Search

Central retinal artery occlusion (CRAO) is a rare emergency department presentation with high morbidity and potential for long-term vision loss. Additionally, this finding requires an expeditious embolic workup for possible systemic pathology (i.e., stroke). The gold standard for diagnosis is visualization of a pale retina with a “cherry-red spot” on the fovea seen under dilated fundoscopic examination. However, performing a dilated fundoscopic exam is often not practical and technically challenging in the emergency room setting. Alternatively, point of care ultrasound is an inexpensive, non-invasive tool that is already highly utilized in the emergency department and can aid in diagnosis. In the case described in this report, a 66-year-old female presented to the emergency department with painless, monocular vision loss. Ultrasound showed a hyperechoic density on the distal aspect of the optic nerve (“retrobulbar spot sign”) and dilated fundoscopic exam showed right eye pale macula with cherry red spot, all consistent with CRAO. Here we present a case that suggests an opportunity for improvement in evaluation of monocular vision loss in the emergency department by adding bedside ocular ultrasound to aid in more rapid diagnosis of CRAO.Topics: Central retinal occlusion, vision loss, point-of-care ultrasound, ocular ultrasound, emboli.

IntroductionArts and health practice and research has expanded rapidly since the turn of the millennium. A World Health Organization scoping review of a large body of evidence claims positive health benefits from arts participation and makes recommendations for policy and implementation of arts for health initiatives. A more recent scoping review (CultureForHealth) also claims that current evidence is sufficient to form recommendations for policy and practice. However, scoping reviews of arts and health research—without critical appraisal of included studies—do not provide a sound basis for recommendations on the wider implantation of healthcare interventions.MethodsWe performed a detailed assessment of 18 Randomised Controlled Trials (RCTs) on arts-based interventions included in Section 1 of the CultureForHealth report using the Joanna Briggs Institute Critical Appraisal Tool for RCTs (2023).ResultsThe 18 RCTs included demonstrated considerable risks of bias regarding internal and statistical conclusion validity. Moreover, the trials are substantially heterogeneous with respect to settings, health-issues, interventions, and outcomes, which limits their external validity, reliability, and generalisability.ConclusionsThe absence of a critical appraisal of studies included in the CultureForHealth report leads to an overinterpretation and overstatement of the health outcomes of arts-based interventions. As such, the CultureForHealth review is not a suitable foundation for policy recommendations, nor for formulating guidance on implementation of arts-based interventions for health.

Abstract Dissipative Kerr soliton (DKS) microcomb has emerged as an enabling technology that revolutionizes a wide range of applications in both basic science and technological innovation. Reliable turnkey operation with sub-optical-cycle and sub-femtosecond timing jitter is key to the success of many intriguing microcomb applications at the intersection of ultrafast optics and microwave electronics. Here we propose an approach and demonstrate the first turnkey Brillouin-DKS frequency comb to the best of our knowledge. Our microresonator-filtered laser design offers essential benefits, including phase insensitivity, self-healing capability, deterministic selection of the DKS state, and access to the ultralow noise comb state. The demonstrated turnkey Brillouin-DKS frequency comb achieves a fundamental comb linewidth of 100 mHz and DKS timing jitter of 1 femtosecond for averaging times up to 56 μs. The approach is universal and generalizable to various device platforms for user-friendly and field-deployable comb devices.

Poetry and philosophy have had a close but uneasy relationship in the western tradition. Both share an eschewal of the discovery of novel facts, but are somewhat opposed in that discovery is a central aim of poetry, but not at all the aim of philosophy. Through a close reading of W.H. Auden’s ‘In Memory of W.B. Yeats’ and a versification of part of G.E. Moore’s ‘A Defence of Common Sense’, I argue that what poetry shows corresponds, in a broadly symbolist sense, to Wittgenstein’s understanding of the miraculous nature of the world. In this regard, poetry can offer philosophy clarity, in the form of its tonal architecture, value, and ethics, and may also constitute a perspicuous representation. Poetry remains in a perpetual mode of potential, as well as being possessed of a vatic autonomy.

The electronic structure and local coordination of binary (Mo6T8) and ternary Chevrel Phases (MxMo6T8) are investigated for a range of metal intercalant and chalcogen compositions. We evaluate differences in the Mo L3-edge and K-edge X-ray absorption near edge structure across the suite of chalcogenides MxMo6T8 (M = Cu, Ni, x = 1-2, T = S, Se, Te), quantifying the effect of compositional and structural modification on electronic structure. Furthermore, we highlight the expansion, contraction, and anisotropy of Mo6 clusters within these Chevrel Phase frameworks through extended X-ray absorption fine structure analysis. Our results show that metal-to-cluster charge transfer upon intercalation is dominated by the chalcogen acceptors, evidenced by significant changes in their respective X-ray absorption spectra in comparison to relatively unaffected Mo cations. These results explain the effects of metal intercalation on the electronic and local structure of Chevrel Phases across various chalcogen compositions, and aid in rationalizing electron distribution within the structure.

This mixed methods study sought the views of early childhood studies students from three universities in England. The research explored motivations, professional aspirations and the attributes they believed were required to work in early childhood. Findings highlighted that the holistic study of early childhood is valued by students and placements offered a "space" where they grew and flourished, as they made sense of where their "personal" intersected with wider theoretical, practice and political systems embedded in early childhood. Students follow a range of career trajectories, either by choice or because there is no specific practitioner role underpinned by the holistic study of early childhood. This study also revealed factors that led to their choice and place of study, as well as the ways that students' personal circumstances affected their studies, reinforcing the importance of academic and pastoral support. Very significantly, this research led to discussions about the core purpose of the early childhood studies degree and helped to inform the development of the Graduate Competencies as an addition to ECS degrees that included placements.

The Common Core State Standards for Mathematical Practice asks students to look for and make use of structure. Hence, mathematics teacher educators need to prepare teachers to support students' structural reasoning. In this article, we present tasks and rubrics designed and validated to characterize teachers' structural reasoning for the purposes of professional development. Initially, tasks were designed and improved using interviews and small pilot studies. Next, we gave written structure tasks to over 600 teachers in two countries and developed and validated rubrics to categorize responses. Our work contributes to the preparation and support of mathematics teachers as they develop their own structural reasoning and their ability to help students develop structural reasoning.

Individuals who have thrombocytopenia and cancer-associated thrombosis (CAT) are difficult to manage because they have a high risk of bleeding and recurrent thrombosis. The International Society on Thrombosis and Haemostasis guidelines for the management of thrombocytopenia in patients with CAT suggest two main approaches: either complete anticoagulation with transfusion support if necessary, or dose-modified anticoagulation while the platelet count is

PurposeTo provide precise age-specific risk estimates of cancers other than female breast and ovarian cancers associated with pathogenic variants (PVs) in BRCA1 and BRCA2 for effective cancer risk management.MethodsWe used data from 3,184 BRCA1 and 2,157 BRCA2 families in the Consortium of Investigators of Modifiers of BRCA1/2 to estimate age-specific relative (RR) and absolute risks for 22 first primary cancer types adjusting for family ascertainment.ResultsBRCA1 PVs were associated with risks of male breast (RR = 4.30; 95% CI, 1.09 to 16.96), pancreatic (RR = 2.36; 95% CI, 1.51 to 3.68), and stomach (RR = 2.17; 95% CI, 1.25 to 3.77) cancers. Associations with colorectal and gallbladder cancers were also suggested. BRCA2 PVs were associated with risks of male breast (RR = 44.0; 95% CI, 21.3 to 90.9), stomach (RR = 3.69; 95% CI, 2.40 to 5.67), pancreatic (RR = 3.34; 95% CI, 2.21 to 5.06), and prostate (RR = 2.22; 95% CI, 1.63 to 3.03) cancers. The stomach cancer RR was higher for females than males (6.89 v 2.76; P = .04). The absolute risks to age 80 years ranged from 0.4% for male breast cancer to approximately 2.5% for pancreatic cancer for BRCA1 carriers and from approximately 2.5% for pancreatic cancer to 27% for prostate cancer for BRCA2 carriers.ConclusionIn addition to female breast and ovarian cancers, BRCA1 and BRCA2 PVs are associated with increased risks of male breast, pancreatic, stomach, and prostate (only BRCA2 PVs) cancers, but not with the risks of other previously suggested cancers. The estimated age-specific risks will refine cancer risk management in men and women with BRCA1/2 PVs.

This review article summarizes the current understanding and recent updates to tropical cyclone outer size and structure forecasting and research primarily since 2018 as part of the World Meteorological Organization's 10th International Workshop on Tropical Cyclones. A more complete understanding of tropical cyclone outer wind and precipitation is key to anticipating storm intensification and the scale and magnitude of landfalling hazards. We first discuss the relevance of tropical cyclone outer size and structure, improvements in our understanding of its life cycle and inter-basin variability, and the processes that impact outer size changes. We next focus on current forecasting practices and differences among warning centers, recent advances in operational forecasting, and new observations of the storm outer wind field. We also summarize recent research on projected tropical cyclone outer size and structure changes by the late 21st century. Finally, we discuss recommendations for the future of tropical cyclone outer size forecasting and research.