Benjamin Franklin constructed his second 8 × 8 magic square. We also construct two new 8 × 8 Franklin squares

Abstract OT3-03-01: Increasing participation in research - Breast cancer

Abstract PURPOSE: Increasing Black patients' participation in cancer clinical trials is particularly important because of the population's lower survival rate. Accrual to clinical trials remains low among the general population (1-3%), with recruitment of Blacks the lowest of all groups at 0.5-1.5%. INSPIRE-BrC aims to increase trial participation rates among Black breast cancer patients and examine the relationship between the intervention and attitudes/beliefs on the decision to participate. METHODS: The study was approved by the Institutional Review Board at all sites and opened in March 16, 2014. Black breast cancer patients at five MedStar sites will view a 15 minute, culturally-tailored video about clinical trials, which targets six cultural and attitudinal barriers to participation. A pre-test/post-test method is used to determine the impact of the video on three variables -- likely participation in therapeutic clinical trials; attitudes toward therapeutic clinical trials (assessed based on the 6 barriers); and actual trial enrollment. Participants are followed for six months after participating in the intervention to assess clinical trial enrollment status. ELIGIBILITY CRITERIA: The study includes patients with invasive breast cancer, who are Black or African American and have never participated in a therapeutic clinical trial. Participants can be male or female and must be 18 years or older. EXPECTED FINDINGS: We hypothesize that the intervention will increase clinical trial enrollment compared to our 2012 clinical trial enrollment baseline rate of 6% (22/384) for Black breast cancer patients in five MedStar hospitals. The primary outcome measure is the proportion of Black breast cancer patients who agree to participate in a therapeutic clinical trial among those who sign consent to INSPIRE-BrC. Study findings have the potential to increase patient recruitment as a promising tool for rapid dissemination of a theory-driven, evidence-based model to enhance clinical trial accrual among Black cancer patients. STATISTICAL METHODS: Bivariate associations between enrollment status and patient-level characteristics will be examined by t-tests for continuous variables and chi-square tests for categorical variables. Paired t-tests and McNemar's test for paired proportions will be used to measure the changes in attitudes and beliefs, measured based on pre-post test. Multiple logistic regression models will be used to predict enrollment status including many factors identified in the literature as predictors, which are, but not limited to age, gender, SES, insurance status, and stage. ACCRUAL: As of June 2, 2015, the total accrual across all five sites is 177 patients. INSPIRE enrollments as of June 2, 2015MedStar Franklin Square Medical Center10MedStar Georgetown University Hospital16MedStar Harbor Hospital12MedStar Union Memorial Hospital19MedStar Washington Hospital Center120Total177 The accrual goal is 200 patients. We anticipate meeting this goal in July 2015, and analyzing the data in January 2016. CONTACT: Brandi N. Robinson, MPH Program Manager Oncology Research MedStar Health Research Institute Washington Cancer Institute at MedStar Washington Hospital Center 110 Irving Street, NW, Room C-2149, Washington, DC 20010 Phone: (202) 877-3058 |Fax: (202) 877-4072 Brandi.n.robinson@medstar.net Citation Format: Robinson BN, Swain SM. Increasing participation in research - Breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-03-01.

