Health care resouce use and stroke outcome

Background and Purpose: Outcome in patients hospitalized for acute stroke varies considerably between populations. Within the framework of the GAIN International trial, a large multicenter trial of a neuroprotective agent (gavestinel, glycine antagonist), stroke outcome in relation to health care resource use has been compared in a large number of countries, allowing for differences in case mix. Methods: This substudy includes 1,422 patients in 19 countries grouped into 10 regions. Data on prognostic variables on admission to hospital, resource use, and outcome were analyzed by regression models. Results: All results were adjusted for differences in prognostic factors on admission (NIH Stroke Scale, age, comorbidity). There were threefold variations in the average number of days in hospital/institutional care (from 20 to 60 days). The proportion of patients who met with professional rehabilitation staff also varied greatly. Three-month case fatality ranged from 11% to 28%, and mean Barthel ADL score at three months varied between 64 and 73. There was no relationship between health care resource use and outcome in terms of survival and ADL function at three months. The proportion of patients living at home at three months did not show any relationship to ADL function across countries. Conclusions: There are wide variations in health care resource use between countries, unexplained by differences in case mix. Across countries, there is no obvious relationship between resource use and clinical outcome after stroke. Differences in health care traditions (treatment pathways) and social We thank the coinvestigators and research staff at the participating centers for their support. Glaxo Wellcome sponsored the GAIN International trial, supported the present analyses and reviewed the final draft of the article

Flare energetics

In this investigation of flare energetics, researchers sought to establish a comprehensive and self-consistent picture of the sources and transport of energy within a flare. To achieve this goal, they chose five flares in 1980 that were well observed with instruments on the Solar Maximum Mission, and with other space-borne and ground-based instruments. The events were chosen to represent various types of flares. Details of the observations available for them and the corresponding physical parameters derived from these data are presented. The flares were studied from two perspectives, the impulsive and gradual phases, and then the results were compared to obtain the overall picture of the energics of these flares. The role that modeling can play in estimating the total energy of a flare when the observationally determined parameters are used as the input to a numerical model is discussed. Finally, a critique of the current understanding of flare energetics and the methods used to determine various energetics terms is outlined, and possible future directions of research in this area are suggested

Engine Component Retirement-For-Cause: A Nondestructive Evaluation (NDE) and Fracture Mechanics Based Maintainance Concep

Historically, cyclic life limited gas turbine engine components have been retired when they reach an analytically determined life where the first fatigue crack per 1000 parts could be expected. By definition, 99.9% of these components are being retired prematurely as they have considerable useful life remaining. Retirement for Cause is a procedure which would allow safe utilization of the full life capacity of each individual component. Since gas turbine engine rotor components are prime candidates and are among the most costly of engine components, adoption of a RFC maintenance philosophy could result in substantial engine systems life cycle cost savings. Two major technical disciplines must be developed and integrated to realize those cost savings: Fracture Mechanics and Nondestructive Evaluation. This paper discusses the methodology, and development activity required, to integrate these disciplines to provide a viable RFC system for use on military gas turbine engines, and illustrates potential benefits of its application

The energetics of the gradual phase

Reseachers compare results with those in the chapter by Moore et al. (1980), who reached five main conclusions about the gradual phase: (1) the typical density of the soft X-ray emitting plasma is between 10 to the 11th power and 10 to the 12th power cm-3 for compact flares and between 10 to the 10th power and 10 to the 11th power cm-3 for a large-area flare; (2) cooling is by conduction and radiation in roughly equal proportions; (3) continual heating is needed in the decay phase of two-ribbon flares; (4) continual heating is probably not needed in compact events; (5) most of the soft-X-ray-emitting plasma results from chromospheric evaporation. The goal was to reexamine these problems with the data from the Solar Maximum Mission (SMM) and other supporting instruments as well as to take advantage of recent theoretical advances. SMM is capable of measuring coronal temperatures more accurately and with a better cadence than has been possible before. The SMM data set is also unique in that the complete transit of an active region was observed, with soft X-ray and UV images being taken every few minutes. Researcher's were therefore able to establish the pre-flare conditions of the region and see whether anything has changed as a result of the flare. The assumptions made in attempting to determine the required plasma parameters are described. The derived parameters for the five prime flares are presented, and the role of numerical simulations is discussed

2-Hydr­oxy-10-propargylpyrrolo[2,1-c][1,4]benzodiazepine-5,11-dione monohydrate

The title compound, C15H14N2O3·H2O, consists of a benzodiazepinedione system fused to a pyrrole system. The seven-membered ring adopts a boat-shaped conformation (with the methine C atom as the prow); the five-membered ring adopts an enveloped-shaped conformation (with the hydr­oxy-bearing C atom as the flap). In the crystal, adjacent mol­ecules are linked by O—H⋯O hydrogen bonds into sheets parallel to (102). In addition, Cacetyl­inic—H⋯O hydrogen bonds occur

