Liberal Use Research Articles

Crime & Punishment in the Jim Crow South ed. by Amy Louise Wood and Natalie J. Ring

Reviewed by: Crime & Punishment in the Jim Crow South ed. by Amy Louise Wood and Natalie J. Ring Max Felker-Kantor (bio) Crime & Punishment in the Jim Crow South. Edited by Amy Louise Wood and Natalie J. Ring. (Urbana: University of Illinois Press, 2019. Pp. 240. $99.00 cloth; $26.00 paper; $19.95 ebook) Recent attention to the crisis of mass incarceration has led historians to rethink the roots of crime and punishment in American society. The burgeoning field of carceral state studies has produced important scholarship on the convict lease period following Reconstruction in the South and the punitive turn after the uprisings of the 1960s. Yet, the first half of the twentieth century in America’s carceral past, particularly in the Jim Crow South, has largely gone overlooked. Amy Louise Wood’s and Natalie J. Ring’s nine chapter edited collection provides a needed addition that bridges the convict lease era with that of mass incarceration. Framed around two broadly defined features of the criminal justice system, Crime & Punishment in the Jim Crow South presents a nuanced argument about the South’s distinctive criminal justice system in areas of policing, incarceration, and capital punishment. The region’s suspicion of state power meant that centralized criminal justice systems developed slowly over the first half of the twentieth century as the Jim Crow South modernized. As southern progressives managed a modernizing region reform brought greater state centralization to the criminal justice system. Government oversight, however, did not challenge Jim Crow. Rather, “Criminal justice served to bolster the racial hierarchy in the face of these changes associated with modernity” (p. 6). The mechanisms that facilitated entrance into southern criminal justice systems explored in part one offer insights into the contested history of southern policing. Despite legal segregation, southern police forces were not all-white. As K. Stephen Prince shows, Black police officers in New Orleans who joined the force during Reconstruction presented a challenge to white supremacy’s supporters. Would they support the police or racial order? Using the trial and [End Page 532] removal of a Black officer, George Doyle, for the killing of a white bar owner, Prince shows how “the lines of race proved more enduring than respect for the authority of the police” (p. 23). For the police to become a modern instrument of racial control, in short, it had to be made white. Despite the consolidation of white police forces, African Americans routinely tried to make the police arm of the modern state work for them. As Brandon Jett and Silvan Niedermeier reveal in their respective chapters on homicide investigations and police torture, Black residents attempted to use the police to advance their own interests within the confines of Jim Crow. African Americans in Memphis called the police, acted as witnesses, assisted officers in gathering evidence, and, at times, apprehended suspects. In contrast, as Niedermeyer shows, African American challenges to police torture served as a catalyst for organizing and the foundation of the long Black freedom movement. Just as African Americans attempted to make the state work for them, Jim Crow shielded white criminals from prosecution, as Tammy Ingram demonstrates in a chapter on organized crime in Phenix City, Alabama, that mirrors Khalil Muhammad’s description of the disappearance of the white criminal in the urban north. Efforts to root out organized crime did not lead to the arrest of whites but produced a new means of racialized control in the form of law-and-order politics. Modernization and progressive government reforms released the powers of white supremacy to police African Americans with the backing of the state. The modes of incapacitation developed in response to state centralization, modernization, and progressive reforms unique to the Jim Crow South. However, as the authors in part two show, the criminal justice system not only responded to reform but was a causal factor in the consolidation of an updated system of racial control. As Amy Wood suggests, South Carolina governor Cole Blease resisted centralized state power but employed a liberal use of the pardon to push [End Page 533] forward penal reform and reinforce the populist and personal control over African Americans rooted in racial paternalism. Or, more...

The Road Not Taken: A Documented Biography of Randall Thompson by Carl B. Schmidt and Elizabeth K. Schmidt

