Can the ischemic penumbra be identified on noncontrast CT of acute stroke?

<p><b>Background and Purpose:</b> Early ischemic changes on noncontrast CT in acute stroke include both hypoattenuation and brain swelling, which may have different pathophysiological significance.</p> <p><b>Methods:</b> Noncontrast CT and CT perfusion brain scans from patients with suspected acute stroke <6 hours after onset were reviewed. Five raters independently scored noncontrast CTs blind to clinical data using the Alberta Stroke Program Early CT Score (ASPECTS). Each ASPECTS region was scored as hypodense or swollen. A separate reviewer measured time to peak and cerebral blood volume in each ASPECTS region on CT perfusion. Time to peak and cerebral blood volume were compared for each region categorized as normal, hypodense, or isodense and swollen.</p> <p><b>Results:</b> Scans of 32 subjects a median 155 minutes after onset yielded 228 regions with both CT perfusion and noncontrast CT data. Isodense swelling was associated with significantly higher cerebral blood volume (P=0.016) and with penumbral perfusion (posttest:pretest likelihood ratio 1.44 [95% CI: 0.68 to 2.90]), whereas hypodensity was associated with more severe time to peak delay and with core perfusion (likelihood ratio 3.47 [95% CI: 1.87 to 6.34]). Neither isodense swelling nor hypodensity was sensitive for prediction of perfusion pattern, but appearances were highly specific (87.2% and 91.0% for penumbra and core, respectively). Intrarater agreement was good or excellent, but interrater agreement for both hypodensity and swelling was poor.</p> <p><b>Conclusions:</b> Regions exhibiting hypoattenuation are likely to represent the infarct core, whereas regions that are isodense and swollen have increased cerebral blood volume and are more likely to signify penumbral perfusion. Although noncontrast CT is not sensitive for detection of core and penumbra, appearances are specific. Some information on tissue viability can therefore be obtained from noncontrast CT.</p&gt

Contemporary splinting practice in the UK for adults with neurological dysfunction: A cross-sectional survey

This article is made available through the Brunel Open Access Publishing Fund.Aim: To explore the contemporary splinting practice of UK occupational therapists and physiotherapists for adults with neurological dysfunction. Method: Cross-sectional online survey of members of the Association of Chartered Physiotherapists in Neurology and College of Occupational Therapists Specialist Section Neurological Practice. Results: Four hundred and twenty therapists completed the survey. Contracture management is the most common rationale for therapists splinting adults with neurological dysfunction. Other shared therapeutic goals of splinting include maintaining muscle and joint alignment, spasticity management, function, pain management and control of oedema. Considerable clinical uncertainty was uncovered in practice particularly around wearing regimens of splints. Most therapists have access to locally-derived splinting guidelines, which may contribute to this diversity of practice. Conclusions: This study provides a unique insight into aspects of contemporary splinting practice among UK therapists, who belong to a specialist neurological professional network and work in a number of different health-care settings with adults who have a neurological condition. Study findings show a wide variation in splinting practice, thereby indicating a potential need for national guidance to assist therapists in this area of clinical uncertainty. Further research is required to establish best practice parameters for splinting in neurological rehabilitation

Theory of Ostwald ripening in a two-component system

When a two-component system is cooled below the minimum temperature for its stability, it separates into two or more immiscible phases. The initial nucleation produces grains (if solid) or droplets (if liquid) of one of the phases dispersed in the other. The dynamics by which these nuclei proceed toward equilibrium is called Ostwald ripening. The dynamics of growth of the droplets depends upon the following factors: (1) The solubility of the droplet depends upon its radius and the interfacial energy between it and the surrounding (continuous) phase. There is a critical radius determined by the supersaturation in the continuous phase. Droplets with radii smaller than critical dissolve, while droplets with radii larger grow. (2) The droplets concentrate one component and reject the other. The rate at which this occurs is assumed to be determined by the interdiffusion of the two components in the continuous phase. (3) The Ostwald ripening is constrained by conservation of mass; e.g., the amount of materials in the droplet phase plus the remaining supersaturation in the continuous phase must equal the supersaturation available at the start. (4) There is a distribution of droplet sizes associated with a mean droplet radius, which grows continuously with time. This distribution function satisfies a continuity equation, which is solved asymptotically by a similarity transformation method

Fertilization and Spacing of Irrigated Corn on the Belle Fourche Irrigation Project

Corn is one of the major crops grown for livestock feed in western South Dakota. This crop is grown both on irrigated and nonirrigated land. It is used as silage, harvested for grain, and fed as fodder. Because of its importance, corn was one of the crops that received special attention when an off-station research program was started on the Belle Fourche Irrigation Project by the Newell Field Station in 1950. Objectives under consideration were to study the value of nitrogen and phosphorus fertilizer and the effect of plant population on the production of silage and grain corn. The trials conducted and their locations are shown in table 1. Results obtained in the field trials conducted on irrigated land from 1950 through 1954 are discussed in this publication. The principles of proper corn culture are of economic value to farmers on the Belle Fourche Irrigation Project and to neighboring irrigated areas

The role of hydrological transience in peatland pattern formation

The sloping flanks of peatlands are commonly patterned with non-random, contour-parallel stripes of distinct microhabitats such as hummocks, lawns and hollows. Patterning seems to be governed by feedbacks among peatland hydrological processes, plant micro-succession, plant litter production and peat decomposition. An improved understanding of peatland patterning may provide important insights into broader aspects of the long-term development of peatlands and their likely response to future climate change

Entrepreneurship in a Transition Economy: An Examination of Venture Creation in Hungary

This study examines entrepreneurs and new ventures in a transition economy, Hungary, and identifies what variables distinguish between Hungarian entrepreneurs and their new ventures in the pre-1988 transition period from that which followed. The variables that discriminate most strongly are their business strategies. The newer firms had a concentration strategy while the older firms had a new product development strategy. Other variables that discriminated between the groups include reacting to the political environment, satisfaction with firm performance, encouragement from investors, recent investment in building improvement, and family history of entrepreneurship. The newer entrepreneurs had more family role models of entrepreneurship

Alliances and Networks: Cooperative Strategies for Small Businesses

Research on large firms shows that cooperative strategies have the potential to improve performance by helping firms gain access to necessary resources, enter new markets, and spread the risk over several partners. Interviews with thirty-four small business managers show small firms also can profit from using a cooperative network. Highly-allied small businesses entered alliances to gain resources and based their alliances on a distinctive competence. The highly allied businesses grew more rapidly than the less allied firms. Mutual goals and joint decision making were viewed as critical to the high level of satisfaction achieved

Formalized Planning in Small Business: Increasing Strategic Choices

A study of 188 small businesses was conducted to examine three distinct relationships in the planning process planning formality in relation to strategic decision processes, planning formality in relation to the strategies adopted, and planning formality in relation to firm performance. The results demonstrated that firms with formal planning emphasized more aspects of the strategic choice process, adopted a wider range of competitive and cooperative strategies, and grew more rapidly than did non-formal planners

DynPeak : An algorithm for pulse detection and frequency analysis in hormonal time series

The endocrine control of the reproductive function is often studied from the analysis of luteinizing hormone (LH) pulsatile secretion by the pituitary gland. Whereas measurements in the cavernous sinus cumulate anatomical and technical difficulties, LH levels can be easily assessed from jugular blood. However, plasma levels result from a convolution process due to clearance effects when LH enters the general circulation. Simultaneous measurements comparing LH levels in the cavernous sinus and jugular blood have revealed clear differences in the pulse shape, the amplitude and the baseline. Besides, experimental sampling occurs at a relatively low frequency (typically every 10 min) with respect to LH highest frequency release (one pulse per hour) and the resulting LH measurements are noised by both experimental and assay errors. As a result, the pattern of plasma LH may be not so clearly pulsatile. Yet, reliable information on the InterPulse Intervals (IPI) is a prerequisite to study precisely the steroid feedback exerted on the pituitary level. Hence, there is a real need for robust IPI detection algorithms. In this article, we present an algorithm for the monitoring of LH pulse frequency, basing ourselves both on the available endocrinological knowledge on LH pulse (shape and duration with respect to the frequency regime) and synthetic LH data generated by a simple model. We make use of synthetic data to make clear some basic notions underlying our algorithmic choices. We focus on explaining how the process of sampling affects drastically the original pattern of secretion, and especially the amplitude of the detectable pulses. We then describe the algorithm in details and perform it on different sets of both synthetic and experimental LH time series. We further comment on how to diagnose possible outliers from the series of IPIs which is the main output of the algorithm.Comment: Nombre de pages : 35 ; Nombre de figures : 16 ; Nombre de tableaux :