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Historians studying the concept of family in sixteenth-century Muscovy have usually relied upon memorial donations as evidence and contrasted two-generation nuclear versus three-generation extended families. This study examines documentary evidence of relatives jointly engaged in primarily entrepreneurial transactions involving property. The concept of “family” in such evidence is only implicit. The data base contains 397 instances of “family partnerships” from members of 288 families. While every conceivable combination of family relationships occurs, what is most striking is the predominance of brothers as the sole family members involved in 162 cases, 40 % of the data base, or in combination with other relatives for an additional 114 instances totaling 276 records, or over 69 % of the data base. Moreover, one-generation family partnerships (just brothers 162, just cousins 8, brothers and cousins 17, just husband and wife 9) total 196 cases, nearly half the data base. The data confirm the important role of women in property relationships (women appear in 107 cases, over 25 % of the data base) and the relative unimportance of in-laws (who appear only 6 times). In practice, then, the Muscovite conception of family included previously unappreciated one-generation families, revealing that family relationships in Muscovy were even more fluid than has been previously supposed.

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.

Background and Objective: Vancomycin and ceftazidime are commonly used intravitreal antibiotics for suspected bacterial endophthalmitis. Many retina surgical practices prepare aliquoted individual doses in syringes that are then stored frozen for future use, but this practice has not been well studied. This investigation aims to examine the stability of frozen vancomycin and ceftazidime. Materials and Methods: Samples of drugs were reconstituted monthly and placed in a −20°C freezer. At the end of 3 months and again at 6 months, a newly reconstituted drug constant was created and compared to a newly created reference sample. The frozen samples were compared to a freshly produced drug solution. Using high-performance liquid chromatography (HPLC), the peak heights were compared to evaluate stability. Results: The vancomycin reference sample was 100 ± 1.67%. Values over time were 97.4 ± 0.75%, 98.8 ± 0.44%, 102.1 ± 0.4%, 100.5 ± 0.12%, 101.8 ± 0.12, 101.5 ± 0.11, and 100.6 ± 1.87 for 1, 2, 3(A), 3(B), 4, 5, and 6 months, respectively. The ceftazidime reference sample was 100 ± 1.8%. Values over time were 100.7 ± 1.78%, 100.0 ± 1%, 102.3 ± 1.55%, 117.5 ± 11.6%, 112.8 ± 1.64%, 123 ± 2.8%, and 117 ± 2.5% for 1, 2, 3(A), 3(B), 4, 5, and 6 months, respectively. Conclusion: Both vancomycin and ceftazidime were stable over 6 months under frozen conditions at −20°C. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:281–283.]

Density altitude (DA) is an aviation parameter that helps determine specific aircraft performance characteristics for the expected atmospheric conditions. However, there are currently no detailed graphical tools for general aviation (GA) pilot education demonstrating the spatial and temporal variation of DA to help improve situational awareness. In this study, the fifth-generation European Centre for Medium-Range Weather Forecasts atmospheric reanalysis of the global climate (ERA5) dataset is used to construct a 30-yr monthly climatology of DA for the conterminous United States. Several DA characteristics are also investigated, including the effect of humidity on DA, the determination of reasonable worst-case conditions, and the applicability of two DA rules of thumb (ROTs). Maximum values of DA (worst aircraft performance) occur during July, reaching 3600 m over areas with high surface elevations. Humidity, while tertiary to the effects of temperature and pressure, causes the DA to increase from their dry values by more than 140 m as far north as the U.S.-Canada border. The dry DA ROT performs well for all conditions outside of strong tropical cyclones, where GA flights would not be expected. The ROT to correct for the effects of humidity performs well except in high elevations or when the dewpoint temperatures fall outside the applicable range of ≥5°C. When applied outside this range, in some situations, DA errors can be greater than if no humidity correction were applied. Therefore, a new ROT to correct for humidity is introduced here that extends the applicable dewpoint temperature range to ≥−28°C and reduces errors in estimated DA. Significance Statement The impacts of density altitude on aircraft performance have led to numerous general aviation (GA) accidents. This study helps GA pilots better understand the spatial and temporal variability in density altitude, thereby increasing their situational awareness during flight planning. This study also evaluates commonly used approximations to estimate density altitude, so pilots can understand the situations where these approximations are (in)applicable. Results suggest the need for a humidity correction approximation when dewpoint temperatures are