Reviewed by: The Road Not Taken: A Documented Biography of Randall Thompson by Carl B. Schmidt and Elizabeth K. Schmidt Brian Cockburn The Road Not Taken: A Documented Biography of Randall Thompson. By Carl B. Schmidt and Elizabeth K. Schmidt. (American Music and Musicians Series, no. 6.) Hillsdale, NY: Pendragon Press, 2018. [xli, 1057 p. ISBN 9781576473085 (hardcover), $92.] Bibliographical references, illustrations, tables, index. [End Page 585] Randall Thompson's influence on American music is unquestioned yet rarely acknowledged. Like many musicians, he lived a multifaceted professional life—as researcher, administrator, teacher, conductor, and accompanist, as well as composer. Thompson taught at Wellesley College, the University of California at Berkeley, the University of Virginia, Princeton University, and Harvard University; his students included such eventual luminaries as Leonard Bernstein, Samuel Adler, and Leo Kraft. Beginning 1 August 1932, he was employed to direct a study examining the state of college music education. Though the subsequent report was instrumental in reshaping these music programs across the United States, modern educators underestimate his influence. His compositions span most genres, and he was recognized as a particularly important composer of choral music, as his informal title "dean of American choral composers" attests (back cover). Still, even seasoned choral conductors can rarely name more than a handful of his works. The published writings on Thompson are far from satisfactory. The small group of theses and dissertations focus primarily on his choral compositions, and the surprisingly meager number of journal articles concentrate mostly on his choral output. Prior to the work at hand, Randall Thompson: A Bio-Bibliography by Caroline Cepin Benser and David Francis Urrows (New York: Greenwood Press, 1991) was arguably the best monographic biographical treatment of Thompson. Other notable publications include "The Choral Music of Randall Thompson," a special issue of American Choral Review (vol. 16, no. 4 [1974]: 1–62), with contributions by Elliot Forbes, James Haar, Alfred Mann, and Thompson himself, and Randall Thompson: A Choral Legacy (Boston: E. C. Schirmer, 1983), a set of essays by Thompson and others edited by Mann. Yet, for most, Thompson's life is only vaguely known. Fortunately, Carl B. Schmidt, who like Thompson is himself a performer, conductor, teacher, researcher, and administrator, has undertaken what he describes as his "Randall Thompson Project" (p. xxxvi). His past work resulted in a number of significant monographs, including catalogs that established the numbering systems for each composer's works: The Music of Georges Auric: A Documented Catalogue in Four Volumes (Lewiston, NY: Edwin Mellon, 2013) and The Music of Francis Poulenc (1899–1963): A Catalogue (Oxford: Clarendon Press, 1995). Schmidt's first Thompson book, The Story of Randall Thompson's Alleluia Revisited: A Facsimile Edition with Commentary (Boston: ECS, 2010), chronicles the creation of one of the world's most beloved sacred American choral works. With his wife, Elizabeth K. Schmidt, he published a catalog of Thompson's music (The Music of Randall Thompson [1899–1984]: A Documented Catalogue [Fenton, MO: E. C. Schirmer, 2014]). The work under review, the authors' most recent book, is surprisingly the first full-length biography of Thompson. For the two authors, these three volumes on Thompson and his work appear to be as much a product of devotion as a remarkable scholarly achievement. The present work is an imposing monograph of almost 1,100 pages divided into eighteen chapters. The most expensive book to date in Pendragon Press's American Music and Musicians Series, it has breadth and depth equal to any. Important to note because of its size: this volume has a solid yet flexible binding that has held up well to significant abuse. One can open the volume [End Page 586] to any page and expect it to stay open and lie flat. The Schmidts begin their preface with a quote from Thompson: "I'm glad I've done more than compose. The other jobs make composing more interesting" (p. xxxi, quoting from Mary Channing Stokes, "Profile: Randall Thompson," Harvard Crimson, 5 June 1950). The authors' organization, liberal use of primary sources, and sensitive prose serve to illustrate Thompson's statement. Each chapter covers a short segment of time in Thompson's life. Most chapters cover two to four...

