Risk factors for chest infection in acute stroke: a prospective cohort study

<p><b>Background and Purpose:</b> Pneumonia is a major cause of morbidity and mortality after stroke. We aimed to determine key characteristics that would allow prediction of those patients who are at highest risk for poststroke pneumonia.</p> <p><b>Methods:</b> We studied a series of consecutive patients with acute stroke who were admitted to hospital. Detailed evaluation included the modified National Institutes of Health Stroke Scale; the Abbreviated Mental Test; and measures of swallow, respiratory, and oral health status. Pneumonia was diagnosed by set criteria. Patients were followed up at 3 months after stroke.</p> <p><b>Results:</b> We studied 412 patients, 391 (94.9%) with ischemic stroke and 21 (5.1%) with hemorrhagic stroke; 78 (18.9%) met the study criteria for pneumonia. Subjects who developed pneumonia were older (mean±SD age, 75.9±11.4 vs 64.9±13.9 years), had higher modified National Institutes of Health Stroke Scale scores, a history of chronic obstructive pulmonary disease, lower Abbreviated Mental Test scores, and a higher oral cavity score, and a greater proportion tested positive for bacterial cultures from oral swabs. In binary logistic-regression analysis, independent predictors (P<0.05) of pneumonia were age >65 years, dysarthria or no speech due to aphasia, a modified Rankin Scale score ≥4, an Abbreviated Mental Test score <8, and failure on the water swallow test. The presence of 2 or more of these risk factors carried 90.9% sensitivity and 75.6% specificity for the development of pneumonia.</p> <p><b>Conclusions:</b> Pneumonia after stroke is associated with older age, dysarthria/no speech due to aphasia, severity of poststroke disability, cognitive impairment, and an abnormal water swallow test result. Simple assessment of these variables could be used to identify patients at high risk of developing pneumonia after stroke.</p&gt

E-Portfolio Development and Implementation in Malaysian Technical and Vocational Education Training (TVET): A Mixed Methods Analysis of Stakeholders' and Students' perceptions

In line with the global increase in the use of E-portfolio technologies in learning organizations, their potential use in Malaysia is promising, especially in the growing areas of Technical and Vocational Education Training (TVET). In order to understand and evaluate the potential of E-portfolios in these education areas, the initial view of the parties related to the Skills Training Program, a sub-program in TVET should be taken into consideration. Since such an electronic learning system has never previously been deployed in any public or private training institutions in Malaysia, there is a need to ensure that it has the support of the parties concerned. Thus, the key questions for this study were to investigate whether the E-portfolio is: (1) suitable for implementation in the Malaysia Skills Training Education Program, and (2) easy, efficient and effective for students to use. This study used both qualitative and quantitative methods where data collection included E-mail based interviews with several officers in Malaysia and a survey of perceptions of E-portfolio Skills Training Students from the Kuantan District of Pahang, Malaysia. The results showed that most participants agreed that the E-portfolio is well suited to be implemented as an evaluation method or value-added to improve the IT skills of the students depending on their level of training course. Although some trainees/students warned that this system needs lots of things to be considered such as facilities, technical and emotional support as well as a sensible process, most agreed that this system should be introduced in their training institutions. Similarly, the interviewees also highlighted constraints that should be considered before execution to ensure that this system will be effectively installed and completely functional to benefit trainees, instructors as well as for the Training Institutions themselves

Octilinear Force-Directed Layout with Mental Map Preservation for Schematic Diagrams

We present an algorithm for automatically laying out metro map style schematics using a force-directed approach, where we use a localized version of the standard spring embedder forces combined with an octilinear magnetic force. The two types of forces used during layout are naturally conflicting, and the existing method of simply combining these to generate a resultant force does not give satisfactory results. Hence we vary the forces, emphasizing the standard forces in the beginning to produce a well distributed graph, with the octilinear forces becoming prevalent at the end of the layout, to ensure that the key requirement of line angles at intervals of 45? is obtained. Our method is considerably faster than the more commonly used search-based approaches, and we believe the results are superior to the previous force-directed approach. We have further developed this technique to address the issues of dynamic schematic layout. We use a Delaunay triangulation to construct a schematic “frame”, which is used to retain relative node positions and permits full control of the level of mental map preservation. This technique is the first to combine mental map preservation techniques with the additional layout criteria of schematic diagrams. To conclude, we present the results of a study to investigate the relationship between the level of mental map preservation and the user response time and accuracy

Complement-Mediated Virus Infectivity Neutralisation by HLA Antibodies Is Associated with Sterilising Immunity to SIV Challenge in the Macaque Model for HIV/AIDS.

