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To assess the mortality, readmission rates, and practice variation of percutaneous cholecystostomy (PC) in patients with acute calculous cholecystitis in the United Kingdom (UK).A total of 1,186 consecutive patients (636 men [53.6%]; median age, 75 years; range, 24-102 years) who underwent PC for acute calculous cholecystitis between January 1, 2019, and December 31, 2020, were included from 36 UK hospitals. The exclusion criteria were diagnostic aspirations, absence of acute calculous cholecystitis, and age less than 16 years. The coronavirus disease 2019 (COVID-19) lockdown was declared on March 26, 2020, in the UK, which served to distinguish among groups.Most patients (66.3%) underwent PC as definitive treatment, whereas 31.3% underwent PC as a bridge to surgery. The overall 30-day readmission rate was 42.2% (500/1,186), and the 30-day mortality was 9.1% (108/1,186). Centers performing fewer than 30 PCs per year had higher 90-day mortality than those performing more than 60 (19.3% vs 11.0%, respectively; P = .006). A greater proportion of patients presented with complicated acute calculous cholecystitis during the COVID-19 pandemic compared to prior (49.9% vs 40.9%, respectively; P = .007), resulting in more PCs (61.3 vs 37.9 per month, respectively; P.001). More PCs were performed in tertiary hospitals than in district general hospitals (9 vs 3 per 100 beds, respectively; P.001), with a greater proportion performed as a bridge to surgery (50.5% vs 22.8%, respectively; P.001).The practice of PC is highly variable throughout the UK. The readmission rates are high, and there is significant correlation between mortality and PC case volume.

Lady Precious Stream is the most globally successful Chinese play in history. A practice-as-research project investigated how Chinese drama aesthetics might have been used in the original production. This revealed that gaps in archival material open up a space where the subjective nature of interpretation can be interrogated.

Intersubjectivity offers a methodology for the comparison of performance training in Chinese jingju and Japanese no. By connecting intersubjectivity with the concept of the rhizome, the article sug...

The use of a marker ball in digital templating for hip arthroplasty is a well-established method of preoperative planning and is used to overcome the inherent magnification in plain film radiographs. Our hospital policy is to place a marker ball in all anteroposterior pelvic films taken in the emergency department (ED) which have been requested for suspected neck of femur fractures. We carried out a baseline measurement followed by three Plan-Do-Study-Act cycles for all pelvic films taken in ED during July 2016, November 2016, February 2017 and November 2017. Interventions between the baseline measurement and cycle 1 were to educate the lead radiographer and publish the results in the radiology newsletter, and between cycles 1 and 2 was to run a teaching session for radiographers, display posters in the X-ray department and place an electronic prompt on the X-ray machine to alert them of the need to place a marker ball in the X-ray field. Cycle 3 looked to see if improvements were sustained. 16/81 (20%) radiographs complied with the policy in our baseline measurement; 25/51 (46%, p=0.002) in cycle 1; 40/54 (74%, p=0.0056) in cycle 2; and 48/63 (76%) in cycle 3. Our quality improvement project led to large improvements in clinical practice through straightforward, small, but appropriately targeted interventions. Stakeholder management is key to successfully implementing change. The next step is to switch from the VoyantMark to the KingMark marker ball, as it has greater accuracy of templating and is also easier to place within the field of an X-ray.

This chapter maps the terrain of existing research on British Chinese culture, positioning it in relation to work on Chinese and Asian diasporas globally and on British multiculture. It briefly charts emerging debates on British Chinese culture in the 1990s and its marginalization in academic work. It reflects on challenges of knowledge production on British Chineseness within the context of institutions that may support, if not, reproduce racial inequalities. Finally it situates British Chinese cultural politics within the specific historical context of British multiculturalism, particularly in its neoliberal forms, from the 1980s through to present-day discussions of the ordinary multiculture of postcolonial Britain.

