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Cunninghamella species are an extremely rare cause of fungal infections. The usual mode of transmission is through inhalation; however, rare cases of cutaneous spread have been reported. The objective of this clinical case report is to highlight the uniqueness of which the patient acquired the infection, the progression, and control of it. A 57-year-old male with chronic lymphocytic leukemia was found to have an abscess next to his peripherally inserted central catheter (PICC) line. The abscess culture grew back Cunninghamella and was debrided and treated with isavuconazonium sulfate. The fungal infection was controlled and the total timeframe took 28 days. Rapid recognition and prompt treatment demonstrate the prevention of rapidly progressive angioinvasion and further systemic complications. This case also proves that isavuconazonium sulfate may be appropriate in controlling the spread of Cunninghamella species.

This chapter sets out the HMCTS approach to its reform programme that first originated in September 2016, when the then Lord Chief Justice and Lord Chancellor, together with the Senior President of Tribunals, set out their joint vision for a reformed, modernised justice system, one that would combine its ‘respected traditions with the enabling power of technology’. The aim of programme is to develop a digital system of civil justice which is increasingly open to all and progressively easier, and more efficient, to run. The need for reform is beyond doubt. Countless reviews and studies have highlighted significant weaknesses of a system that has long been beset by complex, paper-based processes and crippling costs. Our approach to reform deliberately eschews the risky ‘big bangs’ familiar to many reforms, instead favouring incremental change. It involves testing again and again new digital ways of working with real members of the public to establish what works best. In practice, the reforms mean building new, intuitive ways for the public—and their representatives—to structure, submit, and manage claims online. Early feedback, including from the new Online Civil Money Claims Service, suggests higher levels of engagement with the process and high levels of user satisfaction.

UNSTRUCTURED Cunninghamella species are an extremely rare cause of fungal infections. The usual mode of transmission is through inhalation however rare cases of cutaneous spread have been reported. The objective of this clinical case report is to highlight the uniqueness of which the patient acquired the infection, the progression, and control of it. A 57-year-old male with chronic lymphocytic leukemia was found to have an abscess next to his peripherally inserted central catheter (PICC) line. The abscess culture grew back Cunninghamella and was debrided and treated with a novel antifungal. The fungal infection was controlled and the total timeframe took 28 days. Rapid recognition and prompt treatment demonstrate the prevention of rapidly progressive angioinvasian and further systemic complications. This case also proves that a novel antifungal may be appropriate in controlling the spread of Cunninghamella species.

The Long-Term Oxygen Treatment Trial demonstrated that long-term supplemental oxygen did not reduce time to hospital admission or death for patients who have stable chronic obstructive pulmonary disease and resting and/or exercise-induced moderate oxyhemoglobin desaturation, nor did it provide benefit for any other outcome measured in the trial. Nine months after initiation of patient screening, after randomization of 34 patients to treatment, a trial design amendment broadened the eligible population, expanded the primary outcome, and reduced the goal sample size. Within a few years, the protocol underwent minor modifications, and a second trial design amendment lowered the required sample size because of lower than expected treatment group crossover rates. After 5.5 years of recruitment, the trial met its amended sample size goal, and 1 year later, it achieved its follow-up goal. The process of publishing the trial results brought renewed scrutiny of the study design and the amendments. This article expands on the previously published design and methods information, provides the rationale for the amendments, and gives insight into the investigators' decisions about trial conduct. The story of the Long-Term Oxygen Treatment Trial may assist investigators in future trials, especially those that seek to assess the efficacy and safety of long-term oxygen therapy. Clinical trial registered with clinicaltrials.gov (NCT00692198).

This article describes the library career of the English poet, Philip Larkin, from his initial position as a non-professional librarian in Wellington to his tenure as Librarian at the University of Hull.

Project ACORN (Access to Course Readings via Networks) sits within the Electronic Short Loan strand of the Electronic Libraries (eLib) Programme and has been developed by a team at the Pilkington Library at Loughborough University. Having established procedures for making journal articles in short loan collections available electronically, the next stage was to test the portability of these procedures to Leicester University. This paper describes a study undertaken by the Project ACORN team to investigate the portability of the technical model by implementing it at Leicester University, and discusses the main challenges faced (authentication and printing), the solutions proposed by the ACORN team, some possible future solutions, and recommendations for libraries looking to set up an ACORN‐type service.

