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The loss of biodiversity through a rapidly changing climate means humans can no longer assume their longevity on Earth; a crisis that has prompted a wave of literary imaginings. This article examines Maja Lunde’s The History of Bees (2015) and Richard Powers’ The Overstory (2018). Through comparing these authors’ contrasting treatment of temporality, I argue that both novels perform crucial cultural work in destabilising myopic perspectives on human and environmental paradigms and depict human and more-than-human experiences of time. My article investigates how extensive scales and multiple temporalities can be imagined in literature. By illustrating the complexity of scale and time, Lunde and Powers combat narrow, anthropocentric depictions of nature in favour of holistic, multi-faceted depictions of nature. Lunde’s and Powers’ treatment of time illuminates methods that diversify perspectives of human citizenship in, and relationship to, a more-than-human world. Through examining each narrative’s multi-layering of temporalities, this article explores how The History of Bees and The Overstory each capture the complexities of ecological life in an attempt to enlarge and redirect attention to both the minute and cosmological layers of time.

Both the body and actions of George Eliot’s titular character are a source of “half-fearful fascination” in the first pages of Silas Marner (Eliot 1–2). His intimacy with his loom as well as his in...

Purpose To investigate the dosages of swallowing exercises reported in intervention studies on post-stroke dysphagia through systematic review. Methods Five electronic databases were searched from inception until February 2022 with reference tracing of included studies. Studies were included, where adults with post-stroke dysphagia received rehabilitative, behavioural swallowing exercises, pre/post outcomes were reported, and intervention dosage was described in detail, including frequency, intensity, time, and type of exercise. Two reviewers independently screened studies and rated quality using ASHA Levels of Evidence tool. Data was tabulated and narratively described. Results 54 studies were included with a total 1501 participants. Studies included 28 randomised controlled trials, 8 non-randomised controlled trials, 12 pre/post studies, 3 retrospective case controls and 3 case studies. Results showed inconsistent reporting of intervention dosage, with intensity the least consistently reported dosage component. While swallowing intervention was most commonly provided five times per week for four weeks, there was a wide breadth of type, frequency, intensity and duration of swallowing exercises reported. Dosage under-reporting and variation was particularly observed in “standard care” co-interventions or control groups. Study strengths included following PRISMA guidelines, providing a comprehensive review of swallowing exercise methodology and dosages, and including non-English studies. The limitation was lack of meta-analysis due to the heterogeneity of included studies. Conclusions Dosages of swallowing exercises are inconsistently reported and vary significantly in post-stroke dysphagia studies. Results indicate the need for consistent and comprehensive dosage reporting in dysphagia studies, and for further research into evidence-based principles to optimise swallowing exercise dosages. Systematic review registration number 131294

Laser speckle imaging (LSI) is a wide-field optical imaging technique that provides information about the movement of scattering particles in biological samples. LSI is used to create maps of relative blood flow and perfusion in samples such as the skin, brain, teeth, gingiva, and other biological tissues. The presence of static, or non-moving, optical scatterers affects the ability of LSI to provide true quantitative and spatially resolved measurements of blood flow. With in vitro experiments using tissue-simulating phantoms, we determined that temporal analysis of raw speckle image sequences improved the quantitative accuracy of LSI to measure flow beneath a static scattering layer. We then applied the temporal algorithm to assess the potential of LSI to monitor oral health. We designed and tested two generations of miniature LSI devices to measure flow in the pulpal chamber of teeth and in the gingiva. Our preliminary clinical pilot data indicated that speckle contrast may correlate with gingival health. To improve visualization of subsurface blood vessels, we developed a technique called photothermal LSI. We applied a short pulse of laser energy to selectively perturb the motion of red blood cells, increasing the signal from vasculature relative to the surroundings. To study the spectral and depth dependence of laser speckle contrast, we developed a Monte Carlo model of light and momentum transport to simulate speckle contrast. With an increase in the thickness of the overlying static-scattering layer, we observed a quadratic decrease in the quantity of dynamically scattered light collected by the detector. We next applied the model to study multi-exposure speckle imaging (MESI), a method that purportedly improves quantitative accuracy of subsurface blood flow measurements. We unexpectedly determined that MESI faced similar depth limitations as conventional LSI, findings that were supported by in vitro experimental data. Finally, we used the model to study the effects of epidermal melanin absorption on LSI, and demonstrated that speckle contrast is less sensitive to varying melanin content than reflectance. We then proposed a two-wavelength measurement protocol that may enable melanin-independent LSI measurements of blood flow in patients with varying skin types. In conclusion, through in vitro and in silico experiments, we were able to further the understanding of the depth dependent origins of laser speckle contrast as well as the inherent limitations of this technology.

The impact of infectious disease outbreaks on mental health among health care workers is wellestablished Minimal research has focused on health care trainees' well-being, especially during unprecedented events such as the 2019 coronavirus pandemic (COVID-19) Trainees are vulnerable to inherent power and resource differentials, which may exacerbate stress The present study used a mixed methods approach to examine mental health symptoms, perceived safety, and ongoing and desired support among a national sample of psychology interns, psychology intern and postdoctoral trainees during the COVID-19 pandemic (N = 400) Participants reported clinically elevated anxiety and depressive symptoms Participants working on-site who felt that their health or safety was at risk reported more anxiety symptoms Most common workplace safety concerns included inadequate protection against risk and face-to-face patient care requirements Trainees desired more support, better communication, more remote work and telehealth options, and flexibility in training requirements Themes also emerged related to supervisor pressure and disregard of trainees' concerns Results have significant implications for the training environment and quality of patient care Increased support of psychology trainees is vital during the current and potential future public health crises © 2020 American Psychological Association

There has been a recent push for the incorporation of mental/behavioral health (M/BH) services within primary care (PC). The present study aimed to assess current and desired services and perceived...

Stochastic mechanisms diversify cell fates during development. How cells randomly choose between two or more fates remains poorly understood. In the Drosophila eye, the random mosaic of two R7 photoreceptor subtypes is determined by expression of the transcription factor Spineless (Ss). Here, we investigated how cis-regulatory elements and trans factors regulate nascent transcriptional activity and chromatin compaction at the ss gene locus during R7 development. We find that the ss locus is in a compact state in undifferentiated cells. An early enhancer drives ss transcription in all R7 precursors to open the ss locus. In differentiating cells, transcription ceases and the ss locus stochastically remains open or compacts. In SsON R7s, ss is open and competent for activation by a late enhancer, whereas in SsOFF R7s, ss is compact and repression prevents expression. Our results suggest that a temporally dynamic antagonism, in which transcription drives decompaction and then compaction represses transcription, controls stochastic cell fate specification.

This study investigated how swallowing exercise dosage is recorded, and what swallowing exercise dosages are reported in a stroke rehabilitation setting. We additionally explored the relation between mean daily swallowing repetitions and likelihood of improvement in functional swallowing status and considered how swallowing exercise dosages in practice compared to evidence-based principles of neural plasticity and strength training. We audited medical records for 42 patients with post-stroke dysphagia admitted to an inpatient rehabilitation unit over 18 months. Data were collected on participant characteristics, swallowing exercises and dosages, and clinical outcomes. The relation between dosage and outcomes was investigated using logistic regression analysis. On average, patients were seen for a median of 2.4 swallowing intervention sessions per week (IQR: 1.7) over 21 days (IQR: 16) and received a median 44.5 swallowing exercise repetitions per session (IQR: 39.6). Results indicated variable reporting of swallowing exercise dosages. Frequency, intervention duration, exercise type, and number of repetitions were routinely recorded in medical records, while intensity, session length, content, and adherence to home exercise programs were not. Frequency of swallowing intervention was lower in practice compared to research studies, and swallowing exercises did not follow specificity or progressive resistance principles. Likelihood of improvement in swallowing status was partially explained by age (B = -.015, p = .007) but not by mean daily swallowing exercise repetitions. This study illustrates dosages of swallowing exercises used in clinical practice. Results highlight the need for improved consideration and reporting of dosage, and application of evidence-based principles to swallowing exercise dosages.

AimsClinical Team Meetings (CTM) are weekly multidisciplinary (MDT) meetings to review and discuss patients’ clinical care at Reaside Clinic, a medium secure inpatient forensic unit. Last year, there were significant difficulties in releasing nurses from ward duties to attend CTM, with effects on CTM efficiency and patients’ involvement and satisfaction in care. Furthermore, a hospital ‘protected mealtimes’ deadline commencing at 1230 meant additional pressure and further impacted patient attendance when meetings overran. The MDT (comprising doctors, nurses, psychologists, occupational therapists, pharmacists and admin staff) worked together to generate solutions, formulating a QI project to try to make improvements. Three primer drivers were: increasing patient satisfaction, increasing staff participation and increasing CTM efficiency.MethodsThe MDT generated multiple change ideas to test to improve CTM experience and outcomes. Actions implemented included review of timetabling of patients to ensure adequate timekeeping and ensuring availability of attending ward staff, defining patient expectations from CTM through increased communication, and seeking patient feedback on satisfaction or engagement after each CTM through anonymous questionnaires. Data were collected at CTMs from February to April 2022, retrospectively compared to reference data collected before QI actions were implemented. A Microsoft OneDrive document was shared between the MDT to ensure accurate data collection, with information collected on CTM finish time, number of patients offered to attend, number of patients who did attend and anonymous patient satisfaction feedback from questionnaires.ResultsEarly indications show improvement in meeting timelines and increased staff satisfaction with the CTM process, with data collection ongoing. Baseline results from September 2021 show an average of only 2 of between 13–15 patients attending weekly, in addition to finishing beyond the 1230 target on almost all occasions. Anecdotal evidence from the MDT showed poor patient satisfaction and engagement with the process before QI changes were implemented. Full results will be available by the time of presentation; currently, an average of 4 patients have attended CTM each week with all sessions finishing on time since implementation of changes.ConclusionPatient involvement in care and person-centred care are key to improving engagement and satisfaction with inpatient psychiatric management in forensic settings. Targeted multiple change ideas implemented by the MDT through this QI aim to improve patient satisfaction through enabling increased opportunity to attend weekly CTM, with modifications to the CTM process from key staff. Preliminary results show increased opportunity of patients to attend CTM, increased staff and patient satisfaction, and increased CTM efficiency.

