Books on the topic 'Injury criterion'
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1
FEDERAL AVIATION ADMINISTRATION. Injury criteria for human exposure to impact. Washington, D.C: U.S. Dept. of Transportation, Federal Aviation Administration, 1985.
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2
Ishii, Kiyoshi. Influence of vehicle deceleration curve on dummy injury criteria. Warrendale, PA: Society of Automotive Engineers, 1988.
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3
Wis.) Workshop on Criteria for Head Injury and Helmet Standards (2005 Milwaukee. Final report of workshop on criteria for head injury and helmet standards. Edited by Fenner Harold. Milwaukee, WI: Dept. of Neurosurgery, Medical College of Wisconsin, 2005.
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4
Ren shen sun hai pei chang fa lü jiu fen chu li yi ju yu jie du: Legal criteria and interpretations on solving personal injury compensation disputes. Beijing Shi: Fa lü chu ban she, 2014.
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5
United States. Office of Aviation Medicine., ed. Dummy and injury criteria for aircraft crashworthiness. Washington, D.C: U.S.Dept. of Transportation, Federal Aviation Administration, Office of Aviation Medicine, 1996.
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6
Sharples, Edward. Acute kidney injury. Edited by Rutger Ploeg. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0127.
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Acute kidney injury (AKI) is a common, major cause of morbidity and mortality in hospitalized patients, and contributes significantly to length of stay and hence costs. Large epidemiological studies consistently demonstrate an incidence of AKI of 5–18% depending on the definition of AKI utilized. Even relatively small changes in renal function are associated with increased mortality, and this has led to strict definition and staging of AKI. Early recognition with good clinical assessment, diagnosis, and management are critical to prevent progression of AKI and reduce the potential complications, including long-term risk of end-stage renal failure. In this chapter, the pathophysiology, causes, and early management of AKI are discussed. Hypovolaemia and sepsis are the most common causes in hospitalized patients, across medical and surgical specialities. Other common causes are discussed, as well as diagnostic criteria.
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Rady, Mohamed Y., and Ari R. Joffe. Non-heart-beating organ donation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0390.
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The transplantation community endorses controlled and uncontrolled non-heart-beating organ donation (NHBD) to increase the supply of transplantable organs at end of life. Cardiac arrest must occur within 1–2 hours after the withdrawal of life-support in controlled NHBD. Uncontrolled NHBD is performed after failed cardiopulmonary resuscitation in an unexpected witnessed cardiac arrest. Donor management aims to protect transplantable organs against warm ischaemic injury through the optimization of haemodynamics and mechanical ventilation. This also requires antemortem instrumentation and systemic anticoagulation for organ perseveration in controlled NHBD. Interval support with extracorporeal membrane oxygenation or cardiopulmonary bypass is generally required for optimal organ perfusion and oxygenation in uncontrolled NHBD, which remains a controversial medical practice. There are several unresolved ethical challenges. The circulatory criterion of 2–10 minutes of absent arterial pulse does not comply with the uniform determination of death criterion of the irreversible cessation of functions of the cardiovascular or central nervous systems. There are no robust safeguards in clinical practice that can prevent faulty prognostication, and premature withdrawal of treatment or termination of cardiopulmonary resuscitation. Unmanaged conflicting interests of increasing the supply of transplantable organs can have serious consequences on the medical care of potentially salvageable patients. Perimortem interventions can interfere with the delivery of an optimal quality of end-of-life care. The lack of disclosure of these NHBD ethical controversies does not uphold the moral obligation for an informed consent.
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Gevaert, Sofie A., Eric Hoste, and John A. Kellum. Acute kidney injury. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0068.
