517 research outputs found
Use of hemodynamic algorithm after gastrointestinal surgery - reply
No full textIn Reply Drs Saugel and Reuter challenge the description of the OPTIMISE trial as a pragmatic trial. As applied to clinical trials, the term pragmatic has a particular meaning. Pragmatic trials are designed to evaluate the clinical effectiveness of a treatment in the context of routine clinical practice.1 This distinguishes them from explanatory trials, which are designed to evaluate the efficacy of a treatment under ideal conditions
Perioperative haemodynamic optimisation
No full textThe use of fluid and inotropic therapies to optimise global haemodynamic variables, in particular oxygen delivery, in critically ill patients has been a controversial area of research for more than 25 years. The aim of this review is to describe the current evidence base for this treatment and how concepts of haemodynamic optimisation have evolved in recent years. The inconsistent findings of a large number of small phase II trials continue to stimulate the debate about the value of this treatment approach. However, important recent developments include the use of optimisation only during periods of resuscitation, more cautious doses of fluid and/or inotropic therapy, confirmation that pulmonary artery catheter use does not result in excess mortality and an improved understanding of the mechanistic effects of haemodynamic optimisation. These advances in our understanding have now informed the design of large randomised trials in various patient groups. The true value of haemodynamic optimisation is likely to be confirmed or refuted within the next 5 years
Managing perioperative risk in patients undergoing elective non-cardiac surgery
No full textNon-cardiac surgery has a low overall mortality but is associated with a large number of deaths because so many procedures are performed.Most deaths occur in a group of patients who are at high risk because of advanced age, comorbid disease, or major surgery (hospital mortality rate 12%).More effective systems can improve quality of perioperative care and may improve survival while reducing healthcare costs.Further research is needed to identify the most effective approaches to perioperative medicine for high risk patients.Routine audit of outcomes after all non-cardiac surgery is urgently needed
Supplemental material for The association between ICU admission and emergency hospital readmission following emergency general surgery
No full textSupplemental Material for The association between ICU admission and emergency hospital readmission following emergency general surgery by Michael A Gillies, Sadia Ghaffar, Ewen Harrison, Catriona Haddow, Lorraine Smyth, Timothy S Walsh, Rupert M Pearse and Nazir I Lone in Journal of the Intensive Care Society</p
Review Of The Gods Of War: Is Religion The Primary Cause Of Violent Conflict? By M. Pearse
No full textPearse (Houghton College; Why the Rest Hates the West, 2004) succeeds in showing that religion was rarely the primary cause of war, but argues that religion as a part of culture can be used to justify many kinds of war. His range is enormous: ancient, medieval, and modern history, biblical exegesis, just war theory, pacifism, Islam, Christianity, communism. Sections on the roles of tribal Gods in Serbia, Russia, and England are very good. However, the book is flawed by Pearse\u27s complaints against secularism and multiculturalism. He insists that only religion can protect the sanctity of life against atheism and agnosticism. When Christianity supported or justified war, this was not true Christianity. On Islam, his conclusion is the opposite. Pearse blames the four most costly wars (WW I and II, the T\u27ai-ping rebellion, and the Communist revolution in Russia) on modernist secularist ideologies. Yet the T\u27ai-pings were not secular, and the strongest opponents of early-1914 European militarism were the secular socialists of France, Britain, and Germany, as contrasted with professedly Christian monarchs of Europe. This book will appeal to evangelical Christians who share the author\u27s biases, but others will find it difficult to separate the sound scholarship in several chapters from Pearse\u27s theological beliefs. Seminary libraries only. Summing Up: Not recommended
Parnell, Pearse, and Peace in Northern Ireland
No full textThe Troubles in Northern Ireland are not easy to understand and are not easy to solve. People have tried to save Ireland through religion, through government, through violence, and most recently through peace. My focus throughout this paper will be to help the reader to understand the history, motivations and ramifications of the Troubles in Northern Ireland. The past, present and future of Northern Ireland will be discussed and understood through commentary, focused profiles of individuals and groups, and events.Emily Miller
Parnell, Pearse, and Peace in Northern Ireland
PO 99, Professor Gilbert, Spring 1997
Parnell, Pearse, and Peace in Northern Ireland
Emily M. Miller
May 25, 1997
Professor Christopher Gilbert
PO 99 Spring 1997
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Emily Miller
Parnell, Pearse, and Peace in Northern Ireland
PO 99, Professor Gilbert, Spring 1997
Chapter
Introduction ........ Page 3
Outline
History and Comentary ......... Pages 3-16
Parnell/O 'Shea Affair and Home Rule ....... Pages 16-21
Padric Pearse and Easter Rebellion ........ Pages 22-32
Peace Process ............ Pages 32-37
Works Cited .... Pages 38-End
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PO 99, Professor Gilbert, Spring 1997
I n t r o duct i o n
The Troubles in Northern Ireland are not easy t o understand and
are not easy to solve. People have tried to save Ireland through
religion, through government, through violence, and most recently
through peace. My focus throughout this paper will be to help the
reader to understand the history, motivations and ramifications of
the Troubles in Northern Ireland. The past, present and future of
Northern Ireland will be discussed and understood through
commentary, focused profiles of individuals and groups, and
events.
