Aspects of the Russo-Japanese War

On 6 February 1998 a symposium was held in STICERD on Aspects of the Russo-Japanese War at which two papers were presented: 'The Japanese Military during the Russo-Japanese War, 1904-05: A Reconsideration of Command Politics and Public Images', by Dr Lone, and 'British Observers of the Russo-Japanese War', by Dr Towle.

General Katsura Taro and the Japanese Empire in East Asia, 1874-1913

General Katsura Tarö was a key figure in the development of Japan’s first national army, acted as colonial governor-general in Taiwan, developed what is now Takushoku University as a school for Japanese overseas administrators and businessmen, and, as prime minister for most of the period 1901-1913, took his country to alliance with Britain, war with Russia, and finally annexation of Korea. He was a political general who made the transition to full statesman. Ironically, however, on the point of introducing his own political party, he was crippled by the public’s intolerance of continuing military intrusion in Japanese politics. This thesis borrows Katsura’s life in order to investigate the relationship between Japan’s army, society, and empire in a period of extremely rapid change. The focus is on Japan’s overseas expansion, viewed a a kind of "social imperialism"; that is, that the creation of a conscript army was intended to regiment the people and prevent disorder, and that the employment of this army in overseas expansion was further designed to maintain domestic economic progress and divert outwards potentially disruptive social tensions. It is argued, however, that the inherent weaknesses of imperialism, involving expanded military force to defend overseas interests, heated competition between the army and navy for limited budgetary resources, and rising international discord, ultimately exacerbated the domestic pressures such expansion was intended to assuage, and that Katsura was unusual among army leaders in sufficiently perceiving this concertina relationship to adopt a revised approach to foreign policy. He came to emphasise economic development of overseas possessions over and above the military factor, and adopted a British-style business attitude towards imperialism. This is evident in his establishment of the Oriental Development Company in Korea, his willingness to consider joint American-Japanese development in Manchuria, his frequent rejection of inflationary army expansion after 1905, and his assumption of the office of finance minister in his own second cabinet (1908-1911). This study examines Japan’s military and foreign policies in the Meiji period, giving particular attention to China, Korea and Taiwan. It investigates the position of the army within Meiji society, and the changing relationship between the army and nascent political parties after the introduction of constitutional government in 1890. It also charts the rivalry between the Japanese army and navy, and within the army itself. It suggests, in conclusion, that Katsura Tarö was something of the "adaptable general" posited, but not realised, by Clausewitz, a general capable of balancing military and political requirements. However, this balance was ultimately impossible given the extraordinary stresses, nationally and internationally, of the late imperial age, and a viable policy of "economics first" had to wait on Japan’s utter military defeat in 1945

Effectiveness of holistic assessment-based interventions in improving outcomes in adults with multiple long-term conditions and/or frailty:an umbrella review protocol

Objective: This umbrella review aims to synthesize evidence on the effectiveness of holistic assessment-based interventions (HABIs) in improving health outcomes in adults (aged ≥ 18) with multiple long-term conditions (MLTCs) and/or frailty in community and hospital settings.Introduction: Health systems need evidence-based, effective interventions to improve health outcomes for adults with MLTCs. Holistic assessment-based interventions are effective in older people admitted to the hospital (usually called Comprehensive Geriatric Assessment in that context) but the evidence that similar interventions are effective in the community is inconclusive.Inclusion criteria: We will include systematic reviews published since 2010 in English which examine the effectiveness of community and/or hospital HABIs in improving health outcomes among community-dwelling and hospitalized adults aged ≥ 18 with MLTCs and/or frailty. Methods: We will perform systematic searches in MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Scopus, ASSIA, Cochrane Library, and TRIP Medical Database and manually search reference lists of included reviews for additional eligible reviews. Two reviewers will independently screen titles and abstracts for eligibility, and then screen potentially eligible full-texts against selection criteria. We will assess the methodological quality of included reviews using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses tool and extract data using an adapted and piloted JBI data extraction tool. The summary of findings will be presented in tabular form, with narrative descriptions and visual indications accompanying the tabulated results. The citation matrix will be generated and the corrected covered area calculated to analyze the overlap in primary studies included in reviews.<br/

Characterisation of Non-Autoinducing Tropodithietic Acid (TDA) Production from Marine Sponge Pseudovibrio Species.

