Adherence to secondary stroke prevention strategies - Results from the German stroke data bank

Only very limited data are available concerning patient adherence to antithrombotic medication intended to prevent a recurrent stroke. Reduced adherence and compliance could significantly influence the effects of any stroke prevention strategies. This study from a large stroke data bank provides representative data concerning the rate of stroke victims adhering to their recommended preventive medication. During a 2-year period beginning January 1, 1998, all patients with acute stroke or TIA in 23 neurological departments with an acute stroke unit were included in the German Stroke Data Bank. Data were collected prospectively, reviewed, validated and processed in a central data management unit. Only 12 centers with a follow-up rate of 80% or higher were included in this evaluation. 3,420 patients were followed up after 3 months, and 2,640 patients were followed up one year after their stroke. After one year, 96% of all patients reported still adhere to at least one medical stroke prevention strategy. Of the patients receiving aspirin at discharge, 92.6% reported to use that medication after 3 months and 84% after one year, while 81.6 and 61.6% were the respective figures for clopidogrel, and 85.2 and 77.4% for oral anticoagulation. Most patients who changed medication switched from aspirin to clopidogrel. Under the conditions of this observational study, adherence to stroke prevention strategies is excellent. The highest adherence rate is noticed for aspirin and oral anticoagulation. After one year, very few patients stopped taking stroke preventive medication. Copyright (C) 2003 S. Karger AG, Basel

Square patterns in Rayleigh-Benard convection with rotation about a vertical axis

We present experimental results for Rayleigh-Benard convection with rotation about a vertical axis at dimensionless rotation rates in the range 0 to 250 and upto 20% above the onset. Critical Rayleigh numbers and wavenumbers agree with predictions of linear stability analysis. For rotation rates greater than 70 and close to onset, the patterns are cellular with local four-fold coordination and differ from the theoretically expected Kuppers-Lortz unstable state. Stable as well as intermittent defect-free square lattices exist over certain parameter ranges. Over other ranges defects dynamically disrupt the lattice but cellular flow and local four-fold coordination is maintained.Comment: ReVTeX, 4 pages, 7 eps figures include

Elastic turbulence in shear banding wormlike micelles

We study the dynamics of the Taylor-Couette flow of shear banding wormlike micelles. We focus on the high shear rate branch of the flow curve and show that for sufficiently high Weissenberg numbers, this branch becomes unstable. This instability is strongly sub-critical and is associated with a shear stress jump. We find that this increase of the flow resistance is related to the nucleation of turbulence. The flow pattern shows similarities with the elastic turbulence, so far only observed for polymer solutions. The unstable character of this branch led us to propose a scenario that could account for the recent observations of Taylor-like vortices during the shear banding flow of wormlike micelles

Localized transverse bursts in inclined layer convection

We investigate a novel bursting state in inclined layer thermal convection in which convection rolls exhibit intermittent, localized, transverse bursts. With increasing temperature difference, the bursts increase in duration and number while exhibiting a characteristic wavenumber, magnitude, and size. We propose a mechanism which describes the duration of the observed bursting intervals and compare our results to bursting processes in other systems.Comment: 4 pages, 8 figure

Best practice in undertaking and reporting health technology assessments : Working Group 4 report

[Executive Summary] The aim of Working Group 4 has been to develop and disseminate best practice in undertaking and reporting assessments, and to identify needs for methodologic development. Health technology assessment (HTA) is a multidisciplinary activity that systematically examines the technical performance, safety, clinical efficacy, and effectiveness, cost, costeffectiveness, organizational implications, social consequences, legal, and ethical considerations of the application of a health technology (18). HTA activity has been continuously increasing over the last few years. Numerous HTA agencies and other institutions (termed in this report “HTA doers”) across Europe are producing an important and growing amount of HTA information. The objectives of HTA vary considerably between HTA agencies and other actors, from a strictly political decision making–oriented approach regarding advice on market licensure, coverage in benefits catalogue, or investment planning to information directed to providers or to the public. Although there seems to be broad agreement on the general elements that belong to the HTA process, and although HTA doers in Europe use similar principles (41), this is often difficult to see because of differences in language and terminology. In addition, the reporting of the findings from the assessments differs considerably. This reduces comparability and makes it difficult for those undertaking HTA assessments to integrate previous findings from other HTA doers in a subsequent evaluation of the same technology. Transparent and clear reporting is an important step toward disseminating the findings of a HTA; thus, standards that ensure high quality reporting may contribute to a wider dissemination of results. The EUR-ASSESS methodologic subgroup already proposed a framework for conducting and reporting HTA (18), which served as the basis for the current working group. New developments in the last 5 years necessitate revisiting that framework and providing a solid structure for future updates. Giving due attention to these methodologic developments, this report describes the current “best practice” in both undertaking and reporting HTA and identifies the needs for methodologic development. It concludes with specific recommendations and tools for implementing them, e.g., by providing the structure for English-language scientific summary reports and a checklist to assess the methodologic and reporting quality of HTA reports