History and Commentary
Many historic events marked the 1980's and this decade: the
breakup of the Soviet Union, the Bosnian/Serbian conflict, the
tumbling of the Berlin Wall, and the reunification of Germany.
Today, there is still a wall standing and a country divided. In
Gaelic, it means green isle, but it would seem more appropriate to
call it the bloody isle in reference to its history. The country is
actually two countries, the Republic of Ireland and the United
Kingdom's Northern Ireland. Shortly after World War I, the British
government took sole possession of the governing of Northern
Ireland. The British governmental annexation of Northern Ireland
helped reignite age old tensions. Religious and ethnic strife in
Northern Ireland became a way of life that continues into today.
The people of Northern Ireland are fighting a war of religion.
Many of Northern Ireland's residents, approximately 1/3 of the
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population, which are Catholic, want to rejoin the Republic of
Ireland as one whole nation. (United States Institute of Peace, In
Brief, Number 20) One million of Northern Ireland's population are
Protestant, with a majority of them being of Scottish ancestry. The
Protestant population is aliened with the United Kingdom and hold
strong Unionist views. The Catholic population alienees itself with
the Republic of Ireland and have loyalist views. The differing of
loyalist and unionist views is one source of the present conflict in
Northern Ireland.
Catholic history really begins with the introduction of
Catholicism by Patrick, later St. Patrick in about 400 A.D.
(http://www.dup.org. uk/history .htm) Legend states that Patrick
was kidnapped by pirates, was keep in virtual slavery for several
years and eventually was taken to France. While in France, Patrick
,:J was named a Catholic bishop and was assigned to be a missionary
in Ireland. Patrick's arrival brought about a religious movement
that is still powerful today. Ireland, for centuries had been home to
two very large religious groups, each with their own differing beliefs
and customs. Those differing beliefs have been a foundation for the
problems 1n Northern Ireland.
The idea of reunification is not a new one for Northern
Ireland. The internal conflict has ripped apart Ireland for
centuries. Tim Pat Coogan puts it in perceptive in the introduction
to his book, The Troubles,
"The Condition of affairs suggested by the term 'the Irish
Troubles' was already some three centuries old when
Columbus discovered America. A degree of strife between the
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inhabitants of the islands of what now constitute Ireland and
the United Kingdom existed long before the
discovery". (Coogan, pp. 1)
The Irish in the past have held up the idea that the violence in
Northern Ireland is in some way honorable because it has lasted so
long. This view point does nothing to stop the violence. It would
seem that one reason why the violence is accepted is the view that it
is heroic. Both sides view their fighters as heroes for their cause.
The main conflict is really a deadly triangle, between the
Protestant's, the Catholic's and the British. In simple terms, the
Catholics are against the Protestant's and the British, the
Protestant's are against the Catholics, and occasionally the British,
and the British are against the terrorist on whatever side they fight.
The Irish Republic Army or IRA has strong Catholic support
through out the whole of Ireland. The IRA is able to continue
because of Catholic sympathizers in Ireland as well as in large Irish
settlements in the United States, such as Boston.
