Shakespeare\u27s Elizabethan public.

Of all the arts drama is the most democratic. Other forms of artistic and aesthetic expression, literature, music, painting, may be cultivated in solitude. Not so the drama. It is demanded by the public; produced for the public and unless it is approved by the public its doom is certain. Why it is that the drama cannot at any time break away from the tastes, prejudices, and ideals of the public for which it was written, M. Edelstand Du Meril has clearly state: “But the inspiration of the work (the drama) hasn’t at all that egotistical spirit, disdainful of the outside world, which characterizes the other forms of art; this is no longer a monologue of the poet singing to himself for his own pleasure; this author tries by what his drama represents to awaken in others the poetical ideas which have inspired him and are for him real….The serious end of drama, then, depends upon the ideas of the poet in regard to nature and the destiny of man, and his ideas are intimately bound up with the religion and the philosophy of his time…..If a dramatist doesn’t wish to employ his gifts in an effort condemned to failure in advance, he must - and this is one of the first duties of the artist - consider his public, respect their sentiments, and skillfully conform to their ideas and customs.” Knowledge of all this Shakespeare not only possessed but utilized in all his works. In order, then, to appreciate our great literary master in all his fullness, we must have an adequate conception of the conditions under which he lived and wrought, and of the public for the satisfaction of whose desires his work of dramatic creation was being done. Rightly to interpret the drama of our own day, which his, after all, only the reflection of our current life and manners, we must grasp the meaning of the most vital elements in the lives of men and women about us. So, also, to appreciate Shakespeare as a dramatist, must we understand the Elizabethans, the public for which he wrote. Then and only then can we attain an adequate conception of what the Elizabethan drama was. A play is what it is because the people for whose amusement and edification it was originally written and presented were what they were. The spectators at any stage presentation bring with them all the prejudices and pre-conceptions natural to their own day and generation, so that no matter whether the scene be laid in remote antiquity or far-away climes, the spirit of the drama must ring a responsive note in the hearts of the people who assemble to behold it

Reliability of Peak Treadmill Exercise Tests in Mild Alzheimer Disease

This is an Accepted Manuscript of an article published by Taylor & Francis in International Journal of Neuroscience on August 2011, available online: http://www.tandfonline.com/10.3109/00207454.2011.574762.The prevalence of Alzheimer disease (AD) doubles every 5 years after the age of 65, reaching nearly 50% after age 85 (Evans et al., 1989). This, along with an unprecedented growth in the elderly population, is leading to dramatic increases in the incidence of AD. Thus, effective strategies for promoting healthy brain aging and preventing AD are increasingly important. One strategy that appears promising in promoting healthy brain aging is exercise and physical activity. Evidence is accumulating that endurance exercise is beneficial to brain health (Laurin, Verreault, Lindsay, MacPherson, & Rockwood, 2001), and increased cardiorespiratory fitness is associated with increased brain volume in subjects with very mild to mild AD (Burns et al., 2008). While enhancing cardiorespiratory fitness may be a strategy for preventing cognitive decline in AD, there is limited information available on the validity and reliability of cardiorespiratory fitness measures in this population. The gold standard measure of cardiorespiratory fitness is maximum oxygen consumption (VO2max) (Frankin, 2001), the highest rate of oxygen uptake attainable during maximal or exhaustive exercise (American College of Sports Medicine, 2005). If the subject becomes exhausted and ends the test prior to reaching the physiologic VO2max, the end of the test is called peak oxygen consumption (VO2peak). It is unknown if advanced age and cognitive difficulties in people with AD would limit their ability to fully participate in a standard graded exercise test to reliably assess VO2max or VO2peak. Treadmill exercise testing has been found to be reliable in subjects with traumatic brain injury and mental retardation, although these subjects were very young (Fernhall, Millar, Tymeson, & Burkett, 1990; Mossberg & Greene, 2005). Traumatic brain injury and mental retardation are different disease processes than AD and would be expected to result in static rather than progressive cognitive symptoms. With AD, memory is impaired as is the ability to follow commands, however patients in the earliest stages of AD would be expected to respond to prompting and reminders to follow testing procedures. To our knowledge, no studies have assessed the reliability of peak treadmill exercise testing in subjects with AD. In our previous research on patients with very mild to mild AD (Burns, et al., 2008), we have found them to be capable of ambulating on a treadmill and completing peak treadmill exercise testing with 3 participants out of 74 (126 total peak exercise tests) identified as having EKG changes during testing. All 3 participants had negative follow-up testing in cardiology. The purpose of this study was to investigate the reliability of a graded peak treadmill exercise test in elderly people with early AD

Cardiorespiratory fitness and preserved medial temporal lobe volume in Alzheimer's Disease

