Monday, November 15, 2010

Essential Lessons



Whatever else gets cut in this time of nicks and scrapes, incisions and mutilations, the cord of our national memory had better not be among the casualties. For even during the toughest trials it's our history that binds us together as a distinctive community in an otherwise generically globalised culture. Mother Teresa and Lady Gaga are multinationals; Oliver Cromwell and Margaret Thatcher are peculiarly ours. In a headphone world where we get to privatise our brains, it's history that logs us on to Our Space.
This is not to say history is a placebo for our many arguments and ills; a stroll down memory lane to escape the headaches of the present. It's exactly because history is, by definition, a bone of contention (the Greek word historia meant, and was used from the very beginning by Herodotusas, "inquiry") that the arguments it generates resist national self-congratulation. So that inquiry is not the uncritical genealogy of the Wonderfulness of Us, but it is, indispensably, an understanding of the identity of us. The endurance of British history's rich and rowdy discord is, in fact, the antidote to civic complacency, the condition of the irreverent freedom that's our special boast. (Try the American version and you will know what I mean about our brand of salutary disrespect.) The founding masterpiece of European history, Thucydides's Peloponnesian Wars, was written by a veteran for whom the discipline was sceptical or not worth the writing: an attack on Athenian hubris precisely to demonstrate what was, and what was not, worth fighting for in defence of the democratic polis.
So it is exactly at a time when we are being asked to make painful, even invidious, distinctions between the inessential and the indispensable in our public institutions: that we need history's long look at our national makeup. This is not an insular proposal. The way Britain has conducted itself in the world beyond the shores of Albion, for good as well as ill, is integral to the self-examining story. How European are we; how Americanised in our habits and strategies? Why does Hong Kong pretty much run the world? There is no hope of answers to those kinds of questions without history's help.
Who is it that needs history the most? Our children, of course: the generations who will either pass on the memory of our disputatious liberty or be not much bovvered about the doings of obscure ancestors, and go back to Facebook for an hour or four. Unless they can be won to history, their imagination will be held hostage in the cage of eternal Now: the flickering instant that's gone as soon as it has arrived. They will thus remain, as Cicero warned, permanent children, for ever innocent of whence they have come and correspondingly unconcerned or, worse, fatalistic about where they might end up.
The seeding of amnesia is the undoing of citizenship. To the vulgar utilitarian demand, "Yes, all very nice, I'm sure, but what use is it?", this much (and more) can be said: inter alia, the scrutiny of evidence and the capacity to decide which version of an event seems most credible; analytical knowledge of the nature of power; an understanding of the way in which some societies acquire wealth while others lose it and others again never attain it; a familiarity with the follies and pity of war; the distinctions between just and unjust conflicts; a clear-eyed vision of the trappings and the aura of charisma, the weird magic that turns sovereignty into majesty; the still more peculiar surrender to authority grounded in revelation, be that a sacred book or a constitution invoked as if it too were supernaturally ordained and hence unavailable to contested interpretation.
Tell a classroom of 12-year-olds the story of the British (for they took place across our nations) civil wars of the 17th century and all those matters will catch fire in their minds. Explain how it came to be that in the 18th century Britain, a newly but bloodily united kingdom, came somehow to lose most of America but acquire an Indian empire, to engross a fortune on the backs of slaves but then lead the world in the abolition of the trade in humans; explain all that, and a classroom of pupils whose grandparents may have been born in Mumbai or Kingston will grasp what it means to be British today, just as easily as a girl whose grandparents hail from Exeter or Aberdeen.
But the history of how we came to execute our king, or dominate south Asia, is exactly the history that, in practice, gets short shrift from the present national curriculum. The same is true of vast tracts of British history – most of the medieval centuries, in which the relationship between church and state, a topic of compelling contemporary significance – seldom get class time. A comprehensive school teacher I talked to at one of the Prince of Wales's Summer Institutes told me that he was eager to teach his pupils medieval history and the curriculum offered him space to do just that. He made plans to have his class look at pipe rolls in the county archive with their laconically eloquent accountings of villages decimated by the black death; visit churches and cathedrals to understand what a truly Christian England felt like and take all those experiences back into the classroom. But once he realised – or was made to realise – how much more work it would take both for his pupils and himself to satisfy the time-lords of assessment, "I collapsed back on Hitler and the Henries."
My own anecdotal evidence suggests that right across the secondary school system our children are being short-changed of the patrimony of their story, which is to say the lineaments of the whole story, for there can be no true history that refuses to span the arc, no coherence without chronology. A pedagogy that denies that completeness to children fatally misunderstands the psychology of their receptiveness, patronises their capacity for wanting the epic of long time; the hunger for plenitude. Everything we know about their reading habits – from Harry Potter to The Amber Spyglass and Lord of the Rings suggests exactly the opposite. But they are fiction, you howl? Well, make history – so often more astounding than fiction – just as gripping; reinvent the art and science of storytelling in the classroom and you will hook your students just as tightly. It is, after all, the glory of our historical tradition – again, a legacy from antiquity – that storytelling is not the alternative to debate but its necessary condition.