This chapter maps the simultaneous existence of two British East Asian (BEA) theatre companies: Mu-Lan Theatre, which was founded in 1988 and folded in 2004, and Yellow Earth Theatre, which was launched in 1995 and continues into the present. It argues that Arts Council policies on diversity were tokenistic. In particular, by ending the funding for Mu-Lan and revenue funding only one BEA theatre company (Yellow Earth), the council fermented frustration about the narrowness of BEA participation in British theatre in the early twentieth century. The chapter suggests that the logic of the “diversity of diversity”—a cornerstone of Arts Council policy—was not enacted. Until recently, an ongoing lack of funding for BEA theatre practitioners has resulted in a growing plurality of theatre voices, but as many work without even basic expenses being covered, the chapter suggests that BEA performance practice was one of the arts that Britain utterly ignored. The chapter concludes by raising questions about Arts Council policy as it embarks on a new funding initiative for BEA theatre.

In the second of the two commissioned interviews for this Special Issue, we discuss the experience and politics of casting from the perspective of ethnic minority actors. Although there were a number of individuals and organisations who could have been approached, here we talk to Daniel York, who initially drove the debates after he was auditioned for, but not cast in, The Orphan of Zhao, and to Anna Chen, who spearheaded the media campaign against the Royal Shakespeare Company (RSC). Both are also founding members of British East Asian Artists, a lobbying and production group that was formed during the RSC controversy to promote East Asian representation on stage and screen.

This article argues that all casting practices have significant discursive power. Drawing upon Judith Butler’s analysis of materiality, and J. L. Austin’s speech-act theory, it asserts that, in all contexts, casting produces bodies as discursively meaningful, and can facilitate a reflexive gap between actors and the roles they play. The article focuses on Ben Kingsley’s performance as The Mandarin in Iron Man 3 to explore how this gap might articulate both dramaturgical and social performativity. The Royal Shakespeare Company’s (RSC) The Orphan of Zhao is then analysed to consider why ethnic pretence was critiqued by British East Asian artists in this production. Ultimately, the article argues that the way in which The Orphan of Zhao was staged leads to possible charges of cultural imperialism – a charge that framed the relationship between actor and role as ‘authentic’, and prevented the casting from being truly ‘integrated’.

This introduction investigates the issues raised by asserting cultural ownership over specific traditions of performance. In particular, it highlights how casting – one of the least analysed areas of theatre practice – might both empower and complicate debates around who should participate in performance. How might authentic casting – of casting actors who ‘look like’ they are from the same geographical region as the performance text or tradition – and colour-blind casting practices come into conflict? The casting controversy surrounding the Royal Shakespeare Company’s (RSC’s) 2012-13 production of The Orphan of Zhao provides an opportunity to tackle these questions.

In the first of two commissioned interviews for this Special Issue, two prominent members of the Royal Shakespeare Company (RSC) production team, Hannah Miller, Head of Casting, and Kevin Fitzmaurice, Producer, discuss their approaches to casting. The role of the casting director is, perhaps, somewhat overlooked in the analysis of theatre and performance. However, since casting decisions for The Orphan of Zhao became the focus of intense debate, an opportunity presents itself to engage with the work of the casting director more fully.

Is it really possible to study Japanese Noh theatre outside of Japan? Can Noh training be meaningful to non-Japanese, yet faithful to traditional training methods? Is amateur training outside of Japan actually all that different to amateur training inside Japan? In this interview, conducted in September 2013, Richard Emmert explains his approach to Noh training inside and outside of Japan, its relationship to traditional modes of instruction, and the possibilities for innovation. He articulates his rationale for the production of Noh in English, and explores how a lack of skilled performers for these projects led to the creation of the various Noh Training Projects held around the world. Above all, he argues that an understanding of Noh's formal complexity is central to training. He suggests that such knowledge enables the full significance of training to be realised, the meaning of innovation in Noh to be discerned, and the discovery of subtle transferable performance skills through a recognition of the ...

Jingju (Beijing Opera) is widely considered to be a fundamentally non-naturalistic practice that became known in the West after it caught the attention of western practitioners in 1935 following Mei Lanfang's performance in Moscow. Given the implication that its importance is largely historical, some non-specialists have implied that Jingju has little relevance to contemporary modes of thinking, particularly the multiplicities of experience as outlined by philosophers such as Deleuze and Guattari. This article seeks to demonstrate the multiplicity of Jingju for a wider readership through both a historical analysis and a deconstruction of the form. It will show how, at the same time that Mei Lanfang was providing a ‘non-realistic’ model for western practitioners eager to displace the dominance of naturalism, realistic settings were becoming an integral part of Jingju performances in Shanghai. The article also engages with the various acting pai/styles that weave Jingju into a complex, multiple form...

