The British presence in Mediterranean islands, 1793-1815

Between 1794 and 1815 Britain occupied no less than eighteen islands in the Mediterranean, though several were very small indeed (Capraja, Lampedusa, Camino, Cerigo and Ithaca, for instance). Most were held until the wars ended, though some were given up earlier: Corsica in 1796, Elba in 1797, Minorca in 1802, Capri in 1800 and Ischia and Procida in 1809. Can any common purpose or purposes be discerned in this amazing dispersal of effort? First, there was the quest for a sovereign base from which the navy could operate to safeguard trade in the Mediterranean. Second, there was the wish to save Italy from falling into the grips of France and, when this became impossible to attempt a recovery of that peninsula in cooperation with Austria and Russia. Third, there was the determination to preserve Egypt, the route to British possessions in India and ultimately the whole Turkish empire, from conquest from Napoleon, by the occupation of strategically placed islands.peer-reviewe

An Evaluation of Automatically Generated Briefings of Patient Status

We report on an evaluation of MAGIC, a system that automatically generates briefings of patient status after coronary bypass surgery, completed in the Cardio Thoracic Intensive Care Unit at New York Presbyterian Hospital. Through enhancements in system design, robustness and speed, we compared information obtained by nurses against two briefings, one automatically generated by MAGIC and one provided by physicians upon the patient's arrival to the ICU. Our results show that MAGIC and the physician briefing provide a substantial increase in the amount of information than is available prior to the patient's arrival and that the information MAGIC provides is accurate. In many aspects, MAGIC out-performs the physician briefing; information is reported earlier and is always available. We conclude that MAGIC provides the CT ICU staff early on with a better assessment of the patient's status than in current practice and allows them to better prepare for the patient's arrival

How alternative urban stream channel designs influence ecohydraulic conditions.

Streams draining urban catchments ubiquitously undergo negative physical and ecosystem changes, recognized to be primarily driven by frequent stormwater runoff input. The common management intervention is rehabilitation of channel morphology. Despite engineering design intentions, ecohydraulic benefits of urban channel rehabilitation are largely unknown and likely limited. This investigation uses an ecohydraulic modeling approach to investigate the performance of alternative channel design configurations intended to restore key ecosystem functioning in urban streams. Channel reconfiguration design scenarios, specified to emulate the range of channel topographic complexity often used in rehabilitation are compared against a reference 'natural' scenario using ecologically relevant hydraulic metrics. The results showed that the ecohydraulic conditions were incremental improved with the addition of natural oscillations to an increasing number of individual topographic variables in a degraded channel. Results showed that reconfiguration reduced excessive frequency of bed mobility, loss of habitat and hydraulic diversity particularly as more topographic variables were added. However, the results also showed that none of the design scenarios returned the ecohydraulics to their reference conditions. This indicate that channel-based restoration can offer some potential changes to hydraulic habitat conditions but are unlikely to completely mitigate the effects of hydrologic change. We suggest that while reach-scale channel modification may be beneficial to restore urban stream, addressing altered hydrology is critical to fully recover natural ecosystem processes

Models for predicting venous thromboembolism in ambulatory patients with lung cancer:A systematic review and meta-analysis

AimsThe incidence of venous thromboembolism (VTE) in patients with lung cancer is relatively high, and risk stratification models are vital for the targeted application of thromboprophylaxis. We aimed to review VTE risk prediction models that have been developed in patients with lung cancer and evaluate their performance.Methods and resultsTwenty-four eligible studies involving 123,493 patients were included. The pooled incidence of VTE within 12 months was 11 % (95 % CI 8 %–14 %). With the identified four existing VTE risk assessment tools, meta-analyses did not show a significant discriminatory capability of stratifying VTE risk using Khorana, PROTECHT and CONKO scores. The pooled sensitivity and specificity of the Khorana score were 24 % (95 % CI 11 %–44 %) and 84 % (95 % CI 73 %–91 %) at the 3-point cut-off, and 43 % (95 % CI 35 %–52 %) and 61 % (95 % CI 52 %–69 %) at the 2-point cut-off. A COMPASS-CAT score ≥ 7 points indicated a significantly high VTE risk, with a RR of 4.68 (95 % CI 1.05–20.80).ConclusionsThe Khorana score lacked discriminatory capability in identifying patients with lung cancer at high VTE risk, regardless of the cut-off value. The COMPASS-CAT score had better performance, but further validation is needed. The results indicate the need for robust VTE risk assessment tools specifically designed and validated for lung cancer patients. Future research should include relevant biomarkers as important predictors and consider the combined use of risk tools.PROSPERO registration number: CRD42021245907

A protocol for a randomised clinical trial of the effect of providing feedback on inhaler technique and adherence from an electronic device in patients with poorly controlled severe asthma

ntroduction In clinical practice, it is difficult to distinguish between patients with refractory asthma from those with poorly controlled asthma, where symptoms persist due to poor adherence, inadequate inhaler technique or comorbid diseases. We designed an audio recording device which, when attached to an inhaler, objectively identifies the time and technique of inhaler use, thereby assessing both aspects of adherence. This study will test the hypothesis that feedback on these two aspects of adherence when passed on to patients improves adherence and helps clinicians distinguish refractory from difficult-to-control asthma. Methods This is a single, blind, prospective, randomised, clinical trial performed at 5 research centres. Patients with partially controlled or uncontrolled severe asthma who have also had at least one severe asthma exacerbation in the prior year are eligible to participate. The effect of two types of nurse-delivered education interventions to promote adherence and inhaler technique will be assessed. The active group will receive feedback on their inhaler technique and adherence from the new device over a 3-month period. The control group will also receive training in inhaler technique and strategies to promote adherence, but no feedback from the device. The primary outcome is the difference in actual adherence, a measure that incorporates time and technique of inhaler use between groups at the end of the third month. Secondary outcomes include the number of patients who remain refractory despite good adherence, and differences in the components of adherence after the intervention. Data will be analysed on an intention-to-treat and a per-protocol basis. The sample size is 220 subjects (110 in each group), and loss to follow-up is estimated at 10% which will allow results to show a 10% difference (0.8 power) in adherence between group means with a type I error probability of 0.05. Trial registration number NCT01529697; Pre-results

The Analysis of a Bay

This problem, The Analysis of a Bay, is a preparatory exercise directly related to the major architectural design project for this semester, and its particular focus on design development. The following statement by Professor Val Warke (The Cornell Journal of Architecture 3) clearly outlines the rationale and pedagogical objectives for such an exercise

Detection of acute and early HIV-1 infections in an HIV hyper-endemic area with limited resources

BACKGROUND: Two thirds of the world's new HIV infections are in sub-Saharan Africa. Acute HIV infection (AHI) is the time of virus acquisition until the appearance of HIV antibodies. Early HIV infection, which includes AHI, is the interval between virus acquisition and establishment of viral load set-point. This study aimed to detect acute and early HIV infections in a hyper-endemic setting. METHODS: This was a cross-sectional diagnostic study that enrolled individuals who had negative rapid HIV results in five clinics in South Africa. Pooled nucleic acid amplification testing (NAAT) was performed, followed by individual sample testing in positive pools. NAAT-positive participants were recalled to the clinics for confirmatory testing and appropriate management. HIV antibody, p24 antigen, Western Blot and avidity tests were performed for characterization of NAAT-positive samples. RESULTS: The study enrolled 6910 individuals with negative rapid HIV results. Median age was 27 years (interquartile range {IQR}: 23-31). NAAT was positive in 55 samples, resulting in 0.8% newly diagnosed HIV-infected individuals (95% confidence interval {CI}: 0.6-1.0). The negative predictive value for rapid HIV testing was 99.2% (95% CI: 99.0-99.4). Characterization of NAAT-positive samples revealed that 0.04% (95% CI: 0.000-0.001) had AHI, 0.3% (95% CI: 0.1-0.4) had early HIV infection, and 0.5% (95% CI: 0.5-0.7) had chronic HIV infection. Forty-seven (86%) of NAAT-positive participants returned for follow-up at a median of 4 weeks (IQR: 2-8). Follow-up rapid tests were positive in 96% of these participants. CONCLUSIONS: NAAT demonstrated that a substantial number of HIV-infected individuals are misdiagnosed at South African points-of-care. Follow-up rapid tests done within a 4 week interval detected early and chronic HIV infections initially missed by rapid HIV testing. This may be a practical and affordable strategy for earlier detection of these infections in resource-constrained settings. Newer molecular tests that can be used at the points-of-care should be evaluated for routine diagnosis of HIV in hyper-endemic settings.National Health Laboratory Service Research Trust (NHLS-RT) grant (www.nhls.ac. za), SHM and DJM. Federation of Infectious Diseases Societies of Southern Africa and GlaxoSmithKline (FIDSSA- GSK) grant (www.fidssa.co.za), University of Pretoria research assistant grant (www.up.ac.za) and research grant from GlaxoSmithKline, SHM. South African Medical Research Council Self Initiated Research (MRC-SIR) grant (www.mrc.ac.za), Discovery Foundation (www.tshikululu.org.za), SHM. Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (www.nih.gov), TCQ and OL; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health.http://www.plosone.orgam2016Internal MedicineMedical Microbiolog

Genome-Wide Identification of Powdery Mildew Resistance in Common Bean (Phaseolus vulgaris L.)

Genome-wide association studies (GWAS) have been utilized to detect genetic variations related to several agronomic traits and disease resistance in common bean. However, its application in the powdery mildew (PM) disease to identify candidate genes and their location in the common bean genome has not been fully addressed. Single-nucleotide polymorphism (SNP) genotyping with a BeadChip containing 5398 SNPs was used to detect genetic variations related to PM disease resistance in a panel of 211 genotypes grown under two field conditions for two consecutive years. Significant SNPs identified on chromosomes Pv04 and Pv10 were repeatable, ensuring the phenotypic data’s reliability and the causal relationship. A cluster of resistance genes was revealed on the Pv04 of the common bean genome, coiled-coil-nucleotide-binding site–leucine-rich repeat (CC-NBS-LRR, CNL), and Toll/interleukin-1 receptor-nucleotide-binding site–leucine-rich repeat type (TIR-NBS-LRR, TNL)-like resistance genes were identified. Furthermore, two resistance genes, Phavu_010G1320001g and Phavu_010G136800g, were also identified on Pv10. Further sequence analysis showed that these genes were homologs to the disease-resistance protein (RLM1A-like) and the putative disease-resistance protein (At4g11170.1) in Arabidopsis. Significant SNPs related to two LRR receptor-like kinases (RLK) were only identified on Pv11 in 2018. Many genes encoding the auxin-responsive protein, TIFY10A protein, growth-regulating factor five-like, ubiquitin-like protein, and cell wall RBR3-like protein related to PM disease resistance were identified nearby significant SNPs. These results suggested that the resistance to PM pathogen involves a network of many genes constitutively co-expressed