Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: effect of Anticoagulation and Its Timing: the RAF Study.

BACKGROUND AND PURPOSE: The best time for administering anticoagulation therapy in acute cardioembolic stroke remains unclear. This prospective cohort study of patients with acute stroke and atrial fibrillation, evaluated (1) the risk of recurrent ischemic event and severe bleeding; (2) the risk factors for recurrence and bleeding; and (3) the risks of recurrence and bleeding associated with anticoagulant therapy and its starting time after the acute stroke. METHODS: The primary outcome of this multicenter study was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding within 90 days from acute stroke. RESULTS: Of the 1029 patients enrolled, 123 had 128 events (12.6%): 77 (7.6%) ischemic stroke or transient ischemic attack or systemic embolism, 37 (3.6%) symptomatic cerebral bleeding, and 14 (1.4%) major extracranial bleeding. At 90 days, 50% of the patients were either deceased or disabled (modified Rankin score ≥3), and 10.9% were deceased. High CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesion and type of anticoagulant were predictive factors for primary study outcome. At adjusted Cox regression analysis, initiating anticoagulants 4 to 14 days from stroke onset was associated with a significant reduction in primary study outcome, compared with initiating treatment before 4 or after 14 days: hazard ratio 0.53 (95% confidence interval 0.30-0.93). About 7% of the patients treated with oral anticoagulants alone had an outcome event compared with 16.8% and 12.3% of the patients treated with low molecular weight heparins alone or followed by oral anticoagulants, respectively (P=0.003). CONCLUSIONS: Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered each independently led to a greater risk of recurrence and bleedings. Also, data showed that the best time for initiating anticoagulation treatment for secondary stroke prevention is 4 to 14 days from stroke onset. Moreover, patients treated with oral anticoagulants alone had better outcomes compared with patients treated with low molecular weight heparins alone or before oral anticoagulants.

Improving the performance of the single-dish Cherenkov telescope MAGIC through the use of signal timing

The Cherenkov light flashes produced by Extensive Air Showers are very short in time. A high bandwidth and fast digitizing readout, therefore, can minimize the influence of the background from the light of the night sky, and improve the performance in Cherenkov telescopes. The time structure of the Cherenkov image can further be used in single-dish Cherenkov telescopes as an additional parameter to reduce the background from unwanted hadronic showers. A description of an analysis method which makes use of the time information and the subsequent improvement on the performance of the MAGIC telescope (especially after the upgrade with an ultra fast 2 GSamples/s digitization system in February 2007) will be presented. The use of timing information in the analysis of the new MAGIC data reduces the background by a factor two, which in turn results in an enhancement of about a factor 1.4 of the flux sensitivity to point-like sources, as tested on observations of the Crab Nebula.

Prosthetic joint infections : A retrospective study on the timing of reimplantation in a two-stage exchange

Different therapeutic options for prosthetic joint infections exist, but surgery remains the key. With a two-stage exchange procedure, a success rate above 90% can be expected. Currently, there is no consensus regarding the optimal duration between explantation and the reimplantation in a two-stage procedure. The aim of this study was to retrospectively compare treatment outcomes between short-interval and long-interval two-stage exchanges. Patients having a two-stage exchange of a hip or knee prosthetic joint infection at Lausanne University Hospital (Switzerland) between 1999 and 2013 were included. The satisfaction of the patient, the function of the articulation and the eradication of infection, were compared between patients having a short (2 to 4 weeks) versus a long (4 weeks and more) interval during a two-stage procedure. Patient satisfaction was defined as good if the patient did not have pain and bad if the patient had pain. Functional outcome was defined good if the patient had a prosthesis in place and could walk, medium if the prosthesis was in place but the patient could not walk, and bad if the prosthesis was no longer in place. Infection outcome was considered good if there had been no re-infection and bad if there had been a re-infection of the prosthesis 145 patients (100 hips, 45 knees) were identified with a median age of 68 years (range 19-103). The median hospital stay was 58 days (range 10-402). The median follow-up was 12.9 months (range 0.5-152). 28 % and 72 % of the patients had a short-interval and long-interval exchange of the prosthesis, respectively. Patient satisfaction, functional outcome and infection outcome for patients having a short versus a long interval are reported in the Table. The patient satisfaction was higher when a long interval was performed whereas the functional and infection outcomes were higher when a short interval was performed. According to this study a short-interval exchange appears preferable to a long interval, especially in the view of treatment effectiveness and functional outcome.