Abstract A18: Increasing Participation in Research - Breast Cancer

Abstract Increasing Participation in Research – Breast Cancer (INSPIRE-BrC) aims to increase therapeutic clinical trial participation rates among black patients with breast cancer and examine the relationship between the intervention and attitudes/beliefs on the decision to participate. The study was opened in mid-March of 2014. Increasing black patients' participation in cancer clinical trials is particularly important because of the population's lower survival rate. Accrual to clinical trials remains low among the general population (1 to 3%), with recruitment of blacks the lowest of all groups at 0.5 to 1.5%. Clinical trials are key to developing new methods to prevent, detect, and treat cancer. Methods: INSPIRE-BrC is a prospective nonrandomized clinical trial. A sample size of 123 black patients with breast cancer at five MedStar sites (two in the District of Columbia and three in the Baltimore area) will view a 15 minute, culturally tailored video about clinical trials, which targets six cultural and attitudinal barriers to participation. The six cultural and attitudinal barriers to participation that have been documented in literature and verified by the MedStar Washington Hospital Center, Washington Cancer Institute experience are: 1) Fear and distrust of the medical establishment (doctors, scientists and the government); 2) Concern about the ethical conduct of investigators (e.g., Tuskegee Syphilis Study); 3) Fear of losing one's rights by signing a research informed consent document ; 4) Worry that investigators will treat poor or minority patients unfairly (e.g., the patient becomes a guinea pig); 5) Loss of privacy; and 6) Lack of knowledge and awareness of clinical trials (e.g., what would be done, what would be expected from them and what are the expected risks and benefits of the research presented at participant's comprehension level). A pre-test/post-test method is used to determine the impact of the video on three variables — likely participation in therapeutic clinical trials; attitudes toward therapeutic clinical trials (assessed based on the six barriers); and actual trial enrollment. We will use the Attitudes and Intention to Enroll in therapeutic clinical Trials (AIET) questionnaire in which items were all adapted from existing scales that measured concepts similar to those assessed in this study. Each of six attitudinal barriers measured represent a subscale on the AIET consisting of five items, each assessed on a 5-point Likert-type scale. Responses are scored 1=Strongly Disagree; 2=Somewhat Disagree; 3=Not sure/Neither; 4=Somewhat Agree; 5=Strongly Agree. Expected Findings: We hypothesize that the intervention will increase clinical trial enrollment compared to our 2012 clinical trial enrollment baseline rate of 6% (22/384) for black patients with breast cancer in five MedStar hospitals. The primary outcome measure is the proportion of black patients with breast cancer who agree to participate in a therapeutic clinical trial among those who sign consent to INSPIRE-BrC. Study findings have the potential to increase patient recruitment as a promising tool for rapid dissemination of a theory-driven, evidence-based model to enhance clinical trial accrual among black patients with cancer. INSPIRE- BrC Enrollment as of July 28, 2014 MedStar Franklin Square Medical Center - 5 MedStar Georgetown University Hospital - 6 MedStar Harbor Hospital -7 MedStar Union Memorial Hospital - 7 MedStar Washington Hospital Center - 40 Total - 65 Citation Format: Brandi N. Robinson, Sandra M. Swain. Increasing Participation in Research - Breast Cancer. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A18.

Parental Advice: Given Perhaps, but Not Received.

* Abbreviation: SIDS — : sudden infant death syndrome We all think we give good advice, and we think we do it well. We’ve mastered the anticipatory guidance section of the well-child or nursery visit. We have our formula: we cover the salient topics, throw in some personal experience, and assume our parental advice on child rearing has been received and understood. Unfortunately, as shown by Eisenberg et al1 in this issue of Pediatrics , we appear to be failing miserably. Mothers received correct advice from doctors about sleep position only 54% of the time and about sleep location only 19% of the time. Even if doctors gave correct advice more frequently than reported, information cannot protect infants if mothers do not hear, believe, and act on it. Why does this matter? Is our advice really that important? In the case of sleep position and location, it can be a matter of life or death. Every day in the United States, healthy … Address correspondence to Scott D. Krugman, MD, MS, Chairman, Department of Pediatrics, MedStar Franklin Square Medical Center, 9000 Franklin Square Dr, Baltimore, MD 21237. E-mail: scott.krugman{at}medstar.net

Successful IT Initiative to Reduce the Rate of Excessive Uterine Contractions During Labor

Introduction/aims Oxytocin, an effective drug to increase the rate and strength of uterine contractions, is used in more than half of all labors. Intravenous infusions are adjusted frequently at the bedside because the uterine response can vary greatly. Clinical protocols recommend discontinuing oxytocin in the presence of overly frequent contractions because they can decrease oxygen delivery to the fetus and result in brain injury. Despite well-established guidelines, incautious use of oxytocin is reported in 45-71% of births with severe asphyxia and subsequent litigation. In 2011 Medstar Franklin Square Medical Center introduced specialized obstetrical software (PeriCALM Patterns V2.01 PeriGen, Cranbury, NJ) with electronic fetal monitor (EFM) pattern recognition and display features specifically designed to assist in the prompt recognition of uterine tachysystole. Uterine tachysystole (UT) is defined as the presence of more than 5 contractions per 10 minutes, averaged over a 30-minute period. The objective of this study was to compare the rates of UT in the periods “Before” and “After” the introduction of this software in women with induction or augmentation of labor. Methods/process/procedures Inclusion criteria were labors with live singleton cephalic-presenting babies at term with EFM recordings. The “Before” group comprised 6728 births (3869 with induction or augmentation) from February 2006 to February 2010. The “After” group included 3790 births (1988 with induction or augmentation) from January 2012 to December 2013. Induction or augmentation status was ascertained by automated review of the electronic medical record database searching for evidence of interventions or oxytocin use to induce or enhance labor. Each EFM record was analyzed by PeriCALM Patterns software to determine contraction counts in 30 minute segments. Results As a result of early detection and prompt remediation, very substantial reductions were observed in a variety of UT-related measures. In women with induction or augmentation the rate of tachysystole fell from 22.7% to 17.3% (p<0.0001). When UT did occur, the average duration fell from 64 minutes to 54 minutes (p=0.0039). In those who experienced UT, the total percentage of time spent in UT decreased by 36.5% over the course of this study (p<0.0001). There were also decreases in the percentages of babies with severe neonatal depression, but the small numbers precluded statistical significance. Discussion/outcomes This is the first report of a large and systematic review on the effect of efforts to reduce uterine tachysystole. We observed a very substantial and sustained reduction in both the incidence and duration of UT in patients with augmentation or induction of labor. The 36.5% reduction in the total percentage of time spent in UT reflects a marked changed in clinical behavior. We attribute this marked improvement to the coexistence of several essential factors present in IT initiatives that actually change behavior: 1. Objective computations at the point of care that are personalized to the individual patient; 2. Continuous trend analysis and feedback showing the patient’s situation related to expected norms; 3. Clearly established clinical policies regarding expected therapeutic actions; 4. Active quality improvement follow up.

