Journal articles on the topic 'Grave goods – Egypt'

Cemetery 1400–1500 at Armant, excavated by Mond and Myers in the 1930s, is the best-recorded Predynastic cemetery in Egypt. With burials dating to Nagada I, II, and III, the cemetery provides data for a crucial period of social evolution in Egypt. Quantitative methods of analysis show that both mean grave size and mean number of grave goods increase through time. Although clusters of graves show differentiation into two basic hierarchies of grave types, there is a lack of overall complexity in the Armant burials, probably indicative of a society which was not very stratified.

Excavations at the Gebel Ramlah cemetery, in Upper Egypt’s Western Desert, have provided numerous data concerning mortuary practices of the local Final Neolithic period populace. Previous articles have chronicled treatment of disturbed inhumations, in which great care had been taken to recover and rebury all grave goods and skeletal elements including, most notably, dental remains. In several cases, the Neolithic gravediggers apparently went so far as to reinsert, or to in other ways reincorporate, teeth that had fallen from their alveoli during handling. This report describes and interprets a new find, i.e., an anatomically accurate, life-size shell carving of a human incisor, that provides additional insight into the apparent importance of teeth to these desert people.

AbstractA burial chamber on the western necropolis of Chersonesus yielded, among burial goods of the 2nd-3rd c. A.D., a stamped gold medallion depicting Fortuna and Glycon. The cult of Fortuna was widespread in the Roman Empire, especially after the Antonines, and finds of statuettes show it to have been popular on the N. Black Sea coast too. Images of Glycon, the human-headed snake of Alexander the ps.-Prophet, are uncommon outside Egypt, though are known in Asia Minor: they are very rare accompanied by other deities. It is argued that the medallion was struck at Ionopolis near Miletus and its presence at Chersonesus is not improbable given the intensity of trading links between this city and cities of the S. Black Sea coast in the late 2nd-carly 3rd c. A.D. Also discussed is a two-sided indication, made from a 4th c. B.C. silver coin from Heraclea and found in the same complex of grave goods as the medallion.

The article examines four terracotta figurines depicting the ancient Egyptian god Bes and his female counterpart Beset, acquired by Vladimir S. Golenischev in Egypt and kept in the storages of the Department of the Ancient Orient at the Pushkin State Museum of Fine Arts. The analyzed objects are diverse in their topics, form and functional purposes, testifying to the great popularity of this ‘minor’ deity in Graeco-Roman Egypt; all objects are included in the context of domestic worship of the god Bes. They served as a “link” between temple festivals and domestic worship, and could also be placed in a burial place as grave goods or could be brought to a temple as votive offerings. Bes and Beset guarded and helped a person during periods when he faced the forces of chaos – in a time of sleeping, illness, in childbirth, during the war. Bes and Beset were considered the protectors of childhood and motherhood, promoting conception and successful childbirth. Bes was associated with the different borderline states of human health and the period of a person’s transition to another world. The images of Bes do not come from temple theology, but from the context of domestic, private rituals; Bes remains entirely a “popular” god, the part of a daily life cycle of the population of Graeco-Roman Egypt. These multifaced quality is one of the secrets of the incredible popularity of Bes, whose figurines spread along with the Greeks and Romans throughout the oecumene down to the Black Sea region.

Introduction. The Golden Horde epoch in the East European steppe was marked, among other things, by the emergence of urban culture in the region. The urban centers and, first of all, the Golden Horde capital in the Lower Volga were the seats of the ruling elite, but also the centers of trade and crafts people coming from all over the places. Around the towns, there were cemeteries with hundreds of burials that were opened and examined by specialists. In the steppe, near the bank of the river, the Golden Horde epoch is represented by a limited number of burials scattered among a variety of kurgan groups. The article aims to examine Golden Horde burials which comprise silk items; these Volga-Manych sites have previously been part of the studies of steppe elite burials. Materials and methods. The grave goods of most sites in question comprised weaponry, ceramics, and animal bones, the traces of funeral feasts, while luxury items were few. Of much interest in this respect are a Volga-Manych series of Golden Horde burials that comprised silk items. According to numerous data of the written sources, silk was equaled to gold in the medieval time. The fact that the Volga-Manych nomads had clothes made of silk was not only the evidence of their high social status and wealth but also a mark that they were the subjects of the Mongolian Empire. Results. In the burials under study, the silk finds were exclusively the clothing and headdress items of the buried. The fabric originated from the eastern (China, Egypt) and western (Byzantium) production centers. Remains of silk products were found both in the burials of men and women. These were both latitudinal-oriented graves, in which the buried were laid with their heads to the west, and meridionally-oriented graves, with the person’s head to the north. According to the present authors, the latter type may be interpreted as a feature characteristic of ethnic Mongolians’ funeral practice, while the former type graves were those of the Polovtsy and other Turkic-speaking groups.

Refshøjgård. An extraordinary burial-find from the Single Grave Culture Towards the end of 2000, Moesgård Museum excavated a grave mound at Refshøjgård in Folby parish, approx. 15 km NW of Århus in Eastern Jutland (Fig. 1). After the topsoil was removed, it became obvious that the original grave mound had been destroyed completely by ploughing. The mound had been placed on a natural circular elevation consisting of clay. In the periphery of this elevation, seven secondary burials from the Late Roman Iron Age were discovered, while the centre of the mound contained two superimposed burials of the Single Grave Culture (SGC) (Figs. 2-3). These burials are described in the following.The plough had already destroyed most traces of the upper grave. Due to the collapse of the coffin in the grave underneath, part of the fill of the burial mound had sunk down into the resulting depression. Due to this, the grave goods – a typical thick-butted flint axe of SGC type (Fig. 9) and a battle axe of Glob’s type B1 (Fig. 8) – had been preserved in the depression (Figs. 4-5). The remnants of the original mound fill also held eight small pieces of SGC settlement ceramics (Fig. 14), all undecorated belly sherds. Twenty centimetres below, the primary burial showed up. It consisted of a coffin that was open in the eastern end. It was approx. 2 metres long, 85 centimetres wide, orientated E-W and built of planks approx. seven centimetres wide. In the southern side, an upper plank had fallen down and now rested next to a lower plank. The whole construction was obviously made in a provisional way. It was supported by a foundation made from stones up to the size of a human head, which had survived to a height of approx. 30 centimetres (Fig. 6-7). One of the stones turned out to be a quern stone, which had been deliberately placed in the southeastern corner (Fig. 13). There were no supporting stones in the open eastern side of the coffin. Within the coffin, traces of the deceased were clearly visible as dark marks in the earth. It was possible to recognize feet, legs, stomach, back, and part of the head, whereas the arms could not be determined with certainty. The legs were strongly bent under the dead, who was thus resting in a hocker-position. The body was lying on its right side, with the head towards the west and facing south – the typical position of men in burials from the SGC. It was closely surrounded by a thin line of greasy material, probably the remains of a cow hide or the likes. The dead therefore seemed to have been buried in some sort of leather bag. At the back and top of the head, the form of the greasy line suggested that the deceased was buried with some kind of hat. The grave goods consisted of a thick-butted flint axe placed front of the face (Fig. 10), a beaker in the southwest corner of the coffin (Fig. 11) and a rather large, symmetrically formed object of organic material, probably wood, that had only survived as a dark trace in the earth between the beaker and the head of the dead. Both grave finds can be dated to the very early SGC. In the upper grave, this dating is further indicated by the battle axe of type B1, which is characteristic of the very early SGC. It is unusual to find an SGC grave in a stratigraphic position underneath a battle-axe of this type. The lower grave must therefore be considered one of the very earliest finds known from the SGC. Two 14C-dates, obtained from charcoal, confirm this assumption (AAR- 7028, 4140 ± 50 BP = 2855-2680 BC cal and AAR-7029, 4175 ± 50 BP = 2865- 2705 BC cal).The flint axe from the lower burial is of a special nature as it shows typological traits similar to both the A-axes of the Late Funnel Beaker Culture (FBC) and the thick-butted flint axes of the SGC. It thus confirms the dating of the grave to the very early SGC. The beaker from the lower grave is clearly of local origin. It does, however, have some unusual traits, especially regarding the neck, which is higher and more cylindrical than usual. Parallels are known from the Corded Ware Culture south of the Harz in Eastern Germany. The person who manufactured the beaker in Jutland had probably seen beakers in this area of central Europe. Maybe it was someone who had traveled there, or a woman from that region who had moved up north. A thin brown crust was preserved inside the beaker (Fig. 12). It was investigated using both pollen analysis and microscopy. The crust turned out to not contain any pollen, although a pollen analysis of the sand contained in the beaker when it was found (mound fill that fell down) showed pollen in abundance and thus revealed good preservation conditions. The contents of the beaker thus probably did not consist of any drink made of honey (mead) as known from several Late Neolithic/Bronze Age finds in Scotland and Denmark. Investigation in a microscope with polarized light revealed that the crust contained large amounts of starch grains – a strong indicator of some form of beer. An attempt was made to confirm this theory by investigating the starch grains with a scanning electron microscope. Under good preservation conditions, starch grains from beer remnants can be shown to be affected by amylacous pitting due to the malting of cereal grains. This was done successfully with finds from ancient Egypt, but unfortunately the starch grains from Refshøjgård were too badly preserved (Fig. 15). However, in the best-preserved examples, form and size corresponded to starch grains from barley, which was almost the only type of cereal grown in the SGC. It is therefore concluded that the beaker from the lower grave at Refshøjgård once contained a form of beer brewed from barley. It may well be the oldest beer demonstrated in Europe so far. No traces of possible additives survived due to the insufficient preservation conditions.The pollen analysis of the sand from the beaker showed numerous pollen grains from barley (Table 1). The amount is several times higher than what is normal for barley fields, and it is therefore possibly the result of threshing, rather than of natural pollen dispersal. A review of other pollen analyses from barrows of the SGC and FBC showed that in both cultures, the threshing of cereals may have been part of the rituals performed during the building of the mounds or the burials. This phenomenon might then constitute an example of ritual continuity between the two cultures, which are otherwise clearly different in all aspects of material culture, settlement structure, economic strategy, etc. Another example is constituted by the sherds of settlement ceramic found in the remains of the mound fill. Comparable finds are often noted in the literature on the excavation of SGC mounds. This is even the case with the old excavations, which merely consisted of shafts dug in the center of the mounds. It appears that the sherds were deposited just above the graves. This is unlikely to have been the case if the finds merely represented ordi- nary settlement debris, which would normally include other types of materials, such as flint artifacts, charcoal, etc. Another aspect indicating deliberate deposition is the small size of the sherds, which are obviously fragmented as a result of deliberate destruction. The observed practice thus constitutes an apparent parallel to the deposition and smashing of pots that took place by the megalithic graves of the FBC.Several other finds from the earliest SGC are known from the area surrounding Refshøjgård. A distribution map shows that the Refshøjgård area constitutes an isolated settlement region and the easternmost closed distribution area of the SGC in Jutland (Fig. 16). The classical distribution area of the early SGC, Central and West Jutland, is characterized by poor sandy soils. The subsoil in the Refshøjgård area is also of a rather poor type, especially compared with the heavy clayey soils along the east coast of Jutland, where the settlements of the late FBC are found. The subsoil conditions thus may explain why the Refshøjgård area was settled by the early SGC. The emergence of Neolithic settlements in areas of poor soil indicates a remarkable intensification of farming, probably mainly herding, in South Scandinavia during the Neolithic.The flint axe from the earliest burial at Refshøjgård indicates that the deceased was originally related to the late FBC settlement on the coast. He then moved westward and may have been one of the first settlers in the Refshøjgård region. The agricultural symbolism (quern stone, threshing) connected to his burial may in fact indicate that he was the founder of the new settlement. It is interesting to note that quern stones appear in two other graves of the Corded Ware Culture (one from Jutland, and one from Poland) and that all graves are male burials with the quern stone always placed in the eastern end of the grave. This custom may well indicate founders’ graves, as all the known examples mark the earliest burials in the respective micro regions.The foreign typological traits of the Refshøjgård beaker are an important observation, as influences on the SGC from the area south of the Harz have been noted several times before. The origin of the SGC may in some way be connected to that area. According to older theories, the SGC were the result of massive ethnic migration. However, more recent research, including the study of the Refshøjgård burials, indicates that the local population constituted an important component in the transition from FBC to SGC. Migration from Central Europe may nevertheless have been part of the process, perhaps only in the form of translocation of single individuals or small groups.Lutz KlassenInstitut for Antropologi, Arkæologi ogLingvistik, Aarhus UniversitetTranslated by Annette Lerche Trolle

