Background: Chronic inflammatory demyelinating polyradiculoneuropathies (CIDP) is a rare, acquired polyneuropathy, especially in children, affecting the peripheral nervous system. It most commonly presents in a symmetric, proximal and distal, sensorimotor fashion. Immunosuppression and immunomanipulation are treatment modalities. We present a case of a 14 year old male with severe progressive CIDP who became refractory to steroid and IVIg but responded to Rituximab. Methods: Case presentation: A 14-year-old male with a history of asymmetric quadriparesis was diagnosed with CIDP. He had an initial partial response to IVIG and prednisone but then rapidly became refractory to even weekly IVIG and prednisone. Rituximab was therefore started. Results: Within 12 weeks his strength improved from quadriplegia to walker-assisted gait. By 22 weeks he achieved independent ambulation. His JAMAR hand grip increased from 0 to 28 kg. His worst recordable median conduction velocity (CV) improved from a nadir (MRC 0/5) of 14% of normal to 52% at full recovery (MRC 5/5). Conclusions: This case highlights several important clinical points. Dramatic improvement is possible in cases of quadriplegic CIDP. Strength recovery is not linearly related to CV recovery. There appears to be a role for polytherapy.

Background: The lateral prefrontal cortex (LPFC) is uniquely found in primates and has been associated with contextual learning. This function is thought to be subserved by neurons that are tuned to abstract concepts and the combination of those concepts. LPFC neuron tuning remains to be fully investigated in naturalistic conditions. Methods: Two macaques were trained to perform a context-colour association task while using a joystick to navigate in an X-shaped maze. They were implanted with two 96-channel microelectrode arrays, targeting the LPFC. Mean firing rates were computed and multivariate linear regressions were used to determine tuning. Results: LPFC neurons were tuned to context (12.4%), color position (6.2%), target side (17.2%), and were selective to more than one feature (21.2%). LPFC neurons acquired tuning to task features in an ordered manner, starting with context (130.1±27.4ms), followed by the colour position (296.2±21.4ms) and then target side (493.3±19.3ms). Furthermore, most neurons (54%) changed their tuning over time. Conclusions: We demonstrate that single neurons can encode relevant features embedded in a naturalistic virtual environment. Our results support previous observations that LPFC neurons combine individual features and suggest that these features are also combined temporally. These findings contribute towards understanding the LPFC and have potential practical implications.

Background: We tested the hypothesis that delivering remote ischemic conditioning (RIC) with an adjunct tissue reflectance sensor (TRS) device may be feasible in patients with acute ischemic stroke (AIS) and cerebral small vessel disease (cSVD). Methods: AIS patients with neurological deficits within 7 days of symptom onset were screened for moderate to severe cSVD. Eligible patients were randomized 2:1 to receive intervention RIC or sham RIC (7 days). The primary outcome measure was intervention feasibility. It was assessed as an intervention-related comfort by a 5-point Likert scale during each session (1-very uncomfortable, 5-very comfortable). The secondary outcome measure was assessment of TRS derived dermal blood concentration and blood oxygenation changes during RIC. Results: Forty-seven (32 intervention, 15 sham) patients were enrolled at a median (IQR) 39.7 (25-64) hours after symptom onset, with mean±SD age of 75±12 years, 22 (46.8%) were females and median baseline NIHSS of 5(3-7). The Likert scale was 3.5 (3-4) in the intervention group and 4 (4-5) in the sham group. The TRS derived blood concentration and blood oxygenation changes were proportionate in the intervention arm and absent in the sham arm. Conclusions: RIC treatment with TRS is feasible in patients with AIS+cSVD. The efficacy of RIC needs further assessment.

Background: Frontotemporal dementia (FTD) often presents with varying neuropsychiatric symptoms (NPS), which may differ based on genetic mutations. We hypothesized distinct NPS trajectories in FTD progression among carriers of chromosome 9 open reading frame 72 (C9orf72), progranulin (GRN), and microtubule-associated protein tau (MAPT) mutations. Methods: We analyzed 1662 participants from ALLFTD, including 342 C9orf72, 148 GRN, 168 MAPT mutation carriers, and 1004 noncarriers. We categorized participants into four stages based on CDR plus NACC FTLD global scores: 1) Presymptomatic (consistent CDR=0), 2) Early conversion (CDR increasing from 0 to 0.5), 3) Advanced conversion (CDR increasing from 0.5 to ≥1.0), and 4) Symptomatic (CDR>1.0). The Neuropsychiatric Inventory-Questionnaire (NPI-Q) assessed NPS changes, analyzed using a mixed-effects model, accounting for age and baseline scores. Results: Our results indicated similar NPS trajectories in the presymptomatic stage for all groups. Notably, during early conversion, C9orf72 and GRN carriers exhibited significantly higher NPI-Q score increases than MAPT carriers, primarily in psychosis and hyperactivity domains. In later stages, increases in NPS were similar across groups. Conclusions: This study suggests familial FTD progression, particularly in TDP-43 pathology, may involve more severe NPS like psychosis or hyperactivity, differing from tau pathology or sporadic FTD. Further research is needed to explore these distinct trajectories.

