Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS)

BACKGROUND:There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with acute SCI remains uncertain. Our objective was to evaluate the relative effectiveness of early (<24 hours after injury) versus late (≥ 24 hours after injury) decompressive surgery after traumatic cervical SCI. METHODS:We performed a multicenter, international, prospective cohort study (Surgical Timing In Acute Spinal Cord Injury Study: STASCIS) in adults aged 16-80 with cervical SCI. Enrolment occurred between 2002 and 2009 at 6 North American centers. The primary outcome was ordinal change in ASIA Impairment Scale (AIS) grade at 6 months follow-up. Secondary outcomes included assessments of complications rates and mortality. FINDINGS:A total of 313 patients with acute cervical SCI were enrolled. Of these, 182 underwent early surgery, at a mean of 14.2(± 5.4) hours, with the remaining 131 having late surgery, at a mean of 48.3(± 29.3) hours. Of the 222 patients with follow-up available at 6 months post injury, 19.8% of patients undergoing early surgery showed a ≥ 2 grade improvement in AIS compared to 8.8% in the late decompression group (OR = 2.57, 95% CI:1.11,5.97). In the multivariate analysis, adjusted for preoperative neurological status and steroid administration, the odds of at least a 2 grade AIS improvement were 2.8 times higher amongst those who underwent early surgery as compared to those who underwent late surgery (OR = 2.83, 95% CI:1.10,7.28). During the 30 day post injury period, there was 1 mortality in both of the surgical groups. Complications occurred in 24.2% of early surgery patients and 30.5% of late surgery patients (p = 0.21). CONCLUSION:Decompression prior to 24 hours after SCI can be performed safely and is associated with improved neurologic outcome, defined as at least a 2 grade AIS improvement at 6 months follow-up

Christopher Hitchens' Public dying: Toward a Secular-Humanist Ars Moriendi?

This article explores the public dying of journalist, writer, provocateur, public intellectual, and renowned atheist, Christopher Hitchens. It does so primarily through an analysis of television interviews given by Hitchens following his diagnosis with esophageal cancer in June 2010. Four key themes are identified as emerging from analysis of the interviews: (a) Hitchens’ explicit sense of mission in challenging myths and superstitions surrounding cancer, dying, and death; (b) the personal experience of terminal illness and dying and the particular way (or style of dying) by which it is approached; (c) issues of regret and a life well lived; and (d) questions surrounding religion, the afterlife, and possibility of deathbed conversion. In light of the claim that ours is a culture in search of an ars moriendi, the article examines what we can learn from Hitchens’ auto/pathographic interviews (and writings) and the extent to which this rational-humanist, atheistic, and stoical style of dying provides a useable “template” for others nearing the end of life

Rethinking the Architecture: An Action Researcher's Resolution to Writing and Presenting Their Thesis

The thesis as a bulky ‘tome’ with a traditional structure - literature review, methodology, research design, findings and conclusions - is a concept under increasing challenge. Recently, I completed a doctoral action research project based on environmental education in a primary school. However, I found that trying to force the action research process into a linear writing structure was an unsatisfactory experience. After much anxiety and considerable experimentation, I resolved the problem of ‘fit’ between action research and the traditional thesis format by creating an alternative architecture based on each of the action research cycles. While still producing a bulky ‘doorstopper’, I feel this structure is a better reflection of the way the study evolved. This paper outlines this new architecture and discusses its rationale. It also challenges other action researchers to innovate and experiment with the ways they represent their research work. License for such innovation is rapidly developing especially with the advent of digital thesis production and performative theses. I see no reason why action researchers cannot be leaders in the creation of new forms of practice about how research theses and dissertations are represented in the academy

Flow visualization of forced and natural convection in internal cavities. 1998 annual progress report

'The objective of this research program is to understand the fluid physics when corroded spent nuclear fuel (SNF) elements are passivated by injecting treatment gases into a storage canister. By developing a reliable predictive technique for the energy, mass, and momentum transfer in the presence of surface reactions, transfer and storage systems can be efficiently and safely designed. The objective will be reached by using innovative flow visualization techniques and experimental measurements of the flow field to support computational models. This report summarizes work completed after eight months of a three-year, collaborative project. A generic idealization of a combined drying and passivation approach has been defined, which represents a section of a vertical canister with baskets of SNF elements. This simulation includes flow phenomena that occur in canisters for high- and/or low-enrichment fuels. A steady flow of the passivation fluid is introduced at the bottom of the canister via a central tube from the top. Fluid flows through an array of holes in the perforated basket support plate then around the simulated elements and out the top. Dimensions and flow rates for the idealized situation correspond to those for typical drying canisters. Approximate calculations have identified the ranges of values of flow parameters needed to determine the flow regimes occurring in practice.

Low turbulence/high efficiency cyclone separators: Facility qualification results

The objective of this work is to experimentally investigate the near-wall turbulent flow-fields characteristic of cyclone separators in order to determine the influence of wall-originating turbulence on the separation of fine particles. In particular, seven turbulence suppression concepts will be evaluated with reference to a well-established baseline condition. Concepts which appear attractive will be studied and characterized in more detail. The work accomplished to date is principally the design, construction, and qualification of two of the facilities that will be used to study the various concepts of turbulence suppression. The qualification of the primary facility, the Cyclonic Wind Tunnel (CWT), has required the development and adaptation of laser Doppler velocimetry (LDV) to perform simultaneous two-dimensional turbulence measurements in a highly swirling flow. A companion facility to the CWT is the Curvilinear Boundary Layer (CBL) apparatus. The purpose of the CBL is to provide a thick, visually-observable near-wall flow region under dynamically similar conditions to the CWT to that a physical understanding of the turbulence suppression process can be obtained. 9 refs., 15 figs