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Background: After a transient ischemic attack (TIA) or minor stroke, the long-term risk of subsequent stroke is uncertain. Methods: Electronic databases were searched for observational studies reporting subsequent stroke during a minimum follow-up of 1 year in patients with TIA or minor stroke. Unpublished data on number of stroke events and exact person-time at risk contributed by all patients during discrete time intervals of follow-up were requested from the authors of included studies. This information was used to calculate the incidence of stroke in individual studies, and results across studies were pooled using random-effects meta-analysis. Results: Fifteen independent cohorts involving 129794 patients were included in the analysis. The pooled incidence rate of subsequent stroke per 100 person-years was 6.4 events in the first year and 2.0 events in the second through tenth years, with cumulative incidences of 14% at 5 years and 21% at 10 years. Based on 10 studies with information available on fatal stroke, the pooled case fatality rate of subsequent stroke was 9.5% (95% CI, 5.9 – 13.8). Conclusions: One in five patients is expected to experience a subsequent stroke within 10 years after a TIA or minor stroke, with every tenth patient expected to die from their subsequent stroke.
Bustards comprise a highly threatened family of birds and, being relatively fast, heavy fliers with very limited frontal visual fields, are particularly susceptible to mortality at powerlines. These infrastructures can also displace them from immediately adjacent habitat and act as barriers, fragmenting their ranges. With geographically ever wider energy transmission and distribution grids, the powerline threat to bustards is constantly growing. Reviewing the published and unpublished literature up to January 2021, we found 2,774 records of bustard collision with powerlines, involving 14 species. Some studies associate powerline collisions with population declines. To avoid mortalities, the most effective solution is to bury the lines; otherwise they should be either routed away from bustard-frequented areas, or made redundant by local energy generation. When possible, new lines should run parallel to existing structures and wires should preferably be as low and thick as possible, with minimal conductor obstruction of vertical airspace, although it should be noted that these measures require additional testing. A review of studies finds limited evidence that ‘bird flight diverters’ (BFDs; devices fitted to wires to induce evasive action) achieve significant reductions in mortality for some bustard species. Nevertheless, dynamic BFDs are preferable to static ones as they are thought to perform more effectively. Rigorous evaluation of powerline mortalities, and effectiveness of mitigation measures, need systematic carcass surveys and bias corrections. Whenever feasible, assessments of displacement and barrier effects should be undertaken. Following best practice guidelines proposed with this review paper to monitor impacts and mitigation could help build a reliable body of evidence on best ways to prevent bustard mortality at powerlines. Research should focus on validating mitigation measures and quantifying, particularly for threatened bustards, the population effects of powerline grids at the national scale, to account for cumulative impacts on bustards and establish an equitable basis for compensation measures.
We describe the incidence of suicidality (2007–2017) in people with depression treated by secondary mental healthcare services at South London and Maudsley NHS Trust (n = 26 412). We estimated yearly incidence of ‘suicidal ideation’ and ‘high risk of suicide’ from structured and free-text fields of the Clinical Record Interactive Search system. The incidence of suicidal ideation increased from 0.6 (2007) to 1 cases (2017) per 1000 population. The incidence of high risk of suicide, based on risk forms, varied between 0.06 and 0.50 cases per 1000 adult population (2008–2017). Electronic health records provide the opportunity to examine suicidality on a large scale, but the impact of service-related changes in the use of structured risk assessment should be considered.
The early phase of the coronavirus disease 2019 (COVID-19) pandemic and ongoing efforts for mitigation underscore the importance of universal travel and symptom screening. We analyzed adherence to documentation of travel and symptom screening through a travel navigator tool with clinical decision support to identify patients at risk for Middle East Respiratory Syndrome.
An analytical study of the small amplitude electron acoustic double layers in a magnetized plasma consisting of superthermal electrons and ions along with cold fluid electrons is discussed. The dispersion relation allows electron acoustic waves with the frequency within electron and ion gyro-frequency in the modelled plasma. In the process of study of the nonlinear structures, the Sagdeev pseudo-potential method for small amplitude regions is employed. The existence domains for the double layers are investigated in terms of the Mach numbers of the structures and the temperature ratios of the species for different ratios of their concentration. The effects of the compositional parameters on the nature and size of the double layers are also explored and it is observed that the plasma can support both compressive and rarefactive double layers depending on the values of those parameters and the Mach numbers.
For scalar conservation laws in one space dimension with a flux function discontinuous inspace, there exist infinitely many classes of solutions which are L1 contractive.Each class is characterized by a connection (A,B) which determines the interface entropy. Forsolutions corresponding to a connection (A,B), there exists convergent numerical schemesbased on Godunov or Engquist−Osher schemes. The natural question is how to obtain schemes,corresponding to computationally less expensive monotone schemes like Lax−Friedrichs etc., usedwidely in applications. In this paper we completely answer this question for more general(A,B)stable monotone schemes using a novel construction of interface flux function. Then fromthe singular mapping technique of Temple and chain estimate of Adimurthi and Gowda, weprove the convergence of the schemes.
