Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation

Background and Purpose: The morbidity from spontaneous hemorrhage of untreated brain arteriovenous malformations (AVM) is not well described. Methods: The 241 consecutive AVM patients (mean age 3716 years, 52% women) from the prospective Columbia AVM Databank initially presenting with hemorrhage were evaluated using the Rankin Scale (RS) and the National Institute of Health Stroke Scale (NIHSS). From the 241 AVM patients, 29 (12%) had subsequent intracranial hemorrhage during follow-up. For further comparisons, 84 non-AVM patients with intracerebral hemorrhage from the Northern Manhattan Study (NOMAS) served as a control group. Results: In 241 AVM patients presenting with hemorrhage the median RS was 2 and the median NIHSS was 1 (49% RS 0 to 1, 61% NIHSS 2). The median time between hemorrhage and clinical evaluation was 11 days (mean 219 days). Recurrent AVM hemorrhage during follow-up resulted in no significant increase in morbidity (median RS 2, P0.004; median NIHSS 3, P0.322; time between hemorrhage and study evaluation: median 55 days, mean 657 days). Among AVM-hemorrhage subtypes, parenchymatous AVM hemorrhage was associated with higher stroke morbidity (odds ratio, 2.9; 95% CI, 1.5 to 5.8 for NIHSS 2) than nonparenchymatous hemorrhages. Parenchymatous AVM hemorrhage had a significantly better outcome (median NIHSS 1) than non-AVM related hemorrhage (median NIHSS 12; P0.0001). Conclusions: Hemorrhage, either at initial presentation or during follow-up of untreated AVM patients appears to carry

Carbon gold rush and carbon cowboys: a new chapter in green mythology?

Individual and collective efforts to mitigate climate change in the form of carbon offsetting and emissions trading schemes have recently become the focus of much media attention. In this paper we explore a subset of the UK national press coverage centered on such schemes. The articles, selected from general as well as specialized business and finance newspapers, make use of gold rush, Wild West and cowboy imagery which is rooted in deeply entrenched myths and metaphors and allows readers to make sense of very complex environmental, political, ethical, and financial issues associated with carbon mitigation. They make what appears complicated and unfamiliar, namely carbon trading and offsetting, seem less complex and more familiar. A critical discussion of this type of imagery is necessary in order to uncover and question tacit assumptions and connotations which are built into it and which might otherwise go unnoticed and unchallenged in environmental communication.