Added value of acute multimodal CT-based imaging (MCTI) : a comprehensive analysis

Introduction: MCTI is used to assess acute ischemic stroke (AIS) patients.We postulated that use of MCTI improves patient outcome regardingindependence and mortality.Methods: From the ASTRAL registry, all patients with an AIS and a non-contrast-CT (NCCT), angio-CT (CTA) or perfusion-CT (CTP) within24 h from onset were included. Demographic, clinical, biological, radio-logical, and follow-up caracteristics were collected. Significant predictorsof MCTI use were fitted in a multivariate analysis. Patients undergoingCTA or CTA&CTP were compared with NCCT patients with regards tofavourable outcome (mRS ≤ 2) at 3 months, 12 months mortality, strokemechanism, short-term renal function, use of ancillary diagnostic tests,duration of hospitalization and 12 months stroke recurrence

Challenges to the implementation of fiscal sustainability measures

Purpose: Fiscal sustainability is high on the global political agenda. Yet, implementing the needed performance-orientation throughout public-sector organizations remains problematic. Such implementation seems to run counter to deep-seated social structures. In this paper the aim is to shed light via key change agents' views on these social structures at the management level during the implementation of a performance-based budgeting scheme. Design/methodology/approach: The authors analyzed documentary data and conducted in-depth, semi-structured interviews with key change agents operative within central government ministries in The Netherlands. The data were analyzed using a structurational approach to identify the enablers and barriers to performance-based budgeting implementation. Findings: In total, 29 social enablers and barriers to performance-based budgeting implementation were derived. These were categorized into: Context, Autonomy, Traditional beliefs, Influence on results, and Top management support. Based on these categories five propositions were developed on how social structures enable and constrain performance-based budgeting implementation among public managers. Research limitations/implications: The study was executed in one country in a specific period in time. Although the problems with performance-based budgeting exist over the globe, research is needed to study whether similar social structures enable and impede implementation. Social implications: Policy makers and change agents aiming to improve fiscal sustainability by budgeting reform need to consider the found social structures. Where possible they could strengthen enablers and design specific comprehensive measures to tackle the barriers identified. Originality/value: This paper provides insight and develops knowledge on the social structures that enable and constrain performance-based budgeting, which in turn improves fiscal sustainability

The Influence of Positioning of the Nellix Endovascular Aneurysm Sealing System on Suprarenal and Renal Flow: An In Vitro Study

Purpose: To examine the influence of device positioning and infrarenal neck diameter on flow patterns in the Nellix endovascular aneurysm sealing (EVAS) system. Methods: The transition of the aortic flow lumen into two 10-mm-diameter stents after EVAS creates a mismatched area. Flow recirculation may affect local wall shear stress (WSS) profiles and residence time associated with atherosclerosis and thrombosis. To examine these issues, 7 abdominal aortic aneurysm flow phantoms were created, including 3 unstented controls and 3 stented models with infrarenal neck diameters of 24, 28, and 32 mm. Stents were positioned within the instructions for use (IFU). Another 28-mm model was created to evaluate lower positioning of the stents outside the IFU (28-mm LP). Flow was visualized using optical particle imaging velocimetry (PIV) and quantified by time-averaged WSS (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT) in the aorta at the anteroposterior (AP) midplane, lateral midplane, and renal artery AP midplane levels. Results: Flow in the aorta AP midplane was similar in all models. Vortices were observed in the stented models in the lateral midplane near the anterior and posterior walls. In the 32-mm IFU and 28-mm LP models, a steady state of vortices appeared, with varying location during a cycle. In all models, a low TAWSS

Plane waves with negative phase velocity in Faraday chiral mediums

The propagation of plane waves in a Faraday chiral medium is investigated. Conditions for the phase velocity to be directed opposite to the direction of power flow are derived for propagation in an arbitrary direction; simplified conditions which apply to propagation parallel to the distinguished axis are also established. These negative phase-velocity conditions are explored numerically using a representative Faraday chiral medium, arising from the homogenization of an isotropic chiral medium and a magnetically biased ferrite. It is demonstrated that the phase velocity may be directed opposite to power flow, provided that the gyrotropic parameter of the ferrite component medium is sufficiently large compared with the corresponding nongyrotropic permeability parameters.Comment: accepted for publication in Phys. Rev.

Does difference between label and actual potency of factor VIII concentrate affect pharmacokinetic-guided dosing of replacement therapy in haemophilia A?