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Acute kidney injury is a serious condition, occurring in up to two-thirds of intensive care unit patients, and 8.8-55% of patients with acute cardiac conditions. Renal replacement therapy is used in about 5-10% of intensive care unit patients. The term cardiorenal syndrome refers to combined heart and kidney failure; three types of acute cardiorenal syndrome have been described: acute cardiorenal syndrome or cardiorenal syndrome type 1, acute renocardiac syndrome or cardiorenal syndrome type 3, and acute cardiorenal syndrome type 5 (cardiac and renal injury secondary to a third entity such as sepsis). Acute kidney injury replaced the previously used term ‘acute renal failure’ and comprises the entire spectrum of the disease, from small changes in function to the requirement of renal replacement therapy. Not only failure, but also minor and less severe decreases, in kidney function are of clinical significance both in the short and long-term. The most recent definition for acute kidney injury is proposed by the Kidney Disease: Improving Global Outcomes clinical practice guidelines workgroup. This definition is a modification of the RIFLE and AKIN definitions and staging criteria, and it stages patients according to changes in the urine output and serum creatinine (see Tables 68.1 and 68.2). Acute kidney injury is a heterogeneous syndrome with different and multiple aetiologies, often with several insults occurring in the same individual. The underlying processes include nephrotoxicity, and neurohormonal, haemodynamic, autoimmune, and inflammatory abnormalities. The most frequent cause for acute kidney injury in intensive cardiac care patients are low cardiac output with an impaired kidney perfusion (cardiogenic shock) and/or a marked increase in venous pressure (acute decompensated heart failure). Predictors for acute kidney injury in these patients include: baseline renal dysfunction, diabetes, anaemia, and hypertension, as well as the administration of high doses of diuretics. In the intensive cardiac care unit, attention must be paid to the prevention of acute kidney injury: monitoring of high-risk patients, prompt resuscitation, maintenance of an adequate mean arterial pressure, cardiac output, and intravascular volume (avoidance of both fluid overload and hypovolaemia), as well as the avoidance or protection against nephrotoxic agents. The treatment of acute kidney injury focuses on the treatment of the underlying aetiology, supportive care, and avoiding further injury from nephrotoxic agents. More specific therapies have not yet demonstrated efficacy. Renal replacement therapy is indicated in life-threatening changes in fluid, electrolyte, and acid-base balance, but there are also arguments for more early initiation.
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Gevaert, Sofie A., Eric Hoste, and John A. Kellum. Acute kidney injury. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0068_update_001.
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Acute kidney injury is a serious condition, occurring in up to two-thirds of intensive care unit patients, and 8.8-55% of patients with acute cardiac conditions. Renal replacement therapy is used in about 5-10% of intensive care unit patients. The term cardiorenal syndrome refers to combined heart and kidney failure; three types of acute cardiorenal syndrome have been described: acute cardiorenal syndrome or cardiorenal syndrome type 1, acute renocardiac syndrome or cardiorenal syndrome type 3, and acute cardiorenal syndrome type 5 (cardiac and renal injury secondary to a third entity such as sepsis). Acute kidney injury replaced the previously used term ‘acute renal failure’ and comprises the entire spectrum of the disease, from small changes in function to the requirement of renal replacement therapy. Not only failure, but also minor and less severe decreases, in kidney function are of clinical significance both in the short and long-term. The most recent definition for acute kidney injury is proposed by the Kidney Disease: Improving Global Outcomes clinical practice guidelines workgroup. This definition is a modification of the RIFLE and AKIN definitions and staging criteria, and it stages patients according to changes in the urine output and serum creatinine (see Tables 68.1 and 68.2). Acute kidney injury is a heterogeneous syndrome with different and multiple aetiologies, often with several insults occurring in the same individual. The underlying processes include nephrotoxicity, and neurohormonal, haemodynamic, autoimmune, and inflammatory abnormalities. The most frequent cause for acute kidney injury in intensive cardiac care patients are low cardiac output with an impaired kidney perfusion (cardiogenic shock) and/or a marked increase in venous pressure (acute decompensated heart failure). Predictors for acute kidney injury in these patients include: baseline renal dysfunction, diabetes, anaemia, and hypertension, as well as the administration of high doses of diuretics. In the intensive cardiac care unit, attention must be paid to the prevention of acute kidney injury: monitoring of high-risk patients, prompt resuscitation, maintenance of an adequate mean arterial pressure, cardiac output, and intravascular volume (avoidance of both fluid overload and hypovolaemia), as well as the avoidance or protection against nephrotoxic agents. The treatment of acute kidney injury focuses on the treatment of the underlying aetiology, supportive care, and avoiding further injury from nephrotoxic agents. More specific therapies have not yet demonstrated efficacy. Renal replacement therapy is indicated in life-threatening changes in fluid, electrolyte, and acid-base balance, but there are also arguments for more early initiation.
