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AbstractThere is a growing consensus that the end of empire did not necessarily equate with a severing of imperial ties. Some historians have even argued that there was a shift from formal to informal empire in Britain’s relations with the emerging Gulf States. This is especially so with respect to Bahrain which had represented the epicentre of Britain’s position in the Gulf. Nevertheless, an analysis of British relations with Bahrain from the withdrawal East of Suez to the Iranian Revolution belies any notion that Britain succeeded in establishing an informal imperial position after 1971. Not only were Britain’s economic interests in Bahrain eroded by growing competition from its industrial rivals, but also its political and military position was challenged by the encroachment of regional powers. Any hope that Britain could retain an imperial role in Bahrain was undermined still further by the emergence of new internal political forces in Bahrain beyond the direct control of either the ruling family or Britain itself. The unfeasibility of maintaining an imperial relationship with Bahrain after 1971 persuaded British policymakers to seek to establish recognizably post-imperial relations with the Emirate in the decade following the withdrawal from East of Suez. [ABSTRACT FROM AUTHOR]

Existing recommended first-line antibiotic agents for MRSA pneumonia have several shortcomings. We reviewed 29 cases of community- and hospital-acquired MRSA pneumonia managed at our hospital. Lincosamide monotherapy was administered to 21/29 (72%) and was the predominant antibiotic regimen (> 50% course duration) in 19/29 (66%). Patients receiving lincosamide-predominant monotherapy were no more likely to die or require intensive care unit admission than patients receiving vancomycin-predominant monotherapy (5/19 (26%) versus 4/7 (57%), p = 0.19); 5/7 (71%) patients admitted to ICU and 4/5 (80%) bacteraemic patients received lincosamide-predominant monotherapy. MRSA pneumonia can be safely treated with lincosamide monotherapy if the isolate is susceptible. [ABSTRACT FROM AUTHOR]

• HRV indices predict multidimensional driving-related fatigue. • Lower RMSSD associated with greater fatigue in young drivers. • Higher LF/HF ratio linked to higher fatigue levels. • Findings support HRV metrics as fatigue biomarkers. • Applied research needed to validate real-world use. Driver fatigue significantly impairs performance and is a major risk factor for road crashes. However, fatigue is difficult to objectively measure and quantify. This study aimed to elucidate associations between heart rate variability (HRV) metrics and multidimensional fatigue construct encompassing objective and subjective measures in young drivers with self-reported short sleep. Eighty-four young adults underwent assessments during simulated driving. HRV indices RMSSD and LF/HF ratio were derived from an electrocardiogram, while relative Theta power, oculography drowsiness, lane position variability, and Karolinska Sleepiness Score measured fatigue. RMSSD negatively correlated with Theta power, and LF/HF ratio positively correlated with position variability. Exploratory factor analysis extracted three factors, with RMSSD and LF/HF loading onto one. Structural equation modelling tested the prediction of a latent fatigue construct from HRV. Two models demonstrated an acceptable fit. RMSSD negatively predicted fatigue, explaining 6.4 % of the variance, while the LF/HF ratio positively predicted fatigue, accounting for 3.7 % of the variance. In summary, HRV, particularly RMSSD, showed significant relationships with multidimensional fatigue. Lower RMSSD and higher LF/HF ratio are associated with greater fatigue levels. This study demonstrates that HRV indices exhibit significant relationships within a multidimensional model of fatigue incorporating objective performance, ocular, and subjective measures. The findings provide initial evidence towards using HRV for monitoring complex manifestations of fatigue, rather than single dimensions. Further applied research should investigate translating these findings to naturalistic settings and validating HRV thresholds predictive of on-road impairment. [ABSTRACT FROM AUTHOR]

As historical debate has moved from an analysis of the end of empire to its aftermath and consequences, there has been growing emphasis on the retention by the colonial powers of a large measure of influence over their former dependencies. With respect to the British experience, some historians have even suggested that the demission of empire amounted to a shift from formal to informal empire, using the term ‘imperialism of decolonization’ to encapsulate this concept. Given the maintenance of British economic and military ties with the fledgling United Arab Emirates which emerged from the small Sheikhdoms of the Lower Gulf in 1971, the UAE provides an illuminating case study to test interpretations that suggest Britain preserved a degree of influence amounting to the perpetuation of empire. Despite the preservation of such ties, the example provided by the UAE indicates that in the aftermath of formal British withdrawal from the Gulf at the end of 1971, Britain’s political, economic, and military position was eroded by the encroachment of other powers, both regional and international. Equally, an analysis of the United Arab Emirates casts doubt on whether British decision-makers actually sought to establish an informal imperial relationship with the Gulf States after 1971, preferring instead to establish recognisably post-imperial relations which respected their independence. Consequently, the ‘imperialism of decolonization’ paradigm is not an appropriate one to apply to British policy towards, and relations with, the UAE. [ABSTRACT FROM AUTHOR]

N‐Carboxyanhydrides (NCAs) are compounds derived from the addition of a carboxylic acid to an isocyanate, and are known to form amides readily with the release of CO2 as a by‐product. NCAs have been known for over 120 years, but despite their lengthy history, have remained so far overshadowed by more traditional approaches to amide bond formation. In this review, the potential utility of NCAs in the context of amide bond formation is reviewed and their preparation, reactivity and practical application are also discussed. [ABSTRACT FROM AUTHOR]

Stocking is one of the foremost tools in the inland fisheries management toolbox, but it comes with both opportunities and risks. Stocking is often used as compensation for depleted wild populations, particularly where recruitment processes have been disrupted, but it can introduce disease, disrupt community structures, reduce genetic integrity, and cause conflicts between fishery stakeholders. Despite its widespread use, examples of effective stocking for food fisheries in inland waters are sparse in the peer‐reviewed literature. Nevertheless, it is well established that stocking is frequently used to maintain fish yield, so there is a need to conduct the practice in a robust manner that minimises the potential risks. This paper serves as the front matter for a special section of Fisheries Management and Ecology focused on fresh waters feeding the world, which resulted from two panel sessions, one focused on aquaculture and one focused on stocking, hosted by the international InFish research network (https://infish.org/). The paper highlights current practices of fish stock enhancement in inland waters for food, examines potential synergies and interactions of stock enhancement programmes with aquaculture, and provides an outline framework for responsible management of fish stock enhancement. [ABSTRACT FROM AUTHOR]

Aortitis is a life-threatening, manifestation of chronic Q fever. We report a series of 5 patients with Q fever aortitis who have presented to our hospital in tropical Australia since 2019. All diagnoses were confirmed with polymerase chain reaction (PCR) testing of aortic tissue. Only one had a previous diagnosis of acute Q fever, and none had classical high-risk exposures that might increase clinical suspicion for the infection. All patients underwent surgery: one died and 3 had significant complications. Q fever aortitis may be underdiagnosed; clinicians should consider testing for Coxiella burnetii in people with aortic pathology in endemic areas. [ABSTRACT FROM AUTHOR]

Melioidosis, caused by the environmental gram-negative bacterium Burkholderia pseudomallei, usually develops in adults with predisposing conditions and in Australia more commonly occurs during the monsoonal wet season. We report an outbreak of 7 cases of melioidosis in immunocompetent children in Australia. All the children had participated in a single-day sporting event during the dry season in a tropical region of Australia, and all had limited cutaneous disease. All case-patients had an adverse reaction to oral trimethoprim/sulfamethoxazole treatment, necessitating its discontinuation. We describe the clinical features, environmental sampling, genomic epidemiologic investigation, and public health response to the outbreak. Management of this outbreak shows the potential benefits of making melioidosis a notifiable disease. The approach used could also be used as a framework for similar outbreaks in the future. [ABSTRACT FROM AUTHOR]

