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BMC Infectious Diseases
Identification of Enterococcus faecalis in a patient with urinary-tract infection based on metagenomic next-generation sequencing: a case report
Manshi Li1,
Fuhuo Yang2,
Yihan Lu1,3 &
Weifeng Huang4
BMC Infectious Diseases volume 20, Article number: 467 (2020) Cite this article
Urinary tract infection (UTI) caused by various pathogenic microorganisms is ubiquitous in the parts of the urinary system such as kidney, ureter, bladder, and urethra. Currently, clinical detection of UTI is mainly focused on urine culture; however, the diagnostic value of urine culture remains limited due to the time-consuming procedure and low detection rate, especially in patients who have used antibiotics. Generally, treatment for UTI relies on empirical medication rather than pathogen diagnosis, which leads to the inappropriate use of antimicrobial agents and a significant increase in resistant strains. Comparatively, metagenomic next-generation sequencing (mNGS) is capable of overcoming the disadvantages of clinical culture, and identifying pathogens for further treatment.
A 33-year-old male patient was admitted to hospital with a high fever and chills. None of his autoimmune disease or thyroid function related indicators were positive, and he had no risk of endocarditis. His white blood cell count, C-reactive protein, procalcitonin, interleukin 6, and neutrophil proportion were markedly elevated. He was initially diagnosed as having an infection of unknown etiology. Since empirical treatment of Sulperazon and Metronidazole did not relieve his symptoms, both the blood and urine specimens were examined using traditional culture, serological testing, and mNGS assay. Traditional culture and serological testing produced negative results, while the mNGS assay revealed the presence of a potential pathogen, Enterococcus faecalis, in the urine specimen, which was further confirmed by both Sanger sequencing and qPCR analysis. A CT scan of the patient's whole abdomen showed stones in the right kidney. Once targeted antibiotic therapy was administered, the patient recovered quickly.
Our case illustrated that mNGS, as a novel culture-independent approach, demonstrated the capability of rapid, sensitive, and accurate pathogen identification. Furthermore, this technology provides strong support for guiding clinicians to determine appropriate treatment.
Urinary tract infection (UTI) is one of the most prevalent community-acquired and hospital-acquired infections. It has been indicated that UTI is caused by various pathogenic microorganisms, among which the majority are Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus saprophyticus [1]. UTI mainly occurs in women of childbearing age [2], elders [3], and people with low immunity and urinary tract abnormalities. Antibiotic treatment is usually the priority treatment strategy for UTI patients [4, 5] However, due to the recent serious antibiotic abuse, pathogen resistance to antibiotics has been increased dramatically, which further increases disease burden [1]. Therefore, it is crucial to rapidly and accurately identify the pathogens of UTI, and then optimize medical therapy.
The gold standard for diagnosis of UTI remains quantitative urine culture, though various pathogen diagnostic methods are available [6, 7]. However, standard laboratory quantitative urine culture for bacteria usually takes at least 18 h, which indicates possible difficulty in the diagnosis 24 to 48 h after onset [6, 8]. In addition, due to previous use of antibiotics before admission to hospitals, the sensitivity of traditional culture in detecting pathogens remains limited, especially in patients with sepsis [8]. Therefore, incapability of obtaining a targeted and timely diagnosis might lead to inappropriate treatment, antibiotic resistance, and increased medical costs. Moreover, as many viruses and parasites are difficult or impossible to culture traditionally, diagnosis can be performed by serological and molecular methods based on the detection of specific antigens, antibodies, or genes. However, prior judgment by clinicians remains important and necessary for the diagnosis [9, 10].
Metagenomic next-generation sequencing (mNGS) is an emerging detection technique for supporting pathogen diagnosis without the requirement of preclinical prediction or culture. mNGS is capable of identifying novel or rare pathogens by determining all sequences of microbial genomes in clinical specimens within 24–48 h [11], which presents significant advantages in conditional pathogen infection and mixed infection. This further facilitates accurate diagnosis and optimal therapy. Herein, we have presented a case of UTI with Enterococcus faecalis (E. faecalis), in which traditional culture was negative but mNGS provided a positive finding. Consequently, the patient received targeted linezolid therapy and then recovered.
A 33-year-old male was admitted to hospital due to having a high fever with a lower abdominal pain for 1 day. Before arriving at the hospital, the patient developed chills, and his body temperature rose to 39.6 °C. He was administered cold medicine to be taken orally and advised to rest for several hours; however, his symptoms were not significantly relieved, neither did his body temperature drop (Fig. 1a).
Dynamic monitoring of the patient's body temperature and inflammatory markers. a Trend of body temperature by treatment. b Trend of inflammatory markers by routine blood testing, including WBC(× 109/L), neutrophil proportion(%) and procalcitonin (ng/mL) over time
Laboratory testing was performed. Routine blood testing showed that the white blood cell (WBC) count was 22.69 × 109/L with a proportion of 92.6% being neutrophils. The procalcitonin (PCT) level was elevated to 4.52 ng/mL, C-reactive protein (CRP) reached 170 mg/L, and serum interleukin 6 was 34.74 pg/mL (Fig. 1b). Liver and kidney function was basically normal. Routine autoimmune diseases-related indicators were negative, including anti-cardiac antibodies, anti-SMA, anti-AMA, anti-MPO antibodies, anti-RNP/Sm antibodies, anti-SS-A antibodies, anti-SS-B antibodies, anti-Scl-70 antibodies, anti-PM-Scl antibodies, anti-Jo-1 antibodies, and anti-dsDNA antibodies. In addition, NK and T cell subpopulations, complements C3 and C4, anti-cyclic citrullinated peptide antibody, glucose 6-phosphate isomerase, and thyroid function-related indicators including triiodothyronine, thyroxine, free triiodothyronine, free thyroxine, thyroid stimulating hormone, and parathyroid hormone, were normal. Indicators within routine urine testing were normal, including WBC. An echocardiography also ruled out endocarditis. Based on previous clinical experience, the initial diagnosis was determined as infection of unknown etiology.
An initial treatment of Sulperazone (3 g/8 h iv) and Metronidazole (0.5 g/12 h iv) had been empirically administrated for 3 days. The patient's chills disappeared, but he still had an intermittent fever with a peak of 38.8 °C. Serological testing was performed, including antibodies to respiratory syncytial virus, adenovirus, influenza A and B viruses, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila; however, all of them were negative. Following this, both his peripheral blood and urine specimens were examined to investigate possible etiology using traditional culture and mNGS (Dinfectome Inc., Shanghai, China). Both aerobic and anaerobic bacterial cultures in the peripheral blood and urine specimens were negative after 5 days' culture. However, within 24 h, mNGS revealed a total of 27,831,980 single-end reads in the genomic DNA of the urine specimen, of which 163 reads were E. faecalis (Table 1). Subsequently, sanger sequencing and PCR electrophoretogram confirmed identification of E. faecalis in the urine specimen (Fig. 2a, Table S1 and Figure S1). QPCR assay of E. faecalis showed a Ct value of 32, and a positive control Ct value of 26 (Fig. 2b).
Table 1 Pathogenic microorganisms detected by using next-generation sequencing in original and follow-up urine specimen
PCR electrophoretogram and qPCR analysis of the Enterococcus faecalis.a Electrophoretogram identified Enterococcus faecalis. b Amplification curve of the real-time qPCR confirmed the Enterococcus faecalis
Furthermore, from the patient's medical history, we learned that he had a mesenteric cyst in 2015. His whole abdominal CT showed a cystic mass in the mesenteric space of the abdominal cavity with a maximum cross-section of 18 × 7 cm and small stones in his right kidney (Fig. 3). This suggested that the patient had a UTI, and the E. faecalis may be the cause. We then replaced Sulperazon with Linezolid (0.6 g/12 h po) for his therapy. Consequently, the patient's temperature dropped and inflammation indicators (WBC, PCT, and CRP) gradually returned to normal (Fig. 1). Three days later, the patient was discharged without any complications. In the 11th day of the patient's follow-up period, a urine sample was taken again for mNGS assay. A total of 15,974,870 reads were obtained, and the number of E. faecalis decreased to 2 unique reads (Table 1). The relative abundance, the proportion of a detected microbe of total reads, was calculated for comparison. The relative abundance of E. faecalis was decreased from 0.11148856 to 0.00274632, suggesting effective treatment.
Whole abdominal CT of patients. CT image showed small stones in his right kidney
The experiment procedure for mNGS detection is as follows: DNA from urine samples and blood samples is extracted using Tiangen Magnetic DNA Kit (Tiangen). The extracted DNA was fragmented ultrasonically to yield 150–300 bp fragments. Libraries were prepared using the KAPA library preparation kit (KAPA Biosystem). After quantitation and qualification, the libraries were 75 bp single-end sequenced on Illumina NextSeq 550Dx (Illumina). An in-house developed bioinformatics pipeline was used for pathogen identification. High-quality sequencing data were generated by removing adapter, low quality bases, duplicated reads, and short (length < 36 bp) reads. Human host sequences were identified by mapping to human reference genome (hs37d5) using bowtie2 software. Reads that could not be mapped to the human genome were retained and aligned with microorganism genome database for pathogen identification. Our microorganism genome database contained genomes or scaffolds of bacteria, fungi, viruses and parasites related to human infectivity (download from ftp://ftp.ncbi.nlm.nih.gov/genomes/genbank/). Reads were verified using blastn in the NT database and species with reads > = 3 were reported. The obtained sequencing data were submitted to the Sequence Read Archive of the National Center for Biotechnology Information (NCBI) with the accession number SRR11624506, SRR11624507 and SRR11624508.
Discussion and conclusions
Here, we reported a case in which mNGS facilitated clinicians rapidly and accurately identifying E. faecalis in a patient with UTI. This patient was admitted to hospital due to high fever and chills. Traditional culture and serological testing did not determine possible infection etiology, while mNGS identified E. faecalis in the urine specimen. Combined with his clinical characteristics, his diagnosis was confirmed to be a UTI.
Enterococci are a class of bacteria typically found in the human gastrointestinal tract, mouth or vagina. E. faecalis and E. faecium are the two most common enterococci isolated in clinical samples [12]. A survey indicated that E. faecalis can be identified in about 80% of human infections [13]. It is known to be one of the main causes of human UTI worldwide [1]. In recent years, the incidence of UTI caused by E. faecalis has been estimated to be five times than that of E. faecium [14]. In our case, the patient had coexisting kidney stones that are common in the urinary system. Theoretically, once the bacteria has invaded the urinary tract and contributed to urinary stone formation, it triggers UTI easily, and further develops chronic pyelonephritis [15]. In addition to E. faecalis, JC polyomavirus and human herpesvirus 6 were detected in the patient's urine, but were not considered to have caused the patient's UTI as both of them usually cause asymptomatic persistent or latent infection [16, 17]. Therefore, clinicians need to have a good professional knowledge when interpreting mNGS findings. We employed mNGS to evaluate the treatment effects by comparing unique reads before and after treatment. Once the treatment was switched to Linezolid therapy, the patient recovered immediately after 3 days. In addition, the unique reads of E. faecalis in our patient declined dramatically to 2 within 2 weeks, suggesting E. faecalis may be the cause of the UTI, and further confirmed the treatment effects.
mNGS, as a non-biased method for rapid diagnosis of pathogens, overcomes many of the deficiencies of traditional detection methods, and directly performs DNA or RNA sequencing on samples [11, 18, 19], which is increasingly being applied in clinical laboratories. Compared with other diagnostic methods, mNGS has many advantages, but also some limitations. A prominent advantage of mNGS is that it is a completely unbiased technology that can replace many target pathogen tests with a single mNGS assay, which targets all pathogens (bacteria, fungi, viruses, and parasites) in the specimens without the need for doctors to prejudge. Therefore, for the diagnosis and identification of some rare or unknown pathogens, mNGS has comparative advantages. In addition, mNGS is appropriate for a variety of specimen types, including peripheral blood, cerebrospinal fluid, tissue, sputum, and bronchoalveolar lavage, and could be implemented in the clinical practices of sepsis, immunosuppressive host with severe infection, severe pulmonary infection, rare or new pathogen infection, and other infectious diseases [20, 21]. It would broaden the application of mNGS in the clinical practice and further bedside decision making. Furthermore, mNGS can greatly reduce the turnaround time for pathogen identification, and is more sensitive than the cultivation method [19, 22]. Routine culture is a gold standard method for organism identification, but their sensitivity is often low due to prior antibiotics and antifungals exposure [23]. Bacterial and yeast cultivation is generally time consuming, and fastidious organisms are not easy to culture. Additionally, for the identification of viruses or parasites, the role of cultivation is often limited [24]. Therefore, multiple infections are often easily overlooked, and the detection of pathogens in unexplained fever patients is even more difficult for clinical diagnosis. mNGS has the capability to avoid the limitations of traditional culture tests allowing for quickly and effectively identifying the known and unknown pathogens in the specimen within 24–48 h [11] and improving the clinical diagnosis rate [20]. Many successful cases and studies have proved the great potential of mNGS in infectious disease diagnostics. Most articles are published as case reports, such as identifying Leptospirosis [25], Bornavirus [26], Chlamydia psittaci [27], varicella-zoster virus [28], Parvimonas micra [29], and 2019-nCoV [30] in the specimens using mNGS, compared to negative findings using traditional methods. In some multi-center or multi-sample research, mNGS has demonstrated better diagnostic performance for pathogens compared to culture or other methods for different disease types. For the diagnosis of sepsis [31], severe pneumonia [32], encephalitis and meningitis [33], suspected focal infection [22], and infection caused by immunodeficiency after transplantation [18], mNGS can significantly improve the clinical diagnosis rate, and the sensitivity of pathogen identification is significantly higher than traditional microbial diagnostic methods. However, there are still many practical problems in the clinical application of mNGS. It is not easy to distinguish between colonizing bacteria, background bacteria and pathogenic bacteria among the various species detected [21]. In our case, the detected microorganisms might be from the environment (Meiothermus and Comamonas), reagents (Yarrowia and Acinetobacter), consumables, or the surface of the patient's skin (Staphylococcus lugdunensis and Malassezia), or elsewhere. Therefore, it is necessary to set up negative controls on the same batch of samples during the experiment and excluding background pathogens through the establishment of a large sample database in the early stage. Another disadvantage of mNGS is the amplification of host nucleic acids. More than 99% of reads generated by sample sequencing are from human hosts [19], and microorganisms account for only a small proportion. Therefore, sequencing all nucleic acids reduces the sensitivity of pathogen identification. The host nucleic acids can be depleted by certain methods during wet experiments [34,35,36]. Reducing the proportion of human-derived nucleic acid sequences can increase the data volume of microorganisms to a certain extent and increase sensitivity.
In conclusion, our case illustrated the potential application of mNGS in detecting pathogenic microorganisms in samples which were not detected by traditional culture and serological testing. This study suggests that mNGS could be implemented for monitoring the progress of the disease and evaluating therapy effects. It is believed that in the near future, as the cost of sequencing continues to decline, mNGS will be more and more widely used in clinics, benefiting more doctors and patients.
The data supporting the conclusions discussed in this article are included within the article. The datasets used and/or analyzed in the current study are available in NCBI with the accession number SRR11624506, SRR11624507 and SRR11624508. SRR11624507 and SRR11624508 are the sequencing data of urine and blood samples detected for the first time, and SRR11624506 is the urine sample sequencing data during the second follow-up.
UTI:
mNGS:
Metagenomic next-generation sequencing
E. faecalis :
Enterococcus faecalis
WBC:
White blood cell
CRP:
SSSIs:
Skin structure infections
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Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China
Manshi Li & Yihan Lu
Dinfectome Inc., Shanghai, 200120, China
Fuhuo Yang
Ministry of Education Key Laboratory of Public Health Safety (Fudan University), Shanghai, 200032, China
Yihan Lu
Department of Intensive Care Medicine, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
Weifeng Huang
Manshi Li
ML conceptualized the case and drafted the manuscript. FY collected the clinical information of the patient and carried out the data analysis. YL, WH supported the intellectual advice and critically revised the final manuscript. All authors read and approved the final manuscript.
Correspondence to Yihan Lu or Weifeng Huang.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
Additional file 1: Table S1.
Primers used in polymerase chain reaction. Figure S1. Electrophoretogram of PCR identified Enterococcus faecalis. On the right side of the figure, two sets of primers are used for PCR amplification. Urine represents the patient's first urine sample. PTC represents positive template control. NTC represents negative template control. L100 represents DNA ladder.
Li, M., Yang, F., Lu, Y. et al. Identification of Enterococcus faecalis in a patient with urinary-tract infection based on metagenomic next-generation sequencing: a case report. BMC Infect Dis 20, 467 (2020). https://doi.org/10.1186/s12879-020-05179-0
DOI: https://doi.org/10.1186/s12879-020-05179-0
Metagenomic next-generation sequencing (mNGS)
Submission enquiries: bmcinfectiousdiseases@biomedcentral.com


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Home FallDance Dance hopes for postseason success
DanceFallSports
Dance hopes for postseason success
by The Newtonite October 26, 2012
written by The Newtonite October 26, 2012
by Ryan Condon
Fall dance team is practicing hard and expects success in upcoming competitions, according to senior Audrey Derobert, a captain with senior Caroline Nunberg.
The team will compete in an invitational competition Sunday at Beverly, in Bay States as an exhibition team Thursday at Milton, in the New England Cheer and Dance Competition Saturday, Nov. 10 at the Reggie Lewis Track Center and in States at Shrewsbury Sunday, Nov. 18.
The team has been learning its routine for the past three weeks, according to Derobert. "It's a big step up from last year's routine," she said. "We've added lifts, headstands, stalls and other elements that make the dance more exciting to watch."
Nunberg said she is confident in this year's squad. "The team's strengths include being supportive of one another, practicing hard during crunch time, and of course, the fact that everyone is a strong dancer," she said.
"Our plan is to focus on us and not other teams. Our toughest competition is ourselves," she said. "We want to prove that if we want it enough, we can win."
According to Derobert, the team was invited to the competition Sunday based on its performances last year. This is the first year the team has competed, which poses a challenge.
"I'm just hoping for a strong all-around performance so that we can work out whatever problems we might have," she said.
Overall, Derobert said she is confident about the team's chances in the competitions. "The competition at Reggie Lewis has always been a strong one for us, and Bay States will be fun because it's a chance to show off what we're capable of," she said.
"States is sure to be a tough competition because it's at a higher level, but we're hoping to place at least as well as we did last year."
Nunberg said the team hopes to continue last year's success.
"We are all very excited, and we hope to keep the winning streak going!"
dancedance teamfall dance teamfall sportsNewton Northsports
The Newtonite
Students take military assessment
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Campaign '08
THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING
Katrina memorial plans delayed
Patsy Dupart, 58, whose father died in the Hurricane Katrina aftermath, outside the memorial site in New Orleans last week. (Cheryl Gerber/Associated Press)
Email|Print|Single Page| Text size – + By John Moreno Gonzales
Associated Press / July 13, 2008
NEW ORLEANS - Between acres of above-ground tombs that are this marshy city's way to inter the dead, there is a strip of land that is an empty tribute to the victims of Hurricane Katrina.
Unknown to most in town, including the relatives of those who died in the storm, it is the chosen site for a memorial to an estimated 1,600 fatalities, and will serve as the resting place for 85 bodies that remain unclaimed nearly three years after the disaster. During a second-anniversary ceremony, Mayor Ray Nagin wept, gave $1 million in taxpayer money to the project, and delegated management to a city coroner intent on a monument that would double as a warning to be better prepared for the next hurricane.
"This is an example of the dead helping the living," said New Orleans Parish Coroner Frank Minyard. "The underprivileged African-American community suffered worst in this storm and we have to make sure for the next storm that it doesn't happen again. Hopefully, this memorial will be a reminder of that."
But nine months later, what could have been an inspiring focal point for New Orleans has dissolved into a project that is forgotten, frustrated, and delayed - much like the Katrina recovery itself. Some say a lack of follow-up by the mayor is the cause, but Minyard places the blame on his own overburdened office, and the fatigue of a scattered city that had its share of problems long before the levees failed.
Few expect the monument to be built by the target date of Aug. 29, Katrina's third anniversary.
"Maybe by the fourth anniversary, maybe the fifth," said Gwendolyn Davis Brown, 53, the niece of the Rev. Lonnie Garrison, a longtime pastor at Pilgrim Progress Missionary Baptist Church in New Orleans who died in the aftermath of the storm. "There's so much stuff going on in the city, people still have to get back into their homes," added Patsy Dupart, 58, Garrison's daughter.
Some families are so overwhelmed by the storm, or were so troubled before it, that they have declined to pick up the bodies of relatives. The corner's office says 54 of the 85 unclaimed have been positively identified. But family members have either been lost in the massive relocation Katrina triggered, or decided to leave burial to the coroner because they were estranged from the deceased when the storm hit.
"Some families have chosen not to claim the bodies; some we cannot find families for. . . . It's just sad," said Julia Powers, a forensic anthropologist on loan from the Federal Emergency Management Agency to help Minyard.
New Orleans has seen an estimated 67 percent of its population return since the 2005 disaster that submerged 80 percent of town. But government statistics indicate that many are not original inhabitants, with up to 200,000 pre-Katrina residents forwarding their mail to other parts of the country a year after the storm.
With the dislocation, there is no organized group of surviving family members to push for a memorial, as was seen after the 2001 World Trade Center attacks. Residents and activists have focused on the challenges of the living.
"It hasn't been the top priority on my list of outrage, just because there are so many other things on that list," said Tracie Washington, a local attorney who advocates for affordable housing, healthcare, and other needs in the city. "You kind of presume it's going to get done. You just never think in advance who is going to get it done."
Minyard's office shouldered the memorial project after organizing some 900 Katrina-related autopsies, and helping investigate 3,000 missing person's reports. The city coroner has now become a repository for one of the worst per capita murder rates in the country, with 209 killed in 2007 and 95 killed so far this year.
Coroner psychologist Dr. Jeffrey Rouse, whose duty is to help families cope with death, designed a Katrina tribute that will be shaped like a satellite image of the hurricane.
A canopy of trees will lead visitors to the structure, where they can follow circular patterns of plaque-filled walls bearing the names of the deceased. On either side, mausoleums for the unclaimed will stand, the bodies able to be moved if family members claim them. In the eye of the storm will be a bronze statue of two angels rescuing a fleur-de-lis, the city symbol.
It will sit on a piece of land donated by Louisiana State University known as the Charity Hospital Cemetery. The grounds there contain the unmarked graves of centuries of the city's poorest. If remains are discovered during topsoil removal, work will be stopped while an onsite archaeologist documents.
© Copyright 2008 Globe Newspaper Company.
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text:
Migrant worker fired for speaking about COVID-19 wins labour case against farm
By Nicole ThompsonThe Canadian Press
Fri., Nov. 13, 2020timer2 min. read
A Mexican worker has been awarded damages after being fired for speaking out about poor working and living conditions during a COVID-19 outbreak at the Ontario farm where he worked.
The Ontario Labour Review Board ordered Scotlynn Sweetpac Growers Inc. to pay $25,000 to Gabriel Flores, who was fired in June by Robert Biddle, who owned the farm at the time, and was immediately sent back to Mexico.
"This confrontation followed Mr. Flores' comments and questions at the meeting the night before where Mr. Flores suggested that the employer should have done more to protect his co-worker and improve the working conditions," reads the decision from Matthew R. Wilson, alternate chair of the OLRB.
The farm in Norfolk County, Ont., had been gripped by an outbreak of the novel coronavirus, which sickened more than 190 workers -- including Flores -- and killed one.
The worker who died was one of Flores' bunkmates.
The firing came after Biddle showed Flores a video of someone speaking to the media about poor conditions.
"Mr. Biddle accused Mr. Flores of being in the video and then told Mr. Flores that he was being sent back to Mexico in the 'wee hours of the night,'" Wilson said.
Flores denied speaking to the media about farm conditions, but said that he did confront his supervisor about the issues.
"He said the beds were 'one over the other' with poor quality mattresses," Wilson said. "He testified that the walls of the rooms were not finished nor were they painted. On some nights, he had to sleep on the floor because of the poor condition of the mattress and bed."
Flores told the board that there was no way for workers to distance from one another.
For its part, Biddle and others from Scotlynn denied that Flores was fired, arguing instead that he quit.
But Wilson rejected that argument, saying there was no documentation to support Flores quitting, and that the company paid for his plane ticket back to Mexico.
Flores' contract states that if he quits, he must pay for his return ticket, Wilson noted in the decision.
The company also pointed out that it offered Flores his job back -- after Flores had filed a complaint with the labour board -- when it said it realized he thought he had been fired.
But Wilson said that made little difference.
"After more than 190 workers had been infected -- including Mr. Flores and one co-worker who succumbed to the virus -- Mr. Flores could not reasonably be expected to return to the workplace and continue living in the bunkhouse without assurances that sufficient health measures had been taken to specifically address the risks of COVID-19," he wrote. "There is no evidence that the employer had taken any steps to improve the working or living conditions or address the issues raised by Mr. Flores."
Wilson also described testimony from Scotlynn's witnesses as inconsistent and evasive.
"On the whole, I found the applicant's witnesses (including the applicant, himself) to be more believable. They resisted the temptation of self-serving evidence, were not evasive even when asked difficult questions, and provided a consistent narrative that was more in line with the preponderance of probabilities," he wrote.


