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PURPOSE: The circle of Willis is a circulatory anastomosis that supplies blood to the brain. If any of the bridging segments are hypoplastic or absent, the capacity for collateral flow in the setting of large vessel occlusion may be decreased. Outside of the neonatal period, the prevalence of a complete circle of Willis (CoW) in the pediatric population has not been well described. Our objectives include determining the prevalence of a complete CoW in children and identifying if there is an age-related “loss” of arterial segments. METHODS: Following IRB approval, angiograms of the CoW performed on a 3-T MR platform from 2016 to 2020 on patients 21 years or younger were retrospectively reviewed. Any patient with underlying arterial pathology that may affect the CoW was excluded. Patient age and gender at the time of imaging were obtained. RESULTS: In total, 592 pediatric CoW were assessed. Frequencies of completeness were calculated in two different fashions: scenario 1 where a CoW was characterized as complete even if it contained hypoplastic vessels (88.8%), and scenario 2 where it was characterized as complete after excluding hypoplastic vessels (44.0%). In both scenarios, our data showed that older age was more associated with an incomplete CoW (p < 0.0001). In addition, we found a higher percentage of males with an incomplete CoW compared with females (p < 0.0001). CONCLUSIONS: The presence of a complete CoW is greater in our pediatric population than what has been reported in adults. The prevalence of an incomplete circle of Willis also increases significantly with age.

We herein report a case of Childhood Primary Central Nervous System (CNS) Angiitis. This case consisted of a 14-year-old girl who presented with right-sided weakness, aphasia, and a fever. A Magnetic Resonance Imaging of the brain showed multifocal areas of ischemia. Magnetic Resonance Angiography of the head and neck showed narrowing and irregularities of the left middle cerebral artery and right posterior cerebral artery. Cerebrospinal Fluid studies showed a lymphocytic pleocytosis and brain biopsy revealed leptomeningeal and perivascular inflammation. The epidemiology, presenting symptoms, work-up, pathophysiology, diagnostic criteria, and treatment of Childhood Primary CNS angiitis are discussed. This case serves as a reminder that when pediatric patients present with stroke-like symptoms inflammatory etiologies including Primary CNS Angiitis must be considered and treated appropriately in a time sensitive manner.

Cerebral sinovenous thrombosis (CSVT) has been proposed in legal settings to be an atraumatic mimic of abusive head trauma (AHT).The objective of this study was to determine the prevalence of CSVT and subdural hemorrhage (SDH) in a large AHT population.This retrospective cohort study measured the prevalence of CSVT and SDH on magnetic resonance venograms in 243 patients diagnosed with AHT at a single center. We also reported additional intra- and extracranial injuries, head injury severity and length of hospital stay.Among 243 patients diagnosed with AHT, 7% (16/243) had CSVT. SDH was present in 94% (15/16) of the CSVT cases. Cytotoxic edema and subarachnoid hemorrhage were in 88% (14/16) and 69% (11/16) of the CSVT cases, respectively. Extracranial signs of abuse were also in 100% (16/16) of the patients with CSVT. Critical to maximal head injury severity (abbreviated injury scale=5) was in 75% (12/16) of the CSVT population vs. 33% (82/243) in the total AHT population. Length of hospital and pediatric intensive care unit stay was greater in those with CSVT (10 vs. 21.9 and 3.5 vs. 7.3 days).These findings suggest that CSVT is uncommon in AHT and is associated with additional traumatic injuries and greater injury severity.

Purpose The purpose of this paper is to trace the evolution of the Archway Investment Fund (AIF) at Bryant University from its founding in 2005 as a portfolio focused exclusively on US equities to a multi-asset program that incorporates US equities, non-US equities, equity ETFs, REITs, individual bonds, fixed income ETFs and options. It also describes the explicit introduction of environmental, social and governance (ESG) considerations into the investment process. Design/methodology/approach The paper follows a case study approach. Findings The paper describes the programmatic changes that accompanied this evolution in these areas: finance department curriculum innovations; the investment guidelines and constraints that govern the AIF; the investment process utilized; the oversight and governance process; and the reporting, presentation, and publicity initiatives that keep critical constituencies (university administration, faculty, alumni and students) informed and engaged in this program to sustain its success. Originality/value The vast majority of student-managed funds are equity funds focused on individual stock selection. The AIF is a multi-asset fund with separate equity and fixed income sub-portfolios that explicitly incorporates ESG factors into the security selection process.

We describe the design, deployment and operation of a computer system built to efficiently run deep learning frameworks. The system consists of 16 IBM POWER9 servers with 4 NVIDIA V100 GPUs each, interconnected with Mellanox EDR InfiniBand fabric, and a DDN all-flash storage array. The system is tailored towards efficient execution of the IBM Watson Machine Learning enterprise software stack that combines popular open-source deep learning frameworks. We build a custom management software stack to enable an efficient use of the system by a diverse community of users and provide guides and recipes for running deep learning workloads at scale utilizing all available GPUs. We demonstrate scaling of a PyTorch and TensorFlow based deep neural networks to produce state-of-the-art performance results.

