Clinical selection strategies to identify ischemic stroke patients with large anterior vessel occlusion: results from SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry)

Background and Purpose—The National Institutes of Health Stroke Scale (NIHSS) correlates with presence of large anterior vessel occlusion (LAVO). However, the application of the full NIHSS in the prehospital setting to select patients eligible for treatment with thrombectomy is limited. Therefore, we aimed to evaluate the prognostic value of simple clinical selection strategies. Methods—Data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry (January 2012–May 2014) were analyzed retrospectively. Patients with complete breakdown of NIHSS scores and documented vessel status were included. We assessed the association of prehospital stroke scales and NIHSS symptom profiles with LAVO (internal carotid artery, carotid-terminus or M1-segment of the middle cerebral artery). Results—Among 3505 patients, 23.6% (n=827) had LAVO. Pathological finding on the NIHSS item best gaze was strongly associated with LAVO (adjusted odds ratio 4.5, 95% confidence interval 3.8–5.3). All 3 face–arm–speech–time test (FAST) items identified LAVO with high sensitivity. Addition of the item gaze to the original FAST score (G-FAST) or high scores on other simplified stroke scales increased specificity. The NIHSS symptom profiles representing total anterior syndromes showed a 10-fold increased likelihood for LAVO compared with a nonspecific clinical profile. If compared with an NIHSS threshold of ≥6, the prehospital stroke scales performed similarly or even better without losing sensitivity. Conclusions—Simple modification of the face–arm–speech–time score or evaluating the NIHSS symptom profile may help to stratify patients’ risk of LAVO and to identify individuals who deserve rapid transfer to comprehensive stroke centers. Prospective validation in the prehospital setting is required

Phase diagram of an Ising model with long-range frustrating interactions: a theoretical analysis

We present a theoretical study of the phase diagram of a frustrated Ising model with nearest-neighbor ferromagnetic interactions and long-range (Coulombic) antiferromagnetic interactions. For nonzero frustration, long-range ferromagnetic order is forbidden, and the ground-state of the system consists of phases characterized by periodically modulated structures. At finite temperatures, the phase diagram is calculated within the mean-field approximation. Below the transition line that separates the disordered and the ordered phases, the frustration-temperature phase diagram displays an infinite number of ``flowers'', each flower being made by an infinite number of modulated phases generated by structure combination branching processes. The specificities introduced by the long-range nature of the frustrating interaction and the limitation of the mean-field approach are finally discussed.Comment: 32 pages, 7 figure

Metric Features of a Dipolar Model

The lattice spin model, with nearest neighbor ferromagnetic exchange and long range dipolar interaction, is studied by the method of time series for observables based on cluster configurations and associated partitions, such as Shannon entropy, Hamming and Rohlin distances. Previous results based on the two peaks shape of the specific heat, suggested the existence of two possible transitions. By the analysis of the Shannon entropy we are able to prove that the first one is a true phase transition corresponding to a particular melting process of oriented domains, where colored noise is present almost independently of true fractality. The second one is not a real transition and it may be ascribed to a smooth balancing between two geometrical effects: a progressive fragmentation of the big clusters (possibly creating fractals), and the slow onset of a small clusters chaotic phase. Comparison with the nearest neighbor Ising ferromagnetic system points out a substantial difference in the cluster geometrical properties of the two models and in their critical behavior.Comment: 20 pages, 15 figures, submitted to JPhys

Attenuation and modification of the ballast water microbial community during voyages into the Canadian Arctic

Aim: Ballast water is a major vector of non-indigenous species introductions world-wide. Our understanding of population dynamics of organisms entrained in ballast is largely limited to studies of zooplankton and phytoplankton. Bacteria are more numerous and diverse than zooplankton or phytoplankton, yet remain comparatively understudied. We apply a metagenomics approach to characterize changes in the microbial ballast water community over the course of three voyages on one ship, and assess the effects of ballast water exchange (BWE), spring/summer sampling month and time since voyage start. Location: Quebec City and Deception Bay, Quebec, and the coastal marine region offshore of eastern Canada. Methods: We used universal primers to Ion Torrent sequence a fragment of the bacterial 16S ribosomal DNA for samples collected over three voyages of one ship between Quebec City and Deception Bay in June, July and August 2015. We compared richness (total number of species in the community) and diversity (accounts for both species abundance and evenness) using linear mixed-effects analysis and compared community composition using non-metric multidimensional scaling and permutational multivariate analysis of variance. Initial comparisons were between months. Subsequent analyses focused on each month separately. Results: Ion Torrent sequencing returned c. 2.9 million reads and revealed monthly differences in diversity and richness, and in community structure in ballast water. June had higher richness and diversity than either July or August, and showed most clearly the effect of BWE on the microbial community. Main conclusions: Our results suggest that environmental conditions associated with different spring/summer sampling months drive differences in microbial diversity in ballast water. This study showed that BWE removes some components of the freshwater starting microbial community and replaces them with other taxa. BWE also changed proportional representation of some microbes without removing them completely. It appears that some taxa are resident in ballast tanks and are not removed by BWE. © 2017 John Wiley & Sons Lt

