Search

Objective\ud Predicting the outcomes of assisted reproductive technology (ART) treatments is desirable, but adopting prediction models into clinical practice remains limited. We aimed to review available prediction models for ART treatments by conducting a systematic review of the literature to identify the best performing models for their accuracy, generalisability and applicability.\ud \ud Evidence review\ud We searched electronic databases (MEDLINE, EMBASE, and CENTRAL) until June 2020. We included studies reporting on the development or evaluation of models predicting the reproductive outcomes before (pre-ART) or after starting (Intra-ART) treatment in couples undergoing any ART treatment. We evaluated the models’ discrimination, calibration, type of validation, and any implementation tools for clinical practice.\ud \ud Results\ud We included 69 cohort studies reporting on 120 unique prediction models. Half the studies reported on pre-ART (48%) and half on intra-ART (56%) prediction models. The commonest predictors used were maternal age (90%), tubal factor subfertility (50%), and embryo quality (60%).\ud \ud Only fourteen models were externally-validated (14/120, 12%) including eight pre-ART models (Templeton, Nelson, LaMarca, McLernon, Arvis, and the Stolwijk A/I,C,II models), and five intra-ART models (Cai, Hunault, van Loendersloot, Meijerink, Stolwijk B, and the McLernon post-treatment model) with a reported c-statistics ranging from 0.50 to 0.78. Ten of these models provided implementation tools for clinical practice with only two reported online calculators.\ud \ud Conclusion\ud We identified externally validated prediction models that could be used to advise couples undergoing ART treatments on their reproductive outcomes. The quality of available models remains limited and more research is needed to improve their generalizability and applicability into clinical practice.

Background The association between mode of delivery and postnatal depression is uncertain. Mental health history may modify the association. Objectives The objective of this study was to determine whether the association between caesarean and postnatal psychological distress (PPD) differs according to long-standing depression/anxiety. Methods Analysis of the UK-based Millennium Cohort Study of women who gave birth 2000-2002 was carried out. The outcomes were PPD at 9 months by Rutter Malaise Inventory and actively treated physician-diagnosed depression/severe anxiety at 3 years. The exposure was mode of delivery. Adjusted relative risks were estimated using Poisson regression. Effect modification according to long-standing depression/anxiety was investigated multiplicatively and additively. Results We included 15,936 women, of whom 2346 (13.4%, weighted) reported PPD. Women with long-standing depression/anxiety were at 34% lower risk of PPD following elective caesarean, compared with vaginal birth: relative risk (RR) 4.36 (95% confidence interval [CI] 3.76, 5.05), RR 3.25 (95% CI 2.23, 4.75) and RR 4.92 (95% CI 3.67, 6.59) for vaginal, elective and emergency caesarean births, respectively, with relative excess risk due to interaction (RERI) -1.28 (95% CI -2.73, 0.16), ratio of RRs 0.66 (95% CI 0.42, 1.05). Women with long-standing depression/anxiety were at greatest risk of later treatment following emergency caesarean, with RR 4.95 (95% CI 3.86, 6.34), RR 4.09 (95% CI 2.51, 6.65) and RR 6.74 (95% CI 4.87, 9.32), for vaginal, elective and emergency caesarean births, respectively; RERI 1.79 (95% CI -0.13, 3.71), ratio of RRs 1.36 (95% CI 0.94, 1.99); all RRs with reference to vaginal birth in the absence of long-standing depression/anxiety. There was no evidence of a similar association between emergency caesarean and PPD nor elective caesarean and later treatment. Conclusions Women with long-standing depression or anxiety who had elective caesarean had a lower risk of postnatal distress. When this group had emergency caesarean, there was greater risk of actively treated depression/anxiety at 3 years. These associations were not observed in women without long-standing depression/anxiety.

Gestational hypertension may confer risk of atopic disease in offspring through a direct biological mechanism, but another possibility is that risk is mediated through complications of pregnancy. To explore these associations, we conducted an analysis of a nationally representative birth cohort based in the UK involving children born 2000–2002. We included 12,450 mother-child pairs. We used logistic regression to estimate the association between hypertensive disease and asthma, hay fever, or eczema by age 5, and parentally reported early wheeze and severe wheeze. Mediation by gestation at delivery and caesarean delivery was explored using causal mediation analysis. Odds ratios (95% CI) for gestational hypertension and childhood asthma, hay fever, and eczema were 1.32 (1.09, 1.59), 1.22 (0.97, 1.55), and 1.12 (0.96, 1.32) respectively, adjusted for confounding. The population attributable fractions were 2.4% (1.0–3.8%), 0.9% (−0.3% to 2.1%), and 1.8% (0.0–3.7%), respectively. Accounting for mediation by gestational age and caesarean delivery, odds ratios (95% CI) for the potential direct effects of gestational hypertension were 1.21 (0.97, 1.50), 1.17 (0.91, 1.49), and 1.11 (0.94, 1.31) for the same.Conclusion: Gestational hypertension was weakly positively associated with asthma and this was partly mediated by earlier delivery. Only a small proportion of early childhood asthma was attributable to gestational hypertensive disease in this representative UK-based birth cohort. What is known:• Gestational hypertension has been shown to be an inconsistent risk factor for the atopic diseases.• The in utero immune environment may modify the risk of atopy in offspring; alternatively, complications of pregnancy including caesarean delivery and prematurity may explain an association between hypertensive disease and atopy. What is new:• Self-reported gestational hypertension was a weak risk factor for asthma and wheeze in the Millennium Cohort Study.• Part of the association between gestational hypertensive disease and asthma was explained by earlier delivery.

