Background: Pediatric posterior fossa ependymoma contributes to morbidity and mortality in children. Following gross total resection and adjuvant radiotherapy, there is a known risk of local recurrence that portends a dismal prognosis. We sought to characterize survival in a molecularly defined cohort with an emphasis on recurrence patterns that influence outcome. Methods: This study was approved by the Ethics Board of the Hospital for Sick Children. We performed a twenty-year single-center retrospective study to identify clinical, demographic and treatment characteristics of patients with pathologically diagnosed posterior fossa ependymoma. Results: There were 60 patients identified that underwent primary resection. Recurrence rate in the cohort was 48% with 29 cases of recurrent ependymoma occurring at a mean time of 24 months after index surgery. No mortalities were observed among patients undergoing primary resection without recurrent disease. Median cohort survival was 12.3 years in the primary cohort and and 6.32 years among patients recurrent ependymoma. Recurrent disease was significantly associated with worse overall survival after multivariate analysis (HR = 0.024). Conclusions: We highlight overall survival and factors influencing mortality in pediatric posterior fossa ependymoma. Recurrent disease confers a worse prognosis. We describe for the first time survival trends following local and distant recurrences managed through multiple resections.

The most westerly Pacific island chain, running from Taiwan southwards through the Philippines, has long been central in debates about the origins and early migrations of Austronesian-speaking peoples from the Asian mainland into the islands of Southeast Asia and Oceania. Focusing on the Cagayan Valley of northern Luzon in the Philippines, the authors combine new and published radiocarbon dates to underpin a revised culture-historical synthesis. The results speak to the initial contacts and long-term relationships between Indigenous hunter-gatherers and immigrant Neolithic farmers, and the question of how the early speakers of Malayo-Polynesian languages spread into and through the Philippines.

Cassowaries (Casuarius) are one of the largest indigenous animal species of New Guinea. Researchers have long been trying to understand their local socio-cultural significance. Here we present new results from interviews recorded in 2018 on ethnography associated with bone daggers, a material culture ornament and tool carved from the cassowary's tibiotarsus. We present a ‘storied notion’—a contemporary narrative from oral history of why cassowary is not simply a bird, and briefly describe cassowary bone ornamentation in Auwim, East Sepik Province of Papua New Guinea. By exploring the material history of Casuarius through a ‘storied notion’ approach, we reveal that cassowary bone daggers in rock art are narrative ideas of the species from its landscape to ornamentation and through to people's cosmological beliefs surrounding Casuarius. We argue that the cassowary bone dagger stencil can be seen as part of the life history of this animal.

Older adults are often underrepresented in clinical research, even though older adults are major consumers of novel therapies. We present major themes and recommendations from the 2021 "Inclusion of Older Adults in Clinical Research" Workshop, convened by the Clinical and Translational Science Award (CTSA) Inclusion of Older Adults as a Model for Special Populations Workgroup and the Research Centers Collaborative Network (RCCN). The goal of this workshop was to develop strategies to assist the research community in increasing the inclusion of older adults in clinical research. Major identified barriers include historical lack of federal guidelines, ageist biases and stereotypes, and lack of recruitment and retention techniques or infrastructure focused on older adults. Three key recommendations emerged: 1) engaging with the policymaking process to further promote inclusion; 2) using the CTSA Workgroup Presentation Materials Library and other resources to overcome ageism, and 3) building institutional capacity to support age inclusion.