Sterilising immunity is a desired outcome for vaccination against human immunodeficiency virus (HIV) and has been observed in the macaque model using inactivated simian immunodeficiency virus (SIV). This protection was attributed to antibodies specific for cell proteins including human leucocyte antigens (HLA) class I and II incorporated into virions during vaccine and challenge virus preparation. We show here, using HLA bead arrays, that vaccinated macaques protected from virus challenge had higher serum antibody reactivity compared with non-protected animals. Moreover, reactivity was shown to be directed against HLA framework determinants. Previous studies failed to correlate serum antibody mediated virus neutralisation with protection and were confounded by cytotoxic effects. Using a virus entry assay based on TZM-bl cells we now report that, in the presence of complement, serum antibody titres that neutralise virus infectivity were higher in protected animals. We propose that complement-augmented virus neutralisation is a key factor in inducing sterilising immunity and may be difficult to achieve with HIV/SIV Env-based vaccines. Understanding how to overcome the apparent block of inactivated SIV vaccines to elicit anti-envelope protein antibodies that effectively engage the complement system could enable novel anti-HIV antibody vaccines that induce potent, virolytic serological response to be developed

The incidence and risk factors for new onset atrial fibrillation in the PROSPER study

Aims Atrial fibrillation/flutter (AF) is the most common arrhythmia in older people. It associates with reduced exercise capacity, increased risk of stroke, and mortality. We aimed to determine retrospectively whether pravastatin reduces the incidence of AF and whether any electrocardiographic measures or clinical conditions might be risk factors for its development. Methods and results The PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) was a randomized, double-blind controlled trial that recruited 5804 individuals aged 70-82 years with a history of, or risk factors for, vascular disease. A total of 2891 were allocated to pravastatin and 2913 to placebo; mean follow-up was 3.2 years. Electrocardiograms (ECGs), which were recorded at baseline, annually thereafter, and at run-out, were processed by computer and reviewed manually. In all, 264 of 2912 (9.1%) of the placebo group and 283 of 2888 (9.8%) of the pravastatin-treated group developed AF [hazard ratio 1.08 (0.92,1.28), P = 0.35)]. Multivariate analysis showed that PR and QTc intervals, age, left ventricular hypertrophy, and ST-T abnormalities were related to development of AF after adjustment for many variables including alcohol consumption, which itself was univariately predictive of developing AF. Previous myocardial infarction on the ECG was not a risk factor. A history of vascular disease was strongly linked with developing AF but not diabetes and hypertension. Conclusion Pravastatin does not reduce the incidence of AF in older people at risk of vascular disease, at least in the short-medium term. Risk factors for AF include older age, prolongation of PR or QTc intervals, left ventricular hypertrophy, and ST-T abnormalities on the EC

Comparison of bulk milk antibody and youngstock serology screens for determining herd status for Bovine Viral Diarrhoea Virus

BACKGROUND: This paper examines the use of Bulk Milk antibody (BM Ab), Youngstock (YS) serology (Check Tests) and Bulk Milk PCR (BM PCR) for determining the presence or absence of animals persistently infected (PI) with Bovine Viral Diarrhoea Virus (BVDV) within a herd. Data is presented from 26 herds where average herd sizes were 343 and 98 animals for dairy and beef units respectively. Seventeen herds had sufficient data to analyse using Receiver Operating Characteristic (ROC) and probability curves enabling calculation of the sensitivity and specificity of BM Ab and YS Check tests for determining the presence of PI animals within herds in this dataset. RESULTS: Using BM Ab to screen a herd for the presence of PI animals, achieved a herd level sensitivity and specificity of 80.00 % (44.39–97.48 %) and 85.71 % (42.13–99.64 %) respectively (95 % confidence intervals quoted). Sensitivity and specificity of YS Check Tests at a cut off of 3/10 Ab positive YS were 81.82 % (48.22–97.72 %) and 66.67 % (22.28–95.67 %) respectively (95 % confidence interval). These results were achieved by comparing the screening tests to whole herd PI searches that took place 1–19 months after the initial screen with a mean interval of 8 months. Removal of this delay by taking BM samples on the day of a whole herd test and simulating a YS Check Test from the herd test data produced improvements in the reliability of the Check Tests. BM Ab sensitivity and specificity remained unchanged. However, the Check Test sensitivity and specificity improved to 90.9 % (58.72–99.77 %) and 100 % (54.07–100 %) respectively (95 % confidence interval) at a cut of off 2.5/10 Ab positive animals. Our limited BM PCR results identified 5/23 dairy farms with a positive BM PCR result; two contained milking PIs, two had non-milking PIs and another had no PIs identified. CONCLUSIONS: Delaying a PI search following an initial herd screen decreased the diagnostic accuracy and relevance of our results. With careful interpretation, longitudinal surveillance using a combination of the techniques discussed can successfully determine farm status and therefore allow changes in BVDV status to be detected early, thus enabling prompt action in the event of a BVDV incursion

