Improving Stroke Management through Specialized Stroke Units in Nigeria: A situational Review

Background: Stroke therapy is aimed at re-opening blocked arteries and increasing the survival of cells that are injured in addition to the early rehabilitation of the stroke patient. The establishment of stroke units has been found to improve the survival of patients and significantly reduce disability by rendering holistic care. Early intervention to rapidly restore and maintain blood supply to the ischemic area in the brain, minimize brain damage and hence impairment as well as disability and secondary complications which will reduce the risk of death is more likely achievable in specialized care settings. The objective of this review is to discuss the role and feasibility of implementing stroke care in specialized stroke units(SSUs).Methods: Key literature detailing the care of stroke patients at the different tier of health institutions in Nigeria and abroad were reviewed using Medline and Google search utilizing the following keywords' Strokeunit; Management; Shared Burden and Nigeria. The difficulties associated with the provision of care for stroke patients in specialized stroke units were identified while the implications and suggestions for the development of such units in Nigeria are addressed.Results: The care of stroke patients remains mainly uncoordinated and usually managed in the general medical wards with suboptimal management. Issues that may affect establishment of specialized Stroke Unit include lack of Neurologists, Geriatricians with special interest in stroke management, allied health professionals and Nurses trained in providing supportive care. The challenges of the start –up cost, and public education in seeking help early enough are also highlighted.Conclusion: The evidence for the need for change from the usual care of stroke patient's in general medical wards to specialized stroke units is undisputable. Establishment of such units in Nigeria is desirable, urgent and feasible. The establishment of these SSUs can be started by having specific designated beds in a section of the medical wards with the care assigned to specially trained medical and allied health providers.Key Words: Sharing; burden; stroke unit; Nigeria

Gravitational Collapse and Fragmentation in Molecular Clouds with Adaptive Mesh Refinement

We describe a powerful methodology for numerical solution of 3-D self-gravitational hydrodynamics problems with extremely high resolution. Our method utilizes the technique of local adaptive mesh refinement (AMR), employing multiple grids at multiple levels of resolution. These grids are automatically and dynamically added and removed as necessary to maintain adequate resolution. This technology allows for the solution of problems in a manner that is both more efficient and more versatile than other fixed and variable resolution methods. The application of AMR to simulate the collapse and fragmentation of a molecular cloud, a key step in star formation, is discussed. Such simulations involve many orders of magnitude of variation in length scale as fragments form. In this paper we briefly describe the methodology and present an illustrative application for nonisothermal cloud collapse. We describe the numerical Jeans condition, a criterion for stability of self-gravitational hydrodynamics problems. We show the first well-resolved nonisothermal evolutionary sequence beginning with a perturbed dense molecular cloud core that leads to the formation of a binary system consisting of protostellar cores surrounded by distinct protostellar disks. The scale of the disks, of order 100 AU, is consistent with observations of gaseous disks surrounding single T-Tauri stars and debris disks surrounding systems such as $\beta$ Pictoris.Comment: 10 pages, 6 figures (color postscript). To appear in the proceedings of Numerical Astrophysics 1998, Tokyo, March 10-13, 199

The role of insulin receptor substrate 2 in hypothalamic and beta cell function

Insulin receptor substrate 2 (Irs2) plays complex roles in energy homeostasis. We generated mice lacking Irs2 in beta cells and a population of hypothalamic neurons (RIPCreIrs2KO), in all neurons (NesCreIrs2KO), and in proopiomelanocortin neurons (POMCCreIrs2KO) to determine the role of Irs2 in the CNS and beta cell. RIPCreIrs2KO mice displayed impaired glucose tolerance and reduced P cell mass. Overt diabetes did not ensue, because beta cells escaping Cre-mediated recombination progressively populated islets. RIPCreIrs2KO and NesCreIrs2KO mice displayed hyperphagia, obesity, and increased body length, which suggests altered melanocortin action. POMCCreIrs2KO mice did not display this phenotype. RIPCreIrs2KO and NesCreIrs2KO mice retained leptin sensitivity, which suggests that CNS Irs2 pathways are not required for leptin action. NesCreIrs2KO and POMCCreIrs2KO mice did not display reduced beta cell mass, but NesCreIrs2KO mice displayed mild abnormalities of glucose homeostasis. RIPCre neurons did not express POMC or neuropeptide Y. Insulin and a melanocortin agonist depolarized RIPCre neurons, whereas leptin was ineffective. Insulin hyperpolarized and leptin depolarized POMC neurons. Our findings demonstrate a critical role for IRS2 in beta cell and hypothalamic function and provide insights into the role of RIPCre neurons, a distinct hypothalamic neuronal population, in growth and energy homeostasis

