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This chapter investigates the links between the Akkadian poem Etana, the fragmentary Lykambes epode of the archaic Greek poet Archilochus, and the Aesopic fable of The Eagle and the Fox, carefully assessing both similarities and differences in these sources as well as in further, related Greek material, and also considering the possibility of further versions of Etana in India, Egypt and the folklore of the Baltic region. Taken together, these reflections lead to a distinction, in particular, between a floating motif model and a fixed text model of transmission, both of which may be discernible in the various manifestations of Etana in Greece and beyond.
The Pinnacle3 Auto-Planning (AP) package is an automated inverse planning tool employing a multi-sequence optimisation algorithm. The nature of the optimisation aims to improve the overall quality of radiotherapy plans but at the same time may produce higher modulation, increasing plan complexity and challenging linear accelerator delivery capability.
Methods and materials:
Thirty patients previously treated with intensity-modulated radiotherapy (IMRT) to the prostate with or without pelvic lymph node irradiation were replanned with locally developed AP techniques for step-and-shoot IMRT (AP-IMRT) and volumetric-modulated arc therapy (AP-VMAT). Each case was also planned with VMAT using conventional inverse planning. The patient cohort was separated into two groups, those with a single primary target volume (PTV) and those with dual PTVs of differing prescription dose levels. Plan complexity was assessed using the modulation complexity score.
Plans produced with AP provided equivalent or better dose coverage to target volumes whilst effectively reducing organ at risk (OAR) doses. For IMRT plans, the use of AP resulted in a mean reduction in bladder V50Gy by 4·2 and 4·7 % (p ≤ 0·01) and V40Gy by 4·8 and 11·3 % (p < 0·01) in the single and dual dose level cohorts, respectively. For the rectum, V70Gy, V60Gy and V40Gy were all reduced in the dual dose level AP-VMAT plans by an average of 2·0, 2·7 and 7·3 % (p < 0·01), respectively. A small increase in plan complexity was observed only in dual dose level AP plans.
The automated nature of AP led to high quality treatment plans with improvement in OAR sparing and minimised the variation in achievable dose planning metrics when compared to the conventional inverse planning approach.
Apoptosis, a physiological process for the controlled deletion of cells, is critical for the regulation of cell numbers, the management of morphogenesis during embryonic development, and the orchestration of many cellular processes in the adult. Spermatogenesis, the production of functional spermatozoa from spermatogonial stem cells, is no exception. It appears that a functional apoptotic pathway is necessary for normal spermatogenesis to develop, and without it infertility ensues. Apoptosis also plays a crucial role in the maintenance of the testis and its response to external toxicants, as well as in the programmed senescence of terminally differentiated spermatozoa. This chapter focuses specifically on how apoptosis affects sperm quality and function, and the implications of this process for both embryonic development and the health and well-being of the offspring.
Biologists often study living systems in light of their having evolved, of their being the products of various processes of heredity, adaptation, ancestry, and so on. In their investigations, then, biologists think comparatively: they situate lineages into models of those evolutionary processes, comparing their targets with ancestral relatives and with analogous evolutionary outcomes. This element characterizes this mode of investigation - 'comparative thinking' - and puts it to work in understanding why biological science takes the shape it does. Importantly, comparative thinking is local: what we can do with knowledge of a lineage is limited by the evolutionary processes into which it fits. In light of this analysis, the Element examines the experimental study of animal cognition, and macroevolutionary investigation of the 'shape of life', demonstrating the importance of comparative thinking in understanding both the power and limitations of biological knowledge.
Kochia accessions (designated as KS-4A and KS-4H) collected from a corn field near Garden City, KS, have previously shown multiple resistance to glyphosate, dicamba, and fluroxypyr. These accessions were also suspected as being resistant to photosystem II (PS II) inhibitors. The main objectives of this research were to 1) confirm the coexistence of cross-resistance to PS II inhibitors (atrazine and metribuzin) applied PRE and POST, 2) investigate the underlying mechanism of PS II-inhibitor resistance, and 3) determine the effectiveness of alternative POST herbicides for control of these multiple herbicide–resistant (MHR) kochia accessions. Results from dose-response experiments revealed that the KS-4A and KS-4H kochia accessions were 23-fold to 48-fold resistant to PRE- and POST-applied atrazine and 13-fold to 18-fold resistant to POST-applied metribuzin compared to a known susceptible kochia accession (KS-SUS). Both accessions also showed putative resistance to PRE-applied metribuzin that needs to be confirmed. Sequence analyses of the psbA gene further revealed that all samples from the KS-4A and KS-4H kochia accessions had a Ser264Gly point mutation. A pretreatment with malathion followed by a POST application of atrazine at 1,120 g ha−1 or metribuzin at 630 g ha−1 did not reverse the resistance phenotypes of these MHR accessions. In a separate greenhouse study, alternative POST herbicides, including bicyclopyrone + bromoxynil; bromoxynil + pyrasulfotole; paraquat alone or in combination with atrazine, metribuzin, 2,4-D, or saflufenacil; and saflufenacil alone or in combination with 2,4-D effectively controlled the KS-4H accession (≥97% injury). To our knowledge, this research reports the first case of kochia accessions with cross-resistance to PRE-applied atrazine and POST-applied metribuzin. Growers should adopt diversified weed control strategies, including the use of competitive crops, cover crops, targeted tillage, and harvest weed seed control along with effective alternative PRE and POST herbicides with multiple sites of action to control MHR kochia seedbanks on their production fields.
