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We implemented universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing of patients undergoing surgical procedures as a means to conserve personal protective equipment (PPE). The rate of asymptomatic coronavirus disease 2019 (COVID-19) was <0.5%, which suggests that early local public health interventions were successful. Although our protocol was resource intensive, it prevented exposures to healthcare team members.
Institutional deprivation in early childhood is associated with neuropsychological deficits in adolescence. Using 20-year follow-up data from a unique natural experiment – the large-scale adoption of children exposed to extreme deprivation in Romanian institutions in the 1980s –we examined, for the first time, whether such deficits are still present in adulthood and whether they are associated with deprivation-related symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).
Adult neuropsychological functioning was assessed across five domains (inhibitory control, emotion recognition, decision-making, prospective memory and IQ) in 70 previously institutionalized adoptees (mean age = 25.3, 50% female) and 22 non-deprived UK adoptees (comparison group, mean age = 24.6, 41% female). ADHD and ASD symptoms were assessed using parent-completed questionnaires.
Early institutionalization was associated with impaired performance on all tasks in adulthood. Prospective memory deficits persisted after controlling for IQ. ADHD and ASD symptoms were positively correlated. After controlling for ASD symptoms, ADHD symptoms remained associated with deficits in IQ, prospective memory, proactive inhibition, decision-making quality and emotion recognition. ASD symptoms were not independently associated with neuropsychological deficits when accounting for their overlap with ADHD symptoms. Multiple regression analysis revealed that the link between childhood deprivation and adult ADHD symptoms was statistically explained by deprivation-related differences in adult IQ and prospective memory.
These results represent some of the most compelling evidence to date of the enduring power of early, time-limited childhood adversity to impair long-term neuropsychological functioning across the lifespan – effects that are linked specifically to deprivation-related adult ADHD symptoms.
Apolipoprotein E (APOE) E4 is the main genetic risk factor for Alzheimer’s disease (AD). Due to the consistent association, there is interest as to whether E4 influences the risk of other neurodegenerative diseases. Further, there is a constant search for other genetic biomarkers contributing to these phenotypes, such as microtubule-associated protein tau (MAPT) haplotypes. Here, participants from the Ontario Neurodegenerative Disease Research Initiative were genotyped to investigate whether the APOE E4 allele or MAPT H1 haplotype are associated with five neurodegenerative diseases: (1) AD and mild cognitive impairment (MCI), (2) amyotrophic lateral sclerosis, (3) frontotemporal dementia (FTD), (4) Parkinson’s disease, and (5) vascular cognitive impairment.
Genotypes were defined for their respective APOE allele and MAPT haplotype calls for each participant, and logistic regression analyses were performed to identify the associations with the presentations of neurodegenerative diseases.
Our work confirmed the association of the E4 allele with a dose-dependent increased presentation of AD, and an association between the E4 allele alone and MCI; however, the other four diseases were not associated with E4. Further, the APOE E2 allele was associated with decreased presentation of both AD and MCI. No associations were identified between MAPT haplotype and the neurodegenerative disease cohorts; but following subtyping of the FTD cohort, the H1 haplotype was significantly associated with progressive supranuclear palsy.
This is the first study to concurrently analyze the association of APOE isoforms and MAPT haplotypes with five neurodegenerative diseases using consistent enrollment criteria and broad phenotypic analysis.
To define optimal thromboprophylaxis strategy after stent implantation in superior or total cavopulmonary connections.
Stent thrombosis is a rare complication of intravascular stenting, with a perceived higher risk in single-ventricle patients.
All patients who underwent stent implantation within superior or total cavopulmonary connections (caval vein, innominate vein, Fontan, or branch pulmonary arteries) were included. Cohort was divided into aspirin therapy alone versus advanced anticoagulation, including warfarin, enoxaparin, heparin, or clopidogrel. Primary endpoint was in-stent or downstream thrombus, and secondary endpoints included bleeding complications.