10
Lee, Christoph I. Computed Tomography for Minor Head Injury. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190223700.003.0001.
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This chapter, found in the headache section of the book, provides a succinct synopsis of a key study examining the use of computed tomography (CT) scans for minor head injury using the New Orleans criteria. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study showed that head CT scans for patients with minor head injury can be safely limited to those presenting with at least 1 of 7 specific clinical findings. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.
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Van Der Jagt, Mathieu, and Chiara Robba, eds. Crucial Decisions in Severe Traumatic Brain Injury Management: Criteria for Treatment Escalation. Frontiers Media SA, 2021. http://dx.doi.org/10.3389/978-2-88971-603-6.
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Lameire, Norbert, Wim Van Biesen, and Raymond Vanholder. Overall outcomes of acute kidney injury. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0237_update_001.
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This chapter describes the overall short- and long-term, mainly non-renal outcomes of patients who suffer from acute kidney injury (AKI). Despite increasing age and greater burden of co-morbidity at the occurrence of AKI, patient mortality shows an overall decline over time. However, relatively ‘mild’ forms of AKI (i.e. defined as an absolute increase in serum creatinine of at least 0.3 mg/dL (26.4 µmol/L)) are associated with statistically significant decreased patient survival. The absolute mortality rates of AKI vary according to the different patient groups studied (intensive care unit, hospital, and population based), differences in parameters used for the criteria of AKI, differences in acquisition of baseline serum creatinine, differences between need of renal replacement therapy or not, and timing of endpoints (in-hospital mortality, 30 days, 60 days, or longer). In many instances, particularly in critically ill patients, AKI occurs in the setting of other diseases, such as sepsis, which are associated with a significant mortality risk. In such cases, AKI appears to amplify the risk of death associated with the underlying disease.
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Kellum, John A. Diagnosis of oliguria and acute kidney injury. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0212.
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Diagnosis and classification of acute pathology in the kidney is major clinical problem. Azotemia and oliguria represent not only disease, but also normal responses of the kidney to extracellular volume depletion or a decreased renal blood flow. Clinicians routinely make inferences about both the presence of renal dysfunction and its cause. Pure prerenal physiology is unusual in hospitalized patients and its effects are not necessary benign. Sepsismay alter renal function without the characteristic changes in urine indices. The clinical syndrome known as acute tubular necrosis does not actually manifest the histological changes that the name implies. Acute kidney injury (AKI) is a term proposed to encompass the entire spectrum of the syndrome from minor changes in renal function to a requirement for renal replacement therapy. Criteria based on both changes in serum creatinine and urine output represent a broad international consensus for diagnosing and staging AKI.
14
Civil Aviation Authority: Safety Regulation Group. benefit analysis for aircraft 16G dynamic seats configured without enhancements to head injury Criteria. Stationery Office, The, 2005.
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15
Andover, Margaret S., Heather T. Schatten, and Blair W. Morris. Suicidal and Nonsuicidal Self-Injury in Borderline Personality Disorder. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199997510.003.0008.
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Individuals diagnosed with borderline personality disorder (BPD) are at an elevated risk for engaging in self-injurious behaviors, including suicide, attempted suicide, and nonsuicidal self-injury (NSSI). The purpose of this chapter is to provide an overview of research on self-injurious behaviors among individuals with BPD. Definitions and prevalence rates are provided for NSSI, suicide, and attempted suicide. Clinical correlates of and risk factors for the behaviors, as well as associations between specific BPD criteria and self-injurious behaviors, are discussed, and a brief overview of treatments focused on reducing self-injurious behaviors among BPD patients is provided. By understanding risk factors for attempted suicide and NSSI in BPD, we can better identify patients who are at increased risk and focus treatment efforts on addressing modifiable risk factors.
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Wijdicks, Eelco F. M. History of Brain Death. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190662493.003.0001.
