Collaboration in electronic resource provision in university libraries: SHEDL, a Scottish case study

This case study examines the growth of collaboration among Scottish higher education institutions. Following a summary of the work of the Scottish Confederation of University and Research Libraries (SCURL), more detailed information is provided on collaboration in the fields of acquisition, licensing, selection, and purchasing. Some of the UK background is outlined, relating to NESLi2 in particular, in order to illuminate the options within Scotland. The origins of negotiations on electronic resource provision within Scotland are described, drawing on developments in other countries including Ireland and Scandinavia. After initial setbacks, the implementation of the Scottish Higher Education Digital Library (SHEDL) from 2007 to 2009 is detailed. Current benefits arising from SHEDL are explained, and some possible future developments are discussed

Relationship Between Risk Factors and Mortality in Type 1 Diabetic Patients in Europe: The EURODIAB Prospective Complications Study (PCS)

OBJECTIVE—The purpose of this study was to examine risk factors for mortality in patients with type 1 diabetes

Cyberspace and gay rights in a digital China: queer documentary filmmaking under state censorship

Owing to China’s austere censorship regulations on film media, directors of films and documentaries engaging with lesbian, gay, bisexual and transgender themes have struggled to bring their work to domestic attention. Working outside of the state-funded Chinese film industry has become necessary for these directors to commit their narratives to film, but without approval of China’s State Administration of Press, Publication, Radio, Film and Television, these artists have had little chance of achieving widespread domestic distribution of their work. However, advancements in new media technology and Web 2.0, ranging from digital video formats to Internet-based distribution via social media networks and video-hosting platforms, provide opportunities for Chinese audiences to access films and documentaries dealing with LGBT themes. This empirical study assesses how production, promotion and consumption of queer documentary films are influenced by the development of social media within Chinese cyberspace. Through close readings of microblogs from Sina Weibo this study combines analysis of contemporary research with digital social rights activism to illustrate contemporary discourse regarding film-based LGBT representation in China. Finally, the study comments on the role that documentary filmmaking plays in China’s gay rights movement, and discusses the rewards (and challenges) associated with increased levels of visibility within society

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

Genesis of metapelitic migmatites in the Adirondack Mts., New York

Oxygen isotope ratios and rare earth element (REE) concentrations provide independent tests of competing models of injection v. anatexis for the origin of migmatites from amphibolite and granulite facies metasedimentary rocks of the Adirondack Mountains, New York. Values of δ18O and REE profiles were measured by ion microprobe in garnet–zircon pairs from 10 sample localities. Prior U–Pb SIMS dating of zircon grains indicates that inherited cores (1.7–1.2 Ga) are surrounded by overgrowths crystallized during the Grenville orogenic cycle (∼1.2–1.0 Ga). Cathodoluminescence imaging records three populations of zircon: (i) featureless rounded ‘whole grains’ (interpreted as metamorphic or anatectic), and rhythmically zoned (igneous) cores truncated by rims that are either (ii) discordant rhythmically zoned (igneous) or (iii) unzoned (metamorphic or anatectic). These textural interpretations are supported by geochronology and oxygen isotope analysis. In both the amphibolite facies NW Adirondacks and the granulite facies SE Adirondacks, δ18O(Zrc) values in overgrowths and whole zircon are highly variable for metamorphic zircon (6.1–13.4‰; n = 95, 10 μm spot). In contrast, garnet is typically unzoned and δ18O(Grt) values are constant at each locality, differing only between leucosomes and corresponding melanosomes. None of the analysed metamorphic zircon–garnet pairs attained oxygen isotope equilibrium, indicating that zircon rims and garnet are not coeval. Furthermore, REE profiles from zircon rims indicate zircon growth in all regions was prior to significant garnet growth. Thus, petrological estimates from garnet equilibria (e.g. P–T) cannot be associated uncritically with ages determined from zircon. The unusually high δ18O values (\u3e10‰) in zircon overgrowths from leucocratic layers are distinctly different from associated metaigneous rocks (δ18O(Zrc) \u3c 10‰) indicating that these leucosomes are not injected magmas derived from known igneous rocks. Surrounding melanosomes have similarly high δ18O(Zrc) values, suggesting that leucosomes are related to surrounding melanosomes, and that these migmatites formed by anatexis of high δ18O metasedimentary rocks