“Good Bad Stuff”: Editing, Advertising, and the Transformation of Genteel Literary Production in the 1890s

“Good Bad Stuff”: Editing, Advertising, and the Transformation of Genteel Literary Production in the 1890s Michael Epp (bio) “It’s one thing in real life, but another in Harper’s.” —James L. Ford In 2000, Lewis H. Lapham, with Ellen Rosenbush, edited a huge memorial volume dedicated to honoring the influence of Harper’s Magazine on U.S. literary and cultural history. Titled An American Album: One Hundred and Fifty Years of Harper’s Magazine, and accompanied by a short forward in which Arthur Schlesinger, Jr. makes the dramatic, accurate claim that the magazine had “helped to shape the American literary landscape for two thirds of the life of the republic,” this printed celebration anthologizes for posterity the Harper’s tradition of incisive and creative intellectual fare.1 Lapham announces in his introduction, “Hazards of New Fortune,” the magazine’s status as a national institution, concluding with the bold declaration that the magazine would continue to do “as the four brothers Harper long ago intended, [to increase] the common stores of energy and hope.”2 The whole fantastic project, with its striking material features and idealistic account of U.S. literary production, highlights the pivotal role of specific institutions in American literary and cultural history since the late nineteenth century.3 This role has been substantially historicized by American literary scholarship; what I want to consider in this paper is the manifest durability of the specific genteel form of literary history enshrined in 2000 by Lapham and the Franklin Square Press. Works like Eric Lott’s Love and Theft, Janice Radway’s A Feeling for Books, Shelley Streeby’s American Sensations, and June Howard’s Publishing the Family address the enduring influence of nineteenth- and early twentieth-century ideologies of race, literary taste, war, and family on U.S. literature and culture, but the specific form of genteel literary history that remains alive and well at Harper’s requires a new approach.4 This is for two reasons: first, because the long life of this genteel self-historicizing has successfully [End Page 186] refused certain forms of transformation, and, second, because this refusal to change is often made to appear as a profound transformation itself.5 What is this specific genteel form? As quality magazines relied, increasingly, on advertising revenue throughout the latter decades of the nineteenth century, genteel literary production was forced to engage what appeared to be a contradiction between its ostensible purpose (to promote good literature and good taste) and its institutional purpose (to secure capital for literary institutions like Harper’s New Monthly Magazine). The appearance of contradiction has been maintained through the embrace of a powerful representation of literary history that lives today in such coffee table tomes as An American Album. This representation is ambivalent in that it includes, at one and the same time, the image of two distinct histories, of the magazine as living two separate lives: the first as the purveyor of good literature in the interests of enduring standards of good taste, and the second as the purveyor of bad literature in the interests of enduring standards of profit. Harper’s house histories emphasize, typically, the former life through references to Franklin Square publishing, while humorous insider histories, like James L. Ford’s 1894 The Literary Shop, emphasize the second through references to the “Franklin Square Prose and Verse Foundry.”6 Drawing on Terence Whalen’s concept of the “Capital Reader”—an editing figure who determined the selection of literary material at publishing houses—and on The Literary Shop—a contemporary, insider view of the magazine industry—I will argue that the magazine historian’s task, in the specific case of Harper’s, is not to find a single narrative of production beneath the representation of the “good life” of the magazine that promotes taste and the “bad life” that promotes capital. Put another way, the task is not to find a resolution to this ambivalent representation. Instead, I suggest this ambivalent representation is exactly the mechanism by which genteel literary history, which originally was a response to specific social and economic conditions of the late nineteenth-century United States, persists in our literary present. In the 1890s, when the...

