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Historically, it has been proposed that functional neurological symptoms occur more frequently on the left side of the body due to a distinct body representation and emotional processing of the right hemisphere, yet objective imaging data to support this are lacking. We aimed to investigate whether patients with acute left-sided symptoms (right hemisphere) suspected of having a minor stroke are more likely to show negative diffusion-weighted imaging (DWI) compared to those with right-sided symptoms.
Methods:
Data are from the SpecTRA (Spectrometry for Transient Ischemic Attack Rapid Assessment) multicenter prospective cohort study conducted between 2013 and 2017. Patients with mild persistent unilateral hemiparesis and/or hemisensory symptoms (National Institute of Health Stroke Scale ≤ 3) and available DWI were included. The primary outcome was the proportion of patients with a negative DWI.
Results:
Of 1731 patients, 584 (30.8%) were included. Of these, 310 (53.1%) patients presented with left-sided symptoms and 274 (46.9%) with right-sided symptoms. Overall, 214 (36.6%) patients had a negative DWI, 126 (58.9%) with left-sided symptoms and 88 (41.1%) with right-sided symptoms: risk ratio (RR) 1.27 (95% CI = 1.02–1.57). Left-sided hemiparesis was associated with negative DWI (RR 1.42 [95% CI = 1.08–1.87]), while left-sided hemisensory symptoms were not (RR 1.11 [95% CI = 0.87–1.41]). There was no effect modification by age or sex on this association (Pinteraction 0.787 and 0.057, respectively).
Conclusions:
Unilateral left-sided neurological symptoms were more frequently associated with negative DWI compared to right-sided symptoms in suspected minor stroke patients. This observation is exploratory, as the final diagnosis in DWI-negative cases was not established.
To improve its management capacity, Frontiers Clinical and Translational Science Institute overhauled its evaluation infrastructure to be comprehensive, efficient, and transparent in demonstrating outputs and outcomes. We built a platform that standardized measures across program areas, integrated continuous improvement processes, and reduced the data entry burden for investigators. Using the Utilization-Focused Evaluation Framework, we created logic models to identify appropriate metrics. We built the evaluation data platform within REDCap to capture requests, events, attendance, and outcomes and to push work processes to Navigators. We initiated a membership model to serve as the backbone of the platform which allowed tailored communication, demographic data capture, and reduced data entry burden. The platform consists of nine REDCap projects across multiple programmatic areas. Using REDCap Dynamic SQL query fields and External Modules, the membership module was integrated into all forms to check and collect membership before service access. Data is synched to a dashboard for tracking outputs and outcomes in real-time. Since the launch of the evaluation platform in Fall 2022, Frontiers has increased its workflow efficiency and streamlined continuous improvement communication. The platform can serve as a model for other hubs to build efficient processes to create comprehensive and transparent evaluation plans.
In late October 2007 an odd story appeared in the press. A Japanese-owned chemical tanker called the Golden Nori was hijacked off the coast of Somalia. There were no Japanese nationals on board, but the East Asian nation had become entangled, quite unusually, in an East African affair. Unforeseen at that time was that this curious incident would eventually become one of the top foreign policy issues in Tokyo: Somali piracy has emerged as a potential turning point for Article Nine of the Japanese Constitution, and is significant for other reasons as well. The following essay reviews the record of Japanese encounters with Somali pirates and explores the motives and political pressures driving the Maritime Self-Defense Forces (MSDF) toward a proactive role in suppressing East African piracy.
In March 2007 the Japanese Foreign Ministry began speaking of a “long-term and strategic partnership” between Japan and Iraq. The terminology was new: Japan had previously described its policy in post-Saddam Iraq in terms of “reconstruction activities” but not as a “strategic partnership.” What accounts for this shift in language? What does the new policy entail? What does it overlook?
On July 19, 2006, the final elements of the Ground Self-Defense Forces (GSDF) mission rolled across the border between Iraq and Kuwait. The 2 1/2 year mission in Samawa ended without the deaths of any GSDF member on Iraqi soil – although it was indirectly related to the deaths of several Japanese civilians. As this watershed event was taking place, the future policies of the Japanese government remained shrouded in uncertainty. Was this the effective end of Japanese support to the post-Saddam Iraqi government? Or was it simply the beginning of a new phase?
In February 2000, Japan began the new century on a sour note when it lost its rights to the Khafji oil field in the Saudi-Kuwaiti neutral zone. Japan's Arabian Oil Company had held exploration rights in that zone since 1957, and the loss of such a long-term investment was keenly felt.
