Revision Strategies Research Articles

Formalization of a Specialty-Specific Military Unique Curriculum: A Joint United States Army and United States Air Force Infectious Disease Fellowship Program.

There are many unique aspects to the practice of military Infectious Diseases (ID). San Antonio Uniformed Services Health Consortium Infectious Disease (ID) Fellowship is a combined Army and Air Force active duty program. Program leadership thought ID military unique curriculum (MUC) was well integrated into the program. We sought to verify this assumption to guide the decision to formalize the ID MUC. This study describes our strategy for the refinement and implementation of ID specific MUC, assesses the fellow and faculty response to these changes, and provides an example for other programs to follow. We identified important ID areas through lessons learned from personal military experience, data from the ID Army Knowledge Online e-mail consult service, input from military ID physicians, and the Army and Air Force ID consultants to the Surgeons General. The consultants provided feedback on perceived gaps, appropriateness, and strategy. Due to restrictions in available curricular time, we devised a three-pronged strategy for revision: adapt current curricular practices to include MUC content, develop new learning activities targeted at the key content area, and sustain existing, effective MUC experiences.Learners were assessed by multiple choice question correct answer rate, performance during the simulation exercise, and burn rotation evaluation. Data on correct answer rate were analyzed according to level of training by using Mann-Whitney U test. Program assessment was conducted through anonymous feedback at midyear and end of year program evaluations. Twelve military unique ID content areas were identified. Diseases of pandemic potential and blood borne pathogen management were added after consultant input. Five experiences were adapted to include military content: core and noon conference series, simulation exercises, multiple choice quizzes, and infection control essay questions. A burn intensive care unit (ICU) rotation, Transport Isolation System exercise, and tour of trainee health facilities were the new learning activities introduced. The formal tropical medicine course, infection prevention in the deployed environment course, research opportunities and participation in trainee health outbreak investigations were sustained activities. Ten fellows participated in the military-unique spaced-education multiple-choice question series. Twenty-seven questions were attempted 814 times. 50.37% of questions were answered correctly the first time, increasing to 100% correct by the end of the activity. No difference was seen in the initial correct answer rate between the four senior fellows (median 55% [IQR 49.75, 63.25]) and the six first-year fellows (median 44% [IQR 39.25, 53]) (p = 0.114). Six fellows participated in the simulated deployment scenario. No failure of material synthesis was noted during the simulation exercise and all of the fellows satisfied the stated objectives. One fellow successfully completed the piloted burn ICU rotation. Fellows and faculty reported high satisfaction with the new curriculum. Military GME programs are required by congress to address the unique aspects of military medicine. Senior fellow knowledge using the spaced interval multiple-choice quizzes did not differ from junior fellow rate, supporting our concern that the ID MUC needed to be enhanced. Enhancement of the MUC experience can be accomplished with minimal increases to curricular and faculty time.

One- and two-stage surgical revision of infected shoulder prostheses following arthroplasty surgery: A systematic review and meta-analysis

Periprosthetic joint infection (PJI) is a catastrophic complication of shoulder arthroplasty. Commonly used surgical treatments include one- or two-stage revision, but their effectiveness in controlling infection is uncertain. We aimed to compare re-infection (recurrent and new infections) rates; clinical measures of function and pain; and noninfection complication rates of one- and two-stage revision surgery for shoulder PJI using a systematic review and meta-analysis. We searched MEDLINE, Embase, Web of Science, and The Cochrane Library to February 2018. Longitudinal studies conducted in patients with shoulder PJI treated exclusively by one- or two-stage revision were eligible. No clinical trials were identified. Re-infection rates were meta-analysed using random-effect models after arcsine transformation. The re-infection rate (95% CI) in pooled analysis of eight one-stage studies (147 participants) was 5.3% (1.4–10.6). The corresponding rate for 27 two-stage studies (351 participants) was 11.5% (6.0–18.1). Postoperative clinical measures of function and pain were not significantly different between the two revision strategies. The pooled noninfection complication rate (95% CI) for one-stage and two-stage revision was 12.1% (6.1–19.5) and 18.9% (8.4–31.9) respectively. New evidence suggests one-stage revision is at least equally as effective as the two-stage in controlling infection, maintaining joint function, and improving complications in shoulder PJI.