Souvenirs of the Apocalypse: Guns as Authenticating Props

Souvenirs of the ApocalypseGuns as Authenticating Props Rachel Wagner (bio) Seventeen people died in the shooting at Marjory Stoneman Douglas High School in Parkland, Florida, on February 14, 2018. A week later Donald Trump blamed movies and video games for creating the violent culture that led to the shooting, saying: “I don’t know what this does to a young kid’s mind, somebody growing up and forming and looking at videos where people are just being blown away left and right ... the level of craziness and viciousness in the movies, I think we have to look at that too.”1 Trump’s remarks are in sync with the NRA’s take after the massacre at Sandy Hook Elementary in 2012. As a means of explaining the killings, Wayne LaPierre called the movie business “a callous, corrupt and corrupting shadow industry that sells, and sows, violence against its own people.” He pointed to “blood-soaked slasher films like American Psycho and Natural Born Killers that are aired like propaganda loops.”2 And yet, in 2013 the NRA’s magazine The American Rifleman ran a story about the top ten “coolest gun movies.”3 Some of these, like The Alamo (1960), draw on Western themes and celebrate the survivor who uses his gun for masculine adventure. Others, like Terminator (1984) and Red Dawn (1984), imagine an alternate dystopic future in which guns are the only means to survive against hostile foes. Zombieland (2009) and Tremors (1990) stray into fantasy, imagining monstrous enemies that threaten all of civilization. The Road Warrior (1981) celebrates the violent vigilante, scraping out an existence in a dismal post-apocalyptic future. All celebrate the manly pluck of the shooter who knows when to kill and doesn’t hesitate. [End Page 310] These are films about winning with guns. Clearly, there is some inconsistency in the NRA’s views about movies and guns. Part of the problem is definitional: The way that one understands broad terms like “violence” and “media” largely shapes the outcome of one’s analysis. As David Trend points out in his book The Myth of Media Violence, it’s not much of a stretch to say that the Bible is a form of media that is “violent.” War monuments are “violent.” Films like Schindler’s List (1993) and Hotel Rwanda (2004) are “violent.” Even Disney’s The Lion King (1994) is “violent.”4 Media violence, Trend proposes, is “one of the most widely discussed yet least understood issues of our time.”5 In the United States, there are about 37,000 deaths per year from guns, and mass shootings happen at the rate of one or more per day.6 Violent media are not irrelevant in this dangerous equation, but they can hardly be seen as directly causative—especially if we can’t agree on what makes media “violent” in the first place. The issue is far too complex to boil down to a simple cause-and-effect arrangement. However, if we shift from conversations about broad categories like “media” and “violence,” we can ask more nuanced questions about what guns and violent movies might have in common. That is, what broader culture might they both participate in? I argue here that the gun can be viewed as a deadly prop in a mythological construct that is bigger than individual gun-owners, bigger than the movies they watch, and even bigger than the guns themselves. After introducing the cowboy apocalypse myth, I will turn to a consideration of the gun as a kind of quasi-sacramental self-authenticating prop, the material instantiation of the repeated filmic portrayal of a violent post-apocalyptic future yearned for by those who embrace the myth. Indeed, the gun can be viewed as a mode of violent mediation all by itself. The Cowboy Apocalypse In its hybrid form, what I call the “cowboy apocalypse” is a complete mythic story arc. It is about America’s beginnings, but it is also about the whole world’s imminent ending. Those who survive the violent transformation of the world will do so by a combination of grit, individualism, and violence—and often with the liberal use of guns. The cowboy...

Nail Care for Healthcare Workers during COVID-19 Pandemic.

Nail Care for Healthcare Workers during COVID-19 Pandemic.

Endoscopic Mucosal Resection

Endoscopic mucosal resection (EMR) is an effective diagnostic and potentially therapeutic treatment of dysplastic Barrett's esophagus and early intramucosal esophageal carcinoma. Appropriate patient selection for therapeutic resection can follow a diagnostic endoscopic resection, and liberal use of EMR is encouraged to gain insight into the metastatic potential of any early esophageal tumor that appears amenable to EMR. EMR is a low-risk procedure; multidisciplinary groups should consider it a vital component of the staging algorithm for esophageal cancer.

River, Reaper, Rail: Agriculture and Identity in Ohio's Mad River Valley, 1795–1885 by Timothy H. H. Thoresen

