Assessment of Vessel Density on Non-Contrast Computed Tomography to Detect Basilar Artery Occlusion

Introduction: Basilar artery occlusion (BAO) may be clinically occult due to variable and non-specific symptomatology. We evaluated the qualitative and quantitative determination of a hyperdense basilar artery (HDBA) on non-contrast computed tomography (NCCT) brain for the diagnosis of BAO.Methods: We conducted a case control study of patients with confirmed acute BAO vs a control group of suspected acute stroke patients without BAO. Two EM attending physicians, one third-year EM resident, and one medical student performed qualitative and quantitative assessments for the presence of a HDBA on axial NCCT images. Our primary outcome measures were sensitivity and specificity for BAO. Our secondary outcomes were inter-rater and intra-rater reliability of the qualitative and quantitative assessments.Results: We included 60 BAO and 65 control patients in our analysis. Qualitative assessment of the hyperdense basilar artery sign was poorly sensitive (54%–72%) and specific (55%–89%). Quantitative measurement improved the specificity of hyperdense basilar artery assessment for diagnosing BAO, with a threshold of 61.0–63.8 Hounsfield units demonstrating relatively high specificity of 85%–94%. There was moderate inter-rater agreement for the qualitative assessment of HDBA (Fleiss’ kappa statistic 0.508, 95% confidence interval: 0.435–0.581). Agreement improved for quantitative assessments, but still fell in the moderate range (Shrout-Fleiss intraclass correlation coefficient: 0.635). Intra-rater reliability for the quantitative assessments of the two attending physician reviewers demonstrated substantial consistency.Conclusion: Our results highlight the importance of carefully examining basilar artery density when interpreting the NCCT of patients with altered consciousness or other signs and symptoms concerning for an acute basilar artery occlusion. If the Hounsfield unit density of the basilar artery exceeds 61 Hounsfield units, BAO should be highly suspected

Negotiation versus mediation in international conflict: Deciding how to manage violent conflicts

The thesis is an attempt to fill the theoretical and empirical gap in current conflict management research, which has failed to examine methods of conflict management comparatively. Two dominant paradigms exist, neither of which is adequate to the task of comparing negotiation and mediation in the real world of international politics: the Psychology paradigm and the Third Party Intervention paradigm. An alternative theoretical framework, the Contingency framework of negotiation and mediation was therefore, constructed. This model suggests that negotiation and mediation are conceptually and empirically different, and specifies a series of contextual and process variables which are vital to any examination of conflict management. Utilising a unique data set of thousands of cases of negotiation and mediation coded according to the variables specified in the Contingency model, a general bivariate analysis, followed by a more in-depth multivariate analysis, revealed a number of important differences and similarities between the two methods. The results suggest that negotiation and mediation are different forms of conflict management, which are most likely to be successful under contrasting conditions in international politics. Negotiation is the most successful method overall, but tends to be limited to low intensity, interstate conflicts. Mediation tends to occur in the most intense, intractable, and primarily civil conflicts, and is useful under a number of onerous circumstances

The Barometer

(Capt. B.R. Jackson, U.S. Naval Reserve, of Whittier, Calif., comments on Professor Vincent Davis\u27 article Wars and Warriors. ), (Lt. Comdr. Richard C. Davis, USN, Strategic Plans & Policy Division, OPNA V comments on Comdr. Thomas Euell\u27s remarks in the January February Barometer which emphasized the value of the study of history to the military professional.) , and (Lt. W.D. Center, Commanding Officer of U.S.S. Exploit (MSO-440) comments on Lt. Comdr. Beth Coye\u27s, et al., recent article on Women in Management.

Cholinergic suppression: A postsynaptic mechanism of long-term associative learning

Food avoidance learning in the mollusc Pleurobranchaea entails reduction in the responsiveness of key brain interneurons in the feeding neural circuitry, the paracerebral feeding command interneurons (PCNs), to the neurotransmitter acetylcholine (AcCho). Food stimuli applied to the oral veil of an untrained animal depolarize the PCNs and induce the feeding motor program (FMP). Atropine (a muscarinic cholinergic antagonist) reversibly blocks the food-induced depolarization of the PCNs, implicating AcCho as the neurotransmitter mediating food detection. AcCho applied directly to PCN somata depolarizes them, indicating that the PCN soma membrane contains AcCho receptors and induces the FMP in the isolated central nervous system preparation. The AcCho response of the PCNs is mediated by muscariniclike receptors, since comparable depolarization is induced by muscarinic agonists (acetyl-ß -methylcholine, oxotremorine, pilocarpine), but not nicotine, and blocked by muscarinic antagonists (atropine, trifluoperazine). The nicotinic antagonist hexamethonium, however, blocked the AcCho response in four of six cases. When specimens are trained to suppress feeding behavior using a conventional food-avoidance learning paradigm (conditionally paired food and shock), AcCho applied to PCNs in the same concentration as in untrained animals causes little or no depolarization and does not initiate the FMP. Increasing the concentration of AcCho 10-100 times, however, induces weak PCN depolarization in trained specimens, indicating that learning diminishes but does not fully abolish AcCho responsiveness of the PCNs. This study proposes a cellular mechanism of long-term associative learning -- namely, postsynaptic modulation of neurotransmitter responsiveness in central neurons that could apply also to mammalian species