Thomas Christiansen: The Engineer and the Egyptian Mummies: A Scoop from the 1910s The article contains a wealth of new and valuable information on important ancient Egyptian objects that are today housed and on display in the Ny Carlsberg Glyptotek in Copenhagen and the Museum of Ancient Art (Antikmuseet) in Aarhus. Using Mediestream – a service provided by the Royal Library that allows you to access and search more than 35 million digitised Danish newspaper pages – it tells the curious story of a Danish engineer, Jacob Kjeldsen (1873‑1914), and three ancient Egyptian mummiesand coffins from the 21st Dynasty (c. 1070‑950 BCE). From the study of these newspapers it emerges that, during a trip to Egypt in 1910, Kjeldsen had acquired three mummies and coffins in Luxor from Mohammed Abd er-Rasul – a son of the infamous antiquities dealer Mohammed Ahmed Abd er-Rasul – who had discovered them in a tomb in Deir el-Bahari. Shortly after Kjeldsen’s return to Copenhagen, descriptions of the objects began to circulate in the press, and ValdemarSchmidt (1836‑1925), the first Danish Egyptologist, acquired the coffin and mummy of a priest of Amun by the name of Khonshotep for the Ny Carlsberg Glyptotek (inv. ÆIN 1069). During the autumn of the same year, Kjeldsen tried to sell his two remaining mummies, both female priestesses of Amun, and their coffins to the Museum of Aarhus (Aarhus Museum), but without success. Instead, they were impounded and auctioned off by the town magistrate in 1912, because Kjeldsen owed money to a patent office inCopenhagen. This is the last reference to the two mummies in the newspapers, until one of them cropped up out of the blue in Aarhus. In 1950 the newspapers reported that an industrialist, Ivan Lystager (1904‑1985), had donated an Egyptian mummy and coffin to the newly founded Museum of Ancient Art in Aarhus. The name, Taubasti, and titles, ‘Lady of the House’ and ‘Chantress of Amun’, inscribed on the coffin (inv. O 303) leave no room for doubt that it and the accompanying mummy once belonged to Kjeldsen. A letter in the archives of the museum informs us that Lystager had bought them in an antiquities shop in Copenhagen in 1939. The fate of Kjeldsen’s last mummy and coffin and their current whereabouts are still unknown. From the newspapers it can be deduced that the coffin stems from the same period (the 21st Dynasty) and was made for a woman, who also bore the titles ‘Lady of the House’ and ‘Chantress of Amun’, and probably answered to the name of Tamit. Because of onomastics and the fact that the three coffins all derive from the same period and were made for members of clergy of Amun in Thebes, it is likely that Mohammed Abd er-Rasul found the three mummies interred together in an unknown family tomb in Deir el-Bahari in 1910. The article is therefore supplemented with an appendix, which provides a catalogue of the names and titles inscribed in hieroglyphs on the two coffins in the Ny Carlsberg Glyptotek and the Museum of Ancient Art. Hopefully, it can assist researchers in the search for the now lost coffin and mummy (and potentially other grave goods from the same tomb) in state and private ancient Egyptian collections around the world.

Objective: To evaluate the accuracy of ultrasound findings as compared to operative findings and positive predictive value of ultrasonography in the diagnosis of acute appendicitis. Study Design: Cross sectional study. Place and Duration of Study: Pak Field Hospital – 7 (Level III) United Nations African Union Mission in Darfur (UNAMID) Darfur, Sudan, from Mar 2015 to Mar 2016. Methodology: All patients presenting with clinically suspected acute appendicitis (Alvarado’s score >4) were referred for right lower quadrant sonography. Three point scale was used to grade sonographic findings ranging from grade 1 to grade 3. Fifty One patients with persistent symptoms and/or positive sonographic findings were operated. Operative findings were also graded on a 3 point scale. Subsequently, sonographic and operative findings were compared. Surgical findings were considered gold standard to assess diagnostic accuracy of sonography. Results: Out of 51 patients 46 (90.2%) were males and 5 (9.8%) were females. Mean age of the patients was 32.3 ± 7.3 years. Among the study subjects, 15 (29.4%) patients were from Nigeria followed by 12 (23.5%) from Pakistan, 7 (13.7%) from Egypt and 17 (33.5%) from other countries.The sonographic findings were detected positive for acute appendicitis in 40 (78.4%) and negative in 11 (21.6%) out of 51. All Fifty-one patients underwent surgery. The surgical findings were positive for appendicitis in 43 patients (84.3%). Four patients with negative sonographic findings did have acute appendicitis according to surgical findings. The positive predictive value was 90.9%. There was good agreement between sonographicfindings and surgical findings..........

BACKGROUND: Since the declaration of the World Health Organization of the coronavirus (SARS-COV-2) as a pandemic, several countries have locked down and quarantined their residents with restrictive procedures to control spread of the disease. Due to pandemic related stressors, concerns and worries have developed regarding negative psychological impact on the mental well-being of the general population, particularly those known to have higher levels of psychological impairment with high vulnerability to mental health diseases such as medical students. AIM: The objectives of the study were to assess the prevalence of self-reported depression and to explore its predictors during the period of Coronavirus Disease 2019 first lock down among medical students. METHODS: This was a cross-sectional study design. The study was conducted at Kasr Alainy Medical School, Faculty of Medicine, Cairo University, Egypt, in June 2020. A simple random sample was picked of one subgroup of 4th year medical students (No. = 300) at faculty of medicine during the academic year 2019–2020. Self-administered questionnaires including Beck’s Depression Inventory scoring were distributed using Google form through communication social media such as WhatsApp. RESULTS: Out of the 300 participants, 238 responses were received with response rate 79.3%. Results indicated that 38.2% of the respondents were experiencing depression with different degrees with Beck’s Depression Inventory mean scores was 19.4 ± 11.6. Multiple logistic regression analysis point out that gender (odds ratio [OR] = 2.4 and p = 0.022) and “Good” grade level of academic performance (OR = 7.2 and p = 0.045) are significant predictors for developing depression among the participating medical students. CONCLUSION: A significantly high prevalence of depression is detected among medical students during the first wave of the SARS-COV-2 pandemic. The prevalence of depression is more among females than males and more with medical students achieving “Good” grade level.

The article discusses the development of wheat export, which is the main grain crop in the structure of production and export of Russia. The record crop of grain crops in 2017 provided a good basis for the activation of Russian grain exporters in the world market. An analysis of geographical areas by source of grain export showed that crop growth allowed Russia to become a leader, as the main North American and European competitors experienced certain difficulties that led to a reduction in their export potential. The main geographical areas in which there is an increase in demand for wheat are the countries of Africa and Asia, whose population needs a more affordable form of food, which have become the main importers for Russian wheat along with Egypt and Turkey. Russia mainly exports low-grade wheat of the 4th and 5th grade; therefore, such wheat at a lower price and relatively high level of protein content is competitive in a number of foreign markets. The key problems for the export of Russian wheat are unstable gross grain harvests in Russia, which determine the search for innovative-intensive methods of increasing the yield and its stability, and the development of transport and logistics infrastructure. It is necessary to increase port capacities due to the Baltic and Far East directions in the context of political contradictions between Russia and Turkey and expanding the geography of wheat supplies to Africa and Southeast Asia for Russia makes sense. This will not only increase the competitiveness of exports, but also create additional incentives to increase grain production in a number of regions of the country remote from the Azov-Black Sea ports.

AbstractPrader–Willi syndrome (PWS) is the commonest genetic cause of obesity. Oxidative stress and chronic low-grade inflammation play a crucial role in the pathogenesis of obesity. Alterations of vitamin D (25-OHD) levels are commonly encountered with obesity. The aim of this study was to analyze serum chemerin, oxidized low-density lipoprotein (ox-LDL), and 25-OHD values in pediatric PWS patients in comparison with obese healthy children and nonobese control groups, highlighting possible correlations with body mass index (BMI) and obesity. Twenty-six PWS Egyptian patients and 26 obese healthy individuals referred to the outpatient clinic of the Clinical Genetics Department, National Research Centre, Cairo, Egypt, and 20 control patients with matching age and sex were enrolled in the study. Patients were clinically diagnosed and confirmed by routine cytogenetic and fluorescence in-situ hybridization analysis. Anthropometric measurements were performed, and BMI was calculated by weight/height2 (kg/m2), and BMI z score was also determined. Serum chemerin, ox-LDL, and vitamin D were determined by enzyme-linked immunosorbent assay. Chemerin levels, which reflected chronic inflammation, were significantly elevated as compared with obese and nonobese controls (p ≤ 0.0001). Concerning oxidative damage, children with PWS showed higher Ox-LDL levels compared with obese and nonobese controls (p < 0.0001). Vitamin D levels were significantly lower in PWS patients compared with obese and nonobese controls (p ≤ 0.0001). Our data showed that obesity in PWS is associated with oxidative stress and chronic low-grade inflammation. Ox-LDL is a good indicator of oxidative stress, and chemerin could be used as a biomarker for the chronic inflammatory state. Furthermore, vitamin D supplementation is recommended in PWS patients

Introduction: Endometrial adenocarcinoma is characterized by a good prognosis. However, the disease response shows a significant heterogeneity. Treatment of endometrial cancer (EC) is still based on clinico-pathological parameters, which have limited role in risk stratification. There is a need for more determinant markers, such as L1 Cell Adhesion Molecule (L1CAM), to identify patients at higher risk of relapse and tailor a more convenient treatment. L1CAM has a capacity to enhance cell motility and promote tumor invasion in different malignancies. In Egypt, the incidence rate of EC is growing over time. Especially in Elgharbiah governorate (home of this study). L1CAM expression and Ki-67 was reported and compared with other clinico-pathological criteria. Method: Seventy-six female patients of endometrial carcinomas were involved in this prospective study. The patients were treated and followed up at Tanta University Hospitals in the period between January 2015 to April 2019. L1CAM expression and Ki-67 was detected by immuno-histochemical exam and compared with other clinico-pathological criteria. Survival was assessed and compared by Kaplan-Meier curves and log-rank test. Results: Positive L1CAM expression was detected in 17 patients (22.4%) and was significantly correlated with unfavorable prognostic factors such as higher stage and grade ( P= 0.021 and P =0.001 respectively), lympo-vascular invasion ( P <0.001), non-endometroid type ( P <0.027) and Ki-67 ( P= 0.003). Univariate analysis revealed that: positive L1CAM; higher tumor grade; high stage; and non-endometrioid type were significantly associated with shorter disease-free survival (DFS) but no significant correlation was detected between Ki-67 and DFS. In multivariate analysis, positive L1CAM remained statistically significant with DFS [P =0.045; 95%CI (1.028:11.17); HR=3.38]. Conclusion: Our study indicates that L1CAM expression and Ki-67 are significantly associated with poor tumor characteristics. L1CAM is significantly associated with shorter disease-free survival and may be a helpful tool as a part of a simple clinical molecular classification for EC.