This article examines a turning point in the history of the theory of phonological distinctive features. In Morris Halle’s (1959) The Sound Pattern of Russian, features are organized into a contrastive hierarchy designed to minimize the number of specified features. Redundancy rules, however, ensure that the resulting underspecification has no real phonological consequences and, in subsequent generative approaches to phonology, contrastive hierarchies were largely abandoned. We explore how Halle’s hierarchy would have been different if it had been based on phonological patterns such as voicing assimilation, and show that this reorganization makes plausible predictions about other aspects of Russian phonology. We conclude by pointing to recent work in which the concept of a contrastive hierarchy has been revived, illustrating the range of phenomena that this theoretical device can account for if minimizing specifications is not the primary concern.
War with France was bound to have a great impact on the south of England as a whole, not least when armies gathered in the ports and their environs awaiting ships to set sail for France. Between 1415 and 1453 approximately forty-five armies, ranging in size from one hundred to over 12,000 men, embarked from the ports of southern England to cross to France for land campaigns. Over these thirty-eight years somewhere in excess of 100,000 men units (expressed in this way as some men served on more than one expedition) journeyed to the points of assembly on the south coast and were mustered, transported across the Channel and directed to war fronts in France. This number can be boosted if we include men embarking for naval campaigns or crossing to France on other occasions to join or rejoin garrisons in the Calais march, Normandy and elsewhere in northern France and Gascony, to carry messages, to escort materials and officials and, of course, to return home to England after completing their service. The total is increased by acknowledgment that the numbers crossing in paid royal service were not the only people embarking: there were servants, victuallers, craftsmen and countless hangers on – countless in the sense that the documentary evidence does not allow us to detect and number them.
In one sense there was nothing new about this. The southern ports had witnessed departing armies ever since the Anglo-Norman connection had been forged. Edward III's army had crossed from Portsmouth to Barfleur in 1346, and Edward, as Henry V nearly seventy years later, resided in Portchester castle while the troops assembled. A number of other expeditions departed from the south coast in the fourteenth century, but, in a very important sense, the fifteenth-century experience of the ports was unique. Armies crossed to France in almost every year between 1415 and 1453. The only exceptions were 1446, 1447 and 1451. Sometimes more than one army crossed in a year. This essay concentrates first on the choice of ports for the launching of expeditions and subsequently on the impact of the presence of armies in the south-coast ports and their environs.
For someone who has contributed so much to the history of the north of England it may come as a surprise that Tony's own history began in Taunton. It was to his ‘local’ university that he went in 1960 – Bristol – already well known for its late medievalists. An enthusiasm for the period developed during his B.A. (1963), leading to a doctorate, ‘The Family of Talbot, Lords Talbot and Earls of Shrewsbury, 1387–1453’, supervised by Professor Charles Ross and completed in 1968. Even in these early days Tony effortlessly, as well as enthusiastically, combined political, military and social and economic history in his research and writing. He also demonstrated his capacity for multi-tasking, since his doctoral thesis was completed while he was working at the Further Education Staff College at Combe Lodge, Blagdon, writing strategy documents and producing reports. By this time too, he and Sandra were already a couple, Sandra having also taken a history degree at Bristol. In 1969 they moved to Middlesbrough upon Tony's appointment to a lectureship at what was soon to become Teesside Polytechnic. He little suspected at that point that he would remain at the same institution until his final retirement in 2008, being promoted to a chair in 1992, the year the Polytechnic became a University. But the south-west's loss was most certainly the north-east's gain.
Tony's first published article derived from his thesis, as did his first book, a pioneering study of John Talbot, the great war hero of the fifteenth-century phase of the Hundred Years’ War, and one of the first volumes to be selected by the Royal Historical Society for its ‘Studies in History’ series. But it was not too long before he turned his attention to the late medieval north. Throughout his career he has combined detailed study of the locality, especially of Richmondshire and the Tees Valley, with consideration of national politics. Most importantly, perhaps, he has combined the two, as in his seminal discussion of the ‘tyranny’ of Richard III, implemented through the implantation of trusted northerners into the south in order to maintain the regime of a usurper. In 1990 Tony's magisterial study of the north-east during the Wars of the Roses was published by Oxford University Press. Six years later, he edited a collection of articles about Richard III and the north. His early work on the Neville line descended from the marriage of the first earl of Westmorland to Joan Beaufort led in due course to a full biography of Warwick the Kingmaker in 2007. Few other historians have been able to combine as skilfully as Tony has done the study of personality, politics and place.
