Introduction: Individualizing risk for stroke following a transient ischemic attack (TIA) is a topic of intense research, as existing scores are context-dependent or have not been well validated. The Canadian TIA Score stratifies risk of subsequent stroke into low, moderate and high risk. Our objective was to prospectively validate the Canadian TIA Score in a new cohort of emergency department (ED) patients. Methods: We conducted a prospective cohort study in 14 Canadian EDs over 4 years. We enrolled consecutive adult patients with an ED visit for TIA or nondisabling stroke. Treating physicians recorded standardized clinical variables onto data collection forms. Given the ability of prompt emergency carotid endarterectomy (CEA) to prevent stroke (NNT = 3) in high risk patients, our primary outcome was the composite of subsequent stroke or CEA ≤7 days. We conducted telephone follow-up using the validated Questionnaire for Verifying Stroke Free Status at 7 and 90 days. Outcomes were adjudicated by panels of 3 local stroke experts, blinded to the index ED data collection form. Based on prior work, we estimated a sample size of 5,004 patients including 93 subsequent strokes, would yield 95% confidence bands of +/− 10% for sensitivity and likelihood ratio (LR). Our analyses assessed interval LRs (iLR) with 95% CIs. Results: We prospectively enrolled 7,569 patients with mean 68.4 +/−14.7 years and 52.4% female, of whom 107 (1.4%) had a subsequent stroke and 74 (1.0%) CEA ≤7 days (total outcomes = 181). We enrolled 81.2% of eligible patients; missed patients were similar to enrolled. The Canadian TIA Score stratified the stroke/CEA ≤7days risk as: Low (probability <0.2%, iLR 0.20 [95%CI 0.091-0.44]; Moderate (probability 1.3%, iLR 0.79 [0.68-0.92]; High (probability 2.6%, iLR 2.2 [1.9-2.6]. Sensitivity analysis for just stroke ≤7 days yielded similar results: Low iLR 0.17 [95%CI 0.056-0.52], Medium iLR 0.89 [0.75-1.1], High iLR 2.0 [1.6-2.4]. Conclusion: The Canadian TIA Score accurately identifies TIA patients risk for stroke/CEA ≤7 days. Patients classified as low risk can be safely discharged following a careful ED assessment with elective follow-up. Patients at moderate risk can undergo additional testing in the ED, have antithrombotic therapy optimized, and be offered early stroke specialist follow-up. Patients at high risk should in most cases be fully investigated and managed ideally in consultation with a stroke specialist during their index ED visit.

Introduction: Cigarette addiction results from both pharmacological effects of nicotine and the rewarding effects of associated cues, including respiratory tract sensations.

Aims: This study sought to evaluate the initial acceptability of a non-nicotine botanical formulation that provided similar respiratory tract cues.

Methods: Two active test products and matching placebos were evaluated. One test product, an e-cigarette-like device, delivered a visible aerosol upon puffing; the other test product delivered an invisible vapour at ambient temperature. Test products delivered a botanical extract with flavourings and vehicle; the placebos delivered flavourings and vehicle only. Sixteen participants had 3-h ad libitum access to each test product and associated placebos, and were deprived of combustible cigarettes for 1 h before and throughout the 3-h evaluation period. Subjects rated the satisfaction (primary outcome) and other sensory qualities of the products. Safety evaluations included pulmonary function testing and monitoring vital signs.

Results: Satisfaction ratings (seven-point scale) were significantly greater for the active e-cigarette-like condition; M = 3.18, SD = 1.04 versus M = 2.69, SD = 1.22. Safety evaluations showed no clinically significant changes.

Conclusions: The results support the potential acceptability of a non-nicotine cigarette substitute in providing satisfaction to smokers. This approach merits further evaluation for safety and acceptability in tobacco harm reduction and cessation.

Experiments on the National Ignition Facility show that multi-dimensional effects currently dominate the implosion performance. Low mode implosion symmetry and hydrodynamic instabilities seeded by capsule mounting features appear to be two key limiting factors for implosion performance. One reason these factors have a large impact on the performance of inertial confinement fusion implosions is the high convergence required to achieve high fusion gains. To tackle these problems, a predictable implosion platform is needed meaning experiments must trade-off high gain for performance. LANL has adopted three main approaches to develop a one-dimensional (1D) implosion platform where 1D means measured yield over the 1D clean calculation. A high adiabat, low convergence platform is being developed using beryllium capsules enabling larger case-to-capsule ratios to improve symmetry. The second approach is liquid fuel layers using wetted foam targets. With liquid fuel layers, the implosion convergence can be controlled via the initial vapor pressure set by the target fielding temperature. The last method is double shell targets. For double shells, the smaller inner shell houses the DT fuel and the convergence of this cavity is relatively small compared to hot spot ignition. However, double shell targets have a different set of trade-off versus advantages. Details for each of these approaches are described.

