19,835 research outputs found

    The past is the future: innovative designs in acute stroke therapy trials

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    Comparison of lightning location data and polarisation radar observations of clouds

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    Simultaneous observations of both the precipitation and the lightning associated with thunderstorms show that the lightning is within 3 km of the maximum precipitation echo. The intensity and type of the precipitation is observed with 500 m spatial accuracy using an S-band polarization radar and the position of the lightning is inferred from a low frequency magnetic direction finding location system. Empirical adjustment to the angles using the redundancy of the lightning data reduce this error. Radar echoes above 45dBZ may be caused by soft hail or hailstones, but similarly intense echoes may result from melting snow. The data show that a new polarization radar parameter, the linear depolarization ratio, can distinguish between soft hail and melting snow, and that the intense radar echoes associated with melting snow pose no threat of lightning. A lightning risk only exists when the radar indicates that the clouds contain soft hail or hailstones

    Chemical structure matching using correlation matrix memories

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    This paper describes the application of the Relaxation By Elimination (RBE) method to matching the 3D structure of molecules in chemical databases within the frame work of binary correlation matrix memories. The paper illustrates that, when combined with distributed representations, the method maps well onto these networks, allowing high performance implementation in parallel systems. It outlines the motivation, the neural architecture, the RBE method and presents some results of matching small molecules against a database of 100,000 models

    Reliability of the modified Rankin Scale: a systematic review

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    <p><b>Background and Purpose:</b> A perceived weakness of the modified Rankin Scale is potential for interobserver variability. We undertook a systematic review of modified Rankin Scale reliability studies.</p> <p><b>Methods:</b> Two researchers independently reviewed the literature. Crossdisciplinary electronic databases were interrogated using the following key words: Stroke*; Cerebrovasc*; Modified Rankin*; Rankin Scale*; Oxford Handicap*; Observer variation*. Data were extracted according to prespecified criteria with decisions on inclusion by consensus.</p> <p><b>Results:</b> From 3461 titles, 10 studies (587 patients) were included. Reliability of modified Rankin Scale varied from weighted κ=0.95 to κ=0.25. Overall reliability of mRS was κ=0.46; weighted κ=0.90 (traditional modified Rankin Scale) and κ=0.62; weighted κ=0.87 (structured interview).</p> <p><b>Conclusion:</b> There remains uncertainty regarding modified Rankin Scale reliability. Interobserver studies closest in design to large-scale clinical trials demonstrate potentially significant interobserver variability.</p&gt

    Effect of hyperthermia on prognosis after acute ischemic stroke

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    <p><b>Background and Purpose:</b> Experimental studies have shown that hyperthermia is a determinant of poor outcome after ischemic stroke. Clinical studies evaluating the effect of temperature on poststroke outcome have, however, been limited by small sample sizes. We sought to evaluate the effect of temperature and timing of hyperthermia on outcome after ischemic stroke.</p> <p><b>Methods:</b> Data of 5305 patients in acute stroke trials from the Virtual International Stroke Trials Archive (VISTA) data set were analyzed. Data for temperatures at baseline, eighth, 24th, 48th, and 72nd hours, and seventh day were assessed in relation to outcome (poor versus good) based on the modified Rankin Scale at 3 months. Hyperthermia was defined as temperature >37.2°C and poor outcome as 90-day modified Rankin Scale >2. Hazard ratios with 95% CIs were reported for hyperthermia in relation to the outcome. Logistic regression models, in relation to hyperthermia, were fitted for a set of preselected covariates at different time points to identify predictors/determinants of hyperthermia.</p> <p><b>Results:</b> The average age of patients was 68.0±11.9 years, 2380 (44.9%) were females, and 42.3% (2233) received thrombolysis using recombinant tissue plasminogen activator. After adjustment, hyperthermia was a statistically significant predictor of poor outcome. The hazard ratios (95% CI) for poor outcome in relation to hyperthermia at different time points were: baseline 1.2 (1.0 to 1.4), eighth hour 1.7 (1.2 to 2.2), 24th hour 1.5 (1.2 to 1.9), 48th hour 2.0 (1.5 to 2.6), 72nd hour 2.2 (1.7 to 2.9), and seventh day 2.7 (2.0 to 3.8). Gender, stroke severity (National Institutes of Health Stroke Scale score >16), white blood cell count, and antibiotic use were significantly associated with hyperthermia (P≤0.01).</p> <p><b>Conclusions:</b> Hyperthermia, in acute ischemic stroke, is associated with a poor clinical outcome. The later the hyperthermia occurs within the first week, the worse the prognosis. Severity of stroke and inflammation are important determinants of hyperthermia after ischemic stroke. In patients with acute ischemic stroke, aggressive measures to prevent and treat hyperthermia could improve the clinical outcomes.</p&gt

