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Hilda and the nowhere space
\"Meet Hilda -- explorer, adventurer, avid sketchbook-keeper, and friend to every creature in the valley! Well ... almost every creature ... Newly initiated into the Sparrow Scouts, Hilda and her friends are ready to explore and document the wilderness. Yet as luck would have it, there is a dark, menacing creature afoot near Trolberg, and Hilda is whisked back home to safety. Even so, intrigue seems to follow our blue-haired heroine wherever she goes, and she's about to discover the city has many more secrets to reveal...\" --Jacket flap.
AIIMS health check
Australasian Inter-service Incident Management System (AIIMS) - opportunities exist to increase the inclusion of health agencies in mainstream incident management - increased health engagement would drive the improvement of information-sharing systems, build stronger working relationships and improve insight into priorities, plans and systems.
Journal Article
Hilda and the great parade
Hilda and her mom have settled into their new home in the city of Trolberg. Pining for her magical friends and the wonder-filled wilderness, Hilda is finding it hard to fit in, especially at school. But when Hilda makes a new friend she soon begins to uncover some surprising secrets ... Perhaps this concrete labyrinth is a place where wonderful and magical things can happen too?
Book
Tissue-specific modulation of gene expression in response to lowered insulin signalling in Drosophila
Reduced activity of the insulin/IGF signalling network increases health during ageing in multiple species. Diverse and tissue-specific mechanisms drive the health improvement. Here, we performed tissue-specific transcriptional and proteomic profiling of long-lived Drosophila dilp2-3,5 mutants, and identified tissue-specific regulation of >3600 transcripts and >3700 proteins. Most expression changes were regulated post-transcriptionally in the fat body, and only in mutants infected with the endosymbiotic bacteria, Wolbachia pipientis , which increases their lifespan. Bioinformatic analysis identified reduced co-translational ER targeting of secreted and membrane-associated proteins and increased DNA damage/repair response proteins. Accordingly, age-related DNA damage and genome instability were lower in fat body of the mutant, and overexpression of a minichromosome maintenance protein subunit extended lifespan. Proteins involved in carbohydrate metabolism showed altered expression in the mutant intestine, and gut-specific overexpression of a lysosomal mannosidase increased autophagy, gut homeostasis, and lifespan. These processes are candidates for combatting ageing-related decline in other organisms.
Journal Article
Le Tour de France : the official history
Generally considered the greatest test of endurance in sports, the Tour de France covers more than 2,200 miles in just over three weeks, climbing high into both the Alps and Pyrenees before ending on Paris's iconic Champs-âElysâees. This updated edition, with brand-new features and stories, gives an authoritative account of each major era up to and including the 2017 Tour--when Britain's Chris Froome joined an elite club of four-time and three-in-a-row winners. In addition to more than 300 photographs, some dating back to the nineteenth century, there are features on the superstars, coverage of memorable moments in every era, thrilling action shots, and pictures of souvenir brochures, period newspapers, posters, stickers, postcards, and letters will engross every fan of the sport.
Book
Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study
Background
The inappropriate use of antimicrobials drives antimicrobial resistance. We conducted a study to map physician decision-making processes for acute infection management in secondary care to identify potential targets for quality improvement interventions.
Methods
Physicians newly qualified to consultant level participated in semi-structured interviews. Interviews were audio recorded and transcribed verbatim for analysis using NVIVO11.0 software. Grounded theory methodology was applied. Analytical categories were created using constant comparison approach to the data and participants were recruited to the study until thematic saturation was reached.
Results
Twenty physicians were interviewed. The decision pathway for the management of acute infections follows a Bayesian-like step-wise approach, with information processed and systematically added to prior assumptions to guide management. The main emerging themes identified as determinants of the decision-making of individual physicians were (1) perceptions of providing ‘optimal’ care for the patient with infection by providing rapid and often intravenous therapy; (2) perceptions that stopping/de-escalating therapy was a senior doctor decision with junior trainees not expected to contribute; and (3) expectation of interactions with local guidelines and microbiology service advice. Feedback on review of junior doctor prescribing decisions was often lacking, causing frustration and confusion on appropriate practice within this cohort.
Conclusion
Interventions to improve infection management must incorporate mechanisms to promote distribution of responsibility for decisions made. The disparity between expectations of prescribers to start but not review/stop therapy must be urgently addressed with mechanisms to improve communication and feedback to junior prescribers to facilitate their continued development as prudent antimicrobial prescribers.
Journal Article
Immortals
\"In this epic tale of vengeance and destiny, power-mad King Hyperion ... threatens to destroy all of humanity on his maniacal quest to obtain the ultimate weapon - the legendary Epirus Bow that gives the power to unleash war on both Heaven and Earth. But Theseus ..., a heroic young villager chosen by the gods, rises up to stop Hyperion's brutal rampage. With supernatural help from the beautiful oracle Phaedra ..., Theseus embraces his destiny and leads a fierce band of warriors in a desperate fight for the future of mankind\"--Container.
DVD
Burden of enteral supplement interactions with common antimicrobial agents: a single-centre observational analysis
IntroductionOral antimicrobials, including ciprofloxacin, levofloxacin and doxycycline, are susceptible to binding with enteral therapies such as calcium and iron therapies. Administered together, the bioavailability of these antimicrobials is expected to be reduced.MethodsA retrospective case series of patients receiving oral antimicrobials (ciprofloxacin, levofloxacin and doxycycline) was analysed at a single-centre NHS acute hospital (April 2016–September 2019). Patient demographics, including concurrent enteral therapies, were recorded using medical records. Clinically important interactions were defined as doses administered within 2 hours of antimicrobial therapy.ResultsA total of 4067 prescriptions for the study antimicrobials (ciprofloxacin, n=1905; levofloxacin, n=538; and doxycycline, n=1624) were prescribed for 3584 patients. 1918/3583 (53.5%) of the patients were female, and the median age was 67 years (range 0.5–105.0 years). 810/4067 (19.3%) prescriptions reviewed had an interacting enteral therapy (calcium or iron salt) administered within 2 hours of the study medication.ConclusionThe concomitant administration of enteral calcium and iron with oral antimicrobials is common within the acute care hospital setting. Approximately one in five patients has a clinically important interaction which may impair oral bioavailability and limit treatment efficacy. As antimicrobial stewardship teams strive for increased intravenous-to-oral de-escalation, it is important that optimum dosing administration is followed to optimise patient outcomes.
Journal Article
Methods to test the interactive effects of drought and plant invasion on ecosystem structure and function using complementary common garden and field experiments
Abiotic global change drivers affect ecosystem structure and function, but how they interact with biotic factors such as invasive plants is understudied. Such interactions may be additive, synergistic, or offsetting, and difficult to predict. We present methods to test the individual and interactive effects of drought and plant invasion on native ecosystems. We coupled a factorial common garden experiment containing resident communities exposed to drought (imposed with rainout shelters) and invasion with a field experiment where the invader was removed from sites spanning a natural soil moisture gradient. We detail treatments and their effects on abiotic conditions, including soil moisture, light, temperature, and humidity, which shape community and ecosystem responses. Ambient precipitation during the garden experiment exceeded historic norms despite severe drought in prior years. Soil moisture was 48% lower in drought than ambient plots, but the invader largely offset drought effects. Additionally, temperature and light were lower and humidity higher in invaded plots. Field sites spanned up to a 10‐fold range in soil moisture and up to a 2.5‐fold range in light availability. Invaded and resident vegetation did not differentially mediate soil moisture, unlike in the garden experiment. Herbicide effectively removed invaded and resident vegetation, with removal having site‐specific effects on soil moisture and light availability. However, light was generally higher in invader‐removal than control plots, whereas resident removal had less effect on light, similar to the garden experiment. Invasion mitigated a constellation of abiotic conditions associated with drought stress in the garden experiment. In the field, where other factors co‐varied, these patterns did not emerge. Still, neither experiment suggested that drought and invasion will have synergistic negative effects on ecosystems, although invasion can limit light availability. Coupling factorial garden experiments with field experiments across environmental gradients will be effective for predicting how multiple stressors interact in natural systems. We tested the separate and interactive effects of two global change drivers, drought and biological invasion, on native ecosystem structure and function. We used a factorial common garden experiment coupled with a field experiment in which the invader was removed from sites occurring along a natural soil moisture gradient.
Journal Article