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Background: Cerebral venous thrombosis (CVT)most commonly affects younger women. Diagnosis may be delayed due to its distinct presentation and demographic profile compared to other stroke types. Methods: We examined delays to diagnosis of CVT in the SECRET randomized trial and TOP-SECRET parallel registry. Adults diagnosed with symptomatic CVT within <14 days were included. We examined time to diagnosis and number of health care encounters prior to diagnosis and associations with demographics, clinical and radiologic features and functional and patient-reported outcomes (PROMS) at days 180&365. Results: Of 103 participants, 68.9% were female; median age was 45 (IQR 31.0-61.0). Median time from symptom onset to diagnosis was 4 (1-8) days. Diagnosis on first presentation to medical attention was made in 60.2%. The difference in time to diagnosis for single versus multiple presentations was on the order of days (3[1-7] vs. 5[2-11.75], p=0.16). Women were likelier to have multiple presentations (OR 2.53; 95% CI1.00-6.39; p=0.05) and longer median times to diagnosis (5[2-8]days vs. 2[1-4.5] days; p=0.005). However, this was not associated with absolute or change in functional, or any patient reported, outcome measures (PROMs) at days 180&365. Conclusions: Diagnosis of CVT was commonly delayed; women were likelier to have multiple presentations. We found no association between delayed diagnosis and outcomes.
Background: Sex differences in treatment response to intravenous thrombolysis (IVT) are poorly characterized. We compared sex-disaggregated outcomes in patients receiving IVT for acute ischemic stroke in the Alteplase compared to Tenecteplase (AcT) trial, a Canadian multicentre, randomised trial. Methods: In this post-hoc analysis, the primary outcome was excellent functional outcome (modified Rankin Score [mRS] 0-1) at 90 days. Secondary and safety outcomes included return to baseline function, successful reperfusion (eTICI≥2b), death and symptomatic intracerebral hemorrhage. Results: Of 1577 patients, there were 755 women and 822 men (median age 77 [68-86]; 70 [59-79]). There were no differences in rates of mRS 0-1 (aRR 0.95 [0.86-1.06]), return to baseline function (aRR 0.94 [0.84-1.06]), reperfusion (aRR 0.98 [0.80-1.19]) and death (aRR 0.91 [0.79-1.18]). There was no effect modification by treatment type on the association between sex and outcomes. The probability of excellent functional outcome decreased with increasing onset-to-needle time. This relation did not vary by sex (pinteraction 0.42). Conclusions: The AcT trial demonstrated comparable functional, safety and angiographic outcomes by sex. This effect did not differ between alteplase and tenecteplase. The pragmatic enrolment and broad national participation in AcT provide reassurance that there do not appear to be sex differences in outcomes amongst Canadians receiving IVT.
This study aimed to investigate psychometric properties and enhance precision of the 16-item Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-16) up to interval-level scale using Rasch methodology.
Design:
Partial Credit Rasch model was applied to the IQCODE-16 scores using longitudinal data spanning 10 years of biennial follow-up.
Setting:
Community-dwelling older adults aged 70–90 years and their informants, living in Sydney, Australia, participated in the longitudinal Sydney Memory and Ageing Study (MAS).
Participants:
The sample included 400 participants of the MAS aged 70 years and older, 109 out of those were diagnosed with dementia 10 years after the baseline assessment.
Measurements:
The IQCODE-16.
Results:
Initial analysis indicated excellent reliability of the IQCODE-16, Person Separation Index (PSI) = 0.92, but there were four misfitting items and local dependency issues. Combining locally dependent items into four super-items resulted in the best Rasch model fit with no misfitting or locally dependent items, strict unidimensionality, strong reliability, and invariance across person factors such as participants’ diagnosis and relationship to their informants, as well as informants’ age and sex. This permitted the generation of conversion algorithms to transform ordinal scores into interval data to enhance precision of measurement.
Conclusions:
The IQCODE-16 demonstrated strong reliability and satisfied expectations of the unidimensional Rasch model after minor modifications. Ordinal-to-interval transformation tables published here can be used to increase accuracy of the IQCODE-16 without altering its current format. These findings could contribute to enhancement of precision in assessing clinical conditions such as cognitive decline in older people.
The main aim of the current study was to present the abilities of widely used crop models to simulate four different field crops (winter wheat, spring barley, silage maize and winter oilseed rape). The 13 models were tested under Central European conditions represented by three locations in the Czech Republic, selected using temperature and precipitation gradients for the target crops in this region. Based on observed crop phenology and yield from 1991 to 2010, performances of individual models and their ensemble were analyzed. Modelling of anthesis and maturity was generally best simulated by the ensemble median (EnsMED) compared to the ensemble mean and individual models. The yield was better simulated by the best models than estimated by an ensemble. Higher accuracy was achieved for spring crops, with the best results for silage maize, while the lowest accuracy was for winter oilseed rape according to the index of agreement (IA). Based on EnsMED, the root mean square errors (RMSEs) for yield was 1365 kg/ha for winter wheat, 1105 kg/ha for spring barley, 1861 kg/ha for silage maize and 969 kg/ha for winter oilseed rape. The AQUACROP and EPIC models performed best in terms of spread around the line of best fit (RMSE, IA). In some cases, the individual models failed. For crop rotation simulations, only models with reasonable accuracy (i.e. without failures) across all included crops within the target environment should be selected. Application crop models ensemble is one way to increase the accuracy of predictions, but lower variability of ensemble outputs was confirmed.
This study aimed to apply the generalizability theory (G-theory) to investigate dynamic and enduring patterns of subjective cognitive complaints (SCC), and reliability of two widely used SCC assessment tools.
Design:
G-theory was applied to assessment scales using longitudinal measurement design with five assessments spanning 10 years of follow-up.
Setting:
Community-dwelling older adults aged 70–90 years and their informants, living in Sydney, Australia, participated in the longitudinal Sydney Memory and Ageing Study.
Participants:
The sample included 232 participants aged 70 years and older, and 232 associated informants. Participants were predominantly White Europeans (97.8%). The sample of informants included 76 males (32.8%), 153 females (65.9%), and their age ranged from 27 to 86 years, with a mean age of 61.3 years (SD = 14.38).
Measurements:
The Memory Complaint Questionnaire (MAC-Q) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).
Results:
The IQCODE demonstrated strong reliability in measuring enduring patterns of SCC with G = 0.86. Marginally acceptable reliability of the 6-item MAC-Q (G = 0.77–0.80) was optimized by removing one item resulting in G = 0.80–0.81. Most items of both assessments were measuring enduring SCC with exception of one dynamic MAC-Q item. The IQCODE significantly predicted global cognition scores and risk of dementia incident across all occasions, while MAC-Q scores were only significant predictors on some occasions.
Conclusions:
While both informants’ (IQCODE) and self-reported (MAC-Q) SCC scores were generalizable across sample population and occasions, self-reported (MAC-Q) scores may be less accurate in predicting cognitive ability and diagnosis of each individual.
Data on accordance and clinical significancy of objective (doctor, psychometric scales) and subjective (patient with depression) assessment of severity of depression are almost lacking. Aim of the multicenter study “EMOTION” was to compare prognostic value of doctor's and patient's assessment of depressive symptoms severity as for its grading and treatment outcome.
Method
Study sample consist of 107 depressive patients. The study used clinical and psychometric (HDRS, SHAPS, CGI-S, CGI-I, PGI-S, PGI-I, Visual Analog Scale) methods.
Results
Our data suggest that there's statistically significant (Р ˂ 0.001) discrepancy between doctors’ (CGI-S) and patients’ (PGI-S) assessment of depressive symptoms’ severity at first visit. Concordant opinions were found only in “marked depression” (37.49% of doctors and 36.59% of patients) and in “borderline depression” (4.79% of doctors and 3.79% of patients). Otherwise, doctors’ and patients’ opinions were discordant. Doctors’ scores were more extreme (severe and extremely severe depression); patients’ scores were more “moderate”. We have found inconsistence between HDRS and CGI-S scores. In the course of reduction of depression severity during antidepressive treatment (agomelatine) doctors’ and patients’ scores were more and more in line with each other.
