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Montesquieu's many works contain a sophisticated account of military strategy that anticipated nineteenth-century developments in the subject. In particular, his influence over Jomini was more significant than previously realized. [ABSTRACT FROM AUTHOR]

IgG4-related disease (IgG4-RD) is an increasingly recognized immune-mediated fibroinflammatory disorder that promptly responds to glucocorticoids but commonly relapses during steroid tapering or after discontinuation. In the last few years, B-cell depletion therapy with rituximab (RTX) proved to be effective in the induction of remission and maintenance treatment of IgG4-RD, providing a new powerful tool in the management of this emerging condition. In this review, we outline the pathogenetic rationale for using B-cell depleting agents in IgG4-RD, we summarize available clinical experience with RTX in this disease, and we describe future possible therapies targeting B-lymphocytes that are now in the pipeline. [ABSTRACT FROM AUTHOR]

Understanding of the pathophysiology of immunoglobulin G4-related disease (IgG4-RD) over the last dozen years has opened the door to a variety of targeted treatment approaches. Glucocorticoids are an effective treatment for IgG4-RD if used at a sufficiently high dose, but disease flares are common during or after glucocorticoid tapers and these medications seldom lead to long-term, treatment-free remissions. Moreover, their long-term use in a disease that frequently affects middle-aged to elderly individuals and often causes major pancreatic damage leads to a narrow therapeutic index. Biological therapies offer the possibility of effective disease control with fewer treatment-associated side effects. Promising avenues of investigation include B-cell depletion, immunomodulation of B-cell subsets, interference with co-stimulation, Bruton's tyrosine kinase inhibition, and Signaling lymphocytic activation molecule F7-directed treatment. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 59-year-old man with headache and progressive neurologic dysfunction. It mentions that patient reported persistent fever and frontal, temporal, and maxillary headache. It discusses that pathological examination of the meningeal biopsy specimen revealed a densely fibrotic, chronically inflamed dura mater.

The antineutrophil cytoplasmic antibody (ANCA)–associated vasculitides (AAV) comprise a major subset of diseases that cause destructive inflammation of small and medium‐sized blood vessels. Although these conditions have a predilection for pulmonary and renal involvement, they are in fact protean diseases that can involve essentially any organ system. AAV is among the most difficult rheumatic diseases to diagnose and treat. Therapy for AAV has evolved over the past two decades. Rituximab, an anti‐CD20 monoclonal antibody, is now the preferred agent for remission induction in conjunction with a reduced‐dose glucocorticoid taper. Rituximab is also often a key therapy for remission maintenance. Glucocorticoid toxicity reduction has become a major priority for treatment regimens. Avacopan, an important new adjunct to remission induction therapy, may reduce glucocorticoid use and its resulting toxicity. The role of avacopan as a remission maintenance agent requires further study. The duration of immunosuppression following remission is guided by a number of factors, including the patient's overall clinical state, the degree of damage from previous disease activity, the tolerability of remission maintenance medications, and SARS–CoV‐2 vaccination and immunity status. Certain features, including history of previous relapse, the presence of ANCA directed against proteinase 3, and a diagnosis of granulomatosis with polyangiitis, favor prolonged remission maintenance therapy. The interval between rituximab doses can usually be lengthened over time during the maintenance phase. [ABSTRACT FROM AUTHOR]

Objective Tocilizumab plus prednisone induces sustained glucocorticoid-free remission in patients with GCA. However, its long-term benefits in new-onset vs relapsing disease are uncertain, and the value of weekly vs every-other-week dosing has not been evaluated. Methods In Giant-Cell Arteritis Actemra (GiACTA) part 1, patients with new-onset or relapsing GCA received blinded tocilizumab weekly (TCZ QW), tocilizumab every-other-week (TCZ Q2W) or placebo for 52 weeks, with a prednisone taper. In part 2 (open-label), patients were treated at investigator discretion for 104 weeks. In this analysis, patients were evaluated according to their original treatment assignments, and outcomes beyond 52 weeks were assessed. Outcomes of interest included time to first flare and cumulative glucocorticoid exposure over 3 years according to baseline disease status. Results Part 1 enrolled 250 patients; 215 entered part 2. At baseline, 48% had new-onset disease and 52% had relapsing disease. In patients with new-onset and relapsing disease, the median time to first flare in the TCZ QW group was 577 and 575 days, respectively, vs 479 and 428 days with TCZ Q2W and 179 and 224 days with placebo; the median cumulative glucocorticoid dose was 3068 mg and 2191 mg with TCZ QW, 4080 mg and 2353 mg with TCZ Q2W, and 4639 mg and 6178 mg with placebo. Conclusion TCZ QW delayed the time to flare and reduced the cumulative glucocorticoid dose in patients with relapsing GCA and new-onset GCA. These data support initiating TCZ QW as part of first-line therapy in all patients with active GCA. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov , NCT01791153. [ABSTRACT FROM AUTHOR]