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The ability to diagnose brain death is linked to the ability to support catastrophic neurological injury and, thus, linked to the development of critical care. A new comatose state was noted with loss of all brainstem reflexes, absent respiratory drive, and loss of vascular tone leading to progressive hypotension and cardiac arrest. This chapter describes the evolution of thought and refinement of brain death criteria in the United States, from the Harvard criteria in 1968 to the American Academy of Neurology practice guidelines in 2010 and more recent pediatric guidelines.
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Fins, Joseph J., and Barbara Pohl. Neuro-palliative care and disorders of consciousness. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0103.
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Neuro-palliative care is an important resource for patients and families confronting severe brain injury. Although many clinicians equate brain injury with certain death or futility, survivors have substantial needs that might be met by palliative care expertise. This chapter suggests that the boundaries of palliative medicine include those with severe brain injury, most notably those in the minimally conscious state, and that with this nosological expansion practitioners of palliative care reflect carefully on often nihilistic attitudes directed towards patients with disorders of consciousness. This chapter establishes how to better meet the needs of these patients and their surrogates, reviewing definitional criteria for the vegetative and minimally conscious states, highlighting advances in diagnostic and therapeutic interventions (such as neuroimaging, drugs, and deep brain stimulation) and considering what neuroprosthetic devices tell us of the capacity of patients to experience-and functionally communicate-pain, distress, and suffering.
18
Yi liao sun hai pei chang zhi dao an li yu shen pan yi ju: Guiding cases & trial criterions on medical injury compensation. Beijing Shi: Fa lü chu ban she, 2009.
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19
Gong shang ren ding yu pei chang zhi dao an li yu shen pan yi ju: Guiding cases & trial criterions on work injury compensation. Beijing Shi: Fa lü chu ban she, 2009.
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20
Paro, John A. M., and Geoffrey C. Gurtner. Pathophysiology and assessment of burns. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0346.
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Burn injury represents a complex clinical entity with significant associated morbidity and remains the second leading cause of trauma-related death. An understanding of the local and systemic pathophysiology of burns has led to significant improvements in mortality. Thermal insult results in coagulative necrosis of the skin and the depth or degree of injury is classified according to the skin layers involved. First-degree burns involve only epidermis and heal quickly with no scar. Second-degree burns are further classified into superficial partial thickness or deep partial thickness depending on the level of dermal involvement. Damage in a third-degree burn extends to subcutaneous fat. There is a substantial hypermetabolic response to severe burn, resulting in significant catabolism and untoward effects on the immune, gastrointestinal, and renal systems. Accurate assessment of the extent of burn injury is critical for prognosis and initiation of resuscitation. Burn size, measured in total body surface area, can be quickly estimated using the rule of nines or palmar method. A more detailed sizing system is recommended once the patient has been triaged. Appropriate diagnosis of burn depth will be important for later management. First-degree burns are erythematous and painful, like a sunburn; third-degree burns are leathery and insensate. Differentiating between second-degree burn types remains difficult. There are a number of formalized criteria during assessment that should prompt transfer to a burn centre.
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McNee, P., S. Gaba, and E. McNally. Imaging in spinal trauma. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.012037.
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♦ Clinical criteria and the nature of the injury determine who needs imaging♦ Plain films are still commonly employed though CT finds more fractures♦ Alignment, bony contour, cartilage (Disc and facets) and soft tissue are assessed in turn (ABC’S)♦ CT is superior to MRI in assessing the bony configuration of fracture♦ MRI is superior to CT in assessing the ligament tears and associated disc herniations♦ Plain films have little role in the assessment of more chronic back pain and radiculopathy♦ Sacral insufficiency fractures may be misdiagnosed as metastases on MRI.
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Lanctot, Krista, and André Aleman. Apathy. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198841807.001.0001.
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Apathy is characterized by loss of motivation, decreased initiative, and emotional blunting. It is highly prevalent in neurological and psychiatric disorders such as Alzheimer’s disease, traumatic brain injury, schizophrenia, Parkinson’s disease, Huntington’s disease, cerebrovascular disorders, and mild behavioural impairment. It has negative outcomes including impairments in activities of daily living, caregiver burden, and higher rates of institutionalization and mortality. The definition of apathy has changed over the years alongside the development of diagnostic criteria and apathy scales and measurements. Apathy is emerging as a treatment target with interest in pharmacological, non-pharmacological, and neuromodulatory treatments for apathy. There is also an increased understanding of the neurobiology of apathy with functional and structural neuroimaging research studies. This book is a comprehensive, in-depth review from experts in neurology and psychiatry. It examines the current state of apathy in these various disorders while also summarizing apathy diagnostic criteria, scales and measurements, neuropathology, and treatments.
