Early Era Research Articles

Machine Learning Model for Predicting Mortality Risk in Pediatric Cerebral Venous Sinus Thrombosis

Introduction: Pediatric Cerebral Venous Sinus Thrombosis (CVST) is a rare but serious disorder with risk for neurologic sequelae and mortality. Prediction of health outcomes for risk stratification and tailored therapy is difficult based on available literature with single center studies and limited sample sizes. We sought to analyze the CVST data in Pediatric Health Information System (PHIS) database, a large, multicenter administrative database of pediatric inpatient data, to assess if supervised machine learning can assist in identifying pediatric CVST patients with increased risk of adverse outcomes. Methods: Patients 0 to 17 years of age with a diagnosis of CVST were identified in the PHIS database from 2011 to 2022. Demographic information, clinical characteristics, evaluation and management, and outcome data was extracted from diagnostic, imaging, procedure, and pharmaceutical billing codes. An XGBOOST model was fitted using 10-fold cross-validation with Bayesian optimization for hyperparameter tuning. The clinical parameters with values optimal for analysis from the “early era” (2011-2015) dataset were used to train for machine learning, and the test was applied to the “late era” (2016-2022) dataset. The final model was chosen based on the highest test set AUC score. The clinical parameters with significant SHAP values from the model were compared to published risk factors for mortality from an International Pediatric Stroke Study (IPSS) (RN Ichord, et al. Arch Dis Child 2015). Results: 6080 hospitalizations with CVST diagnosis (0.1% of all hospitalizations) were identified. The clinical parameters applied for machine learning included the following: age, gender, race, major complications (intracranial bleeding, hydrocephalus, coma), child opportunity index and ICU admission (Table 1.). The overall mortality rate at discharge was 4.2%. 2029 hospitalizations occurred in the early era and 4051 hospital admissions occurred in the late era. With the analyzable clinical parameters, the XGBOOST model could predict mortality with a probability of 0.7906. Of the clinical parameters used for machine learning (Figure 1), ICU admission, intracranial bleeding, hydrocephalus and coma had positive SHAP values indicating higher mortality risk prediction, whereas older age and being non-Hispanic white had negative SHAP values indicating lower mortality risk prediction. Similar risk associations for mortality were reported in the IPSS study, with patients with intracranial bleeding, younger age, and coma having higher mortality risk, consistent with our study finding. Conclusion: Our study in pediatric CVST, using machine learning, shows higher risk of mortality with ICU admission, and complications including intracranial bleeding, hydrocephalus, and coma; and lower risk of mortality with older age and non-Hispanic White status, which are consistent with IPSS study observations. Our study also illustrates how machine learning can be utilized by investigators to predict adverse clinical outcomes in pediatric CVST. In rare diseases which are difficult to study due to limited sample sizes like pediatric CVST, our study shows that data from large databases such as PHIS can be utilized for machine learning to predict health care outcomes, which can in turn inform future clinical practice to improve patient outcome.

Favorable Survival Outcomes in AML Patients Undergoing Allogeneic Hematopoietic Cell Transplant with Fludarabine/Melphalan-Conditioning with Tacrolimus/Sirolimus-Based Gvhd Prophylaxis