Florida annually leads the United States in lightning-caused fatalities. While many studies have examined the lightning frequency maximum near Cape Canaveral, relatively little attention has been paid to the western Florida peninsula, which features a similar warm-season lightning event density. Of particular concern are first cloud-to-ground (FCG) lightning events in developing thunderstorms, which are difficult to predict with sufficient lead time and can catch people off guard. This study performs an environmental analysis of warm-season (May–September) FCG events (2014–21) across the western Florida peninsula using high-resolution model analysis data, including a comparison to null (No CG) days. FCG events and No CG days are first identified from ground-based lightning data and partitioned into nine synoptic-scale flow regimes. Next, spatiotemporal distributions of FCG events are elucidated for the western Florida peninsula. An ingredients-based analysis shows that the convective environment one hour before FCG events during strong south-southeast flow features the largest amounts of moisture, but the smallest instability values and weak midtropospheric lapse rates, primarily due to warm advection and moisture transport from the Atlantic Ocean. Environments one hour before FCG events in all nine flow regimes feature markedly greater instability values, larger relative humidity values, and steeper midtropospheric lapse rates than do No CG days. Results emphasize that instability and moisture are the key ingredients for warm-season FCG events in the region. Convective parameter statistical distributions and composite soundings populate an online dashboard that can be used by regional forecasters to better predict FCG events and increase alert lead times. Significance Statement Florida annually leads the United States in lightning fatalities. Of particular concern are first cloud-to-ground (FCG) lightning events, which are difficult to forecast and can catch people off guard especially during outdoor recreational activities and labor. We investigate the environmental characteristics of warm-season FCG events across the western Florida peninsula. Among nine regional flow patterns, some are associated with a less moist and more unstable atmosphere one hour before an FCG event, while other regimes exhibit a more moist and less unstable atmosphere. However, regardless of flow pattern, FCG events consistently feature substantially greater instability and moisture than do null events. Key findings are displayed on an online dashboard, to better inform regional forecasters.

Many historians have questioned the accuracy of the “Tale of Ivan IV’s Campaign against Novgorod in 1570.” Cornelia Soldat now expands that critical approach to the “Tale” by arguing that it derives from German pamphlets published a century earlier. She relies upon the congruence of macro- and micro-structures to demonstrate textual influence without textual borrowing. Given the absence of Muscovite manuscripts of the “Tale” between 1570 and the second half of the seventeenth century, the composers of the “Tale” “must have” relied upon foreign sources about the raid, because no domestic sources existed. Her analysis is certainly possible, but it elides a number of issues about the transmission and translation into Russian of the German pamphlets. Reliable contemporary Muscovite sources tells us more about the “real” raid than Soldat allows. It is equally possible that the “Tale” derives from circulating native oral legends. However, the methodological and evidentiary issues Soldat raises are serious and deserve further discussion.

The History of the Grand Prince of Moscow traditionally attributed to Prince Andrei Kurbskii presents the “Josephians” (Iosifliane) in a very negative light. Donald Ostrowski contends that the History did not describe the Josephians as a Church “party.” However, the History did describe the Josephians as monks who pursued material wealth, supported Ivan the Terrible’s tyranny, and persecuted opponents of monastic possessions, a Church party even if the text lacked such a concept. The History did not invoke the supposed founders of the Church parties, Iosif of Volokolamsk and Nil Sorskii, nor was it equally precise in portraying the opponents and victims of the Josephians. Nevertheless, the nineteenth-century creators of the paradigm of Josephian/Non-Possessor (Trans-Volga Elders) Church parties, which Ostrowski has strongly criticized, did not misinterpret the History in using its passages to formulate their conceptualization of sixteenth-century Muscovite Church history.

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.

Following spine surgery, postoperative surgical site infection (SSI) is a rare but potentially devastating complication. Previous studies have assessed risk factors for spine SSI and one aimed to develop risk stratification tool to assess management options, but this tool has not been externally validated or regularly used.The current study aimed to investigate the rate of SSI following elective spine surgery, surgical management pursued, and success of traditionally utilized one-stage of irrigation and debridement (ID) with closure over drains.Retrospective case-control study.Adult, elective spine surgeries performed at a single academic institution between 2013 and 2021 were evaluated. Patients who developed SSI requiring surgical intervention were identified.Those who underwent initial management with ID and closure over drains were assessed for need of subsequent ID (considered failure of initial infection management).Of spine surgeries meeting inclusion criteria, those with SSI were identified and management was characterized. For those who did and did not fail attempted one stage ID with closure over drains, pre-operative and surgical variables from the index procedure as well as infection characteristics were assessed and compared with univariable and multivariable analyses.Of 11,023 elective spine surgeries, SSI was identified for 76 (0.7%). For initial management, ID with closure over drains was used for 66 (86.8%) while ID and wound vacuum management was used 10 (13.2%). Failure of attempted one stage ID (requiring subsequent ID procedure) was identified for 18 (27% of those undergoing ID and closure over drains). Of multiple patient, surgical, and infection characteristics, the only factor identified as independently predictive of one stage ID failure was presence of bacteremia (odds ratio [OR] 38.3, p=0.0007). Within the sub-cohort of patients with bacteremia, failure of attempted one stage ID was noted for 80%.Less than one percent of a large cohort of patients undergoing spine surgery were found to develop SSIs. Of those undergoing attempted one stage ID, most patient, surgical, and infection variables did not influence outcome of the intervention. However, those with bacteremia were at 38.3 times greater odds of failing attempted one-stage ID. These results suggest considering delayed closure approaches in these cases.