Oxygen adsorption on the Ru (10 bar 1 0) surface: Anomalous coverage dependence

Oxygen adsorption onto Ru (10 bar 1 0) results in the formation of two ordered overlayers, i.e. a c(2 times 4)-2O and a (2 times 1)pg-2O phase, which were analyzed by low-energy electron diffraction (LEED) and density functional theory (DFT) calculation. In addition, the vibrational properties of these overlayers were studied by high-resolution electron loss spectroscopy. In both phases, oxygen occupies the threefold coordinated hcp site along the densely packed rows on an otherwise unreconstructed surface, i.e. the O atoms are attached to two atoms in the first Ru layer Ru(1) and to one Ru atom in the second layer Ru(2), forming zigzag chains along the troughs. While in the low-coverage c(2 times 4)-O phase, the bond lengths of O to Ru(1) and Ru(2) are 2.08 A and 2.03 A, respectively, corresponding bond lengths in the high-coverage (2 times 1)-2O phase are 2.01 A and 2.04 A (LEED). Although the adsorption energy decreases by 220 meV with O coverage (DFT calculations), we observe experimentally a shortening of the Ru(1)-O bond length with O coverage. This effect could not be reconciled with the present DFT-GGA calculations. The nu(Ru-O) stretch mode is found at 67 meV [c(2 times 4)-2O] and 64 meV [(2 times 1)pg-2O].Comment: 10 pages, figures are available as hardcopies on request by mailing [email protected], submitted to Phys. Rev. B (8. Aug. 97), other related publications can be found at http://www.rz-berlin.mpg.de/th/paper.htm

Detectable Anthropogenic Shift toward Heavy Precipitation over Eastern China

Changes in precipitation characteristics directly affect society through their impacts on drought and floods, hydro-dams, and urban drainage systems. Global warming increases the water holding capacity of the atmosphere and thus the risk of heavy precipitation. Here, daily precipitation records from over 700 Chinese stations from 1956 to 2005 are analyzed. The results show a significant shift from light to heavy precipitation over eastern China. An optimal fingerprinting analysis of simulations from 11 climate models driven by different combinations of historical anthropogenic (greenhouse gases, aerosols, land use, and ozone) and natural (volcanic and solar) forcings indicates that anthropogenic forcing on climate, including increases in greenhouse gases (GHGs), has had a detectable contribution to the observed shift toward heavy precipitation. Some evidence is found that anthropogenic aerosols (AAs) partially offset the effect of the GHG forcing, resulting in a weaker shift toward heavy precipitation in simulations that include the AA forcing than in simulations with only the GHG forcing. In addition to the thermodynamic mechanism, strengthened water vapor transport from the adjacent oceans and by midlatitude westerlies, resulting mainly from GHG-induced warming, also favors heavy precipitation over eastern China. Further GHG-induced warming is predicted to lead to an increasing shift toward heavy precipitation, leading to increased urban flooding and posing a significant challenge for mega-cities in China in the coming decades. Future reductions in AA emissions resulting from air pollution controls could exacerbate this tendency toward heavier precipitation

Fluxes and fate of dissolved methane released at the seafloor at the landward limit of the gas hydrate stability zone offshore western Svalbard

Widespread seepage of methane from seafloor sediments offshore Svalbard close to the landward limit of the gas hydrate stability zone (GHSZ) may, in part, be driven by hydrate destabilization due to bottom water warming. To assess whether this methane reaches the atmosphere where it may contribute to further warming, we have undertaken comprehensive surveys of methane in seawater and air on the upper slope and shelf region. Near the GHSZ limit at ?400 m water depth, methane concentrations are highest close to the seabed, reaching 825 nM. A simple box model of dissolved methane removal from bottom waters by horizontal and vertical mixing and microbially mediated oxidation indicates that ?60% of methane released at the seafloor is oxidized at depth before it mixes with overlying surface waters. Deep waters are therefore not a significant source of methane to intermediate and surface waters; rather, relatively high methane concentrations in these waters (up to 50 nM) are attributed to isopycnal turbulent mixing with shelf waters. On the shelf, extensive seafloor seepage at <100 m water depth produces methane concentrations of up to 615 nM. The diffusive flux of methane from sea to air in the vicinity of the landward limit of the GHSZ is ?4–20 ?mol m?2 d?1, which is small relative to other Arctic sources. In support of this, analyses of mole fractions and the carbon isotope signature of atmospheric methane above the seeps do not indicate a significant local contribution from the seafloor source

Direct isotopic evidence of biogenic methane production and efflux from beneath a temperate glacier

The base of glaciers and ice sheets provide environments suitable for the production of methane. High pressure conditions beneath the impermeable ‘cap’ of overlying ice promote entrapment of methane reserves that can be released to the atmosphere during ice thinning and meltwater evacuation. However, contemporary glaciers and ice sheets are rarely accounted for as methane contributors through field measurements. Here, we present direct field-based evidence of methane production and release from beneath the Icelandic glacier Sólheimajökull, where geothermal activity creates sub-oxic conditions suited to methane production and preservation along the meltwater flow path. Methane production at the glacier bed (48 tonnes per day, or 39 mM CH4 m−2 day−1), and evasion to the atmosphere from the proglacial stream (41 tonnes per day, or 32 M CH4 m−2 day−1) indicates considerable production and release to the atmosphere during the summer melt season. Isotopic signatures (−60.2‰ to −7.6‰ for δ13CCH4 and −324.3‰ to +161.1‰ for DCH4), support a biogenic signature within waters emerging from the subglacial environment. Temperate glacial methane production and release may thus be a significant and hitherto unresolved contributor of a potent greenhouse gas to the atmosphere