The Historical Writing of Alfred of Beverley

Author’s note 1: Fig 1 p. 34 Item 5. Presently reads 'Grant in free alms by William Tison to Rufford Abbey (Cistercian) of land in ‘Arthes’ in Averham in East Riding of Yorkshire'. It should read 'Grant in free alms by William Tison to Rufford Abbey (Cistercian) of land in ‘Arthes’ in Averham, south west of the village of Kelham in Nottinghamshire'.Author's note 2: Fig.2 p.49. Cambridge, Trinity College, MS O.2.52. Final sentence should read- 'The text of the manuscript takes Alfred's Historia down to the accession of William I in 1066.'Author's note 3: Page 200, ‘The Death of Earl Godwine’. Whilst Geoffrey Gaimar’s Estoire des Engleis, extensively reports the public trial of Earl Godwine for complicity in the death of Alfred, brother of Edward the Confessor, he does not describe his death resulting from trial-by-bread.This thesis examines the historical writing of the twelfth-century Yorkshire historian Alfred of Beverley, compiler of a Latin chronicle covering the history of Britain from its supposed foundation by Brutus down to the time of Henry I. From the late Middle Ages until the eighteenth century Alfred enjoyed a considerable reputation amongst chroniclers, antiquaries and topographers but by the mid-nineteenth century scholarly opinion had come to consider his work highly derivative, uninformative and of little historical value. The chronicle was printed by Thomas Hearne in 1716, but was never edited in the Rolls Series and the text has remained largely neglected until today. Alfred’s sources in the chronicle have been identified and his use of them examined. The circumstances and date of compilation have been reconsidered and supported by internal evidence from the text, a date of compilation of c.1148 - c.1151 x 1154 is proposed. Alfred’s purpose and intended audience of the work has been considered and evidence for the work’s dissemination and reception from the twelfth to the seventeenth century has been gathered in order to assess the place of the work in medieval historiography. This study finds the Historia to be a text of considerable historical interest and value. It shares common features with historical narratives of the first half of the twelfth century in attempting to provide a comprehensive account of the island’s past, but does so in a more concise, less discursive literary manner. It reveals the application of the methodologies of scholastic exegesis to the writing of history, in its language, textual organization and in the interrogation of authorities that it engages in to determine the veracity of historical data.The text is an important witness for the dissemination of the important twelfth-century source texts it uses. It is the first Latin chronicle to incorporate Geoffrey of Monmouth’s British history into its narrative fabric (Henry of Huntingdon’s c.1139 abbreviation of Geoffrey’s history was inserted as a self-standing ‘Letter to Warinus’). Alfred’s critical reception of the Galfridian material is examined in the thesis. The extensive borrowings from Henry of Huntingdon, Geoffrey of Monmouth, John of Worcester and the Durham Historia Regum, provide important evidence for the dissemination of these texts, which the thesis examines. A finding of the study is that the Historia has been powerfully influenced by Henry of Huntingdon’s Historia Anglorum in its structure and thematic approach. The later reception of Alfred’s Historia by Ranulph Higden in his Universal Chronicle Polychronicon is examined and the impact that this had on Alfred’s later reception in historiography, from William Caxton to William Camden is traced and explored

Investigating the role of early low-dose aspirin in diabetes: A phase III multicentre double-blinded placebo-controlled randomised trial of aspirin therapy initiated in the first trimester of diabetes pregnancy

Background: Preeclampsia, preterm birth and low birth weight represent key contributing factors to perinatal morbidity and mortality. Pregnancies complicated by type 1 and type 2 diabetes are at increased risk of these complications, which are purported to be largely attributed to placental dysfunction. Studies investigating a potential role for aspirin therapy in optimizing perinatal outcome have consistently failed to demonstrate a benefit among women with pre-existing diabetes, and yet widespread aspirin administration has become common practice in many centres. This study seeks to examine the effect of aspirin therapy, administered from the first trimester until 36 weeks gestation, on perinatal outcome in women with established pre-pregnancy diabetes. Our hypothesis is that aspirin therapy will reduce complications mediated by placental dysfunction, and improve perinatal outcomes. Methods: This phase III double-blinded, placebo-controlled randomized clinical trial will be conducted in seven tertiary-level perinatology centres in Ireland. Consenting participants who meet all eligibility criteria will be allocated randomly to either aspirin 150 mg once daily or matching placebo, commenced between 11 + 0 and 13 + 6 weeks. Allocation will take place electronically using software by Clininfo with randomization tables provided by the trial biostatistician. The primary outcome will be a composite clinical measure of placental dysfunction (preeclampsia, preterm birth before 34 weeks, birthweight below the 10th centile or perinatal mortality). This trial has been set up such that it is parallel in design and is a superiority study. No participants have been recruited yet. The trial has been registered with Eudra Clinical Trials - EudraCT Number 2018-000770-29. Funding for this trial was granted by the Health research Board (HRB) 1/9/2017(DIFA-2017-026). Discussion: Aspirin therapy has been investigated for the prevention of preeclampsia owing to its reduction on thromboxane production. Previous studies have failed to demonstrate a beneficial effect of aspirin on perinatal outcome amongst women with type I or type II diabetes. It is plausible that the failure to observe benefit to date, among the limited aspirin studies that have included participants with diabetes, may be a consequence of aspirin initiation too late in pregnancy to exert any effect on placentation. We believe that if aspirin is to be used for the prevention of placental dysfunction, it must be initiated before the second active phase of trophoblast invasion, which takes place from 14 weeks’ gestation onwards. No randomized trials investigating the role of aspirin in prevention of preeclampsia in pregnancies complicated by diabetes have previously initiated treatment in the first trimester, the gestational period at which it is most likely to exert an effect on placentation

