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The 2020 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for the Secondary Prevention of Stroke includes current evidence-based recommendations and expert opinions intended for use by clinicians across a broad range of settings. They provide guidance for the prevention of ischemic stroke recurrence through the identification and management of modifiable vascular risk factors. Recommendations address triage, diagnostic testing, lifestyle behaviors, vaping, hypertension, hyperlipidemia, diabetes, atrial fibrillation, other cardiac conditions, antiplatelet and anticoagulant therapies, and carotid and vertebral artery disease. This update of the previous 2017 guideline contains several new or revised recommendations. Recommendations regarding triage and initial assessment of acute transient ischemic attack (TIA) and minor stroke have been simplified, and selected aspects of the etiological stroke workup are revised. Updated treatment recommendations based on new evidence have been made for dual antiplatelet therapy for TIA and minor stroke; anticoagulant therapy for atrial fibrillation; embolic strokes of undetermined source; low-density lipoprotein lowering; hypertriglyceridemia; diabetes treatment; and patent foramen ovale management. A new section has been added to provide practical guidance regarding temporary interruption of antithrombotic therapy for surgical procedures. Cancer-associated ischemic stroke is addressed. A section on virtual care delivery of secondary stroke prevention services in included to highlight a shifting paradigm of care delivery made more urgent by the global pandemic. In addition, where appropriate, sex differences as they pertain to treatments have been addressed. The CSBPR include supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.
This article traces the postbellum development and dissemination of the notion of “negro superstition.” By the end of Reconstruction, many whites across the nation, both liberal and conservative, shared in the belief that credulity was the keystone of African American culture. The formulation of superstition as innate racial trait served the conjoined causes of sectional reconciliation and white supremacy, eroding white support for black citizenship. As liberal estimations of black Christianity declined and conservative depictions of African American magical beliefs proliferated, “voodoo” gained traction as a potent imaginary, shorthand for racial atavism, unreason, and dangerous sexuality.
To prioritise and refine a set of evidence-informed statements into advice messages to promote vegetable liking in early childhood, and to determine applicability for dissemination of advice to relevant audiences.
Design:
A nominal group technique (NGT) workshop and a Delphi survey were conducted to prioritise and achieve consensus (≥70 % agreement) on thirty evidence-informed maternal (perinatal and lactation stage), infant (complementary feeding stage) and early years (family diet stage) vegetable-related advice messages. Messages were validated via triangulation analysis against the strength of evidence from an Umbrella review of strategies to increase children’s vegetable liking, and gaps in advice from a Desktop review of vegetable feeding advice.
Setting:
Australia.
Participants:
A purposeful sample of key stakeholders (NGT workshop, n 8 experts; Delphi survey, n 23 end users).
Results:
Participant consensus identified the most highly ranked priority messages associated with the strategies of: ‘in-utero exposure’ (perinatal and lactation, n 56 points) and ‘vegetable variety’ (complementary feeding, n 97 points; family diet, n 139 points). Triangulation revealed two strategies (‘repeated exposure’ and ‘variety’) and their associated advice messages suitable for policy and practice, twelve for research and four for food industry.
Conclusions:
Supported by national and state feeding guideline documents and resources, the advice messages relating to ‘repeated exposure’ and ‘variety’ to increase vegetable liking can be communicated to families and caregivers by healthcare practitioners. The food industry provides a vehicle for advice promotion and product development. Further research, where stronger evidence is needed, could further inform strategies for policy and practice, and food industry application.
Consumption is driven by children’s sensory acceptance, but little is known about the sensory characteristics of vegetables that children commonly eat. A greater understanding could help design more effective interventions to help raise intakes, thus realising beneficial health effects. This study sought to: (1) Understand the vegetable consumption patterns in children, with and without potatoes, using the Australian and WHO definitions. (2) Describe the sensory characteristics of vegetables consumed by children by age group, level of intake and variety. (3) Determine the vegetable preferences of children, by age group, level of intake and variety.
Design:
Analysis of National Nutrition Survey data, combining reported vegetable intake with sensory characteristics described by a trained panel.
Setting:
Australia
Participants:
A nationally representative sample of Australian children and adolescents aged 2–17·9 years (n 2812).
Results:
While consumption increased in older age groups, variety remained constant. Greater variety, however, was associated with higher vegetable consumption. Potato intake increased with consumption, contributing over one-third of total vegetable intake for highest vegetable consumption and for older age groups. Children favoured relatively sweet vegetables and reported lower consumption of bitter vegetables. There were no differences in the sensory properties of vegetables consumed by children in different age groups. After potatoes, carrots, sweetcorn, mixtures, fruiting and cruciferous types were preferred vegetables.