"transeant Things": Materialism and Mortality in the Lyrics of Lucy Hutchinson and Margaret C... Graph. [Extracted from the article]

• The case fatality rate of group A Streptococcus bacteremia can rise to 48%. • However, the optimal duration of antimicrobial treatment is uncertain. • In this study, the patients' all-cause 90-day mortality rate of 5.6% was low. • Importantly, all-cause mortality was no greater with shorter antibiotic courses. • Group A Streptococcus bacteremia can be safely treated with shorter courses of antimicrobial therapy. To determine if shorter courses of antibiotic therapy for group A Streptococcus (GAS) bacteremia are associated with excess mortality. In this retrospective study of consecutive cases of GAS bacteremia in tropical Australia, the duration of antibiotic therapy was correlated with 90-day all-cause mortality. There were 286 episodes of GAS bacteremia; the patients' median (interquartile range) age was 60 (48-71) years and 169/286 (59.1%) patients identified as an Indigenous Australian. There were 227/286 (79.4%) patients with a significant comorbidity. The all-cause 90-day mortality was 16/286 (5.6%); however, 12/16 (81.3%) patients died while still receiving their initial course of antibiotics and only 7/16 (43.8%) deaths were directly attributable to the GAS infection. After excluding patients who died while taking their initial course of antibiotics and those in whom the duration of therapy was uncertain, there was no difference in 90-day mortality between patients receiving ≤5 days of intravenous antibiotics and those receiving longer courses (1/137 [0.7%] vs 3/107 [2.8%], P -value = 0.32) nor in patients receiving ≤10 days of total therapy and those receiving longer courses (1/67 [1.5%] vs 3/178 [1.7%], P -value = 1.0). Even among patients with significant comorbidity, shorter antibiotic courses for GAS bacteremia are not associated with excess mortality. [ABSTRACT FROM AUTHOR]

There is growing recognition that the end of formal empire did not equate with the ending of ties between the imperial power and its erstwhile dependencies. This was especially so of the 'fortress colony' of Malta which following constitutional separation from Britain in September 1964 remained firmly linked to Britain economically and militarily. The existing historiography suggests that Britain actively sought to maintain imperial connections after decolonisation, even to the extent of attempting to convert formal empire into informal influence. The case of Malta, by contrast, indicates that the remaining imperial ties proved increasingly vexatious for Britain which sought either to limit its liabilities or even transfer them to its NATO allies. For their part, the Maltese proved adept at manipulating, cajoling, and even threatening the former imperial power to maintain and even increase its commitments to the island, especially in the military and financial fields. [ABSTRACT FROM AUTHOR]

Filamentary structures have been found nearly ubiquitously in molecular clouds and yet their formation and evolution is still poorly understood. We examine a segment of Taurus Molecular Cloud 1 (TMC-1) that appears as a single, narrow filament in continuum emission from dust. We use the Regularized Optimization for Hyper-Spectral Analysis (ROHSA), a Gaussian decomposition algorithm that enforces spatial coherence when fitting multiple velocity components simultaneously over a data cube. We analyse HC5N (9–8) line emission as part of the Green Bank Ammonia Survey and identify three velocity-coherent components with ROHSA. The two brightest components extend the length of the filament, while the third component is fainter and clumpier. The brightest component has a prominent transverse velocity gradient of 2.7 ± 0.1 km s−1 pc−1 that we show to be indicative of gravitationally induced inflow. In the second component, we identify regularly spaced emission peaks along its length. We show that the local minima between pairs of adjacent HC5N peaks line up closely with submillimetre continuum emission peaks, which we argue is evidence for fragmentation along the spine of TMC-1. While coherent velocity components have been described as separate physical structures in other star-forming filaments, we argue that the two bright components identified in HC5N emission in TMC-1 are tracing two layers in one filament: a lower density outer layer whose material is flowing under gravity towards the higher density inner layer of the filament. [ABSTRACT FROM AUTHOR]

This essay considers the archival traces left by early modern playhouse song. Acknowledging that most extant sources of theatrical song were not actually produced as records of playhouse practice per se, it advocates an approach to such material that is as attentive to the context of the surviving textual witnesses as it is to a song's dramatic origins. By putting playhouse and wider context in direct conversation, this approach seeks not only to elucidate the cultural life of dramatic songs beyond the playhouse, but also to shed new light on playhouse music itself, based on wider engagements with and transformations of the songs. Taking a case study approach, the essay investigates one song, "Come Follow Your Leader, Follow," from The Spanish Gypsy , tracing its wide cultural circulation as a ballad tune under the title "The Spanish Jeepsie." Building on previous work focusing on the song's dramatic function in the playhouse, the essay argues that the song's theatrical use as a locus of imaginative identification with marginal subject positions is then taken up in a series of ballads encouraging identification with figures ranging from fairies and drunkards to cobblers and Diggers. [S.S.] [ABSTRACT FROM AUTHOR]

We evaluate the use of a Virtual Exchange (VE) writing task, Stimulus Writing, which we assigned to groups of UK and Finnish business students. There were two learner cohorts in the study: one in the UK (mainly Chinese students), the other in Finland (mainly Finns). The Finnish students wrote authentic case studies about Nordic businesses, while the students in the UK adopted our Stimulus Writing approach to write a report based on a case study given to them by the Finnish students. In Smith & Keng (2017) we reported on the experiences of the Finnish students in the collaboration. In this study, we examine the perceptions of the UK-based Chinese students. They found the approach motivating, and believed that through it their academic English skills improved, as did their understanding of business and culture. [ABSTRACT FROM AUTHOR]

The existing historiography on relations between Britain and the states of Lower Gulf after British withdrawal from 'East of Suez' in 1971 suggests that the former imperial power successfully established an informal role in the 1970s and beyond which amounted to empire in all but name. While Britain certainly sought to retain as much of its influence and as many of its interests in the economically important Lower Gulf as possible, an analysis of Anglo-Qatari relations after 1971 demonstrates that Britain's former exclusive position was substantially eroded. British economic weakness, fierce competition from Britain's industrial rivals, and the encroachment of the Arab world into the affairs of Qatar all militated still further against the preservation of British influence and interests, let alone the establishment of an informal imperial relationship with Qatar. [ABSTRACT FROM AUTHOR]