Objective: To determine the value of uterine CD138+ cells, as a marker of chronic endometritis, in predicting subsequent reproductive outcome in women with history of recurrent pregnancy loss.\ud Design: A prospective longitudinal study.\ud Setting: Tertiary specialised clinic.\ud Patients: Women with history of recurrent pregnancy loss or implantation failure over a 12-months follow-up period. \ud Intervention: We quantified the CD138+ cells/high powered field (hpf) using immunohistochemistry and image analysis of endometrial biopsies obtained during the secretory stage post ovulation. \ud Main Outcome Measures: live birth and subsequent pregnancy loss. We calculated the receiver operator curve for predicting subsequent pregnancy loss and reported using relative risk (RR) and 95% confidence intervals (CI).\ud Results: We enrolled 344 women of whom eighty-eight became pregnant (88/344, 25.5%). Half of them had a subsequent live birth (47/88, 53%) and the rest lost their pregnancy (41/88, 46%). The median CD138+ score was significantly lower in the live birth group (p

Objectives\ud In bladder drainage, an essential part of post-hysterectomy care, the optimal timing for removing the urinary catheter is unclear. Our objective was to evaluate the risks and benefits of early (6 h) catheter removal post-hysterectomy.\ud Study design\ud A systematic review searching MEDLINE, EMBASE and Cochrane CENTRAL from inception till May 2019 for randomised trials of women undergoing hysterectomy. We reported on urinary retention, positive urine culture, urinary tract infection (UTI) (defined by symptoms and/or antibiotic use), post-operative pyrexia, time to ambulation, and length of hospital stay. We assessed risk of bias in included trials and used a random-effect model to generate risk ratios (RR) for dichotomous outcomes and weighted mean differences (WMD) for continuous outcomes, with 95 % confidence intervals (CI).\ud Results\ud Of 1020 potentially relevant citations, we included 10 randomised trials (1120 women). Four trials had low risk of bias for randomisation and allocation concealment while five had low risk for outcome assessment and selective reporting. Compared to delayed removal, women in the early catheter removal group had a higher risk of urinary retention and needing re-catheterisation (10 RCTs, RR 3.61, 95 %CI 1.21–9.21, I 2 = 56 %). There was some reduction in the risk of post-operative UTI (6 RCTs, RR 0.42, 95 %CI 0.18 to 0.96, I 2 = 0 %), but we did not find a significant difference in post-operative pyrexia (6 RCTs, RR 0.73, 95 %CI 0.43–1.24, I 2 = 18 %) or positive urine cultures (6 RCTs, RR of 0.56, 95 %CI 0.27–1.12, I 2 = 55 %). There was no significant difference in the average time to ambulation (3RCTs, WMD −4.6, 95 %CI −9.16 to −0.18, I 2 = 98 %) and length of hospital stay (3RCTs, WMD −1.05, 95 %CI −2.42 to 0.31, I 2 = 98 %). Our meta-regression on the provision of prophylactic antibiotics did not show a significant effect on the reported outcomes. Our analysis was limited by our inability to adjust for potential effect modifiers such as the surgical route.\ud Conclusions\ud Early removal of the urinary catheter

Cathepsin S inhibitors attenuate mechanical allodynia in preclinical neuropathic pain models. The current study evaluated the effects when combining the selective cathepsin S inhibitor MIV-247 with gabapentin or pregabalin in a mouse model of neuropathic pain. Mice were rendered neuropathic by partial sciatic nerve ligation. MIV-247, gabapentin, or pregabalin were administered alone or in combination via oral gavage. Mechanical allodynia was assessed using von Frey hairs. Neurobehavioral side effects were evaluated by assessing beam walking. MIV-247, gabapentin, and pregabalin concentrations in various tissues were measured. Oral administration of MIV-247 (100-200 µmol/kg) dose-dependently attenuated mechanical allodynia by up to approximately 50% reversal when given as a single dose or when given twice daily for 5 days. No behavioral deficits were observed at any dose of MIV-247 tested. Gabapentin (58-350 µmol/kg) and pregabalin (63-377 µmol/kg) also inhibited mechanical allodynia with virtually complete reversal at the highest doses tested. The minimum effective dose of MIV-247 (100 µmol/kg) in combination with the minimum effective dose of pregabalin (75 µmol/kg) or gabapentin (146 µmol/kg) resulted in enhanced antiallodynic efficacy without augmenting side effects. A subeffective dose of MIV-247 (50 µmol/kg) in combination with a subeffective dose of pregabalin (38 µmol/kg) or gabapentin (73 µmol/kg) also resulted in substantial efficacy. Plasma levels of MIV-247, gabapentin, and pregabalin were similar when given in combination as to when given alone. Cathepsin S inhibition with MIV-247 exerts significant antiallodynic efficacy alone, and also enhances the effect of gabapentin and pregabalin without increasing side effects or inducing pharmacokinetic interactions.

In civil engineering, composite construction has become increasingly widespread due to the improvement of mechanical properties it provides. Recently, research on the development of post installed or retrofitted shear connectors has been conducted. The benefits of this are the ease of installation and the ease of removal for decommissioning structures at the end of their life. Most of the research in this area is concerned with modified versions of welded shear studs or various threaded rod and nut configurations and refers to only one type of shear connector. Therefore, the suitability of the proposed models across differing shear connection types is unknown. In the first of two companion papers an experimental study has been undertaken to ascertain the dynamic behaviour of identical steel–concrete composite beams with differing shear connection systems. Two blind bolt connector types were used as shear connection systems in steel–concrete composite beams. Alongside these, a welded shear stud specimen, and a non-composite specimen were tested for comparison.