    Variability in modified rankin scoring across a large cohort of observers

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    <br>Background and Purpose— The modified Rankin scale (mRS) is the most commonly used outcome measure in stroke trials. However, substantial interobserver variability in mRS scoring has been reported. These studies likely underestimate the variability present in multicenter clinical trials, because exploratory work has only been undertaken in single centers by a few observers, all of similar training. We examined mRS variability across a large cohort of international observers using data from a video training resource.</br> <br>Methods— The mRS training package includes a series of “real-life” patient interviews for grading. Training data were collected centrally and analyzed for variability using kappa statistics. We examined variability against a standard of “correct” mRS grades; examined variability by country; and for UK assessors, examined variability by center and by professional background of the observer.</br> <br>Results— To date, 2942 assessments from 30 countries have been submitted. Overall reliability for mRS grading has been moderate to good with substantial heterogeneity across countries. Native English language has had little effect on reliability. Within the United Kingdom, there was no significant variation by profession.</br> <br>Conclusion— Our results confirm interobserver variability in mRS assessment. The heterogeneity across countries is intriguing because it appears not to be related solely to language. These data highlight the need for novel strategies to improve reliability.</br&gt

    Exploring the reliability of the modified Rankin Scale

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    <p><b>Background and Purpose:</b> The modified Rankin Scale (mRS) is the most prevalent outcome measure in stroke trials. Use of the mRS may be hampered by variability in grading. Previous estimates of the properties of the mRS have used diverse methodologies and may not apply to contemporary trial populations. We used a mock clinical trial design to explore inter- and intraobserver variability of the mRS.</p> <p><b>Methods:</b> Consenting patients with stroke attending for outpatient review had the mRS performed by 2 independent assessors with pairs of assessors selected from a team of 3 research nurses and 4 stroke physicians. Before formal assessment, interviewers estimated disability based only on initial patient observation. Each patient was then randomized to undergo the mRS using standard assessment or a prespecified structured interview. The second interviewer in the pair reassessed the patient using the same method blinded to the colleague’s score. For each patient assessed, one rater was randomly assigned to video record their interview. After 3 months, this interviewer reviewed and regraded their original video assessment.</p> <p><b>Results:</b> Across 100 paired assessments, interobserver agreement was moderate (k=0.57). Intraobserver variability was good (k=0.72) but less than would be expected from previous literature. Forty-nine assessments were performed using the structured interview approach with no significant difference between structured and standard mRS. Researchers were unable to reliably predict mRS from initial limited patient assessment (k=0.16).</p> <p><b>Conclusions:</b> Despite availability of training and structured interview, there remains substantial interobserver variability in mRS grades awarded even by experienced researchers. Additional methods to improve mRS reliability are required.</p&gt

    Temperature dependence of the average electron-hole pair creation energy in Al0.8Ga0.2As

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    The temperature dependence of the average energy consumed in the creation of an electron-hole pair in the wide bandgap compound semiconductor Al 0.8Ga0.2As is reported following X-ray measurements made using an Al0.8Ga0.2As photodiode diode coupled to a low-noise charge-sensitive preamplifier operating in spectroscopic photon counting mode. The temperature dependence is reported over the range of 261 K-342 K and is found to be best represented by the equation ε AlGaAs 7.327-0.0077 T, where εAlGaAs is the average electron-hole pair creation energy in eV and T is the temperature in K. © 2013 © 2013 Author(s)

    A comparison of the physical and chemical composition of UK waste streams based on hypothetical compound structure

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    The suitability and effectiveness of a waste treatment process or strategy depends upon a waste stream’s physical and chemical composition. Chemical properties of UK waste streams, particularly MSW, are limited while physical properties are better documented. Consequently this presents a degree of uncertainty with the waste’s properties, manifesting itself as financial risk in the investment of new treatment or disposal plant. To mitigate this uncertainty, a number of UK waste surveys have been reviewed to determine if there is significant difference in the calorific value between waste streams. Ultimate and proximate analysis data from a number of sources have been collected and used to approximate the chemical composition of each waste fraction. To facilitate the comparison of each waste stream, a hypothetical compound of the form C6HaOb has been determined for each. Based on this analysis, all UK waste streams share the hypothetical formula C6H10O3, indicating that on a dry basis, the composition of waste in the UK is fairly consistent. Monte Carlo analysis of the hypothetical compound structure revealed that for both household and civic amenity waste streams, the hydrogen and oxygen content only deviate slightly from the mean values. Since MSW is predominantly comprised of household and civic amenity waste, the hypothetical compound C6H10O3 can be used to approximate UK MSW
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