To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Obstructive sleep apnea (OSA) is prevalent after stroke and associated with recurrent stroke, prolonged hospitalization, and decreased functional recovery. Sex differences in post-stroke OSA remain underexplored. The objective of this study was to evaluate sex differences in functional outcomes, stroke and OSA severity, and clinical manifestations of OSA in stroke patients with OSA.
We retrospectively evaluated data from three previously conducted studies. Study patients had an imaging-confirmed stroke and had been found to have OSA (apnea–hypopnea index [AHI] ≥ 5) on either in-laboratory polysomnography or home sleep apnea testing performed within 1 year of their stroke. Linear regression models were used to evaluate study outcomes.
In total, 171 participants with post-stroke OSA (117 males [68.4%] and 54 females [31.6%]) were included. Female sex was an independent predictor for greater functional impairment (β = 0.37, 95% CI 0.029–0.71, p = 0.03), increased stroke severity (β = 1.009, 95% CI 0.032–1.99, p = 0.04), and greater post-stroke depressive symptoms (β = 3.73, 95% CI 0.16–7.29, p = 0.04). Female sex was associated with lower OSA severity, as measured by the AHI (β = –5.93, 95% CI –11.21– –0.66). Sex was not an independent predictor of specific symptoms of OSA such as daytime sleepiness, snoring, tiredness, and observed apneas.
Females with post-stroke OSA had poorer functional outcomes and more severe strokes compared to males, despite having lower OSA severity. Females with post-stroke OSA also exhibited more depressive symptoms. Understanding sex differences in patients with post-stroke OSA will likely facilitate better recognition of OSA and potentially improve clinical outcomes.
In a well-known scene from the Mahābhārata, the female renunciate Sulabhā engages in a philosophical debate against King Janaka. This chapter will examine Sulabhā’s arguments and methods, while demonstrating that she makes important contributions to philosophical discussions that are going on throughout the text. I will focus on three aspects of her argument: (1) her discussion on good speech; (2) her articulation of the ethics of renunciation; and (3) her characterisation of the highest knowledge as beyond the dualities of gender distinctions. As I will show, Sulabhā makes original contributions to ongoing debates about rhetoric, ethics, and ontology in Indian philosophy. I will also address the thorny question of whether Sulabhā should be understood as a woman philosopher, or as a literary character most likely constructed by male authors. Despite the ultimate unanswerability of this question, Sulabhā articulates an understanding of enlightenment (mokṣa) that is as available for women as for men.
OBJECTIVES/GOALS: By establishing a youth-centric web-app as a central hub of information and inspiration in an attempt to engage a young demographic, this project aims to increase community awareness and reduce misconceptions surrounding clinical trials, in hopes of fairly representing marginalized communities among future clinical trial participants. METHODS/STUDY POPULATION: We designed a children’s web-app to host a collection of child-friendly educational materials (such as picture books, games, and age-appropriate articles about advances in clinical research) explaining clinical research and its process. An emphasis was put on ensuring the web-app and its contents were understandable and appealing to children. The effectiveness of this tool will be tested through a focus group study. Children ages 7-10 will be given a preliminary survey measuring their knowledge and opinions about clinical research, and then given time to explore the web-app. Afterwards, they will be given a secondary survey to gauge their acquired knowledge from the website and asked about their opinion on the design and usability of the web-app and its materials, as well as how likely they were to revisit the site. RESULTS/ANTICIPATED RESULTS: We anticipate a very positive response from the children regarding the design and usability of the web-app and its materials. By using an adolescent-focused design methodology at every step of the design process, we will ensure that all materials are attractive and engaging to our younger target audience. Exposing children to accessible information about clinical trials at a young age allows us to build their trust in the research process prior to the possible internalization and acceptance of cultural misconceptions. Over time, we hope to see a change in attitudes toward clinical research as well as increased participation, whether from under-represented groups or a younger demographic, and positively contribute to T3 and onwards in the translational continuum. DISCUSSION/SIGNIFICANCE: In a rapidly changing world, the best approach to making change is through targeting the younger demographic, the leaders of tomorrow. Our project will allow adolescents to foster a more well-rounded opinion of clinical research, increasing their participation and better paving a more positively received future for translational science as a whole.
