Can Emergency Physicians Perform Carotid Artery Point-of-Care Ultrasound to Detect Stenosis in Patients with TIA and Stroke? A Pilot Study

Introduction: Patients with severe, symptomatic carotid stenosis can have their subsequent stroke risk reduced by surgical intervention if performed soon after a transient ischemic attack (TIA) or stroke. Patients presenting to an emergency department (ED) without computed tomography angiography (CTA) with TIA/stroke, may require transfer to another hospital for imaging to rule out carotid artery stenosis. The objective of this study was to determine the test characteristics of carotid artery point-of-care ultrasound (POCUS) in detecting greater than 50% stenosis in patients presenting with TIA/stroke.Methods: We conducted a prospective cohort study on a convenience sample of adult patients presenting to a comprehensive stroke centre with TIA or stroke between June–October 2017. Carotid POCUS was performed. Primary outcome measure, stenosis ≥ 50%, was determined by the final radiology report of CTA. A blinded POCUS expert separately reviewed the archived carotid POCUS scans. We calculated sensitivity and specificity for stenosis ≥ 50%.Results: We conducted POCUS on 75 patients, of which 70 were included in our analyses. Of those 70, 14.3% were diagnosed with greater than 50% stenosis. Carotid POCUS performed as follows: sensitivity 70.0% (95% confidence interval [CI], 34.8%-93.3%); specificity 86.7% (95% CI, 75.4%-94.1%); positive likelihood ratio (LR +) 5.3 (95% CI, 1.2-9.3); negative likelihood ratio (LR -) 0.4 (95% CI, 0.0-0.7). The inter-rater reliability between POCUS performer interpretation and expert interpretation had moderate agreement (k = 0.68). Scans took a mean 6.2 ± 2.2 minutes to complete.Conclusion: Carotid POCUS has low to moderate association with CTA for detection of carotid artery stenosis ≥ 50%. Further research and investigation is needed prior to widespread use of carotid POCUS in patients with acute cerebral ischemia. Additionally, external validity is likely affected by availability of training, maintenance of competency, and experience in more rural centres

Yellow and green luminescence in a freestanding GaN template

We have studied a broad photoluminescence band in high-mobility freestanding 200-μm-thick GaN template prepared by hydride vapor-phase epitaxy. Variable-excitation intensity and energy experiments showed two defect-related bands: a yellow luminescence (YL) band at about 2.15 eV and a green luminescence (GL) band at about 2.43 eV. In contrast to epitaxial GaN samples prepared by both vapor-phase and molecular-beam epitaxy, the YL in the sample studied is weak and can be easily saturated. However, the GL is dominant. We attribute the GL to isolated defects involving galliumvacancies and the YL to the same defect, but bound to dislocations, or possibly to structuralsurface defects

An Optical and Infrared Photometric Study of the Young Open Cluster IC 1805 in the Giant H II Region W4

We present deep wide-field optical CCD photometry and mid-infrared Spitzer/IRAC and MIPS 24micron data for about 100,000 stars in the young open cluster IC 1805. The members of IC 1805 were selected from their location in the various color-color and color-magnitude diagrams, and the presence of Halpha emission, mid-infrared excess emission, and X-ray emission. The reddening law toward IC 1805 is nearly normal (R_V = 3.05+/-0.06). However, the distance modulus of the cluster is estimated to be 11.9+/-0.2 mag (d = 2.4+/-0.2 kpc) from the reddening-free color-magnitude diagrams, which is larger than the distance to the nearby massive star-forming region W3(OH) measured from the radio VLBA astrometry. We also determined the age of IC 1805 (tau_MSTO = 3.5 Myr). In addition, we critically compared the age and mass scale from two pre-main-sequence evolution models. The initial mass function with a Salpeter-type slope of Gamma = -1.3+/-0.2 was obtained and the total mass of IC 1805 was estimated to be about 2700+/-200 M_sun. Finally, we found our distance determination to be statistically consistent with the Tycho-Gaia Astrometric Solution Data Release 1, within the errors. The proper motion of the B-type stars shows an elongated distribution along the Galactic plane, which could be explained by some of the B-type stars being formed in small clouds dispersed by previous episodes of star formation or supernova explosions.Comment: 45 pages, 32 figures, 9 tables, accepted for publication in ApJ

