10 results
Characteristics and safety of interventions and procedures performed during catheterisation of patients with congenital heart disease: early report from the national cardiovascular data registry
- Ralf Holzer, Robert Beekman, Lee Benson, Lisa Bergersen, Natalie Jayaram, Kathy Jenkins, Kevin Kennedy, John Moore, Richard Ringel, Jonathan Rome, Robert Vincent, Gerard R. Martin
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- Journal:
- Cardiology in the Young / Volume 26 / Issue 6 / August 2016
- Published online by Cambridge University Press:
- 12 October 2015, pp. 1202-1212
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Objectives
The objective of this study was to report procedural characteristics and adverse events on the data collected in the IMproving Paediatric and Adult Congenital Treatment registry.
BackgroundThe IMproving Paediatric and Adult Congenital Treatment– registry is a catheterisation registry focussed on paediatric and adult patients with congenital heart disease who are undergoing diagnostic catheterisations and catheter-based interventions. This study reports procedural characteristics and adverse events of patients who have undergone selected catheterisation procedures from January, 2011 to June, 2013.
MethodsDemographic, clinical, procedural, and institutional data elements were collected at participating centres and entered via either a web-based platform or software provided by the American College of Cardiology-certified vendors, and were collected in a secure, centralised database. For the purpose of this study, procedures that were not classified as one of the ‘core’ IMproving Paediatric and Adult Congenital Treatment procedures originally chosen for additional data collection were identified and selected for further data analysis.
ResultsDuring the time frame of data collection, a total of 8021 cases were classified as other procedures and/or multiple procedures. The most commonly performed case types – isolated or in combination with other procedures – were right ventricular biopsy in 3433 (42.8%), conduit/MPA interventions in 979 (12.3%), and systemic pulmonary artery collateral occlusion in 601 (7.5%). For the whole cohort, adverse events of any severity occurred in 957 (12.0%) cases, whereas major adverse events occurred in 113 (1.4%) cases; six patients (0.1%) died in the catheterisation laboratory.
ConclusionsThe IMproving Paediatric and Adult Congenital Treatment registry has provided important data on the frequency and spectrum of cardiac catheterisation procedures performed in the present era. For many procedures, more data and work are needed to identify more subtle differences between case categories, especially as it relates to the incidence of major adverse events, and to further develop a risk-adjustment methodology to allow equitable comparisons among institutions.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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- By Brittany L. Anderson-Montoya, Heather R. Bailey, Carryl L. Baldwin, Daphne Bavelier, Jameson D. Beach, Jeffrey S. Bedwell, Kevin B. Bennett, Richard A. Block, Deborah A. Boehm-Davis, Corey J. Bohil, David B. Boles, Avinoam Borowsky, Jessica Bramlett, Allison A. Brennan, J. Christopher Brill, Matthew S. Cain, Meredith Carroll, Roberto Champney, Kait Clark, Nancy J. Cooke, Lori M. Curtindale, Clare Davies, Patricia R. DeLucia, Andrew E. Deptula, Michael B. Dillard, Colin D. Drury, Christopher Edman, James T. Enns, Sara Irina Fabrikant, Victor S. Finomore, Arthur D. Fisk, John M. Flach, Matthew E. Funke, Andre Garcia, Adam Gazzaley, Douglas J. Gillan, Rebecca A. Grier, Simen Hagen, Kelly Hale, Diane F. Halpern, Peter A. Hancock, Deborah L. Harm, Mary Hegarty, Laurie M. Heller, Nicole D. Helton, William S. Helton, Robert R. Hoffman, Jerred Holt, Xiaogang Hu, Richard J. Jagacinski, Keith S. Jones, Astrid M. L. Kappers, Simon Kemp, Robert C. Kennedy, Robert S. Kennedy, Alan Kingstone, Ioana Koglbauer, Norman E. Lane, Robert D. Latzman, Cynthia Laurie-Rose, Patricia Lee, Richard Lowe, Valerie Lugo, Poornima Madhavan, Leonard S. Mark, Gerald Matthews, Jyoti Mishra, Stephen R. Mitroff, Tracy L. Mitzner, Alexander M. Morison, Taylor Murphy, Takamichi Nakamoto, John G. Neuhoff, Karl M. Newell, Tal Oron-Gilad, Raja Parasuraman, Tiffany A. Pempek, Robert W. Proctor, Katie A. Ragsdale, Anil K. Raj, Millard F. Reschke, Evan F. Risko, Matthew Rizzo, Wendy A. Rogers, Jesse Q. Sargent, Mark W. Scerbo, Natasha B. Schwartz, F. Jacob Seagull, Cory-Ann Smarr, L. James Smart, Kay Stanney, James Staszewski, Clayton L. Stephenson, Mary E. Stuart, Breanna E. Studenka, Joel Suss, Leedjia Svec, James L. Szalma, James Tanaka, James Thompson, Wouter M. Bergmann Tiest, Lauren A. Vassiliades, Michael A. Vidulich, Paul Ward, Joel S. Warm, David A. Washburn, Christopher D. Wickens, Scott J. Wood, David D. Woods, Motonori Yamaguchi, Lin Ye, Jeffrey M. Zacks
- Edited by Robert R. Hoffman, Peter A. Hancock, University of Central Florida, Mark W. Scerbo, Old Dominion University, Virginia, Raja Parasuraman, George Mason University, Virginia, James L. Szalma, University of Central Florida
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- The Cambridge Handbook of Applied Perception Research
- Published online:
