69 research outputs found
REACH MUSC: A Telemedicine Facilitated Network for Stroke: Initial Operational Experience
REACH Medical University of South Carolina (MUSC) provides stroke consults via the internet in South Carolina. From May 2008 to April 2011 231 patients were treated with intravenous (IV) thrombolysis and 369 were transferred to MUSC including 42 for intra-arterial revascularization [with or without IV tissue plasminogen activator (tPA)]. Medical outcomes and hemorrhage rates, reported elsewhere, were good (Lazaridis et al., 2011). Here we report operational features of REACH MUSC which covers 15 sites with 2,482 beds and 471,875 Emergency Department (ED) visits per year. Eight Academic Faculty from MUSC worked with 165 different physicians and 325 different nurses in the conduct of 1085 consults. For the 231 who received tPA, time milestones (in minutes) were: Onset to Door: 62 (mean), 50 (median); Door to REACH Consult: 43 and 33, Consult Request to Consult Start: was 9 and 7, Consult Start to tPA Decision: 31 and 25; Decision to Infusion: 20 and 14, and total Door to Needle: 98 and 87. The comparable times for the 854 not receiving tPA were: Onset to Door: 140 and 75; Door to REACH Consult: 61 and 41; Consult Request to Consult Start: 9 and 7, Consult Start to tPA Decision: 27 and 23. While the consultants respond to consult requests in <10, there is a long delay between arrival and Consult request. Tracking of operations indicates if we target shortening Door to Call time and time from tPA decision to start of drug infusion we may be able to improve Door to Needle times to target of <60. The large number of individuals involved in the care of these patients, most of whom had no training in REACH usage, will require novel approaches to staff education in ED based operations where turnover is high. Despite these challenges, this robust system delivered tPA safely and in a high fraction of patients evaluated using the REACH MUSC system
A Guide to the Dead Sea Scrolls and Related Literature What Are the Dead Sea Scrolls and Why Do They Matter? The Dead Sea Scrolls: A Short History
Linguistics, Philology, and the Role of Theory: Linguistic and Philological Perspectives: Papers forming part of the 2017 and 2018 SBL Linguistics and Biblical Hebrew Seminar
What is “philology” in contemporary research? How does it relate to linguistics? Does studying language for the purpose of reading texts legitimise a pre-theoretical approach to language analysis? Is research without an explicit theoretical undergirding (no matter how deep beneath the overt layers of argument) anything more than naive empiricism? This essay addresses a long-standing issue in Biblical Hebrew studies that has recently flared up: is a theory of language necessary for the study of Biblical Hebrew grammar? Rather than a comprehensive review of literature on the study of Biblical Hebrew, this essay is programmatic, weaving questions of discipline, theory, and praxis together to present a case for how Biblical Hebrew linguists ought to orient themselves in the process of collecting and analysing their data
Anaphora in Biblical Hebrew: A Generative Perspective: “Theoretical Approaches to Anaphora and Pronouns in Biblical Hebrew”: Papers forming part of the 2017 SBL Linguistics and Biblical Hebrew Seminar (Boston, USA)
Anaphora, that is, backwards-referring relations, are well-known in language and include such common items as a variety of pro-forms (it, that, myself, each other) and even adverbs (so). Lesser studied are forward-referring relations, i.e., cataphora. Biblical Hebrew utilises a variety of anaphoric relations, though it lacks a true reflexive anaphor. This study will introduce the investigation of anaphora from a generative syntactic perspective, then proceed to a survey of the features of Biblical Hebrew anaphora, and finally conclude with a discussion of anaphoric complexities that require future attention
University training of senior fire brigade officers. The new approach in Sweden
In Sweden a fundamental development has recently taken place in the training of future senior fire brigade officers. There are two main changes: the training period has been substantially increased and the theoretical part upgraded to university curriculum level with final requirements corresponding to a university undergraduate degree. The new educational system reflects the changing and expanding role of fire brigades and the need for a professionally improved leadership. To put the new training system into a proper context, the varied and dissimilar responsibilities of a Swedish fire brigade officer should be touched upon. Four main sectors are identified: business administration, fire prevention, training of employed staff and rescue service operations. The main structure of the training system and the university curriculum are discussed
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Abstract TMP4: Impact of Bridging Therapy With Intravenous Thrombolysis Prior to Mechanical Thrombectomy in Patients With Large Vessel Occlusion- Insights From the STAR Registry
Introduction:
Clinical trials have proven the safety and efficacy of mechanical thrombectomy (MT) with intravenous alteplase (tPA) compared to tPA alone in patients presenting with large vessel occlusion (LVO). The impact of tPA prior to MT on procedural metrics, successful revascularization, symptomatic hemorrhage and long-term functional outcome has not been established from large scale real-world studies. In this study we evaluate the impact of tPA prior to MT on procedural times, immediate and long-term outcomes.
Methods:
The STAR registry combined prospectively maintained databases of 11 thrombectomy-capable stroke centers in the US, Europe and Asia. Patients who received mechanical thrombectomy with or without intravenous tPA prior to MT were included in these analyses. Baseline characteristics, procedural time, successful revascularization (TICI ≥ 2B), symptomatic intracranial hemorrhage (PH2), and long-term functional outcomes were compared between the two groups.
Results:
Total of 1869 patients were included in this analysis. Of those, 907 received tPA prior to MT. Baseline features and outcomes are summarized in table 1. There were more white patients in the non-tPA group, and more patients in this group had atrial fibrillation and hyperlipidemia; otherwise there were no differences in baseline features between the two groups. Median NIHSS on admission was 16 in both groups, median ASPECTS was 9 in the tPA group versus 8 in the non-tPA group, p=0.208. Patients in the tPA group had higher rate of successful revascularization, lower number of revascularizations attempts and were more likely to achieve excellent long-term functional outcome. There was no difference in procedural time, rate of symptomatic hemorrhage or length of hospital stay.
Conclusion:
Bridging therapy with intravenous tPA prior to mechanical thrombectomy may facilitate MT and yield to better long-term functional outcome
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