Background: Patients with rheumatic heart disease (RHD) and congestive cardiac failure (CCF) are believed to have an increased risk of melioidosis and are thought to be more likely to die from the infection. This study was performed to confirm these findings in a region with a high incidence of all three conditions. Principal findings: Between January 1998 and December 2021 there were 392 cases of melioidosis in Far North Queensland, tropical Australia; 200/392 (51.0%) identified as an Indigenous Australian, and 337/392 (86.0%) had a confirmed predisposing comorbidity that increased risk for the infection. Overall, 46/392 (11.7%) died before hospital discharge; the case fatality rate declining during the study period (p for trend = 0.001). There were only 3/392 (0.8%) with confirmed RHD, all of whom had at least one other risk factor for melioidosis; all 3 survived to hospital discharge. Among the 200 Indigenous Australians in the cohort, 2 had confirmed RHD; not statistically greater than the prevalence of RHD in the local general Indigenous population (1.0% versus 1.2%, p = 1.0). RHD was present in only 1/193 (0.5%) cases of melioidosis diagnosed after October 2016, a period which coincided with prospective data collection. There were 26/392 (6.6%) with confirmed CCF, but all 26 had another traditional risk factor for melioidosis. Patients with CCF were more likely to also have chronic lung disease (OR (95% CI: 4.46 (1.93–10.31), p<0.001) and chronic kidney disease (odds ratio (OR) (95% confidence interval (CI): 2.98 (1.22–7.29), p = 0.01) than those who did not have CCF. Two patients with melioidosis and CCF died before hospital discharge; both were elderly (aged 81 and 91 years) and had significant comorbidity. Conclusions: In this region of tropical Australia RHD and CCF do not appear to be independent risk factors for melioidosis and have limited prognostic utility. Author summary: Melioidosis, a disease caused by Burkholderia pseudomallei, rarely develops in the absence of well-described predisposing conditions that include diabetes mellitus, hazardous alcohol intake, chronic kidney disease, chronic lung disease, malignancy, and immunosuppression. These comorbidities are also strongly linked to patients' short and long-term outcomes. In the large Darwin Prospective Melioidosis Study (DPMS) performed in Australia's Northern Territory, the presence of rheumatic heart disease (RHD) and/or congestive cardiac failure (CCF) were independently associated with pulmonary melioidosis and independently predicted death. Indeed, patients with RHD and/or CCF and melioidosis had the highest case-fatality rate in the DPMS cohort. The prevalence of RHD and/or CCF in cases of melioidosis in this study in Far North Queensland (FNQ), was similar to that seen in the Northern Territory. However, every patient had at least one other traditional risk factor for the disease. Furthermore, pulmonary involvement and mortality were not higher in patients with RHD and/or CCF. In FNQ, RHD and CCF are not independent risk factors for melioidosis and have limited prognostic utility. The high prevalence of these cardiac diseases in patients with melioidosis may be, at least partly, explained by the confounding presence of socioeconomic disadvantage that increases the incidence of all three conditions. [ABSTRACT FROM AUTHOR]

Background: The epidemiology of central nervous system (CNS) infections in tropical Australia is incompletely defined. Methods: A retrospective study of all individuals in Far North Queensland, tropical Australia, who were diagnosed with a CNS infection between January 1, 2000, and December 31, 2019. The microbiological aetiology of the infection was correlated with patients' demographic characteristics and their clinical course. Results: There were 725 cases of CNS infection during the study period, meningitis (77.4%) was the most common, followed by brain abscess (11.6%), encephalitis (9.9%) and spinal infection (1.1%). Infants (24.3%, p<0.0001) and Aboriginal and Torres Strait Islander Australians (175/666 local residents, 26.3%, p<0.0001) were over-represented in the cohort. A pathogen was identified in 513 cases (70.8%); this was viral in 299 (41.2%), bacterial in 175 (24.1%) and fungal in 35 (4.8%). Cryptococcal meningitis (24 cases) was diagnosed as frequently as pneumococcal meningitis (24 cases). There were only 2 CNS infections with a S. pneumoniae serotype in the 13-valent pneumococcal vaccine after its addition to the National Immunisation schedule in 2011. Tropical pathogens–including Cryptococcus species (9/84, 11%), Mycobacterium tuberculosis (7/84, 8%) and Burkholderia pseudomallei (5/84, 6%)–were among the most common causes of brain abscess. However, arboviral CNS infections were rare, with only one locally acquired case—a dengue infection in 2009—diagnosed in the entire study period. Intensive Care Unit admission was necessary in 14.3%; the overall case fatality rate was 4.4%. Conclusion: Tropical pathogens cause CNS infections as commonly as traditional bacterial pathogens in this region of tropical Australia. However, despite being highlighted in the national consensus guidelines, arboviruses were identified very rarely. Prompt access to sophisticated diagnostic and supportive care in Australia's well-resourced public health system is likely to have contributed to the cohort's low case-fatality rate. [ABSTRACT FROM AUTHOR]

During January 1998-December 2019, the annual incidence of melioidosis in Far North Queensland, Queensland, Australia, more than doubled. Because climate and prevalence of predisposing medical conditions remained stable during that time, we hypothesize that the increased incidence was caused by urban expansion and increased construction, resulting in greater exposure to Burkholderia pseudomallei. [ABSTRACT FROM AUTHOR]

This article is different. Original testimonies are reproduced, in full, from three autistic adults who reflect on their education experiences. These accounts evolved from a webinar which explored autistic 'voice' through research presentations and lived experiences, and this co‐authored article seeks to communicate these reflections to a wider audience. The testimonies are brought together, interpreted and analysed through the lens of the social model of disability exposing the ableist systems in which these adults had to operate. All share the challenge of trying to fit in to a socially, neuronormatively constructed education system, experiencing marginalisation, lack of understanding and lack of appropriate support. However, all three writers emerge as more than 'sea‐glass survivors', weathered and worn, having developed survival strategies, but demonstrate their determination to improve lives for those who follow in their wake. This article draws attention to the need to listen to autistic people more frequently, but more importantly to involve them as architects of change for the future. The article was co‐created by three autistic people, who identify as neurodivergent, in discussion and collaboration with the lead author who is an autism ally, autism and education researcher, and parent to an autistic son. [ABSTRACT FROM AUTHOR]

The ring contraction‐lactamisation of anhydrides upon reaction with trimethylsilylazide in the presence of an amine catalyst has been studied. Under controlled conditions, 5,‐ 6‐ and 8‐membered ring lactams can be generated from cyclic anhydrides in an operationally simple procedure. In the case of γ‐lactams, the methodology allows for the synthesis of challenging systems incompatible with the usual disconnection involving an amine and an activated carbonyl group. The synthesis of simple larger ring lactams is hampered by inaccessible monomeric cyclic anhydride precursors ‐ a problem which can be circumvented through rigidification. Succinic anhydrides make N‐carboxyanhydrides of use in polymer chemistry and as β‐peptide precursors. [ABSTRACT FROM AUTHOR]

The clinical needs of young people with gender dysphoria (GD) have outpaced the capacity of health services to provide appropriate care. The study aimed to explore the interface of Paediatric Endocrinology and young people with GD, detailing the clinical characteristics and the clinical care provided, in order to inform future service development. Medical records of all young people with GD (n=91, 59 (65%) birth-assigned females and 32 (35%) birth-assigned males) referred to Paediatric Endocrinology during 2011–2019 for puberty suppression were reviewed. Median age at initial assessment was 14.6 years (range 8.8–17.6 years). There was a threefold increase from 2016 (n=22) to 2019 (n=73). Mental health disorders were present in 34 (37%) and autistic spectrum disorder in 21 (23%), while 54 (59%) had at least one comorbidity. Sixty-four (70%) young people fulfilled the criteria for consideration of fertility preservation, with 6 (9%) of them preserving their gametes. Seventy-nine (87%) young people commenced treatment with gonadotrophin-releasing hormone analogue, at a median age of 14.8 years (range 9.7–18.0 years). Six (8%) of those discontinued treatment, following a median duration of 6 months (range 6–18 months). Forty-one young people commenced gender-affirming hormones. One (2%) of those who started gender-affirming hormones discontinued treatment. Conclusions: We have witnessed increasing numbers of young people with GD attending Paediatric Endocrinology, with an over-representation of comorbidities, necessitating provision of an individualised approach to treatment. Addressing young people's acceptability of fertility services and ongoing close collaboration between endocrinology and mental health professionals require innovative models of multidisciplinary care. What is Known: • A worldwide increase in presentation of gender dysphoria has been mirrored in our service, with majority assigned female at birth and post-pubertal. • An over-representation of comorbidities exists, notably mental health disorders and autistic spectrum disorder. What is New: • Coordination of interprofessional care to meet complex needs, at an individual level, while improving efficiency of working, at a systemic level, can be met by the development of specialist centres. • The reasons for low uptake of fertility services demand further exploration. [ABSTRACT FROM AUTHOR]

