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Background: Observational studies have demonstrated improved outcomes with the adjunctive use of balloon guide catheters (BGC) during endovascular thrombectomy (EVT) for anterior circulation acute ischaemic stroke (AIS). However, the lack of high-level evidence and global practice heterogeneity justifies a randomised controlled trial (RCT) to investigate the effect of transient proximal blood flow arrest on the procedural and clinical outcomes of patients with AIS following EVT. Hypothesis: Proximal blood flow arrest in the cervical internal carotid artery during EVT for proximal large vessel occlusion is superior to no flow arrest in achieving complete vessel recanalisation. Methods: ProFATE is an investigator-initiated, pragmatic, multicentre RCT with blinding of participants and outcome assessment. An estimated 124 participants with an anterior circulation AIS due to large vessel occlusion, an NIHSS of ⩾2, ASPECTS ⩾ 5 and eligible for EVT using a first-line combined technique (contact aspiration and stent retriever) or contact aspiration only will be randomised (1:1) to receive BGC balloon inflation or no inflation during EVT. Outcomes: The primary outcome is the proportion of patients achieving near-complete/complete vessel recanalisation (eTICI 2c-3) at the end of the EVT procedure. Secondary outcomes include the functional outcome (modified Rankin Scale at 90 days), new or distal vascular territory clot embolisation rate, near-complete/complete recanalisation after the first pass, symptomatic intracranial haemorrhage, procedure-related complications and death at 90 days. Discussion: This is the first RCT to investigate the effect of proximal blood flow arrest during EVT using a BGC on the procedural and clinical outcomes of patients with AIS due to large vessel occlusion.

This article explores how the presence of competing logics in craft higher education (HE) influences educational provision and student experience. Findings are presented from four craft HE case studies across England, including analysis of degree programme specifications and module curricula and interviews with educators, current students and recent graduates conducted in 2018. The article presents how these logics influence employability-focused teaching in craft curricula and how this impacts time, space and facilities allocated to physical craft work. Key tensions identified include perceptions and measurement of graduate “success”, the impact on skill development and studio space and (dis)engagement with professional development training. The article concludes with reflection on how this relates to the perceived value of arts degrees, but argues that the responsibility to “prepare” students for craft careers cannot lie solely with HE providers.

School nurses frequently interact with school-age children and their parents/guardians regarding vaccinations. As a trusted source of information, the school nurse is in a unique position to share vaccine information with parents/guardians and school-age children that may dispel myths and, consequently, improve vaccination rates. Nevertheless, some parents/guardians are still reluctant to vaccinate their school-age children against Human Papilloma Virus (HPV) for a variety of reasons. Common barriers to HPV vaccination include a lack of understanding of the vaccine’s purpose, concerns regarding the vaccine’s safety, and insufficient recommendation from healthcare workers. However, school nurses have many duties in addition to ensuring vaccine compliance. School nurses may have difficulty remaining up-to-date on evidence-based answers to parents’/guardians’ questions about HPV vaccine. Therefore, the purpose of this article is to provide school nurses with a quick reference question and answer guide to parents’/guardians’ common HPV-related vaccination questions.

Creative intermediaries are increasingly recognised for their role in facilitating the growth and development of creative entrepreneurs and creative and cultural industries. There is also a growing interest in the role of creative and cultural industries in developing economies, for economic development but also cultural engagement and social change. In this article, we bring a Global South perspective to the study of creative intermediaries in the craft sector by exploring how they engage with makers and markets for craft products in Cape Town, South Africa and beyond. Using qualitative interviews with key players from four intermediary organisations working at the community level through to luxury export, we present their different business models and approaches to supporting the development of the craft sector and makers. We reflect on the role they play in addressing inequalities, especially in opportunities to access craft careers and develop sustainable livelihoods for disadvantaged communities. We also consider some of the key challenges these intermediaries face in relation to policy, infrastructure, finance and global competition. The article argues for the value of adopting an ecological perspective in studying the role of craft intermediaries to recognise their role in addressing inequalities in accessing craft careers and the importance of support for makers at different stages in their professional development.

There is growing interest in creative graduate skillsets, but so far there has been limited investigation of the specific skills and resource requirements of early-career crafts graduates. Drawing on qualitative interviews and quantitative rankings of skills and resources conducted with 25 graduates from four higher education providers in England, this article examines the role and relative priority of different skills and resources in establishing a professional practice. It is identified that the skills and resources key to professional practice are highly interrelated, and proposed that the diverse requirements for professional practice should be understood as an amalgam rather than isolated components, with the acquisition of skills and resources seen as accumulative. The potential for a lack of key resources to exacerbate inequalities in who can enter and work in the craft economy is discussed and recommendations made for initiatives that could help to address an unequal distribution of resources.

Frontline workers in welfare systems are often understood as an ‘uncaring’ group, with their affective labour co-opted and reframed in terms of systemic efficiency. Yet they also operate at the frontlines of neoliberal paternalism, their work structured by encounters with extreme hardship, required to address this through ‘pedagogical interventions’ aimed at instilling a competitive, individualistic ‘self-care’ mindset in applicants. Approaching care as a universal need, an embodied practice, and a location of resistance to capitalism, I explore how actors at the frontlines of welfare governance mobilise care in their daily encounters with welfare subjects. Reporting upon 54 extended interviews with frontline workers within the post-2015 Welsh homelessness system, I argue that care is central to the operation of the neoliberal paternalistic welfare system, providing a motivation for workers to engender compliance with neoliberal paternalistic methods of governance. I illustrate this with the example of the Housing (Wales) Act 2014, drawing upon three findings. First, workers operate from a core caring sensibility, caring despite structural constraints. Second, responsibilisation is conceptualised as a strategy which, through its focus on individual empowerment, becomes one of care. Third, however, the focus of these interventions was performative, giving workers strategies to help clients fit into the system and thus increase the legibility of their deservedness. Thus responsibilisation, a technology associated with state abandonment of welfare subjects, was used by workers as a strategy to enable meaningful care in the context of the intense constraints of their role.

This article journeys to a medieval century, to a remote figure, and to distant historical events that might mirror Desmond Tutu’s (1931–2021) context—possibly shed light on his spirituality. It is suggested that Desmond Tutu’s devotion and vision may invoke a unique Christian who remains influential among Anglicans/Episcopalians: Julian of Norwich (c. 1342/3–c. 1416). A child during a plague, an adult during civil strife, and a schooled theologian during her final years, Julian exhibited an embodied spiritual discipline echoing, perhaps, the “prayer and work” of Desmond Tutu. The Revelations to Julian began with the torment of crucifixion and ended with the disclosure of their purpose as “love” ( Rev. 86: 14). How Julian engaged with the God of these “shewings” might recall two “prisoners of hope” who, in their own challenging contexts, believed that ultimately “alle shalle be wele” ( Vis. 13: 61; Rev. 27: 28).

Background: Cocaine is a stimulant and Schedule II drug used as a local anesthetic and vasoconstrictor. Objective: This descriptive study characterized medical cocaine use in the United States. Methods: Retail drug distribution data from 2002 to 2017 were extracted for each state from the Drug Enforcement Administration, which reports on medical, research, and analytical chemistry use. The percentage of buyers (pharmacies, hospitals, and providers) was obtained. Use per state, corrected for population, was determined. Available cross-sectional data on cocaine use as reported by the Medicare and Medicaid programs for 2013-2017 and electronic medical records were examined. Results: Medical cocaine use decreased by −62.5% from 2002 to 2017. Hospitals accounted for 84.9% and practitioners for 9.9% of cocaine distribution in 2017. The number of pharmacies carrying cocaine dropped by −69.4%. The percentages of hospitals, practitioners, and pharmacies that carried cocaine in 2017 were 38.4%, 2.3%, and 0.3%, respectively. There was a 7-fold difference in 2002 (South Dakota, 76.1 mg/100 persons; Delaware, 10.1 mg/100 persons). Relative to the average state in 2017, those reporting the highest values (Montana, 20.1; North Dakota, 24.1 mg/100 persons) were significantly elevated. Cocaine use within the Medicare and Medicaid programs was negligible. Cocaine use within the Geisinger system was rare from 2002 to 2007 (

Background Direct mechanical thrombectomy may result in similar outcomes compared to a bridging approach with intravenous thrombolysis (IVT + MT) in acute ischemic stroke. Recent randomized controlled trials have varied in their design and noninferiority margin. Aim We sought to meta-analyze accumulated trial data to assess the difference and non-inferiority in clinical and procedural outcomes between direct mechanical thrombectomy and bridging therapy. Summary of review We conducted a systematic review of electronic databases following the preferred reporting items for systematic reviews and meta-analyses guidelines. Random effects meta-analyses were conducted for the pooled data. The primary outcome was good functional outcome at 90 days (modified Rankin scale (mRS) ≤ 2). Secondary outcomes included excellent functional outcome (mRS ≤ 1), mortality, any intracranial hemorrhage, symptomatic intracranial hemorrhage, successful reperfusion (thrombolysis in cerebral infarction ≥ 2 b), and procedure-related complications. Four randomized controlled trials comprising 1633 patients (817 direct mechanical thrombectomy, 816 bridging therapy) were included. There were no statistical differences for the 90-day good functional outcome (OR = 1.02, 95% CI 0.84–1.25, p = 0.54, I2 = 0%), and the absolute risk difference was 1% (95% CI: −4% to 5%). The lower 95% CI falls within the strictest noninferiority margin of −10% among included randomized control trials. Direct mechanical thrombectomy reduced the odds of successful reperfusion (OR = 0.76, 95% CI: 0.60–0.97, p = 0.03, I2 = 0%) and any intracranial hemorrhage (OR = 0.65, 95% CI: 0.49–0.86, p = 0.003, I2 = 38%). There was no difference in the remaining secondary outcomes. The risk of bias for all studies was low. Conclusion The combined trial data assessing direct mechanical thrombectomy versus bridging therapy showed no difference in improving good functional outcome. The wide noninferiority thresholds set by individual trials are in contrast with the clinical consensus on minimally important differences. However, our pooled analysis indicates noninferiority of direct mechanical thrombectomy with a 4% margin of confidence. The application of these findings is limited to patients presenting directly to mechanical thrombectomy-capable centers and real-world workflow times may differ against those achieved in a trial setting.

Professionals who counsel and serve survivors of childhood abuse may be at risk of experiencing symptoms of post-traumatic stress disorder (PTSD), which can be exacerbated by cognitive and emotional processes. It is hypothesized that (1) a significant proportion of professionals who primarily serve child abuse survivors experience elevated levels of PTSD symptoms and (2) elevated PTSD symptoms are associated with psychological inflexibility processes, specifically increased experiential avoidance, cognitive fusion, and emotion regulation difficulties. Child abuse counselors and service workers ( N = 31) in a major metropolitan area were recruited for a small pilot study. Participants completed self-report measures of PTSD symptoms and levels of psychological flexibility processes. A significant proportion of counselors endorsed clinically significant PTSD symptoms ( n = 13, 41.9%). PTSD symptoms were significantly associated with experiential avoidance ( r = .54, p < .01) and emotion regulation difficulties ( r = .51, p < .01). These associations remained significant after controlling for the personality trait of emotional stability/neuroticism. These findings suggest that PTSD symptoms may be common among child abuse counselors and service workers, and these symptoms tend to be of greater intensity when responded to in avoidant and inflexible ways.

Remote ischaemic conditioning (RIC) is achieved by repeated transient ischaemia of a distant organ/limb and is neuroprotective in experimental ischaemic stroke. However, the optimal time and methods of administration are unclear. Systematic review identified relevant preclinical studies; two authors independently extracted data on infarct volume, neurological deficit, RIC method (administration time, site, cycle number, length of limb occlusion (dose)), species and quality. Data were analysed using random effects models; results expressed as standardised mean difference (SMD). In 57 publications incorporating 99 experiments (1406 rats, 101 mice, 14 monkeys), RIC reduced lesion volume in transient (SMD −2.0; 95% CI −2.38, −1.61; p

We present a case of a 33-year-old woman in her third pregnancy diagnosed with platelet storage pool disorder who had previously suffered two postpartum major obstetric haemorrhages. Platelet storage pool disorder is a rare bleeding disorder where the platelet count is normal but platelet function is impaired due to deficiency of dense granules. A peripartum plan devised by an extensive multi-disciplinary team using principles for managing other bleeding and platelet function disorders helped minimise her risk of major haemorrhage. We also describe how point-of-care thromboelastography can help guide management and enable an individualised risk-benefit discussion with the woman about her anaesthetic choices.

We examine change across U.S. cohorts born between 1920 and 2000 in their probability of having had sex with same-sex partners in the last year and since age 18. Using data from the 1988–2018 General Social Surveys, we explore how trends differ by gender, race, and class background. We find steep increases across birth cohorts in the proportion of women who have had sex with both men and women since age 18, whereas increases for men are less steep. We suggest that the trends reflect an increasingly accepting social climate, and that women’s steeper trend is rooted in a long-term asymmetry in gender change, in which nonconformity to gender norms is more acceptable for women than men. We also find evidence that, among men, the increase in having had sex with both men and women was steeper for black than for white men, and for men of lower socioeconomic status; we speculate that the rise of mass incarceration among less privileged men may have influenced this trend.

The goal of the current study was to better understand the development of gender typicality in young adulthood by applying the dual-identity approach to gender typicality, previously developed with children, to a university sample. Participants ( n = 215, Mage = 20.20 years; 62% female) were asked to rate their perceived similarity to both own- and other-gender peers. They also completed questionnaires assessing sexist attitudes, internalized sexualization (females), adherence to male-typed behaviors in the context of interpersonal relationships (males; adherence to physical toughness and restrictive emotional expressivity), gender-based relationship efficacy, friendships, self-esteem, social self-efficacy, and social anxiety. Results indicated that self-perceived gender typicality involves comparisons to both gender groups, and that meaningful typologies can be created based on similarity to own- and other-gender groups. As with children, results indicated that identifying with one’s own gender was advantageous in terms of low social anxiety and relationships with own-gender peers. For adults who identified with both own- and other-gender peers, we identified additional social benefits (i.e., efficacy and friendships with other-gender peers). Further, we identified a downside to own-gender typicality: individuals who identified only with their own gender had more sexist attitudes than those who identified with the other gender. Findings support the viability of the dual-identity approach in young adults, and have implications for researchers assessing gender typicality across development.

BackgroundSmall vessel disease causes a quarter of ischaemic strokes (lacunar subtype), up to 45% of dementia either as vascular or mixed types, cognitive impairment and physical frailty. However, there is no specific treatment to prevent progression of small vessel disease.AimWe designed the LACunar Intervention Trial-2 (LACI-2) to test feasibility of a large trial testing cilostazol and/or isosorbide mononitrate (ISMN) by demonstrating adequate participant recruitment and retention in follow-up, drug tolerability, safety and confirm outcome event rates required to power a phase 3 trial.Methods and designLACI-2 is an investigator-initiated, prospective randomised open label blinded endpoint (PROBE) trial aiming to recruit 400 patients with prior lacunar syndrome due to a small subcortical infarct. We randomise participants to cilostazol v no cilostazol and ISMN or no ISMN, minimising on key prognostic factors. All patients receive guideline-based best medical therapy. Patients commence trial drug at low dose, increment to full dose over 2–4 weeks, continuing on full dose for a year. We follow-up participants to one year for symptoms, tablet compliance, safety, recurrent vascular events, cognition and functional outcomes, Trails B and brain MRI. LACI-2 is registered ISRCTN 14911850, EudraCT 2016–002277-35.Trial outcome: Primary outcome is feasibility of recruitment and compliance; secondary outcomes include safety (cerebral or systemic bleeding, falls, death), efficacy (recurrent cerebral and cardiac vascular events, cognition on TICS, Trails B) and tolerability.SummaryLACI-2 will determine feasibility, tolerability and provide outcome rates to power a large phase 3 trial to prevent progression of cerebral small vessel disease.

Introduction: Seizures are common after intracerebral haemorrhage. Tranexamic acid increases the risk of seizures in non-intracerebral haemorrhage population but its effect on post-intracerebral haemorrhage seizures is unknown. We explored the risk factors and outcomes of seizures after intracerebral haemorrhage and if tranexamic acid increased the risk of seizures in the Tranexamic acid for IntraCerebral Haemorrhage-2 trial. Patients and methods: Seizures were reported prospectively up to day 90. Cox regression analyses were used to determine the predictors of seizures within 90 days and early seizures (≤7 days). We explored the effect of early seizures on day 90 outcomes. Results: Of 2325 patients recruited, 193 (8.3%) had seizures including 163 (84.5%) early seizures and 30 (15.5%) late seizures (>7 days). Younger age (adjusted hazard ratio (aHR) 0.98 per year increase, 95% confidence interval (CI) 0.97–0.99; p = 0.008), lobar haematoma (aHR 5.84, 95%CI 3.58–9.52; p < 0.001), higher National Institute of Health Stroke Scale (aHR 1.03, 95%CI 1.01–1.06; p = 0.014) and previous stroke (aHR 1.66, 95%CI 1.11–2.47; p = 0.013) were associated with early seizures. Tranexamic acid did not increase the risk of seizure within 90 days. Early seizures were associated with worse modified Rankin Scale (adjusted odds ratio (aOR) 1.79, 95%CI 1.12–2.86, p = 0.015) and increased risk of death (aOR 3.26, 95%CI 1.98–5.39; p < 0.001) at day 90. Discussion and conclusion: Lobar haematoma was the strongest independent predictor of early seizures after intracerebral haemorrhage. Tranexamic acid did not increase the risk of post-intracerebral haemorrhage seizures in the first 90 days. Early seizures resulted in worse functional outcome and increased risk of death.

Introduction Closed central slip injuries can be difficult to manage and there is a lack of published research to support evidence-based clinical decision making in practice. This article presents the results of a service review in a busy trauma hospital hand therapy department. Method Following a literature review and retrospective review of outcomes, new clinical guidelines for central slip injuries were developed. These were implemented with 22 patients referred to hand therapy for conservative management of closed central slip injuries during a one-year period. Results The majority of patients (72%) had either an excellent or good outcome using the Strickland-Glogovac outcome measure and an average total active motion of 90% compared to their unaffected hand. Conclusions The outcomes following implementation of new treatment guidelines following the service review are in line with the small amount of published data currently available. They provide detailed guidelines for the conservative management of closed central slip injuries in a busy out-patient setting.

An intractable problem that characterizes the contemporary philosophical discussion of emotion is whether emotions are fundamentally cognitive or noncognitive. In this article, I will establish that this problem arises from the influence of an underlying philosophical anthropology that entails a mind/body “split” ultimately inherited from Cartesianism, and further show that it can be fruitfully addressed by adopting a contemporary construal of the self and emotions derived from the philosophy of a key critic of Descartes’ dualism, Spinoza.

Purpose: We investigated the incidence and extent of stent migration after endovascular sealing of\ud abdominal aortic aneurysms (EVAS), its relationship with adherence to the instructions for use of the\ud Nellix endograft and its association with aneurysm growth.\ud Methods: In this retrospective single centre study, the clinical data and follow-up CT images of\ud patients undergoing infra-renal EVAS with a minimum follow-up of 1 year were reviewed. The first\ud postoperative CT scan at one month and the subsequent scans were used to measure the distances\ud between the proximal end of the stent and reference visceral vessels using a previously validated\ud technique. Device migration was based on the Society of Vascular Surgery definition of >10mm\ud downward movement of either Nellix stent in the proximal landing zone; furthermore, we defined\ud proximal displacement a downward movement of ≥4mm. Patients were categorised according to\ud adherence to the old (2013) or new (2016) Nellix IFU. Aneurysm diameter was measured for each\ud scan and a change of ≥5mm was deemed indicative of aneurysm growth.\ud Results: Seventy-five patients were eligible for inclusion in our study. Over a 4-year period, migration\ud ≥4mm occurred in 42 (56%) patients and migration of ≥10mm in 16 (21%), with similar incidence in\ud right and left stents. Migration ≥4mm was significantly more frequent among patients whose\ud anatomy did not conform to any IFU (p=0.025). Presence of aneurysm growth ≥5mm was observed\ud in 14 patients (19%) and was significantly associated with proximal displacement ≥4mm (p=0.03).\ud Conclusion: Infra-renal EVAS may be complicated by proximal displacement and migration,\ud particularly when performed outside IFU. The definition of migration used for EVAR is inappropriate\ud for EVAS; a new consensus on definition and measurement technique is necessary.