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Numerous studies have shown longer pre-hospital and in-hospital workflow times and poorer outcomes in women after acute ischemic stroke (AIS) in general and after endovascular treatment (EVT) in particular. We investigated sex differences in acute stroke care of EVT patients over 5 years in a comprehensive Canadian provincial registry.
Methods:
Clinical data of all AIS patients who underwent EVT between January 2017 and December 2022 in the province of Saskatchewan were captured in the Canadian OPTIMISE registry and supplemented with patient data from administrative data sources. Patient baseline characteristics, transport time metrics, and technical EVT outcomes between female and male EVT patients were compared.
Results:
Three-hundred-three patients underwent EVT between 2017 and 2022: 144 (47.5%) women and 159 (52.5%) men. Women were significantly older (median age 77.5 [interquartile range: 66–85] vs.71 [59–78], p < 0.001), while men had more intracranial internal carotid artery occlusions (48/159 [30.2%] vs. 26/142 [18.3%], p = 0.03). Last-known-well to comprehensive stroke center (CSC)-arrival time (median 232 min [interquartile range 90–432] in women vs. 230 min [90–352] in men), CSC-arrival-to-reperfusion time (median 108 min [88–149] in women vs. 102 min [77–141] in men), reperfusion status (successful reperfusion 106/142 [74.7%] in women vs. 117/158 [74.1%] in men) as well as modified Rankin score at 90 days did not differ significantly. This held true after adjusting for baseline variables in multivariable analyses.
Conclusion:
While women undergoing EVT in the province of Saskatchewan were on average older than men, they were treated just as fast and achieved similar technical and clinical outcomes compared to men.
Cet article est une étude expérimentale menée sur le site archéologique de Gasr Chouline à Tataouine en utilisant la prospection archéologique et les systèmes d'informations géographiques (SIG) pour améliorer la gestion du site. Bien que cette étude n'ait pas prétendu à l'exhaustivité, elle a fourni de nouvelles données archéologiques par suite d'une prospection systématique.
Xenotransplant patient selection recommendations restrict clinical trial participation to seriously ill patients for whom alternative therapies are unavailable or who will likely die while waiting for an allotransplant. Despite a scholarly consensus that this is advisable, we propose to examine this restriction. We offer three lines of criticism: (1) The risk–benefit calculation may well be unfavorable for seriously ill patients and society; (2) the guidelines conflict with criteria for equitable patient selection; and (3) the selection of seriously ill patients may compromise informed consent. We conclude by highlighting how the current guidance reveals a tension between the societal values of justice and beneficence.
Adolescent girls are an important target group for micronutrient interventions particularly in Sub-Saharan Africa where adolescent pregnancy and micronutrient deficiencies are common. When consumed in sufficient amounts and at levels appropriate for the population, fortified foods may be a useful strategy for this group, but little is known about their effectiveness and timing (regarding menarche), particularly in resource-poor environments. We evaluated the effect of consuming multiple micronutrient-fortified biscuits (MMB), sold in the Ghanaian market, 5 d/week for 26 weeks compared with unfortified biscuits (UB) on the micronutrient status of female adolescents. We also explored to what extent the intervention effect varied before or after menarche. Ten2Twenty-Ghana was a 26-week double-blind, randomised controlled trial among adolescent girls aged 10–17 years (n 621) in the Mion District, Ghana. Biomarkers of micronutrient status included concentrations of Hb, plasma ferritin (PF), soluble transferrin receptor (TfR) and retinol-binding protein (RBP), including body-iron stores. Intention-to-treat analysis was supplemented by protocol-specific analysis. We found no effect of the intervention on PF, TfR and RBP. MMB consumption did not affect anaemia and micronutrient deficiencies at the population level. MMB consumption increased the prevalence of vitamin A deficiency by 6·2 % (95 % CI (0·7, 11·6)) among pre-menarche girls when adjusted for baseline micronutrient status, age and height-for-age Z-score, but it decreased the prevalence of deficient/low vitamin A status by −9·6 % (95 % CI (−18·9, −0·3)) among post-menarche girls. Consuming MMB available in the market did not increase iron status in our study, but reduced the prevalence of deficient/low vitamin A status in post-menarcheal girls.
