Large Supports are required for Well-Supported Nash Equilibria

We prove that for any constant $k$ and any $\epsilon<1$, there exist bimatrix win-lose games for which every $\epsilon$-WSNE requires supports of cardinality greater than $k$. To do this, we provide a graph-theoretic characterization of win-lose games that possess $\epsilon$-WSNE with constant cardinality supports. We then apply a result in additive number theory of Haight to construct win-lose games that do not satisfy the requirements of the characterization. These constructions disprove graph theoretic conjectures of Daskalakis, Mehta and Papadimitriou, and Myers

High-resolution monitoring of catchment nutrient response to the end of the 2011-2012 drought in England, captured by the demonstration test catchments.

The Demonstration Test Catchments (DTC) project is a UK Government funded initiative to test the effectiveness of on-farm mitigation measures designed to reduce agricultural pollution without compromising farm productivity. Three distinct catchments in England have been chosen to test the efficacy of mitigation measures on working farms in small tributary sub-catchments equipped with continuous water quality monitoring stations. The Hampshire Avon in the south is a mixed livestock and arable farming catchment, the River Wensum in the east is a lowland catchment with predominantly arable farming and land use in the River Eden catchment in the north-west is predominantly livestock farming. One of the many strengths of the DTC as a national research platform is that it provides the ability to investigate catchment hydrology and biogeochemical response across different landscapes and geoclimatic characteristics, with a range of differing flow behaviours, geochemistries and nutrient chemistries. Although numerous authors present studies of individual catchment responses to storms, no studies exist of multiple catchment responses to the same rainfall event captured with in situ high-resolution nutrient monitoring at a national scale. This paper brings together findings from all three DTC research groups to compare the response of the catchments to a major storm event in April 2012. This was one of the first weather fronts to track across the country following a prolonged drought period affecting much of the UK through 2011–2012, marking an unusual meteorological transition when a rapid shift from drought to flood risk occurred. The effects of the weather front on discharge and water chemistry parameters, including nitrogen species (NO3-N and NH4-N) and phosphorus fractions (total P (TP) and total reactive P (TRP)), measured at a half-hourly time step are examined. When considered in the context of one hydrological year, flow and concentration duration curves reveal that the weather fronts resulted in extreme flow, nitrate and TP concentrations in all three catchments but with distinct differences in both hydrographs and chemographs. Hysteresis loops constructed from high resolution data are used to highlight an array of potential pollutant sources and delivery pathways. In the Hampshire Avon DTC, transport was dominated by sub-surface processes, where phosphorus, largely in the soluble form, was found to be transport-limited. In the Wensum DTC, transport was largely dominated by rapid sub-surface movement due to the presence of under-drainage, which mobilised large quantities of nitrate during the storm. In the Eden DTC, transport was found to be initially dominated by surface runoff, which switched to subsurface delivery on the falling limb of the hydrograph, with the surface delivery transporting large amounts of particulate phosphorus to the river, with a transport-limited response. The lack of exhaustion of nutrient delivery in response to such extreme flow generation indicates the size of the nutrient pools stored in these catchments, and highlights the scale of the challenges faced by environmental managers when designing mitigation measures to reduce the flux of nutrients to UK river systems from diffuse agricultural sources

Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity

Importance: Neurological manifestations during acute SARS-CoV-2–related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity. Objective: To assess the association of severe neurological manifestations during a SARS-CoV-2–related hospital admission with new neurocognitive or functional morbidities at discharge. Design, Setting, and Participants: This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021. Exposure: Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. Main Outcomes and Measures: The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2–related condition. Results: Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P  Conclusions and Relevance: The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery.</p

Civic republican social justice and the case of state grammar schools in England

The aim of this paper is to consider the ways in which civic republican theory can provide a meaningful and useful account of social justice, one that is which holds resonance for educational debates. Recognising the need for educationalists interested in civic republicanism to pay greater attention to ideas of justice – and in particular social justice as it concerns relationships between citizens (citizen to citizen, group to group or citizen to group) – it is argued that a form of civic republicanism committed to freedom as non-domination is capable of providing a substantive model for analysing social (in)justice within educational arenas. After positioning the contribution offered here within existing educational literature on civic republicanism, salient elements of social justice as freedom as non-domination are identified. On this basis, debates concerning the existence and potential expansion of state (public) grammar schools in England are considered in relation to the account of republican social justice as non-domination. It is argued that from this republican position grammar schools (1) represent an arbitrary domination of the interests of those less well off by those with greater material and cultural capital and (2) in doing so lead to advantages for some at the expense of others. Though the focus of the paper is on grammar schools in England, it is suggested that republican justice may be a useful frame for considering similar educational cases in England and elsewhere

Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model. Crit Care 2014;18:R98

in press). Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model. Critical Care, 18(R98) http://dx.doi.org/doi:10.1186/cc13873 _____________________________________________________________ This article is brought to you by Swansea University. Any person downloading material is agreeing to abide by the terms of the repository licence. Authors are personally responsible for adhering to publisher restrictions or conditions. When uploading content they are required to comply with their publisher agreement and the SHERPA RoMEO database to judge whether or not it is copyright safe to add this version of the paper to this repository. Abstract Introduction: Blunt chest wall trauma accounts for over 15% of all trauma admissions to Emergency Departments worldwide. Reported mortality rates vary between 4 and 60%. Management of this patient group is challenging as a result of the delayed on-set of complications. The aim of this study was to develop and validate a prognostic model that can be used to assist in the management of blunt chest wall trauma. Methods: There were two distinct phases to the overall study; the development and the validation phases. In the first study phase, the prognostic model was developed through the retrospective analysis of all blunt chest wall trauma patients (n = 274) presenting to the Emergency Department of a regional trauma centre in Wales (2009 to 2011). Multivariable logistic regression was used to develop the model and identify the significant predictors for the development of complications. The model&apos;s accuracy and predictive capabilities were assessed. In the second study phase, external validation of the model was completed in a multi-centre prospective study (n = 237) in 2012. The model&apos;s accuracy and predictive capabilities were re-assessed for the validation sample. A risk score was developed for use in the clinical setting. Results: Significant predictors of the development of complications were age, number of rib fractures, chronic lung disease, use of pre-injury anticoagulants and oxygen saturation levels. The final model demonstrated an excellent c-index of 0.96 (95% confidence intervals: 0.93 to 0.98). Conclusions: In our two phase study, we have developed and validated a prognostic model that can be used to assist in the management of blunt chest wall trauma patients. The final risk score provides the clinician with the probability of the development of complications for each individual patient

Globalisation, adjustment and the structural transformation of African economies?: the role of international financial institutions

Under the auspices of the World Bank and IMF, for almost two decades, sub-Saharan African countries have implemented structural adjustment, an orthodox package of economic reform measures. During this period there has been an unprecedented proliferation of technology investment and trade in the world economy. However sub-Saharan Africa has performed poorly under adjustment and has been largely marginalized from the international economy. The paper investigates the problems with the theoretical model underlying structural adjustment policies to explain why the model is not conducive to either African development or Africa’s increasing participation in the global economy. An example is used to illustrate the existence of an alternative set of policies that may be better suited for Africa

Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity

Importance: Neurological manifestations during acute SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity. Objective: To assess the association of severe neurological manifestations during a SARS-CoV-2-related hospital admission with new neurocognitive or functional morbidities at discharge. Design, Setting, and Participants: This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021. Exposure: Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. Main Outcomes and Measures: The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2-related condition. Results: Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P &lt; .001). For survivors with MIS-C, 28.0% (n = 39) with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% (n = 68) of those without severe neurological manifestations (P = .002). When adjusting for risk factors in those with severe neurological manifestations, both patients with acute SARS-CoV-2 (odds ratio, 1.85 [95% CI, 1.27-2.70]; P = .001) and those with MIS-C (odds ratio, 2.18 [95% CI, 1.22-3.89]; P = .009) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge. Conclusions and Relevance: The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Sustainable landscape governance: Lessons from a catchment based study in whole landscape design

This paper investigates the implementation of governance for sustainable landscapes, based on a catchment case study in lowland England. A participatory research process, spanning six and a half years, employed formal and informal in-depth interviews, focus group work and workshop techniques with 71 stakeholders representative of a wide range of interests in the catchment. A scenario design process within a GIS framework was used as a focus for capturing the key issues and visions of the stakeholders. Two contrasting but plausible scenarios for 2020 emerged from this process; one scenario was driven by the sustainable intensification of agricultural production and world trade, the other by the enhanced protection of ecosystem services and multi-objective land use. It was clear from discussions with stakeholders that the mechanisms for delivering an integrated approach to landscape management are not currently in place, although there have been some policy successes that could be built upon. There is also a need for new approaches to land tenure which include tax incentives and improved forms of cooperation and leadership in both policy and contiguous landscape stewardship. The methodology itself was appreciated by the stakeholders who found it useful to think more holistically. In addition, the study demonstrates an approach that individual practitioners and researchers can develop the skills to implement