text:
Q: Добавление роли в Wordpress После добавления кода, роль не появляется в списке выбора. Подскажите, что не так? Может что-то мешает созданию новой роли? Так как код идеальный).
    register_activation_hook( __FILE__, array( 'mpg', 'mpg_activation' ) );

    function mpg_activation(){

    add_role('mpg_new',
          'New',
              array(
                  'read'          => true,
                  'edit_posts'    => true,
                  'delete_posts'  => true,
                  'publish_posts' => true
              )
      );
}

Функция прописана в плагине. Также уже прописаны определённые права для кастомного типа поста, которым будут управлять юзер с вышеуказанной ролью.
Инструкции читал:

*

*https://wp-kama.ru/function/add_role

*https://3.7designs.co/blog/2014/08/restricting-access-to-custom-post-types-using-roles-in-wordpress/

*https://wordpress.org/support/topic/custom-post-type-and-user-role/

A: Не верно использовал функцию активации плагина register_activation_hook. Правильно:
register_activation_hook( __FILE__, 'mpg_activation' );

    function mpg_activation(){

    add_role('mpg_new',
          'New',
              array(
                  'read'          => true,
                  'edit_posts'    => true,
                  'delete_posts'  => true,
                  'publish_posts' => true
              )
      );
}

redpajama_set_name: RedPajamaStackExchange


Twenty-five story tall office tower in downtown built in 1969 and designed by Charles Paine & Associates. The tower originally featured a pedestrian overpass crossing over to Oceanic Plaza which was torn down in 2014.
Marina visits the offices of a hedge witch in San Francisco only to find her contact murdered in episode 2x02 "Hotel Spa Potions".
Kara leaves her symbol on the roof to draw out Reign and then confronts her when she arrives in episode 3x09 "Reign".
Kara and Reign smash into an office holiday party and smash up the place during their fight in episode 3x09 "Reign".
Ben Lockwood ambushes Lena in the lobby to ask about his father's foundry in episode 4x03 "Man of Steel".
Agent Duram and GDD Director Singh chat on these steps in episode 1x11 "Retribution".


text:
Q: Spring @Autowired в новом потоке Имеется некоторый бин
@Repository
@Transactional
public class UserServiceImpl implements UserService {
...
}

Его необходимо вызывать в другом методе, который создает новые потоки:
@Autowired
UserService userService;

new Thread(new NewClientsThread(new Runnable(){
    @Override
    public void run() {
        //Здесь вызывается userService
    }
})).start();

Но при работе в момент обращения к бину получаю NullPointerException. Я так понимаю, что в новом потоке недоступен контекст спринга.
Есть какие-то способы побороть эту проблему?

A: Замени
new Thread(new NewClientsThread(new Runnable(){
    @Override
    public void run() {
        //Здесь вызывается userService
    }
})).start();

на
new Thread(new NewClientsThread(new Runnable(){
    @Autowired
    UserService userService;

    @Override
    public void run() {
         SpringBeanAutowiringSupport.processInjectionBasedOnCurrentContext(this);
        //далее вызывается userService
    }
})).start();

Хочу заметить, что, по-моему мнению, у тебя где-то закралась архитектурная недоработка, ибо создание потоков нужно использовать в очень редких случаях.


text:
Galleywinter
Support Music You Love
COVID Concert Series
THE CO-WRITE
11 Bones-Four Day March
May 5, 2010 January 31, 2011 Ryan "Tank" Hargrave 0 Comments
reprinted from MusicFest Magazine.
Individually, the members of 11 Bones putting out a new release would be noteworthy in and of itself. Yet, their collective effort brings an even greater depth of buzz due to the fresh and innovative sounds produced by this supergroup that is poised to become the next big thing in the Texas/Red Dirt scene.
Lead vocalist Dub Miller is a name familiar to fans that have been around since the late 90's. Miller delivered two standout albums of his own before putting music on hold to attend law school.
Two members of his Highway 6 band from that time, Matt Skinner and Adam Odor, join Miller in the 11 Bones project. Skinner is a talented multi-instrumentalist and vocalist who has played with a number of acts aside from Miller including Drew Kennedy and Doug Moreland. Odor's name may not be familiar to the average music fan, but you've no doubt heard his work as a highly demanded studio bassist and engineer for what is seemingly every other recording coming out of Austin.
The group is rounded out by Meagan Jones on vocals, Brian Beken on guitars, and John Ross Silva on drums. Miller's songwriting has always been very literate and romantic, while Skinner's solo work is peppered with western themes. While maintaining their firm country roots underneath, they have created a new, original sound that evokes shades of Texas Music legends Doug Sahm and Roky Erickson. Sounds of the Beatles and the Mavericks populate "Forget" as Miller sings a sticky melody over oozing guitars and multi-tracked backing vocals.
Much of the same is found on a track titled "Loser". Miller's baritone drips down low and is juxtaposed by backing vocals straight from Southern California and guitar tones to match. By including elements of pop, psychadelic rock and a large heaping of Texas attitude, 11 Bones are heading into uncharted waters with tunes like "Paranoia" sung by Jones and "Don't Want to Fall" delivered by Skinner.
This collection of songs is a strong example of what is possible when musicians chase their creative dreams and create something that can be best summed up with one word: cool.
← {Contest Give-a-way} Wade Bowen House Concert
{Contest Give-a-way} Rodney Hayden's Songwriter Festival & Album Giveaway →
Ryan "Tank" Hargrave
I'm a husband, father, traveler, a Light in the dark, lover of photography/film and I believe that good music can change your life.
Micky and The Motorcars – Ain't In It For the Money
December 10, 2004 January 7, 2014 Galleywinter 11
Wade Bowen – The Waiting
September 15, 2020 September 15, 2020 Cody Starr
Ryan Bingham & The Dead Horses – Junky Star
August 29, 2010 January 31, 2011 Ryan "Tank" Hargrave 3
Want to know what is bending our ear lately? Check out this curated list of tunes from some of our favorite artists.
Brad's Corner
Brad's Corner
December 2020 – Timing
December 1, 2020 December 2, 2020 Brad Beheler
"Songs are like tattoos." – Margo Price Tattoos are permanent. Sure you can pay tons of money to have them covered up or removed, but the memory remains forevermore. Songs are the same way. And much like tattoos, songs seem to come to us at just the right time. Some are visible for a short period of time and others are indelible marks on our psyche and soul. I'm a big believer that things happen for a reason. Songs and music are no different. Music, people, events all hit you at the right time in your life. Your opinion of
September 2020: The Value of Music
September 18, 2020 December 2, 2020 Brad Beheler
August 2020: The Music Remains
August 5, 2020 September 18, 2020 Brad Beheler 1
July 2020: Defending the Music
July 6, 2020 September 15, 2020 Brad Beheler 0
Best of 2020…so far
July 1, 2020 August 5, 2020 Brad Beheler 0
Categories Select Category 20 Questions Album Reviews Brad's Corner Contest Give-a-way Covid Concert Series Dallas in the Midwest Face The Music Favorites of the Year Greenfest Music of New Braunfels Music Premiere Off the Cuff Outside the Lines River Jam Starr Reflections Texas Best Americana Red's Texas Talkin' Podcast Texas Treasures The Drop Visiting Venues What's Going On
Copyright © 2021 Galleywinter. All rights reserved.


Born and currently residing in Midland, Texas, Angela shuffles three busy children (not including her husband) all over the place. She works in a busy pediatric doctor's office as a nurse during the day, and writes at night. She is addicted to coffee——who isn't? And firmly believes chocolate can fix all——especially chocolate ice cream. She laughs a lot, often at herself and is willing to try anything once (she thinks). When Angela isn't rushing kids around, working or writing, she's reading. Other than life experience, Angela turns to a wide variety of music to help spark her creative juices. She loves to dance and sing, though her kids often beg her not to.
This book starts intriguing almost immediately with the angst all teenagers feel. With every turn of the page you experience high school life with our Heroine Trinity. Young love and of course the boys who deny the feeling, brings a wonderful reality to this paranormal tale. From the antics of her friends, to the bullies and the rogues that plague her, Trinity has an inner strength that almost glows off the pages.
"Blain, I'm not scared." I listened to the empty hallway, knowing there was no longer anyone out there. "The hallway is empty. I can't pull in emotions from thin air." His eyes changed from clear to stormy. He took a small step closer, shortening the distance between us even more.
I loved this book and read it twice before I wrote this review. There are so many twists and turns it is impossible to guess the outcome. I am looking forward to the next book in this series.
Five contented PURRS for this book and your editors.


Border Patrol in the ER?
Hospital emergency room admitting clerks would become involuntary agents of the Department of Homeland Security under HR 3722, a bill being proposed by Rep. Dana Rohrabacher (R-Calif). The bill to amend the Medicare Prescription Drug Act of 2003 is still pending, according to a spokesperson in the congressman's office, who declined to answer a reporter's questions about the bill's provisions.
"The hospital then uploads this information into a database that is now being set up by the Department of Health and Human Services and, of course, the Department of Homeland Security," the congressman continued.
"Thus the information that we have collected will become available to the Department of Homeland Security and these other government agencies for national security purposes." The congressman confirmed that the intent is for the information to be used to immediately begin deportation proceedings.
Rohrabacher emphasized that another "very important factor" in this bill is the redefinition of what constitutes a medical "emergency," with the goal of limiting the emergency care that a hospital is required to give undocumented immigrants who are victims of illness or accidents.
Rohrabacher demanded – and received – support from the Republican leadership to get his bill to the House floor last November as the price for his vote in favor of the administration's Medicare bill, according to a Knight Ridder/Tribune report carried by HispanicVista.com.


text:
Safety of Endofeed® DC (endo-1,3(4)-β-gluc...
Safety of Endofeed® DC (endo-1,3(4)-β-glucanase and endo-1,4-β-xylanase) as a feed additive for chickens for fattening, laying hens, pigs for fattening and minor poultry and porcine species
zootechnical additive, digestibility enhancer, endo-1,3(4)-b-glucanase, endo-1,4-bxylanase, safety
First published in the EFSA Journal:
Adopted:
31 March 2017. This version replaces the previous one/s.
Read it on the Wiley Online Library: Article | PDF
Endofeed® DC is a preparation of endo-1,3(4)-β-glucanase and endo-1,4-β-xylanase to be used as a feed additive for chickens for fattening, laying hens, pigs for fattening and minor poultry and porcine species. In a previous assessment, the safety of the additive for the target species, user and environment as well as the efficacy were established. In that assessment, the applicant provided in order to address the safety for the consumer, a bacterial reverse mutation assay and an in vitro micronucleus test, and a subchronic oral toxicity study. However, considering the limitations on the description of the manufacturing process, the characterisation of the additive and on the toxicological studies provided, the Panel could not conclude on the safety for the consumer. The applicant provided new data/information on the manufacturing process, characterisation of the additive and new toxicological studies, to support the safety for the consumer, which was the main subject of this opinion. Complete and detailed information regarding the manufacturing process of the additive, including details on the composition of the intermediate products were provided. With the new information on the manufacturing and on the test items used in the toxicological studies evaluated in 2013, the Panel identified the need for new genotoxicity studies, while confirmed the appropriateness of the test item used in the subchronic oral toxicity study. New genotoxicity studies were submitted by the applicant and the results of the tests showed no genotoxic potential of the test items. The Panel considered that the conclusions drawn in the subchronic oral toxicity study previously submitted can be considered valid; the results showed no evidence for adverse effects. Therefore, the Panel concluded that the additive is safe for the consumers when used as a feed additive.
© European Food Safety Authority, 2017
Panel members at the time of adoption
Gabriele Aquilina, Giovanna Azimonti, Vasileios Bampidis, Maria de Lourdes Bastos, Georges Bories, Andrew Chesson, Pier Sandro Cocconcelli, Gerhard Flachowsky, Jürgen Gropp, Boris Kolar, Maryline Kouba, Marta López-Alonso, Secundino López Puente, Alberto Mantovani, Baltasar Mayo, Fernando Ramos, Guido Rychen, Maria Saarela, Roberto Edoardo Villa, Robert John Wallace and Pieter Wester.
Panel on Additives and Products or Substances used in Animal Feed
feedap [at] efsa.europa.eu
10.2903/j.efsa.2017.4706
EFSA Journal 2017;15(3):4706
Question Number:
EFSA-Q-2014-00504
On request from:


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text:
Inside the Bone Box
by Anthony Ferner
Pub Date: 01 Mar 2021 | Archive Date: 14 Dec 2018
Jeimy G, Educator
Very different from any book I have read before. More than merely the story of an obese surgeon, this is the story of two people disillusioned by life who both escape into unhealthy habits.
Wendi W, Reviewer
This was my third novella from Fairlight Moderns, who granted me a reader's copy.
At least one star for that title, right?? The primary protagonist, Nicholas Anderton, is a brain surgeon and likes to explain that "the skull is like a bone box, with the brain trapped inside."
He and his wife Alyson, however, are each trapped inside their own heads with stress and some amount of grief and terrible events in their family's lives. She turns to alcohol, he turns to food, and neither of them turn to one another.
Only a couple of minor quibbles with this one: sometimes the timeline was quite confusing, wherein it sometimes took me several pages (and in a couple of instances, never) to figure out whether the events described occurred in the current/"live" story or was a flashback. As well, I found the characters (primarily Nicholas and Alyson for a majority of the story) fairly intensely unlikeable and struggled for a while to keep reading.
However, I'm glad that I did. Ultimately, this fascinating (and gruesome, sometimes) story of a dissolving marriage seen through the lens of practicing brain surgeon was just as interesting and engaging as I thought it might be based on the synopsis. I plucked up a couple of mirrored collations that I thoroughly enjoyed; Nicholas/the author described, in opposing terms, food as either really quite disgusting and off putting as he did delicious and savory and compelling. Equally and oppositely described was the brain - either beautiful and mysterious or a chunk of meat easily dissected and discarded.
If you've the patience to suffer through a couple of insufferable characters for a bit, you'll be rewarded with an ultimately lovely story (especially once Sophie shows up).
Melise G, Reviewer
This was a quick and well-written novella. It is the story of a neurosurgeon whose marriage is falling apart. His wife turns to alcohol, while he uses food to soothe his emotional pain. The changes these activities cause in their behavior in turn wreak more damage to their relationship, in a sad downward spiral. His continued weight gain eventually causes him to have trouble performing his job, and he has to stop.
Unfortunately this book was not one of my favorites. As mentioned earlier, I thought it was quite well-written, and I thought the author did a really good job of describing that emotional experience that comes when you realize that you have a certain vision of yourself, but that is no longer the way you are perceived by those around you...a situation that I think is probably endemic to reaching middle age.
However, I was surprised when I came to the end of this book (something that only really happens with ebooks), feeling as if the book itself is only be partially complete. It is a familiar experience for me...one that I feel after reading the majority of short stories in The New Yorker magazine, or in many literary (read non-genre) short story collections. I feel that there is a style of short story that focuses on describing an experience, or an emotional revelation, and that is the sole purpose of the story. I am never satisfied by this type of story...I always feel a bit as if I was having some sort of very vivid hallucination that is suddenly cut short, leaving me wondering what I just experienced.
That's a bit how I felt reading this book, and so it was not among my favorites. But, if you like this type of literary storytelling, i think the quality of writing, and the carefully described breakdown of this marriage is wel, worth your time.
Anne M, Reviewer
Ruminations and torments of a brain surgeon
Nick Anderton is fighting to stay on top of the game as a neurosurgeon. His morbid obesity is raising serious questions about his professional abilities. His demons are rivals in his profession, being locked into a toxic marriage with his acerbic lawyer wife and, last not least, the "bone box": This container of all that makes us an individual being, its fragile contents being an often unpredictable mix of neurons, blood vessels and tumours. In part human struggle, in part phylosophical treatise about surgeons in general, it is a blindingly candid view of a brain surgeon's tribulations, torn between self-doubt and cockiness. But the bone box is also the prison that obese Nick and his alcoholic wife Alyson have build for themselves, that makes them react to trauma, grief and indifference in a car-crash way of cohabiting. Very thoroughly researched and very powerfully written, but one star less for intimating that weight loss will solve all your problems.
Barbara M, Reviewer
I enjoyed this book for the writing, especially the little medical bits, and for the characters. I was put off by what felt was some pretty serious exageration of what it is like to be as obese as the main character. While the main character and his wife's feelings about his obesity are fairly believable, I can't help wonder if the author is perpetuating some harmful ideas about obesity and whether he truly believes something like weight loss surgery would solve all a persons problems.
Elizabeth D, Educator
The Anderton's are two professionals that society tends to look up to, a doctor and a lawyer. However, in this story, the doctor is morbidly obese, and the lawyer is an alcoholic.  INSIDE THE BONE BOX is a unique novella describing the most private and painful aspects of Nicholas and Alyson Anderton's lives.
The apparent issue is Nicholas's morbid obesity.  He is a surgeon who needs to be clear-headed and physically active to perform the long, delicate brain surgeries he specializes in, but Nicholas has trouble walking from his car to the operating theater. Nicholas is still able to function with his team giving him their full support.  At home, the support level is entirely different Alyson is disgusted with how Nicholas looks and the lack of attention he gives to anyone but himself and his food.  Their two children are loving but barely hanging on with two dysfunctional parents.
A crisis takes the novel to its beautiful denouement, and I applaud this expertly told story of life in that part of society we think is perfect.  There is no perfection, we all live with a struggle.  The critical factor is how we handle those struggles.
Thank you, NetGalley and the publisher for the opportunity to read this E-ARC.
Kate V, Reviewer
Nicholas Anderton is a successful neurosurgeon, married to a lawyer, with two adult children. But he is also grappling with obesity after a series of crises in his personal and professional life. Now, his weight is threatening his ability to do his job. His wife, Alyson, is not inclined to be supportive and is dealing with issues of her own.
Nicholas is a complex and contradictory character. He is an accomplished neurosurgeon but has little time for philosophical discussions on the nature of the mind, preferring to see himself as more like his butcher father – good with his hands, with an instinctive understanding of anatomy. He has succeeded in a profession that requires great discipline and stamina but he is unable to stop himself from eating.
The story is told in alternating chapters from Nicholas and Alyson, though we only see Alyson at home, and hear about her life as it relates to her husband. Perhaps this reflects how Nicholas sees her, his curiosity limited to how she affects him.
Nicholas spends his day looking deep into the brains of others but his own remains mysterious to him. How far are we shaped by our minds, and how far by the confines of our body?
This slim novel asks some big questions, with compassion, wry humour and elegant, understated prose.
Noel M, Reviewer
Anthony Ferner's intense little novella is somewhat domestic in nature, exploring the deep feelings that run between a married couple. Those feelings are mostly hate and contempt, which might make Inside the Bone Box sound like an unpleasant but common experience, but Ferner's vivid writing and insightful ability to get 'inside the bone box', explores the deeper sentiments that lie behind the ruins of Nick and Alyson's marriage. Nick and Alyson might hate each other, but there's reason to believe that they hate themselves even more.
Nick Anderton is an eminent and well-respected neurosurgeon, but he is grossly overweight and aware that his health problems could start to have an impact on his ability to handle the delicate nature of his work and potentially lead to mistakes in the operating theatre. And indeed there already have been mistakes and indications that he could lose his position at the hospital and his licence to operate unless he takes steps to resolve his problem. He's thinking of going for an operation to insert a gastric band.
Nick's wife, Alyson has her own issues to worry about. She feels she has underperformed in her career as a lawyer and is dealing with her professional and personal problems by drinking heavily. She has even driven when drunk and recently knocked a man off his bike. Both she and Nick suffer nightmares, and their relationship with their children Ben and Sophie is difficult. They direct vicious barbs at each other at every opportunity, blaming the other for their condition, which is easier than facing up to their own failings.
As Nick's detailed observations on the nature of his neurosurgical work, Inside the Bone Box is about the fragility of the human body and the human spirit. It's about finding ways of coping with our personal flaws, issues and problems, and Ferner's writing finds several interesting ways of expressing that, never allowing his characters to wallow in self-abasement and become unsympathetic, but expressing their feelings in calm, measured prose that bristles with spikes of insightful observation as much as self-hatred.
