An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England

Objective Effective provision of urgent stroke care relies upon admission to hospital by emergency ambulance and may involve pre-hospital redirection. The proportion and characteristics of patients who do not arrive by emergency ambulance and their impact on service efficiency is unclear. To assist in the planning of regional stroke services we examined the volume, characteristics and prognosis of patients according to the mode of presentation to local services. Study design and setting A prospective regional database of consecutive acute stroke admissions was conducted in North East, England between 01/09/10-30/09/11. Case ascertainment and transport mode were checked against hospital coding and ambulance dispatch databases. Results Twelve acute stroke units contributed data for a mean of 10.7 months. 2792/3131 (89%) patients received a diagnosis of stroke within 24 hours of admission: 2002 arrivals by emergency ambulance; 538 by private transport or non-emergency ambulance; 252 unknown mode. Emergency ambulance patients were older (76 vs 69 years), more likely to be from institutional care (10% vs 1%) and experiencing total anterior circulation symptoms (27% vs 6%). Thrombolysis treatment was commoner following emergency admission (11% vs 4%). However patients attending without emergency ambulance had lower inpatient mortality (2% vs 18%), a lower rate of institutionalisation (1% vs 6%) and less need for daily carers (7% vs 16%). 149/155 (96%) of highly dependent patients were admitted by emergency ambulance, but none received thrombolysis. Conclusion Presentations of new stroke without emergency ambulance involvement were not unusual but were associated with a better outcome due to younger age, milder neurological impairment and lower levels of pre-stroke dependency. Most patients with a high level of pre-stroke dependency arrived by emergency ambulance but did not receive thrombolysis. It is important to be aware of easily identifiable demographic groups that differ in their potential to gain from different service configurations

Medical image analysis methods in MR/CT-imaged acute-subacute ischemic stroke lesion:Segmentation, prediction and insights into dynamic evolution simulation models. A critical appraisal

AbstractOver the last 15years, basic thresholding techniques in combination with standard statistical correlation-based data analysis tools have been widely used to investigate different aspects of evolution of acute or subacute to late stage ischemic stroke in both human and animal data. Yet, a wave of biology-dependent and imaging-dependent issues is still untackled pointing towards the key question: “how does an ischemic stroke evolve?” Paving the way for potential answers to this question, both magnetic resonance (MRI) and CT (computed tomography) images have been used to visualize the lesion extent, either with or without spatial distinction between dead and salvageable tissue. Combining diffusion and perfusion imaging modalities may provide the possibility of predicting further tissue recovery or eventual necrosis. Going beyond these basic thresholding techniques, in this critical appraisal, we explore different semi-automatic or fully automatic 2D/3D medical image analysis methods and mathematical models applied to human, animal (rats/rodents) and/or synthetic ischemic stroke to tackle one of the following three problems: (1) segmentation of infarcted and/or salvageable (also called penumbral) tissue, (2) prediction of final ischemic tissue fate (death or recovery) and (3) dynamic simulation of the lesion core and/or penumbra evolution. To highlight the key features in the reviewed segmentation and prediction methods, we propose a common categorization pattern. We also emphasize some key aspects of the methods such as the imaging modalities required to build and test the presented approach, the number of patients/animals or synthetic samples, the use of external user interaction and the methods of assessment (clinical or imaging-based). Furthermore, we investigate how any key difficulties, posed by the evolution of stroke such as swelling or reperfusion, were detected (or not) by each method. In the absence of any imaging-based macroscopic dynamic model applied to ischemic stroke, we have insights into relevant microscopic dynamic models simulating the evolution of brain ischemia in the hope to further promising and challenging 4D imaging-based dynamic models. By depicting the major pitfalls and the advanced aspects of the different reviewed methods, we present an overall critique of their performances and concluded our discussion by suggesting some recommendations for future research work focusing on one or more of the three addressed problems