Introduction: Recent experimental evidence suggests normothermic machine perfusion of the vascularized composite allograft results in improved preservation compared to static cold storage, with less reperfusion injury in the immediate post‐operative period. However, metabolic acidosis is a common feature of vascularized composite allograft perfusion, primarily due to the inability to process metabolic by‐products. We evaluated the impact of combined limb‐kidney perfusion on markers of metabolic acidosis and inflammation in a porcine model. Methods: Ten paired pig forelimbs were used for this study, grouped as either limb‐only (LO, n = 5) perfusion, or limb‐kidney (LK, n = 5) perfusion. Infrared thermal imaging was used to determine homogeneity of perfusion. Lactate, bicarbonate, base, pH, and electrolytes, along with an inflammatory profile generated via the quantification of cytokines and cell‐free DNA in the perfusate were recorded. Results: The addition of a kidney to a limb perfusion circuit resulted in the rapid stabilization of lactate, bicarbonate, base, and pH. Conversely, the LO circuit became progressively acidotic, correlating in a significant increase in pro‐inflammatory cytokines. Global perfusion across the limb was more homogenous with LK compared to LO. Conclusion: The addition of a kidney during limb perfusion results in significant improvements in perfusate biochemistry, with no evidence of metabolic acidosis. [ABSTRACT FROM AUTHOR]

Isaiah Berlin has not attracted much attention from academic strategists. This is unfortunate, because his concept of value pluralism helps explain why strategic decisions are burdened by uncertainty. It also highlights the importance of political judgement in reducing this uncertainty and the role of history in educating political judgement. [ABSTRACT FROM AUTHOR]

Chronologies of glacier deposits in the Transantarctic Mountains provide important constraints on grounding-line retreat during the last deglaciation in the Ross Sea. However, between Beardmore Glacier and Ross Island – a distance of some 600 km – the existing chronologies are generally sparse and far from the modern grounding line, leaving the past dynamics of this vast region largely unconstrained. We present exposure ages of glacial deposits at three locations alongside the Darwin–Hatherton Glacier System – including within 10 km of the modern grounding line – that record several hundred meters of Late Pleistocene to Early Holocene thickening relative to present. As the ice sheet grounding line in the Ross Sea retreated, Hatherton Glacier thinned steadily from about 9 until about 3 ka. Our data are equivocal about the maximum thickness and Mid-Holocene to Early Holocene history at the mouth of Darwin Glacier, allowing for two conflicting deglaciation scenarios: (1) ∼500 m of thinning from 9 to 3 ka, similar to Hatherton Glacier, or (2) ∼950 m of thinning, with a rapid pulse of ∼600 m thinning at around 5 ka. We test these two scenarios using a 1.5-dimensional flowband model, forced by ice thickness changes at the mouth of Darwin Glacier and evaluated by fit to the chronology of deposits at Hatherton Glacier. The constraints from Hatherton Glacier are consistent with the interpretation that the mouth of Darwin Glacier thinned steadily by ∼500 m from 9 to 3 ka. Rapid pulses of thinning at the mouth of Darwin Glacier are ruled out by the data at Hatherton Glacier. This contrasts with some of the available records from the mouths of other outlet glaciers in the Transantarctic Mountains, many of which thinned by hundreds of meters over roughly a 1000-year period in the Early Holocene. The deglaciation histories of Darwin and Hatherton glaciers are best matched by a steady decrease in catchment area through the Holocene, suggesting that Byrd and/or Mulock glaciers may have captured roughly half of the catchment area of Darwin and Hatherton glaciers during the last deglaciation. An ensemble of three-dimensional ice sheet model simulations suggest that Darwin and Hatherton glaciers are strongly buttressed by convergent flow with ice from neighboring Byrd and Mulock glaciers, and by lateral drag past Minna Bluff, which could have led to a pattern of retreat distinct from other glaciers throughout the Transantarctic Mountains. [ABSTRACT FROM AUTHOR]