Youth are commonly exposed to potentially traumatic events (PTEs). Following exposure, approximately 25% develop persistent mental and behavioral health (M/BH) symptoms, yet many go untreated or are misdiagnosed and suffer adverse outcomes. Primary care is an ideal setting for detection of trauma-related symptoms. The current article uses archival data to (1) examine the prevalence of posttraumatic stress symptoms that are unlikely, possible, and likely to meet diagnostic criteria for posttraumatic stress disorder (PTSD) and the M/BH and physical health concerns that co-occur with PTSD symptoms among adolescents (n = 133, mean age = 15.1 years, 67% female, 60% White) referred for brief, integrated M/BH services within primary care and (2) identify the prevalence of referred adolescents with elevated symptoms of PTSD that would not be identified for services by traditional depression screening. M/BH providers assessed referred patients for PTSD, M/BH, and physical health symptoms as a routine part of services. Fifty-eight percent screened positive for PTSD (PTSD-possible or PTSD-likely range). The subset of adolescents in the PTSD-likely range (29%) reported significantly greater stress, depression, anxiety, anger, and externalizing symptoms than those categorized as PTSD-possible or PTSD-unlikely. Adolescents in the PTSD-possible or PTSD-unlikely ranges did not differ on any M/BH variables; PTSD groups' physical health did not differ. Of note, 15% of adolescents reporting symptoms likely to meet PTSD criteria did not report elevated depressive symptoms and would have been overlooked by depression screening alone. Given the prevalence of PTEs among M/BH patients, trauma-informed care is necessary for quality patient care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background Specialized primary care internal medicine (PC IM) residency programs and tracks aim to provide dedicated PC training. How programs deliver this is unclear. Objective We explored how PC IM programs and tracks provide ambulatory training. Methods We conducted a cross-sectional survey from 2012 to 2013 of PC IM program and track leaders via a search of national databases and program websites. We reported PC IM curricular content, clinical experiences, and graduate career pursuits, and assessed correlation between career pursuits and curricular content and clinical experiences. Results Forty-five of 70 (64%) identified PC IM programs and tracks completed the survey. PC IM programs provide a breadth of curricular content and clinical experiences, including a mean 22.8 weeks ambulatory training and a mean 69.4 continuity clinics per year. Of PC IM graduates within 5 years, 55.8% pursue PC or general internal medicine (GIM) careers and 23.1% pursue traditional subspecialty fellowship training. Curricular content and clinical experiences correlate weakly with career choices. PC IM graduates pursuing PC or GIM careers correlated with ambulatory rotation in women's health (correlation coefficient [rho] = 0.36, P = .034) and mental health (rho = 0.38, P = .023) and curricular content in teaching and medical education (rho = 0.35, P = .035). PC IM graduates pursuing subspecialty fellowship negatively correlated with curricular content in leadership and teams (rho = -0.48, P = .003) and ambulatory training time (rho = -0.38, P = .024). Conclusions PC IM programs and tracks largely deliver on the promise to provide PC training and education and produce graduates engaged in PC and GIM.

Background The longitudinal experience in continuity clinic plays a crucial role in building a strong foundation in general pediatrics. Pediatric residents struggle to maintain continuity in their clinics, which may impact comfort in managing common chronic pediatric conditions. Little is known about the prevalence of common chronic diseases managed on resident panels and if they are associated with resident continuity. Objectives We hypothesize that the presence of common chronic disease will be associated with resident continuity. We will also determine prevalence of common chronic diseases seen in clinic. This study will help inform a prospective quality improvement (QI) project. Methods Unique patients that had been seen for at least two non-urgent care visits (with at least one well visit) in our residency continuity clinic over a 2-year period were identified. To date, 618 of 685 patient charts reviewed meet the visit criteria. We have defined continuity as seeing the same resident provider for two or more visits. We have defined a resident primary care provider (PCP) as a resident who has seen a patient for >50% of their visits. Patient visit data and presence of chronic diseases for each patient were recorded in a password-protected Excel database. Results Of the 685 patients reviewed, there were 5584 unique visits, of which 3775 visits were related to well care (68%). Of those that met inclusion criteria (618), 309 (50%) met our definition for continuity, and 116 (16.9%) met our definition for having an identified resident PCP. For patients that had an identified resident PCP, they were less likely than those without one to have chronic diseases such as ADHD (0.86% vs. 3.56%, OR 0.28), obesity (6% vs. 15.5%, OR 0.78) and anxiety/depression (1.7% vs. 5.5%, OR 0.53). Conclusions While data collection/analysis is incomplete, it is clear that achieving continuity in a resident clinic is challenging. Chronic diseases are unlikely to be associated with resident continuity. QI interventions may be needed to increase resident continuity particularly among patients with common chronic pediatric conditions