Background: Standard of care treatment for adult intracranial ependymoma patients includes maximal safe surgical resection, while the role for adjuvant radiotherapy remains unclear with existing data from small retrospective series’. Accordingly, we built a multi-institutional cohort to assess the prognostic value of adjuvant radiotherapy and other clinical factors in these patients. Methods: Patients managed for adult intracranial ependymomas from 1968 onwards within the University Health Network in Toronto, The University of Oklahoma Health Sciences Center, and The Ottawa Hospital were identified. Multivariate models assessing the prognostic value of clinical factors were built using variables with known prognostic value and/or significance in univariate Cox models. Results: Of 122 ependymomas, 71% were infratentorial, 78% grade two, 55% gross/near-totally resected (GTR/NTR), and 65% treated with adjuvant radiotherapy. Multivariate analyses identified GTR/NTR (vs. subtotal resection; HR=0.2, 95%CI=0.1–0.4, p<0.0001) and cranial (HR=0.5, 95%CI=0.2–1.1) or craniospinal (HR=0.2, 95%CI=0.04–0.5) radiotherapy receipt (p=0.01) as independent statistically significant predictors of more favourable PFS. Grade II pathology (vs. grade III; HR=0.2, 95%CI=0.05–0.6, p=0.006) and GTR/NTR (vs. subtotal resection; HR=0.1, 95%CI=0.03–0.3, p=0.0001) were independent statistically significant predictors of better OS. Conclusions: This work confirms the importance of maximal safe resection for adult intracranial ependymomas and establishes that adjuvant radiotherapy improves progression-free survival in these patients.

Background: Mean arterial pressure augmentation is one current established practice for management of patients with SCI. We present the first data investigating the effectiveness of Intrathecal Pressure (ITP) reduction through CSF drainage (CSFD) in managing patients with acute traumatic SCI at a large academic center. Methods: Data from 6 patients with acute traumatic SCI were included. A lumbar intrathecal catheter was used to monitor ITP and volume of CSFD. CSFD was performed and recorded hourly. ITP recordings were collected hourly and the change in ITP was calculated (hour after minus before CSFD). 369 data points were collected and change in ITP was plotted against volume of CSFD. Results: Data across all patients showed variability in the ITP over time without a significant trend (slope=0.016). We found no significant change in ITP with varying amounts of CSFD (slope=0.007, r2=0.00, p=0.88). Changes in ITP were not significantly different across groups of CSFD but the variation in the data decreased with increasing levels of CSFD. Conclusions: We present the first known data on changes in ITP with varying degrees of CSFD in patients with acute traumatic SCI. These results may provide insight into the complexity of ITP changes in patients post-injury and help inform future SCI management.

The excavation of the Qin wooden documents from Well No. 1 at Liye 里耶, Hunan province has significantly reshaped our knowledge of Qin history. This article examines a multi-slip manuscript from Liye on the Qin management of human resources in a newly conquered area, Qianling County. The manuscript is the best example of the multi-layered structure of a Qin administrative document; it also sheds new light on the difficulties the Qin encountered in resource management during the early years of unification. The manuscript shows that the responsible officials in Qianling County had failed to engage tuli 徒隸 (laborer-servants)—a major labor source in the Qin—in agricultural production, which appears to have deviated from the Qin strategy of managing human resources. To minimize the harmfulness that this deviation might cause, the Qin heavily relied upon a system of supervision and punishment. This article offers a contextualized study of the manuscript with an analysis of the related Qin excavated sources.

The introduction of new animals into hunter-gatherer societies produces a variety of cultural responses. This article explores the role of rock art in western Arnhem Land, Australia, in helping to mediate contact-period changes in Indigenous society in the nineteenth century. The authors explore etic and emic perspectives on the ‘re-emergence’ of water buffalo into Aboriginal cultural life. Merging archaeological analysis, rock art and ethnographic accounts, the article demonstrates how such artworks were used as a tool for maintaining order in times of dramatic social change. The results of this research have significant implications for understanding how cultural groups and individuals worldwide used rock art during periods of upheaval.

This article examines the evolution of the video game industry in Britain from its start in 1978. The industry originated with passionate hobbyists and amateurs who benefited from the national broadcaster's campaign to expand computer literacy. Unlike the regional clustering of the industry in the United States and Japan, the British industry was dispersed geographically, consisting of mini-clusters with porous boundaries. During the 2000s, the fragmented British industry was largely acquired by U.S. and Japanese multinational companies and became part of global value chains, but the development of mobile gaming and digital distribution provided opportunities for a new generation of start-ups to emerge in Britain.