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Background: Ischemic stroke is a major cause of morbidity and mortality in Canada. Since 2015, mechanical thrombectomy has been the standard of care for eligible large vessel occlusions (LVOs), though anesthetic strategies remain variable. Methods: We conducted a single-center retrospective review of patients undergoing mechanical thrombectomy for anterior circulation LVOs between 2021 and 2023. Patients were categorized by anesthetic strategy (general anesthesia vs. conscious sedation), and outcomes, including time to recanalization, angiographic results (mTICI), and 90-day functional status (mRS), were compared. Statistical analyses included Student’s t-test, Mann-Whitney U-test, and Fisher’s exact test. Results: Among 226 patients, 177 (78%) received general anesthesia and 49 (22%) underwent conscious sedation. Baseline characteristics including sex, age, NIHSS, ASPECTS, collaterals, and laterality were similar between groups. Conscious sedation was associated with a statistically significant shorter time from arrival to the angiography suite to groin puncture (p=0.007), but no differences in time to recanalization (p=0.893), angiographic outcomes (p=0.987), or 90-day functional status (p=0.795) were observed. Conclusions: Conscious sedation led to faster procedural initiation, though no difference in clinical or radiographic outcome was observed. Anesthetic choice should be individualized based on patient and physician factors in acute mechanical thrombectomy.
Previously [‘Radicals and idempotents I, II’, Comm. Alg.49(1) (2021), 73–84 and 50(11) (2022), 4791–4804], we have studied the interaction between radicals of rings and idempotents in general or those of particular types, for example, left semicentral. Here we carry out similar investigations for q-central idempotents, that is, those idempotents e satisfying the condition $(ea-eae)(be-ebe) = 0$ for all a, b.
Marsupials give birth to immunologically naïve young after a relatively short gestation period compared with eutherians. Consequently, the joey relies significantly on maternal protection, which is the focus of the present review. The milk and the pouch environment are essential contributors to maternal protection for the healthy development of joeys. In this review, we discuss bioactive components found in the marsupial pouch and milk that form cornerstones of maternal protection. These bioactive components include immune cells, immunoglobulins, the S100 family of calcium-binding proteins, lysozymes, whey proteins, antimicrobial peptides and other immune proteins. Furthermore, we investigated the possibility of the presence of plurifunctional components in milk and pouches that are potentially bioactive. These compounds include caseins, vitamins and minerals, oligosaccharides, lipids and microRNAs. Where applicable, this review addresses variability in bioactive components during different phases of lactation, designed to fulfil the immunological needs of the growing pouch young. Yet, there are numerous additional research opportunities to pursue, including uncovering novel bioactive components and investigating their modes of action, dynamics, stability and ability to penetrate the gut epithelium to facilitate systemic effects.
This article seeks to contribute to the growing scholarship on object-focused Roman histories by expanding the conversation to previously overlooked archaeological finds from Roman Palestine. This case study focuses on “Northern Collar-Neck Lamps,” which have been found throughout Roman Galilee and date to the first two centuries CE. I argue that their distinctive high collar, perhaps designed to reduce spillage, also served as an affordance that invited additional modes of interaction, namely placing a supplemental reservoir for oil – such as a pierced eggshell – over the filling hole. Once set up, this would allow for a slow drip of oil to prolong illumination time without human intervention. This usage is suggested from chronologically and geographically proximate sources, namely early rabbinic literature: Hebrew and Aramaic writings from the first centuries that reference physical details and uses of hundreds of objects and could prove helpful for future material histories of the Roman era.
Describing our institution’s off-label use of gabapentin to treat irritability after superior cavopulmonary connection surgery and its impact on subsequent opiate and benzodiazepine requirements.
Methods:
This is a single-center retrospective cohort study including infants who underwent superior cavopulmonary connection operation between 2011 and 2019.