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

BACKGROUND: To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. METHODS: In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. FINDINGS: Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0·685 (95% CI 0·629-0·741) to 0·833 (0·783-0·882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. INTERPRETATION: We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide. FUNDING: World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research

Quantitative analysis of a footwall‐scarp degradation complex and syn‐rift stratigraphic architecture, Exmouth Plateau, NW Shelf, offshore Australia

Interactions between footwall‐, hangingwall‐ and axial‐derived depositional systems make syn‐rift stratigraphic architecture difficult to predict, and preservation of net‐erosional source landscapes is limited. Distinguishing between deposits derived from fault‐scarp degradation (consequent systems) and those derived from long‐lived catchments beyond the fault block crest (antecedent systems) is also challenging, but important for hydrocarbon reservoir prospecting. We undertake geometric and volumetric analysis of a fault‐scarp degradation complex and adjacent hangingwall‐fill associated with the Thebe‐2 fault block on the Exmouth Plateau, NW Shelf, offshore Australia, using high resolution 3D seismic data. Vertical and headward erosion of the complex and fault throw are measured. Seismic‐stratigraphic and seismic facies mapping allow us to constrain the spatial and architectural variability of depositional systems in the hangingwall. Footwall‐derived systems interacted with hangingwall‐ and axial‐derived systems, through diversion around topography, interfingering or successive onlap. We calculate the volume of footwall‐sourced hangingwall fans (VHW) for nine quadrants along the fault block, and compare this to the volume of material eroded from the immediately up‐dip fault‐scarp (VFW). This analysis highlights areas of sediment bypass (VFW > VHW) and areas fed by sediment sources beyond the degraded fault scarp (VHW > VFW). Exposure of the border fault footwall and adjacent fault terraces produced small catchments located beyond the fault block crest that fed the hangingwall basin. One source persisted throughout the main syn‐rift episode, and its location coincided with: (a) an intra‐basin topographic high; (b) a local fault throw minimum; (c) increased vertical and headward erosion within the fault‐scarp degradation complex; and (d) sustained clinoform development in the immediate hangingwall. Our novel quantitative volumetric approach to identify through‐going sediment input points could be applied to other rift basin‐fills. We highlight implications for hydrocarbon exploration and emphasize the need to incorporate interaction of multiple sediment sources and their resultant architecture in tectono‐stratigraphic models for rift basins

The Sisters of Mercy in Newfoundland : their contribution to business education

The purpose of this study was to trace the work of the sisters of Mercy in Newfoundland in the field of business education. The Sisters began their work in the late 1800’s, when they first introduced business education courses into the curriculum of their convent schools. Their work continued until the mid-1900’s, when they began phasing out the formal business education programs which they had developed over the years in their schools. Their activities in this area constitute an important and lasting contribution to the field of business education. There has been no previous in-depth scholarly investigation into this aspect of the Sisters’ work. Therefore, a study of the Sisters’ contribution to this field is long overdue. -- The first part of this study provides historical background of the Sisters of Mercy, the establishment of the early convent schools in Newfoundland, and the introduction of business education subjects into the curriculum of these schools. -- The second part of the study deals with the opening of Commercial Departments at several of the Sisters’ schools and colleges around the Island, the development of comprehensive business education programs in these departments, and the introduction and development of business education programs at convent schools where Commercial Departments were not established. -- The Sisters of Mercy in Newfoundland started their business training at a time when business education was in its infancy and when the field of employment for women. The foresight, energy, and determination of the early Sisters won the respect of educators and business people across Newfoundland. An, the outstanding achievements of so many of their students won for the institutions they represented a recognized place not only in the educational and business circles of the Island but also in international business education competitions. -- In the late 1950’s and early 1960’s, many schools and colleges in Newfoundland began closing down their Commercial Departments or phasing out their business education classes. The convent schools and colleges operated by the Sisters of Mercy were among this group. New educational institutions such as Holy Heart of Mary Regional High School for girls and The College of Trades and Technology in St. John’s, along with the District Vocational Schools across the Island, now took up the task of preparing the youth of Newfoundland for the world of business. -- By the time the Sisters were ready to concede the responsibility for business training to the new institutions, they had already helped to raise business education from a small cluster of basic skills courses to a highly sophisticated field of learning for young men and women. In addition, the Sisters had trained for the business communities of the Island thousands of qualified typists, stenographers, and bookkeepers. In so doing, they had given well over half a century of dedicated service to the field of business education in Newfoundland