In the first paper of these two companion papers an experimental study was undertaken to ascertain the dynamic behaviour of identical steel–concrete composite beams with differing shear connection systems. Two blind bolt connector types were used as shear connection systems in steel–concrete composite beams. Alongside these, a welded shear stud specimen, and a non-composite specimen were tested for comparison. In this, the second paper a Timoshenko beam model for steel–concrete composite beams is developed and is compared with the experimental results. An uncertain boundary condition is investigated using the Timoshenko beam model and an empirical relation between the displacements at the beam supports and the rotation of the cross section face is proposed.

The use of blind bolts in steel–concrete composite beams is beneficial for promoting sustainable design and for retrofitting existing steel structures. This paper presents an experimental study as well as finite element (FE) modelling analyses for the time-dependent behaviour of composite beams with blind bolts subjected to sustained loads. Four full-scale simply supported beams utilising different types of bolts and studs were tested under long-term static loads. The mid-span deflections were monitored for a period of over 260 days. Short-term push-out tests were also carried out on the connectors used in the composite beams, and their slip deformation was recorded for determining the initial stiffness. The experimental results were modelled by using a three-dimensional FE model, in which the creep of the concrete was simulated through defining a viscoelastic response and the shrinkage of concrete was incorporated by means of notional thermal expansion. The FE model was validated against the experimental results reported herein and other independent results of composite beams using conventional welded studs reported elsewhere, and it was subsequently applied to carry out parametric studies. An extensive body of parameters was considered to clarify their effects on the time-dependent behaviour of composite beams with blind bolts, including the mechanical properties and configuration details of shear connectors, the concrete strength, the loading conditions, the span-to-depth ratio and the reinforcement ratio. It was demonstrated that the time-dependent behaviour was sensitive to the stiffness and the bolt-to-hole clearance of connectors, and some other parameters also possessed effects with different degrees. The research findings implied that using blind bolts in composite beams was beneficial to the time-dependent response due to their relatively lower deflections resulting from the creep and shrinkage of the concrete over time. The outcome may provide an important basis and guidance for designing such composite beams when considering their long-term response with time effects.

Introduction There is a paucity of evidence in diagnostic radiography evaluating a career path into industrial imaging despite several higher education institutes stating this route as a career option on graduation. The link between a career in industrial radiography and diagnostic routes is unknown although there are anecdotal examples of individuals transferring between the two. Successfully obtaining a first post job following graduation in diagnostic radiography can be challenging in the current financial climate. A partnership was formed with an energy sector company that offered non-destructive testing/non-destructive evaluation (NDT/NDE) employing industrial radiographic technicians. Method As an initial pilot, 5 ( n = 5) final year diagnostic radiography students visited an industrial radiography site and underwent theoretical and practical training. Following this placement they engaged in a focus group and the student perceptions/responses were explored and recorded. Results Common themes were identified and categorised via a thematic analysis. These were; radiation safety, physics and technology, widening access, graduate attributes/transferable skill sets and working conditions. Conclusion Student discussion focussed around the benefits of working conditions in healthcare, the value of technology, safety and physics education in alternative placements and the transferability of skills into other/industrial sectors (e.g. NDT/NDE). Contemporary practice placements are a useful pedagogical approach to develop complex conceptual theoretical constructs, such as radiation physics. An in depth evaluation between the two industries skill sets is postulated. Additionally, this could offer alternative/emerging roles to interested diagnostic radiographers potentially meeting the skill shortage in industrial radiography.

The long and tragic history of human warfare manifests an endless quest for more effective ways to conduct attacks and defeat adversaries. This has in turn driven innovation in means and methods of defence against attacks. Remote warfare exemplifies both streams of development. The ability to conduct effective attacks at great distance from your own forces is a significant advantage in attack. Similarly, the ability to distance military personnel from the effective range of enemy weapons is a significant advantage in defence. Military forces have sought these advantages since time immemorial.Modern remote weapon systems, including vehicles that can be operated remotely, are but the latest element in this continuum of development. For a variety of reasons, the means of remote warfare that involve armed remotely operated vehicles have evoked significant social, political and legal reactions. The next evolution, autonomous weapon systems (AWS), inherent in which is the concept of autonomous decision making by machines to conduct attacks on human beings, arouses visceral trepidation for many and has given rise to calls for bans before the technology can be developed. The potential development of remote AWS is an important topic for legal and ethical discussion by governments, non-government organisations and scholars. This chapter discusses the legal dimensions of remote AWS, analysing how the precautions in attack in Article 57 of Additional Protocol I might apply to such systems and how the persons creating or using such systems may be held accountable under international humanitarian law for outcomes of their use.The authors suggest that this analysis of the law has demonstrated that neither remote warfare systems nor autonomous weapon systems are means of warfare that are currently proscribed by the law of armed conflict. Like all means of warfare, there are methods of use of these systems that may contravene the law of armed conflict. There is no doubt that continued developments in remote and automated systems will inspire further study of the law as it applies to such systems and further advocacy for what the law ought to be. It also seems that the developments in remote and autonomous systems may be destined to change the role played by combatants; but it appears unlikely that this will reduce the role played by lawyers.