Results:
Gabapentin was administered in 74 subjects (74/323, 22.9%) during the observation period, with a median (IQR) starting dose of 5.7 (3.3, 15.0) mg/kg/day and a maximum dose of 10.7 (5.5, 23.4) mg/kg/day. Infants who underwent surgery in 2015–19 were more likely to receive gabapentin compared with those who underwent surgery in 2011–14 (p < 0.0001). Infants prescribed gabapentin were younger at surgery (137 versus 146 days, p = 0.007) and had longer chest tube durations (1.8 versus 0.9 days, p < 0.001), as well as longer postoperative intensive care (5.8 versus 3.1 days, p < 0.0001) and hospital (11.5 versus 7.0 days, p < 0.0001) lengths of stays. The year of surgery was the only predisposing factor associated with gabapentin administration in multivariate analysis. In adjusted linear regression, infants prescribed gabapentin on postoperative day 0–4 (n = 64) had reduced benzodiazepine exposure in the following 3 days (−0.29 mg/kg, 95% CI −0.52 – −0.06, p = 0.01) compared with those not prescribed gabapentin, while no difference was seen in opioid exposure (p = 0.59).
Conclusions:
Gabapentin was used with increasing frequency during the study period. There was a modest reduction in benzodiazepine requirements associated with gabapentin administration and no reduction in opioid requirements. A randomised controlled trial could better assess gabapentin’s benefits postoperatively in children with congenital heart disease.
This comprehensive literature scoping review outlines available infection prevention and control (IPC) methods for viral-mediated gene therapies and provides one IPC strategy for the healthcare setting based on a single-center recommendation.
Methods:
A team of experts in pharmacy, healthcare epidemiology, and biosafety with experience in viral-mediated gene therapy was assembled within a pediatric hospital to conduct a comprehensive literature scoping review. The comprehensive review included abstracts and full-text articles published since 2009 and utilized prespecified search terms of the five viral vectors of interest: adenovirus (AV), retrovirus (RV), adeno-associated virus (AAV), lentivirus (LV), and herpes simplex virus (HSV). Case reports, randomized controlled trials, and bench research studies were all included, while systematic reviews were excluded.
Results:
A total of 4473 case reports, randomized control trials, and benchtop research studies were identified using the defined search criteria. Chlorine compounds were found to inactivate AAV and AV, while alcohol-based disinfectants were ineffective. There was a relative paucity of studies investigating surface-based disinfection for HSV, however, alcohol-based disinfectants were effective in one study. Ultraviolent irradiation was also found to inactivate HSV in numerous studies. No studies investigated disinfection for LV and RV vectors.
Conclusions:
The need to define IPC methods is high due to the rapid emergence of viral-mediated gene therapies to treat rare diseases, but published clinical guidance remains scarce. In the absence of these data, our center recommends a 1:10 sodium hypochlorite solution in clinical and academic environments to ensure complete germicidal activity of viral-mediated gene therapies.
This chapter surveys the rise of New Criticism in American letters during the interwar years through the 1950s. It pays attention to the influence of two overlapping associations: the Fugitive Poets and the Nashville Agrarians. The Fugitives, a group of Vanderbilt English professors and Nashville notables, had formed in the years leading up to World War I to discuss current trends in literature and philosophy. The Agrarians, southern commentators trained in a variety of disciplines, collaborated on a symposium in the 1930s that decried the deleterious effects of industrial capitalism and promoted values that purportedly undergirded an agrarian economy. Together the two groups came to shape the tenets of New Criticism. New Critics mourned the turn away from formalist principles that had established the criteria by which one should evaluate literature. Agrarians bemoaned the demise of a set of values that ostensibly emerged from a labor system that championed family farming, property ownership, and small government. Both New Critics and Agrarians, then, engaged in reclamation projects as they sought to salvage what they believed to be all that was good and beautiful in the world.
Numerous studies have shown longer pre-hospital and in-hospital workflow times and poorer outcomes in women after acute ischemic stroke (AIS) in general and after endovascular treatment (EVT) in particular. We investigated sex differences in acute stroke care of EVT patients over 5 years in a comprehensive Canadian provincial registry.
Methods:
Clinical data of all AIS patients who underwent EVT between January 2017 and December 2022 in the province of Saskatchewan were captured in the Canadian OPTIMISE registry and supplemented with patient data from administrative data sources. Patient baseline characteristics, transport time metrics, and technical EVT outcomes between female and male EVT patients were compared.
Results:
Three-hundred-three patients underwent EVT between 2017 and 2022: 144 (47.5%) women and 159 (52.5%) men. Women were significantly older (median age 77.5 [interquartile range: 66–85] vs.71 [59–78], p < 0.001), while men had more intracranial internal carotid artery occlusions (48/159 [30.2%] vs. 26/142 [18.3%], p = 0.03). Last-known-well to comprehensive stroke center (CSC)-arrival time (median 232 min [interquartile range 90–432] in women vs. 230 min [90–352] in men), CSC-arrival-to-reperfusion time (median 108 min [88–149] in women vs. 102 min [77–141] in men), reperfusion status (successful reperfusion 106/142 [74.7%] in women vs. 117/158 [74.1%] in men) as well as modified Rankin score at 90 days did not differ significantly. This held true after adjusting for baseline variables in multivariable analyses.
Conclusion:
While women undergoing EVT in the province of Saskatchewan were on average older than men, they were treated just as fast and achieved similar technical and clinical outcomes compared to men.
Dance for older adults is increasingly being used to support health and well-being. While dance may be enjoyable for many, understanding its benefits for those with limited physical and cognitive abilities may provide further support for how dance may be used in these contexts. This was a study of Sharing Dance Older Adults, a dance program with remotely streamed sessions. Data were collected from 48 older adults who took part in the On Your Feet version of the program, and from 38 who took part in the In Your Seat version. Measures included interviews, physical fitness tests and surveys on mood, quality of life, and program satisfaction. Physical fitness significantly improved for both groups, unlike for mood, social well-being, or quality of life. This contrasts with qualitative findings, with participants reporting how the program enhanced their mood, social interactions, and quality of life.
Knowledge graphs have become a common approach for knowledge representation. Yet, the application of graph methodology is elusive due to the sheer number and complexity of knowledge sources. In addition, semantic incompatibilities hinder efforts to harmonize and integrate across these diverse sources. As part of The Biomedical Translator Consortium, we have developed a knowledge graph–based question-answering system designed to augment human reasoning and accelerate translational scientific discovery: the Translator system. We have applied the Translator system to answer biomedical questions in the context of a broad array of diseases and syndromes, including Fanconi anemia, primary ciliary dyskinesia, multiple sclerosis, and others. A variety of collaborative approaches have been used to research and develop the Translator system. One recent approach involved the establishment of a monthly “Question-of-the-Month (QotM) Challenge” series. Herein, we describe the structure of the QotM Challenge; the six challenges that have been conducted to date on drug-induced liver injury, cannabidiol toxicity, coronavirus infection, diabetes, psoriatic arthritis, and ATP1A3-related phenotypes; the scientific insights that have been gleaned during the challenges; and the technical issues that were identified over the course of the challenges and that can now be addressed to foster further development of the prototype Translator system. We close with a discussion on Large Language Models such as ChatGPT and highlight differences between those models and the Translator system.
Recent scholarship in the history of emotions encourages us to think about the ways war-time Americans managed their feelings. Separation of families fostered loneliness, for example, the tedium of camp life brought on boredom, the delays of news from home or from camp occasioned anxiety, and the uncertainty of the war’s outcome eroded confidence. Reading, this chapter argues, became a deliberate strategy to mitigate these corrosive effects of warfare. By looking at Civil War–era reading practices we can see how readers engaged imaginative literature and other genres popular in the mid-nineteenth century to maintain the ties that bind. Epistolary conversations about books allowed those separated by war to approximate shared reading, a common practice in antebellum America. And they allowed readers to express emotions by proxy, using fictional characters and imagined scenarios to voice their thoughts and invite reassurance. Fundamentally, reading reminded readers they were not alone.