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Banerjee, Ashis, and Clara Oliver. Major trauma. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198786870.003.0004.
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Trauma management is a major presentation in the Royal College of Emergency Medicine (RCEM) curriculum for both adults and children due its associated morbidity and mortality. Trauma management can appear in any aspect of the Fellowship of the Royal College of Emergency Medicine (FRCEM) examination, including the short-answer question (SAQ) paper. This chapter focuses on adult trauma, in accordance with the advanced trauma life support (ATLS) guidelines. It provides information on the different aspects of trauma including that of the chest/abdomen/pelvis, in keeping with ATLS and national guidelines. In addition, this chapter highlights the criteria for imaging and management, which may appear in the SAQ paper. It also has a detailed section on head and spinal injury and is linked to current NICE guidance. Paediatric trauma is not covered in this chapter, however, as it is reviewed in Chapter 19.
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Ritchie, James, Darren Green, Constantina Chrysochou, and Philip A. Kalra. Renal artery stenosis. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0213.
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Renovascular disease refers to a narrowing of a main or branch renal artery. Consequences include loss of functional renal tissue and renovascular hypertension, with other manifestations depending on the underlying cause. Worldwide the most common cause is atherosclerotic narrowing, with other causal pathologies including fibromuscular disease (FMD) and inflammatory conditions. FMD occurs much more frequently in women than in men, and is associated with smoking but genetic predisposing factors are also suspected. In South East Asia, Takayasu arteritis is an important cause.Takayasu disease often presents in a non-specific syndromic manner with fatigue and malaise. FMD often presents with early-onset hypertension. Atherosclerotic renal artery stenosis is often clinically silent with suspicion raised due to the existence of other cardiovascular pathology with the more dramatic presentations of acute decompensated heart failure or acute kidney injury less common. Clinical criteria can identify patients at risk.
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Wijdicks, Eelco F. M. Critics and Brain Death. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190662493.003.0005.
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Matters of life and death—and the physician’s role—invite criticisms and alternate interpretations. Commentaries against the clinical diagnosis of brain death or the concept of brain death have shifted their focus. These range from criticisms of the Harvard Committee (alleging conflict of interest, as shown by the presence of transplant physicians), to clinical examination (alleging injury with the apnea test), to critiques of the total brain necrosis criteria (alleging intact pituitary and hypothalamic function), to critiques on the difficulty of support (alleging long-term support in pregnant “brain-dead” women and children) and, most recently, to critiques on irreversibility (alleging possible recoveries). Philosophical arguments may reach the bedside, which may become consequential. In this chapter, a fair assessment of these criticisms, particularly those regarding determination of brain death, is provided, followed by a rebuttal. Practitioners should be aware of the existing body of literature analyzed herein.
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Sullivan, Maria A. Conclusion. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199392063.003.0012.
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Addiction in older adults very often goes unrecognized, for several reasons: social biases about the elderly, age-related metabolic changes, and the inappropriate use of prescription benzodiazepines and opioids to address untreated anxiety and mood conditions. Alcohol or substance-use disorders (SUDs) in older individuals may present in subtle and atypical ways. Strategies to overcome such difficulties include systematic screening using validated instruments, patient education regarding the impact of psychoactive substances on health, and cautious prescribing practices. Relying on standard DSM criteria may result in a failure to detect an SUD that presents with cognitive symptoms or physical injury, as well as the absence of work or social consequences. Older individuals can benefit from the application of risk-stratification measures, and they can be referred, e.g., to age-appropriate group therapy and non-confrontational individual therapy focusing on late-life issues of loss and sources of social support, as well as be offered medication management for alcohol or substance use disorder. Although research has been limited in this population, treatment outcomes have been found to be superior in older adults than younger adults.
