Background Patients with atrial fibrillation are at risk for ischemic stroke, even with low CHA2DS2-VASc scores. The left atrial appendage is a known site of thrombus formation in individuals with ...atrial fibrillation. Methods We conducted a prospective study, enrolling patients with nonvalvular atrial fibrillation and CHA2DS2-VASc scores of 0 or 1. Patients were divided into groups based on left atrial appendage morphology (determined by computed tomography): the “chicken wing” group and the non–chicken wing group. We followed patients for more than 1 year to observe the incidence of stroke. Results Of 509 patients with a mean (SD) age of 48.9 (11.6) years; 332 (65.2%) were men. The chicken wing group had fewer left atrial appendage lobes, a lower left atrial appendage depth, and a smaller left atrial appendage orifice area (all P < .001). During the follow-up period, 5 of the 133 patients (3.8%) in the chicken wing group and 56 of the 376 patients (14.9%) in the non–chicken wing group experienced ischemic stroke (P < .001). The following findings were significantly associated with the incidence of stroke: left atrial appendage depth (hazard ratio HR, 1.98; 95% CI, 1.67-3.12; P = .03), left atrial appendage orifice area (HR, 2.16; 95% CI, 1.59–3.13; P < .001), and non–chicken wing left atrial appendage morphology (HR, 1.16; 95% CI, 1.10–1.23; P < .001). Conclusion For patients with atrial fibrillation and a low CHA2DS2-VASc score, the non–chicken wing left atrial appendage morphology type is independently associated with ischemic stroke.
Surveillance in America Greenberg, Ivan; Greenberg, Ivan
2012., 2012, 2012-05-31, 20120101
eBook
Surveillance in America provides a historical exploration of FBI surveillance practices and policies since 1920 based on recently declassified FBI files. Using the new information available through ...these documents, Ivan Greenberg sheds light on the activities and beliefs of top FBI officials as they develop and implement surveillance practices. Paying particular attention to the uses of the media, Greenberg provides a thorough reconsideration of the Watergate scandal and the role of W. Mark Felt as “Deep Throat.” He exposes new evidence which suggests that Felt led a faction at the FBI that worked together to bring down President Nixon. The book concludes with an in-depth treatment of surveillance practices since the year 2000. He considers the question of “surveillance as harassment” and looks at the further erosion of privacy. stemming from Obama’s counter-terror policies which extend those of the Bush Administration’s second term. The startling increase in surveillance since the events of September 11th, reveal the extent to which America is losing the battle for civil liberties.
Presence of phenazopyridine residues in water resources can be harmful to human body, hence it is very important to remove them from aqueous media. In this study, a magnetic nano-composite adsorbent, ...i.e. reduced graphene–iron oxide (rGO–Fe3O4) was synthesized and used for removal of phenazopyridine residues from wastewater samples. Experimental parameters influencing adsorption process were optimized, and results showed a sorption capacity of 14.064 mg g−1 at pH=6.0 for phenazopyridine. Under the best experimental condition, rGO–Fe3O4 nanocomposite showed an efficiency of 91.4% for removal of phenazopyridine in aqueous solution. Adsorption of phenazopyridine on flat and parallel oxygen and iron–terminated rGO–Fe3O4 surfaces was studied by density functional theory calculations. It was found that, in case of both oxygen and iron–terminated rGO–Fe3O4 surfaces, phenazopyridine prefers to interact with aromatic ring and amino flat to oxygen–terminated rGO–Fe3O4 surface, as opposed to iron–terminated sites due to enhanced charge migration at the interface. Negative adsorption energy revealed that formation of phenazopyridine@rGO–Fe3O4 is an exothermic process, confirming stability of these species.
•First investigation for removal of phenazopyridine drug•Using the DFT technique for confirming first removal report of phenazopyridine•Introduce of reduced graphene/Fe3O4 nano-adsorbent for removal of phenazopyridine
The choice of inhalational or intravenous anesthetic agents is debatable in neurosurgical patients. Desflurane, a cerebral vasodilator, may be advantageous in ischemic cerebral pathologies. Hence, we ...planned to compare desflurane and propofol in patients with moyamoya disease (MMD) with the objective of comparing neurological outcomes.
This prospective pilot trial was initiated after institutional ethics committee approval. Patients with MMD undergoing revascularization surgery were randomized into two groups receiving either desflurane or propofol intraoperatively. Neurological outcomes were assessed using a modified Rankin score (mRS) at discharge and an extended Glasgow outcome score (GOS-E) at 1 month. Intraoperative parameters, including hemodynamic parameters, end-tidal carbon dioxide, entropy, intraoperative brain relaxation scores (BRS), and rescue measures for brain relaxation, were compared.
The normality of quantitative data was checked using Kolmogorov-Smirnov tests of normality. Normally distributed data were compared using unpaired
-tests, skewed data using Mann-Whitney U tests, and categorical variables using chi-squared tests.
A total of 17 patients were randomized, 10 in the desflurane and 7 in the propofol group. mRS (1.3 ± 0.6 and 1.14 ± 0.4,
= 0.450) and GOS-E (6.7 ± 0.6 and 6.85 ± 0.5,
= 0.45) were comparable between desflurane and propofol groups, respectively. BRS was significantly higher in the desflurane group (3.6 ± 0.5) compared to the propofol group (2.1 ± 0.3,
= 0.001), with a significant number of patients requiring rescue measures in the desflurane group (70%,
< 0.001). Other outcome parameters were comparable (
> 0.05).
We conclude that postoperative neurological outcomes were comparable with using either an anesthetic agent, desflurane, or propofol in MMD patients undergoing revascularization surgery. Maintenance of anesthesia with propofol had significantly superior surgical field conditions.
Can Justice Department officials effectively investigate wrongdoing within their own administration without relying on an independent counsel?
In Prosecution among Friends political scientist David ...Alistair Yalof explores the operation of due process as it is navigated within the office of the attorney general and its various subdivisions. The attorney general holds a politically appointed position within the administration and yet, as the nation’s highest ranking law enforcement officer, is still charged with holding colleagues and superiors legally accountable. That duty extends to allegations against those who had a hand in appointing the attorney general in the first place: Even the President of the United States may be enmeshed in a Justice Department investigation overseen by the attorney general and other department officials.?
To assess this fundamental problem, Yalof examines numerous cases of executive branch corruption—real or alleged—that occurred over the course of four decades beginning with the Nixon administration and extending up through the second Bush administration. All of these cases—Watergate, Whitewater, and others—were identified and reported to varying degrees in the press and elsewhere. Some garnered significant attention; others drew only limited interest at the time. In all such cases the attorney general and other officials within the executive branch were charged with initially assessing the matter and determining the proper road for moving forward. Only a handful of the cases resulted in the appointment of a statutorily protected independent counsel.
Fire scene investigators examine the physical characteristics of a fire scene and identify and collect physical evidence at the scene. This evidence is then analyzed to help determine whether the ...cause of the fire was accidental or intentional. During the fire scene investigation, investigators may find evidence that could point to criminal activity, such as accelerants, damaged vehicles, and certain burn patterns. As a study aimed at developing new tools and techniques for interpreting, identifying, and analyzing evidence at the scene of a fire, this book will hopefully contribute to the improvement of fire research and help fill a gap in this field in our country.
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