Search

An international research project led by the University of Plymouth is working to update a centuries-old construction technique for a new generation of energy efficient homes. Whilst it used to be ...

Background: Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date. Methods: We used data from the Extracorporeal Life Support Organization (ELSO) Registry to characterise the epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries. The primary outcome was in-hospital death in a time-to-event analysis assessed at 90 days after ECMO initiation. We applied a multivariable Cox model to examine whether patient and hospital factors were associated with in-hospital mortality. Findings: Data for 1035 patients with COVID-19 who received ECMO support were included in this study. Of these, 67 (6%) remained hospitalised, 311 (30%) were discharged home or to an acute rehabilitation centre, 101 (10%) were discharged to a long-term acute care centre or unspecified location, 176 (17%) were discharged to another hospital, and 380 (37%) died. The estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 37·4% (95% CI 34·4–40·4). Mortality was 39% (380 of 968) in patients with a final disposition of death or hospital discharge. The use of ECMO for circulatory support was independently associated with higher in-hospital mortality (hazard ratio 1·89, 95% CI 1·20–2·97). In the subset of patients with COVID-19 receiving respiratory (venovenous) ECMO and characterised as having acute respiratory distress syndrome, the estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 38·0% (95% CI 34·6–41·5). Interpretation: In patients with COVID-19 who received ECMO, both estimated mortality 90 days after ECMO and mortality in those with a final disposition of death or discharge were less than 40%. These data from 213 hospitals worldwide provide a generalisable estimate of ECMO mortality in the setting of COVID-19. Funding: None.

Living wall systems are a relatively new form of facade cladding treatment on buildings. Bringing a host of benefits such as added biodiversity, they also have the potential to aid the thermal efficiency of a wall construction by offering an extra layer of thermal resistance. Yet few studies have been conducted to ascertain the thermal influence of living wall systems can have on existing buildings. This study reviews the impact of living walls upon the thermal and environmental performance of buildings and isolates a lack of research that directly measures associated retrofitted living wall thermal performance. A case study then monitors the heat flux through a pre 1970s uninsulated cavity masonry wall construction that has been retrofitted with an external living wall system face. Results are compared with an identical wall build-up on the same elevation without the living wall cladding. Results found that the calculated thermal transmission value for the pre 1970s wall with an additional Living wall facade cladding was 31.4% lower than that of the same wall without the living wall. Furthermore, diurnal fluctuations in heat flux were lower over the study period for the wall with the living wall system cladding. These findings demonstrate that a living wall facade offers a viable solution for helping to minimise heat loss from existing buildings of this construction.

Oceans and coasts provide a wide array of services to humans, including climate regulation, food security, and livelihoods. Managing them well is vital to human well-being as well as the maintenance of marine biodiversity and ocean-dependent economies. Carbon sequestration and storage is increasingly recognized as a valuable service provided by coastal vegetation. Carbon sequestered and stored by mangrove forests, tidal marshes, and seagrass meadows is known as ‘blue’ carbon. These habitats capture and store carbon within the plants themselves and in the sediment below them. When the habitats are destroyed, much of their carbon is released back to the atmosphere and ocean contributing to global climate change. Therefore, blue carbon ecosystem protection is becoming a greater priority in marine management and is an area of interest to scientists, policy makers, coastal communities, and the private sector including those that contribute to ecosystem degradation but also those that are looking to reduce their carbon footprint. A range of policy and management responses aim to reduce coastal ecosystem loss, including the establishment of marine protected areas (MPAs). This paper explores how MPA design, location, and management could be used to protect and increase carbon sequestration and ensure integrity of carbon storage through conservation and restoration activities. While additional research is necessary to validate the proposed recommendations, this paper describes much needed first steps and highlights the potential for blue carbon finance mechanisms to provide sustainable funding for MPAs.

As evidence has accumulated that entrepreneurs may pay a financial penalty for their career choice, researchers have struggled to explain the motivation that might lead individuals to pursue the creation of new firms, technologies, and opportunities. We introduce the desire to leave a legacy as both a common source of motivation for many entrepreneurs, and a source of variation, as entrepreneurs who wish to leave a legacy must decide what they would like to leave behind, and whom they wish to benefit from that act. We discuss the implications of the different kinds of legacies for entrepreneurs and their organizations, particularly at founding and exit, when the legacy motive is likely to be particularly salient.