Hobbes' relevance to the concerns of strategy has gone unappreciated. He is, after all, interested in escaping the condition of war, rather than exploiting its political utility. And yet, exactly because of this, Leviathan addresses the principal difficulty with strategic deliberation – which is the epistemic deficit that attends human interaction, encouraging anticipatory violence. As the military theorist Carl von Clausewitz observed, minimizing the costs of war involves identifying opportunities for exercising mutual restraint over its conduct. And achieving this requires that the aforementioned epistemic deficit be ameliorated. For Hobbes, the sovereign state achieves this for its citizens; but he also considers other solutions in the context of relations between such states. The resulting insights are relevant to matters such as nuclear deterrence, and recent stability operations in the Middle East. [ABSTRACT FROM AUTHOR]

IgG4-related disease (IgG4-RD) has only existed as a unique disease entity since 2003, yet remarkable progress has already been achieved in describing the essential features of the disease. A framework for systematic clinical studies has been created by the development of a quantitative disease activity tool (the IgG4-RD Responder Index) and the validation of classification criteria, both of which were the products of international, multi-centre investigations. In addition, substantial strides have been made in understanding the pathophysiology of IgG4-RD. In particular, the central role of B cells in the disease has been demonstrated by both the robust clinical responsiveness of IgG4-RD to B cell depletion and by the identification of multiple self-antigens that promote B cell expansion. CD4+ T cells have also been investigated in detail; CD4+ cytotoxic T lymphocytes (suspected of promoting disease) and a specific T follicular helper cell subset that contributes to IgG4 isotype switching have both been defined by multiple groups. The mechanisms by which these immune cells converge on target tissues, interact with fibroblasts and promote tissue remodelling are beginning to be understood and will be an important research focus in the coming years. [ABSTRACT FROM AUTHOR]

Using results from a design-research studio analysing rail station access in Melbourne, this article considers how differing Autonomous Vehicle (AV) deployment models might fit into a suburban landscape. The results challenge assumptions about AV deployment. If AVs are low occupancy, peak demands may require station carparks to be used entirely as pick-up/drop off zones. This suggests little opportunity to re-purpose car parks for non-transport uses. Further, with AVs uncoupling station demand from existing feeder bus and park-and-ride provision, a re-distribution of demand along rail corridors may occur. The work has broad applicability to the policy challenges of an AV future. [ABSTRACT FROM AUTHOR]

The article discusses the early modern English quartos included in the collection of the library of the Royal Scots College of Salamanca in Spain as of September 2020. Among the plays are "The Two Noble Kinsmen" by William Shakespeare and John Fletcher, "The Dumbe Knight" by Lewis Machin and Gervase Markham, and "The Raging Turke" by Thomas Goffe.

Background: Diarrhea is a common problem in the pediatric post‐solid organ transplant and post‐hematopoietic stem cell transplant populations. Infectious etiology incidences are poorly defined, and the possibility of multi‐organism positivity is often uninvestigated. The aim of this study is to utilize stool multiplex GIP assays to compare the PTP and NTP regarding the incidence and profiles of single‐organism and multi‐organism infectious diarrhea. Methods: A single‐center retrospective review was conducted, investigating stool multiplex GIP panel results over a more than 3‐year period, for pediatric patients. Assays test for 23 viral, bacterial, and protozoal organisms. Results: Positive assays in the PTP and NTP were 70/101 (69.3%) and 962/1716 (56.1%), respectively (P =.009). Thirty‐two percent (32/101) of assays within the PTP were multi‐organism positive, significantly more than 14.8% (254/1716) in the NTP (P <.00001). There was no significant difference in the incidence of single‐organism positives, 37.6% (38/101) in PTP and 41.3% (708/1716) in the NTP. The PTP demonstrated a statistically significantly higher incidence of the following organisms within multi‐agent positive GIPs (P <.05 for each): Clostridioides difficile, Cryptosporidium, EPEC, norovirus, and sapovirus. Conclusions: The pediatric PTP demonstrates higher incidence of positive GIPs, higher rate of multi‐organism positivity, and unique infectious organism incidence profiles. These data can provide a framework for understanding organism‐specific pathogenicity factors, assessing the clinical impact of enteric co‐infection, and understanding the utility of this testing modality in this unique population. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 37-year-old man who was evaluated in the rheumatology clinic of this hospital for joint pain and rash, and patient was evaluated by his primary care physician, blood levels of electrolytes were reportedly normal, as were results of kidney-function tests, the complete blood count, and the erythrocyte sedimentation rate. He diagnosed with Proteinase 3 antineutrophil cytoplasmic antibody associated vasculitis consistent with granulomatosis with polyangiitis.