Background Peer-assisted learning provides a means through which individuals can learn from one another through a reciprocal process. Radiographic image interpretation skills are fundamental to both diagnostic radiography students and medical students due to their shared role in preliminary evaluation of conventional radiographic images. Medical students on graduation, may not be well prepared to carry out image interpretation, since evidence suggests that they perform less well than radiographers in e.g. Accident and Emergency situations. Method A review of literature was conducted exploring the application of peer-assisted learning within diagnostic radiography and health education more widely as well as the practice of initial image interpretation. An extensive and systematic search strategy was developed which provided a range of material related to the areas. Findings An overview was obtained of the effectiveness of peer-assisted learning and the issues associated with development of image interpretation skills and a degree of discrepancy was identified between the two cohorts regarding their interpretative competence and confidence. This inconsistency may create an opportunity to apply peer-assisted learning, better preparing both disciplines for the practical application of image interpretation skills. Conclusion The review identified the lack of a substantial evidence base relating to peer-assisted learning in radiography. Peer-assisted learning is not widely embraced in an interprofessional context. Multiple positive factors of such an intervention are identified which outweigh perceived negative issues. Student teacher and learner may benefit as should the clinical service from enhanced practitioner performance. The findings justify further research to develop the evidence base.

Background Recent evidence has suggested an association between postoperative non-steroidal anti-inflammatory drugs (NSAIDs) and increased operation-specific complications. This study aimed to determine the safety profile following gastrointestinal surgery across a multicentre setting in the UK. Methods This multicentre study was carried out during a 2-week interval in September–October 2013. Consecutive adults undergoing elective or emergency gastrointestinal resection were included. The study was powered to detect a 10 per cent increase in major complications (grade III–V according to the Dindo–Clavien classification). The effect of administration of NSAIDs on the day of surgery or the following 2 days was risk-adjusted using propensity score matching and multivariable logistic regression to produce adjusted odds ratios (ORs). The type of NSAID and the dose were registered. Results Across 109 centres, early postoperative NSAIDs were administered to 242 (16·1 per cent) of 1503 patients. Complications occurred in 981 patients (65·3 per cent), which were major in 257 (17·1 per cent) and minor (Dindo–Clavien grade I–II) in 724 (48·2 per cent). Propensity score matching created well balanced groups. Treatment with NSAIDs was associated with a reduction in overall complications (OR 0·72, 95 per cent confidence interval 0·52 to 0·99; P = 0·041). This effect predominately comprised a reduction in minor complications with high-dose NSAIDs (OR 0·57, 0·39 to 0·89; P = 0·009). Conclusion Early use of NSAIDs is associated with a reduction in postoperative adverse events following major gastrointestinal surgery.

This article explores the relationship between Victorian and Ngaiwong ways of knowing by bringing a ‘planetary’ framework to bear upon an extraordinary meeting which took place at Buckingham Palace on 26 January 1846. To do so, it invokes the long history of the Antipodes; deploys, modifies and comments upon methodologies for conceiving and analysing ‘world literature’ by Americanist Wai Chee Dimock; and engages with the role of the imagination in Gayatri Chakravorty Spivak's concept of ‘planetarity’.

With the emergence of advanced Internet technologies, access to scientific literature is evolving at an unprecedented pace. While the number of peer-reviewed publications is growing exponentially, unpublished technical reports, dissertations and other forms of grey literature are becoming increasingly accessible for researchers across the world. Research organizations and universities are capitalizing on this opportunity, actively making their research available on the Internet. At the National Research Council, the Institute for Research in Construction ensures that all fire-related literature produced is stored in an Institutional Repository and posted on the Web in a freely available manner. In doing so, this system has provided fire researchers with a vehicle to improve visibility of their research, having pronounced advantages. For the fire community, the material is an excellent source of scholarly articles, reports, technical data and conference papers. A close examination of the Institute’s fire-related literature in Google Scholar reveals citation patterns which illustrate the value of open-access, free literature to fire researchers.

Reported results for patellar ACI include a mixed population of patients having or not a concomitant correction of the extensor mechanism. No study has reported separate outcome for those two patellar ACI subgroups. Forty four patients were included in this study designed to compare the outcome of patellar ACI with extensor realignment (group A) to patellar ACI with normal patellofemoral tracking (group B). Group A (n=22) had a higher increase in average modified Cincinnati knee score (4.5 vs. 1.7 points), better function (1.7 vs. 2.5), better SF-36 physical component scores (70.9 vs. 55.4 points) and higher IKDC scores (85.2 vs. 60.6 points) when compared to group B (n=22) at an average follow-up of 2 years. Patellar ACI with concomitant extensor realignment has superior outcome than patellar ACI with normal patellofemoral tracking. An unloading osteotomy could be desirable in selected patients with normal patellofemoral biomechanics to improve the outcome in this population.

Between October 2000 and December 2003, 252 autologous chondrocyte implants were performed in 183 patients. Eighty lesions showed overgrowth of the subchondral bone plate under the chondral lesion, this was termed a "bone boss." Thirty-seven were on the medial femoral condyle (MFC), 18 on the lateral femoral condyle (LFC), 21 in the trochlea and 4 on the patella. There was a statistically significant association between the LFC and "bone boss." The lesions showing this finding were of a larger area (3.4 cm2 and 2.8 cm2 respectively, p=0.006), and had more diffuse chondral changes than lesions without. The patients with a "bone boss" had a tendency to longer duration of symptoms (85.3 months and 64.3 months respectively, p=0.089). The "bone bosses" were resected back to the level of the surrounding subchondral bone prior to implantation. Radiological and clinical follow-up showed no statistical difference between the two groups. A discussion of the possible aetiology of the "bone boss" is made.