Comparing genotype results of tuberculosis (TB) isolates from individuals diagnosed with TB can support or refute transmission; however, these conclusions are based upon the criteria used to define a genotype match. We used a genotype-match definition which allowed for variation in IS6110 restriction fragment length polymorphism (RFLP) to support transmission between epidemiologically linked persons. Contacts of individuals with infectious TB (index cases) diagnosed in New York City from 1997 to 2003 who subsequently developed TB (contact cases) from 1997 to 2007 were identified. For each contact case and index case (case-pair), isolate genotypes (spoligotype and RFLP results) were evaluated. Isolates from case-pairs were classified as exact or non-exact genotype match. Genotypes from non-exact match case-pairs were reviewed at the genotyping laboratory to determine if the isolates met the near-genotype-match criteria (exactly matching spoligotype and similar RFLP banding patterns). Of 118 case-pairs identified, isolates from 83 (70%) had exactly matching genotypes and 14 (12%) had nearly matching genotypes (supporting transmission), while the remaining 21 (18%) case-pairs had discordant genotypes (refuting transmission). Using identical genotype-match criteria for isolates from case-pairs epidemiologically linked through contact investigation may lead to underestimation of transmission. TB programmes should consider the value of expanding genotype-match criteria to more accurately assess transmission between such cases.

Improving neurocognitive outcomes following treatment for brain metastases have become increasingly important. We propose that a brief telephone-based neurocognitive assessment may improve follow-up cognitive assessments in this palliative population. Aim: To prospectively assess the feasibility and reliability of a telephone based brief neurocognitive assessment compared to the same tests delivered face-to-face. Methods: Brain metastases patients to be treated with whole brain radiotherapy (WBRT) were assessed using a brief validated neurocognitive battery at baseline, at 1 month and 3 months following WBRT (in person and over the phone). The primary outcome was feasibility and inter-procedural (in person versus telephone) reliability. The secondary objective was to evaluate the change in neurocognitive function before and after WBRT. Results: Out of 39 patients enrolled, 82% of patients completed the baseline in-person and telephone neurocognitive assessments. However, at 1 month, only 41% of enrolled patients completed the in-person and telephone cognitive assessments and at 3 months, only 10% of patients completed them. Results pertaining to reliability and change in neurocognitive function will be updated. Conclusion: The pre-defined definition of feasibility (at least 80% completion for face to face and telephone neurocognitive assessments) was met at baseline. However, a large proportion of participants did not complete either telephone or in person neurocognitive follow-up at 1 month and at 3 months post-WBRT. Attrition remained a challenge for neurocognitive testing in this population even when a telephone-based brief assessment was used.

The authors have reviewed over 60 texts on the subject of Enterprise Risk Management (ERM). In this paper they set out a summary of ERM based on three of those sources, selected for their relevance and breadth of view. The paper observes that the approaches described vary widely in nature. A separate ‘on-line” source is provided, which summarises key readings from the 60 texts. Combining findings from these texts with the authors' own experiences, the paper suggests some best practice checklists, designed to enable organisations to take stock of their current ERM frameworks. It discusses other aspects of ERM for practitioners, including extreme events, opportunity management and the link with corporate strategy. The paper looks at immediate and longer-term implications for actuaries in the United Kingdom, and then poses questions about future professional development and education. It suggests an emerging role for the ‘ERM actuary’, and, finally, it suggests future work to progress the development of ERM and the actuaries' role.

The aim of this preliminary study was to determine specific proteins, related to inflammation process and nutritional status as well as to total antioxidant capacity, in children suffering from cystic fibrosis (CF). The study was performed on 17 nonhospitalized children (12 boys and 5 girls) with CF aged 3 months to 10 years, who were assisted at the Nutrition Service from Pedro de Elizalde Hospital. Transferrin, transthyretin, ceruloplasmin (Cp), haptoglobin, C-reactive protein (CRP) and fibrinogen were measured by single radial immunodiffusion techniques. Total antioxidant capacity (TAC) was determined by a decolorization assay. Statistical analyses were performed by the Student's t test. Transferrin and transthyretin values were lower in CF patients in comparison with data obtained from healthy children (reference group, RG). The decreased transferrin concentration and the tendency towards low plasma transthyretin values suggested an abnormal nutritional status. However, higher Cp and haptoglobin levels were shown in patients than in RG. The fact that 23 and 50% of patients exceeded the desirable values for fibrinogen (<285·0 mg/dl) and CRP (<0·2 mg/dl), respectively, should be highlighted. The TAC (mM; Trolox equivalents) was shown to be lower in the CF group than in RG. The diminished TAC concomitant with an increased plasma Cp concentration would exacerbate the inflammatory status and could explain the depression of the immune system. These preliminary results could explain the need to include biochemical and functional parameters in the early nutritional status evaluation in CF patients in order to use appropriate nutritional and pharmacological therapies and consequently to improve their survival and quality of life.

