Telemedicine quality and outcomes in stroke: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association

Purpose - Telestroke is one of the most frequently used and rapidly expanding applications of telemedicine, delivering much-needed stroke expertise to hospitals and patients. This document reviews the current status of telestroke and suggests measures for ongoing quality and outcome monitoring to improve performance and to enhance delivery of care. Methods - A literature search was undertaken to examine the current status of telestroke and relevant quality indicators. The members of the writing committee contributed to the review of specific quality and outcome measures with specific suggestions for metrics in telestroke networks. The drafts were circulated and revised by all committee members, and suggestions were discussed for consensus. Results - Models of telestroke and the role of telestroke in stroke systems of care are reviewed. A brief description of the science of quality monitoring and prior experience in quality measures for stroke is provided. Process measures, outcomes, tissue-type plasminogen activator use, patient and provider satisfaction, and telestroke technology are reviewed, and suggestions are provided for quality metrics. Additional topics include licensing, credentialing, training, and documentation

Creating QED photon jets with present-day lasers

© 2021 authors.Large-scale, relativistic particle-in-cell simulations with quantum electrodynamics (QED) models show that high-energy (1<Eγ75 MeV) QED photon jets with a flux of 1012sr-1 can be created with present-day lasers and planar, unstructured targets. This process involves a self-forming channel in the target in response to a laser pulse focused tightly (f number unity) onto the target surface. We show the self-formation of a channel to be robust to experimentally motivated variations in preplasma, angle of incidence, and laser stability, and present in simulations using historical shot data from the Texas Petawatt. We estimate that a detectable photon flux in the tens of MeV range will require about 60 J in a 150 fs pulse.11Nscopu

Caracterização epidemiológica, molecular e perfil de resistência aos antimicrobianos de Escherichia coli isoladas de criatórios suínos do sul do Brasil Epidemiology, molecular characterization and resistance to antimicrobials of Escherichia coli isolated from South-Brazilian pig herds

A colibacilose é a enfermidade entérica de maior impacto na suinocultura, sendo ocasionada por cepas enterotoxigênicas de Escherichia coli. Quarenta isolados clínicos de suínos com diarréia e 13 isolados ambientais foram analisados quanto ao perfil genotípico, relação genética e resistência antimicrobiana. O gene que codifica para a toxina Stb foi identificado em 50% dos isolados clínicos, seguido por Sta e Lt, com 35%. Dentre os fatores de adesinas pesquisados, a F18 foi encontrada em 27,5% das amostras. A técnica de ERIC-PCR utilizada para caracterização epidemiológica dos isolados, não demonstrou poder discriminatório esperado, e apesar de permitir a separação dos isolados em grupos, estes não evidenciaram grupos relacionados aos fatores de virulência. No teste de susceptibilidade antimicrobiana a maior resistência foi observada à tetraciclina, em 88,6%. O índice de resistência múltipla aos antimicrobianos (IRMA), variou entre 0 a 0,69.<br>Colibacillosis is an enteric disease with a major impact to the swine industry and is caused by enterotoxigenic strains of Escherichia coli. Forty clinical isolates from pigs with diarrhea and 13 environmental isolates were analysed regarding their genotypic profile, genetic relationship and antibiotic resistance. The most prevalent gene was Stb, identified in 50% of the isolates from clinical cases, and Sta and Lt were detected in 35% of them. Among the adesine factors investigated, F18 was found in 27.5% of the E. coli strains. The ERIC-PCR technique used for epidemiological characterization of the isolates did not show the expected discriminatory power. However, the test allowed separation of the isolates in groups, but did not evidence groups related to virulence factors. In the susceptibility test, the highest values for resistance were to tetracycline, in 88.6%. The index of multiple resistance to antimicrobials varied from 0 to 0.69

Rethinking the Emergence of Relationship Marketing

In this article, the history of relationship marketing (RM) is challenged. Similar to discussions of the marketing concept, the debates surrounding RM are largely ahistorical. This is despite numerous scholars indicating that RM has a far longer history than is currently appreciated. In contrast to received wisdom that RM emerged in the late 1970s, it is demonstrated that RM themes have been present in the marketing literature for longer than is recognized by the contemporary scholars