Endovascular Cure of a Locked-In Patient

We report the case of a 60 year-old right-handed gentleman who became acutely “Locked-In” several days after a lower extremity orthopedic procedure. He underwent emergent endovascular treatment and had complete resolution of his neurologic findings except for mild dysarthria and dysphagia. Endovascular intervention for posterior circulation thrombosis is highly effective when patients are treated within 24 hours

Understanding Neurosurgery Through Experimental and Computer Models

Endovascular neurosurgery is an evolving field, with the goal of treating neurological disease with minimal invasion of the body. The current approach is to deliver focused therapies via catheters traveling through the vascular tree. Refinement and advancement of these techniques requires not just new ideas, but new ideas that hold up when tested through the scientific method. Before clinical trials can begin, ethics and law demand that the ideas are tested first under experimental models. One benefit of these pre-clinical tests is the early identification of side effects. Another is the opportunity to practice and polish surgical technique in advance of human surgery. Historically, the best models of human systems have been similar systems in appropriate animals. Like human care, animal use is governed by strict laws and regulations. Violating these rules can not only result in criminal penalties, they can also make the research worthless: an animal poorly cared for may have physical symptoms that mask or confound the response to treatment. As computing power has increased, mathematical models have become more popular. The advantages of computational models include relative costs and relative speed. No animals, drugs or equipment have to be purchased, just a computer and software. The disadvantage is that the computational model can only represent those aspects of the modeled system that are understood and quantifiable. This article is an overview of how both animal and computational models have been used to approximate neurovascular conditions by researchers seeking to explore treatment options

Case Report: Signal Drop on MRA Imaging of the Internal Carotid Artery after Neuroform Stent Placement

Magnetic resonance angiography (MRA) is an important tool in evaluating the patency of vessels which have previously been stented. Neuroform stents (Boston Scientific, Natick, MA, U.S.A.) are utilized to provide a scaffold across the neck of an aneurysm. These stents are synthesized from Nitinol (nickel and titanium) and thus cause minimal distortion upon imaging with MRA. Patients who have undergone Neuroform stent assisted coiling of aneurysms are routinely followed with MRA to delineate stenosis of the stented segment of vessel as well as recurrence of the aneurysms. While numerous reports show that Neuroform stents do not lead to MRA imaging artifact, we report of a case where the utilization of the Neuroform stent led to a signal drop out at the site of the stent upon evaluation with MRA and thus led to further invasive radiological procedures

E-puck motion control using multi-objective particle swarm optimization

This article describes the velocity-based motion and orientation control method for a differential-driven two-wheeled E-puck Robot (DDER) using the Multi-Objective Particle Swarm Optimization (MPSO) algorithm in the Virtual Robot Experimentation Platform (V-REP) software environment. The wheel velocities data and Infra-Red (IR) sensors reading make the multi-objective fitness functions for MPSO. We use front, left, and right IR sensors reading and right wheel velocity data to design the first fitness function for MPSO. Similarly, the front, left, and right IR sensors reading, and left wheel velocity data have been taken for making the second fitness function for MPSO. The multi-objective fitness functions of MPSO minimize the motion and orientation of the DDER during navigation. Due to the minimization of motion and orientation, the DDER covers less distance to reach the goal and takes less time. The Two-Dimensional (2D) and Three-Dimensional (3D) navigation results of the DDER among the scattered obstacles have been presented in the V-REP software environment. The comparative analysis with previously developed Invasive Weed Optimization (IWO) algorithm has also been performed to show the effectiveness and efficiency of the proposed MPSO algorithm

Use of observation followed by outpatient stress testing in chest pain patients with prior coronary artery disease history: An evaluation of prognostic utility.

OBJECTIVE: To determine the outcomes of patients with chest pain (CP) and prior history of coronary artery disease (CAD) managed with observation followed by outpatient stress myocardial perfusion imaging (MPI). METHODS: Retrospective analysis of patients with CP managed with observation followed by outpatient stress MPI, comparing cardiovascular (CV) event rates stratified by CAD history. RESULTS: 375 patients were included: 111 with and 264 without a CAD history. All patients underwent outpatient stress MPI within 72 h of observation. MPI identified patients at risk for CV events. However, while patients with negative MPI and without a CAD history had very low rates of short- and long-term CAD events (0.8%, 0.8%, and 1.3% at 30 days, 1 year, and 3 years, respectively), event rates of those with a negative test but a CAD history were significantly higher (2.6%, 5.3%, and 6.6% at 30 days, 1 year and 3 years, respectively; p = 0.044 and p = 0.034 compared to CAD- patients at 1 year and 3 years, respectively). In a multivariable logistic regression model, a positive MPI proved to be an independent predictor of long-term CV events in patients with CP and prior CAD. CONCLUSION: Observation followed by stress MPI can effectively risk stratify CP patients with prior CAD for CV risk. These patients are at increased risk of CV events even after a low-risk stress MPI study. Patients presenting with CP and managed with a strategy of observation followed by a negative stress MPI warrant close short- and long-term monitoring for recurrent events