Reviewed by: River, Reaper, Rail: Agriculture and Identity in Ohio's Mad River Valley, 1795–1885 by Timothy H. H. Thoresen Ginette Aley (bio) Keywords Ohio, Old Northwest, agriculture, farming, railroads, markets River, Reaper, Rail: Agriculture and Identity in Ohio's Mad River Valley, 1795–1885. By Timothy H. H. Thoresen. (Akron, OH: The University of Akron Press, 2018. Pp. 279. Paper, $59.95.) As late as 1860, the eve of the Civil War, Ohioans' collective identity was wrapped up in agriculture. As historian Timothy H. H. Thoresen observes, "Land to own and to farm, that was the desire" (114). Indeed, this sentiment pervaded the nineteenth-century Midwest. Although his study, River, Reaper, Rail: Agriculture and Identity in Ohio's Mad River Valley, 1795–1885, is firmly rooted in Champaign County, Ohio, its tracing of farmers' early market orientation, including adaptations of traditional farming practices to changing circumstances and technology, and development of state-sponsored farmer organizations tells a much broader story of agrarianism across the North and, specifically, emerging Midwest. Making liberal use of land, tax, and county records as well as census data, land policy, annual state agriculture reports, and newspapers, Thoresen deftly re-creates the world of nineteenth-century farming in Ohio, from the primitive pioneering phase to a post-Civil War era dominated by railroads. While his heavy reliance on local newspapers casts an impressionistic view on his interpretation, it nevertheless offers up some of the prominent male voices, concerns, and ideas in these farm communities. As others have done, Thoresen characterizes farmers as fundamentally conservative. Yet his study demonstrates at least an interest on their part in change and improvement—so long as the cost did not significantly alter or constrain farm operations. As shown here, farmers historically have also been innovators. [End Page 176] In 1805, two years after Ohio's statehood, Champaign County was established in the Mad River Valley in the west-central part of the state; however, settler-farmers had been pushing into the area from the east and by way of the Ohio River since the 1790s, especially after the 1795 Treaty of Greenville. New arrivals, who settled mainly along the waterways as well as the Virginia Military District, faced a physically arduous process in clearing the forested land, which typically required 3 to 5 years until farms were self-sustaining. The landscape became dotted with unfenced cattle and pigs; small grain cultivation; draft animals, especially oxen; and plowing at the rate of about an acre per day. Migrants came in several waves including after the War of 1812 and then again in the 1820s and 1830s, each time indicating land-purchase patterns that reflected changing land policies. In ways that call to mind the insightful work of noted agricultural and rural historian R. Douglas Hurt, Thoresen pays close attention to the farming practices and market attitudes settler-farmers brought with them and how both evolved with the new farming environment, transportation connections, and expanding market economy. Two key adaptations that advanced American agriculture and productivity were improved plows and the cradle scythe. Extremely marginal transportation and market access, however, loomed as the early nineteenth century's defining problems; solving them, the author points out, "is essentially the history of Champaign County" (11). One need only look at the legislative history concerning local and state-level agriculture societies and infrastructure-building—roads, bridges, canals, and early railroads—to discern growing market interest, locally, statewide, and regionally. Thoresen perceptively surmises that "participation in the market economy was not a conceptual problem; it was a practical problem" (39). Eliminating obstacles opened the door for and, as he characterizes, gave incentive to, farmers to strive for greater productivity, improved breeding of livestock, and higher-yielding seed. Clearly, though, the impact of the railroad on Champaign County, Ohio, farmers and American agriculture more broadly, even in its infancy in the 1850s, cannot be overstated. The prospects of commercial agriculture transformed ideas about farming. More market connections, reduction of transit time and freight charges not only made increased productivity logical but also led to a related rise in storage and processing enterprises such as grain-storage warehouses, grain cars, and so on. Greater productivity came...

Ellipsis as Resistance in Heinrich Böll's “Wanderer, kommst du nach Spa…” (1950)

One of the most salient features of Heinrich Böll's short story “Wanderer, kommst du nach Spa…” (1950) is its prominent and liberal use of typographical ellipsis. The ellipses that permeate this wartime story both underline the theme of loss and enable the narrator to use his tale to exercise one last measure of resistance to his fate. As part of a first‐person narrative, the ellipses can be read as an assertion of narrative authority and authenticity. Through the refusal to say certain words and phrases and by rejecting physical and chronological restrictions, the young narrator rejects Nazi ideology and creates for himself a limited yet meaningful sense of freedom. His resistance is mirrored by the final image of the text, an indelible cross on the wall which, like a textual ellipsis, persistently marks that which has been erased.

Atherothrombosis Prevention and Treatment with Anti-interleukin-1 Agents

Despite major advances in terms of prevention, diagnosis, risk-stratification, management and rehabilitation, atherosclerosis and atherothrombosis continue to have major morbidity and mortality implications worldwide. Since the unraveling of the pivotal role of inflammation in atherothrombosis pathophysiology, several focused treatments have been proposed with the ultimate goal of preventing or treating myocardial infarction, stroke, and peripheral artery disease. In particular, given the centrality of interleukin-1 (IL-1), targeted anti-IL-1 agents have attracted substantial attention and efforts. Yet, uncertainty persists on the real risk-benefit and cost-benefit balance of anti-IL-1 agents in patients with or at risk of atherothrombosis. Several trials have been recently completed on atherothrombosis prevention and treatment with anti-IL-1 agents, ranging, for instance, from the large Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) trial to the series of translational studies conducted within the Virginia Commonwealth University-Anakinra Remodeling Trial (VCU-ART) platform. In light of the present scoping umbrella review, it appears evident that anti-IL-1 agents can reduce systemic inflammation and improve surrogate markers of cardiac and vascular function, with potential benefits on the risk of new/worsening heart failure. One trial suggested an increased risk of major adverse events with anti-interleukin-1 agents, possibly due to a rebound phenomenon, but this was based on a post-hoc analysis of a small number of events, and it was not supported by all other pertinent trials. The CANTOS study showed a potential hazard due to an increased risk of fatal infections, but the effect size was rather small. In addition, cost issues limit the foreseeable scope of these treatment strategies in unselected patients, calling instead for more refined prescribing. The evidence base on the risk-benefit and cost-benefit profile of anti-IL-1 agents for atherothrombosis prevention and treatment has expanded substantially in the last decade. While largely dominated by the landmark CANTOS trial, effect estimates also including the VCU-ART trials suggest complex short- and long-term effects which may prove favorable in carefully selected patients with acute or chronically sustained inflammation. Conversely, more liberal use appears less promising, and further studies with currently available agents or novel ones are eagerly needed to better define their role in the era of precision molecular medicine.

Effects of Conservative Versus Liberal Oxygen Therapy on the Outcomes of Critically Ill Patients: A Systematic Review and Meta-Analysis

Background: The liberal use of supplemental oxygen therapy is common in intensive care units (ICUs) for critically ill patients, but this practice still lacks high-quality evidence, especially for patients receiving mechanical ventilation (MV). We systematically reviewed the effects of conservative versus liberal oxygen therapy in critically ill adults. Methods: We searched the following electronic databases, including dates from Jan 1st, 2001 until Nov 31st, 2018: PubMed/MEDLINE, Embase, the Cochrane (Central) database and Ovid. Randomized controlled clinical trials (RCT), before-and-after trials or cohort studies comparing conservative with liberal oxygen therapy in critically ill adults (aged ≥18 years) were retrieved. The main outcomes were mortality and ventilator-free days, length of stay, and adverse effects assessed by random-effects meta-analyses. We used the GRADEpro Guideline Development Tool and Trial sequential analysis (TSA) to evaluate the quality of evidence and information size, respectively. Meta-regression was conducted to explore heterogeneity among studies. Findings: Five RCTs and 2 before-and-after trials enrolled 16188 ICU patients. Compared with liberal oxygen therapy, a conservative oxygen strategy (maintaining peripheral oxygen [SpO2] ≤ 98% or arterial oxygen partial pressure [PaO2] ≤ 100 mmHg at the lowest possible FiO2) decreased hospital mortality (RR = 0.88; 95% CI, 0.81-0.95; p = 0.002, moderate quality), especially for patients receiving MV (N = 12327; RR = 0.91; 95% CI, 0.84-1.00; p = 0.05, moderate quality). Moreover, it reduced hospital length of stay (Std. MD = -0.04; 95% CI, -0.06- -0.01; p = 0.01, moderate quality) and increased ventilator-free days either at day 28 (Std. MD = 0.04; 95% CI, 0.01-0.08; p = 0.005, low quality) or during ICU stay (Std. MD = 0.49; 95% CI, 0.30-0.68; p < 0.00001, low quality). The incidence of new bacteremia was much lower in the conservative oxygen therapy group (RR = 0.53; 95% CI, 0.30-0.92; p = 0.02, very low quality). TSA indicated that no more clinical studies should be conducted to prove a beneficial effect of conservative oxygen therapy on hospital length of stay rather than ICU length of stay for critically ill patients. Interpretation: In critically ill adults, conservative oxygen therapy improves hospital mortality, decreases hospital length of stay and increases ventilator-free days, without impacting overall adverse effects. More clinical trials with better designs are needed to optimize the strategy of conservative oxygen therapy in ICU. Funding Statement: This work was supported by the National Natural Science Foundations of China (No. 81571874, 81670074, 81870066), the Key Research and Development Plan of Jiangsu Province (BE2018743), the Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX17_0168), Natural Science Foundation of Jiangsu Province (BK20171271), the Jiangsu Provincial Medical Youth Talent (QNRC2016807) and Third Level Talents of the “333 High Level Talents Training Project” in the fifth phase in Jiangsu (LGY2016051). Declaration of Interests: None declared.

