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Introduction The top research priority for cavernoma, identified by a James Lind Alliance Priority setting partnership was ‘Does treatment (with neurosurgery or stereotactic radiosurgery) or no treatment improve outcome for people diagnosed with a cavernoma?’ This pilot randomised controlled trial (RCT) aims to determine the feasibility of answering this question in a main phase RCT.Methods and analysis We will perform a pilot phase, parallel group, pragmatic RCT involving approximately 60 children or adults with mental capacity, resident in the UK or Ireland, with an unresected symptomatic brain cavernoma. Participants will be randomised by web-based randomisation 1:1 to treatment with medical management and with surgery (neurosurgery or stereotactic radiosurgery) versus medical management alone, stratified by prerandomisation preference for type of surgery. In addition to 13 feasibility outcomes, the primary clinical outcome is symptomatic intracranial haemorrhage or new persistent/progressive focal neurological deficit measured at 6 monthly intervals. An integrated QuinteT Recruitment Intervention (QRI) evaluates screening logs, audio recordings of recruitment discussions, and interviews with recruiters and patients/parents/carers to identify and address barriers to participation. A Patient Advisory Group has codesigned the study and will oversee its progress.Ethics and dissemination This study was approved by the Yorkshire and The Humber—Leeds East Research Ethics Committee (21/YH/0046). We will submit manuscripts to peer-reviewed journals, describing the findings of the QRI and the Cavernomas: A Randomised Evaluation (CARE) pilot trial. We will present at national specialty meetings. We will disseminate a plain English summary of the findings of the CARE pilot trial to participants and public audiences with input from, and acknowledgement of, the Patient Advisory Group.Trial registration number ISRCTN41647111.

Introduction Unruptured intracranial aneurysms (UIA) are common in the adult population, but only a relatively small proportion will rupture. It is therefore essential to have accurate estimates of rupture risk to target treatment towards those who stand to benefit and avoid exposing patients to the risks of unnecessary treatment. The best available UIA natural history data are the PHASES study. However, this has never been validated and given the known heterogeneity in the populations, methods and biases of the constituent studies, there is a need to do so. There are also many potential predictors not considered in PHASES that require evaluation, and the estimated rupture risk is largely based on short-term follow-up (mostly 1 year). The aims of this study are to: (1) test the accuracy of PHASES in a UK population, (2) evaluate additional predictors of rupture and (3) assess long-term UIA rupture rates.Methods and analysis The Risk of Aneurysm Rupture study is a longitudinal multicentre study that will identify patients with known UIA seen in neurosurgery units. Patients will have baseline demographics and aneurysm characteristics collected by their neurosurgery unit and then a single aggregated national cohort will be linked to databases of hospital admissions and deaths to identify all patients who may have subsequently suffered a subarachnoid haemorrhage. All matched admissions and deaths will be checked against medical records to confirm the diagnosis of aneurysmal subarachnoid haemorrhage. The target sample size is 20 000 patients. The primary outcome will be aneurysm rupture resulting in hospital admission or death. Cox regression models will be built to test each of the study’s aims.Ethics and dissemination Ethical approval has been given by South Central Hampshire A Research Ethics Committee (21SC0064) and Confidentiality Advisory Group support (21CAG0033) provided under Section 251 of the NHS Act 2006. The results will be disseminated in peer-reviewed journals.Trial registration number ISRCTN17658526.

There is much pessimism as to the current state of Sino-American relations, especially since the onset of the COVID-19 pandemic in January 2020. Such pessimism has led to some scholars and commentators asserting that the Sino-American relationship is on the cusp of either a new Cold War or, even more alarmingly, something akin to the Peloponnesian War (via a Thucydides Trap) whereby the United States might take pre-emptive measures against China. This article rejects such analogizing and argues that, due to important technological advancements found at the intersection of the digital and fourth industrial revolutions, most of the real competition in the relationship is now occurring in cyberspace, especially with regards to the aim of asserting narratives of truth. Two key narrative battlegrounds that have raged since the onset of the COVID-19 pandemic are examined: where was the origin of the COVID-19 pandemic? and who has had the most successful response to the COVID-19 pandemic?. This article shows that Sino-American competition in cyberspace over asserting their narratives of truth (related to the COVID-19 pandemic) is fierce and unhinged. Part of what is driving this competition is the challenging domestic settings politicians and officials find themselves in both China and the United States, thus, the competing narratives being asserted by both sides are predominately for domestic audiences. However, given that cyberspace connects states with foreign publics more intimately, the international aspect of this competition is also important and could result in further damage to the already fragile Sino-American relationship. Yet, whether this competition will bleed into the real world is far from certain and, because of this, doomsaying via historical analogies should be avoided.

Abstract Background Paediatric focal intracranial suppurative infections are uncommon but cause significant mortality and morbidity. There are no uniform guidelines regarding antibiotic treatment. This study reviewed management in a tertiary healthcare centre in the United Kingdom and considers suggestions for empirical treatment. Methods A retrospective, single-centre cohort review of 95 children (

Since the late 2000s, New Zealand has largely followed an asymmetrical hedging strategy in its foreign policy: growing its trade relationship with China while concurrently remaining firmly within the US-led security architecture. However, as the room for hedging in the Indo-Pacific has shrunk, especially after Wellington adopted an Indo-Pacific outlook in 2019, New Zealand has taken steps to lessen its trade reliance on China while further committing itself within the Anglosphere. Since the election of the Sixth National Government of New Zealand in late 2023, Wellington appears to be tentatively switching from a strategy of hedging to something closer to a more conventional balancing strategy, evident in its efforts to participate in AUKUS. While the current situation can still be characterized as an asymmetrical hedge given the ongoing importance of China, if the room for hedging continues to shrink, it is likely that New Zealand will completely abandon its hedge in the future. [ABSTRACT FROM AUTHOR]

The topic of whether New Zealand should participate in AUKUS or not has emerged as a significant debate in popular political discourses in 2024. Thus far, clear pro-AUKUS and anti-AUKUS camps have developed. The pro-AUKUS camp emphasises the growing threat of China in the Indo-Pacific and New Zealand's lacking technological capabilities that have it exposed if a conflict emerges. The anti-AUKUS camp emphasises New Zealand's embedded independent foreign policy and staunch anti-nuclear stance which makes participating in AUKUS an ethically untenable option. However, neither side has considered the deeper, ontological questions on the table and how this affects New Zealand's main foreign policy concern: the Pacific. New Zealand's recent engagement with the Pacific and its experimentation with a Māori foreign policy led it to being a champion of the Blue Pacific narrative, an ontologically distinct approach that challenges the geopolitically-focussed Indo-Pacific concept. Yet, in the wake of New Zealand's flirtation with AUKUS, the Blue Pacific has been largely ignored in debates. Ultimately, the debate about AUKUS misses the big picture as it, so far, limits the focus on the true existential threat to New Zealand and the Pacific which is not China's rise but rather climate change. [ABSTRACT FROM AUTHOR]