I don't underestimate the difficulty, especially with a looming rise in classroom numbers as the mini baby-boom of the 2000s comes to school, of reinstating a more complete history; especially one that will not neglect Europe and the non-western world. And it can't be a good idea to treat school age as if it ran on parallel tracks to chronology, so that the eight-year-olds automatically get Boudicca. Better, perhaps, to start the reconnections between then and now in primary school with the history closest to the children: families, the local town and country, while not stinting their natural fascination with those who live their lives on the world stage. All of which makes added time for history in the curriculum the precondition of its rescue from disconnection.
Academies – where history is discouraged, or even ruled out, in favour of more exam-friendly utilitarian options – must be persuaded to teach it, and for more than a trivial hour a week. Drive-by history is no history at all. Ideally, no pupils should be able to abandon the subject at 14.
To the retort that teachers have enough on their hands in the state system getting their students to be literate and numerate, I would respond that in a pluralist Britain of many cultures, vocational skills are the necessary but insufficient conditions of modern civility. Kids need to know they belong to a history that's bigger, broader, more inclusive than the subject they imagine to be the saga of remote grandees alien to their traditions and irrelevant to their present. A truly capacious British history will not be the feeder of identity politics but its dissolvent. In the last resort, all serious history is about entering the lives of others, separated by place and time. It is the greatest, least sentimental, least politically correct tutor of tolerance.
None of this is to underestimate the heroic job being done by history teachers in primary and secondary schools throughout the country, with brutally constrained resources of time and materials. Nor is it to turn a deaf ear to their own concerns. As two successive Historical Association surveys in 2009 and this year make dramatically clear (they are available online at history.org.uk along with an excellent podcast debate about history in schools chaired by Sir David Cannadine), my concerns are but an echo of theirs. "My subject is disappearing," writes one anguished teacher in the 2009 report, in a spirit of lament rather than recrimination. What emerges most startlingly from testimonies of hundreds of teachers is that at a moment fraught with the possibility of social and cultural division, we are, in effect, creating two nations of young Britons: those, on the one hand, who grow up with a sense of our shared memory as a living, urgently present body of knowledge, something that informs their own lives and shapes their sense of community; and those on the other hand who have been encouraged to treat it as little more than ornamental polishing for the elite.
Independent and grammar schools by and large teach the subject for 90 minutes or more a week (albeit often in those chopped-up modules); and their teachers have usually had specialist historical training. But one in three comprehensives and academies teach the subject, if at all, with teachers who have no history themselves beyond GCSE; and with harshly truncated hours. There is absolutely no more guaranteed recipe for boredom than discontinuous subject matter taught as an exercise in "learning" by someone who is passionless about the past. How would you rather spend an hour: "learning about learning", trapped in some sort of indeterminate swamp of histo-geographic-social studies, or listening to and talking about, the murder of Thomas Becket?
If we care about this as a country; if we believe, as I do, that one of its cultural glories is that our future absorbs our past not as dead weight but inspiration, then there is much to consider, debate and do. And nothing worthwhile can be done without listening to and learning from those charged with the mission, working on its frontlines up and down the country in all kinds of schools. But in the end, the history community is – or ought to be – bigger than just its school lessons: it should involve and engage academics who might want to think as deeply about how the subject is taught to 13-year-olds as to undergraduates and PhD students; writers outside the academy who might want to produce new books – not just textbooks – but for the digital age, integrating the kinds of sources that can be put without straining too many resources, on every student's laptop, or even smartphone; the many devoted curators and custodians of historic sites and museums. And, not least, the reform and rejuvenation of history as a living breathing subject ought to involve parents, who, after all, are themselves, one hopes, the first storytellers their children listened to.
Of course, the first obligation parents will feel towards their children, beyond their safety, is that they be equipped with the skills and knowledge needed to earn their living in a world in which that task gets harder by the day. But caring parents, whatever their means, and wherever they live, surely have another concern too, beyond the exigencies of pounds and pence: that their children come to understand that the value of the house they live in is not measured by square footage, the size of the car or the number of electronic machines whirring and flashing in room after room, but the wealth of its memories, the abundance of its shared stories; for it is from that history that we recognise our membership of a common family. Like all other families, it will row and rage and seldom sing from the same page. But somehow that common memory will make it pause before it tears itself apart and shreds the future to ribbons.

