The middle

Inspired by Hamlet, The Middle (2013) is a one-man show devised for a theatre foyer – a liminal space between outside and inside, the real world and the theatre. Hamlet is a character caught in a limbo between ‘To be or not to be’ and by casting his father, Tony Pinchbeck, to play the title role, Michael Pinchbeck explores time passing, ageing and the relationship between father and son. Supported by Curve (Leicester), hÅb (Manchester) and LPAC (Lincoln), The Middle is the final part of a Shakespeare trilogy - The Trilogy (2014) and took place in the interval between The Beginning (2012) and The End (2011)

The end [programme]

Inspired by the stage direction from The Winter’s Tale, ‘Exit pursued by a bear’, The End explores endings and exits and asks why we perform and how we will know when to stop. Developed at The Junction (Cambridge), Brighton Dome and Festival, New Art Exchange and Lakeside Arts Centre (Nottingham). Commissioned by Chester Performs. Supported by the National Lottery through Arts Council England. Selected for the British Council’s Edinburgh Showcase 2011

The beginning [programme]

Inspired by A Midsummer Night’s Dream, The Beginning is the second in a trilogy of works deconstructing Shakespearean stage directions. The Beginning was developed at Lakeside Arts Centre (Nottingham), Leeds Met Studio Theatre, Loughborough University and The Junction (Cambridge). Supported by the National Lottery through Arts Council England and commissioned by the World Event Young Artists 2012. Selected for the British Council's Edinburgh Showcase 2013

Mirror, signal, manoeuvre: reflections on the role of the dramaturg in contemporary performance

Using metaphors to capture the subtle interplay of strategies involved, this presentation seeks to explore different definitions of the role of the dramaturg in circulation. I attempt an analysis of analogies, approaching the role from different perspectives, and explore the role through the metaphor of Mirror Signal Manoeuvre. I ask how the role of the contemporary outside eye is evolving through practice as research and interviews with practitioners. I intersperse critical analysis with creative reflections on my own work as a dramaturg and outside eye. I attempt to determine the value of the role to a context that has only recently embraced its catalysing potential

Plasma mEV levels in Ghanain malaria patients with low parasitaemia are higher than those of healthy controls, raising the potential for parasite markers in mEVs as diagnostic targets

This study sought to measure medium-sized extracellular vesicles (mEVs) in plasma, when patients have low Plasmodium falciparum early in infection. We aimed to define the relationship between plasma mEVs and: (i) parasitaemia, (ii) period from onset of malaria symptoms until seeking medical care (patient delay, PD), (iii) age and (iv) gender. In this cross-sectional study, n = 434 patients were analysed and Nanosight Tracking Analysis (NTA) used to quantify mEVs (vesicles of 150–500 nm diameter, isolated at 15,000 × g, β-tubulin-positive and staining for annexin V, but weak or negative for CD81). Overall plasma mEV levels (1.69 × 1010 mEVs mL−1) were 2.3-fold higher than for uninfected controls (0.51 × 1010 mEVs mL−1). Divided into four age groups, we found a bimodal distribution with 2.5- and 2.1-fold higher mEVs in infected children (10 mEVs mL−1) and the elderly (>45 yo) (median:1.92 × 1010 mEVs mL−1), respectively, compared to uninfected controls; parasite density varied similarly with age groups. There was a positive association between mEVs and parasite density (r = 0.587, p p p = 0.667). Parasite density was also exponentially related to patient delay. Gender (p = 0.667) had no effect on plasma mEV levels. During periods of low parasitaemia (PD = 72h), mEVs were 0.93-fold greater than in uninfected controls. As 75% (49/65) of patients had low parasitaemia levels (20–500 parasites µL−1), close to the detection limits of microscopy of Giemsa-stained thick blood films (5–150 parasites µL−1), mEV quantification by NTA could potentially have early diagnostic value, and raises the potential of Pf markers in mEVs as early diagnostic targets

Visualising spatio-temporal health data: the importance of capturing the 4th dimension