Conclusion
We have found leveling of prognostic value of psychometric assessment of depression severity by doctors and patients (in terms of reduction of depressive symptoms severity and treatment outcome) during antidepressive therapy. It is possible that in some HDRS items scores were overestimated.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The β-diversity of fleas parasitic on small mammals in 45 regions of the Palearctic was partitioned into species [species contributions to β-diversity (SCBD)] and site ( = assemblage) contributions [local contributions to β-diversity (LCBD)]. We asked what are the factors affecting SCBD and LCBD and tested whether (a) variation in ecological, morphological, life history and geographic traits of fleas can predict SCBD and (b) variation in flea and host community metrics, off-host environmental factors, host species composition of flea assemblages can predict LCBD. We used spatial variables to describe geographic distribution of flea assemblages with various LCBD values. SCBD significantly increased with an increase in abundance and a decrease in phylogenetic host specificity of a flea as well as with size and latitude of its geographic range, but was not associated with any morphological/life history trait. LCBD of flea assemblages did not depend on either flea or host species richness or environmental predictors, but was significantly affected by compositional uniqueness ( = LCBD) of regional host assemblages and variables describing their species composition. In addition, variation in LCBD was also explained by broad-to-moderate-scale spatial variables. We conclude that SCBD of fleas could be predicted via their ecological and geographic traits, whereas LCBD of their assemblages could be predicted via host composition.
The dynamic growth of multinational enterprises (MNEs) from emerging economies – mostly from so-called BRIC countries (Brazil, Russia, India and China) – is widely acknowledged as one of the key developments in the global economy in the last fifteen years. Today emerging market multinational enterprises (EMNEs) account for nearly one-tenth of the foreign sales and foreign assets of the top 500 multinationals in the world, compared to only 1–2 per cent in 1995 (UNCTAD, 2010). In the 2000s, the number of companies from emerging economies in the Fortune Global 500 has more than tripled (from twenty-one to seventy-five). In the new decade, competition between multinationals from developed countries and EMNEs with global aspirations (defined by Boston Consulting Group as ‘global challengers’) will continue to intensify. This new trend in globalisation of the world economy was reflected recently in booming interest in EMNEs in international business (IB) and strategic management (SM) fields, including publication of several books on the subject (Rugman, 2005; Goldstein, 2007; Casanova, 2009; Larcon, 2009; Ramamurti and Singh, 2009a).
Most of the existing EMNEs literature is either quite descriptive or is based on rather limited arguments in the early theoretical interpretations of foreign expansion of MNEs from emerging economies. Attempts to explain the growth of foreign direct investment (FDI) and reinforcement of EMNEs’ positions with country-specific advantages (CSA) come across several difficulties. Reasoning based on CSAs could not suffice the need for our comprehensive understanding of the nature and mechanisms of EMNEs’ competitive advantages. On one hand, today (as compared to the second half of the twentieth century) FDI is no longer the only attribute of multinational activities. Cross-border value-adding non-equity arrangements are gaining at least similar strategic importance for MNEs from both developed and emerging economies.
We report on experiments aimed at the generation and characterization of solid density plasmas at the free-electron laser FLASH in Hamburg. Aluminum samples were irradiated with XUV pulses at 13.5 nm wavelength (92 eV photon energy). The pulses with duration of a few tens of femtoseconds and pulse energy up to 100 µJ are focused to intensities ranging between 1013 and 1017 W/cm2. We investigate the absorption and temporal evolution of the sample under irradiation by use of XUV and optical spectroscopy. We discuss the origin of saturable absorption, radiative decay, bremsstrahlung and atomic and ionic line emission. Our experimental results are in good agreement with simulations.
Recent PIC simulations of relativistic electron-positron (electron-ion) jets injected into a stationary medium show that particle acceleration occurs in the shocked regions. Simulations show that the Weibel instability is responsible for generating and amplifying highly nonuniform, small-scale magnetic fields and for particle acceleration. These magnetic fields contribute to the electron's transverse deflection behind the shock. The “jitter” radiation from deflected electrons in turbulent magnetic fields has different properties from synchrotron radiation calculated in a uniform magnetic field. This jitter radiation may be important for understanding the complex time evolution and/or spectral structure of gamma-ray bursts, relativistic jets in general, and supernova remnants. In order to calculate radiation from first principles and go beyond the standard synchrotron model, we have used PIC simulations. We will present detailed spectra for conditions relevant to various astrophysical sites of collisionless shock formation. In particular we will discuss application to GRBs and SNRs.