Introduction: Fludarabine/melphalan (F/M) conditioning is associated with superior disease-free survival (DFS) compared to busulfan-based reduced-intensity conditioning (RIC) regimens in patients with AML/MDS undergoing allogeneic hematopoietic cell transplantation (alloHCT). A recent CIBMTR analysis in AML patients reported 5-year OS, cumulative incidence of Relapse (CIR) and NRM of 29%, 36% and 36% respectively after F/M conditioning when Tac/MTX was used for graft-vs-host disease (GVHD) prophylaxis (Blood Adv 2020). At City of Hope (COH), tacrolimus and sirolimus (T/S)-based GVHD prophylaxis has been used in patients undergoing HLA-matched sibling and unrelated donor alloHCT, based on the results of a phase 2 study by Rodriguez et al (Blood 2010). Here, we retrospectively reviewed clinical outcomes of 409 consecutive AML patients who underwent RIC alloHCT at COH from 2008-2019 with F/M conditioning and T/S-based GVHD prophylaxis. The primary objective was to assess long term survival outcomes and associated risk factors adjusted for secular trends in patient demographics undergoing alloHCT over time. Methods: Descriptive statistics were used to summarize patient demographics, and disease characteristics. Kaplan-Meier curves and log-rank test were used to evaluate OS and LFS. Cumulative incidence curves and Gray test were used to examine differences in relapse and NRM. The assumptions of proportionality for Cox regression and Fine-Gray models were checked by corresponding tests and plots of the scaled Schoenfeld residuals. To study changes in patient demographics, we divided patients into early era of 2008-2012 (n=140; 34%) and late era of 2013-2019 (n=269; 66%). Results: Patient and HCT characteristics are shown in Table 1. Briefly, the median age was 63 years (range: 19-78) and 70% of patients underwent alloHCT in CR-1. Cytogenetics (ELN 2017) were classified as adverse risk in 25% (n=104) and intermediate risk in 65% (n=265) patients. By disease risk index (DRI), patients were categorized as low (32%; n=131), intermediate (47%; n=193), or high/very high risk (20%; n=84). KPS of 80-100 was recorded in 93% of patients and HCT comorbidity index score of ≥3 was seen in 41%. AML-from prior hematologic disorder (secondary AML) or therapy related was documented in 32% (n=133) and data on somatic mutations and measurable residual disease (MRD) were available only in the recent era. Compared to the early era, HCT recipients of the recent era were significantly older(64 vs 60 years; p=0.0001), had higher HCT-CI (median score of 3 vs 1; p<0.0001), and more patients with KPS < 80 (9% vs 2 %; p=0.0024). With the median follow-up duration of 4 years (range: 0.3-12.5) for the whole cohort, the 5-year OS and DFS were 53% (95% CI: 0.48-0.58) and 51% (95% CI: 0.46-0.56), respectively. The cumulative incidence of relapse (CIR) at 5 years was 23% (95% CI: 0.19-0.28). The non-relapse mortality (NRM) at day+100 and 5 years were 5% (95% CI: 0.03-0.08) and 25% (95% CI:0.20-0.29), respectively. Day +100 grade 2-4 acute GVHD was 37% (95% CI: 0.32-0.42) and 2-year chronic GVHD was 70% (95% CI: 0.65-0.74). Overall survival (OS) and disease-free survival (DFS) were not significantly different in the two eras (Figure 1). Despite high incidence of cGVHD, only 21% (n=86) required prednisone at one year with median dose of 10 mg/day (range: 2-60mg/day). In key subgroups of interest, the 5-year OS were: 70% for FLT3-ITD mutation (n=50), 70% for NPM1 mutation (n=47), 83% for IDH 1/2 mutation (n=30), 65% for patients older than ≥70 (n=55), and 55% (95%CI :43-63) for secondary AML (n=102). MRD by multi-color flow cytometry was available in 58 patients in CR of whom 18 were MRD-positive; this was associated with worse 5-year OS (26%: 95% CI: 5.5-53%). Multivariate analyses (MVA) identified DRI high/very high-risk as the only independent variable associated with worse OS (HR=1.62, [95%CI: 1.16-2.27]) and DFS (HR=1.76, [95%CI: 1.28-2.41]), primarily due to increased NRM (HR 1.86, 95%CI [1.21-2.87]), while its impact on relapse was insignificant. Conclusion: Fludarabine-melphalan with T/S associated with favorable long-term OS with good disease control without excessive NRM, even in high-risk patient subgroups and changing demographics of older adults with higher comorbidity. However, cGVHD rates remain high and novel strategies are being explored to realize the OS benefits of the FM backbone while attenuating chronic GVHD and NRM.

Disability Adjusted Life-Years (DALYs) As a Measure of the Changing Lifetime Disease Burden in Long-Term Survivors of Allogeneic Hematopoietic Cell Transplantation (HCT)