We develop a general equilibrium overlapping generations framework with incompletely rational individuals to study old-age saving incentives. Such incentives are used worldwide to help achieve the high savings rate required to sustain sufficient consumption in old age. We show that they raise the welfare of financially illiterate individuals and those with a high degree of time inconsistency. They also reduce the incidence of poverty in old age. We further quantify the fiscal cost, crowd-out, and ability to target the transfers to individuals who need the most. Given the high prevalence of these schemes, our paper has broad policy implications.
We prove some results on weakly almost square Banach spaces and their relatives. On the one hand, we discuss weak almost squareness in the setting of Banach function spaces. More precisely, let $(\Omega,\Sigma)$ be a measurable space, let E be a Banach lattice and let $\nu:\Sigma \to E^+$ be a non-atomic countably additive measure having relatively norm compact range. Then the space $L_1(\nu)$ is weakly almost square. This result applies to some abstract Cesàro function spaces. Similar arguments show that the Lebesgue–Bochner space $L_1(\mu,Y)$ is weakly almost square for any Banach space Y and for any non-atomic finite measure µ. On the other hand, we make some progress on the open question of whether there exists a locally almost square Banach space, which fails the diameter two property. In this line, we prove that if X is any Banach space containing a complemented isomorphic copy of c0, then for every $0 \lt \varepsilon \lt 1$, there exists an equivalent norm $|\cdot|$ on X satisfying the following: (i) every slice of the unit ball $B_{(X,|\cdot|)}$ has diameter 2; (ii) $B_{(X,|\cdot|)}$ contains non-empty relatively weakly open subsets of arbitrarily small diameter and (iii) $(X,|\cdot|)$ is (r, s)-SQ for all $0 \lt r,s \lt \frac{1-\varepsilon}{1+\varepsilon}$.
Little is known about the connection between individuals’ evaluative reactions to (i) minority languages as such, and (ii) specific varieties of these minority languages. This study investigates such evaluative reactions amongst new speakers of Frisian in the Netherlands (n = 264). A questionnaire was used to elicit participants’ attitudes towards the Frisian language and their evaluations of the specific variety of Frisian they were taught. The results reveal a significant correlation between participants’ status-related attitudes towards Frisian and their anonymity-related evaluations of the variety they were taught—as well as between participants’ solidarity-related attitudes towards Frisian and their authenticity-related evaluations of the variety they were taught. The former are close to neutral; the latter are mildly positive. The article discusses how these results not only advance our general understanding of language in society, but also facilitate the development of more comprehensive science communication to inform revitalisation strategies in minority contexts. (Language attitudes, language ideologies, minority languages, language planning, language revitalisation, language transmission, new speakers)*
This paper proposes a wideband four-element multiple-input multiple-output (MIMO) antenna operating in the millimeter-wave frequency band for 5G communications from 24.37–39.44 and 45.09–50.62 GHz. The antenna design has been realized using Rogers 5880 substrate and consists of a T-shaped strip that is attached to the top of a 50 Ω feeding line. Two microstrip lines are affixed at the terminal points of T-shaped strip and bent toward the feeding structure. These bent strip lines are then extended by joining two additional L-shaped microstrip lines. On the back, there is a partial defective ground plane featuring a rectangular slot and a thin strip line located at its center. The dimensions of the proposed single element and MIMO antenna are 0.933λ × 0.933λ × 0.024λ and 1.865λ × 1.865λ × 0.024λ, respectively (at 28 GHz), while the edge-to-edge distance between the radiation elements of the MIMO antenna is 4.0 mm. The design incorporates an efficient passive fan-shaped decoupling structure to decrease coupling between antenna elements. Simulations and experimental results show good agreement with each other. For all resonant frequencies the measured peak gain is greater than 4.85 dBi, radiation efficiency is over 90%, diversity gain is greater than 9.5, ECC is less than 0.025, TARC is less than -10 dB and CCL is below 0.4 bits/s/Hz. The proposed MIMO antenna, with its wide bandwidth, high gain, high inter-port isolation, and high efficiency characteristics, can be used for 5G wireless communication applications.
Gangs are widely considered major contributors to the high levels of violence afflicting Latin America, including in particular Central America. At the same time, however, the vast majority of individuals who join a gang will also leave it and, it is assumed, become less violent. Having said this, the mechanisms underlying this ‘desistance’ process are not well understood, and nor are the determinants of individuals’ post-gang trajectories, partly because gang desistance tends to be seen as an event rather than a process. Drawing on long-term ethnographic research carried out in barrio Luis Fanor Hernández, a poor neighbourhood in Nicaragua's capital city Managua, and more specifically a set of ‘archetypal’ gang member life histories that illustrate the occupational options open to former gang members, this article offers a longitudinal perspective on desistance and its consequences, with specific reference to the determinants of individuals’ continued engagement with violence (or not).
The smart glasses were implemented as an innovative communication tool to enhance effectiveness in the field. The traditional mode of communication for Emergency Medical Services (EMS) was radio, which had significant restrictions, primarily that they were unable to transmit any visual data. To enhance efficiency, the smart glasses were used for a more accurate assessment of the condition of patients during transportation. At this time, however, no prior study has shown significant benefits of employing smart glasses into EMS.
Study Objective:
The primary objective of this study is to compare the duration of patient care in an ambulance between the use and non-use of smart glasses. The secondary objective is to identify the characteristics of data communication between the ambulance and the hospital.
Methods:
This retrospective study utilized data gathered from closed-circuit television (CCTV) in ambulances at Srinagarind Hospital, Thailand. The data were collected over a six-month period, specifically from July through December 2021. The study included two groups: the smart glasses group and no smart glasses groups, both used during EMS operations. The primary data collected focused on the duration of patient care in the ambulance. Additionally, the type and characteristics of data transfers via smart glasses during EMS operations were also recorded.
Results:
Out of the 256 EMS operations included in this study, 53.1% (N = 68) of the participants in the smart glasses group were male. The majority of operations were performed during the afternoon shift in both groups. The average patient care time in the smart glasses group was 10.07 minutes, while it was 5.10 minutes in the no smart glasses group (P <.001), indicating a significant difference. Visual data communication between the ambulance and the hospital via smart glasses predominantly involved vital signs (100.0%), physical examination (56.3%), and neurological examination (42.2%). The use of audio data from the hospital to the ambulance primarily included taking additional patient history (26.6%) and performing physical examinations (19.5%).
Conclusion:
The implementation of smart glasses in EMS operations resulted in an increase in patient care time in the ambulance. Furthermore, the use of smart glasses facilitated an effective channel of real-time two-way communication between the ambulance and the hospital.
This paper outlines the ways in which the project is addressing the colonial legacy of Henry Wellcome as well as presenting the data from the first three field seasons at Jebel Moya, south-central Sudan. These data have substantially revised our chronological and socio-economic understanding of the site. Our excavations, initiated in 2017 and continued in 2019 and 2022, show a longer, more continuous occupation of the site than has been previously recognised. The faunal and botanical remains have implications for the spread of early domesticates in the eastern Sahel and for climate changes, and raise issues of resilience. There is confirmed human burial activity from at least the third millennium BC onwards, while the pottery continues to yield information about the variety of decoration and, for the final Assemblage 3, data on its usage. Overall, the continued importance of the site for the eastern Sahel is re-emphasised.
Dance for older adults is increasingly being used to support health and well-being. While dance may be enjoyable for many, understanding its benefits for those with limited physical and cognitive abilities may provide further support for how dance may be used in these contexts. This was a study of Sharing Dance Older Adults, a dance program with remotely streamed sessions. Data were collected from 48 older adults who took part in the On Your Feet version of the program, and from 38 who took part in the In Your Seat version. Measures included interviews, physical fitness tests and surveys on mood, quality of life, and program satisfaction. Physical fitness significantly improved for both groups, unlike for mood, social well-being, or quality of life. This contrasts with qualitative findings, with participants reporting how the program enhanced their mood, social interactions, and quality of life.
The challenge that delegated legislation poses to parliamentary sovereignty and associated supremacy in the UK is purportedly addressed through what we term the ‘constitutional bargain of delegated law-making’. This has three elements: the proper limitation of delegation by Parliament through well-designed parent legislation; the exercise of self-restraint by the Executive in the use of delegated authority; and the enablement of meaningful scrutiny by Parliament. As a paradigm situation in which delegated law-making might be said to be necessary, the first year of the Covid-19 pandemic is an apposite context in which to assess the robustness of that bargain. Our analysis uses a sample of Westminster-generated pandemic-related secondary instruments as a peephole into the broader dynamics of this constitutional bargain and further reveals its significant frailties; frailties that are exposed, but not created, by the pandemic.
Thyroglossal duct cysts and dermoid cysts both commonly present as midline neck lumps in children. They are treated as separate entities with different embryological origins. There are isolated reports of thyroid gland tissue in a dermoid cyst, concurrent thyroglossal and dermoid cysts, and cysts with mixed histology. It is not known if these are rare or common.
Methods
All children undergoing excision of a congenital midline neck cyst between January 2017 and December 2022 were identified. Histopathology slides were reviewed in detail.
Results
In 53 children, there were 26 thyroglossal duct cysts, 24 dermoids, 1 lymph node and 2 with no diagnostic material identified. Five dermoids (28 per cent) had associated thyroid gland tissue, and 1 (4 per cent) had hybrid histology with keratinising and respiratory epithelium. Infection occurred in 17 per cent of dermoids prior to excision and 8 per cent of dermoids recurred after excision.
Conclusion
Hybrid histology, infection and recurrence are all common in midline neck dermoids. A new theory for their embryological origin is proposed, with the suggestion that some may need more extensive surgery.
The homeless population experience significant inequalities in health, and there is an increasing appreciation of the potential of lifestyle factors in the development of neurodegenerative diseases, including Parkinson’s disease. We performed a study on the prevalence and distribution of pathological alpha-synuclein deposition throughout the central and peripheral nervous systems in a homeless population.
Methods:
Forty-four homeless individuals consecutively available for autopsy were recruited. Immunohistochemistry was performed using 5G4 antibody recognizing disease-associated forms of alpha-synuclein, complemented by phospho-synuclein antibody on autopsy tissues collected from 18 regions of the brain and spinal cord, as well as the right and left olfactory bulb, the cauda equina, the extramedullary portion of the vagus nerve, and 27 sites of peripheral organs.
Results:
The study cohort consisted of 38 males and 6 females, median age 58 years (range 32–67). Lewy-related pathology was present in the brains of three male cases. One showed Braak stage 2 (60 years old), and two stage 4 (56 and 59 years old). One of the Braak stage 4 cases had Lewy-related pathology in the spinal cord, the cauda equina, and the extramedullary portion of the vagus nerve. Examination of 27 sites of peripheral organs found that all three cases with Lewy-related pathology present in the brain were devoid of peripheral organ alpha-synuclein pathology. Multiple system-type alpha-synuclein pathology was not found.
Conclusion:
Our study, representing a snapshot of the homeless population that came to autopsy, suggests that alpha-synuclein pathology is prevalent in the homeless supporting further study of this vulnerable population.