High tibial osteotomy has been generally accepted as a useful treatment for unicompartment osteoarthritis of the knee to improve a patient's quality of life. Few studies have examined the outcome from the patient's perspective. A survival analysis of one to twenty-one years was conducted on 67 knees including analysis of the patients' satisfaction level with this procedure. Cumulative survival probability of 89.5% at 5 years, 74.7% at 10 years and 66.9 % for 15 and 20 years was reported. Ninety-one percent of patients had improvement in pain score and would choose to have this surgery again. Average patient satisfaction level was 75.5%. Forty-eight percent of patients were able to perform at a higher level of activity than before surgery, although none was able to perform at the level prior to the onset of knee pathology. It was concluded that this procedure was able to improve a patient's quality of life and achieved high satisfaction among patients. There is an increasing role of high tibial osteotomy as an adjunct to an autologous chondrocyte implantation procedure.

Background. Lateral epicondylitis resistant to conservative treatment is a rare yet disabling condition. When diagnosed, it should be treated surgically. The appropriate surgical treatment relies on a precise diagnosis, usually based on physical examination. Exclusion of other pathologies in the lateral elbow area is essential. Methods. We report on an outcome in a group of 19 consecutive patients treated by excision, release, reattachment and repair of the common extensor origin. These patients were followed clinically for at least 2 years. Results. Eighteen patients reported recovery from pain and a satisfactory subjective gaining of strength in their forearm on average 3 and 4 months after the surgery, respectively. Conclusions. The presented treatment method is highly effective in the treatment of resistant lateral epicondylitis.

This essay describes the entanglement in Australia of three concepts: modernism; 'settler modernity'; and Aboriginality. Its three principal arguments are: (i) that European perceptions of Australian Aboriginal cultures were deeply influential in the development of modernism; (ii) that anxieties about the proximity of Aboriginal and settler peoples in Australia - but also resistance to European theories of Aboriginal culture not validated through personal experience of interacting with Aboriginal Australians - influenced strong anti-modernist sentiment among some Australian artists and writers; and (iii) that perhaps this 'anti-modernism' might instead be characterized as an 'alternative' modernism in Australia - an entanglement of visions of progress and degeneration - to which I will give the purposefully ugly label of 'antipodernism'. In developing these arguments I will make reference to Sigmund Freud's Totem and Taboo (1913) as inflected by the work in Australia of Francis Gillen and Baldwin Spencer, and discuss writings by Miles Franklin in particular, as well as Katherine Susannah Prichard, D.H. Lawrence, A.D. Hope, and Christina Stead.1Altogether, then, I will be exploring the impact of a particular construction of Australian Aboriginality on the development of modemist writing in Australia, a vast and complex subject, not least for its invocation of such contested terms as 'modernism', on the one hand, and 'Aboriginality', on the other. By virtue of providing an overview, then, I will necessarily crush significant nuances within the writing of the authors whose work I will mention; I am conscious also of working with a European figuration of Aboriginality, which is well removed from the knowledge derived from the lives, traditions, and experiences of real Aboriginal Australian men and women. I beg forgiveness for this on methodological grounds, for misconceptions of Aboriginality historically have been as influential on the cultural development of European and Australian writing as those messy and entangled truths about Indigenous Knowledge that emerge directly from interventions by Aboriginal people and from collaborations between Aboriginal and non-Aboriginal thinkers and activists.As a starting point for this exploration I find useful a 'traditional' distinction made in discussions of Western modernity summarized by Dilip Parameshwar Gaonkar in his introduction to Alternative Modernities (2001). The distinction is that between societal modernization ("the growth of scientific consciousness, the development of a secular outlook, the doctrine of progress, [... ] individualistic understanding of the self, contractualist understandings of society, and so on") and cultural modernity, or modernism:By and large, the proponents of cultural modernity were repelled by the middle-class ethos - by its stifling conformities and banalities; by its discounting of enthusiasm, imagination, and moral passion in favour of pragmatic calculation and the soulless pursuit of money; and, more than anything else, by its pretensions, complacencies, and hypocrisies as represented by the figure of the philistine.2Avant-garde artists, in this reading, invoke both "the cultural patina of modernity as a spectacle of speed, novelty, and effervescence"3 - they celebrate the positive outcomes of a technological age - and also set themselves up against regimes of social and intellectual routine, of bourgeois aspirations, and political, social, and aesthetic complacency. In doing so, they break tradi2 tional forms in the making of their art, architecture, design, and writing: they 'make it new'. They also make their artwork deliberately difficult to consume: because the complacency of consumer culture is one of their targets; and because they work outwards from those new and challenging models of human subjectivity and history that rise from (i) scientific studies of nature, notably Darwin's in the nineteenth century, and (ii) those new theories of the human psyche, and materialist histories of culture, produced in the early decades of tiie twentieth. …

Mobile bearing knee replacement has been designed to provide an effective prosthetic tool for improving long-term survivorship. Although, its potential long-term superiority has not been proven, an alarming possibility of its early mechanical failure has been previously reported. In the present study on 27 patients with 35 replaced knees due to osteoarthritis, 97.1% of a 5-year survivorship of LCS mobile bearing cementless total knee prosthesis is reported. This high survival rate, with a satisfactory functional outcome at middle term follow-up has been achieved by following an optimal technique of implantation. Therefore, in the middle term this mobile bearing design of total knee replacement is no less effective than the conventional fixed bearing designs.

The manner in which colonial painter Mary Morton Allport presents her life after their settlement in Van Diemen's Land in 1831as representative of a colony of genteel free-settlers in her journals is discussed. Her two miniature portraits titled 'Paul and Virginia' based on a fictional colonial role model, and placed strategically in her public document 'Book of Treasures' were aimed at creating a lady-like image for herself.

