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Harold Pinter’s Mountain Language presents a national military’s violent attempt to outlaw an ethnic minority group’s language. The conflict between the military personnel and an injured Elderly Woman who waits to visit her imprisoned son orients this ban and its effects. But the common qualification that the work is one of Pinter’s “political plays” risks obfuscating its specific ethical dimension. By following the Elderly Woman and her son’s words and actions, it becomes possible to observe how Mountain Languages situates its ethical significance in the figure of the maternal body. This figure precipitates a form of corporeal cohabitation – a touch shared by two bodies that makes it impossible to distinguish completely where one body ends and the other begins – that not only troubles the distinction between self and other that often foregrounds theatre and performance studies’ “ethical turn” but also makes it necessary to reimagine the political itself. Such a matter bears on the play’s performance: the only sound that the Elderly Woman’s silent stillness emits during the play’s conclusion is that of the actor’s body who plays her. In this setting, the sound produced by the actor’s body touches the body of the spectator, inspiring them both to find the language to undo the “terrible trap” that the play depicts. Mountain Language makes it possible to consider how Pinter explores the ethical implications of theatrical performance.

Background: Psychiatric intensive care units (PICUs) house some of the highest acuity patients within the mental health system. Little is known about patient characteristics and adverse events occurring in these settings and this study aimedto examine clinical, demographic and offending characteristics and correlates of problem behaviours for patients admitted to the first forensic PICU in Australia.Aims: To identify common characteristics held by patients admitted to one high secure forensic PICU in Australia.Method: Retrospective file review occurred for patients admitted between March 2019 and May 2020, during which 96 male patients were admitted.Results: Mean (range) age was 37.3 (21–76) years, and when admitted most patients were: single (n = 80; 83.3%), homeless (n = 52; 54.2%), had not completed high-school education (n = 60; 62.5%), had histories of trauma (n = 38; 39.6%) and antisocial behaviour (n = 40; 41.7%) in adolescence and presented with personality disorder (n = 23; 24.0%) and substance abuse (n = 93; 96.9%). Frequent problem behaviours, particularly aggression (n = 65; 67.7%), were encountered and rates of seclusion (n = 62; 64.6%) were high. Segregation in prison prior to admission and co-morbid personality disorder were associatedwith increased likelihood of aggression or self-harm respectively occurring.Conclusion: With high mental illness acuity and significant behavioural risk complicated by multi-vulnerability, forensic PICUs need specialist environments, models of care and high level relational and de-escalation staff expertise tomaintain safety and promote recovery.

(1) To compare maximum glottic opening angle (anterior glottic angle, AGA) in patients with bilateral vocal fold immobility (BVFI), unilateral vocal fold immobility (UVFI) and normal larynges (NL), and (2) to correlate maximum AGA with patient-reported outcome measures.Patients wisth BVFI, UVFI, and NL were retrospectively studied. An open-source deep learning-based computer vision tool for vocal fold tracking was used to analyze videolaryngoscopy. Minimum and maximum AGA were calculated and correlated with three patient-reported outcomes measures.Two hundred and fourteen patients were included. Mean maximum AGA was 29.91° (14.40° SD), 42.59° (12.37° SD), and 57.08° (11.14° SD) in BVFI (N = 70), UVFI (N = 70), and NL (N = 72) groups, respectively (p 0.001). Patients requiring operative airway intervention for BVFI had an average maximum AGA of 24.94° (10.66° SD), statistically different from those not requiring intervention (p = 0.0001). There was moderate negative correlation between Dyspnea Index scores and AGA (Spearman r = -0.345, p = 0.0003). Maximum AGA demonstrated high discriminatory ability for BVFI diagnosis (AUC 0.92, 95% CI 0.81-0.97, p 0.001) and moderate ability to predict need for operative airway intervention (AUC 0.77, 95% CI 0.64-0.89, p 0.001).A computer vision tool for quantitative assessment of the AGA from videolaryngoscopy demonstrated ability to discriminate between patients with BVFI, UVFI, and normal controls and predict need for operative airway intervention. This tool may be useful for assessment of other neurological laryngeal conditions and may help guide decision-making in laryngeal surgery.III Laryngoscope, 2022.

Osteomyelitis is an infection of the bone tissue and bone marrow which is becoming increasingly difficult to treat due to the infection causing pathogens associated.

Lung squamous cell carcinoma (LUSC) is a type of lung cancer with a dismal prognosis that lacks adequate therapies and actionable targets. This disease is characterized by a sequence of low and high-grade preinvasive stages with increasing probability of malignant progression. Increasing our knowledge about the biology of these premalignant lesions (PMLs) is necessary to design new methods of early detection and prevention, and to identify the molecular processes that are key for malignant progression. To facilitate this research, we have designed XTABLE, an open-source application that integrates the most extensive transcriptomic databases of PMLs published so far. With this tool, users can stratify samples using multiple parameters and interrogate PML biology in multiple manners, such as two and multiple group comparisons, interrogation of genes of interests and transcriptional signatures. Using XTABLE, we have carried out a comparative study of the potential role of chromosomal instability scores as biomarkers of PML progression and mapped the onset of the most relevant LUSC pathways to the sequence of LUSC developmental stages. XTABLE will critically facilitate new research for the identification of early detection biomarkers and acquire a better understanding of the LUSC precancerous stages.

Originally funded by the US Department of Defense in 2009, Theater of War Productions’ first project, Theater of War, performs dramatic readings of Ajax at military bases, hospitals, and academic institutions throughout the United States. Developed by Bryan Doerries, Theater of War brings awareness to the epidemic of suicide and other forms of violence committed by American military service members in the wake of the United States’ so-called ‘war on terror’. But like Ajax, American military personnel typically turn to violence only after being betrayed by the institutions that they served. This article follows how Ajax’s more modern manifestation disrupts the tragic protagonist’s status as a sacrificial victim whose death precipitates tragedy’s cathartic effect, and challenges what René Girard calls the ‘scapegoat mechanism’ and its socio-political function. It argues that Ajax’s appearance as a cathartic figure in American society provokes spectators and artists to reckon with the conditions that can cause military personnel to act violently, and inspires protests against broader hegemonic socio-political structures and the military culture that sustains them. Matthew Roberts is Assistant Professor and Librarian for Comparative and World Literature, English, and Drama at the University of Illinois at Urbana-Champaign.

Harold Pinter’s Ashes to Ashes, comprising an extended dialogue between two protagonists, Rebecca and Devlin, repeatedly returns to a “guide” who steals babies from their mothers at a railway station. This image has led Pinter scholars to interpret the play as a representation of the Shoah and its impact on Pinter’s life. However, during the play’s conclusion, Rebecca assumes the position of one of the mothers and, while ventriloquizing her, disavows the existence of her child at the very moment when another woman asks her to confirm the infant’s whereabouts. Rather than maintaining the customary position that Ashes to Ashes represents a specific historical atrocity, I read the play’s engagement with trauma through the figure of this abducted, but ultimately disowned, infant. Specifically, I attend to how the infant’s disappearance informs the poetic qualities of Ashes to Ashes as its heartbeat figures prominently throughout the play, resonates in its dialogue, and organizes its rhythmic structure. By examining how these poetic features situate Rebecca’s mode of listening as an exemplary ethico-political response to suffering, I propose an alternative to the interpretation of Pinter’s use of dramatic speech in terms of referentiality or language games.

Athletic participation provides a unique forum for the practice of spiritual disciplines. Central to Dallas Willard’s robust theory of spiritual formation is the critical role the body plays in effectively engaging in spiritual disciplines and thereby cultivating Christlikeness. I outline the central themes of Willard’s theology and philosophy of spiritual disciplines, with particular attention to how they bear on athletic participation. I distinguish between classical and novel spiritual disciplines and show how the latter are usefully appropriated towards the ordinary activities of daily life, and particularly towards the arena of athletics. Using basketball as a case study, I show in detail how this activity can be fruitfully reappropriated as a set of novel spiritual disciplines.

