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BACKGROUND: In patients with aneurysmal subarachnoid haemorrhage, short-term antifibrinolytic therapy with tranexamic acid has been shown to reduce the risk of rebleeding. However, whether this treatment improves clinical outcome is unclear. We investigated whether ultra-early, short-term treatment with tranexamic acid improves clinical outcome at 6 months.METHODS: In this multicentre prospective, randomised, controlled, open-label trial with masked outcome assessment, adult patients with spontaneous CT-proven subarachnoid haemorrhage in eight treatment centres and 16 referring hospitals in the Netherlands were randomly assigned to treatment with tranexamic acid in addition to care as usual (tranexamic acid group) or care as usual only (control group). Tranexamic acid was started immediately after diagnosis in the presenting hospital (1 g bolus, followed by continuous infusion of 1 g every 8 h, terminated immediately before aneurysm treatment, or 24 h after start of the medication, whichever came first). The primary endpoint was clinical outcome at 6 months, assessed by the modified Rankin Scale, dichotomised into a good (0-3) or poor (4-6) clinical outcome. Both primary and safety analyses were according to intention to treat. This trial is registered at ClinicalTrials.gov, NCT02684812.FINDINGS: Between July 24, 2013, and July 29, 2019, we enrolled 955 patients; 480 patients were randomly assigned to tranexamic acid and 475 patients to the control group. In the intention-to-treat analysis, good clinical outcome was observed in 287 (60%) of 475 patients in the tranexamic acid group, and 300 (64%) of 470 patients in the control group (treatment centre adjusted odds ratio 0·86, 95% CI 0·66-1·12). Rebleeding after randomisation and before aneurysm treatment occurred in 49 (10%) patients in the tranexamic acid and in 66 (14%) patients in the control group (odds ratio 0·71, 95% CI 0·48-1·04). Other serious adverse events were comparable between groups.INTERPRETATION: In patients with CT-proven subarachnoid haemorrhage, presumably caused by a ruptured aneurysm, ultra-early, short-term tranexamic acid treatment did not improve clinical outcome at 6 months, as measured by the modified Rankin Scale.FUNDING: Fonds NutsOhra.

Veil 1954 and Carbon Dad 2017, two new works from South African artist Paul Emmanuel's most recent exhibition Substance of Shadows (2021), are examined as depicting rites of passage of memory and mourning, following the recent loss of both Emmanuel's parents. They are discussed in dialogue with the five untitled incised drawings from Emmanuel's 2008 Transitions exhibition, which addressed significant male rites of passage that were also liminal moments in male lives. In rites of passage, the citations, quotations and traces that form a subject's socially constituted body are undone and rearranged. Transitions (5), however, represents the quotidian liminality of commuting and while it is fruitfully interpreted as a metaphor for death, a deeper exploration of this particular rite of passage is held over, this article argues, until Veil 1954 and Carbon Dad 2017. These two works are therefore examined as a continuation of the works of Transitions. Crucially, however, it is proposed that Emmanuel's principal memory engagement in these two works is enacted materially, through his medium of obsolete carbon paper, rather than the exposed photographic paper of Transitions. The ways in which Emmanuel works with carbon paper allows a sensitive embodied exploration of aging and frailty to emerge.

Background and ObjectivesThe ULTRA trial showed that ultra-early and short-term tranexamic acid treatment after subarachnoid hemorrhage did not improve clinical outcome at 6 months. An expected proportion of the included patients experienced nonaneurysmal subarachnoid hemorrhage. In this post hoc study, we will investigate whether ultra-early and short-term tranexamic acid treatment in patients with aneurysmal subarachnoid hemorrhage improves clinical outcome at 6 months.MethodsThe ULTRA trial is a multicenter, prospective, randomized, controlled, open-label trial with blinded outcome assessment, conducted between July 24, 2013, and January 20, 2020. After confirmation of subarachnoid hemorrhage on noncontrast CT, patients were allocated to either ultra-early and short-term tranexamic acid treatment with usual care or usual care only. In this post hoc analysis, we included all ULTRA participants with a confirmed aneurysm on CT angiography and/or digital subtraction angiography. The primary endpoint was clinical outcome at 6 months, assessed by the modified Rankin scale (mRS), dichotomized into good (0–3) and poor (4–6) outcomes.ResultsOf the 813 ULTRA trial patients who experienced an aneurysmal subarachnoid hemorrhage, 409 (50%) were assigned to the tranexamic acid group and 404 (50%) to the control group. In the intention-to-treat analysis, 233 of 405 (58%) patients in the tranexamic acid group and 238 of 399 (60%) patients in the control group had a good clinical outcome (adjusted odds ratio [aOR] 0.92; 95% CI 0.69–1.24). None of the secondary outcomes showed significant differences between the treatment groups: excellent clinical outcome (mRS 0–2) (aOR 0.76; 95% CI 0.57–1.03), all-cause mortality at 30 days (aOR 0.91; 95% CI 0.65–1.28), and all-cause mortality at 6 months (aOR 1.10; 95% CI 0.80–1.52).DiscussionUltra-early and short-term tranexamic acid treatment did not improve clinical outcomes at 6 months in patients with aneurysmal subarachnoid hemorrhage and therefore cannot be recommended.Trial Registration InformationClinicalTrials.gov(NCT02684812; submission date February 18, 2016, first patient enrollment on July 24, 2013).Classification of EvidenceThis study provides Class II evidence that tranexamic acid does not improve outcomes in patients presenting with aneurysmal subarachnoid hemorrhage.

Ilené Bothma knits with nylon stockings, stitches with human hair, and performs interventional actions with household furniture. Many of her canvases are vintage handkerchiefs and stockings. The body - specifically female and maternal bodies - is everywhere signalled, but seldom present. The artist also produces meticulously detailed, naturalistic paintings of her own and others' knitting, embroidery and crochet. Her delicate patterning with hair and her paintings of fabric soiled by bodily fluids provide a reflective tension within her work that speaks to how narratives of gendered roles and identities are written into representation. What the artist calls her 'deliberately bad knitting' is central here (Bothma 2020b). Bothma also creates a narrative for the work itself, encouraging possibilities for the interpretation of creative labour. As Valerie Mainz and Griselda Pollock (2000:3) put it, 'attention [is] given here to the work process by which an image is itself produced'. What emerges is a foregrounding of women's ambivalence.

Tamara Kostianovsky creates three-dimensional sculptural forms with repurposed clothing, fabric and needlework. It is argued that these sculpted textiles become meditations on flesh. Her works that depict carcasses and body parts, in particular, explore the paradoxes of embodiment in order to speak to issues of gender, trauma, and migration. In this article, the author describes a number of ways in which Kostianovsky has parodied canonical works of fine art by Manet, Goya, and Botticelli as well as the eroticized anatomical illustrations of Gautier. The five works on which she focuses here metabolize their diverse quotations such that they engage with restrictive tropes and conventions that operate in representations of female bodies and subjectivities. Sculpted clothing reads as flesh, flesh as meat, and meat as a symbol for conscious embodiment and a vulnerable and violated mortality. They thus become a parody of the dualistic moralism of the memento mori, as well as the phallocentric hypocrisy ...

In “Massa” and Mina(h) (2008), Zanele Muholi engages with the alterity of the South African domestic-worker figure by creating a narrative that employs libidinised energy to both transform and rigi...

Nomsa Dhlamini is variously a Swazi-born nonagenarian, performance artist Steven Cohen's frequent collaborator and ‘muse’, his childhood ‘nanny’ and his family's former domestic worker. Cradle of Humankind (2012) is the most recent of Steven Cohen's performances with Dhlamini, where, in four parts, the two characters walk (slowly) and talk (inaudibly) through a series of choreographed tableaux vivants that relate Cohen's story of human evolution, innovation and exploitation through and with a person with whom he demonstrably has a deeply emotional and surrogate maternal relationship. I focus in this article on the presence and participation of Dhlamini in a number of Cohen's other performances, and suggest how Cohen extends what may be called his self-othered representational strategies, which I demonstrate as being consistent in his performance work, to accentuate the fetishism of the figure of a black domestic worker and ‘nanny’. Drawing on Mulvey's discussion of cultural, scopic fetishes, I sug...

Paul Emmanuel's early prints and incised drawings represent the human body as a presence that either is not easily seen, actively disappears or erases itself, or is entirely absent. In doing so, th...

This article discusses how the four figures in Jane Alexander's sculptural installation Pastoral Scene (1995) - the "domestic worker", the nursing "Black Madonna", the "white widow" and the lactating wild dog - may be seen to subvert the colonial role that domestic workers perform within the suburban home and landscape. The article delves with more sustained attention than has hitherto been given into some of the visual histories in relation to this tableau, specifically a colonial- and apartheid-era pastoralism that framed landscape conventions and servant portraiture. The article discusses how black African women, when represented as servants in landscapes, function to delineate a space that may be determined by a Europeanised artistic sensibility. Alexander's tableau subverts these anxieties, and the obfuscation of labour and presence that results, by centering the segregation, migration, urbanisation and disconnection that frequently arises out of South Africa's socio-political realities. Returning to this work, produced during the formative time of South Africa's sociopolitical transition in the 1990s, allows for the examination of Alexander's characteristically riddling allegories but also of her allusive, wide-reaching method of enquiry into a subject - paid domestic labour - that remains woven, frequently in the most challenging and complex ways, into the national psyche and way of life.