In March 2009, (1) I saw a production called The White Goddess: A Love over Four Seasons (Bai Niangzi: Aiqing Siji), billed as "Multimedia Beijing Opera Music Theatre" (Duomeiti Jingju Yinyue Juchang). The performance, which was also dubbed "A Chinese Musical Experiment: Peking Opera + Symphony + Media Arts + Sound Arts," ran for just three nights at the Shanghai Oriental Arts Centre (Shanghai Dongfang Yishu Zhongxin), a venue situated in Pudong, a western district of Shanghai, known for performances of both Western classical music and traditional Chinese "opera" theatre. The production was a collaboration between staff from the Shanghai Conservatory of Music (Shanghai Yinyue Xueyuan) and the affiliated Oriental Digital Media Arts Research and Development Center (Shanghai Yinyue Xueyuan Dongfang Shuzi Meiti Yishu Yanfa Zhongxin (2)). It starred Shi Yihong as the White Goddess and Jin Xiquan as her scholar-lover, Xu Xian, with the majority of the supporting cast taken from the ranks of the Shanghai Jingju Company (Shanghai Jingju Yuan). The performance was different from conventional jingju (Beijing opera) in that it was configured as a symphony, with a Western and jingju orchestra placed side by side on stage for the entire performance. Multimedia projections were used throughout, and actors were only intermittently present to provide snatches of narrative. The performance, which took more than a year to stage, generated a greater critical discussion among Shanghai theatre critics than would normally be expected for a performance of jingju. For example, the April 2009 issue of the periodical Shanghai Theatre contained four articles about the production, and the subsequent issue included a further critical article discussing its artistic merits. One critic even hailed the production as an example of "modern theatre for the 21st century" with its mixing of symphonic music, jingju, multimedia arts and Western dramatic ideas (Wang 2009: 12-17). This article seeks to analyze whether the production really was "modern." Given that the orchestration of traditional theatre with Western instruments is nothing new, and that it is working within the confines of the symphonic form, precisely how groundbreaking was The White Goddess? In a move away from narrative theatre toward the scenographic musical event, the suitability of Western perspectives to modern Chinese performance will also be tested. In particular, this article will assess the applicability of discourses on postdramatic theatre, music theatre, and multimedia theatre in an attempt to accurately classify the work and gauge its importance. The Production of The White Goddess The White Goddess was based on the famous jingju play The White Snake (Baishezhuan). The play recounts how the White Snake Goddess assumes human form and descends to earth. She meets a scholar with whom she falls in love, and they marry. However, a Buddhist monk, Fa Hai, suspects that the scholar's new wife is actually a serpent goddess in disguise and, during the Mid-Autumn Festival, forces her to drink wine, whereupon her true reptilian form is revealed. The White Snake Goddess and the monk fight; the goddess loses, and she is imprisoned under a pagoda, where she is left to pine for her husband. (3) In adapting the story to fit a symphonic framework, The White Goddess took four scenes from the 1952 source text of The White Snake written by Tian Han (scenes 1, 2, 12, and 14), which became the four movements of the symphony: "Spring," represented the romance between the goddess and her future husband; "Summer," depicted their marriage; "Autumn," the revelation of the goddess's true form and the fight with the Buddhist monk; and "Winter," her imprisonment under the pagoda. These four scenes were also chosen because they could be epitomized by the colors green, red, blue, and white. These colors, in turn, corresponded with the four seasons--spring, summer, autumn, and winter--which formed the compositional structure for the music of the play (Gong 2009: 23). …

Jingju(‘Beijing opera’) is China's most iconic traditional theatre, marketed as a global signifier of Chinese theatre and national identity. Although troupes from mainland China regularly tour Europe, audiences in the UK have also had access toJingjuvia two indigenous organizations: the UK Beijing Opera Society (now defunct) and the London Jing Kun Opera Association (now in its ninth year). These organizations consist of Chinese, overseas Chinese and Western performers performing bothJingjuandKunju(‘Kun opera’). Where there is a mix of ethnicity, can ‘traditional Chinese theatre’ still be conceived of as ‘traditional’? How isJingjumapped onto non-Chinese bodies? CanJingjuperformances by ethnically white performers reflect diasporic identities? Drawing on the theories of Judith Butler and Homi Bhabha, this article argues that by highlighting the performativity of identity, the performance ofJingjuby non-Chinese performers challenges the notion ofJingjuas a global signifier of ‘authentic traditional Chinese theatre’.

This article compares two approaches to teaching Asian theatre at undergraduate level in the United Kingdom. One approach samples a variety of different traditions as a means to challenge students to produce performance for a combined audience of hearing and deaf, whereas the other focuses on the effect of exploring one geographical area intensively over the course of one academic year. The article seeks to highlight the merits and pitfalls of both approaches, and questions whether student work that actively questions ethnicity and identity, as well as the tension between innovation and tradition, might be considered diasporic in character.

The author argues that the resumption of tours from the late 1970s onwards correlate with the economic strategy that led China towards greater internationalism following the Cultural Revolution (1966–1976). Although the artistic decisions behind the intercultural experiments from the 1980s and 1990s are not directly connected to PRC government initiatives, and were motivated as much by aesthetic concerns as political ones, the author nevertheless argues that they took place in a socio-political and economic context that made such intercultural experiments, and the prospect of touring them abroad, possible. By drawing upon models from foreign policy and international relations, he argues that Chinese opera remains a potent tool of cultural diplomacy both in this period and into the twenty-first century, and continues to play an important role in asserting Chinese structural power.

This chapter offers the first systematic documentation of the performance of Chinese opera amongst Chinese communities in London. Drawing upon primary research, the author records how Republic of China embassy staff began their own Peking opera society after they lost employment following the creation of the People’s Republic of China in 1949. Concurrent with the influx of Cantonese immigrants to Britain in the post-war period, Cantonese opera groups were established. These groups provided an opportunity for immigrants to socialise around a shared interest. The chapter then describes the more recent activities of the UK Beijing Opera Society, and the London Jing Kun Opera Society, both of which involved non-Chinese in performances. The author argues that if the first societies constructed a sense of community through the study of Chinese opera, the involvement of non-Chinese in the latter societies reflected the diasporic conditions of its performance, positioning Chinese opera as a hybrid form.

The author offers an overview of the political machinations that brought the performance of Chinese opera to London for the first time in the twentieth century. He explores its importance in asserting identity and nation to the wider international community in a time of Chinese political and social upheaval. In the context of the Cold War, British concern over the future of Hong Kong following the establishment of the People’s Republic of China (PRC) in 1949, the PRC and Taiwan jockeying for recognition as the ‘true’ China, as well as the Communist Party of Great Britain’s (CPGB) own interest in maintaining relations with the communist bloc, the arrival of Peking opera troupes in London created a flurry of diplomatic activity. The author documents the objections voiced by the British government to CPGB involvement in the visits, as well as PRC objections to a visit by a troupe from Taiwan. Such criticism highlights the significance of Chinese opera to assertions of nation, identity and statehood.

The author focuses on a British response to the Chinese opera Monkey: Journey to the West, a production that was first performed in 2007 – a period in which Beijing would host the Olympics in 2008 and it was announced that London would do so in 2012. He suggests that the production could be construed as Orientalist and as sustaining a British fascination for theatrical chinoiserie. Yet, he highlights how China itself is no stranger to self-Orientalisation, and thus Monkey might also demonstrate how the increasing circulation of transnational stereotypes is, itself, indicative of China’s growing economic influence.

The author proposes that the performance of Chinese opera, and its intercultural offspring, reflect the wider concerns of Sino-British relations. He suggests that its performance in London functioned as a mirror for both British and Chinese audiences to assess their place in the world. He claims that Said’s theory of Orientalism, which asserts a rigid dichotomy between the self and other, Britain and China, is too inflexible to account for this dynamic.