For 12 days in April 1944, a hastily constituted force of British and Indian combat troops held at bay 10 times their number of the seemingly invincible Japanese Imperial Army. The story of the siege of Kohima is one of courage, determination, and leadership. The Burma campaign and, indeed, the Asian theater of World War II as a whole are often overlooked other than by those with a special interest; this article is intended to inform and perhaps inspire a wider readership. The article describes the situation in North Eastern India, prior to and during the siege, from both military and medical points of view. It highlights some of the qualities of leadership that led to the garrison’s survival and describes the remarkable performance, against all odds, of the medical staff who cared for the many casualties.

Early mortality rates of female patients on dialysis have been, at times, observed to be higher than rates among male patients. The differences in cause-specific mortality between male and female incident dialysis patients with kidney failure are not well understood and were the focus of this study.Retrospective cohort study.Participants: Incident patients who had initiated dialysis in Australia and New Zealand between 1998-2018.Sex.Cause-specific and all-cause mortality on dialysis, censored for kidney transplantation.Adjusted cause-specific proportional hazards models, focusing on the first 5 years following initiation of dialysis.Among 53,414 patients (20,876 [39%] of whom were female) followed for a median period of 2.8 (IQR 1.3-5.2) years, 27,137 (51%) died, with the predominant cause of death attributed to cardiovascular disease (CVD, 18%), followed by dialysis withdrawal (16%). Compared to male patients, female patients were more likely to die in the first 5 years after dialysis initiation (adjusted hazard ratio (aHR) of 1.06 [95% CI 1.03-1.09]). Even though female patients experienced a lower risk of CVD-related mortality (aHR 0.93 [0.89-0.98]) compared to male patients, they experienced a greater risk of infection-related (aHR 1.20 [1.10-1.32]) and dialysis withdrawal-related mortality (aHR 1.19 [1.13-1.26]).Possibility of residual and unmeasured confounders.Compared with male patients, female patients had a higher risk of all-cause mortality in the first 5 years post-dialysis initiation, a difference driven by higher mortality from infections and dialysis withdrawals. These findings may inform the study of sex differences in mortality in other geographic settings.

Introduction: Given restrictions on electives outside of medical students’ home institutions during the COVID-19 pandemic, the objective of this study was to create a novel recruitment strategy for the University of Ottawa’s (uOttawa) urology residency program. Methods: A steering committee was formed and created a three-part recruitment strategy that included a new uOttawa urology website, a residency program social media campaign (Twitter and Instagram), and a virtual open house (VOH). Descriptive data from the website and Instagram and Twitter accounts were collected. Attendees of the VOH completed a mixed-methods survey, which collected quantitative and qualitive responses assessing aspects of the VOH and virtual resource use. Results: From August 1 to December 31, 2020, the uOttawa urology website had 1707 visits. The Twitter account had a total of 29 000 views with 1000–5000 views per tweet. Thirty-one candidates attended the VOH. Survey responders reported that the most frequently used resources to gain knowledge of the program were the website (81%) and Twitter account (71%). The most helpful and informative resources were the uOttawa urology website, the VOH, and direct conversations with residents arranged through the website. Despite not having completed an elective, 26 students (84%) felt they had an understanding of what it might feel like to train in the program. Suggestions by students for future initiatives included one-on-one virtual meetings, another VOH, and more information on selection processes. Conclusions: A multifaceted, virtual recruitment strategy can be implemented to improve candidate understanding and engagement with residency programs while visiting elective opportunities remain limited.