Background: Although HCT is curative for many hematologic diseases, long-term survivors face a high burden of morbidity and premature mortality compared to the general population. Standard risk measures (prevalence, incidence, hazard, and standardized mortality ratios) do not convey a holistic picture of chronic disease burden because they do not account for degradation in quality of life associated with living with health conditions preceding death. DALY is an established risk measure that accounts for quality of life; it is the sum of years of healthy life lost due to disability (YLD) and years of life lost (YLL) to premature death. YLD weighs the years lived with a health condition by its disability weight (range: 0 for full health, 1 for death). Higher DALY, YLL, YLD indicate worse outcomes. We used microsimulation to estimate DALYs in 5-year survivors of HCT done over four decades, taking into consideration the changing practice of transplantation and the evolving burden of morbidity and mortality over time. Methods: The cohort included 1577 patients who underwent HCT at age ≥18 years (y) at City of Hope in 1976-2011, survived 5y, and were followed to December 31, 2016. Vital status and cause of death (COD) were determined using medical records and the National Death Index Plus. CODs were grouped into eleven broad categories used in a Global Burden of Disease (GBD) study ( Chang et al., Lancet Public Health, 2019). All cause and cause-specific mortality risks by attained age and other risk factors were estimated from deceased patients' data. These risks were applied in microsimulation to project age at death and COD for patients known to be alive. The onset age of COD was estimated for each patient using the age-specific disease incidence rates in GBD (https://www.healthdata.org/gbd). Life expectancy (LE) at time of death was determined from the US Life Tables. YLL was calculated as LE minus age at death. YLD was calculated as age at death minus disease onset age, weighted by disability weights of the COD available at Global Health Data Exchange (https://ghdx.healthdata.org). DALY was computed as YLL+YLD. Microsimulation, performed 1000 times, provided mean YLL, YLD, DALY for each patient. Results: Patient and treatment characteristics evolved over 35 years of HCT era ( Table). Patients who underwent HCT in the earliest era (1976-1989) had characteristics consistent with more favorable post-HCT outcomes compared to patients transplanted in later eras. From 1976-1989 to 2005-2011, there was an increase in patients who were older (median, 28y to 49y), had high relapse risk (26% to 42%), had an unrelated donor (0% to 45%), and developed chronic graft vs host disease (54% to 84%). Conversely, fewer patients received total body irradiation over time (88% to 36%). The proportion of patients transplanted for chronic myeloid leukemia declined from 24% to 5%, and there was a relative increase in patients with myelodysplastic syndrome (4% to 17%). Sex and race/ethnicity remained steady. The most common causes of death were relapse (35%), subsequent malignant neoplasms (22%), cardiovascular disease (10%), diabetes, kidney disease (10%), and infection (8%). Despite more patients with higher risk features receiving HCT in recent eras, median DALY was projected to decline from 19.2y to 15.5y from the earliest to latest HCT era (p<0.0001) ( Figure). YLL also declined from a median of 18.0y to 14.2y across eras (p<0.0001). Although YLD constituted a small portion of DALY, patients were projected to lose a median of 1.6y (1976-1989) to 1.2y (2005-2011) of healthy life due to disease-related disability. The projected age at death for the cohort (median, 67.5y to 73.4y across era) adjusted for rising life expectancy (median, 85y to 88y) suggested that survival after HCT increased in more recent HCT eras: age at death / life expectancy ratio median, 0.79 (1976-1989) to 0.84 (2005-2011) (p<0.0001). Conclusion: Outcomes after HCT have improved during the past four decades in spite of the evolving pattern of higher risk disease and patient characteristics with time. There was notable reduction across all measures (DALY, YLL, YLD), suggesting improvements in both the quantity and quality of survival. Our results highlight the importance and utility of DALY when characterizing health outcomes after HCT, as it provides a more comprehensive assessment of the changing pattern of efficacy associated with transplantation.

REVITALIZATION OF MOSQUE MANAGEMENT MODELS AND THEIR APPLICATION IN SOCIAL CAPITAL

<div>The revitalization of mosque management at Kurir Langit Mosque aims to restore its function as a place of worship and a relevant social practice aligned with the current needs of the Muslim community by reinstating the practices of the early era of Islam during the time of Prophet Muhammad (peace be upon him) and his companions. The research objective is to examine the strategies for revitalizing mosque management models and their implementation in the context of social capital at Kurir Langit Mosque. This study utilizes a qualitative method with a field research approach. The research findings reveal that the revitalization of Kurir Langit Mosque's management has brought about significant transformation in</div><div>mosque management, fundraising, and various social practices, thereby introducing the concept of social capital within the community. The modern concept of revitalization at Kurir Langit Mosque involves a return to the roots of early Islam, adopting early Islamic practices, and making the mosque a centre for education and empowerment. Community funds are managed meticulously, combining religious values with educational services, primarily funded through endowments, zakat, almsgiving, and donations, enabling the mosque to operate independently. A comprehensive social welfare program focusing on education,</div><div>well-being, and empowerment is implemented with a mentorship-based approach, fostering positive change and reducing reliance on aid and donations.</div>

Time-varying risks of infection in patients as they proceed through the phases of ‘pre-RA’: results from the Scottish Early RA inception cohort

ObjectiveRheumatoid arthritis (RA) develops after progressing through sequential ‘pre-RA’ phases. The mechanisms driving progression from one phase to the next remain poorly understood. This study examined the longitudinal rates of...

Considering Kemalist secularization process through the eyes of the ordinary

ABSTRACT While the dominant narrative of Turkey's secularism process is discussed in terms of the Kemalist leadership’s regulation of social life in a top-down manner, this article focuses on the practices of religious organizations in the early Republican era by examining secularism through the everyday practices of the ‘ordinary’ people and relying upon oral history. In recent years, studies considering the social dynamics of this era have included more critical approaches that challenge the dominant understanding by focusing on practices excluded from centralized power control. This has allowed for a more critical approach to the arguments claiming that Kemalist cadres successfully achieved social transformation. With this impetus, this study aims to demonstrate the flexible appearances of power struggles and develops an approach examining both social relations and local dynamics by considering micro and macro perspectives.

Euclidean Wormhole with k-essence field in the presence of Gauss–Bonnet term

In this paper, we present some analytical solutions of wormhole in four-dimensional Robertson–Walker Euclidean background considering Einstein–Gauss–Bonnet dilaton interaction with a [Formula: see text]-essence field for [Formula: see text]. The solutions are obtained assuming some restrictions on coupling function with a form of potential or with the ratio of kinetic to potential energy of the dilaton field. Euclidean wormhole, in one case, evolves through early transient inflationary era and after graceful exit from inflation, it asymptotically yields a radiation dominated era or a matter dominated era. In another solution, initial Euclidean wormhole is accompanied by oscillation of scale factor in Euclidean time at some late era which asymptotically yields exponential expansion. The violation of the null energy condition can be avoided asymptotically. The potential is also found to decay sharply.

Textor viator. Mobilność tkaczy Pogórza Karpackiego w epoce nowożytnej

Spatial mobility of communities living in the Carpathian Foothills in the early modern era is an interesting issue, primarily because of local ethnic diversity. In addition to representatives of Polish ethnic groups, Orthodox (later Greek Catholic) Wallachians and Ruthenians, Hungarians and Jews lived here. According to chronicle narratives (Kromer, Bielski, Stryjkowski, Piasecki, Starowolski) from the 16th–17th centuries, however, the region was characterized above all by a high degree of population of descendants of former German settlers (called Deaf Germans), brought in 14th–15th centuries, who still spoke a language similar to German and professionally engaged in weaving (especially nearby the towns of Biecz, Krosno and Łańcut). The aim of the article is to look at the issue of mobility of this professional group based on the entries from the Book of Admission to the Municipal Law of Biecz (1538–1690) and in the context of research on the Deaf Germans. The analysis of the data confirms that the key group arriving in the foothills town were weavers from various areas of the former German settlement. In addition to the issue of spatial mobility, attention will also be devoted to social mobility, because moving from the countryside to the city was an opportunity for social advancement at that time.

ENAMEL HYPOPLASIA AS A STRESS SIGNAL: UNVEILING PALEOENVIRONMENTAL STRESS EPISODES IN THE SIWALIK’S SUIDS OF PAKISTAN FROM THE MIDDLE MIOCENE TO EARLY PLEISTOCENE

Numerous paleontologists have used research on tooth enamel hypoplasia as a stress signal when assessing paleoenvironments. The goal of the current study was to identify and evaluate stress periods that occurred in the middle Miocene to early Pleistocene eras of the Siwaliks of Pakistan by analyzing enamel hypoplasia in eight extinct suids species: Listriodon pentapotamiae, Tetraconodon minor, Sivachoerus prior, Hippohyus lydekkeri, Hippohyus sivalensis, Hippopotamodon sivalense, Tetraconodon magnus, Propotamochoerus hysudricus. All suid species from all time intervals between 14.2 and 0.6 million years old (Myo) were analyzed, with the exception of those from the 11.2-9.0 Myo time frame (late Miocene), when no suids were found to show enamel hypoplasia. Enamel hypoplasia was the most common in suids from the middle Miocene Siwalik (63%), followed by those from the early Pliocene to the Pleistocene (43%), the late Miocene to the Pliocene (25%), and the late Miocene to the early Pleistocene (33%). The percentage of incidence of E.H with respect to each species was 62.50% in Listriodon pentapotamiae, 50% in Sivachoerus prior and Hippohyus sivalensis, 33.33% in Hippohyus lydekkeri and Propotamochoerus hysudricus and 0% in Tetraconodon minor and Tetraconodon magnus. The prevalence of enamel hypoplasia during the Neogene and Quaternary in the Siwalik region provides evidence for the occurrence of stress episodes, while the proportion of hypoplastic enamel illustrates the relative intensity of these stresses. These stressful events brought on by a lack of food or nutrition happened because of the historical periods' drastic shifts in weather, vegetation, ecology, and wildlife. These stress periods, which occurred from the early Miocene to the Pleistocene, may have spurred the evolution and speciation of the Siwalik fauna, notably the mammals. Key Words: Enamel hypoplasia, Stress signals, Paleoenvironment, Siwaliks, Suids

Moss kill dates and modeled summer temperature track episodic snowline lowering and ice cap expansion in Arctic Canada through the Common Era

Abstract. Most extant ice caps mantling low-relief Arctic Canada landscapes remained cold based throughout the late Holocene, preserving in situ bryophytes killed as ice expanded across vegetated landscapes. After reaching peak late Holocene dimensions ∼1900 CE, ice caps receded as Arctic summers warmed, exposing entombed vegetation. The calibrated radiocarbon ages of entombed moss collected near ice cap margins (kill dates) define when ice advanced across the site, killing the moss, and remained over the site until the year of their collection. In an earlier study, we reported 94 last millennium radiocarbon dates on in situ dead moss collected at ice cap margins across Baffin Island, Arctic Canada. Tight clustering of those ages indicated an abrupt onset of the Little Ice Age at ∼1240 CE and further expansion at ∼1480 CE coincident with episodes of major explosive volcanism. Here we test the confidence in kill dates as reliable predictors of expanding ice caps by resampling two previously densely sampled ice complexes ∼15 years later after ∼250 m of ice recession. The probability density functions (PDFs) of the more recent series of ages match PDFs of the earlier series but with a larger fraction of early Common Era ages. Post 2005 CE ice recession has exposed relict ice caps that grew during earlier Common Era advances and were preserved beneath later ice cap growth. We compare the 106 kill dates from the two ice complexes with 80 kill dates from 62 other ice caps within 250 km of the two densely sampled ice complexes. The PDFs of kill dates from the 62 other ice caps cluster in the same time windows as those from the two ice complexes alone, with the PDF of all 186 kill dates documenting episodes of widespread ice expansion restricted almost exclusively to 250–450 CE, 850–1000 CE, and a dense early Little Ice Age cluster with peaks at ∼1240 and ∼1480 CE. Ice continued to expand after 1480 CE, reaching maximum dimensions at ∼1880 CE that are still visible as zones of sparse vegetation cover in remotely sensed imagery. Intervals of widespread ice cap expansion coincide with persistent decreases in mean summer surface air temperature for the region in a Community Earth System Model (CESM) fully coupled Common Era simulation, suggesting the primary forcings of the observed snowline lowering were both modest declines in summer insolation and cooling resulting from explosive volcanism, most likely intensified by positive feedbacks from increased snow cover and sea ice and reduced northward heat transport by the oceans. The clusters of ice cap expansion defined by moss kill dates are mirrored in an annually resolved Common Era record of ice cap dimensions in Iceland, suggesting this is a circum-North-Atlantic–Arctic climate signal for the Common Era. During the coldest century of the Common Era, 1780–1880 CE, ice caps mantled >11 000 km2 of north-central Baffin Island, whereas <100 km2 is glaciated at present. The peak Little Ice Age state approached conditions expected during the inception phase of an ice age and was only reversed after 1880 CE by anthropogenic alterations of the planetary energy balance.

Making the Modern Turkish Citizen: Vernacular Photography in the Early Republican Era , by Ozge Baykan Calafato

Making the Modern Turkish Citizen: Vernacular Photography in the Early Republican Era , by Ozge Baykan Calafato

Geophysical constraints on the deep structure beneath the Xiong'an New Area geothermal field, North China

