Of vapor beneath the evening star

The things we see are but shadows of reality. We are in a cave, but if we tum around we can see the fire that casts the shadows we call reality. We can take the difficult journey to see the beauty and magic that is our true world. Stories such as this, Plato\u27s allegory of the cave in The Republic, have taught for centuries that there is more to our world than we initially know. Allegory and metaphor can help us begin to understand the shadows for what they are. II is in our hearts and our imaginations that we find our reality. In my mind I walk on a path deep in the woods. The forest is so dense and large that one could easily become lost. It is a place of mystery where the unknown awaits discovery. Myth and history seem to hang in the wind. Finding my way through the trees I stumble upon an object. Finding this artifact, I begin to tell myself a story of its life. Is this all that remains of a long forgotten palace? Perhaps here was an ancient place of worship and this was once a ritual object. Was some human-made object abandoned and then reclaimed by nature? If I walk closer, will it come alive? No matter the explanation, the object holds a certain power. My finds are gates to the unknown, paths found to mysterious destinations, protection against negative forces, and reflections of my heart. II is a place where I feel the unseen forces around me and anything is possible - a place of changes in perception. Here, time holds very little meaning. I imagine the history of my finds , but the past, present, and future of the place and the thing all exist simultaneously within the object as in a dream. Like the forests of folk and fairy tales, spiritual and religious teachings, legends and myths across cultures, what I find in the woods and translate into objects are m etaphors for real experience. My work springs from this vision of the woods as an attempt to bring the intangible into visual space. My touch transforms the clay, the dirt, the earth, into the object of my imagination. Manipulated natural imagery is the language I use sculpturally to convey meaning and reconnect with both the actual woods and the m etaphorical woods of inner self. Within each piece is a fantasy realm rooted in the magical realities all around us. It is a visual tale, a myth view ers must discover for themselves from the object before them. It holds an expanded view of reality, conveying a sense of wonder and possibility

Level I and II deficits—A clinical survey on international practice of awake craniotomy and definitions of postoperative “major” and “minor” deficits

Background. Awake craniotomy (AC) is a technique that balances maximum resection and minimal postoperative deficits in patients with intracranial tumors.To aid in the comparability of functional outcomes after awake surgery, this study investigated its international practice and aimed to define categories of postoperative deficits. Methods. A survey was distributed via neurosurgical networks in Europe (European Association of Neurosurgical Societies, EANS), the Netherlands (Nederlandse Vereniging voor Neurochirurgie, NVVN), Belgium (Belgian Society of Neurosurgery, BSN), and the United States (Congress of Neurological Surgeons, CNS) between April 2022 and April 2023. Questions involved decision-making, including patient selection, anxiety assessment, and termination of resection. Interpretation of “major” and “minor” deficits, respectively labeled “level I” and “level II,” was assessed. Results. Three hundred and ninety-five neurosurgeons from 46 countries completed the survey. Significant heterogeneity was found in the domains of indications, anxiety assessment, seizure management, and termination of resection. Moreover, the interpretation of “major” deficits mainly included language and motor impairments. Analysis across deficit categories showed significant overlap in the domains of executive function, social cognition, and vision. Secondly, “minor” deficits and “minor cognitive” deficits showed vast overlap. Conclusions. This survey demonstrates high variability between neurosurgeons in AC practice across multiple domains, inviting international efforts to reach a consensus regarding the standardization and grading of postoperative deficits.The proposed categories of “level I” and “level II” deficits may aid in this standardization. It allows for systematic assessment of the benefit of surgery in neuro-oncology patients and allows for comparison of surgical outcomes between institutions and surgeons.This may help to optimize international guidelines for surgical neuro-oncology, including AC.</p

Mobile Health Biometrics to Enhance Exercise and Physical Activity Adherence in Type 2 Diabetes (MOTIVATE-T2D):a decentralised feasibility randomised controlled trial delivered across the UK and Canada

