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Like every other continent in the world, Antarctica has been affected by the COVID-19 pandemic, in an imagined as well as a practical sense. Antarctica is a mediated experience; that is, most of us experience the place through films, novels, music, visual arts and the media. We present an analysis of media articles from eight countries over three time periods - pre-COVID-19 outbreak (October–December 2019), shortly after the pandemic hit the headlines (March–May 2020) and when the virus was established (October–December 2020) - to discover how COVID-19 may have changed Antarctic discourse. Our study shows that representations of Antarctica have been affected by the pandemic, in some instances reinforcing existing ideas and in other cases bringing new ideas to the fore. Based on our findings, we believe that COVID-19 has begun to change representations of Antarctica, stepping us away from the prevailing Antarctic hero narrative and providing a more contemporary understanding of the Antarctic experience. We argue that this may increase our motivation to engage with Antarctic issues, with associated implications for future global stewardship of the region.

Background Total knee replacement (TKR) is clinically and cost-effective. The surgical approach employed influences the outcome, however there is little generalisable and robust evidence to guide practice. We compared outcomes between the common primary TKR surgical approaches. Methods 875,166 primary TKRs captured in the National Joint Registry, linked to hospital inpatient, mortality and patient reported outcome measures (PROMs) data, with up to 15.75 years follow-up were analysed. There were 10 surgical approach groups: medial parapatellar, midvastus, subvastus, lateral parapatellar, ‘other’ and their minimally invasive versions. Survival methods were used to compare revision rates and 45-day mortality. Groups were compared using Cox proportional hazards regression and Flexible Parametric Survival Modelling (FPM). Confounders included age at surgery, sex, risk group (indications additional to osteoarthritis), American Society of Anesthesiologists grade, TKR fixation, year of primary, body mass index, and for mortality, deprivation and Charlson comorbidity subgroups. PROMs were analysed with regression modelling or non-parametric methods. Results The conventional midvastus approach was associated with lower revision rates (Hazard Rate Ratio (HRR) 0.80 (95% CI 0.71–0.91) P = 0.001) and the lateral parapatellar with higher revision rates (HRR 1.35 (95% CI 1.12–1.63) P = 0.002) compared to the conventional medial parapatellar approach. Mortality rates were similar between approaches. PROMs showed statistically significant, but not clinically important, differences. Conclusions There is little difference in PROMs between the various surgical approaches in TKR with all resulting in good outcomes. However, the conventional midvastus approach (used in 3% of cases) was associated with a 20% reduced risk of revision surgery compared to the most commonly used knee approach (the conventional medial parapatellar: used in 91.9% of cases). This data supports the use of the midvastus approach and thus surgeons should consider utilising this approach more frequently. Minimally invasive approaches did not appear to convey any clinical advantage in this study over conventional approaches for primary TKR.

Background: Current guidance on pre-operative fasting for clear fluids to reduce aspiration risk may result in unnecessary dehydration and more liberal fluid regimes are being advocated. Methods: This randomised single blinded crossover study used an established ultrasound protocol to measure the gastric volume of 15 healthy volunteers following the 2011 European Society of Anaesthesia (ESA) ‘Perioperative Fasting in Adults and Children’ guidelines (nil-by-mouth two hours before induction of anaesthesia) and the 2005 Scandinavian guidelines (150 mL water with medication up to 1 hour before induction of anaesthesia). Results: We observed that gastric volumes increased following ingestion of water in all individuals compared to their fasted states. Water left the stomach within 30 minutes following ingestion in ten individuals, and within an hour in three individuals (gastric volume − 1). A reduction in thirst was observed in the group allowed to drink water, whereas hunger and anxiety scores were unaffected.