The Anglo-Irish Treaty was a result of the Easter Rising of
1916 in Dublin. The Easter Rising will be written about in greater
detail in the Padric Pearse Chapter. The treaty ended the rebellion
in Dublin. The treaty was not agreed upon by all of the various
Catholic paramilitary groups. One faction was headed by Michael
Collins and the other was headed by Eamian de Valera. Both men
had very different views on the methods and the future of Ireland.
The Irish Volunteers or Oglaigh na hEireann were established in
November 1913 to "secure and maintain the rights and the liberties
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common to all the people of
Ireland". (http://w ww. utexas .edu/students/iig/archi ve/ira/history
/irahist.html) The Irish volunteers would later become the IRA.
There are two factions in the IRA today, the Official Branch and the
Provisional Branch also know as the Provos. The Official Branch
historically has been more conservative than the Provisional
branch. The Official Wing used Marxist ideology to fight its battles.
The Provisional Wing has used armed violence for political gains,
and this policy continues today. (Gist, Northern Irealnd, GPO May
1989) The Official Branch has lost membership in recent years as
the older members pass away.
The Provisional Branch is a very radical terrorist group to this
day. The Provos killed Earl Louis Mountbatten along with his
grandson in August of 1979 and in the mid 1980's planted a bomb
in former Prime Minister Thatcher's hotel room. The bomb was
only partially successful, it detonated but not at the correct time
and the Prime Minister was not in the room.
Generally, the Provos has a younger membership with more
radical tendencies. The Official branch wants social change
through generally nonviolent means. One might think that the
British occupation would be the IRA's chief target, but most often
the IRA is more concerned with public opinion rather than the
British occupation force. Public opinion is death with by the
political branch of the IRA, Sinn Fein. Gerry Adams is the current
president of Sinn Fein. Sinn Fein political candidates have been
successful in several elections, and as a political statement the
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election winners have refused to take their seats . in Parliament.
Sinn Fein is Gaelic for "We Ourselves", the name itself seems like a
comment on their position within Ireland.
In 1988, in Northern Ireland there were 3 58 shootings, 253
terrorist bombings, and 205 bombs that were found before they
had exploded. (Kronnewetter, p. 127) In addition, secretarian
violence has caused 2,450 deaths since 1969. The IRA has in the
past taken hostages and forced their captives to drive vehicles with
explosives to targets where they are killed along with numerous
unsuspecting civilians. The Irish Republican Army and its branches
want a secular and socialist governmental for all of Ireland. The
IRA along with the Catholic population wants a united Ireland. The
Catholic population in Northern Ireland is in the minority, but not
in the Republic of Ireland. The acts perpetrated by the IRA were
and are generally accepted by the Catholic community. The IRA
claims no random violence, but at least 93 men, women, and
children were killed and another 1,047 people were injured in IRA
random attacks.(Maas, pg.29-3 1)
The IRA 's only hope for survival is the support of the Catholic
population. A resident of Belfast's Fall 's Road neighborhood
stated, "If I was arrested and in a police station, I'd be proud to die
by an IRA bomb".(Mass, pg. 29-31) The IRA has strong support
within the Catholic community, although the actual membership
numbers within the IRA are very small. In the last two decades
2,600 people have dies. 1 out of 20 have suffered a death or injury
in their close family. (Kronnenwetter, pg. 68) The death and injury
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totals are relative to the American Civil War.
In Northern Ireland, the largest battleground 1s Belfast. The
British forces in Belfast have erected a peace wall to separate the
two waring factions in hopes of keeping the peace. Check points
are still common m Belfast and through out Northern Ireland. Each
day people must go through checkpoints where their cars and
belongings are searched. The purpose of these checkpoints is to
stop the flow of arms and explosives in and out of the Irish cities.
In 1988, 3 Provisional terrorist were shot and killed in
the British Crown Colony of Gibraltar, although the terrorists were
unarmed, the British SAS or Special Air Service felt that their
actions were justified. During the funeral for the 3 dead Provos
terrorists, a radical Protestant opened firing on the crowd of
mourners. The Protestant killed 3 and injured more then 60. The
violence escalated again at the funeral's of those who were killed at
the previous funeral. Two off-duty British soldiers came too close to
the funeral procession and were attacked. Several members of the
Provisional Wing then proceeded to shoot the men execution style.