The region known as the Xiong'an New Area serves as a testing and validation research laboratory for the development and utilization of geothermal energy in China. To better understand the lithospheric structure and associated geothermal features in the region, a comprehensive approach was employed, combining deep seismic reflection and an overlapping magnetotelluric sounding (MT) profile analysis. The analysis reveals arched reflections, coinciding with a relatively high-resistivity anomaly, demonstrating concentric patterns that indicate the presence of lithospheric gneiss domes beneath the Rongcheng and Niutuozhen structural highs. Additionally, the seismic image reveals a marked transparent zone characterised by low-resistivity beneath the Niubei slope. These dome-like features are interpreted as plutons and/or intrusive bodies that were formed by upwelling of the asthenosphere during the early Paleogene era. These relatively deep-rooted plutons are highly likely to be the primary heat sources in this geothermal region. Deep-seated faults beneath the Niubei slope act as channels, allowing the flow of fluids and the transfer of heat from the source to shallower levels. Isotope data supports that the notion that near-surface water flows through a shallow network of fractures, ultimately reaching the geothermal reservoir. The interpreted geometry suggests that the gneiss domes likely resulted from a Rayleigh-Taylor instability process. This process involves diapiric flow induced by density inversion, leading to an upwelling of the asthenosphere. These dynamics, superimposed onto a melted layered structure, generate the distinctive arcuate seismic reflectors found at the core of these domes. Surface geology analysis indicates that the initiation and final emplacement of these domes most likely occurred during the late Mesozoic period.

Networks of Power in the Nineteenth Century: The Sampradaya, Princely States and Company Rule

Abstract This article reconsiders a religious institution in India during the early colonial era as a manifestation of regional influence, or a non-statist public force. Founded by Sahajanand Swami, the Hindu devotional (bhakti) community known as the Swaminarayan Sampradaya expanded in the area that is today Gujarat in western India. The community arose as a source of popular influence in a region that lacked a dominant state at this time. Its creation was forged in relation to local struggles for power and resources, involving princely states, Maratha and East India Company powers, Kathi chieftains, and broader social and cultural changes in the nineteenth century. Historically examining the process of community expansion in the region through aspects like patronage and cultural production, I argue that the sampradaya’s articulation of devotion internalized political acumen to navigate material realities successfully. Effectively, the modern articulation enabled adherents to broker power from diverse networks and strengthen the community’s complex, multifaceted authority in Gujarat.

Abstract 16034: Heart Transplant in Older Adults: Outcomes in the Modern Era of Transplant

Introduction: The total number and the proportion of older adults receiving heart transplants have increased over the last two decades. In 2016, the ISHLT guidelines for patients over 70 years of age were updated to remove the use of an alternate-type pool of donors, and now recommend transplanting carefully selected patients over 70 from the general pool. Aims: This study examines outcomes of older adults (>70) who receive heart transplants in the modern era. Methods: Adult patients who received heart transplant between January 1, 2010 and December 31, 2021 were identified in the United Network for Organ Sharing (UNOS) registry. Outcomes of interest were mortality at 1 and 5 years after heart transplant. Results: Those over 70 were more likely to be male, white, have an ischemic etiology of their heart failure, and have had a prior malignancy. Overall mortality at 1 year was 10.8% for those over 70 and 8.9% for those under 70 (p<0.033). Overall mortality at 5 years was 12.8% for those over 70 and 19.8% for those under 70 (p=0.37). Time to event survival analysis showed mortality was higher at 1 (HR 1.25, 1.04-1.51, p=0.019) and 5 years (HR 1.21, 1.05-1.39, p=0.006), however if patients conditionally survived the first year, 5-year conditional mortality was not different (HR 1.17, 0.95-1.43, p=0.135). Those over 70 were less likely to suffer from rejection, more likely to die from infectious disease or malignancy, but less likely to die from cardiovascular causes or graft failure. Conclusions: Older adults (over 70) who receive heart transplants have slightly worse 1- and 5-year survival but similar conditional 5-year survival to those under 70—the difference is driven by mortality in the first year. Both cohorts’ survival curves are improved compared to transplants in earlier eras. Those over 70 are less likely to experience rejection, consistent with the well-described phenomenon of immunosenescence.

Examining the Grooves at the Ptah Temple, Karnak in Light of Comparanda


 
 
 Grooves in stone surfaces remain an enigmatic, but ubiquitous phenomenon throughout Egypt. They date as early as the New Kingdom and endure at least into the early modern era. Woefully understudied, these marks, also known as “pilgrim grooves” or cupules were likely used by different actors across time towards a variety of ends. This study offers an introduction to the phenomenon and explores the possible functions of these grooves at the Ptah Temple located within Karnak Temple. To better understand these grooves, this study turns to “external contexts of practice”—comparanda from later periods in Egypt, and cross-cultural examples from outside of Egypt. I conclude with analyses that use these external examples as possible bridges to better understand the phenomenon in ancient Egypt; here I argue that increased temple access in the New Kingdom may contribute to an increase in grooving activities and that grooves at Ptah Temple were pious acts of engagement.
 