In acute multiple sclerosis (MS) lesions, axonal pathology and the number of transected axons correlate with the number of immune cells and therefore with inflammatory activity. In addition to the commonly described white matter locations, demyelination also occurs in the gray matter of MS patients. The concept of MS as an inflammatory demyelinating and neurodegenerative disease provides a framework to help explain disease progression and development of permanent neurological disability in MS patients. Prevention of persistent neurological disability is the main goal when treating neurological diseases. In contrast to most neurodegenerative diseases, patients with MS can be identified early before the occurrence of extensive neurodegeneration by the presentation of symptoms mediated by inflammatory demyelination. Therefore, neuroprotective therapeutics may have a greater probability of clinical efficacy in MS patients since treatment can be initiated before extensive axonal loss. Regardless of the cause of MS, axons and neurons are important therapeutic targets.
We study resonant tunneling through a layered medium with a passive negative index medium (NIM) slab as a constituent layer. Using a causalmodel for susceptibilities with the parameters of a recently reported metamaterial [G. Dolling, C. Enkrich, M. Wegener, C.M. Soukoulis, S. Linden, Opt. Lett. 31, 1800 (2006)] we show that resonant tunnelling and the associated delay are mostly suppressed. This is in sharp contrast with the naive approach of retaining phase velocity dispersion with arbitrary low losses, predicting sharp resonances with large associated delays. This is shown to be a nontrivial issue because of the necessity of losses for NIM behaviour, while their presence spoils the quality factor of the resonant devices.
Following earlier work of Huggins and Nix [Ionics6, 57 (2000)], several recent theoretical studies have used the shrinking core model to predict intraparticle Li concentration profiles and associated stress fields. A goal of such efforts is to understand and predict particle fracture, which is sometimes observed in degraded electrodes. In this paper we present experimental data on LiCoO2 and graphite active particles, consistent with previously published data, showing the presence of numerous internal pores or cracks in both positive and negative active electrode particles. New calculations presented here show that the presence of free surfaces, from even small internal cracks or pores, both quantitatively and qualitatively alters the internal stress distributions such that particles are prone to internal cracking rather than to the surface cracking that had been predicted previously. Thus, the fracture strength of particles depends largely on the internal microstructure of particles, about which little is known, rather than on the intrinsic mechanical properties of the particle materials. The validity of the shrinking core model for explaining either stress maps or transport is questioned for particles with internal structure, which includes most, if not all, secondary electrode particles.
The generation of poloidal magnetic field in an inhomogeneous cold, collisionless plasma by an elliptically polarized Gaussian laser beam is discussed. A field in the range of megagauss is induced by the laser inhomogeneity effect even for a normal incident beam. This field scales as I0 λ, where I0 and λ are the intensity and wavelength of the laser beam, respectively, and is independent of the density profile structure. The small angular correction factor due to focal spot asymmetry scales as ∼I0λ3 and may be significant for a small-sized plasma with a steep density profile. The limitation of our model is discussed, with possible implications.
The exhausting effect of dura for a single year in a rotation was shown. Rotations including dura consistently yielded less than those including lubia or fallow. With 2 successive years of dura the reduction in yields of cotton was extremely large.
Substantial increases in yields of cotton were obtained when the first fallow of the CFF rotation was replaced by lubia. The superiority of the rotation CLF appeared to be firmly established in the Gezira, where the soil was known to be deficient in nitrogen. By growing lubia, instead of leaving a fallow 2 years preceding cotton, an average annual increase of 0·65 k.p.f. of cotton was obtained. Itwas interesting to note that fertility of rotation CLF over CFF was still increasing.
Twenty one genotypes belonging to Spanish, Valencia and Virginia groups of groundnut were studied at Patancheru and a further seventeen at Delhi. Their relative performance based on a large number of characters spanning the entire growth phase was assessed. Nitrogenase activity and nodule mass were measured at three stages of crop growth starting from first flowering, and these two characters alone when measured at 30 days after flowering closely matched the measure of relative performance based on the entire set of characters.
We report for the first time, to the best of our knowledge, an inexpensive fabrication procedure for obtaining perfectly coupled PbS quantum dots. Evidence of quantum dot pairing (each, 10–12 nm) was confirmed by transmission electron microscopy, and the stability with aging was checked by dark-current measurements. The method of encapsulating PbS quantum dots in a nontoxic cis-trans polymer is simple, convenient and attractive for reproducible reasons. Such coupled quantum dots are promising to act as qubits which are vital in quantum computers and qubit architecture.
