AIM:To examine factors influencing percutaneous endoscopic gastrostomy(PEG) uptake and outcomes in motor neuron disease(MND) in a tertiary care centre.METHODS:Case notes from all patients with a confirmed diagnosis of...AIM:To examine factors influencing percutaneous endoscopic gastrostomy(PEG) uptake and outcomes in motor neuron disease(MND) in a tertiary care centre.METHODS:Case notes from all patients with a confirmed diagnosis of MND who had attended the clinic at the Repatriation General Hospital between January 2007 and January 2011 and who had since died,were audited.Data were extracted for demographics(age and gender),disease characteristics(date of onset,bulbar or peripheral predominance,complications),date and nature of discussion of gastrostomy insertion,nutritional status [weight measurements,body mass index(BMI)],date of gastrostomy insertion and subsequent progress(duration of survival) and quality of life(QoL) [Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised(ALSFRS-R)].In addition,the type of clinician initiating the discussion regarding gastrostomy was recorded as Nutritional Support Team(involved in providing nutrition input viz Gastroenterologist,Speech Pathologist,Dietitian) and other(involved in non-nutritional aspects of patient care).Factors affecting placement and outcomes including length of survival,change in weight and QoL were determined.RESULTS:Case records were available for all 86 patients(49 men,mean age at diagnosis 66.4 years).Thirty-eight patients had bulbar symptoms and 48 had peripheral disease as their presenting feature.Sixty-six patients reported dysphagia.Thirty-one patients had undergone gastrostomy insertion.The major indications for PEG placement were dysphagia and weight loss.Nine patients required immediate full feeding,whereas 17 patients initially used the gastrostomy to supplement oral intake,4 for medication administration and 1 for hydration.Initially the PEG regime met 73% ± 31% of the estimated total energy requirements,increasing to 87% ± 32% prior to death.There was stabilization of weight in patients undergoing gastrostomy [BMI at 3 mo(22.6 ± 2.2 kg/m 2) and 6 mo(22.5 ± 2.0 kg/m 2) after PEG placement compared to weight at the time of the procedure(22.5 ± 3.0 kg/m 2)].However,weight loss recurred in the terminal stages of the illness.There was a strong trend for longer survival from diagnosis among MND in PEG recipients with limb onset presentation compared to similar patients who did not undergo the procedure(P = 0.063).Initial discussions regarding PEG insertion occurred earlier after diagnosis when seen by nutrition support team(NST) clinicians compared to other clinicians.(5.4 ± 7.0 mo vs 11.9 ± 13.4 mo,P = 0.028).There was a significant increase in PEG uptake(56% vs 24%,P = 0.011) if PEG discussions were initiated by the NST staff compared to other clinicians.There was no change in the ALSFRS-R score in patients who underwent PEG(pre 34.1 ± 8.6 vs post 34.8 ± 7.4),although in non-PEG recipients there was a nonsignificant fall in this score(33.7 ± 7.9 vs 31.6 ± 8.8).Four patients died within one month of the procedure,4 developed bacterial site infection requiring antibiotics and 1 required endoscopic therapy for gastric bleeding.Less serious complications attributed to the procedure included persistent gastrostomy site discomfort,poor appetite,altered bowel function and bloating.CONCLUSION:Initial discussion with NST clinicians increases PEG uptake in MND.Gastrostomy stabilizes patient weight but weight loss recurs with advancing disease.展开更多
During spring 2013, an important uprising had broken out and marked a historic period for political activism in Turkish memory. Focusing on the afterlives of photographic portraits produced during this “Occupy Gezi M...During spring 2013, an important uprising had broken out and marked a historic period for political activism in Turkish memory. Focusing on the afterlives of photographic portraits produced during this “Occupy Gezi Movement”, the paper considers iconized digital portraitures as a peculiar genre of vernacular photography and focuses on its visual language, and cultural codes as a part of the underground resisting culture in daily life. It explores different contexts in which photographic portraits have been used as a tool of protest and their various kinds of remediation from the Gezi Park Protest onwards. Private portraits as an agent of resistance have been creatively modified, recreated, rematerialized and circulated in distinct ways during and after the protest： from city walls as stencils, stickers, and graffiti （in actual public spaces） to Facebook profile walls as online digital re-mastering （virtual spheres）. This article concentrates on aesthetics of such iconized digital photographic portraitures in contemporary Turkey. It particularly focuses on one of the instances that have labeled the Occupy