Ward 402: A Novel
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His quest to find the good doctor leads Eric to a world called un-space, literally an underground labyrinth whose gateway is located, of all places, in a bookstore. Fidorus in a hideout built completely from books. The Raw Shark Texts not only identifies the material format of books as a safe location but also a particular kind of content: text that demands interpretation and, specifically, literary texts and novels.
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This focus on ink-based, textual interpretation is made explicit and literal when the shark appears as a few blots of ink on the page, as in the beginning of the flipbook animation sequence discussed earlier. Novels provide shelter that is reinforced by their physical frame and their method of circulation; it is not just the content of the books that matters but also the physical nature of book as shelter for the story.
So, complex literary works may be the best shield against the shark, but it is even better if these literary works are library books.
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The Raw Shark Texts makes this point formally and thematically through its overwhelming range of intertextual connections to all variations of narrative popular culture: literary works by the likes of Jorge Luis Borges, Paul Auster, Lewis Carroll, Italo Calvino and Mark Danielewski as well as films ranging across The Wizard of Oz , The Matrix , Jaws , and Casablanca. Recognizing a correspondence between the book and the shark makes it hard to view the book as a passive victim bleeding out into the waters of digital technoculture.
Instead, as I am suggesting, the book The Raw Shark Texts uses bookishness as a strategic mode of combating not the digital world but the claims about the death of the book that circulate within it. I want to reiterate that the aesthetic of bookishness is not merely nostalgia for print amid an era seemingly devoted to becoming paperless.
This is not about retreating into book-bound structures as barriers from which to hide from the real world. Instead, the book-bound shelters like Dr. It is from these book-bound spaces that characters, and readers through them, learn to rethink the ways in which we relate to books as objects and media forms. Reading works of twenty-first-century literature through the paradigm I am constructing here prompts us to think beyond dichotomies when considering the relationship between print and digital media, particularly in relation to contemporary discourse about the death of the book.
Works that adopt an aesthetic of bookishness respond to their contemporary, digital moment by showing how literature retains a central role in our emergent technoculture as a space for aesthetic expression and cultural critique. They harness the power and potential, as well as the fears and frustrations, of new media into print and onto paper. Examining the ways in which they do so promotes a crosscurrent of analysis that demands that we rethink the very terms and means through which we articulate our concerns about the future of reading, literacy, and certainly, of literature.
Especially out of old people. Noah Wardrip-Fruin and Nick Monfort, eds. Audeguy, Stephane. The Theory of Clouds. Paris: Editions Gallimard, Timothy D. New York: Houghton Mifflin Harcourt , Carpenter, J. Dalley, Jan.
September 6 Danielewski, Mark Z. House of Leaves. New York: Pantheon, Only Revolutions New York: Pantheon, Dominguez, Carlos Maria. The House of Paper. Nick Caistor. New York: Harcourt Books, Gomez, Jeff. Basingstoke, UK: Palgrave Macmillan, Hayles, N. Chicago: University of Chicago Press, Hunter, J. New York: WW Norton, Kittler, Friedrich. Trans by Michael Metteer, with Chris Cullens. Liu, Alan. Marino, Mark C. McCrum, Robert. Sunday 8 May Nelson, Jason. Rich, Motoko. October 6, July 27, Advances in Nutrition Bethesda, Md.
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Journal of Agricultural and Food Chemistry. Membrane-rich milk fat diet provides protection against gastrointestinal leakiness in mice treated with lipopolysaccharide. Journal of Dairy Science. Distinct tissue distributions and subcellular localizations of differently phosphorylated forms of the myosin regulatory light chain in Drosophila.
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Gene Expression Patterns : Gep. Sec61alpha is required for dorsal closure during Drosophila embryogenesis through its regulation of Dpp signaling. Dietary milk fat globule membrane reduces the incidence of aberrant crypt foci in Fischer rats. A second-site noncomplementation screen for modifiers of Rho1 signaling during imaginal disc morphogenesis in Drosophila.