This article discusses the role of some pathogenetical factors in the main morphological variants of vascular dementia and their correlation with certain clinical parameters. On the basis of computer-tomographical (CT) studies of 62 patients with dementia, it was possible to distinguish three groups of patients, according to the type of parenchymatous brain lesions: (1) 14 patients with “pure” leukoaraiosis (LA); (2) 23 patients with ischemic foci (IF), and (3) 25 patients with a combination of LA and IF. A comparative study of these groups confirmed the concept that in the development of LA and dementia related to it, a special role is being attributed to such factors as arterial hypertension and aging.
One of the high levels of actinide, and in particular Cm, waste streams at the Russian radiochemical Production Association (PA) Mayak was generated during spent fuel reprocessing. Using oxalate precipitation, the rare earth elements (REE) and transuranic elements (TRU) settled out in the form of oxalate residues. Due to in high REE contents in this residue, the mineral-like matrix based on (REE)PO4 solid solution, with monlclinic monazite structure have been proposed to use as a suitable ceramics form for final actinide immobilization. For this purpose the synthetic REE oxalates were first transformed into REE orthophosphates in a thin-film evaporator (TFE). Then the (REE)PO4 powder was compacted both by either hot uniaxial pressing (HUP) or cold uniaxial pressing followed by sintering (CUP). This ceramic with the monazite structure has a high density and exhibits chemical durability by leaching.
We prove the existence of a family of Travelling Wave (TW) solutions for a large class of scalar reaction-diffusion equations with degenerate, nonlinear diffusion coefficients and monostable nonlinear reaction terms. We also investigate stability. Specifically, we show that, as in the linear diffusion case [6], the slowest TW in the family yields the asymptotic rate of the propagation of disturbances from the unstable rest state in these systems. In addition, we give conditions on the reaction term and diffusion coefficient ensuring the existence of interfaces.
If ω ≡ 1 is a group law implying virtual nilpotence in every finitely generated metabelian group satisfying it, then it implies virtual nilpotence for the finitely generated groups of a large class of groups including all residually or locally soluble-or-finite groups. In fact the groups of satisfying such a law are all nilpotent-by-finite exponent where the nilpotency class and exponent in question are both bounded above in terms of the length of ω alone. This yields a dichotomy for words. Finally, if the law ω ≡ 1 satisfies a certain additional condition—obtaining in particular for any monoidal or Engel law—then the conclusion extends to the much larger class consisting of all ‘locally graded’ groups.
This paper is concerned with the question of whether n-Engel groups are locally nilpotent. Although this seems unlikely in general, it is shown here that it is the case for the groups in a large class C including all residually soluble and residually finite groups (in fact all groups considered in traditional textbooks on group theory). This follows from the main result that there exist integers c(n), e(n) depending only on n, such that every finitely generated n-Engel group in the class C is both finite-of-exponent-e(n)–by–nilpotent-of-class≤c(n) and nilpotent-of-class≤c(n)–by–finite-of-exponent-e(n). Crucial in the proof is the fact that a finitely generated Engel group has finitely generated commutator subgroup.
We studied flea assemblages on rodents in different habitats of the Ramon erosion cirque in the Negev Desert to examine whether host–habitat relations influence flea spatial distribution. Eleven flea species parasitizing 12 rodent species were recorded. There was significant positive relationship between flea species richness and body mass of the host species; no relationships were found between relative richness of flea assemblage and either the number of habitats occupied by the host species or the size of host geographical range. The differences in pattern of flea parasitism among habitat types within host species were determined by both environmental features of a habitat and the specific pattern of habitat use by rodents. There was replacement of Xenopsylla conformis by Xenopsylla ramesis on Meriones crassus and Gerbillus dasyurus among different habitats. The results of ordination of the flea collections from each individual host demonstrated that the flea assemblages were segregated mainly along 4 axes, which explained 86% of total variance. Each of the ordination axes corresponded with a change in flea species composition. The directions of these changes were (1) among-hosts within a habitat and (2) among-habitats within a host.
This paper analyzes archaeological remains from Verkholenskaia Gora in Cis-Baikal and discusses the placement of this culture in the archaeological sequence of the Baikal region. The tools are classified on the basis of manufacturing technique and technological function. The discovery of a bone arrowpoint at this site may increase the antiquity of the bow by several millennia. A comparison of the materials from Verkholenskaia Gora with materials from other regional archaeological assemblages suggests that the site was occupied at the end of the transitional period that extends from the Palaeolithic of the Mal'ta stage to the Neolithic. Verkholenskaia Gora is therefore assigned to the Siberian Mesolithic.
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