Purpose: Determine the incidence of metallosis around MAGEC rods. Methods: A multicentre explant database was searched to identify cases with complete intraoperative findings at rod removal. Surgeons removing rods detailed the presence or absence of tissue metallosis associated with rods. More recently surgeons measured the 'length' of tissue metallosis. Prior to rod disassembly, the majority underwent testing with an external remote controller (ERC). The impact of clinical and explant variables on metallosis was assessed. Results: Sixty-six cases were identified. Mean age at insertion was 8.1 ± 2.3 years with mean duration of implantation 37.6 ± 15.1 months. Tissue metallosis was noted at revision surgery in 52/66 cases (79%). Metallosis was noted more commonly when rods were removed during fusion surgery than rod removal/exchange (97% vs. 58% (p = < 0.01)). The mass at insertion was greater in cases with metallosis (25.9 ± 7.8 kg vs. 21.1 ± 6.2 kg, p = 0.04). Length of tissue metallosis was reported for 45 rods, median 9 cm (range 1–25). Metallosis was noted in 43/59 (73%) rods that produced no force and 22/30 (73%) rods that produced some force on ERC activation (p = 0.96). Wear debris was found within the actuator in all rods, and all but 3 rods had damaged O-rings. Conclusion: MAGEC rods are associated with tissue metallosis in the majority of cases. It is seen with functional rods as well as failed rods and appears related to wear debris within the actuator and high rates of O-ring failure. Until the implications of metal debris in children are known, we urge caution with the use of this implant. [ABSTRACT FROM AUTHOR]

Both in Die Riddere metter Mouwen (‘The Knight with the Sleeve’), a Flemish Arthurian romance written in the second part of the thirteenth century, and in Lodewijk van Velthem’s Fifth Part of the Spiegel Historiael (‘Mirror of History’), an early fourteenth-century continuation of Jacob van Maerlant’s voluminous world history (1284-1289), a frightening forest appears which is called Woud(e) sonder Genade (‘Forest without Mercy’). This correspond- ence is remarkable, for these Middle Dutch texts offer the oldest known occurences of a toponym not found in adjacent languages. Following the reasoning of Marijke Carasso-Kok, Thea Summerfield believes that Velthem has borrowed the name ‘Forest without Mercy’ from the Arthurian romance, which the chronicler may have known at the time: an adaptation of the story is inserted in the Velthem-owned Lancelot Compilation (c. 1320-1330). As Summerfield argues, Velthem presents the English King Edward I as a second King Arthur, not only by stating this explicitly and having Edward enact the role of his predecessor in Round Table festivities, but also, when narrating Edward’s feats, by reminding listeners and readers of Arthurian events from the past as described in romances. One of these romances, according to Summerfield, is Die Riddere metter Mouwen. After drawing his audience’s attention to this romance by using the singular name ‘Forest without Mercy’ again, Velthem in his chronicle – so Summerfield asserts – alludes to frightening incidents in the Arthurian Woud sonder Genade as told in the Flemish story. This narrative strategy, Summerfield concludes, served Velthem’s purpose to prove the historicity of the adventures King Arthur and his Knights of the Round Table once experienced. The current paper aims to prove that Summerfield’s argument is not supported by evidence present in Velthem’s text: apart from the shared toponym, the chronicle contains no intertextual references to Die Riddere metter Mouwen. Therefore, its date of composition (1315-1317) is not valid as terminus ante quem for the creation of the Flemish romance. [ABSTRACT FROM AUTHOR]

Background: There is growing recognition of the contribution of the social determinants of health to the burden of many infectious diseases. However, the relationship between socioeconomic status and the incidence and outcome of melioidosis is incompletely defined. Methods: All residents of Far North Queensland, tropical Australia with culture-proven melioidosis between January 1998 and December 2020 were eligible for the study. Their demographics, comorbidities and socioeconomic status were correlated with their clinical course. Socioeconomic status was determined using the Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-economic Disadvantage score, a measure of socioeconomic disadvantage developed by the Australian Bureau of Statistics. Socioeconomic disadvantage was defined as residence in a region with a SEIFA score in the lowest decile in Australia. Results: 321 eligible individuals were diagnosed with melioidosis during the study period, 174 (54.2%) identified as Indigenous Australians; 223/321 (69.5%) were bacteraemic, 85/321 (26.5%) required Intensive Care Unit (ICU) admission and 37/321 (11.5%) died. 156/321 (48.6%) were socioeconomically disadvantaged, compared with 56603/269002 (21.0%) of the local general population (p<0.001). Socioeconomically disadvantaged patients were younger, more likely to be female, Indigenous, diabetic or have renal disease. They were also more likely to die prior to hospital discharge (26/156 (16.7%) versus 11/165 (6.7%), p = 0.002) and to die at a younger age (median (IQR) age: 50 (38–68) versus 65 (59–81) years, p = 0.02). In multivariate analysis that included age, Indigenous status, the presence of bacteraemia, ICU admission and the year of hospitalisation, only socioeconomic disadvantage (odds ratio (OR) (95% confidence interval (CI)): 2.49 (1.16–5.35), p = 0.02) and ICU admission (OR (95% CI): 4.79 (2.33–9.86), p<0.001) were independently associated with death. Conclusion: Melioidosis is disease of socioeconomic disadvantage. A more holistic approach to the delivery of healthcare which addresses the social determinants of health is necessary to reduce the burden of this life-threatening disease. Author summary: The social determinants of health—the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness—have a profound effect on how, when, and even if patients access healthcare, and yet they are generally under-appreciated by practicing clinicians whose training emphasises the biomedical model of healthcare. In this region of tropical Australia patients diagnosed with melioidosis were more likely to live in a socioeconomically disadvantaged region. Socioeconomically disadvantaged individuals with melioidosis were also more likely to die from their infection and to die at a younger age. It was notable that socioeconomic disadvantage had a greater independent association with in-hospital death than age, Indigenous status, the presence of bacteraemia or any of the comorbidities that classically predispose individuals to melioidosis. A more holistic approach to the delivery of healthcare—which addresses the social determinants of health—is necessary if we are to reduce the burden of melioidosis and the many other health conditions that disproportionately affect the most disadvantaged members of our society. [ABSTRACT FROM AUTHOR]

The UK government instruction to stay at home exemplifies how governments do things by saying things in a crisis. The force of the government slogan was amplified by its intertextual circulation in wider public discourse to produce an alignment between the duty of government to protect citizens, the spiritual mission of the Church and the public information role of the press. By analysing the rhetorical and sequential structure of promotional discourse with recourse to speech act, narrative and routine theory, we show how its authors concurrently use cognitive and empathetic interpellations to induce subjectivation, configuring pending accounts which not only involve recipients in scripts for restoring order (if ... then ... programming constructions) but also implicate them in restorative storylines (just as there and then ... so here and now ... mimetic constructions). The result is to overlay on the official inducement new voices of hope, conditioned by participation in a collaborative community, naturalising compliance. • Health promotional discourse configures pending accounts. • Pending accounts interrupt and displace stories or routines. • Pending accounts offer empathetic and/or cognitive interpellations. • Interlayering different speakers' voices expands and diversifies the original message. • Alignment of programmes of action naturalises compliance. [ABSTRACT FROM AUTHOR]

