The Cross-Channel Interests of the Baronage of the Pays de Caux and Cotentin, 1189-1204

The Norman conquest of England in 1066 created a cross-Channel baronage whose personal interests in Normandy and England were an important influence on their subsequent political activities during the reigns of the Norman king-dukes. While there has been extensive scholarship on this theme prior to 1154, there has been only limited research in the later twelfth century, when the Plantagenets ruled both countries. Most modern assessments of baronial motives and behaviour during the latter period assume their cross-Channel interests had diminished, becoming less influential on their ambitions and actions, and contributing to the loss of Normandy in 1204. The purpose of this thesis is to test the validity of these conclusions through a study of the baronial families of two specific areas, the Pays de Caux and Cotentin, between 1189 and 1204. The extent of their commitment to maintaining the cross-Channel connection is determined through a detailed analysis of their cross-Channel interests and activities, based primarily on the evidence provided by their own charters, and the increasingly abundant records of the Plantagenet administration. The two regions presented their barons with different circumstances and challenges. In the Pays de Caux significant cross-Channel interests were largely confined to a small number of very rich barons, whereas in the Cotentin they were distributed more extensively across many lesser families. Similarly, the two regions were exposed to different external influences: the Pays de Caux was increasingly vulnerable to the expanding influence of the king of France, whereas the barons of the Cotentin continued to maintain their traditional connections with the cross-border families of the Norman-Breton frontier. The barons of these two regions have been little studied previously, in contrast to those of the frontier regions of Normandy, especially by Daniel Power, and hence the thesis provides a fresh perspective on the barons of Normandy during the reigns of the final two Plantagenet king-dukes. The thesis consists of an introduction, including a survey of the historiography and sources, a main body of four parts each divided into two chapters, a conclusion and appendices, including genealogies of selected families. The first two parts examine the personal stake of individual barons in both countries through an analysis of the distribution and evolution of their cross-Channel landholdings, and their participation in social networks within local aristocratic communities in Normandy and England. This understanding of where barons focused their ambitions, whether in one country or on both sides of the Channel, informs the assessment in parts III and IV of their political interest in maintaining the Anglo-Norman realm as reflected in their military service in Normandy and loyalty to the Plantagenet king-dukes. The analysis reveals that by the end of the twelfth century these cross-Channel interests remained of vital importance to the baronial families and underpinned the consistent loyalty shown by most to the Plantagenet rulers. This close alignment with the king-dukes encouraged many families to extend their cross-Channel interests in this period, further strengthening their commitment to the Anglo-Norman realm

Relationship between pulmonary exacerbations and daily physical activity in adults with cystic fibrosis

The aim of this study was to examine the relationship between pulmonary exacerbations and physical activity (PA) in adults with cystic fibrosis (CF)

Science review: The brain in sepsis – culprit and victim

On one side, brain dysfunction is a poorly explored complication of sepsis. On the other side, brain dysfunction may actively contribute to the pathogenesis of sepsis. The current review aimed at summarizing the current knowledge about the reciprocal interaction between the immune and central nervous systems during sepsis. The immune-brain cross talk takes part in circumventricular organs that, being free from blood-brain-barrier, interface between brain and bloodstream, in autonomic nuclei including the vagus nerve, and finally through the damaged endothelium. Recent observations have confirmed that sepsis is associated with excessive brain inflammation and neuronal apoptosis which clinical relevance remains to be explored. In parallel, damage within autonomic nervous and neuroendocrine systems may contribute to sepsis induced organ dysfunction

Improving Optimization of Convolutional Neural Networks through Parameter Fine-tuning

In recent years, convolutional neural networks have achieved state-of-the-art performance in a number of computer vision problems such as image classification. Prior research has shown that a transfer learning technique known as parameter fine-tuning wherein a network is pre-trained on a different dataset can boost the performance of these networks. However, the topic of identifying the best source dataset and learning strategy for a given target domain is largely unexplored. Thus, this research presents and evaluates various transfer learning methods for fine-grained image classification as well as the effect on ensemble networks. The results clearly demonstrate the effectiveness of parameter fine-tuning over random initialization. We find that training should not be reduced after transferring weights, larger, more similar networks tend to be the best source task, and parameter fine-tuning can often outperform randomly initialized ensembles. The experimental framework and findings will help to train models with improved accuracy

Mechanisms of improvement of respiratory failure in patients with COPD treated with NIV

Annabel H Nickol1,2, Nicholas Hart1,3, Nicholas S Hopkinson1, Carl-Hugo Hamnegård4, John Moxham5, Anita Simonds1, Michael I Polkey11Respiratory Muscle Laboratory, Royal Brompton Hospital, London, UK; 2Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK; 3The Lane Fox Unit, St Thomas’ Hospital, London, UK; 4Department of Pulmonary Medicine and Clinical Physiology, Sahlgrenska University, Gotenborg, Sweden; 5Respiratory Muscle Laboratory, King’s College London School of Medicine, King’s College Hospital, London, UKBackground: Noninvasive ventilation (NIV) improves gas-exchange and symptoms in selected chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure. We hypothesized NIV reverses respiratory failure by one or all of increased ventilatory response to carbon-dioxide, reduced respiratory muscle fatigue, or improved pulmonary mechanics.Methods: Nineteen stable COPD patients (forced expiratory volume in one second 35% predicted) were studied at baseline (D0), 5–8 days (D5) and 3 months (3M) after starting NIV.Results: Ventilator use was 6.2 (3.7) hours per night at D5 and 3.4 (1.6) at 3M (p = 0.12). Mean (SD) daytime arterial carbon-dioxide tension (PaCO2) was reduced from 7.4 (1.2) kPa to 7.0 (1.1) kPa at D5 and 6.5 (1.1) kPa at 3M (p = 0.001). Total lung capacity decreased from 107 (28) % predicted to 103 (28) at D5 and 103 (27) % predicted at 3M (p = 0.035). At D5 there was an increase in the hypercapnic ventilatory response and some volitional measures of inspiratory and expiratory muscle strength, but not isolated diaphragmatic strength whether assessed by volitional or nonvolitional methods.Conclusion: These findings suggest decreased gas trapping and increased ventilatory sensitivity to CO2 are the principal mechanism underlying improvements in gas-exchange in patients with COPD following NIV. Changes in some volitional but not nonvolitional muscle strength measures may reflect improved patient effort.Keywords: COPD; hypercapnic respiratory failure; NIV; pulmonary mechanics; ventilatory driv

Use of infection control measures in people with chronic lung disease: mixed methods study

BACKGROUND: The introduction of community infection control measures during the COVID-19 pandemic was associated with a reduction in acute exacerbations of lung disease. We aimed to understand the acceptability of continued use of infection control measures among people with chronic lung disease and to understand the barriers and facilitators of use. METHODS: Australian adults with chronic lung disease were invited to an online survey (last quarter of 2021) to specify infection control measures they would continue themselves post-pandemic and those they perceived should be adopted by the community. A subset of survey participants were interviewed (first quarter of 2022) with coded transcripts deductively mapped to the COM-B model and Theoretical Domains Framework. RESULTS: 193 people (COPD 84, bronchiectasis 41, interstitial lung disease 35, asthma 33) completed the survey. Physical distancing indoors (83%), handwashing (77%), and avoidance of busy places (71%) or unwell family and friends (77%) were measures most likely to be continued. Policies for the wider community that received most support were those during the influenza season including hand sanitiser being widely available (84%), wearing of face coverings by healthcare professionals (67%) and wearing of face coverings by the general population on public transport (66%). Barriers to use of infection control measures were related to physical skills, knowledge, environmental context and resources, social influences, emotion, beliefs about capabilities and beliefs about consequences. CONCLUSIONS: Adults with chronic lung diseases in Australia are supportive of physical distancing indoors, hand hygiene, and avoidance of busy places or unwell family and friends as long-term infection control measures