As evidence accumulates that carotid artery stenting (CAS) is a durable and effective procedure for stroke prevention, the utility of the procedure hinges on the perioperative risk. The perioperative ...risk of CAS procedures has historically been higher than carotid endarterectomy in most clinical trials. The perioperative risk of the series presented here is lower than any previously reported in the context of a clinical trial.
Data were collected prospectively from 227 consecutive elective CAS procedures by a single neurointerventionalist performed as part of carotid stenting clinical trials as per the trial protocols, which included randomized trials of "average risk" patients and non-randomized trials of "high risk" patients. The primary outcome measures were 30 day stroke and death, and in most cases 30 day myocardial infarction (MI) also.
Follow-up was 100%. There were no deaths. There was one technical failure. The overall 30 day stroke/death/MI rate was 5/226 (2.2%). There was one MI. The 30 day stroke and death rate for symptomatic patients was 2.5% and for asymptomatic patients 1.4%. Two of the four strokes occurred in vascular territories separate from the target carotid artery.
The perioperative CAS complications in this series were well below the 6% for symptomatic patients and 3% for asymptomatic patients currently recommended based on historic carotid endarterectomy data. Carotid stenting can be performed safely in the community, provided there are experienced interventionalists and proper patient selection.
A new method to derive an upper limit on photon primaries from small data sets of air showers is developed which accounts for shower properties varying with the primary energy and arrival direction. ...Applying this method to the highest-energy showers recorded by the AGASA experiment, an upper limit on the photon fraction of 51% (67%) at a confidence level of 90% (95%) for primary energies above 1.25 x 10(20) eV is set. This new limit on the photon fraction above the Greisen-Zatsepin-Kuzmin cutoff energy constrains the -burst model of the origin of highest-energy cosmic rays.
The identification of primary photons or specifying stringent limits on the photon flux is of major importance for understanding the origin of ultra-high energy (UHE) cosmic rays. UHE photons can ...initiate particle cascades in the geomagnetic field, which leads to significant changes in the subsequent atmospheric shower development. We present a Monte Carlo program allowing detailed studies of conversion and cascading of UHE photons in the geomagnetic field. The program named PRESHOWER can be used both as an independent tool or together with a shower simulation code. With the stand-alone version of the code it is possible to investigate various properties of the particle cascade induced by UHE photons interacting in the Earth's magnetic field before entering the Earth's atmosphere. Combining this program with an extensive air shower simulation code such as CORSIKA offers the possibility of investigating signatures of photon-initiated showers. In particular, features can be studied that help to discern such showers from the ones induced by hadrons. As an illustration, calculations for the conditions of the southern part of the Pierre Auger Observatory are presented.
Title of program:PRESHOWER 1.0
Catalogue identifier:ADWG
Program summary URL:
http://cpc.cs.qub.ac.uk/summaries/ADWG
Program obtainable: CPC Program Library, Quen's University of Belfast, N. Ireland
Computer on which the program has been thoroughly tested:Intel-Pentium based PC
Operating system:Linux, DEC-Unix
Programming language used:C, FORTRAN 77
Memory required to execute with typical data:<100 kB
No. of bits in a word:32
Has the code been vectorized?:no
Number of lines in distributed program, including test data, etc.:2567
Number of bytes in distributed program, including test data, etc.:25 690
Distribution format:tar.gz
Other procedures used in PRESHOWER
:IGRF N.A. Tsyganenko, National Space Science Data Center, NASA GSFC, Greenbelt, MD 20771, USA,
http://nssdc.gsfc.nasa.gov/space/model/magnetos/data-based/geopack.html, bessik, ran2 Numerical Recipes,
http://www.nr.com.
Nature of the physical problem:Simulation of a cascade of particles initiated by UHE photon passing through the geomagnetic field above the Earth's atmosphere.
Method of solution: The primary photon is tracked until its conversion into
e
+
e
−
pair or until it reaches the upper atmosphere. If conversion occurred each individual particle in the resultant preshower is checked for either bremsstrahlung radiation (electrons) or secondary gamma conversion (photons). The procedure ends at the top of atmosphere and the shower particle data are saved.