Conclusion:
Children tend to prefer vegetables with sensory characteristics consistent with innate taste preferences (sweet and low bitterness). Increasing exposure to a variety of vegetables may help increase the persistently low vegetable consumption patterns of children.
Bisphenol-A (BPA) is associated with adverse health outcomes and is found in many canned foods. It is not understood if some BPA contamination can be washed away by rinsing. The objective of this single-blinded crossover experiment was to determine whether BPA exposure, as measured by urinary concentrations, could be decreased by rinsing canned beans prior to consumption. Three types of hummus were prepared from dried beans, rinsed, and unrinsed canned beans. Fourteen healthy participants ate two samples of each hummus over six experimental days and collected spot urine specimens for BPA measurement. The geometric mean BPA levels for dried beans BPA (GM = 0.97 ng/ml, 95%CI = 0.74,1.26) was significantly lower than rinsed (GM = 1.89 ng/ml, 1.37,2.59) and unrinsed (GM = 2.46 ng/ml, 1.44,4.19). Difference-in-difference estimates showed an increase in GM BPA from pre- to post-hummus between unrinsed and rinsed canned beans of 1.39 ng/ml, p-value = 0.0400. Rinsing canned beans was an effective method to reduce BPA exposure.
Parasites sometimes expand their host range and cause new disease aetiologies. Genetic changes can then occur due to host-specific adaptive alterations, particularly when parasites cross between evolutionarily distant hosts. Characterizing genetic variation in Cryptosporidium from humans and other animals may have important implications for understanding disease dynamics and transmission. We analyse sequences from four loci (gp60, HSP-70, COWP and actin) representing multiple Cryptosporidium species reported in humans. We predicted low genetic diversity in species that present unusual human infections due to founder events and bottlenecks. High genetic diversity was observed in isolates from humans of Cryptosporidium meleagridis, Cryptosporidium cuniculus, Cryptosporidium hominis and Cryptosporidium parvum. A deviation of expected values of neutrality using Tajima's D was observed in C. cuniculus and C. meleagridis. The high genetic diversity in C. meleagridis and C. cuniculus did not match our expectations but deviations from neutrality indicate a recent decrease in genetic variability through a population bottleneck after an expansion event. Cryptosporidium hominis was also found with a significant Tajima's D positive value likely caused by recent population expansion of unusual genotypes in humans. These insights indicate that changes in genetic diversity can help us to understand host-parasite adaptation and evolution.
This chapter draws on research into the lives and prison experiences of around 650 male and female convicts who were released on licence (an early form of parole) from sentences of long-term imprisonment in England in the mid- to late nineteenth century. While both men and women were overwhelmingly committed to the convict system for larceny, their treatment differed significantly. The vast majority of convicts were released early on licence from their prison terms, even those committing very serious offences. However, female offenders were released slightly earlier and under different conditions than men. Having offended against their gender as well as society, more moral rehabilitation was deemed necessary for deviant women than for men, leading to requirements such as entering refuges or shelters. Female convicts’ internment in these institutions after being granted a licence reveals the impact of gender expectations on female prisoners in England.
The flavonoid curcumin is believed to be responsible for the purported health benefits of turmeric. Like other flavonoids, curcumin affects several systemic and central processes involved in neurocognitive aging. We have previously shown that one month administration of a highly bioavailable curcumin extract (Longvida™) improved working memory and reduced fatigue and workload stress in an older, cognitively intact cohort(1). This study focused on the effects of the same extract, focusing on memory tasks subserved by the hippocampus, one of two areas of the adult brain believed to be capable of adult neurogenesis.
Eighty healthy older participants (aged 50–80 years, mean = 68.1, ± SD 6.34) took part in this double-blind, placebo-controlled, parallel-groups trial. Volunteers were randomised to receive administration of 400 mg daily Longvida™ (containing 80 mg curcumin) or a matching placebo. Assessment took place at baseline and 4 and 12 weeks thereafter. Outcomes included two tasks evaluating memory processes relevant to hippocampal function. These were i) a human analogue of the widely used rodent Morris Water Maze - the virtual Morris Water Maze (vMWM) and ii) a Mnemonic Similarity task evaluating pattern separation. Measures of mood, cardiovascular function and other blood biomarkers were collected, and a subset of the cohort underwent neuroimaging using functional magnetic resonance imaging.
Compared with placebo, there were a number of improvements in the curcumin group. The curcumin group had significantly better performance at 12 weeks on the virtual Morris Water Maze (p = .019). Curcumin was also associated with better performance on a pattern separation task (p = .025). Curcumin was also associated with number of significantly benefits to mood, including, from the Profile of Mood States (POMS), including, at 28 days only, total mood disturbance (p = .006), tension-anxiety (p = .028), confusion-bewilderment (p = .019), anger-Hostility (p = .009). There were also significant benefits to the POMS fatigue scores at both assessments (p ≤ .011). There were no group differences in biomarker levels.
These results confirm that Longvida™ curcumin improves aspects of mood and working memory in a healthy older cohort. The pattern of results is consistent with improvements in hippocampal function and may hold promise for alleviating cognitive decline in populations at risk of pathological cognitive decline.
We present 0.″2–0.″4 resolution ALMA images of the submillimeter dust continuum and the CO, H2O, and H2O+ line emission in a z = 3.63 strongly lensed dusty starburst. We construct the lens model for the system with an MCMC technique. While the average magnification for the dust continuum is about 11, the magnification of the line emission varies from 5 to 22 across the source, resolving the source down to sub-kpc scales. The ISM content reveals that it is a pre-coalescence major merger of two ultra-luminous infrared galaxies, both with a large amount of molecular gas reservoir. The approaching galaxy in the south shows no apparent kinematic structure with a half-light radius of 0.4 kpc, while the preceding one resembles a 1.2 kpc rotating disk, separated by a projected distance of 1.3 kpc. The distribution of dust and gas emission suggests a large amount of cold ISM concentrated in the interacting region.
Deutetrabenazine is approved for treating Huntington disease (HD) chorea and is being evaluated for tardive dyskinesia (TD).
Objective
To assess the effect of deutetrabenazine on cardiac repolarization.
Methods
A QT interval study was performed to evaluate effects of deutetrabenazine 12 and 24 mg on cardiac repolarization, as assessed by time-matched change from baseline, placebo-adjusted, in Fridericia-corrected QT interval (ΔΔQTcF). Moxifloxacin (400 mg) and tetrabenazine (50 mg) were the positive control and comparator, respectively. An exposure–response analysis was developed from this study to predict maximal effects on QTcF at maximum recommended dosing based on CYP2D6 status, an approach consistent with regulatory guidance at predicting QT interval effects.
Results
Maximal ΔΔQTcF between the least-squares mean (90% two-sided confidence interval) of deutetrabenazine 12 and 24 mg (n=45 in each group) were 2.8 (0.7–4.8) ms and 4.5 (2.4–6.5) ms, respectively. The ΔΔQTcF increase with tetrabenazine (n=45) was 7.6 (5.6–9.5) ms. Assay sensitivity was verified with moxifloxacin (n=47), which produced a maximal effect on ΔΔQTcF of 14.0 (11.9–16.0) ms. A linear model was developed that described a correlation between plasma concentrations from pivotal HD andTD trials (n=101) and QT interval prolongation. Using that model and the individual predicted Cmax for HD and TD patients, the placebo-adjusted change from baseline inQTcF for deutetrabenazine at maximal recommended daily doses was found to be 5.4 (2.5–9.5) ms.
Conclusions
Patients receiving the maximal recommended doses of deutetrabenazine are predicted to have a QTcF increase below the level of regulatory concern.
Presented at: Psych Congress; September 16–19, 2017; New Orleans, Louisiana, USA.
Funding Acknowledgements
This study was funded by Teva Pharmaceutical Industries, Petach Tikva, Israel
Recent evidence suggests that exercise plays a role in cognition and that the posterior cingulate cortex (PCC) can be divided into dorsal and ventral subregions based on distinct connectivity patterns.
Aims
To examine the effect of physical activity and division of the PCC on brain functional connectivity measures in subjective memory complainers (SMC) carrying the epsilon 4 allele of apolipoprotein E (APOE 4) allele.
Method
Participants were 22 SMC carrying the APOE ɛ4 allele (ɛ4+; mean age 72.18 years) and 58 SMC non-carriers (ɛ4–; mean age 72.79 years). Connectivity of four dorsal and ventral seeds was examined. Relationships between PCC connectivity and physical activity measures were explored.
Results
ɛ4+ individuals showed increased connectivity between the dorsal PCC and dorsolateral prefrontal cortex, and the ventral PCC and supplementary motor area (SMA). Greater levels of physical activity correlated with the magnitude of ventral PCC–SMA connectivity.
Conclusions
The results provide the first evidence that ɛ4+ individuals at increased risk of cognitive decline show distinct alterations in dorsal and ventral PCC functional connectivity.
FOR much of his life Æthelwig had been troubled by an intermittent form of gout. It was very painful and he was said to have been ‘worn out’ by it before he died. That was on 16 February 1078 and within three months a page was turned when the king appointed Walter as the new abbot. It was the first time since 1014 that someone not a monk of Evesham had taken up the position and Walter was, of course, the first foreigner ever to be chosen. When he arrived at Evesham he was completely unknown to the community, but the personal contrast between Walter and Æthelwig was immediately obvious to the all-English monks, for Walter was a cultured Norman and was younger and physically fitter than Æthelwig had been in recent years. He had been promoted to Evesham from Canterbury, where he had been a chaplain to Archbishop Lanfranc, and his association with the learned Lanfranc went back to the 1060s, when Lanfranc was abbot of Caen in Normandy and Walter was his pupil there. Before Caen and Canterbury Walter had been a monk at the abbey of Cerisy-la- Forêt, thirty miles west of Caen. A fellow pupil and friend at Caen was Gundulf, later bishop of Rochester (1077–1108); they were able and ambitious young men and Lanfranc was evidently grooming them for high office. The chronicler William of Malmesbury relates that Walter and Gundulf were one day at Caen studying a gospel-book with Lanfranc, and while Lanfranc's attention was momentarily distracted they decided to play a game. They said ‘Let us turn the pages and see which of us is to be abbot and which bishop.’ They came to the gospel of Matthew, and in the twenty-fourth chapter Gundulf's finger alighted on the words ‘a faithful and wise servant, whom the lord hath appointed over his family’, while in the next chapter Walter found the line ‘good and faithful servant, … enter thou into the joy of thy lord’. They began laughing over these promising words and when Lanfranc asked them what they were so happy about, they confessed. Without hesitation Lanfranc is then said to have predicted that Gundulf would become a bishop and Walter an abbot.
IN 1190 the disgraced former prior of Christ Church Canterbury, Roger Norreis, had been foisted upon Evesham abbey in succession to Abbot Adam. It turned out to be an even greater misfortune than the monks might have imagined, and one that would be compounded during Roger's long abbacy by a frustrating three-way struggle between Norreis, who was a charming but dangerous libertine, the Evesham monk Thomas of Marlborough, a vigorous, tenacious, and eloquent lawyer, and Master Mauger, their conscientious and respected bishop.
Norreis's family background is unknown except that he had a nephew (nepos) called Roger and a kinsman called Matthew Dolfin; Dolfin and Norreis are surnames that indicate northern ancestry. In his first few years at Evesham the abbot's conduct seemed acceptable but as he became accustomed to the privileges of office the flaws in his character began to assert themselves, and privilege then turned to licence and licence to utter wantonness. All the while he was able to cloak his weaknesses in a seductive bonhomie that was hard to resist. Fluent and impressive in speech, he had the air of being both learned and courtly, and in his quarters he kept a convivial table at which good food and drink were freely enjoyed by his household, his guests, and himself. Norreis allowed himself the luxuries, unusual for a monk, of sleeping in linen sheets, of wearing comfortable shirts and linen garments, of sporting smart boots like a knight’s, and of going about the abbey in a cape instead of in the customary monastic dress. Such were the attributes of a secular baron, not an abbot, and he made no attempt to conceal them from the convent. Still less appropriate to a monk was Roger's enjoyment of carnal relations with women, with some of whom he was reputed to have fathered children. Needless to say, he disappointed early expectations that he might sometimes attend the church, consult the monks in chapter, dine with them, or sit with them in the cloister. Although the abbots of Evesham had begun to live apart from the monks long before Abbot Roger's time, with him the separation was taken beyond acceptable limits.
IT is clear from archaeological finds that Anglo-Saxon cultural influences had arrived in the left-bank area by the early sixth century, and by the end of the seventh century there were several burial grounds in which the graves were furnished in Germanic style with such items as beads, brooches, spears, and shields. Before the Norman Conquest other places nearby were reputed to be the sites of pagan burials. The richest of the Germanic-style graves known to us were discovered when a railway cutting was made at Great Hampton near Evesham in 1862. The remains of at least two people were found there and two spearheads and a large knife blade were recovered. Also in the graves at Great Hampton was a delicately made seventh-century gold and garnet pin suite, a dress or hair fastening made up of two pins linked by an ornamental chain and pendant. So costly an item shows that in the seventh century the local population included not only subsistence farmers but also men and women with money and prestige. Such privileged people may have had high standing within an orderly and stratified society; order is certainly implied by the existence of an early place of public assembly at a burial mound called ‘Fissesberg’ (‘Fisc's barrow’), which has been plausibly identified at Blackminster near Offenham (Fig. 3). From some unknown period matters affecting the whole area were discussed there and decisions approved and promulgated. Much remains uncertain but it seems reasonable to believe that Evesham minster's lands on the left bank of the Avon were not marginal in 703 but were populous and productive, just as they had been in Roman times. There is even some evidence that in 703 the farmers, though Anglo-Saxon in culture, were of the same Celtic blood as their Romano-British predecessors and were occupying settlements that had evolved directly from theirs.
The Britons
Anglo-Saxon culture pervaded the Vale of Evesham by the end of the seventh century but most of the inhabitants of the minster's land on both sides of the river were probably descended from Iron Age or Romano-British people. Local evidence of that comes from the former land unit known as ‘Wycweon’, which lay about two miles south-east of Evesham and has long been divided into the conjoined parishes of Childswickham and Wickhamford (Fig. 3).
AS bishop of the Hwicce Ecgwine had responsibility for an area that would later constitute the counties of Gloucester and Worcester and part of Warwickshire. The territory was so large that he would have been unable to devote more than a fraction of his attention to any particular part of it, and he could not have seen to the daily administration of his new minster at Evesham. According to Byrhtferth Ecgwine was the first abbot there, but that would have been in the sense that he had strategic control over the minster's affairs, not that he lived at Evesham with the community. As soon as the minster began to function Ecgwine would have needed to delegate the day-to- day management of it to a resident superior, just as Benedict Biscop had done some twenty years before in his foundations at Jarrow and Wearmouth; Benedict was abbot of both but each had its own abbot subordinate to him. At Evesham the first resident head was probably Æthelwald. He is the first man named in a tenth-century chronological list of the abbots. He also seems to be mentioned in a papal privilege in favour of Evesham; it purports to have been granted in 713 by Pope Constantine I at the request of Æthelwald, who is there described as the minster's envoy to Rome.
Some elements of the 713 privilege, in its received form, are clearly anachronistic, but at least one of the clauses may be authentic because there seem to be contemporary parallels for it: the Evesham privilege stipulates that the community should be allowed to elect its own abbot after the death of the previous head. A clause to that effect can be found in other alleged papal privileges of the period such as that which Pope Constantine is said to have granted for the minsters at Bermondsey and Woking, a document that may have an authentic basis, and the privilege that Pope Agatho (678–81) issued for the minster of St Peter and St Paul (later St Augustine's abbey) at Canterbury, where the surviving text is certainly based on a genuine original. It is also recorded that Benedict Biscop obtained a papal privilege for Wearmouth in 679 and that Wilfrid did the same for Ripon and Hexham between 679 and 680.
WALTER could not expect to match Æthelwig's experience and aptitude when it came to worldly matters and when he first came to Evesham he also had much to learn about local people and their personal connections. It was almost inevitable that in some respects Walter's abbacy would begin by upsetting them. Matters were especially difficult for him because he had also to contend with the resentment felt by everyone whom Æthelwig had outmanoeuvred to gain estates for the abbey; they nursed a latent bitterness, which Æthelwig's personal authority had forced them to suppress. Among the aggrieved parties the monks of Worcester cathedral priory were the ones most able to put their feelings about Æthelwig into words, and they propagated a story that implied that God shared their hostility towards him. They said that when Bishop Wulfstan heard that Æthelwig was dead his natural charity had moved him to offer prayers for the abbot's soul but that on doing so he had been instantly stricken with the abbot's disease of gout. When Wulfstan's physicians were unable to find a cure, he had resorted to prayer and it was revealed to him one night that it was his praying for Æthelwig that had incurred the affliction. Wulfstan stopped interceding for him and within a few days had completely recovered.
Walter was unable to reverse the local ill-will that Æthelwig's death had released, but his own initial tactlessness made matters worse. Walter had refused to accept as his feudal tenants many of the English people who had commended their estates to Æthelwig's personal protection. Walter did so in order that he could oust the holders and gain unfettered control of their land. Moreover, it was suspected that Walter was acting partly under the influence of young relatives who had followed him to Evesham in expectation of gains for themselves. They were not disappointed, in fact, for in due course Walter would enfeoff his brother Randal, against the monks’ wishes, with the manors of Weethley and Kinwarton in Warwickshire and Lark Stoke in Gloucestershire, and probably with the manor of Abbots Morton near Evesham, as well as with substantial estates at Littleton and Bretforton.