The first and second Earls of Rutland and their part in the central and local politics of mid-Tudor England

This thesis investigates the role of Thomas and Henry Manners, first and second earls of Rutland, in the central and local politics of mid -Tudor England. In so doing, five factors are scrutinized throughout: landed property, political and military office -holding, Court politics, religion, and the Manners' network of friends, servants, and relatives. The thesis is divided into seven chapters, the first six of which explore how most or all of these factors influenced the political life of the family during a segment of time. The final chapter compares and contrasts the achievement of the Manners with other noble families.Chapter 1 deals with the beginnings of the family until the creation of Thomas Manners, Lord Roos, as earl of Rutland in 1525. The next chapter studies the political life of the new earl until 1536 and particu- larly emphasizes his being drawn into Henry's religious policy. Chapter 3 reveals the effects of his involvement in suppressing the rebels in the Pilgrimage of Grace, his increasing employment in the service of the Crown, and his ability to profit from the Dissolution of the Monasteries until his death in 1543. By this time the family had reached its Tudor economic peak.The themes of continuity and development are explored from the wardship of the next earl until his imprisonment in the Fleet for supporting Northumberland in the Lady Jane Grey crisis. This is followed by a chapter which probes the young earl's ability to come to terms with the Marian regime. Chapter 6 reveals that he experienced even higher favour during Elizabeth's reign, culminating in his office of president of the Council of the North, during which he fell ill and died in 1563.It is seen that the mid -Tudor Manners were able firmly to establish a powerbase in the north -east Midlands, to continue their involvement in the North, and to pass on a pattern of office -holding which would be utilized by successive earls of Rutland. Further, they were able to weather the turbulent mid -Tudor high politics because they were able to demonstrate that they were too useful and loyal to the Crown to be ignored and yet not dangerous enough to be eliminated.In comparison with other nobles at the time they were successful; and yet, they were in many ways typical of the high nobility. In fact, the story of the mid - Tudor Manners demonstrates that if there was a mid -Tudor crisis it was, at least in part, a crisis in the highest levels of leadership. The ruling powers during this time failed to make effective use of these willing and highly important servants of the Crown, and instead tended to place personal ambition or ideology above good governing

The effect of antiretroviral therapy provision on all-cause, AIDS and non-AIDS mortality at the population level--a comparative analysis of data from four settings in Southern and East Africa.

OBJECTIVE: To provide a broad and up-to-date picture of the effect of antiretroviral therapy (ART) provision on population-level mortality in Southern and East Africa. METHODS: Data on all-cause, AIDS and non-AIDS mortality among 15-59 year olds were analysed from demographic surveillance sites (DSS) in Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and the Africa Centre (South Africa), using Poisson regression. Trends over time from up to 5 years prior to ART roll-out, to 4-6 years afterwards, are presented, overall and by age and sex. For Masaka and Kisesa, trends are analysed separately for HIV-negative and HIV-positive individuals. For Karonga and the Africa Centre, trends in AIDS and non-AIDS mortality are analysed using verbal autopsy data. RESULTS: For all-cause mortality, overall rate ratios (RRs) comparing the period 2-6 years following ART roll-out with the pre-ART period were 0.58 (5.9 vs. 10.2 deaths per 1000 person-years) in Karonga, 0.79 (7.2 vs. 9.1 deaths per 1000 person-years) in Kisesa, 0.61 (6.7 compared with 11.0 deaths per 1000 person-years) in Masaka and 0.79 (14.8 compared with 18.6 deaths per 1000 person-years) in the Africa Centre DSS. The mortality decline was seen only in HIV-positive individuals/AIDS mortality, with no decline in HIV-negative individuals/non-AIDS mortality. Less difference was seen in Kisesa where ART uptake was lower. CONCLUSIONS: Falls in all-cause mortality are consistent with ART uptake. The largest falls occurred where ART provision has been decentralised or available locally, suggesting that this is important

The impact of antiretroviral therapy on adult mortality in rural Tanzania.

OBJECTIVE: To describe the impact of antiretroviral therapy (ART) on mortality rates among adults participating in an HIV community cohort study in north-west Tanzania. METHODS: Serological and demographic surveillance rounds have been undertaken in a population of approximately 30,000 people since 1994. Free HIV care including ART has been available since 2005. Event history analysis was used to compare mortality rates among HIV-negative and HIV-positive adults in the 5-year period before and after the introduction of ART. Crude and adjusted hazard ratios were calculated using exponential regression models. Interaction between time period and HIV status was assessed to investigate whether there was a non-linear relationship between these two variables. RESULTS: Male and female mortality patterns varied over the pre- and post-ART period. In women, the crude death rate fell for both HIV negatives and HIV positives hazard rate ratio (HRR = 0.71; 95%CI 0.51-0.99 and HRR = 0.68; 95%CI: 0.46-0.99, respectively). For men, the mortality among the HIV negatives increased (HRR = 1.47; 95%CI: 1.06-2.03) while the decline in mortality among the HIV positives (HRR = 0.77; 95%CI 0.52-1.13) was not statistically significant. The largest decrease in HIV-positive mortality over the two periods was among the 30- to 44-year-old age group for women and among the 45- to 59-year-old age group for men. CONCLUSION: There has been a modest effect on mortality in the study population following the introduction of free ART 5 years ago. Improving access to treatment and placing greater focus on retaining individuals on treatment are essential if the full potential of treatment for reducing HIV-related mortality is to be realised

“Off-the-shelf” devices for complex aortic aneurysm repair

BACKGROUND: Fenestrated devices currently require a 3- to 4-week manufacturing period before implantation; as such, there have been efforts to develop "off-the-shelf" (OTS) devices to reduce the time before definitive treatment can be accomplished. We examined all patients treated for complex aortic problems at our institution during the past 12 months to evaluate the suitability and early outcomes of the OTS devices vs commercially available endovascular options. METHODS: Between July 2012 and September 2013, patients undergoing aortic aneurysm repair were extracted from a prospectively managed aortic database. Two OTS devices, the Cook (Bloomington, Ind) p-Branch and the Endologix (Irvine, Calif) Ventana device, were being evaluated through clinical trials during this time frame. The custom Cook Zenith fenestrated endovascular (ZFEN) device was also available and approved by the U.S. Food and Drug Administration (FDA) during the study period. RESULTS: Of 224 aortic aneurysms treated at our institution during this period, there were a total of 85 patients with type IV thoracoabdominal aneurysms including juxtarenal aneurysms. Only 23 patients (27%) met anatomic criteria for OTS devices, with 16 patients having these investigational devices implanted. The major exclusion criterion for the p-Branch device was renal axial or circumferential position; the limiting factor for Ventana was infrasuperior mesenteric artery neck length restriction. Five of the patients who would have fit criteria for an OTS device had an FDA-approved (ZFEN) device implanted instead, and two patients opted for open repair as a result of follow-up requirements. An additional 25 patients received custom-designed (ZFEN) devices (n = 30; 35%), whereas 37 (44%) others did not meet criteria for any available endovascular device and were repaired with alternative management strategies. The mean age and maximal aortic diameter of the two cohorts (OTS and ZFEN) were 71.8 years and 72.7 years (P = NS) and 61.3 mm and 58.5 mm (P = NS), respectively. Technical success was 100%, with an overall 30-day mortality of 2.1% (n = 1, ZFEN). Major complications occurred in eight patients (17%; two OTS, six ZFEN). CONCLUSIONS: Whereas OTS device strategies will reduce the waiting times for patients with complex aortic aneurysmal disease, a significant number will still require custom-made device repair until additional device designs become available. Early experience with OTS devices does not demonstrate any significant renal risks; however, the treatment numbers are low and should be interpreted with caution until larger confirmatory studies are published. Further studies comparing the outcomes of these techniques are required to establish the best approach to handle endovascular repair of complex aortic aneurysm