This paper uses subject positioning theory to explore how conflicts between autonomy and protection are managed in the justification of controversial care arrangements for patients with mental/neurological illness. Its basic argument is twofold: firstly, to justify or propose care arrangements at strategic or contentious moments, actors position illness as an actant and make it present in talk‐in‐interaction, exploiting alignments and misalignments between the there and then of reported events and the above and beyond of shared societal discourses to say what matters and what's to be done here and now; secondly, the introduction of authoritative voices from elsewhere involves imbricating narrative and routine sequences in order to prioritise different subjectivities. Dilemmas opposing autonomy and protection may seem less intractable if we adopt a corresponding perspective interplay between narrative and routine situational readings. [ABSTRACT FROM AUTHOR]

Aim/Purpose Grounded Theory (GT) has grown and developed into several strands making its application all the more problematic, argumentative and remaining potentially as a research methodology to avoid when it comes to doctoral research, early-career research. Thus, the purpose of this paper is to revisit GT as a general approach and present an evolved and more considered step-by-step guide to conduct research using this methodology. A leadership development context is applied in this paper to examine how this methodology could work for a new generation of researchers, i.e., new to doctoral research or an early career researcher. Background Since its academic inception in the seminal text in 1967 (Glaser & Strauss, 1967), GT has emerged and developed to become a popular choice for researchers contemplating qualitative data approaches amongst a variety of subject backgrounds. However, the divergent development and criticized approaches within GT families can lead researchers to avoid such a research methodology. This can especially be the case within doctoral research or other early-career research. Indeed, a specific/explicit GT guideline or framework to assist doctoral students in conducting GT research does not currently exist. Methodology There is a general review of GT approaches followed by theoretical development of a framework and an applied doctoral example. Contribution The three evolved methods in GT research and the developed supporting author-designed three-phase research framework will contribute to two aspects. Firstly, the step-by-step guideline can reduce the sense of confusion within an area where criticisms and conflicting approaches exist. This will hopefully assist the next generation of GT researchers in conducting their research through detailed processes and applications. Secondly, there is arguably a need for more GT applications and evolvements to further enrich the body of knowledge that exists in this area and further support a diversity of subject research. Findings The authors outline numerous differences and similarities within divergent GT practices. By integrating Glaser's four core principles and three evolved methods, the authors design a three-phase research framework that presents a transparent step-by-step guide. This framework attempts to mitigate criticisms within GT approaches whilst maintaining clarity, flexibility, depth, and rigour within a study. Recommendations for Practitioners Three GT evolvements (the two-step literature review method, two-step opencoding method, and two-step theory-constitute method) provides greater clarity within a rigorous author-designed three-phase research framework that demonstrates a transparent step-by-step guide. These techniques can encourage a new generation of GT researcher through confident and structured analytical techniques. Recommendations for Researchers We hope the presented framework and concise view of GT in action will inspire other doctoral students and new GT researchers to conduct GT research following an evolved GT framework. Impact on Society The debates and innovations around GT, like in this paper, are needed within a methodological society to keep the area contemporary and constantly evolving. Future Research The framework presented will need further testing beyond the parameters set out here. We hope future research can adopt the evolved GT techniques and procedures to enforce research quality overall and inspire further GT methodological developments. [ABSTRACT FROM AUTHOR]

• Rickettsial infections are difficult to diagnose and usually treated empirically. • It is taught that fever typically resolves in patients after <48 hours of therapy. • It is taught that this can distinguish rickettsial infection from other pathogens. • In this series most patients' fever persisted for >48 hours after therapy commenced. • We should discard the dogma that fever settles rapidly in rickettsial infections. Clinicians are commonly taught that if patients with suspected rickettsial disease have continuing fever after 48 hours of anti-rickettsial therapy, an alternative diagnosis is likely. This retrospective study of patients hospitalised with scrub typhus and Queensland tick typhus (QTT) in tropical Australia, examined the time to defervescence after initiation of the patients' anti-rickettsial therapy. It also identified factors associated with delayed defervescence (time to defervescence >48 hours after antibiotic commencement). Of the 58 patients, 32 (56%) had delayed defervescence. The median (interquartile range (IQR)) age of patients with delayed defervescence was 52 (37-62) versus 40 (28-53) years in those who defervesced within 48 hours (p = 0.05). Patients with delayed defervescence were more likely to require Intensive Care Unit (ICU) admission than those who defervesced within 48 hours (12/32 (38%) versus 3/26 (12%), p = 0.02). Even among patients not requiring ICU care, patients with delayed defervescence required a longer hospitalisation than that those who defervesced within 48 hours (median (IQR): 6 (3-8) versus 3 (2-5) days, p = 0.006). A significant proportion of patients with confirmed scrub typhus and QTT will remain febrile for >48 hours after appropriate anti-rickettsial therapy. Delayed defervescence is more common in patients with severe disease. [ABSTRACT FROM AUTHOR]

Rickettsial infections are an under-recognized cause of acute, undifferentiated fever in the tropics. In Asia, intensive care unit (ICU) admission rates as high as 21% and case-fatality rates of up to 5% have been reported. This 20-year retrospective audit of children and adults with serologically confirmed scrub typhus or spotted fever group (SFG) infection was performed at a tertiary-referral hospital in tropical Australia. There were 15 paediatric cases during the study period (11 scrub typhus, 3 SFG and 1 undifferentiated). Hypotension [5/15 (33%)], tachycardia [6/15 (40%)] and tachypnoea [6/15 (40%)] were common at presentation. Children were more likely to be hypotensive at admission than adults [5/15 (33%) vs. 5/118 (4%), p = 0.002]. However, no child died or was admitted to ICU, compared with 18/120 (15%) adults who required ICU support during the study period, one of whom died. Paediatric rickettsial infections have a relatively benign clinical course in tropical Australia with serious complications appearing far less frequently than have been reported in the Asian literature. [ABSTRACT FROM AUTHOR]

Background The autotransporter protein Burkholderia intracellular motility A (BimA) facilitates the entry of Burkholderia pseudomallei into the central nervous system (CNS) in mouse models of melioidosis. Its role in the pathogenesis of human cases of CNS melioidosis is incompletely defined. Methods Consecutive culture-confirmed cases of melioidosis at 2 sites in tropical Australia after 1989 were reviewed. Demographic, clinical, and radiological data of the patients with CNS melioidosis were recorded. The bimA allele (bimA Bm or bimA Bp ) of the B. pseudomallei isolated from each patient was determined. Results Of the 1587 cases diagnosed at the 2 sites during the study period, 52 (3.3%) had confirmed CNS melioidosis: 20 (38.5%) had a brain abscess, 18 (34.6%) had encephalomyelitis, 4 (7.7%) had isolated meningitis, and 10 (19.2%) had extra-meningeal disease. Among the 52 patients, there were 8 (15.4%) deaths; 17/44 (38.6%) survivors had residual disability. The bimA allele was characterized in 47/52; 17/47 (36.2%) had the bimA Bm allele and 30 (63.8%) had the bim A Bp allele. Patients with a bimA Bm variant were more likely to have a predominantly neurological presentation (odds ratio [OR]: 5.60; 95% confidence interval: 1.52–20.61; P  = .01), to have brainstem involvement (OR: 7.33; 1.92–27.95; P  = .004), and to have encephalomyelitis (OR: 4.69; 1.30–16.95; P  = .02). Patients with a bimA Bm variant were more likely to die or have residual disability (OR: 4.88; 1.28–18.57; P  = .01). Conclusions The bimA allele of B. pseudomallei has a significant impact on the clinical presentation and outcome of patients with CNS melioidosis. [ABSTRACT FROM AUTHOR]