While Unmanned Aerial Vehicles (UAVs) have been part of warfare for over 150 years, the recent increase in their use, particularly as part of targeted strikes in Afghanistan, Pakistan and Yemen, has resulted in heightened public and academic interest. A significant amount of the public and academic debate has focused on public international law issues. This chapter examines the most relevant aspects of international law to UAV operations, namely the law concerning the resort to and use of force by states (jus ad bellum and jus in bello). Drawing on the recently released Manual on International Law Applicable to Air and Missile Warfare published by the Program on Humanitarian Policy and Conflict Research at Harvard University, the authors critically examine the following main legal issues in relation to UAV operations: can a state respond in national self-defence to the actions of a non-state actor acting independently of any state; can a state use force in the territory of a third state against a non-state actor (what are the geographic limits of a non-international armed conflict?); what is the status of a civilian operator of a UAV in a non-international armed conflict; and is there is an obligation under the law of armed conflict to positively consider the option of capture prior to attempting to kill? While the authors believe that there are preferred legal positions to be adopted on these points, it would be misleading to indicate that there are concluded positions that represent ‘the law’. Rather, there is a variety of views, some of which command more or less agreement from states, judicial fora and commentators. Some positions certainly are more consistent with historical and more recent state practice, and it is generally those positions that the authors have found more persuasive.

Extreme Ultraviolet Lithography (EUVL) is a leading candidate for the future development of smaller and faster microchips with feature sizes of 32 nm or less. Tin laser-produced plasmas (LPPs) are one of the most promising sources of in-band radiation for EUV lithography and inspection applications. However, ions emitted from these LPPs may cause significant damage to components, specifically the collector optics. Tin-droplet targets have the ability to supply the minimum mass required to generate the EUV radiation, leading to substantial decrease in the amount of generated debris. Absolute intensity measurements of the EUV radiation formed using a droplet target, have been recorded. Measurements were recorded over 2 pi steradian with respect to the plasma. The droplet generator, a fully in-house developed system, was synchronized with a Nd:YAG laser operating at a frequency of 5 kHz. The laser pulse was focused to a power density of approximately 10 11 W/cm 2 to maximize in-band emission. EUV measurements were recorded at the Intermediate Focus of the High Brightness Source of the Laboratory for Energy Conversion. To complement the EUV measurements, out-of-band measurements were simultaneously recorded with a calibrated spectrometer from 300 to 1000 nm.

The next generation of semi-conductor devices will be manufactured using extreme ultraviolet lithography with a laser-produced plasma as a candidate 13.5nm light source. A primary challenge, particularly for metrology tools, is the stability and the brightness of the generated EUV at the intermediate focus. In the experimental facility at ETH a novel collecting system is studied to optimize brightness and stability, and to avoid contamination after the intermediate focus. Different experimental studies are shown to confirm the design's success for both the EUV beam quality and lack of contamination after the intermediate focus.

The leading candidate for the manufacture of next generation semi-conductor devices is extreme ultraviolet lithography, with laser-produced plasmas as a candidate 13.5nm light source. A primary challenge for continuous operation is elimination of the debris load on the collector, without compromising the radiation intensity at the intermediate focus. A novel combination of thermal management and debris mitigation is developed in order to reduce the deformation and degradation of collector optics. This patent-pending novel debris mitigation technique enables the continuous operation of the source. The paper shows atomic force microscope measurements of the collector surface deposition. The debris mitigation system run at 50% design operating condition gives 90% debris mitigation effectiveness. The average temperature of the cooled collector is 36.5°C at the design point, with a peak-to-peak difference of 0.8°C. The collector geometry, after being adapted to compensate the thermal deformation, yields a spot size of 30μm at IF. Computational simulations, using ETH's multi-scale computational tools, complement the presented experimental results.

Information regarding the quality of autologous chondrocyte implantation repair is needed to determine whether the current autologous chondrocyte implantation surgical technology and the subsequent biologic repair processes are capable of reliably forming durable hyaline or hyaline-like cartilage in vivo. We report and analyze the properties and qualities of autologous chondrocyte implantation repairs. We evaluated 66 autologous chondrocyte implantation repairs in 57 patients, 55 of whom had histology, indentometry, and International Cartilage Repair Society repair scoring at reoperation for mechanical symptoms or pain. International Knee Documentation Committee scores were used to address clinical outcome. Maximum stiffness, normalized stiffness, and International Cartilage Repair Society repair scoring were higher for hyaline articular cartilage repairs compared with fibrocartilage, with no difference in clinical outcome. Reoperations revealed 32 macroscopically abnormal repairs (Group B) and 23 knees with normal-looking repairs in which symptoms leading to arthroscopy were accounted for by other joint disorders (Group A). In Group A, 65% of repairs were either hyaline or hyaline-like cartilage compared with 28% in Group B. Autologous chondrocyte repairs composed of fibrocartilage showed more morphologic abnormalities and became symptomatic earlier than hyaline or hyaline-like cartilage repairs. The hyaline articular cartilage repairs had biomechanical properties comparable to surrounding cartilage and superior to those associated with fibrocartilage repairs.

The process of reading conscripted by certain mid-Victorian novel is addressed. European tradition of Antipodes is described before discussing conscription process, then the discoveries and development of the early science of reading are compared and finally the implications of this reading process for the formation of British imperial subjectivity, and the continuing role of the tradition of 'the Antipodes' are discussed.

Purpose: Our purposes were to report the clinical outcome of autologous chondrocyte implantation (ACI) patients with graft hypertrophy compared with that of unoperated ACI patients and to longitudinally assess the effects of graft hypertrophy debridement. Methods: We divided 170 knee ACI patients with a minimum of 2 years' follow-up into groups according to the need for reoperation after ACI and the findings at surgery. Group A (n = 73) comprised patients who did not undergo reoperation, group B (n = 61) comprised patients who underwent reoperation and had findings unrelated to the repair, and group C (n = 36) comprised patients who underwent reoperation and had isolated graft hypertrophy. The International Knee Documentation Committee, modified Cincinnati knee rating, and Short Form 36 physical component scores for the 3 groups were compared. Of the repairs debrided because of graft hypertrophy, 41 were longitudinally assessed with arthroscopy or magnetic resonance imaging. Results: The mean follow-up was 42.2 months. Patch-related problems were seen in 73.7% of cases undergoing reoperation less than 2 years after implantation, whereas cartilage-related problems were the dominant finding more than 2 years after implantation (70.2%). Group A patients fared significantly better than group B or C patients with regard to all 3 parameters measured, with no difference between groups B and C. Longitudinal assessment of 41 hypertrophied repairs revealed 18 with signs of pathology after graft debridement. Conclusions: This study shows that reoperation is frequent after ACI and is associated with a less satisfying outcome. Furthermore, debridement of a hypertrophied ACI graft appears to be detrimental as shown by longitudinal assessment of repairs. Level of Evidence: Level IV, therapeutic case series.

To determine the efficacy of autologous chondrocyte implantation (ACI) in treating focal chondral defects of the knee, we reviewed the 2-year treatment outcome of ACI in 53 patients (72 lesions) through clinical evaluation, MRI, second-look arthroscopy and biopsies obtained. Improvement in mean subjective score from preoperative (37.6) to 12 months (56.4) and 24 (60.1) months post-ACI were observed. Knee function levels also improved [86% International Cartilage Repair Society (ICRS) III/IV to 66.6% I/II] from preoperative period to 24 months postimplantation. Objective IKDC score of A or B were observed in 88% preoperatively. This decreased to 67.9% at 3 months before improving to 92.5% at 12 months and 94.4% at 24 months post implantation. Transient deterioration in all these clinical scores was observed at 3 months before progressive improvement became evident. MRI studies demonstrated 75.3% with at least 50% defect fill, 46.3% with near normal signal, 68.1% with mild/no effusion and also 66.7% with mild/no underlying bone marrow oedema at 3 months. These values improved to 94.2%, 86.9%, 91.3% and 88.4%, respectively, at 12 months. At 24 months, further improvements to 97%, 97%, 95.6% and 92.6%, respectively, were observed. Second-look arthroscopy carried out in 22 knees (32 lesions) demonstrated all grafts to be normal/nearly normal based on the International Cartilage Repair Society (ICRS) visual repair assessment while core biopsies from 20 lesions demonstrated 13 grafts to have hyaline/hyaline-like tissue. Improvement in clinical and MRI findings obtained from second-look arthroscopy and core biopsies evaluated indicate that, at 24 months post-ACI, the resurfaced focal chondral defects of the knee remained intact and continued to function well.

Powerlase has made significant steps forward in developing reliable and cost-effective, kilowatt-class laser modules with short pulse duration and small footprint, for use as EUV drivers. These characteristics in parallel to EUV target requirements are essential for the generation of 115W of in-band EUV power at the intermediate focus. These laser modules can be coupled to the EUV target by using our flexible spatial and temporal multiplexing approach in order to scale up the laser average power on target. The multiplexing method developed by Powerlase is modular and optimised for maximum EUV collection angle. To further this goal we are currently evaluating target materials such as xenon in various phases and forms and also have a programme in place to investigate suitable tin targets.

Background: Simultaneous anterior and posterior ankle impingement has not been previously reported. We identified 62 patients with both anterior and posterior impingement and report the results of anterior arthroscopic and posterior open treatment. Methods: Between January, 1990, and December, 2003, 62 consecutive patients with symptoms and signs of both anterior and posterior impingement of the ankle were identified. Fifty-eight recorded a single injury or multiple ankle sprains. The most common mechanism of injury was inversion or plantarflexion. Initial conservative treatment failed in all patients and anterior arthroscopy and open posterior clearance were done. Followup averaged 11.4 months (up to 5 years). All patients showed posttraumatic synovitis at arthroscopy, and 48 had other arthroscopically-detected lesions, such as anterior tibial plafond lesions, ossicles, or soft-tissue impingement. The posterior arthrotomy revealed a bony cause for impingement in all but four patients, usually an os trigonum or a long posterior process of the talus. Results: Three patients had anterolateral tenderness after arthroscopy and three had tenderness of the posterior arthrotomy scar. There were no persistent neurologic complications. Fifty-eight patients were available for followup. Forty-seven (81%) had excellent or good outcomes, nine (15.5%) had fair outcomes, and two (3.5%) were graded as poor. Conclusion: Usually, anterior and posterior impingement occur separately; however, there are patients who have symptoms and signs of both anterior and posterior ankle impingement. A single inversion or plantarflexion mechanism of injury may be responsible for this syndrome, although it may also be caused by repetitive inversion injury. Combined anterior arthroscopic and posterior open treatment obtained good results with minimal complications and morbidity.

Laser milling of diverse materials has been demonstrated with short pulse lasers ranging from microsecond to femtosecond pulse durations, and with wavelengths from the far infrared to vacuum ultra-violet. In all cases a balance between quality, throughput and cost of ownership must be struck in order to determine commercial relevance. Latest generation Q-switched Diode Pumped Solid State Lasers offer the potential to enable the industrial uptake of laser milling for a wide variety of materials including aerospace alloys, thermal barrier coatings, tool steels, diamond and diamond substitutes. This paper will investigate these practical applications of laser milling with reference to comparative laser and non-laser processes.