What every child should learn

Murder in the cathedral :The whole showdown between religious and royal/secular ideas of law and sovereignty embodied in the persons of Thomas Becket and Henry II. This could hardly be more relevant in our contemporary world, where secular law and authority are asked to submit to religious law. And a thrilling story, given that Becket goes from being the king's right-hand man to his indefatigable opponent. What kind of conversion was that? The story of Henry's penitence and the establishment of a martyr legend is just as riveting.
The black death and the peasants revolt: How did society deal with the arrival of a terrifying pandemic in the reign of Richard II? (Are we any more prepared?) How did the plague change society among rich and poor. Was there any connection between the trauma and a rebellion that took over the capital?
The execution of King Charles I: How did Britain get from a country that revered its monarch to one that cut off his head? How could a total British war – fought in Ireland, Scotland and Wales, as well as England – happen over religion?! What happened when whole families divided in civil war? What was it like for Britain to be governed by a non-royal who turned quasi-dictator? Why did the official campaign to abolish Christmas fail? The really big question is why this most thrilling, terrifying epic moment in British history, seldom gets classroom time.
The Indian moment: How was it that a country throwing its weight around the world's oceans got kicked out of most of America but in two generations came to rule an immense part of the subcontinent? Any class would want to know about the cunning-crazed Robert Clive; to look again at Siraj ud Daula and the tragic ruin that Warren Hastings became, not to mention stories of Brits who defied the race and culture barrier by wearing Indian dress, speaking Indian languages; illicitly marrying Indian princesses.
The Irish wars: William Gladstone, Charles Parnell and the Irish wars – the subject that never goes away! Two heroic and, in their own ways, tragic figures. Could it ever have worked out peacefully?
The opium wars and China: Victorian Britain using the royal navy to protect hard drug trafficking? True

Simon Schama @GUARDIAN
Pic : One of Schama’s six epic moments in British history: the execution of King Charles I in 1649. Source: The Gallery Collection/Corbis



Sunday, November 14, 2010

A Source of Inspiration


Dozens of previously unknown sketches by the artist and sculptor Alberto Giacometti have come to light, including impromptu drawings of Christine Keeler, the showgirl whose 1960s affair with Conservative minister John Profumo shook the British establishment.

Nine months ago, one of Giacometti's sculptures sold for £65m. Now the Swiss artist's family has allowed his biographer, the distinguished art historian Michael Peppiatt, access to the collection for a major new book and a loan exhibition. The unseen images reveal Giacometti at his most intimate and unselfconscious.
Giacometti seems to have taken his inspiration for the Keeler sketch from a 1963 French newspaper report. A series of nude female figures sketched across a page from France-Soir is thought to represent her. The collection also contains sculptures, paintings and drawings not seen since they left his dilapidated studio in Paris. Another find is an art book owned by Giacometti which he used to produce a striking drawing of Van Gogh's self-portrait.
Another previously unknown sketch appears across a torn-out page of L'Express, a 1964 edition with a report on Lee Harvey Oswald, President John Kennedy's assassin. Giacometti scribbled over Oswald's photograph, giving him a beard and scrawling across the page the repeated word continuare ("to go on") and the phrase "the busts were made quickly, and a painting this evening, the drawings soon". The words seem to convey Giacometti's constant urge to push himself into yet more work. The artist, who died in 1966, obsessively scrutinised his work for hints of failure, always destroying works that did not match his vision. Peppiatt said that the newspaper sketches showed that drawing was fundamental for Giacometti. "Drawing was a form of instinctive thinking for him. He was never without a pencil in his hand or a fag in his mouth," he explained.
Peppiatt, an art critic for the Observer during the 1960s, recalled his excitement at being given access to the images, taken from a collection owned by the widow of Giacometti's nephew, Silvio Berthoud: "There is something very intimate about these works. I was allowed to choose from 300 drawings. I was deeply moved. I felt that Giacometti was almost there with me … as if his drawings were dropping from his hands. He had scribbled over the inside covers of books, doodled on bits of paper in cafes." Some of the unknown images are in Peppiatt's forthcoming book, In Giacometti's Studio, and a loan exhibition he has curated at the Eykyn Maclean gallery in New York.
Through newly published letters, Peppiatt offers new insight into Giacometti, the man and his art. He has delved into the artist's relationships, notably his doomed affair with Isabel Rawsthorne, a raucous, bohemian painter and model.
Peppiatt said: "Isabel was a terrifying animal, a man-eater. She was having affairs with both sexes and drinking everybody under the table. He was ambivalent towards women. What he liked were prostitutes. Giacometti was both attracted and repelled by Isabel." Feelings of despair emerge from their letters, Peppiatt said. In one, Giacometti wrote: "I didn't think your stay was a washout, Isabel, otherwise I wouldn't have felt so upset when you left. My throat was tight. I was sobbing inside."
Peppiatt also casts light on the artist's friendship with Samuel Beckett. Describing Giacometti's skeletal figures as a visual embodiment of the Irish writer's pared down prose, he said: "They had the same nocturnal habits. They'd bump into one another in Montparnasse around midnight, go to the same brothels together and walk home together." He tried to imagine their conversations as they strolled the deserted streets. "I researched and researched, following every line of inquiry, until I came to the truth," he recalled. These 20th-century geniuses would walk in "deep, utter, total silence", he said.