BACKGROUND: The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) has monitored the performance of consultant surgeons performing primary total hip (THR) or knee replacements (KR) since 2007. The aims of this study were: 1) To describe the surgical practice of consultant hip and knee replacement surgeons in the National Joint Registry for England and Wales (NJR), stratified by potential outlier status for revisions. 2) To compare the practice of revision outlier and non-outlier surgeons.METHODS: We combined NJR primary THR and KR data from 2008-2017 separately with relevant anonymised NJR outlier notification records. We described the surgical practice of outliers and non-outliers by surgical workload, implant choice, and patients' clinical and demographic characteristics. We explored associations between surgeon-level factors and outlier status with conditional logistic regression models.RESULTS: We included 764,888 primary THRs by 3213 surgeons and 889,954 primary KRs by 3084 surgeons performed between 2008-2017. One hundred and eleven (3.5%) THR and 114 (3.7%) KR consultant surgeons were potential revision outliers. Surgeons who used more types of implant had increased odds of being an outlier (KR: OR/additional implant = 1.35, 95%CI 1.17-1.55; THR: OR = 1.12, 95%CI 1.06-1.18).CONCLUSIONS: The use of more types of implant is associated with increased risk of being a potential revision outlier. Further research is required to understand why surgeons use many different implants and to what extent this is responsible for the effects observed here.

Background The eosin-5′-maleimide (EMA) Binding test measures reduced mean channel fluorescence (MCF) reading of EMA-labeled red cells (EMA-RBCs) from patients with hereditary spherocytosis (HS). Reporting test results can be either in the actual MCF reading or as a ratio by normalization of the test MCF result to the mean MCF value of six normal controls. The latter format has potential for universal reporting. Methods We analyzed three years' archival MCF data from HS and non-HS patient groups for establishment of reference ranges of ratios for normal adults and HS. A prospective study used FC500 and FACS Canto II cytometers to analyze contemporaneously EMA-RBCs from several patient groups and normal donors. Statistical analyses of the prospective data determined the cut-off values, and the sensitivity and specificity for HS respectively for the MCF and the ratio result presentations. The effect of using fewer than six normal controls for the ratio denominator was explored. Results The FC500 gave a mean ratio of 0.782 (SD = 0.086) in HS patients with an optimal cut-off ratio of 0.918 (98.7% specificity, 95.6% sensitivity), and gray area ratio of 0.868–0.918. The Canto II gave a mean ratio of 0.774 (SD = 0.085) with an optimal cut-off ratio of 0.925 (97.1% specificity and 100% sensitivity), and gray area ratio of 0.859–0.925. Conclusion Harmonization of result presentation is feasible with no apparent constraint by instrument design. Interpretation of gray-area data requires an assessment of patient's clinical presentation and family history or performing a family study. © 2014 International Clinical Cytometry Society

[1] We present a new approach to constrain and validate atomic oxygen (O) concentrations in the mesopause region (~ 80 to ~ 100 km). In a prior companion paper [Mlynczak et al., 2013], we presented O-atom concentrations in the mesopause region inferred from measurements of day ozone and night hydroxyl emission rates made by the Sounding of the Atmosphere using Broadband Emission Radiometry (SABER) instrument. The approach presented here uses the constraint of global, annual mean energy balance to derive atomic oxygen concentrations, consistent with rates of radiative cooling by carbon dioxide (CO2) and solar heating due to molecular oxygen (O2). The mathematical difference between these cooling and heating rates, on a global annual mean basis, effectively constrains the maximum heating rate for the sum of all other processes. The remaining terms, solar heating due to ozone plus a series of exothermic chemical reactions can be expressed as functions of O. This new approach enables a simple mathematical expression that yields the vertical profile of global annual mean “radiatively constrained” atomic oxygen in the mesopause region. The radiatively constrained atomic oxygen depends only on the CO2 cooling rates, O2 solar heating rates, and standard reaction rate coefficients and enthalpies. Radiative cooling and solar heating rates used in these analyses are derived from measurements made by the SABER instrument on the NASA Thermosphere Ionosphere Mesosphere Energetics and Dynamics satellite. There is excellent agreement between the SABER radiatively constrained atomic oxygen and that derived from the SABER ozone and OH emission measurements over most of the mesopause region. Radiatively constrained atomic oxygen represents an upper limit on the global average O-atom concentration in the mesopause region.

As recently as the 2011 National Hockey League (NHL) season, all but two NHL goaltenders used wood goalie sticks, even while the trend among players was almost unanimous carbon fiber stick usage. The reason for this trend is because the goalies do not like the vibration felt by composite sticks because there is a lot of sting in the carbon fiber sticks. The design and implementation of vibration absorbers have been successful in baseball bats and field hockey sticks. Experimental Modal Analysis (EMA) was conducted on a number of wood and composite sticks to identify the mode shapes and frequencies that are responsible for sting. Using a background in structural vibrations, a vibration absorber was designed to eliminate the undesirable frequencies in composite goalie sticks to improve feel for goalies. Design and validation was conducted using a series of damping tests as well as EMA to develop the vibration absorber. Before and after results were compared to see the effect of the vibration absorber.

Background The morphology, motor responses and spatiotemporal organization among colonic propagating sequences (PS) have never been defined throughout the entire colon of patients with slow transit constipation (STC). Utilizing the technique of spatiotemporal mapping, we aimed to demonstrate ‘manometric signatures’ that may serve as biomarkers of the disorder. Methods In 14 female patients with scintigraphically confirmed STC, and eight healthy female controls, a silicone catheter with 16 recording sites spanning the colon at 7.5 cm intervals was positioned colonoscopically with the tip clipped to the cecum. Intraluminal pressures were recorded for 24 h. Key Results Pan-colonic, 24 h, spatiotemporal mapping identified for the first time in STC patients: a marked paucity of propagating pressure waves in the mid-colon (P = 0.01), as a consequence of a significant (P

Diversity has become an increasingly important issue in the business world as multi-cultural working environments become commonplace. Businesses, operating in today’s global environment, require the ability to leverage diversity by utilizing knowledge and experiences from different groups of workers. A number of benefits are realized by organizations that embrace diversity. As business realizes diversity as a significant factor for organizational competitiveness, demand is created for professionals prepared to think critically about multifaceted diversity issues in the workplace. While the benefits of diversity in society are well established, business schools have not always actively incorporated elements of diversity into their curriculums. In this paper we conduct a survey of twenty-eight universities in Southern California. Our survey results indicate that a large portion of business schools do not incorporate diversity into their curriculum. We provide recommendations for how business schools might effectively incorporate diversity into their curriculum.

Sacral nerve stimulation (SNS) is a potential treatment for constipation refractory to standard therapies. However, there have been no randomized controlled studies examining its efficacy. In patients with slow transit constipation, we evaluated the efficacy of suprasensory and subsensory SNS compared with sham, in a prospective, 18-week randomized, double-blind, placebo-controlled, two-phase crossover study. The primary outcome measure was the proportion of patients who, on more than 2 days/week for at least 2 of 3 weeks, reported a bowel movement associated with a feeling of complete evacuation.After 3 weeks of temporary peripheral nerve evaluation (PNE), all patients had permanent implantation and were randomized to subsensory/sham (3 weeks each) and then re-randomized to suprasensory/sham (3 weeks each) with a 2-week washout period between each arm. Daily stool dairies were kept, and quality of life (QoL; SF36) was measured at the end of each arm.Between November 2006 and March 2012, 234 constipated patients were assessed, of whom 59 were willing and deemed eligible to participate (4 male; median age 42 years). Of the 59 patients, 16 (28%) responded to PNE. Fifty-five patients went on to permanent SNS implantation. The proportion of patients satisfying the primary outcome measure did not differ between suprasensory (30%) and sham (21%) stimulations, nor between subsensory (25%) and sham (25%) stimulations. There were no significant changes in QoL scores.In patients with refractory slow transit constipation, SNS did not improve the frequency of complete bowel movements over the 3-week active period.

IN 1861 AMY LEVY was born into a middle-class Anglo-Jewish family with deep roots in England, and was part of the first generation of women at Cambridge University. Her life was marked by the opportunities and predicaments of Anglo-Jews at a pivotal moment in their history. Receiving full political rights in 1858, two years before Levy was born, England’s Jews attained positions of status in the late-Victorian period and became integrated into the fabric of British society. Todd Endelman, however, like other commentators on Anglo-Jewry in this period, gives the British a mixed evaluation on their treatment of the Jews. Tolerant in many ways, England was “hostile to the notion of cultural diversity. Circles and institutions quite willing to tolerate Jews as intimate associates were not willing to endorse the perpetuation of a separate Jewish culture or to see any value in the customs or beliefs of the Jewish religion” (209).

