Copyright © 2015 by the Society of Criti. Objective: Global lung stress varies considerably with low tidal volume ventilation for acute respiratory distress syndrome. High stress despite low tidal volumes may worsen lung injury and increase risk of death. No widely available parameter exists to assess global lung stress. We aimed to determine whether the volume delivered during a recruitment maneuver is inversely associated with lung stress and mortality in acute respiratory distress syndrome. Design: Substudy of an acute respiratory distress (...) syndrome clinical trial on esophageal pressure-guided positive end-expiratory pressure titration. Setting: U.S. academic medical center. Patients: Forty-two patients with acute respiratory distress syndrome in whom airflow, airway pressure, and esophageal pressure were recorded during the recruitment maneuver. Interventions: A single recruitment maneuver was performed before initiating protocol-directed ventilator management. Recruitment maneuvers consisted of a 30-second breath hold at 40 cm H2O airway pressure under heavy sedation or paralysis. VRM was calculated by integrating the flow-time waveform during the maneuver. End-inspiratory stress was defined as the transpulmonary pressure during end-inspiratory pause of a tidal breath and tidal stress as the transpulmonary pressure difference between end-inspiratory and end-expiratory pauses. Measurements and Main Results: VRM ranged between 7.4 and 34.7 mL/kg predicted body weight. Lower VRM predicted high end-inspiratory and tidal lung stress. After adjusting for Pao2/Fio2 and either driving pressure, tidal volume, or plateau pressure and positive end-expiratory pressure, VRM remained independently associated with both end-inspiratory and tidal stress. In unadjusted analysis, low VRM predicted increased risk of death. VRM remained significantly associated with mortality after adjusting for study arm. Conclusions: Low VRM independently predicts high lung stress and may predict risk of death in patients with acute respiratory distress syndrome. (shrink)

Professor R. J. Getty has drawn attention to a tenth- or early eleventh-century manuscript of Statius’ Thebaid, hitherto examined only in Book I, namely Turonensis. Dr. Klotz, in his Teubner edition of 1908, gave citations from Book I, and wrote, ‘dolendum est sane de hoc codice primum tantum librum innotuisse, sed cum Roffensis libri maxime affinis accuratiorem notitiam haberemus, collatione quamvis -aegre careri posse nobis visum est.’ I have collated both T and Roffensis in full, and find firstly that the (...) citations of r by Klotz are far from accurate, especially in the last six books, and secondly that while it is indeed true thatT and r are very closely related, T is a much better representative than r of their common source. (shrink)

The list of Italian forces1 with which Virgil concluded Aeneid 7 was a piece of the ‘machinery’ of epic, that is to say an expected part of the content of an epic poem, established by Homer and expected of his successors; cf. Apollonius 1. 20–228, Silius 3. 222 f., Statius, Th. 4. 32 f., Milton, P.L. 1. 376 f. The straightforward enumeration of Homer was naturally appropriate in the Iliad both because oral technique sought this kind of directness and because (...) of the immediate relationship of the subject-matter to a heroic community. But Virgil was well aware that the Homeric manner would not fit satisfactorily into the sophisticated and elaborate structure of literary and contemplative epic. Two essential requirements had to be met in the transplanting of such ‘machinery’ into a new milieu. The first was one of function: the piece should blend with the whole intricate pattern of theme and tone which a poem like the Aeneid possesses. The second was one of structure: it must possess within itself artistic symmetries and designs of a carefully organized kind. (shrink)

Of the unusual grammatical constructions which Statius employs for the sake of variety and novel effect, among the most remarkable is his use of the ablative case. There are striking instances at Th. 8. 157, Th. 10. 309, Ach. 1. 219, Ach. 2. 129; and W. C. Summers was led to say: ‘We see some traces in Valerius of the lax use of this case which became almost a disease with Statius, who employs it for almost any kind of idea.’ (...) There are three passages in Statius which have been misinterpreted or emended through the failure to recognize a use of the ablative to which he was especially prone—the local ablative where the poetic dative of ‘motion towards’ would seem more normal. I shall first list examples of this use in Statius where there is little or no doubt about interpretation or reading, and in the light of this accumulated evidence consider the three passages which are disputed. (shrink)

Shortly after his arrival at Carthage, while he is waiting for Dido to meet him, Aeneas finds that the walls of her temple are adorned with pictures of the Trojan War. Sunt hie etiam sua praemia laudi, he cries to Achates, sunt lacrimae rerum et mentem mortalia tangunt. The description of the pictures which follows is a remarkable example of Virgil's ability to use a traditional device in such a way as to strengthen and illuminate the main themes of his (...) poem. It is my object here first to reinterpret one of the scenes which has been misunderstood, and then to discuss how Virgil has chosen and arranged his episodes so that the description of a picture gallery becomes a part of an epic poem. (shrink)