Cdk5 interacts with Hif-1α in neurons: A new hypoxic signalling mechanism?

The cyclin dependent kinase 5 (Cdk5)/p35 complex is essential for regulation of cell survival during development and in models of neuronal excitotoxicity. Dysregulation of Cdk5, by cleavage of its neuronal specific activators p35 and p39, has been implicated in various neurodegenerative disorders such as Alzheimer's disease, however targets of the complex that regulate neuronal survival physiologically and/or during pathogenesis are largely unknown. Since hypoxia is a key feature in the pathogenesis of several neuronal disorders we investigated a role for Cdk5/p35 in the neuronal hypoxic response. Our data shows that hypoxia modulates the p35/Cdk5 complex in primary cortical neurons at the transcriptional and protein level. Furthermore hypoxic induction of Cdk5 activity correlates with Hif-1α stabilisation, and direct interaction between these proteins can occur. Importantly, we demonstrate that Cdk5-mediated signaling is involved in Hif-1α stabilisation since inhibition of Cdk5 by roscovitine abrogates Hif-1α accumulation and induces cell death. Taken together our results show that the Cdk5/p35 complex may significantly contribute to modulation of Hif-1α stabilisation and impact neuronal survival during oxygen deprivation. Thus this study highlights a new hypoxia-mediated signaling pathway and implicates the cytoskeleton as a potential regulator of Hif-1α. Section: Cellular and Molecular Biology of Nervous Systems

Electrochemistry at nanoscale electrodes : individual single-walled carbon nanotubes (SWNTs) and SWNT-templated metal nanowires

Individual nanowires (NWs) and native single-walled carbon nanotubes (SWNTs) can be readily used as well-defined nanoscale electrodes (NSEs) for voltammetric analysis. Here, the simple photolithography-free fabrication of submillimeter long Au, Pt, and Pd NWs, with sub-100 nm heights, by templated electrodeposition onto ultralong flow-aligned SWNTs is demonstrated. Both individual Au NWs and SWNTs are employed as NSEs for electron-transfer (ET) kinetic quantification, using cyclic voltammetry (CV), in conjunction with a microcapillary-based electrochemical method. A small capillary with internal diameter in the range 30–70 μm, filled with solution containing a redox-active mediator (FcTMA+ ((trimethylammonium)methylferrocene), Fe(CN)64–, or hydrazine) is positioned above the NSE, so that the solution meniscus completes an electrochemical cell. A 3D finite-element model, faithfully reproducing the experimental geometry, is used to both analyze the experimental CVs and derive the rate of heterogeneous ET, using Butler–Volmer kinetics. For a 70 nm height Au NW, intrinsic rate constants, k0, up to ca. 1 cm s–1 can be resolved. Using the same experimental configuration the electrochemistry of individual SWNTs can also be accessed. For FcTMA+/2+ electrolysis the simulated ET kinetic parameters yield very fast ET kinetics (k0 > 2 ± 1 cm s–1). Some deviation between the experimental voltammetry and the idealized model is noted, suggesting that double-layer effects may influence ET at the nanoscale

The Gly2019Ser mutation in LRRK2 is not fully penetrant in familial Parkinson's disease: the GenePD study