Cosmological evolution of massive black holes: effects of Eddington ratio distribution and quasar lifetime

A power-law time-dependent lightcurve for active galactic nuclei (AGNs) is expected by the self-regulated black hole growth scenario, in which the feedback of AGNs expels gas and shut down accretion. This is also supported by the observed power-law Eddington ratio distribution of AGNs. At high redshifts, the AGN life timescale is comparable with (or even shorter than) the age of the universe, which set a constraint on the minimal Eddington ratio for AGNs on the assumption of a power-law AGN lightcurve. The black hole mass function (BHMF) of AGN relics is calculated by integrating the continuity equation of massive black hole number density on the assumption of the growth of massive black holes being dominated by mass accretion with a power-law Eddington ratio distribution for AGNs. The derived BHMF of AGN relics at z=0 can fit the measured local mass function of the massive black holes in galaxies quite well, provided the radiative efficiency ~0.1 and a suitable power-law index for the Eddington ratio distribution are adopted. In our calculations of the black hole evolution, the duty cycle of AGN should be less than unity, which requires the quasar life timescale >0.5 giga-years.Comment: 7 pages, accepted by Ap

Religious coping among African Americans, Caribbean Blacks and Non-Hispanic Whites

This study examined demographic predictors of attitudes regarding religious coping (i.e., prayer during stressful times and look to God for support, strength and guidance) within a national sample of African Americans, Caribbean Blacks, and non-Hispanic Whites (National Survey of American Life). The findings demonstrate significant Black-White differences in attitudes regarding religious coping with higher endorsements of religious coping among African Americans and Black Caribbeans (Caribbean Blacks). Comparisons of African Americans and Black Caribbeans revealed both similar and divergent patterns of demographic effects. For both African Americans and Black Caribbeans, women were more likely to utilize religious coping than men and married respondents were more likely than never married respondents to report utilizing prayer when dealing with a stressful situation. Further, for both groups, higher levels of education were associated with lower endorsements of the importance of prayer in dealing with stressful situations. Among African Americans only, Southerners were more likely than respondents who resided in other regions to endorse religious coping. Among Black Caribbeans, those who emigrated from Haiti were more likely than Jamaicans to utilize religious coping when dealing with a stressful episode. © 2008 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58064/1/20202_ftp.pd

Analysis of two-player quantum games in an EPR setting using geometric algebra

The framework for playing quantum games in an Einstein-Podolsky-Rosen (EPR) type setting is investigated using the mathematical formalism of Clifford geometric algebra (GA). In this setting, the players' strategy sets remain identical to the ones in the classical mixed-strategy version of the game, which is then obtained as proper subset of the corresponding quantum game. As examples, using GA we analyze the games of Prisoners' Dilemma and Stag Hunt when played in the EPR type setting.Comment: 20 pages, no figure, revise

What two models may teach us about duality violations in QCD

Though the operator product expansion is applicable in the calculation of current correlation functions in the Euclidean region, when approaching the Minkowskian domain, violations of quark-hadron duality are expected to occur, due to the presence of bound-state or resonance poles. In QCD finite-energy sum rules, contour integrals in the complex energy plane down to the Minkowskian axis have to be performed, and thus the question arises what the impact of duality violations may be. The structure and possible relevance of duality violations is investigated on the basis of two models: the Coulomb system and a model for light-quark correlators which has already been studied previously. As might yet be naively expected, duality violations are in some sense "maximal" for zero-width bound states and they become weaker for broader resonances whose poles lie further away from the physical axis. Furthermore, to a certain extent, they can be suppressed by choosing appropriate weight functions in the finite-energy sum rules. A simplified Ansatz for including effects of duality violations in phenomenological QCD sum rule analyses is discussed as well.Comment: 17 pages, 6 figures; version to appear in JHE