The circle of violence illustrated by these deaths 1s very typical of
Northern Ireland, no one wins and no one cares. A unknown
author put it well, "The IRA has an affinity for graves matched only
Dracula's, and a skill equal to his for volumptous manipulation of
their grisly trophies and rites".
The Protestant's are equally guilty of terrorism. The Ulster
Defense Association or UDA, the Ulster Freedom Fighters, and the
Red Hand Commandos all are terrorist organizations that have
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sympathizers within the Protestant community. The Ulster Freedom
Fighters and the Red Hand Commandos were outlawed in 1973 by
the British government for terroristic activities. The Protestant
population may have a genuine concern for themselves. If Ireland
is reunited they will become a minority in a largely Catholic
Ireland. The Protestant groups may still be planning for a
doomsday situation. The Protestant forces have been known to
stock pile weapons so in the event that Britain pulls out they will be
ready to fight an all out war with the Catholic forces. A minister at
a Protestant funeral denounced paramilitary violence and a half a
dozen people walked out in disagreement . Emotions run deeply on
the subject of violence, methods, peace and reunification. The
Protestant's would not benefit from peace. If there is peace the
British will leave Northern Ireland and the Protestant's will have to
fend for themselves. The Protestant's would rather kill the British
then have them leave, if their forces keep the soldiers busy they will
not be able to leave Northern Ireland. The British thus indirectly
stay to protect the Protestant's from the Catholics. The British
occupation forces have been the source of many problems, but they
also have held off many other problems as well, as long as the
British are in Northern Ireland, there doesn't seem to be a
likelihood of an all out war. Most British citizens favor a continued
presence in Northern Ireland, although those views have become
less staunch in light of the continued peace process, and the
acceptance of Gerry Adams within the United States.
The last parties in this conflict are the British Security Forces
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and the Royal Ulster Constabulary or the RUC. The RUC is the
official police force in Northern Ireland. The RUC is similar to the
New Scotland Yard in England. During the mid-1980's the RUC was
accused in several deaths of suspected IRA terrorists or supporters.
The general population of Ireland accused the RUC of a shoot to kill
policy. Chief Investigator John Stalker of the Manchester Police
Department was called in as a special investigator. Stalker and a
team of investigators uncovered several mishandled pieces of
evidence. Inspector Stalker was gathering crucial evidence when he
was removed from the case. The Irish population around the world
was angered at the removal of John Stalker from the case. The RUC
as of 1990, can not go out on patrols unless specifically called in by
the British forces.
Northern Ireland is not a large area of land, but it has a large
population. The population is comparable to the Kansas City
metropolitan area or just smaller than the Philadelphia
metropolitan area in a geographic area the size of Connecticut. 2/3
or about 900,000 to a million people are Protestant while only 1/3
or about 600,000 are Catholic. Even if a person is an atheist they
must be a Catholic or a Protestant atheist to survive in the country.
When a three-year old was killed by an IRA bomb, his death
was the last straw for many Irish citizens. The consensus in some
circles is that the IRA does not speak for the general population.
The Irish Republican Army, the Royal Ulster Constabulary and the
Ulster Defense Association all have a responsibility to the the
civilian population to protect the children of Ulster. When children
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are victims of paramilitary violence the population relives the
harsh reality of the troubles in Northern Ireland. The terrorism has
caused a tolerance to the violence. When children are victims of
terrorism, people stop and think a little about the situation in
Ulster. The children of Ireland are one of the few hopes for peace
and reunification, if they are not destroyed by the violence. Belfast
has a school that has been integrated with children of both faiths
attending, and in recent years the number of students enrolling has
gone up. The children really can be looked upon as a bright spot in
the violence.
