Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice

Background: The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy.Methods: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics.Results: In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0-79.5%) and a specificity of 84.9% (95%-CI: 82.6-87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4-26.5%); specificity, 100% (95%-CI: 100-100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1-78.0%) and a specificity of 83.5% (95%-CI: 81.0-86.0%).Conclusions: State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.</p

Stateless DNS

Several network applications, like service discovery, file discovery in P2P networks, distributed hash tables, and distributed caches, use or would benefit from distributed key value stores. The Domain Name System (DNS) is a key value store which has a huge infrastructure and is accessible from almost everywhere. Nevertheless storing information in this database makes it necessary to be authoritative for a domain or to be “registered” with a domain, e.g. via DynDNS, to be allowed to store and update resource records using nsupdate . Applications like the ones listed above would greatly benefit from a configurationless approach, giving users a much more convenient experience. In this report we describe a technique we call Stateless DNS, which allows to store data in the cache of the local DNS server. It works without any infrastructure updates; it just needs our very simple, configurationless echo DNS server that can parse special queries containing information desired to be stored, process this information, and generate DNS answers in a way that the DNS cache that was asked the special query will store the desired information. Because all this happens in the authority zone of our echo DNS server, we do not cause cache poisoning. Our tests Show that Stateless DNS works with a huge number of public DNS servers

Formgedächtnislegierungen

Formgedächtnislegierungen sind »Legierungen, die nach geeigneter Behandlung aufgrund einer martensitischen Umwandlung ihre Gestalt in Abhängigkeit von der Temperatur ändern«. Derartige Materialien werden in den nächsten Jahrzehnten eine wachsende Rolle in der Technik spielen. Um die Eigenschaften dieser Werkstoffe optimal nutzen zu können, ist es wichtig, den Einfluss des Herstellungs- und Verarbeitungsprozesses auf ihre Anwendung zu kennen. Das Buch behandelt die metallkundlichen Hintergründe und die Verwendungsmöglichkeiten der Formgedächtnislegierungen in verständlicher, auf den Anwender zugeschnittener Weise

Organ-specific Neurodegeneration in Triple A syndrome-related Achalasia

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Impact of AlN/Si Nucleation Layers Grown Either by NH 3 -MBE or MOCVD on the Properties of AlGaN/GaN HFETs

International audienc