A total of 58 patients with single-ventricle circulation underwent 72 stent implantations. Of them 14 stents (19%) were implanted post-superior cavopulmonary connection and 58 (81%) post-total cavopulmonary connection. Indications for stenting included vessel/conduit stenosis (67%), external compression (18%), and thrombotic occlusion (15%). Advanced anticoagulation was prescribed for 32 (44%) patients and aspirin for 40 (56%) patients. Median follow up was 1.1 (25th–75th percentile, 0.5–2.6) years. Echocardiograms were available in 71 patients (99%), and advanced imaging in 44 patients (61%). Thrombosis was present in two patients on advanced anticoagulation (6.3%) and none noted in patients on aspirin (p = 0.187). Both patients with in-stent thrombus underwent initial stenting due to occlusive left pulmonary artery thrombus acutely post-superior cavopulmonary connection. There were seven (22%) significant bleeding complications for advanced anticoagulation and none for aspirin (p < 0.001).
Antithrombotic strategy does not appear to affect rates of in-stent thrombus in single-ventricle circulations. Aspirin alone may be sufficient for most patients undergoing stent implantation, while pre-existing thrombus may warrant advanced anticoagulation.
Nearly 258 million ha (28%) of the United States is publicly owned land that is managed by federal government agencies. For example, the US Department of Agriculture's Forest Service (USFS) manages over 77 million ha of national forests and grasslands for the benefit of the American public. Given its legal directive to manage multiple uses, it is not surprising that conflicts arise among stakeholders over how this land should be used (Lansky, 1992). The USFS has much discretion in how land is managed, yet must often balance conflicting values of public use and benefit (Nie, 2004). As national priorities, social preferences and public awareness of national forest goods, services and values have changed over time, USFS managers have faced increased pressure to balance consumptive uses with the need for environmental protection. Competing stakeholder demands coupled with increased environmental risks (wildfires, tree diseases and insect epidemics) have resulted in an escalating conservation conflict that is manifested in administrative appeals, lawsuits and a growing distrust of the agency.
Over time, the USFS has embraced new directions and management paradigms to reduce conflict. Some of these have been ecosystem management, adaptive management and now collaborative management (e.g. Holling, 1978; Maser, 1988; Franklin, 1992; Boyce and Haney, 1997; Wondolleck and Yaffee, 2000; Brown et al., 2004). These approaches reflect changing societal values, political pressures and new scientific information.
A persistent conflict has been the logging of trees in national forests and related impacts on forest ecosystems (Lansky, 1992). The USFS’ timber sale programme has supported jobs and community stability through economic development. Logging has also been a mechanism to reduce the risk of wildfire by reducing tree density (fuel for fires) and vertical stand diversity (‘ladder’ fuels; North et al., 2009). However, logging can also negatively affect forest integrity, watershed quality, wildlife, aesthetic and spiritual values of forests (Satterfield, 2002; North et al., 2009).
The correspondences between the names in the Scylding genealogy at the beginning of Beowulf and three names in the upper reaches of the genealogy of Æthelwulf in the Anglo-Saxon Chronicle, Beaw, Sceldwa and Sceaf, frequently appear in arguments for a late dating of Beowulf. But these arguments overlook many aspects of Æthelwulf's genealogy that disrupt their case for a late dating. As H. Munro Chadwick pointed out over a century ago, the forms Sceldwa and Beaw found in the Chronicle for Scyld and Beow are not West Saxon spellings, and the -wa suffix of Sceldwa and Tætwa suggests that these forms may be archaic. Thus spelling alone indicates that these names were probably copied from an older, non-West Saxon text. Furthermore, the very presence of these names in the royal pedigree is puzzling. On one level the presence of Scyld is easy to explain: Scyld and the Scyldings were famous in heroic legend, and his inclusion in Æthelwulf's pedigree provides reflected glory for the West Saxon dynasty and implies genealogical, political and cultural connections between the West Saxons and the Danes that could be useful for Alfred and his heirs to foster. But on another level his inclusion is rather surprising: according to genealogical conventions, the presence of Scyld implies that the West Saxon royal family is a cadet branch of the Scylding dynasty, and is thus potentially subordinate to Scandinavian rulers in England claiming direct descent from Scyld.
Since the date of the Beowulf manuscript is widely agreed upon, the very question which prompts this volume (and the conference it derives from, and even the 1980 conference with its 1981 proceedings volume) must assume that the date of the poem may not be the same as the date of the manuscript. It is certain that there must have been a moment of first inscription for the poem, and that the time and place of that moment remains a central point of interest for students of the poem. In this essay, I will bring new evidence to bear on this venerable question, and my argument shall be that Beowulf is metrically conservative according to a variety of independent metrical criteria. Further, I will suggest that that conservatism is so varied and consistent as to strongly indicate that the original version of Beowulf must be placed among the very earliest of the longer narrative Old English poems that survive, probably in the eighth century.