Effect of Focused Debriefing on Team Communication Skills

Community hospitals often lack tertiary care support such as pediatric intensivists and anesthesiologists. Resuscitation of critically ill and injured children in community hospitals requires a well-coordinated team effort, because good team performance improves quality of care. The lack of subspecialty support makes team coordination and communication more imperative yet much more challenging. This study sought to determine if the addition of a defined focused post-mock code debriefing session improved communication skills among team members in a community pediatric emergency department. Twenty-two volunteer members of the pediatric emergency and respiratory therapy departments at Medstar Franklin Square Medical Center took part in monthly simulated resuscitations for 3 consecutive months. After each simulation, participants answered an 18-item survey on observed communication among their team members. Members then participated in a 30-minute debriefing session in which they reflected on their own communication skills. A video taping of the resuscitation was later scored by one of the investigators by using a rubric designed by the investigators. Descriptive statistics were calculated for both the participant survey and the team communication indicator scores. Paired-sample Wilcoxon signed rank test examined the difference in the scores between each of 3 sessions. The mean scores by investigator-scored video recordings of the teams' mock resuscitation by session showed overall team communication improved between sessions 1 and 3 for all communication areas (P = .03), with significant improvement in 4 of 9 communication areas by the third session. All team members improved communication skills as well, with the greatest improvement by the clinical multifunctional technicians. Communication skills improve with the addition of focused debriefing sessions after mock codes as perceived by participants during debriefing sessions and evidenced by investigator-scored video recordings of resuscitations.

A Survey of Central Association Members About the Definition, Management, and Complications of Shoulder Dystocia

Franklin Square Medical Center Baltimore, Maryland Financial Disclosure: Dr. Gherman has testified as an expert witness for both plaintiffs and defendants.

Two Poems

Two Poems LAWRENCE DUGAN Another Ithaka Three big questions: Where is home? Why Did he leave? Is he sure that he ever left? The last sounds like a dangerous, flexible View of reality, but Cullen once told me This about two brothers who lived on Franklin Square In Philadelphia: They loved baseball so much, On winter evenings when they were kids, You’d see them in the park hitting flies to each other. The last time he saw the older brother He was sleeping at the curb outside a bar Just a couple of blocks from the square. arion 20.3 winter 2013 The Sea Again “He says he’s all shored out,” to say he’s done With the Jersey beaches for awhile, through With the two-hour drive that starts at a bridge, And ends with a field of cat-tails swept by breezes As if the passing cars made them move. So he says. So did the Vikings after Sailing on the Poison Sea, and finding The North Atlantic had reached into their Dreams with cold hands and tales of plunder To be found, where there were none. So it is With the Jersey shore. But you go back, starting At a bridge, the Ben, the Walt or the Betsy, Down 70 to 72, past Woodland Liquors and Patty’s Custard and those scores Of white paths that run nowhere into the dwarf pines, A roof of trees that stretches for miles, then Over the bridge, the inlet, the main drag And five miles of signs welcoming you back In neon shorthand to Long Beach Island Before your first glimpse of gray, green and silver. two poems 38 ...

287: Breech deliveries in the Netherlands: effect of increased caesarean section rate on perinatal outcome

287: Breech deliveries in the Netherlands: effect of increased caesarean section rate on perinatal outcome

Wnt5A Activates the Calpain-Mediated Cleavage of Filamin A

We have previously shown that Wnt5A and ROR2, an orphan tyrosine kinase receptor, interact to mediate melanoma cell motility. In other cell types, this can occur through the interaction of ROR2 with the cytoskeletal protein filamin A. Here, we found that filamin A protein levels correlated with Wnt5A levels in melanoma cells. Small interfering RNA (siRNA) knockdown of WNT5A decreased filamin A expression. Knockdown of filamin A also corresponded to a decrease in melanoma cell motility. In metastatic cells, filamin A expression was predominant in the cytoplasm, which western analysis indicated was due to the cleavage of filamin A in these cells. Treatment of nonmetastatic melanoma cells with recombinant Wnt5A increased filamin A cleavage, and this could be prevented by the knockdown of ROR2 expression. Further, BAPTA-AM chelation of intracellular calcium also inhibited filamin A cleavage, leading to the hypothesis that Wnt5A/ROR2 signaling could cleave filamin A through activation of calcium-activated proteases, such as calpains. Indeed, WNT5A knockdown decreased calpain 1 expression, and by inhibiting calpain 1 either pharmacologically or using siRNA, it decreased cell motility. Our results indicate that Wnt5A activates calpain-1, leading to the cleavage of filamin A, which results in a remodeling of the cytoskeleton and an increase in melanoma cell motility.