1098 Background: MBC (metastatic breast cancer) is among the leading causes of cancer deaths in women worldwide and in Egypt. Gemcitabine has shown synergy with vinorelbine in preclinical models, and has a toxicity profile that is different from vinorelbine. Methods: This was an open-label, single-arm, non-randomised phase II study in patients with locally advanced or MBC who have been previously treated with one anthracycline with/without taxane, based regimen in the adjuvant/neoadjuvant setting. The primary objective of this study was to assess the efficacy of this combination by determining overall response rate. Secondary endpoints were the assessment of the toxicity of gemcitabine in combination with vinorelbine, as well as the time to disease progression, one-year survival. Results: Of the 74 patients enrolled, 72 patients were evaluable for primary treatment outcome (tumor response rates). Overall response rate was 42%. Four patients (6%) had complete response and 26 patients (36%) had partial response. Nineteen patients (26%) had stable disease. Among the 30 patients who had a response to treatment during the study period, the median time to disease progression was 37 weeks (range 1 -60). Median duration of response was 43 weeks (95% CI 31- unestimated). The probability of surviving one year from the Kaplan-Meier estimate for 12 months is 77% (95% CI 64%-86%). Mean percentage of dose intensity of gemcitabine and vinorelbine received was 86% (SD 13%). Mean number of cycles received was 4.4 (SD 1.8). Grade III-IV neutropenia was reported to be 10%, thrombocytopenia was 1.4%, and febrile neutropenia (with documented infection) was 1.4%. As for the clinical toxicities, the most common grade III-IV toxicities were nausea (24%) and diarrhea and stomatitis (11%). Serious clinical adverse events; 5 (7%) hospitalizations for adverse events mainly due to anemia, febrile neutropenia, septic shock and hepatic failure. There were 2 platelet transfusions and 14 RBC transfusions. Conclusions: With a disease control rate of 68%, gemcitabine/vinorelbine demonstrated to have a promising efficacy and at the same time good tolerability in metastatic breast cancer patients. [Table: see text]

AbstractAccessory tourmaline in metasediments from the Sinai crystalline basement exhibits textural and chemical signatures that relate to the evolution of regional metamorphism and deformation during the Pan-African orogeny and testifies to different P-T path segments. Tourmaline inclusions in various porphyroblasts were formed during the prograde phase of metamorphism; acicular to prismatic crystals in the matrix, oriented sub-parallel to, and enveloped by, the main foliation crystallized syntectonically under prograde and peak metamorphic conditions; tourmaline cross-cutting the main foliation may have formed just after the peak or during the retrograde phase of metamorphism. Some of the cores in tourmaline crystals, showing different colours, are interpreted as former detrital grains. The abundance of tourmaline decreases with increasing peak metamorphic conditions. The tourmaline investigated belongs to the schorl-dravitess group, generally with XMg of 0.42–0.73 and XCa = Ca/(Ca+Na+K+□) of 0.02–0.24, typical of tourmalines in metapelites and metapsammites; whereas detrital cores have been derived from various sources, including former tourmaline-quartz and pre-existing high-metamorphic rocks. Tourmaline of the Sinai metasediments was formed during metamorphism of the sedimentary precursors, essentially in a closed system, where clay minerals and organic matter, together with detrital tourmaline, served as the source of boron. Although a metamorphic facies should be defined by characteristic mineral assemblages present in metamorphic rocks, tourmaline chemistry is a good monitor of P-T conditions in the metapelites and semi-metapelites investigated, showing an increase in XMg with increasing metamorphic grade, where XturMg = 0.60 distinguishes between greenschist and lower-amphibolite facies, while XturMg = 0.65 could distinguish lower- from middle- to upper-amphibolite facies. The results of tourmaline-biotite geothermometry compare well with our former temperature estimates using conventional geothermometry and phase-diagram modelling.

Background: The objective of the study was to evaluate the outcome of the ellipse technique in 10 Egyptian patients in contrast with state-of-the-art practice cited in the medical literature.Methods: A prospective comparative study was carried out on 10 consecutive patients with grade III (Simon’s classification) gynecomastia presenting to the outpatient clinic at Menoufia university hospital, Menoufia, Egypt during the period during from June 2015 to march 2018. History taking, local examination, radiological examination and laboratories investigation were done.Results: Mean age of patients was 29.3 years. The BMI of the patients ranged from 32.3 kg/m2 to 37 kg/m2 with a mean BMI of 34.82 kg/m2. All patients showed good wound healing when dressings were removed at the 10-day interval. The scars showed maturation at around 10 to 12 months. None of the patients had a major complication such as infection, hematoma, seroma, or nipple-areola complex necrosis. There were no early postoperative complications apart from moderate bruising in 3 patients. Late complications included slowly resolving hypoesthesia in two patients. This was a transient complication that resolved completely. No patient required revision surgery.Conclusions: The technique allows precise control of the final shape and contour of the corrected chest wall with proper positioning of the nipple-areola complex without a residual deformity. It has been shown to yield consistent and reproducible results in this subset of patients in an easy, quick and safe manner. The technique is also easily learned and taught. The resultant scarring is positioned along the lines of least skin tension and is quite inconspicuous and well hidden in patients with excess chest wall hair.

The article discusses the physical, chemical and functional properties of tiger nut (Cyperus esculentus) and the possibility of its use in meat products. Tiger nuts grow on the territory of the Republic of Egypt. This traditional plant goes back to ancient times. As a rule, its tubers are soaked and then eaten as a snack. Tiger nuts are currently used in beverages, bakery, and dairy products. According to the data obtained, tiger nuts contain 15.77% of dietary fibers, 22.64% of lipids, namely 79.41% of unsaturated and 20.59% of saturated fatty acids. The experiment proved that tiger nuts contain a substantial amount of minerals: potassium – 710 mg/100g, calcium and magnesium – 90 mg/100g. The plant also contains vitamins C, E, and B, while its antioxidant activity reaches 10.4 mg/g. The research featured the sensory properties of meat samples with various concentrations of tiger nuts as a partial replacement. The study revealed that the tiger nut is a cream-colored and odorless fine powder, with a weak sweet taste of almonds. During the experiment, 2.5%–10% of tiger nut powder was introduced into first grade beef samples with a 2.5% interval. When used as a meat substitute, 5% of tiger nut was found to have a positive effect on such indicators as taste, smell, color, and aroma. Hence, tiger nuts can be used as a functional ingredient in meat products to increase the content of dietary fibers, vitamins, and minerals. In addition, tiger nuts have a good antioxidant property, which increases the shelf life of meat products, and is a cheap partial substitute for raw meat.

Background and aim: Improving the eating habits of children is essential to reduce the future burden of non-communicable illnesses. Nutritional diseases affect higher than 30% of school age children. This study aimed to assess the dietary habits and nutritional knowledge among primary school age children in Fayoum Governorate, Egypt.Study design: A cross-sectional descriptive design was utilized. Setting: The study was implemented in three governmental mixed primary schools in EL-Fayoum city; Egypt, that were selected randomly. Sample: Cluster random sample techniques used for selecting of the study group consisted of 300 students aged from 10-12 years for both sexes attending grade five and six. Tools: three tools of data collection consisted of: 1- self-administered questionnaire comprised socio-demographic data of the students and parents, and students’ knowledge about nutrition, 2- the students’ dietary habits as consumption of the breakfast, drinking water, 3- Health assessment sheet to assess the students’ nutritional status including weight, height, BMI, and appearance.The study findings revealed that 69.3% of the study group were underweight, 36.3% were stunted, and 6.7%, 3.3% were overweight and obese respectively. About 45% had fair knowledge while 34% had good knowledge about the nutrition. More than half of the students had unhealthy dietary behavior and appearance. There was a statistically significant difference (P: 0<0.00) between the academic performance of the school children and their HAZ while there was no statistically significant difference between the academic performance of the students and their WAZ (P: 0.264).Conclusions: underweight is highly prevalent among the primary school students followed by stunting. Most of the students had unhealthy dietary habits and unhealthy appearance while around half of them had fair knowledge about nutrition. The current study recommended developing a nutritional health program for primary school children about the proper nutrition.

The purpose of the current study is to characterize Egyptian cotton using HVI and CCS measurements. The present investigation was carried out at two different locations: The Global Center for Cotton Testing Research in International Cotton Association (ICA) using HVI instrument in Germany and Egyptian and International Cotton Classification Center (EICCC), Cotton Research Institute (CRI), Agricultural Research Center (ARC) using CCS instrument in Egypt. Samples are sourced from standardized preparation stages to obtain more homogeneity. All samples were collected from 2018 and 2019 cotton growing seasons. The studied cotton fiber properties: upper half mean (UHM), uniformity index (UI %), short fiber index (SFI %), strength (FS) and elongation (E %) and micronaire reading (Mike) and maturity ratio (MR). The studied cotton varieties include long staple cotton varieties i.e., Giza 86 and Giza 95 and extra-long staple cotton varieties i.e., Giza 92 and Giza 93, in terms of basic Egyptian cotton grade Good (G). The results of HVI and CCS measurements were detected by using descriptive statistics such as measures of central tendency and dispersion, skewness, and kurtosis. The CCS measurements were more stable than HVI measurements. Confidence intervals of CCS measurements were close to each other compared to HVI measurements. For instance, in Giza 92, confidence interval of UHM was 32.00-32.32for HVI and 32.50-32.55for CCS, adding to confidence intervals for FS were 45.19-46.83for HVI and 46.99-47.17 for CCS. Meanwhile, confidence intervals for Mike were 3.04–3.21 for HVI and 3.12–3.14 for CCS. Basically, sample sizes of CCS were larger more than sample sizes of HVI so that results of CCS measurements were more homogenous than HVI measurements. Applying reliability analysis for consistent results in CCS and HVI measurements elaborated Cronbach's value were more efficient than using Cronbach's value if item deleted for both CCS and HVI. Cronbach's value of CCS measurements was more than HVI measurements and that due to the homogeneity of CCS samples compared to HVI samples.

e12584 Background: Triple negative breast cancer (TNBC) is a term that has been applied to breast cancers which lack expression of three receptors: estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2). It represents about 20% of breast cancers diagnosed worldwide. TNBC is a challenging type by its presentation criteria and limited options of treatment. Continuous research for finding specific target is the aim of scientists. Androgen receptors (AR) expression take special attention in this type of breast cancer as its expression can help for finding special targeted treatment as antiandrogen therapy.Purpose:is to assess the AR expression in TNBC patients and to correlate its expression with clinicopathological parameters and disease outcome of patients in study populations. Methods: This prospective study included 90 female patients confirmed as TNBC patients in medical oncology and clinical oncology departments, in Mansoura University and Zagazig University, Egypt, between December, 2013 to May, 2016. AR positive expression was defined as ≥10% nuclear immunostaining. Results: AR expression was positive in twenty seven (27/90) patients (30% ), and lack of its expression was significantly associated with younger age group(p < 0.001), higher grade(p = 0.017)& higher tumor stage(p < 0.001), presence of lymph node metastasis(p < 0.001) & distant metastases(p = 0.032), vascular(p = 0.044)& perineural invasion and high baseline CA 15-3 level (p < 0.001).Median follow up duration was 17.5months (range 6-40), 32/90 died (35.6%).Mean OS was 28months for AR negative TNBC patients versus 32months for AR positive patients. Twenty four of died patients (24/32) were AR negative. Three years OS was 50.8% and 44.1% for AR positive and AR negative respectively, but with nonsignificant P-value. Conclusions: Our study confirmed that AR positive expression in TNBC is a good prognostic feature and it can be sued as target for antiandrogen therapy in this group who is lacking any targettreatment.