Patellofemoral pain remains one of the most common musculoskeletal disorders encountered in orthopaedic practice. In this retrospective clinical study, 108 knees in 98 patients with patellofemoral pain due to malalignment were treated using a combined proximal and distal realignment technique. The results were evaluated at an average of 29.2 (1–9.2 years) months postoperatively. At final evaluation using the modified Trillat grading scale, good or excellent results were obtained in 88 (81.4%) of the knees treated. Second-look arthroscopy performed in 65 (60.2%) knees demonstrated good patellar tracking and Grade II articular changes were noted in 16 (14.8%) of the patellofemoral joints examined. Complications noted included anterior compartment syndrome with foot drop in one case and arthrofibrosis in another. We conclude that extensor realignment surgery with a combined proximal and distal realignment procedure is a reliable technique for patellofemoral pain secondary to malalignment.

Laser milling of a variety of substrates is investigated with the intention of achieving high quality material removal to create three-dimensional shapes in the material. A high power Q-switched Diode Pumped Solid State Nd:YAG Laser at 1064nm is used in all cases. Materials investigated include Nickel Superalloys, Thermal Barrier Coatings, Steels, Tungsten Carbide and Polycrystalline Diamond. Multi-layer substrates are also considered. The effects of laser intensity, plasma formation, pulse duration, material properties, and resulting removal rate, recast and surface finish are explored for this process. This paper defines the findings of this study within the context of commercial imperatives.

We have reviewed 22 patients from a total of 135 treated by autologous chondrocyte implantation (ACI) who had undergone further surgery for pain in the knee and mechanical symptoms after a mean of 10.5 months. There were 31 grafted lesions. At operation the findings included lifting (24/31) and detachment (3/31) of periosteal patches for which arthroscopic shaving was performed. Chondroplasty was undertaken on two new lesions, another required an ACI and a further patient required trimming of a meniscus. The mechanical symptoms resolved within two weeks. At the last review, two to 14 months from reoperation; 68% had improved, and 86% had normal or nearly normal IKDC scores. Of the 31 lesions, 30 (97%) had normal or nearly normal visual repair scores. Biopsy showed good integration with subchondral bone and the marginal interface in all specimens, most of which showed hyaline or hyaline-like cartilage (70%). Troublesome mechanical symptoms required surgery in 13% of ACI-treated patients and were attributed to periosteal extrusion. Simple arthroscopic debridement was curative.

Publisher Summary Very valuable resources for the discovery of biologically active agents are encoded combinatorial libraries of small molecules. A binary encoding protocol employing electrophoric molecular tags (ECLiPSe technology) has been developed at Pharmacopeia. A series of quality control (QC) protocols to ensure the highest degree of library has also been put into practice. This protocol, sets of synthons are serially combined through split-and-pool or direct divide synthesis in tandem with the incorporation of binary sets of electrophoric tags on solid support. Quality control steps occur throughout the entire library construction pipeline. To ensure a successful library synthesis and production elution Extensive synthon profiling, rigorous analysis of QC compounds, final confirmation of library chemistry (library QA), and production-in-process-QC analysis are essential. Empirical information regarding overall fidelity and an indication of the performance of individual synthons is provided by both in-line and final library QA. The quality of large, encoded combinatorial libraries can be assessed by library QA, a powerful analytical protocol. Based on the combined application of tag decoding and single bead liquid chromatography/mass spectrometry (LC/MS), QA analysis would be virtually impossible to carry out without an encoding strategy due to redundant masses produced during split synthesis. The statistical theory and its application to library assessment are analogous to the accepted statistical sampling practices used in the industry to ascertain the quality of mass-produced material. The simplicity of tag reading and rapid acquisition of structure activity relationship (SAR) information is arguably the most significant advantage of encoding technology vs. other deconvolution techniques. Library QA serves to substantiate and enhance the value of nascent SAR obtainment from library screening.

Investigations are reported in a number of key applications areas for nanosecond pulsed Diode-Pumped Solid-State Lasers. Lasers with a range of pulse durations, frequencies, and pulse energies are assessed for performance in such applications as fine hole drilling in steels, cooling vane drilling, and machining three dimensional shapes in metals and composites. The effects of varying laser parameters are reported with respect to the interrelated phenomena of plasma formation, dimensional accuracy, material removal, dross formation and processed material properties. Process enhancements are also considered.It is found that lasers operating in this regime offer significant advantages in terms of process rates and achievable quality over competing industrial technologies.Investigations are reported in a number of key applications areas for nanosecond pulsed Diode-Pumped Solid-State Lasers. Lasers with a range of pulse durations, frequencies, and pulse energies are assessed for performance in such applications as fine hole drilling in steels, cooling vane drilling, and machining three dimensional shapes in metals and composites. The effects of varying laser parameters are reported with respect to the interrelated phenomena of plasma formation, dimensional accuracy, material removal, dross formation and processed material properties. Process enhancements are also considered.It is found that lasers operating in this regime offer significant advantages in terms of process rates and achievable quality over competing industrial technologies.

Electrical to EUV conversion efficiency is a key parameter for systems scaled to EUV emission in the 100W regime. Improvement in efficiency of conversion from laser radiation at the EUV source, reduces the required laser power and as such can lend itself to reduced heat load and debris emission. Also, improvement in the electrical to laser conversion efficiency results in a direct reduction in cost of ownership. Laser solutions optimised for efficient conversion to high M 2 CW laser radiation are not optimised in design for efficient short-pulsed operation; the mode of operation required for EUV generation. Aspects of both EUV source and laser design are discussed, with a view to optimising conversion efficiency for scalable EUV solutions.