Clinical and radiological recurrence after childhood arterial ischemic stroke

Background: Data on rates and risk factors for clinical and radiological recurrence of childhood arterial ischemic stroke (AIS) might inform secondary prevention strategies. Methods and Results: Consecutive Great Ormond Street Hospital patients with first AIS were identified retrospectively (1978–1990) and prospectively (1990–2000). Patients underwent repeat neuroimaging at the time of clinical recurrence or, if asymptomatic, at least 1 year after AIS. Cox and logistic regression analyses were used to explore the relationships between risk factors and clinical and radiological recurrence, respectively. A total of 212 patients were identified, of whom 97 had another prior diagnosis. Seventy-nine children had a clinical recurrence (29 strokes, 46 transient ischemic attacks [TIAs], 4 deaths with reinfarction 1 day to 11.5 years (median 267 days) later); after 5 years, 59% (95% confidence interval, 51% to 67%) were recurrence free. Moyamoya on angiography and low birth weight were independently associated with clinical recurrence in the whole group. Genetic thrombophilia was associated with clinical recurrence in previously healthy patients, independent of the presence of moyamoya. Sixty of 179 patients who had repeat neuroimaging had radiological reinfarction, which was clinically silent in 20. Previous TIA, bilateral infarction, prior diagnosis (specifically immunodeficiency), and leukocytosis were independently associated with reinfarction. Previous TIA and leukocytosis were also independently associated with clinically silent reinfarction. Conclusions: Clinical and radiological recurrence are common after childhood AIS. The risk of clinical recurrence is increased in children with moyamoya and, in previously healthy patients, in those with genetic thrombophilia. Preexisting pathology, including immunodeficiency, and persistent leukocytosis are risk factors for radiological recurrence, which suggests a potential role for chronic infection

Attacks on midwives, attacks on women’s choices

Nadine Edwards, Jo Murphy-Lawless, Mavis Kirkham and Sarah Davies ask whether recent attacks on midwives are a Human Rights issu

Hydraulic characterisation of the tailings associated with the abandoned mine at Frongoch, Mid-Wales

This report describes the material classification and results of field and laboratory hydraulic testing of tailings from the Frongoch Tailings Lagoon, situated immediately to the south of the abandoned Frongoch mine site in mid-Wales. The results are considered in the context of the conceptual site model

Structure of self-assembled Mn atom chains on Si(001)

Mn has been found to self-assemble into atomic chains running perpendicular to the surface dimer reconstruction on Si(001). They differ from other atomic chains by a striking asymmetric appearance in filled state scanning tunneling microscopy (STM) images. This has prompted complicated structural models involving up to three Mn atoms per chain unit. Combining STM, atomic force microscopy and density functional theory we find that a simple necklace-like chain of single Mn atoms reproduces all their prominent features, including their asymmetry not captured by current models. The upshot is a remarkably simpler structure for modelling the electronic and magnetic properties of Mn atom chains on Si(001).Comment: 5 pages, 4 figure

Factors associated with midwives\u27 job satisfaction and intention to stay in the profession: An integrative review

AIMS AND OBJECTIVES: To conduct an integrative review of the factors associated with why midwives stay in midwifery. BACKGROUND: Midwifery retention and attrition are globally acknowledged as an issue. However, little is known as to why midwives stay in midwifery as the focus has previously focussed on why they leave. DESIGN: A structured six-step integrative review approach was used, and this involved the development of a search strategy, study selection and critical appraisal, data abstraction and synthesis, interpretation of findings and recommendations for future practice. METHODS: The review was conducted using the databases MEDLINE, CINAHL and PsychInfo. Included studies were in the English language with an unlimited publication date. RESULTS: Six studies were included in this review: one qualitative, two quantitative and three using mixed methods. Seven themes emerged from synthesisation of the data reported for the six included studies that together help answer the question of why midwives stay in midwifery. CONCLUSION: This integrative review has highlighted some important factors that assist in answering the question why midwives stay in midwifery. However, it has also highlighted the need for quality data that reflects the range of contexts in which midwifery is practised. RELEVANCE TO CLINICAL PRACTICE: There is an abundance of literature focussing on why midwives leave the profession; however, the gap exists in the reasons why midwives stay. If we can uncover this important detail, then changes within the profession can begin to be implemented, addressing the shortage of midwives issue that has been seen globally for a large number of years

Lady and the accounts: Missing from accounting history?

Amanda Vickery\u27s, The Gentleman\u27s Daughter: Women\u27s Lives in Georgian England, [1998] provides a challenging and controversial account of the lives of genteel women in provincial England. In this review essay, we consider the implications of her insights and revelations for accounting history research. We argue that her work raises a number of issues concerning what and where accounting took place in the 18th century. In particular, it is suggested that the detailed accounts\u27 contained within genteel women\u27s pocket books were a means by which they came to know\u27 their household in order to manage their duties and responsibilities. Accounting historians are encouraged to consider these private\u27 records as a potentially illuminating source of material on accounting within and without the 18th-century household

Electronic coupling between Bi nanolines and the Si(001) substrate: An experimental and theoretical study

Atomic nanolines are one dimensional systems realized by assembling many atoms on a substrate into long arrays. The electronic properties of the nanolines depend on those of the substrate. Here, we demonstrate that to fully understand the electronic properties of Bi nanolines on clean Si(001) several different contributions must be accounted for. Scanning tunneling microscopy reveals a variety of different patterns along the nanolines as the imaging bias is varied. We observe an electronic phase shift of the Bi dimers, associated with imaging atomic p-orbitals, and an electronic coupling between the Bi nanoline and neighbouring Si dimers, which influences the appearance of both. Understanding the interplay between the Bi nanolines and Si substrate could open a novel route to modifying the electronic properties of the nanolines.Comment: 6 pages (main), 2 pages (SI), accepted by Phys. Rev.

A methodological approach for assessing the uptake of core outcome sets using ClinicalTrials.gov: findings from a review of randomised controlled trials of rheumatoid arthritis

Objective To assess the uptake of the rheumatoid arthritis core outcome set using a new assessment method of calculating uptake from data in clinical trial registry entries. Design Review of randomised trials. Setting ClinicalTrials.gov. Subjects 273 randomised trials of drug interventions for the treatment of rheumatoid arthritis and registered in ClinicalTrials.gov between 2002 and 2016. Full publications were identified for completed studies from information in the trial registry or from an internet search using Google and the citation database Web of Science. Main outcome measure The percentage of trials reporting or planning to measure the rheumatoid arthritis core outcome set calculated from the information presented in the trial registry and compared with the percentage reporting the rheumatoid arthritis core outcome set in the resulting trial publications. Results The full rheumatoid arthritis core outcome set was reported in 81% (116/143) of trials identified on the registry as completed (or terminated) for which results were found in either the published literature or the registry. For trials identified on the registry as completed (or terminated), using information only available in the registry gives an estimate for uptake of 77% (145/189). Conclusions The uptake of the rheumatoid arthritis core outcome set in clinical trials has continued to increase over time. Using the information on outcomes listed for completed or terminated studies in a trial registry provides a reasonable estimate of the uptake of a core outcome set and is a more efficient and up-to-date approach than examining the outcomes in published trial reports. The method proposed may provide an efficient approach for an up-to-date assessment of the uptake of the 300 core outcome sets already published