This is not the final published version.Exercise and cardiorespiratory (CR) fitness may moderate age-related regional brain changes in nondemented older adults (ND). The relationship of fitness to Alzheimer's disease (AD) related brain change is understudied, particularly in the hippocampus which is disproportionately affected in early AD. The role of apolipoprotein E4 (apoE4) genotype in modulating this relationship is also unknown. Nondemented (n=56) and early-stage AD subjects (n=61) over age 65 had MRI and CR fitness assessments. Voxel-based morphometry (VBM) techniques were utilized to identify AD-related atrophy. We analyzed the relationship of CR fitness with white and gray matter within groups, assessed fitness-related brain volume change in areas most affected by AD-related atrophy, and then analyzed differential fitness-brain relationships between apoE4 carriers. Atrophy was present in the medial temporal, temporal, and parietal cortices in subjects with mild AD. There was a significant positive correlation of CR fitness with parietal and medial temporal volume in AD subjects. ND subjects did not have a significant relationship between brain volume and CR fitness in the global or SVC analyses. There was not a significant interaction for fitness × apoE4 genotype in either group. In early-stage AD, cardiorespiratory fitness is associated with regional brain volumes in the medial temporal and parietal cortices suggesting that maintaining cardiorespiratory fitness may modify AD-related brain atrophy

A community-based approach to trials of aerobic exercise in aging and Alzheimer’s disease

The benefits of exercise for aging have received considerable attention in both the popular and academic press. The putative benefits of exercise for maximizing cognitive function and supporting brain health have great potential for combating Alzheimer’s disease (AD). Aerobic exercise offers a low-cost, low-risk intervention that is widely available and may have disease modifying effects. Demonstrating aerobic exercise alters the AD process would have enormous public health implications. The purpose of this paper is to a report the protocol of a current, community-based pilot study of aerobic exercise for AD to guide future investigation. This manuscript provides 1) an overview of possible benefits of exercise in those with dementia, 2) a rationale and recommendations for implementation of a community-based approach, 3) recommendation for implementation of similar study protocols, 4) unique challenges in conducting an exercise trial in AD

The carbon-rich type Ic supernova 2016adj in the iconic dust lane of Centaurus A: signatures of interaction with circumstellar hydrogen?

We present a comprehensive data set of supernova (SN) 2016adj located within the central dust lane of Centaurus A. SN 2016adj is significantly reddened and after correcting the peak apparent $B$-band magnitude ($m_B = 17.48\pm0.05$) for Milky Way reddening and our inferred host-galaxy reddening parameters (i.e., $R_{V}^{host} = 5.7\pm0.7$ and $A_{V}^{host} = 6.3\pm0.2$), we estimate it reached a peak absolute magnitude of $M_B \sim -18$. Detailed inspection of the optical/NIR spectroscopic time-series reveals a carbon-rich SN Ic and not a SN Ib/IIb as previously suggested in the literature. The NIR spectra shows prevalent carbon-monoxide formation occurring already by +41 days past $B$-band maximum, which is $\approx 11$ days earlier than previously reported in the literature for this object. Interestingly around two months past maximum, the NIR spectrum of SN~2016adj begins to exhibit H features, with a +97~d medium resolution spectrum revealing both Paschen and Bracket lines with absorption minima of $\sim 2000$ km/s, full-width-half-maximum emission velocities of $\sim 1000$ km/s, and emission line ratios consistent with a dense emission region. We speculate these attributes are due to circumstellar interaction (CSI) between the rapidly expanding SN ejecta and a H-rich shell of material formed during the pre-SN phase. A bolometric light curve is constructed and a semi-analytical model fit suggests the supernova synthesized 0.5 solar masses of $^{56}$Ni and ejected 4.2 solar masses of material, though these values should be approached with caution given the large uncertainties associated with the adopted reddening parameters, possible CSI contamination, and known light echo emission. Finally, inspection of Hubble Space Telescope archival data yielded no progenitor detection.Comment: Submitted to A&A, comments are welcom

A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the use of methylprednisolone sodium succinate

Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest." Results: The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) "We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI"; (2) "We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option"; and (3) "We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI." Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients

A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (<= 24 hours versus > 24 hours) of decompressive surgery

Objective: To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. Methods: A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as "we recommend," whereas a weak recommendation is presented as "we suggest." Results: Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation; (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery; and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: "We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome" and "We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level." Quality of evidence for both recommendations was considered low. Conclusions: These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction

Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis.

Introduction: The objective of this study is to develop evidence-based guidelines that recommend effective, safe and cost-effective thromboprophylaxis strategies in patients with spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions relating to thromboprophylaxis in SCI. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest." Results: Based on conclusions from the systematic review and expert panel opinion, the following recommendations were developed: (1) "We suggest that anticoagulant thromboprophylaxis be offered routinely to reduce the risk of thromboembolic events in the acute period after SCI;" (2) "We suggest that anticoagulant thromboprophylaxis, consisting of either subcutaneous low-molecular-weight heparin or fixed, low-dose unfractionated heparin (UFH) be offered to reduce the risk of thromboembolic events in the acute period after SCI. Given the potential for increased bleeding events with the use of adjusted-dose UFH, we suggest against this option;" (3) "We suggest commencing anticoagulant thromboprophylaxis within the first 72 hours after injury, if possible, in order to minimize the risk of venous thromboembolic complications during the period of acute hospitalization." Conclusions: These guidelines should be implemented into clinical practice in patients with SCI to promote standardization of care, decrease heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions