The signficance of the wyrm in Early Medieval England

This thesis argues that, rather than being viewed as an incidental feature of Old English literary texts, the group of creatures referred to as wyrmas should be viewed as a significant, symbolic feature of early medieval English culture. Wyrmas were a diverse category of creatures which included parasites, snakes, serpents residing in Hell, grave-dwelling creatures and even dragons; it is this diversity that allowed wyrmas to become synonymous with imagery of death and corruption, but also with the hope of resurrection in a developing Christian society. The significance of wyrmas will be demonstrated through an interdisciplinary study of literary and theological sources in Old English and Latin, alongside archaeological material; these sources will be considered alongside theoretical frameworks of taxonomy and categorisation in order to facilitate a greater understanding of the meaning of wyrmas. This thesis will examine the stages of the human experience as understood by early medieval English people – life, death and the afterlife – to demonstrate that wyrmas became a way to express the anxieties and hopes of early medieval people as they reconciled with Christian beliefs and doctrine

Twin reversed arterial perfusion (TRAP) sequence in association with VACTERL association: a case report

<p>Abstract</p> <p>Introduction</p> <p>Twin reversed arterial perfusion (TRAP) sequence is a rare complication of multiple pregnancy caused by defects in early embryogenesis. The pump twin supplies the acardiac recipient twin with blood, and although the pump twin is usually structurally normal, congenital anomalies have sometimes been reported. We report a unique case of twin reversed arterial perfusion sequence with a prenatal diagnosis of VACTERL association in the surviving pump twin.</p> <p>Case presentation</p> <p>A 24-year-old Caucasian woman presented at 11 weeks' gestation with a monochorionic, monoamniotic twin pregnancy. A reversed arterial flow was noted on a Doppler imaging study coming from the larger, apparently normal twin to the smaller, grossly abnormal twin, and a diagnosis of twin reversed arterial perfusion sequence was made. Cardiac activity was undetectable in the recipient twin by 16 weeks' gestation. Further detailed assessment at 18 weeks' gestation revealed multiple congenital anomalies of the surviving pump twin, in keeping with a diagnosis of VACTERL association. A live infant girl was delivered at 39 weeks by elective cesarean section. She underwent extensive surgery with subsequent normal development at the age of two years.</p> <p>Conclusion</p> <p>The co-existence of two rare and complex conditions in this unique case raises interesting questions about the role of early defects in embryogenesis and their subsequent effects on fetal development. This case also highlights the importance of prenatal diagnosis of major congenital anomalies to the plan treatment, reduce morbidity and aid the survival of affected children.</p

Genome-wide analyses demonstrate novel loci that predispose to drusen formation

PURPOSE. To test whether genes for drusen formation are independent of age-related macular degeneration (AMD) pathogenesis. METHODS. A genome-wide model-free linkage analysis was performed, using two semiquantitative drusen traits, size and type, on two sets of data: (1) 325 individuals (225 sib pairs) from the Beaver Dam Eye Study (BDES), and (2) 297 individuals (346 sib pairs) from the Family Age Related Maculopathy Study (FARMS). Apolipoprotein E (APOE) genotypes were used as a covariate in a multipoint sibpair analysis. RESULTS. The authors found evidence of linkage on 19q13.31 (D19S245), with size of drusen in both the BDES (P ϭ 0.0287) and the FARMS (P ϭ 0.0013; P ϭ 0.0005, combined). In the BDES, type showed linkage evidence on 3p24.3 (D3S1768; P ϭ 0.0189) and 3q25.1 (D3S2404; P ϭ 0.0141); the linkage on 3p24.3 was also found with size (D3S1768; P ϭ 0.0264). In the FARMS, size showed evidence of linkage at 5q33.3 (D5S820; P ϭ 0.0021), 14q32.33 (D14S1007; P ϭ 0.0013), and 16p13.13 (D16S2616; P ϭ 0.0015) and type at 21q21.2 (D21S2052; P ϭ 0.0070). For size in the FARMS, there was a small increase in P-value at marker D19S245 from 0.0044 to 0.0111, and from 0.0044 to 0.0064, when the 4-carrier and the 3-carrier genotype were the covariates, respectively. CONCLUSIONS. The results show that APOE effects may be mediated early in the progression of ARM to AMD and thus may not be detected by standard genome scans for more severe disease. (Invest Ophthalmol Vis Sci. 2005;46:3081-3088

Latin American immigrants in Indianapolis: Perceptions of prejudice and discrimination

The article focuses on immigrants’ interactions with the Indiana natives, with emphasis in the city of Indianapolis and its suburbs. More specifically, this study aims at providing an understanding of the experiences of Latin American immigrants with special attention to perceptions of prejudice and discrimination and to feelings of social exclusion. A substantial proportion of Latin American immigrants interviewed indicated that they considered Indiana natives to be prejudiced and that they had personally experienced discrimination. The study reveals specific examples of discrimination experienced by the immigrants at the work place, in housing, in stores, restaurants and by various service providers. The results of the study demonstrate the relevance of the normative and power resource theories to explain prejudice and discrimination

Turbidity measurement: its application for water resource recycling in buildings

Supplying treated greywater within buildings delivers continuous additional resilience and improvements in water efficiency. This includes the making available (by substitution) of greywater resources suitable for non-potable purposes such as flushing toilets. Thereby, the overall daily consumption of pristine potable water for flushing and other lower quality uses is reduced. The empirical measurement of turbidity was confirmed as an accurate and resilient indicator of greywater quality, greywater treatment process efficiency and of well-functioning greywater reuse systems in the short-, medium- and long-term. The methodology applies turbidity monitoring for evidential management and control of treated greywater quality, essential for greywater recycling in the building stock. The results demonstrated evidence of co-variation between turbidity and biochemical oxygen demand in a lightly-loaded greywater treatment process. Real-time monitoring of turbidity delivers responsive, reliable, in-situ and remote measurements for informing building management systems (BMS), comprising an essential part of routine monitoring of greywater treatment plant. The analytical evidence confirms the importance of turbidity measurement and control in both current and future UK and international greywater standards. By undertaking turbidity measurements in compliance with BS 8525−2:2011, greater assurance in the use and compliance of greywater supplies in the built environment is achieved. Consequently, the rationale for including the empirical measurement of turbidity to demonstrate satisfactory management of the greywater quality, treatment system operation, monitoring and compliance in buildings has been confirmed

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

OBJECTIVES: To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS: Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS: A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION: This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening