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The First Large Absorption Survey in H i (FLASH) is a large-area radio survey for neutral hydrogen in and around galaxies in the intermediate redshift range $0.4\lt z\lt1.0$, using the 21-cm H i absorption line as a probe of cold neutral gas. The survey uses the ASKAP radio telescope and will cover 24,000 deg$^2$ of sky over the next five years. FLASH breaks new ground in two ways – it is the first large H i absorption survey to be carried out without any optical preselection of targets, and we use an automated Bayesian line-finding tool to search through large datasets and assign a statistical significance to potential line detections. Two Pilot Surveys, covering around 3000 deg$^2$ of sky, were carried out in 2019-22 to test and verify the strategy for the full FLASH survey. The processed data products from these Pilot Surveys (spectral-line cubes, continuum images, and catalogues) are public and available online. In this paper, we describe the FLASH spectral-line and continuum data products and discuss the quality of the H i spectra and the completeness of our automated line search. Finally, we present a set of 30 new H i absorption lines that were robustly detected in the Pilot Surveys, almost doubling the number of known H i absorption systems at $0.4\lt z\lt1$. The detected lines span a wide range in H i optical depth, including three lines with a peak optical depth $\tau\gt1$, and appear to be a mixture of intervening and associated systems. Interestingly, around two-thirds of the lines found in this untargeted sample are detected against sources with a peaked-spectrum radio continuum, which are only a minor (5–20%) fraction of the overall radio-source population. The detection rate for H i absorption lines in the Pilot Surveys (0.3 to 0.5 lines per 40 deg$^2$ ASKAP field) is a factor of two below the expected value. One possible reason for this is the presence of a range of spectral-line artefacts in the Pilot Survey data that have now been mitigated and are not expected to recur in the full FLASH survey. A future paper in this series will discuss the host galaxies of the H i absorption systems identified here.
Chapter 2 considers the implications of Greenwood’s innovation for contemporary perceptions of psychiatric institutions. The roles of undercover pioneer and literary author converge here in a single individual: the Anglo-Irish aristocrat Lewis Strange Wingfield, who impersonated an asylum warder for the purposes of literary research. Wingfield aimed to expose the endemic abuse of vulnerable individuals – but in the form of a novel. Covert observation, he believed, would furnish him with material for a new kind of fiction whose authenticity would supersede the factual scrupulousness of a ‘newspaper novelist’ like Charles Reade and even the first-hand testimonies of former inmates. As his novel Gehenna (1882) makes clear, Wingfield’s extraordinary experiment in undercover authorship attests to the creative opportunities opened up by undercover journalism as well as to the overshadowing of British trailblazers by American investigators such as Nellie Bly.
Chapter 6 centres on a cluster of related activities loosely designated as ‘tramping’: primarily labour migrancy and rural vagrancy but also the leisure activity known today as hiking. The advent of covert investigation radically extended the possibilities for exploring the hardships and freedoms associated with these overlapping varieties of mobility. In illuminating the psychology, social mores, and solidarities of lives spent on the move, undercover journalists changed the way Britons viewed rural space and its inhabitants. Foremost among the many writers impacted by this development was Thomas Hardy, whose Tess of the D’Urbervilles (1891–92) is set in a landscape being doubly reshaped by labour migrancy and pedestrian tourism. In Tess Durbeyfield and Angel Clare’s aimless but utopian flight across open country, Hardy imagines a new kind of cross-class ‘tramping’ whose origins can be traced back to the impersonations and blurred identities of investigative journalism’s most openly participatory genre.
Chapter 1 makes a thoroughgoing reassessment of James Greenwood’s infiltration of Lambeth Workhouse that establishes its centrality for the emergence of undercover journalism and the ‘amateur’ investigations that followed in its wake. Greenwood’s ‘A Night in a Workhouse’ was one of the most reprinted news stories of the century and defined the methods, terminology, and even descriptive monikers used by generations of practitioners. Our focus is on the historical novelty of the reading experience that underpinned the new mode of covert reporting. Greenwood’s account gripped the public where previous investigators had failed because it inaugurated an original narrative subject position. Examining a Greenwood imitator named Thomas Carlisle who was motivated by scepticism, we show that undercover journalism appealed to audiences, not on the grounds of compassion or political sympathy, but because the incognito persona of an immersed reporter presented a powerful opportunity for readers to identify with the investigator.
Chapter 4 focuses on childcare and adoption services, at this time a motley array of provisions that included long- and short-term supervision by impoverished private entrepreneurs, whose negligence or callous calculation, in a few proven cases, resulted in infant deaths. Despite the public’s strength of feeling on the issue, neither the authorities nor the medical press were ever able to demonstrate the existence of neglect or infanticide on a systemic scale. Undeterred, undercover journalists conducted lurid and manipulative investigations into so-called baby farmers and abortionists that effectively created their own discursive object of enquiry. Tracing this development, we show how investigative journalism harnessed popular outrage and a spirit of vigilantism to call for greater state regulation. This investigative context is crucial to understanding the force of George Moore’s Esther Waters (1894), in whose climactic scene the heroine refuses a baby-farmer’s offer to dispose of her illegitimate child.
The conclusion considers the limits of undercover journalism as illustrated by the special case of prison investigating. Though widely considered impossible to infiltrate, prisons were in fact among the earliest social realms to attract undercover investigators. Yet the reports brought back by these intrepid journalists ultimately confirm the experiential gap separating the ostensible subjects of undercover reporting and the observers.
The Introduction sets out the scale of the Victorian investigative revolution and its relation to other literary and journalistic modes such as special correspondence, official commissions, low-life guides, and social exploration. We highlight the prominent role played by female investigators and the local press in developing the new genre as well as key formal features such as the series and the first-person narrative voice. In making the reporter’s own experience central to their narratives, we argue, undercover investigations drew periodical audiences into a new kind of identificatory relationship. Journalists who pretended to be insane, destitute, or otherwise straitened were not merely penetrating closed social spaces but serving as proxies for readers imagining a hypothetical social catastrophe of their own. This impulse to titillate, rather than campaigning zeal, lay behind most undercover forays and underlay the genre’s long-term popularity and, not least, its wide-reaching impact on literary writing of these years.
Chapter 5 addresses undercover investigations of street begging, a topic that illustrates the new genre’s prioritizing of journalistic considerations over humanitarian aims. Beggary’s conflation with fraud in the public imagination made the practice a unique object for incognito investigating. Undercover journalists sought to reveal not the sufferings of those driven to public humiliation but the exploitation of charity by a cadre of swindlers. Despite failing in this ambition, such would-be exposés were perennially popular with newspaper audiences, who saw in them a simulation of their own hypothetical shipwreck but also a low-life equivalent to the specialist expertise and terminology characteristic of all professions. Undercover investigators thereby forged the troubling connection between respectability and criminality that informs the portrayal of beggars in fictional works such as Arthur Conan Doyle’s ‘The Man with the Twisted Lip’ (1891), a Sherlock Holmes story in which a respected businessman is exposed as a professional beggar.
Chapter 3 examines the exposure of conditions in emigrant steerage travel to the United States and other countries. Despite the efforts of campaigners and several commissions of inquiry, the public long remained unaware of the sufferings of transatlantic emigrants. In exposing the brutal realities behind the assurances of emigration firms, undercover journalists gave a voice to the countless thousands of emigrants who endured overcrowding, inadequate food, and sexual harassment while crossing the Atlantic. Yet their harrowing accounts of squalor and danger also offered newspaper readers a vicarious experience of the exotic. Drawing on this investigative archive, we establish how Robert Louis Stevenson’s The Amateur Emigrant (1895) began life as an incognito investigation destined for a newspaper. By turns idealizing and disillusioning, Stevenson’s narrative illustrates the social insights and unanticipated personal transformations that are hallmarks of undercover journalistic experience and whose influence extends to his best-known fictional work, Treasure Island (1883).
The scandalous 1866 publication of 'A Night in a Workhouse' altered the course of press history. Victorian journalist James Greenwood's disconcerting exposé of spending a night in a casual ward while disguised as a vagrant launched an enormously popular genre of newspaper writing that would come to be known as undercover reporting. Inspired by the exploits of the 'Amateur Casual', imitators infiltrated restricted areas by adopting disguises of their own as beggars, migrants, homeless people, mental patients, street performers, and single mothers. Undercover traces the seismic consequences that the radical innovation of 'going undercover' had for Victorian media, literature, and culture. This revisionist history of a distinctly British tradition of investigative journalism reconstitutes the pioneering investigations that shaped the global development of undercover reporting, analyses the format's vicarious appeal to audiences anxious about their own precarity, and traces the impact that incognito investigations had on the Victorian era's leading novelists.
To compare rates of Clostridioides difficile infection (CDI) recurrence following initial occurrence treated with tapered enteral vancomycin compared to standard vancomycin.
Design:
Retrospective cohort study.
Setting:
Community health system.
Patients:
Adults ≥18 years of age hospitalized with positive C. difficile polymerase chain reaction or toxin enzyme immunoassay who were prescribed either standard 10–14 days of enteral vancomycin four times daily or a 12-week tapered vancomycin regimen.
Methods:
Retrospective propensity score pair matched cohort study. Groups were matched based on age < or ≥ 65 years and receipt of non-C. difficile antibiotics during hospitalization or within 6 months post-discharge. Recurrence rates were analyzed via logistic regression conditioned on matched pairs and reported as conditional odds ratios. The primary outcome was recurrence rates compared between standard vancomycin versus tapered vancomycin for treatment of initial CDI.
