Exile Vol. XLII No. 1

40th Year Title Page by Sakura Yamamoto \u2797 i Epigraph by Ezra Pound ii Table of Contents iii / Untitled (artwork) by Gretchen Hambly \u2796 iv Breughel Again, Brussels by Adrienne Fair \u2796 1 for play with whitman by alex e blazer \u2797 4 Saeta Sunday by Carl Boon \u2796 5 An Abbreviated Life by Mike Westmoreland 6 Anthem of Governor\u27s Bay by Jamey Hein \u2796 7-10 Time is everywhere, yet nowhere (artwork) by Susanne Ducker \u2796 11 Crosses by Liz Bolyard \u2796 12 Raccoons at the Cats\u27 Food by Jennifer Rudgers \u2796 13-14 Father Federico by Trish Klei \u2797 15 Dream Poem I by Colin Bossen \u2798 16 Virgin Mary in Kentucky by Amy Ard \u2796 17 the jig is up by alex e blazer \u2797 18-20 Visiting Uncle Ernie by Liz Bolyard \u2796 21-22 A Capuchin Monk by Linda Fuller-Smith 23 Sunday, October 15, 1995 by Carl Boon \u2796 24 Old Man and the Marriage Party by Trish Klei \u2797 25 Untitled (artwork) by Gretchen Hambly \u2796 26 Cowboy Up by J. Murdoch Be Matheson \u2796 27-34 Fragments by Colin Bossen \u2798 35 meditation (artwork) by alex e blazer \u2797 36 Palazzo Rezzonico by Linda Fuller-Smith 37 A Poem About The Photographic Imprint I Would Leave If A Nuclear Bomb Hit Nearby As I Took Out The Trash One Night by Trish Klei \u2797 38 The Crazies I\u27ve Called by Julie Johnston \u2796 39-46 Contributors\u27 Notes 47-48 Editorial Board 49 Editorial decisions are shared equally among the Editorial Board. -49 Cover art by alex emmons -4

Exile Vol. XLIII No. 2

41st Year Title Page i Epigraphy by Ezra Pound ii Table of Contents iii / Contributors\u27 Notes 70-71 Editorial Board 72-73 ART Untitled by Kari Hernquist \u2799 4 Talking Out my Window by Heather Trabert \u2797 13 Renamed I by Ben Blake \u2797 18 photo paint by alex e. blazer \u2797 23 Butterfly by Mary Donnelley \u2797 32 unabridged by alex e. blazer \u2797 37 Holding Me In by Heather Trabert \u2797 43 Untitled by Kari Hernquist \u2797 55 Untitled by Camille Gammon-Hittelman \u2799 61 Stars by Mary Donnelley \u2797 69 POETRY Victrola by erin c. malone \u2799 1 All by Kellam Ayres \u2797 2-3 curtailed sun in the net by alex e. blazer \u2797 5 the weaker sex by Bekah Taylor \u2700 6 A poem concerning a silent manifesto by Colin Bossen \u2798 14 Father by Alison Stine \u2700 15 Vacant by Sean Boyle \u2700 16 Ecstasy by Amy spears \u2798 17 Seven Haikus by Jen Suster \u2797 21 Pages from a Diary by Trish Klei \u2797 22 Watching an Ageless Woman and an Ancient Trade by Heather Trabert \u2797 24-25 Still Waters by Jay Brandeis \u2799 26 just shy of freedom by Sean Boyle \u2700 36 [Touch the mothers you never knew] by Heather Trabert \u2797 38 Fishing for Meaning by Bekah Taylor \u2700 39 the novel by Sara Brown \u2799 40-41 annihilation by erin c. malone \u2799 42 Upon Enlistment by Trish Klei \u2797 44 the expatriate by erin c. malone \u2799 47 Rockettes by Trish Klei \u2797 48-49 Abstraction by Colin Bossen \u2798 54 always kinesis by alex e. blazer \u2797 56-57 Lily by Alison Stine \u2700 58-59 Falling In by Bekah Taylor \u2700 60 this bird has flown by paul durica \u2700 62-63 exfoliating some sun by alex e. blazer \u2797 64 Liberation: May 8, 1945 by Jen suster \u2797 65 PROSE Journal: 12 December 1996 through 15 January 1997 by Lynn Tramonte \u2798 7-12 Ash by paul durica \u2700 19-20 Birdhouse by Tyler Smith \u2797 27-35 Party in December by paul durica \u2700 45-46 Smoke Circles by Alison Stine \u2700 50-53 Seal by Lynn Tramonte \u2798 66-68 All submissions are reviewed on an anonymous basis, and all editorial decisions are shared equally among the members of the Editorial Board. -72 Cover art Toy Child by Ben Blake \u2797 -7

Beyond bones: the relevance of variants of connective tissue (hypermobility) to fibromyalgia, ME/CFS and controversies surrounding diagnostic classification: an observational study

Background Fibromyalgia and myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) are poorly understood conditions with overlapping symptoms, fuelling debate as to whether they are manifestations of the same spectrum or separate entities. Both are associated with hypermobility, but this remains significantly undiagnosed, despite impact on quality of life. Objective We planned to understand the relevance of hypermobility to symptoms in fibromyalgia and ME/CFS. Method Sixty-three patient participants presented with a confirmed diagnosis of fibromyalgia and/or ME/CFS; 24 participants were healthy controls. Patients were assessed for symptomatic hypermobility. Results Evaluations showed exceptional overlap in patients between fibromyalgia and ME/CFS, plus 81% met Brighton criteria for hypermobility syndrome (odds ratio 7.08) and 18% met 2017 hypermobile Ehlers–Danlos syndrome (hEDS) criteria. Hypermobility scores significantly predicted symptom levels. Conclusion Symptomatic hypermobility is particularly relevant to fibromyalgia and ME/CFS, and our findings highlight high rates of mis-/underdiagnosis. These poorly understood conditions have a considerable impact on quality of life and our observations have implications for diagnosis and treatment targets

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Developing a collaborative agenda for humanities and social scientific research on laboratory animal science and welfare.

Improving laboratory animal science and welfare requires both new scientific research and insights from enquiry in the humanities and social sciences. Whilst scientific research provides evidence to replace, reduce and refine procedures involving laboratory animals (the ‘3Rs’), work in the humanities and social sciences can help understand the social, economic and cultural processes that enhance or impede humane ways of knowing and working with laboratory animals. However, communication across these disciplinary perspectives is currently limited, and they frame questions, generate results, engage users, and seek to influence policy in different ways. To facilitate dialogue and future research at this interface, we convened an interdisciplinary group of 45 life scientists, social scientists, humanities scholars, non-governmental organisations and policy-makers to generate a collaborative research agenda. This drew on other agenda-setting exercises in science policy, using a collaborative and deliberative approach for the identification of research priorities. Participants were recruited from across the community, invited to submit research questions and vote on their priorities. They then met at an interactive workshop in the UK, discussed all 136 questions submitted, and collectively defined the 30 most important issues for the group. The output is a collaborative future agenda for research in the humanities and social sciences on laboratory animal science and welfare. The questions indicate a demand for new research in the humanities and social sciences to inform emerging discussions and priorities on the governance and practice of laboratory animal research, including around: international harmonisation, openness and public engagement, ‘cultures of care’, harm-benefit analysis and the future of the 3Rs. The process underlines the value of interdisciplinary exchange for improving mutual understanding of different research cultures and identifies ways of enhancing the effectiveness of future research at the interface between the humanities, social sciences, science and science policy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention