Resolution of Occlusive Carotid Artery Thrombus Treated with Anticoagulation as Demonstrated on Duplex Ultrasonography.

BACKGROUND AND PURPOSE: While the majority of cerebral ischemic events due to carotid occlusive disease result from atherosclerotic plaque rupture, intraluminal carotid artery thrombus occasionally occurs in patients without preexisting carotid atherosclerosis. Identification of nonatherosclerotic thrombus as the cause of the carotid occlusive disease can obviate the need for an interventional procedure, and resolution of thrombus can be monitored with B-mode duplex ultrasonography. METHODS: We reviewed 3 patients treated on The Mount Sinai Hospital Stroke Unit with anticoagulation for nonatherosclerotic carotid thrombi and followed with serial Doppler ultrasonogrpahy for resolution of thrombus. RESULTS: Occlusive carotid thrombus was successfully treated in all 3 patients with systemic anticoagulation. B-mode duplex ultrasonography allowed for demonstration of resolving thrombus. CONCLUSION: Differentiation between a stenotic plaque and occlusive thrombus can be achieved by ultrasonographic analysis of thrombus morphology, attachment site potential, and characteristics of a resolving thrombus. Systemic anticoagulation can safely and effectively eliminate the risk for future embolization and complete occlusion of the carotid artery in patients who present with transient ischemic events or completed infarcts of small size

Women’s Experiences and Perspectives of Certification Schemes and Empowerment in the Costa Rican Coffee Industry

Coffee certification schemes, such as Fair Trade, Rainforest Alliance, and Organic, influence the environmental, economic, and social conditions of the global coffee industry by promoting sustainable production practices and equitable trade relations. Over the past three decades, studies show that adhering to environmental standards supports ecological conservation in agricultural communities. However, research examining the economic and social impacts among producers yields mixed results due to context-specific factors such as management strategies, landholding size, and market conditions. Furthermore, although many certification schemes incorporate gender equality and women’s empowerment initiatives, little attention has been given to the perspectives of women producers, many of whom confront challenges due to socially constructed gender norms. This research addresses this gap in knowledge through case study analysis of two organizations in southern Costa Rica: CoopeAgri, a mixed-gender producer cooperative, and ASOMOBI, an all-women’s coffee association. Data were gathered through in-depth interviews, document analysis, and participant observation within each organization. Preliminary results suggest that while the majority of women believe certifications can provide benefits, there are significant costs (i.e., money, time, energy), and the actual benefits received can be minimal

Coffee Certifications as Potential Pathways to Women’s Empowerment in Costa Rica

The market for certified coffee is rapidly expanding and influencing the environmental, economic, and social conditions of global coffee production. Overarching goals of coffee certification schemes, such as fair trade, include encouraging sustainable production practices and promoting equitable trade relations that enhance economic stability and quality of life for producers. Women play a significant role in the coffee industry; yet, they typically have little control over resources and harvest proceeds and limited participation in decision-making processes. Although some certification schemes, namely Fairtrade International, include gender equality and women’s empowerment initiatives, knowledge and understanding of how certifications can create pathways to women’s empowerment remain limited. To address this gap in knowledge, this research consists of a case study comparing two coffee organizations in Costa Rica: CoopeAgri, a mixed-gender fair trade-certified cooperative, and ASOMOBI, an all-women’s non-fair trade-certified association. Qualitative methods were employed to obtain in-depth data exploring women’s experiences in the Costa Rican coffee industry and their perspectives on certification schemes and empowerment. Data was analyzed using Jo Rowlands’ (1995) framework conceptualizing empowerment as a result of cultivating forms of “positive power.” Results suggest that while certification schemes minimally contribute to some components of empowerment, primarily through increased incomes and access to resources in organizations, economic and social factors (e.g. low consumer demand for certified coffee, persistence of traditional gender roles) limit certifications’ capacity to create pathways to empowerment. This study also explores how the scale and structure (i.e. women-only versus mixed-gender) of local organizations influence their ability to facilitate women’s empowerment. Results indicate that smaller-scale, women-only settings may be more effective for creating pathways to empowerment for women in the Costa Rican coffee industry. Results of this preliminary study provide a base upon which future research examining certification schemes and women’s empowerment can be built

Review of A Troublesome Inheritance by Nicholas Wade

Review of A Troublesome Inheritance: Genes, Race and Human History, by Nicholas Wade. New York: Penguin Press, 2013. x + 278 pp. 978-1-5942-0446-3 (hardcover). US $27.95

Review of \u27A Troublesome Inheritance\u27 by Nicholas Wade

Review of A Troublesome Inheritance: Genes, Race and Human History, by Nicholas Wade. New York: Penguin Press, 2013. x + 278 pp. 978-1-5942-0446-3 (hardcover). US $27.95

Timing of vessel imaging for suspected large vessel occlusions does not affect groin puncture time in transfer patients with stroke.

BACKGROUND: Access to endovascular therapy (ET) in cases of acute ischemic stroke may be limited, and rapid transfer of eligible patients to hospitals with endovascular capability is needed. OBJECTIVE: To determine the optimal timing of diagnostic CT angiography to confirm large vessel occlusion (LVO). METHODS: Of 57 emergency department transfers to Mount Sinai Hospital (MSH) for possible ET from January 2015 through March 2016, 39 (68%) underwent ET, among whom 22 (56%) had CT angiography before transfer and 17 (44%) had CT angiography on arrival. We compared mean outside hospital arrival to groin puncture (OTG) time between the two groups using t-tests and Wilcoxon rank sum tests. OTG was defined as the difference between groin puncture and outside hospital arrival time minus ambulance travel time. RESULTS: Average age was 73±13 years and average National Institute of Health Stroke Scale score was 19±5. There was no difference in average OTG time between the two groups (191 min for CT angiography at outside hospital vs 190 min for CT angiography at MSH (p=0.99 for t-test and 0.69 for rank sum test)). Among the 18 patients who were transferred but did not receive ET, 10 had no LVO, 5 had large established infarcts on arrival and 3 had post-tissue plasminogen activator hemorrhage. In 9/10 patients without LVO, CT angiography was not performed before transfer. CONCLUSIONS: CT angiography timing in the transfer process does not affect OTG time, but 90% of patients without LVO had not had CT angiography before transfer. Hence, it might be beneficial to obtain a CT angiogram at the outside hospital, if it can be acquired and read rapidly, to avoid the cost and potential clinical deterioration associated with unnecessary transfers

BEFAST Assessment in a Rural Community Hospital – the BIRCH Study

Background: There are known regional disparities in treatment rates with thrombolysis and thrombectomy for acute ischemic stroke. BEFAST has been implemented in acute stroke protocols to aid in recognition of signs of stroke, but its utility in a rural ED is not well known.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1001/thumbnail.jp

Intermediate-Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set.

BACKGROUND: Studies on stroke risk following cardiac procedures addressed only perioperative and long-term risk following limited higher-risk procedures, were poorly generalizable, and often failed to stratify by stroke type. We calculated stroke risk in the intermediate risk period following cardiac procedures compared with common noncardiac surgeries and medical admissions. METHODS AND RESULTS: The Nationwide Readmissions Database contains readmission data for 49% of US admissions in 2013. We compared age-adjusted stroke readmission rates up to 90 days postdischarge. We used Cox regression to calculate hazard ratios, up to 1 year, of stroke risk comparing transcatheter aortic valve replacement versus surgical aortic valve replacement and coronary artery bypass graft versus percutaneous coronary intervention. Procedures and diagnoses were identified by International Classification of Disease, Ninth Revision, Clinical Modification codes. After cardiac procedures, 90-day ischemic stroke readmission rate was highest after transcatheter aortic valve replacement (2.05%); 90-day hemorrhagic stroke rate was highest after left ventricular assist device placement (0.09%). The hazard ratio for ischemic stroke after transcatheter aortic valve replacement, compared with surgical aortic valve replacement, in fully adjusted Cox models was 1.86 (95% confidence interval, 1.12-3.08; P=0.016) and 6.17 (95% confidence interval, 1.97-19.33; P=0.0018) for hemorrhagic stroke. There was no difference between coronary artery bypass graft and percutaneous coronary intervention. CONCLUSIONS: We demonstrated elevated readmission rates for ischemic and hemorrhagic stroke in the intermediate 30-, 60-, and 90-day risk periods following common cardiac procedures. Furthermore, we found an elevated risk of stroke after transcatheter aortic valve replacement compared with surgical aortic valve replacement up to 1 year

Cellular Distribution Pattern of tjp1 (ZO-1) in Xenopus laevis Oocytes Heterologously Expressing Claudins

Epithelial barriers constitute a fundamental requirement in every organism, as they allow the separation of different environments and set boundaries against noxious and other adverse effectors. In many inflammatory and degenerative diseases, epithelial barrier function is impaired because of a disturbance of the paracellular seal. Recently, the Xenopus laevis oocyte has been established as a heterologous expression model for the analysis of transmembrane tight junction protein interactions and is currently considered to be a suitable screening model for barrier effectors. A prerequisite for this application is a physiological anchoring of claudins to the cytoskeleton via the major scaffolding protein tjp1 (tight junction protein 1, ZO-1). We have analyzed the oocyte model with regard to the interaction of heterologously expressed claudins and tjp1. Our experiments have revealed endogenous tjp1 expression in protein and mRNA analyses of unfertilized Xenopus laevis oocytes expressing human claudin 1 (CLDN1) to claudin 5 (CLDN5). The amphibian cell model can therefore be used for the analysis of claudin interactions