This paper describes the methodology used to model the behaviour of Scott Dam and its foundation corresponding to a rising reservoir. The laboratory testing for Scott Dam had ascribed to the melange foundation the unusually low modulus of 20,000 psi. The rock mass deformability, evaluated by comparing the response of the model to instrumental measures of Scott Dam’s tilting and deformation under the load increment produced by flood conditions, was found to be fifteen times greater, but still unusually soft for a rock foundation. We wished to learn how the softness of the foundation might alter conventional concepts about sliding stability, particularly since the contact surface was very rough such that failure could not occur by any simple rigid-block sliding mechanism. A method of calculating the reserve of safety conforming to stability evaluations in rock masses led to the conclusion that the dam had a sufficient margin of safety under all conceivable loading conditions. Particularly germane to this was the finding tha:t the concrete dam would not debond from its foundation under the heel, as might have been expected had the foundation been harder. Introduction Scott Dam, on the Eel River, California, has been the object of numerous safety evaluations since its construction in 1920/21. An overview of its difficulties and engineering studies was presented in companion papers by Goodman, Ahlgren, and Lindquist, and McManus & Bro in these same Proceedings. Additionally, a paper by Hendron 6~ Hendron evaluates the traditional factor of safety for the dam and the implications for dam safety. * Senior Engineer, Jacobs Associates, San Francisco **Consultant, Mendocino, CA, and Emeritus Professor, Univ. Calif. Berkeley

For fixed p (0 ≤ p ≤ 1), let { L 0 , R 0 } = {0, 1} and X 1 be a uniform random variable over { L 0 , R 0 }. With probability p let { L 1 , R 1 } = { L 0 , X 1 } or = { X 1 , R 0 } according as X 1 ≥ 1 2 (L 0 + R 0 ) or 1 2 (L 0 + R 0 ) ; with probability 1 − p let { L 1 , R 1 } = { X 1 , R 0 } or = { L 0 , X 1 } according as X 1 ≥ 1 2 (L 0 + R 0 ) or 1 2 (L 0 + R 0 ) , and let X 2 be a uniform random variable over { L 1 , R 1 }. For n ≥ 2, with probability p let { L n , R n } = { L n − 1 , X n } or = { X n , R n − 1 } according as X n ≥ 1 2 (L n − 1 + R n − 1 ) or 1 2 (L n − 1 + R n − 1 ) , with probability 1 − p let { L n , R n } = { X n , R n − 1 } or = { L n − 1 , X n } according as X n ≥ 1 2 (L n − 1 + R n − 1 ) or 1 2 (L n − 1 + R n − 1 ) , and let X n + 1 be a uniform random variable over { L n , R n }. By this iterated procedure, a random sequence { X n } n ≥ 1 is constructed, and it is easy to see that X n converges to a random variable Y p (say) almost surely as n → ∞. Then what is the distribution of Y p ? It is shown that the Beta, (2, 2) distribution is the distribution of Y 1 ; that is, the probability density function of Y 1 is g ( y ) = 6 y (1 − y ) I 0,1 ( y ). It is also shown that the distribution of Y 0 is not a known distribution but has some interesting properties (convexity and differentiability).

LetA 1 andA 2 be floating point numbers represented in arbitrary base β and randomly chosen from a logarithmic distribution. Letr denote the round-off error $$r = fl(A_1 * A_2 ) - (A_1 * A_2 )$$ where * is floating point multiplication and wherefl(A 1*A 2) denotes the normalizedN digit computer result of forming (A 1*A 2). This paper analyzes the mean and variance of both the actual round-off error and the fraction round-off error. This analysis relies upon sharp order estimates for the digit by digit deviation of logarithmically distributed numbers from uniformly distributed numbers. This completely resolves open questions of Kaneko and Liu and of Tsao. Also included is a generalization to arbitrary base (from binary) of an important round-off theorem of Henrici.

This paper summarizes the procedure used to evaluate surface subsidence hazards posed by abandoned room and pillar workings beneath a school site. If the workings are deeper than about 150 feet, the expense of providing deep foundations may be prohibitive and filling the mines may be required. However, if it can be demonstrated that the pillars can support the overburden safely, the site may be utilized without such expenses. This was done at the particular site by examining the implications of failure of isolated pillars on the stability of contiguous pillars and the roof. The method used is applicable only if reliable mine maps can be obtained.

Consider the numerical solution of a retarded ordinary differential equation (RODE) by some standard algorithms. For a linear RODE, we estimate the accumulated round-off error as a linear combination of the preceding local round-off errors, and we bound the accumulated round-off error. For a non-linear RODE, we obtain by linearization similar estimates and bounds for the dominant part of the accumulated round-off error.

This paper studies the propagation of discretization error for discontinuou ordinary and retarded differential equations. Various applications are given including one which extends a fundamental theorem of Henrici concerning round-off error.

ALTHOUGH SOME attention has been devoted recently to the nature of teaching machines, very little thought has been given to the problems that will be encountered in their introduction and use. This article is an attempt to envisage and think about some of those difficulties.

Outlines the copyright clearance difficulties faced by librarians in the development of the Electronic Library and states the need for an electronic copyright management system (ECMS) to log the clearance process and to protect electronic documents. Reports the absence of a suitably priced commercially available ECMS for the academic sector and describes the design process for the eLib project ACORN's Rights Management system entitled CLEAR (Copyright Licensed Electronic Access to Readings) based on Microsoft Access. Describes the functionality of the CLEAR database and concludes that it might provide a template for other institutions in the design of subsequent ECMSs.