Cerebral Microbleeds in a Stroke Prevention Clinic.

The objective of this study is to assess the effectiveness of a stroke clinic in stroke prevention and progression of cerebral microbleeds (CMB). We conducted a retrospective observational study of patients who visited a stroke clinic between January 2011 and March 2017. Susceptibility-weighted imaging (SWI) MRI studies were obtained at baseline and follow-up visits to identify new infarctions and CMB progression. Patients with CMB who also underwent brain computed tomography (CT) imaging were identified and their cerebral arterial calcification was quantified to evaluate the relationship between the extent of intracranial calcification and CMB burden. A total of 64 stroke patients (mean age 73.1 ± 11.0, 47% males) had CMB on baseline and follow-up MRI studies. During a mean follow-up period of 22.6 months, four strokes occurred (4/64, 6%; 3 ischemic, 1 hemorrhagic), producing mild neurological deficit. Progression of CMB was observed in 54% of patients with two MRIs and was significantly associated with length of follow-up. Subjects with intracranial calcification score > 300 cm3 had higher CMB count than those with scores <300 cm3 at both baseline (12.6 ± 11.7 vs. 4.9 ± 2.2, p = 0.02) and follow-up (14.1 ± 11.8 vs. 5.6 ± 2.4, p = 0.03) MRI evaluations. Patients with CMB had a relatively benign overall clinical course. The association between CMB burden and intracranial calcification warrants further study

The Innovative Approach for Accounting and Accountability of Government Revenues in Iraq

This study indicates that accountability of government revenue procedures are sufficient, adequate,  and well developed and illustrates new control bodies that parliament has created (such as the Commission of Integrity) in addition to the Board of Supreme Audit (BSA)  to fight financial and managerial corruption.  It covers both theoretical and empirical aspects. The theoretical side includes literature review, defining the accountability, audit of revenues, performance audit, taxation policy, and the sources of governmental income. While the empirical side includes studying the economic influence of government revenues in Iraq, different sources of government income, governmental control bodies, and the auditing procedures used by the BSA.This research considers how the contribution of oil revenue and tax revenues can be measured. It shows that the Iraqi Government depends almost totally on oil revenues (about 93% in 2012). The situation has deteriorated since 2003, when Iraq was first occupied, in spite of increased revenue from taxation.The Study highlights that the State should increase its role from different organizations to control all expenditures and develop revenue streams in other sectors. Although there is an emphasis on financial and budgetary measures for financial accountability, the use of non-financial measures in determining outcome accountability is increasing. Keywords: Government, Revenues, Accountability, Audit, Control Bodies, Innovation

The preparation, metal binding ability and catalytic activity of poly itaconate copolymers with pendant ethylene amine groups

A polymeranalogous reaction in homogeneous medium was carried out to prepare poly itaconate copolymers with pendant ethylene imine groups. Three copolymers, poly- (MHpI+DHpI), poly (MBI+DBI) and poly (MMI+DMI) were prepared, characterised and their composition analysed. The acid groups in the monoesters were reacted with ethylene diamine, diethylenetriamine, triethylenetetramine or tetraethylenepentamine in the presence of dicyclohexyl car bodiimide. Two types of polymer-metal complexes, polymer chelates and pendant-type polymer-metal complexes were prepared. The complexation between the polymeric ligands and cobalt(II) chloride or copper(II) chloride was studied by visible spectroscopy. The electron microscopy study of these polymer-metal complexes shows that the size and the number of the metal ion clusters increases proportionally with the mole percentage of the metal ions. The catalytic activity of the polymer-metal complexes on the decomposition of hydrogen peroxide has been studied. Graphical and mathematical methods were used to show and compare the catalytic activity of these polymer-metal complexes. It was found that the catalyst efficiencies were in the decreasing order of: poly(MHpI+DHpI)/EN/ Co(en)2Cl] 2+ 2Cl" ^ poly(MMI+DMI)/EN/[ Co(en)2Cl] 2+ 2C1~ ^ poly(MHpI+DHpI)/TEPA/CoCl2 ^ poly(MHpI+DHpI)/TEPA/CuCl2^ poly (MMI+DMI) /TEPA/CoCl^ poly (MMI+DMI) /TEPA/CuC12. The thermal stability of these modified polymers and polymer-metal complexes confirms that degradation was a random chain scission process and that the thermal stability of the polymer-metal complexes were higher than the polymeric ligands due to crosslinking. The viscoelasticity study shows that the modulus in the rubbery region increases when the mole percentage of the pendant ethylene amine group was less than 6.3. The glass transition temperature increases and becomes broader and ill-defined as the mole percentage of pendant ethylene amine group increases due to enhanced inter molecular interactions in the system

Usefulness of routine pairing of anaerobic with aerobic blood culture bottles and decision making on antimicrobial therapy

ObjectivesTo evaluate the growth concordance in paired aerobic/anaerobic sets, and the impact of the anaerobic growth on patients' antimicrobial management.MethodThis is a prospective multicenter study which was conducted in three hospitals, with total beds of 750 beds and 52 ICU beds. Prospectively, laboratory blood cultures logbooks were daily reviewed and patients from whom blood cultures were ordered were followed, their chart were reviewed. Entries on antimicrobial therapeutic changes were noted for all paired sets. Clinicians were blinded to the study, though they were informed about culture results via the usual work protocol in each hospital.ResultsCollected Blood culture sets totaled 2492; 172 single sets were excluded, and 1160 paired sets were analyzed. 1046 were concordant; 79 sets had bacterial growth and 967 sets had no bacterial growth. 114 sets were discordant; 97 in aerobic bottles, 13 in anaerobic, and 4 in both.The proportion of agreement for the concordant paired growth sets was 90.2%.  The composite proportion of agreement for sets with any growth (N = 193, composite proportion of agreement = 56%, 95% C.I., 34% - 48%). Cohen kappa composite agreement, measured for the total analyzed paired-sets (N = 1160, K = .52, SE = .038. 95% C.I., .447 - .595). The odds of modifying antimicrobial regimen were for total and subgroups intent to treat odds, based on paired sets showed that one modification took place in one anaerobic growth set (N = 1160, Odds = 0.0008), the odds for all sets with any growth (N = 193, odds = .005), and based on any anaerobic sets (79 concordant, 13 anaerobic, and 4 discordant) with bacterial growth (N = 96: odds = 0.010).ConclusionThe study demonstrates that the proportion of agreement among paired sets were high, and needless to include anaerobic sets in routine blood culture collection. Also the decision-making of anti-infective treatment on patients based on anaerobic blood culture growth was not evident