OBJECTIVES: Assess the feasibility of a mobile health (mHealth)-supported home-delivered physical activity (PA) intervention (MOTIVATE-T2D) in people with recently diagnosed type 2 diabetes (T2D).DESIGN: Feasibility multicentre, parallel group, randomised controlled trial (RCT).SETTING: Participants were recruited from England and Canada using a decentralised design.PARTICIPANTS: Adults (40-75 years) recently diagnosed with T2D (5-24 months).INTERVENTIONS: Participants were randomised 1:1 to intervention (MOTIVATE-T2D) or active control groups. Participants codesigned 6month- home-delivered, personalised, progressive PA programmes supported by virtual behavioural counselling. MOTIVATE-T2D used biofeedback from wearable technologies to support the programme. The active control group received the same intervention without wearables.OUTCOMES: The primary outcomes were recruitment rate, retention and adherence to purposeful exercise. Clinical data on effectiveness were collected as exploratory outcomes at baseline, 6 and 12 months, with HbA1c and systolic blood pressure (BP) proposed as primary outcomes for a future full RCT.RESULTS: n=135 eligible participants expressed an interest in the trial, resulting in 125 participants randomised (age 55±9 years, 48% female, 81% white), a recruitment rate of 93%. Retention at 12 months was 82%. MOTIVATE-T2D participants were more likely to start (OR 10.4, CI 3.4 to 32.1) and maintain purposeful exercise at 6 (OR 7.1, CI 3.2 to 15.7) and 12 months (OR 2.9, CI 1.2 to 7.4). Exploratory clinical outcomes showed a potential effect in favour of MOTIVATE-T2D, including proposed primary outcomes HbA1c and systolic BP (between-group mean differences: HbA1c: 6 months: -5% change from baseline, CI -10 to 2: 12 months: -2% change from baseline, CI -8 to -4; systolic BP: 6 months: -1 mm Hg, CI -5 to 3: 12 months: -4 mm Hg, CI -8 to 1).CONCLUSIONS: Our findings support the feasibility of delivering the MOTIVATE-T2D mHealth-supported PA intervention for people with recently diagnosed T2D and progression to a full RCT to examine its clinical and cost-effectiveness.TRIAL REGISTRATION NUMBER: ISRCTN: 14335124; ClinicalTrials.gov: NCT0465353.</p

Transient Vestibulopathy in Wallenberg's Syndrome: Pathologic Analysis

Objective: To report an unusual lateral medullary stroke (LMS) associated with transient unidirectional horizontal, nystagmus, and decreased horizontal vestibulo-ocular reflex (h-VOR) gain that mimicked a peripheral vestibulopathy. MRI suggested involvement of caudal medial vestibular nucleus (MVN);however, the rapid resolution of the nystagmus and improved h-VOR gain favored transient ischemia without infarction. Decreased h-VOR gain is expected with peripheral vestibular lesions within the labyrinth or superior vestibular nerve;less frequently lateral pontine strokes involving the vestibular root entry, the vestibular fascicle, or neurons within the MVN may be responsible. The h-VOR is typically normal in LMS. Methods: Clinicopathologic examination of a 61-year-old man with an acute vestibular syndrome (AVS) and left LMS who died 3 weeks after the stroke. Postmortem brainstem analysis was performed. Results: The stroke involved the lateral medulla and pontomedullary junction, near the MVN, sparing the cerebellum and pons. To explain transient vestibular findings there are two possible hypotheses;the first would be that the MVN survived the ischemic process and would be histologically intact, and the second that vestibular afferents in the horizontal semicircular canal were ischemic and recovered after the ischemic process. Neuropathological examination showed a left LMS whose extent matched that seen by imaging. Non-ocular motor signs correlated well with structures affected by the infarction. Neurons and glia within nearby MVN were spared, as predicted by the rapid normalization of the ocular motor signs. Although unlikely, the possibility of transient intralabyrinthine arteriolar ischemia cannot be excluded. Additionally, truncal lateropulsion was due to combined lateral vestibulospinal tract and lateral reticular nucleus infarction. Conclusion: LMS may rarely be associated with an AVS that either represents or mimics a peripheral vestibulopathy. To our knowledge, this is the first neuropathologic examination of the brainstem of an LMS associated with transient vestibular findings occurring in the context of an anterior/posterior (AICA/PICA) cerebellar arterial variant stroke

Longitudinal MR imaging after unilateral MR-guided focused ultrasound thalamotomy: clinical and radiological correlation