Two charge states of dominant acceptor in unintentionally doped GaN: Evidence from photoluminescence study

Photoluminescence of the dominant deep-level acceptor in high-purity freestanding GaN is studied over a wide range of excitation intensities. A yellow luminescence (YL) band at about 2.2 eV saturates with increasing excitation intensity, whereas a green luminescence (GL) band at about 2.5 eV increases as a square of the excitation intensity. The YL and GL bands are attributed to two charge states of the same defect, presumably a gallium vacancy-oxygen complex

Transient photoluminescence of defect transitions in freestanding GaN

Deep level defects responsible for the 2.4 eV photoluminescence (PL) band in a freestanding GaN template were studied by transient photoluminescence. A nonexponential decay of PL intensity observed at low temperature is attributed to a donor–acceptor pair recombination involving a shallow donor and a deep acceptor. At room temperature, a single-exponential PL decay with a lifetime of 30 μs was observed at the high-energy side of the band, whereas the second component with a lifetime of about 750 μs was detected at the low-energy side of the band. The PL decay and transformation of the PL spectrum at room temperature can be explained by transitions from the conduction band to two deep acceptors. Electron-capture cross section has been estimated as 4×10−21 and 10−19 cm2 for the yellow and green bands, respectively, contributing to the broad 2.4 eV band

Investigation of linezolid resistance in staphylococci and enterococci

The objective of this study was to investigate an apparent increase in linezolid-nonsusceptible staphylococci and enterococci following a laboratory change in antimicrobial susceptibility testing from disk diffusion to an automated susceptibility testing system. Isolates with nonsusceptible results (n = 27) from Vitek2 were subjected to a battery of confirmatory testing which included disk diffusion, Microscan broth microdilution, Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution, gradient diffusion (Etest), 23S rRNA gene sequencing, and cfr PCR. Our results show that there is poor correlation between methods and that only 70 to 75% of isolates were confirmed as linezolid resistant with alternative phenotypic testing methods (disk diffusion, Microscan broth microdilution, CLSI broth microdilution, and Etest). 23S rRNA gene sequencing identified mutations previously associated with linezolid resistance in 16 (59.3%) isolates, and the cfr gene was detected in 3 (11.1%) isolates. Mutations located at positions 2576 and 2534 of the 23S rRNA gene were most common. In addition, two previously undescribed variants (at positions 2083 and 2345 of the 23S rRNA gene) were also identified and may contribute to linezolid resistance

Long-lasting photoluminescence in freestanding GaN templates

We studied time-resolvedphotoluminescence(PL) over a temporal range 10−6–103 s in high-purity freestanding GaN templates. Red, yellow, green, blue, and shallow donor–acceptor emission bands can be resolved in the PLspectrum. Observation of luminescence long after the excitation is switched off is a striking feature of our study. The persistent PL observed for all above bands, except for the green band, is primarily attributed to the donor–acceptor-pair-type recombination. An unusually slow, nonexponential decay of radiative transitions from the conduction band to the shallow acceptor was also observed, pointing to some additional mechanism for the persistent PL. Possible role of the surface states in this effect is discussed

Plaquette Ordering in SU(4) Antiferromagnets

We use fermion mean field theory to study possible plaquette ordering in the antiferromagnetic SU(4) Heisenberg model. We find the ground state for both the square and triangular lattices to be the disconnected plaquette state. Our mean field theory gives a first order transition for plaquette ordering for the triangular lattice. Our results suggest a large number of low lying states.Comment: 16 pages, 5 figure