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People with diabetes have an increased risk of adverse events during the peri-colonoscopy period, including hypoglycemia, lactic acidosis, diabetic ketoacidosis and acute kidney injury. This is secondary to inadequate dietary modification, the bowel preparation and antihyperglycemic agent modification. With the availability of many new diabetes agents, endoscopists need updated guidance. This review of current literature provides a practical approach to antihyperglycemic agent modification in the context of colonoscopy preparation, as well as guidelines on dietary changes, the bowel preparation itself and glucose monitoring.

We study the application of a square perturbing lattice to the naturally forming hexagonal arrays of dipolar droplets in a dipolar Bose-Einstein condensate. We find that the application of the lattice causes spontaneous pattern formation and leads to frustration in some regimes. For certain parameters, the ground state has neither the symmetry of the intrinsic hexagonal supersolid nor the symmetry of the square lattice. These results may give another axis on which to explore dipolar Bose-Einstein condensates and to probe the nature of supersolidity.

Research objectives: To provide a comprehensive overview of Muscovite interaction with Tatars during Ivan IV’s reign, both with each successor state of the Jochid ulus and with Tatars who moved to Muscovy and entered Ivan IV’s service. Research materials: This study is based upon Russian sources from the reign of Ivan IV concerning the Tatars, including narratives such as chronicles and documentary evidence such as diplomatic reports. Results and novelty of the research: Muscovite policy toward the Tatars did not derive from a single dominating motive, neither hostility, such as religious animosity toward Muslims or the drive for imperial territorial expansion, nor the desire to cooperate with Tatars for the sake of commerce or the need for steppe military allies. Ivan adapted his policies to individual circumstances, vassal puppet rulers or outright conquest as needed. Tatars from the vassal khanate of Kasimov helped Ivan conquer Kazan’ and Astrakhan’ and fight Crimea. Nogai merchants sold the Muscovite army horses. Muscovites possessed intimate knowledge of foreign Tatars, but also lived in close proximity to “native” Tatars who lived on Muscovite soil or traveled to Moscow as envoys or merchants. However expertise on the Tatars, borrowing Tatar institutions, enrolling Tatar servitors, and conquering successor states of the Golden Horde did not make Muscovy a successor state of the Golden Horde. Nevertheless the Tatars were a fact of life in Ivan IV’s Muscovy, as both allies and enemies.

Numerous Atlantic basin tropical cyclones have recently developed prior to the official start of hurricane season, including several pre-season landfalls in the continental United States. Pre-season and early-season tropical cyclones disproportionately affect populated landmasses, often producing outsized precipitation impacts. Here we show a significant trend towards earlier onset of tropical cyclone activity in the North Atlantic basin, with threshold dates of the first three percentiles of accumulated cyclone energy shifting earlier at a rate exceeding five days decade−1 since 1979, even correcting for biases in climatology due to increased detection of short-lived storms. Initial threshold dates of continental United States named storm landfalls have trended earlier by two days decade−1 since 1900. The trend towards additional pre-season and early-season activity is linked to spring thermodynamic conditions becoming more conducive for tropical cyclone formation. Genesis potential index value increases in the western Atlantic basin are primarily driven by warming ocean temperatures.

The five-volume but incomplete Ocherki istorii istoricheskoy nauki v SSSR published between 1955 and 1985 is a fascinating artifact of Soviet historiography. It is a palpable reminder of the ability of Soviet historiography to mobilize by command the expertise and financial resources required to produce multi-author multi-volume series. Ocherki istorii istoricheskoy nauki v SSSR encompassed the histories of all peoples living on the territory of the USSR after World War II. This article examines the project from a mostly technical point of view.

This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.

Operational forecasting of tropical cyclone (TC) genesis has improved in recent years but still can be a challenge. Output from global numerical models continues to serve as a primary source of forecast guidance. Bulk verification statistics (e.g., critical success index) of TC genesis forecasts indicate that, overall, global models are increasingly able to predict TC genesis. However, as global model configurations are updated, TC genesis verification statistics will change. This study compares operational and retrospective forecasts from three configurations of NCEP’s Global Forecast System (GFS) to quantify the impact of model upgrades on TC genesis forecasts. First, bulk verification statistics from a homogeneous sample of model initialization cycles during the period 2013–14 are compared. Then, composites of select output fields are analyzed in an attempt to identify any key differences between hit and false alarm events. Bulk statistics indicate that TC genesis forecast performance decreased with the implementation of the 2015 version of the GFS, but then modestly recovered with the 2016 version of the model. In addition, the composite analysis suggests that false alarm forecasts in the 2015 version of the GFS may have been the result of inaccurately forecasting the location and/or strength of upper-level troughs poleward of the TC. There is also evidence of convective feedbacks occurring, such as ridging above the low-level circulation and upper-level convective outflow that were too strong, in this same set of false alarm forecasts. Overall, analyzing retrospective forecasts can assist forecasters in determining the strengths and weaknesses associated with a new configuration of a global model with respect to TC genesis.