Testing the Feasibility of Measuring Recovery in Adolescent Participants of an Alternative Peer Group: Lessons Learned and Next Steps

The aim of this article is to report lessons learned from feasibility challenges faced in a mixed-methods study designed to test the feasibility of measuring recovery in participants of an Alternative Peer Group (APG). The APG integrates pro-recovery peers and social activities into clinical practice to engage adolescents in recovery. Though well established, APGs have never been tested. This study was one phase in a line of research that aims to develop an APG evidence base. The study used a mixed-methods design and naturalistic sampling of participants of one APG program. Repeated measures analysis with linear mixed models was planned to test the hypothesis that spending time in the APG builds recovery capital, resulting in progress in the processes of recovery, and improved symptoms. Semistructured interviews were conducted and framework analysis was used to explore feasibility challenges. Recruitment and retention challenges precluded meaningful measurement of change over time in recovery. Lessons learned from qualitative findings informed multiple strategies for revisions to strengthen future study protocols. Recruitment and retention of adolescents are common challenges that can threaten a study’s validity. Researchers seeking to recruit and retain adolescents with SUD in longitudinal studies may benefit from strategies derived from this study.

PROFESSORS´ PERCEPTION OF MENTAL HEALTH TEACHING IN NURSING

ABSTRACT Objective: to understand how mental health education is developed in a nursing undergraduate course based on professors' perceptions of specific disciplines. Method: qualitative, exploratory and descriptive research, developed with 11 nursing professors of mental health disciplines, from a public university in the south of Brazil. Data collection was performed through semi-structured interview in 2014. Data were submitted to thematic analysis. Results: the following categories emerged: Training for mental health education; Specificities of teaching in mental health; and Development of practical classes / internships in mental health. Mental Health education, which prioritizes cognitive and technical aspects in line with the Psychiatric Reform, the consolidation of the Unified Health System and the implementation of the National Nursing Curricular Guidelines, becomes a challenge as the break with the teaching model and health, once in force, is current. Conclusion: this scenario highlights the need for mental health education training for nursing professors and ongoing curricular revision and pedagogical strategies.

A new classification for proximal femur bone defects in conservative hip arthroplasty revisions.

In the last three decades, total hip replacement in young patient became a habitual procedure. Principles of bone preservation are pushing many surgeons to implant conservative femoral components in patient younger than 65years. Despite an overall good survivorship and clinical outcomes of conservative implants, failed cases are reported and the need to revise a conservative femoral component became an occasional procedure (with high prevalence of failed resurfacing implants). During conservative femoral component revisions, we analyzed proximal bone stock preservation, considering the type of original component removed, etiology of failure, timing of revision, and femoral explantation technique. We identified four patterns of proximal femoral changes (types I-IV). We suggest, for each of them, a revision strategy directed toward a "conservative revision procedure" using conservative or primary component. Out of our 21 cases, none underwent further revision due to mechanical failure (follow-up ranging from 6 to 152months, mean 54months). We had two case of re-operation: one for early septic loosening and one for prosthetic modular neck fracture. If literature offers well-established guidelines to femoral revision of conventional stems, there is, on the other hand, a lack of data about revision strategies in presence of failed conservative implants. Although the mean follow-up of our procedures is still too short (4.5years) to give final conclusions, we would leave a message: a conservative hip arthroplasty is not a "one-time" opportunity for young and active people. A "conservative revision" is a valid option for at least a part of them, when an early failure of primary procedure occurred.

Addressing the “My Students Cannot Write” Dilemma: Investigating Methods for Improving Graduate Student Writing

Improved writing can help students in their academic and professional careers, thus this action research project examined the use of three revision strategies in a graduate course by collecting three sources of data. One-sample t-tests revealed no significant differences across paper scores. However, students indicated rough drafts and rewrites were helpful because they were able to make changes to receive a better grade. Students did not find peer reviews helpful. To help students improve their writing, faculty should train them to become effective peer reviewers and give them multiple options for revising their writing.

