An Astrophysical Laboratory: Understanding and Exploiting the Young Massive Cluster Westerlund 1

Westerlund 1 provides a unique opportunity to probe the physics of massive stars, from birth to death and beyond, as well as the formation and evolution of a super star cluster that appears destined to evolve into a globular cluster. We highlight the result of current studies of this cluster, its diverse stellar constituents and immediate environment, concluding with a summary of future research avenues enabled by ESO facilities

Surviving through story: Experiences of people with learning disabilities in the covid19 pandemic 2020–2021

Background: History starts from where we are now ‐ it is not just things that happened a long time ago. The global pandemic began in 2019. It has changed the lives of people with learning disabilities. We began our project during the first lockdown in April 2020. We came together to set up a website to collect stories and support and learn from each other about how to survive and keep strong. Storytelling is very important because it helps us understand what is going on. It is also a way to capture the history of people with learning disabilities at a very difficult time. We know that thousands of people with learning disabilities became ill and died in the flu epidemic of 1918. But nobody recorded their stories in their own words. We want to make sure this does not happen again, so we created an archive to help us remember. Methods: The project was managed with an advisory group of people with and without learning disabilities who met monthly to monitor the collection and analysis of stories on the site. A site audit was performed regularly to determine the themes in the stories and who had submitted. The article describes the progress of the project, the stories we have shared, and the challenges we have faced. Conclusions: We discuss how people with learning disabilities have been presented in the media and our views about the way we are not heard, or always shown as vulnerable victims. We have found many sad stories, but also positive ones about people being creative and supportive. We look forward to the future and share our ideas about how society could be different and more inclusive. Being part of this project has given us confidence to know we are not alone, and shown us how we can help with the 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

Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Managing the transition to online teaching: the role of project management methodology in the learning organisation

This paper examines the application of project management methodology to the development and delivery of online units within University environments. While project management is acknowledged as having advantages as a methodology in certain circumstances, it can be argued that it is culturally and ideologically inappropriate for managing academic development. Online development which occurs within an institution-wide context presents significant challenges in terms of cultural change and staff development. Furthermore it is argued that online units should not be viewed as a product - there is no beginning or end to the process of online unit development and the pedagogical and technical goal posts are continually shifting. If online development is to be successful then it must be embraced as an integral aspect of the everyday work of academics and general staff alike. It is argued that that management , per se, is antithetical with academic work and that academic environments are more appropriately approached as learning organisations . The experiences of three individuals who have acted in the role of project managers within one institution are used to illustrate the perceived advantages and shortcomings of project management methodology. It is proposed that a more appropriate central approach rests with action learning where learning is intrinsic to the process and there is no expectation of a beginning and end to the product. Staff development is integral, as are processes of evaluation, documentation and shared growth towards improved practice. It is acknowledged that there is an important coordination role to be played in initial and ongoing online development but that this process should be viewed as one of facilitation and coordination rather than management

Studies in Medieval Mysticism, Volume 5: Authority and the Female Body in the Writings of Julian of Norwich and Margery Kempe

The writings of Julian of Norwich and Margery Kempe show an awareness of traditional and contemporary attitudes towards women, in particular medieval attitudes towards the female body. This study examines the extent to which they make use of such attitudes in their writing, and investigates the importance of the female body as a means of explaining their mystical experiences and the insight gained from them; in both writers, the female body is central to their writing, leading to a feminised language through which they achieve authority and create a space in which they can be heard, particularly in the context of their religious and mystical experiences. The three archetypal representations of woman in the middle ages, as mother, as whore and as wise woman , are all clearly present in the writings of Julian of Norwich and Margery Kempe; in examining the ways in which both writers make use of these female categories, McAvoy establishes the extent of their success in resolving the tension between society\u27s expectations of them and their own lived experiences as women and writers. LIZ HERBERT MCAVOY is Senior Lecturer in Gender in English and Medieval Literature, College of Arts and Humanities, Swansea Universityhttps://digitalcommons.tacoma.uw.edu/ias_books/1082/thumbnail.jp

Reflections and learning from using action learning sets in a healthcare education setting

This paper describes the delivery of action learning sets to students on the peer educator course provided by the Dementia Studies Department at University of Bradford. Our understanding of action learning sets is laid out together with our rationale for their use on this course. Feedback is presented that described a conflicted, even confused experience for many of those involved. This paper is the outcome of the organising teams' effort to make sense of, and learn from, this feedback in order to inform our future practice. We conclude that, amongst the many issues, most key was that the students had been subscripted into an action learning process for which voluntary commitment is more usually the norm