The challenge of acute-stroke management: does telemedicine offer a solution?

<p><b>Background:</b> Several studies have described successful experiences with the use of telemedicine in acute stroke. The objective of this study was to assess the feasibility, acceptability, and treatment delivery reliability, of telemedicine systems for the clinical and radiological assessment, and management of acute-stroke patients.</p> <p><b>Summary of Review:</b> A systematic review of the literature was carried out. Studies were included if they met the following criteria: (1) study population included participants with a diagnosis of suspected acute stroke, (2) intervention included the use of telemedicine systems to aid assessment, diagnosis, or treatment in acute stroke, and (3) outcomes measured related to feasibility in clinical practice, acceptability to patients, carers, and staff, reliability of telemedicine systems, and effectiveness in delivering treatment, especially tissue plasminogen activator (tPA). Overall, 17 relevant non-randomised studies reported that telemedicine systems were feasible and acceptable. Interrater reliability was excellent for global clinical assessments and decisions on radiological exclusion criteria although agreement for individual assessment items was more variable. Telemedicine systems were associated with increased use of tPA.</p> <p><b>Conclusion:</b> Although there is limited reliable evidence, observational studies have indicated that telemedicine systems can be feasible, acceptable, and reliable in acute-stroke management. In addition, telemedicine consultations were associated with improved delivery of tPA.</p&gt

XUV Opacity of Aluminum between the Cold-Solid to Warm-Plasma Transition

We present calculations of the free-free XUV opacity of warm, solid-density aluminum at photon energies between the plasma frequency at 15 eV and the L-edge at 73 eV, using both density functional theory combined with molecular dynamics and a semi-analytical model in the RPA framework with the inclusion of local field corrections. As the temperature is increased from room temperature to 10 eV, with the ion and electron temperatures equal, we calculate an increase in the opacity in the range over which the degree of ionization is constant. The effect is less pronounced if only the electron temperature is allowed to increase. The physical significance of these increases is discussed in terms of intense XUV-laser matter interactions on both femtosecond and picosecond time-scales.Comment: 4 pages, 3 figure

Yttria and Ceria Doped Zirconia Thin Films Grown by Pulsed Laser Deposition

The Yttria stabilized Zirconia (YSZ) is a standard electrolyte for solid oxide fuel cells (SOFCs), which are potential candidates for next generation portable and mobile power sources. YSZ electrolyte thin films having a cubic single phase allow reducing the SOFC operating temperature without diminishing the electrochemical power density. Films of 8 mol % Yttria stabilized Zirconia (8YSZ) and films with addition of 4 weight % Ceria (8YSZ + 4CeO2) were grown by pulsed laser deposition (PLD) technique using 8YSZ and 8YSZ + 4CeO2 targets and a Nd-YAG laser (355 nm). Films have been deposited on Soda-Calcia-Silica glass and Si(100) substrates at room temperature. The morphology and structural characteristics of the samples have been studied by means of X-ray diffraction and scanning electron microscopy. Films of a cubic-YSZ single phase with thickness in the range of 1-3 µm were grown on different substrates.Fil: Saporiti, F.. Universidad de Buenos Aires. Facultad de Ingeniería. Departamento de Ingeniería Mecánica. Grupo de Materiales Avanzados; Argentina;Fil: Juarez, R. E.. Universidad de Buenos Aires. Facultad de Ingeniería. Departamento de Ingeniería Mecánica. Grupo de Materiales Avanzados; Argentina;Fil: Audebert, Fernando Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Tecnologías y Ciencias de la Ingeniería; Argentina; Universidad de Buenos Aires. Facultad de Ingeniería. Departamento de Ingeniería Mecánica. Grupo de Materiales Avanzados; Argentina;Fil: Boudard, M.. Centre National de la Recherche Scientifique. Laboratoire des Matériaux et du Génie Physique; Francia

Nanotecnología: ¿Revolución científico-tecnológica de pequeños riesgos?

La nanotecnología es un campo de las ciencias aplicadas dedicado al control y manipulación de la materia a nivel de átomos y moléculas, en un rango comprendido entre uno y cien nanómetros. Permite la creación de materiales, dispositivos y sistemas mediante el control de la materia a esa escala. En el campo de la Odontología se han desarrollado bio-sensores altamente especializados, que permitirían la identificación de enfermedades en la saliva. En un futuro cercano será clave su uso en el diagnóstico de enfermedades de alto impacto como el cáncer de mama, ovario y páncreas, enfermedad de Alzheimer, SIDA, diabetes y osteoporosis.Fil: Olmedo, Daniel Gustavo. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Anatomía Patologica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Tasat, Deborah R.. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Odontología; ArgentinaFil: Cabrini, Rómulo L.. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Anatomía Patologica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Audebert, Fernando Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ingeniería. Departamento de Ingeniería Mecánica; ArgentinaFil: Guglielmotti, Maria Beatriz. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Anatomía Patologica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Clinical selection strategies to identify ischemic stroke patients with large anterior vessel occlusion: results from SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry)