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Eleftheriou, Despina, and Paul A. Brogan. Paediatric vasculitis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0136.
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Systemic vasculitis is characterized by blood vessel inflammation which may lead to tissue injury from vascular stenosis, occlusion, aneurysm, and/or rupture. Apart from relatively common vasculitides such as Henoch-Schönlein purpura (HSP) and Kawasaki's disease (KD), most of the primary vasculitic syndromes are rare in childhood, but are associated with significant morbidity and mortality. New classification criteria for childhood vasculitis have recently been proposed and validated. The cause of most vasculitides is unknown, although it is likely that a complex interaction between environmental factors such as infections and inherited host responses trigger the disease and determine the vasculitis phenotype. Several genetic polymorphisms in vasculitis have now been described that may be relevant in terms of disease predisposition or development of disease complications. Treatment regimens continue to improve, with the use of different immunosuppressive medications and newer therapeutic approaches such as biologic agents. We provide an overview of paediatric vasculitides focusing on HSP, KD, and polyarteritis nodosa (PAN). Key differences (where relevant) between paediatric and adult vasculitis are highlighted. In addition we discuss new emerging challenges particularly in respect to the long-term cardiovascular morbidity for children with systemic vasculitis, and emphasize the importance of future international multicentre collaborative studies to further increase and standardize the scientific base of investigating and treating childhood vasculitis.
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Raines, James C., ed. Evidence-Based Practice in School Mental Health. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780190886578.001.0001.
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Schools have become the default mental health providers for children and adolescents, but they are often poorly equipped to meet the mental health needs of their students. The introduction tackles how to make students eligible for school-based services using the Individuals with Disabilities Education Act or Section 504 of the Rehabilitation Act. Using the new DSM-5 as an organizing principle, this book then addresses the 12 most common mental disorders of childhood and adolescence, ages 3–18. While there are many books that address child and adolescent psychopathology, this book focuses on how to help students with mental disorders in pre-K–12 schools. Each chapter addresses the prevalence of a disorder in school-age populations, appropriate diagnostic criteria, differential diagnosis, comorbid disorders, rapid assessment instruments available, school-based interventions using multitiered systems of support, and easy-to-follow suggestions for progress monitoring. Unique to this book, each chapter has detailed suggestions for how school-based clinicians can collaborate with teachers, parents, and community providers to address the needs of youth with mental health problems so that school, home, and community work together. Each chapter ends with a list of extensive web resources and a real-life case example drawn from the clinical practice of the authors. The final chapter addresses two newly proposed diagnoses for self-harm in the DSM-5 and brings a cautious and sensible approach to assessing and helping students who may be at risk for serious self-injury or suicide.
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Canuel, Mark. The Fate of Progress in British Romanticism. Oxford University Press, 2022. http://dx.doi.org/10.1093/oso/9780192895301.001.0001.
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What did Romantic writers mean when they wrote about “progress” and “perfection”? This book shows how Romantic writers inventively responded to familiar ideas about political progress which they inherited from the eighteenth century. Whereas earlier writers such as Voltaire and John Millar likened improvements in political institutions to the progress of the sciences or refinement of manners, the novelists, poets, and political theorists examined in this book reimagined politically progressive political associations in multiple genres. While embracing a commitment to optimistic improvement—increasing freedom, equality, and protection from injury—they also cultivated increasingly visible and volatile energies of religious and political dissent. Earlier narratives of progress tended not only to edit and fictionalize history but also to agglomerate different modes of knowledge and practice in their quest to describe and prescribe uniform cultural improvement. But Romantic writers seize on internal division and take it less as an occasion for anxiety, exclusion, or erasure, and more as an impetus to rethink the groundwork of progress itself. Political entities, from Percy Shelley’s plans for political reform to Charlotte Smith’s motley associations of strangers in The Banished Man, are progressive because they advance some version of collective utility or common good. But they simultaneously stake a claim to progress only insofar as they paradoxically solicit contending vantage points on the criteria for the very public benefit which they passionately pursue. The “majestic edifices” of Wordsworth’s imagined university in The Prelude embrace members who are “republican or pious,” not to mention the recalcitrant “enthusiast” who is the poet himself.