Restrictions on the complexity of the problem: Gamma conversion into particles other than electron pair has not been taken into account.
Typical running time: 100 preshower events with primary energy
10
20
eV
require a 800 MHz CPU time of about 50 min, with
10
21
eV
the simulation time for 100 events grows up to 500 min.
Patient outcomes after knee replacement HECK, D. A; ROBINSON, R. L; PARTRIDGE, C. M ...
Clinical orthopaedics and related research,
11/1998, Letnik:
356, Številka:
356
Conference Proceeding, Journal Article
Recenzirano
A prospective, observational cohort investigation was performed to help understand the impact of knee replacement on patients with knee osteoarthritis in community practice. Of those, 291 patients ...(330 knees) were eligible and willing to participate. Forty-eight orthopaedic surgeons referred 563 patients from 25 institutions within the state of Indiana. Demographics, patient completed health status, satisfaction, independent radiographic measures, surgeon reported intraoperative factors, hospital discharge factors, and independent physical examinations were recorded. A minimum 2-year followup was obtained in 92% of the patients. At followup, 88% were satisfied, 3% were neutral, and 9% were dissatisfied with the results of their knee surgery. The physical composite score improved from 27.4 +/- 0.4 (range, 13.3-50.3) to 37.7 +/- 0.7 (range, 12.9-61.3) at two years. Maximal improvement in physical composite score was seen in patients who had their surgery performed in institutions that performed greater than 50 knee replacements per year in patients with Medicare insurance; who had a better mental health status at baseline; who had surgery performed on Monday, Friday, or Saturday; who were older; who were treated with a posterior cruciate sparing device; and who had worse preoperative function. A lower likelihood of complications were found with surgeons who performed greater than 20 knee replacements per year; midweek surgeries; in patients with more severe preoperative knee dysfunction; patients with fewer comorbidities; patients with less preoperative stiffness; patients being treated by younger surgeons; and in patients undergoing unilateral knee replacement. Among voluntarily participating physicians, knee replacement can be a highly effective medical technology with high levels of patient satisfaction and low rates of complications.
In-stent restenosis (ISR) is a potentially preventable cause of stroke in carotid artery stent (CAS) patients. Understanding the frequency and timing of ISR would be useful in developing optimal ...protocols for carotid stent surveillance. The time course and frequency of moderate and severe ISR in our single institution prospective registry of CAS procedures is reported here.
Data were collected prospectively from 296 consecutive elective CAS procedures. Doppler surveillance was performed at 1, 6 and 12 months and annually thereafter in some cases. Moderate ISR (>50%) was defined as a peak systolic velocity (PSV) > 200 cm/s. Severe ISR (>70%) was defined as PSV > 200 cm/s and end diastolic velocity > 125 cm/s or internal carotid artery/common carotid artery ratio >4. Patients with severe ISR underwent digital subtraction angiography for confirmation and possible retreatment.
Clinical follow-up at 1 year was 98%. Clinical and ultrasound follow-up at 1 month was 100%, at 6 months 96% and at 1 year 91%. The incidence of all ISR at 6 months was 8%; 5% moderate and 3% severe. Two patients had asymptomatic occlusions at 6 months (0.8%). Patients with moderate ISR at 6 months did not progress to severe ISR. There were two strokes caused by stent thrombosis, one acute and one delayed.
Doppler surveillance is important for detecting ISR after CAS procedures. Severe ISR (>70%) should be retreated in most cases as ISR may progress to occlusion. Asymptomatic patients with moderate ISR (50-69%) at 6 months can be safely followed conservatively. Progression of ISR after 6-12 months is uncommon over a 2-3 year period.
Modifications made to medication-use processes after an overdose of U-500 regular insulin are described.