Comparison of electromagnetic and gravitational radiation: What we can learn about each from the other

We compare the nature of electromagnetic fields and gravitational fields in linearized general relativity. We carry out this comparison both mathematically and visually. In particular, the “lines of force” visualizations of electromagnetism are contrasted with the recently introduced tendex/vortex eigenline technique for visualizing gravitational fields. Specific solutions, visualizations, and comparisons are given for an oscillating point quadrupole source. Among the similarities illustrated are the quasistatic nature of the near fields, the transverse 1/r nature of the far fields, and the interesting intermediate field structures connecting these two limiting forms. Among the differences illustrated are the meaning of field line motion and of the flow of energy

Adaptable-radius, time-orbiting magnetic ring trap for Bose-Einstein condensates

We theoretically investigate an adjustable-radius magnetic storage ring for laser-cooled and Bose-condensed atoms. Additionally, we discuss a novel time-dependent variant of this and other ring traps. Time-orbiting ring traps provide a high optical access method for spin-flip loss prevention near a storage ring's circular magnetic field zero. Our scalable storage ring will allow one to probe the fundamental limits of condensate Sagnac interferometry.Comment: 5 pages, 3 figures. accepted in J Phys

Space Shuttle Program: Automatic rendezvous, proximity operations, and capture (category 3)

The NASA Johnson Space Center is actively pursuing the development and demonstration of capabilities for automatic rendezvous, proximity operations, and capture (AR&C) using the Space Shuttle as the active vehicle. This activity combines the technologies, expertise, tools, and facilities of the JSC Tracking and Communications Division (EE), Navigation, Control and Aeronautics Division (EG), Automation and Robotics Division (ER), and Structures and Mechanics Division (ES) of the Engineering Directorate and the Flight Design and Dynamics Division (DM) of the Mission Operations Directorate. Potential benefits of AR&C include more efficient and repeatable rendezvous, proximity operations, and capture operations; reduced impacts on the target vehicles (e.g., Orbiter RCS plume loads); reduced flight crew work loads; reduced ground support requirements; and reduced operational constraints. This paper documents the current JSC capabilities/tools/facilities for AR&C and describes a proposed plan for a progression of ground demonstrations and flight tests and demonstrations of AR&C capabilities. This plan involves the maturing of existing technologies in tracking and communications; guidance, navigation and control; mechanisms; manipulators; and systems management and integrating them into several evolutionary demonstration stages

Update to the Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) protocol: statistical analysis plan for a prospective, multicenter, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial.

BACKGROUND: Observational research suggests that combined therapy with Vitamin C, thiamine and hydrocortisone may reduce mortality in patients with septic shock. METHODS AND DESIGN: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a multicenter, double-blind, adaptive sample size, randomized, placebo-controlled trial designed to test the efficacy of combination therapy with vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) given every 6 h for up to 16 doses in patients with respiratory or circulatory dysfunction (or both) resulting from sepsis. The primary outcome is ventilator- and vasopressor-free days with mortality as the key secondary outcome. Recruitment began in August 2018 and is ongoing; 501 participants have been enrolled to date, with a planned maximum sample size of 2000. The Data and Safety Monitoring Board reviewed interim results at N = 200, 300, 400 and 500, and has recommended continuing recruitment. The next interim analysis will occur when N = 1000. This update presents the statistical analysis plan. Specifically, we provide definitions for key treatment and outcome variables, and for intent-to-treat, per-protocol, and safety analysis datasets. We describe the planned descriptive analyses, the main analysis of the primary end point, our approach to secondary and exploratory analyses, and handling of missing data. Our goal is to provide enough detail that our approach could be replicated by an independent study group, thereby enhancing the transparency of the study. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03509350. Registered on 26 April 2018

On the possibility of a relativistic correction to the E and B fields around a current-carrying wire

It is well known that electric and magnetic fields may change when they are observed from different frames of reference. For example, the motion of a charged probe particle moving parallel to a current-carrying wire would be described by utilizing different electric or magnetic fields, depending on from which frame of reference the system is observed and described. To describe the situation in all frames by utilizing the theory of relativity, one has to first describe the situation in one particular frame, and this choice in the case of a current-carrying wire is the topic of this paper. In this study I examine an alternative to the standard choice, and consider its theoretical and experimental validity. An outcome of the alternative approach is that in the rest frame of a wire, running a current introduces also an electric field by giving rise to a minute charge. Present day experimental sensitivities, specifically those of cold ions, may be able to differentiate between the observable signatures predicted by the different approaches