We report cosmogenic-nuclide measurements from two isolated groups of nunataks in West Antarctica: the Pirrit Hills, located midway between the grounding line and the divide in the Weddell Sea sector, and the Whitmore Mountains, located along the Ross–Weddell divide. At the Pirrit Hills, evidence of glacial-stage ice cover extends ∼320 m above the present ice surface. Subsequent thinning mostly occurred after ∼14 kyr BP, and modern ice levels were established some time after ∼4 kyr BP. We infer that, like at other flank sites, these changes were primarily controlled by the position of the grounding line downstream. At the Whitmore Mountains, cosmogenic 14C concentrations in bedrock surfaces demonstrate that ice there was no more than ∼190 m thicker than present during the past ∼30 kyr. Combined with other constraints from West Antarctica, the 14C data imply that the divide was thicker than present for a period of less than ∼8 kyr within the past ∼15 kyr. These results are consistent with the hypothesis that the divide initially thickened due to the deglacial rise in snowfall and subsequently thinned in response to retreat of the ice-sheet margin. We use these data to evaluate several recently published ice-sheet models at the Pirrit Hills and Whitmore Mountains. Most of the models we consider do not match the observed timing and/or magnitude of thickness change at these sites. However, one model performs relatively well at both sites, which may, in part, be due to the fact that it was calibrated with geological observations of ice-thickness change from other sites in Antarctica. [ABSTRACT FROM AUTHOR]

Questions about how to plan and govern for future urban mobility are reaching a critical point as Australian cities are faced with disruption to transport and urban systems arising from new forms of shared mobility services and the rise of autonomous vehicles. An industry engagement workshop, drawing on the insights of participants from public and private sectors of the industry, articulated a large array of complex and interrelated questions highlighting the uncertainty and scarcity of knowledge. These questions are grouped into three key themes concerning how implementation may take place, what the impacts of the uptake of these emerging transport technologies may be and how to understand them. The resultant research agenda is vast and one of multi-complexity by space, time and institutionally. 新型共享移动服务和无人驾驶汽车的出现，打乱了澳大利亚城市现有的交通和城市系统，如何规划和治理 未来城市的移动，便成为一个迫在眉睫的问题。在一场有公共部门和私营部门参与的产业交流工作坊中，人们提出了一系列错综复杂的问题，凸显了相关知识的不确定性和稀缺性。这些问题可大致分为三个方面： 策略如何实施，交通新技术会产生哪些影响，以及如何认识这些新技术。随之而产生的研究计划非常庞大， 且涉及空间、时间和制度，因而具有多重复杂性。 [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to evaluate glucocorticoid dosages and serologic findings in patients with giant cell arteritis (GCA) flares. Methods: Patients with GCA were randomly assigned to receive double‐blind dosing with either subcutaneous tocilizumab (TCZ) 162 mg weekly plus 26‐week prednisone taper (TCZ‐QW + Pred‐26), every‐other‐week TCZ plus 26‐week prednisone taper (TCZ‐Q2W + Pred‐26), placebo plus 26‐week prednisone taper (PBO + Pred‐26), or placebo plus 52‐week prednisone taper (PBO + Pred‐52). Outcome measures were prednisone dosage, C‐reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) at the time of flare. Results: One hundred patients received TCZ‐QW + Pred‐26, 49 received TCZ‐Q2W + Pred‐26, 50 received PBO + Pred‐26, and 51 received PBO + Pred‐52. Of the 149 TCZ‐treated patients, 36 (24%) experienced flare, 23 (64%) of whom were still receiving prednisone (median dosage 2.0 mg/day). Among 101 PBO + Pred–treated patients, 59 (58%) experienced flare, 45 (76%) of whom were receiving prednisone (median dosage 5.0 mg/day). Many flares occurred while patients were taking >10 mg/day prednisone: 9 (25%) in the TCZ groups and 13 (22%) in the placebo groups. Thirty‐three flares (92%) in TCZ‐treated groups and 20 (34%) in PBO + Pred–treated groups occurred with normal CRP levels. More than half of the PBO + Pred–treated patients had elevated CRP levels without flares. Benefits of the TCZ and prednisone combination over prednisone alone for remission induction were apparent by 8 weeks. Conclusion: Most GCA flares occurred while patients were still receiving prednisone. Acute‐phase reactant levels were not reliable indicators of flare in patients treated with TCZ plus prednisone or with prednisone alone. The addition of TCZ to prednisone facilitates earlier GCA control. [ABSTRACT FROM AUTHOR]

Major developments in the technology and technique of warfare are commonly understood to be an important source of historical change. Not only do they alter the character of warfare, but they also prompt broader social developments. This position has been notably adopted by Clifford J. Rogers, who claims that the emergence of newly effective infantry forces was responsible for the rise of the commons during the fourteenth century. This article argues that developments in the technique of infantry warfare during the period were largely a consequence, rather than a cause, of social change. In doing so it calls for a new approach to understanding late-medieval military developments, one which is informed by the view that war is powerfully shaped by the societies which wage it. [ABSTRACT FROM AUTHOR]

This article analyzes a child psychiatrist's referral approach when the patient's care must be transferred to an adult psychiatrist and the otherwise best adult psychiatrist has "accented" language, which is associated with the patient's prior trauma. The analysis considers the value of simplicity and a related "simplicity strategy," revealing that many ethical factors lay behind the simplicity approach. The inquiry then addresses simplicity regarding practical wisdom and context. The paper argues that simplicity should mean considering just what's relevant and no more. Applied to the case, simplicity includes respect for persons, openness, honesty, trustworthiness, beneficence, nonmaleficence, ethics of care, professional empathy, group inquiry, epistemic humility, and justice. An objection regarding undue complexity is noted and refuted. [ABSTRACT FROM AUTHOR]

Among policymakers and researchers at an international level, there is great interest in the performance of the Melbourne rail franchise model. This review attempts to examine the Melbourne model in an international context and assess the performance of the system under current contracts. Potential flaws are highlighted including lack of information, concerns over performance and contestability, and the treatment of the potential long-term maintenance backlog under short-term contracts. The authors conclude with an overall stance of there needing to be far greater public information transparency to allow proper scrutiny of the effectiveness of these contracts for the public good. [ABSTRACT FROM AUTHOR]

Abstract In 2015, a plebiscite was held on a new source of funding to support the expansion of the transit network in the Lower Mainland of Vancouver. Thus, in a region that has achieved admirable results over several decades through a strategic planning system based on a consensus model, civic leaders were forced to step outside this model to argue the case for a 0.5% increase to a local goods and service tax. This pitted a 'no new tax' grouping against a Better Transit and Transportation Coalition which brought supporters from across the community including from business, the unions, the environmental sector and students in support of the 'yes' case and the package of works crafted by consensus among municipal leaders. In this paper, we draw on in-depth key informant interviews with transportation and land use planners, municipal politicians and individuals involved in the 'yes' and 'no' campaigns built around the 2015 transport plebiscite. We show how the plebiscite was framed and how a critical component of Vancouver's planning ethos – consensus decision-making – catalysed the formation of the coalition of 'yes' campaign supporters. Despite its defeat, this coalition remained persistent and unified in their support for the development of a new funding stream and for the continued expansion of transit infrastructure across the Lower Mainland. The paper draws lessons from the transit plebiscite and how its outcome highlight the unique role that consensus planning can play in achieving progressive outcomes to politically vexing questions in transport planning in Vancouver and elsewhere. [ABSTRACT FROM AUTHOR]

Background:The availability of pediatric subspecialty services is a problem evident throughout the United States. Access to pediatric gastroenterology services, especially in rural areas, can be scarce. Telemedicine has been proposed as a tool capable of decreasing healthcare costs while extending medical care. Objective:The purpose of this article is to review available literature regarding the utility of telemedicine as it applies to pediatric gastroenterology, specifically its role in eliminating healthcare disparities. Methods:Research articles were identified through a PubMed search with key words focusing on telemedicine initiatives in pediatric gastroenterology, pediatric subspecialty, rural pediatric care, and adult gastroenterology. Studies were categorized based on the following areas of application: financial, time management, communication/community, and patient health and satisfaction. Results:We reached the conclusion that evidence-supported trends in available literature provide a framework for pediatric gastroenterology telemedicine initiatives that can provide resource-sparing, community-enriching, and physician-improving services that ultimately serve to better patient health. [ABSTRACT FROM AUTHOR]

Mass loss from the West Antarctic Ice Sheet (WAIS) is increasing, and there is concern that an incipient large-scale deglaciation of the marine basins may already be underway. Measurements of cosmogenic nuclides in subglacial bedrock surfaces have the potential to establish whether and when the marine-based portions of the WAIS deglaciated in the past. However, because most of the bedrock revealed by ice-sheet collapse would remain below sea level, shielded from the cosmic-ray flux, drill sites for subglacial sampling must be located in areas where thinning of the residual ice sheet would expose presently subglacial bedrock surfaces. In this paper we discuss the criteria and considerations for choosing drill sites where subglacial samples will provide maximum information about WAIS extent during past interglacial periods. We evaluate candidate sites in West Antarctica and find that sites located adjacent to the large marine basins ofWest Antarctica will be most diagnostic of past ice-sheet collapse. There are important considerations for drill site selection on the kilometer scale that can only be assessed by field reconnaissance. As a case study of these considerations, we describe reconnaissance at sites in West Antarctica, focusing on the Pirrit Hills, where in the summer of 2016-2017 an 8m bedrock core was retrieved from below 150m of ice. [ABSTRACT FROM AUTHOR]

The 56th IEEE Nuclear and Space Radiation Effects Conference (NSREC) was held on July 8–12, 2019, at the Marriott Rivercenter Hotel in San Antonio, TX, USA. The NSREC is recognized as one of the premier international conferences on radiation effects in electronic materials, devices, and systems. The 2019 conference continued this tradition with a strong technical program, a one-day tutorial short course, a radiation effects data workshop, an industrial exhibit, and the meetings for the IEEE Women in Engineering and Young Professionals Organizations. The conference was sponsored by the Radiation Effects Committee of the IEEE Nuclear and Plasma Sciences Society (NPSS) and supported by Aerospace Corporation, BAE Systems, Boeing, Cobham, Harris, Intersil Space Products, IR HiRel Products, an Infineon Technologies company, the Jet Propulsion Laboratory, the Southwest Research Institute, and VPT. [ABSTRACT FROM AUTHOR]

Abstract: Walker Connor's extensive writings on nationalism covered a wide range of issues and an even wider range of societies, from North America to Western Europe, from the countries of the Communist bloc to the evolving forms of identity and affiliation throughout the postcolonial, developing world. No theme in his work is perhaps more salient than his critical distinction between state and nation, one that was so often blurred by a loose terminology that saw political units and forms of ethnic identity as synonymous. For Connor, this sin was perpetrated by both academic scholars and general writers and led to a lack of appreciation of one of the foremost forces – what he called ethno‐nationalism – shaping the contemporary world. [ABSTRACT FROM AUTHOR]

Abstract: Granulomatosis with polyangiitis (GPA; formerly Wegener's) can present with clinical and histopathological features similar to those of immunoglobulin‐G4 related disease (IgG4‐RD), a recently described fibro‐inflammatory condition. The ability of these two distinct entities to mimic each other closely creates significant pitfalls in diagnosis. We present a unique case in which GPA presented as a peri‐aortic fibrotic mass in the retroperitoneum. The patient's other clinical features also overlapped with classic IgG4‐RD disease manifestations, but the histopathology in two organs and the serological data confirmed the diagnosis of GPA. Rigorous histopathological review remains the gold standard for the diagnosis of GPA and the distinction of this entity from IgG4‐RD and other mimickers. [ABSTRACT FROM AUTHOR]

Early diagnosis and treatment of GCA is essential to prevent complications of the disease, including permanent vision loss. Temporal artery biopsy has been intrinsically linked with the diagnosis of GCA for several decades. A negative predictive value of>90% has been reported for temporal artery biopsy; however, a negative result does not reliably indicate the absence of GCA because inflammation of the temporal artery is not always evident because of segmental involvement or other reasons. This is demonstrated by a case study of a patient hospitalized following acute vision loss to the right eye whose glucocorticoid treatment was suspended after temporal artery biopsy revealed no evidence of GCA. The patient subsequently lost sight in the left eye 6 weeks after stopping glucocorticoid therapy. The specificity of temporal artery biopsy for the diagnosis of GCA is variable and influenced by many factors, including length of biopsy specimens, vasculitis in vessels other than the temporal artery (ophthalmic, retinal and posterior ciliary vessels), unilateral versus bilateral biopsy, expertise of the surgeon, interpretation of histology, effects of treatment and confounding factors such as atherosclerosis or other non-GCA diseases that can affect the temporal artery. Considering the limitations of temporal artery biopsy, collaboration and education between the clinician, the pathologist and the patient, taking into account a thorough examination of patient history, recognizing signs and symptoms, and potentially involving newer imaging studies with trained technicians and physicians, are essential in confirming or eliminating diagnosis of GCA. [ABSTRACT FROM AUTHOR]

This work investigates a variety of properties of eleven and fourteen branch five junction comb polymers in the ideal regime in two and three dimensions. A method based on the Kirchhoff matrix eigenvalue spectrum for arbitrary tree-branched polymers is used to compute shape properties and a scheme originally proposed by Benhamous (2004), is used to produce an exact equation for the form factor of the fourteen branch comb polymers. A Monte Carlo growth algorithm is also employed to compute the same properties. It is found that the values obtained by all of these methods are in fine agreement with each other and available theory. [ABSTRACT FROM AUTHOR]

Clausewitz has much to tell us about strategy. However, his most fundamental and enduring insights are obscured by his problematic theorizing about war in general. Essentially the same insights have been more clearly and economically articulated in the fields of political philosophy and game theory. As such, these literatures provide a more accessible introduction to the basics of strategy. The real value of Clausewitz resides in his profound understanding of how basic strategic dynamics play out in the specific context of war. [ABSTRACT FROM AUTHOR]

Background. Donor kidneys contain a large reservoir of passenger leucocytes that contribute to acute rejection via direct alloantigen presentation and pro-inflammatory cytokine secretion. However, the early contribution of these cells following revascularization has not previously been described. We performed a secondary, high-volume preservation flush following cold storage to characterize the inflammatory contribution of the donor kidney upon reperfusion. Methods. Porcine kidneys were retrieved using a protocol analogous to current UK clinical practice. Following 2 h of cold static preservation, kidneys underwent a secondary flush with Ringer's solution. The venous effluent was collected and leucocytes phenotyped via flow cytometry. Inflammatory mediators, including cytokines and cell-free DNA, were then assessed to determine the inflammatory contribution of the donor kidney. Results. Upon reperfusion, a significant population of donorderived CD45þ leucocytes mobilized from the renal vasculature via the renal vein [mean 4.738×108 (SD 1.348×108)]. Within this population, T cells were dominant, representing >60% of the leucocyte repertoire. Granulocytes, monocytes and natural killer cells were also identified, but in comparatively lower numbers. Significant concentrations of cytokines and cell-free DNA were also eluted upon reperfusion. Conclusions. The donor kidney contains a significant immune load that rapidly mobilizes following reperfusion. Performing a secondary preservation flush prior to implantation may reduce this inflammatory burden via diversion of donor leucocytes and inflammatory mediators from entry into the recipient circulation. This may modulate direct presentation and reduce the inflammatory contribution of the donor kidney following transplantation. [ABSTRACT FROM AUTHOR]

Deglaciation of the Ross Sea following the last ice age provides an important opportunity to examine the stability of marine ice sheets and their susceptibility to changing environmental conditions. Insufficient chronology for Ross Sea deglaciation has helped sustain (i) the theory that this region contributed significantly to Meltwater Pulse 1A (MWP-1A) and (ii) the idea that Ross Sea grounding-line retreat occurred in a 'swinging gate' pattern hinged north of Roosevelt Island. We present deglaciation records from southern Transantarctic Mountain glaciers, which delivered ice to the central Ross Sea. Abrupt thinning of these glaciers 9-8 kyr B.P. coincided with deglaciation of the Scott Coast, ∼800 km to the north, and ended with the Ross Sea grounding line near Shackleton Glacier. This deglaciation removed grounded ice from most of the central and western Ross Sea in less than 2 kyr. The Ross Sea Sector neither contributed nor responded significantly to MWP-1A. [ABSTRACT FROM AUTHOR]

This article attempts to assess some of Herb Gans’s influential contributions, not only in his important paper on symbolic ethnicity, but also his wider discussion of the changing role of race, ethnicity, and religion in American society. In a period spanning more than half a century, he has helped to raise key questions and to suggest avenues of research that have stimulated debates and the re-evaluation of a complex, controversial, and highly dynamic field of social science research and policy. [ABSTRACT FROM PUBLISHER]

Dominant social theories have rarely placed migration at the center of our understanding of society and social change. Classical theories in the Western tradition have been more preoccupied with the impact of economic and political revolutions on social change, stratification and class conflict, and have paid far less attention to other important aspects of society. Contemporary theories have expanded the theoretical gaze to include a much wider set of issues, from racial and gender divisions to warfare and the environment. In an era of globalization, we argue that such a marginalization of the migrant, and the failure to better integrate both internal and external migration into a more nuanced interpretation of social change, is a significant shortcoming. By examining some of the key elements linked to such human movement in Europe, North America and China -- in the light of five recent studies in this field -- we argue that migration is a vital factor in changing the world as we know it and consequently a central concern for social theory. This is a review essay on: Richard Alba and Nancy Foner. Strangers No More: Immigration and the Challenges of Integration in North America and Western Europe. Princeton: Princeton University Press, 2015. Louis DeSipio and Rodolfo de la Garza. US Immigration in the Twenty-First Century: Making Americans, Remaking America. Boulder, CO: Westview Press, 2015. Adrian Favell. Immigration, Integration and Mobility: New Agendas in Migration Studies. Colchester: ECPR Press, 2015. Zhongshan Yue. Social Integration of Rural-Urban Migrants in China: Current Status, Determinants and Consequences. Singapore: World Scientific Publishers, 2015. Robyn R Iredale and Fei Guo. Handbook of Chinese Migration: Identity and Wellbeing. Cheltenham: Edward Elgar Publishing, 2015. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 20-year-old man who was diagnosed with IgA vasculatis after being sent to an outpatient clinic due to complaints of purpuric rash and pain and swelling in his left calf. It mentions that the patient has a history of Crohn's disease at the age of 10 due to prolonged used of glucocorticoid. It discusses the effectiveness of using glucocorticoid with the lowest effective dose for treating the disease.