Antibiotic Allergy Labels in Children Are Associated With Adverse Clinical Outcomes

To examine whether antibiotic allergy labeling has a significant impact on clinical outcomes in children.The study included 1672 pediatric patients. The mean age of patients was 6.8 years (range: 0–18.7 years).Children with an antibiotic allergy label in their charts admitted to a tertiary care teaching hospital in Australia were retrospectively identified from April 2014 to April 2015 through chart review. Data collected included history of allergic reaction, antibiotic allergy label, diagnosis on admission, antibiotics prescribed, admitting specialty, length of stay, and hospital readmissions within 4 weeks and 6 months of discharge.Antibiotic allergies were recorded in 5.3% of the cohort, with β-lactams most commonly reported (85%). Increasing age was significantly associated with increased likelihood of having a documented allergy label, most commonly a β-lactam allergy label. Children with antibiotic allergy labels were more likely to receive macrolides, quinolones, lincosamides, and nitroimidazoles compared with patients without an allergy label. After adjusting for age, sex, diagnosis, and admitting specialty, an antibiotic allergy label was associated with prolonged length of hospital stay (odds ratio: 1.62; 95% confidence interval: 1.05–2.50).Researchers in this study found that antibiotic allergy labeling was associated with negative clinical outcomes in children, including longer hospital stays and greater use of broad-spectrum antibiotics when compared with patients without an antibiotic allergy label.This is the first study to examine the effect of antibiotic allergy labels on clinical outcomes in children. In addition to increased hospital stays, this study demonstrated increased use of reserve antibiotics. More liberal use of broad-spectrum antimicrobial agents is concerning because these medications can increase risk of multidrug resistance. Patients with mild to moderate reactions could potentially undergo allergy evaluation and be delabeled. Researchers in this study suggest that early delabeling may aid in mitigating adverse clinical outcomes in children with antibiotic allergy labels.

Trends in Primary Kidney Cancer: A South Australian Registry Review

Background The incidence of primary kidney cancer (PKC) has been increasing over the last three decades. This has been attributed to the liberal use of radiological examinations for unrelated indications. We investigated the incidence and survival trends of PKC in South Australia. Methods Data were provided through the South Australian Cancer Registry and comprised pathology, hospital admission and death notifications between 1977- 2013. Basic demographic data at diagnosis, tumour grade, and overall survival (OS) were available for analysis. Results During 1977-2013 there were 5529 cases of PKC diagnosed. Mean overall survival was 70.6 months (standard deviation 80.2). The age adjusted incidence of PKC has increased from 5 per 100,000 to 12.7 per 100,000. However, CSS and OS has significantly improved at each decade of diagnosis since 1977 (p&lt;0.001). Conclusion Since 1977 the incidence of kidney cancer has doubled in South Australia with step-wise improvement in OS at each decade of diagnosis.

Comorbidities and sex differences in causes of death among mantle cell lymphoma patients – A nationwide population‐based cohort study

The prognosis for mantle cell lymphoma (MCL) remains poor. Our aim was to assess the impact of comorbidities on survival and causes of death. For 1,385 MCL patients (1,009 males, 376 females) diagnosed in 2000-2014 (median age 71years, range 22-96) comorbidities≤10years of diagnosis were classified according to the Charlson comorbidity index (CCI; 0, 1, 2+). Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated to compare lymphoma-specific and all-cause mortality rates. Model-based predictions were used to obtain probabilities of death. Overall, 44% had any comorbidity (CCI1+) and 28% severe comorbidity (CCI2+). Over a median follow-up of 3·7years (range 0-16), 633 (46%) died, the majority (76%) from lymphoma. Severe comorbidity was independently associated with higher all-cause [hazard ratio (HR)=1·52; 95% CI: 1·24-1·85) and lymphoma-specific mortality (HR=1·31; 95% CI: 1·04-1·65). Particularly among patients with connective tissue, renal and psychiatric diseases, and dementia. Among females with any comorbidity, non-lymphoma deaths represented a larger proportion of all deaths, compared to males with any comorbidity. In general, more efficient lymphoma treatments need to be considered also for patients with severe comorbidity. However, among females with any comorbidity, the likelihood of non-lymphoma death was still considerable, perhaps favouring a more liberal use of a "wait and watch" approach.