BACKGROUND: To account for interindividual variability in the pharmacokinetics (PK) of factor concentrates, PK‐guided dosing is increasingly implemented in haemophilia patients. Calculations are based on provided label potency, but legislation allows a potency difference of ±20% between label and actual potency. It is unknown if these differences affect PK guidance. AIM: Explore the effects of potency differences on individual factor VIII (FVIII) PK parameters and the prediction of FVIII trough levels of dosing regimens. METHODS: We analyzed individual preoperative PK profiling data from severe and moderate haemophilia A patients included in the OPTI‐CLOT randomized controlled trial. Label and actual potency were compared, with data on potency provided by pharmaceutical companies. For both potencies, individual PK parameters were estimated and concentration‐time curves were constructed by nonlinear mixed‐effects modelling. Finally, we explored the effect of both the identified and the maximum legislated potency difference on predicted FVIII trough levels infused in a low and high dose regimen. RESULTS: In 45/50 included patients, actual potency was higher than its label potency. The median potency difference was 6.0% (range ‐9.2% to 18.4%) and resulted in varying individual PK parameter estimates but practically identical FVIII concentration‐time curves. As expected, predicted FVIII trough levels were linearly correlated to the actual dose. CONCLUSION: It is not necessary to take potency differences into account when applying PK guidance of FVIII concentrates in haemophilia A patients. However, when the patient is switched to another FVIII batch after PK‐guided dosing, trough levels may deviate ±20% from calculations based on label dose

Transversality Conditions for Infinite Horizon Variational Problems on Time Scales

We consider problems of the calculus of variations on unbounded time scales. We prove the validity of the Euler-Lagrange equation on time scales for infinite horizon problems, and a new transversality condition.Comment: Submitted 6-October-2009; Accepted 19-March-2010 in revised form; for publication in "Optimization Letters"

Recent glitches detected in the Crab pulsar

From 2000 to 2010, monitoring of radio emission from the Crab pulsar at Xinjiang Observatory detected a total of nine glitches. The occurrence of glitches appears to be a random process as described by previous researches. A persistent change in pulse frequency and pulse frequency derivative after each glitch was found. There is no obvious correlation between glitch sizes and the time since last glitch. For these glitches $\Delta\nu_{p}$ and $\Delta\dot{\nu}_{p}$ span two orders of magnitude. The pulsar suffered the largest frequency jump ever seen on MJD 53067.1. The size of the glitch is $\sim$ 6.8 $\times 10^{-6}$ Hz, $\sim$ 3.5 times that of the glitch occured in 1989 glitch, with a very large permanent changes in frequency and pulse frequency derivative and followed by a decay with time constant $\sim$ 21 days. The braking index presents significant changes. We attribute this variation to a varying particle wind strength which may be caused by glitch activities. We discuss the properties of detected glitches in Crab pulsar and compare them with glitches in the Vela pulsar.Comment: Accepted for publication in Astrophysics & Space Scienc

Multicenter experience of upper extremity access in complex endovascular aortic aneurysm repair

Purpose: Upper extremity access (UEA) for antegrade cannulation of aortic side branches is a relevant part of endovascular treatment of complex aortic aneurysms and can be achieved using several techniques, sites, and sides. The purpose of this study was to evaluate different UEA strategies in a multicenter registry of complex endovascular aortic aneurysm repair (EVAR). Methods: In six aortic centers in the Netherlands, all endovascular aortic procedures from 2006 to 2019 were retrospectively reviewed. Patients who received UEA during complex EVAR were included. The primary outcome was a composite end point of any access complication, excluding minor hematomas. Secondary outcomes were access characteristics, access complications considered individually, access reinterventions, and incidence of ischemic cerebrovascular events. Results: A total of 417 patients underwent 437 UEA for 303 fenestrated/branched EVARs and 114 chimney EVARs. Twenty patients had bilateral, 295 left-sided, and 102 right-sided UEA. A total of 413 approaches were performed surgically and 24 percutaneously. Distal brachial access (DBA) was used in 89 cases, medial brachial access (MBA) in 149, proximal brachial access (PBA) in 140, and axillary access (AA) in 59 cases. No significant differences regarding the composite end point of access complications were seen (DBA: 11.3% vs MBA: 6.7% vs PBA: 13.6% vs AA: 10.2%; P =.29). Postoperative neuropathy occurred most after PBA (DBA: 1.1% vs MBA: 1.3% vs PBA: 9.3% vs AA: 5.1%; P =.003). There were no differences in cerebrovascular complications between access sides (right: 5.9% vs left: 4.1% vs bilateral: 5%; P =.75). Significantly more overall access complications were seen after a percutaneous approach (29.2% vs 6.8%; P =.002). In multivariate analysis, the risk for access complications after an open approach was decreased by male sex (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.10-0.72; P =.009), whereas an increase in age per year (OR: 1.08; 95% CI: 1.004-1.179; P =.039) and diabetes mellitus type 2 (OR: 3.70; 95% CI: 1.20-11.41; P =.023) increased the risk. Conclusions: Between the four access localizations, there were no differences in overall access complications. Female sex, diabetes mellitus type 2, and aging increased the risk for access complications after a surgical approach. Furthermore, a percutaneous UEA resulted in higher complication rates than a surgical approach