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Introduction Measuring performance in End of Life Care within an acute setting is a complex and difficult task. GSF implementation within a hospital setting can improve quality of care, patient satisfaction and an increase in advance care planning. This study aims to show how by developing an internal hospital application and protocol for GSF patients, improved data collection can be transformed from data into intelligence and impact on delivery of high quality, individualised end of life care. Methods Most wards within Dudley had different ways of capturing GSF identified patients and recorded information manually. Informatics and the Specialist Palliative Care team developed an internal application to monitor all patient admissions against a GSF outcome and to provide additional information such as preferred place of care and ACP. This provided the ward with a visual management tool, easily identifying end of life patients and the ability to capture essential end of life metrics. Results Since the launch of this application, analysis of the data has demonstrated an increase in the percentage of adult inpatients assessed for GSF and currently using this information for targeted education and learning. As of the 30th September 2019, the three front runner wards had a combined assessment rate of 90.2% Through this log, other metrics broken down by ward include identification rate, percentage of patients who achieve their preferred place of care and how many have an individualised plan of care in place or offered ACP. Conclusion Initial results indicate that having an electronic centralised database for monitoring GSF outcomes provides a platform to scrutinise key metrics for end of life care, which enable the wards and specialist palliative care team to ensure high quality end of life care is achieved.

In 2013, researchers announced that a newborn child from Mississippi, USA might have been functionally cured of HIV by being given combination antiretroviral therapy within hours of birth. Public and media attention has since been captured by the possibility of finding a cure for HIV transmitted from mother to child. Research into the strategy used for the Mississippi patient is crucially important to establish whether it can be replicated and shown to work in diverse populations. At the same time, any ethical issues likely to arise in such studies should be addressed and not ignored in the pursuit of a functional cure. In this Personal View we identify ethical issues that could arise in research towards achievment of a functional cure for HIV in neonates, including difficult trade-offs associated with choosing the study population and questions about the broader social implications of the research, and propose ways to resolve them.

Recently the “Mississippi Child” was reported as having a prolonged clearance of HIV viremia after the initiation of antiretroviral therapy shortly after birth. Further follow-up of this case is now reported.

Examples of technical assistance in a range of London settings are discussed in this paper. Skilled trades people, apprentices, lab boys and girls, family members, research students, research assistants, and laboratory technicians were, in different ways, all important to the organization of scientific work in this period. To illustrate this point, examples of work performed in trades shops, academic laboratories, entrepreneurial businesses and private laboratories are given. The examples demonstrate not only the complex and collective nature of scientific work, but also something of the social interactions of scientists and their assistants. Of especial note is the dependence of scientists on people who worked in the skilled trades.

Silvanus Phillips Thompson, FRS (1851–1916) began his career in the 1870s when there were still few academic posts for scientists, and when it was still uncertain whether the newer professional ideals would overtake the older, more gentlemanly, ones – in terms of both career advancement and of what being a ‘good’ scientist entailed. Thompson's many scientific, technical and literary activities are discussed in this paper, as is his Quakerism, perhaps the chief motivating force in his life. The paper raises the question of how success in science is measured, and shows how Thompson's sabbatarian impulse influenced both his scientific practice and his pedagogical approach. In detailing the ways in which Thompson made a successful career, despite his lack of professional research focus, the paper relates to larger contexts of science, class, religion and education in late nineteenth-century Britain.

Pyomyositis is a musculoskeletal infection with formation of an intramuscular abscess. Endemic in tropical climates, it is being reported with increasing frequency in temperate climates such as the United States. The most common causative organism is Staphylococcus aureus, present in greater than 90% of reported cases. Risk factors include underlying chronic illness, malnutrition, immunocompromised state, and muscle trauma. We present a case in which Streptococcus agalactae was the causative agent of myositis in a child with a history of perinatally derived human immunodeficiency virus infection.

Recently, while reading papers left by the chemist Raphael Meldola (1849–1915), I came across seventy-two letters that relate to a 1904 campaign, led by Meldola, to have a memorial tablet for Herbert Spencer placed in Westminster Abbey. A list of those who eventually signed Meldola's petition to the Dean of Westminster can be found in David Duncan's Life and Letters of Herbert Spencer. The Meldola Papers include letters from some, but not all, of the signatories, from people who refused to sign, and from one or two who agreed to sign, but whose names do not appear on the published list. The surviving correspondence is probably incomplete, as can be inferred from references in the existing letters and from the fact that the Meldola Papers appear to have been somewhat haphazardly collected. Together, the letters show how Spencer's work was viewed by some of Britain's leading intellectuals, shortly after his death in 1903. They reveal that the details of Spencer's work were largely forgotten and that Meldola's correspondents were divided on whether Spencer had been simply a controversialist or had done something worthwhile. Even those (the majority) who believed the latter were unable to articulate exactly what was worthwhile in Spencer's work.This paper records some of the content of the letters as well as some details of the memorial campaign and of the people involved. My main purpose is to bring these interesting letters to light. James Moore has written of the successful effort to have Charles Darwin buried in Westminster Abbey and of the subsequent campaign for an Abbey memorial plaque, and for a statue to be placed in the Natural History Museum in South Kensington. The unsuccessful campaign on behalf of Spencer, twenty-two years later, provides an interesting comparison. It is not my purpose fully to explore the cultural implications. However, the letters suggest that this and one or two other avenues of inquiry might be worth pursuing.