By the end of the nineteenth century, the Civil War and Reconstruction had become sites of significant narrative contests that were carried out in scores of novels and in hundreds of stories published in popular magazines. These writings are arguably central to any understanding of American literary history but usually are represented by only a few canonical Civil War novels, such as Stephen Crane’s Red Badge of Courage (1895), Thomas Nelson Page’s Red Rock (1898), and Thomas Dixon Jr.’s The Clansman: A Historical Romance of the Ku Klux Klan (1905). Well before the moonlight and magnolia school of Civil War fiction exerted its death grip on the postwar literary imagination, however, an earlier contest waged that sought to set the terms of the debate. Rebecca Harding Davis, Louisa May Alcott, William Wells Brown, and Frances Ellen Watkins Harper each sought a narrative capable of accounting for the uncertainties and possibilities of this political moment. This essay traces their attempts to imagine a different future, one that broke with the nation’s history of continued abrogation of the principles laid out in the Declaration of Independence.
The Subglacial Antarctic Lakes Scientific Access (SALSA) Project accessed Mercer Subglacial Lake using environmentally clean hot-water drilling to examine interactions among ice, water, sediment, rock, microbes and carbon reservoirs within the lake water column and underlying sediments. A ~0.4 m diameter borehole was melted through 1087 m of ice and maintained over ~10 days, allowing observation of ice properties and collection of water and sediment with various tools. Over this period, SALSA collected: 60 L of lake water and 10 L of deep borehole water; microbes >0.2 μm in diameter from in situ filtration of ~100 L of lake water; 10 multicores 0.32–0.49 m long; 1.0 and 1.76 m long gravity cores; three conductivity–temperature–depth profiles of borehole and lake water; five discrete depth current meter measurements in the lake and images of ice, the lake water–ice interface and lake sediments. Temperature and conductivity data showed the hydrodynamic character of water mixing between the borehole and lake after entry. Models simulating melting of the ~6 m thick basal accreted ice layer imply that debris fall-out through the ~15 m water column to the lake sediments from borehole melting had little effect on the stratigraphy of surficial sediment cores.
Neuropsychological assessment via video conferencing has been proposed during the COVID-19 pandemic. Existing literature has demonstrated feasibility and acceptance of neuropsychological measures administered by videoconference, although few studies have examined feasibility and patient acceptance of TNP visits directly to patients’ homes (DTH-TNP).
Methods:
We modified a previously published patient satisfaction survey for DTH-TNP and developed a clinician feasibility survey to examine experiences during DTH-TNP.
Results:
Seventy-two patients (age range: preschool-geriatric) evaluated by DTH-TNP for cognitive problems at an academic medical center responded to voluntary surveys between April 20, 2020, and August 19, 2020, and 100% indicated satisfaction. Fifty-nine percent of patients reported limitations (e.g., technological concern) during the appointment. 134 clinician surveys were collected and indicated that clinicians achieved the goal of their appointment in 90% of encounters.
Conclusions:
These qualitative data suggest that patients and clinicians found DTH-TNP to be satisfactory during the COVID-19 pandemic, while also recognizing limitations of the practice. These results are limited in that voluntary surveys are subject to bias. They support the growing body of literature suggesting that DTH-TNP provides a valuable service, though additional research to establish reliability and validity is needed.
Assertions of the Civil War’s meaning began well before the formal cessation of hostilities. In poetry, prose, and oratory, Unionists and Confederates staked out claims for the legitimacy of their cause. We continue to lay out these claims well into the twenty-first century, in large measure because we cannot agree on the stakes, let alone on what they mean. Literature has played an outsized role in these conversations in part because of its popularity and accessibility. Equally important, literature has an immediacy that other genres and disciplines lack. By surveying canonical and lesser-known literary works, this essay outlines how generations of Americans have written about the war. And by highlighting narratives and counternarratives, it makes clear that alternative visions always challenged the dominance of the Lost Cause trope.
Neuropsychological assessment via videoconference could assist in bridging service access gaps due to geographical, mobility, or infection control barriers. We aimed to compare performances on neuropsychological measures across in-person and videoconference-based administrations in community-based survivors of stroke.