Results:
The CDI recurrence rate at 6 months was 5.3% (4/75) in the taper cohort versus 28% (21/75) in the standard vancomycin cohort. The median time to CDI recurrence was 115 days versus 20 days in the taper and standard vancomycin cohorts, respectively. When adjusted for matching, patients in the taper arm were less likely to experience CDI recurrence at 6 months when compared to standard vancomycin (cOR = 0.19, 95% CI 0.07–0.56, p < 0.002).
Conclusions:
Larger prospective trials are needed to elucidate the clinical utility of tapered oral vancomycin as a treatment option to achieve sustained clinical cure in first occurrences of CDI.
Lack of sexual orientation and gender identity (SOGI) data creates barriers for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people in health care. Barriers to SOGI data collection include physician misperception that patients do not want to answer these questions and discomfort asking SOGI questions. This study aimed to assess patient comfort towards SOGI questions across five quaternary care adult congenital heart disease (ACHD) centres.
Methods:
A survey administered to ACHD patients (≥18 years) asked (1) two-step gender identity and birth sex, (2) acceptance of SOGI data, and (3) the importance for ACHD physicians to know SOGI data. Chi-square tests were used to analyse differences among demographic groups and logistic regression modelled agreement with statement of patient disclosure of SOGI improving patient–physician communication.
Results:
Among 322 ACHD patients, 82% identified as heterosexual and 16% identified as LGBTQ+, across the age ranges 18–29 years (39.4%), 30–49 years (47.8%), 50–64 years (8.7%), and > 65 years (4.0%). Respondents (90.4%) felt comfortable answering SOGI questions. Respondents with bachelor’s/higher education were more likely to “agree” that disclosure of SOGI improves patient–physician communication compared to those with less than bachelor’s education (OR = 2.45; 95% CI 1.41, 4.25; p = .0015).
Conclusion:
These findings suggest that in this largely heterosexual population, SOGI data collection is unlikely to cause patient discomfort. Respondents with higher education were twice as likely to agree that SOGI disclosure improves patient–physician communication. The inclusion of SOGI data in future studies will provide larger samples of underrepresented minorities (e.g. LGBTQ+ population), thereby reducing healthcare disparities within the field of cardiovascular research.
To describe neutropenic fever management practices among healthcare institutions.
Design:
Survey.
Participants:
Members of the Society for Healthcare Epidemiology of America Research Network (SRN) representing healthcare institutions within the United States.
Methods:
An electronic survey was distributed to SRN representatives, with questions pertaining to demographics, antimicrobial prophylaxis, supportive care, and neutropenic fever management. The survey was distributed from fall 2022 through spring 2023.
Results:
40 complete responses were recorded (54.8% response rate), with respondent institutions accounting for approximately 15.7% of 2021 US hematologic malignancy hospitalizations and 14.9% of 2020 US bone marrow transplantations. Most entities have institutional guidelines for neutropenic fever management (35, 87.5%) and prophylaxis (31, 77.5%), and first-line treatment included IV antipseudomonal antibiotics (35, 87.5% cephalosporin; 5, 12.5% penicillin; 0, 0% carbapenem).
We observed significant heterogeneity in treatment course decisions, with roughly half (18, 45.0%) of respondents continuing antibiotics until neutrophil recovery, while the remainder having criteria for de-escalation prior to neutrophil recovery. Respondents were more willing to de-escalate prior to neutrophil recovery in patients with identified clinical (27, 67.5% with pneumonia) or microbiological (30, 75.0% with bacteremia) sources after dedicated treatment courses.
Conclusions:
We found substantial variation in the practice of de-escalation of empiric antibiotics relative to neutrophil recovery, highlighting a need for more robust evidence for and adoption of this practice. No respondents use carbapenems as first-line therapy, comparing favorably to prior survey studies conducted in other countries.
In the summer of 2022, Tulane University, in collaboration with archaeologists from other institutions, began excavations at the site of Pompeii. The archaeological work was focused on Insula 14 of Region 1, located in the southeastern sector of the site. To overcome the challenges of recording a complex urban excavation, and of working with a collaborative team, we designed and implemented a unique workflow that combines paperless and 3D data-capture methods through the use of GIS technologies. The final product of our documentation workflow was a robust and easy-to-use online geodatabase where archaeologists can revisit, explore, visualize, and analyze each excavated context using virtual tools. We present our workflow for digitally documenting observational and spatial data in the field, and how we made these data available to project archaeologists during and after the field season. First, we describe the development of digital forms in ESRI's Survey123. Then, we explain our procedures for 3D documentation through SfM photogrammetric methods and discuss how we integrated the data and transformed it into an accessible format by using interactive dashboards and online 3D web scenes. Finally, we discuss the components of our workflow that are broadly applicable and that can easily be adapted to other projects.