One in 6 Americans live with a neurologic disease.1–3 Recent evidence suggests that the number of people dying from and affected by these disorders has increased substantially in the past 25 years, contributing to a higher health loss across the lifespan.2 The American Academy of Neurology's (AAN's) mission is in part to promote the highest-quality patient-centered neurologic care for these patients, and the AAN's leadership in quality improvement initiatives and developing outcome measures is a conveyance of this mission. Quality, as defined by the National Academy of Medicine, is “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”4 Quality improvement is “systematic, data-guided activities designed to bring about immediate improvements in health care delivery” and is considered “an intrinsic part of normal health care operations.”5 Data from outcome measures can be effectively used to establish a baseline of care quality delivered within a given health care unit (e.g., multispecialty group)5,6 and guide the implementation and ongoing evaluation of quality improvement initiatives intended to improve care quality and delivery.6 Increasing demands to provide health care outcomes data from patients and payers and the need for neurologic providers to have these data available to assist in care planning necessitated the AAN's former Quality and Safety Subcommittee to recommend the seating of a small work group to develop neurologic outcome quality measures, which would be applicable broadly across major neurologic diseases.

Background Demonstration of intrathecal production of Borrelia-specific antibodies (ITAb) is considered the most specific diagnostic marker of Lyme neuroborreliosis (LNB). Limitations include delayed detectability in early infection and continued presence long after successful treatment. Markers of active inflammation—increased cerebrospinal fluid (CSF) leukocytes, protein, and CXCL13—provide nonspecific markers of active infection. To assess the utility of CSF CXCL13, we measured its concentration in 132 patients with a broad spectrum of neuroinflammatory disorders, including LNB. Methods CSF CXCL13 was measured by immunoassay. Spearman rank correlation test was performed to explore its relationship to conventional markers of neuroinflammation and Borrelia-specific ITAb production. Results In non-LNB neuroinflammatory disorders, CSF CXCL13 elevation correlated with CSF immunoglobulin G (IgG) synthesis and leukocyte count. In LNB, CXCL13 concentration was far greater than expected from overall CSF IgG synthesis, and correlated with Borrelia-specific ITAb synthesis. Median CSF CXCL13 concentration in ITAb-positive LNB patients was > 500 times greater than in any other group. Conclusions Intrathecal CXCL13 and IgG production are closely interrelated. CXCL13 is disproportionately increased in “definite LNB,” defined as having demonstrable Borrelia-specific ITAb, but not “probable LNB,” without ITAb. This disproportionate increase may help identify patients with very early infection or those with active vs treated LNB, or may help to differentiate ITAb-defined active LNB from other neuroinflammatory disorders. However, its reported specificity is closely related to the diagnostic requirement for ITAb. It may add little specificity to the demonstration of a pleocytosis or increased overall or specific IgG production in the CSF.

The toy industry has grown substantially over time, with billions of dollars of toys sold each year in the United States alone. Even after safety considerations, injuries can result. This study examined toy-related fractures in the US Emergency Departments (ED).The 1999 to 2018 National Electronic Injury Surveillance System from the US Consumer Product Safety Commission was examined data for fractures involving a toy-related injury. The incidence, trends, and anatomic locations for such fractures were assessed.In total, 347,135 toy-related fractures were identified, of which 237,754 (68%) were in patients younger than 18 years, 182,516 (53%) were sustained by male subjects, and a 95% yearly incidence increase was observed over the years of the study. Anatomically, 37% were shoulder/arm/elbow, 24% wrist/hand/finger, 19% ankle/toe/foot, 10% leg/knee, 6% face/neck/head, and 4% trunk/pubic region.Despite safety considerations with toy design, more than a third of toy-related fractures were seen in the ED, with a nearly doubling yearly incidence over the study period. This could be contributed to by increased production and prevalence of toys and/or rougher play and increased overall violence. These results are important not only for patient safety but also for orthopaedic surgeons, EDs, toy manufacturers, and policymakers.

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are outstanding options for many older patients at the discretion of the patient and the surgeon. As patients turn 65 years, greater than 98% of the US population becomes eligible for Medicare, and this represents a time of changing healthcare coverage for many.Patients undergoing elective TKA and THA were abstracted from the 2012 to 2018 National Surgical Quality Improvement Program database. Incidences of TKA and THA (combined and separate) were plotted and assessed by age. To assess factors associated with who "delayed" surgery until 65 years, demographic and preoperative characteristics, and postoperative adverse events were compared for the 2 years above and the 2 years below the 65-year-old mark with multivariate analysis. Significance was set at P0.05.In total, 515,139 TKA and THA patients were identified (62.04% TKA and 37.95% THA). When the number of procedures was plotted by age, a discontinuity in the bell-shaped curve was noted at age 65 years. Highlighting this finding, the changes in percent population between 63 and 64 years was -1.52%, between 64 and 65 years was +15.36%, and between 65 and 66 years was -2.32%. Relative to those who were 63 and 64 years (n = 36,511), those who were 65 and 66 years (n = 41,671) were more likely to be female, be non-Hispanic White, have a lower body mass index, and have a lower functional status but were not different in the preoperative American Society of Anesthesiologists class.In this large national sample, there was a clear step increase in undergoing TKA or THA once patients reached the age of 65 years (Medicare eligibility). This discontinuity in the bell-shaped curve may be evidence for a moral hazard in healthcare markets. Although factors in decision-making were not assessed, there were demographic factors associated with this step finding.