Using Rubrics in A University EFL Process Writing Program: An Exploratory Case Study

While rubrics have been widely recognized as an effective instructional tool for teachers to evaluate students’ writing products, fewer studies explored how students use it for their writing process in an EFL university academic writing classes. This study explores the application of process-oriented rubrics in two EFL writing programs, and investigates whether English language proficiency, motivation to writing, and their previous experiences with writing programs would significantly affect the use of the rubrics. The participants (N=190) were from two student cohorts, each of which had 95 participants. The data set includes students’ self-, peer- use and the instructor’s use of the rubrics, and students’ written reflection upon peer feedbacks. The data showed that the rubrics can guide students to practice a writing process, and that the 20-item rubric was statistically reliable. The data of rubrics also showed that the participants were more critical on their peers’ writing, and the reflection data showed students’ awareness of revision strategies. The qualitative data seemed to suggest that peer reviews and reflections upon such reviews could enhance students' revision strategies. This article will conclude itself by providing some pedagogical suggestions in EFL contexts

A new classification for proximal femur bone defects in conservative hip arthroplasty revisions

In last three decades, total hip replacement in young patients became an habitual procedure. Principles of bone preservation are pushing many surgeons to implant conservative femoral components in patient younger than 65years. Despite an overall good survivorship and clinical outcomes of conservative implants, failed cases are reported and the need to revise a conservative femoral component became an occasional procedure (with high prevalence of failed resurfacing implants). During conservative femoral component revisions, we analyzed proximal bone stock preservation, considering the type of original component removed, aetiology of failure, timing of revision, and femoral explantation technique. We identified four patterns of proximal femoral changes (types I-IV). We suggest, for each of them, a revision strategy directed toward a "conservative revision procedure" using conservative or primary component. Out of our 21 cases, none underwent further revision due to mechanical failure (follow-up ranging from 6 to 152months, mean 54months). We had two cases of re-operation: one for early septic loosening and one for prosthetic modular neck fracture. If literature offers well-established guidelines to femoral revision of conventional stems, there is, on the other hand, a lack of data about revision strategies in presence of failed conservative implants. Although the mean follow-up of our procedures is still too short (4.5years) to give final conclusions, we would leave a message: a conservative hip arthroplasty is not a "one time" opportunity for young and active people. A "conservative revision" is a valid option for at least a part of them, when an early failure of primary procedure occurred.

The Effects of Mental Accounting on Project Performance

Problem Definition: Project managers are responsible for setting and then revising projects' goals. As uncertainty related to project performance is resolved, a project manager is tasked with comparing ongoing costs, and potentially achieved scope, to a baseline plan. We question whether project managers can rationally anticipate and track this revision process. Academic/Practical Relevance: In practice, projects often fail to meet their goals and are subject to changes in scope, cost, and scheduled time. We consider the implications of behavioral tendencies and the revision strategy on decisions made and on overall project performance. Methodology: Our stylized model compares a rational project manager to a behavioral one. Specifically, we offer a framework for modeling mental accounting—which includes loss aversion and reference point updating—and narrow framing. We use the model to explore how project-level decisions are made. Results: We show that mental accounting results in insufficient adjustments of project scope and cost during revisions, and prevents abandoning projects even when doing so is optimal. Ultimately, mental accounting and narrow framing decrease projects' actual profits. Managerial Implications: We offer practical prescriptions for mitigating harmful effects of loss aversion, reference-point updating, and narrow framing. Beyond training, hiring less loss averse project managers, and practicing scenario planning, we show that reviewing a project using a cost milestone instead of a scope milestone helps maintain the reference cost equal to the budgeted cost, thereby inducing overall better decisions.

A multicenter retrospective clinical study on "symptomatic facet of residual bone mass", a rare complication of percutaneous trasforaminal endoscopic discectomy