 

The Vedic Era: Indian Women And Spirituality

this monograph, an attempt has been made to ascertain the spiritual state and spirituality of women in the Vedic period. The socio-religious status of women, their contribution and involvement in philosophical-intellectual debates, along with a comparison of Gender spiritual rights have also been revisited. Since the concept of spirituality has changed and grown over time, various definitions coexist today. Saints or enlightened ones have shown higher degrees of spiritual growth than the common man. The word "spirituality" has been used here to refer to a religious reforming process that comprises the examination of some universal concepts, such as compassion, love, generosity, afterlife, enlightenment, and truth. The Vedic civilization is an intriguing exception to the norm concerning the general situation of women becoming unsatisfactory as the years progressed. The role of women is increasingly gratifying the further back we look, including the spiritual realm. As a period of great social and political stability, the early Vedic era is regarded as the "golden age" of women. In contrast, the later Vedic era marked a sharp and apparent decline in the social standing of women. This work emphasizes the spiritual empowerment of women and highlights the crucial role they had in forming religious and cultural traditions during this time through a review of Vedic texts, academic interpretations, and archaeological data. The approach used in this work is strictly descriptive, and the data needed was gathered from primary as well as secondary sources with reference to Vedic women in antiquity. KEYWORDS- Vedic Era, Religion, Society, and Women’s Spirituality.

Increased Neonatal Mortality and Increasing Rate of Cerebral Venous Sinus Thrombosis in Hospitalized Children: A Pediatric Health Information System Database Study

Introduction: Pediatric Cerebral Venous Sinus Thrombosis (CVST) poses risks of neurological sequelae and mortality, necessitating timely diagnosis and appropriate antithrombotic therapy. Limited sample sizes in previous studies have led to inconsistent treatment recommendations. To better understand pediatric CVST, we used the Pediatric Health Information System (PHIS) database to compare clinical features, treatment practices, and outcomes in neonates versus older children, and in different time periods, to analyze the influence of various parameters on healthcare outcomes. Methods: Deidentified, retrospective data of pediatric CVST was extracted from the large multi-center PHIS administrative database from January 1, 2011, to October 1, 2022. Diagnostic, imaging, procedure, and pharmaceutical billing codes were used to identify demographic information, clinical characteristics, management, and outcome. Multivariance analysis was performed on study parameters in neonates vs. older children (Table 1) and early (2011-2015) vs. late (2016-2022) study era (Table 2). Results: 6080 hospitalizations with CVST diagnosis (0.1% of all hospitalizations) were identified (61% male; median age 5 years; range 0-17 years). Median hospital stay was 8 days (IQR 4, 22), with 52% (N=3147) admitted to the intensive care unit (ICU). Overall mortality of all children was 4.2%. Neonates constituted 17.3% of the hospitalizations (N=1,054). Clinical features in neonates were less-often reported vs. older children more often had headache, hypertension, vomiting, papilledema and hemiparesis (p<0.001). Congenital heart disease/sepsis were common associated diagnoses in neonates vs. sinusitis/mastoiditis in older children (p<0.001). Neonates had a longer hospital stay (median 24 (IQR 11, 55), vs. 8 days (IQR 4, 17); p <0.001), but lower ICU admission (33.4% vs. 55.6%; p<0.001) and readmission rate (0% vs. 1.0%; p=0.002) when compared to older children. CT without contrast was used less often (33.4% vs. 55.1%; p < 0.001), and head ultrasound more often (76.3% vs. 8.0%; p < 0.001) for neonates vs. older children. Enoxaparin and unfractionated heparin (UFH) remained the primary treatments for CVST, with UFH utilized more often in neonates (71.6% vs. 59.2%; p<0.001). Direct oral anticoagulants (DOACs) were predominantly used in older children in limited numbers. Coma and hydrocephalus as complications were lower (0.7% vs. 5.6%, p<0.001 and 6.2% vs. 9.4%, p=0.001), and intracranial bleeding was (19.1% vs.7.0%, p<0.001) in neonates vs. older children. Neonates had increased mortality rate compared to older children (9.7% vs. 3.1%; p<0.001). The number of CVST admissions increased in the late (2016-2022) compared to the early study era (2011-2015) (0.11% vs. 0.08% of all admissions, p<0.001). Patient demographics, duration of hospital stay, ICU admission rates, clinical features, and imaging modalities remained similar in both groups. The use of bivalirudin, and DOACs was present in the late vs. none in the early era (p<0.001 except Dabigatran). Coma in the late (p<0.001) and brain infarct in the early study era (p<0.001) were more common complications. Both readmission rate (p=0.006) and hospital stay (p=0.006) were slightly higher in the late era. No statistically significant differences were found in mortality rate between the two eras (p= 0.226). Conclusion: Pediatric CVST is a serious disorder, with an overall mortality rate of 4.2% in our study. Neonates had distinct clinical features, associated diagnoses, and complications compared to older children. Predominantly UFH and rarely DOACs were administered in neonates. Neonates experienced longer hospital stay, and statistically significant higher mortality rate when compared to older children, consistent with prior studies. Newer anticoagulants were utilized increasingly in the late vs. early study era. Though readmission rate and hospital stay increased in the late era (not statistically significant), this did not translate into increased mortality. Increasing rate of hospitalizations in late compared to early study era is likely due to increasing medical complexity/technological advances in diagnosis/management of pediatric CVST. Future multi-center, prospective studies are needed to better address the increased neonatal mortality and improve overall care of pediatric CVST which is increasingly prevalent as seen in our study.