Staircase Quantum Dots Configuration in Nanowires for Optimized Thermoelectric Power

The performance of thermoelectric energy harvesters can be improved by nanostructures that exploit inelastic transport processes. One prototype is the three-terminal hopping thermoelectric device where electron hopping between quantum-dots are driven by hot phonons. Such three-terminal hopping thermoelectric devices have potential in achieving high efficiency or power via inelastic transport and without relying on heavy-elements or toxic compounds. We show in this work how output power of the device can be optimized via tuning the number and energy configuration of the quantum-dots embedded in parallel nanowires. We find that the staircase energy configuration with constant energy-step can improve the power factor over a serial connection of a single pair of quantum-dots. Moreover, for a fixed energy-step, there is an optimal length for the nanowire. Similarly for a fixed number of quantum-dots there is an optimal energy-step for the output power. Our results are important for future developments of high-performance nanostructured thermoelectric devices

RNA polymerase II stalling promotes nucleosome occlusion and pTEFb recruitment to drive immortalization by Epstein-Barr virus

Epstein-Barr virus (EBV) immortalizes resting B-cells and is a key etiologic agent in the development of numerous cancers. The essential EBV-encoded protein EBNA 2 activates the viral C promoter (Cp) producing a message of ~120 kb that is differentially spliced to encode all EBNAs required for immortalization. We have previously shown that EBNA 2-activated transcription is dependent on the activity of the RNA polymerase II (pol II) C-terminal domain (CTD) kinase pTEFb (CDK9/cyclin T1). We now demonstrate that Cp, in contrast to two shorter EBNA 2-activated viral genes (LMP 1 and 2A), displays high levels of promoter-proximally stalled pol II despite being constitutively active. Consistent with pol II stalling, we detect considerable pausing complex (NELF/DSIF) association with Cp. Significantly, we observe substantial Cp-specific pTEFb recruitment that stimulates high-level pol II CTD serine 2 phosphorylation at distal regions (up to +75 kb), promoting elongation. We reveal that Cp-specific pol II accumulation is directed by DNA sequences unfavourable for nucleosome assembly that increase TBP access and pol II recruitment. Stalled pol II then maintains Cp nucleosome depletion. Our data indicate that pTEFb is recruited to Cp by the bromodomain protein Brd4, with polymerase stalling facilitating stable association of pTEFb. The Brd4 inhibitor JQ1 and the pTEFb inhibitors DRB and Flavopiridol significantly reduce Cp, but not LMP1 transcript production indicating that Brd4 and pTEFb are required for Cp transcription. Taken together our data indicate that pol II stalling at Cp promotes transcription of essential immortalizing genes during EBV infection by (i) preventing promoter-proximal nucleosome assembly and ii) necessitating the recruitment of pTEFb thereby maintaining serine 2 CTD phosphorylation at distal regions

Mycotic aneurysm of the femoral artery complicating Staphylococcus aureus bacteremia: a case report

INTRODUCTION: Staphylococcus aureus is the major cause of bacteremia, with the potential for some complications, namely mycotic aneurysms, defined as irreversible dilatation of an artery due to destruction of the vessel wall by infection. CASE PRESENTATION: The authors present the case of a 52 year-old-Caucasian male, admitted with Staphylococcus aureus bacteremia and mycotic aneurysm of the right superficial femoral artery, associated with advanced atherosclerotic process. CONCLUSION: Mycotic aneurysms are rare, and a high index of suspicion is needed, because appropriate treatment will certainly affect the outcome, as they are associated with high morbidity and mortality