This paper describes a detailed experimental study of turbulent boundary-layer development over rough walls in both zero and adverse pressure gradients. In contrast to previous work on this problem the skin friction was determined by pressure tapping the roughness elements and measuring their form drag.

Two wall roughness geometries were chosen each giving a different law of behaviour; they were selected on the basis of their reported behaviour in pipe flow experiments. One type gives a Clauser type roughness function which depends on a Reynolds number based on the shear velocity and on a length associated with the size of the roughness. The other type of roughness (typified by a smooth wall containing a pattern of narrow cavities) has been tested in pipes and it is shown here that these pipe results indicate that the corresponding roughness function does not depend on roughness scale but depends instead on the pipe diameter. In boundary-layer flow the first type of roughness gives a roughness function identical to pipe flow as given by Clauser and verified by Hama and Perry & Joubert. The emphasis of this work is on the second type of roughness in boundary-layer flow. No external length scale associated with the boundary layer that is analogous to pipe diameter has been found, except perhaps for the zero pressure gradient case. However, it has been found that results for both types of roughness correlate with a Reynolds number based on the wall shear velocity and on the distance below the crests of the elements from where the logarithmic distribution of velocity is measured. One important implication of this is that a zero pressure gradient boundary layer with a cavity type rough wall conforms to Rotta's condition of precise self preserving flow. Some other implications of this are also discussed.

Yields of arable crops are commonly lower on the crop margins or headlands, but the nature of the relationship between yield and distance from the crop edge has not been clearly defined, nor have the reasons for lower marginal yields. Surveys of 40 winter wheat headlands were carried out in 2 years to determine how yield changed with distance, and what factors might influence this relationship. Two field experiments were also conducted over 3 years in winter cereal headlands, in which the effect of distance was measured under conservation headland and conventional (fully sprayed) management.

Yields in the headland surveys varied from 0·8 to 10·2 t/ha. An inverse polynomial regression model was fitted to yield and weed data. Best fits were obtained by using separate parameters for each site. Adjusting yields to take account of weed dry matter improved the non-linear fit between yield and distance from crop edge. Field experiments provided similar results but the non-linear relationship was not as apparent.

There was a negative relationship between soil compaction, as measured by a cone penetrometer, and yield in one field experiment, where soil density values were relatively constant. No relationship was found between pattern of nitrogen fertilizer application and yield. Conservation headland management resulted in lower yield at one experimental site, especially in the third year, but not at the other site. Where yields were affected, weed dry matter was higher in conservation headland plots than in fully sprayed plots.

Although greater weed competition appears to account for at least part of the observed yield reductions on headlands, the role of other factors, particularly soil compaction, needs further study. Increased weed infestation may be an indirect result of reduced crop competition caused by other adverse conditions.

Thin films of AlxGa1−xN (0.05 ≤ x ≤ 0.96) having smooth surfaces were deposited directly on both vicinal and on-axis 6H-SiC(0001) substrates. Cross-sectional TEM of Al0.13Ga0.87N revealed stacking faults near the SiC/Nitride alloy interface and numerous threading dislocations. EDX, AES and RBS were used to determine the compositions, which were paired with their respective CL near band-edge emission energies. A negative bowing parameter was determined. The CL emission energies were similar to the bandgap energies obtained by SE. FE-AES of the initial growth of Al0.2Ga0.8N revealed an aluminum rich layer near the interface. N-type (silicon) doping was achieved for AlxGa1−xN for 0.12 ≤ x ≤ 0.42. Al0.2Ga0.8N/GaN superlattices were fabricated with coherent interfaces. Additionally, HEMT structures using an AlN/GaN/AlN buffer structure were fabricated.

We have studied the near-edge optical response of a LT-grown GaAs sample which was deposited at 300 °C on a Si substrate, and then annealed at 600 °C. The Si was etched away to leave a 3-micron free standing GaAs film. Femtosecond transmission measurements were made using an equal pulse technique at four wavelengths between 825 and 870 nm. For each wavelength we observe both a multipicosecond relaxation time, as well as a shorter relaxation time which is less than 100 femtoseconds.