Of course, it remains true, I believe, that the moment of inscription is only one of the moments of interest which might engage modern scholars of the poem. As I argued in Authors, Audiences, and Old English Verse, our focus on authorship (and on moments of authorship) may sometimes cause us to lose sight of what can be gained by also considering audience, and I proposed there two later audiences for Beowulf, one located at Alfred's Wessex court in the late ninth century, and another, sometime around the turn of the eleventh century, perhaps in Canterbury, represented most clearly by the author of Maldon.
As the introduction to this collection makes clear, the various forms of linguistic and metrical evidence bearing on the dating of Beowulf point to a date of composition fairly early in the Anglo-Saxon period. In his article for The Dating of Beowulf in 1980, Thomas Cable proposed a rough guide to the metrical dating of poems using the incidence of type C, D, and E verses, which decline in frequency over the Anglo-Saxon period. Cable's criterion places Beowulf toward the beginning of a relative chronology. Since then, much additional metrical and linguistic evidence has been gathered that places Beowulf in the early to mid-eighth century. R.D. Fulk's A History of Old English Meter is the most substantial work of this kind, for it examines the presence of archaic metrical features through-out the corpus of Old English poetry and finds that Beowulf is by far the most archaic poem. Since that work, other scholars have written articles on individual metrical or linguistic features of the poetic corpus, which have corroborated the conclusions that Fulk so carefully reached.
Some scholars, however, remain dubious about the reliability of this type of evidence. At this point, the force of linguistic scholarship is too formidable to be undermined by the doubts raised by E.G. Stanley, who urged that the poem should not be dated by means of sundry linguistic oddities that could well be scribal error or just a few bad lines.
From the publication of the poem's editio princeps in 1815 to the emergence of the present collection two centuries later, few topics in Anglo-Saxon studies have generated as much speculation and scholarship as the dating of Beowulf. Marshaling disparate forms of evidence and argumentation, scholars have assigned dates to Beowulf that range from the seventh to the eleventh century. Various individuals have been unpersuasively identified as the author of Beowulf and dozens of kings, clerics, and contexts have been associated with the poem's genesis. Scholarship on the dating of Beowulf is markedly uneven in quality: alongside sober and thoughtful argumentation, there has been a great deal of improbable hypothesizing about the author of the poem or the milieu in which it was composed. Awareness of the qualitative differences in the scholarly literature is tacitly registered in the relative frequency with which publications are cited, but these differences have rarely received explicit discussion. This introduction to the dating of Beowulf controversy examines the changing standards of evidence, methodology, and argumentation that have attended this topic, particularly in the past thirty years. The dating of Beowulf has not been a static or monolithic subject, but has undergone considerable change in the disputes it connotes and the practices it encompasses. In the following account, emphasis will be given to the reasons for prevailing opinions rather than to the multiplicity of opinions as such.
Arguments about the date of Beowulf are more impassioned than the question seems to merit. Even so, the controversy has its uses. Beowulf is a great work, all agree, but it constitutes only a sliver of the poetic canon and is doubtless more important to Anglo-Saxon culture now than it was a thousand years ago. For all its glory, Beowulf provides no better an index to Anglo-Saxon poetry than Hamlet to Renaissance drama, which is to say that one can know both works well without knowing much about the corpus to which either belongs. It is to welcome and good effect, then, that several chapters in this volume link the date of Beowulf to the date of everything else, which, for purposes of this discussion, is the rest of Old English poetry.
At the Harvard conference, R.D. Fulk argued that the date of the poem's composition is less significant than the means used to hypothesize the date. The introduction to Fulk's Chapter 1 in this volume sums up an extended discussion regarding probability, proof, and linguistic evidence drawn from his History of Old English Meter. Fulk observes that the criteria for dating verse are not uniformly rigorous and that they have not been subjected to uniformly rigorous testing. Words can be counted and their forms analyzed, so that exceptions to linguistic and metrical criteria emerge quickly; in these cases, the relative probability of competing hypotheses can be readily gauged.