Objective Retrospective study and report on cases of symptomatic facet of residual bone caused by percutaneous transforaminal endoscopic discectomy (PTED), to analysis of its causes and revision strategies. Methods Seven cases of symptomatic facet of residual bone after PTED were found in six medical centers from July 2015 to November 2017.Weintroduced the course of diagnosis and treatment, to analysis of the causes, clinical features and revision strategies of the rare complication. Results Seven patients came from different medical centers (2 cases in Ningbo No.6 Hospital and 1 case in each of the other medical centers). The average age of the subject is 67.29±9.64 years (range from 57-83 years). Among them there were 1 male and 6 female. PTED was performed for all cases with lumbar disc herniation or stenosis. The operative segments were 1 of L2,3, 2 of L3,4, 3 of L4,5, 1 of L5S1. Symptoms occurred immediately after surgery in all cases except one after a week of operation and another one month later. Two cases were appeared symptom of contralateral irritation, and the rest were aggravated by the original symptoms. Two cerebrospinal fluid leakage caused by bone mass piercing the dural sac. The bone mass compressed the nerve root and caused 1 case of lower limb muscle weakness. Foraminoplasty was performed during PTED in all patients. After CT scan, 5 cases of bone mass were found on the same side of operation, and 2 cases were in the contralateral side. The shortest time for revision was 2 days and the longest 3 months. After conservative treatment, the symptoms were relieved in only one case. Revision surgeries were performed for all the other 6 cases, 2 with microendoscopic discectomy (MED), 1 mobile microendoscopic discectomy (MMED), 1 small incision operation, 1 PTED and 1 with minimal invasive surgery of transforaminal lumbar intervertebral fusion (MIS-TLIF). The VAS scores of low back pain and leg pain was significantly relieved from 8.67±0.52 to 1.50±0.55. Conclusion PTED may lead to residual bone mass in lumbar foraminoplasty. The penetration of the bone mass block into the spinal canal can cause the compression symptoms of the corresponding segment. The patients showed the corresponding spinal canal stenosis and nerve root irritation symptoms. A revision operation is required to remove the oppressed bone mass to relieve the symptoms as soon as possible if the conservative treatment not effective. Key words: Zygapophyseal joint; Multicenter study; Treatment outcome

Strategies of Mandibular Revision: A Retrospective Study of Revisional Mandibular Surgery for Unaesthetic Results of Previous Mandibular Reduction.

Mandibular reduction has been developed and popularized in Asia for decades. Despite the technical advancement and experience accumulation, complications and unaesthetic results still occur, and some need a revision surgery. This study aims to introduce the experience of revision surgery to reshape the unaesthetic mandibular contour after previous mandibular reduction. From May 2011 to September 2017, patients dissatisfied with the result of previous mandibular reduction and who received a secondary mandibular revision were retrospectively reviewed and analyzed. Twenty-five patients were included in this study. Under-correction (88%, 22/25) was the most common aesthetic problem requiring revision, followed by asymmetry (56%, 14/25), broad chin (40%, 10/25), second mandibular angle (32%, 8/25), and over-correction (8%, 2/25). As revision techniques, long-curve mandibular reduction, simple mandibular reduction, and mandibular grinding were performed on 60% (15/25), 36% (9/25), and 4% (1/25) of the patients, respectively. All the patients were satisfied with the results. Cephalometric measurements indicated a significant bone removal after revision. When performing a revision surgery to reshape the mandibular contour, the surgeon should have a clear surgical plan based on comprehensive evaluation, focus on the balanced harmony of the entire face, use proper technique and instruments, and avoid concomitant injury and complications. The one-staged technique that treats the whole mandible as an entirety is superior than multistaged techniques to improve the aesthetic outcomes to the largest extent. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

College Student Writers' Use and Modification of Planning and Evaluation Strategies After a Semester of Instruction

AbstractThe purpose of this study was to investigate how students in a developmental writing course at a community college used and adapted cognitive writing strategies learned in the course. The students participated in a funded research project for the development and evaluation of a writing curriculum based on self‐regulated strategy instruction. The authors investigated students’ application of the planning and revising strategies using think‐aloud protocols. The results showed that students remembered the strategies but did not use them consistently. Also, students tended to use an outline but not always effectively. Finally, reading comprehension seemed to impact their use of revision strategies. Limitations and implications for future research are discussed.

Outcomes of Sphincter Pharyngoplasty in the Cleft Population.

Sphincter pharyngoplasty (SP) is becoming increasingly popular for correction of velopharyngeal insufficiency (VPI) after cleft palate repair because of high success rate, low incidence of postoperative obstructive sleep apnea (OSA), and ease of revision in case of failure. This study is a meta-analysis of SP outcomes, reasons for failure, and revision strategies. A comprehensive review of the literature on SP outcomes was conducted. Sphincter pharyngoplasty failure was defined as persistent hypernasality, incomplete velopharyngeal port (VP) closure on instrumental evaluation with concomitant VPI, or nonresolving hyponasality and/or OSA persisting >3 months after surgery. Two-tailed paired Student t test was used to compare outcomes between syndromic versus nonsyndromic patients and preoperative versus postoperative OSA rates. Forty-four publications evaluating 2402 patients were included. Overall SP success rate was 78.4% (77.3% in nonsyndromic vs 84.8% in syndromic patients, P = 0.11). Overall primary revision rate was 17.8% (20% in nonsyndromic vs 15.4% in syndromic patients P = 0.97). Most failures (89.5%) manifested as persistent VPI with continued hypernasality requiring revision, whereas 10.5% of failures manifested as obstructive symptoms and/or severe hyponasality requiring revision. Causal factors of SP failure were the following: large central port (62.8%), dehiscence (15.5%), tight port (12.1%), and low-inset (9.7%). Primary revision success rate was 75.6%. Obstructive sleep apnea rates increased from 5.1% to 18.4% (P = 0.02). This study suggests that SP can resolve VPI in 78.4% of patients, which can be increased to 94.7% after one revision. Most failures are technique-dependent; therefore, there could be significant ground for improvement of outcomes.