The Troubles m Northern Ireland are similar to a knot in a
rope, if one pulls . on the wrong string the knot tightens even worse
than before, but if the right string is pulled, at the right time,the
knot can be untied. Northern Ireland has many knots and many
wrong strings, but only one solution. What is that solution? and at
what cost? In every solution there is a loser. If the British pull out
of Northern Ireland, the Protestant's are losers. The religious
conflict that the Protestant's would face at the hands of the
Catholic's could be comparable to the situation in Israel with the
Jews and the Muslims. If the British do not pull out of Northern
Ireland the continual violence will rip apart the country, but if they
do pull out there will still not be peace. The children, both Catholic
and Protestant will still be growing up in a war zone. Reunification
may be the only solution to the troubles. The Catholic's and the IRA
are pitted against the Protestant's and the UDA but the harsh reality
is that the parties on both sides are Irish and Scot/Irish in blood
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and in heritage,
Northern Ireland was really a colony of the United Kingdom,
and like all colonies there have been settlers, The native
population, in this case, the Irish Catholics want to reclaim what
they feel is their land, The settlers, in this case the Irish Protestants,
want to keep what they have earned over the years, The Troubles
are similar to the treaty disputes in the United States, where Native
Americans are fighting for there land. The Catholic Irish are still
fighting for their own homeland as well. One might ask if there is
room in a predominately Catholic Irish homeland for the Protestant
minority. Until there is peace the world may never know.
Many other problems have ravaged Northern Ireland besides
the religious conflict. Severe unemployment, economic instability
along with the growing inflationary problems have crippled
Northern Ireland's economy and have caused many domestic
problems as well. The problems in Northern Ireland have caused an
economic recession. Catholic workers are still more likely to be
unemployed than Protestant workers. High unemployment has
caused people to lash out at their surroundings. Violence is one way
of showing their feelings and frustration.
Peace, not to long ago it would have been impossible to
imagine. The IRA, in 1988, stepped up its campaign to remove the
British from Northern Ireland, all they succeeded in doing was
making the British resistance tougher. The RUC with a possible
shoot-to-kill policy, is now confined to barracks unless otherwise
ordered on assignment. The UDA may be stock piling weapons for
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PO 99, Professor Gilbert, Spring 1997
an all out civil war. Reunification offers a solution to this complex
problem. The British soldiers would be out the battle zone, the IRA
would no longer have a use, and the RUC could be disbanded. The
only losers would be the Protestant's. All the Protestant's really want
is to be part of the British rule and to be able to practice their
religion. If peace was negotiated well there would be a solution that
every party could agree. Either way the coin flips there will be a
victor and a loser, if it is possible in this situation. Peace in
Northern Ireland will a painful and most likely violent process.
Ireland will be reunified, it may take time, but it will happen. The
Catholic's, the Protestant's, the Royal Ulster Constabulary, the
British, the people and the children are all tragic figures in the
story. Peace is a long way away, but it will be achieved. However,
rrow there is still a wall standing and a country divided. The peace
process will be discussed in a later chapter.
The Parnell/O'Shea Affair and Home Rule
Northern Ireland has been in conflict through out history. One
of the main causes of this is the presence of both British and
Protestant peoples in Ulster. Ulster is the six most northern counties
on the island of Ireland, and makes up Northern Ireland. History
tells us that the Irish have tried to remove these forces from Ulster,
but with out success. In the late nineteenth century a man by the
name of Charles Stewart Parnell began a movement to rid Ireland of
the British once and for all. The movement became known as Home
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Rule.
Home Rule was a concept of self-government for all of Ireland.
The Irish would ideally govern the Irish. Leaders such as Charles
Parnell, W.E. Gladstone, and Thomas P. O'Connor would lead the
drive for self government. (O"Connor, pp.17)
Charles Stewart Parnell was a member of the British
Parliament, he had successfully won election through the Home Rule
Party. Parnell had many supporters among an organization called
the Land League. While in Parliament, Parnell met Captain William
O'Shea, and while the men were never friends by any means, they
became distant allies with mutual respect for each other.(Lyons,
pp.41-43) Captain O'Shea was born in 1840, into a middle class
English family, although he would later settle in Ireland. Captain
O'Shea, at the age of 27, in 1867, married Katherine Page Wood.
O'Shea had lost most of his assets in gambling although he still held
land in Ireland. Historians have speculated that O'Shea married
Katherine for her money.(Hurst, pp.28)
The marriage was not a love match. The couple had four
children while they were married, the last being born in 1874.
Katherine and the O' Shea children lived on an estate near her
wealthy aunt, while Captain O'Shea lived in a nearby town.
Katherine on occasion would attend and also plan social gatherings
with her husband. The O'Shea's marriage in the later years was a
marnage of appearances. O ' Shea was more concerned about his
political career than his wife and
The whole truth and nothing but the truth: the need for full reporting of randomised trials.