Young people who leave Out-of-Home Care (OoHC) are a significantly vulnerable cohort. No after-care support program to date has been completely informed by young people and their care team. This scoping study explored the perspectives of young people and their wider care team on: (1) challenges surrounding the transition process; and (2) how these challenges can be addressed. Semi-structured interviews and focus group sessions were conducted with 33 stakeholders from OoHC (i.e., young people in care; young people who had transitioned from care; carers; caseworkers and senior OoHC executives). Four themes captured the challenges of transitioning out of care, including: (1) inadequate processes underpinning the transition; (2) instability within the family unit; (3) financial challenges and (4) lack of independence during care. Stakeholders agreed that greater support during the transition process is necessary, including life-skills training while in care and a post-care worker and/or mentor to provide after-care support. These findings provide compelling insights into the challenges that young people transitioning from OoHC experience and possible solutions for how such challenges can be addressed. These findings will inform the development and delivery of a co-designed and specialised after-care support service for this population.
Background: Allogeneic bone marrow transplant (BMT) as well as liver, heart, and lung transplant patients have high reported incidence rates of Clostridioides difficile infection (CDI). The prevalence and incidence of asymptomatic colonization with Clostridioides difficile (ACCD) in this group is not known. Methods: ACCD was defined as the presence of C. difficile on screening cultures without positive clinical testing for CDI ±1 week from the date of sampling. Patients undergoing BMT as well as liver, heart, and lung transplants at MUSC between October 2017 and October 2019 were cultured for C. difficile at admission for transplant then once weekly during inpatient admissions and at each outpatient follow-up for 90 days after transplantation. Testing for CDI occurred at the discretion of treating physicians and was done by PCR. Transient ACCD was defined as a positive culture from samples collected <7 days apart, and persistent ACCD was defined as having 2 or more positive cultures collected a minimum of 7 days apart. Results: The baseline prevalences of ACCD were 1 of 5 (20%), 0 of 2 (0%), 1 of 40 (3%), and 2 of 16(13%) for lung, heart, liver and BMT patients, respectively. Of 63 patients, 3 had a pretransplant history of CDI, 2 of whom had baseline ACCD. Incident ACCD occurred in 23 of 63 patients (37%) (Table 1). Overall, ACCD was observed in 30 of 63 patients (48%). Of the 30 patients with ACCD, 14 displayed persistent asymptomatic colonization, whereas 16 displayed transient asymptomatic colonization. Also, 5 patients in the cohort were diagnosed with CDI after transplantation, of whom 3 had ACCD prior to or following CDI. Conclusions: The baseline prevalence of C. difficile colonization in transplant patients (6.3%) was not substantially greater than those observed in recent studies of hospitalized inpatients, but the incidence of new colonization events (37%) was high in this patient population with numerous pretransplant risk factors for CDI.
It would not be very much of an overstatement to say that modern academic writing about medieval warfare – in English, at least – began with Sir Charles Oman, whose first essay on the subject was written in 1884 and later expanded into his History of the Art of War in the Middle Ages, which went through two editions (1898 and 1924). Oman’s brisk narrative weaving together weaponry, military institutions and exemplary battles is typical of the pioneering generation of literature on the subject – and not just in English, as attested by such works as Hans Delbrück’sGeschichte der Kriegskunst im Rahmen der politischen Geschichte (three editions between 1900 and 1920) and Ferdinand Lot’s L’Art militaire et les armées au Moyen Age en Europe et dans le Proche Orient (1946). Another characteristic shared by all of these early surveys is their lack of interest in the world beyond Europe, except to the extent that Europeans came into contact with that world through encounters such as the Crusades (as suggested by the wording of Lot’s title).