The eosin-5'-maleimide (EMA) Binding test measures reduced mean channel fluorescence (MCF) reading of EMA-labeled red cells (EMA-RBCs) from patients with hereditary spherocytosis (HS). Reporting test results can be either in the actual MCF reading or as a ratio by normalization of the test MCF result to the mean MCF value of six normal controls. The latter format has potential for universal reporting.We analyzed three years' archival MCF data from HS and non-HS patient groups for establishment of reference ranges of ratios for normal adults and HS. A prospective study used FC500 and FACS Canto II cytometers to analyze contemporaneously EMA-RBCs from several patient groups and normal donors. Statistical analyses of the prospective data determined the cut-off values, and the sensitivity and specificity for HS respectively for the MCF and the ratio result presentations. The effect of using fewer than six normal controls for the ratio denominator was explored.The FC500 gave a mean ratio of 0.782 (SD=0.086) in HS patients with an optimal cut-off ratio of 0.918 (98.7% specificity, 95.6% sensitivity), and gray area ratio of 0.868-0.918. The Canto II gave a mean ratio of 0.774 (SD=0.085) with an optimal cut-off ratio of 0.925 (97.1% specificity and 100% sensitivity), and gray area ratio of 0.859-0.925.Harmonization of result presentation is feasible with no apparent constraint by instrument design. Interpretation of gray-area data requires an assessment of patient's clinical presentation and family history or performing a family study.

Few past studies discuss the subject of bullying by students with their teachers as targets. Examining preventative measures to gain a more thorough understanding of the complex, behavioral issue needs to be addressed. As a starting point the purpose of this study is to examine the scope of the problem as well as the various preventative initiatives with an added focus on clear rules, classroom management and consequences along with application while proposing that higher education be the educational sector that takes the leadership role in a community approach to diminish the problematic behavioral issue of teacher’s being bullied by students.

Previous studies discuss the subject of whistleblowing by women and the consequences of retaliation. However an examination of the past and current research is needed to gain a more thorough understanding of this complex issue and how the women are viewed, and how the topic is evolving. As a starting point the purpose is to examine whistleblowing with a focus on women’s roles as well as the various legislation initiatives and global progress toward minimizing retaliation. The author investigates prior research in the areas of women whistle blowers, and adds current whistleblowers of note. This research review and derived information to encourage change will prove interesting in contributing further material for those embroiled in this issue. This work contributes to the existing literature by adding further insight into the areas of anti-retaliation progress and how society views women whistleblowers. Furthermore it evidences that women continue to demonstrate courage in standing up for ethics in the workplace in spite of persistent retaliation.

Background Sacral nerve stimulation (SNS) is emerging as a potential treatment for patients with constipation. Although SNS can elicit an increase in colonic propagating sequences (PSs), the optimal stimulus parameters for this response remain unknown. This study evaluated the colonic motor response to subsensory and suprasensory SNS in patients with slow-transit constipation. Methods Patients with confirmed slow-transit constipation were studied. Either a water-perfused manometry catheter or a high-resolution fibre-optic manometry catheter was positioned colonoscopically to the caecum. A temporary electrode was implanted transcutaneously in the S3 sacral nerve foramen. In the fasted state, three conditions were evaluated in a double-blind randomized fashion: sham, subsensory and suprasensory stimulation. Each 2-h treatment period was preceded by a 2-h basal period. The delta (Δ) value was calculated as the frequency of the event during stimulation minus that during the basal period. Results Nine patients had readings taken with a water-perfused catheter and six with a fibre-optic catheter. Compared with sham stimulation, suprasensory stimulation caused a significant increase in the frequency of PSs (mean(s.d.) Δ value − 1·1(7·2) versus 6·1(4·0) PSs per 2 h; P = 0·004). No motor response was recorded in response to subsensory stimulation compared with sham stimulation. Compared with subsensory stimulation, stimulation at suprasensory levels caused a significant increase in the frequency of PSs (P = 0·006). Conclusion In patients with slow-transit constipation, suprasensory SNS increased the frequency of colonic PSs, whereas subsensory SNS stimulation did not. This has implications for the design of therapeutic trials and the clinical application of the device.