OBJECTIVES/GOALS: Biomedical research fields are facing the challenges of demand for skilled workers as well as challenges related to diversity in that workforce. It is important that the healthcare workforce reflect the population it serves. The Exposures Internship seeks to address this by building pathways for youth to pursue careers in research and medicine. METHODS/STUDY POPULATION: In 2021, the Yale Cultural Ambassadors expressed concern about the lack of free high quality, educational offerings for youth that summer. They asked YCCI to consider developing a summer program for students aged 15 and older that focused on spurring interest in careers in healthcare, medicine, and clinical and translational research. The result was a 4-week virtual learning experience for 34 interns who met daily via Zoom and participated in course work, lectures, journal clubs, group projects, and virtual lunches with internationally renowned clinical research and healthcare leaders. Sessions were designed to help interns gain knowledge of and exposure to current topics in clinical and translational science and to observe the various steps of proposing, designing, undertaking, and analyzing clinical trials. RESULTS/ANTICIPATED RESULTS: YCCI received over 900 inquiries from around the world with more than 200 completed applications for participation in the internship for the pilot year. Since then, YCCI leadership has worked with community partners to engage young scholars from 17 different states, Canada, Mexico and Puerto Rico. Of those, we estimate 75% are minority, ~50% female and 20% from rural areas with limited similar opportunities. During the four weeks of the program these highly motivated students worked on projects aimed at increasing participation in pediatric research through a revised Informed consent and adolescent assent process and a youth centered awareness campaign. Interns were so inspired that they requested the program be continued beyond the initial four weeks. As such, YCCI continued to offer sessions throughout the year. DISCUSSION/SIGNIFICANCE: In evaluation of the pilot program 95% of respondents strongly agreed that the program exposed them to new information about clinical and translational research. One intern shared, This program has unquestionably made me consider becoming a researcher in the future with the goal of becoming a principal investigator within my interest in medicine.
Americans proudly streamed to the 1939 World’s Fair in New York City as World War II flared on the other side of the Atlantic. Not yet part of the conflict, Americans used the opportunity to escape the present and wax utopian. Although the dreams on display took many forms, they were synched together by an invisible hand – more specifically, by a basic assumption – concealed within each of the scenes: bountiful supplies of cheap energy.
Lyricism and drama do not sit well together in discussions of Schubert's instrumental music. Today it is widely accepted that the main impulse in his writing is ‘lyrical’ – a term that usually is set in opposition to ‘dramatic’, implying a looser, more relaxed approach to the way the music progresses and a privileging of the self-contained lyrical moment over the broader sweep of the work. Yet Schubert's finest instrumental music is also animated by a compelling dramatic process that seizes the imagination of its listeners from the very first bar of the piece and does not relent until all issues and conflicts have been resolved. By ‘dramatic’ I mean that the music projects the continuity of a coherent chain of events moving irresistibly to a final denouement, much like the unfolding of a well-crafted play. Its hold on the listener depends upon consistency in the music's plan and a progressive development of its material in which the implications of initial actions are realized later in the form. I would thus propose that in such instances, rather than being diametrically opposed, drama and lyricism work together effectively to create a unified and engaging whole. Here the overall disposition and relationship of the parts of the form create a powerful dramatic shape or scenario within which lyricism plays a crucial role.
The principal features of lyricism in Schubert's instrumental music include motivic and melodic repetition, the use of variation as opposed to motivic development, and the presence of ‘closed song forms’ within the overall structure. These features have been cast as a brake on the forward drive of Schubert's music and thus deficient in producing a truly dramatic structure. As shall be demonstrated, however, they are not in themselves impediments to the realization of the music's potential as drama, but instead often contribute effectively to that realization. A prime example of how lyricism works within an essentially dramatic conception of form is provided by the Impromptu in C minor, D. 899/1, which shall be the exclusive focus of the discussion that follows here. Before dealing with it in some depth, though, it is necessary first to examine those attitudes towards lyricism and drama in Schubert's instrumental music that have shaped its critical reception.
Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.
Schubert has long been famous for the striking character of his modulations. In fact, they are considered a hallmark of his style, particularly in his sonata-form transitions. Here, the precise moment that the subordinate key enters is often highlighted as an extraordinary event, capable of infusing a new and intense atmosphere into the subordinate theme. To achieve this effect, Schubert uses a variety of schemes. One of the most prominent of these consists of a “deflected-cadence” strategy involving two successive cadential progressions. The first, which occurs in the home key, may either achieve closure or be thwarted by an evaded or deceptive cadence. It is followed immediately by the second cadence, which begins the same way, only to be diverted at the last moment into a perfect authentic cadence (PAC) in the subordinate key. The modulation is thus accomplished exclusively by the second cadence, which both ends the transition and ushers in the subordinate-key region.
Schubert's deflected-cadence strategy constitutes a small, yet significant, departure from the classical transition, which usually targets the dominant, rather than the tonic, of the new key. The use of a concluding PAC and the unusual way it is set up create a new effect that distinguishes this type of transition from those of Haydn, Mozart, and Beethoven, as well as many of Schubert's own generation. What is more, the scheme itself has serious ramifications for other sections of the form, especially when elevated to a broader structural level, as shall be seen later in this chapter. Thus in this one detail of Schubert's sonata forms we see a subtle transformation of the classical style indicative of a new approach to sonata form and its aesthetics in the early nineteenth century. This situation emerges more clearly in a further comparison of Schubert's deflected-cadence strategy with conventional classical practice.
The Classical Sonata-Form Transition in the Theory of Formal Functions
We will begin with a discussion of the characteristics of the classical transition as defined by William E. Caplin's theory of formal functions. In Caplin's theory, the transition (what concerns us in this case is the modulating type) destabilizes the home key by a modulation that targets the dominant of the new key, either through a half cadence (HC) or a simple dominant arrival (a noncadential move to the new dominant).
A survey of publicly available data from the Intergovernmental Panel on Climate Change (IPCC) suggests that the Middle East will become significantly drier as greenhouse gas levels rise – with potentially devastating consequences. Simulating the climate of the eastern Mediterranean and the Middle East is, however, a tough challenge for climate models and those results should be interpreted with caution. The cyclones which migrate from west to east across the Mediterranean in winter and early spring, and which deliver much of the annual precipitation to the Middle East, are not well resolved by global climate models of the type included in the IPCC archive. Furthermore, the local climate is modified by coastlines and mountains throughout the region. For these reasons we provide a supplement to the IPCC results with simulations from a regional climate model. As in the global models, the regional model projects that, under an A2 (business-as-usual) scenario, precipitation will decrease significantly in the Middle East. Further investigation of the daily statistics of the weather, along with tracking of weather systems in the present day and future climate scenarios, suggest that the dominant mechanism for these changes is a reduction in the strength of the Mediterranean storm track. The Mediterranean storm track is fairly well simulated by the regional climate model, increasing confidence in this projection. […]
The arid climate of the Middle East means that variations in rainfall on all timescales from days to years have an enormous impact on the people who live in the region. Understanding this variability is crucial if we are to interpret model simulations of the region's climate and make meaningful predictions of how the climate may change in the future and how it has changed in the past (Chapters 3 and 4). This study uses rain gauge measurements in conjunction with other meteorological data to address the following questions. How does rainfall vary from day to day and from year to year? How does rainfall vary spatially within Jordan and Israel? How does the atmospheric circulation over the Mediterranean region affect the daily probability of rain? What effect do large-scale modes of variability such as the North Atlantic Oscillation have on rainfall variability in the region?
Variability in precipitation has posed a considerable challenge to the population of the Middle East throughout the Holocene, and continues to be a key issue today. Understanding this variability is crucial for the design and interpretation of climate model experiments that characterise how precipitation has changed in the past and predict how it will change in the future.
In this chapter, we develop an improved understanding of the Mediterranean's past climate through a series of ‘time-slice’ climate integrations relating to the past 12,000 years, performed using a version of the Met Office Hadley Centre's global climate model (HadSM3). The output is dynamically downscaled using a regional version of the same model to offer unprecedented spatial detail over the Mediterranean. Changes in seasonal surface air temperatures and precipitation are discussed at both global and regional scales along with their underlying physical drivers.
In the experiments the Mediterranean experiences more precipitation in the early Holocene than the late Holocene, although the difference is not uniform across the eastern Mediterranean. The results suggest that there may have been a relatively strong reduction in precipitation over the eastern Mediterranean coast during the period around 6–10 thousand years before present (kaBP). The early Holocene also shows a stronger seasonal cycle of temperature throughout the Northern Hemisphere but, over the northeast Mediterranean, this is mitigated by the influence of milder maritime air carried inland from the coast.
Understanding the changes in the Mediterranean climate during the Holocene period is a challenging problem, but one that is critical to interpreting long-term change in human settlement. The region at present displays marked seasonality with dry, hot summers and cool, wet winters.