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This essay argues that African American writing emerged as a consequence of slave evangelicalism’s ecstatic worship practices, the frenzied, uncontrollable, and unrehearsed behaviors that are commonly referred to as “shouting.” Persons shout when they are seized by God through the Holy Spirit, and the affective and intellectual qualities slaves acquired while shouting disposed them to take up written discourse and literary culture more broadly as viable enterprises with which to express political dissent and pursue aesthetic fulfillment. This essay establishes shouting’s conceptual formations and contextual features, then reads Richard Allen’s “Spiritual Song” (c. 1800) as well as Jupiter Hammon’s An Address to the Negroes in the State of New-York (1786/7) and “The Kind Master and the Dutiful Servant” (n.d.) as works that exemplify how shouting shaped the figural, ideological, and rhetorical dimensions of early black literary and textual productions.

Although American blackface minstrelsy in its early period (1829–1843) esteemed the anti-authoritarian potentiality of black alterity, the form's performers and most influential public (the white working class of the urban northeast) spurned actual black people. In minstrelsy they fashioned \"blackness,\" a new \"race\" with which to distinguish themselves from socioeconomic elites as well as African Americans.

SUMMARY Goal: The COVID-19 pandemic, healthcare market disruptors, and new digital healthcare technologies have made a substantial impact on the delivery of healthcare services, highlighting the critical roles of leaders in hospitals and health systems. This study sought to understand the evolving roles of CEOs, CIOs, and other executive leaders in the postpandemic era and highlight the adaptability and strategic vision of executives in shaping the future of healthcare delivery. Methods: Between October 2022 and May 2023, 51 interviews were conducted with CEOs, CIOs, and other executives responsible for delivering technology solutions for 33 nonprofit health systems in the United States. They were asked to describe their backgrounds; how information solutions and technologies were viewed within their organizations' strategy, operations, and governance; and the key characteristics of executive leaders. Principal Findings: The study has found that effective CEOs have an authentic belief in technology's role in achieving their organization's mission and that contemporary CIOs are strategic executive partners who align strategy with culture to improve care. This study examines how healthcare systems are creating digitally savvy executive leadership teams that operate in a new, integrated model that unites previously siloed functions. Practical Applications: Some healthcare CIOs are unprepared for current and future business challenges, and some CEOs are unsure how to leverage digital technologies and C-suite expertise to transform their organizations. This research provides insights into how the nation's health systems are building and sustaining leadership teams capable of adapting to the healthcare environment and accelerating organizational transformation.

Aims—In recent years there has been increased use of core biopsy for the preoperative diagnosis of screen detected and symptomatic breast lesions. The aim of this study was to compare the quality assessment parameters for preoperative diagnosis by fine needle aspiration cytology (FNAC) before conversion to core biopsy with those for core biopsy after conversion in screening and symptomatic practice. Accuracy of typing and grading of tumours on core biopsy was assessed. Methods—Correlation of FNAC (C1–5) and core biopsy (B1–5) results (total of 1768 cases) with subsequent available resection histology was performed for 473 FNAC samples in 1997/98, 349 core biopsies in 1998/99 performed in symptomatic practice, for 561 FNAC samples in 1997/98, and 385 core biopsies in 1998/99 performed in screening. Quality assessment parameters were calculated using the methodology detailed in the National Health Service Breast Screening Programme guidelines for cytology practice. Results—Increased absolute and complete specificity, lower inadequate rates, and lower suspicious rates were found for core biopsy compared with FNAC in both symptomatic and screening practice. Typing of tumours was attempted in 86.7% of core biopsies in symptomatic practice and was accurate in 93.6% (132 of 141 where type was stated). Grading of tumours was attempted in 63.5% of invasive carcinomas, with the provisional grade on core biopsy being confirmed on later histology in 75% of grade 1 cases, in 70% of grade 2 cases, and in 86% of grade 3 cases. No case provisionally graded as 1 was subsequently found to be grade 3 and no provisionally grade 3 case was found to be grade 1. Conclusion—Conversion to core biopsy for the preoperative diagnosis of breast lesions increases specificity and reduces inadequate and suspicious rates. Grading and typing of tumours and assessment of oestrogen receptor status by immunocytochemistry is also possible in core biopsy, thereby increasing diagnostic information available when considering treatment options.

This study reports two cases of intracystic papillary carcinoma of the breast, which had been biopsied preoperatively using a 14 gauge (14G) core biopsy needle. In each case, a needle tract containing groups of epithelial cells within granulation tissue could be identified on histology of the excised specimen. Both cases showed extracapsular tumour, which was interpreted as displacement of epithelium related to preoperative core biopsy. Subsequent axillary lymph node sampling showed no evidence of metastasis. In one case, extracapsular tumour appeared to be in blood vessels, but flattened cells lining the spaces containing tumour failed to react with factor 8 related antigen or CD34 on immunohistochemistry. It is likely that intracystic papillary carcinomas are particularly prone to this artefact because friable tumour fragments escape, accompanied by cyst fluid, when the capsule is punctured by a 14G core biopsy needle.