by : Dalya Alberge @Guardian
Pic : Christine Keeler

Saturday, November 13, 2010

New York : Cantankerous To Old Metropolitan Criteria


This is a fantastic article about New York by NYU professor Tony Judth

I came to New York University in 1987 on a whim. The Thatcherite assault on British higher education was just beginning and even in Oxford the prospects were grim. N.Y.U. appealed to me: by no means a recent foundation — it was established in 1831 — it is nevertheless the junior of New York City’s great universities. Less of a “city on a hill,” it is more open to new directions: in contrast to the cloistered collegiate worlds of Oxbridge, it brazenly advertises itself as a “global” university at the heart of a world city.
But just what is a “world city”? Mexico City, at 18 million people, or São Paulo at near that, are unmanageable urban sprawls; they are not “world cities.” Conversely, Paris — whose central districts have never exceeded three million inhabitants — was the capital of the 19th century.
Is it a function of the number of visitors? In that case, Orlando, Fla., would be a great metropolis. Being the capital of a country guarantees nothing: think of Madrid or Washington (the Brasília of its time). It may not even be a matter of wealth: within the foreseeable future Shanghai (14 million people) will surely be among the richest places on earth; Singapore already is. Will they be “world cities”?
I have lived in four such cities. London was the commercial and financial center of the world from the defeat of Napoleon until the rise of Hitler; Paris, its perennial competitor, was an international cultural magnet from the building of Versailles through the death of Albert Camus. Vienna’s apogee was perhaps the shortest: its rise and fall coincided with the last years of the Hapsburg Empire, though in intensity it outshone them all. And then came New York.
It has been my mixed fortune to experience these cities at twilight. In their prime they were arrogant and self-assured. In decline, their minor virtues come into focus: people spend less time telling you how fortunate you are to be there. Even at the height of “Swinging London” there was something brittle about the city’s self-promotion, as though it knew this was but an Indian summer.
Today, the British capital is doubtless geographically central, its awful bling-bloated airport one of the world’s busiest. And the city can boast the best theater and a multicolored cosmopolitanism sadly lacking in years past. But it all rests precariously on an unsustainable heap of other peoples’ money: the capital of capital.
By the time I got to Paris, most people in the world had stopped speaking French (something the French have been slow to acknowledge). Who now would deliberately reconstruct their city — as the Romanians did in Bucharest in the late 19th century — to become “the Paris of the East,” complete with grand boulevards like the Calea Victoria? The French have a word for the disposition to look insecurely inward, to be preoccupied with self-interrogation: nombrilisme — “navel-gazing.” They have been doing it for over a century.
I arrived in New York just in time to experience the bittersweet taste of loss. In the arts the city led the world from 1945 through the 1970s. If you wanted to experience modern painting, music or dance, you came to the New York of Clement Greenberg, Leonard Bernstein and George Balanchine. Culture was more than an object of consumption: people thronged to New York to produce it too. Manhattan in those decades was the crossroads where original minds lingered — drawing others in their wake. Nothing else came close.
Jewish New York too is past its peak. Who now cares what Dissent or Commentary says to the world or each other? In 1979, Woody Allen could count on a wide audience for a joke about the two magazines merging and forming “Dissentary” (see “Annie Hall”). Today? A disproportionate amount of the energy invested in these and certain other small journals goes to the Israel question: perhaps the closest that Americans get to nombrilisme.

