Background: Atrial fibrillation (AF) is a risk for stroke. The Canadian Cardiovascular Society advises patients who are CHADS65 positive should be started on oral anticoagulation (OAC). Our local emergency department (ED) review showed that only 16% of CHADS65 positive patients were started on OAC and that 2% of our patients were diagnosed with stroke within 90 days. We implemented a new pathway for initiation of OAC in the ED (the SAFE pathway). Aim Statement: We report the effectiveness and safety of the SAFE pathway for initiation of OAC in patients treated for AF in the ED. Measures & Design: A multidisciplinary group of physicians and pharmacist developed the SAFE pathway for patients who are discharged home from the ED with a diagnosis of AF. Step 1: contraindications to OAC, Step 2: CHADS65 score, Step 3: OAC dosing if indicated. The pathway triggers referral to AF clinic, family physician letter and follow up call from the ED pharmacist. Patients are followed for 90 days by a structured medical record review and a structured telephone interview. We record persistence with OAC, stroke, TIA, systemic arterial embolism and major bleeding (ISTH criteria). Patient outcomes are fed back to the treating ED physician. Evaluation/ Results: The SAFE pathway was introduced in two EDs in June 2018. In total, 177 patients have had the pathway applied. The median age was 70 (interquartile range (IQR) 61-78), 48% male, median CHADS2 score 2 (IQR 0-2). 19/177 patients (11%) had a contraindication to initiating OAC. 122 patients (69%) had no contraindication to OAC and were CHADS65 positive. Of these 122 patients, 109 were given a prescription for OAC (96 the correct dose, 9 too high a dose and 4 too low a dose). 6 patients declined OAC and the physician did not want to start OAC for 7 patients. 73/122 were contacted by phone at 90 days, 15 could not be reached and 34 have not completed 90 days of follow up since their ED visit. Of the 73 who were reached by phone after 90 days, 65 were still taking an anticoagulant. To date, 1 patient who declined OAC (CHADS2 score of 2) had a stroke within 90 days and one patient prescribed OAC had a gastrointestinal bleed. Discussion/Impact: The SAFE pathway appears safe and effective although we continue to evaluate and improve the process.

F17464 is a new dopamine receptor antagonist that recently demonstrated antipsychotic activity in a proof of concept study in schizophrenic patients under acute exacerbation. The compound has a unique profile with high affinity for hD3 receptors (Ki = 0.17 nM) and lower affinity for hD2L (Ki = 12.1 nM) and hD2S (Ki = 6.5 nM). F17464 exhibits also high affinity for h5-HT1A receptors (Ki = 0.16 nM). F17464 is a hD3 antagonist (pKB = 9.13), hD2S very week partial agonist (pKB = 7.87, emax 8% of DA stimulated in ERK assay) and a 5-HT1A partial agonist (pEC50 = 7.99). F17464 exhibits consistent affinities for rat striatal D2 (Ki = 4.8 nM) and for rat hippocampal 5-HT1A receptors (Ki = 1.14 nM). Neurochemical studies show that F17464 ip (1 h post-dose) produces a significant dose–dependent increase in the levels of DOPAC and HVA in the frontal cortex, caudate-putamen and limbic forebrain and an increase in 3-MT levels in the latter two regions with no changes in total DA content. The effect is significant at the doses of 0.63–2.5 mg/kg ip (PK/PD data will be provided). This pattern of DA metabolite changes is similar to that described for several antipsychotic drugs in rodents and it is indicative of a cortical effect of F17464. F17464 has a very low cataleptogenic activity in rats and mice and does not induce serotoninergic signs typical of 5-HT1A. F17464 is therefore a novel a D3 preferential antipsychotic with a unique mechanism of action and receptor affinity profile and a consistent effect in neurochemistry studies in rodents.

Three types of HIV-associated neurocognitive disorders (HAND) exist that are distinguished by presence and severity of impairment in cognitive and everyday functioning. Although well-validated neurocognitive measures exist, determining impairment in everyday functioning remains a challenge. We aim to determine whether Self-Report measures of everyday functioning are as effective in characterizing HAND as Performance-Based measures. We assessed 674 HIV-infected participants with a comprehensive neurocognitive battery; 233 met criteria for a HAND diagnosis by having at least mild neurocognitive impairment. Functional decline was measured via Self-Report and Performance-Based measures. HAND diagnoses were determined according to published criteria using three approaches to assess functional decline: (1) Self-Report measures only, (2) Performance-Based measures only, and (3) Dual-method combining Self-Report and Performance-Based measures. The Dual-method classified the most symptomatic HAND, compared to either singular method. Singular method classifications were 76% concordant with each other. Participants classified as Performance-Based functionally impaired were more likely to be unemployed and more immunosuppressed, whereas those classified as Self-Report functionally impaired had more depressive symptoms. Multimodal methods of assessing everyday functioning facilitate detection of symptomatic HAND. Singular Performance-Based classifications were associated with objective functional and disease-related factors; reliance on Self-Report classifications may be biased by depressive symptoms. (JINS, 2012, 18, 79–88)

Infection of the snail, Biomphalaria glabrata, by the free-swimming miracidial stage of the human blood fluke, Schistosoma mansoni, and its subsequent development to the parasitic sporocyst stage is critical to establishment of viable infections and continued human transmission. We performed a genome-wide expression analysis of the S. mansoni miracidia and developing sporocyst using Long Serial Analysis of Gene Expression (LongSAGE). Five cDNA libraries were constructed from miracidia and in vitro cultured 6- and 20-day-old sporocysts maintained in sporocyst medium (SM) or in SM conditioned by previous cultivation with cells of the B. glabrata embryonic (Bge) cell line. We generated 21 440 SAGE tags and mapped 13 381 to the S. mansoni gene predictions (v4.0e) either by estimating theoretical 3′ UTR lengths or using existing 3′ EST sequence data. Overall, 432 transcripts were found to be differentially expressed amongst all 5 libraries. In total, 172 tags were differentially expressed between miracidia and 6-day conditioned sporocysts and 152 were differentially expressed between miracidia and 6-day unconditioned sporocysts. In addition, 53 and 45 tags, respectively, were differentially expressed in 6-day and 20-day cultured sporocysts, due to the effects of exposure to Bge cell-conditioned medium.

