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The Canadian Stroke Best Practice Recommendations suggests that patients suspected of transient ischemic attack (TIA)/minor stroke receive urgent brain imaging, preferably computed tomography angiography (CTA). Yet, high requisition rates for non-cerebrovascular patients overburden limited radiological resources, putting patients at risk. We hypothesize that our clinical decision support tool (CDST) developed for risk stratification of TIA in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization.
Retrospective study design with clinical information gathered from ED patient referrals to an outpatient TIA unit in Victoria, BC, from 2015-2016. Actual CTA orders by ED and TIA unit staff were compared to hypothetical CTA ordering if our CDST had been used in the ED upon patient arrival.
For 1,679 referrals, clinicians ordered 954 CTAs. Our CDST would have ordered a total of 977 CTAs for these patients. Overall, this would have increased the number of imaged-TIA patients by 89 (10.1%) while imaging 98 (16.1%) fewer non-cerebrovascular patients over the 2-year period. Our CDST would have ordered CTA for 18 (78.3%) of the recurrent stroke patients in the sample.
Our CDST could enhance CTA utilization in the ED for suspected TIA patients, and facilitate guideline-based stroke care. Use of our CDST would increase the number of TIA patients receiving CTA before ED discharge (rather than later at TIA units) and reduce the burden of imaging stroke mimics in radiological departments.
Simplicity of construction and operation are advantages of iTMC (ionic transition metal complex) OLEDs compared with multi-layer OLED devices. Unfortunately, lifetimes do not compare favorably with the best multi-layer devices. We have previously shown for Ru(bpy)3(PF6)2 based iTMC OLEDs that electrical drive produces emission-quenching dimers of the active species. We report evidence here that a chemical process may also be implicated in degradation of devices based on Ir(ppy)2(dtb-bpy)PF6 albeit by a very different mechanism. It appears that degradation of operating devices made with this Ir-based complex is related to current-induced heating of the organic layer, resulting in loss of the dtb-bpy ligand. (The dtb-bpy ligand is labile compared with the cyclometallated ppy ligands.) Morphological changes observed in electrically driven Ir(ppy)2(dtb-bpy)PF6 OLEDs provide evidence of substantial heating during device operation. Evidence from UV-vis spectra in the presence of an electric field as well as MALDI-TOF mass spectra of the OLED materials before and after electrical drive add support for this model of the degradation process.
Campbell's ambitious target article attempts to
explain gender differences in both aggressive behavior and cultural
representations of aggressive behavior. I comment on some of the
specific arguments that require further clarification, some areas that
merit expanded discussion, some topics which should be mentioned,
and some research and theoretical questions raised by the
Objective: To report the occurrence, clinical characteristics and genealogical analysis of multiple sclerosis in the Hutterites of North-Western United States and Western Canada. Background: The incidence of multiple sclerosis is reported to be lower or rare in certain ethnic groups and genetic isolates and was previously observed to be absent in the Hutterite population. Methods: After long-term surveillance, six patients were identified and clinical examinations and laboratory investigations including VER and MRI were completed. Results: The six cases included two brothers, two first cousins, male and female, another male and female, all representing two of the three endogamous groups of Hutterites, are linked to two common ancestors through lines of descent dating to 1723. The individual pedigrees were analyzed from extensive genealogical records covering eight generations. Conclusion: The incidence of multiple sclerosis in Hutterites is low in a high risk area of North America. A specific mode of inheritance pattern has not been established and a common founder effect may play a role in the development of multiple sclerosis. The genetic contribution of the Hutterites seems greater than previously recognized.
Precipitated hydrous zirconium oxide can be calcined to produce either a monoclinic or tetragonal product. It has been observed that the time taken to attain the final pH of the solution in contact with the precipitate plays a dominant role in determining the crystal structure of the zirconium oxide after calcination at 500 °C. The dependence of crystal structure on the rate of precipitation is observed only in the pH range 7–11. Rapid precipitation in this pH range yields predominately monoclinic zirconia, whereas slow (8 h) precipitation produces the tetragonal phase. At pH of approximately 13.0, only the tetragonal phase is formed from both slowly and rapidly precipitated hydrous oxide. The present results, together with earlier results, show that both the pH of the supernatant liquid and the time taken to attain this pH play dominant roles in determining the crystal structure of zirconia that is formed after calcination of the hydrous oxide. The factors that determine the crystal phase are therefore imparted in a mechanism of precipitation that depends upon the pH, and it is inferred that it is the hydroxyl concentration that is the dominant factor.
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