IntroductionLyme disease is the most common vectorborne disease in the Northern hemisphere with more than 400 000 new cases in the USA annually. Lyme meningitis is an uncommon but potentially serious clinical manifestation of Lyme disease. Intravenous ceftriaxone had been the first-line treatment for Lyme meningitis, but is associated with a high rate of complications. Although efficacy and effectiveness (or real-world evidence) data for oral doxycycline are limited, practice guidelines were recently expanded to recommend either oral doxycycline or ceftriaxone as first-line treatments for Lyme meningitis. Our goal is to compare oral doxycycline with intravenous ceftriaxone for the treatment of Lyme meningitis on short-term recovery and long-term quality of life.Methods and analysisWe are performing a prospective cohort study at 20 US paediatric centres located in diverse geographical range where Lyme disease is endemic. The clinical care team will make all antibiotic treatment decisions for children with Lyme meningitis, as per usual practice. We will follow enrolled children for 6 months to determine time of acute symptom recovery and impact on quality of life.Ethics and disseminationBoston Children’s Hospital, the single Institutional Review Board (sIRB), has approved the study protocol with the other 19 enrolling sites as well as the Utah data coordinating centre relying on the Boston Children’s Hospital sIRB. Once the study is completed, we will publish our findings in a peer-reviewed medical journal.

Background Papilledema can be a manifestation of neurologic Lyme borreliosis (LB). The clinical manifestations and progression of these cases have not been comprehensively documented to date. We aimed to describe clinical and diagnostic features and to assess patient outcomes in cases of papilledema secondary to neurologic LB. Methods We searched MEDLINE, EMBASE, and the Cochrane Database from inception to August 2019. We did not restrict our search by study design or by publication date, status, or language. Results Twenty-eight studies describing 46 cases of papilledema secondary to neurologic LB were included. Common clinical features included cranial neuropathy (68%) and diplopia (61%). Most patients did not recall tick bite (71%) and were afebrile (74%). Brain imaging was normal in 64% cases. Cerebrospinal fluid analysis showed lymphocytic pleocytosis (77%). Initial treatment with intravenous ceftriaxone was given in 52% of cases and resulted in a 100% resolution rate. Concomitant treatment with acetazolamide resulted in favorable outcomes. Conclusions For patients in endemic regions who describe symptoms suggestive of intracranial hypertension and papilledema, especially accompanied by facial nerve palsy and other cranial nerve palsies, underlying neurologic LB should be considered.

We apply a hyperspherical formulation to a trapped Bose-Einstein condensate with dipolar and contact interactions. Central to this approach is a general correspondence between $K$-harmonic hyperspherical methods and a suitable Gaussian ansatz to the Gross-Pitaevskii equation, regardless of the form of the interparticle potential. This correspondence allows one to obtain hyperspherical potential energies for a wide variety of physical problems. In the case of the dipolar Bose-Einstein condensate, this motivates the inclusion of a beyond-mean-field term within the hyperspherical picture, which allows us to describe the energies and wave functions of excitations of self-bound dipolar droplets outside the mean-field limit.

The latest monograph by Iurii Vasil’evich Seleznev of Voronezh State University, Kartiny ordynskogo iga, discusses the social and political interaction of Rus’ prin­ces with the Juchid ulus (the Horde) during the thirteenth to fifteenth centuries. By examining trips by Rus’ princes to and from the Horde and the amount of time they spent at the Horde, the activities of Rus’ princes who became in-laws of the khans by marrying Chingissid princesses, Rus’ princely attendance at Horde quriltais (assemblies), how the Rus’ princes greeted khans who crossed Rus’ territory, Rus’ princely service in Horde military campaigns, possible Rus’ princely membership in the Horde’s Imperial Guard (keshig), the reception of Horde envoys by the Rus’ princes and the dispatch of Rus’ envoys to the Horde, and the judicial processes that led to the execution of Rus’ princes at Sarai or in the Horde’s nomadic camp, Seleznev demonstrates conclusively that the Rus’ princes had the opportunity to become familiar with Horde military strategy and tactics, Horde ceremonial and ritual, and Horde political culture. However, the question of the extent of Tatar inf­luence on Rus’ political institutions and identity remains a difficult one.

BackgroundThe traditional management of papillary thyroid cancer (PTC) is thyroidectomy (total or partial removal of the thyroid). Active surveillance (AS) may be considered as an alternative option for small, low risk PTC. AS involves close follow-up (including regularly scheduled clinical and radiological assessments), with the intention of intervening with surgery for disease progression or patient preference.MethodsThis is a protocol for a prospective, observational, long-term follow-up multi-centre Canadian cohort study. Consenting eligible adults with small, low risk PTC (< 2cm in maximal diameter, confined to the thyroid, and not immediately adjacent to critical structures in the neck) are offered the choice of AS or surgery for management of PTC. Patient participants are free to choose either option (AS or surgery) and the disease management course is thus not assigned by the investigators. Surgery is provided as usual care by a surgeon in an institution of the patient’s choice. Our primary objective is to determine the rate of ‘failure’ of disease management in respective AS and surgical arms as defined by: i) AS arm – surgery for progression of PTC, and ii) surgical arm - surgery or other treatment for disease persistence or progression after completing initial treatment. Secondary outcomes include long-term thyroid oncologic and treatment outcomes, as well as patient-reported outcomes.DiscussionThe results from this study will provide long-term clinical and patient reported outcome evidence regarding active surveillance or immediate surgery for management of small, low risk PTC. This will inform future clinical trials in disease management of small, low risk papillary thyroid cancer.Registration detailsThis prospective observational cohort study is registered on clinicaltrials.gov (NCT04624477), but it should not be considered a clinical trial as there is no assigned intervention and patients are free to choose either AS or surgery.

Purpose: The Covid-19 pandemic is a public health emergency with both physical and mental health risks. Medical students have baseline elevated rates of anxiety, depression and burnout. As such, they may be especially susceptible to the psychological stresses of Covid-19. The current study aimed to evaluate the prevalence of anxiety and depression among United States medical students during the Covid-19 pandemic. Methods: A cross-sectional, survey-based study collected demographic data as well as the 7-item Generalized Anxiety Disorder (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9) to assess anxiety and depression symptoms, respectively. The survey was administered from April 13, 2020 to April 28, 2020 amidst the height of the Covid-19 pandemic. Results: A total of 1,428 students from 40 US medical schools completed the survey. From those surveyed, 30.6% and 24.3% of respondents screened positive for anxiety and depression, respectively. Median GAD-7 scores were higher among females (7.0 vs 5.0, P Conclusion: When compared to previous medical student studies, these results are 61% higher for anxiety and 70% higher for depression during the Covid-19 era. The current study suggests that there should be a heightened awareness of and sensitivity to student’s mental health during the Covid-19 pandemic with certain cohorts at greater potential risk.

In his book An Attempt at Microhistoriography (Rus. Опыт микроисториографии), Gyula Szvák, an outstanding Hungarian specialist in Russian history, republishes seven of his earlier articles and presents a previously unpublished eighth article on the Soviet historiography of the key issues of 16th-century Russian history. The articles consider Ivan Peresvetov’s works, reforms and oprichnina between the middle and second half of the sixteenth century; also, they compare the reigns and personalities of Ivan the Terrible and Peter the Great. Additionally, the author explores the personal stories of his mentors, Russian historian Ruslan Skrynnikov and Hungarian József Perényi. The book reviewed presents a kind of panorama of two historiographic traditions of studying the Russian Middle Ages in the Soviet Union and Hungary before the collapse of the communist regime there. The author returns to the peculiarities of Russia’s historical development and comprehension of the concept of “Russian feudalism” and reflects on the fate of historians who were engaged in the study of mediaeval Russia under rigid ideological principles.

This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.

After the Mongol conquest of the 13th century, the Kyivan myth of the “Rus' Land” played a less important role in the east Slavic lands that came under the control of Poland or Lithuania than in the northeastern territory that came to constitute Muscovy. Galicia, which belonged to Poland, became known administratively as the Rus' Land. The Belarusian-Lithuanian Chronicles revived the concept in the Ruthenian lands incorporated into the Grand Duchy of Lithuania. In these chronicles, Rus' Land referred to all of Kyivan Rus' historically, but could denote all the Ruthenian territories in the Grand Duchy, or only those in Belarusian regions, or only those in Ukrainian regions in the post-Kyivan period. In addition, the Belarusian-Lithuanian Chronicles borrowed passages from northeastern Rus' chronicles in which the Rus' Land meant northeastern Rus' or Muscovy. In the text of the Union of Lublin, the Rus' Land connoted the four borderland palatinates annexed by Poland after the Union of Lublin. The Rus' Land also occasionally appeared in other sources. However, Bohdan Khmel'nyts'kyi and the mid-seventeenth century Cossacks did not invoke the term to legitimize their new polity, thus discarding an element of the Kyivan inheritance. In Ukraine, this discontinuity of the Rus' Land myth has not been appreciated and remains unexplained.

The boundary between human and animal in seventeenth-century Russia was more porous than has been realized. In several witchcraft cases supposedly-bewitched humans were described as speaking like animals. Muscovite hagiography and miracle stories also portrayed the demon-possessed as speaking and acting like animals. This dehumanization of humans as animals constitutes the polar opposite of the anthropomorphizing of animals as humans in bestiaries, which depicted animals as possessing human characteristics. Visual evidence corroborates these connections between the bewitched and demon-possessed on the one hand, and animals on the other, by picturing demons and humans turning to sin with animal characteristics. Early demonic representations featured the eidalon, a Greek-based figure with animal features. This textual and visual material from seventeenth-century Muscovy zoomorphized the bewitched and demon-possessed by categorizing their behavior as beastly, as that of wild animals, and by projecting the attributes and emotions of animals onto human beings. Attributing human traits to an animal might be a compliment but ascribing traits to a human could only be a criticism, thus demonstrating and confirming the Muscovite premise of human superiority over animals.

Understanding and forecasting tropical cyclone (TC) intensity change continues to be a paramount challenge for the research and operational communities, partly because of inherent systematic biases contained in model guidance, which can be difficult to diagnose. The purpose of this paper is to present a method to identify such systematic biases by comparing forecasts characterized by large intensity errors with analog forecasts that exhibit small intensity errors. The methodology is applied to the 2015 version of the Hurricane Weather Research and Forecasting (HWRF) Model retrospective forecasts in the North Atlantic (NATL) and eastern North Pacific (EPAC) basins during 2011–14. Forecasts with large 24-h intensity errors are defined to be in the top 15% of all cases in the distribution that underforecast intensity. These forecasts are compared to analog forecasts taken from the bottom 50% of the error distribution. Analog forecasts are identified by finding the case that has 0–24-h intensity and wind shear magnitude time series that are similar to the large intensity error forecasts. Composite differences of the large and small intensity error forecasts reveal that the EPAC large error forecasts have weaker reflectivity and vertical motion near the TC inner core from 3 h onward. Results over the NATL are less clear, with the significant differences between the large and small error forecasts occurring radially outward from the TC core. Though applied to TCs, this analog methodology could be useful for diagnosing systematic model biases in other applications.

Background Lyme encephalopathy, characterized by nonspecific neurobehavioral symptoms including mild cognitive difficulties, may occur in patients with systemic Lyme disease and is often mistakenly attributed to central nervous system (CNS) infection. Identical symptoms occur in many inflammatory states, possibly reflecting the effect of systemic immune mediators on the CNS. Methods Multiplex immunoassays were used to measure serum and cerebrospinal fluid (CSF) cytokines in patients with or without Lyme disease to determine if there are specific markers of active CNS infection (neuroborreliosis), or systemic inflammatory mediators associated with neurobehavioral syndromes. Results CSF CXCL13 levels were elevated dramatically in confirmed neuroborreliosis (n = 8), less so in possible neuroborreliosis (n = 11) and other neuroinflammatory conditions (n = 44). Patients with Lyme (n = 63) or non-Lyme (n = 8) encephalopathy had normal CSF findings, but had elevated serum levels of interleukins 7, 17A, and 17F, thymic stromal lymphopoietin and macrophage inflammatory protein-α. Conclusions CSF CXCL13 is a sensitive and specific marker of neuroborreliosis in individuals with Borrelia-specific intrathecal antibody production. However, it does not distinguish individuals strongly suspected of having neuroborreliosis, but lacking confirmatory intrathecal antibodies, from those with other neuroinflammatory conditions. Patients with mild cognitive symptoms occurring during acute Lyme disease, and/or after appropriate treatment, have normal CSF but elevated serum levels of T-helper 17 markers and T-cell growth factors, which are also elevated in patients without Lyme disease but with similar symptoms. In the absence of CSF abnormalities, neurobehavioral symptoms appear to be associated with systemic inflammation, not CNS infection or inflammation, and are not specific to Lyme disease.

Because Stalin’s cult of Ivan the Terrible failed to impose uniformity on representations of Ivan by historians and artists, Sergei Eisenstein could choose how to deal with religion in sixteenth-century Muscovy. Some contemporary critics and later scholars have noted how religious ‘Ivan the Terrible’ is, but no one interpreted what message Eisenstein sought to convey by presenting Ivan, his supporters and lay opponents as religious, and all clergy and affiliates of the Russian Orthodox Church as enemies of Ivan and of Russia. Eisenstein’s depiction actually argues that lay piety neither guaranteed nor precluded patriotism. But professional piety, even that of a saint of the Russian Orthodox Church, Metropolitan Philip, virtually precluded patriotism. Eisenstein’s uncompromisingly hostile attitude toward the Russian Orthodox Church stands in sharp contrast to the Soviet government’s policy of compromise toward the Church at the time Eisenstein wrote his screenplay and filmed Part I.

The National Hurricane Center (NHC) has stated that guidance on tropical cyclone (TC) genesis is an operational forecast improvement need, particularly since numerical weather prediction models produce TC-like features and operationally required forecast lead times recently have increased. Using previously defined criteria for TC genesis in global models, this study bias corrects TC genesis forecasts from global models using multiple logistic regression. The derived regression equations provide 48- and 120-h probabilistic genesis forecasts for each TC genesis event that occurs in the Environment Canada Global Environmental Multiscale Model (CMC), the NCEP Global Forecast System (GFS), and the Met Office's global model (UKMET). Results show select global model output variables are good discriminators between successful and unsuccessful TC genesis forecasts. Independent verification of the regression-based probabilistic genesis forecasts during 2014 and 2015 are presented. Brier scores and reliability diagrams indicate that the forecasts generally are well calibrated and can be used as guidance for NHC’s Tropical Weather Outlook product. The regression-based TC genesis forecasts are available in real time online.

Accurately forecasting tropical cyclone (TC) genesis is an important operational need, especially since the National Hurricane Center’s Tropical Weather Outlook product has been extended from 2 to 5 days. A previous study by the coauthors verified North Atlantic TC genesis forecasts from five global models out to 4 days during 2004–11. This study expands on the previous research by 1) verifying TC genesis forecasts over both the Atlantic and eastern North Pacific basins, 2) extending the forecast window to 5 days, and 3) updating the analysis period through 2014. Verification statistics are presented and compared between the two basins. Probability of detection and critical success indices generally are greater over the eastern North Pacific basin compared to the North Atlantic. There is a trade-off between models that exhibit a greater probability of detection and a greater false alarm ratio, and models that exhibit a smaller false alarm ratio and a smaller probability of detection. Results also reveal that the models preferentially miss TCs over the North Atlantic (eastern North Pacific) that have a relatively small radius of the outer closed isobar (radius of maximum wind) at the forecast genesis time. Overall, global models have become a more reliable source of TC genesis guidance during the past few years compared to the early years in the dataset.

We describe a diabatic protocol to prepare a strongly-interacting Bose-Einstein condensate in a regime where neither an adiabatic ramp nor a direct diabatic quench are desirable. This protocol is expected to achieve a nearly unit population transfer to the strongly-interacting ground state for realistic experimental parameters for $^{85}$Rb. The protocol matches the initial and final density profiles by modifying the trap along with the scattering length during the quench. The protocol should reveal several properties of the strongly-interacting Bose gas, and enable further investigation of beyond mean-field corrections to the Gross-Pitaevskii equation.

The relationship of the ruler to his advisors was a central issue of sixteenth-century Muscovite political theory. This article explores how narrative sources presented the ideal paradigm of the ruler consulting his subjects to Ivan in practice by analyzing passages containing forms of the verb sovetovati (to advise, to consult with) pertaining to Ivan. Such references did not occur uniformly throughout Ivan’s reign. Two brief clusters, a smaller one when Grand Princess Elena exercised authority, and a much denser one dealing with the eventual conquest of Kazan’, were each followed by periods of only erratic and scattered references. This disparity cannot be explained by any hostility during Ivan’s maturity on the part of the compilers of narrative accounts, because those narratives, although they did not regurgitate every earlier usage of the concept, did not rewrite the past consistently to erase previous references. This chronological disparity in references to consultation cannot be attributed to content. Overall the chronicles did not lack for opportunities to allude to consultation. Though foreign policy decisions dealing with Lithuania and Kazan’ dominate passages from narrative sources before 1554 that invoke consultation, Muscovite history still was not lacking in foreign policy resolved in a consultative manner between 1538 and 1549 or 1552 and 1567. Although it is tempting to see the apparent attrition of references to Ivan’s consultations with the elite after 1552 to Ivan’s growing ‘autocratic’ pretensions to rule without interference by his elite, such a line of reasoning cannot explain the comparable ‘decline’ of references to consultation between 1538 and 1549. Therefore proposing a rational explanation for the pattern of allusions to Ivan’s consultation with the elite would be premature. Refs 19.

Lyme disease is a multisystem infectious disease caused by tick-borne spirochetes of the Borrelia burgdorferi group. The disease occurs primarily in specific areas of North America, Europe and Asia, reflecting the distribution of the hard-shelled Ixodes ticks that are required for disease transmission. Diagnosis of this infection can be somewhat problematic, although in clinically appropriate settings, serologic testing can be highly useful, particularly if Western blots are used to confirm borderline or positive results. The organism has several specific organotropisms-involvement of the heart, joints and nervous system being particularly common. The nervous system can be involved in one or more ways. Early in infection, patients tend to get a lymphocytic meningitis, cranial neuritis (particularly the facial nerves) or a painful radiculitis. Rarely, an encephalomyelitis can occur. In patients with more protracted and indolent involvement, a more disseminated mononeuropathy multiplex may occur, or a mild, non-focal alteration of cognitive function and memory, i.e. an encephalopathy. In patients with central nervous system involvement, the most sensitive diagnostic test is the demonstration of intrathecal production of anti-Borrelia burgdorferi antibody. Culture, polymerase chain reaction and other techniques appear to be less specific. In most instances, the disease is quite responsive to antimicrobial therapy. Oral treatment with doxycycline has been shown to be effective in meningitis. In more serious cases two to four week courses of parenteral ceffriaxone or cefotaxime are effective in the vast majority of patients.

Background. Some patients with medically unexplained symptoms or alternative medical diagnoses suspect that they chronically suffer from the tick-borne infection Lyme disease. These patients are commonly targeted by providers of alternative therapies. This study was designed to identify and characterize the range of unorthodox alternative therapies advertised to patients with a diagnosis of Lyme disease. Methods. Internet searches using the Google search engine were performed to identify the websites of clinics and services that marketed nonantimicrobial therapies for Lyme disease. We subsequently used the PubMed search engine to identify any scientific studies evaluating such treatments for Lyme disease. Websites were included in our review so long as they advertised a commercial, nonantimicrobial product or service that specifically mentioned utility for Lyme disease. Websites with patient testimonials (such as discussion groups) were excluded unless the testimonial appeared as marketing on a commercial site. Results. More than 30 alternative treatments were identified, which fell into several broad categories: these included oxygen and reactive oxygen therapy; energy and radiation-based therapies; nutritional therapy; chelation and heavy metal therapy; and biological and pharmacological therapies ranging from certain medications without recognized therapeutic effects on Borrelia burgdorgeri to stem cell transplantation. Review of the medical literature did not substantiate efficacy or, in most cases, any rationale for the advertised treatments. Conclusions. Providers of alternative therapies commonly target patients who believe they have Lyme disease. The efficacy of these unconventional treatments for Lyme disease is not supported by scientific evidence, and in many cases they are potentially harmful.

This article for the first time in scholarship surveys the contribution of Iurii Vasil’evich Seleznev of Voronezh State University to the study of Rus’-Tatar relations and the Juchid ulus, called the Golden Horde, during the thirteenth to fifteenth centuries. The article contains analyses of five major monographs written by Seleznev dealing with Rus’-Tatar relations from 1385 to 1434, the composition of the elite of the Juchid ulus, military conflicts between Rus’ and the Horde during the thirteenth to fifteenth centuries, (with Andrei Olegovich Amel’kin) the history and historical memory of the battle of Kulikovo Field in 1380, and the role of Rus’ princes as members of the Juchid ulus elite. The article identifies the strengths and weaknesses of each monograph. Finally the article attempts for the first time to draw connections among the conclusions of the five monographs. The strength of Seleznev’s work are his equal mastery of the societies on both sides of the Rus’-Tatar border. His employs the Rus’ sources and Russian translations of oriental sources in new and creative ways to extract hard data on previously unposed questions or on questions which have been previously posed but answered subjectively such as the parameters of Rus’ princely trips to the Horde or the frequency of Rus’-Tatar military conflicts. In addition he appreciates the complex evolution of Rus’ literary works such as those about the battle of Kulikovo Field in 1380. Seleznev also approaches questions of social history with an open mind inoculated against nationalist prejudices which would reject out of hand any possibility of Tatar influence on the Rus’ mentality or society. He is sparing in his use of anachronistic and biased terminology toward the Tatars. The weaknesses of his studies include a lack of familiarity with studies of the Mongol Empire and its successor states other than the Juchid ulus in Western languages which by and large precludes comparative analysis and results in an insular presentation of Rus’-Horde relations in isolation from the parallel experience of other sedentary societies subjected to Mongol rule. He has not himself integrated the results of his separate monographs, for example by addressing the contradiction between what must have been the enormous Rus’ expertise about the Horde with the often simplistic pejorative depiction of the Tatars in Rus’ sources. Seleznev had not as yet written a comprehensive study of Rus’-Tatar relations which would encompass the totality of Rus’-Tatar interaction, including for example institutional borrowing. Nevertheless the strengths of his research far outweigh the weaknesses. Seleznev’s ever-growing body of work makes a significant contribution to increasing historical knowledge of medieval Rus’ and the Tatars of the Juchid ulus.

Tropical cyclone (TC) forecasts rely heavily on output from global numerical models. While considerable research has investigated the skill of various models with respect to track and intensity, few studies have considered how well global models forecast TC genesis in the North Atlantic basin. This paper analyzes TC genesis forecasts from five global models [Environment Canada's Global Environment Multiscale Model (CMC), the European Centre for Medium-Range Weather Forecasts (ECMWF) global model, the Global Forecast System (GFS), the Navy Operational Global Atmospheric Prediction System (NOGAPS), and the Met Office global model (UKMET)] over several seasons in the North Atlantic basin. Identifying TCs in the model is based on a combination of methods used previously in the literature and newly defined objective criteria. All model-indicated TCs are classified as a hit, false alarm, early genesis, or late genesis event. Missed events also are considered. Results show that the models' ability to predict TC genesis varies in time and space. Conditional probabilities when a model predicts genesis and more traditional performance metrics (e.g., critical success index) are calculated. The models are ranked among each other, and results show that the best-performing model varies from year to year. A spatial analysis of each model identifies preferred regions for genesis, and a temporal analysis indicates that model performance expectedly decreases as forecast hour (lead time) increases. Consensus forecasts show that the probability of genesis noticeably increases when multiple models predict the same genesis event. Overall, this study provides a climatology of objectively identified TC genesis forecasts in global models. The resulting verification statistics can be used operationally to help refine deterministic and probabilistic TC genesis forecasts and potentially improve the models examined.

Of broad scientific and public interest is the reliability of global climate models (GCMs) to simulate future regional and local tropical cyclone (TC) occurrences. Atmospheric GCMs are now able to generate vortices resembling actual TCs, but questions remain about their fidelity to observed TCs. Here the authors demonstrate a spatial lattice approach for comparing actual with simulated TC occurrences regionally using observed TCs from the International Best Track Archive for Climate Stewardship (IBTrACS) dataset and GCM-generated TCs from the Geophysical Fluid Dynamics Laboratory (GFDL) High Resolution Atmospheric Model (HiRAM) and Florida State University (FSU) Center for Ocean–Atmospheric Prediction Studies (COAPS) model over the common period 1982–2008. Results show that the spatial distribution of TCs generated by the GFDL model compares well with observations globally, although there are areas of over- and underprediction, particularly in parts of the Pacific Ocean. Difference maps using the spatial lattice highlight these discrepancies. Additionally, comparisons focusing on the North Atlantic Ocean basin are made. Results confirm a large area of overprediction by the FSU COAPS model in the south-central portion of the basin. Relevant to projections of future U.S. hurricane activity is the fact that both models underpredict TC activity in the Gulf of Mexico.

