Characterisation of acute respiratory infections at a United Kingdom paediatric teaching hospital: observational study assessing the impact of influenza A (2009 pdmH1N1) on predominant viral pathogens

Background According to the World Health Organisation, influenza A (2009 pdmH1N1) has moved into the post-pandemic phase, but there were still high numbers of infections occurring in the United Kingdom in 2010-11. It is therefore important to examine the burden of acute respiratory infections at a large children’s hospital to determine pathogen prevalence, occurrence of co-infection, prevalence of co-morbidities and diagnostic yield of sampling methods. Methods This was a retrospective study of respiratory virus aetiology in acute admissions to a paediatric teaching hospital in the North West of England between 1st April 2010 and 31st March 2011. Respiratory samples were analysed either with a rapid RSV test if the patient had symptoms suggestive of bronchiolitis, followed by multiplex PCR testing for ten respiratory viruses, or with multiplex PCR testing alone if the patient had suspected other ARI. Patient demographics and data regarding severity of illness, presence of co-morbidities and respiratory virus sampling method were retrieved from case notes. Results 645 patients were admitted during the study period. 82/645 (12.7%) patients were positive for 2009 pdmH1N1, of whom 24 (29.2%) required PICU admission, with 7.3% mortality rate. Viral co-infection occurred in 48/645 (7.4%) patients and was not associated with more severe disease. Co-morbidities were present more frequently in older children, but there was no significant difference in prevalence of co-morbidity between 2009 pdmH1N1 patients and those with other ARI. NPA samples had the highest diagnostic yield with 192/210 (91.4%) samples yielding an organism. Conclusions Influenza A (2009 pdmH1N1) is an ongoing cause of occasionally severe disease affecting both healthy children and those with co-morbidities. Surveillance of viral pathogens provides valuable information on patterns of disease

Towards the digital university: a brief introduction to E-Texts and open access

The notion of "E-texts" or "electronic texts" made its way onto the agenda of the Academic Support Committee in April 2009. This interest in E-Text was prompted by an inquiry to the Committee Chair by several faculty members who had questions about academic publisher presentations that were occurring on campus. Following from the Committee discussions, a Subcommittee was struck to examine the trends, tools and potential of e-text as it relates to academic resources. The Subcommittee held its first meeting on May xx, 2009 and established the intial Terms of Reference for the working group. The following document reports our findings and reflects the nature of these conversations. The report conveys how E-Texts are currently dealt with by publishers, by the University Bookstore, and by Library collections. As well, it describes the concept of Open Access as it applies to the individuals' ability to electronically publish academic materials, as a way of making academic information available to students and faculty alike

Infectivity of Plasmodium falciparum in malaria-naive individuals is related to knob expression and cytoadherence of the parasite

Plasmodium falciparum is the most virulent human malaria parasite because of its ability to cytoadhere in the microvasculature. Nonhuman primate studies demonstrated relationships among knob expression, cytoadherence, and infectivity. This has not been examined in humans. Cultured clinical-grade P. falciparum parasites (NF54, 7G8, and 3D7B) and ex vivo-derived cell banks were characterized. Knob and knob-associated histidine-rich protein expression, CD36 adhesion, and antibody recognition of parasitized erythrocytes (PEs) were evaluated. Parasites from the cell banks were administered to malaria-naive human volunteers to explore infectivity. For the NF54 and 3D7B cell banks, blood was collected from the study participants for in vitro characterization. All parasites were infective in vivo. However, infectivity of NF54 was dramatically reduced. In vitro characterization revealed that unlike other cell bank parasites, NF54 PEs lacked knobs and did not cytoadhere. Recognition of NF54 PEs by immune sera was observed, suggesting P. falciparum erythrocyte membrane protein 1 expression. Subsequent recovery of knob expression and CD36-mediated adhesion were observed in PEs derived from participants infected with NF54. Knobless cell bank parasites have a dramatic reduction in infectivity and the ability to adhere to CD36. Subsequent infection of malaria-naive volunteers restored knob expression and CD36-mediated cytoadherence, thereby showing that the human environment can modulate virulence