The intellectual gangs of New York have folded their knives and gone home to the suburbs — or else they fight it out in academic departments to the utter indifference of the rest of humanity. The same, of course, is true of the self-referential squabbles of the cultural elites of Russia or Argentina. But that is one reason neither Moscow nor Buenos Aires matters on the world stage. New York intellectuals once did, but most of them have gone the way of Viennese cafe society: they have become a parody of themselves, their institutions and controversies of predominantly local concern.
And yet, New York remains a world city. It is not the great American city — that will always be Chicago. New York sits at the edge: like Istanbul or Mumbai, it has a distinctive appeal that lies precisely in its cantankerous relationship to the metropolitan territory beyond. It looks outward, and is thus attractive to people who would not feel comfortable further inland. It has never been American in the way that Paris is French: New York has always been about something else as well.
Today I drop my cleaning off with Joseph the tailor and we exchange Yiddishisms and reminiscences (his) of Jewish Russia. Two blocks south I lunch at a place whose Florentine owner disdains credit cards and prepares the best Tuscan food in New York. In a hurry, I can opt instead for a falafel from the Israelis on the next block; I might do even better with the sizzling lamb from the Arab at the corner.
Fifty yards away are my barbers: Giuseppe, Franco and Salvatore, all from Sicily — their “English” echoing Chico Marx. They have been in Greenwich Village forever but never really settled: how should they? They shout at one another all day in Sicilian dialect, drowning out their main source of entertainment and information: a 24-hour Italian-language radio station. On my way home, I enjoy a mille-feuille from a surly Breton pâtissier who has put his daughter through the London School of Economics, one exquisite éclair at a time.
All this within two square blocks of my apartment — and I am neglecting the Sikh newsstand, the Hungarian bakery and the Greek diner (actually Albanian but we pretend otherwise). Three streets east and I have Little Hapsburgia: Ukrainian restaurant, Uniate church, Polish grocery and, of course, the long-established Jewish deli serving Eastern European staples under kosher labels. All that is missing is a Viennese cafe — for this, symptomatically, you must go uptown to the wealthy quarters of the city.
Such variety is doubtless available in London. But the cultures of contemporary London are balkanized by district and income — Canary Wharf, the financial hub, keeps its distance from the ethnic enclaves at the center. Contrast Wall Street, within easy walking distance of my neighborhood. As for Paris, it has its sequestered quarters where the grandchildren of Algerian guest workers rub shoulders with Senegalese street vendors, while Amsterdam has its Surinamese and Indonesian districts: but these are the backwash of empire, what Europeans now refer to as the “immigrant question.”
One must not romanticize. I am sure that most of my neighborhood traders and artisans have never met and would have little to say to one another: at night they return home to Queens or New Jersey. If I told Joseph and Sal they had the good fortune to live in a “world city,” they would probably snort. But they do — just as the barrow boys of early 20th-century Hoxton were citizens of the same cosmopolitan London that Keynes memorialized in “The Economic Consequences of the Peace,” even though they would have had no idea what he was talking about.
We are experiencing the decline of the American age. But how does national or imperial decay influence the lifecycle of a world city? Modern-day Berlin is a cultural metropolis on the make, despite being the capital of a medium-sized and rather self-absorbed nation. Meanwhile, Paris retained its allure for nearly two centuries after the onset of French national decline.
New York — a city more at home in the world than in its home country — may do better still. As a European, I feel more myself in New York than in the European Union’s semi-detached British satellite, and I have Brazilian and Arab friends here who share the sentiment.
To be sure, we all have our complaints. And while there is no other city where I could imagine living, there are many places that, for different purposes, I would rather be. But this too is a very New York sentiment. Chance made me an American, but I chose to be a New Yorker. I probably always was.