The first divergent synthesis of both γ‐amino acid and γ‐lactam derivatives from meso‐glutaric anhydrides is described. The organocatalytic desymmetrisation with TMSN3 relies on controlled generation of a nucleophilic ammonium azide species mediated by a polystyrene‐bound base to promote efficient silylazidation. After Curtius rearrangement of the acyl azide intermediate to access the corresponding isocyanate, hydrolysis/alcoholysis provided uniformly high yields of γ‐amino acids and their N‐protected counterparts. The same intermediates were shown to undergo an unprecedented decarboxylation–cyclisation cascade in situ to provide synthetically useful yields of γ‐lactam derivatives without using any further activating agents. Mechanistic insights invoke the intermediacy of an unconventional γ‐N‐carboxyanhydride (γ‐NCA) in the latter process. Among the examples prepared using this transformation are 8 APIs/molecules of considerable medicinal interest. [ABSTRACT FROM AUTHOR]

Background The prevalence of age-related hearing loss (ARHL) increases with age. Older adults are amongst the most dependent users of healthcare and most vulnerable to medical error. This study examined health professionals' strategies, as well as level of formal training completed, for communication with older adults with ARHL, and their views on the contribution of ARHL to suboptimal quality of patient care. Methods A 17-item questionnaire was distributed to a sample of Irish primary care physicians, as well as hospital-based clinicians providing inpatient palliative care and geriatric services. Results A total of 172 primary care physicians and 100 secondary care providers completed the questionnaire. A total of 154 (90%) primary and 97 (97%) secondary care providers agreed that ARHL had a negative impact on quality of care. Across both settings, 10% of respondents reported that communication issues contributed to multiple medication error events each year. Although only 3.5% of secondary care providers and 13% of primary care physicians attended formal training on communication with hearing-impaired patients, 66.5% of respondents were confident in their capacity to communicate with these patients. Primary care physicians reported that they either never used assistive hearing technology (44%) or were unfamiliar with this technology (49%). Conclusions Primary and secondary care health providers reported that ARHL reduces patient care quality and may initiate errors leading to patient harm. Formal training addressing the communication needs of ARHL patients appears to be underdeveloped, and there is a limited familiarity with assistive hearing technology. This is both an error in health professional training and healthcare services. [ABSTRACT FROM AUTHOR]

Background: Indigenous Australians suffer a disproportionate burden of sepsis, however, the performance of scoring systems that predict mortality in Indigenous patients with critical illness is incompletely defined. Materials and methods: The study was performed at an Australian tertiary-referral hospital between January 2014 and June 2017, and enrolled consecutive Indigenous and non-Indigenous adults admitted to ICU with sepsis. The ability of the ANZROD, APACHE-II, APACHE-III, SAPS-II, SOFA and qSOFA scores to predict death before ICU discharge in the two populations was compared. Results: There were 442 individuals enrolled in the study, 145 (33%) identified as Indigenous. Indigenous patients were younger than non-Indigenous patients (median (interquartile range (IQR) 53 (43–60) versus 65 (52–73) years, p = 0.0001) and comorbidity was more common (118/145 (81%) versus 204/297 (69%), p = 0.005). Comorbidities that were more common in the Indigenous patients included diabetes mellitus (84/145 (58%) versus 67/297 (23%), p<0.0001), renal disease (56/145 (39%) versus 29/297 (10%), p<0.0001) and cardiovascular disease (58/145 (40%) versus 83/297 (28%), p = 0.01). The use of supportive care (including vasopressors, mechanical ventilation and renal replacement therapy) was similar in Indigenous and non-Indigenous patients, and the two populations had an overall case-fatality rate that was comparable (17/145 (12%) and 38/297 (13%) (p = 0.75)), although Indigenous patients died at a younger age (median (IQR): 54 (50–60) versus 70 (61–76) years, p = 0.0001). There was no significant difference in the ability of any the scores to predict mortality in the two populations. Conclusions: Although the crude case-fatality rates of Indigenous and non-Indigenous Australians admitted to ICU with sepsis is comparable, Indigenous patients die at a much younger age. Despite this, the ability of commonly used scoring systems to predict outcome in Indigenous Australians is similar to that of non-Indigenous Australians, supporting their use in ICUs with a significant Indigenous patient population and in clinical trials that enrol Indigenous Australians. [ABSTRACT FROM AUTHOR]

Study Design: Analysis of explanted MAGnetic Expansion Control (MAGEC) growing rods.Objective: The aim of this study was to quantify the rate of locking pin breakage in explanted MAGEC rods and compare with the manufacturer's data.Summary Of Background Data: On June 25, 2019, NuVasive released an Urgent Field Safety Notice stating that MAGEC rods manufactured before March 26, 2015 had a higher than expected locking pin breakage rate of 5%. For rods made on or after that date, no pin breakages had occurred.Methods: From our independent explant database of 139 explanted MAGEC rods supplied from 10 UK spinal centers (Belfast, Bristol, Birmingham, Edinburgh, Exeter, Leeds, Newcastle, Nottingham, Oxford, and Sheffield) and one Danish center (Aarhus), we divided the rods into those manufactured before March 26, 2015, and those manufactured on or after that date. MAGEC rods were cut open to fully assess internal components including locking pins. From each of the two cohorts, 10 locking pins were selected at random and their diameters were measured using a micrometer.Results: One hundred and five explanted MAGEC rods were made before March 26, 2015 and could be disassembled to allow the locking pin to be examined. Fifty-nine percent (62/105) of these locking pins had fractured. For the MAGEC rods manufactured on or after March 26, 2015, 21% (6/29) were found to have fractured locking pins. Locking pins in MAGEC rods made on or after March 26, 2015 were of a stronger material and a larger diameter.Conclusion: Fifty-nine percent of the locking pins in MAGEC rods manufactured before March 26, 2015 had fractured, far greater than the 5% stated in the Urgent Field Safety Notice. Locking pin fracture still occurred in MAGEC rods manufactured on or after that date, in 21% of cases. This contrasted with the 0% reported by the manufacturer.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Irish kings eager to conquer Britain are rare in episodic Arthurian romance. Even so, belligerent rulers of Ireland show up in the thirteenth-century Moriaen and Die Riddere metter Mouwen (‘the Knight with the Sleeve’). The Irish king’s appearance in the Flemish Moriaen derives from an episode in the Lancelot propre (cf. Besamusca 1991 and 1993, 110-114), while his similar role in the second romance may be attributed to an adapter, the compiler of the Lancelot Compilation, who probably inserted four additional adventures in his reworking of the Flemish original. The episode of Arthur’s war against the Irish in Die Riddere metter Mouwen differs significantly from the story as told so far. When the hero is sidetracked in a separate adventure, a dozen knights of the Round Table suddenly take center stage in an interlaced episode that perfectly fits with the narrative style of the ‘historical’ Lancelot-Grail Cycle. In this dark episode, King Arthur appears as a vulnerable and negligent sovereign, in need of reproach by his illustrious nephew Walewein (Gawain), the Round Table’s foremost knight and the prime guardian of courtly values. Apparently, the compiler intended to align the Flemish romance with the cycle’s content and narrative technique of interlace, to revitalize the character of Walewein (until then only a pale version of his former self), and to expose a crack in the Round Table in order to foreshadow the final demise of Arthur’s kingdom. If we accept this hypothesis, one important question remains: what did the Flemish Riddere metter Mouwen look like before the compiler reworked the story, added new episodes and, in the process, maybe even changed the storyline? [ABSTRACT FROM AUTHOR]