- 05 July 2015
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- 26 January 2015, pp xi-xiv
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A Magnetic Resonance Imaging Study of Regional Cortical Volumes Following Stereotactic Anterior Cingulotomy
- Scott L. Rauch, Nikos Makris, G. Rees Cosgrove, Hackjin Kim, Edwin H. Cassem, Bruce H. Price, Lee Baer, Cary R. Savage, Verne S. Caviness, Jr., Michael A. Jenike, David N. Kennedy
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- CNS Spectrums / Volume 6 / Issue 3 / March 2001
- Published online by Cambridge University Press:
- 07 November 2014, pp. 214-222
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The purpose of this study was to test the hypothesis that orbitofrontal cortical volume would be reduced following anterior cingulotomy for obsessive-compulsive disorder (OCD). Whole brain cortical parcellation was performed on magnetic resonance imaging (MRI) data from nine patients, before and 9(±6) months following anterior cingulotomy. No significant volumetric reductions were found in the orbitofrontal cortex. Exploratory findings of reduced volume in ventral temporo-fusiform and posterior cingulate regions were consistent with chance differences, in the face of multiple comparisons. Therefore, though the circumscribed lesions of anterior cingulotomy have recently been associated with corresponding volumetric reductions in the caudate nucleus, no comparable volumetric reductions are evident in cortical territories. Taken together, these results are most consistent with a model of cingulo-striatal perturbation as a putative mechanism for the efficacy of this procedure. While limitations in sensitivity may have also contributed to these negative findings, the methods employed have previously proven sufficient to detect cortical volumetric abnormalities in OCD. The current results may reflect a relatively diffuse pattern of cortico-cortical connections involving the neurons at the site of cingulotomy lesions. Future functional neuroimaging studies are warranted to assess possible cortical or subcortical metabolic changes associated with anterior cingulotomy, as well as predictors of treatment response.
Contributors
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- By Gregory W. Albers, Sylvan J. Albert, Eitan Auriel, Natan M. Bornstein, Michael Brainin, Lara Caeiro, Valeria Caso, Barbara Casolla, Ángel Chamorro, László Csiba, Hans-Christoph Diener, Corina Epple, José M. Ferro, Jochen B. Fiebach, Jens Fiehler, Josef Finsterer, Jan Gralla, Wolf-Dieter Heiss, Konstantin-A. Hossmann, Achim J. Kaasch, Jürg Kesselring, Wilfried Lang, Kennedy R. Lees, Didier Leys, Philipp Lichti, Sharan K. Mann, Isabel P. Martins, Karl Matz, Patrik Michel, Pasquale Mordasini, Bo Norrving, Richard E. O’Brien, Céline Odier, Jobst Rudolf, Gerhard Schroth, Harald Seifert, Thorsten Steiner, Claudia Stöllberger, Yvonne Teuschl, Danilo Toni, Jaakko Tuomilehto
- Edited by Michael Brainin, Donau-Universität Krems, Austria, Wolf-Dieter Heiss
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- Textbook of Stroke Medicine
- Published online:
- 05 September 2014
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- 11 September 2014, pp vii-viii
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Chapter 18 - Acute therapies for stroke
- from Section 4: - Therapeutic strategies and neurorehabilitation
- Edited by Michael Brainin, Donau-Universität Krems, Austria, Wolf-Dieter Heiss
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- Textbook of Stroke Medicine
- Published online:
- 05 September 2014
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- 11 September 2014, pp 294-310
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16 - Acute therapies and interventions
- from Section IV - Therapeutic strategies and neurorehabilitation
- Edited by Michael Brainin, Zentrum für Klinische Neurowissenschaften, Donnau-Universität, Krems, Austria, Wolf-Dieter Heiss, Universität zu Köln
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- Textbook of Stroke Medicine
- Published online:
- 05 May 2010
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- 19 November 2009, pp 230-242
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Summary
Introduction
Over recent decades the early management of acute stroke has changed dramatically and the early post-stroke period has been the focus of much research. With advances in pharmacotherapeutics, and on the basis of many randomized controlled trials, the potential interventions now available within the first 24–48 hours following acute stroke are numerous.
This chapter will present the evidence and best practice guidance for interventions during the first 24–48 hours following stroke, based upon the European Stroke Organisation Guidelines 2008 and the European Stroke Initiative recommendations for the management of intracranial hemorrhage [1,2]. For the purposes of this chapter, the interventions discussed will generally be limited to the initial 48 hours following ictus. Access to some of these therapies may not be universal and may be dictated by local availability at individual stroke units. As with other aspects of stroke care, however, close cooperation and inter-disciplinary communication are essential.