Value of the Application of Neuroendoscope in the Treatment of Ventriculoperitoneal Shunt Blockage

To explore the value of the application of neuroendoscopy techniques in the treatment of ventriculoperitoneal (VP) shunt blockage. Our study included 3 plans for revision surgeries for VP shunt blockage. In plan A, the choroid plexus or ependyma growing inside the ventricular catheter was completely removed. In plan B, the terminal part of the ventricular catheter was clipped and removed. In plan C, the ventricular catheter was carefully extracted with the aid of neuroendoscopy, and the tissues blocking the catheter were removed. The ventricular catheter was then reinserted into the lateral ventricle. The side holes of the tube may be blocked by cerebral tissue, granulation tissue, newly formed blood vessels, choroid plexus, or ependyma. Five patients successfully underwent plan A revision surgery, 8 patients underwent plan B revision surgery, and the remaining 22 patients underwent plan C revision surgery. After the operation, 34 patients experienced relief of symptoms of elevated intracranial pressure. In all patients, the shunt obstruction was resolved. Neuroendoscopy techniques can be used to reveal the various causes of shunt obstruction. Any attempt to extract the tube should be performed with the aid of a neuroendoscope. The 3 surgical revision strategies for a blocked catheter are described for the first time in the literature. These approaches can reduce the operation time, the incidence of intraventricular hemorrhage, and the risk of infection.

One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies

One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data (IPD). Observational cohort studies with PJI of the hip treated exclusively by one- or two-stage revision and reporting re-infection outcomes were retrieved by searching MEDLINE, EMBASE, Web of Science, The Cochrane Library, and the WHO International Clinical Trials Registry Platform; as well as email contact with investigators. We analysed IPD of 1856 participants with PJI of the hip from 44 cohorts across four continents. The primary outcome was re-infection (recurrence of infection by the same organism(s) and/or re-infection with a new organism(s)). Hazard ratios (HRs) for re-infection were calculated using Cox proportional frailty hazards models. After a median follow-up of 3.7 years, 222 re-infections were recorded. Re-infection rates per 1000 person-years of follow-up were 16.8 (95% CI 13.6–20.7) and 32.3 (95% CI 27.3–38.3) for one-stage and two-stage strategies respectively. The age- and sex-adjusted HR of re-infection for two-stage revision was 1.70 (0.58–5.00) when compared with one-stage revision. The association remained consistently absent after further adjustment for potential confounders. The HRs did not vary importantly in clinically relevant subgroups. Analysis of pooled individual patient data suggest that a one-stage revision strategy may be as effective as a two-stage revision strategy in treating PJI of the hip.