Purpose – The purpose of this paper is to prepare high-performance agro-based composites from the non-toxic rice bran-urea-formaldehyde (RB-UF) adhesive system. Investigations have continued for production high performance agro-based composites using environmentally acceptable approaches. The utilisation of such system with the available used local agro-based wood products (sugar-cane bagasse, SCB) adds economic value and helps reducing the environmental impact of commercial urea-formaldehyde (UF) adhesive, and most importantly, provides a potentially inexpensive alternative to the existing commercial artificial wood-panel mills. Design/methodology/approach – Optimising the process for incorporating the RB in UF, as wood adhesive for binding the bagasse fibres, was carried out, by partially replacing commercial UF by denaturalised RB in slurry (wet) and dry form or through synthesis of UF. The denaturalisation of RB was carried out at different pHs (10-11) and at temperature 60°C for two hours. While incorporating the RB during synthesis of UF, it was carried out according to the method reported elsewhere. The formulation of adhesive components, pH value of the denaturalisation stage and the process of incorporating the RB were optimised. Assessment of the role of RB adhesive was specified from its free-formaldehyde (HCHO) content, as well as the properties (mechanical and physical properties) of the produced composites of bagasse particle board type, in comparison with the environmental impact of commercial thermosetting resin (UF). Findings – The promising adhesive system exhibits improvement in the environmental performance (as E1 type) over a commercially UF adhesive (as E2 type), besides providing boards fulfill the requirements of grade H-3 (according to ANSI A208.1 (NPA1993). This adhesive system was resulted from replacing 30 per cent of UF by denalturalised RB (at pH 10) in slurry form. Where, its reduction in free-HCHO reached 53 per cent, as well as modulus of rupture (MOR), modulus of elasticity (MOE), internal bond (IB) and TS of the produced boards were approximately 24.2 N/mm2, approximately 3753 N/mm2, approximately 0.84 N/mm2 and approximately 11.4 per cent, respectively. Research limitations/implications – The eco-adhesive with relatively high percentage of low-cost commercial UF (70 per cent) and 30 per cent RB, as oil production by-product, in slurry form provides good board strength and is environmentally friendly compared to SCB-based composite properties, with that produced from commercial UF. The mechanical (MOR, MOE and IB) and water-resistance properties of the produced composite comply with the standard values. Practical implications – The approach provided low HCHO-free UF adhesive with good comparative board strength and water resistance and reasonable working life. Replacing 30 per cent of UF by RB in slurry form and denaturalised at pH 10 is considered a promising inexpensive alternate adhesive (as E1) in the wood industry based on SCB wastes. Social implications – Incorporating the RB by-product of oil production to commercial UF will be beneficial for saving the health of wood co-workers and motivating the wood mill to export its wood products. Originality/value – It provided a potentially simple way to improve both the utilisation of commercial UF and SCB as industrial substrates for particle-board production. This will benefit farmers, local wood mills in Upper Egypt, significantly. Meanwhile, incorporating low percentage of RB, as oil-mill by-products, is promising to partly replace UF resin in the wood industry, minimising formaldehyde emission or toxic gasses during board formation.

Background.Rosa, as the "Queen of Flowers" has always occupied a special place in the garden. The emergence of rose gardens is rooted in antiquity. Rose is a kind of “tuning fork” of eras. We can see how the symbolism of the flower was transformed, depending on the philosophy and cultural values of society. And this contributed to the various functions and aesthetic delivery of roses in gardens and parks of different eras. Despite the large number of works on roses, today there are no studies that can combine philosophy, cultural aspects of the era, the history of gardens and parks with symbols of the plant world (in particular roses) with the identification of a number of features and patterns.Objectives.The purpose of the article is to study the symbolism of rosesin landscape gardening art of different eras.Methods.The historical method helps to trace the stages of the transformation of the symbolism of roses in different historical periods. The inductive method allows you to move from the analysis of the symbolism of roses in each era to generalization, the identification of patterns, the connection of the cultural life of society with the participation of roses in it. Graph-analytical method reveals the features of creating various types of gardens with roses, taking into account trends in styles and time.Results.In the gardens of Ancient Greece, the theme of refined aesthetics, reflections on life and death dominated. It is no accident that in ancient times it was an attribute of the goddesses of love. In antiquity, she was a favorite flower of the goddess of beauty and love of Aphrodite (Venus). In connection with the legend of the goddess, there was a custom to draw or hang a white rose in the meeting rooms, as a reminder of the non-disclosure of the said information. It was also believed that roses weaken the effect of wine and therefore garlands of roses decorated feasts, festivities in honor of the god of winemaking Dionysus (Bacchus). The rose was called the gift of the gods. Wreaths of roses were decorated: statues of the gods during religious ceremonies, the bride during weddings. The custom of decorating the floor with rose petals, twisting columns of curly roses in the halls came to the ancient palace life from Ancient Egypt, from Queen Cleopatra, highlighted this flower more than others. In ancient Rome, rose gardens turned into huge plantations. Flowers from them were intended to decorate palace halls during feasts. In Rome, a religious theme was overshadowed by luxurious imperial greatness. It is interesting that in Rome, which constantly spreads its borders, a rose from a "female" flower turned into a "male" one. The soldiers, setting out on a campaign, put on pink wreaths instead of helmets, symbolizing morality and courage, and returning with victory, knocked out the image of a rose on shields. From roses weaved wreaths and garlands, received rose oil, incense and medicine. The banquet emperors needed so many roses, which were also delivered by ships from Egypt. Ironically, it is generally accepted that Nero's passion for roses contributed to the decline of Rome. After the fall of the Roman Empire, rose plantations were abandoned because Christianity first associated this flower with the licentiousness of Roman customs. In the Early Middle Ages, the main theme is the Christian religion and roses are located mainly in the monastery gardens, symbolizing divine love and mercy. Despite the huge number of civil wars, when the crops and gardens of neighbors were violently destroyed, the only place of peace and harmony remained the monastery gardens. They grew medicinal plants and flowers for religious ceremonies. During this period, the rose becomes an attribute of the Virgin Mary, Jesus Christ and various saints, symbolizing the church as a whole. More deeply, the symbolism of the rose was revealed in Catholic life, when the rosary and a special prayer behind them were called the "rose garden". Now the rose has become the personification of mercy, forgiveness, martyrdom and divine love. In the late Middle Ages, in the era of chivalry, roses became part of the "cult of the beautiful lady." Rose becomes a symbol of love of a nobleman to the wife of his heart. Courtesy was of a socially symbolic nature, described in the novel of the Rose. The lady, like a rose, symbolized mystery, magnificent beauty and temptation. Thus, in the Late Middle Ages, the secular principle manifests itself on a par with the religious vision of the world. And in the Renaissance, the religious and secular component are in balance. The theme of secular pleasures and entertainments was transferred further to the Renaissance gardens. In secular gardens at palaces, villas and castles, it symbolized love, beauty, grace and perfection. In this case, various secret societies appear that choose a rose as an emblem, as a symbol of eternity and mystery. And if the cross in the emblem of the Rosicrucians symbolized Christianity, then the rose symbolized a mystical secret hidden from prying eyes. In modern times, secular life comes to the fore, and with it new ways of communication, for example, in the language of flowers, in particular roses. In the XVII–XVIII centuries. gardening art is becoming secular; sesame, the language of flowers, comes from Europe to the East. White rose symbolized a sigh, pink –an oath of love, tea –a courtship, and bright red –admiration for beauty and passionate love [2]. In aristocratic circles, the creation of lush rose gardens is in fashion. Roses are actively planted in urban and suburban gardens. In modern times, rose gardens carry the idea of aesthetic relaxation and enjoyment. Many new varieties were obtained in the 19th century, during the period of numerous botanical breeding experiments. At this time, gardening ceased to be the property of the elite of society and became publicly available. In the XX–XXI centuries. rosaries, as before, are popular. Many of them are located on the territory of ancient villas, palaces and other structures, continuing the tradition.

Aims: Attaining the highest ginning efficiency process and fiber quality properties of Egyptian cotton cultivar ̔ Giza 88᾿during feeding methods of roller gin stand is the ultimate objective of the community of cotton field industry for local uses, but the productivity of the three feeding methods of conventional roller gin stand used in ginning process still limited. Therefore, the aim of this investigation is to overcome this obstacle. Study Design: This investigation was conducted in a completely randomized design with three replicates and analyzed as a factorial experiment. Place and Duration of Study: Plant Production Department, the Faculty of Agriculture (Saba Basha), Alexandria University, Egypt during 2017. Methods: Four seed cotton grades; namely, Good to Fully Good (G/FG), Good + ¼ (G + ¼), Good (G) and Good -¼ (G - ¼) belonging to ̔ Giza 88᾿ cotton cultivar were used in this work. The extra-long staple Egyptian cotton variety with the pedigree and origin of cotton Giza 88 (Giza 77 x Giza 45 B) was used. This work was carried out in 2017. About half cantar (1 cantar = 157.5 kg) of each seed cotton grade as a bulk sample was thoroughly mixed and checked and reclassified by a committee of three expert classers belong to the Cotton Arbitration for Testing General Organization (CATGO), in the gin plan. Results: The obtained results indicated that the gin stand's hand feeding method (control treatment); results in significant increases the highest mean values of the gin stand capacity (0.97 kg lint/inch/h), Lint % (36.59%) and lint grade code (27.33) and the lowest mean value of the ginning time (1.42 h/cantar). Meanwhile, the Belt (2 row) as a mechanical feeding method; gave rise to the lowest mean value of gin stand capacity (0.89 kg lint/inch/h). The differences in fiber length parameters (Upper half mean length and short fiber index), fiber elongation %, micronaire reading, yellowness degree (+b) were not significantly affected. The highest seed cotton grade (Good / Fully Good) gave the better lint cotton grade and the best fiber properties tested by HVI instrument of ̔ Giza 88᾿ cotton cultivar. Conclusion: The hand feeding method of seed cotton to the gin stand surpassed all studied feeding methods in gin stand productivity, lint percentage and the most HVI fiber properties are better classer grade. Though, this method is recommended to be used specially with the high levels of the extra-long cottons. Cylinder feeding method ranked first in order among studied mechanical method and it could be recommended for ginning medium and low seed cotton level. Belt (2 rows) is the preferred feeding method regardless of gin stand productivity.

