ABCD² risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis

ABCD² risk score and cerebral microemboli detected by transcranial Doppler (TCD) have been separately shown to the predict risk of recurrent acute stroke. We studied whether ABCD² risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis. We studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis (≥50%). 86 patients (age 70±1 (SEM: years), 58 men, 83 Caucasian) had evidence of microemboli; 72 (84%) of these underwent carotid endarterectomy (CEA). 120 patients (age 72±1 years, 91 men, 113 Caucasian) did not have microemboli detected; 102 (85%) of these underwent CEA. Data were analysed using X2 and Mann-Whitney U tests and receiver operating characteristic (ROC) curves. 140/206 (68%: 95% CI 61.63 to 74.37) patients with hyper-acute symptomatic critical carotid stenosis had an ABCD2 risk score ≥4. There was no significant difference in the NICE red flag criterion for early assessment (ABCD² risk score ≥4) for patients with cerebral microemboli versus those without microemboli (59/86 vs 81/120 patients: OR 1.05 ABCD² risk score ≥4 (95% CI 0.58 to 1.90, p=0.867)). The ABCD² risk score was <4 in 27 of 86 (31%: 95% CI 21 to 41) embolising patients and in 39 of 120 (31%: 95% CI 23 to 39) without cerebral microemboli. After adjusting for pre-neurological event antiplatelet treatment (APT), area under the curve (AUC) of ROC for ABCD2 risk score showed no prediction of cerebral microemboli (no pre-event APT, n=57: AUC 0.45 (95% CI 0.29 to 0.60, p=0.531); pre-event APT, n=147: AUC 0.51 (95% CI 0.42 to 0.60, p=0.804)). The ABCD² score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis. On the basis of NICE guidelines (refer early if ABCD² ≥4), assessment of high stroke risk based on ABCD² scoring may lead to inappropriate delay in urgent treatment in many patients

The Environment of Warm-Season Elevated Thunderstorms Associated with Heavy Rainfall Over the Central United States

Twenty-one warm-season heavy-rainfall events in the central United States produced by mesoscale convective systems (MCSs) that developed above and north of a surface boundary are examined to define the environmental conditions and physical processes associated with these phenomena. Storm-relative composites of numerous kinematic and thermodynamic fields are computed by centering on the heavy-rain-producing region of the parent elevated MCS. Results reveal that the heavy-rain region of elevated MCSs is located on average about 160 km north of a quasi-stationary frontal zone, in a region of low-level moisture convergence that is elongated westward on the cool side of the boundary. The MCS is located within the left-exit region of a south-southwesterly lowlevel jet (LLJ) and the right-entrance region of an upper-level jet positioned well north of the MCS site. The LLJ is directed toward a divergence maximum at 250 hPa that is coincident with the MCS site. Near-surface winds are light and from the southeast within a boundary layer that is statically stable and cool. Winds veer considerably with height (about 1408) from 850 to 250 hPa, a layer associated with warm-air advection. The MCS is located in a maximum of positive equivalent potential temperature ue advection, moisture convergence, and positive thermal advection at 850 hPa. Composite fields at 500 hPa show that the MCS forms in a region of weak anticyclonic curvature in the height field with marginal positive vorticity advection. Even though surfacebased stability fields indicate stable low-level air, there is a layer of convectively unstable air with maximumu e CAPE values of more than 1000 J kg21 in the vicinity of the MCS site and higher values upstream. Maximumu e convective inhibition (CIN) values over the MCS centroid site are small (less than 40 J kg21) while to the south convection is limited by large values of CIN (greater than 60 J kg21). Surface-to-500-hPa composite average relative humidity values are about 70%, and composite precipitable water values average about 3.18 cm (1.25 in.). The representativeness of the composite analysis is also examined. Last, a schematic conceptual model based upon the composite fields is presented that depicts the typical environment favorable for the development of elevated thunderstorms that lead to heavy rainfall

Power Anomaly Effects and Costs in Low-Voltage Mobile Power Systems

Electric power anomalies or disturbances can disrupt the normal operation of equipment, accelerate aging, or even cause outright failures thus resulting in increased costs of maintenance and reduced system reliability. Past research on the effects caused by power anomalies has been mostly focused on industrial, commercial, or residential systems, or on power distribution equipment. A literature survey reveals that there is no comprehensive review related to low-voltage (LV) power systems and utilization equipment applicable to military combat vehicles, such as aircraft and ships. This paper summarizes the results of a new literature survey that focused on the causes, effects, and mitigation methods for power anomalies typical of LV mobile power systems. Electric power anomaly cost data collected from the literature are also presented, from which the costs of anomalies to the national defense are estimated using some simple rationales

Late-Onset Erythropoietic Porphyria Caused by a Chromosome 18q Deletion in Erythroid Cells

The erythropoietic porphyrias, erythropoietic protoporphyria and congenital erythropoietic porphyria, result from germline mutations in the ferrochelatase gene and uroporphyrinogen III synthase gene, respectively. Both conditions normally present in childhood but rare cases with onset past the age of 40 y have been reported. Here we show that late-onset erythropoietic protoporphyria can be caused by deletion of the ferrochelatase gene in hematopoietic cells with clonal expansion as part of the myelodysplastic process. This is the first direct demonstration of porphyria produced by an acquired molecular defect restricted to one tissue. Some other cases of late-onset erythropoietic porphyria may be explained by a similar mechanism

Heavy-to-light baryonic form factors at large recoil

We analyze heavy-to-light baryonic form factors at large recoil and derive the scaling behavior of these form factors in the heavy quark limit. It is shown that only one universal form factor is needed to parameterize Lambda_b to p and Lambda_b to Lambda matrix elements in the large recoil limit of light baryons, while hadronic matrix elements of Lambda_b to Sigma transition vanish in the large energy limit of Sigma baryon due to the space-time parity symmetry. The scaling law of the soft form factor eta(P^{\prime} \cdot v), P^{\prime} and v being the momentum of nucleon and the velocity of Lambda_b baryon, responsible for Lambda_b to p transitions is also derived using the nucleon distribution amplitudes in leading conformal spin. In particular, we verify that this scaling behavior is in full agreement with that from light-cone sum rule approach in the heavy-quark limit. With these form factors, we further investigate the Lambda baryon polarization asymmetry alpha in Lambda_b to Lambda gamma and the forward-backward asymmetry A_{FB} in Lambda_b to Lambda l^{+} l^{-}. Both two observables (alpha and A_{FB}) are independent of hadronic form factors in leading power of 1/m_b and in leading order of alpha_s. We also extend the analysis of hadronic matrix elements for Omega_b to Omega transitions to rare Omega_b to Omega gamma and Omega_b to Omega l^{+} l^{-} decays and find that radiative Omega_b to Omega gamma decay is probably the most promising FCNC b to s radiative baryonic decay channel. In addition, it is interesting to notice that the zero-point of forward-backward asymmetry of Omega_b to Omega l^{+} l^{-} is the same as the one for Lambda_b to Lambda l^{+} l^{-} to leading order accuracy provided that the form factors \bar{\zeta}_i (i=3, 4, 5) are numerically as small as indicated from the quark model.Comment: 19 page

Consensus guidelines on analgesia and sedation in dying intensive care unit patients

BACKGROUND: Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. METHODS: Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12). RESULTS: After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. CONCLUSION: Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia

Multifocal multi-organ ischaemia and infarction in a preterm baby due to maternal intravenous cocaine use: a case report

<p>Abstract</p> <p>Introduction</p> <p>Although the adverse effects of cocaine use in pregnancy are well recognised, we believe this case highlights the importance of considering the route of administration, and suggests the possibility of multifocal damage relating to intravenous use.</p> <p>Case presentation</p> <p>A Caucasian female baby of 29-weeks' gestation was spontaneously delivered and subsequently developed multi-organ failure considered unrelated to simple prematurity. Intensive care was re-orientated following the development of massive intraventricular haemorrhage.</p> <p>Conclusion</p> <p>This case illustrates the need for regular cranial ultrasound in babies of pregnancies at risk due to intravenous cocaine use and also the necessity of counselling women who misuse cocaine in the antenatal period. As such, this article will be of most interest to paediatric and obstetric staff.</p

Hydrocortisone therapy for patients with septic shock

Background Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. Methods In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period. At 28 days, the primary outcome was death among patients who did not have a response to a corticotropin test. Results Of the 499 patients in the study, 233 (46.7%) did not have a response to corticotropin (125 in the hydrocortisone group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the two study groups who did not have a response to corticotropin (39.2% in the hydrocortisone group and 36.1% in the placebo group, P=0.69) or between those who had a response to corticotropin (28.8% in the hydrocortisone group and 28.7% in the placebo group, P=1.00). At 28 days, 86 of 251 patients in the hydrocortisone group (34.3%) and 78 of 248 patients in the placebo group (31.5%) had died (P=0.51). In the hydrocortisone group, shock was reversed more quickly than in the placebo group. However, there were more episodes of superinfection, including new sepsis and septic shock. Conclusions Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed. (ClinicalTrials.gov number, NCT00147004 [ClinicalTrials.gov] .)Peer reviewedPublisher PD

Late 1920s film theory and criticism as a test-case for Benjamin’s generalizations on the experiential effects of editing

This article investigates Walter Benjamin’s influential generalization that the effects of cinema are akin to the hyper-stimulating experience of modernity. More specifically, I focus on his oft-cited 1935/36 claim that all editing elicits shock-like disruption. First, I propose a more detailed articulation of the experience of modernity understood as hyper-stimulation and call for distinguishing between at least two of its subsets: the experience of speed and dynamism, on the one hand, and the experience of shock/disruption, on the other. Then I turn to classical film theory of the late 1920s to demonstrate the existence of contemporary views on editing alternative to Benjamin’s. For instance, whereas classical Soviet and Weimar theorists relate the experience of speed and dynamism to both Soviet and classical Hollywood style editing, they reserve the experience of shock/disruption for Soviet montage. In order to resolve the conceptual disagreement between these theorists, on the one hand, and Benjamin, on the other, I turn to late 1920s Weimar film criticism. I demonstrate that, contrary to Benjamin’s generalizations about the disruptive and shock-like nature of all editing, and in line with other theorists’ accounts, different editing practices were regularly distinguished by comparison to at least two distinct hyper-stimulation subsets: speed and dynamism, and shock-like disruption. In other words, contemporaries regularly distinguished between Soviet montage and classical Hollywood editing patterns on the basis of experiential effects alone. On the basis of contemporary reviews of city symphonies, I conclude with a proposal for distinguishing a third subset – confusion. This is an original manuscript / preprint of an article published by Taylor & Francis in Early Popular Visual Culture on 02 Aug 2016 available online: https://doi.org/10.1080/17460654.2016.1199322

Content analysis of elite articulations

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67140/2/10.1177_002200276400800406.pd