Stroke mimic diagnoses presenting to a hyperacute stroke unit.

Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered

Patient-Perceived Stigma & Communication in Mental Healthcare: Predictors of Medication Adherence and Mental Health Outcomes

Patients with mental illness often report feeling stigmatized by their mental healthcare providers, which may deter them from seeking care services altogether. Although workplace interventions can be implemented to reduce stigma, outcomes are limited and may not be long-lasting. The objectives of this study are to investigate which variables of interpersonal communication are significant predictors of medication adherence and mental health outcomes in patients with mental illness. This study surveyed 258 participants from the United States who were at least 18 years of age and reported seeing a mental healthcare provider and taking psychotropic medication within the past five years. Each respondent completed an online survey that involved the following measures: patient-perceived stigmatization, patient-physician communication, trust, satisfaction, medication adherence, and mental health outcomes. Responses suggested that the presence of patient-perceived stigma reveals statistically inverse relationships with patient-provider communication, trust, and satisfaction. Significant predictors of medication adherence included patient-perceived stigma, patient-provider communication, trust, and satisfaction. The only identified significant predictor for mental health outcomes was satisfaction. The responses to survey questions suggested patient-provider communication skills must be taught to mental health providers, leading to enhanced mental healthcare satisfaction and ultimately, improved care for patients treated for mental illness

Echoes of Scripture in the Emmaus Road Encounter of Luke 24:13-35

The encounter between the risen Jesus and two disciples on the Emmaus Road in Luke 24: 13-35 offers rich textual interpretive possibilities when compared ·with the Bible overall. What model(s) or method(s) might the writer of the third gospel have employed to proclaim the presence of the risen Jesus? The method of textual and intertextual dialogue used to examine the Luke 24: 13-35 pericope is that of identifying echoes of Scripture. This thesis examines God\u27s Word to point out a few of the many echoes of Scripture that contribute to the exegetical and hermeneutical process. Echoes of Scripture are reflections or mirrored words, phrases, or related Scriptural ideas located in a particular biblical passage. The word(s) or idea from an earlier passage or text is used in a later passage for various reasons. One reason a writer may use an echo is to strengthen a theological premise, or to illustrate how God is at work in a way similar as in an earlier time in history. and even to show how God is the same even though God may be doing or revealing something new. Three specific areas (echoes) in particular are chosen for this study from Luke 24:13-35. The first echo is the revealed divine presence of God with theophany and the incarnation as compared to the burning bush of Exodus 3. Then the second echo raises the theme of Scripture, the prophetic word from God pointing to the Messiah with images of suffering and deliverance, such as Isaiah 53. The third echo is one of bread blessing and breaking with table/meal fellowship with hospitality and remembrance of Jesus the delivering host in Luke· s gospel and Exodus 12 with the Passover meal

Echoes of Scripture in the Emmaus Road Encounter of Luke 24:13-35

The encounter between the risen Jesus and two disciples on the Emmaus Road in Luke 24: 13-35 offers rich textual interpretive possibilities when compared ·with the Bible overall. What model(s) or method(s) might the writer of the third gospel have employed to proclaim the presence of the risen Jesus? The method of textual and intertextual dialogue used to examine the Luke 24: 13-35 pericope is that of identifying echoes of Scripture. This thesis examines God\u27s Word to point out a few of the many echoes of Scripture that contribute to the exegetical and hermeneutical process. Echoes of Scripture are reflections or mirrored words, phrases, or related Scriptural ideas located in a particular biblical passage. The word(s) or idea from an earlier passage or text is used in a later passage for various reasons. One reason a writer may use an echo is to strengthen a theological premise, or to illustrate how God is at work in a way similar as in an earlier time in history. and even to show how God is the same even though God may be doing or revealing something new. Three specific areas (echoes) in particular are chosen for this study from Luke 24:13-35. The first echo is the revealed divine presence of God with theophany and the incarnation as compared to the burning bush of Exodus 3. Then the second echo raises the theme of Scripture, the prophetic word from God pointing to the Messiah with images of suffering and deliverance, such as Isaiah 53. The third echo is one of bread blessing and breaking with table/meal fellowship with hospitality and remembrance of Jesus the delivering host in Luke· s gospel and Exodus 12 with the Passover meal

Spectral Evolution of an Earth-Like Planet

We have developed a characterization of the geological evolution of the Earths atmosphere and surface in order to model the observable spectra of an Earth-like planet through its geological history. These calculations are designed to guide the interpretation of an observed spectrum of such a planet by future instruments that will characterize exoplanets. Our models focus on spectral features that either imply habitability or are required for habitability. These features are generated by H2O, CO2, CH4, O2, O3, N2O, and vegetation-like surface albedos. We chose six geological epochs to characterize. These epochs exhibit a wide range in abundance for these molecules, ranging from a CO2 rich early atmosphere, to a CO2/CH4-rich atmosphere around 2 billion years ago to a present-day atmosphere. We analyzed the spectra to quantify the strength of each important spectral feature in both the visible and thermal infrared spectral regions, and the resolutions required to unambiguously observe the features for each epoch. We find a wide range of spectral resolutions required for observing the different features. For example, H2O and O3 can be observed with relatively low resolution, while O2 and N2O require higher resolution. We also find that the inclusion of clouds in our models significantly affects both the strengths and resolutions required to observe all spectral features.Comment: 34 pages, 24 fig, pdf, ApJ, TB

Shop Rotordynamic Testing - Options, Objectives, Benefits and Practices

TutorialUnderstanding the lateral rotordynamic behavior is critical in determining the reliability/operability of rotating equipment. Whether examining a centrifugal pump or compressor, steam or gas turbine, motor or generator, rotating machinery share the same need to accurately predict and measure dynamic behavior. Industrial specifications determining fit for purpose rely on the accuracy of rotordynamic predictions where direct measurement is impractical or otherwise impossible in an industrial setting. Testing to confirm rotordynamic prediction and behavior provides both the purchaser and vendor the confidence that the design will meet project expectations. Rotordynamic shop testing has several options available to the project during acceptance tests at the vendor’s shop. These options include mechanical run, string and full load/Type 1 testing as well as verification testing to validate unbalance response and stability predictions. Such testing has numerous advantages; the most important being the avoidance of production disruptions involved with testing at the job site. Each test option has associated costs as well as limitations as to what lateral vibration characteristics are revealed. Understanding these factors is vital to efficiently mitigate the risks associated with the purchased equipment. Applying best practices and an understanding of the industrial (API) test requirements are needed to derive the maximum benefit of each test option. The best practices not only involve the test procedure but also the associated analytical methods used to post process the measurement information. Whether performing a simple mechanical run test or more complex stability verification during ASME Type I testing, ensuring that a logical, repeatable and proven methodology is followed produces reliable evidence to confirm the rotordynamic model and lateral vibration performance. The rationale behind the API test requirements provides an understanding of why that test is being performed and its correct application to the dynamic behavior. Test options can be separated into two categories; tests that reveal portions of the dynamic behavior of the equipment to specific operating conditions and those used to verify the analytical predictions of that behavior. API mechanical, string and Type I (or full load) tests reveal the rotordynamic behavior of the equipment to a given set of conditions. These are used specifically to determine acceptability of the design. Unbalance and stability verification testing is used to confirm (or provide confidence in) the rotordynamic model. Confidence in the model permits extrapolation of the design (vendor) and operation (purchaser) beyond the machine’s asbuilt and specific shop test conditions

Assessing satisfaction with social care services among black and minority ethnic and white British carers of stroke survivors in England

Overall satisfaction levels with social care are usually high but lower levels have been reported among black and minority ethnic (BME) service users in England. Reasons for this are poorly understood. This qualitative study therefore explored satisfaction with services among informal carer participants from five different ethnic groups. Fifty-seven carers (black Caribbean, black African, Asian Indian, Asian Pakistani and white British) were recruited from voluntary sector organisations and a local hospital in England, and took part in semi-structured interviews using cognitive interviewing and the critical incident technique. Interviews took place from summer 2013 to spring 2014. Thematic analysis of the interviews showed that participants often struggled to identify specific ‘incidents’, especially satisfactory ones. When describing satisfactory services, participants talked mostly about specific individuals and relationships. Unsatisfactory experiences centred on services overall. When rating services using cognitive interviewing, explicit comparisons with expectations or experiences with other services were common. Highest satisfaction ratings tended to be justified by positive personal characteristics among practitioners, trust and relationships. Lower level ratings were mostly explained by inconsistency in services, insufficient or poor care. Lowest level ratings were rare. Overall, few differences between ethnic groups were identified, although white British participants rated services higher overall giving more top ratings. White British participants also frequently took a more overall view of services, highlighting some concerns but still giving top ratings, while South Asian carers in particular focused on negative aspects of services. Together these methods provide insight into what participants mean by satisfactory and unsatisfactory services. Cognitive interviewing was more challenging for some BME participants, possibly a reflection of the meaningfulness of the concept of service satisfaction to them. Future research should include comparisons between BME and white participants’ understanding of the most positive parts of satisfaction scales and should focus on dissatisfied participants

Economics as a Source of National Power

War by Other Means: Geoeconomics and Statecraft, by Robert D. Blackwill and Jennifer Harri