IntroductionMagnetic-resonance-guided focused ultrasound (MRgFUS) thalamotomy uses multiple converging high-energy ultrasonic beams to produce thermal lesions in the thalamus. Early postoperative MR imaging demonstrates the location and extent of the lesion, but there is no consensus on the utility or frequency of postoperative imaging. We aimed to evaluate the evolution of MRgFUS lesions and describe the incidence, predictors, and clinical effects of lesion persistence in a large patient cohort.MethodsA total of 215 unilateral MRgFUS thalamotomy procedures for essential tremor (ET) by a single surgeon were retrospectively analyzed. All patients had MR imaging 1 day postoperatively; 106 had imaging at 3 months and 32 had imaging at 1 year. Thin cut (2 mm) axial and coronal T2-weighted MRIs at these timepoints were analyzed visually on a binary scale for lesion presence and when visible, lesion volumes were measured. SWI and DWI sequences were also analyzed when available. Clinical outcomes including tremor scores and side effects were recorded at these same time points. We analyzed if patient characteristics (age, skull density ratio), preoperative tremor score, and sonication parameters influenced lesion evolution and if imaging characteristics correlated with clinical outcomes.ResultsVisible lesions were present in all patients 1 day post- MRgFUS and measured 307.4 ± 128.7 mm3. At 3 months, residual lesions (excluding patients where lesions were not visible) were 83.6% smaller and detectable in only 54.7% of patients (n = 58). At 1 year, residual lesions were detected in 50.0% of patients (n = 16) and were 90.7% smaller than 24 h and 46.5% smaller than 3 months. Lesions were more frequently visible on SWI (100%, n = 17), DWI (n = 38, 97.4%) and ADC (n = 36, 92.3%). At 3 months, fewer treatment sonications, higher maximum power, and greater distance between individual sonications led to larger lesion volumes. Volume at 24 h did not predict if a lesion was visible later. Lesion visibility at 3 months predicted sensory side effects but was not correlated with tremor outcomes.DiscussionOverall, lesions are visible on T2-weighted MRI in about half of patients at both 3 months and 1 year post-MRgFUS thalamotomy. Certain sonication parameters significantly predicted persistent volume, but residual lesions did not correlate with tremor outcomes

The Magellanic Mopra Assessment (MAGMA). I. The Molecular Cloud Population of the Large Magellanic Cloud

We present the properties of an extensive sample of molecular clouds in the Large Magellanic Cloud (LMC) mapped at 11 pc resolution in the CO(1-0) line. We identify clouds as regions of connected CO emission, and find that the distributions of cloud sizes, fluxes and masses are sensitive to the choice of decomposition parameters. In all cases, however, the luminosity function of CO clouds is steeper than dN/dL \propto L^{-2}, suggesting that a substantial fraction of mass is in low-mass clouds. A correlation between size and linewidth, while apparent for the largest emission structures, breaks down when those structures are decomposed into smaller structures. We argue that the correlation between virial mass and CO luminosity is the result of comparing two covariant quantities, with the correlation appearing tighter on larger scales where a size-linewidth relation holds. The virial parameter (the ratio of a cloud's kinetic to self-gravitational energy) shows a wide range of values and exhibits no clear trends with the CO luminosity or the likelihood of hosting young stellar object (YSO) candidates, casting further doubt on the assumption of virialization for molecular clouds in the LMC. Higher CO luminosity increases the likelihood of a cloud harboring a YSO candidate, and more luminous YSOs are more likely to be coincident with detectable CO emission, confirming the close link between giant molecular clouds and massive star formation.Comment: Accepted by ApJS; 22 pages in emulateapj format; full-resolution version and data tables available at http://mmwave.astro.illinois.edu/magma

Magnesium nebulization utilization in management of pediatric asthma (MagNUM PA) trial: study protocol for a randomized controlled trial

BACKGROUND: Up to 30 % of children with acute asthma are refractory to initial therapy, and 84 % of this subpopulation needs hospitalization. Finding safe, noninvasive, and effective strategies to treat this high-risk group would substantially decrease hospitalizations, healthcare costs, and the psycho-social burden of the disease. Whereas intravenous magnesium (Mg) is effective in severe refractory asthma, its use is sporadic due to safety concerns, with the main treatment goal being to prevent intensive care unit admission. In contrast, nebulized Mg is noninvasive, allows higher pulmonary drug concentrations, and has a much higher safety potential due to the lower rate of systemic delivery. Previous studies of inhaled Mg show disparate results due to the use of unknown/inefficient delivery methods and other methodological flaws. METHODS/DESIGN: The study is a randomized double-blind controlled trial in seven Canadian pediatric Emergency Departments (two-center pilot 2011 to 2014, Canada-wide November 2014 to December 2017). The trial will include 816 otherwise healthy children who are 2 to 17 years old, having had at least one previous wheezing episode, have received systemic corticosteroids, and have a Pediatric Respiratory Assessment Measure (PRAM) ≥ 5 points after three salbutamol and ipratropium treatments for a current acute asthma exacerbation. Eligible consenting children will receive three experimental treatments of nebulized salbutamol with either 600 mg of Mg sulfate or placebo 20 min apart, using an Aeroneb Go nebulizer, which has been shown to maximize pulmonary delivery while maintaining safety. The primary outcome is hospitalization within 24 h of the start of the experimental therapy for persistent respiratory distress or supplemental oxygen. Secondary outcomes include all-cause hospitalization within 24 h, PRAM, vital signs, number of bronchodilator treatments by 240 min, and the association between the difference in the primary outcome between the groups, age, gender, baseline PRAM, atopy, and “viral induced wheeze” phenotype (Fig. 1). DISCUSSION: If effective, inhaled Mg may represent an effective strategy to minimize morbidity in pediatric refractory acute asthma. Unlike previous works, this trial targets nonresponders to optimized initial therapy who are the most likely to benefit from inhaled Mg. Future dissemination of results will include knowledge translation, incorporation into a Cochrane Review, presentation at scientific meetings, and a peer-reviewed publication. TRIAL REGISTRATION: NCTO1429415, registered 2 September 2011. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-015-1151-x) contains supplementary material, which is available to authorized users

