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Just like fate
\"With her Grandmother dying, Caroline is given a choice to either stay by her Gram's side or go to the biggest party of the year. The story is told in alternating chapters, revealing what happens if Caroline stays or goes\"-- Provided by publisher.
Book
Enacting Brittany
Brittany offers an excellent example of a French region that once attracted a certain cultivated elite of travel connoisseurs but in which more popular tourism developed relatively early in the twentieth century. It is therefore a strategic choice as a case study of some of the processes associated with the emergence of mass tourism, and the effects of this kind of tourism development on local populations. Efforts to package Breton cultural difference in the late nineteenth and early twentieth centuries marked a significant advance in heritage tourism, and a departure from what is commonly perceived to be a French intolerance of cultural diversity within its borders. This study explores the means by which key actors - middle class associations, businesses, governmental bodies, cultural intermediaries - pursued tourist development in the region and the effect this had on Breton cultural identification. Chapters are arranged thematically and consider the rise of rural tourism in France and the preservation, display, and enactment of Breton culture in its most visible locations: the natural landscape of Brittany, Breton dress, early heritage festivals and religious Pardons. The final chapter explores the staging of Breton culture at the Paris World's Fair of 1937 and the roots of state-sponsored mass tourism. Beyond those interested in the history of French tourism, this study will also be invaluable to historians and social scientists concerned with understanding the dynamics involved in the emergence of mass tourism, its causes and consequences in particular locales in the present as well as in the past.
eBook
Place and locality in modern France
\"Place and Locality in Modern France is an edited collection that successfully analyses the significance and changing constructions of local place in modern France. Drawing on the expertise of a range of scholars from around the world, this book is a timely overview of the cross-disciplinary thinking that is currently taking place over a central issue in French history. The book investigates the politics of administrative reform, regionalism and projects of decentralization. It looks at the role of commerce in engendering narratives and experience of local place, explores the importance of ethnic, class and gender distinctions, and considers the generation and transmission of knowledge about local place and culture through academia, civic heritage and popular memory. In short, this text provides a sweeping account of the concept of the 'local' in French history in a way that will effectively bridge the divide between micro- and macro-history for those interested in ideas of locality and culture in modern French and European history\"-- Provided by publisher.
Book
Park Chan-kyong : Red Asia Complex
Park Chan-kyong is the second artist selected for the \"MMCA Artist Studies\" series. Since the late 1980s, Park has been a member of a community of critics writing art and organizing exhibitions through forums such as the Research Society for Art Criticism (misul bipyeong yeonguhoe), Forum A, BOL. Park took his first steps as an artist with the solo exhibition Black Box: The Memory of Cold War Images, held at the Kumho Museum in 1997, and has since continued to produce film and video works critically examining the Cold War, Korean modernity, and colonialism. Under the title Red Asia Complex, this book examines, from various perspectives, the nearly thirty-years trajectory of Park Chan-kyong's art and writing.--Gallery Website.
Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study
PurposeThe Acute Disease Quality Initiative (ADQI) Workgroup recently released a consensus definition of sepsis-associated acute kidney injury (SA-AKI), combining Sepsis-3 and Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria. This study aims to describe the epidemiology of SA-AKI.MethodsThis is a retrospective cohort study carried out in 12 intensive care units (ICUs) from 2015 to 2021. We studied the incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes of SA-AKI based on the ADQI definition.ResultsOut of 84,528 admissions, 13,451 met the SA-AKI criteria with its incidence peaking at 18% in 2021. SA-AKI patients were typically admitted from home via the emergency department (ED) with a median time to SA-AKI diagnosis of 1 day (interquartile range (IQR) 1–1) from ICU admission. At diagnosis, most SA-AKI patients (54%) had a stage 1 AKI, mostly due to the low urinary output (UO) criterion only (65%). Compared to diagnosis by creatinine alone, or by both UO and creatinine criteria, patients diagnosed by UO alone had lower renal replacement therapy (RRT) requirements (2.8% vs 18% vs 50%; p < 0.001), which was consistent across all stages of AKI. SA-AKI hospital mortality was 18% and SA-AKI was independently associated with increased mortality. In SA-AKI, diagnosis by low UO only, compared to creatinine alone or to both UO and creatinine criteria, carried an odds ratio of 0.34 (95% confidence interval (CI) 0.32–0.36) for mortality.ConclusionSA-AKI occurs in 1 in 6 ICU patients, is diagnosed on day 1 and carries significant morbidity and mortality risk with patients mostly admitted from home via the ED. However, most SA-AKI is stage 1 and mostly due to low UO, which carries much lower risk than diagnosis by other criteria.
