Statistical analysis of the primary outcome in acute stroke trials

Common outcome scales in acute stroke trials are ordered categorical or pseudocontinuous in structure but most have been analyzed as binary measures. The use of fixed dichotomous analysis of ordered categorical outcomes after stroke (such as the modified Rankin Scale) is rarely the most statistically efficient approach and usually requires a larger sample size to demonstrate efficacy than other approaches. Preferred statistical approaches include sliding dichotomous, ordinal, or continuous analyses. Because there is no best approach that will work for all acute stroke trials, it is vital that studies are designed with a full understanding of the type of patients to be enrolled (in particular their case mix, which will be critically dependent on their age and severity), the potential mechanism by which the intervention works (ie, will it tend to move all patients somewhat, or some patients a lot, and is a common hazard present), a realistic assessment of the likely effect size, and therefore the necessary sample size, and an understanding of what the intervention will cost if implemented in clinical practice. If these approaches are followed, then the risk of missing useful treatment effects for acute stroke will diminish

Rejoinder

Classical and Mediterranean Archaeolog

The hidden landscape of prehistoric Greece.

Classical and Mediterranean Archaeolog

A radical rethink on approaches to surface survey and the rural landscape of Central Greece in Roman times.

Classical and Mediterranean Archaeolog

A Model for the Stray Light Contamination of the UVCS Instrument on SOHO

We present a detailed model of stray-light suppression in the spectrometer channels of the Ultraviolet Coronagraph Spectrometer (UVCS) on the SOHO spacecraft. The control of diffracted and scattered stray light from the bright solar disk is one of the most important tasks of a coronagraph. We compute the fractions of light that diffract past the UVCS external occulter and non-specularly pass into the spectrometer slit. The diffracted component of the stray light depends on the finite aperture of the primary mirror and on its figure. The amount of non-specular scattering depends mainly on the micro-roughness of the mirror. For reasonable choices of these quantities, the modeled stray-light fraction agrees well with measurements of stray light made both in the laboratory and during the UVCS mission. The models were constructed for the bright H I Lyman alpha emission line, but they are applicable to other spectral lines as well.Comment: 19 pages, 5 figures, Solar Physics, in pres

Translating solid state organic synthesis from a mixer mill to a continuous twin screw extruder

YesA study on the translation of a solid-state synthetic reaction from a mechanochemical mixer-mill to a continuous twin-screw extruder is discussed herein. The study highlights some considerations to be made and parameters to be tested in the context of a model fluorination reaction, which is the first organic fluorination to be attempted using extrusion. Upon optimization, which features the first use of grinding auxiliary solids to enable effective synthetic extrusion, the difluorination reaction was successfully translated to the extruder, leading to a 100-fold improvement in Space Time Yield (STY); 29 kg m−3 day−1 in a mixer mill to 3395 kg m−3 day−1 in a twin screw extruder.D. L. B is grateful to the EPSRC for a First Grant (D. L. B. EP/P002951/1), CRD for a studentship award to J. L. H., Queen’s University Belfast for a Visiting Research Fellowship and the School of Chemistry at Cardiff University for generous support. S. L. J. is grateful to EPSRC for support (EP/L019655/1)

Palatini Variational Principle for an Extended Einstein-Hilbert Action

We consider a Palatini variation on a generalized Einstein-Hilbert action. We find that the Hilbert constraint, that the connection equals the Christoffel symbol, arises only as a special case of this general action, while for particular values of the coefficients of this generalized action, the connection is completely unconstrained. We discuss the relationship between this situation and that usually encountered in the Palatini formulation.Comment: 14 pages, LaTe

Breaking the Cycle of Pain In Diabetic Peripheral Neuropathy

An attitude of helplessness pervades both patients and health professionals when dealing with the problems of dia betic peripheral neuropathy. Those afflicted are often over whelmed by the pain and find themselves unable to fulfill the daily requirements of their diabetes regimen. The in consistencies in amounts and timing of meals, levels of ac tivity, and scheduling of insulin injections can result in hyperglycemia, a state that has been found to correlate strongly with the occurrence of nerve damage. Thus the pain perpetrates itself. For the health professional, having to confront this devastating pain without objective factors to assess and few scientific treatment measures to offer con tributes to a sense of inadequacy and ignorance. It is fre quently assumed that "nothing can be done." In reality, health professionals do have something to offer the person suffering from this condition. First, they can provide infor mation about the relationship between control and compli cations, and explain the need for the patient to change those behaviors that may be perpetuating the pain. Sec ond, and most importantly, health professionals can con vey support and confidence, without which many patients will be unable to make the changes in their behavior neces sary to resolve their pain.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68854/2/10.1177_014572178501100103.pd

Shaping a Corporate Identity From Below; the Role of the BAT Bulletin.

Existing studies that have explored the use of company journals as a mode of corporate communication during the early 20th century have invariably adopted an instrumentalist view of these publications. Company journals have been seen as a means of projecting to employees a top-down view of organisations. This article identifies a counter-example in which the origins of a company journal, the 'Bat Bulletin', are seen to arise as the result of an initiative stemming from the employees themselves. These antecedents gave the 'Bat Bulletin' a high degree of legitimacy amongst staff and provided the company with an important means of establishing a unified corporate culture across a disparate group international operating companies. Over time, however, the contents of the journal gradually became more conventional, and it was eventually closed down when the strategy of international integration ceased to be a desirable corporate objective during the 1930's