Gerontology, Art, and Activism: Can the Intersection of Art, Social Research, and Community Power Lead to Lasting Change?

This paper seeks to address the question of what gerontologists and humanities scholars can learn from how their respective fields engage with critical issues of age-based intersectional disadvantage, inequality, colonialism, and exclusion. The paper considers the Uncertain Futures Project, a participatory arts-led social research study based in Manchester, United Kingdom. The project explores the inequalities of women over 50 regarding issues of work using an intersectional lens. This work has produced a complex entanglement of methodological ideas that underpin performance art, community activism, and gerontological research. The paper will consider if this model can lead to a lasting impact beyond the scope of the project and beyond the individuals involved. First, we outline the work undertaken from the conception of the project. We consider the relationship between these activities and the ongoing nature of qualitative data analysis within the complexity of academic workloads and competing priorities. We raise questions and considerations of how the elements of the work have connected, collaborated, and intertwined. We also explore the challenges within interdisciplinary and collaborative work. Finally, we address the kind of legacy and impact created by work of this nature.

A comparison of on-site and off-site patent ductus arteriosus ligation in premature infants.

INTRODUCTION: Persistent patent ductus arteriosus (PDA) often produces hemodynamic and respiratory derangement necessitating use of inotropic drugs and escalating ventilatory support in premature infants. When medical therapy fails, surgical ligation is indicated. Because of the risks of transferring unstable neonates to the operating room, ductal ligation is routinely performed at the neonatal intensive care unit (NICU) bedside. Some patients, however, require transfer from hospitals without pediatric cardiac surgical teams. In an attempt to eliminate the risks associated with transfer, a surgical team from our institution offered to perform duct ligation in the NICUs of referring institutions. This experienced team consisted of a pediatric cardiac attending anesthesiologist and certified registered nurse anesthetist, cardiac operating room nurses, an attending cardiothoracic surgeon, and a cardiothoracic surgery fellow. We retrospectively reviewed our experience. METHODS: After approval from the Committee for the Protection of Human Subjects, the charts of premature neonates who underwent PDA ligation in the NICU at the Children's Hospital of Philadelphia NICU or in a network NICU between January 1996 and April 2002 were reviewed. Data abstracted included institution, gender, gestational age, birth weight, weight at surgery, and number of courses of indomethacin. Mean arterial blood pressure and use of inotropic drugs and ventilatory parameters (fraction of inspired oxygen, peak inspiratory pressure) were recorded at the time of surgery and 96 hours postoperatively. Perioperative complications were recorded. RESULTS: Seventy-two patients met the criteria for inclusion. PDA ligation was performed in the Children's Hospital of Philadelphia NICU in 38 of 72 patients, 53% (group 1). The remainder, 34 of 72 (47%) underwent PDA ligation in the NICU at 1 of 6 referring institutions (group 2). There were no significant differences between groups with respect to demographics, number of courses of indomethacin, or use of inotropic drugs or ventilatory support. The incidence of perioperative complications did not differ between groups: 3 in group 1 (bleeding, chylothorax, and pleural effusion) and 3 in group 2 (pneumothorax [3]). There were no anesthetic-related complications. Seven patients died (4 in group 1 and 3 in group 2), none within 96 hours of surgery and none secondary to the procedure. DISCUSSION: The data demonstrate that an experienced team can perform PDA ligation safely in NICUs of hospitals without on-site pediatric cardiac surgical capabilities in critically ill neonates without incurring the risks inherent in patient transport. Most importantly, patient care is continued by the neonatology team most familiar with the infant's medical and social history, and the patient's family is minimally inconvenienced.