In recent years the computer processors underpinning the large, distributed, workhorse computers used to solve the Boltzmann transport equation have become ever more parallel and diverse. Traditional CPU architectures have increased in core count, reduced in clock speed and gained a deep memory hierarchy. Multiple processor vendors offer a collectively diverse range of both CPUs and GPUs, with the architectures used in the fastest machines in the world ever growing in diversity of many-core architectures. Going forward, the landscape of processor technologies will require our codes to function well across multiple architectures. This ever increasing range of architectures represents a unique challenge for solving the Boltzmann equation using deterministic methods in particular, and so it is important to characterize the performance of those key algorithms across the processor spectrum. The solution of the transport equation is computationally expensive, and so we require well optimized and highly parallel solver implementations in order to solve interesting problems quickly. In this work we explore the performance profiles of deterministic SN transport sweeps for both 3D structured (Cartesian) and unstructured (hexahedral) meshes. The study focuses on the characteristics of computational performance which are responsible for the actual performance of a transport solver. [ABSTRACT FROM AUTHOR]

Study Design: Laboratory analysis of explanted MAGnetic Expansion Control (MAGEC) rods.Objective: The aim of this study was to identify the in vivo lengthening of MAGEC rods.Summary Of Background Data: Little data is available regarding the lengthening achieved by MAGEC rods.Methods: Cases were identified from the largest series of independently analyzed explanted MAGEC rods. The in vivo growth of rods was determined by the distance between the first "growth mark" and the actuator. The instrumented spinal lengthening was calculated for each construct. Constructs were considered functional if all rods could lengthen with external remote controller activation and no rods were "telescoping".Results: Fifty-five MAGEC constructs (99 rods) from 53 patients treated at 10 centers were included. The mean age at insertion was 8.5 years with rods implanted a mean of 35 months. Sixty rods were suitable for analysis with mean lengthening 21.7 mm, 8.9 mm/year. Of these 60 rods, three were maximally distracted. Mean instrumented spinal lengthening for 38 suitable cases was 22.1 mm, 8.4 mm/year. This was positively correlated with the duration of implantation (r = 0.34, P = 0.04) but negatively with patient age at insertion (r = -0.35, P = 0.03). The rate of instrumented spinal lengthening was negatively correlated with duration of implantation (r = -0.47, P = 0.004). Of 55 constructs, 34 were nonfunctional at time of removal with nine functional and 12 indeterminate. Functional constructs had been implanted significantly less time (20.0 vs. 39.7 months, P < 0.001) and lengthened less than those nonfunctional (12.3 mm vs. 23.3 mm, P = 0.04).Conclusion: This multicenter explant study represents the largest cohort managed with MAGEC rods reported. Rods are very rarely removed having fully lengthened with mean instrumented spinal growth of 22 mm over the implant's life. This may be explained by a high rate of lengthening mechanism failure in received rods after around 3 years in vivo. Our findings question the effectiveness of the MAGEC system and mandate urgent comparative clinical studies.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

It has been shown that language learners can benefit from a discovery-based learning process whereby they construct as well as consult their own specialist corpora and vocabulary portfolios, for the purposes of translator training (Castagnoli 2006), for general English (Smith 2011) and for academic English learning (Charles 2012; Smith 2015). In the present study, a cohort of 94 international students on an EAP module, majoring in Accounting and Finance, was divided into hands-on (treatment) and hands-off (control) groups. Both groups were subjected to a pre-test consisting of specialist terms that would be encountered on their course (not only in the EAP class, but also on the Accounting and Finance modules). The hands-on group spent about 20 min per weekly class constructing domain-specific DIY corpora and generating subject vocabulary portfolios. The results of a post-test indicated that the hands-on group had achieved a slightly greater improvement in domain vocabulary knowledge than the hands-off group (which used corpora and vocabulary lists provided by the teacher). A participant questionnaire showed that the students found the approaches useful for vocabulary learning. • Language learners can benefit from corpus-based approaches to learning. • Most corpus approaches involve consulting corpora made by others. • This project gives learners sense of ownership from creating their own corpora. • Helps learners engage with financial vocabulary in academic English. [ABSTRACT FROM AUTHOR]

Background: Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit (ICU) support. Multiple strategies–including protective ventilation and early renal replacement therapy (RRT)–have been recommended to improve outcomes. However, management guidelines vary widely around the world and there is no consensus on the optimal approach. Methodology/Principal findings: All cases of leptospirosis admitted to the ICU of Cairns Hospital in tropical Australia between 1998 and 2018 were retrospectively reviewed. The patients' demographics, presentation, management and clinical course were examined. The 55 patients' median (interquartile range (IQR)) age was 47 (32–62) years and their median (IQR) APACHE III score was 67 (48–105). All 55 received appropriate antibiotic therapy, 45 (82%) within the first 6 hours. Acute kidney injury was present in 48/55 (87%), 18/55 (33%) required RRT, although this was usually not administered until traditional criteria for initiation were met. Moderate to severe acute respiratory distress syndrome developed in 37/55 (67%), 32/55 (58%) had pulmonary haemorrhage, and mechanical ventilation was required in 27/55 (49%). Vasopressor support was necessary in 34/55 (62%). Corticosteroids were prescribed in 20/55 (36%). The median (IQR) fluid balance in the initial three days of ICU care was +1493 (175–3567) ml. Only 2/55 (4%) died, both were elderly men with multiple comorbidities. Conclusion: In patients with severe leptospirosis in tropical Australia, prompt ICU support that includes early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for RRT initiation and corticosteroid therapy is associated with a very low case-fatality rate. Prospective studies are required to establish the relative contributions of each of these interventions to optimal patient outcomes. Author summary: Severe leptospirosis continues to carry a high mortality. To improve outcomes, several countries have developed national guidelines for the management of severe disease. However, there is substantial variation in these guidelines despite the fact that severe leptospirosis has a very similar presentation around the world. In tropical Australia, the case-fatality rate of severe leptospirosis is only 4%. This retrospective study reviewed 55 patients with leptospirosis requiring support in an Australian Intensive Care Unit (ICU) in an effort to identify the management strategies that might explain these excellent outcomes. The low case-fatality rate was associated with prompt multimodal ICU support that included early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for renal replacement therapy initiation and corticosteroid therapy. However prospective, multinational studies–which include the resource-poor settings that bear the greatest burden of disease–are necessary to define which of these interventions have the greatest therapeutic value. [ABSTRACT FROM AUTHOR]

The role of inland fisheries in livelihoods, food security and sustainable development is often overshadowed by the higher profile interest in ocean issues. Whilst inland fisheries' catch and contribution to global nutrition, food security and the economy, are less than that of marine fisheries, global‐level comparisons of fish production obscure considerable livelihood impacts in certain countries and sub‐national areas. To highlight these contributions, this paper synthesizes recent data and innovative approaches for assessing such livelihood contributions and their importance in countries with limited access to ocean resources and aquaculture. Inland fisheries are crucial for many socially, economically and nutritionally vulnerable groups of people around the world, but the challenges in monitoring inland fisheries preclude a complete understanding of the magnitude of their contributions. This situation is rapidly improving with increasing recognition of inland fisheries in development discourses, which has also encouraged research to enhance knowledge on the importance of inland fisheries. We review this work, including collated information published in a recent Food and Agriculture Organization report, to provide an up to date characterization of the state of knowledge on the role of inland fisheries. [ABSTRACT FROM AUTHOR]