Aims—The use of the H score (involving the assessment of intensity and distribution of positivity) on sections stained for the oestrogen receptor (ER) by immunocytochemistry (ICC) allows different samples to be compared and detailed correlations to be made between hormone receptor expression and morphology. This study assessed the reliability of core biopsy in predicting ER expression in the same tumour excised later at treatment. The distribution of ER within excised tumours was investigated. Methods—The distribution of ER positivity was investigated in 51 diagnostic core biopsies and across the diameter of 51 subsequently excised tumours in a field by field (magnification, ×40; field diameter, 0.4 mm) assessment using the semiquantitive H scoring system. Results—The ER H score in diagnostic core biopsy was significantly higher (p = 0.05, paired rank test; overall mean, 130; n = 51) than the mean in the corresponding excised tumour (mean, 110; n = 51). There was a significant downward trend in ER positivity from the periphery of tumours towards the centre (p = 0.001). The reduction of ER positivity was 6 H score units (2%)/mm. If core biopsies were orientated with the tumour edge at one end no change in ER positivity with field number along the length of the core could be demonstrated. Conclusions—ER estimation in core biopsies correlated well with expression in tumours but ER expression was higher in the core biopsies than in the excised tumours. ER expression was higher at the periphery of tumours than at the centre. The higher ER expression in cores may reflect the higher chance of sampling the peripheral part of a tumour using a needle core.

[...]theater in the 1830s United States was popular, extremely so.) Proceeding from Tocqueville's notion that \"no form of literature has closer and more numerous links with the current condition of society than the theater,\" I consider how changes in US theater culture from the years following the War of 1812 through the fin de siecle mark significant transformations in the ways Americans, as performers and spectators, conceptualized and gave shape to their Americanness over the course of the same period.1 This long-view approach reveals the remarkably protean nature of nineteenth-century US theater culture, its ability to respond affirmatively to new, ever-changing demands-new and everchanging because audiences themselves were, too. (Philadelphia and New Orleans set the terms of theatrical production in their respective regions, so their archives are particularly illustrative of national currents in antebellum theater culture.) In the first, an anonymous broadside from the early 1820s took aim at Philadelphia's Chestnut Street Theatre and its separate entrances for patrons who bought the priciest tickets, casting its remonstrance in chauvinistic, quasi-martial terms. [...]grudgingly, playwrights and actors found themselves submitting to the homogenizing impulse that by and large defined antebellum theater culture; that is, an impulse that projects and thereby strives to achieve \"oneness,\" which \"has for centuries been central to descriptions of the proper aspirations of a democratic people,\" as the political philosopher Danielle Allen writes.6 As a sociopolitical project, oneness requires persons to surrender fully to dominant creeds and procedures because it cannot tolerate difference or peculiarity.7 The least powerful members of a polity shoulder most of the burden; if they refuse to make the necessary sacrifices or assimilate their particularity for the sake of oneness, they face brutal sanction. Yet \"the optimism in regard to the United States as an arena of unprecedented freedom and expanding choices for women peaked during the early national period and then was lost\" by the late 1820s.9 The later plays contribute to a reading of the first half century of US history as a time defined by social and political retrogression for the polity's least powerful members-a history that not only belied the optimism of early national feminists but also includes the steady revocation of African Americans' already limited civil and political rights as well as the genocidal displacement of native peoples.

“Where do we find ourselves?” We ask some permutation of this question in response to life events, as Ralph Waldo Emerson does to open his haunting essay on the death of his young son, the magisterial “Experience” (1844). Commemorations also compel us to make such accountings, to break from the requisite, often monotonous routines of everyday life to assess our evolutions. The sixtieth anniversary of the founding of the American Society for Theatre Research offers such an occasion, and this forum's invitation to imagine and, perhaps, sway the direction of the organization's discursive and institutional practices over the next decade or more requires, first of all, estimating where we, as scholars of theatre and performance culture, find ourselves. Although these inspections would certainly reveal actions and innovations worthy of commemoration, the more important task is to lay bare and come to grips with those assumptions, ruts, and shibboleths in our respective fields of inquiry that have become so ingrained that they have achieved a kind of sacrosanctity. We must contest and, in many cases, abandon these conceptual and analytical habits: such efforts, though to the detriment of ideology, will be to the good of the discipline and the enrichment of our individual scholarly sensibilities.

“Where do we find ourselves?” We ask some permutation of this question in response to life events, as Ralph Waldo Emerson does to open his haunting essay on the death of his young son, the magisterial “Experience” (1844). Commemorations also compel us to make such accountings, to break from the requisite, often monotonous routines of everyday life to assess our evolutions. The sixtieth anniversary of the founding of the American Society for Theatre Research offers such an occasion, and this forum's invitation to imagine and, perhaps, sway the direction of the organization's discursive and institutional practices over the next decade or more requires, first of all, estimating where we, as scholars of theatre and performance culture, find ourselves. Although these inspections would certainly reveal actions and innovations worthy of commemoration, the more important task is to lay bare and come to grips with those assumptions, ruts, and shibboleths in our respective fields of inquiry that have become so ingrained that they have achieved a kind of sacrosanctity. We must contest and, in many cases, abandon these conceptual and analytical habits: such efforts, though to the detriment of ideology, will be to the good of the discipline and the enrichment of our individual scholarly sensibilities.