This research includes combining a geophysical study with a geotechnical study to explore different soil types in the western Kom Umbo area. First: The geophysical study, which includes Electrical Resistivity and Ground Penetrating Radar were conducted to determine the subsurface layers, and to identify “gaps and soil heterogeneity, if any.” Fifty Vertical Electrical Soundings (VESs) were made to determine the layers and the electrical resistivity of the layers. Twelve Ground Penetrating Radar profiles (GPR) have also been created to identify soil homogeneity, gaps, geotechnical properties and to identify “existing cracks or faults. Second: the geotechnical study, which includes the study of a different boreholes in all areas of the study to determine the different layers and geotechnical properties. And field tests (standard penetration test) were done and laboratory tests (such as sieves analysis). And how to determine the degree of soil quality and the ability to build on it. From the above, we can combine the results of geophysics with the results of the geotechnical study to evaluate of soil foundation and to obtain confirmed and accurate information about the nature of the soil in the study area and its homogeneity and determine the possibility of exploiting and benefiting from it in industrial facilities, large, small, residential buildings, green spaces. According to this research the study area is generally divided into two layers, the first layer consists of gravel sand which has a resistivity range from 4189 to 38033 and the second layer is sand which has a resistivity value ranging from 1224 to 9682 ohm/m. and in the present study we have achieved the next procedure on the processed GPR data, displaying 2D profiles that contain the expected anomalies. Because the study area is saturated with silty sand and gravel, part of radar waves is attenuated and the reflections from the subsurface materials are weak. Results with the 100 MHz antennae are the resistive sand, gravel is a very good GPR target, and horizontal layering and stratification are evident throughout the deposit. Engineering studies on samples which collected from different sites in the study area reveal that, the results of uniformity coefficient (Cu) ranging between 3.15 (Very uniform) to 35.56 (Non-uniform). The results of coefficient of gradation range between 0.61 (poorly graded) to 2.41 (Well graded).

Abstract Urinary bladder cancer is a common malignancy in Egypt, thus reliable methodologies are required for screening and early detection. In this study, we analyzed the gene expression of a Schistosoma hematobium specific microRNA “Sha-miR-71a” and mitogen-associated protein kinase-3 (MAPK-3) in the urine samples of 50 bladder cancer patients and 50 patients with benign bilharzial cystitis. Fifty control subjects were also tested. Indirect hemagglutination test (IHA) diagnosed 70% of studied cancer cases as bilharzial associated bladder cancer (BBC), while histopathological examination detected only 18%. Urinary Sha-miR-71a & MAPK-3 revealed enhanced expression in BBC (p-value = 0.001) compared to non-bilharzial bladder cancer (NBBC) cases. Patients with chronic bilharzial cystitis exhibited a significant increase in gene expression compared to those with acute infection (p-value = 0.001). Sha-miR-71a and MAPK-3 showed good sensitivity and specificity in the diagnosis of BBC when analyzed by the receiver operating characteristic (ROC) curve. They were also prognostic regarding malignancy grade. Both biomarkers showed a positive correlation. Our results revealed that IHA is a reliable test in the diagnosis of bilharziasis associated with bladder cancer, and that Sha-miR-71a and MAPK-3 provide non-invasive specific biomarkers to diagnose BBC, as well as a potential role in testing bilharzial patients for risk to develop cancer.

Abstract Background: Medical students are vulnerable to infection by the coronavirus. Their awareness of the disease is crucial for their safety and for the management of the epidemic by spreading supportive information in their communities. The aim of this study was to assess coronavirus disease 2019 (COVID-19)-related knowledge, attitude, and preventive practices among Egyptian medical students. Methods: We conducted a cross-sectional study from the beginning of April to June 2020; a total of 439 undergraduate medical students (1st to 6th academic years) were assessed using an online questionnaire. The questionnaire consisted of 33 questions, including 5 items regarding socio-demographic features, 23 items concerning COVID-19 related knowledge, 2 items regarding attitude, and 3 items related to preventive measures. Results: We observed an acceptable level of knowledge (74.3%) among the sample studied. Preclinical and female students were significantly more optimistic as 69.1% expected successful control of COVID-19, and 48.9% predicted that Egypt will win the fight against COVID-19. The majority of participants reported wearing a facemask in public places as a preventive measure (56.7%). Conclusions: Egyptian medical students had an acceptable level of knowledge, positive attitude, and good practices of preventive measures regarding the COVID-19 virus. There is no significant difference in almost all items of knowledge, attitude, and practices in relation to gender or academic grade.

Aims: To assess the safety and efficacy of chemo-radiotherapy before radical surgery in locally advanced gastric and gastroesophageal adenocarcinoma. Study Design: This was a prospective phase Ⅱ single arm study. Place and Duration of Study: Department of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital, Mansoura, Egypt, between May 2017 and June 2019. Methodology: Patients with pathologically proven gastric or gastroesophageal junction adenocarcinoma are included. They received one cycle of induction chemotherapy paclitaxel-carboplatin, [paclitaxel dose of 175 mg/m2, carboplatin dose of (AUC: 5)], followed by CCRT [RT 45 Gy over 25 fractions over 5 weeks concurrent with weekly paclitaxel at a dose of 50 mg/m2, carboplatin at a dose of (AUC: 2)], followed by surgery and 2 cycles of paclitaxel-carboplatin for responders. Results: The study included 24 patients. Most of the patients were diagnosed at stage III (83.3%). There were no major side effects of the induction chemotherapy cycle. There were no reported grade 3 or 4 toxicities for the CCRT. Only two patients suffered from late radiation toxicities (distal esophageal stenosis). Pathological complete response was achieved in seven patients (31.8%). Twenty-two patients had surgical resection with a 95% resection margin zero. The median follow-up time was 22.5 months. The median progression-free survival (PFS) and overall survival (OS) were 23, 23.5 months, respectively. Conclusion: The preliminary data suggested good efficacy of the studied treatment design with acceptable adverse-event rates, however a larger multicentric phase 3 trial with a longer follow-up duration is recommended.

Background: Sepsis-induced myocardial dysfunction (SIMD) occurs in 50% of septic patients and is characterized by reduced ejection fraction (EF), cardiac index, impaired contractility, and diastolic dysfunction (DD). In sepsis-induced cardiomyopathy (SICM), EF shows initial significant deterioration on the 1st day, then final improvement at the end of the study. This study evaluated the value of different parameters measured with trans-thoracic echocardiography (TTE) in the diagnosis and prognosis of SIMD in the surgical intensive care unit (SICU). Methodology: This prospective cohort study was conducted on 100 patients, aged from 18 to 50 years admitted to SICU being affected by sepsis or septic shock. TTE parameters [EF, tricuspid annular systolic excursion (TAPSE), inferior vena cava (IVC) diameter, E/A ratio and grading of DD and hemodynamic parameters [mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP)] on admission, three day post-admission and after one week. Results: The mortality rate was 45%. DD was found in 90%. The mortality group had higher DD, higher HR, and lower MAP than the surviving group, with an insignificant difference in LVEF, TAPSE, IVC, and CVP on the 3rd and 7th days. Sepsis-induced cardiomyopathy (SICM) was found in 31% of surviving patients. DD (grade III had the highest mortality followed by grade I then grade II), HR >110 bpm, and MAP < 65mmHg are independent factors that negatively affect the duration of survival significantly. Conclusion: TTE in patients with sepsis or septic shock is vital for diagnosis and prognosis. DD, tachycardia (HR >110 bpm), and hypotension (MAP < 65mmHg) are independent predictors of mortality in those patients. Patients with SICM (little reversible impairment of LV systolic function) had a good prognosis. Keywords: Sepsis Induced Myocardial Dysfunction, Diastolic dysfunction, Sepsis, Septic Shock Preregistration: The study was registered in the Ethical Committee of Faculty of Medicine, Tanta University, Tanta, Egypt (approval number: 31728/08/17) Abbreviations: SIMD–Sepsis-induced myocardial dysfunction; SICM–sepsis-induced cardiomyopathy; TTE– transthoracic echocardiogram. EF–Ejection fraction; DD–diastolic dysfunction; MD–Myocardial dysfunction; TAPSE–tricuspid annular systolic excursion; SICU–surgical intensive care unit Citation: El-Oraby MA, Shaban AES, El-Dada AA, El-Badawy AEH. Echocardiographic evaluation of sepsis induced myocardial dysfunction in patients with sepsis or septic shock: a prospective cohort study. Anaesth pain intensive care 2021;25(2):150-162. DOI: 10.35975/apic.v25i2.1463 Received: 6 November 2020, Reviewed: 30 December 2020, Accepted: 3 February 2021