Background and Purpose—The National Institutes of Health Stroke Scale (NIHSS) correlates with presence of large anterior vessel occlusion (LAVO). However, the application of the full NIHSS in the prehospital setting to select patients eligible for treatment with thrombectomy is limited. Therefore, we aimed to evaluate the prognostic value of simple clinical selection strategies. Methods—Data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry (January 2012–May 2014) were analyzed retrospectively. Patients with complete breakdown of NIHSS scores and documented vessel status were included. We assessed the association of prehospital stroke scales and NIHSS symptom profiles with LAVO (internal carotid artery, carotid-terminus or M1-segment of the middle cerebral artery). Results—Among 3505 patients, 23.6% (n=827) had LAVO. Pathological finding on the NIHSS item best gaze was strongly associated with LAVO (adjusted odds ratio 4.5, 95% confidence interval 3.8–5.3). All 3 face–arm–speech–time test (FAST) items identified LAVO with high sensitivity. Addition of the item gaze to the original FAST score (G-FAST) or high scores on other simplified stroke scales increased specificity. The NIHSS symptom profiles representing total anterior syndromes showed a 10-fold increased likelihood for LAVO compared with a nonspecific clinical profile. If compared with an NIHSS threshold of ≥6, the prehospital stroke scales performed similarly or even better without losing sensitivity. Conclusions—Simple modification of the face–arm–speech–time score or evaluating the NIHSS symptom profile may help to stratify patients’ risk of LAVO and to identify individuals who deserve rapid transfer to comprehensive stroke centers. Prospective validation in the prehospital setting is required

Synthesis and characterization of core-shell structure silica-coated Fe29.5Ni70.5 nanoparticles

In view of potential applications of magnetic particles in biomedicine and electromagnetic devices, we made use of the classical Stober method base-catalysed hydrolysis and condensation of tetraethoxysilane (TEOS) to encapsulate FeNi nanoparticles within a silica shell. An original stirring system under high power ultrasounds made possible to disperse the otherwise agglomerated particles. Sonication guaranteed particles to remain dispersed during the Stober synthesis and also improved the efficiency of the method. The coated particles are characterized by electron microscopy (TEM) and spectroscopy (EDX) showing a core-shell structure with a uniform layer of silica. Silica-coating does not affect the core magnetic properties. Indeed, all samples are ferromagnetic at 77 K and room temperature and the Curie point remains unchanged. Only the coercive force shows an unexpected non-monotonous dependence on silica layer thickness.Comment: Regular paper submited to international peer-reveiwed journa

Femtosecond Laser-Produced Plasma X-Rays from Periodically Modulated Surface Targets

We have studied theoretically and experimentally the x-ray production above 1 keV from femtosecond laser plasmas generated on periodically modulated surface targets. Laser energy coupling to plasma surface waves has been modeled using a numerical differential method. Almost total absorption of incident laser radiation is predicted for optimized interaction conditions. Silicon gratings have been irradiated by a 120fs Ti:sapphire laser at irradiances in excess of 1016 W/cm2. X-ray intensities above 1.5 keV (K-shell lines) have been measured as a function of the incidence angle. Results show a distinct x-ray emission maximum for the first order diffraction angle and are in good qualitative agreement with our theoretical predictions

Anisotropic linear forcing for synthetic turbulence generation in large eddy simulation and hybrid RANS/LES modeling

International audienceA general forcing method for Large Eddy Simulation (LES) is proposed for the purpose of providing the flow with fluctuations that satisfy a desired statistical state. This method, the Anisotropic Linear Forcing (ALF) introduces an unsteady linear tensor function of the resolved velocity which acts as a restoring force in the mean velocity and resolved stress budgets. The ALF generalizes and extends several forcing previously proposed in the literature. In order to make it possible to impose the integral length scale of the turbulence generated by the forcing term, an alternative formulation of the ALF, using a differential spatial filter, is proposed and analyzed. The anisotropic forcing of the Reynolds stresses is particularly attractive, since unsteady turbulent fluctuations can be locally enhanced or damped, depending on the target stresses. As such, it is shown that the ALF is an effective method to promote turbulent fluctuations downstream of the LES inlet or at the interface between RANS and LES in zonal hybrid RANS/LES modeling. The detailed analysis of the influence of the ALF parameters in spatially developing channel flows and hybrid computations where the ALF target statistics are given by a RANS second-moment closure show that this original approach performs as well as the synthetic eddy method. However, since the ALF method is more flexible and significant computational savings are obtained, the method appears a promising all-in-one solution for general embedded LES simulations

An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England

Objective Effective provision of urgent stroke care relies upon admission to hospital by emergency ambulance and may involve pre-hospital redirection. The proportion and characteristics of patients who do not arrive by emergency ambulance and their impact on service efficiency is unclear. To assist in the planning of regional stroke services we examined the volume, characteristics and prognosis of patients according to the mode of presentation to local services. Study design and setting A prospective regional database of consecutive acute stroke admissions was conducted in North East, England between 01/09/10-30/09/11. Case ascertainment and transport mode were checked against hospital coding and ambulance dispatch databases. Results Twelve acute stroke units contributed data for a mean of 10.7 months. 2792/3131 (89%) patients received a diagnosis of stroke within 24 hours of admission: 2002 arrivals by emergency ambulance; 538 by private transport or non-emergency ambulance; 252 unknown mode. Emergency ambulance patients were older (76 vs 69 years), more likely to be from institutional care (10% vs 1%) and experiencing total anterior circulation symptoms (27% vs 6%). Thrombolysis treatment was commoner following emergency admission (11% vs 4%). However patients attending without emergency ambulance had lower inpatient mortality (2% vs 18%), a lower rate of institutionalisation (1% vs 6%) and less need for daily carers (7% vs 16%). 149/155 (96%) of highly dependent patients were admitted by emergency ambulance, but none received thrombolysis. Conclusion Presentations of new stroke without emergency ambulance involvement were not unusual but were associated with a better outcome due to younger age, milder neurological impairment and lower levels of pre-stroke dependency. Most patients with a high level of pre-stroke dependency arrived by emergency ambulance but did not receive thrombolysis. It is important to be aware of easily identifiable demographic groups that differ in their potential to gain from different service configurations