Background Constipation severity is often defined by symptoms including feelings of complete evacuation, straining, stool frequency and consistency. These descriptors are mostly obtained in the absence of laxative use. For many constipated patients laxative usage is ubiquitous and long standing. Our aim was to determine the impact of laxative use upon the stereotypic constipation descriptors. Methods Patients with confirmed slow transit constipation completed 3-week stool diaries, detailing stool frequency and form, straining, laxative use and pain and bloating scores. Each diary day was classified as being under laxative affect (laxative affected days) or not (laxative unaffected days). Unconditional logistic regression was used to assess the affects of laxatives on constipation symptoms. Results Ninety four patients with scintigraphically confirmed slow transit constipation were enrolled in the study. These patients reported a stool frequency of 5.6 ± 4.3 bowel motions/week, only 21 patients reported P P Conclusions The reporting of frequent and loose stools with abdominal pain and/or bloating is common in patients with slow transit constipation. While laxative use is a significant contributor to altering stool frequency and form, laxatives have no apparent affect on pain or bloating or upon a patients feeling of complete evacuation. These factors need to be taken into account when using constipation symptoms to define this population.

To outline the etiology, clinical course, short-term survival to discharge and neurological outcome of infants (1 yr) with new cardiac diagnoses presenting to a pediatric intensive care (PICU) unit with acute cardiac compromise.Retrospective search of a computerized database and medical case notes for all acute cardiac admissions to PICU from June 2001 to 2006. Pre-existing hospital-based patients with new cardiac diagnoses were excluded.Seventy patients were identified, 38 (54%) of whom were male. There were six main subgroups: obstructive left heart lesions (n= 20), transposition of the great arteries (TGA) (n= 9), total anomalous pulmonary venous drainage (TAPVD) (n= 7), dilated cardiomyopathy (n= 11), arrhythmia (n= 12), and others (n= 11). Fifty-nine patients (84%) were external referrals to our center. The median age at presentation was 13.5 days (0-272) with median duration of symptoms of 1 day (0-21). The median base deficit at presentation was -7.6 mEq/L (-43 to +4.2). Fifty-three patients (76%) required respiratory support with a median duration of ventilation of 4 days (1-49). Fifty-six patients (80%) required inotropic support. The median PICU stay was 7 days (1-64) with a median total hospital stay of 16 days (1-71). Six patients (9%) died prior to discharge. Of the survivors 7 (11%) had seizure activity or evolving clinical neurological abnormalities.Cardiovascular compromise due to previously unrecognized congenital or acquired heart disease is associated with clinically significant morbidity and mortality. Longer term follow-up is required to evaluate the initial effect of poor cardiac output and hypoxia on long-term neurodevelopmental outcome.

To determine whether distinct symptom groupings exist in a constipated population and whether such grouping might correlate with quantifiable pathophysiological measures of colonic dysfunction.One hundred and ninety-one patients presenting to a Gastroenterology clinic with constipation and 32 constipated patients responding to a newspaper advertisement completed a 53-item, wide-ranging self-report questionnaire. One hundred of these patients had colonic transit measured scintigraphically. Factor analysis determined whether constipation-related symptoms grouped into distinct aspects of symptomatology. Cluster analysis was used to determine whether individual patients naturally group into distinct subtypes.Cluster analysis yielded a 4 cluster solution with the presence or absence of pain and laxative unresponsiveness providing the main descriptors. Amongst all clusters there was a considerable proportion of patients with demonstrable delayed colon transit, irritable bowel syndrome positive criteria and regular stool frequency. The majority of patients with these characteristics also reported regular laxative use.Factor analysis identified four constipation subgroups, based on severity and laxative unresponsiveness, in a constipated population. However, clear stratification into clinically identifiable groups remains imprecise.

Women Whistleblowers face unique challenges in the workplace. The headline news of ethical concerns in business is transforming the workplace culture and the workforce. More women are beginning to step forward when ethical concerns arise. However they experience gender differences within the corporate culture when they come forward. Women often approach ethical concerns in a different manner than men. This article will bring research to this issue and uncover the unique challenges that women encounter as whistleblowers and the relationship of social status.