“Off-the-shelf” devices for complex aortic aneurysm repair

BACKGROUND: Fenestrated devices currently require a 3- to 4-week manufacturing period before implantation; as such, there have been efforts to develop "off-the-shelf" (OTS) devices to reduce the time before definitive treatment can be accomplished. We examined all patients treated for complex aortic problems at our institution during the past 12 months to evaluate the suitability and early outcomes of the OTS devices vs commercially available endovascular options. METHODS: Between July 2012 and September 2013, patients undergoing aortic aneurysm repair were extracted from a prospectively managed aortic database. Two OTS devices, the Cook (Bloomington, Ind) p-Branch and the Endologix (Irvine, Calif) Ventana device, were being evaluated through clinical trials during this time frame. The custom Cook Zenith fenestrated endovascular (ZFEN) device was also available and approved by the U.S. Food and Drug Administration (FDA) during the study period. RESULTS: Of 224 aortic aneurysms treated at our institution during this period, there were a total of 85 patients with type IV thoracoabdominal aneurysms including juxtarenal aneurysms. Only 23 patients (27%) met anatomic criteria for OTS devices, with 16 patients having these investigational devices implanted. The major exclusion criterion for the p-Branch device was renal axial or circumferential position; the limiting factor for Ventana was infrasuperior mesenteric artery neck length restriction. Five of the patients who would have fit criteria for an OTS device had an FDA-approved (ZFEN) device implanted instead, and two patients opted for open repair as a result of follow-up requirements. An additional 25 patients received custom-designed (ZFEN) devices (n = 30; 35%), whereas 37 (44%) others did not meet criteria for any available endovascular device and were repaired with alternative management strategies. The mean age and maximal aortic diameter of the two cohorts (OTS and ZFEN) were 71.8 years and 72.7 years (P = NS) and 61.3 mm and 58.5 mm (P = NS), respectively. Technical success was 100%, with an overall 30-day mortality of 2.1% (n = 1, ZFEN). Major complications occurred in eight patients (17%; two OTS, six ZFEN). CONCLUSIONS: Whereas OTS device strategies will reduce the waiting times for patients with complex aortic aneurysmal disease, a significant number will still require custom-made device repair until additional device designs become available. Early experience with OTS devices does not demonstrate any significant renal risks; however, the treatment numbers are low and should be interpreted with caution until larger confirmatory studies are published. Further studies comparing the outcomes of these techniques are required to establish the best approach to handle endovascular repair of complex aortic aneurysm

The Pointing System of the Herschel Space Observatory. Description, Calibration, Performance and Improvements

We present the activities carried out to calibrate and characterise the performance of the elements of attitude control and measurement on board the Herschel spacecraft. The main calibration parameters and the evolution of the indicators of the pointing performance are described, from the initial values derived from the observations carried out in the performance verification phase to those attained in the last year and half of mission, an absolute pointing error around or even below 1 arcsec, a spatial relative pointing error of some 1 arcsec and a pointing stability below 0.2 arsec. The actions carried out at the ground segment to improve the spacecraft pointing measurements are outlined. On-going and future developments towards a final refinement of the Herschel astrometry are also summarised. A brief description of the different components of the attitude control and measurement system (both in the space and in the ground segments) is also given for reference. We stress the importance of the cooperation between the different actors (scientists, flight dynamics and systems engineers, attitude control and measurement hardware designers, star-tracker manufacturers, etc.) to attain the final level of performance.Comment: 28 pages, 8 figures, accepted for publication in Experimental Astronom

High Resolution Infrared Imaging and Spectroscopy of the Pistol Nebula: Evidence for Ejection

We present new NICMOS/HST infrared images and CGS4/UKIRT Br-alpha (4.05 um) spectroscopy of the Pistol Star and its associated nebula, finding strong evidence to support the hypothesis that the Pistol Nebula was ejected from the Pistol Star. The Pa-alpha NICMOS image shows that the nebula completely surrounds the Pistol Star, although the line intensity is much stronger on its northern and western edges. The Br-alpha spectra show the classical ring-like signature of quasi-spherical expansion, with weak blueshifted emission (V_max approx -60 km/s) and strong redshifted emission (V_max approx +10 km/s), where the velocities are with respect to the velocity of the Pistol Star; further, the redshifted emission appears to be "flattened" in the position-velocity diagram. These data suggest that the nebula was ejected from the star several thousand years ago, with a velocity between the current terminal velocity of the stellar wind (95 km/s) and the present expansion velocity of gas in the outer shell of the nebula (60 km/s). The Pa-alpha image reveals several emission-line stars in the region, including two newly-identified emission-line stars north of the Pistol Star with spectral types earlier than WC8 (T_eff > 50,000 K). The presence of these stars, the morphology of the Pa-alpha emission, and the velocity field in the gas suggest that the side of the nebula furthest from us is approaching, and being ionized by, the hot stars of the Quintuplet, and that the highest velocity redshifted gas has been decelerated by winds from the Quintuplet stars. We also discuss the possibility that the nebular gas might be magnetically confined by the ambient magnetic field delineated by the nearby nonthermal filaments.Comment: Figure 1 is included as a JPG file. Figure 1 and 2 also available at ftp://quintup.astro.ucla.edu/pistol2

Coverage of the left subclavian artery during thoracic endovascular aortic repair