Blaise Pascal once offered the following advice to those perennially worried about knowing fact from fiction: “how few things can be demonstrated! Proofs only convince the mind; custom provides the strongest and most firmly held proofs” (148). The concern about whether or not God existed was for Pascal an unnecessary anxiety: the question couldn’t be answered by human knowledge, and so ultimately one just had to “wager” on whatever stood to be most beneficial, act as if this chosen answer was true, and the mind would eventually fall into line. For Pascal, if one stood to gain from believing in the truth of an idea then the great problems of epistemology could be reduced to a relatively simple and pragmatic calculation of benefit. Doubt, suspicion, and all the attendant epistemological worries would only count as wasted time.It might at first seem surprising that this somewhat antiquated idea of Pascal’s, conceived in seventeenth-century France, appears at the core of a novel by a writer considered to be the quintessential “modern” author, David Foster Wallace. But consider the following advice offered to a recovering drug addict in Wallace’s 1996 novelInfinite Jest. To reap the benefits of the AA program, Don Gately, one of the central characters of the novel, is told by resident counsellor Gene M to imagine he is holding a box of Betty Crocker Cake Mix. The box of cake mix represents Boston AA. Gately is advised that the “box came with directions on the side any eight-year-old could read”: Gene M. said all Gately had to do was for fuck’s sake give himself a break and relax and for once shut up and just follow the directions on the side of the fucking box. It didn’t matter one fuckola whether Gately like believed a cake would result, or whether he understood the like fucking baking-chemistry of howa cake would result: if he just followed the motherfucking directions, and had sense enough to get help from slightly more experienced bakers to keep from fucking the directions up if he got confused somehow, but basically the point was if he just followed the childish directions, a cake would result. He’d have his cake. (467) This advice indeed seems lifted from Pascal almost verbatim (plus or minus a few turns of phrase, of course):Learn from those who have been bound like you, and who now wager all they have. They are people who know the road you want to follow and have been cured of the affliction of which you want to be cured. Follow the way by which they began ... (Pascal 156).While the Pascalian influence on Wallace’s work is perhaps interesting in its own right, and there are certainly more extensive and capable analyses of it to be done than mine, I invoke it here to highlight a particular emphasis in Wallace’s work that I think exceeds the framework through which it is usually understood. Wallace’s fiction is commonly considered an attack on irony, being supposedly at the vanguard of a movement in recent American literature that Adam Kelly, in an illuminating analysis, has called the “New Sincerity” (131). But before anything else irony is a particular trope of understanding, a way of situating oneself in regards to an object of knowledge, and so Wallace’s work needs not only to be understood in terms of what a culture considers unhip, trite, and sentimental, but how it comes to decide upon those things at all, how it chooses to understand its reality. Inspired by the Pascalian influence apparent in Wallace’s portrayal of the Alcoholics Anonymous program, I intend to shift the focus away from issues of irony and sincerity and instead consider the importance of the epistemological tropes of suspicion and trust in reading Infinite Jest. More than anything else Wallace’s depiction of the AA program tells us he is interested, like Pascal, in the existential implications of suspicion, in what might be lost in following doubt to its most “radical” conclusions. I SuspicionIt is fruitful to view Western intellectual practice as exhibiting suspicious tendencies. From Descartes’s “hyperbolic doubt,” the “hermeneutics of suspicion” that Ricœur and Foucault see coming out of the legacy of Marx, Nietzsche, and Freud, to the endless “paranoia of the postmodern” that typifies recent academic trends (Bywater 79), the refusal to trust the veracity of surfaces has been a driving force in post-Enlightenment thought, becoming largely inextricable from how we understand the world. As a mode of critique, suspicion has a particular anxiety about the way fiction masquerades as truth. When a suspicious mind reads a given object, be it an advertisement, a novel, a film, a supermarket, or an egg carton, it most often proceeds by first separating the text into what Paul Ricœur calls an “architecture of meaning” (18), defining those elements it considers fictive and those it considers truer, more essential, in order to locate what it considers “the intentional structure of double meaning” (Ricœur 9). Beneath the fictive surface of a novel, for example, it might find hidden the “truer” forces of social repression and patriarchy. Behind the innocence of a bedtime tale it might discern the truth of the placating purpose of story, or the tyranny of naïve narrative closure, the fantasies of teleology and final consonance. And behind Pascal’s wager it might find a weak submission to ideological fictions, a confirmation of the processes of social conditioning.Over the years suspicion has doubtless proved itself a crucial resource for various politics of resistance, for challenging ossified structures of knowledge, and for exposing heinous fictions that definitely needed exposing. But some contend that these once fruitful intellectual practices have become so deeply entrenched that they are now the things to be suspiciously overcome. Rather than being a subversive tactic of liberation, the “routinisation” of suspicion can stand to mark a hermeneutic stasis. It can even, as Bruno Latour argues, mire important social and ecological issues in counterproductive doubt, the most obvious example being the tiresome “debates” about global warming:the danger would no longer be coming from an excessive confidence in ideological arguments posturing as matters of fact—as we have learned to combat so efficiently in the past—but from an excessive distrust of good matters of fact disguised as bad ideological biases! (Latour 227) The work of David Foster Wallace can be considered another example of such a discourse, one that definitely admits suspicion’s hermeneutic force, but is a little uneasy with its predominance. While Wallace’s work is most commonly understood in relation to irony, irony itself, as I have suggested, can in turn be understood as related to a subtending culture of suspicion and cynicism. In his 1993 essay “E Unibus Pluram: Television and U.S. Fiction,” Wallace notes a complex interaction between knowledge, suspicion, art, and televisual culture, in which a particular rendering of irony—a mistrust in clichéd sentiment and all those words we now so confidently put between “shudder” quotes—is commoditised and exploited in order to constantly provide the psychological payoffs of knowingness, those feelings of superiority, safety, and power that come from suspiciously seeing through to the “truth” of things. In Wallace’s reading, ostensibly postmodern advertisements draw attention to their fictive layers to make viewers feel attuned to the supposed truth of their intent. But this access to the “truth” is itself just another fiction aimed to mislead them into commercial pliancy:[TV can] ease that painful tension between Joe’s need to transcend the crowd and his status as Audience member. For to the extent that TV can flatter Joe about “seeing through” the pretentiousness and hypocrisy of outdated values, it can induce in him precisely the feeling of canny superiority it’s taught him to crave, and can keep him dependent on the cynical TV-watching that alone affords this feeling. (Wallace 180) The ironic viewer who would stand above these deliberately naive appeals would then also, and perhaps before anything else, be a suspicious reader, someone predisposed to seeing through the “surface” of a text. Irony, in these examples, would even be alike to the effect gained from “successful” suspicion, something like its reward, rather than an epistemological mode in itself. While in his essay Wallace ultimately intends that his critique of such tendencies will highlight the way much contemporary fiction struggles to subvert this culture, and thus we cannot help but look to his own work to see how it supposedly “attacks” irony, it is also just as crucial to consider its embedded critique of suspicious hermeneutics.II Trust In Infinite Jest’s portrayal of Boston’s Alcoholics and Narcotics Anonymous programs, Wallace attempts to propose a kind of neo-Pascalian “wager.” And like Pascal’s, Wallace’s is based on the willed performance of that most critically maligned of concepts, trust: that is, a willingness to become, like Pascal, blasé with truth as long as it stands to be beneficial. Within the novel the fictitious Ennet Drug and Alcohol House, along with the adjacent Enfield Tennis Academy, is staged as a school of personal (re)development, dramatising approaches to self-help in the damaged landscape of the Year of the Depend Adult Undergarment’s Boston. And it is here where Don Gately, the novel’s unlikely hero, has ended up on his quest to escape the “spider” of addiction. As it openly admits, Alcoholics Anonymous is an easy target for a suspicious mode of thought bent on locating fictions because it “literally makes no sense” (368). But like Pascal, Wallace’s AA submits the problem of truth and error to a more primary consideration of benefit, and celebrates the power of language and custom to create realities, rather than being suspicious of this process of linguistic mediation. So it is a system, like signification itself, that functions on “the carrot-and-donkey aspect of trudging to Meetings only to be told to trudge to still more Meetings” (1001); like any transcendental signifier, the revelations it hints at can never truly arrive. It is also based on assertions that “do not make anything resembling rational sense” (1002). For example, Joelle van Dyne battles with the AA precept “I’m Here But For the Grace of God.” She finds the phrase is literally senseless, and regardless of whether she hears it or not it’s meaningless, and that the foamy enthusiasm with which these folks can say what in fact means nothing at all makes her want to put her head in a Radarange. (366) But perhaps the strongest reason Joelle feels uncomfortable with the present example is that she senses in its obvious untruth the potential truth of all meaning’s fictitiousness, how all sense might just be made up of nonsense of one form or another. Within the AA program these words are a means to an end, rather than something to be resisted or deconstructed.To exist within Infinite Jest’s AA program is thus to be uncomfortably close to the linguistic production of reality, to work at meaning’s coalface, exposed to the flames of its fictitiousness, but all the while being forced to deny this very vista. So while AA is a process firmly against the mechanisms of denial (one of its favourite slogans is “Denial is not a river in Egypt” [272]), it is also based on a paradoxical imperative to deny the status of meaning as a production, as well as the denial of the significance of this paradox: For me, the slogan [Analysis-Paralysis] means there’s no set way to argue intellectual-type stuff about the Program [...] You can’t think about it like an intellectual thing [...] You can analyse it til you’re breaking tables with your forehead and find a cause to walk away, back Out There, where the Disease is. Or you can stay and hang in and do the best you can. (1002) Although it is common knowledge that its precepts are full of logical contradiction and impasse, that it is a blatantly fictitious enterprise, the difficulty which Wallace’s portrayal poses, both for his characters and for his readers schooled in suspicious hermeneutics, is that as a process of healing the AA program somehow seems to work with great efficacy. Enter the redemption of Don Gately.Despite his initial reluctance to embrace the program’s undertakings, much to his surprise Gately finds it having a definite effect: he “all of a sudden realised that quite a few days had gone by since he’d even thought about Demerol or Talwin or even weed” (467). The bracketing of the desire to know and interpret, and the willed trust in the efficacy of a process that one cannot know by necessity, initially frustrates him, and even makes him suspicious: “He couldn’t believe it. He wasn’t Grateful so much as kind of suspicious about it, the Removal [of his addiction]” (468). And all this can definitely be intellectually uncomfortable for a reader well-versed in suspicious hermeneutics, let alone the somewhat unintellectual Gately:It did, yes, tentatively seem maybe actually to be working, but Gately couldn’t for the life of him figure out how just sitting on haemorrhoid-hostile folding chairs every night looking at nose-pores and listening to clichés could work. Nobody’s ever been able to figure AA out, is another binding commonality. (349)Ultimately the AA program presents the novel’s hero and its readers with an impasse, a block to what one knows and can critique, refuting the basic assumption that links narrative progression and change with the acquisition of knowledge. While others in AA seek to understand and debunk it, they also significantly fail to achieve the kind of recovery experienced by Gately. As Elizabeth Freudenthal suggests, “despite the problems one may have with AA as a vehicle for healthy living, Gately’s mode of fighting addiction is the only one in the novel that actually works” (191). And while Freudenthal suggests that Gately’s success comes through a ritual “anti-interiority,” a “mode of identity founded in the material world of both objects and biological bodies and divested from an essentialist notion of inner emotional, psychological, and spiritual life” (192), to me it seems that were Gately unable to resist the pleasures of the suspicious mind then little of his “abiding” in the exterior world would be possible. Ultimately, what Gately achieves comes through a kind of epistemological “trust.”III Reading TrustfullyBy occupying such a central place in the narrative, this neo-Pascalian wager around which the novel’s AA program is built is obviously intended to bear not only on its characters, but on how the novel is read. So how might we also “learn” from such Pascalian gambits? How might we read the novel without suspicion? What might we gain by becoming Don Gately? What, on the other hand, might we lose? While this essay is far too short to conduct this kind of investigation in full, a few points might still be raised in lieu of a proper conclusion.By openly submitting to his ignorance of what his actions mean, Gately is able to approach success, conclusion, and fulfillment. What the novel’s ending has in store for him is another question altogether, but Freudenthal views Gately’s closing scenes as the apotheosis of his “anti-intellectual endeavor” (206). Gately’s narrative thus also presents a challenge to readers thoroughly led by suspicious hermeneutics, and encourages us, if we are to accept this notion that is key to Infinite Jest (but we can, of course, refuse not to), to place ourselves in the position of the AA attendee, as a subject of the text’s discourse, not in possession of knowledge through which to critique it and scale that “architecture of meaning.” Many aspects of the novel of course impel us to read suspiciously, to gather clues like detectives, to interrogate the veracity of claims. Consider, for example, the compounded conflicting accounts of whether Joelle van Dyne has been horribly disfigured by acid, or is sublimely beautiful (compare, for instance, the explanation given on 538 with that on 795). Yet ultimately, recalling the AA ethos, the narrative makes it difficult for us to successfully execute these suspicious reading practices. Similar to a text like Thomas Pynchon’s Gravity’s Rainbow, that for Brian McHale ultimately resists any attempt to answer the many questions it poses (90-91), Infinite Jest frequently invokes a logic of what we might call epistemological equivocation. Either the veil-wearing Joelle van Dyne is hideously and improbably deformed or is superlatively beautiful; either AA is a vapid institution of brainwashing or is the key to recovery from substance abuse; either the novel’s matriarch, Avril Incandenza, is a sinister “black widow” or a superlatively caring mother. The list goes on.To some extent, the plethora of conflicting accounts simply engages an “innocent” readerly curiosity. But regardless of the precise nature of this hermeneutic desire stimulated by the text, one cannot help but feel, as Marshall Boswell suggests, that “Wallace’s point seems to be that these issues are not the issue” (175). If we read the novel attempting to harmonise these elements, interrogating the reliability of the given textual evidence, we will be sorely disappointed, if not doomed to the “analysis paralysis” that is much feared in the novel’s AA program. While one of the pleasures Wallace’s novel offers readers is the encouragement to participate actively in the text, it is also something it is wary of. And this is where the rub of the book lies. Just like in AA, we can potentially keep analysing its ambiguities forever; it is indeed designed to be pleasurable in just this way. But it is also intended, at least so Wallace tells us, to resist the addictive nature of pure entertainment:The original title was A Failed Entertainment. The idea is that the book is structured as an entertainment that doesn’t work [...]. And the tension of the book is to try to make it at once extremely entertaining—and also sort of warped, and to sort of shake the reader awake about some of the things that are sinister in entertainment. (Wallace in Lipsky 79)If we consider what it might mean to view the book as a “Failed Entertainment,” and consider what it is we love to do when reading suspiciously, we can then see that it is perhaps intended to steer us away from trying to decode it, especially when it is constantly suggested to us that it is this effort of analysis that tends to move one out of the immediacy of a given moment. The fact that “nobody’s ever been able to figure AA out” (349), yet it still indubitably works, seems to suggests how we are to approach the novel.But what are we offered instead of these pleasures of suspicious reading? Perhaps, like the AA attendee, the novel wants us to learn to listen to what is already in front of us: for the AA member it is all those stories offered up at the “podium”; for us it is all the pain and joy written in the text. In place of a conclusive ending that gives us all that we want to know, that shows us everything that “happens,” in its final scene the novel instead tells the story of a man finding his “bottom,” his lowest ebb, waking up “flat on his back on the beach in the freezing sand” (981). This man, of course, is Don Gately. If we see this final moment only as a frustration of narrative desire, as a turning away from full understanding, from a revelation of the “truth” the narrative has been withholding, then we perhaps fail the task Wallace’s text, like AA, constantly asks of us: to listen, to accept, to trust.ReferencesBoswell, Marshall. Understanding David Foster Wallace. Columbia, SC: U of South Carolina P, 2003.Bywater, William. “The Paranoia of Postmodernism.” Philosophy and Literature 14.1 (1990): 79–84. Foucault, Michel. “Nietzsche, Freud, Marx.” Aesthetics, Method, and Epistemology: Essential Works of Foucault 1954–84, Volume 2. Ed. James Faubion. Trans. Robert Hurley et al. London: Penguin, 2000. 269–78. Freudenthal, Elizabeth. “Anti-Interiority: Compulsiveness, Objectification, and Identity in Infinite Jest.” New Literary History 41.1 (2010): 191–211. Kelly, Adam. “David Foster Wallace and the New Sincerity in American Fiction.” Consider David Foster Wallace: Critical Essays. Los Angeles: Sideshow Media Group Press, 2010. 131–46.Latour, Bruno. “Why Has Critique Run Out of Steam? From Matters of Fact to Matters of Concern.” Critical Inquiry 30.2 (2004): 225–48.Lipsky, David. Although of Course You End Up Becoming Yourself: A Road Trip With David Foster Wallace. New York: Broadway Books, 2010.McHale, Brian. “Modernist Reading, Post-Modern Text: The Case of Gravity's Rainbow.” Poetics Today 1.1 (1979): 85–110.Pascal, Blaise. Pensées and Other Writings. Trans. Honor Levi. Ed.Anthony Levi. New York: Oxford UP, 1995.Ricœur, Paul. Freud and Philosophy: An Essay on Interpretation. Trans. Denis Savage. New Haven: Yale UP, 1970.Wallace, David Foster. “E Unibus Pluram: Television and U.S. Fiction.” Review of Contemporary Fiction 13.2 (1993): 151–94. ---. Infinite Jest. New York: Back Bay Books, 1996.

