Image to Fit the Clinical Picture: Point-of-care Ultrasound Assessment of Ebstein’s Anomaly in Peru

Ebstein’s anomaly is a congenital heart defect that when left untreated can lead to unique physical exam and ultrasound findings. This case describes a patient who presented with dyspnea and was found to have cyanosis, clubbing, and dilation of right-sided chambers on point-of-care ultrasound. The series of images highlights findings in late-stage Ebstein’s anomaly and serves as a springboard for the discussion of the pathophysiology, diagnosis, and treatment of this rare congenital heart disease

The medieval biological clock? Gendered reproductive aging in medieval western medicine

This is the final version. Available on open access from Elsevier via the DOI in this record. Data availability: Data will be made available on request.This paper examines discussions of women’s and men’s reproductive aging in a series of western European medical texts written in the period 1100–1300. It uses the modern image of the biological clock to explore how far physicians in earlier periods understood reproductive aging to be a process of slow decline before a final age at which fertility ended (menopause for women, or a less defined ‘old age’ for men), and how far they viewed women’s reproductive aging as different from men’s. The article argues that, in contrast to modern medical and popular understandings, medieval physicians assumed men and women were broadly fertile up to a final cut-off point, and had little interest in viewing age-related fertility decline as a slow process beginning well before menopause. This was true in part because there was no realistic prospect of treatment for age-related reproductive disorders. The article also argues that in many respects – although not all – medieval writers viewed men’s and women’s reproductive aging as similar processes. Overall the model of reproductive aging they offered was flexible and offered room for individual variation. In this way the article demonstrates how changing understandings of the body, reproduction, and aging, demographic and social change, and changing medical treatments influence concepts of reproductive aging.Leverhulme Trus

Hue shifts produced by temporal asymmetries in chromatic signals depend on the alignment of the first and second harmonics

When M- or L-cone-isolating sawtooth waveforms flicker at frequencies between 4 and 13.3 Hz, there is a mean hue shift in the direction of the shallower sawtooth slope. Here, we investigate how this shift depends on the alignment of the first and second harmonics of sawtooth-like waveforms. Below 4 Hz, observers can follow hue variations caused by both harmonics, and reliably match reddish and greenish excursions. At higher frequencies, however, the hue variations appear as chromatic flicker superimposed on a steady light, the mean hue of which varies with second-harmonic alignment. Observers can match this mean hue against a variable-duty-cycle rectangular waveform and, separately, set the alignment at which the mean hue flips between reddish and greenish. The maximum hue shifts were approximately frequency independent and occurred when the peaks or troughs of the first and second harmonics roughly aligned at the visual input-consistent with the hue shift's being caused by an early instantaneous nonlinearity that saturates larger hue excursions. These predictions, however, ignore phase delays introduced within the chromatic pathway between its input and the nonlinearity that produces the hue shifts. If the nonlinearity follows the substantial filtering implied by the chromatic temporal contrast-sensitivity function, phase delays will alter the alignment of the first and second harmonics such that at the nonlinearity, the waveforms that produce the maximum hue shifts might well be those with the largest differences in rising and falling slopes-consistent with the hue shift's being caused by a central nonlinearity that limits the rate of hue change