The authors of four National Institutes of Health (NIH)-sponsored antibiotic treatment trials of patients with persistent unexplained symptoms despite previous antibiotic treatment of Lyme disease determined that retreatment provides little if any benefit and carries significant risk. Recently, two groups have provided an independent reassessment of these trials and concluded that prolonged courses of antibiotics are likely to be helpful. We have carefully considered the points raised by these groups, along with our own critical review of the treatment trials. Based on this analysis, the conclusion that there is a meaningful clinical benefit to be gained from retreatment of such patients with parenteral antibiotic therapy cannot be justified.

Objective:To review the evidence base for different treatment strategies in intraparenchymal neurocysticercosis in adults and children.Method:A literature search of Medline, EMBASE, LILACS, and the Cochrane Database from 1980 to 2008, updated in 2012, resulted in the identification of 10 Class I or Class II trials of cysticidal drugs administered with or without corticosteroids in the treatment of neurocysticercosis.Results:The available data demonstrate that albendazole therapy, administered with or without corticosteroids, is probably effective in decreasing both long-term seizure frequency and the number of cysts demonstrable radiologically in adults and children with neurocysticercosis, and is well-tolerated. There is insufficient information to assess the efficacy of praziquantel.Recommendations:Albendazole plus either dexamethasone or prednisolone should be considered for adults and children with neurocysticercosis, both to decrease the number of active lesions on brain imaging studies (Level B) and to reduce long-term seizure frequency (Level B). The evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis (Level U).

Background and Purpose— Time to treatment is critically important in ischemic stroke. We compared the efficacy and cost of teleneurology evaluation during patient transport with that of mobile stroke transport units. Methods— Using cellular-connected telemedicine devices, we assessed 89 presumptive stroke patients in ambulances in transit. Paramedics assisted remote teleneurologists in obtaining a simplified history and examination, then coordinating care with the receiving emergency department. We prospectively assessed door-to-needle and last-known-well-to-needle times for all intravenous alteplase–treated stroke patients brought to our emergency departments by emergency medical services’ transport, comparing those with and without in-transit telestroke. Results— From January 2015 through March 2016, 111 stroke patients received intravenous alteplase at study emergency departments. Mean door to needle was 13 minutes less with in-transit telestroke (28 versus 41; P =0.02). Although limitations in cellular communication degraded transmission quality, this did not prevent the completion of satisfactory patient evaluations. Conclusions— Improvement in time to treat seems comparable with in-transit telestroke and mobile stroke transport units. The low cost/unit makes this approach scalable, potentially providing rapid management of more patients.

Johnson and Stricker published an opinion piece in the Journal of Medical Ethics presenting their perspective on the 2008 agreement between the Infectious Diseases Society of America (IDSA) and the Connecticut Attorney General with regard to the 2006 IDSA treatment guideline for Lyme disease. Their writings indicate that these authors hold unconventional views of a relatively common tick-transmitted bacterial infection caused by the spirochete Borrelia burgdorferi. Therefore, it should come as no surprise that their opinions would clash with the IDSA's evidence-based guidelines for the diagnosis and treatment of Lyme disease. Their allegations of conflict of interest against the IDSA resemble those made against the National Institutes of Health, the Food and Drug Administration and the Centers for Disease Control and Prevention in 2000, which were found to be baseless. It is the responsibility of all physicians and medical scientists to stand up to antiscientific, baseless and unethical attacks on those who support an evidence-based approach to caring for patients.

Background Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of young women. First-line treatment is often the oral contraceptive pill (OC), but evidence suggests that OC may worsen metabolic outcomes in this population. We undertook this meta-analysis of observational studies and cohorts from within randomized controlled studies to investigate the association between OC use and dysglycemia, dyslipidemia and insulin resistance (IR) in women with PCOS. Methods We searched MEDLINE (1966-April 2010), EMBASE (1980-April 2010) and All EBM Reviews. We included prospective cohorts and RCTs that treated women, aged 13-44, with PCOS with OC for at least 3 months. Blinded quality assessment and data extraction were conducted on 35 included studies by two independent reviewers. We used random effects methods to calculate weighted mean differences as the effect size. We investigated heterogeneity using sequential removal of studies, subgroup analysis and meta-regression. Results OC use was significantly associated with an increase in high-density lipoprotein cholesterol (HDL-C) (P = 0.004) and triglycerides (P = 0.004). Significant heterogeneity was found in glucose, cholesterol, HDL-C, low-density lipoprotein cholesterol triglycerides, fasting glucose to insulin ratios and homeostatic model assessments-IR. Study characteristics such as mean BMI, mean age and duration of study could explain some of the heterogeneity. Conclusions Use of OC was not associated with clinically significant adverse metabolic consequences. Because of limitations of the underlying studies, further research including rigorously designed randomized trials would more definitively confirm our findings.