Background: Electrophysiological tests such as the tapping test are used to distinguish functional and organic tremors, in which patients with functional tremor commonly show entrainment and amplitude reduction (>50% decrease relative to baseline) of contralateral tremor during tapping. While these features are suggested to be specific to functional tremor, the tapping test in Parkinson’s disease (PD) tremor has not been tested. Methods: We evaluated 18 PD patients (2F, age 64.17±7.30 [mean±SD] years) with rest and postural tremors using surface electromyography and triaxial accelerometry. Patients were recorded while tapping at 1, 3 and 5 Hz with the contralateral arm at rest or outstretched. Tremor amplitude and frequency were calculated using power spectrum analysis from accelerometer recordings. Results: Reduction of rest tremor amplitude was observed in 3/18 patients during 1 and 3 Hz tapping. Reduction was seen in 3/16 and 1/16 patients with postural tremors at 1 and 3 Hz tapping, respectively. Frequency shifts (>1.5 Hz) were observed in 3/18 rest tremors and 6/16 postural tremors. Seven patients exhibited rest and/or postural tremor entrainment during 3 or 5 Hz tapping. Conclusions: Distractibility and entrainment can be found in PD tremor. The tapping test may not reliably distinguish between PD tremor and functional tremor.

Background: Pituitary apoplexy is a rare clinical syndrome resulting from infarction or hemorrhage of a pituitary tumor. Here, we present a large single center retrospective cohort study of patients with apoplexy. Methods: Patients with symptomatic apoplexy treated from January 2000 to October 2022 were isolated from the Halifax Neuropituitary Program’s database, containing prospectively entered data. Patients treated surgically typically presented with vision deterioration or decreased consciousness. Patient demographics, tumor size, endocrinologic values, and clinical outcomes were analyzed. Results: Eighty-three patients met our inclusion criteria. Seventy-two percent of tumours (n=60) were biochemically non-functioning adenomas. Sixty (72.3%) patients were treated surgically, while twenty-three (27.7%) were treated conservatively. At time of presentation, patients treated surgically had a tumor size in maximum dimension of 2.7±1.4 cm versus 1.6±0.5 cm for those treated conservatively (p=0.0003). There were no significant differences in endocrinological values at time of presentation between groups. Fifteen percent (n=9) of patients treated surgically underwent an additional surgery (mean 2.8±2.0 years from index), of which 67% (n=6) were secondary to tumor recurrence. Conclusions: This is one of the largest reported series of apoplexy with long-term follow up. A subset of surgically treated patients will require additional intervention, highlighting the importance of ongoing follow up in this population.

Background: Quality of life (QoL) is the awareness of individuals’ well-being in life in physical, personal, mental and social wellbeing and needs to be addressed in brain tumor patients. Methods: A retrospective study conducted in 2017 in a single academic center that included patients diagnosed with brain tumors in a 10 year period. The assessment of the QoL was done using the European Organization for Research and Treatment of Cancer (EORTC), a standardized model (QLQ-C30) that assess several domains (Global Health, Physical function, Role functioning, Emotional Functioning, Cognitive functioning, social functioning and symptoms domain) and Brain cancer model (BN20) to assess symptoms to evaluate all aspects of wellbeing. Results: The total number of patients included in this study is 76 patients with no gender predilection. The most common brain tumor was meningioma by 40% followed by glioma/ others. More than half of the brain tumor patients had a WHO grade I (65%), intermediate grading grade II (15%) and higher grading grade III/IV (20%). The scales and measurements of functioning in life were low in all types of brain tumors. Conclusions: Quality of life in brain tumor patients seemed poor regardless of the type. Further prospective studies are needed to assess QoL worldwide.

