History and fiction: Tales of the hegemons of the Spring and Autumn period from c. 300 BC to AD 220.

This thesis focusses on historical and fictional accounts of the hegemons of the Spring and Autumn period: Lord Huan of Qi, Lord Wen of Jin, Lord Mu of Qin, King Zhuang of Chu, King Helii of Wu and King Goujian of Yue. Chapter One describes the methodological basis. Many ancient Chinese texts underwent periods of oral transmission, but the effect on their form and content has been little researched. Theme and formula are important for understanding the development of these texts. The hegemons are also investigated for the degree to which they conform to greater patterns: the Indo-European models of the hero and good ruler. In Chapters Two and Three selected tales about the hegemons are considered. Some were chosen because the same story appeared in a large number of texts over many centuries, in the works of widely differing philosophers and historians. This shows the diffusion and popularity of these tales, and the way that the same story appealed to thinkers of very different persuasions. Others were chosen for the range of literary forms in which they appear. Some show the use of theme and formula with particular clarity, and others the way in which a story was adapted to bring it closer to the models of the hero or good king. In Chapter Four analysis of stories about the hegemons is expanded to cover the full range of tales appearing before the end of the Han dynasty, to demonstrate the degree to which they conform to the stereotypes of the hero and the good king. Chapter Five compares the hegemons to other rulers of their day, and considers their enduring literary legacy. Throughout the imperial period, the hegemons inspired prose, poetry and drama. Apart from their importance as historical figures, the hegemons have an important place in Chinese literary history

A multicentre evaluation and expert recommendations of use of the newly developed BioFire Joint Infection polymerase chain reaction panel

Septic arthritis is a serious condition with significant morbidity and mortality, routinely diagnosed using culture. The FDA has recently approved the rapid molecular BioFire® Joint Infection Panel (BJIP) for synovial fluid. We aimed to evaluate the BJIP compared to culture and its potential use in patient management. A multicentre retrospective evaluation of BJIP was conducted in the UK and Ireland. Positive percent agreement (PPA) and negative percent agreement (NPA) were calculated between the BJIP and routine culture. A multidisciplinary team (MDT) discussion addressing the optimal or potential case use of the assay practice was facilitated. Three hundred ninety-nine surplus synovial fluid samples (~ 70% from native joints) from eight centres were processed using BJIP in addition to routine culture. An increased yield of positive results was detected using BJIP compared to routine culture (98 vs 83), giving an overall PPA of 91.6% and overall NPA of 93% for the BJIP compared to culture results. The BJIP detected resistant markers and additional organisms that could influence antibiotic choices including Neisseria gonorrhoeae and Kingella kingae. The MDT agreed that the assay could be used, in addition to standard methods, in adult and children patients with specialist advice use based on local needs. Rapid results from BJIP were assessed as having potential clinical impact on patient management. Organisms not included in the panel may be clinically significant and may limit the value of this test for PJI

A multicentre evaluation and expert recommendations of use of the newly developed BioFire Joint Infection polymerase chain reaction panel

Septic arthritis is a serious condition with significant morbidity and mortality, routinely diagnosed using culture. The FDA has recently approved the rapid molecular BioFire® Joint Infection Panel (BJIP) for synovial fluid. We aimed to evaluate the BJIP compared to culture and its potential use in patient management. A multicentre retrospective evaluation of BJIP was conducted in the UK and Ireland. Positive percent agreement (PPA) and negative percent agreement (NPA) were calculated between the BJIP and routine culture. A multidisciplinary team (MDT) discussion addressing the optimal or potential case use of the assay practice was facilitated. Three hundred ninety-nine surplus synovial fluid samples (~ 70% from native joints) from eight centres were processed using BJIP in addition to routine culture. An increased yield of positive results was detected using BJIP compared to routine culture (98 vs 83), giving an overall PPA of 91.6% and overall NPA of 93% for the BJIP compared to culture results. The BJIP detected resistant markers and additional organisms that could influence antibiotic choices including Neisseria gonorrhoeae and Kingella kingae. The MDT agreed that the assay could be used, in addition to standard methods, in adult and children patients with specialist advice use based on local needs. Rapid results from BJIP were assessed as having potential clinical impact on patient management. Organisms not included in the panel may be clinically significant and may limit the value of this test for PJI

Potential value of a rapid syndromic multiplex PCR for the diagnosis of native and prosthetic joint infections: a real-world evidence study

Introduction: The BIOFIRE Joint Infection (JI) Panel is a diagnostic tool that uses multiplex-PCR testing to detect microorganisms in synovial fluid specimens from patients suspected of having septic arthritis (SA) on native joints or prosthetic joint infections (PJIs). Methods: A study was conducted across 34 clinical sites in 19 European and Middle Eastern countries from March 2021 to June 2022 to assess the effectiveness of the BIOFIRE JI Panel. Results: A total of 1527 samples were collected from patients suspected of SA or PJI, with an overall agreement of 88.4 % and 85 % respectively between the JI Panel and synovial fluid cultures (SFCs). The JI Panel detected more positive samples and microorganisms than SFC, with a notable difference on Staphylococcus aureus, Streptococcus species, Enterococcus faecalis, Kingella kingae, Neisseria gonorrhoeae, and anaerobic bacteria. The study found that the BIOFIRE JI Panel has a high utility in the real-world clinical setting for suspected SA and PJI, providing diagnostic results in approximately 1 h. The user experience was positive, implying a potential benefit of rapidity of results' turnover in optimising patient management strategies. Conclusion: The study suggests that the BIOFIRE JI Panel could potentially optimise patient management and antimicrobial therapy, thus highlighting its importance in the clinical setting

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Tiger Hill, also known as “虎丘山”

Tiger Hill was a major site for popular religion and Buddhist worship. As the supposed site of the tomb of King Helu of Wu 吳王闔廬/闔閭 (r. 514-496 BCE), one of the most powerful political leaders of the Eastern Zhou dynasty (771-475 BCE) this location was preserved as both as a historical monument within easy reach of his former capital city at Suzhou 蘇州, and as a site with significant local superstitions attached to it. These superstitions concerned the appearance of supernatural tigers at this place (hence the name): tigers that were believed to be transmutations of the precious swords buried with the great King Helu. Nothing is known of the history of this place from the time of King Helu to the Eastern Jin dynasty (317- 429). At this time, Tiger Hill was donated by its two owners, the brothers Wang Xun 王珣 (349-400) and Wang Min 王珉 (351-388), to the Buddhist faith, and their residences became the East and West Temples. (All accounts of the founding of these temples, however, incorrectly date this event to 327). During the Tang dynasty, in the period 836-840, these two temples were destroyed, and replaced by a single foundation: the Yunyan si 雲岩寺 (Cloud Cliff Temple) or Yunyan chan si 雲岩禪寺 (Cloud Cliff Chan Buddhist Temple). A pagoda was added during the Sui dynasty and rebuilt in 978 (the present structure). By this time, Tiger Hill was well-established as the most prestigious religious site in the greater Suzhou area, and there was considerable competition among elite lineages and organizations to establish shrines and monuments there. As a result, there was almost constant construction and renovation underway at Tiger Hill, and any sheer rock surface is heavily inscribed with the calligraphy of distinguished visitors. By the Ming dynasty, Tiger Hill was well established as one of the most important destinations for internal tourism in China. Both secular and sacred structures continued to be erected until the Taiping Rebellion in 1860, when the site suffered severe damage. Rebuilt in 1871, worship would continue at this temple until 1945, when all the religious buildings except the Song dynasty pagoda were destroyed. Other parts of the site, however, were undamaged at this time. In 1961, Tiger Hill was declared a National-level Cultural Protection Unit (全國重點文物保護單位). During the Cultural Revolution, Tiger Hill was guarded by the PLA, and damage is thought to have been limited. Following restoration programs beginning in 1980, the site has been returned to something of its former glory, and in 2011, its importance for tourism was recognized by being designated an AAAAA tourist attraction.Non UBCUnreviewedFacult

Numinous Cliff Mountain Temple (Lingyan shan si 靈岩山寺)

Numinous Cliff Mountain Temple (Lingyan shan si 靈岩山寺) stands outside the city of Suzhou 蘇州, dominating the waterway that debouches into Lake Tai at Xukouzhen 胥口鎮. This mountain-top site was originally the location of a summer palace, the Guanwa gong 館娃宮 (Lodging Beauties Palace) constructed at vast expense for King Fuchai of Wu 吳王夫差 (r. 495-473 BCE) for his beloved favorite Xi Shi 西施. Xi Shi, one of the four great beauties of ancient China, was presented to the last king of Wu by his greatest enemy, King Goujian of Yue 越王勾踐 (r. 496-465 BCE), to seduce him to his doom. After the fall of Wu in 473 BCE, this great palace was destroyed. The history of the site is obscure until the Eastern Jin dynasty, when Lu Wan 陸玩 (278-341), a member of the distinguished Lu family of Wu Commandery, constructed the first Buddhist temple here. In the Liang dynasty (502-557), the Bodhisattva Zhiji 智積菩薩 (Sanskrit: Pratibhanakuta) is said to have manifested himself here to spread the Buddhist faith. In honor of this, numerous stupas were erected on this site from 503 onwards. In the early Song dynasty, the temple became a Chan Buddhist institution (having previously been a Luzong 律宗 temple), only to be temporarily rededicated as a popular religion foundation honoring Han Shizhong 韓世忠 (1090-1151) at the beginning of the Southern Song dynasty. Han Shizhong had played a key role in the founding of the Southern Song dynasty, as general in command at the battle of Huangtiandang 黃天蕩, during which he held off a massive assault by Jurchen forces for 48 days, allowing the Song court and countless refugees to cross the Yangtze River in safety. Even though the temple soon returned to Chan Buddhist worship, the name of the temple in the Southern Song dynasty still commemorated Han Shizhong, who is buried at the foot of the mountain. The Song dynasty also saw the construction of a magnificent pagoda at the temple. Numinous Cliff Mountain Temple underwent cycles of neglect and restoration throughout the Yuan, Ming, and Qing dynasties, only to suffer almost total destruction during the Taiping Rebellion of 1850-1864. The temple was subsequently rebuilt, but in 1926, it became a Pure Land Buddhist institution, and received its present name in 1932, as chosen by Master Yinguang 印光 (1861-1940). In 1966, at the beginning of the Cultural Revolution, the monastic community was forced to leave, and the buildings were abandoned, but after 1976, restoration began. The temple has officially been active again since 1980 and continues to the present day. In 1990-1991, a program of restoration returned the Song pagoda to its original appearance, and the temple complex remains a popular pilgrimage site as well as receiving the occasional tourist.Non UBCUnreviewedFacult