Gezi Movement： the death of Berkin Elvan, who turned 15 while in a coma who has been struck in the head by a tear gas canister, fired by police, while on his way to buy bread. This case has been a catalyst for further demonstrations against Turkey＇s ruling party and turned Elvan＇s high-spirited face and dark eyebrows, to one of the strong symbols of the resistance. The teenage boy＇s injury during the protests, his birthday while he was in a coma at the hospital, his death, funeral and commemorations have been stress points in which his photographic portrait have been modified and redesigned according to the occasion and circulated widely. The image of the youth symbol of the struggle and the different kinds of cultural work his photograph have performed is the main focus of this research. The digital social afterlives of Elvan＇s iconized imagery as illustrations and drawings; as stencils and graffiti at streets; as posters and framed photographs in political performances carried around in public spaces and commemorative acts; and as digital data circulated in social media both consisting of indexical and iconic dements regarding their photographic features. This transformation of the single analog vernacular photograph of Elvan to various digital versions and continuous re-interpretation and re-materialization is discussed depending on the local history of the occasion and the critical literature on photographic history and theories of photographic vernacularity. This research makes use of data collecting methods that netnographic research methodology uses. The paper focuses on the ways local vernacularity is historically produced and evolved in this particular time of Gezi Park Resistance.展开更多
A writer＇s narrative style is about the way in which he or she comes to handle a subject--it can be a theme, a character, or a place, etc.. When someone tries to define Henry James＇s writing style, for instance, he ...A writer＇s narrative style is about the way in which he or she comes to handle a subject--it can be a theme, a character, or a place, etc.. When someone tries to define Henry James＇s writing style, for instance, he or she is amazed by the sense of richness in Jamesian styles, because of the writer＇s own life experience and life style Travelling around different cities and going to art galleries and museums certainly construct James＇s unique way of seeing. In this article, the author wants to focus on Jamesian ways of seeing the relation between art and writing. Treating novel as a form of fine arts, the author would suggest, James uses techniques of painting and photography in the writing about the impressions of the cities.展开更多
Since the beginning of human civilization, the existence of a variety of production and life, etiquette and other social customs are obvious. The invention of photography is natural firstly used to the performance of ...Since the beginning of human civilization, the existence of a variety of production and life, etiquette and other social customs are obvious. The invention of photography is natural firstly used to the performance of various phenomena of human existence. Not until 1993 did Folk photography was formally proposed and was quickly accepted by the public. Folk photographer should have a certain amount of theoretical knowledge of folklore, ethnology, anthropology, and folklore should familiar with the laws of photography. Folk photographer should not only be able to skillfully use a variety of photographic techniques to create photographer, but also have the ability of folklore studies, which means a certain level of theory and master certain research methods. Folk photography creative process is a cultural experience and explores the process of discovery. Folk photography is methods and means to record, release and heritage attending profound traditional Chinese culture. Folk photography through a unique form of expression, with its visual image, embodies the academic value of folk history, the development of human history, cultural heritage and makes a positive contribution to the spread. In the 21st century, China＇ s social stable, economic development rapidly, which provide a good folk photography authoring environment. Folk photography range will also change with the development of folk and continuously expanding, concerns and reflections about the new folk themes have yet to be excavated, to meet the needs of social development.展开更多