Signal generation mechanisms in scanning-electron acoustic microscopy of ionic crystals

MgO crystals have been studied by scanning‐electron acoustic microscopy under different experimental conditions. Contrast mechanisms in imaging are discussed and compared. The experimental results obtained by earthing or nonearthing the specimen‐transducer interface suggest the existence of a signal generation mechanism that is related to the ionic nature of these kind of crystals. Electron‐acoustic microscopy appears then to be a useful tool for the characterization of ionic materials

2-Hydr­oxy-10-phenacyl­pyrrolo[2,1-c][1,4]benzodiazepine-5,11-dione

The title compound, C20H18N2O4, consists of a benzodiazepinedione system fused to a pyrrole system. The seven-membered ring adopts a boat-shaped conformation (with the methine C atom as the prow); the five-membered ring adopts an enveloped-shaped conformation (with the hydr­oxy-bearing C atom as the flap). In the crystal, the hydr­oxy group is hydrogen bonded to the carbonyl O atom of an adjacent mol­ecule, generating a zigzag chain

Heterogeneity in ess transcriptional organization and variable contribution of the Ess/Type VII protein secretion system to virulence across closely related <em>Staphylocccus aureus </em>strains

The Type VII protein secretion system, found in Gram-positive bacteria, secretes small proteins, containing a conserved W-x-G amino acid sequence motif, to the growth medium. Staphylococcus aureus has a conserved Type VII secretion system, termed Ess, which is dispensable for laboratory growth but required for virulence. In this study we show that there are unexpected differences in the organization of the ess gene cluster between closely related strains of S. aureus. We further show that in laboratory growth medium different strains of S. aureus secrete the EsxA and EsxC substrate proteins at different growth points, and that the Ess system in strain Newman is inactive under these conditions. Systematic deletion analysis in S. aureus RN6390 is consistent with the EsaA, EsaB, EssA, EssB, EssC and EsxA proteins comprising core components of the secretion machinery in this strain. Finally we demonstrate that the Ess secretion machinery of two S. aureus strains, RN6390 and COL, is important for nasal colonization and virulence in the murine lung pneumonia model. Surprisingly, however, the secretion system plays no role in the virulence of strain SA113 under the same conditions

Amyloid Precursor Proteins Are Dynamically Trafficked and Processed during Neuronal Development

Proteolytic processing of the Amyloid Precursor Protein (APP) produces beta-amyloid (Aβ) peptide fragments that accumulate in Alzheimer’s Disease (AD), but APP may also regulate multiple aspects of neuronal development, albeit via mechanisms that are not well understood. APP is a member of a family of transmembrane glycoproteins expressed by all higher organisms, including two mammalian orthologs (APLP1 and APLP2) that have complicated investigations into the specific activities of APP. By comparison, insects express only a single APP-related protein (APP-Like, or APPL) that contains the same protein interaction domains identified in APP. However, unlike its mammalian orthologs, APPL is only expressed by neurons, greatly simplifying an analysis of its functions in vivo. Like APP, APPL is processed by secretases to generate a similar array of extracellular and intracellular cleavage fragments, as well as an Aβ-like fragment that can induce neurotoxic responses in the brain. Exploiting the complementary advantages of two insect models (Drosophila melanogaster and Manduca sexta), we have investigated the regulation of APPL trafficking and processing with respect to different aspects of neuronal development. By comparing the behavior of endogenously expressed APPL with fluorescently tagged versions of APPL and APP, we have shown that some full-length protein is consistently trafficked into the most motile regions of developing neurons both in vitro and in vivo. Concurrently, much of the holoprotein is rapidly processed into N- and C-terminal fragments that undergo bi-directional transport within distinct vesicle populations. Unexpectedly, we also discovered that APPL can be transiently sequestered into an amphisome-like compartment in developing neurons, while manipulations targeting APPL cleavage altered their motile behavior in cultured embryos. These data suggest that multiple mechanisms restrict the bioavailability of the holoprotein to regulate APPL-dependent responses within the nervous system. Lastly, targeted expression of our double-tagged constructs (combined with time-lapse imaging) revealed that APP family proteins are subject to complex patterns of trafficking and processing that vary dramatically between different neuronal subtypes. In combination, our results provide a new perspective on how the regulation of APP family proteins can be modulated to accommodate a variety of cell type-specific responses within the embryonic and adult nervous system