Background: Meningiomas have significant heterogeneity between patients, making prognostication challenging. For this study, we prospectively validate the prognostic capabilities of a DNA methylation-based predictor and multiomic molecular groups (MG) of meningiomas. Methods: DNA methylation profiles were generated using the Illumina EPICarray. MG were assigned as previously published. Performance of our methylation-based predictor and MG were compared with WHO grade using generalized boosted regression modeling by generating time-dependent receiver operating characteristic (ROC) curves and computing area under the ROC curves (AUCs) along with their 95% confidence interval using bootstrap resampling. Results: 295 meningiomas treated from 2018-2021 were included. Methylation-defined high-risk meningiomas had significantly poorer PFS and OS compared to low-risk cases (p<0.0001). Methylation risk increased with higher WHO grade and MG. Higher methylome risk (HR 4.89, 95%CI 2.02-11.82) and proliferative MG (HR 4.11, 95%CI 1.29-13.06) were associated with significantly worse PFS independent of WHO grade, extent of resection, and adjuvant RT. Both methylome-risk and MG classification predicted 3- and 5-year PFS and OS more accurately than WHO grade alone (ΔAUC=0.10-0.23). 42 cases were prescribed adjuvant RT prospectively although RT did not significantly improve PFS in high-risk cases (p=0.41). Conclusions: Molecular profiling outperforms conventional WHO grading for prognostication in an independent, prospectively collected cohort of meningiomas.

Background: People with epilepsy experience higher rates of cardiac arrhythmia and sudden death than the general population, with the highest risk in genetic epilepsies. Despite growing evidence of a possible cardiac contribution, routine cardiac screening for epilepsy patients is rarely performed. Methods: We performed a single center, retrospective review of patients with developmental epileptic encephalopathies caused by genetic variants expressed in the heart and brain. Clinical history, medications, age, and cardiac evaluation data were extracted. Results: Among 67 patients (56% female), 54 (81%) had at least one ECG. Twenty (37%) had an abnormal ECG. Forty-one had a repeat ECG: 8 showed persistent abnormalities, 7 resolution of abnormalities, and 7 a new abnormality. Five patients with an abnormality did not receive a follow up ECG. Two patients each had histories of cardiac arrest, syncope, and sudden death in a family member. Cardiac phenotypes differed in patients who experienced generalized tonic-clonic seizures and patients with epilepsy for 3+ years. Conclusions: Almost 1/3 of our high-risk epilepsy cohort had history of cardiac events or abnormalities on cardiac testing. Seizure type and epilepsy duration were associated with altered cardiac phenotypes. Since some findings were potentially clinically significant, routine cardiac screening of high-risk epilepsy patients may be warranted.

In this paper, we investigate the twisted GGP conjecture for certain tempered representations using the theta correspondence and establish some special cases, namely when the L-parameter of the unitary group is the sum of conjugate-dual characters of the appropriate sign.

This article begins by outlining the changing approach in Anglican attitudes to contraception at the Lambeth Conference of 1930, where birth control was permitted for married couples and sex separated from the possibility of procreation. The logical extension of this teaching, as was noted by Bishop Charles Gore, was that other forms of sexual pleasure, including homosexuality, which was increasingly seen as a ‘natural’ condition, might eventually be sanctioned by the church. Later in the 1930s, a series of letters by Robert Reid to Cosmo Gordon Lang, archbishop of Canterbury, shows the beginnings of a campaign for a change of policy. At the outbreak of the Second World War, the Anglican writer Kenneth Ingram published Sex-Morality Tomorrow, which pressed for full homosexual equality and provoked calls to William Temple to suppress the book. 1940 proved an inopportune moment for reform of church teaching on homosexuality, which continues to elicit widespread controversy.

Seventeenth-century British preachers persistently defined hypocrisy in contrast to its divine antidote: sincerity. This article looks at four such case studies from across the ‘puritan’-‘Anglican’ divide, analysing the sermons of the Independent Nicholas Lockyer, the Presbyterian Christopher Love, the Church of England clergyman James Oldfield, and the archbishop of Canterbury John Tillotson. It considers to what extent Protestant instruction on sincerity and hypocrisy shifted according to religious affiliation and socio-political context, arguing that although these sermons possessed considerable continuities in their theological underpinnings, they also exhibited divergences in focus and instruction that are sometimes, but not always, predictable along denominational lines. These differences held weighty implications for the individual receiving spiritual guidance on how to forswear hypocrisy and live a truly sincere life, particularly throughout the period of instability and contention that marked Britain from the Civil Wars to the Glorious Revolution.