A total of 113 strains of Shigella dysenteriae type 2 isolated from patients attending the Dhaka diarrhoea treatment centre of ICDDR,B: Centre for Health and Population Research during the period 1999–2004 were studied. Serotype of the isolates was confirmed using commercially available antisera. Except for arabinose fermentation, all the strains had similar biochemical reactions. More than 60% of the strains were sensitive to commonly used antibiotics; only 6% (n=7) of the strains were resistant to nalidixic acid, and none of the strains were resistant to mecillinam and ciprofloxacin. All strains were invasive as demonstrated by the presence of a 140 MDa plasmid, ial, sen and ipaH genes, Congo Red absorption ability and by the Sereny test performed on representative strains. Plasmid patterns were heterogeneous but more than 50% of strains were confined to a single pattern. All strains possessed a 1·6 MDa plasmid and 87% of the strains contained a 4 MDa plasmid. Middle-range plasmids (90 MDa to 30 MDa) present in 36% of the strains were not associated with antibiotic resistance. All the strains were clustered within a single type with four subtypes by pulsed-field gel electrophoresis while ribotyping patterns of all the strains were identical.
Pulsed-field gel electrophoresis (PFGE) is commonly used in molecular epidemiology. However, this technique has never been used in studying intra-family spread of enteric diseases in Bangladesh. Our objective was to evaluate the intra-familial transmission of shigella infection using PFGE. Children of either sex, less than 10 years old, who were family contacts of shigella-infected index cases were the study population. PFGE was applied if the same serotypes/sub-serotypes of shigella were isolated from both the index case and the family contact children. In total, 227 index cases were studied. Shigella was isolated from 61 (27%) contact children on day 1 of enrolment, among which Shigella flexneri (41%) and S. boydii (41%) were dominant, followed by S. dysenteriae (10%), S. sonnei (3%), and shigella-like organisms (5%). Seventeen (28%) of the asymptomatic infections in contact children were caused by the same serotype of shigella as that found in the index case. The intra-familial shigella transmission rate was 8% (17/227). Of the 227 contact children, eight (4%) developed diarrhoea during a 10-day follow-up and shigella was isolated from five (2%) of these children, and three of them (S. flexneri 3a, 1b, and 3a) were identical to the strains from their respective index cases. Compared to children without asymptomatic carriage of shigella (2/166), the risk (odds ratio) of developing diarrhoea for the children with asymptomatic carriage of shigella identical to their cases (3/17) was 9·0 (95% CI 1·5–49·0, P=0·01). The attributable risk for symptomatic shigella infection by intra-familial transmission was 50%. Results of this study demonstrated that intra-familial transmission of shigella carries a higher risk for diarrhoea.
Background and objective: We studied the effect of different recumbent positions (supine, left and right lateral decubitus), on arterial oxygenation in 42 valvular heart disease patients planned for cardiac surgery. All patients had cardiomegaly (cardiothoracic ratio ≥0.5) in their chest X-rays. Their left ventricular end-diastolic diameter was also noted from the preoperative echocardiogram. Methods: Arterial blood gas analysis was performed in supine, left and right lateral positions after keeping the patient in a given position for 15 min. During this period all patients received 35% oxygen supplementation. Results: Arterial oxygen tension and haemoglobin saturation were significantly higher in the right lateral position (PaO2 = 120.6 ± 29.5 mmHg, SaO2 = 98.1 ± 1.4%) than in supine (PaO2 = 111.0 ± 30.6 mmHg, SaO2 = 97.6 ± 2.2%) and left lateral positions (PaO2 = 109.7 ± 32.0 mmHg, SaO2 = 97.6 ± 1.7%; mean ± SD; P < 0.01). There was no significant difference in arterial oxygenation between left lateral and supine positions (P > 0.05). The change in PaO2 and SaO2 with change of posture from left to right was significantly related to left ventricular end-diastolic diameter (r = 0.50 and r = 0.63, respectively; Pearson correlation). Repeated measures of analysis of variance with left ventricular end-diastolic diameter as a covariate showed a significant change in arterial PaO2 with posture (P = 0.011). Conclusion: Right lateral posture improves arterial oxygenation in the valvular heart disease patient with an enlarged left ventricle. In the preoperative period, these patients may benefit from a right lateral posture when lying in bed.
Instrumented indentation testing was used to evaluate the changes in mechanical properties of single-walled carbon nanotube composite specimens with varying weight percentage (0, 0.1, 0.5, and 1.0 wt%) of nanotubes using a low-viscosity liquid epoxy resin. The nanotubes were prepared using laser ablation technique. Reference tensile tests were also performed on the same samples, and relevant comparisons with indentation results were made. The variations in modulus and hardness obtained using nanoindentation (considering time effects) showed quantifiable differences between the various composite specimens, but differed from tensile test data. The small changes in the observed stiffness and breaking strength of carbon nanotube composites was due to the formation of bundles, their curvy morphology, and microporosity in the specimens. Interesting fluctuations obtained from the interpreted values of modulus with depth of indentation is attributed to varying degrees of the local confining effect of nanotube bundles. Creep exponents for these nanocomposites were also evaluated and indicate considerable improvements.