The disciplines of “area studies” (exploring the language, culture and religious traditions of particular geographic regions) have always been bound up with geopolitics and perceptions of national interest. Not only does academic (and popular) interest in these studies wax and wane according to their role in contemporary politics, but their basic assumptions and orientations are often strongly influenced by those interests. In Michael Penn's interview with Cemil Aydin, they discuss the rise and decline of Japanese Islamic Studies during the 1930s and 40s. Aydin suggests that the preconceptions of Islamicists during that period were strongly shaped by the geopolitical image of Japan as a leading light in Asian efforts to throw off the yoke of Western imperialism. For these scholars, the monotheistic roots of Islam - shared with both Judaism and Christianity - often seemed to be in tension with the twentieth-century political context of much of the Islamic world, which struggled with the domination of Western powers in ways not unlike Asia. Despite the changes in Japanese Islamic Studies since the end of the Pacific War, this perspective (so very different from many of the preconceptions that drive Islamic Studies in the Western academy) not only helps us understand some of the distinctive features of Japanese images of Islam, but may provide a useful vantage from which to re-evaluate our own images of this tradition.
We have recently crossed the five-year mark since the American invasion of Iraq. President George W. Bush used the occasion to triumphantly declare that, due to his decision to invade, ‘the world is better, and the United States of America is safer.‘
On the morning of August 26, 2008, aid worker Ito Kazuya arrived at work as usual. Four armed men suddenly appeared and abducted him. Local people witnessed the abduction, and a force of policemen and villagers gave chase into the mountains above north of the village of Bodyalai near Dara-e-Noor, Nangarhar Province, Afghanistan. The result was a tragedy: Ito was shot three times in the leg and once in the left thigh. On the morning following the abduction, his body was found by the local people: Ito had bled to death.
The story of how Japan gained, and then lost, the development rights to one of the richest oil fields in the world has been treated rather casually in the international media despite the fact that it will strongly affect Japan's relations with Iran and other countries for many years to come. The issue of the Japanese involvement in the Azadegan oil field was divisive from the start, but became more and more so as the political situation in the Persian Gulf deteriorated after September 11 and the U.S. invasion of Iraq. This essay traces the development of the Japan-Iran partnership in Azadegan from its inception in November 2000 to its effective dissolution in October 2006.
After the election of moderate President Khatami in Iran in 1997, and the lack of any change in Washington's hardline policies toward that country in the months and years that followed, Tokyo began to grow more and more uncomfortable with the American line. As a result, by about 1999 the Japanese government began to seek closer relations with Teheran. This was symbolized by Foreign Minister Komura Masahiko's visit to Iran in August 1999, and the resumption of yen loans.
Grassroots conservative groups led by Gambare Nippon began marching in the streets of Japanese cities beginning in 2010, but this year rightwing activism has notably intensified, coinciding with the establishment of the second Abe administration. Gaining the most notoriety is a group called the Zaitokukai or “The Citizen's Association That Will Not Permit Special Privileges for Resident Koreans.”
The Yomiuri Shinbun stunned the world in late November with a highly unusual apology. The paper announced that it had found dozens of articles in past issues of the English-language Daily Yomiuri (now called The Japan News) between February 1992 and January 2013 that used the expression “sex slave” to refer to wartime comfort women.
Little is known about the preferences of US at-home gardeners for potting mix characteristics. This study uses a Best-Worst Scaling approach to evaluate consumer preferences for eleven characteristics of potting mix. The most important characteristics identified are formulated for specific plant or garden types, pre-mixed ingredients, and price. The least important are the brand, packaging, and home delivery. There is some variation in the relative importance of these potting mix characteristics depending on consumer demographics. This study guides Industry stakeholders and policymakers on product development while enhancing environmental sustainability.
The role that nurseries play in supplementing family care is an important subject - but in the UK, there is currently little consensus about what nurseries should provide, how they should be run, and who should pay for them. In this book, Helen Penn asks: is there a more considered way ahead?
A mother–child relationship is one of the strongest, closest and most powerful bonds that human beings experience. The extremely influential psychiatrist John Bowlby certainly thought motherlove was crucial to a good upbringing; he considered that experience of attachment to a mother figure was crucial to a sense of self, and that loss of a mother figure – for whatever reason, including work – was likely to lead to delinquency. His views shaped government policy in the UK for many years, and through his role at the World Health Organization (WHO), his views were exported worldwide. There are still echoes of his magnum opus ‘Child Care and the Growth of Love’ in today's WHO policy, which promotes the idea of ‘loving nurturing care’, best undertaken by a mother or mother substitute. In this scenario, the infant is the focus of continuous attention, no matter what other obligations the mother might have. WHO policy argues that this maternal care is analogous to adequate nutrition for a growing body. Without proper loving care, children are being starved of what they need to grow, and their development is thwarted. Their brains in effect become stunted.
It is mainly in Western societies that ‘loving nurturing care’ is understood to mean that children should be at the centre of their parents’ attention. This week I was in a local shop with closely packed shelves and restricted aisle space. A mother had parked her pushchair almost blocking the aisle and kept addressing her child in a loud voice about what they were doing: ‘Look what mummy's found. Some spaghetti. Are you playing with teddy? He's in a good mood today. Look, he's sitting up’ and so on. This dyadic behaviour, and exclusive chattering focus on her child, to the oblivion of everyone else around, might conceivably be called good parenting. But in other circumstances, it might be considered as downright rude. I have sat in at meetings of mothers and young children in small non-Western rural communities, where mothers very quietly and unobtrusively encouraged their children to be aware of others and not to disturb the meeting, attentiveness to and consideration of others being a highly valued and necessary skill in societies where people live closely together in communities that are closely and mutually interdependent.
