Portable, high intensity isotopic neutron source provides increased experimental accuracy

Small portable, high intensity isotopic neutron source combines twelve curium-americium beryllium sources. This high intensity of neutrons, with a flux which slowly decreases at a known rate, provides for increased experimental accuracy

The SITS-UTMOST: a registry-based prospective study in Europe investigating the impact of regulatory approval of intravenous Actilyse in the extended time window (3–4.5 h) in acute ischaemic stroke

Introduction: The SITS-UTMOST (Safe Implementation of Thrombolysis in Upper Time window Monitoring Study) was a registry-based prospective study of intravenous alteplase used in the extended time window (3–4.5 h) in acute ischaemic stroke to evaluate the impact of the approval of the extended time window on routine clinical practice. Patients and methods: Inclusion of at least 1000 patients treated within 3–4.5 h according to the licensed criteria and actively registered in the SITS-International Stroke Thrombolysis Registry was planned. Prospective data collection started 2 May 2012 and ended 2 November 2014. A historical cohort was identified for 2 years preceding May 2012. Clinical management and outcome were contrasted between patients treated within 3 h versus 3–4.5 h in the prospective cohort and between historical and prospective cohorts for the 3 h time window. Outcomes were functional independency (modified Rankin scale, mRS) 0–2, favourable outcome (mRS 0–1), and death at 3 months and symptomatic intracerebral haemorrhage (SICH) per SITS. Results: 4157 patients from 81 centres in 12 EU countries were entered prospectively (N ¼ 1118 in the 3–4.5 h, N ¼ 3039 in the 0–3 h time window) and 3454 retrospective patients in the 0–3 h time window who met the marketing approval conditions. In the prospective cohort, median arrival to treatment time was longer in the 3–4.5 h than 3 h window (79 vs. 55 min). Within the 3 h time window, treatment delays were shorter for prospective than historical patients (55 vs. 63). There was no significant difference between the 3–4.5 h versus 3 h prospective cohort with regard to percentage of reported SICH (1.6 vs. 1.7), death (11.6 vs. 11.1), functional independency (66 vs. 65) at 3 months or favourable outcome (51 vs. 50). Discussion: Main weakness is the observational design of the study. Conclusion: This study neither identified negative impact on treatment delay, nor on outcome, following extension of the approved time window to 4.5 h for use of alteplase in stroke

The History of Reconstruction’s Third Phase

There is no Society for Historians of Reconstruction. That should tell you something. There are also no Reconstruction re-enactments, and no museums teeming with artifacts of Reconstruction. Because what, after all, would there be for us to re-enact? The Memphis race massacre of May 1-3, 1866? And what artifacts would we be proud to display? Original Ku Klux Klan outfits (much more garish than the bland white-sheet versions of the 1920s)? Serial-number-identified police revolvers from the New Orleans’ Mechanics Institute killings of July 30, 1866? Looked at coldly, the dozen years that we conventionally designate as “Reconstruction” constitute the bleakest failure in American history, and they are all the more bleak for squatting, head-in-hands, between the towering drama of the Civil War and the savage conflicts of the Gilded Age. As a nation, we delivered four million African American slaves from bondage, at the hideous cost of a generation of American youth and the murder of our greatest president -- and then allowed the freedpeople to slip back into the leering control of the same Southern white ruling class which had caused the war in the first place. If slavery was the birth defect of the American founding, Reconstruction was its principal malpractice case. Reconstruction’s historiography has not been much more cheerful. Despite its deformations, Reconstruction was actually one of the first subjects to become the focus of an entire school of professional historical practice, in this case the “school” created by William Archibald Dunning at Columbia University before the First World War and the students (and dissertations) he guided into explorations of Reconstruction in the former Confederate States. [excerpt

Thrombolysis for Ischemic Stroke in Patients Aged 90 Years or Older

none5noneM. Balestrino; L. Dinia; M. Del Sette; B. Albano; C. GandolfoBalestrino, Maurizio; L., Dinia; M., Del Sette; B., Albano; Gandolfo, Carl

Compilation of detection sensitivities in thermal-neutron activation

Detection sensitivities of the chemical elements following thermal-neutron activation have been compiled from the available experimental cross sections and nuclear properties and presented in a concise and usable form. The report also includes the equations and nuclear parameters used in the calculations

Effects of alteplase for acute stroke on the distribution of functional outcomes: a pooled analysis of 9 trials

Background—Thrombolytic therapy with intravenous alteplase within 4.5 hours of ischemic stroke onset increases the overall likelihood of an excellent outcome (no, or nondisabling, symptoms). Any improvement in functional outcome distribution has value, and herein we provide an assessment of the effect of alteplase on the distribution of the functional level by treatment delay, age, and stroke severity. Methods—Prespecified pooled analysis of 6756 patients from 9 randomized trials comparing alteplase versus placebo/open control. Ordinal logistic regression models assessed treatment differences after adjustment for treatment delay, age, stroke severity, and relevant interaction term(s). Results—Treatment with alteplase was beneficial for a delay in treatment extending to 4.5 hours after stroke onset, with a greater benefit with earlier treatment. Neither age nor stroke severity significantly influenced the slope of the relationship between benefit and time to treatment initiation. For the observed case mix of patients treated within 4.5 hours of stroke onset (mean 3 hours and 20 minutes), the net absolute benefit from alteplase (ie, the difference between those who would do better if given alteplase and those who would do worse) was 55 patients per 1000 treated (95% confidence interval, 13–91; P=0.004). Conclusions—Treatment with intravenous alteplase initiated within 4.5 hours of stroke onset increases the chance of achieving an improved level of function for all patients across the age spectrum, including the over 80s and across all severities of stroke studied (top versus bottom fifth means: 22 versus 4); the earlier that treatment is initiated, the greater the benefit

Predicting long-term outcome after acute ischemic stroke: a simple index works in patients from controlled clinical trials

Background and Purpose—An early and reliable prognosis for recovery in stroke patients is important for initiation of individual treatment and for informing patients and relatives. We recently developed and validated models for predicting survival and functional independence within 3 months after acute stroke, based on age and the National Institutes of Health Stroke Scale score assessed within 6 hours after stroke. Herein we demonstrate the applicability of our models in an independent sample of patients from controlled clinical trials. Methods—The prognostic models were used to predict survival and functional recovery in 5419 patients from the Virtual International Stroke Trials Archive (VISTA). Furthermore, we tried to improve the accuracy by adapting intercepts and estimating new model parameters. Results—The original models were able to correctly classify 70.4% (survival) and 72.9% (functional recovery) of patients. Because the prediction was slightly pessimistic for patients in the controlled trials, adapting the intercept improved the accuracy to 74.8% (survival) and 74.0% (functional recovery). Novel estimation of parameters, however, yielded no relevant further improvement. Conclusions—For acute ischemic stroke patients included in controlled trials, our easy-to-apply prognostic models based on age and National Institutes of Health Stroke Scale score correctly predicted survival and functional recovery after 3 months. Furthermore, a simple adaptation helps to adjust for a different prognosis and is recommended if a large data set is available. (Stroke. 2008;39:000-000.