Institutions of high education must respond to the urgent need that exists for organizations operating in the global marketplace to hire and retain professionals prepared to think critically about multifaceted diversity issues in the workplace. Where do organizations find managers and supervisors equipped to handle the mulifaceted issues of diversity facing global firms? Unfortunately, it seems that they cannot rely on business schools. How can business schools assist future executives and managers to develop diversity competencies necessary to compete in the global marketplace? This paper will explore diversity from an organizational and educational context, looking at the concept of diversity and exploring the value of teaching a diversity curriculum. KEY WORDS Diversity competencies, organic diversity, global marketplace, global organizations

Social stress was assessed in 92 women with low-birthweight babies and 92 controls using the detailed LEDS measure of life events and severe chronic difficulties. The low-birthweight group was divided into preterm delivery (n = 40), small for gestational age (SGA) (n = 40) and mixed groups. Multivariate analysis was performed using a binomial-logit model to examine whether social factors were independently and significantly associated with low birthweight once the effect of demographic factors, obstetric factors and smoking/drinking were taken into account. Comparison of preterm births with controls indicated that three factors were significantly associated: a previous low-birthweight baby, severe life event/difficulty and bleeding during pregnancy. For SGA babies the factors were: previous low-birthweight baby, low social support and smoking. By using a reliable measure of life events and adequate numbers of low-birthweight babies, this study overcame the potential inaccuracies of previous studies and indicates a more specific relation between social stress and low birthweight.

International audience; Anxiety symptoms are commonly described in children with chronic fatigue syndrome or myalgic encephalopathy (CFS/ME) but to date there has been little information on the type of anxiety children experience or the relationship between anxiety and school attendance, disability or fatigue. The aim of this study was to first describe the prevalence and type of anxiety symptoms in children with CFS/ME compared with a normal European population, and secondly to investigate the association of anxiety symptoms with age, gender, school attendance, fatigue, and physical function in paediatric CFS/ME. Data were prospectively collected on children and young people with CFS/ME referred to a large specialist CFS/ME service. One hundred and sixty-four children with CFS/ME had complete data for the Spence Children's Anxiety Scale. Teenage girls had the highest rates of total anxiety symptoms with 38% (95% CI 27–49) over the cut off (top 10% of normal European population) and significantly higher rates of symptoms in each subscale. Younger girls were more likely to score over the cut off in separation anxiety (37%, 19–40) and social phobia (39%, 25–47). There was no evidence of association between total anxiety symptoms and: time at school, time to assessment, pain or age. Associations with fatigue and physical function were attenuated when adjusted for other variables. Although anxiety symptoms are high in CFS/ME, particularly in teenage girls, it does not appear to be associated with school attendance or other measures of disability. Separation anxiety and social phobia were the most clearly elevated in paediatric CFS/ME.

There has been little research describing the role of family physicians in the care of patients with an active diagnosis of cancer.Using qualitative methods, we interviewed 15 family physicians and 15 of their cancer patients. We asked physicians about care of cancer patients in general and of the specific patient included in this study. Patient interviews focused on the role their family physician played in their care and their satisfactions and frustrations with that care.The physicians reported coordinating referrals, providing general medical care, helping with decisions, and providing emotional support. Their involvement was more intense at the time of diagnosis and near death. The patients gave similar responses and also said they valued clear explanations and spending time with and feeling comfortable with their family physicians.Family physicians fulfill a number of important roles in caring for their patients with an active diagnosis of cancer. More research using representative samples is needed to determine the generalizability of these findings, but this study gives us some preliminary insight into the role family physicians play in cancer care.

To longitudinally assess on-road driving performance in healthy older adults and those with early-stage dementia of the Alzheimer type (DAT).A prospective longitudinal study.Large urban medical center and surrounding area.A sample of 58 healthy controls, 21 participants with very mild DAT, and 29 participants with mild DAT participated. DAT was diagnosed using validated clinical diagnostic criteria and staged according to the Clinical Dementia Rating (CDR) Scale.Healthy controls and individuals with very mild DAT and mild DAT were administered a standardized on-road driving assessment over repeated times of testing.Subjects in the CDR=1 group (mild DAT) had a faster rate of receiving a rating of not safe on the driving test than subjects in the CDR=0 group (healthy controls; log rank test, P=.006), and the survival function of the CDR=0.5 group (very mild DAT) fell between those of the CDR=0 and CDR=1 groups. A Cox proportional hazards model indicated a significant difference in survival functions between the CDR=0 and CDR=1 groups after baseline age was controlled for (P.001). Cox regression analysis also indicated that baseline age was a significant risk factor for a rating of "not safe" (P=.002).This study provides longitudinal evidence for a decline in driving performance over time, primarily in early-stage DAT, and supports the need not only for driving assessments, but also for reevaluation of individuals with very mild and mild DAT.