The latest guidelines recommend opportunistic screening above the age of 65 using pulse palpation, followed by a lead electrocardiogram ECG in case of an irregular pulse. Handheld ECG recording devices receive most interest for opportunistic screening, as they are easy to use, portable, low-cost, allow fast rhythm strip recordings, do not require experienced personnel, and often have built-in algorithms that provide an immediate interpretation of the ECG.
In out-of-hospital settings, such devices have shown high sensitivity In contrast, little is known about their usability in a hospital environment although there may be a much higher prevalence of patients at risk for AF and its complications. Even in this setting, early detection and management of AF patients can be improved since not every patient on every ward will undergo regular lead ECGs and the effectiveness of pulse checks by nurses to detect silent AF may be suboptimal.
The aim of this study was to determine the usability and accuracy of two handheld single-lead ECG devices AliveCor and MyDiagnostick for AF screening in a hospital population with an increased risk for AF. On the basis of our findings, we did cost-effectiveness simulations for different screening approaches.
This non-randomized blinded observational study was performed at two departments of a large Belgian tertiary care hospital. First, a cardiac ward setting was chosen to perform an initial validation of the handheld ECG devices. Afterwards, a similar screening study was performed at the geriatric ward because of the higher expected prevalence of AF patients but absence of systematic ECG recording.
Patients needed to be able to give oral informed consent. The study complied with the Declaration of Helsinki and the research protocol was approved by the local ethics committee. MyDiagnostick left and AliveCor right with representative recordings in a patient with sinus rhythm and a patient with atrial fibrillation. To record a single-lead ECG with the MyDiagnostick, the patient has to hold the rod-like device with both hands for 1 min. For this study, the device was programmed in screening mode, meaning that all ECG recordings are stored together with a recording time, date, and automated algorithm diagnosis.
During the screening, the recording time and the patient's identification data were noted by the operator.
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After a screening session, the ECG recordings were uploaded to a computer and linked to the patients' identification by means of the accompanying software. After each 30 s recording, identification data are directly entered and stored in the app. Together with the automated rhythm diagnosis, these data are wirelessly transferred to a web-based software platform. Moreover, every recording was later reviewed randomly and independently by two electrophysiologists H.
Atrial flutter and AF were seen as one diseased state since consequences and management are similar, and were classified as AF for further analysis. A chart review was done for every patient to evaluate the known presence of AF and to record clinical and demographic data. Throughout the study, all time investments of nurses and physicians were tracked. To investigate whether electrode solution spray may optimize the quality of the handheld ECG recordings, a substudy was performed in 53 patients hospitalized at the cardiology ward. The patients were asked to successively hold the MyDiagnostick and the AliveCor.
Thereafter, patients' hands were moisturized with an electrode solution spray SignaSpray, Parker Laboratories, USA and they were asked to hold both devices for a second time. All paired recordings were randomly presented to two blinded electrophysiologists to indicate which of the two had the best quality. On the basis of the screening results and time-investment measurements, a cost-effectiveness simulation was performed for different screening strategies.
Taking into account the Belgian staff costs, these values were translated into a hospital cost together with the costs of the three screening tools. A calculation was made as cost per newly identified AF patient. Moreover, to calculate the costs per preventable stroke, the yearly expected stroke risk of patients admitted to both wards was calculated, based on their mean CHA 2 DS 2 -VASc score.
Statistical analysis was performed using SPSS Additionally, the same analyses were performed for the manual interpretation of the handheld ECG recordings by each electrophysiologist. The kappa coefficient was determined to assess the agreement between the reference ECG, the automated analysis of the devices and the interpretation by the electrophysiologists, and the agreement between the two electrophysiologists.
Logistic regression analysis, including age as a variable into the model, was used to evaluate the effect of different variables on the readability of the handheld ECG recordings. A logistic mixed model was used to check whether both electrophysiologists had a preference for handheld ECG recordings with electrode solution spray, for each device. None of the patients who were asked to participate in the study refused.