Hsiung Shih-yi, a professor and translator of English Literature, came to Britain in 1933 to further his academic career. After arriving in London, he achieved fame with his play Lady Precious Stream, a spoken drama adaptation of a Chinese opera Lady Precious Bracelet (Wang Bao Chuan), which opened in London on 22 November 1934. The author argues that Lady Precious Stream may have been sufficiently exotic to excite interest, but this ‘traditional Chinese play’ was anything but traditional. The first production fused Chinese and British dramatic styles to create something both exotic and familiar to British audiences in a way that was more sophisticated than the plays discussed so far in this study. The author also analyses the visit of Mei Lanfang – China’s most celebrated opera actor – to London. The author concludes that Mei’s time in London was a personal failure: he was unable to transcend the barriers placed in his way, possibly because theatre impresarios understood that British audiences preferred chinoiserie. However, in his support for Hsiung’s endeavours, Mei demonstrated a commitment to raising China’s profile through the international performance of Peking opera. The author concludes with an analysis of Hsiung’s second – and final – attempt to stage Chinese opera in London. The Western Chamber, based upon Jin Shengtan’s Xixiang Ji, was a commercial failure, demonstrating how London audiences preferred to consume Chinese opera as amusement and chinoiserie, rather than as a serious alternative to Western dramaturgy.

With the British finally securing trading rights with the Qing Empire through Canton in the 1760s, the author suggests that there was an increased interest in experiencing China in London in contradictory ways: through the reasoned categorisation of Chinese culture leading to the advent of sinology and fantasy imaginings that seemed to defy it. He analyses the first ‘serious’ British academic studies of Chinese drama undertaken by Sir John Francis Davis, showing how they were as much a product of the desire for increased trade as they were of genuine curiosity. He also explores the display of Chinese opera in a number of imperial exhibitions across the second half of the nineteenth century, culminating in the 1884 Health Exhibition, which witnessed the first performance of Chinese opera in London. He concludes by analysing The Yellow Jacket, a play that transferred from Broadway to London in 1913, and which brought together sinology, fantasy and exhibition for the amusement of London audiences.

The author contends that before the first translation of a Chinese play into English in 1736, the English understanding of Chinese drama was pieced together through a pan-European sharing of information gleaned from the accounts of missionaries and travellers. Such accounts suggested correspondences between European and Chinese drama, which, rather than assert the supremacy of European culture, sought to demonstrate European compatibility with a politically stable and economically prosperous China.

The author shows how The Orphan of Zhao (Zhaoshi Gu Er) – the first Chinese play to come to Europe – was, like the literature analysed in Chap. 2, produced through a series of European translations and adaptations by missionaries, such as Du Halde. In accordance with the travel literature that preceded it, the author proposes that Chinese drama was ultimately harnessed as a foil to explore the British self via an invocation of the Chinese other that imagined a general cultural compatibility between the two nations. Through the adaptations of The Orphan of Zhao by Voltaire, Hatchett and Murphy, the author argues that the deployment of chinoiserie, and the assertion of Francophobic and Islamophobic sentiment, enabled the British to use China as a foil to present itself to itself as a modern, morally virtuous, state.

The author suggests that the enthusiasm for chinoiserie was reignited in the early decades of the twentieth century, though the context of this resurgence was contradictory. Whilst East Asian design was held in high regard as an inspirational source for new kinds of European self-expression, the cultural decontextualisation of it in the service of Western modernity was also an act of cultural imperialism. It was in this context that London audiences were able to see another ‘Chinese opera’ play, The Circle of Chalk, based upon a translation of the Chinese play of the same name, Huilan Ji. Much like The Orphan of China some 200 years earlier, The Circle of Chalk arrived in London via multiple European translations. Without a doubt, one of the main selling points was Anna May Wong, the star Hollywood actress making her British stage debut. The author suggests that Wong was undoubtedly objectified and commercialised as an ethnic object, yet she could also be considered to represent the edgier, more politically engaged, sides of chinoiserie fashion. He also analyses the Australian–Chinese actor Rose Quong, arguing that she was able to express both Australian–Chinese and Chinese identities in London.