Background: Rickettsial infections are a common cause of hospitalization in tropical settings, although early diagnosis is challenging in the rural locations where these infections are usually seen. Methods: This retrospective, clinical audit of microbiologically-confirmed cases of scrub typhus or spotted fever group (SFG) rickettsial infection between 1997 and 2016 was performed a tertiary referral hospital in tropical Australia. Clinical, laboratory and radiological findings at presentation were correlated with the patients’ subsequent clinical course. Results: There were 135 locally-acquired cases (95 scrub typhus, 37 SFG, 3 undifferentiated). There were nine hospitalizations during the first 5 years of the study period and 81 in the last 5 years (p for trend = 0.003). Eighteen (13%) of the 135 cases required ICU admission, all of whom were adults. A greater proportion of patients with SFG infection required ICU support (8/37 (22%) compared with 10/95 (11%) scrub typhus cases), although this difference did not reach statistical significance (p = 0.10). Three (8%) of the 37 patients with SFG infection had severe disease (1 died, 2 developed permanent disability) versus 0/95 scrub typhus patients (p = 0.02). Adults with a high admission qSOFA score (≥2) had an odds ratio (OR) of 19 (95% CI:4.8–74.5) for subsequent ICU admission (p<0.001); adults with a high NEWS2 score (≥7) had an OR of 14.3 (95% CI:4.5–45.32) for ICU admission (p<0.001). A patient’s respiratory rate at presentation had strong prognostic utility: if an adult had an admission respiratory rate <22 breaths/minute, the negative predictive value for subsequent ICU admission was 95% (95% CI 88–99). Conclusions: In the well-resourced Australian health system outcomes are excellent, but the local burden of rickettsial disease appears to be increasing and the clinical phenotype of SFG infections may be more severe than previously believed. Simple, clinical assessment on admission has prognostic utility and may be used to guide management. [ABSTRACT FROM AUTHOR]

Farmland comprises an important opportunity for biodiversity conservation worldwide. The likelihood of a farmer fostering habitat for biodiversity has been studied from the perspective of personal or economic drivers. Beyond farm area, the geographic characteristics of the farmland itself—such as parcel sizes, numbers, and distribution—are rarely considered. This paper uses a landholder survey (n = 350, 37% response rate) to explore the variety of farmland management fragmentation and its implications for habitat on farms, specifically ponds, wetlands, and woodlands. This exploratory research was implemented in Nova Scotia, a relatively long‐settled province of Canada, which is subject to inheritance, farmland abandonment, and farm expansion. An index and a typology of management fragmentation were developed, based on geographical impacts (increased distance to travel and edge per unit area), drawing on hypotheses about how geography may affect farmer decision making about habitat. Results suggest that farm size matters more than fragmentation, but also that perceptions of ecosystem services from each ecosystem may have an impact. Suggestions for further research are provided, including alternative methods that could be used and testing these insights in more homogenous agricultural landscapes. [ABSTRACT FROM AUTHOR]

Study Design: Laboratory analysis of explanted MAGnetic Expansion Control (MAGEC) growing rods.Objective: The aim of this study was to measure the force produced by explanted MAGEC rods compared with new rods and assess the influence of clinical variables.Summary Of Background Data: MAGEC rods are increasingly used in early-onset scoliosis. Some data are available describing the structure of explanted MAGEC rods, but to date, no study has assessed their function.Methods: Explanted MAGEC rods were received from seven UK and one Danish center. The force produced by explanted rods on activation with the external remote controller was measured using a dedicated jig. Forces were compared with two unused rods as well as the manufacturer's defined standard (42 Ibf). Clinical variables were collected from contributing centers where possible and correlated with the force measurements.Results: Forty-five MAGEC rods from 25 cases were received for analysis. The mean age at insertion was 8.6 years and rods were in vivo for a mean of 2.7 years in predominantly dual rod constructs. Two unused MAGEC rods produced a mean force of 45.3 (0.25) and 50.2 (1.4) Ibf, above the manufacturer's stated standard. Of the 45 explanted rods, 10 (22%) produced force greater or equal to manufacturer's standard, mean 46.7 (2.7) Ibf. Six rods (13%) produced some force but less than the manufacturer's standard, mean 34.8 (3.6) Ibf. Twenty-nine rods (64%) produced no force. The duration the rods were in vivo was significantly negatively correlated with the force produced on testing (r = -0.63, P < 0.005). Of the 12 rods implanted longer than 38 months, none produced any force.Conclusion: This is the first study of the force, and hence likely function, of explanted MAGEC rods. The majority of explanted rods produced no force, while others produced reduced force. These findings raise questions regarding the longevity of the implant and further clinical outcome studies are recommended.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

The Roman van den Riddere metter Mouwen ('Romance of the Knight with the Sleeve') is a thirteenth-century Arthurian romance written in Middle Dutch, of which a fourteenth- century version is preserved in the Lancelot Compilation. The original, Flemish romance seems to have been adapted considerably: the Brabantine compiler abridged his source text, added several episodes, and even changed the storyline, turning the romance into a diptych. The second half of the current story differs in many ways from the first half, raising questions about the compiler's part in its creation. Remarkable is an abrupt change in the portrayals of King Arthur and his nephew Walewein. In the 'Aragon Episode' the monarch, until then a benevolent overlord, makes an awkward decision, which provokes a critical response from Walewein. The famous knight appeared as only a minor character so far, but now, the story's hero being sidetracked in another adventure, he suddenly lives up to his reputation. In this article, a case is made for the hypothesis that the compiler wrote the Aragon Episode himself, offering his favourite knight Walewein an opportunity to shine. [ABSTRACT FROM AUTHOR]

Abstract Concerns have been published about the cases of non-conservatism when the BS 7910 option 2 Failure Assessment Curve (FAC) is used in the Strain Based Analysis and Design (SBAD) regime. An assessment of these concerns has been made using an analytical solution for the Crack Driving Force (CDF) associated with an infinite notched strip. It was shown that the option 2 FAC could underpredict the CDF for this case and that the level of error was bigger for lower levels of strain hardening. A modification to the option 2 FAC is proposed. The modification has been studied in other publications and has been shown to provide conservatism in all cases investigated to-date. Highlights • A modification to the option 2 FAC for SBAD is proposed. • Application in the SBAD regime provides conservatism. • A modification is proposed for the transition between the SSY and SBAD regimes. [ABSTRACT FROM AUTHOR]

High-performance computing systems continue to increase in size in the quest for ever higher performance. The resulting increased electronic component count, coupled with the decrease in feature sizes of the silicon manufacturing processes used to build these components, may result in future exascale systems being more susceptible to soft errors caused by cosmic radiation than in current high-performance computing systems. Through the use of techniques such as hardware-based error-correcting codes and checkpoint-restart, many of these faults can be mitigated at the cost of increased hardware overhead, run-time, and energy consumption that can be as much as 10–20%. Some predictions expect these overheads to continue to grow over time. For extreme scale systems, these overheads will represent megawatts of power consumption and millions of dollars of additional hardware costs, which could potentially be avoided with more sophisticated fault-tolerance techniques. In this paper we present new software-based fault tolerance techniques that can be applied to one of the most important classes of software in high-performance computing: iterative sparse matrix solvers. Our new techniques enables us to exploit knowledge of the structure of sparse matrices in such a way as to improve the performance, energy efficiency, and fault tolerance of the overall solution. [ABSTRACT FROM AUTHOR]

The article highlights the representation of love-song performance on the commercial stage. It mentions the reference of play like 'Twelfth Night' that describe as a love-song; 'The Knight of the Burning Pestle' by Francis Beaumont that perform with voices, musical convention and playhouse affect; different version of the song in John Fletcher's 'The Captain'.