Neonatal and pediatric platelet transfusions: current concepts and controversies.

In this review, we focus on three specific concepts related to platelet transfusion in the neonatal and pediatric population: choice of transfusion threshold; use of ABO-mismatched platelets; transfusion of pathogen-reduced or inactivated platelets. Recent trials support the use of lower platelet transfusion thresholds (25 000/μl) in preterm neonates, although data is limited to guide transfusion among more mature neonates. In children, there is low-level evidence as to what the prophylactic platelet transfusion threshold should be in many situations of thrombocytopenia, revealing major variability in platelet transfusion practices. Most pediatric guidelines are extrapolated from adult studies with the most evidence in treatment-associated hypoproliferative thrombocytopenia varying between a platelet transfusion threshold of 10 000/μl to 20 000/μl. Although pathogen-reduced platelets may lower the risks of transfusion-transmitted infection, the effects on platelet refractoriness and transfusion burden in this population warrant additional study. Our review highlights recent advances in neonatal and pediatric platelet transfusion and also emphasizes the urgent need for better evidence to guide practice given recent studies showing the potential harms of platelet transfusion, particularly with liberal use.

Secular Lyric: The Modernization of the Poem in Poe, Whitman, and Dickinson

Secular Lyric: The Modernization of the Poem in Poe, Whitman, and Dickinson

When Less Is More: Why Extubation With Less Than Routine 100% Oxygen May Be a Reasonable Strategy.

When Less Is More: Why Extubation With Less Than Routine 100% Oxygen May Be a Reasonable Strategy.

Laparoscopic adrenalectomy - is it safe in hands of residents in training?

BackgroundLaparoscopic adrenalectomy (LA) has become the “gold standard” for treating most adrenal tumors in the past decade. However, it is still considered a relatively complicated procedure requiring experience from surgeon. The aim of the study was to evaluate the safety of laparoscopic adrenalectomy performed by residents who are undergoing training in general surgery.MethodsA prospectively collected database containing all 300 transperitoneal laparoscopic adrenalectomies performed in II Department of General Surgery JU MC, Krakow between January 2013 and March 2018 was retrospectively reviewed. Patients were divided into two groups; patients operated on by residents (group 1, 54 operations) and by attending general surgeons (group 2, 246 operations). We compared the course of the operation and patient hospitalization in these two groups. If the operation was completed by a different person than the one who started the procedure, we refer to this as “operator conversion”.ResultsWe found no differences in demographic factors or comorbidities between the two groups. The mean operative time was similar in the residents’ and the specialists’ groups (p = 0.5761). Median blood loss did not differ between the groups (p = 0.4325). The overall ratio of intraoperative adverse events was similar in both groups (p = 0.8643). The difference in the ratio of perioperative complications between the groups was not statistically significant (p = 0.6442). The average mean hospital stay after surgery was 2 days for both groups. We identified 25 cases (8.33%) of operator conversion; the difference in operator conversions between two groups was not statistically significant (p = 0.1741).ConclusionsLaparoscopic transperitoneal adrenalectomy performed by a supervised resident is a safe procedure. The course of the operation and patient hospitalization did not differ importantly when comparing procedures performed by residents and attending surgeons. Liberal use of operator conversions from resident to attending surgeon and from a surgeon to a senior surgeon provides reasonable safety and prevents complications. In high-volume centers performing minimally invasive techniques, closed supervision allows residents to safely perform LA.

Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database.

To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database. Retrospective analysis on 52982 anatomic lung resections registered in the ESTS database (July 2007-31 December 2017) (6587 pneumonectomies and 46395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared. 8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P < 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak >5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44). Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer.

Current role of trisectionectomy for hepatopancreatobiliary malignancies.