<p>Abstract</p> <p>Background</p> <p>We report age-dependent penetrance estimates for leucine-rich repeat kinase 2 (<it>LRRK2</it>)-related Parkinson's disease (PD) in a large sample of familial PD. The most frequently seen <it>LRRK2 </it>mutation, Gly2019Ser (G2019S), is associated with approximately 5 to 6% of familial PD cases and 1 to 2% of idiopathic cases, making it the most common known genetic cause of PD. Studies of the penetrance of <it>LRRK2 </it>mutations have produced a wide range of estimates, possibly due to differences in study design and recruitment, including in particular differences between samples of familial PD versus sporadic PD.</p> <p>Methods</p> <p>A sample, including 903 affected and 58 unaffected members from 509 families ascertained for having two or more PD-affected members, 126 randomly ascertained PD patients and 197 controls, was screened for five different <it>LRRK2 </it>mutations. Penetrance was estimated in families of <it>LRRK2 </it>carriers with consideration of the inherent bias towards increased penetrance in a familial sample.</p> <p>Results</p> <p>Thirty-one out of 509 families with multiple cases of PD (6.1%) were found to have 58 <it>LRRK2 </it>mutation carriers (6.4%). Twenty-nine of the 31 families had G2019S mutations while two had R1441C mutations. No mutations were identified among controls or unaffected relatives of PD cases. Nine PD-affected relatives of G2019S carriers did not carry the <it>LRRK2 </it>mutation themselves. At the maximum observed age range of 90 to 94 years, the unbiased estimated penetrance was 67% for G2019S families, compared with a baseline PD risk of 17% seen in the non-<it>LRRK2</it>-related PD families.</p> <p>Conclusion</p> <p>Lifetime penetrance of <it>LRRK2 </it>estimated in the unascertained relatives of multiplex PD families is greater than that reported in studies of sporadically ascertained <it>LRRK2 </it>cases, suggesting that inherited susceptibility factors may modify the penetrance of <it>LRRK2 </it>mutations. In addition, the presence of nine PD phenocopies in the <it>LRRK2 </it>families suggests that these susceptibility factors may also increase the risk of non-<it>LRRK2</it>-related PD. No differences in penetrance were found between men and women, suggesting that the factors that influence penetrance for <it>LRRK2 </it>carriers are independent of the factors which increase PD prevalence in men.</p

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Human-centred recommendations to maximise the potential for digital health in the management of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) negatively impacts the quality of life and mortality of patients and is very costly for healthcare systems to manage. Digital health (DH) has been proposed as a novel solution to support self-management, reduce exacerbations and decrease hospitalisations. However, despite the promises, evidence demonstrating significant outcomes for patients, or for the management of the disease, are limited and unconvincing. To smooth adoption and mitigate sustained engagement challenges, human-centred design (HCD) approaches are recommended when designing digital health interventions (DHI) as they emphasise the importance of situating user experiences, needs and preferences as the driver of the intervention design. However, recent research has identified there is an absence of a core principle in HCD, user-involvement, in the development of DHIs in COPD with user-experience issues commonly cited as reasons for poor levels of adoption for both HCPs and patients. To address these shortcomings and to contribute new insights to an area lacking in empirical research, this thesis explored the perceptions of HCPs and patients regarding the potential for DH in the management of COPD. The thesis employed a qualitative study design, namely semi-structured interviewing. The sample consisted of n=30 patients and n=32 HCPs. Thematic analysis was conducted on the data using NVivo 12 software. The research also involved conducting a systematic review that explored the use of HCD principles in the design of DHIs in COPD randomised controlled trials (RCT). The findings identified there is an absence of user-involvement in the design of COPD DHIs, and that the needs of patients and HCPs are rarely the foundation or driver of the design process. The findings also offer previously unexplored insights regarding the potential for DH to address the needs of COPD patients and HCPs. The findings show there are several opportunities for DH to enhance patient self-management practices such as symptom management, improving patient self-efficacy and engagement, and increasing the delivery of preventative and personalised care which to date, have not been researched elsewhere. Furthermore, the findings provide new insights regarding the barriers and facilitators patients and HCPs perceive facing the adoption and implementation of DHIs. The findings highlight substantial individual, structural and social barriers to overcome before DH can be realised as a routinely prescribed intervention in COPD. Patient and HCP digital literacy for example represents a significant individual level barrier, as does the patient’s perception of their illness. Structural barriers however, such as an absence of an evidence-base, or clinical guidelines, for the use of DHIs in COPD represent salient obstacles to overcome. Several facilitators to support the implementation and adoption of DHIs were identified. The facilitators focus largely on education and training, but the participants also placed significant weight on the importance of being aware of patient’s needs as a means to ease the adoption of DHIs. Such facilitators have not been published in the COPD context until now. This thesis offers a comprehensive list of human-centred recommendations for future DHI design in COPD. They propose a number of potential new research trajectories and provide new insights regarding the adoption needs of this cohort which can inform the development of implementation strategies for future DHIs in COPD. Importantly, these recommendations are generated from an empirical exploration of the needs and experiences of the patients and HCPs which has not been conducted thoroughly to date