Timing and nature of alluvial fan and strath terrace formation in the Eastern Precordillera of Argentina

Sixty-eight 10Be terrestrial cosmogenic nuclide (TCN) surface exposure ages are presented to define the timing of alluvial fan and strath terrace formation in the hyper-arid San Juan region of the Argentine Precordillera. This region is tectonically active, and numerous fault scarps traverse Quaternary landforms. The three study sites, Marquesado strath complex, Loma Negra alluvial fan and Carpintería strath complex reveal a history of alluvial fan and strath terrace development over the past w225 ka. The Marquesado complex Q3m surface dates to w17 3 ka, whereas the Loma Negra Q1ln, Q2ln, Q3ln, Q4ln, and Q5ln surfaces date to w24 3 ka, w48 2 ka, w65 13 ka, w105 21 ka, and w181 29 ka, respectively. The Carpintería complex comprises eight surfaces that have been dated and include the Q1c (w23 3 ka), Q2c (w5 5 ka), Q3ac (w25 12 ka), Q3bc (w29 15 ka), Q4c (w61 12 ka), Q5c (w98 18 ka), Q6c (w93 18 ka), and Q7c (w212 37 ka). 10Be TCN depth profile data for the Loma Negra alluvial fan complex and Carpintería strath terrace complex, as well as OSL ages on some Carpintería deposits, aid in refining surface ages for comparison with local and global climate proxies, and additionally offer insights into inheritance and erosion rate values for TCNs (w10 104 10Be atoms/g of SiO2 and w5 m Ma 1, respectively). Comparison with other alluvial fan studies in the region show that less dynamic and older preserved surfaces occur in the Carpintería and Loma Negra areas with only younger alluvial fan surfaces preserved both to the north and south. These data in combination with that of other studies illustrate broad regional agreement between alluvial fan and strath terrace ages, which suggests that climate is the dominant forcing agent in the timing of terrace formation in this region.

Timing History: The Introduction of Graphical Analysis in 19th Century British Economics

The introduction of time-series graphs into British economics in the 19th century depended on the « timing » of history. This involved reconceptualizing history into events which were both comparable and measurable and standardized by time unit. Yet classical economists in Britain in the early 19th century viewed history as a set of heterogenous and complex events and statistical tables as giving unrelated facts. Both these attitudes had to be broken down before time-series graphs could be brought into use for revealing regularities in economic events by the century's end.

Timing of visual stimuli in V1 and V5/MT: fMRI and TMS

Time perception is used in our day-to-day activities. While we understand quite well how our brain processes vision, touch or taste, brain mechanisms subserving time perception remain largely understudied. In this study, we extended an experiment of previous master thesis run by Tatiana Kenel-Pierre. We focused on time perception in the range of milliseconds. Previous studies have demonstrated the involvement of visual areas V1 and V5/MT in the encoding of temporal information of visual stimuli. Based on these previous findings the aim of the present study was to understand if temporal information was encoded in V1 and extrastriate area V5/MT in different spatial frames i.e., head- centered versus eye-centered. To this purpose we asked eleven healthy volunteers to perform a temporal discrimination task of visual stimuli. Stimuli were presented at 4 different spatial positions (i.e., different combinations of retinotopic and spatiotopic position). While participants were engaged in this task we interfered with the activity of the right dorsal V1 and the right V5/MT with transcranial magnetic stimulation (TMS). Our preliminary results showed that TMS over both V1 and V5/MT impaired temporal discrimination of visual stimuli presented at specific spatial coordinates. But whereas TMS over V1 impaired temporal discrimination of stimuli presented in the lower left quadrant, TMS over V5/MT affected temporal discrimination of stimuli presented at the top left quadrant. Although it is always difficult to draw conclusions from preliminary results, we could tentatively say that our data seem to suggest that both V1 and V5/MT encode visual temporal information in specific spatial frames.