Immunogenicity of Danish-SSI 1331 BCG vaccine in the UK: comparison with Glaxo-Evans 1077 BCG vaccine.

The immunogenicity and reactogenicity, in British schoolchildren, of the newly introduced Danish-SSI 1331 BCG vaccine was compared with that of the previously used Glaxo-Evans 1077 BCG vaccine. Interferon-gamma (IFN-gamma) response to M. tuberculosis purified protein derivative (M.tb PPD) in a 6-day whole blood assay and delayed type hypersensitivity (DTH) to tuberculin PPD were determined before and 1 year after receiving BCG or no vaccination. Scar size was measured 1 year after vaccination. There was no evidence of a difference in immunogenicity (IFN-gamma and DTH conversion rates) but evidence of lower reactogenicity (scar size) with Danish-SSI 1331 compared to Glaxo-Evans 1077 vaccines

An Integrated Geoarchaeology of a Late Woodland Sand Mound

AbstractThe Graveline Mound (22JA503) is a sand platform mound in Jackson County, Mississippi, built on a low, late Pleistocene terrace on the Mississippi Sound. The Late Woodland mound (A.D. 590–780) is composed of local soils, and its presence today is a testament to the ancient builders’ knowledge of earthen construction materials and methods. Central to the study of the mound is an integrated geoarchaeological approach that uses stratigraphy and micromorphology to decipher material source and selection, construction techniques, and periodicity, in combination with more traditional artifacts, revealing the activities that created this ultimately monumental space. The mound was built in three rapid stages beginning with a low earthwork demarcating a ritual precinct used during late spring/early summer. Stage II quickly followed with a series of alternating zoned fills, sealing the space that was then subsequently covered by Stage III, a massive hard red surface that marked the location with a platform mound.</jats:p

The Effects of Hardness Variation on a CMP Model of Copper thin Films

AbstractWith the rapid change of materials systems and decreased feature size, thin film microstructure and mechanical properties have become critical parameters for microelectronics reliability. An example of a major driver of this new technology is the data storage community who is pushing for 1 Terabit/square inch on its magnetic disk hard drives. This requires inherent knowledge of the mechanical properties of materials and in depth understanding of the tribological phenomena involved in the manufacturing process. Chemical mechanical polishing (CMP) is a semi-conductor manufacturing process used to remove or planarize ultra-thin metallic, dielectric, or barrier films (copper) on silicon wafers. The material removal rate (MRR), which ultimately effects the surface topography, corresponding to CMP is given by the standard Preston Equation, which contains the load applied, the velocity of the pad, the Preston coefficient which includes chemical dependencies, and the hardness of the material. Typically the hardness, a bulk material constant, is taken as a constant throughout the wafer and thereby included in the Preston coefficient. Through metallurgy studies, on the micro and nano scale, it has been proven that the hardness is dependent upon grain size and orientation. This research served to first relate the crystallographic orientation to a specific hardness value and secondly use the hardness variation in the previously developed particle augmented mixed-lubrication (PAML) model to simulate the surface topography and MRR during CMP. Recent test and results show that currently there is no empirical formula to relate the crystallographic orientation and thereby a critically resolved shear stress (CRSS) to a specific hardness value. The second part of this investigation utilized the variation in hardness values from the initial study and incorporated these results into the PAML numerical model that incorporates all the physics of chemical mechanical polishing (CMP). Incorporation of the variation of hardness resulted in a surface topography with a difference in roughness (Ra) from the bulk constant hardness value of 60 nm. The material removal rate (MRR) of the process differs by 2.17 μm3/s.</jats:p