Defect Chaos of Oscillating Hexagons in Rotating Convection

Using coupled Ginzburg-Landau equations, the dynamics of hexagonal patterns with broken chiral symmetry are investigated, as they appear in rotating non-Boussinesq or surface-tension-driven convection. We find that close to the secondary Hopf bifurcation to oscillating hexagons the dynamics are well described by a single complex Ginzburg-Landau equation (CGLE) coupled to the phases of the hexagonal pattern. At the bandcenter these equations reduce to the usual CGLE and the system exhibits defect chaos. Away from the bandcenter a transition to a frozen vortex state is found.Comment: 4 pages, 6 figures. Fig. 3a with lower resolution no

Hexagons become second if symmetry is broken

Pattern formation on the free surface of a magnetic fluid subjected to a magnetic field is investigated experimentally. By tilting the magnetic field the symmetry can be broken in a controllable manner. When increasing the amplitude of the tilted field, the flat surface gives way to liquid ridges. A further increase results in a hysteretic transition to a pattern of stretched hexagons. The instabilities are detected by means of a linear array of magnetic hall sensors and compared with theoretical predictions.Comment: accepted for publication by Physical Review E/Rapid Communicatio

Generation and Structure of Solitary Rossby Vortices in Rotating Fluids

The formation of zonal flows and vortices in the generalized Charney-Hasegawa-Mima equation is studied. We focus on the regime when the size of structures is comparable to or larger than the deformation (Rossby) radius. Numerical simulations show the formation of anticyclonic vortices in unstable shear flows and ring-like vortices with quiescent cores and vorticity concentrated in a ring. Physical mechanisms that lead to these phenomena and their relevance to turbulence in planetary atmospheres are discussed.Comment: 3 pages in REVTeX, 5 postscript figures separately, submitted to Phys. Rev.

Planform selection in two-layer Benard-Marangoni convection

Benard-Marangoni convection in a system of two superimposed liquids is investigated theoretically. Extending previous studies the complete hydrodynamics of both layers is treated and buoyancy is consistently taken into account. The planform selection problem between rolls, squares and hexagons is investigated by explicitly calculating the coefficients of an appropriate amplitude equation from the parameters of the fluids. The results are compared with recent experiments on two-layer systems in which squares at onset have been reported.Comment: 17 pages, 7 figures, oscillatory instability included, typos corrected, references adde

Full sphere hydrodynamic and dynamo benchmarks

Convection in planetary cores can generate fluid flow and magnetic fields, and a number of sophisticated codes exist to simulate the dynamic behaviour of such systems. We report on the first community activity to compare numerical results of computer codes designed to calculate fluid flow within a whole sphere. The flows are incompressible and rapidly rotating and the forcing of the flow is either due to thermal convection or due to moving boundaries. All problems defined have solutions that allow easy comparison, since they are either steady, slowly drifting or perfectly periodic. The first two benchmarks are defined based on uniform internal heating within the sphere under the Boussinesq approximation with boundary conditions that are uniform in temperature and stress-free for the flow. Benchmark 1 is purely hydrodynamic, and has a drifting solution. Benchmark 2 is a magnetohydrodynamic benchmark that can generate oscillatory, purely periodic, flows and magnetic fields. In contrast, Benchmark 3 is a hydrodynamic rotating bubble benchmark using no slip boundary conditions that has a stationary solution. Results from a variety of types of code are reported, including codes that are fully spectral (based on spherical harmonic expansions in angular coordinates and polynomial expansions in radius), mixed spectral and finite difference, finite volume, finite element and also a mixed Fourier–finite element code. There is good agreement between codes. It is found that in Benchmarks 1 and 2, the approximation of a whole sphere problem by a domain that is a spherical shell (a sphere possessing an inner core) does not represent an adequate approximation to the system, since the results differ from whole sphere results