It has come to notice that developments that take place in rural communities bring about a lot of challenges both positive and negative. However, people who try to manage these challenges use ＂text type＂ in books an...It has come to notice that developments that take place in rural communities bring about a lot of challenges both positive and negative. However, people who try to manage these challenges use ＂text type＂ in books and through other communication media （publications）, but the effect has scarcely been effective because, most of the people living in rural communities are illiterates. The purpose of this study was to use pictorial illustrations to create awareness on how socioeconomic development affects rural communities （Cape Three Points） and the extent to which its effect can be seen on human life within the local communities （fishermen, farmers, and fish mongers） in terms of their livelihood, attitudes, education and on the general environment. Interviews were mainly used to ascertain facts on how the situation was before the new developments started. Workshops were also organized for focus groups, through which the effect of pictorial illustrations on the people were ascertained. Again, how they should prepare for the foreseen changes that will emanate from any form of rural development was also discussed. At the end of the study, it came to light that many of our rural areas face significant challenges. These challenges as a matter of fact affect their cultural practices and the socio-economic development of the people in such rural communities and the country as a whole. It is believed that these challenges and many other related concerns that have emanated from this study would be critically recognized and managed if not solved by the powers that be. Results from this study will form a basis for further discussion of socio-economic effects of rural development on rural communities and any other related effects caused by any physical change on rural environment.展开更多
文摘AIM:To examine factors influencing percutaneous endoscopic gastrostomy(PEG) uptake and outcomes in motor neuron disease(MND) in a tertiary care centre.METHODS:Case notes from all patients with a confirmed diagnosis of MND who had attended the clinic at the Repatriation General Hospital between January 2007 and January 2011 and who had since died,were audited.Data were extracted for demographics(age and gender),disease characteristics(date of onset,bulbar or peripheral predominance,complications),date and nature of discussion of gastrostomy insertion,nutritional status [weight measurements,body mass index(BMI)],date of gastrostomy insertion and subsequent progress(duration of survival) and quality of life(QoL) [Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised(ALSFRS-R)].In addition,the type of clinician initiating the discussion regarding gastrostomy was recorded as Nutritional Support Team(involved in providing nutrition input viz Gastroenterologist,Speech Pathologist,Dietitian) and other(involved in non-nutritional aspects of patient care).Factors affecting placement and outcomes including length of survival,change in weight and QoL were determined.RESULTS:Case records were available for all 86 patients(49 men,mean age at diagnosis 66.4 years).Thirty-eight patients had bulbar symptoms and 48 had peripheral disease as their presenting feature.Sixty-six patients reported dysphagia.Thirty-one patients had undergone gastrostomy insertion.The major indications for PEG placement were dysphagia and weight loss.Nine patients required immediate full feeding,whereas 17 patients initially used the gastrostomy to supplement oral intake,4 for medication administration and 1 for hydration.Initially the PEG regime met 73% ± 31% of the estimated total energy requirements,increasing to 87% ± 32% prior to death.There was stabilization of weight in patients undergoing gastrostomy [BMI at 3 mo(22.6 ± 2.2 kg/m 2) and 6 mo(22.5 ± 2.0 kg/m 2) after PEG placement compared to weight at the time of the procedure(22.5 ± 3.0 kg/m 2)].However,weight loss recurred in the terminal stages of the illness.There was a strong trend for longer survival from diagnosis among MND in PEG recipients with limb onset presentation compared to similar patients who did not undergo the procedure(P = 0.063).Initial discussions regarding PEG insertion occurred earlier after diagnosis when seen by nutrition support team(NST) clinicians compared to other clinicians.(5.4 ± 7.0 mo vs 11.9 ± 13.4 mo,P = 0.028).There was a significant increase in PEG uptake(56% vs 24%,P = 0.011) if PEG discussions were initiated by the NST staff compared to other clinicians.There was no change in the ALSFRS-R score in patients who underwent PEG(pre 34.1 ± 8.6 vs post 34.8 ± 7.4),although in non-PEG recipients there was a nonsignificant fall in this score(33.7 ± 7.9 vs 31.6 ± 8.8).Four patients died within one month of the procedure,4 developed bacterial site infection requiring antibiotics and 1 required endoscopic therapy for gastric bleeding.Less serious complications attributed to the procedure included persistent gastrostomy site discomfort,poor appetite,altered bowel function and bloating.CONCLUSION:Initial discussion with NST clinicians increases PEG uptake in MND.Gastrostomy stabilizes patient weight but weight loss recurs with advancing disease.