Expectations about how infants and young children are cared for and nurtured, and who is best placed to bring them up, have varied enormously over time, place and class. In Chapter 6, I discuss childcare and nurseries in a much broader, European and global perspective. In the present chapter, I discuss in more detail the exceptionally muddled history of childcare and nurseries in the UK. The aims of provision for young children in the UK have continually shifted, according to the political zeitgeist, and current welfare and educational theories about what is good for young children. The types of provision have gone through various metamorphoses. As a result, the statistical evidence is not consistent, and the commentary from politicians, activists, researchers and others has varied considerably in its focus about what is happening and why. My intention here is to describe what provision has been available for working parents and their children over the last century, how this has dovetailed (or not) with other provision, and how this patchwork history has led to today's profoundly unsatisfactory situation. There are other overlapping ways of recounting this history and picking out its salient features, for instance by focusing on the welfare of children and families, or highlighting the curricular changes made to further children's intellectual development and educational attainment, or, most recently, considering longterm outputs such as children's future economic performance. Working mothers and provision for their children have not been, until relatively recently, an important or topical issue. But the quality of motherhood and mothering, and its impact on the development of young children, has always been a public issue, from the Virgin Mary onwards.
The UK has a particular history of class and empire that has shaped views about appropriate provision for young children, who should look after them and in what conditions. With the help and encouragement of Richard Aldrich, who was then Professor of History at the Institute of Education (now UCL), I’ve written about this background history at length. What follows are extracts and summaries of those papers.
Ofsted (The Office for Standards in Education, Children's Services and Skills) has also made international comparisons (see Chapter 6), and claims it has gained insights from these comparisons. In June 2023, it published a research and analysis brief entitled ‘International Perspectives on Early Years’. Drawing mainly on the Eurydice data discussed in the previous chapter, and on some of the more recent Starting Strong reports, it organized its ‘insights’ into four themes:
• availability and access
• workforce
• curriculum and pedagogy
• inspection and regulation
Ofsted discussed its opinions and strategies at a round table meeting with representatives from 13 countries: Belgium, Czechia, England, France, Germany, Ireland, Italy, the Netherlands, Norway, Switzerland, Scotland, Serbia and Sweden. Some of the named representatives are well-known and have a history both with the original OECD Starting Strong programme and its subsequent iterations, and the EU. The discussion was clearly very civilized and well-informed. The difficulty is that Ofsted set the agenda, and the parameters for the discussion were framed by Ofsted in the light of its present – and limited – remit as a centralized national body.
Childcare is regulated through Ofsted. This covers all provision in England, distinguished for inspection purposes into two categories: in-home and out-of-home provision. Similar bodies to Ofsted exist for Scotland and Wales. Ofsted's original remit was to oversee the standards of free public sector education, to replace local authority monitoring and inspection, which was regarded as too variable and, in some cases, too lenient. As the Labour Party started to diversify childcare provision, Ofsted subsequently took on local authority roles in relation to childcare as well, to try to maintain similar standards across the entire sector. Ofsted now includes the inspection of market-based childcare services, most of which are part-subsidized by the government. However, Ofsted still retains its separate schools remit, which covers state-based nursery education, so that the standards for nursery classes refer not to childcare, but to school education more generally. The Ofsted regulatory standards for childcare run to several handbooks, including a suite of health and safety regulations. They prescribe developmental standards, using background research papers to justify these standards.
What does a nursery place cost and who should pay for it is a question in the same category as how long is a piece of string? It is less an economic question than a social and political one. Should all children be entitled to attend nurseries? If not, which children should be prioritized, and how? Should children of working parents have priority? Who pays for a child to attend a nursery? How should childcare fees be calculated and who by? What government budget does the money for childcare come from, how should it be paid out, who devises the relevant forms and who fills them in? Whose job is it to create or run nurseries, and what is their reward (or what profits can they reasonably extract) for doing so? What counts as household income and what contribution should parents make to the costs of a nursery place? Should mothers (or fathers) be paid for better maternal/paternal leave so that there is a reduction in the need for babycare, as babies are the most expensive age group to look after, and arguably benefit most from more one-to-one care at home? What is a fair wage for those who work in the sector, and who should pay them? What should staff be expected to do to earn their wage? How should nurseries be coordinated so they can pool resources? What back-up services are needed to monitor whether policies are working, and how will they be paid for?
The problem is that, in the UK, there are no coherent answers to any of these questions, or to closely related issues regarding in-home carers such as childminders and nannies Many of these crucial questions have not even been asked, because we have such a fragmented system in the UK! But until at least some of these questions are resolved, it is a mistake to throw more money at the childcare sector. Someone must have a plan first. Otherwise, as at present, funding childcare does not enable parental choice in a free market, as the government claims. Instead, it is a wasteful process, enriching a few at the expense of many, crippling family budgets, and failing to give value for money to the taxpayer. It is an unedifying and an unequal free-for-all, in which the poorest children and families lose out.