Method:
Participants were recruited through a stroke-specific database and community advertising. Stroke survivors were eligible if they had no upcoming neuropsychological assessment, concurrent neurological and/or major psychiatric diagnoses, and/or sensory, motor, or language impairment that would preclude standardised assessment. Thirteen neuropsychological measures were administered in-person and via videoconference in a randomised crossover design (2-week interval). Videoconference calls were established between two laptop computers, facilitated by Zoom. Repeated-measures t tests, intraclass correlation coefficients (ICCs), and Bland–Altman plots were used to compare performance across conditions.
Results:
Forty-eight participants (26 men; Mage = 64.6, SD = 10.1; Mtime since stroke = 5.2 years, SD = 4.0) completed both sessions on average 15.8 (SD = 9.7) days apart. For most measures, the participants did not perform systematically better in a particular condition, indicating agreement between administration methods. However, on the Hopkins Verbal Learning Test – Revised, participants performed poorer in the videoconference condition (Total Recall Mdifference = −2.11). ICC estimates ranged from .40 to .96 across measures.
Conclusions:
This study provides preliminary evidence that in-person and videoconference assessment result in comparable scores for most neuropsychological tests evaluated in mildly impaired community-based survivors of stroke. This preliminary evidence supports teleneuropsychological assessment to address service gaps in stroke rehabilitation; however, further research is needed in more diverse stroke samples.
Ryabukhin showed that there is a correspondence between elementary radical classes of rings and certain filters of ideals of the free ring on one generator, analogous to the Gabriel correspondence between torsion classes of left unital modules and certain filters of left ideals of the coefficient ring. This correspondence is further explored here. All possibilities for the intersection of the ideals in a filter are catalogued, and the connections between filters and other ways of describing elementary radical classes are investigated. Some generalisations to nonassociative rings and groups are also presented.
Dual energy X-ray absorptiometry (DEXA) is an imaging modality that has been used to predict the computed tomography (CT)-determined carcass composition of multiple species, including sheep and pigs, with minimal inaccuracies, using medical grade DEXA scanners. An online DEXA scanner in an Australian abattoir has shown that a high level of precision can be achieved when predicting lamb carcass composition in real time. This study investigated the accuracy of that same online DEXA when predicting fat and lean percentages as determined by CT over a wide range of phenotypic and genotypic variables across 454 lambs over 6 kill groups and contrasted these results against the current Australian industry standard of grade-rule (GR) measurements to grade carcasses. Lamb carcasses were DEXA scanned and then CT scanned to determine CT Fat % and CT Lean %. All phenotypic traits and genotypic information, including Australian Sheep Breeding Values, were recorded for each carcass. Residuals of the DEXA predicted CT Fat % and Lean %, and the actual CT Fat % and Lean % were calculated and tested against all phenotypic and genotypic variables. Excellent overall precision was recorded when predicting CT Fat % (R2 = 0.91, RMSE = 1.19%). Small biases present for sire breed, sire type, dam breed, hot carcass weight and c-site eye muscle area could be explained by a regression paradox; however, biases among kill group (−0.73% to 1.01% for CT Fat %, −1.48% to 0.76% for CT Lean %) and the Merino sire type (0.36% for CT Fat %, −0.73% for CT Lean %) could not be explained by this effect. Over the large range of phenotypic and genotypic variation, there was excellent precision when predicting CT Fat % and CT Lean % by an online DEXA, with only minor biases, showing superiority to the existing Australian standard of GR measurements.
In the case of a first episode of psychosis among members of different associations of families of mentally ill people, little is known about their priorities and how satisfied they are with the help provided to them. A survey was conducted in five European family associations. Respondents emphasized the need for early (ambulant) intervention through outreach with very practical goals directed at creating stability and social functioning. About one-third of the respondents are unsatisfied or very unsatisfied. The highest percentage of unsatisfied respondents was in the following five areas of care: advice on how to handle specific problems; help with preserving or regaining social functioning; help with regaining structure and routine; information; prompt assistance preferably in patientˈs own environment. The agreement of these findings with findings from earlier studies underlines the importance of suggesting specific changes in the delivery of care.