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

American literature and global time, 1812-59

American Literature and Global Time, 1812-59 explores the effects of the early stages of globalization on time consciousness in antebellum American literature and non-fiction. It argues that oceanic trade, extracontinental imperialism, immigration, and Pacific exploration all affected how antebellum Americans configured their national pasts, presents, and futures. The ensuing pluralisation of time that followed disallowed cogent conceptions of national identity. It analyses transnational geographies to examine how they transmit heterogeneous times. The project’s interest is in U.S. national sites that counterintuitively acted as fulcrums for the importations of foreign times and non-U.S. sites that interacted with and modified the homogenous progressive time of nationalism. As such, my project seeks to combine the transnational and temporal turns. It argues that the ethnic, racial, and geographic contestation emphasized by transnational critics found parallels in how antebellum Americans conceived of time. Conversely, it suggests that there were profound links between globalization and the sorts of instabilities in time identified by the critics of the temporal turn. Over its course my project identifies a series of “global times” that came into being in the years between the War of 1812 and the discovery of petroleum in 1859. These fall under three broad headings. First, what I term, entangled times that came about as a result of the movement of ships across borders and different social contexts; secondly, foreign local times that re-set the clock of imperialism and national progress; and, thirdly, a huge mass of reconfigurations in the origins and futures of the still-young United States.This thesis is not currently available in ORA

Quixotic exceptionalism: British and US co-narratives, 1713-1823

Scholars have long since identified a quixotic mode in fiction, acknowledging the widespread influence of Miguel de Cervantes' Don Quixote (1605-15) on subsequent texts. In most cases, “quixotic” signifies a preponderance of allusions to Don Quixote in a given text, such that most studies of “quixotic fictions” or “quixotic influence” are primarily taxonomic in purpose and in outcome: they name and catalogue a text or group of texts as “quixotic,” then argue that, by virtue of the vast and protean influence of Don Quixote, the quixotic mode in fiction is always divided, lacking any semblance of ideological consistency. I argue, however, that the very characteristics of Don Quixote that make him such an attractive literary model for such a broad range of narratives—his bookish idealism, his fixation on the upper-classed grandiosity of the lives of noble knights—also form the consistent, ideological groundwork of quixotism: the exceptionalist substitution of fictive idealism for material reality. By tracing the ways in which quixotes become mouthpieces for various exceptionalist arguments in eighteenth-century British and American texts, like Henry Fielding's Joseph Andrews (1742), Tobias Smollett's Launcelot Greaves (1760), Charlotte Lennox's The Female Quixote (1752), Hugh Henry Brackenridge's Modern Chivalry (1792-1815), and Royall Tyler's The Algerine Captive (1797), among others, I demonstrate the link between quixotism and exceptionalism, or between fictive idealism and the belief that one (or one's worldview) is an exception to the scrutiny of the surrounding world.This thesis is not currently available in ORA

The devil is the detail: finding meaning indicators of nutrient management on organic and low-input farms

In low-input and organic systems, nutrient management is key to ensuring the short-term productivity and the longer-term sustainability of the farming system. Farm-gate nutrient budgets/balances calculate the inputs of nutrients to, and outputs from a system. Hence, they can be used to assess the nutrient use efficiency. Nutrient balances of 69 organic and low-input dairy farms in seven European countries were carried out using a sustainability assessment tool. The tool assesses each individual farm against a number of indicators. Part of the assessment of nutrient management is the calculation of an N,P,K budget, based on physical inputs and outputs for each enterprise. The results show considerable variation in the calculated N,P,K balances. The paper will explore the reasons for high nutrient surpluses and deficits and discuss the advantages and disadvantages of calculated farm-gate nutrient budgets

Predicting the effect of rotation design on N, P, K balances on organic farms using the NDICEA model

The dynamic model Nitrogen Dynamics in Crop rotations in Ecological Agriculture (NDICEA) was used to assess the nitrogen (N), phosphorus (P) and potassium (K) balance of long-term organic cropping trials and typical organic crop rotations on a range of soil types and rainfall zones in the UK. The measurements of soil N taken at each of the organic trial sites were also used to assess the performance of NDICEA. The modeled outputs compared well to recorded soil N levels, with relatively small error margins. NDICEA therefore seems to be a useful tool for UK organic farmers. The modeling of typical organic rotations has shown that positive N balances can be achieved, although negative N balances can occur under high rainfall conditions and on lighter soil types as a result of leaching. The analysis and modeling also showed that some organic cropping systems rely on imported sources of P and K to maintain an adequate balance and large deficits of both nutrients are apparent in stockless systems. Although the K deficits could be addressed through the buffering capacity of minerals, the amount available for crop uptake will depend on the type and amount of minerals present, current cropping and fertilization practices and the climatic environment. A P deficit represents a more fundamental problem for the maintenance of crop yields and the organic sector currently relies on mined sources of P which represents a fundamental conflict with the International Federation of Organic Agriculture Movements organic principles