Background: Sensitive diagnostic testing is critical in responses to mumps outbreaks. PCR testing of buccal swabs is the most sensitive diagnostic test, but IgM serology remains standard in much of the United States. We provided testing guidance stressing use of mumps PCR to ambulatory clinics and emergency departments in addition to the standard serologic testing for acute mumps beginning in 2018. We compared the performance of PCR and IgM serology to assess cases of parotitis presenting during a community outbreak of mumps in fall 2019 associated with a university in Charleston, SC. Methods: All patients tested for mumps who presented to our facility (ER and ambulatory clinics) with mumps PCR and/or mumps IgM ordered between September 2019 and January 2020 were included. Mumps PCRs were sent to a commercial reference laboratory (ARUP). Confirmed cases were defined as having a positive mumps PCR and/or IgM with parotitis. Clinical characteristics of mumps patients including age, duration of symptoms, MMR history, and association with the university were obtained by chart review. Results: Mumps was confirmed in 15 of 44 tested patients (34%), with 15 of 15 mumps patients (100%) having positive PCR and 1 of 15 patients (7%) and 1 of 15 patients (7%) having positive and equivocal mumps IgM serologies, respectively. Only 1 patient who did not meet our mumps case definition (no CT imaging evidence of parotitis, no fevers, chronic sinus symptoms) had a positive PCR and had recent receipt of a third MMR dose in response to the ongoing outbreak. Median age for mumps patients was 22 years (range, 15–48) with 8 of 15 cases (53%) detected among university students and an additional 2 cases having close connections to the university associated with the outbreak. Only 1 of 15 mumps patients (6.7%) was febrile at presentation (median temperature, 37.2°C) and mumps cases presented for testing ≤3 days for 7 of 15 cases (47%) (range, 0–13 days from symptom onset). No cases were diagnosed by IgM only, and 10 of 15 mumps cases had some recollection of remote MMR immunization, whereas 6 of 15 (40%) had 2 documented MMR doses at <5 years of age. Conclusion: Serologic IgM testing for diagnosis of mumps appears insensitive for detection of cases in outbreaks within highly immunized adult patients. Although our recommended shift to PCR likely enhanced case finding during this outbreak, the potential for false-positive PCRs due to vaccine strain shedding following third-dose MMR immunization may also be considered a threat to the specificity of the test during outbreak situations.
Background: Acute-care hospitals began reporting methicillin-resistant Staphylococcus aureus (MRSA) LabID facility-wide inpatient events to the NHSN in 2013. Few data are available regarding the epidemiology of these patients. Methods: We conducted a retrospective cohort study of patients who developed hospital onset Staphylococcus aureus bloodstream infections (HO-SA-BSIs) to describe the epidemiology (characteristics and outcomes) from January 2014 through June 2019 and to compare MRSA LabID BSIs to HO-MSSA BSIs. Proportions were compared using 2 and continuous variables using the Kruskal-Wallis test (EpiInfo). Results: Overall, 264 HO-SA BSIs occurred over the study period (2.21 per 10,000 patient days), 160 HO-MSSA BSIs (1.34 per 10,000 patient days), and 104 MRSA LabID BSIs (0.869 per 10,000 patient days). These rates have not significantly changed over time (Fig. 1). Most of these patients were men (64%); 42.4% were African-American; mean age was 43.5 years; mean Charlson comorbidity index was 3.2; 67.8% were admitted for medical care (vs surgical); and 13.3% had a previous history of S. aureus infection. Of all HO-SA-BSIs, 49.2% were acquired in the ICU, 53.8% were primary BSIs, and 37.9% were catheter associated. Patients were hospitalized a mean of 19.9 days prior to HO-SA BSI, and the mean overall length of stay was 48.5 days. Compared to HO-MSSA BSIs, there were no significant differences in these characteristics among MRSA LabID BSIs except that a significantly greater proportion were catheter associated (46.2% vs 32.5%; OR, 1.78; 95% CI, 1.07–2.96; P = .04). Overall, 101 patients (38.3%) died: 41 with MRSA LabID BSI (39.4%) and 60 with HO-MSSA BSI (37.5%). Mortality rates have not changed significantly over time. The mean number of days to death was 154.2, and 59 patients (22.3%) died during incident hospitalization: 26.9% of MRSA patients and 19.4% of MSSA BSI patients. Moreover, 28.3% of patients were readmitted within 30 days of discharge from incident hospitalization, and compared to HO-MSSA BSI, this rate was significantly higher among MRSA LabID BSI patients (34.2% vs 24.8%; OR, 2.07; 95% CI, 1.09–3.93; P = .03). Among those who died, 58.4% died during hospitalization, 52.5% died within 30 days, 66.3% died within 60 days, and 74.3% had died within 90 days. Also, 47.5% died as a result of their HO-SA BSI, and compared to HO-MSSA BSI, this rate was significantly higher among those with MRSA LabID-BSI (63.4% vs 36.7%; OR, 2.99; 95% CI, 1.31–6.83; P = .02). Conclusions: Among patients with HO-SA BSI, methicillin-resistance continues to be associated with higher attributable mortality, and in our study, higher rates of 30-day readmission. There has been no significant change in HO-SA BSI rates (MSSA or MRSA) since reporting for MRSA LabID events began. Furthermore, mortality rates have not changed and remain high for both MRSA BSI and MSSA BSI patients. Given these findings, MSSA LabID event reporting should be considered.