Shakespeare and the Spheres:the representation of astrology, astronomy and folklore surrounding the moon in King Lear, A Midsummer Night’s Dream and The Tempest.

This paper discusses the representation of astrology, astronomy, and folklore surrounding the moon, in King Lear, A Midsummer Night’s Dream and The Tempest. It includes an explanation of the forms of astrology and astronomy practiced during the Renaissance while discussing their representation within the three plays. The paper shows how Shakespeare’s reference to astrology and the folklore surrounding it reflects the social, historical and cultural significance of his work at the time, and therefore the importance of Shakespeare and his place in English Literature

Competitive Intensity as Driver of Innovation and Productivity Growth: A Synthesis of the Literature

The objective of the report is to survey and assess the existing economic theoretical literature and empirical evidence on the linkages between open and competitive markets (competitive intensity) and innovation and productivity growth. The report is divided into three main parts. The first part examines the state of economic theory on the relationship between competitive intensity, innovation and productivity. The second section examines relevant empirical work that has been done on the role of firm dynamics in sustaining a competitive environment. The third section surveys evidence of linkages provided by the international case studies of the effects of open and competitive markets on innovation and productivity. The report concludes that the weight of the evidence indicates that competitive intensity has a strong positive effect on innovation and productivity. Accordingly, Canada should pay closer attention to the competitive implications of public policy than has been the case in the past. The international experience provides strong support for this conclusion. While there can be negative implications for certain groups from such policy changes, the evidence shows that they are often smaller than anticipated. Restrictions on competition should only be allowed when it can be demonstrated that they are needed to achieve overriding societal interests.Competition, Competition policy, competitive intensity, innovation, productivity, firm dynamics, empirical work, case studies

Proliferation and maturation in developing human liver

In the United Kingdom, the number of patients with liver failure awaiting transplantation now exceeds the capacity of the nation's donor pool, with the result that 20% of patients now die on the waiting list. The future for the treatment of liver failure lies in part with cell-based therapies, in which liver support may be provided on a short-term basis by biological liver-assist devices, or in which sufficient mass of liver tissue may be transplanted into patients to reverse liver failure as a graft. However, cell therapies are at a preliminary stage, due to a lack of basic understanding as to how human liver cells can be made to divide and to undergo functional maturation in vitro.In order to understand how human liver cells can proliferate and differentiate in vitro, a culture system was developed to support second trimester fetal liver cells. Having characterised the culture system, and demonstrated viable hepatocytes after seven days in vitro, experiments were carried out to determine which circulating endocrine stimuli might initiate morphologic and functional maturation in the developing hepatocytes. Cells were then incubated with growth factors and cytokines and subject to two-colour flow cytometry to assess which cell fraction might proliferate in vitro. Finally, urea metabolism and protein secretion were assessed in the presence and absence of glucocorticoid and different growth factors, to assess the interactions of these various stimuli at a functional level.The results showed that glucocorticoid alone brought about functional maturation in terms of increased protein secretion, with significant increases observed in a-fetoprotein, fibrinogen and a-i-antichymotrypsin secretion. This represented increased secretion per cell, as there was no effect of glucocorticoid on cell number. However, incubation with growth factors and cytokines showed that EGF stimulated cellular proliferation. This proliferation occurred within a primitive epithelial fraction, positive for cytokeratin 18, but negative for fibrinogen. Final experiments showed that EGF and HGF had modest stimulatory effects on urea synthesis. By contrast, KGF reduced urea synthesis by channelling ammonia into anabolic pathways. With regard to protein secretion, EGF inhibited fibrinogen and oc-i-antichymotrypsin secretion, whereas, tumour necrosis factor inhibited fibrinogen alone. All of these observations were made only in the presence of dexamethasone.These data show that a satisfactory method for fetal liver cell culture was developed. This model demonstrated that proliferation of liver epithelial cells was stimulated by EGF, whereas functional maturation of fetal liver cells could be brought about by exposure to glucocorticoid. Various growth factors and cytokines had modest effects on urea and protein secretion, but only in the presence of glucocorticoid. These experiments have provided new insights into the maturational and proliferative signals in developing human liver. These data provide a frame of reference from which to develop cell-based therapies for the treatment of liver failure in clinical practice

Effective ways to grow urban bus markets – a synthesis of evidence

Institute of Transport and Logistics Studies. Faculty of Economics and Business. The University of Sydne

Alcohol-specific activity in hospitals in England

Alcohol-related harm is placing increasing demands on the NHS. At a time when unprecedented efficiencies need to be made by the NHS and local authorities, preventative action must be taken seriously. This analysis explores trends in alcohol-specific activity in hospitals due to alcohol poisoning and alcohol-related inpatient admissions by looking at six years of hospital activity data in England. The analysis also explores the use of hospital services before and after a diagnosis of alcohol-related liver disease and highlights opportunities for preventative action to reduce future alcohol-related harm in England