In a media saturated world, doodles have recently received the kind of attention usually reserved for coverage of racy extra marital affairs, corrupt governance, and product malfunction. Former British Prime Minister Blair’s private doodling at a World Economic Forum meeting in 2005 raised suspicions that he, according to one keen graphologist, struggled “to maintain control in a confusing world," which infers he was attempting to cohere a scattershot, fragmentary series of events (Spiegel). However, placid-faced Microsoft CEO Bill Gates, who sat nearby, actually scrawled the doodles. In this case, perhaps the scrawls mimicked the ambience in the room: Gates might have been ‘tuning’–registering the ‘white noise’ of the participants, letting his unconscious dictate doodles as a way to cope with the dissonance trekking in with the officialspeak. The doodles may have documented and registered the space between words, acting like deposits from his gestalt.Sometimes the most intriguing doodles co-exist with printed texts. This includes common vernacular graffiti that lines public and private books and magazines. Such graffiti exposes tensions in the role of readers as well as horror vacui: a fear of unused, empty space. Yet, school children fingering fresh pages and stiff book spines for the first few times often consider their book pages as sanctioned, discreet, and inviolable. The book is an object of financial and cultural investment, or imbued both with mystique and ideologies. Yet, in the e-book era, the old-fashioned, physical page is a relic of sorts, a holdover from coarse papyrus culled from wetland sage, linking us to the First Dynasty in Egypt. Some might consider the page as a vessel for typography, a mere framing device for text. The margins may reflect a perimeter of nothingness, an invisible borderland that doodles render visible by inhabiting them. Perhaps the margins are a bare landscape, like unmarred flat sand in a black and white panchromatic photo with unique tonal signature and distinct grain. Perhaps the margins are a mute locality, a space where words have evaporated, or a yet-to-be-explored environment, or an ambient field. Then comes the doodle, an icon of vernacular art.As a modern folklorist, I have studied and explored vernacular art at length, especially forms that may challenge and fissure aesthetic, cultural, and social mores, even within my own field. For instance, I contend that Grandma Prisbrey’s “Bottle Village,” featuring millions of artfully arranged pencils, bottles, and dolls culled from dumps in Southern California, is a syncretic culturescape with underlying feminist symbolism, not merely the product of trauma and hoarding (Ensminger). Recently, I flew to Oregon to deliver a paper on Mexican-American gravesite traditions. In a quest for increased multicultural tolerance, I argued that inexpensive dimestore objects left on Catholic immigrant graves do not represent a messy landscape of trinkets but unique spiritual environments with links to customs 3,000 years old. For me, doodles represent a variation on graffiti-style art with cultural antecedents stretching back throughout history, ranging from ancient scrawls on Greek ruins to contemporary park benches (with chiseled names, dates, and symbols), public bathroom latrinalia, and spray can aerosol art, including ‘bombing’ and ‘tagging’ hailed as “Spectacular Vernaculars” by Russell Potter (1995). Noted folklorist Alan Dundes mused on the meaning of latrinalia in Here I Sit – A Study of American Latrinalia (1966), which has inspired pop culture books and web pages for the preservation and discussion of such art (see for instance, www.itsallinthehead.com/gallery1.html). Older texts such as Classic American Graffiti by Allen Walker Read (1935), originally intended for “students of linguistics, folk-lore, abnormal psychology,” reveal the field’s longstanding interest in marginal, crude, and profane graffiti.Yet, to my knowledge, a monograph on doodles has yet to be published by a folklorist, perhaps because the art form is reconsidered too idiosyncratic, too private, the difference between jots and doodles too blurry for a taxonomy and not the domain of identifiable folk groups. In addition, the doodles in texts often remain hidden until single readers encounter them. No broad public interaction is likely, unless a library text circulates freely, which may not occur after doodles are discovered. In essence, the books become tainted, infected goods. Whereas latrinalia speaks openly and irreverently, doodles feature a different scale and audience.Doodles in texts may represent a kind of speaking from the ‘margin’s margins,’ revealing the reader-cum-writer’s idiosyncratic, self-meaningful, and stylised hieroglyphics from the ambient margins of one’s consciousness set forth in the ambient margins of the page. The original page itself is an ambient territory that allows the meaning of the text to take effect. When those liminal spaces (both between and betwixt, in which the rules of page format, design, style, and typography are abandoned) are altered by the presence of doodles, the formerly blank, surplus, and soft spaces of the page offer messages coterminous with the text, often allowing readers to speak, however haphazardly and unconsciously, with and against the triggering text. The bleached whiteness can become a crowded milieu in the hands of a reader re-scripting the ambient territory. If the book is borrowed, then the margins are also an intimate negotiation with shared or public space. The cryptic residue of the doodler now resides, waiting, for the city of eyes.Throughout history, both admired artists and Presidents regularly doodled. Famed Italian Renaissance painter Filippo Lippi avoided strenuous studying by doodling in his books (Van Cleave 44). Both sides of the American political spectrum have produced plentiful inky depictions as well: roughshod Democratic President Johnson drew flags and pagodas; former Hollywood fantasy fulfiller turned politician Republican President Reagan’s specialty was western themes, recalling tropes both from his actor period and his duration acting as President; meanwhile, former law student turned current President, Barack Obama, has sketched members of Congress and the Senate for charity auctions. These doodles are rich fodder for both psychologists and cross-discipline analysts that propose theories regarding the automatic writing and self-styled miniature pictures of civic leaders. Doodles allow graphologists to navigate and determine the internal, cognitive fabric of the maker. To critics, they exist as mere trifles and offer nothing more than an iota of insight; doodles are not uncanny offerings from the recesses of memory, like bite-sized Rorschach tests, but simply sloppy scrawls of the bored.Ambient music theory may shed some light. Timothy Morton argues that Brian Eno designed to make music that evoked “space whose quality had become minimally significant” and “deconstruct the opposition … between figure and ground.” In fact, doodles may yield the same attributes as well. After a doodle is inserted into texts, the typography loses its primacy. There is a merging of the horizons. The text of the author can conflate with the text of the reader in an uneasy dance of meaning: the page becomes an interface revealing a landscape of signs and symbols with multiple intelligences–one manufactured and condoned, the other vernacular and unsanctioned. A fixed end or beginning between the two no longer exists. The ambient space allows potential energies to hover at the edge, ready to illustrate a tension zone and occupy the page. The blank spaces keep inviting responses. An emergent discourse is always in waiting, always threatening to overspill the text’s intended meaning. In fact, the doodles may carry more weight than the intended text: the hierarchy between authorship and readership may topple.Resistant reading may take shape during these bouts. The doodle is an invasion and signals the geography of disruption, even when innocuous. It is a leveling tool. As doodlers place it alongside official discourse, they move away from positions of passivity, being mere consumers, and claim their own autonomy and agency. The space becomes co-determinant as boundaries are blurred. The destiny of the original text’s meaning is deferred. The habitus of the reader becomes embodied in the scrawl, and the next reader must negotiate and navigate the cultural capital of this new author. As such, the doodle constitutes an alternative authority and economy of meaning within the text.Recent studies indicate doodling, often regarded as behavior that announces a person’s boredom and withdrawal, is actually a very special tool to prevent memory loss. Jackie Andrade, an expert from the School of Psychology at the University of Plymouth, maintains that doodling actually “offsets the effects of selective memory blockade,” which yields a surprising result (quoted in “Doodling Gets”). Doodlers exhibit 29% more memory recall than those who passively listen, frozen in an unequal bond with the speaker/lecturer. Students that doodle actually retain more information and are likely more productive due to their active listening. They adeptly absorb information while students who stare patiently or daydream falter.Furthermore, in a 2006 paper, Andrew Kear argues that “doodling is a way in which students, consciously or not, stake a claim of personal agency and challenge some the values inherent in the education system” (2). As a teacher concerned with the engagement of students, he asked for three classes to submit their doodles. Letting them submit any two-dimensional graphic or text made during a class (even if made from body fluid), he soon discovered examples of “acts of resistance” in “student-initiated effort[s] to carve out a sense of place within the educational institution” (6). Not simply an ennui-prone teenager or a proto-surrealist trying to render some automatic writing from the fringes of cognition, a student doodling may represent contested space both in terms of the page itself and the ambience of the environment. The doodle indicates tension, and according to Kear, reflects students reclaiming “their own self-recognized voice” (6).In a widely referenced 1966 article (known as the “doodle” article) intended to describe the paragraph organisational styles of different cultures, Robert Kaplan used five doodles to investigate a writer’s thought patterns, which are rooted in cultural values. Now considered rather problematic by some critics after being adopted by educators for teacher-training materials, Kaplan’s doodles-as-models suggest, “English speakers develop their ideas in a linear, hierarchal fashion and ‘Orientals’ in a non-liner, spiral fashion…” (Severino 45). In turn, when used as pedagogical tools, these graphics, intentionally or not, may lead an “ethnocentric, assimilationist stance” (45). In this case, doodles likely shape the discourse of English as Second Language instruction. Doodles also represent a unique kind of “finger trace,” not unlike prints from the tips of a person’s fingers and snowflakes. Such symbol systems might be used for “a means of lightweight authentication,” according to Christopher Varenhorst of MIT (1). Doodles, he posits, can be used as “passdoodles"–a means by which a program can “quickly identify users.” They are singular expressions that are quirky and hard to duplicate; thus, doodles could serve