After a medication error occurred with U-500 regular insulin, a multidisciplinary team of ...physicians, nurses, advanced-practice nurses, and pharmacists was created to review and improve the ordering, dispensing, and administration processes associated with U-500 regular insulin. The group determined that current safety practices for managing insulin were inadequate. New safety processes specific to U-500 regular insulin were developed and implemented. Vials of U-500 regular insulin are no longer dispensed to nursing units and are stored only in the pharmacy and separated from other insulins. The ordering of U-500 regular insulin is limited to the endocrinology service, and all orders are written using a specialized U-500 regular insulin order set. The option for i.v. administration for U-500 regular insulin was removed from the pharmacy order-entry system; thus, only the subcutaneous route is entered by the pharmacist. In addition, patient-specific doses of U-500 regular insulin are prepared in the pharmacy using only tuberculin syringes that require a double check by two pharmacists. These syringes are delivered to patient care areas in a bag distinguishing the medication as "high alert." One last safety check involving a two-nurse check at the bedside to confirm correct medication administration is performed. Lastly, patient education material specifically for U-500 regular insulin is available online.
A multidisciplinary team recommended modifications to the medication-use system regarding U-500 regular insulin after review of a medication error. No errors involving U-500 regular insulin have been reported since implementation of the changes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Changes in UV-B radiation can have large effects on the management of the pathogen
Botrytis cinerea
, especially on strawberry production in Brazil. The aim of this work was to investigate the effect ...of the increased UV-B radiation on biological control of gray mold by
Clonostachys rosea
and on the expression of plant defense-related enzymes. The experiments were laid out in randomized complete blocks in a split-plot design. The whole-plot factor was represented by UV-B treatments: 1. ambient solar UV; 2. ambient solar UV reduced by 80% (UV-); 3 ambient solar UV supplemented with UV-B lamps (UV+). The split-plot factors were: 1. plants sprayed with water (control); 2. plants exposed to
B. cinerea
; 3 plants sprayed weekly with an inoculum suspension of
C. rosea
and exposed to
B. cinerea
. The latent infection of
B. cinerea
was evaluated during five weeks per season, after which leaves were collected to assess the peroxidase, polyphenoloxidase and chitinase activities. No significant effect on
B. cinerea
incidence for irradiation treatments were observed during both seasons, although
C. rosea
treatments have been able to control gray mold on fruits. The enzymatic activity was related to the ambient condition, not to the exposure of the plants to these micro-organisms. Only UV+ conditions led to an increase of polyphenoloxidase activity in season 2. The results indicate that the increase of UV-B radiation has no influence on the ability of
C. rosae
to control the gray mold on strawberry.
The cosmic-ray experiment KASCADE Antoni, T; Apel, W.D; Badea, F ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
11/2003, Letnik:
513, Številka:
3
Journal Article
Recenzirano
KASCADE has been designed to measure air showers of primary cosmic-ray energies in the PeV region and to investigate the
knee phenomenon in the all-particle energy spectrum. Several observations are ...measured simultaneously for each event by different detector systems. The experiment started to take data in 1996 and has been completed and extended since then. The individual detector systems and their performances are described. Also, the experience in long-term operation of the experiment and the interplay between different components is outlined.
The optimal management of carotid artery in-stent restenosis is not well described. Reported here is experience with cutting balloon angioplasty in six patients with long-term follow-up.
A ...single-operator, prospective, elective, carotid artery stent registry (n = 296) was reviewed for patients who underwent retreatment for early (within 6 months) in-stent restenosis after carotid artery stenting (CAS). Six patients were identified. All were treated with cutting balloons. Procedural outcome and long-term follow-up was collected from the registry and hospital records.
Cutting balloon angioplasty was technically successful and uncomplicated in all six treated patients. The procedure was durable in 5/6 (range of follow-up 3-36 months, median = 24 months).
Cutting balloon angioplasty is an effective initial treatment for severe carotid in-stent restenosis.
The development of cosmic ray air showers can be influenced by atmospheric electric fields. Under fair weather conditions these fields are small, but the strong fields inside thunderstorms can have a ...significant effect on the electromagnetic component of a shower. Understanding this effect is particularly important for radio detection of air showers, since the radio emission is produced by the shower electrons and positrons. We perform Monte Carlo simulations to calculate the effects of different electric field configurations on the shower development. We find that the electric field becomes important for values of the order of 1
kV/cm. Not only can the energy distribution of electrons and positrons change significantly for such field strengths, it is also possible that runaway electron breakdown occurs at high altitudes, which is an important effect in lightning initiation.
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