Sunset Video 1975

The boundaries between viewer and artwork are well established by gallery and museum conventions, and reinforced via the minimal yet authoritative presence of thin cordon strings, white lines marked on the floor, alarms, glass cases, raised platforms and gallery staff. Relational art overrides these boundaries, inviting the audience into the spatiality and fabric of an artwork, requiring the work to be viewed, experienced or completed only once the audience member is actively involved and participating. The work Sunset Video is placed within the installation C20th Mythological Beasts: At Home with the Locust People, the viewer is only able to view the video work by entering the physical space of the installation work, disrupting the conventional relationship between artwork and viewer, and potentially enhancing the viewers empathic contemplation. At the time of this works creation in 1975, video as an integrated component of a sculptural installation (at this time called an ‘environment’), was an innovation, as was video as an art form.The significance of the work Sunset Video is attested by its long exhibition history including: with C20th Mythological Beasts: 1975, West Street Gallery, Sydney; 1976, Three Statements on Environment, Ewing and George Paton Galleries, University of Melbourne; 1976, Post Object Show, Experimental Art Foundation, Adelaide; 1995, Sutton Gallery, Melbourne; as a video only: 2004, Sutton Gallery, Melbourne; 2005, Bellas Milani Gallery, Brisbane; 2007, Performance Space, Sydney. Additionally the work has been included in the inaugural selection of 20 Australian video artists for Monash University’s Australian Video Art Archive

Intracellular adhesion molecule-1 up-regulation on thyrocytes by iodine of non-obese diabetic.H2h4 mice is reactive oxygen species-dependent

Intracellular adhesion molecule-1 (ICAM-1) expression on the thyroid follicular cells of non-obese diabetic (NOD).H2h4 mice is enhanced by iodide treatment, which correlates with autoimmune thyroid disease in genetically susceptible NOD.H2h4 mice. The current study examines the mechanism of iodine-enhanced up-regulation of ICAM-1 on the surface of thyroid cells. We hypothesized that the up-regulation of ICAM-1 is due to a transient increase in production of reactive oxygen species (ROS). ROS may initiate signalling of the ICAM-1 gene promoter, enhancing up-regulated ICAM-1 protein on the cell surface. Single-cell suspensions of thyroid follicular cells from thyroiditis-susceptible NOD.H2h4 or non-susceptible BALB/c mice were treated in vitro with sodium iodide. Extracellular and intracellular ROS were assessed by luminol-derived chemiluminescence and flow cytometry assays respectively. Our results demonstrate that thyroid follicular cells of NOD.H2h4 generate higher levels of ROS compared with cells from non-susceptible strains of mice. Expression of a subunit protein of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, p67phox, was analysed by Western blot immunoassay. A constitutive expression of the p67phox subunit protein was observed in NOD.H2h4 mice prior to iodine treatment. No such expression was found in BALB/c mice. Treatment of NOD.H2h4 thyroid cells with diphenyleneiodium, an inhibitor of NADPH oxidase, reduced generation of ROS and of ICAM-1 protein expression. Thus, thyrocytes from NOD.H2h4 mice produce enhanced levels of ROS that may be mediated by NADPH oxidase. Consequently, in NOD.H2h4 mice the ROS-induced signal for ICAM-1 up-regulation may contribute to mononuclear cellular infiltration of the thyroid gland and the progression of autoimmune thyroid disease