TPS397 Background: Multi-parametric magnetic resonance imaging (MRI) has an established role for the diagnosis of clinically significant prostate cancer (sPCa), with superior diagnostic accuracy compared with transrectal ultrasound guided prostate biopsy alone. PRIMARY demonstrated significant improvement in sensitivity (97% vs 83%) and negative predictive value (91% vs 72%) with the addition of [68Ga]Ga-PSMA-11 PET/CT (PSMA PET/CT) vs MRI alone. Furthermore, 38% of patients with PI-RADS 2 or 3 were true negative on PSMA PET/CT, a population which may potentially benefit from avoiding transperineal prostate biopsy (TPPB). We hypothesize that the addition of PSMA PET/CT is non-inferior to MRI for the detection of sPCa in men with PI-RADS 2-3 disease, while providing the advantages of reducing unnecessary biopsies and limiting to targeted-only TPPB. Methods: This multi-centre, two-arm, randomized controlled, phase III trial will recruit 660 men with high clinical suspicion of sPC. Participants will be randomized in a 1:1 ratio in permuted blocks, stratified by center. In the experimental arm, participants will undergo a pelvic PSMA PET/CT. Local and central reviewers will interpret independently, based on the PRIMARY Score. Participants with a positive result will undergo targeted-TPPB, whereas those with negative PSMA PET/CT will avoid biopsy. In the control arm, all participants undergo template-TPPB. Patients will continue follow-up for subsequent clinical care for up to two years post-randomization. Key eligibility criteria include an MRI result of PI-RADS 2 with at least one red flag [PSA density >0.1, abnormal digital rectal examination (DRE), strong family history, BRCA mutation, PSA >10, PSA doubling time 0.75/year], or PI-RADS 3, having never undergone a prostate biopsy

Three-dimensional printing (3DP) allows production of novel fast dissolving oral films (FDFs). However, mechanical properties of the films may not be desirable when certain excipients are used. This work investigated whether adding chitosan micro-ribbons or cellulose microfibres will achieve desired FDFs by fused deposition modelling 3DP. Filaments containing polyvinyl alcohol (PVA) and paracetamol as model drug were manufactured at 170 °C. At 130 °C, filaments containing polyvinylpyrrolidone (PVP) and paracetamol were also created. FDFs were printed with plain or mesh patterns at temperatures of 200 °C (PVA) or 180 °C (PVP). Both chitosan micro-ribbons and cellulose micro-fibres improved filament mechanical properties at 1% w/w concentration in terms of flexibility and stiffness. The filaments were not suitable for printing at higher concentrations of chitosan micro-ribbons and cellulose micro-fibres. Furthermore, mesh FDFs containing only 1% chitosan micro-ribbons disintegrated in distilled water within 40.33 ± 4.64 s, while mesh FDFs containing only 7% croscarmellose disintegrated in 55.33 ± 2.86 s, and croscarmellose containing films showed signs of excipient scorching for PVA polymer. Cellulose micro-fibres delayed disintegration of PVA mesh films to 108.66 ± 3.68 s at 1% w/w. In conclusion, only chitosan micro-ribbons created a network of hydrophilic channels within the films, which allowed faster disintegration time at considerably lower concentrations.

Anti-platelet factor 4 (PF4) antibodies that activate platelets via FcγRIIA drive the pathophysiology of vaccine-induced immune thrombocytopenia and thrombosis (VITT). Evolution of these antibodies and their ability to activate platelets after initial treatment remains unknown.To assess how clinical and platelet parameters, anti-PF4 antibody levels, and patient serum reactivity changes during follow-up after VITT presentation.We describe cases of seven discharged VITT patients that were followed from diagnosis up to 280 days (range 199-280) after vaccination. We measured anti-PF4 antibodies and PF4 levels in patient serum during follow-up and tested the ability of patient serum to activate healthy donor platelets and patient platelets over time.Anti-PF4 immunoglobulin G antibody levels are very high at diagnosis (0.9-2.6 OD) and remain relatively high (1.0 OD) in all patients, except one treated with rituximab, at 7 months post vaccination. All patients were on direct oral anticoagulants throughout follow-up and no patients had recurrent thrombosis. Patients' platelets during follow-up have normal FcγRIIA levels and responsiveness to platelet agonists. Patient diagnostic serum strongly activated control platelets, either alone or with PF4. Most follow-up serum alone was weaker at stimulating donor and patient platelets. However, follow-up serum beyond 150 days still strongly activated platelets with PF4 addition in three patients. Patient serum PF4 levels were lower than controls at diagnosis but returned within normal range by day 50.Explanations for reduced platelet activation during follow-up, despite similar total anti-PF4 antibody levels, remains unclear. Clinical implications of persistent anti-PF4 antibodies in VITT require further study.

Multiparametric MRI (mpMRI) is validated for the diagnosis of clinically significant prostate cancer (csPCa). (68)Ga-PSMA-11 PET/CT ((68)Ga-PSMA PET/CT) combined with mpMRI has improved negative predictive value over mpMRI alone for csPCa. The aim of this post hoc analysis of the PRIMARY study was to evaluate the clinical significance of patterns of intraprostatic PSMA activity, proposing a 5-point PRIMARY score to optimize the accuracy of (68)Ga-PSMA PET/CT for csPCa in a low-prevalence population. Methods: The PRIMARY trial was a prospective multicenter phase II imaging trial that enrolled men with suspected PCa, no prior biopsy, and a recent mpMRI examination (6 mo) and for whom prostate biopsy was planned. In total, 291 men underwent mpMRI, (68)Ga-PSMA PET/CT, and systematic biopsy with or without targeted biopsy. The mpMRI was read separately using the Prostate Imaging Reporting and Data System (PI-RADS) (version 2). (68)Ga-PSMA PET/CT (pelvis only) was acquired a minimum of 60 min after injection. (68)Ga-PSMA PET/CT was centrally read for pattern (diffuse transition zone [TZ], symmetric central zone [CZ], focal TZ, or focal peripheral zone [PZ]) and intensity (SUV(max)). In this post hoc analysis, a 5-level PRIMARY score was assigned on the basis of analysis of the central read: no pattern (score of 1), diffuse TZ or CZ (not focal) (score of 2), focal TZ (score of 3), focal PZ (score of 4), or an SUV(max) of at least 12 (score of 5). Two further readers independently assigned a PRIMARY score to 118 scans to determine interrater agreement. Associations between PRIMARY score and csPCa (International Society of Urological Pathology grade group ≥ 2) were evaluated. Results: Of the 291 men enrolled, 162 (56%) had csPCa. A PRIMARY score of 1 was present in 16% (47); a score of 2, in 19% (55); a score of 3, in 10% (29); a score of 4 in 40% (117); and a score of 5, in 15% (43). The proportion of patients with csPCa and a PRIMARY score of 1, 2, 3, 4, and 5 was 8.5% (4/47), 27% (15/55), 38% (11/29), 76% (89/117), and 100% (43/43), respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for a PRIMARY score of 1 or 2 (low-risk patterns) versus a PRIMARY score of 3–5 (high-risk patterns) were 88%, 64%, 76%, and 81%, respectively, compared with 83%, 53%, 69%, and 72%, respectively, for a PI-RADS score of 2 versus 3–5 on mpMRI. The Cohen κ for a PRIMARY score of 1 of 2 versus a PRIMARY score of 3–5 was 0.76 (95% CI, 0.64–0.88) for reader 1 and 0.64 (95% CI, 0.49–0.78) for reader 2. Conclusion: A PRIMARY score incorporating intraprostatic pattern and intensity on (68)Ga-PSMA PET/CT shows potential, with high diagnostic accuracy for csPCa. Further validation is warranted before implementation.

Erectile dysfunction (ED) impacts the wellness and quality of life of millions of Canadians. An evaluation focused on the identification of reversible and irreversible underlying factors is recommended for patients presenting with ED. Through a shared decision-making model framework, the goal of ED treatment is to improve functional outcomes and enhance sexual satisfaction while minimizing adverse effects associated with treatment. Given that ED is assessed and treated by multiple different types of health practitioners, the purpose of this guideline is to provide the best available evidence to facilitate care delivery through a Canadian lens. After a narrative review of ED assessment and treatment for general readership, five key clinical questions relating to priority areas of ED are assessed using the GRADE and Evidence to Decision making frameworks.

This article revisits the relationship between women and Chartism, the mass movement for democratic rights that swept across Britain from the late 1830s to the 1850s. It argues that the opportunities for women to participate in Chartism were more varied, extensive and enduring than has often been argued. Particular attention is paid to late Chartism (1843-52) by documenting in full, for the first time, the number of female Chartist bodies in existence for the period of late Chartism. By presenting new material, based on a combing of the press and the Home Office files, the article then moves on to consider the role played by Chartist women in 1848, the year of European revolution when the movement revived. By presenting new material, based on a combing of the press and the Home Office files, the article then moves on to consider the role played by Chartist women in 1848, the year of European revolution when the movement revived. It then builds on the theme of late Chartism by offering a case study of the Women’s Rights Association (WRA), a body established in 1851 by a group of Sheffield Chartist women, to campaign for votes for women, which, it is argued here, represented the culmination of a women’s rights discourse within early Chartism, documented by previous historians. The article concludes by comparing the women’s rights discourse in early Chartism and other contemporary feminisms with that deployed by the WRA.

Fire-generated tornadic vortices (FGTVs) linked to deep pyroconvection, including pyrocumulonimbi (pyroCbs), are a potentially deadly, yet poorly understood, wildfire hazard. In this study we use radar and satellite observations to examine three FGTV cases during high-impact wildfires during the 2020 fire season in California. We establish that these FGTVs each exhibit tornado-strength anticyclonic rotation, with rotational velocity as strong as 30 m s−1 (60 kt), vortex depths of up to 4.9 km AGL, and pyroCb plume tops as high as 16 km MSL. These data suggest similarities to EF2+ strength tornadoes. Volumetric renderings of vortex and plume morphology reveal two types of vortices: embedded vortices anchored to the fire and residing within high-reflectivity convective columns and shedding vortices that detach from the fire and move downstream. Time-averaged radar data further show that each case exhibits fire-generated mesoscale flow perturbations characterized by flow splitting around the fire’s updraft and pronounced flow reversal in the updraft’s lee. All the FGTVs occur during deep pyroconvection, including pyroCb, suggesting an important role of both fire and cloud processes. The commonalities in plume and vortex morphology provide the basis for a conceptual model describing when, where, and why these FGTVs form.

BackgroundAnti-Platelet Factor 4 (PF4) IgG antibodies that activate platelets via FcγRIIa have been shown to be an important part of the pathophysiology of vaccine-induced immune thrombocytopenia and thrombosis (VITT). There is now extensive literature on its presentation and initial management. There is no literature however on what happens to these patients following discharge.MethodsWe collected clinical data and samples from seven patients presenting with VITT and followed them up for 82-145 days. We also collected clinical samples from them at last follow-up. Testing for anti-PF4/heparin antibodies was done using an anti-PF4/heparin enzymatic immunoassay. Flow Cytometry was used to look at FcγRIIa levels on patient platelets. Light Transmission Aggregometry with patient serum and healthy donor / patient platelets was used to analyse platelet responsiveness, in the presence and absence of PF4.FindingsAll patients were discharged on direct oral anticoagulants. Two patients remain completely symptom free, three have ongoing headaches, two have residual neurological deficits. Two patients developed mild thrombocytopenia and worsening headache (but without cerebral venous sinus thrombosis) and were retreated, one of these with rituximab. All patients, except the one treated with rituximab, had similar anti-PF4 antibody titres at 80-120 days to their levels at diagnosis. Platelets from patients at follow-up had normal levels of FcγRIIa and had normal responses to thrombin and collagen-related-peptide. Patient serum from diagnosis strongly activated healthy donor platelets in the presence of PF4. Serum from follow-up was much weaker at stimulating platelets, even in the presence of PF4.InterpretationThis study shows that despite similar PF4 antibody titres at diagnosis and during follow-up, there are further differences in patient serum, that are not apparent from currently used testing, that result in lower levels of platelet activation during the follow-up period. Further understanding of these factors are important in order to assess duration of anticoagulation for these patients.FundingThis work was supported by an Accelerator Grant (AA/18/2/34218) from the British Heart Foundation (BHF) and by a National Institute for Health Research (NIHR) grant.Key pointsPF4 antibody titres do not reduce up to 4-months post ChAdOx1 nCoV-19 in patients with VITTDespite similar PF4 antibody titres, diagnostic serum is more potent at activating platelets in the presence of PF4 than follow-up serum.