Thrombolysis
In respect of acute interventions, one of the most significant advances during the last two decades has been the introduction of intravenous thrombolysis as a standard therapy for a well-selected population of patients with acute ischemic stroke. At present, the only thrombolytic agent licensed in Europe for the treatment of ischemic stroke is recombinant-tissue plasminogen activator (rtPA), alteplase.
Optical and Microstructural Characterisation of InN Grown by PAMBE on (0001) Sapphire and (001) YSZ
- P. A. Anderson, C. E. Kendrick, T. E. Lee, W. Diehl, R. J. Reeves, V. J. Kennedy, A. Markwitz, R. J. Kinsey, S. M. Durbin
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- Journal:
- MRS Online Proceedings Library Archive / Volume 798 / 2003
- Published online by Cambridge University Press:
- 01 February 2011, Y12.3
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- 2003
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InN continues to be a topic of great interest, particularly with respect to the issues surrounding its bandgap energy. To further explore this material and its properties, we have grown 200–300 nm InN films by a plasma-assisted molecular beam epitaxy (PAMBE) technique on a variety of substrates, including (0001) sapphire, (100) InAs, and both (100) and (111) YSZ. Single-crystal films regardless of quality all show the commonly reported broad luminescence feature in the range of 0.7 to 0.8 eV, although we have also observed this feature in polycrystalline films. Growth on (100) InAs and (100) YSZ was motivated by a desire to explore cubic InN; in both cases growth appears to be initially cubic, but a mixture of hexagonal and cubic phases is detected in the final layer.
35 - Prospects for improved neuroprotection trials in stroke
- from Part X - Risk factors, clinical trials and new therapeutic horizons
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- By Kennedy R. Lees, University Department of Medicine & Therapeutics, Western Infirmary, Glasgow, Scotland
- Edited by Pak H. Chan, Stanford University, California
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- Book:
- Cerebrovascular Disease
- Published online:
- 02 November 2009
- Print publication:
- 28 March 2002, pp 430-443
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Summary
Introduction
The experimental basis for neuroprotection is well founded. In a range of animal models of ischemic stroke, drugs acting by a variety of mechanisms can be administered up to several hours after the ischemic insult and reductions in infarct volume can be demonstrated. Whilst individual models have their proponents and their disadvantages, numerous strategies have been sufficiently convincing to encourage clinical development. Examples of drugs reaching large clinical trials range from free radical scavengers, γ-aminobutyric acid (GABA) agonists and calcium antagonists, through a range of drugs acting on the glutamate cascade to precursors of membrane constituents such as citicoline. Unfortunately, the range of drugs and mechanisms that has been tested in the clinic and has so far failed, exactly parallels the former list (Table 35.1). In most cases, the result has been neutral but a few drugs had adverse effects that were not anticipated from the preclinical studies.
In the face of these disappointments, some pessimism amongst the clinical researchers would be understandable, but instead a cautious optimism remains. This is based on sound scientific analysis of the progress that has been made and the prospects for adjusting the development strategy for future compounds.
Potential reasons for the failure of previous clinical trials have been widely reviewed. Most are speculative, but the principles that underlie them can readily be tested and bear repetition. First, the translation from animal models to human stroke demands certain assumptions.
9 - Adaptive resonance theory: a foundation for ‘apprentice’ systems in clinical decision support?
- Edited by Richard Dybowski, King's College London, Vanya Gant, University College London Hospitals NHS Trust, London
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- Clinical Applications of Artificial Neural Networks
- Published online:
- 06 October 2009
- Print publication:
- 09 August 2001, pp 192-222
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Summary
Introduction
apprentice n. Learner of a craft. [Old French apprendre]
In the field of clinical decision-making, a decision aid that is able to continue to learn from ‘experience’ is likely to have an advantage over one which is not. For instance, a system that is developed from data gathered at one location should be able, safely, to tune in to local conditions, for example demography elsewhere. Similarly, as practice or technology changes, such changes should be accommodated by the device itself, rather than by having to involve statisticians, knowledge engineers, etc. to rederive algorithms. After all, when doctors change hospital they are not subjected to complete retraining. Neither should a computerized decision aid have to be. Of course, this assumes the need for such systems in the first place, which is a wider question not addressed here. We use the analogy of an apprentice to motivate development of systems that learn in perpetuity.
Expert systems are characterized by the processes of rule elicitation, rule-base development and inference. Knowledge, in the form of rules, is built into the system a priori and, once embedded, remains unchanged throughout the lifetime of the system, unless a knowledge engineer intervenes. Conclusions are drawn by a deductive process. As a model of human expert behaviour this has some drawbacks because it presupposes that once individuals have achieved expert status they no longer continue to learn from their experience.