Background: Experience and evidence from the Integrated Care Organisation (ICO) in Torbay and South Devon, UK show that implementation of fully integrated systems (comprising acute, community, primary, social, and voluntary services) require, amongst others, leadership and a co-produced engagement approach to foster a shared culture. Aims and Objectives: This is an interactive workshop to explore with participants through plenary and small group, flipcharts, and a prioritisation exercise relevant elements of the ‘Context and Capabilities for Integrated Care’ (CCIC) implementation framework for integration. The outcome is to identify with participants the elements which are most salient and critical (both as facilitator and barriers), how they interact with key processes and outcomes of system transformation, and to discuss emerging best practice and potential solutions. Format (timing, speakers, discussion, group work, etc): The workshop is facilitated by key leaders, representative of the wider system: Dawn Butler - Deputy Director of Strategy, Performance and Planning, Torbay and South Devon NHS Foundation Trust [TSDFT]; Dr Matthew Fox –GP, Locality Clinical Director TSDFT, Governing Body Locality GP (Coastal) South Devon and Torbay Clinical Commissioning Group [CCG], Chloe Myers - Manager, Volunteering In Health @ Coastal Information Centre. Researchers-in-Residence Dr Felix Gradinger, and Dr Julian Elston (University of Plymouth). If participants are consenting to do so, researchers would aim to capture and record the content of the workshop for co-production of research, learning and dissemination. Timing: 90minutes required 10mins: Introductions, co-production aim, overview Clarify and manage expectations, consent 25mins Introducing speakers and 5mins pitch each, RIRs to introduce CCIC framework and relevant domains; Brainstorming exercise (depending on numbers split into 3 or 4 groups each allocated to key elements), Showcase Torbay story; Highlight leadership domains/approaches and interdependence at system level, explain method and highlighted main elements 5mins Individual exercise, prioritising and thinking of examples for key elements; think about how most important elements link to others in the framework in own context; Get people to think about examples from their own practice 25mins Collectively rank around table/group and make links to other elements, consider solutions of how challenges were overcome; and discuss examples for feedback to the plenary (using flip charts); Get people to share why and how links start emerging; reach consensus around feedback from group and prepare to share in plenary 20mins Plenary and live feedback populating domains on whiteboard tying up most important connections and solutions; Start making connections between key elements across domains, formulate best practice elements 5mins End; summary and next steps; Encourage people to think about how to apply this personally or through conference networks Target audience: Managers, Practitioners, Researchers, and Public Representatives. Learnings/Take away: To illustrate system transformation, leadership and approach To introduce an implementation framework for integrated working Prioritise and identify key elements relevant to attendants Share and note experiences of how elements play out Identify solutions (facilitators and barriers) Record and feedback notes from workshop (co-produced leagacy)

publisher: Elsevier articletitle: Building defect detection: External versus internal thermography journaltitle: Building and Environment articlelink: http://dx.doi.org/10.1016/j.buildenv.2016.06.011 content_type: article copyright: © 2016 Elsevier Ltd. All rights reserved.

Background Literature is limited regarding low-fidelity simulation related to patient safety. A low-fidelity simulation was implemented to assess prelicensure students' ability to detect patient safety issues and their perceptions of the simulation. Method A descriptive design was used with a convenience sample of students enrolled in associate, bachelor, or accelerated bachelor degree programs. Results Participants were not successful in identifying all the patient safety issues. However, they perceived themselves as being successful. Participants valued the learning experience and felt it increased their confidence in identifying patient safety issues. Conclusions Nurse educators need to examine their nursing curriculum related to how patient safety concepts are taught and reinforced throughout the curriculum.

Acute myeloid leukaemia (AML) cells often up-regulate pro-survival members of the BCL-2 protein family, such as BCL-2 and MCL-1, to avoid apoptosis. Venetoclax (ABT-199) targets BCL-2 and has shown promising efficacy in AML but over-expression of MCL-1 can cause resistance. A co-operative approach, targeting both BCL-2 and MCL-1 may therefore prove beneficial. This study investigated the potential synergistic relationship between Venetoclax and the MCL-1 inhibitor S63845 in AML cells. We treated MV4-11 cells and primary AML samples for 4 hours with Venetoclax, S63845 or the combination. We used a short-term flow cytometric technique to assess synergy using cytochrome C release as a read out of response. The combination of Venetoclax and S63845 produced a synergistic apoptotic response in MV4-11 cells and primary samples, including the leukaemia re-populating leukaemic stem cell (LSC) population, in 92% of the samples. Known molecular biomarkers of response to BCL-2 and MCL-1 targeting agents were corroborated, and augmented, with the short-term functional assay. The assay also predicted potential biomarkers of response to the combination of BCL-2 and MCL-1 targeting agents. Primary samples with an IDH2_140 mutation were more sensitive to Venetoclax as a single agent whereas samples with a FLT3-ITD mutation were more resistant. This resistance could be reversed when combined with S63845. All FLT3-ITD and NPM1 mutated samples were sensitive to the combination of drugs. We report that co-operatively targeting BCL-2 and MCL-1 may be beneficial in AML and a short-term in vitro assay can identify patients who might best respond to this combination.