文摘During spring 2013, an important uprising had broken out and marked a historic period for political activism in Turkish memory. Focusing on the afterlives of photographic portraits produced during this “Occupy Gezi Movement”, the paper considers iconized digital portraitures as a peculiar genre of vernacular photography and focuses on its visual language, and cultural codes as a part of the underground resisting culture in daily life. It explores different contexts in which photographic portraits have been used as a tool of protest and their various kinds of remediation from the Gezi Park Protest onwards. Private portraits as an agent of resistance have been creatively modified, recreated, rematerialized and circulated in distinct ways during and after the protest： from city walls as stencils, stickers, and graffiti （in actual public spaces） to Facebook profile walls as online digital re-mastering （virtual spheres）. This article concentrates on aesthetics of such iconized digital photographic portraitures in contemporary Turkey. It particularly focuses on one of the instances that have labeled the Occupy Gezi Movement： the death of Berkin Elvan, who turned 15 while in a coma who has been struck in the head by a tear gas canister, fired by police, while on his way to buy bread. This case has been a catalyst for further demonstrations against Turkey＇s ruling party and turned Elvan＇s high-spirited face and dark eyebrows, to one of the strong symbols of the resistance. The teenage boy＇s injury during the protests, his birthday while he was in a coma at the hospital, his death, funeral and commemorations have been stress points in which his photographic portrait have been modified and redesigned according to the occasion and circulated widely. The image of the youth symbol of the struggle and the different kinds of cultural work his photograph have performed is the main focus of this research. The digital social afterlives of Elvan＇s iconized imagery as illustrations and drawings; as stencils and graffiti at streets; as posters and framed photographs in political performances carried around in public spaces and commemorative acts; and as digital data circulated in social media both consisting of indexical and iconic dements regarding their photographic features. This transformation of the single analog vernacular photograph of Elvan to various digital versions and continuous re-interpretation and re-materialization is discussed depending on the local history of the occasion and the critical literature on photographic history and theories of photographic vernacularity. This research makes use of data collecting methods that netnographic research methodology uses. The paper focuses on the ways local vernacularity is historically produced and evolved in this particular time of Gezi Park Resistance.
文摘A writer＇s narrative style is about the way in which he or she comes to handle a subject--it can be a theme, a character, or a place, etc.. When someone tries to define Henry James＇s writing style, for instance, he or she is amazed by the sense of richness in Jamesian styles, because of the writer＇s own life experience and life style Travelling around different cities and going to art galleries and museums certainly construct James＇s unique way of seeing. In this article, the author wants to focus on Jamesian ways of seeing the relation between art and writing. Treating novel as a form of fine arts, the author would suggest, James uses techniques of painting and photography in the writing about the impressions of the cities.
文摘Since the beginning of human civilization, the existence of a variety of production and life, etiquette and other social customs are obvious. The invention of photography is natural firstly used to the performance of various phenomena of human existence. Not until 1993 did Folk photography was formally proposed and was quickly accepted by the public. Folk photographer should have a certain amount of theoretical knowledge of folklore, ethnology, anthropology, and folklore should familiar with the laws of photography. Folk photographer should not only be able to skillfully use a variety of photographic techniques to create photographer, but also have the ability of folklore studies, which means a certain level of theory and master certain research methods. Folk photography creative process is a cultural experience and explores the process of discovery. Folk photography is methods and means to record, release and heritage attending profound traditional Chinese culture. Folk photography through a unique form of expression, with its visual image, embodies the academic value of folk history, the development of human history, cultural heritage and makes a positive contribution to the spread. In the 21st century, China＇ s social stable, economic development rapidly, which provide a good folk photography authoring environment. Folk photography range will also change with the development of folk and continuously expanding, concerns and reflections about the new folk themes have yet to be excavated, to meet the needs of social development.
文摘It has come to notice that developments that take place in rural communities bring about a lot of challenges both positive and negative. However, people who try to manage these challenges use ＂text type＂ in books and through other communication media （publications）, but the effect has scarcely been effective because, most of the people living in rural communities are illiterates. The purpose of this study was to use pictorial illustrations to create awareness on how socioeconomic development affects rural communities （Cape Three Points） and the extent to which its effect can be seen on human life within the local communities （fishermen, farmers, and fish mongers） in terms of their livelihood, attitudes, education and on the general environment. Interviews were mainly used to ascertain facts on how the situation was before the new developments started. Workshops were also organized for focus groups, through which the effect of pictorial illustrations on the people were ascertained. Again, how they should prepare for the foreseen changes that will emanate from any form of rural development was also discussed. At the end of the study, it came to light that many of our rural areas face significant challenges. These challenges as a matter of fact affect their cultural practices and the socio-economic development of the people in such rural communities and the country as a whole. It is believed that these challenges and many other related concerns that have emanated from this study would be critically recognized and managed if not solved by the powers that be. Results from this study will form a basis for further discussion of socio-economic effects of rural development on rural communities and any other related effects caused by any physical change on rural environment.