BackgroundTrisectionectomy is a treatment option in extensive liver malignancy, including colorectal liver metastases (CRLM). However, the reported experience of this procedure is limited. Therefore, we present our experience with right hepatic trisectionectomy (RHT) for CRLM as an example and discuss the changing role of trisectionectomy in the context of modern treatment alternatives based on a literature review.MethodsBetween January 1993 and December 2014 all patients undergoing RHT at a single center in the UK for CRLM were included. Patient and tumor characteristics were reviewed and a multivariate analysis was done. Based on a literature review the role of trisectionectomy in the treatment of HPB malignancies was discussed.ResultsA total of 211 patients undergoing RHT were included. Overall perioperative morbidity was 40.3%. Overall 90‐day mortality was 7.6% but reduced to 2.8% over time. Multivariate analysis identified additional organ resection (P = .040) and blood transfusion (P = .028) as independent risk factors for morbidity. Multiple tumors, total hepatic vascular exclusion, and R1 resection were independent risk factors for significantly decreased disease‐free and disease‐specific survival. Further surgery for recurrence after RHT significantly prolonged survival compared with palliative chemotherapy only.ConclusionWith the further development of surgical and multimodal treatment strategies in CRLM the indications for trisectionectomy are decreasing. Having being formerly associated with high rates of perioperative morbidity and mortality, this single‐center experience clearly shows that these concomitant risks decrease with experience, liberal use of portal vein embolization and improved patient selection. Trisectionectomy remains relevant in selected patients.

Outcomes and complications for portal vein or superior mesenteric vein injury: No improvement in the era of damage control resuscitation

IntroductionPortal vein (PV) and superior mesenteric vein (SMV) injuries are lethal. We hypothesised outcomes have improved with modern trauma care. MethodsWe reviewed patients presenting to our Level 1 trauma centre over ten-years with PV/SMV injuries, analysing physiology, operative management, associated injuries, and outcomes. ResultsTwenty-four patients had 7 PV and 15 SMV injuries, 2 had both; all had operative exploration. Sixty-seven percent had penetrating trauma. While many had normal vitals, profound acidosis was common. All patients had ≥2 additional abdominal injuries, liver most common (50%). Additional abdominal vascular injuries were more common in non-survivors than survivors: IVC 46% vs 22%, common hepatic artery 20% vs 0%, SMA 26% vs 11%. The mean injury severity score (ISS) was 32.4, and the mean new injury severity score (NISS) was 44.5. Mortality was 63%. Eleven patients died from exsanguination, two from SMV thrombosis, and two from sequelae of other injuries. All survivors had venorrhaphy, as did 8 non-survivors. Non-survivors were also shunted; had ligation; or bypass, shunting, and ligation. Three exsanguinated prior to repair. Two survivors had SMV related complications. One with proximal SMV injury developed severe venous congestion and multiple enterocutaneous fistulae. Another developed an arterioportal fistula, managed with embolisation and percutaneous portal vein stenting. ConclusionDespite advances (REBOA, damage control surgery and resuscitation, liberal use of ED thoracotomy), PV and SMV injuries remain lethal. Injuries to other structures are ubiquitous. Early exsanguination is the major cause of death. All survivors had successful venorrhaphy; those who required more complex repairs died. Compromised mesenteric venous flow causes morbidity and mortality.

P335Prevalence of transthyretin cardiac amyloidosis in a community-based heart failure population

Abstract Introduction Cardiac wild type (wt) transthyretin (ATTR) amyloidos causes hypertrophic, restrictive cardiomyopathy in older patients and is generally considered underdiagnosed. However, its prevalence remains poorly investigated. Scintigraphy using bone tracers, e.g. Tc-PYP and Tc-DPD, is a highly sensitive and specific method for detection of cardiac ATTR and has revolutionised diagnostics The aim of this study was to describe the prevalence of wtATTR amyloidosis in our heart failure population. Methods Our University Hospital is the sole provider of specialised heart care in an area with around 150 000 inhabitants, 37 600 of which are older than 60 years. Medical records for all living patients in the area with a diagnosis of heart failure, hypertensive heart disease or cardiomyopathy between 2010 and May 2018 were scrutinized (n=2237). 95% of these patients had an echocardiographic exam available for re-evaluation. All patients withseptal thickness &gt;14 mm who had no previous DPD scintigraphy or genetic diagnosis of sarcomeric hypertophic cardiomyopathy were offered DPD scintigraphy (n=131). Eight patients died prior to and 38 patients declined work up, mainly due to old age. A DPD uptake of grade 2 or higher was considered diagnostic in absence of signs of AL amyloidosis. Results Adding up patients found during the screening effort and those with an already known diagnosis of wtATTR amyloidosis, 26 patients had wtATTR. Their men age was 84 years and 90% were male. Conclusions The study gives us an estimated prevalence of disease warranting specialized heart failure treatment of 1/1500 in the population older than 60 years. Cardiac wtATTR amyloidosis is common in patients with heart failure and increased LV wall thickness, especially among the older male patients. Therefore we recommend a liberal use of bone scintigraphy in this group.