Adding Student Video Projects to Physics Courses

Physics students have traditionally prepared many kinds of reports—laboratory, activity, project, and even book or article reports. Smartphones and YouTube videos are familiar cultural objects to current students, and our students use smartphone cameras to include photographs of apparatus, phenomena, hand-sketched figures, graphs, and mathematical equations in their physics reports. Here we present basic techniques for physics students to use smartphones and tablets to create short (\u3c 5 min) end-of-semester video projects. Our students mainly use Apple Computer’s iPad1 tablets, but also other tablets and various smartphones. Finally we discuss appropriate instructor expectations and grading. Similar non-physics student video reporting efforts were reported using video cameras by Kearney,2 and Hechter and Guy.

Magnetic Properties of 2-Dimensional Dipolar Squares: Boundary Geometry Dependence

By means of the molecular dynamics simulation on gradual cooling processes, we investigate magnetic properties of classical spin systems only with the magnetic dipole-dipole interaction, which we call dipolar systems. Focusing on their finite-size effect, particularly their boundary geometry dependence, we study two finite dipolar squares cut out from a square lattice with $\Phi=0$ and $\pi/4$, where $\Phi$ is an angle between the direction of the lattice axis and that of the square boundary. Distinctly different results are obtained in the two dipolar squares. In the $\Phi=0$ square, the ``from-edge-to-interior freezing'' of spins is observed. Its ground state has a multi-domain structure whose domains consist of the two among infinitely (continuously) degenerated Luttinger-Tisza (LT) ground-state orders on a bulk square lattice, i.e., the two antiferromagnetically aligned ferromagnetic chains (af-FMC) orders directed in parallel to the two lattice axes. In the $\Phi=\pi/4$ square, on the other hand, the freezing starts from the interior of the square, and its ground state is nearly in a single domain with one of the two af-FMC orders. These geometry effects are argued to originate from the anisotropic nature of the dipole-dipole interaction which depends on the relative direction of sites in a real space of the interacting spins.Comment: 21 pages, 13 figures, submitted to Journal of Physical Society Japa

Violation of the fluctuation-dissipation theorem in glassy systems: basic notions and the numerical evidence

This review reports on the research done during the past years on violations of the fluctuation-dissipation theorem (FDT) in glassy systems. It is focused on the existence of a quasi-fluctuation-dissipation theorem (QFDT) in glassy systems and the currently supporting knowledge gained from numerical simulation studies. It covers a broad range of non-stationary aging and stationary driven systems such as structural-glasses, spin-glasses, coarsening systems, ferromagnetic models at criticality, trap models, models with entropy barriers, kinetically constrained models, sheared systems and granular media. The review is divided into four main parts: 1) An introductory section explaining basic notions related to the existence of the FDT in equilibrium and its possible extension to the glassy regime (QFDT), 2) A description of the basic analytical tools and results derived in the framework of some exactly solvable models, 3) A detailed report of the current evidence in favour of the QFDT and 4) A brief digression on the experimental evidence in its favour. This review is intended for inexpert readers who want to learn about the basic notions and concepts related to the existence of the QFDT as well as for the more expert readers who may be interested in more specific results.Comment: 120 pages, 37 figures. Topical review paper . Several typos and misprints corrected, new references included and others updated. to be published in J. Phys. A (Math. Gen.