No full textThe use of cardiac output monitoring to guide fluid and inotropic therapy in surgical patients has remained a controversial topic for more than 40 years. The reasons for this are numerous and complex, but key amongst them is the interplay between poor research methodology and the likely selective reporting of randomised trials. In this issue of Perioperative Medicine, we find a very unusual report, one which describes a randomised trial stopped for futility after the recruitment of only a small proportion of the target patient sample (Jammer et al. Periop Med). The authors offer no statistical analysis of their findings but simply an explanation of what went wrong. On the face of it, this exercise would seem to offer little of value to the general reader. How can publication of the findings of an unsuccessful trial contribute to the evidence base on this topic? To understand this, we must delve a little deeper into the evidence and see how these trials were designed
Chronotropic incompetence and myocardial injury after noncardiac surgery: planned secondary analysis of a prospective observational international cohort study
No full text
Background: Physiological measures of heart failure are common in surgical patients, despite the absence of a diagnosis. Heart rate (HR) increases during exercise are frequently blunted in heart failure (termed chronotropic incompetence), which primarily reflects beta-adrenoreceptor dysfunction. We examined whether chronotropic incompetence was associated with myocardial injury after noncardiac surgery. Methods: This was a predefined analysis of an international cohort study where participants aged ≥40 yr underwent symptom-limited cardiopulmonary exercise testing before noncardiac surgery. Chronotropic incompetence was defined as the ratio of increase in HR during exercise to age-predicted maximal increase in HR <0.6. The primary outcome was myocardial injury within 3 days after surgery, defined by high-sensitivity troponin assays >99th centile. Explanatory variables were biomarkers for heart failure (ventilatory efficiency slope [minute ventilation/carbon dioxide production] ≥34; peak oxygen consumption ≤14 ml kg
−1
min
−1
; HR recovery ≤6 beats min
−1
decrease 1 min post-exercise; preoperative N-terminal pro-B-type natriuretic peptide [NT pro-BNP] >300 pg ml
−1
). Myocardial injury was compared in the presence or absence of sympathetic (i.e. chronotropic incompetence) or parasympathetic (i.e. impaired HR recovery after exercise) thresholds indicative of dysfunction. Data are presented as odds ratios (ORs) (95% confidence intervals). Results: Chronotropic incompetence occurred in 396/1325 (29.9%) participants; only 16/1325 (1.2%) had a heart failure diagnosis. Myocardial injury was sustained by 162/1325 (12.2%) patients. Raised preoperative NT pro-BNP was more common when chronotropic incompetence was <0.6 (OR: 1.57 [1.11–2.23]; P=0.011). Chronotropic incompetence was not significantly associated with myocardial injury (OR: 1.05 [0.74–1.50]; P=0.78), independent of rate-limiting therapy. HR recovery <12 beats min
−1
decrease after exercise was associated with myocardial injury in the presence (OR: 1.62 [1.05–2.51]; P=0.03) or absence (OR: 1.60 [1.06–2.39]; P=0.02) of chronotropic incompetence. Conclusions: Chronotropic incompetence is common in surgical patients. In contrast to parasympathetic dysfunction which was associated with myocardial injury, preoperative chronotropic incompetence (suggestive of sympathetic dysfunction) was not associated with postoperative myocardial injury.
</p
Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2) : a cluster-randomised controlled trial
No full textFunding Information: R M Pearse reports grants from Edwards Lifesciences and Intersurgical; and personal fees from Edwards Lifesciences and GlaxoSmithKline, outside of the submitted work. R M Pearse also reports being a member of the editorial boards of the British Journal of Anaesthesia and the British Journal of Surgery. A B A Prempah was the recipient of the World Federation of Societies of Anaesthesiologists–International Anesthesia Research Society Clinical Research Fellow in Global Surgery and Anaesthesia in Africa. All other authors declare no competing interests. Funding Information: The ASOS-2 pilot and trial were partially supported by a grant (OPP#1161108) from the Bill & Melinda Gates Foundation, as a subaward from Praekelt. Researchers for the process evaluation were supported by a grant from the World Federation of Societies of Anaesthesiologists. Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licensePeer reviewe
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