Journal Article
Assessment of the integrity of real-time electronic health record data used in clinical research
Near real-time electronic health record (EHR) data offers significant potential for secondary use in research, operations, and clinical care, yet challenges remain in ensuring data quality and stability. While prior studies have assessed retrospective EHR datasets, few have systematically examined the integrity of real-time data for research readiness.
We developed an automated benchmarking pipeline to evaluate the stability and completeness of real-time EHR data from the Yale New Haven Health clinical data warehouse, transformed into the OMOP common data model. Twenty-nine weekly snapshots of the EHR collected from July to November 2024 and twenty-two daily snapshots collected from April to May 2025 were analyzed. Benchmarks focused on (1) clinical actions such as patient additions, deletions, and merges; (2) changes in demographic variables (date of birth, gender, race, ethnicity); and (3) stability of discharge information (time and status). A synthetic dataset derived from MIMIC-III was used to validate the benchmarking code prior to large-scale analyses.
Benchmarking revealed frequent updates due to clinical actions and demographic corrections across consecutive snapshots. Demographic changes were most frequently related to race and ethnicity, highlighting potential workflow and data entry inconsistencies. Discharge time and status values demonstrated instability for several days post-encounter, typically reaching a stable state within 4-7 days. These findings indicate that while near real-time EHR data provide valuable insights, the timing of data stabilization is critical for accurate secondary use.
This study demonstrates the feasibility of automated benchmarking to assess the integrity of real-time EHR data and identify when such data become analysis ready. Our findings highlight key challenges for secondary use of dynamic clinical data and provide an automated framework that can be applied across health systems to support high-quality research, surveillance, and clinical trial readiness.
Journal Article
As the Stomach Turns: A Case of Chronic Gastric Volvulus
Introduction Gastric volvulus is a rare condition with an unknown incidence and prevalence. Mortality rates may be as high as 50%. Some cases may be intermittent or undiagnosed.Case Description A 96 year-old male with a history of coronary artery disease status post drug-eluting stents on aspirin and clopidogrel presented to the hospital with 3 episodes of nausea and bloody emesis. The patient was at his clinical baseline other than a mild decrease in appetite. Labs were normal except for an acute kidney injury. He was admitted to intensive care, put on a continuous proton pump inhibitor infusion, and resuscitated. Aspirin was continued and clopidogrel was held. An EGD demonstrated diffuse gastropathy with heme staining in the gastric body which was likely the source of patient's hematemesis. Of note, upon passing into the stomach, a large paraesophageal hernia with volvulus of the stomach was appreciated making it difficult to locate the antrum. In retroflexion with a biopsy forceps to stiffen the scope and abdominal pressure, we were able to position the scope tip into the thoracic component of the hernia which allowed us then to navigate into the gastric antrum and complete the examination. The hematemesis resolved and the patient was started on a diet without issue. A CT scan the following day confirmed the presence of a paraesophageal hernia and volvulus though whether it was organoaxial versus mesenteroaxial was not clear. A prior chest CT scan from 2 years prior showed the same findings. Due to patient's age, high surgical risk, and chronic nature of the volvulus, the patient elected for observation rather than surgery. He continued to do well and was discharged home 7 days later. Discussion Acute gastric volvulus is a rare but important diagnosis as rapid definitive surgical management decreases mortality. In this case, it is possible that the patient's chronic volvulus acutely worsened causing ischemia and bleeding which led to the hematemesis. The acute aspect of the volvulus may then have resolved on its own. It is also possible that his bleeding gastropathy was unrelated. Regardless, this is a case that demonstrates the importance of diagnosis and establishing chronicity in managing gastric volvulus.
Journal Article