The economic consequences of limits on political donations depend on the degree of political competition. Donors, who are ideologically aligned with candidates, decide how much to contribute to their own candidate. They may benefit from rent-seeking by their own candidate but dislike rent-seeking by the opposition. Increased rent-seeking by politicians thus generates campaign contributions for themselves but also mobilizes donations to the opposing candidate, potentially to a greater extent. This latter effect acts as a deterrent to rent-seeking when contributions finance electoral campaigns and positively affect election chances. When political competition is low, incumbent donors outnumber opposition donors and limits reduce rent-seeking. When political competition is high, donors are equalized and laissez-faire reduces rent-seeking. Consistent with these hypotheses, data from the US states suggest that limits are associated with better policies and stronger growth performance at low levels of political competition, whilst laissez-faire is preferred when political competition is high.

We analyse the results of British general elections from 1950 to 2015. In our model, voting is both instrumental and expressive, and is driven both by ideology and the perceived valence of different parties. On most assumptions the model predicts that the safer the seat the lower the swing. The exception is where ideological factors are relatively dominant in instrumental voting, and valence factors are relatively dominant in expressive voting. In this case the highest swings might be in the safest seats. Alternatively swing might peak at intermediate majorities, and this is what we find when we look at swings between Conservative and Labour in seats held by one or other of these parties. We also find that marginals behave more distinctively when the national result is expected to be close or when there has been another general election recently; and that at least some voters have a sense of what is a ‘bellwether’ seat i.e. one that would be marginal in a close election. However in those seats where the main contest has been between the Conservatives and Liberal Democrats, the swing is positively related to the closeness of the contest.

Background: In May 2018, Children's Hospital Colorado (CHCO) noted an outbreak of enterovirus (EV) A71-associated neurologic disease. Methods: A case of EV-associated neurologic disease was defined as any child presenting to CHCO with meningitis, encephalitis, acute flaccid myelitis (AFM), and/or seizures between March 1 and November 30, 2018 with an EV detected from a biologic specimen. EV-A71 cases were compared to other EV cases during the same period. EV-A71-associated AFM cases were also compared to EV-D68-associated AFM cases from 2013-2018. Findings: Of seventy-four children with EV-associated neurologic disease, forty-three (58%) were EV-A71-associated. Median age of EV-A71 cases was 22.7 months (IQR: 4-31.9 months); 34 (79%) were male. Neurologic involvement in EV-A71 cases included meningitis (93%), encephalitis (72%), and AFM (23%). All EV-A71 cases had fever; eighteen (42%) had hand, foot, or mouth (HFM) lesions. Neurologic findings distinguishing EV-A71-associated cases from other EV-associated cases (n=31) included myoclonus (60% vs. 16%, p

Background Several enteroviruses (EVs), including EV-A71 and EV-D68, have been associated with acute flaccid myelitis (AFM). Clinical features distinguishing AFM presentations associated with specific EV types are not well described. Methods EV-associated AFM was defined as any child presenting to Children’s Hospital Colorado in 2013–2018 who met the Council of State and Territorial Epidemiologists definition for confirmed AFM (flaccid limb weakness with longitudinal gray-matter-predominant spinal cord lesion on MRI) and had EV-A71 or EV-D68 identified in any biologic specimen (cerebrospinal fluid [CSF], nasopharyngeal [NP], oropharyngeal [OP], rectal) by VP1-specific RT-PCR and sequencing. Summative limb strength scores (SLSS) were calculated by adding Medical Research Council strength scores (1–5) for all limbs. Results Ten cases of EV-A71-associated AFM were identified, all from 2018; 8 cases of EV-D68-associated AFM were identified from 2013 (1), 2014 (4), 2016 (1), and 2018 (2) [Table 1]. Viral detection rates were higher in rectal and OP swabs in EV-A71 cases and NP specimens in EV-D68 cases. Virus was not detected in CSF of EV-D68 cases and in 1 EV-A71 case. EV-A71 cases were younger (median 19 vs. 100 months) and had neurologic onset earlier after prodromal symptom onset (median 1 vs. 5.5 days) than EV-D68 cases. Hand, foot, and/or mouth lesions distinguished EV-A71 cases, whereas respiratory symptoms were uniformly noted in EV-D68 cases. Associated neurologic findings more commonly associated with EV-A71 cases than EV-D68 cases included irritability, myoclonus, and ataxia. Weakness was more generalized with EV-A71 and more asymmetric with EV-D68, though patterns of brainstem and spinal cord involvement on MRI were similar. Compared with EV-D68, EV-A71 cases had milder weakness at onset and improved strength at 1- to 2-month follow-up (Figure 1), shorter length of stay (median 5.5 vs. 32 days) and a greater rate of full neurologic recovery (90% vs. 13%). Conclusion EV-D68 and EV-A71 are both associated with AFM with similar MRI findings, but cases can be distinguished by associated prodromal symptoms, neurologic findings, and outcomes. Timely collection and testing of nonsterile site specimens, particularly NP for EV-D68 and OP and rectal for EV-A71, are key to case identification. Disclosures All Authors: No reported Disclosures.