The article argues that the post-Tridentine papacy was more focused on maintaining its own centrality than on implementing the reforms established by the Council of Trent. It shows that the Roman Curia often undermined its own bishops and interfered with their efforts to reform their dioceses. This practice – which might be perceived as hypocritical by us and was viewed as such by some contemporary commentators – was seen as justified by the baroque political virtue of ‘prudence’, and the idea of bishops being the conscience keepers of their dioceses. The article, in pondering the theme of hypocrisy, explores the work of the Sacred Congregation of Bishops and Regulars, which was responsible for overseeing the episcopate and religious orders. It uses previously unnoticed sources from the Bodleian Library in Oxford to show how the Congregation operated and how it perceived its role in defending the rights of the church and its clergy.

Thomas Aquinas and most Christian theologians after him asserted that it is improper to attribute hatred to God. In 1598 the Jesuit theologian Gabriel Vázquez intrepidly argued that God can hate – not only with hatred of abomination but also with inimical hatred. Vázquez's surprising innovation is best explained in the context of the theological disputes between Jesuits and Dominicans on justification. Specifically, Vázquez is elaborating on the idea found in the Council of Trent that justification is a transition from enmity to friendship requiring a real change in the person being justified. He did so to counter views among Dominican theologians that this interior renewal could be in some way operated by God from the outside by way of a reconceptualisation of the sinner or a reevaluation of the value of his meritorious actions. These polemics drove Vázquez to rely on a robust, realist picture of friendship, based on the idea that affections must fit real qualities.

Tra il 2019 e il 2022 un nuovo programma di ricerche nell'area monumentale di Tusculum è stato dedicato all'indagine del versante sud-orientale della piazza forense, occupato dalla basilica di epoca imperiale e da un edificio la cui interpretazione è da lungo tempo incerta. Le indagini archeologiche hanno consentito di acquisire dati di rilevante interesse ai fini della ricostruzione delle fasi di occupazione di questo settore della città e sulla successione dei monumenti che qui furono edificati nel corso del tempo. Tra le scoperte effettuate spicca un gruppo di frammenti pertinenti a un apparato architettonico in stucco policromo caratterizzato dalla presenza di capitelli corinzieggianti di tipo figurato. Lo stato di conservazione e le caratteristiche tecniche e stilistiche di tali materiali, consentono di sviluppare alcune riflessioni sul contesto monumentale cui essi appartenevano e l'orizzonte storico-culturale entro il quale questo sistema decorativo venne realizzato. In questo contributo, dunque, proponiamo un'analisi tecnica e stilistico-formale di questi reperti, un tentativo di ricomposizione dello schema architettonico che essi componevano e un'ipotesi di attribuzione di quest'ultimo a uno degli edifici più dibattuti del foro tuscolano, il cosiddetto “Edificio porticato”. L'esame del contesto stratigrafico di provenienza dei reperti e la ricomposizione dell'impianto del monumento sulla base dei dati archeologici aprono nuove prospettive per la conoscenza della più antica basilica tuscolana.

This volume aims to explore the concepts of hypocrisy and dissimulation, conceived in the framework of the ‘tensions at the heart of Christian teaching and experience’. This tension primarily points towards a conflict between ideal and lived practice; however, in certain circumstances, dissimulation and deceit might be understood as legitimate responses to a given situation. This article examines significant aspects of dissimulation in the specific case of early modern missions in China and Japan at the end of the sixteenth and throughout the seventeenth century, where missionaries often had to resort to disguise and concealment. Many of them had to overcome immense difficulties just to enter the country; some had to evangelize in secret, living in constant fear and facing ongoing persecution. In these territories, the ‘policy of deceit’ therefore became a relevant part of the proselytizing enterprise. I examine these practices of dissimulation with regard to evangelization strategies, and relate them to the sincerity and the confession of the faith, two of the central problems of the Christian credo. I argue that dissimulation was perceived, by the missionaries, as a legitimate and tactical response to the challenging and complex circumstances of the Japanese and Chinese missions in this period.

With the growing prevalence of AI tools, such as ChatGPT, political science instructors are navigating how to manage the use and misuse of AI in the classroom. This study underscores the prevalence of AI in academic settings and suggests pedagogical practices to integrate AI in the classroom in ways that are informed by students’ current interactions with and attitudes toward AI. Using a survey of undergraduate students in political science courses, the study finds that ChatGPT usage is widespread at the university level and that students are not confident in their skills for using AI appropriately to improve their writing or prepare for exams. These findings point to key areas where instructors can intervene and integrate AI in ways that enhance student learning, reduce potential achievement gaps that may emerge due to differences in AI usage across student backgrounds, and help students develop critical AI literacy skills to prepare for careers that increasingly are affected by AI.