Benchmarking local practice in view of introduction of thrombolysis for stroke in Malta

The aim of the study was to benchmark the quality of local stroke care in view of introduction of thrombolysis. Stroke patients admitted to Mater Dei Hospital over 6 weeks in 2008 were recruited. A questionnaire based on the 2006 Royal College of Physicians (RCP) National Sentinel Stroke Audit phase II (Clinical Audit) was used. Results were compared to the 2008 RCP National Sentinel Stroke Audit phase II (Clinical Audit) report. 42 confirmed strokes were admitted. All patients underwent CT scanning within 24 hours. 97% received aspirin within 48 hours. 26.2% spent >50% of their stay in the neurology ward. 81% were discharged alive. At 24 hours from admission, 54.7% were not screened for swallowing. 47.6% were not assessed by an occupational therapist. 81% were assessed by physiotherapy at 72 hours of admission. None of the patients had documented goals set by a multi- disciplinary team. If thrombolysis were available, 16.7% would have been eligible. The commonest contraindications were late presentation (52.4%) and age >80 years (35.7%). Local results compared well to the RCP 2008 results in initiation of aspirin, imaging, and nutrition. However, we noted need for improvement in the assessment of swallowing, mood and cognitive function as well as involvement of a multidisciplinary team. Since then, adherence to international guidelines has improved by the introduction of thrombolysis, a dedicated multidisciplinary service and the use of local guidelines for stroke.peer-reviewe

Gas rising through a large diameter column of very viscous liquid: Flow patterns and their dynamic characteristics

Gas-liquid flows are affected strongly by both the liquid and gas properties and the pipe diameter, which control features and the stability of flow patterns and their transitions. For this reason, empirical models describing the flow dynamics can be applied only to limited range of conditions. Experiments were carried out to study the behaviour of air passing through silicone oil (360 Pa.s) in 240 mm diameter bubble column using Electrical Capacitance Tomography and pressure transducers mounted on the wall. These experiments are aimed at reproducing expected conditions for flows including (but not limited to) crude oils, bitumen, and magmatic flows in volcanic conduits. The paper presents observation and quantification of the flow patterns present. It particularly provides the characteristics of gas-liquid slug flows such as: void fraction; Taylor bubble velocity; frequency of periodic structures; lengths of liquid slugs and Taylor bubbles. An additional flow pattern, churn flow, has been identified. The transition between slug and churn has been quantified and the mechanism causing it are elucidated with the assistance of a model for the draining of the liquid film surrounding the Taylor bubble once this has burst through the top surface of the aerated column of gas-liquid mixture. It is noted that the transition from slug to churn is gradual

Interactive detection of incrementally learned concepts in images with ranking and semantic query interpretation

This research was performed in the GOOSE project, which is jointly funded by the MIST research program of the Dutch Ministry of Defense and the AMSN enabling technology program.The number of networked cameras is growing exponentially. Multiple applications in different domains result in an increasing need to search semantically over video sensor data. In this paper, we present the GOOSE demonstrator, which is a real-time general-purpose search engine that allows users to pose natural language queries to retrieve corresponding images. Top-down, this demonstrator interprets queries, which are presented as an intuitive graph to collect user feedback. Bottomup, the system automatically recognizes and localizes concepts in images and it can incrementally learn novel concepts. A smart ranking combines both and allows effective retrieval of relevant images.peer-reviewe

TNO at TRECVID 2013 : multimedia event detection and instance search

We describe the TNO system and the evaluation results for TRECVID 2013 Multimedia Event Detection (MED) and instance search (INS) tasks. The MED system consists of a bag-of-word (BOW) approach with spatial tiling that uses low-level static and dynamic visual features, an audio feature and high-level concepts. Automatic speech recognition (ASR) and optical character recognition (OCR) are not used in the system. In the MED case with 100 example training videos, support-vector machines (SVM) are trained and fused to detect an event in the test set. In the case with 0 example videos, positive and negative concepts are extracted as keywords from the textual event description and events are detected with the high-level concepts. The MED results show that the SIFT keypoint descriptor is the one which contributes best to the results, fusion of multiple low-level features helps to improve the performance, and the textual event-description chain currently performs poorly. The TNO INS system presents a baseline open-source approach using standard SIFT keypoint detection and exhaustive matching. In order to speed up search times for queries a basic map-reduce scheme is presented to be used on a multi-node cluster. Our INS results show above-median results with acceptable search times.This research for the MED submission was performed in the GOOSE project, which is jointly funded by the enabling technology program Adaptive Multi Sensor Networks (AMSN) and the MIST research program of the Dutch Ministry of Defense. The INS submission was partly supported by the MIME project of the creative industries knowledge and innovation network CLICKNL.peer-reviewe

Keratinocyte growth factor impairs human thymic recovery from lymphopenia

Background: The lymphocyte-depleting antibody alemtuzumab is a highly effective treatment of relapsing-remitting multiple sclerosis (RRMS); however 50% of patients develop novel autoimmunity post-treatment. Most at risk are individuals who reconstitute their T-cell pool by proliferating residual cells, rather than producing new T-cells in the thymus; raising the possibility that autoimmunity might be prevented by increasing thymopoiesis. Keratinocyte growth factor (palifermin) promotes thymopoiesis in non-human primates. Methods: Following a dose-tolerability sub-study, individuals with RRMS (duration ≤10 years; expanded disability status scale ≤5·0; with ≥2 relapses in the previous 2 years) were randomised to placebo or 180mcg/kg/day palifermin, given for 3 days immediately prior to and after each cycle of alemtuzumab, with repeat doses at M1 and M3. The interim primary endpoint was naïve CD4+ T-cell count at M6. Exploratory endpoints included: number of recent thymic-emigrants (RTEs) and signaljoint T-cell receptor excision circles (sjTRECs)/mL of blood. The trial primary endpoint was incidence of autoimmunity at M30. Findings: At M6, individuals receiving palifermin had fewer naïve CD4+T-cells (2.229x107 /L vs. 7.733x107 /L; p=0.007), RTEs (16% vs. 34%) and sjTRECs/mL (1100 vs. 3396), leading to protocoldefined termination of recruitment. No difference was observed in the rate of autoimmunity between the two groups Conclusion: In contrast to animal studies, palifermin reduced thymopoiesis in our patients. These results offer a note of caution to those using palifermin to promote thymopoiesis in other settings, particularly in the oncology/haematology setting where alemtuzumab is often used as part of the conditioning regime.Trial - MRC and Moulton Trust Funding Me (senior Author) - Wellcome Trust Funding

Therapeutic hypothermia translates from ancient history in to practice

Acute postasphyxial encephalopathy around the time of birth remains a major cause of death and disability. The possibility that hypothermia may be able to prevent or lessen asphyxial brain injury is a “dream revisited”. In this review, a historical perspective is provided from the first reported use of therapeutic hypothermia for brain injuries in antiquity, to the present day. The first uncontrolled trials of cooling for resuscitation were reported more than 50 y ago. The seminal insight that led to the modern revival of studies of neuroprotection was that after profound asphyxia, many brain cells show initial recovery from the insult during a short “latent” phase, typically lasting ~6 h, only to die hours to days later during a “secondary” deterioration phase characterized by seizures, cytotoxic edema, and progressive failure of cerebral oxidative metabolism. Studies designed around this conceptual framework showed that mild hypothermia initiated as early as possible before the onset of secondary deterioration, and continued for a sufficient duration to allow the secondary deterioration to resolve, is associated with potent, long-lasting neuroprotection. There is now compelling evidence from randomized controlled trials that mild induced hypothermia significantly improves intact survival and neurodevelopmental outcomes to midchildhood

Columnar cell lesions and subsequent breast cancer risk: a nested case-control study

Introduction: Histologic and genetic evidence suggests that at least some columnar cell lesions (CCL) of the breast represent precursor lesions in the low-grade breast neoplasia pathway. However, the risk of subsequent breast cancer associated with the presence of CCL in a benign breast biopsy is poorly understood.Methods The authors examined the association between the presence of CCL and subsequent breast cancer risk in a nested case-control study of benign breast disease (BBD) and breast cancer within the Nurses' Health Studies (394 cases, 1,606 controls). Benign breast biopsy slides were reviewed by pathologists and CCL presence assessed. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for the association between CCL and breast cancer risk. Results: Women with CCL (140 cases, 448 controls) had an increased risk of breast cancer compared with those without CCL (OR = 1.44, 95% CI: 1.14 to 1.83), although this was attenuated and became non-significant after adjustment for the histologic category of BBD (OR = 1.20, 95% CI: 0.94 to 1.54). CCL presence was associated with the greatest risk of breast cancer for those with nonproliferative BBD (OR = 1.36, 95% CI: 0.79 to 2.37) and the lowest risk for those with atypical hyperplasia (AH) (OR = 1.10, 95% CI: 0.65 to 1.87); however, this apparent heterogeneity in risk across BBD categories was not significant (P for interaction between CCL presence and BBD category = 0.77). Conclusions: These results provide evidence that CCL may be an important marker of breast cancer risk in women with BBD but suggest that CCL do not increase breast cancer risk independently of concurrent proliferative changes in the breast

Harnessing Evolution of Multi-Turn Conversations for Effective Answer Retrieval

With the improvements in speech recognition and voice generation technologies over the last years, a lot of companies have sought to develop conversation understanding systems that run on mobile phones or smart home devices through natural language interfaces. Conversational assistants, such as Google Assistant and Microsoft Cortana, can help users to complete various types of tasks. This requires an accurate understanding of the user's information need as the conversation evolves into multiple turns. Finding relevant context in a conversation's history is challenging because of the complexity of natural language and the evolution of a user's information need. In this work, we present an extensive analysis of language, relevance, dependency of user utterances in a multi-turn information-seeking conversation. To this aim, we have annotated relevant utterances in the conversations released by the TREC CaST 2019 track. The annotation labels determine which of the previous utterances in a conversation can be used to improve the current one. Furthermore, we propose a neural utterance relevance model based on BERT fine-tuning, outperforming competitive baselines. We study and compare the performance of multiple retrieval models, utilizing different strategies to incorporate the user's context. The experimental results on both classification and retrieval tasks show that our proposed approach can effectively identify and incorporate the conversation context. We show that processing the current utterance using the predicted relevant utterance leads to a 38% relative improvement in terms of nDCG@20. Finally, to foster research in this area, we have released the dataset of the annotations.Comment: To appear in ACM CHIIR 2020, Vancouver, BC, Canad