Confronted by a rapidly evolving health threat, such as an infectious disease outbreak, it is essential that decision-makers are able to comprehend the complex dynamics not just in space but also in the 4th dimension, time. In this paper this is addressed by a novel visualisation tool, referred to as the Dynamic Health Atlas web app, which is designed specifically for displaying the spatial evolution of data over time while simultaneously acknowledging its uncertainty. It is an interactive and open-source web app, coded predominantly in JavaScript, in which the geospatial and temporal data are displayed side-by-side. The first of two case studies of this visualisation tool relates to an outbreak of canine gastroenteric disease in the United Kingdom, where many veterinary practices experienced an unusually high case incidence. The second study concerns the predicted COVID-19 reproduction number along with incidence and prevalence forecasts in each local authority district in the United Kingdom. These studies demonstrate the effectiveness of the Dynamic Health Atlas web app at conveying geospatial and temporal dynamics along with their corresponding uncertainties.Comment: 4 Figures, 27 page

Factors Associated with Prescription of Antimicrobial Drugs for Dogs and Cats, United Kingdom, 2014–2016

Antimicrobial stewardship is a cornerstone of efforts to curtail antimicrobial resistance. To determine factors potentially influencing likelihood of prescribing antimicrobials for animals, we analyzed electronic health records for unwell dogs (n = 155,732 unique dogs, 281,543 consultations) and cats (n = 69,236 unique cats, 111,139 consultations) voluntarily contributed by 173 UK veterinary practices. Using multivariable mixed effects logistic regression, we found that factors associated with decreased odds of systemic antimicrobial prescription were client decisions focused on preventive health: vaccination (dogs, odds ratio [OR] 0.93, 95% CI, 0.90-0.95; cats, OR 0.92, 95% CI 0.89-0.95), insurance (dogs, OR 0.87, 95% CI 0.84-0.90; cats, OR 0.82, 95% CI 0.79-0.86), neutering of dogs (OR 0.90, 95% CI 0.88-0.92), and practices accredited by the Royal College of Veterinary Surgeons (OR 0.79, 95% 95% CI 0.68-0.92). This large multicenter companion animal study demonstrates the potential of preventive healthcare and client engagement to encourage responsible antimicrobial drug use

Discovery of mating in the major African livestock pathogen Trypanosoma congolense

The protozoan parasite, Trypanosoma congolense, is one of the most economically important pathogens of livestock in Africa and, through its impact on cattle health and productivity, has a significant effect on human health and well being. Despite the importance of this parasite our knowledge of some of the fundamental biological processes is limited. For example, it is unknown whether mating takes place. In this paper we have taken a population genetics based approach to address this question. The availability of genome sequence of the parasite allowed us to identify polymorphic microsatellite markers, which were used to genotype T. congolense isolates from livestock in a discrete geographical area of The Gambia. The data showed a high level of diversity with a large number of distinct genotypes, but a deficit in heterozygotes. Further analysis identified cryptic genetic subdivision into four sub-populations. In one of these, parasite genotypic diversity could only be explained by the occurrence of frequent mating in T. congolense. These data are completely inconsistent with previous suggestions that the parasite expands asexually in the absence of mating. The discovery of mating in this species of trypanosome has significant consequences for the spread of critical traits, such as drug resistance, as well as for fundamental aspects of the biology and epidemiology of this neglected but economically important pathogen

Prevalence of faecal carriage of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in veterinary hospital staff and students

This study is the first to investigate prevalence of antimicrobial-resistant (AMR) and ESBL-producing faecal Escherichia coli within 84 veterinary hospital staff and student members across three UK veterinary hospitals. Longitudinal carriage was followed for six weeks in 27 of the participants. MDR E. coli was detection was common (32.1 per cent; 95per cent CI 22.2 to 42.1 per cent) with a notably high prevalence of resistance to ciprofloxacin (11.9 per cent; 95 per cent CI 4.98 to 18.8 per cent). Extended-spectrum β-lactamase (ESBL) producing E coli were isolated from five samples (5.95 per cent: 95 per cent CI 0.89 to 11.0 per cent); two of these samples (E38 and S57) contained MDR ESBL-producing E coli, resistant to all antimicrobials tested. Two participants carried ESBL-producing E coli for the entire study period. Twenty-six participants (96.3 per cent; 95 per cent CI 89.2 to 100) carried ≥1 MDR E coli isolate during the six-week period, with seven participants (25.9 per cent) carrying ≥1 MDR isolate for at least five out of six weeks highlighting that whilst prevalence of ESBL-producing E coli is similar to asymptomatic in general populations, higher levels of carriage were observed longitudinally in our participants. This study highlights that veterinary hospital workers represent a high-risk population for carriage of MDR and ESBL-producing bacteria and that healthcare providers should be made aware of this