Botho Strauss's (1993) attempts to resurrect a premodern approach to German culture centered on themes such as the sacred & myth is defended against those who see it as a resurgence of Nazi themes. This attempt to reintroduce the power of a traditional religion-based culture is based on three claims about culture: (1) A crisis of values is inevitable for a society organized around economic prosperity. (2) Tradition-based authority is essential for the building of individuals. (3) Violence against scapegoats is necessary for the maintenance of social order. The idea of the sacred & its relation to myth, imagination, & the sublime are made central to political organization. On all these issues, Strauss is invoked as an alternative to the standard liberal positions derived from Immanuel Kant. Strauss is criticized for privileging German language over concrete interpersonal relations, which serves to render his notions of sacred & community into a contrived nationalism that removes art from the everyday. A reading of Strauss's works provides an example of how myth can provide meaning to recent German history. H. von Rautenfeld

Peculiarity Franz Kafka's "In the Penal Colony " has almost always been read as the description of a barbaric machine of torture. Yet the first sentence of the story, "It's a peculiar kind of apparatus,"1 uttered by the officer, does not direct attention to the apparatus itself but to its peculiarity. For the voyager who listens to the officer describing the apparatus, the latter is certainly peculiar as an instrument of torture and execution, but it is also peculiar for the officer in the sense that it belongs to a particular culture which has created it and supported its functioning. The peculiarity extends beyond the machine to the notion of justice of which the apparatus is an integral part. The story contraposes the two notions of peculiarity in order to stage a conflict between two cultures, one represented by the liberal, humanitarian voyager and the other embodied in the traditional justice of the officer. From the viewpoint of liberal humanitarianism, the apparatus is peculiar because of its barbarism and must be eradicated. But from the perspective of a community in which traditions are still alive, the apparatus' peculiarity lies in the fact that it is part of a cultural system "peculiar to" a specific community. The story thus presents two modes of justice opposed to each other in the struggle to determine the fate of the apparatus.

Background

Atrial fibrillation (AF) adversely impacts health-related quality of life (hrQoL). While some patients demonstrate improvements in hrQoL, the factors associated with large improvements in hrQoL are not well described.

Methods

We assessed factors associated with a 1-year increase in the Atrial Fibrillation Effect on Quality-of-Life score of 1 SD (≥18 points; 3× clinically important difference), among outpatients in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation I registry.

Results

Overall, 28% (181/636) of patients had such a hrQoL improvement. Compared with patients not showing large hrQoL improvement, they were of similar age (median 73 versus 74, P=0.3), equally likely to be female (44% versus 48%, P=0.3), but more likely to have newly diagnosed AF at baseline (18% versus 8%; P=0.0004), prior antiarrhythmic drug use (52% versus 40%, P=0.005), baseline antiarrhythmic drug use (34.8% versus 26.8%, P=0.045), and more likely to undergo AF-related procedures during follow-up (AF ablation: 6.6% versus 2.0%, P=0.003; cardioversion: 12.2% versus 5.9%, P=0.008). In multivariable analysis, a history of alcohol abuse (adjusted OR, 2.41; P=0.01) and increased baseline diastolic blood pressure (adjusted OR, 1.23 per 10-point increase and >65 mm Hg; P=0.04) were associated with large improvements in hrQoL at 1 year, whereas patients with prior stroke/transient ischemic attack, chronic obstructive pulmonary disease, and peripheral arterial disease were less likely to improve (P<0.05 for each).

Conclusions

In this national registry of patients with AF, potentially treatable AF risk factors are associated with large hrQoL improvement, whereas less reversible conditions appeared negatively associated with hrQoL improvement. Understanding which patients are most likely to have large hrQoL improvement may facilitate targeting interventions for high-value care that optimizes patient-reported outcomes in AF. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01165710.