As you might expect from the title, Inside the Bone Box also has recourse to plentiful metaphors on brain surgery as a way to express the nature of Nick and Alyson's condition and their marriage; a tumour that if you attempt to cut out the malignant parts, risks damaging good tissue. But there are also other more esoteric metaphysical questions considered on behaviour, whether we are at the mercy of chemical brain reactions or whether we truly have free will. But more than anything, Inside the Bone Box is a very human story, insightful in its observations, finding a humanity buried deep down in Nick and Alyson that you can't help but find warm and compelling.
Jennifer C, Reviewer
'He walked slowly; any kind of exercise seemed a form of expiation.'
Nicholas Anderton is a consultant neurosurgeon.  He is morbidly obese and although he's largely been able to ignore the impact of his obesity on his marriage, he can't ignore the limitations it's starting to impose on his professional life.
'Operating was now the only thing, other than eating, that gave him a sense of purpose and identity, and if he continued to gain weight, he'd sooner or later be unable to continue.'
Nicholas is married to Alyson, a lawyer.  Alyson, who despises him for his weight gain, has an alcohol addiction.  Two unhappy people, each with addiction issues, each with security issues, each blaming each other (and others) for the problems they have.  Both Nicholas and Alyson are aware that change is needed, and while they work towards the what and the how, they reflect on the past.
It's cleverly done.  Mr Ferner alternates chapters between Nicholas and Alyson.  Nicholas's chapters draw their titles from events or memories largely external to Nicholas but in which he participates, while Alyson's chapters have only her name. Nicholas as observer, perhaps, while Alyson is kept focussed by her anger.  Neither character is particularly likeable, but both are recognisable.  Each addicted to self-destructive behaviour, each aware of the risks.  Who knows what really goes on 'inside the bone box?'  Nicholas can explain, from a neurological perspective, how the brain works.  Alyson can explain how she feels but I doubt that either could explain their own behaviour. Each is imprisoned by a mixture of emotion and addictive response.
But just as I begin to think that neither Nicholas nor Alyson will be able to step back from their personal abysses, there is a glimmer of hope.  A possibility that all is not lost.
Note: My thanks to NetGalley and Fairlight Books for providing me with a free electronic copy of this book for review purposes.   Thanks also to The Idle Woman, whose review intrigued me and led me to request this title.
Jennifer Cameron-Smith
Franco V, Librarian
It's nice to see literary fiction being marketed for busy people, but this one is not all that interesting and reads a bit like the down market slop that often tops bestseller charts.
Elizabeth S, Reviewer
Nicholas Anderton is a neurosurgeon whose weight is becoming a threat to both his job and his marriage, this novella follows Nick as he reaches the pivotal moment of his professional capacity being questioned.   Each chapter alternates between the perspectives of Nick and that of his wife Alyson; and are either a continuation of the present or a flashback to an earlier point in their career or marriage which gives you a great picture of how the couple have got to where they are; one of my favourite things was how realistic these two characters in particular were, they're both flawed and while they do identify those flaws in themselves they're doing what most people do which is pretend is a much smaller problem than it is.  I think the book challenges a difficult topic to talk about, being set in the UK where obesity is continually becoming more of an issue the challenges Nick faces in the book must be a harsh reality for some and it's great that it's not shying away from things like this.   I gave this three stars as I thought a couple of chapters were a bit disjointed from the overall plot and I didn't get that 'must keep reading' feeling.
The Idle Woman ., Reviewer
In this day and age, with independent bookshops and small publishers closing in swathes, it's a joy to hear of a newly-founded enterprise: Fairlight Books in Oxford. At one year old, they're just about to release a series of five novellas in their Fairlight Moderns series and I was delighted to have a sneak peek. I decided to start with Inside the Bone Box, because it focused on a doctor and that appealed in the wake of Adam Kay's diaries. It's the story of consultant neurosurgeon Nicholas Anderton, whose burgeoning obesity has already threatened his marriage and now raises very serious questions about his professional capabilities. Meanwhile his wife, Alyson, has her own demons to fight. It soon becomes clear that the 'bone box' of the title isn't just the skull, within which the brain-self resides, but also the prisons we build for ourselves, trapping ourselves within excess flesh or addictions.
The story is about surgery, of course, and there are several intriguing accounts of operations on the brain, which fascinated me because it's something I know nothing about and neuroscience still has an almost mystical quality for me. Ferner has done a phenomenal amount of research into brain surgery and writes with an authority which completely convinced me, as a layman. Yet there's another kind of surgery in the novella as well: the diagnosis and (premature) autopsy of Nick's and Alyson's marriage: its current failings arising from the issues of the past, and the petty spite of a union dragged through the wringer by infidelity, trauma and growing indifference. It's a story about how we present ourselves to others, and the grief that arises when there's too great a gulf between others' understanding of ourselves and what we feel to be our true natures.
Neither Nick nor Alyson are particularly pleasant people. They have both done terrible things, to themselves and to others, and yet they feel gut-wrenchingly believable. You feel that you might well know couples like this: two deeply mismatched people, who are nevertheless trapped by the bond of long cohabitation. They've both allowed stress or unhappiness to goad them into unhealthy behaviours: now Nick finds that everyday tasks grow harder as his girth expands, layering tiers of fat around his body which make it hard for him to see certain parts of his anatomy, let alone use them. Alyson has come to rely on alcohol, which gives her the sense of gaining control over her brittle, unhappy emotions while also undoing her physical self-control. Neither of them are healthy; but dare they admit it? Dare they combat it? If they tried to change, how would this affect their identity? What would existence be without the pleasures of good food or good wine, which make up for the dismal lack of joy elsewhere in their lives - never mind that their pleasures might be slowly be killing them along the way?
The novella alternates chapters between Nick's and Alyson's perspectives: I thought it interesting that Nick's are given fragmentary titles excised from the text of the chapters, while Alyson's are only ever titled with her name. We see Nick out in the world: at foreign conferences; at work in the hospital; dining expansively in a favourite restaurant. But we also only ever see Alyson at home, trapped within the confines of the walls, aggressively nursing her habitual glass of wine. I don't know to what degree this was deliberate, but it gives extra force to Alyson's sense of being belittled, ignored and overlooked, even though we're told that she has a (presumably demanding) job as a solicitor. It also emphasises the claustrophobia of her chapters, a tight and tensely-wound anxiety, which goes well with her nervous alcoholism.
I really enjoyed Ferner's flair as a writer. He can give you a strong picture of a character in just a sentence or two of elegant prose, and combines precision with just the right amount of ornamentation. Predicated on questions of identity and the loss thereof - through brain damage, perhaps, or the renunciation of a quality that we feel defines us - it's a little book that packs a punch far greater than its size.
I can't wait to dive into the rest of Fairlight's new releases, so watch this space...
For the review, please see my blog:
https://theidlewoman.net/2018/06/13/inside-the-bone-box-anthony-ferner/
Maria S, Reviewer
This book is different from anything I've read recently and I loved it. I adored the whole world the author created around the hero being a neurosurgeon, how operating patients' brains is so much part of himself and so much ingrained in himself that his actions and how he sees life and the world are completely contaminated by his craft.
Nicholas Anderton, an almost fifty-year-old British doctor, is not your typical hero. He could be handsome but he's too fat, and and perhaps a bit to be appealing. Yet, the author's candid and rational approach to the harsh realities of neurosurgery successes and failures and his passion about it make him a rather honest, matter-of-fact and attractive character, in spite of all his non-romantic features.
His relation with his obesity and with food is amazingly explored. I found this part a bit hard to read sometimes, because of its crude authenticity. The realities of the operating room are also realistically depicted here but somehow that didn't shock me as much, perhaps because of some familiarity with it. And all these dimensions seem very well researched and put together, creating an engaging story.


This is the second segment of a fairly comprehensive list of allegedly haunted libraries, or at least ones where patrons, staff, or local folklorists have associated with paranormal happenings. Most often the manifestations involve odd noises, cold spots, or objects moved; other times a visual apparition is reported. In many cases, phenomena can be attributed to the sights, the sounds, and the aura of a historic building. But if I've missed anything, or my lists need correction and even updating, please send along your comments and suggestions. The paranormal demands precision!
Miami, Southwest Miami Senior High School. Books in the media center are often rearranged and the lights flicker.
Tampa, Howard W. Blake High School. A cold spot can be felt around the tables in the back of the library.
West Palm Beach, Palm Beach Atlantic University library. A janitor who disappeared mysteriously haunts the library near an old janitor's closet.
Cairo, A. B. Safford Memorial Library. A ghost nicknamed Toby reportedly hangs out in the special collections room on the second floor of this 1884 building. "I'm here a lot of times by myself at night, and I do hear many different sounds like someone walking around upstairs," director Monica Smith said. "Many times I come back and find the lights on that we turned off in that room. I definitely think there is a presence there." Former librarian Louise Ogg and another staffer once saw a ghostly light rise up from behind a desk, pass slowly by her office, and disappear into the book stacks. There used to be a rocking chair in the library that made creaking noises by itself, as if someone were rocking it. "You kinda get used to it," Smith said.
Decatur, Millikin University, Gorin Library. A room in the basement is supposed to be haunted by a maintenance worker who was accidentally killed there.
Godfrey, Lewis and Clark Community College, Reid Memorial Library. This institution started life in 1838 as Monticello College. Harriet Haskell, an ardent feminist who directed the college from 1868 to 1912, haunts the library that stands on the spot of a former chapel. One incident in the 1970s involved a young librarian who felt a hand touch her on the shoulder blade. She was so scared that she closed the library and left. Two prominent cold spots have been noticed in the reading room.
McHenry, McHenry East High School. The library metal detectors go off for no reason on the last day of the school year.
Normal, Illinois State University, Williams Hall. The ghost of ISU's first librarian, Angie Milner (d. 1928), has been seen by several faculty, staff, and students. Archives Specialist Jo Rayfield sensed a "kind, gentle" presence one day while looking at microfilm. Others have reported cold spots, a white figure, and books restacked in an odd fashion. The building is used for the Illinois Regional Archives Depository and stores infrequently used books owned by the Milner Library (named after Angie).
Peoria Public Library. Mrs. Andrew Gray, who owned the land where the library now stands, uttered a curse in 1847 that allegedly resulted in the untimely deaths of three library directors in the early 20th century. The first was killed in a streetcar accident in 1915, and the second died from a heart attack suffered after a heated debate at a library board meeting in 1921. Ever since 1924 when the third committed suicide by swallowing arsenic, Peoria library directors have lived long, fruitful lives. Employees have allegedly seen ghostly faces in the basement.
Peru Washington School. A disturbed school librarian supposedly killed three students and herself April 12, 1956, in the library. Since then, students have reported hearing screams and seeing an apparition.
Evansville, Willard Library. A "lady in gray" has been seen in this 1884 Victorian Gothic building since 1937. The specter sports a scent of perfume that is often sensed near the elevator, near the rest rooms, or in the children's room. Occasionally staff will walk into cold spots. Former Director William Goodrich said the lady appeared once on a security monitor placed near the rest rooms. One theory is that the ghost is Louise Carpenter, the daughter of the library's founder. Louise once sued the library's trustees, claiming that her father was "of unsound mind and was unduly influenced in establishing [Willard] Library." She lost the suit and, as a result, her claim to any of the library's property. The Evansville Courier and Press set up three ghostcams in the research room, the children's room, and the basement; images can be examined at www.willardghost.com.
Fort Wayne, University of Saint Francis Library, Bass Mansion. A student suicide is said to be the source of cold spots and occasional apparitions.
Greencastle, DePauw University, Roy O. West Library. An old story has the ghost of James Whitcomb, Indiana's governor from 1843 to 1848, appearing to students who took home books that he had donated to the library.
Madison–Jefferson County Public Library. Women riding the elevator sometimes find themselves patted or caressed. A young man confined to a wheelchair is said to have lived in the Powell residence before the library moved to the site in 1930. The ghost has been nicknamed Charlie.
North Webster Elementary School. A young boy wearing khakis and a blue sweater is sometimes seen in the library trying to check out books.
Poseyville Carnegie Public Library. After the town expanded and rededicated this 1905 building in 2000, staff and volunteers began to feel that someone was watching them. Several staffers also reported sounds like someone was entering the building when the door was locked, though no one could be seen on the security camera. Library Assistant Sheryl Taylor was the first to see the ghost in the winter of 2001, a matronly woman surrounded by a hazy mist. The four computers in the old Carnegie section are always having problems, while those in the new section behave perfectly.
Cedar Rapids Art Museum. Prior to 1985 this building housed the Cedar Rapids Public Library. An apparent case of "crisis apparition" occurred sometime in the late 1960s when a longtime patron was seen in the library shortly after she had died in a fire.
Cedar Rapids, Brucemore Mansion. Strange groans and laughter can be heard and objects move by themselves in the library of this 1886 home.
Council Bluffs, Union Pacific Railroad Museum. A 1903 Carnegie library until taken over and renovated by the museum in 1998, this building's basement was supposed to be haunted. Books would fly off the shelves, items disappeared, and people saw shadowy figures.
Dodge City, Soule Intermediate Center. The library of this former high school used to be haunted by the ghost of a student who died in the school.
Hutchinson Public Library. The ghost of Ida Day Holzapfel, head librarian from 1915 to 1925 and 1947 to 1954, has been seen and heard since her death in California in 1954, according to the October 31, 1975, Hutchinson News. Library staffer Rose Hale said she saw a lady standing below the stairs one day. She did not know the woman's name, but when she described the woman to another library employee, Hale was told she had just described Ida Day. Other employees claim to have heard footsteps in the basement, and it became a shared joke that whenever anything was misplaced or missing, Ida Day took it. The stacks area in the southwest corner of the basement is notorious for cold spots, disembodied voices, and hazy apparitions.
Bowling Green, Western Kentucky University, Helm Library. A student who fell to his death while trying to open a window on the ninth floor is said to haunt the library.
Owensboro, Daviess County Public Library. The library hosts the apparition of a young boy with high red knee socks, a red vest, high shorts, and other clothing that seems to date from the 1920s or 1930s.
Eliot, William Fogg Library. A newspaper photo apparently shows a transparent skull floating above a staircase.
Elkton, Old Library. This was the Cecil County Public Library from 1955 until the early 1990s. The Cecil County Historical Society occupies part of the space now. Former Mayor Henry Hooper Mitchell, who bought this building in 1925, haunts it and makes items move around or disappear.
Ellicott City, Howard County Law Library, Hayden House. Built in 1840 by the first county clerk, Edwin Parsons Hayden, this small building was part of the Howard County District Court complex in the 1970s. Former Judge J. Thomas Nissel said his secretary used to come to work early in the morning and smell eggs, toast, and bacon cooking, although there were no kitchen facilities. A rocking chair in the offices of the Department of Parole and Probation kept rocking on its own. The house was renovated before the library moved in, and the phenomena have apparently ceased.
This information can also be found in my Whole Library Handbook 4: Current Data, Professional Advice, and Curiosa about Libraries and Library Services, published by the American Library Association in 2006.


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