The games students play: student perceptions of creative revision strategies

BACKGROUNDTowards examinations, students are conscious of maximising study opportunities. Recently we introduced the “Anatomy Theory Games” as a new method of theory revision for the final anatomy session of the first year of the Sydney Medical Program. The purpose of this study was to demonstrate the design and implementation of this new program; and explore participant perceptions to consider its strengths, and needs for improvement.METHODSA theory revision session for anatomy students was devised incorporating activities based on retrieval practice and team‐based learning, presented in a games format. The program was introduced for all Stage 1 students in 2016 (n=350) and 2017 (n=257). Students self‐allocated into teams of approximately 6 or 7. Rounds consisted of 1) students verbally describing anatomical features written on cards to peers; and 2) multiple choice questions (MCQ) answered initially as individuals, then discussed and answered as a team. Immediate feedback from students was sought using a paper‐based survey. The survey included three closed questions, using a Likert‐scale of 1–5, and open‐ended questions. Descriptive statistics were used to analyse data.RESULTSIn total, 473/607 (77.9%) students participated in the games in 2016 and 2017, and 451/473 (95.4%) of participants responded to the survey. Regarding the card game, 79.8% agreed or strongly agreed that it was helpful for identifying knowledge gaps. Nearly all students (96.7%) agreed or strongly agreed that the MCQs were helpful for identifying knowledge gaps. Almost as strongly, 92.8% agreed or strongly agreed that working as a team after the individual test was beneficial. Students described the card game as “great fun”. However, they found the MCQ with teamwork to be more beneficial to their learning. Students additionally commented that the MCQs helped to identify their knowledge gaps, and motivated them to revise. Students valued working in teams, however would prefer to work in smaller teams. Students suggested that more sessions be held throughout the year, and some felt more time should be allocated to the session.CONCLUSIONSThe students found the Anatomy Theory Games both a valuable and enjoyable means to revise and identify knowledge gaps. They found the card games to be fun, and the MCQ and teamwork particularly useful to their learning. Improvements include considering scheduling more such sessions where possible, and increasing the time for each MCQ.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision: Implications of Device Component Survival

BackgroundUp to 50% of patients receiving an artificial urinary sphincter (AUS) require surgical revision after initial placement. However, the literature is heterogeneous regarding the leading causes of AUS failure and appropriate surgical management. ObjectiveTo inform a revision approach by tabulating the causes of AUS failure, assessing AUS component survival, and examining the single-component revision efficacy. Design, setting, and participantsWe retrospectively reviewed 168 patients receiving AUS placements carried out by a single surgeon from 2008 to 2016 at a high-volume academic institution. The median follow-up from initial placement was 2.7 yr, with 37.5% experiencing recurrent incontinence. The cuff size ranged from 4.0 to 5.5cm, with median size of 4.5cm. InterventionPatients without infection or erosion underwent systematic device interrogation and revision, starting with the pressure-regulating balloon (PRB) and then, if necessary, the urethral cuff. Device revision involved either PRB-only correction or cuff and PRB revision. Outcome measurements and statistical analysisWe used bootstrapped intervals to estimate the mean time to failure for individual AUS components. Kaplan-Meier estimates were used to compare survival for individual components and for revised devices by revision technique. Results and limitationsPRB malfunction most commonly caused device failure, while cuff or pump malfunction was rare. Among patients undergoing surgical revision, those with PRB-only correction had similar outcomes to those with more extensive device correction (cuff and PRB exchange; p=0.46). This study, while systematic and detailed, is limited by sample size, follow-up length, and its retrospective nature. ConclusionsPRB malfunction most commonly caused AUS failure in our cohort. PRB-only correction may satisfactorily restore AUS function in select patients. Consequently, initial interrogation of the PRB may avoid a second incision and urethral exposure for many patients requiring AUS revision. Patient summaryArtificial urinary sphincters remain prone to failure over time. In many instances, correcting only the pressure-regulating balloon may effectively restore device function, allowing for a less invasive revision.

Twisting the Australian realist short story: Murray Bail’s “Camouflage”

Although the short story is regarded as a minor genre in many literary traditions, it is arguably a major one in Australian literature, which, more specifically, was long dominated by the realist short story. Deriving from the colonial “yarns”, the so-called “hard-luck stories” were indeed felt to be characterized by a realism that was in turn seen to result from the archetypal dryness of Australia itself. While the contemporary Australian writer Murray Bail has repeatedly questioned the realistic quality of his homeland’s literature, he has also sought to broaden the subgenre to which it has often been reduced, namely bush realism. With “Camouflage” (1998), Bail appropriates the hard-luck story to convey a marginal perspective. This article shows how this strategy of revision allows him to contest both the archetypality of bush realism and the stereotypical perceptions of the Australian landscape, thereby problematizing the highly controversial relationship between place and literature.

Nobody's Protest Novel: Novelistic Strategies of the Black Lives Matter Movement

Nobody's Protest NovelNovelistic Strategies of the Black Lives Matter Movement Vincent Haddad Though the medium of the novel may seem anachronistic for a Black liberation movement founded by three queer Black women—Alicia Garza, Patrisse Khan-Cullors, and Opal Tometi—on Twitter, the stunning blockbuster success of Angie Thomas's 2017 debut novel The Hate U Give represents a high-water mark for an already-rich archive of what we might label BLM novels.1 A fictionalized representation of the precipitating events and formation of BLM, the retrospective quality of this realist novel offers an opportunity to reflect on the novelistic strategies pursued by African American novelists since the murder of Trayvon Martin in 2012 and to interrogate which formal commitments and affective states best align with and provoke the Movement's radical imaginary. While similarities in content are evident in a survey of these novels (nearly all, for example, focalize from the perspective of young Black adults and feature violent and sometimes fatal confrontations with police officers), there is significant diversity in the novelistic strategies and forms these works undertake.2 When measured against the now fully developed Movement for Black Lives platform, fissures between some novelistic strategies and the Movement become visible, whereas others demonstrate the potentiality of the novel to expand and animate the politics of Black liberation. More specifically, the conservative impulses I will identify in The Hate U Give as compared to the Movement's political objectives, in terms of race and even gender and sexuality, are embedded in the conservatism of its commitment to the historical form of literary realism.3 In contrast, experimentations on linearity and fictionality like we see in Kiese Laymon's 2013 debut speculative novel Long Division, which I see as the first contribution to this growing and impressive archive, not only connects more closely to the politics of the Movement, but also offers it an aesthetic, if also dissonant, vision for Black liberation. Through a comparative analysis of The Hate U Give's realist construction of empathy and Long Division's speculative strategy of collective revision and queer love, this article assesses the aesthetic and political potential of novels that claim a relation to the BLM movement and outlines what different and successful forms the BLM novel can and should adopt.4 Told from the grief-stricken perspective of teen-aged Starr Carter who witnesses her close friend Khalil fatally shot by a white police officer, The Hate U Give delivers [End Page 40] a powerful first-person account of the impact of racial terror on a young Black woman within the conventions of literary realism. Stocked with real-life references and allusions to BLM, readers are granted unfettered access to Starr Carter's inner life as she grieves the unjust slaying of her friend, navigates between her poor, urban neighborhood in Garden Heights and a wealthy, mostly white suburban private school, and comes into her own as an activist following the inevitable and predictable acquittal of the guilty officer. The linear plot charts out a clear progression from rising action (biased criminal investigation of the guilty police officer) and climax (BLM protest compromised by violence) to a clean and uplifting resolution. Through this structure, the novel fulfills a commonplace, transcendental view of the novel as a privileged aesthetic to produce empathy; in Guido Mazzoni's words, "its ability to make us see the world through the eyes and conscience of someone else, its ability to allow us to step into a possible life that is not ours" (55).5 Yet, as calls for empathy have become a ritual and hollow imperative after the video documentation and circulation of the murders of unarmed Black citizens by police,6 tracking the ways a BLM novel actually functions to produce empathy, and calling these processes into question, is crucial. The Hate U Give re-asserts what Saidiya V. Hartman calls the "precariousness of empathy" from 19th century accounts of racial terror, in which there becomes an "uncertain line between witness and spectator" for the reader, and demonstrates how the direction of empathy all too easily shifts away from victims and towards the perpetrators of state-sanctioned violence (4...

The Role of Bone Scintigraphy in Determining Spinal Fusion after Spinal Stabilisation Surgery.

To evaluate the usefulness of bone scintigraphy in spinal fusion surgery. This retrospective study included 21 patients who had undergone previous anterior or posterior spinal fusion procedures, or both. Implant failure, fusion failure and adjacent segment disease were the evaluated pathological parameters. Scintigraphic data from all patients were evaluated with intraoperative observational data, radiological data and clinical data. Radiological evaluation revealed adjacent segment disease in 5 patients (23.8%), implant failure in 2 (9.5%), and fusion failure in 1 (4.8%). Scintigraphic evaluation of operating segments revealed pseudo-fusion in 3 patients (14.3%) and fusions in 18 (85.7%). Reoperations were performed in 9 patients (42.9%): in 5 (23.8%) because of adjacent segment disease, and in 4 (19.0%) because they requested removal of the implants. Two patients (9.5%) with implant failure did not undergo reoperation because their scintigraphic data were consistent with fusion and they were almost symptom free, with lower Visual Analogue Scale (VAS) scores. The VAS scores of the rest of the patients were significantly reduced after the reoperations (p < 0.001). Bone scintigraphy may be helpful for surgeons in planning appropriate surgical revision strategy by giving proper data about spinal fusion at least one year after the initial surgery.