The central or peripheral nervous systems may be involved in up to 15% of patients with untreated infection with B burgdorferi sensu lato, characteristic involvement including meningitis, cranial neuritis, and radiculoneuritis. Diagnosis, based on a logical combination of clinical context and antibody-based testing, is usually straightforward, as is treatment. Misconceptions about what does and does not constitute neurologic disease, and about laboratory testing in this infection, have resulted in widespread anxiety that a broad range of other disorders may be attributable to nervous system Lyme disease. This article will review the reasons for these misunderstandings and the arguments against them.

In Ivan the Terrible: Free to Reward and Free to Punish I contradicted myself in discussing the possible existence of church parties in Muscovy. After accepting Ostrowski’s argument that Iosif Volotskii and Nil Sorskii did not belong to antagonistic “parties,” I followed Goldfrank’s earlier publications that there were Josephan and Non-Possessor “parties” after the deaths of their “founders.” I proposed that the Josephans were an old-boy network in Iosif’s time and then promptly dropped that concept in discussing the rest of the sixteenth century. This article attempts to rectify those errors by consistently applying the concept of old-boy network to the Josephans throughout the sixteenth century. Because the persecution of heretics is central to the paradigm of the Josephans as a “party,” this reconsideration entailed engaging the very notion of “heresy” in the Russian Orthodox Church at the time. It also proposes that the paradigm of antagonistic church parties, the Josephans and the Non-Possessors / Trans-Volga Elders, originated in Prince Andrei Kurbsky’s History of the Grand Prince of Moscow.

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.

The incomplete five-volume Ocherki istorii istoricheskoi nauki v sssr , published between 1955 and 1985, is a fascinating artifact of Soviet historiography’s ability to mobilize academic resources for large-scale projects. It is also a barometer of the evolution of Soviet historiography between the death of Stalin and the onset of perestroika. This essay traces its treatment of the hottest, hot-button historical issue it addressed, Stalin.

Nine of the ten articles in this Forum critique and/or expand upon themes, conclusions, or interpretations in Charles J. Halperin’s Ivan the Terrible: Free to Reward and Free to Punish (2019), albeit in greatly varying proportion. The tenth addresses how to teach from the book. The quality of the articles speaks for itself. The range of the themes addressed speaks to the scope of Ivan’s reign. All the contributions to the Forum constitute valuable contributions to scholarship on Ivan, but to further discussion the remarks below concentrate on areas of disagreement. Much research remains to be done, but it is doubtful that historians will ever fully understand Ivan the Terrible and his reign. Ivan will always remain “a riddle wrapped in a mystery inside an enigma,” and consensus among historians will forever remain an elusive dream.

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.

A 43-year-old woman with dermatomyositis presented with Mycobacterium avium complex (MAC) knee septic arthritis with superimposed polymicrobial infection. After poor infection control with antibiotic therapy, she underwent debridement and antibiotic cement spacer placement, followed by knee arthrodesis 6 months later. At 2-year follow-up, she had no pain and was ambulating without assistive devices.As far as we know, this is the first reported case of MAC native-knee septic arthritis successfully treated with antibiotic cement spacer followed by knee arthrodesis. This case sheds insight on treatment strategies for a rare native-knee infection.

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.

This chapter focuses on viral encephalitis—typically evidenced by fever, headache, and changes in nervous system function. Neurologic symptoms range from mild somnolence to coma, from focal deficits to seizures. Differentiating encephalitis from meningitis from encephalopathy can be challenging; determining whether it is due to a specific virus, bacteria, or fungus can be lifesaving. Encephalitis, involving inflammation of the brain parenchyma, typically directly alters brain function by either impairing functions normally mediated by the damaged area or triggering seizures from it. When the inflammation affects the brainstem, or substantial portions of the cerebral hemispheres, level of consciousness is depressed, up to and including coma. Virtually all viruses that cause encephalitis have developed highly specialized mechanisms to invade the central nervous system (CNS).

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.

On the basis of a data base of 137 instances of conflict between Muscovite monasteries and their neighbors during the reign of Ivan IV (1533–1584), this article concludes that such conflicts occurred during the entire course of Ivan IV’s reign, that they occurred with members of all Muscovite social classes, including other monks, and that they occurred in many regions of Muscovy. These data do not permit concluding whether all monasteries engaged in disputes with their neighbors in all years in all districts of Muscovy. Although monasteries tended to settle disputes peacefully, they did not always act properly, even in relations with other monasteries. Monasteries were not immune to the violence endemic to such disputes, many of which involved litigation, although they may have been slightly more peaceful in their relations with other monasteries than with lay landowners and landholders and the residents of their estates.

On the basis of 734 dated colophons in sixteenth-century Russian manuscript books, Sergei Usachev examines where the books were written, who copied them, and who ordered them. He concludes that the books were produced in all regions of Russia and that members of all social classes ordered them and copied them, although in different proportions: the former had a higher social profile than the latter. His publication of the full texts of the colophons makes it possible for historians to explore additional themes of sixteenth-century Russian social and cultural history.

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.