DT is an established final therapeutic choice in adult patients with severe heart failure who do not meet criteria for cardiac transplantation. Patients are given VADs, without the prospect of care escalation to transplantation. VADs are now established therapy for children and are currently used as a bridge until transplantation can be performed or heart failure improves. For children who present in severe heart failure but do not meet transplantation criteria, the question has emerged whether DT can be offered. This qualitative study aimed to elicit the perspectives of early adopters of DT at one of the few institutions where DT has been provided for children. Responses were recorded and coded and themes extracted using grounded theory. Interviewees discussed: envisioning of the DT candidate; approach to evaluation for DT; contraindications to choosing DT; and concerns about choosing DT. Providers articulated two frameworks for conceptualizing DT: as a long bridge through resolution of problems that would initially contraindicate transplantation or, alternatively, as a true destination instead of transplantation. True destination, however, may not be the lasting concept for long-term VAD use in children given improvement in prognosis for current medical contraindications and improving VAD technology.
This essay details the implications of focusing on the forest as a point of figuration and analysis for a world literature emanating from English-, French-, and Spanish-language work on the Caribbean. Of primary interest are two instances of meta- and paratextual comment on forests in the South: André Breton and André Masson's Martinique: Charmeuse de serpents and Alejo Carpentier's uses of José Martí and Wifredo Lam in his prologue to El reino de este mundo. Though Carpentier is known for his rejection of Breton and Masson's surreal forest for Lam's visual representation of the marvelous in the Caribbean selva, Ikoku suggests that Breton, Masson, and Carpentier were each committed to a territorialization of the Antilles, and as alternatives, he offers Lam's translation of Aimé Césaire and Edouard Glissant's explorations of William Faulkner—both attempts to deterritorialize an oeuvre known for its grounded, rooted character, and thus important approaches for landscaping a global South and, by extension, a contemporary world literature.
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