Five blocks programming environment developers were invited to share their thoughts about the future of blocks programming and seed a discussion among all attendees about this topic for the final session of the workshop.

The first programming language for most children worldwide today is a blocks-based language like Scratch or Snap. GP is a blocks-based programming language designed to be a follow-on. GP aims to be a general purpose language, like Python or Ruby, in which students can create more complex programs or create standalone applications. GP includes a mechanism for creating modules for others to re-use and a wide variety of primitives, including tools for manipulating CVS and JSON data, using serial port and network connections, and manipulating pixels in pictures or samples in sounds. The language could be used in computer science classes beyond introductory computer science. GP explores the questions: "How far can we go with a blocks-based programming language? Do we have to move students to a textual programming language to explore advanced computational ideas and applications?" In this laptop required workshop, participants will try out GP. They will explore sample projects and create their own projects that push on advanced features of GP such as using multiple classes and instances, creating sets of blocks that can be shared as extension modules, using cloud data, or manipulating images and sounds. GP will be released (free and open source) in Summer 2017, so our goal is to find early adopters who are interested in trying GP and developing examples for others.

Sophisticated voters assess incumbent competence by filtering out economic cycles (which they do not like) from trend growth (which they do). Naive voters on the other hand respond only to raw economic growth. This implies that voting in the aggregate should respond asymmetrically to the economic cycle. Upswings are rewarded by the naive, but punished by the sophisticated. Downswings are punished by all voters. Using an established dataset of over 400 general elections we find that the incumbent vote share (a) responds differently to trend growth than to the cycle, (b) does not respond significantly to positive variation in the economic cycle, and (c) responds significantly and negatively to negative realizations in the economic cycle. In contrast to standard formulations of the ‘grievance asymmetry’ this asymmetric vote response is found to be independent of trend growth.

We study the formation of government policy in democracies when turnout depends on party activists and campaign spending--parties' "political capital." The functional importance of political capital determines equilibrium rent- seeking in government. If activists and donors are better than the ordinary voter at distinguishing between good governments and lucky governments, then the more potent political capital is the less the extent of rent-seeking. This situation also rules out finite limits on election spending, though a zero limit could be the optimum if donors and activists are close enough substitutes in the work they do for the party. The one policy that is never optimal is a finite limit on local spending. The Author 2012. Published by Oxford University Press on behalf of Yale University. All rights reserved. For Permissions, please email: journals.permissions@oup.com, Oxford University Press.

Despite limited government control over the pre-1914 economy, opposition politicians were enthusiastic in blaming bad economic news on the incumbent. In a study of 458 by-elections between 1857 and 1914, we find that voters typically gave new governments a 'honeymoon' but thereafter held them responsible for high unemployment and high prices. Each 1% rise in the price level, on average, brought about a 0.21% swing against the government of the day, while each one-point rise in the percentage unemployed had double this effect. Attributing shorter- or longer-term memories to voters, as they used the past to determine what constituted unacceptable price and unemployment levels, makes little difference to this result. We also look at grievance asymmetry - the idea that voters give governments more blame for bad outcomes than they give credit for good ones - and find some evidence in its favour.

This article investigates possible bandwagons in actual elections rather than the usual opinion poll data. Until 1918, British general elections were staggered over a fortnight or more. We use the eight general elections between 1885 and 1910 to investigate whether there was a general bandwagon or underdog effect as the election progressed. We find that any bandwagon effect was in favor of the party which eventually won the election, not the party gaining seats compared with last time. We also find that a typical election featured an initial bandwagon effect which peaked about halfway through the election and then declined. Its decline appears to be due both to declining enthusiasm for the leading party and to later polls occurring in places where voters were less prone to get on a bandwagon in the first place. The weakening of the bandwagon was correlated to distance of the constituency from London, although it revived to some extent in Scotland.

With the release of Treasury papers from the 1970s under the 30-year rule we have a much more complete picture of the dispute in the 1970s between the Treasury and the Cambridge Economic Policy Group (CEPG), especially given the role of three Cambridge economists--Nicholas Kaldor, Wynne Godley and Francis Cripps--as ministerial advisers at the time. The records show some eventual closing of the gap between the Treasury and the CEPG regarding the latter's proposition of stable private-sector NAFA (where NAFA stands for net acquisition of private sector assets) and its implications for demand management and the balance of payments. In contrast, the initial differences on counterinflation policy and, above all, on import controls versus free trade were wider at the end of the decade than at the start of it. Copyright The Author 2012. Published by Oxford University Press on behalf of the Cambridge Political Economy Society. All rights reserved., Oxford University Press.