Extensive damage to school buildings has been observed during past earthquakes in Italy, with the 2002 Molise event resulting in the complete collapse of a school building leading to numerous casualties. As part of a wider project in Italy to assess the seismic risk in school structures, six school buildings of various construction typologies were surveyed and instrumented to validate detailed numerical models of typical school structures located throughout Italy.

Purpose The aim of this study was to determine T2* values for the fetal brain in utero and to compare them with previously reported values in preterm and term neonates. Knowledge of T2* may be useful for assessing brain development, brain abnormalities, and for optimizing functional imaging studies. Methods Maternal respiration and unpredictable fetal motion mean that conventional multishot acquisition techniques used in adult T2* relaxometry studies are not practical. Single shot multiecho echo planar imaging was used as a rapid method for measuring fetal T2* by effectively freezing intra-slice motion. Results T2* determined from a sample of 24 subjects correlated negatively with gestational age with mean values of 220 ms (±45) for frontal white matter, 159 ms (±32) for thalamic gray matter, and 236 ms (±45) for occipital white matter. Conclusion Fetal T2* values are higher than those previously reported for preterm neonates and decline with a consistent trend across gestational age. The data suggest that longer than usual echo times or direct T2* measurement should be considered when performing fetal fMRI to reach optimal BOLD sensitivity. Magn Reson Med 73:1795–1802, 2015. © 2014 Wiley Periodicals, Inc.

Introduction: International policy is encouraging a re-design of health and social care services, including the use of social prescribing. Torbay and South Devon NHS Foundation Trust, an Integrated Care Organisation in the UK, commissioned a voluntary sector ‘Wellbeing Coordination’ service as a key element of the wider care model. This case study seeks to understand how primary, acute, social, community and voluntary services are working together in a locality hub and the impact of wellbeing coordinators on service users’ well-being, use and cost of health and social care services Methods: A before-and-after study, supplemented with qualitative case studies, practitioner interviews/surveys, observations of multidisciplinary team (MDT) meetings and service user/caregiver interactions. Applying an action-based participatory approach, findings were co-produced with stakeholders and members of the public by embedded researchers-in-residence. Quantitative service user data were collected on health and social well-being outcomes and frailty on referral and 12 weeks. Comprehensive activity and cost data were collected at 12 months pre- and post-referral. Results: Health outcomes and service activity data were collected on 49 participants receiving the wellbeing coordination programme. All person-reported outcomes showed statistically significant increases in mean change scores (Warwick-Edinburgh Mental Well-being Scale, Well-being Star™, Patient Activation Measure, Rockwood Clinical Frailty Scale, Living well goals met). Qualitative case studies and observations highlighted key mechanisms of the intervention and the hub working. The impact on health and social care use and cost was more nuanced, with mean activity and cost increasing overall. Referrals from the Enhanced Intermediate Care MDTs (20/49) showed higher levels of use and cost. At locality hub level, the practitioner survey, observations and interview findings show an increase in vertical and horizontal organisational integration and high levels of staff-reported person-centeredness while embodying a strengths-based approach. Discussion: The study shows a positive impact on outcomes and mixed patterns regarding activity and cost. The findings indicate potential for more ‘down-stream’ and preventative work. The close links with the wider voluntary sector add to the hub offer in holding more complexity, providing access and continuity of care, and delivering holistic and personalised care in the right place and at the right time. Conclusion: Key elements of how the hub works indicate the importance of leadership, co-ordination, communication, colocation, and contracting that allows the nourishing of trusting relationships and crossing of organisational and professional boundaries. Lessons learned: Challenges included pooling resources, record sharing, information governance and engaging all stakeholders in a shared vision for a strengths-based, person-centred culture. Ownership and bottom up dynamics and formal and informal relationships between practitioners at all levels, including the community they work with, were key features for overcoming these. Limitations: Case studies and participatory research approaches may be considered lesser to experimental study designs. However, context is crucial to integrated care and extrapolating generalizable findings. Co-production and triangulating varying data sources helps studying and implementing complex system wide transformation. Suggestions for future research: The Researcher-in-Residence model could be rolled out across systems to facilitate learning, and to increase robustness of insights.

Fetal magnetic resonance imaging (MRI) is now routinely used to further investigate cerebellar malformations detected with ultrasound. However, the lack of 2D and 3D biometrics in the current literature hinders the detailed characterisation and classification of cerebellar anomalies. The main objectives of this fetal neuroimaging study were to provide normal posterior fossa growth trajectories during the second and third trimesters of pregnancy via semi-automatic segmentation of reconstructed fetal brain MR images and to assess common cerebellar malformations in comparison with the reference data. Using a 1.5-T MRI scanner, 143 MR images were obtained from 79 normal control and 53 fetuses with posterior fossa abnormalities that were grouped according to the severity of diagnosis on visual MRI inspections. All quantifications were performed on volumetric datasets, and supplemental outcome information was collected from the surviving infants. Normal growth trajectories of total brain, cerebellar, vermis, pons and fourth ventricle volumes showed significant correlations with 2D measurements and increased in second-order polynomial trends across gestation (Pearson r, p

Background Vancomycin has historically been the mainstay of therapy for MRSA bacteremia, but severe infections due to vancomycin-intermediate Staphylococcus aureus have emerged. In vitro studies have shown that the combination of a β-lactam antibiotic, such as ceftaroline with daptomycin, was synergistic against MRSA. The purpose of this study was to compare outcomes in patients who received daptomycin and ceftaroline in combination vs. vancomycin for the treatment of MRSA bacteremia. Methods This was a retrospective exploratory cohort study approved by the institutional review board at Cooper University Hospital. Patients were included if they received daptomycin/ceftaroline (cases) or vancomycin (controls) for the treatment of MRSA bacteremia between November 2010 and March 2017. Cases were matched 1:1 with controls based on source of MRSA bacteremia, age within 10 years, and renal function. The primary endpoint was clinical cure, defined as the improvement of signs and symptoms of bacteremia. Secondary endpoints included microbiologic cure, time to sterilization of blood cultures, duration of hospital stay, overall mortality, and MRSA-related mortality. Results Forty-one cases were included. There was no statistical difference between the two groups in microbiologic cure, time to sterilization of blood cultures, overall mortality, or MRSA-related mortality. There were no significant differences between patients in each group including in those with ICU admissions and who required vasopressors. Cases were significantly more likely to have hardware compared with the control group (43.9% vs. 12.2%; P = 0.0014). Clinical cure was achieved in 27 patients (65.9%) in the case group and 26 patients (63.4%) in the control group (P = 0.8173). Patients in the case group had a statistically longer mean hospital duration (29 days vs. 21 days, respectively, P = 0.0206) and more secondary complications such as bone infection (P = 0.0076). Conclusion Time to sterilization of blood cultures and overall mortality were similar in both groups. Patients in the combination group had longer hospital stays compared with vancomycin monotherapy. Daptomycin/ceftaroline combination therapy is an option for complicated MRSA bacteremia. Larger studies should be conducted to further evaluate this combination. Disclosures All authors: No reported disclosures.

Introduction: This research was conducted to investigate if X-ray cassettes could be a possible source of pathogens capable of causing nosocomial infections, and if they could be a possible vector for cross infection within the hospital environment. Method: The research involved the swabbing of X-ray cassettes in a Diagnostic Imaging Depart- ment of a large hospital in the east of England. Two areas of the Diagnostic Imaging Depart- ment were included in the study. Research concentrated on X-ray cassettes used for mobile radiography, accident and emergency and inpatient use. Forty cassettes were swabbed in total specifically for general levels of bacterial contamination, also for the presence or absence of methicillin-resistant Staphylococcus aureus (MRSA). A mapping exercise was completed follow- ing the location of an X-ray cassette typically used in mobile radiography. The exercise noted the level of direct contact with patient's skin and other possible routes of infection. Results: The results demonstrated that there were large levels of growth of samples taken from cassettes and developed in the Microbiology Department. Coagulase-negative Staphylo- coccus, Micrococci, Diptheroids and species of Bacillus were all identified. The mapping exer- cise in which the journey of a 35/43 cm cassette used for mobile radiography was tracked found that contact with patient's skin and potential pathogens or routes of cross infection was a common occurrence whilst undertaking mobile radiography. Conclusion: The research has identified the presence of bacterial contamination on cassettes. The research established that X-ray cassettes/imaging plates are often exposed to pathogens and possible routes of cross infection; also that patient's skin often comes directly in contact with the X-ray cassette/imaging plate. The research also shows that as cassettes/imaging plates are a potential source of cross infection, the Diagnostic Imaging Department may be partly responsible for adding to the transference of pathogens around the hospital.

The legacy of Winckelmann was for an idealized, non-corporeal version of antique homosexual behaviour, grounded in Plato.. This chapter explores the more complex material relating to Roman homosexuality, and its interpretation in the eighteenth century. It examines the concept of 'decency' as a problem for thinkers of the period, in particular how Roman literature itself deals with that concept in relation to male homosexual acts, examining Ovid and Martial. It then looks at how the idea of decency affected the Enlightenment reception of particular texts, including Petronius and book 12 of the Greek Anthology.

Building thermography traditionally captures the thermal condition of building fabric at one single point in time, rather than changes in state over a sustained period. Buildings, materials and the environment are, however, rarely in a thermal equilibrium, which therefore risks the misinterpretation of building defects by employing this standard methodology. This paper tests the premise that time-lapse thermography can better capture building defects and dynamic thermal behaviour. Results investigating the temporal resolution required for time-lapse thermography over two case study houses found that under typical conditions small temperature differences (approximately 0.2 K) between thermal areas could be expected for 30-min image intervals. Results also demonstrate that thermal patterns vary significantly from day-to-day, with a 2.0 K surface temperature difference experienced from one day to the next. Temporal resolutions needed adjusting for different types of construction. Time-lapse experiments raised practical limitations for the methodology that included problems with the distance to target and foreground obstructions. At the same time, these experiments show that time-lapse thermography could greatly improve our understanding of building transient behaviour and possible building defects. Time-lapse thermography also enables enhanced differentiation between environmental conditions (such as clear sky reflections), actual behaviour and construction defects, thereby mitigating the risk of misinterpretation.

Summary Background Previous studies concerning the effect of hamstring stretching and sacroiliac joint manipulation on hamstring flexibility or hip flexion range of motion have only concentrated on the immediate post-intervention effects. Objective To examine the effect of a 3-week trial of hamstring stretching compared to stretching and sacroiliac joint manipulation on hamstring flexibility as measured using the passive straight leg raise (SLR) and the back saver sit and reach (BSSR) test. Methods All 15 volunteers passed the inclusion criteria and had a passive straight leg raise less than or equal to 70°. The participants were randomly divided into either the hamstring stretching or stretching/manipulation group. Both protocols lasted for 3 weeks and involved participants stretching twice a day, being tested twice a week (SLR and BSSR tests) during which the manipulation group received bilateral sacroiliac joint manipulations. A final assessment was performed 1 week after the cessation of the protocol. Non-parametric Mann–Whitney U and Wilcoxen Signed Ranks tests were performed on the data. Results Both protocols produced significantly greater results for the SLR and BSSR tests. When compared, results for both tests in the manipulation group were greater than the stretch group. However, only increases in the passive straight leg raise on the left leg were significantly greater in the manipulation group. Conclusions The results suggest both hamstring stretching and stretching with sacroiliac joint manipulation significantly increase flexibility over a 4-week period; however, more research is needed to determine whether manipulation has a greater effect.

Background and Objectives Temporary dermal clearing, i.e., reduction in the attenuation coefficient of the dermis and epidermis, may lead to improved laser tattoo removal by providing increased efficiency of laser delivery to embedded ink particles and enabling the use of shorter wavelength visible lasers more effective on certain inks. Study Designs/Materials and Methods In a hairless guinea pig model of human tattoo, we tested both intradermal and transdermal application of glycerol, using visual inspection, spectral analysis, and optical coherence tomography techniques to assess effectiveness. In controlled experiments, we compared the outcomes of single laser treatment sessions for both cleared and uncleared tattoo sites using Q-switched 755 and 532 nm lasers on three different inks. Results Intradermal injection of clearing agents induced dermal clearing but resulted in necrosis and scar. Transdermal application of clearing agents resulted in moderate reversible clearing, which was localized to the superficial layers of the skin and did not result in complications. Statistically significant differences in laser treatment outcome were observed relative to a number of treatment parameters including the treatment of certain tattoos by short wavelength lasers. Conclusions Temporary clearing of superficial skin layers may be performed in an apparently safe and reliable manner. Clearing should lead to increased penetration of laser light to tattoos and should, therefore, increase treatment efficiency. Further study is needed to determine the degree to which this change is of clinical value. Lasers Surg. Med. 36:289–296, 2005. © 2005 Wiley-Liss, Inc.