Streptococcus pyogenes (group A streptococcus) strains may express several distinct fibronectin-binding proteins (FBPs) which are considered as major streptococcal adhesins. Of the FBPs, SfbI was shown in vitro to promote internalization of the bacterium into host cells and has been implicated in persistence. In the tropical Northern Territory, where group A streptococcal infection is common, multiple genotypes of the organism were found among isolates from invasive disease cases and no dominant strains were observed. To determine whether any FBPs is associated with invasive disease propensity of S. pyogenes, we have screened streptococcal isolates from bacteraemic and necrotizing fasciitis patients and isolates from uncomplicated infections for genetic endowment of 4 FBPs. No difference was observed in the distribution of sfbII, fbp54 and sfbI between the blood isolates and isolates from uncomplicated infection. We conclude that the presence of sfbI does not appear to promote invasive diseases, despite its association with persistence. We also show a higher proportion of group A streptococcus strains isolated from invasive disease cases possess prtFII when compared to strains isolated from non-invasive disease cases. We suggest that S. pyogenes may recruit different FBPs for different purposes.

The reading and oral language scores of 110 children with a specific reading disability (SRD) and 102 children with a specific language impairment (SLI) indicated that approximately 53% of children with an SRD and children with an SLI could be equally classified as having an SRD or an SLI, 55% of children with an SRD have impaired oral language, and 51% of children with an SLI have a reading disability. Finding that a large percentage of children can be equally classified as SRD or SLI has repercussions for the criteria used to define an SRD, for conceptualising subgroups of learning disability, and for estimates of the incidence of SRD. Further, it highlights the need for future studies to assess both the reading and oral language abilities of SRD and SLI participants to determine how specifically impaired and homogeneous samples really are.

We present a case of fibrous histiocytoma of the larynx in a young female who presented eight years ago and is still alive and well with no evidence of any regional invasion or distant metastasis. This rare lesion has been described in 30 cases previously of which 26 were malignant and four benign. Our case is unusual in a sense that histologically it has not been possible to determine its exact biological behaviour and growth potential. However, clinically it behaved as a low-grade malignant tumour.

We study logical systems for reasoning about equations involving recursive definitions. In particular, we are interested in “propositional” fragments of the functional language of recursion FLR [18, 17], i.e., without the value passing or abstraction allowed in FLR. The “pure,” propositional fragment FLR0 turns out to coincide with the iteration theories of [1]. Our main focus here concerns the sharp contrast between the simple class of valid identities and the very complex consequence relation over several natural classes of models.

Three silicon-doped 3 µm thick GaN epilayers were grown simultaneously by metalorganic chemical vapour deposition on (0001) sapphire substrates misorientated by 0°, 4° and 10° toward the m-plane (100). A comparative study of these epilayers was undertaken using photoluminescence (PL) spectroscopy, atomic force microscopy (AFM), scanning electron microscopy (SEM), cathodoluminescence (CL) imaging, CL spectroscopy and Hall effect measurements. Low temperature PL of the 0° and 4° epilayers shows donor bound exciton (BE) emission between 3.47 and 3.48 eV and a low level of yellow band emission. The peak intensities of both emission bands are a factor of 2 higher for the 4° layer. In the 10° epilayer, the BE band is 3x stronger than in the 0° epilayer but there is no discernible yellow band. However, a number of additional bands appear at 3.459, 3.417, 3.362, 3.345, 3.309, and 3.285 eV. These bands, some of which are acceptor related, may be attributed to the presence of structural defects in this epilayer, pointing to an abrupt degradation of its structural quality compared to the others. This degradation is confirmed by AFM studies. On a 20 µm x 20 µm image the 0° and 4° epilayers exhibit smooth surface morphologies, while the 10° epilayer shows a high density of hexagonal pits. Finally, SEM images reveal the surface of the 10° epilayer to be “streaked” and pitted. Low temperature CL images at 3.48 eV (bound exciton region) show random spotty emission, while those at 3.28 eV and 3.41 eV exhibit a streaky appearance similar to the SEM image. This suggests that these luminescence bands are indeed associated with structural defects.

The position and dimensions of the jugular bulb and the venous dural sinuses vary considerably. While the anatomical variations of the jugular bulb have been extensively reported in the literature, that of the sigmoid sinus have been reported only rarely. We report a case of unusual anterior course of the vertical segment of the sigmoid sinus which was encountered during an attempted myringoplasty. Anomalies of the jugular bulb in general are also described.

Solitary fibrous tumour was first described as a pleural tumour. It has been reported in a number of extrapleural sites including the head and neck. We present the first case of solitary fibrous tumour of the infratemporal fossa described in the English literature. Complete excision was achieved using the orbitozygomatic infratemporal craniotomy approach.