Tony Judth

Friday, November 12, 2010

Faceless Man


I spent a day by the river 
It was quiet and the wind stood still 
I spent some time with nature 
To remind me of all that's real 
It's funny how silence speaks sometimes when you're alone 
And remember that you feel 
Again I stand against the Faceless Man 
Now I saw a face on the water 
It looked humble but willing to fight 
I saw the will of a warrior 
His yoke is easy and His burden is light 
He looked me right in the eyes 
Direct and concise to remind me 
To always do what's right 
Again I stand against the Faceless Man 
'Cause if the face inside can't see the light 
I know I'll have to walk alone 
And if I walk alone to the other side 
I know I might not make it home 
Again I stand against the Faceless Man 
Next time I see this face 
I'll say I choose to live for always 
So won't you come inside And never go away



Creed

Wednesday, November 10, 2010

سایش های روزمره

امروز در دپارتمان فارماکولوژی بودم برای یک جلسه و انتخاب ژورنال برای مقاله تصمیم  گیری قطعی را هنوز انجام ندادم
در حقیقت جلسه کوتاه و تنش زا یی بود
به تدریج می اموزم که خیلی وقت و انرزی را در سایش با انسان های  درجه دو (از نظر حرفه ای) هدر ندهم
یک دغدغه ی بزرگ من همکاران جوانترم بودند که برای پروژه استروژن  اضافه شده اند
این همه سختی باید پاداش درخوری هم در پی داشته باشد

Baby With Asthma and Vomitting






at first glance some more probable differentials outshine:
Esophageal Duplication,Esophageal Atresia,Neurogenic Tumor,Vascular Anomaly,Foreign Body


But lets take a look at the patient's CT images:











Now we have a more precise image of the underlying abnormality. 
which is the most likely diagnosis ?
a.Double Aortic Arch
b.Right Aortic Arch with aberrant left subclavian artery
c.Left Aortic Arch with aberrant right subclavian artery
d.Transposition of great vessels
e.Tetralogy of Fallot
-----------------------------------------------------------------------------------------------------------


Findings :


CXR: Mild indentation of the right distal aspect of the trachea. Barium swallow: There is an abnormal indentation of the posterior esophagus
CT: Right aortic arch with aberrant left subclavian artery coursing behind the esophagus and compressing it. This is consistent with a vascular ring. The aorta descends on the right and then crosses to the left at the level of the crus. Trachea is mild to moderately narrowed at the level of the vascular ring.


Diagnosis:  Right aortic arch with aberrant left subclavian artery (left SCA)

Discussuion:
  • Right arch is present in 0.1% of asymptomatic population
  • 10-15% with associated congenital heart disease (tetralogy of fallot most common) compared to patients with mirror image branching type of right aortic arch who have >90% chance of having associated congenital heart disease
  • May present with symptoms (stridor, dysphagia, cough), but most are asymptomatic
  • Most common congenital anomaly of aortic arch
  • Related to embryological persistence of the right fourth aortic arch
  • Diverticulum of Kommerell is dilatation of origin of left SCA (occurs in 60% of right arch with aberrant left SCA)
  • Left SCA can arise directly from the descending aorta or can arise from diverticulum of Kommerell)
  • The left ductus persists as ligamentum arteriosum, which completes the vascular ring
    • Left ligamentum arteriosum connects to subclavian artery= loose vascular ring
    • Left ligamentum arteriosum connects to diverticulum of Kommerell= tight vascular ring (constricting, symptomatic)
Treatment:
  • Right arch with aberrant left SCA and constricting (symptomatic) left ligamentum arteriosum: Division of ligamentum via left thoracotomy








Radiological overview:
  • Aortic arch located to right of trachea, coursing over right main stem bronchus
  • Large vessel arising from the distal aorta and passing behind the esophagus with oblique course to the left
  • In 60% there is dilatation of the origin of the aberrant subclavian artery (aortic diverticulum of Kommerell)
  • Aorta descends on right and crosses to left before entering abdomen
  • 4 branches off aortic arch: Right subclavian artery, right carotid artery, left carotid artery, left subclavian artery
  • CXR:
    • Aortic arch indentation on right of trachea, which is deviated to the left
    • Increased right paravertebral soft tissue density
    • Right-sided descending aorta line
    • Lateral shows indentation on the posterior aspect of the trachea
    • There may be prominence of the left mediastinum
  • Barium swallow:
    • Frontal view: Oblique filling defect coursing from right-inferior to left-superior
    • Lateral view: Posterior indentation
  • CT: Define patency of arch segments, branching patterns, depict constricting effect on tracheal airway, if present
  • Indications for additional imaging:
    • Right arch with airway compression and aberrant left SCA on esophagram: Perform cross-sectional imaging
    • Right arch, mirror image branching pattern: Evaluate for congenital heart disease

Key points:
  • Most common congenital anomaly of aortic arch
  • 10-15% with congenital heart disease
  • Most asymptomatic
  • Vascular ring formed by ligamentum arteriosum connecting to left subclavian artery or diverticulum of Kommerell
  • Aberrant left subclavian courses behind the esophagus
  • Right aortic arch courses over right main stem bronchus

Tuesday, November 9, 2010

Football : An Empty Pleasure


An article written by Mario Vargas Llosa in Nou Camp 1982;dissecting the entertaining might of Football ,as it meets the characteristics of a innocuous ,ephemeral and non-transcendent entertainment.
Pedram 


A couple of years ago, I heard the Brazilian anthropologist Roberto da Matta give a brilliant lecture in which he explained that the popularity of football expresses an innate desire for legality, equality and freedom.
His argument was clever and amusing. According to him, the public sees football as a sort of model society-one governed by clear and simple laws which everyone understands and observes and which, if violated, bring immediate punishment to the guilty party. A football field is an egalitarian space which excludes all favouritism and privilege. Here, on this grass marked out by white lines, a person is valued for what he is: for his skill, dedication, inventiveness and effectiveness. Names, money and influence count for nothing when it comes to scoring goals and earning the applause or whistles from the stands. The football player exercises the only form of freedom that society can allow its members if it is not to come apart: to do whatever they please as long as it is not prohibited by rules that everyone accepts.
This is what, in the end, stirs the passions of the crowds that, the world over, pour into the grounds, follow games on television with rapt attention and fight over their football idols: the secret envy, the unconscious nostalgia for a world that -unlike the one they live in, which is full of injustice, corruption, lawlessness and violence-offers harmony, law and equality.
Could this beautiful theory be true? Would that it were, for nothing could be more positive for the future of humanity than to have these civilised feelings nestling in the instinctive depths of the crowds. But, as usual, reality overtakes theory-showing it up as incomplete. Theories are always rational, logical, intellectual (even those theories that propose irrationality and madness); but in society, in human behaviour, the unconscious, unreason and pure spontaneity will always play a part. This is both inevitable and immeasurable.
I’m scribbling these lines in a seat in the Nou Camp, a few minutes before the Argentina-Belgium game that is kicking off this World Cup (Spain 1982). The signs are favourable: a radiant sun; an impressive multi-coloured crowd full of waving Spanish, Catalan, Argentine and a few Belgian flags; noisy fireworks; a festive atmosphere and applause for the dancing and gymnastic displays which are a warm-up to the game.
This is a much more appealing world than the one left outside, behind the Nou Camp stands and the people applauding the dances and patterns made by dozens of young people on the pitch. This is a world without wars, such as those in the South Atlantic and Lebanon, which the World Cup has relegated to second place in the minds of millions of fans throughout the world; they, like those of us here in the stands, will be thinking of nothing else in the next two hours except the passes and the shots of the 22 Argentine and Belgian players who are opening the tournament.
Perhaps the explanation for this extraordinary contemporary phenomenon, the passion for football-a sport raised to the status of a lay religion, with the greatest following of all-is in fact a lot less complicated than sociologists and psychologists would have us suppose; football might simply offer people something they can scarcely ever have: an opportunity to have fun, to enjoy themselves, to get excited, to feel certain intense emotions that daily routine rarely offers them.
To want to have fun, to enjoy ourselves, to have a good time, is a most legitimate aspiration-a right as valid as the desire to eat and work. For many, doubtless complex reasons, football in the world today has taken on this role with more success than any other sport.
Those of us who get pleasure from football are not in any way surprised at its great popularity as a collective entertainment. But there are many who do not understand it and even criticise it. They see it as deplorable because, they say, football alienates and impoverishes the masses-distracting them from important issues. Those who think like this forget that it is important to have fun. They also forget that what characterises entertainment, however intense and absorbing (and a good game of football is enormously intense and absorbing), is that it is ephemeral, non-transcendent, innocuous. An experience where the effect disappears at the same time as the cause. Sport, for those who enjoy it, is the love of form, a spectacle that does not transcend the physical, the sensory, the instant emotion; a spectacle that, unlike a book or a play, scarcely leaves a trace in the memory and does not enrich or impoverish knowledge. This is its appeal: it is exciting and empty. For that reason, intelligent and unintelligent, cultured and uncultured people can equally enjoy football. But that’s enough for now. The King has arrived. The teams have come out. The World Cup has been officially opened. The game is beginning. That’s enough writing. Let’s enjoy ourselves a bit.