Summary Homologous chromosomes colocalize to regulate gene expression in processes including genomic imprinting, X-inactivation, and transvection. In Drosophila, homologous chromosomes pair throughout development, promoting transvection. The “button” model of pairing proposes that specific regions along chromosomes pair with high affinity. Here, we identify buttons interspersed across the fly genome that pair with their homologous sequences, even when relocated to multiple positions in the genome. A majority of transgenes that span a full topologically associating domain (TAD) function as buttons, but not all buttons contain TADs. Additionally, buttons are enriched for insulator protein clusters. Fragments of buttons do not pair, suggesting that combinations of elements within a button are required for pairing. Pairing is necessary but not sufficient for transvection. Additionally, pairing and transvection are stronger in some cell types than in others, suggesting that pairing strength regulates transvection efficiency between cell types. Thus, buttons pair homologous chromosomes to facilitate cell-type-specific interchromosomal gene regulation.

Homologous chromosomes colocalize to regulate gene expression in processes including genomic imprinting and X-inactivation, but the mechanisms driving these interactions are poorly understood. InDrosophila, homologous chromosomes pair throughout development, promoting an interchromosomal gene regulatory mechanism called transvection. Despite over a century of study, the molecular features that facilitate chromosome-wide pairing are unknown. The “button” model of pairing proposes that specific regions along chromosomes pair with a higher affinity than their surrounding regions, but only a handful of DNA elements that drive homologous pairing between chromosomes have been described. Here, we identify button loci interspersed across the fly genome that have the ability to pair with their homologous sequences. Buttons are characterized by topologically associated domains (TADs), which drive pairing with their endogenous loci from multiple locations in the genome. Fragments of TADs do not pair, suggesting a model in which combinations of elements interspersed along the full length of a TAD are required for pairing. Though DNA-binding insulator proteins are not associated with pairing, buttons are enriched for insulator cofactors, suggesting that these proteins may mediate higher order interactions between homologous TADs. Using a TAD spanning thespinelessdgene as a paradigm, we find that pairing is necessary but not sufficient for transvection.spinelesspairing and transvection are cell-type-specific, suggesting that local buttoning and unbuttoning regulates transvection efficiency between cell types. Together, our data support a model in which specialized TADs button homologous chromosomes together to facilitate cell-type-specific interchromosomal gene regulation.

International audience; Each individual perceives the world in a unique way, but little is known about the genetic basis of variation in sensory perception. In the fly eye, the random mosaic of color-detecting R7 photoreceptor subtypes is determined by stochastic ON/OFF expression of the transcription factor Spineless (Ss). In a genome-wide association study, we identified a naturally occurring insertion in a regulatory DNA element in ss that lowers the ratio of SsON to SsOFF cells. This change in photoreceptor fates shifts the innate color preference of flies from green to blue. The genetic variant increases the binding affinity for Klumpfuss (Klu), a zinc finger transcriptional repressor that regulates ss expression. Klu is expressed at intermediate levels to determine the normal ratio of SsON to SsOFF cells. Thus, binding site affinity and transcription factor levels are finely tuned to regulate stochastic expression, setting the ratio of alternative fates and ultimately determining color preference.

Each individual perceives the world in a unique way, but little is known about the genetic basis of variation in sensory perception. Here we investigated natural variation in the development and function of the color vision system ofDrosophila. In the fly eye, the random mosaic of color-detecting R7 photoreceptor subtypes is determined by stochastic expression of the transcription factor Spineless (Ss). Individual R7s randomly choose between SsONor SsOFFfates at a ratio of 65:35, resulting in unique patterns but consistent proportions of cell types across genetically identical retinas. In a genome wide association study, we identified a naturally occurring insertion in a regulatory DNA element in thessgene that lowers the ratio of SsONto SsOFFcells. This change in photoreceptor fates shifts the innate color preference of flies from green to blue. The genetic variant increases the binding affinity for Klumpfuss (Klu), a zinc finger transcriptional repressor that regulatesssexpression. Klu is expressed at intermediate levels to determine the normal ratio of SsONto SsOFFcells. Thus, binding site affinity and transcription factor levels are finely tuned to regulate stochastic on/off gene expression, setting the ratio of alternative cell fates and ultimately determining color preference.