George Orwell is not generally remembered for his views on strategy. Nevertheless a careful reading of his written work reveals a coherent appreciation of war’s strategic dimension. For Orwell, war is a necessary adjunct to politics, and the utility of strategic action should be based on rational considerations of cost and benefit. He rejected pacifism and self-imposed restraints on warfare on the basis that such positions proceeded from unexamined emotional commitments, and were neither instrumentally nor morally sound. He also maintained that the enemy’s political values are an essential input into effective strategic calculations. On this latter basis he criticised the strategic prescriptions of H. G. Wells and B. H. Liddell Hart for limited war with Nazi Germany. [ABSTRACT FROM PUBLISHER]

The article presents a case study of a 57-year-old woman who was taken at the outpatient rheumatology clinic of the Massachusetts General Hospital due to weight loss, fatigue and skin lesions. The woman was diagnosed with mild chronic and focally active gastritis following esophagogastroduodenoscopy and pathological examination.

IgG4-related disease (IgG4-RD) is a systemic condition of unknown cause characterized by highly fibrotic lesions, with dense lymphoplasmacytic infiltrates containing a preponderance of IgG4-expressing plasma cells. CD4+ T cells and B cells constitute the major inflammatory cell populations in IgG4-RD lesions. IgG4-RD patients with active, untreated disease show a marked expansion of plasmablasts in the circulation. Although the therapeutic depletion of B cells suggests a role for these cells in the disease, a direct role for B cells or IgG4 in the pathogenesis of IgG4-RD is yet to be demonstrated. Among the CD4+ T-cell subsets, Th2 cells were initially thought to contribute to IgG4-RD pathogenesis, but many previous studies were confounded by the concomitant history of allergic diseases in the patients studied and the failure to use multi-color staining to definitively identify T-cell subsets in tissue samples. More recently, using an unbiased approach to characterize CD4+ T-cell subsets in patients with IgG4-RD – based on their clonal expansion and ability to infiltrate affected tissue sites – CD4+ CTLs have been identified as the major CD4+ T-cell subset in disease lesions as well as in the circulation. CD4+ CTLs in affected tissues secrete pro-fibrotic cytokines including IL-1β, TGF-β1, and IFN-γ as well as cytolytic molecules such as perforin and granzymes A and B. In this review, we examine possible mechanisms by which activated B cells and plasmablasts may collaborate with the expanded CD4+ CTLs in driving the fibrotic pathology of the disease and describe the lacunae in the field and in our understanding of IgG4-RD pathogenesis. [ABSTRACT FROM AUTHOR]

The bayonet has long been regarded as an obsolete piece of military technology. This article advances a proxemic account of close combat, which points to its continuing utility under modern battlefield conditions. It is argued that bayonet training remains an effective way of preparing soldiers to psychologically dominate contested spaces on the battlefield. Thus, although other weapons and techniques can fulfil the same role, it can nevertheless be argued that the bayonet’s enduring presence is not simply the result of some atavistic military mind-set. [ABSTRACT FROM PUBLISHER]

IgG4-related disease (IgG4-RD) is an immune-mediated disease driven by interactions on several levels between cells of the B and T lineages. A key driver of IgG4-RD is believed to be a novel CD4+ cytotoxic T lymphocyte that bears SLAM-F7 on its surface. This cell is presumed to be sustained by continuous antigen presentation by cells of the B cell lineage, particularly plasmablasts. Because IgG4-RD has been recognized for fewer than 15 years as a unified diagnostic entity, no controlled clinical trials or few prospective studies of any sort have been performed. Although progress in understanding disease pathophysiology will likely lead in due course to disease-specific therapies-undoubtedly with implications for other immune-mediated diseases-at this juncture, the management of IgG4-RD remains more an art than a science, driven largely by the published clinical experience of only a few centers of expertise. We identify here six common management dilemmas in IgG4-RD and describe our typical approach to the management of each one. [ABSTRACT FROM AUTHOR]