The search for new antimicrobial compounds has gained added momentum in recent years, paralleled by the exponential rise in resistance to most known classes of current antibiotics. While modifications of existing drugs have brought some limited clinical success, there remains a critical need for new classes of antimicrobial compound to which key clinical pathogens will be naive. This has provided the context and impetus to marine biodiscovery programmes that seek to isolate and characterize new activities from the aquatic ecosystem. One new antibiotic to emerge from these initiatives is the antibacterial compound tropodithietic acid (TDA). The aim of this study was to provide insight into the bioactivity of and the factors governing the production of TDA in marine Pseudovibrio isolates from a collection of marine sponges. The TDA produced by these Pseudovibrio isolates exhibited potent antimicrobial activity against a broad spectrum of clinical pathogens, while TDA tolerance was frequent in non-TDA producing marine isolates. Comparative genomics analysis suggested a high degree of conservation among the tda biosynthetic clusters while expression studies revealed coordinated regulation of TDA synthesis upon transition from log to stationary phase growth, which was not induced by TDA itself or by the presence of the C10-acyl homoserine lactone quorum sensing signal molecule

Use of protracted CPAP as a supportive treatment for COVID-19 pneumonitis and associated outcomes: a national cohort study

Background: Continuous positive airway pressure (CPAP) has been increasingly deployed to manage patients with COVID-19 and hypoxemic respiratory failure, often for protracted periods. However, concerns about protracted CPAP have been raised. This study aims to examine the use of CPAP for patients with COVID-19 and the outcomes after protracted use. Methods: This is a national cohort study of all adults admitted to Scottish critical care units with COVID-19 from 01/03/20 to 25/12/21 that received CPAP. Protracted CPAP was defined as ≥ 5 continuous days of CPAP. Outcomes included CPAP failure rate (institution of invasive mechanical ventilation (IMV) or death), mortality, and outcomes following institution of IMV. Multivariable logistic regression was performed to assess the impact of protracted CPAP on mortality after IMV. Results: 1961 patients with COVID-19 received CPAP for COVID pneumonitis with 733 patients (37.4%) receiving protracted CPAP. CPAP failure occurred in 891 (45.4%): 544 patients (27.7%) received IMV and 347 patients (17.7%) died in critical care without IMV. Hospital mortality rate was 41.3% for the population. For patients that subsequently commenced IMV, hospital mortality was 58.7% for the standard duration CPAP group and 73.9% for the protracted duration CPAP group (p=0.003), however, there was no statistical difference in hospital mortality after adjustment for confounders (OR 1.4, (95% CI 0.84, 2.33, p=0.195). Conclusions: Protracted CPAP was used frequently for managing patients with COVID-19. Whilst it was not associated with worse outcomes for those patients who subsequently required IMV, this may be due to residual confounding and differences in processes of care

Influence of socioeconomic deprivation on interventions and outcomes for patients admitted with COVID-19 to critical care units in Scotland: a national cohort study

Background: Coronavirus disease 2019 (COVID-19) can lead to significant respiratory failure with between 14% and 18% of hospitalised patients requiring critical care admission. This study describes the impact of socioeconomic deprivation on 30-day survival following critical care admission for COVID-19, and the impact of the COVID-19 pandemic on critical care capacity in Scotland. Methods: This cohort study used linked national hospital records including ICU, virology testing and national death records to identify and describe patients with COVID-19 admitted to critical care units in Scotland. Multivariable logistic regression was used to assess the impact of deprivation on 30-day mortality. Critical care capacity was described by reporting the percentage of baseline ICU bed utilisation required. Findings: There were 735 patients with COVID-19 admitted to critical care units across Scotland from 1/3/2020 to 20/6/2020. There was a higher proportion of patients from more deprived areas, with 183 admissions (24.9%) from the most deprived quintile and 100 (13.6%) from the least deprived quintile. Overall, 30-day mortality was 34.8%. After adjusting for age, sex and ethnicity, mortality was significantly higher in patients from the most deprived quintile (OR 1.97, 95%CI 1.13, 3.41, p=0.016). ICUs serving populations with higher levels of deprivation spent a greater amount of time over their baseline ICU bed capacity. Interpretation: Patients with COVID-19 living in areas with greatest socioeconomic deprivation had a higher frequency of critical care admission and a higher adjusted 30-day mortality. ICUs in health boards with higher levels of socioeconomic deprivation had both higher peak occupancy and longer duration of occupancy over normal maximum capacity. Funding: None

Hypoxic regulation of neutrophil function and consequences for Staphylococcus aureus infection.

Staphylococcal infection and neutrophilic inflammation can act in concert to establish a profoundly hypoxic environment. In this review we summarise how neutrophils and Staphylococcus aureus are adapted to function under hypoxic conditions, with a particular focus on the impaired ability of hypoxic neutrophils to effect Staphylococcus aureus killing.This work was supported by a Wellcome Trust Research Training Fellowship awarded to K.M.L, Papworth Hospital Research and Development Department and the NIHR Cambridge Biomedical Research Centre

Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK:a prospective multicentre cohort study

BACKGROUND: Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea. METHODS: CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2-7 months after hospital discharge and a later time point 10-14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107). FINDINGS: 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4-6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5-8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (-19%; 95% CI -20 to -16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18-39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27-41% of this effect. INTERPRETATION: Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition. FUNDING: UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council