BackgroundThoracic aortic stent grafts require proximal and distal landing zones of adequate length to effectively exclude thoracic aortic lesions. The origins of the left subclavian artery and other aortic arch branch vessels often impose limitations on the proximal landing zone, thereby disallowing endovascular repair of more proximal thoracic lesions.MethodsBetween October 2000 and November 2005, 112 patients received stent grafts to treat lesions involving the thoracic aorta. The proximal aspect of the stent graft partially or totally occluded the origin of at least one great vessel in 28 patients (25%). The proximal attachment site was in zone 0 in one patient (3.6%), zone 1 in three patients (10.7%), and zone 2 in 24 patients (85.7%). Patients with proximal implantation in zones 0 or 1 underwent debranching procedures of the supra-aortic vessels before stent graft repair. In one patient who underwent zone 1 deployment, the left subclavian artery was revascularized before stent graft deployment. Among patients who underwent zone 2 deployment with partial or complete occlusion of the left subclavian artery, none underwent prior revascularization. Patients were assessed postoperatively and at follow-up for development of neurologic symptoms as well as symptoms of left upper extremity claudication or ischemia.ResultsMean follow-up was 7.3 months. Among the 24 patients with zone 2 implantation, 10 (42%) had partial left subclavian artery coverage at the time of their primary procedure. A total of 19 patients experienced complete cessation of antegrade flow through the origin of the left subclavian artery without revascularization at the time of the initial endograft repair as a result of a secondary procedure or as a consequence of left subclavian artery thrombosis. Left upper extremity symptoms developed in three (15.8%) patients that did not warrant intervention, and rest pain developed in one (5.3%), which was treated with the deployment of a left subclavian artery stent. Two primary (type IA and type III) endoleaks (7.1%) and one secondary endoleak (type IA) (3.6%) were observed in patients who underwent zone 2 deployment. Three cerebrovascular accidents were observed. Thoracic aortic lesions were successfully excluded in all patients who underwent supra-aortic debranching procedures.ConclusionIntentional coverage of the origin of the left subclavian artery to obtain an adequate proximal landing zone during endovascular repair of thoracic aortic lesions is well tolerated and may be managed expectantly, with some exceptions

The DIP-approach:Student-staff partnerships as a vital tool for learning developers and educators to develop academic [and digital] literacies

Student-staff partnerships can be used to support the development of contextualised digital learning and teaching practices. This can be done by shifting the focus from IT skills to addressing a priority in learning and teaching using a digital approach that is appropriate for that discipline. The development of a formal ‘Digital Innovation Partnership’ (DIP) scheme at the University of Leicester brings students’ digital confidence, perspectives and motivation to enhance learning and teaching. It also recognises the valuable contribution and expertise of student and staff participants. This draws on the academic literacies work of Lea and Street (1998; 2006) and digital literacies work of Sharpe and Beetham (2010) to appreciate that staff and students are developing social practices that are situated within a discipline and intertwined with social, cultural and political factors, power and identity. The reasons for the success of the scheme are explored here, with recommendations for how the model can be applied more generally to educational design to support students’ academic literacies development

Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency

Objective: Although newer techniques to promote the healing of leg ulcers associated with chronic venous insufficiency are promising, improved healing rates and cost effectiveness are unproven. We prospectively followed a series of patients who underwent treatment with outpatient compression for venous stasis ulcers without adjuvant techniques to determine healing rates and costs of treatment. Methods: Two hundred fifty-two patients with clinical or duplex scan evidence of chronic venous insufficiency and active leg ulcers underwent treatment with ambulatory compression techniques. The patients were prospectively followed with wound measurements at 1-week to 2-week intervals, and the factors that were associated with delayed healing were determined. Results: Of all the ulcers, 57% were healed at 10 weeks of treatment and 75% were healed at 16 weeks. Ultimately, 96% of the ulcers healed, and only 1 major amputation was necessitated (0.4%). Initial ulcer size and moderate arterial insufficiency (ankle brachial index, 0.5 to 0.8; n=34) were factors that were independently associated with delayed healing (P < .01). Patient age, ulcer duration before treatment, and morbid obesity did not significantly affect healing times. The cost of 10 weeks of outpatient treatment with compression techniques ranged from $1444 to$2711. Conclusion: The treatment of venous stasis ulcers with compression techniques results in reliable, cost-effective healing in most patients. Current adjuvant techniques may prove to be useful but are likely to be cost effective only in a minority of cases, particularly in patients with large initial ulcer size or arterial insufficiency. (J Vasc Surg 1999;30:491-8.