Climate proofing infrastructure in Bangladesh : the incremental cost of limiting future inland monsoon flood damage

Two-thirds of Bangladesh is less than 5 meters above sea level, making it one of the most flood prone countries in the world. Severe flooding during a monsoon causes significant damage to crops and property, with severe adverse impacts on rural livelihoods. Future climate change seems likely to increase the destructive power of monsoon floods. This paper examines the potential cost of offsetting increased flooding risk from climate change, based on simulations from a climate model of extreme floods out to 2050. Using the 1998 flood as a benchmark for evaluating additional protection measures, the authors calculate conservatively that necessary capital investments out to 2050 would total US$2,671 million (at 2009 prices) to protect roads and railways, river embankments surrounding agricultural lands, and drainage systems and erosion control measures for major towns. With gradual climate change, however, required investments would be phased. Beyond these capital-intensive investments, improved policies, planning and institutions are essential to ensure that such investments are used correctly and yield the expected benefits. Particular attention is needed to the robustness of benefits from large-scale fixed capital investments. Investments in increased understanding of risk-mitigation options and in economic mobility will have especially high returns.Hazard Risk Management,Transport Economics Policy&Planning,Climate Change Mitigation and Green House Gases,Science of Climate Change,Climate Change Economics

Pathways linking bullying victimisation and suicidal behaviours among adolescents

Aims: To examine the pathways explaining the association between bullying victimisation and suicidal behaviours among school-based adolescents. Methods: We used data from the Global School-based Student Health Survey from 90 countries conducted between 2003 and 2017. We applied multivariate regression and generalised structural equation models to examine the pathways. Results: Of 280,076 study adolescents, 32.4% experienced bullying and 12.1%, 11.1% and 10.9% reported suicidal ideation, suicidal planning and suicidal attempt, respectively. Adolescents who experienced bullying had higher rates of hunger (8.7% vs 5.0%), drinking soft drinks (44.0% vs 40.2%), truancy (35.8% vs 22.7%), smoking (14.0% vs 6.9%), alcohol consumption (19.9% vs 11.8%), peer victimisation (54.0% vs 25.6%), peer conflict (47.4% vs 20.1%), sleep disturbance (13.7% vs 5.6%), loneliness (18.1% vs 7.6%), no close friends (7.5% vs 5.2%), lack of peer support (64.9% vs 53.3%), lack of parental connectedness (67.0% vs 60.4%) and less parental bonding (64.1% vs 55.2%). Nearly one-fourth (18.7%) of the total association between bullying and suicidal ideation was mediated by loneliness. Similarly, sleep disturbances and alcohol consumption also mediated 4 to 9% of the association between bullying and suicidal behaviours. Conclusion: This study suggests targeted policies and early implementation of interventional strategies focusing on addressing loneliness, sleep disturbance and alcohol consumption to reduce the risk of adverse suicidal behaviours among adolescents

Interlayer-engineered high remnant polarization (2Pr_r > 70μ\muC/cm2^2) in Hf0.5_{0.5}Zr0.5_{0.5}O2_2 thin films

In this letter, we report a high remnant polarization, 2P$_r$ > 70$\mu$C/cm$^2$ in thermally processed atomic layer deposited Hf$_{0.5}$Zr$_{0.5}$O$_2$ (HZO) film on Silicon with NH$_3$ plasma exposed thin TiN interlayer and Tungsten (W) as a top electrode. The effect of interlayer on the ferroelectric properties of HZO is compared with standard Metal-Ferroelectric-Metal and Metal-Ferroelectric-Semiconductor structures. The x-ray diffraction confirms that the thickness of the interlayer plays an important role to enhance the orthorhombic ferroelectric phase. The HRTEM images reveal that TiN acts as a seed layer for the local epitaxy in HZO and hence a 2X improvement in remnant polarization. Finally, the HZO devices are shown to be wake-up free, and exhibit endurance $>10^6$ cycles. This study opens a pathway to achieve epitaxial ferroelectric HZO films on Si with improved memory performance.Comment: 4 pages, 4 figure