The prime function of the clown (chou) in jingju (Beijing "opera") has often been considered as light entertainment, but there is evidence that could support a different interpretation. The clown is associated with the origin of Chinese acting, and performance shows a fundamental relationship between the clown and drumming which comes from shamanism. While other martial roles share some of the tie to percussion, the improvisational freedom of the clown, the customary verse the clown uses, drumming, and parallels to Taoist ritual music may point back to shamanistic roots. If this is true, the clown's comedy may come from exorcism and not only joking. Ashley Thorpe received his PhD from the University of London and currently teaches theatre at Royal Holloway, University of London, and the University of Reading. He has studied jingju in China and performed in the United Kingdom as both a jingju actor and a musician. His book on the role of the clown in traditional Chinese drama is forthcoming from Edwin Mellen Press. ********** There are four principal role types in jingju (commonly known as Beijing "opera"), which are usually listed in order of importance: sheng (male), dan (female), jing (painted face), and chou (clown). The clown is always placed last in the hierarchy of roles, and his significance in jingju has been frequently overlooked. Indeed, the majority of studies on jingju describe the clown as a minor role, suggesting that it exists purely to entertain the audience through joking. (1) Yet, the importance of the clown to the development of traditional theatre can be gauged historically. Historical Importance of the Clown The first document concerning "actors" is found in the Records of the Great Historian, written by Sima Qian (145-90 BCE), who was appointed to the court of Emperor Wu (reigned 141-87 BCE) of the Western Han dynasty. In a section entitled Lives of the Jesters, Sima chronicled a jester called Meng from the Zhou imperial court of Emperor Zhang (696-683 BCE). Because Lives of the Jesters is "the first record of actors and their lives in China" (Fei 2002: 19), Meng is regarded as the first recorded actor in China. Indeed, the saying "the actor Meng in costume" (you Meng yi guan) is still used as an idiom meaning "to imitate others," an expression that linguistically acknowledges the important role that the jester played in the development of traditional theatre in China. In jingju, the role of the clown is essentially divided into two principal male roles: the martial clown (wu chou) and the civilian clown (wen chou). (2) The martial clown specializes in portraying military personnel or great action heroes and is considered to be the most demanding role to perform in jingju. (3) This is because the role requires the actor to develop excellent acrobatics, comic acting, and a strong, clear voice. Although acrobatics are not as important to the civilian clown (who specializes in portraying government officials and servants), the actor must portray a range of different characters through movement in addition to acquiring the improvisational skills to impress the audience with his comic ingenuity. However, while it is perceived that the primary stage function of the clown is to entertain, the connection between the clown and the exorcistic properties of percussion (specifically drums and gongs) suggests that there is also a serious subtext to his comic antics. To demonstrate this, I will offer a contextualization of the musical performance of the clown, arguing that in both the mythical origins of theatre and in actual performance, the relationship between the clown and percussion references the shamanic origins of performance. Though my discussion is primarily concerned with the historic and actual techniques of jingju performance that have not been documented elsewhere (rather than an analysis of joking (4)), my aim is to show that alongside its comedic function, the clown's musical performance actually harks back to exorcistic patterns of using percussion to gather and subdue demons. …

In comparison to traditional forms, modern Asian drama is relatively unknown to students of theatre and performance studies in the West. The reasons for this are numerous, but the insufficient avai...

Body surface potential mapping (BSPM) can be used to non-invasively measure the electrical activity of the heart using a dense set of thorax electrodes and a CT/MR scan of the thorax to solve the inverse problem of electrophysiology (ECGi). This technique now shows potential clinical value for the assessment and treatment of patients with arrhythmias. Co-localisation of the electrode positions and the CT/MR thorax scan is essential. This manuscript describes a method to perform the co-localisation using multiple biplane X-ray images. The electrodes are automatically detected and paired in the X-ray images. Then the 3D positions of the electrodes are computed and mapped onto the thorax surface derived from CT/MR. The proposed method is based on a multi-scale blob detection algorithm and the generalized Hough transform, which can automatically discriminate the leads used for BSPM from other ECG leads. The pairing method is based on epi-polar constraint matching and line pattern detection which assumes that BSPM electrodes are arranged in strips. The proposed methods are tested on a thorax phantom and two clinical cases. Results show an accuracy of 0.33 ± 0.20mm for detecting electrodes in the X-ray images and a success rate of 95.4%. The automatic pairing method achieves a 91.2% success rate.