Using astronomy software, this article provides a systematic re- examination of the astronomical references in Ovid's Fasti and reviews the previous authority on the question, Ideler (1825). The review finds that most (three out of four) of the more than fifty astronomical references in the poem are accurate and reflects on the negative reception of Ovid's handling of astronomy in light of these findings. OVID'S CALENDAR POEM, the Fasti, weaves together the Roman civil calendar with astronomical observations, as the second line announces: "lapsaque sub terras ortaque signa canam" ("signs risen and set under earth I will sing," 1.2). Later, at the end of the Fasti's long programmatic opening, Ovid expands on his astronomical project (1.295-310). After honoring the devotion and genius of pioneer astronomers in Lucretian fashion, Ovid concludes

As evidence has accumulated that entrepreneurs may pay a financial penalty for their career choice, researchers have struggled to explain the motivation that might lead individuals to pursue the cr...

There is growing interest in exploring fetal functional brain development, particularly with Resting State fMRI. However, during a typical fMRI acquisition, the womb moves due to maternal respiration and the fetus may perform large-scale and unpredictable movements. Conventional fMRI processing pipelines, which assume that brain movements are infrequent or at least small, are not suitable. Previous published studies have tackled this problem by adopting conventional methods and discarding as much as 40% or more of the acquired data.In this work, we developed and tested a processing framework for fetal Resting State fMRI, capable of correcting gross motion. The method comprises bias field and spin history corrections in the scanner frame of reference, combined with slice to volume registration and scattered data interpolation to place all data into a consistent anatomical space. The aim is to recover an ordered set of samples suitable for further analysis using standard tools such as Group Independent Component Analysis (Group ICA).We have tested the approach using simulations and in vivo data acquired at 1.5 T. After full motion correction, Group ICA performed on a population of 8 fetuses extracted 20 networks, 6 of which were identified as matching those previously observed in preterm babies.

Livy uses the early kings to establish his credentials as a historian and narrator, and the chapter begins with a detailed discussion of the start of the monarchy. It discusses the balance between economy of scale and verisimilitude, and looks at Livy's techniques for rooting historical analysis in small details. A section on aetiology shows how prevalent that method is for dealing with the regal period, and analyses aetiology in the episode of the Horatii and Curiatii. Aetiology concerns not just to monuments and institutions, but also to ways of thinking, and the chapter discusses how the seeds of later political concepts appear in the regal period, as well as the Augustan resonance of monarchy. The final section deals with the political implications of book 1, and ends with reflections on the rape of Lucretia, and on Livy's view of the political role of individuals.

The Language Learning Network project has set out to design, deliver and evaluate empirically vocational language courses with a strong emphasis on sound pedagogical approach. This report of the project's pilot phase will demonstrate how a range of learning and technological devices can be combined to create a rich and communicative content‐driven learning experience via a mix of media, including the Internet and Video‐Conferencing, for distance (or indeed classroom and self) study. The primary focus of the courses is to offer the learner stimulating materials which will encourage, enable and enhance language learning. The course Units draw on customized situational dialogues, rich in humour and imagination. While technology is utilised as a conduit for enriched language acquisition, it is clearly not the end in itself ‐‐ the project aims to address the question of what type of content should be used and how it is best mediated through technology to enable successful language acquisition. The maj...

This article explores a neglected period in the history of classical scholarship: the first decades of the eighteenth century. It focuses on the tension between an evolving idea of method, and the tradition of personal polemic which had been an important part of the culture of scholarship since the Renaissance. There are two case studies: the conflict between Jean Le Clerc and Pieter Burman, and the controversy that followed Richard Bentley's edition of Horace'sOdes. Both demonstrate the need to revise current paradigms for writing the history of scholarship, and invite us to reconsider the role of methodology in producing of scholarly authority.

Acute hemorrhagic leukoencephalopathy (AHLE) is a rare condition associated with H1N1. In this condition the infection triggers an autoimmune response which results in perivascular demyelination and hemorrhage in the brain parenchyma.We report a case of a patient who developed brain edema and herniation as a result of AHLE.A 27-year-old presented to a community hospital with fever, dyspnea, and malaise and was found to have H1N1-associated pneumonia. Despite treatment he progressed to acute respiratory distress syndrome and required mechanical ventilation. Due to failure on conventional ventilation, he was transferred to our hospital and was placed on high-frequency oscillatory ventilation. He was showing improvement until day 6 of transfer to our hospital when he was suddenly noted to have a rise in his blood pressure followed by hypotension. The following morning he was noted to have non-reactive pupils and was declared brain dead. Autopsy of the brain was consistent with AHLE.This case emphasizes the importance of awareness of this disease. The non-specific signs and symptoms, and the use of sedatives, make diagnosis challenging in the early stages of this disease. If suspected early, appropriate imaging can aid in the diagnosis. Treatment with immunosuppressive agents and plasmapheresis may prevent rapid progression and death. This is the first published case of AHLE in association with H1N1 that has been confirmed pathologically.

An examination of the popular reception of Cicero during the long 18th century, with a detailed examination of the biographical and anecdotal traditions, both of which have been seriously neglected by scholars. This chapter examines a number of eighteenth sources which have received very little previous scholarly attention, and presents an innovative view of Cicero's influence in the period.

Background Fetal cardiac MRI offers the potential for a safe, radiation-free adjunct to echocardiography. In practice, its use has been limited by the technical challenges imposed by the small size of the fetal heart, the lack of external gating, and gross fetal and maternal movements. We present our initial experience of 20 fetal cases assessed by MRI, referred after routine fetal cardiology assessment to resolve specific points of diagnostic uncertainty. Methods Referrals were based on the judgements of the attending fetal cardiologists between June 2014 and May 2015. Following a three-plane localiser, gross fetal movement was assessed with a balanced steady-state free precession (bSSFP) cine. Half-Fourier single-shot turbo spin echo (HASTE) and bSSFP gradient echo sequences were used for diagnostic imaging. The MRI diagnosis was subsequently compared with postnatal findings. Results 20 fetal cardiac MRI scans were performed over the referral period, at an average gestational age of 32 +4 weeks, (range 26 +4 –38 +1 weeks). 3 scans were abandoned due to excessive fetal movement or inadequate visualisation. The most frequent referral indications were suspected coarctation of the aorta/abnormal arch anatomy (n = 9), cardiac masses or diverticulums (n = 5), and assessment of pulmonary vasculature (n = 4). HASTE sequences produced T2-weighted “black-blood” images, useful for assessing extracardiac vasculature (figure 1). Balanced SSFP sequences showed good contrast between the blood pool and surrounding tissue and were useful for intracardiac structures; however these were more susceptible to motion artefacts. Real-time SSFP sequences allowed for dynamic assessment of moving structures (e.g. masses/diverticulums-figure 2). Using a combination of sequences we were able to accurately characterise rhabdomyomas in 3 patients. In total, of the 17 scans with useful data, MRI was diagnostic in 15. Neonatal coarctation was incorrectly predicted in one case, and no postnatal data was available in another due to fetal demise. Conclusions Certain fetal cardiovascular abnormalities may be difficult to diagnose with ultrasound alone, reflected in the referral pattern we observed for MRI. Our preliminary experience suggests that MRI can provide safe and useful complimentary imaging in this cohort within a tertiary fetal cardiac unit. As technical challenges continue to be addressed, prenatal MRI may develop a more prominent role in routine fetal cardiovascular assessment.

This article explores the relationship between historical truth and rhetorical education in theAntiquitates Romanaeof Dionysius of Halicarnassus. These two concerns dominate Dionysius' output, and have provided fuel for a long tradition of adverse criticism. Schwartz'sREarticle set the standard for a series of dismissive accounts; his premise is that by choosing a period of such remote history, Dionysius can fulfil his desire to make history the servant of rhetorical display, adding, with scorn, that Dionysius' love of the Romans disqualifies him from being a real Greek. Palm, still using Schwartz over fifty years later, is so convinced that Dionysius cannot have believed what he was writing that he ascribes the meticulously executed proof that the Romans were Greeks to ‘paradoxe Effekte’, in which anyone writing a rhetorical exercise of this kind would be careful to indulge. Polemic has recently waned, although by far the most common use of Dionysius' history is as a source for antiquarian anecdote or the lost annalistic tradition, often to highlight the originality of Livy. The recently published lectures of Gabba will do much to redress the balance, and are the first concerted attempt at harmonizing the details of Dionysius' rhetorical theory with his history.