as substitute methods of verifying people who desire devices that can safeguard their privacy without users having to rely on an ever-increasing number of passwords. Doodles may represent one such key. For many years, psychologists and psychiatrists have used doodles as therapeutic tools in their treatment of children that have endured hardship, ailments, and assault. They may indicate conditions, explain various symptoms and pathologies, and reveal patterns that otherwise may go unnoticed. For instance, doodles may “reflect a specific physical illness and point to family stress, accidents, difficult sibling relationships, and trauma” (Lowe 307). Lowe reports that children who create a doodle featuring their own caricature on the far side of the page, distant from an image of parent figures on the same page, may be experiencing detachment, while the portrayal of a father figure with “jagged teeth” may indicate a menace. What may be difficult to investigate in a doctor’s office conversation or clinical overview may, in fact, be gleaned from “the evaluation of a child’s spontaneous doodle” (307). So, if children are suffering physically or psychologically and unable to express themselves in a fully conscious and articulate way, doodles may reveal their “self-concept” and how they feel about their bodies; therefore, such creative and descriptive inroads are important diagnostic tools (307). Austrian born researcher Erich Guttman and his cohort Walter MacLay both pioneered art therapy in England during the mid-twentieth century. They posited doodles might offer some insight into the condition of schizophrenics. Guttman was intrigued by both the paintings associated with the Surrealist movement and the pioneering, much-debated work of Sigmund Freud too. Although Guttman mostly studied professionally trained artists who suffered from delusions and other conditions, he also collected a variety of art from patients, including those undergoing mescaline therapy, which alters a person’s consciousness. In a stroke of luck, they were able to convince a newspaper editor at the Evening Standard to provide them over 9,000 doodles that were provided by readers for a contest, each coded with the person’s name, age, and occupation. This invaluable data let the academicians compare the work of those hospitalised with the larger population. Their results, released in 1938, contain several key declarations and remain significant contributions to the field. Subsequently, Francis Reitman recounted them in his own book Psychotic Art: Doodles “release the censor of the conscious mind,” allowing a person to “relax, which to creative people was indispensable to production.”No appropriate descriptive terminology could be agreed upon.“Doodles are not communications,” for the meaning is only apparent when analysed individually.Doodles are “self-meaningful.” (37) Doodles, the authors also established, could be divided into this taxonomy: “stereotypy, ornamental details, movements, figures, faces and animals” or those “depicting scenes, medley, and mixtures” (37). The authors also noted that practitioners from the Jungian school of psychology often used “spontaneously produced drawings” that were quite “doodle-like in nature” in their own discussions (37). As a modern folklorist, I venture that doodles offer rich potential for our discipline as well. At this stage, I am offering a series of dictums, especially in regards to doodles that are commonly found adjacent to text in books and magazines, notebooks and journals, that may be expanded upon and investigated further. Doodles allow the reader to repopulate the text with ideogram-like expressions that are highly personalised, even inscrutable, like ambient sounds.Doodles re-purpose the text. The text no longer is unidirectional. The text becomes a point of convergence between writer and reader. The doodling allows for such a conversation, bilateral flow, or “talking back” to the text.Doodles reveal a secret language–informal codes that hearken back to the “lively, spontaneous, and charged with feeling” works of child art or naïve art that Victor Sanua discusses as being replaced in a child’s later years by art that is “stilted, formal, and conforming” (62).Doodling animates blank margins, the dead space of the text adjacent to the script, making such places ripe for spontaneous, fertile, and exploratory markings.Doodling reveals a democratic, participatory ethos. No text is too sacred, no narrative too inviolable. Anything can be reworked by the intimate graffiti of the reader. The authority of the book is not fixed; readers negotiate and form a second intelligence imprinted over the top of the original text, blurring modes of power.Doodles reveal liminal moments. Since the reader in unmonitored, he or she can express thoughts that may be considered marginal or taboo by the next reader. The original subject of the book itself does not restrict the reader. Thus, within the margins of the page, a brief suspension of boundaries and borders, authority and power, occurs. The reader hides in anonymity, free to reroute the meaning of the book. Doodling may convey a reader’s infantalism. Every book can become a picture book. This art can be the route returning a reader to the ambience of childhood.Doodling may constitute Illuminated/Painted Texts in reverse, commemorating the significance of the object in hitherto unexpected forms and revealing the reader’s codex. William Blake adorned his own poems by illuminating the skin/page that held his living verse; common readers may do so too, in naïve, nomadic, and primitive forms. Doodling demarcates tension zones, yielding social-historical insights into eras while offering psychological glimpses and displaying aesthetic values of readers-cum-writers.Doodling reveals margins as inter-zones, replete with psychogeography. While the typography is sanctioned, legitimate, normalised, and official discourse (“chartered” and “manacled,” to hijack lines from William Blake), the margins are a vernacular depository, a terminus, allowing readers a sense of agency and autonomy. The doodled page becomes a visible reminder and signifier: all pages are potentially “contested” spaces. Whereas graffiti often allows a writer to hide anonymously in the light in a city besieged by multiple conflicting texts, doodles allow a reader-cum-writer’s imprint to live in the cocoon of a formerly fossilised text, waiting for the light. Upon being opened, the book, now a chimera, truly breathes. Further exploration and analysis should likely consider several issues. What truly constitutes and shapes the role of agent and reader? Is the reader an agent all the time, or only when offering resistant readings through doodles? How is a doodler’s agency mediated by the author or the format of texts in forms that I have to map? Lastly, if, as I have argued, the ambient space allows potential energies to hover at the edge, ready to illustrate a tension zone and occupy the page, what occurs in the age of digital or e-books? Will these platforms signal an age of acquiescence to manufactured products or signal era of vernacular responses, somehow hitched to html code and PDF file infiltration? Will bytes totally replace type soon in the future, shaping unforeseen actions by doodlers? Attached Figures Figure One presents the intimate graffiti of my grandfather, found in the 1907 edition of his McGuffey’s Eclectic Spelling Book. The depiction is simple, even crude, revealing a figure found on the adjacent page to Lesson 248, “Of Characters Used in Punctuation,” which lists the perfunctory functions of commas, semicolons, periods, and so forth. This doodle may offset the routine, rote, and rather humdrum memorisation of such grammatical tools. The smiling figure may embody and signify joy on an otherwise machine-made bare page, a space where my grandfather illustrated his desires (to lighten a mood, to ease dissatisfaction?). Historians Joe Austin and Michael Willard examine how youth have been historically left without legitimate spaces in which to live out their autonomy outside of adult surveillance. For instance, graffiti often found on walls and trains may reflect a sad reality: young people are pushed to appropriate “nomadic, temporary, abandoned, illegal, or otherwise unwatched spaces within the landscape” (14). Indeed, book graffiti, like the graffiti found on surfaces throughout cities, may offer youth a sense of appropriation, authorship, agency, and autonomy: they take the page of the book, commit their writing or illustration to the page, discover some freedom, and feel temporarily independent even while they are young and disempowered. Figure Two depicts the doodles of experimental filmmaker Jim Fetterley (Animal Charm productions) during his tenure as a student at the Art Institute of Chicago in the early 1990s. His two doodles flank the text of “Lady Lazarus” by Sylvia Plath, regarded by most readers as an autobiographical poem that addresses her own suicide attempts. The story of Lazarus is grounded in the Biblical story of John Lazarus of Bethany, who was resurrected from the dead. The poem also alludes to the Holocaust (“Nazi Lampshades”), the folklore surrounding cats (“And like the cat I have nine times to die”), and impending omens of death (“eye pits “ … “sour breath”). The lower doodle seems to signify a motorised tank-like machine, replete with a furnace or engine compartment on top that bellows smoke. Such ominous images, saturated with potential cartoon-like violence, may link to the World War II references in the poem. Meanwhile, the upper doodle seems to be curiously insect-like, and Fetterley’s name can be found within the illustration, just like Plath’s poem is self-reflexive and addresses her own plight. Most viewers might find the image a bit more lighthearted than the poem, a caricature of something biomorphic and surreal, but not very lethal. Again, perhaps this is a counter-message to the weight of the poem, a way to balance the mood and tone, or it may well represent the larval-like apparition that haunts the very thoughts of Plath in the poem: the impending disease of her mind, as understood by the wary reader. References Austin, Joe, and Michael Willard. “Introduction: Angels of History, Demons of Culture.” Eds. 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Morton, Timothy. “‘Twinkle, Twinkle Little Star’ as an Ambient Poem; a Study of Dialectical Image; with Some Remarks on Coleridge and Wordsworth.” Romantic Circles Praxis Series (2001). 6 Jan. 2009 ‹http://www.rc.umd.edu/praxis/ecology/morton/morton.html›. Potter, Russell A. Spectacular Vernaculars: Hip Hop and the Politics of Postmodernism. Albany: State University of New York, 1995. Read, Allen Walker. Classic American Graffiti: Lexical Evidence from Folk Epigraphy in Western North America. Waukesha, Wisconsin: Maledicta Press, 1997. Reitman, Francis. Psychotic Art. London: Routledge, 1999. Sanua, Victor. “The World of Mystery and Wonder of the Schizophrenic Patient.” International Journal of Social Psychiatry 8 (1961): 62-65. Severino, Carol. “The ‘Doodles’ in Context: Qualifying Claims about Contrastive Rhetoric.” The Writing Center Journal 14.1 (Fall 1993): 44-62. Van Cleave, Claire. Master Drawings of the Italian Rennaissance. Cambridge, Mass.: Harvard UP, 2007. Varenhost, Christopher. Passdoodles: A Lightweight Authentication Method. Research Science Institute. Cambridge, Mass.: Massachusetts Institute of Technology, 2004.