Search

Background: Mortality remains a substantial problem after acute ischemic stroke, despite advances in acute stroke treatment over the past three decades. Mortality is particularly high among patients with Total Anterior Circulation Stroke (TACS), generally representing patients with middle cerebral artery occlusions. Notably however, these patients also stand to benefit most from new therapies including endovascular thrombectomy (EVT). In this study, we aimed to examine temporal trends in, and factors associated with, 30-day in-hospital mortality after TACS. Methods: Information on all patients with community-onset TACS from 1994 through 2019 was extracted from a prospective acute stroke registry. Multivariate analysis was performed on the primary outcome of 30-day in-hospital mortality, as well as secondary functional outcomes. Results: We studied 1106 patients hospitalized for community-onset TACS, 456 (41%) of whom experienced 30-day in-hospital mortality. Over the 25 years of observation, 30-day in-hospital mortality rose and then fell. Increased odds of mortality was associated with age and stroke severity. Decreased odds of mortality was associated with alteplase therapy and EVT, as well as presentation to hospital more than 12 hours after stroke onset. Treatment with alteplase, EVT, or both was associated with higher odds of functional independence and discharge home, and shorter lengths of stay in acute care. Conclusions: Patients receiving alteplase, EVT, or both had lower 30-day in-hospital mortality and better functional outcomes than those who were untreated. These observational data demonstrate the benefits of recanalization therapy in routine clinical practice.

The Upper Cretaceous Rock Springs Formation of the Mesaverde Group in northwestern Colorado, southwestern Wyoming, and northeastern Utah is composed of fluvial, deltaic, and marine sediments that record the regression of the Western Interior Seaway during the Early to Middle Campanian. Contemporaneous deposits are present along the eastern and southeastern margins of the Greater Green River Basin in Wyoming, but correlation across the basin is challenging. Analysis of a small (1-km-long), understudied outcrop in northwestern Colorado assists in bridging that gap. The outcrop consists of distal and proximal deltaic deposits, overlain by distributary-channel complexes within delta-plain deposits. Correlation panels based on subsurface wireline logs and outcrop gamma-ray profiles show that the deposits are younger than lithostratigraphically equivalent strata of the Rock Springs Formation in Utah and Wyoming. Regional nomenclature is introduced for the area, and it is shown that these deposits differ from better-documented, older Rock Springs Formation deposits in Utah and Wyoming by having a higher net sandstone percentage due to the presence of substantial distributary-channel complexes. This study benefits subsurface exploration efforts in the Greater Green River Basin by providing outcrop analogs of reservoir distribution and quality.

Item does not contain fulltext 6 p.

High-risk buildings can be considered as complex systems involving various social actors and technology, which draws attention to the organisational and social underpinnings of their safety. This r...

Part III of the 2020 Business Information Review survey, this is the world’s longest running conversation about business information services and their management, which is celebrating its 30th anniversary. The third installment of the 2020 survey captures the participants’ reflections on a range of topics that are shaping their operations including supplier relations, client engagement as well as providing a summary of their 2021 priorities.

Rock-wallabies occupy outcrops, escarpments and cliffs that incorporate structurally complex refuges; because of this, local populations present methodological challenges for monitoring purposes. We describe the development and adaptive modification of a survey technique intended to measure changes in rock-wallaby activity on a site-by-site basis. Twenty spatially independent field sites were collectively sampled across two geological strata using transects consisting of regularly spaced sampling points, with concentric series of fixed-radius circular plots at each sampling point used to count numbers of fresh/recent and/or older rock-wallaby scats. The presence/absence of fresh and/or recently deposited scats was identified as likely to be the more sensitive measure of changing use. Indexes of Activity (IoA) at each field site were subsequently obtained by transect-based sampling at 10 m intervals using 2 m fixed-radius circular plots and recording the presence/absence of fresh/recent scats therein. Derived rock-wallaby IoA ranged between 0.13 and 0.94 across the 20 sites and were approximately normally distributed. Central tendency measures associated with the IoA metrics imply some potential to develop management-themed activity thresholds. Further refinement and potential applications of the approach are discussed.

Intravenous thrombolysis with alteplase bolus followed by infusion is a global standard of care for patients with acute ischaemic stroke. We aimed to determine whether tenecteplase given as a single bolus might increase reperfusion compared with this standard of care.In this multicentre, open-label, parallel-group, registry-linked, randomised, controlled trial (AcT), patients were enrolled from 22 primary and comprehensive stroke centres across Canada. Patients were eligible for inclusion if they were aged 18 years or older, with a diagnosis of ischaemic stroke causing disabling neurological deficit, presenting within 4·5 h of symptom onset, and eligible for thrombolysis per Canadian guidelines. Eligible patients were randomly assigned (1:1), using a previously validated minimal sufficient balance algorithm to balance allocation by site and a secure real-time web-based server, to either intravenous tenecteplase (0·25 mg/kg to a maximum of 25 mg) or alteplase (0·9 mg/kg to a maximum of 90mg; 0·09 mg/kg as a bolus and then a 60 min infusion of the remaining 0·81 mg/kg). The primary outcome was the proportion of patients who had a modified Rankin Scale (mRS) score of 0-1 at 90-120 days after treatment, assessed via blinded review in the intention-to-treat (ITT) population (ie, all patients randomly assigned to treatment who did not withdraw consent). Non-inferiority was met if the lower 95% CI of the difference in the proportion of patients who met the primary outcome between the tenecteplase and alteplase groups was more than -5%. Safety was assessed in all patients who received any of either thrombolytic agent and who were reported as treated. The trial is registered with ClinicalTrials.gov, NCT03889249, and is closed to accrual.Between Dec 10, 2019, and Jan 25, 2022, 1600 patients were enrolled and randomly assigned to tenecteplase (n=816) or alteplase (n=784), of whom 1577 were included in the ITT population (n=806 tenecteplase; n=771 alteplase). The median age was 74 years (IQR 63-83), 755 (47·9%) of 1577 patients were female and 822 (52·1%) were male. As of data cutoff (Jan 21, 2022), 296 (36·9%) of 802 patients in the tenecteplase group and 266 (34·8%) of 765 in the alteplase group had an mRS score of 0-1 at 90-120 days (unadjusted risk difference 2·1% [95% CI - 2·6 to 6·9], meeting the prespecified non-inferiority threshold). In safety analyses, 27 (3·4%) of 800 patients in the tenecteplase group and 24 (3·2%) of 763 in the alteplase group had 24 h symptomatic intracerebral haemorrhage and 122 (15·3%) of 796 and 117 (15·4%) of 763 died within 90 days of starting treatment INTERPRETATION: Intravenous tenecteplase (0·25 mg/kg) is a reasonable alternative to alteplase for all patients presenting with acute ischaemic stroke who meet standard criteria for thrombolysis.Canadian Institutes of Health Research, Alberta Strategy for Patient Oriented Research Support Unit.

Background : Intravenous thrombolysis with alteplase is widely used in acute ischemic stroke patients presenting early after symptom onset. Recent phase II trials have suggested that intravenous tenecteplase may be safer and associated with higher early reperfusion rates as compared to alteplase. This study investigates whether intravenous tenecteplase is non‐inferior to intravenous alteplase for the treatment of acute ischemic stroke. Methods : This is a pragmatic, registry‐linked, prospective, randomized (1:1) controlled, open‐label parallel group clinical trial with blinded endpoint assessment of 1600 patients to test if intravenous tenecteplase (0.25 mg/kg body weight, max dose 25 mg) is non‐inferior to intravenous alteplase (0.9 mg/kg body weight, max dose 90 mg) in patients with acute ischemic stroke eligible for intravenous thrombolysis in clinical routine. Patients are recruited from comprehensive and primary stroke centers and enrolled using deferral of consent. The proposed sample has at least 90% power with a non‐inferiority margin of 5%, assuming incidence of 90‐day mRS 0–1 is 38% in the tenecteplase and 35% in the alteplase groups, and a loss to follow‐up rate < 5%. Results : The blinded primary endpoint is the proportion of subjects achieving a 90‐day mRS (modified Rankin scale) of 0–1. Key safety outcomes include 24‐hour symptomatic intracerebral hemorrhage and 90‐day all‐cause mortality. All serious adverse events within 24‐hour period will be reported and coded using MedDRA. Outcomes are collected either centrally (primary, key secondary and safety endpoints) or through ongoing Canadian stroke registries. The primary analysis is a simple unadjusted comparison of proportions. Conclusion : Results from the trial will provide real‐world evidence of the effectiveness of intravenous tenecteplase vs. alteplase in patients with acute ischemic stroke presenting early after stroke onset. Clinical Trial Registration: NCT03889249 https://clinicaltrials.gov/ct2/show/NCT03889249 This article is protected by copyright. All rights reserved

The impact of bushfire events on wild Koala (Phascolarctos cinereus) populations is poorly understood. Following the 2019/2020 bushfire season in eastern Australia, we resurveyed 123 field sites for which contemporaneous (current koala generation) pre‐fire survey data were available. Field sites were distributed across six fire grounds between Foster and Ballina on the north coast of New South Wales. At these sites, pre‐fire naive occupancy levels by koalas ranged from 25% to 71% of the sampled habitat, while post‐fire naive occupancy levels ranged from 0% to 47%. The median reduction in the naive occupancy rate by koalas when considered across all six fire grounds was 71% when standardized against pre‐fire occupancy levels. Field data provided strong corroboration between site‐based, post‐fire foliage canopy cover estimates and modelled Google Earth Engine Burnt Area Map (GEEBAM) fire‐severity categories. In terms of GEEBAM fire‐severity categories, koala survival was five times more likely in areas where forest canopies were modelled as Unburnt or Partially burnt, compared to areas where forest canopies were Fully burnt. The capacity of bushfire‐affected koala populations to recover from the 2019/20 fire season will be conditional upon size of the original population in each fire‐affected area, the enactment and implementation of supportive, recovery‐themed management regimes, future inter‐fire intervals and associated intensities. Management actions necessary to assist recovery actions are discussed.

Implant surgical guides are often fabricated using CBCT technology. In this study, an alternative technique is proposed. The aim of this in vitro study was to compare the accuracy of the guide sleeve corrections of a geometric approach to guided surgery to the accuracy of in vitro studies of stereolithographic guides.Four arch forms were milled from acrylic blocks each with 12 root form sites. Root form inserts were made. Holes were milled in the inserts at arbitrary angles. Guide posts were placed in these sites. Guide sleeves were placed on the posts and connected with light-cured resin to form verification jigs. The goal was to correct the angles of the guide sleeves to a vertical position 90 degrees from the base of the arch forms. The initial angles from the vertical and horizontal positions of the center of each guide sleeve were determined radiographically and geometrically. Horizontal and angle corrections were made using two-piece guide posts. Guide sleeves placed over the corrected guide posts were connected with light-cured resin, forming new verification jigs. The accuracy of the angle correction and the coronal horizontal and apical horizontal deviations of the 3-mm guide sleeves were determined. The experimental sites were divided into two groups to determine if the size of the initial angles of the guide sleeves had any effect on the accuracy of the corrections.The initial angles of the guide sleeves before corrections revealed the mean difference between the two methods of measurements in groups 1 and 2 as 0.36 degrees (P = .14) and 0.69 degrees (P = .07), respectively. A comparison of the angle error measurements from 90 degrees after corrections between the two groups in the mesiodistal and buccolingual planes was not significant. The coronal and apical horizontal deviations after corrections revealed a significant difference between the two groups at the coronal level (P = .005) but not at the apical level (P = .14). In comparison of the methods of the two measurements of the angle error from vertical after corrections, the mean difference was 1.23 degrees (P = .01) and 0.69 degrees (P = .02).The in vitro accuracy of the guide sleeve corrections made with the geometric approach for implant guidance was compared to the results of the meta-analyses of in vitro studies of implant placement with stereolithographic guides. The mean errors were smaller and within the recommendations of the EAO Consensus Conference of 2012.

Technology adoption is often predicted based on little information such as the Perceived ease-of-use and the Perceived usefulness of the technology. Related constructs such as Attitude to use, Behavioral intention to use and External variables cannot be easily operationalised and so are often ignored. However, technology characteristics themselves fail to represent other factors such as potential adopter attitudes and how they react to the opportunities offered by the technology to meet their needs. In a series of three studies, qualitative methods were used to identify, validate and then exploit narrative themes. Based on the short narratives of potential adopters discussing their experiences with a set of cybersecurity tools, we are developing a small-story narrative framework to capture how they respond to the technology contextualised directly within their professional environment. Akin to concepts from adoption frameworks in healthcare intervention studies, we conclude that adopter’s personal response to a technology and how they make sense of it in their environment becomes evident in the narratives they create.

Small and medium enterprises (SMEs) make up a significant part of European economies. Despite their economic importance, they are often described as poorly placed to deal with cyber risks because of resource constraints or commercial interests. Providing appropriate tooling would facilitate a greater appreciation of the risks and provide mitigation strategies. In a series of workshops demonstrating visualization tools for cybersecurity, constructs from healthcare models such as awareness, self-efficacy, and a willingness to engage were investigated to throw light on the likelihood that the technologies would be adopted. Although most constructs were validated, it turns out that self-efficacy could more appropriately be interpreted as a desire to understand a broader company narrative rather than empowering any individual to identify and manage cyber risk. As part of an ongoing examination of technology acceptance, this work provides further evidence that technology must be contextualised to make sense for the individual as part of the SME rather than as individual employee.

BACKGROUND: A robust rail seat comfort assessment can inform the GB rail industry when procuring new seats and identify areas for comfort improvement in the refurbishment of existing seats, improving the customer experience. OBJECTIVE: To take a multifactorial approach to measuring comfort and to create a robust seat comfort assessment method for the GB rail industry. METHODS: Seat comfort assessment scores were developed by identifying seat dimensions (e.g. Seat height, seat width, seat depth), seat pad thickness and hardness requirements, seat accessories and seat attractiveness components. Scores for each seat feature were verified by conducting a fitting trial and asking 7 participants to rank dimensions through a range of adjustment. The combined scoring of features was verified by asking 14 participants to rank seats in three configurations (minimum comfort). The seat comfort dimensions scores were then validated by ranking seven existing rail seats using the assessment method and comparing the ranks with subjective comfort ranks of 12 participants. RESULTS: The validation testing resulted in a moderate positive correlation, indicating an alignment between the seat comfort assessment method and subjective comfort scores. CONCLUSIONS: A multifactorial seat comfort assessment has been shown to be a good indicator of passenger seat comfort.