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This article is an invitation to truly postmodern conversational approaches to preaching beyond a monological modern mass media sermon dressed up in conversational style. This involves proposing a new who and how for preaching in the digital age, resulting in a New (Media) homiletic. Engaging with Parker J. Palmer’s The Courage to Teach, this article first explores issues with the traditional top-down model for preaching solidified during the age of mass media technoculture. Next this article names some stumbling blocks to dialogical preaching in a mainline Protestant US context. Then this article explores what difference the implementation of Palmer’s Community of Truth model could make for preaching in this digital age. The technoculture of social media allows for and expects preachers to be more conversational in the who and how of sermon delivery, preparation, and feedback.

The CCLI charts may not reflect it, yet one thing many Christian churches discovered as the pandemic raged across the world (and violence at home and abroad) was the need for songs of sacred lament. Unfortunately, many churchgoers, especially those who identify as practitioners of contemporary Christian worship, have cultivated a gap between the biblical give and take of praise and lament revealed most poignantly in the book of Psalms. This chasm between praise and lament is a problem, as a liturgical discourse about disastrous events is weakened. Churches sing congregational songs of praise in the church, the chorus of ‘what ought to be’. Meanwhile, outside the church, artists in genres as diverse as folk and rap sing the chorus of what frankly ‘is’. For the church to be transformative, it must be grounded in what is (lament) and aiming toward what ought to be (praise). This is the value of the cycle of praise and lament in the church’s liturgy. This article explores the impact of CCM (contemporary Christian music) and praise and worship culture as it laments the loss of lament in Christian worship. The essay articulates the missing sense of ‘Truth’ in contemporary congregational music, as defined by Don Saliers’ Worship Come to Its Senses. The article closes by amplifying emerging Christian songwriters reintroducing lament to contemporary worship.

PurposeExternal ventricular drains (EVD) are commonly used in aneurysmal subarachnoid hemorrhage (aSAH) patients and can be life-saving by diverting cerebrospinal fluid. However, the overall relationship between EVD use and outcome is poorly understood.MethodsIn an exploratory analysis of an aSAH patient cohort, we examined EVD use in relation to modified Rankin Scale (mRS) at hospital discharge and at 6 months (unfavorable outcome = mRS > 2) using univariable and multivariable analyses.ResultsEVDs were placed in 31 of 56 (55.4%) patients and more often in women than men (66.7% vs 35.0%, p = 0.022) despite similar rates of hydrocephalus. Women had greater ICU [18 (13.5–25) vs 11.5 (6.5–18.5) days, p = 0.014] and hospital lengths of stay (LOS) [20.5 (16.5–34) vs 13.5 (10.5–27) days, p = 0.015] than men and greater mRS at discharge [4 (3–5) vs 3 (2–3.5), p = 0.011] although mRS at 6 months was similar. Patients with EVDs had longer ICU and hospital LOS and greater mRS at discharge [5 (3–6) vs 2 (2–3), p < 0.001] and at 6 months [4 (2–6) vs 1 (0–2), p = 0.001] than those without an EVD. In multivariable models, EVD use was associated with unfavorable 6-month outcome accounting for age, sex, and admission modified Fisher scale, but not in models adjusting for Hunt and Hess scale and World Federation of Neurological Surgeons scale.ConclusionIn an aSAH cohort, the use of EVDs was associated with female sex and longer LOS, and may be linked to functional outcomes at discharge and at 6 months, although these associations warrant further investigation.

Background/Objective Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality despite advances in management. We evaluated the prognostic significance of a qualitative score using brain magnetic resonance imaging (MRI) features obtained early after aSAH. Methods Patients with aSAH were enrolled in a prospective observational cohort and underwent brain MRI during their acute hospitalization. MRIs were rated using a scoring system that considers the anatomical location of signal intensity changes on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences. The relationship between MRI scores and functional outcome defined by modified Rankin scale (mRS) at 6 months was evaluated in uni- and multivariable models. Results The cohort included 45 aSAH patients (median World Federation of Neurologic Surgeons (IQR) 2 (1–4)) who underwent brain MRI a mean (SD) of 9.0 ± 8.0 days after aSAH. At 6 months after aSAH, 26 patients had achieved a favorable outcome (mRS ≤ 2) while 15 had an unfavorable outcome (mRS > 2). Deep gray nuclei (DGN) score ( p  = 0.016), cortex + DGN score ( p  = 0.015), FLAIR score ( p  = 0.016), DWI score ( p  = 0.0045), and overall score ( p  = 0.0081) were significantly lower in patients with favorable outcome compared to those with unfavorable outcome. However, MRI scores were not independent predictors of outcome in multivariable models adjusting for admission Hunt and Hess, Glasgow Coma Scale, or World Federation of Neurologic Surgeons scales. Conclusions In this pilot study, a qualitative scoring system using anatomically defined MRI FLAIR and DWI signal abnormalities identified in the acute phase of aSAH was linked to 6-month functional outcome. However, these scores did not add prognostic value to established indices of neurological severity.