@Prospect Magazine

Street Life,Street Death

Here's an interesting Economist article about HIV/AIDS management in critical areas.It reveals how a derogatory attitude  hampers the fight to curb the spread of AIDS.
Pedram
At a glance, the calf-length cape that a good-looking young model swirled around on stage appeared to be made of shaggy sheepskin, wildly inappropriate for the tropical climate of Pattaya, a seaside resort in Thailand. In fact its composition was more apt, if no less uncomfortable: hundreds of dangling prophylactics. Pattaya has one of Thailand’s highest concentrations of go-go bars, massage parlours and other shop windows for the sex trade. Parts of it call to mind Sodom-on-Sea. But this “Condom Fashion Show” was not part of the sleaze. It was staged at a recent United Nations-led “consultation”. The theme—sex workers and HIV, the virus that causes AIDS—was deadly serious, and the effort to turn it into burlesque rather heroic.
The consultation differed in more fundamental ways from the usual run of international conferences. Several dozen sex workers from eight countries (Cambodia, China, Fiji, Indonesia, Myanmar, Pakistan, Papua New Guinea and Thailand) attended as full-fledged participants, not just models in the fashion show. Sex workers are on the front line in the struggle against an epidemic that in Asia still claims 350,000 new infections each year. A 2008 report prepared for the United Nations by an independent commission confirmed that men who buy sex are the single-most powerful driving force in Asia’s HIV epidemics.” It is thought that about 10m Asian women sell sex to 75m men, who in turn have a further 50m regular partners.
A simple and effective way to cut HIV transmission is to ensure that sex workers have access to condoms, know how to use them and always do so. Yet the UN estimates that only a third of Asia’s sex workers are reached by HIV-prevention programmes. And in some countries possession of condoms is taken as evidence of involvement in prostitution, and hence a cause for harassment, extortion or detention.
Yet sex workers themselves are normally excluded—or exclude themselves—from the air-conditioned conference halls where officials and NGOs discuss their plight. One reason is a poor grasp of English, a language, one male Thai sex worker complained, that “we learned only from our clients”. More importantly, sex workers often suffer from official disdain or condescension and are seen as the problem, not the solution.
Of course, the sex industry has not been ignored in the battle against AIDS. Thailand’s early successes are perhaps best-known. It was the first country in Asia to launch a “100% condom-use programme” in the early 1990s, and it managed to cut HIV prevalence sharply. The danger now is of complacency.
The best prevention schemes involve sex workers themselves. As a Chinese delegate put it, given the chance they do a far better job of educating and helping peers than do the UN or government. Myanmar, not normally cited as an outpost of progressive policy, has an HIV-prevention scheme seen as a model. Population Services International, an international NGO, has set up a “peer-to-peer” network with 18 drop-in centres around the country. There, 350 staff, mostly former or present sex workers themselves, dispense advice, discounted condoms and treatment for sexually transmitted infections. HIV prevalence among sex workers dropped from over 30% in 2000-06 to 18% in 2008.
Still, a Burmese sex worker made a passionate intervention at the conference lamenting the stigma her profession carries. In Myanmar as elsewhere, sex workers suffer at the hands of the authorities. And the worst perpetrators are often the police and other official protectors. Take Cambodia, recognised for bringing down HIV prevalence, partly through a condom-use programme. In 2008 a law on “the Suppression of Human Trafficking and Sexual Exploitation” led to the closure of brothels and a shift of the sex trade to bars and other places, complicating measures to prevent HIV. Worse, Human Rights Watch says, it has helped the police to beat, rob and rape sex workers “with impunity”.
A group of Cambodians wrote: “Our lives and our industry have been ruined by the anti-trafficking industry. We used to work in a brothel where we have safety and solidarity… Now we are scattered on the street where it is more dangerous.”
This is an extreme example of two problems besetting efforts to help sex workers. One is that, in most places, sex work is illegal, and almost everywhere frowned upon. Indonesian delegates complained that a new “Puritanism” accompanying a slow Islamisation of public life is forcing the sex trade underground and so making it more dangerous. As our debate showed, arguments for and against decriminalising prostitution are fierce and complex. But as long as it remains a criminal act, sex workers will be vulnerable to arbitrary abuse.
Second, the debate about sex work has become drowned in a campaign against human trafficking. That campaign, however justified its goals, fosters an assumption that all sex workers ply their trade against their will. Yet most migrant sex workers have left home for good reasons of their own—among them a desire to work away from their families, and to earn more money.
Parts of the debate, such as terminology, are as old as the oldest profession. One side regards “sex worker” as a dangerously obfuscatory euphemism. The other sees “prostitute” as degrading and derogatory. One sees those who sell sex inevitably as the victims of exploitation. But those seeking to be heard in Pattaya wanted recognition as independent actors who have made their own choices. They demand to be treated with basic human dignity just as they are.