In his note on Hesiod, WD 705 M. L. West tentatively suggests adeo for deo, saying rightly that ‘Charon is not a god in the literary tradition generally or in Virgil's scheme’. Palaeographically nothing could be more attractive than this emendation. But for all Virgil's fondness for adeo he does not use it in this intensifying sense with adjectives other than those indicating number, nor does he ever use it later than the second foot. The difficulty which West is combating (...) is a very real one, but it is not solved by the removal of deo. Virgil's dilemma was that the old ferryman must be as timeless as all the other members of Pluto's establishment, and to achieve this object of portraying an unchanging picture of the machinery of the underworld he has elevated Charon to the rank of dues. In Olympus the gods are frozen at the point suitable for the anthropomorphic vision of them: Cupid is always a boy, Apollo young and handsome, Neptune older and more austere. Similarly Charon is frozen just as he has reached vigorous old age. He may not be, indeed is not, a real god, but he is a necessary part of the world of the gods and so must share their agelessness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:R. D. Ackerman BELIEVING IN A FICTION: WALLACE STEVENS AT THE LIMITS OF PHENOMENOLOGY The "ring of men" of "Sunday Morning" will chant their "devotion to the sun, / Not as a god, but as a god might be, / Naked among them, like a savage source" (CP, pp. 69-70).' Solar nakedness is deferred even as it is named. The problem for belief is the question of appearance and (...) representation. Things appear as and like.... The phenomenological return to things is also a turn to fiction, as Husserl understood: "If anyone loves a paradox, he can really say... that the element which makes up the life of phenomenology... is fiction. ' " The sun is divine, and it is not; it is both naked and clothed, savage and civilized, source (or end) and means. But such paradox is ultimately unsatisfying, and as we will see with Stevens, the need for belief—for an image or idea of totality—forces the issue of fiction and reality. The Stevens we will have in view is not the Stevens—as if there were such a creature. Our Stevens is the one most persuaded by promises such as those of phenomenology, the one most concerned with decreation (reduction) and fresh beginnings, with discovery and recognition, with imagination, the body, and the earth. This is the Stevens for whom the barrier of language presages at last not absence and difference but fictive recovery of presence and identity, the one for whom poetry represents a way of belief beyond mysticism even as it bodes mythic proximity. Finally, this is the Stevens who predominates throughout the prose (as well as in much of the poetry), who tries mightily to secure a belief while disencumbering himself of metaphysics—but alas, I think, with small success. Although Stevens's association of the problem of belief with the idea of fiction occurs in early poems such as "A High-Toned Old Christian 79 80Philosophy and Literature Woman" and "To the One of Fictive Music," his most intensive involvement with fiction as belief dates from the early 1940s and spans the period of his major essays and his last four volumes of poems. He recounts, for instance, a 1942 conversation with a student: "I said that I thought that we had reached a point at which we could no longer really believe in anything unless we recognized that it was a fiction. The student said that that was an impossibility, that there was no such thing as believing in something that one knew was not true. It is obvious, however, that we are doing that all the time" (L, p. 430). What does it mean to believe in a fiction? That is my main subject here, as we seek out the limits of the phenomenological Stevens. His letters of this period are preoccupied with the problem of fictive belief: "If one no longer believes in God (as truth), it is not possible merely to disbelieve; it becomes necessary to believe in something else.... A good deal of my poetry recently has concerned an identity for that thing.... In one of the short poems that I have just sent to the harvard advocate, I say that one's final belief must be in a fiction. I think that the history of belief will show that it has always been in a fiction" (L, p. 370). The poem referred to, "Asides on the Oboe," begins: The prologues are over. It is a question now, Of final belief. So, say that final belief Must be in a fiction. It is time to choose. (CP, p. 250) Acknowledging that "in the long run, poetry would be the supreme fiction" (L, pp. 430-31), Stevens nonetheless singles out the nominative function of poetry as the essence of its claim to supremacy: "Poetry means not the language of poetry but the thing itself.... The subject matter is what comes to mind when one says of the month of August... 'Thou art not August, unless I make thee so'" (L, p. 377). The quoted line (also from "Asides") underscores the paradox that for Stevens the essence of fiction (the nontrue) is its capacity to nominate the true or the real. This... (shrink)

Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith (...) traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured. (shrink)

Hicks' edition of the De Anima contains valuable commentary from Hicks as well as useful summaries of the views of earlier commentators.

In Classical Quarterly N.S. ix , 80 ff. Professor Hugh Lloyd-Jones published an article on the closing scenes of Seven Against Thebes. In it he directed an assault on the orthodox belief that these scenes are, in whole or in part, not authentic. The movement in favour of authenticity seemed all the stronger when independently, and in the same year, Walter Potscher put forward arguments in Eranos in defence of some parts of the disputed passages.