Exploring the use of high and low demand simulation for human performance assessment during multiorgan retrieval with the joint scrub practitioner

INTRODUCTION: The National Organ Retrieval Service (NORS) 2015 review recommended a Joint Scrub Practitioner for abdominal and cardiac teams during combined organ retrieval. To evaluate the feasibility of this role, and to understand the functional implications, this study explores the use of simulation and provides a novel and comprehensive approach to assess individual and team performance in simulated multiorgan retrievals. METHODS: Two high-fidelity simulations were conducted in an operating theatre with porcine organs, en bloc, placed in a mannequin. For donation after brainstem death (DBD) simulation, an anaesthetic machine provided simulated physiological output. Retrievals following donation after circulatory death (DCD) began with rapid arrival in theatre of the mannequin. Cardiothoracic (lead surgeon) and abdominal (lead and assistant surgeons; joint scrub practitioner, n=9) teams combined for the retrievals. Data collected before, during and after simulations used self-report and expert observers to assess: attitudinal expectations, mental readiness, mental effort, non-technical skills, teamwork, task workload and social validation perceptions. RESULTS: Attitudinal changes regarding feasibility of a joint scrub practitioner for DBD and DCD are displayed in the main body. There were no significant differences in mental readiness prior to simulations nor in mental effort indicated afterwards; however, variance was noted between simulations for individual team members. Non-technical skills were slightly lower in DCD than in DBD. Global ratings of teamwork were significantly (p<0.05) lower in DCD than in DBD. Measures of attitude indicated less support for the proposed joint scrub practitioner role for DCD than for DBD. DISCUSSION: The paper posits that the joint scrub practitioner role in DCD multiorgan retrieval may bring serious and unanticipated challenges. Further work to determine the feasibility of the NORS recommendation is required. Measures of team performance and individual psychological response can inform organ retrieval feasibility considerations nationally and internationally

Plasma creatine kinase indicates major amputation or limb preservation in acute lower limb ischemia

ObjectiveAcutely ischemic limbs are often of uncertain viability. To assist operative management, this study determined prospectively which indicators on admission were the best predictors of major amputation and, conversely, limb preservation.MethodsData were collected on admission. Presenting complaint, history, clinical assessment, and blood test results, including creatine kinase (CK), were recorded. Surgical procedures were noted—in particular, the presence or absence of major amputation by death or discharge. The setting was a tertiary vascular referral center in a university teaching hospital. Subjects included all patients referred as emergency cases to the vascular unit over an 18-month period who were admitted for inpatient management with acute lower limb ischemia. The main outcome measure was major amputation.ResultsA total of 97 patients with acute ischemia were studied prospectively (51 men and 46 women). Twenty-one patients (21.6%) underwent major amputation. Previous vascular surgery (P = .012), mottling (P = .001), sensory loss (P = .003), motor loss (P = .001), muscle tenderness (P < .001), absent ankle Doppler signals (P = .008), neutrophilia (P = .011), and increased CK (P < .001) were significantly associated with major amputation. If CK was normal, the risk of major amputation was 4.6% (95% confidence interval, 0.0%-9.7%). If CK was increased, the risk was 56.2% (95% CI, 39.1%-73.4%).ConclusionsSpecific clinical findings were significantly associated with major amputation. Of these, only CK had a positive predictive value greater than 50%. Plasma CK can assist operative management of acute lower limb ischemia by quantifying prospectively the risk of major amputation or limb preservation on admission

Liver Development, Regeneration, and Carcinogenesis

The identification of putative liver stem cells has brought closer the previously separate fields of liver development, regeneration, and carcinogenesis. Significant overlaps in the regulation of these processes are now being described. For example, studies in embryonic liver development have already provided the basis for directed differentiation of human embryonic stem cells and induced pluripotent stem cells into hepatocyte-like cells. As a result, the understanding of the cell biology of proliferation and differentiation in the liver has been improved. This knowledge can be used to improve the function of hepatocyte-like cells for drug testing, bioartificial livers, and transplantation. In parallel, the mechanisms regulating cancer cell biology are now clearer, providing fertile soil for novel therapeutic approaches. Recognition of the relationships between development, regeneration, and carcinogenesis, and the increasing evidence for the role of stem cells in all of these areas, has sparked fresh enthusiasm in understanding the underlying molecular mechanisms and has led to new targeted therapies for liver cirrhosis and primary liver cancers