How differential levels of gene expression are controlled in post-mitotic neurons is poorly understood. In the Drosophila retina, expression of the transcription factor Defective Proventriculus (Dve) at distinct cell-type-specific levels is required for terminal differentiation of color- and motion-detecting photoreceptors. Here, we find that the activities of two cis-regulatory enhancers are coordinated to drive dve expression in the fly eye. Three transcription factors act on these enhancers to determine cell-type-specificity. Negative autoregulation by Dve maintains expression from each enhancer at distinct homeostatic levels. One enhancer acts as an inducible backup (“dark” shadow enhancer) that is normally repressed but becomes active in the absence of the other enhancer. Thus, two enhancers integrate combinatorial transcription factor input, feedback, and redundancy to generate cell-type specific levels of dve expression and stable photoreceptor fate. This regulatory logic may represent a general paradigm for how precise levels of gene expression are established and maintained in post-mitotic neurons.

Over the past generation, sexual minorities—particularly lesbian, gay, bisexual, and transgender (LGBT) persons—have gained increased visibility in the public arena. Yet organizational research has lagged behind in recognizing and studying this category of organizational members. This article offers a critical review of this growing body of research. More specifically, we identify and discuss four dominant scholarly frames that have informed LGBT organizational research from the late nineteenth century to date. The frames include a “medical abnormality,” “deviant social role,” “collective identity,” and “social distinctiveness” view of sexual minorities. We argue that these frames have profoundly shaped the scope and range of organizational scholarship devoted to sexual minorities by showing that scholars using such contrasted frames have been drawn to very different research questions with respect to sexual minorities. We document and discuss the main and contrasted questions asked within each of these frames and show how they have both enabled and constrained LGBT organizational research. We conclude by calling for more attention to the frames organizational scholars adopt when studying sexual minorities, but also for more research on both minority and majority sexual orientations in organizations.

How differential levels of gene expression are controlled in post-mitotic neurons is poorly understood. In the Drosophila retina, expression of the transcription factor Defective Proventriculus (Dve) at distinct cell type-specific levels is required for terminal differentiation of color- and motion-detecting photoreceptors. Here, we find that the activities of two cis-regulatory enhancers are coordinated to drive dve expression in the fly eye. Three transcription factors act on these enhancers to determine cell-type specificity. Negative autoregulation by Dve maintains expression from each enhancer at distinct homeostatic levels. One enhancer acts as an inducible backup (‘dark’ shadow enhancer) that is normally repressed but becomes active in the absence of the other enhancer. Thus, two enhancers integrate combinatorial transcription factor input, feedback and redundancy to generate cell type-specific levels of dve expression and stable photoreceptor fate. This regulatory logic may represent a general paradigm for how precise levels of gene expression are established and maintained in post-mitotic neurons.

The Hippo pathway is critical for not only normal growth and apoptosis but also cell fate specification during development. What controls Hippo pathway activity during cell fate specification is incompletely understood. In this research report, we identify the BEAF-32 insulator protein as a regulator of Hippo pathway activity in Drosophila photoreceptor differentiation. Though morphologically uniform, the fly eye is composed of two subtypes of R8 photoreceptor neurons defined by expression of light-detecting Rhodopsin proteins. In one R8 subtype, active Hippo signaling induces Rhodopsin6 (Rh6) and represses Rhodopsin5 (Rh5) whereas in the alternate subtype, inactive Hippo signaling induces Rh5 and represses Rh6. The activity state of the Hippo pathway in R8 is determined by the expression of warts, a core pathway kinase, which interacts with the growth regulator melted in a double negative feedback loop. We show that the BEAF-32 insulator is required for expression of warts and repression of melted. Furthermore, BEAF-32 plays a second role downstream of Warts to induce Rh6 and prevent Rh5 fate. BEAF-32 is dispensable for Warts feedback, indicating that BEAF-32 differentially regulates warts and Rhodopsins. Loss of BEAF-32 does not noticeably impair the functions of the Hippo pathway in eye growth regulation. Our study identifies a context-specific regulator of Hippo pathway activity in post-mitotic neuronal fate, and reveals a developmentally specific role for a broadly expressed insulator protein.