Metabolic Strata, Corporeal Sediment

This article explores the uneven geosocial traces created by transcontinental and corporeal circulations of tin ore, metallic tin, and tin cans from the mid-nineteenth to mid-twentieth centuries. Although tin has no essential relationship to human life, I argue that the extraction, circulation, and consumption of tin have nevertheless contributed to the production of metabolic unevenness across continental space. Since the early industrial era, tin has been used primarily for food preservation, in which capacity it has nutritionally supported the metabolic processes (and labor power) of workers, settlers, and soldiers, among others. Tin canning technologies relied, in turn, on the relentless labor of tin miners, whose own metabolic processes were interrupted by the accumulation of mineral dust in their lungs. These histories have been archived as geosocial strata as both discarded tin cans and pulmonary fibrosis. Drawing insights from geophilosophy and both Marxian and toxicological approaches to metabolism, this article reflects on how inhuman forces and substances subtend not only life but also its disparate energies and exposures.

Midwifery and APRN Scope of Practice in Abortion Care in the Early Post-Roe Era: Everything Old Is New Again.

Over the past 10 years, there has been a rapid expansion of legal and legislative changes in abortion care provision for advanced practice clinicians (APCs), including nurse practitioners, midwives, and physician associates (formerly physician assistants), with most of that expansion occurring in the last several years. This expansion has occurred via several routes (eg, legislative, popular vote, court decision, attorney general opinion), and the patchwork of legal statuses nationally creates confusion for clinicians who are unclear on current regulations. This review explores the historical context of abortion practice for APCs, as well as the primary philosophical and legal concepts relevant to this role development. Since 2012, the number of states permitting abortion practice by APCs has more than quintupled, and the changes to abortion law in the United States in the wake of the 2022 Supreme Court decision in the case of Dobbs v. Jackson Women's Center creates a new imperative to understand the role of APCs in accessing abortion care. Additionally, although the research on abortion safety for APC abortion providers is well-established, the physician-centered paradigm of abortion care has limited the ability of APCs to develop expertise in this essential public and clinical health service.

Houses of Terror, Castles of Despair: Nightmarish Necropoetics and Necropolitics in the Victorian Workhouse

This essay brings Achille Mbembe’s intellectually trenchant theory of necropower to bear on the early Victorian era’s most despised and iconic institution, known as the workhouse, arguably one of the most preeminent emblems of democracy’s nocturnal body located within Britain. Regarded by many of its critics as enacting the Utilitarian, inhumane, and ‘mechanistic’ treatment of the poor (Crowther, ‘Workhouse’ 194), the workhouse was frequently portrayed using the Gothic mode as a necropolitical institution, a death manufactory that monstrously combined prison, factory, asylum, slaughterhouse, and dead house – some of society’s most dehumanizing, disciplinary, and dreaded locales. Taking posters, illustrations, broadside ballads, penny dreadfuls, and novels as its primary sources – cultural productions with working and lower-middle class readerships for whom the workhouse and the Anatomy Act posed the greatest threat – this essay examines the workhouse through socio-political, economic, and theological lenses, and relevant scholarship in the rapidly expanding, interdisciplinary field of Thanatology Studies. It contextualises Workhouse Gothic in relation to Victorian Christian beliefs and attitudes towards death, dying, mourning, and memorialisation, phenomena and concerns that span both sides of the grave, and discusses what was at stake in those cultural narratives in relation to domestic and national values, and the development of working-class identity, subjectivity, and class consciousness.