The chapter centres on the detailed reading of a little-known treatise on Cicero, written in Latin by the Enlightenment thinker, John Toland. His treatise, Cicero Illustratus, presents Cicero as a cornerstone of the Enlightenment. This chapter looks at Toland's approach to Cicero as representing particular views of criticism that were current at the time. Toland's ambitions for his new edition of Cicero, which was never produced, are presented in some detail. Toland's reading reveals both how far back prejudices against Cicero as an advocate lie, but also that a sensitivity towards the dialogic quality of his writing was easier for Toland than it for today's readers. The chapter reinforces the usefulness of looking at this earlier reading to reveal the difficulties of approaching Cicero caused by subsequent developments in the academic disciplines.

This chapter integrates the readings of earlier chapters to consider the place of Cicero's ironic treatment of historical representation in the light of mainstream Latin historiography. First, the question of how far the past can actually be known is explored from treading texts that illustrate both historiographical and philosophical approaches. For Cicero, history is predominantly a form of representation. Cicero's Letter to Lucceius is explored, in which he asks shamelessly for his own historical glorification. The letter is taken as further evidence for Cicero's ironic approach to the past, and to his own relationship to it. A brief discussion of Sallust, Livy, and Tacitus follows, and the chapter concludes that all these writers shared an awareness of the literary and educational potential of presenting conflicting accounts of Rome's past.

On November 12, 2001, about 9:16 a.m., American Airlines flight 587, an Airbus Industrie A300-605R, N14053, crashed into a neighborhood in Belle Harbor, New York, after taking off from John F. Kennedy International Airport (JFK), Jamaica, New York. The airplane was on a scheduled flight to Santo Domingo, Dominican Republic. Two pilots, seven flight attendants, 251 passengers, and five persons on the ground were killed. The airplane crashed after a loss of control resulting from the separation of the vertical stabilizer from the fuselage. The separation of the vertical stabilizer from a transport-category airplane was unprecedented. As a result, the National Transportation Safety Board conducted an extensive structures investigation. For this effort, the Safety Board enlisted the assistance of the Federal Aviation Administration; the National Aeronautics and Space Administration’s Langley Research Center; and the airplane manufacturer, Airbus Industrie. The Board’s final report on the American Airlines flight 587 accident was issued in October 2004.

Background Experimental studies suggest that melatonin is neuroprotective. Preterm infants are deprived of thenormal intrauterine exposure to maternal melatonin and may benefit from supplementation to adult physiological levels. Aim To prove that melatonin supplementation to adult concentrations decreases prematurity associated white matter injury assessed by tract based spatial statistics at term equivalent age. Methods The study was a phase 2 exploratory; multi-centre double-blinded randomised placebo-controlled 2-arm trial, evaluating the neuroprotective effect of melatonin in preterm infants less than 31 weeks gestation. The 2 study drugs, melatonin (active) and normal saline (placebo) were given as an intravenous infusion once a day for 7 days starting by 48 h after birth. The dose of melatonin (0.1 mcg/kg/hr for 2 h) was derived from our previous pharmacokinetic study. Analysis was by intention to treat. Magnetic resonance imaging (MRI) was done at term corrected age. A 5% difference in the fractional anisotropy (FA) on MRI was taken as the primary endpoint. Results Fifty-eight preterm infants participated in the study; 30 received melatonin and 28 received saline. Four babies died in each group. The 2 groups did not show any differences inthe demographic data or in the short term adverse events. Seventeen infants from the melatonin group and 19 from the placebo group had MR images which were analysed. There was no difference in the FA in the 2 groups. Conclusions Melatonin supplementation to adult physiological levels during the first week after birth did not alter FA in the preterm white matter at term equivalent age.

Over thirty years have passed since Anderson published his influential account of Propertius 4.9, in which he drew attention to the resemblance of the scene of Hercules before the shrine of the Bona Dea to a Hellenistic paraklausithyron1. It was an interpretation which aimed to explain the poem by reference to its literary antecedents. But since that time developments in the reception of Propertius have taken a strange turn. Doubtless the shadows of the European dictators fell strongly on The Roman Revolution2, but the fading of those shadows has, if anything, led to an intensification of readings which make Propertius into a political dissident. If Anderson's work marks an interest in literary solutions to the problem of placing Propertius in his political context, Stahl's Propertius: Love and War provides the opposite pole in its detailed pursuit of real political resistance through the poems3. And if today's critics no longer feel obliged to adopt one position over another, there is still a sense that two alternative modes of interpretation exist: the literary or the political, and in spite of a new flexibility regarding questions of fiction and history, the polarity between literary and historical interests persists4. It is a sign of this persistence that few critics have tackled Propertius 4.95. That poem, which reworks Hercules' battle with Cacus from Aeneid 8, provides an easy object for uncov