Prioritising surveillance for alien organisms transported as stowaways on ships travelling to South Africa

The global shipping network facilitates the transportation and introduction of marine and terrestrial organisms to regions where they are not native, and some of these organisms become invasive. South Africa was used as a case study to evaluate the potential for shipping to contribute to the introduction and establishment of marine and terrestrial alien species (i.e. establishment debt) and to assess how this varies across shipping routes and seasons. As a proxy for the number of species introduced (i.e. 'colonisation pressure') shipping movement data were used to determine, for each season, the number of ships that visited South African ports from foreign ports and the number of days travelled between ports. Seasonal marine and terrestrial environmental similarity between South African and foreign ports was then used to estimate the likelihood that introduced species would establish. These data were used to determine the seasonal relative contribution of shipping routes to South Africa's marine and terrestrial establishment debt. Additionally, distribution data were used to identify marine and terrestrial species that are known to be invasive elsewhere and which might be introduced to each South African port through shipping routes that have a high relative contribution to establishment debt. Shipping routes from Asian ports, especially Singapore, have a particularly high relative contribution to South Africa's establishment debt, while among South African ports, Durban has the highest risk of being invaded. There was seasonal variation in the shipping routes that have a high relative contribution to the establishment debt of the South African ports. The presented method provides a simple way to prioritise surveillance effort and our results indicate that, for South Africa, port-specific prevention strategies should be developed, a large portion of the available resources should be allocated to Durban, and seasonal variations and their consequences for prevention strategies should be explored further. (Résumé d'auteur

A systematic review of strategies to recruit and retain primary care doctors

Background There is a workforce crisis in primary care. Previous research has looked at the reasons underlying recruitment and retention problems, but little research has looked at what works to improve recruitment and retention. The aim of this systematic review is to evaluate interventions and strategies used to recruit and retain primary care doctors internationally. Methods A systematic review was undertaken. MEDLINE, EMBASE, CENTRAL and grey literature were searched from inception to January 2015.Articles assessing interventions aimed at recruiting or retaining doctors in high income countries, applicable to primary care doctors were included. No restrictions on language or year of publication. The first author screened all titles and abstracts and a second author screened 20%. Data extraction was carried out by one author and checked by a second. Meta-analysis was not possible due to heterogeneity. Results 51 studies assessing 42 interventions were retrieved. Interventions were categorised into thirteen groups: financial incentives (n=11), recruiting rural students (n=6), international recruitment (n=4), rural or primary care focused undergraduate placements (n=3), rural or underserved postgraduate training (n=3), well-being or peer support initiatives (n=3), marketing (n=2), mixed interventions (n=5), support for professional development or research (n=5), retainer schemes (n=4), re-entry schemes (n=1), specialised recruiters or case managers (n=2) and delayed partnerships (n=2). Studies were of low methodological quality with no RCTs and only 15 studies with a comparison group. Weak evidence supported the use of postgraduate placements in underserved areas, undergraduate rural placements and recruiting students to medical school from rural areas. There was mixed evidence about financial incentives. A marketing campaign was associated with lower recruitment. Conclusions This is the first systematic review of interventions to improve recruitment and retention of primary care doctors. Although the evidence base for recruiting and care doctors is weak and more high quality research is needed, this review found evidence to support undergraduate and postgraduate placements in underserved areas, and selective recruitment of medical students. Other initiatives covered may have potential to improve recruitment and retention of primary care practitioners, but their effectiveness has not been established

Analytical and computational study of magnetization switching in kinetic Ising systems with demagnetizing fields

An important aspect of real ferromagnetic particles is the demagnetizing field resulting from magnetostatic dipole-dipole interaction, which causes large particles to break up into domains. Sufficiently small particles, however, remain single-domain in equilibrium. This makes such small particles of particular interest as materials for high-density magnetic recording media. In this paper we use analytic arguments and Monte Carlo simulations to study the effect of the demagnetizing field on the dynamics of magnetization switching in two-dimensional, single-domain, kinetic Ising systems. For systems in the ``Stochastic Region,'' where magnetization switching is on average effected by the nucleation and growth of fewer than two well-defined critical droplets, the simulation results can be explained by the dynamics of a simple model in which the free energy is a function only of magnetization. In the ``Multi-Droplet Region,'' a generalization of Avrami's Law involving a magnetization-dependent effective magnetic field gives good agreement with our simulations.Comment: 29 pages, REVTeX 3.0, 10 figures, 2 more figures by request. Submitted Phys. Rev.