In early nineteenth-century London scientific activity was located mainly in two areas, Westminster and the City. Westminster, with its learned societies, was the focal point of a largely gentlemanly science founded upon the expertise of the Westminster scientific elite, the gentleman scientists and the skilled Westminster artisans. In the city, the Guilds promoted instruction serving the many technically based manufacturing industries that existed in London’s East End, an area that was also home to a number of scientific societies and clubs serving the interests of those in the various trades. In the aftermath of the 1851 and 1867 Exhibitions, with a growing awareness of foreign competition in trade and industry, there was much pressure on the government to promote higher education in the sciences. This paper examines the cultural identities of three of London’s mid-nineteenth-century scientific educational institutions, two located in the West End, the Royal College of Chemistry and the Royal School of Mines as well as the City and Guilds of London Institute, located in the East End. In comparing them it will be shown that while the West End institutions show the infusion of gentlemanly ideals held by members of the government, high civil servants and the members of learned societies located near by, and the East End institution shows something of guild and trades ideals, their scientific cultures cannot be easily demarcated. These cultures were hybrids in which various shared ideals, differently weighted, were represented.

In a 1976 paper, Robert DeKosky wrote ‘William Crookes is a puzzle to historians of latenineteenth century science. Despite his achievements we are forced to ask why he did not accomplish more.’ It is an interesting question; equally interesting is the question that prompts this paper – how did he accomplish so much?Why some scientists become prolific and successful is a question with both historical and ahistorical dimensions. Among the former are a number of cultural aspects rarely studied by historians. They include the nature of childhood experience, family attitudes, mentoring, and the existence of intellectual and practical support networks in adulthood. Ail are important, but how they contribute to individual success varies with time and place.

Disseminated cryptococcal disease is often associated with immunodeficient states. The diagnosis is usually made using standard antigen tests on serum and cerebrospinal fluid in patients with known immunodeficiency. Often, blood and cerebrospinal fluid cultures also yield Cryptococcus neoformans. The authors describe a child whose diagnosis remained elusive until a bone marrow aspiration, performed as part of an evaluation for suspected neoplasm, revealed the offending organism.

The use of chemical pesticides increased considerably after World War II, and ecological damage was noticeable by the late 1940s. This paper outlines some ecological problems experienced during the post-war period in the UK, and in parts of what is now Malaysia. Also discussed is the government's response. Although Rachel Carson's book, Silent Spring (1962), was important in bringing the problems to a wider public, she was not alone in sounding the alarm. Pressure from the public and from British scientists led, among other things, to the founding of the Natural Environment Research Council in 1965. By the 1970s, environmentalism was an important movement, and funding for ecological and environmental research was forthcoming even during the economic recession. Some of the recipients were ecologists working at Imperial College London. Moved by the political climate, and by the evidence of ecological damage, they carried out research on the biological control of insect pests.

Environmental issues are high on today's political agenda. Why we have landed in our present undesirable, and possibly even dangerous, situation and how we should act differently in the future, are questions central to our time. Max Oelschlaeger joins the current debate on both these questions. As historian he examines the roots of our environmental problems and looks, in some detail, at the history of wilderness as an idea. As philosopher he outlines some of the principal positions taken by eco-philosophers towards wilderness and its preservation; he also presents his own views.

Raphael Meldola FRS (1849-1915) was professor of chemistry at the City and Guilds Technical College in Finsbury. He was a colleague and close friend of Silvanus Phillips Thompson FRS (1851-1916), the college principal and professor of physics. This paper follows an earlier one on Thompson and the making of his career. It is intended to illustrate further the ways in which scientists of Meldola and Thompson's generation gained advancement within the scientific community. Meldola had interests beyond chemistry, including a serious interest in field entomology. In this he had several well-known mentors including Alfred Russel Wallace and Charles Darwin. The paper, which includes much new information derived from archival work, is presented as six thematic narratives related, among other things, to chemical and technical education, dye chemistry, the Royal Society solar eclipse expedition of 1875, natural history and Darwinism, field clubs, learned societies, and the honouring of scientists. Together these narratives illustrate a generalist/voluntarist career pattern that came to an end with the First World War.

This collection of essays, written over the past fifteen years by one of the more intrepid defenders of current Darwinian theory, contains material that will be of interest both to historians and philosophers of science and, since Ruse writes well and in an accessible manner, to an even wider audience. A preliminary glance at the contents primes one to expect to be both engaged and provoked; one is not disappointed. The essays include historical speculation on some of the views of Charles Darwin, a defence of human sociobiology and discussion of its feminist critique, punctuated equilibria theory, teleology in biology, extraterrestrial biology and moral theory, the plate tectonic revolution in geology, and the relationship between evolutionary theory and Christian ethics.

We report an 8-year-old boy with AIDS, extremely elevated serum immunoglobulin G (IgG) concentration and IgG kappa [IgG(κ)] and IgG lambda [IgG(λ)] paraproteinemia. This paraproteinemia partially responded to highly active antiretroviral therapy. This case emphasizes the importance of controlling B-cell activation.