PurposeThis paper aims to provide a rationale for the development of a community‐based group for men with intellectual disability who have been involved in sexually inappropriate behaviour but may not have been charged.Design/methodology/approachThe group was based on a cognitive behavioural model: group process and adaptations are briefly described. The group has been run on two occasions and preliminary data on outcome are provided.FindingsParticipants show a reduction in attitudes consistent with offending, an increase in sexual knowledge, and a more external locus of control on completion of the group. One of the 12 men who attended was recorded as offending again within 18 months of group completion; however, three moved to less well supervised placements.Originality/valueIt is concluded that this style of treatment has some advantages over other models and may be more effective, yet further research is required.

Researchers have found that children as young as elementary school age have already begun to develop negative stereotypes about older people. In order to determine television's role in children's perceptions of older adults, this study looks at how older characters' mental, physical, and overall characteristics are portrayed in children's animated television programs. The results indicate that although the overall portrayal of older characters is positive, there were a number of negative mental and physical characteristics used to portray the older characters. These negative characteristics were identical to the characteristics children reported to past researchers when asked to describe older people.

Objective: The purpose of this study was to investigate physician attitudes toward the treatment of overweight and obese individuals and to evaluate potential gender differences in treatment recommendations. Research Methods and Procedures: A survey describing several hypothetical patients was sent to 700 randomly selected physicians; 209 (29.9%) returned the survey. Two versions of the questionnaire (one for men and one for women) described three hypothetical patients at three levels of body mass index (BMI) (32, 28, and 25 kg/m2). One-half of the physicians received a version of the questionnaire describing the patients as women, and one-half received a version describing the patients as men. Respondents answered questions about attitudes toward treatment and specific interventions and referrals they would view as appropriate. Results: Physicians were more likely to encourage women with a BMI of 25 kg/m2 to lose weight than men with the same BMI, and indicated that they would suggest more treatment referrals for women than men. Men with a BMI of 32 kg/m2 were more likely to be encouraged to lose weight than women with the identical BMI. Physicians were more likely to encourage weight loss and see treatment referrals as appropriate for patients with higher BMIs. Discussion: This study indicates that physicians treat male and female patients differently, with physicians more likely to encourage weight loss and provide referrals for women with a BMI of 25 kg/m2 than for men with an identical BMI and less likely to encourage weight loss for women than men with a BMI of 32 kg/m2.

This chapter is part of a larger effort to understand British citizenship—perhaps better termed subjecthood—during the late eighteenth and early nineteenth centuries.1 For intellectual historians like J. C. D. Clark, British subjecthood has been a question about authority and allegiance best answered with reference to sermons, legal treatises and other canonical works of political theology; for new imperial historians like Kathleen Wilson or Catherine Hall, it is a question of identity and difference and the cultural politics of ‘subject positioning’.2 Yet these two modes of historical analysis seldom speak to one another. For all that has been written on eighteenth-century legal and intellectual history there is little on the laws of allegiance and authority in practice, while the growing body of work on the cultural history of empire tends to treat the law vaguely if at all. I argue, in contrast, that when eighteenth-century Britons labelled certain individuals as British subjects and others as aliens, they triangulated between ancient doctrines of legal and political theology and the demands of new colonial circumstances.

Central venous catheters are essential in the medical management of critically ill pediatric patients. Medical practitioners should be aware of the potential for misplacement of these devices as such complications may result in serious injury and possible death. Catheter malpositioning is not limited to any particular site and may have far-reaching consequences that affect a single or multiple organ systems. We present two cases where central venous catheter positioning led to complications that resulted in intracranial pathology which was fatal in one case.