9 research outputs found
Ohio Residency Law for Student Voters - Its Implications and a Proposal for More Effective Implementation of Residency Statutes
The task is to evaluate the traditional common law tests of domicile, many of which are outmoded, and to select those which are compatible with the new constitutional requirements of real fairness and equality in order to lay a firm foundation for the accomplishment of the original purposes of residency law in the modern world. Furthermore, the theoretical problems involved -constitutional exposition, common law analysis, statutory construction, and governmental policy- need to be synthesized into a system that is easily implemented by the Secretary of State, easily applied by local boards of election, and finally, easily understood by all new registrants for voting in Ohio. This article seeks to solve these problems in the soundest possible manner as a guide to the future and proposes a method of implementing them for boards of election and the general public
Injecting, Controlling, and Storing Magnetic Domain Walls in Ferromagnetic Nanowires
Domain walls in ferromagnetic nanowires are important for proposed devices in recording, logic, and sensing. The realization of such devices depends in part on the ability to quickly and accurately control the domain wall from creation until placement. Using micromagnetic computer simulation we demonstrate how a combination of externally applied magnetic fields is used to quickly inject, move, and accurately place multiple domain walls within a single wire for potential recording and logical operations. The use of a magnetic field component applied perpendicular to the principle domain wall driving field is found to be critical for increased speed and reliability. The effects of the transverse field on the injection and trapping of the domain wall will be shown to be of particular importance
Controlling Individual Domain Walls in Ferromagnetic Nanowires for Memory and Sensor Applications
Controlled motion of 180o and 360o domain walls along planar nanowires is presented. Standard Landau â Lifshitz micromagnetic modeling has been used to simulate the response of the domain walls to the application of an external magnetic field. A 180o wall is quickly and easily moved with the application of an applied. field along the axis of the wire but a 360odomain wall is stationary in the same case. An oscillatory applied field can be used to continually move the wall along the wires axis. The speed at which the 360o domain wall is found to be several times slower than a similar 180o domain wall and is limited by interaction between the magnetization of the domain wall and the external field
Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data
Background:
General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care.
Methods:
For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered.
Findings:
Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09â2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75â3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14â2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low.
Interpretation:
Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons
Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data
Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0â1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0â2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4â6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10â2·03]; p=0·011), with low heterogeneity across studies (I 2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05â1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06â2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4â6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52â1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03â4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [<1%], adjusted OR 5·58 [1·22â25·50]; p=0·024). Interpretation: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. Funding: None