Perception du timing pubertaire et comportements à risque chez des adolescents suisses

Il faut distinguer timing pubertaire objectif (TPO ; comparaison du timing pubertaire réel d'un sujet avec celui d'un groupe de référence) et timing pubertaire subjectif (TPS ; perception subjective par le sujet de son timing pubertaire par rapport à celui de ses pairs). Chez l'adolescente, la ménarche est couramment utilisée comme marqueur du TPO. La littérature s'intéressant aux variations physiologiques (normales) du timing pubertaire montre qu'un TPO précoce est corrélé chez les adolescentes avec de nombreux problèmes de santé (p.ex. dépression, abus de substances, comportements à risques, niveau d'études inférieur). Un TPO tardif chez l'adolescente serait quant à lui associé à une meilleure réussite scolaire. Les diverses hypothèses expliquant ces corrélations sont brièvement décrites dans notre travail. Certaines hypothèses impliquent des facteurs objectifs tels les changements du corps à la puberté, alors que d'autres privilégient des facteurs plus subjectifs, dans le registre de la perception de soi. A ce jour, la littérature ne s'est que très peu intéressée au TPS en soi. Une adolescente percevant son timing pubertaire comme précoce est-elle à risque même si sa puberté survient objectivement au même âge que la majorité de ses pairs ? L'objectif de ce travail est de rechercher d'éventuelles corrélations entre TPS et adoption de comportements à risque chez des adolescentes rapportant un TPO dans la moyenne. Nos données proviennent de l'enquête SMASH 2002, une étude par questionnaire auto-administré conduite parmi un échantillon de 7548 adolescentes et adolescents suisses âgés de 16-20 ans. Des 3658 adolescentes de l'échantillon initial, nous ne sélectionnons que les 1003 d'entre elles qui ont répondu à la question sur le TPS et qui ont rapporté un âge à la ménarche de 13 ans, soit la moyenne et la médiane de l'âge à la ménarche rapporté par les 3658 adolescentes de l'échantillon initial. Ces 1003 adolescentes sélectionnées sont considérées comme ayant un TPO dans la moyenne. Ces 1003 adolescentes sont séparées en 3 groupes en fonction de leur TPS (précoce/correspondant à la moyenne/tardif). A l'aide d'analyses bivariées et logistiques, nous comparons ces 3 groupes en termes d'adoption de comportements à risque dans le champ de la sexualité (précocité des rapports sexuels) et dans celui de la consommation de substances (tabac, cannabis, drogues dures). Nos résultats montrent principalement qu'une perception de précocité pubertaire est associée avec une précocité des premiers rapports sexuels et de l'usage de drogues dures. A l'inverse, les adolescentes percevant leur puberté comme tardive rapportent moins fréquemment des rapports sexuels avant 16 ans que les adolescentes percevant leur puberté comme dans la moyenne. Les implications cliniques sont les suivantes : face à une adolescente percevant sa puberté comme étant ou ayant été précoce, le praticien devrait investiguer l'existence de comportements à risque même si la puberté survient ou est survenue à un âge similaire à ce qui est retrouvé chez la majorité des pairs. En effet, notre étude suggère que même si cette adolescente se trompe en percevant sa puberté comme précoce, la probabilité de comportements à risque est augmentée dans le champ de la sexualité et de la consommation de substances. Nos résultats suggèrent aussi que l'association retrouvée dans la littérature entre précocité objective de la puberté et comportements à risque chez les adolescentes n'est pas uniquement médiée par les changements corporels pubertaires mais qu'un facteur psychologique tel que la perception subjective est également impliqué.

The Role of Tactical Marketing Decisions on New Product Performance: The Moderating Effect of Entry Timing

This study focuses on observing how Finnish companies execute their new product launch processes. The main objective was to find out how entry timing moderates the relationship between launch tactics (namely product innovativeness, price and emotional advertising) and new product performance (namely sales volume and customer profitability). The empirical analysis was based on data collected in Lappeenranta University of Technology. The sample consisted of Finnish companies representing different industries and innovation activities. Altogether 272 usable responses were received representing a response rate of 37.67%. The measures were first assessed by using exploratory factor analysis (EFA) in PASW Statistics 18 and then further verified with confirmatory factor analysis (CFA) in LISREL 8.80. To test the hypotheses of the moderating effects of entry timing, hierarchical regression analysis was used in PASW Statistics 18. The results of the study revealed that the effect of product innovativeness on new product sales volume is dependent on entry timing. This implies that companies should carefully consider what would be the best time for entering the market when launching highly innovative new products. The results also depict a positive relationship between emotional advertising and new product sales volume. In addition, partial support was found for a positive relationship between pricing and new product customer profitability.

Mutual Fund Performance and the Market Timing Ability - Finnish Evidence

The purpose of this thesis is to examine the performance of Finnish equity funds and their market timing ability. Fund performance is evaluated by using annual returns and various risk-adjusted measures, including Sharpe ratio, DDSR, SKASR, Treynor ratio and Jensen’s alpha, whereas portfolio manager’s timing ability is examined with Treynor-Mazuy model and Henriksson-Merton model. The data is collected from the Finnish fund market during the sample period from January 1997 to February 2010. Results show that Finnish equity funds have been able to outperform the market return on a risk-adjusted basis, but these results are influenced heavily by the exceptionally good performance during the IT-bubble. Market timing models show that fund managers have been, to some degree, able to time the market but not a single fund have been able to possess security selection ability and market timing ability simultaneously.

The effect of timing temporary cements to treat induced pulp necrosis in the teeth of dogs

During endodontic therapy (pulpectomy, root canal debridement and root canal filling) microbiological management is a major concern. Bacteria present in dentine tubules, apical foramina and apical delta are causally related to failure of the procedure. Studies have shown that during single session endodontic treatment bacteria remain within dental structures. The aim of the present study was to evaluate endodontic treatment performed as two sessions, using temporary endodontic dressing materials for different periods in four groups of experimental dogs. A total of 80 roots of second and third upper premolar teeth and second, third and fourth lower premolar teeth were divided into four groups. The pulp chamber was opened with burrs and the pulp exposed for 60 days to induce pulpal inflammation and necrosis. Groups II, III and IV were treated with calcium hydroxide plus camphorated paramono-chlorophenol (PMCC) for 7, 15 and 30 days, respectively. In all groups, the root canals were filled with zinc oxide-eugenol and gutta-percha cones. Clinical and radiographical measurements were performed every 2 weeks. After 60 days a small block section containing the teeth, surrounding periapical tissues and the periodontium was removed for histological and microbiological study. Histological analysis revealed intense inflammatory response in all groups. Microbiological analysis showed microbial reduction inversely proportional to the period of time that the intracanal temporary medicament was left in place.

Corn and soybean yields as affected by cover crops and herbicide timing under no-tillage system

To achieve better results in the no-tillage system (NTS), it is important to properly manage the cover crop prior to planting by using herbicides, usually glyphosate. The effect of glyphosate on plant coverage is slow, and plants take a few days to die completely. Thus, when applying the herbicide on the same day of planting soybean or corn, cover crops are still alive and standing, causing initial shading on seedlings of the crop and delaying its establishment. Therefore, this study aimed to evaluate the effect of distinct cover crops and their timing of desiccation prior to planting soybean or corn, on crop yield and yield components. Two experiments were installed, one for soybean and another for corn. Each experiment consisted in combining three cover crops (Brachiaria brizantha, common bean or millet) chemically desiccated at two timings before planting the crop (15 or 0 days before planting) under no-tillage system (NTS). Experiments were installed in a completely randomized block design with five replications. Brachiaria brizantha produced the highest amount of biomass; common bean and millet as cover crops allowed higher soybean grain yields; herbicide application under common bean, millet and Brachiaria brizantha 15 days before planting soybean allowed higher crop grain yields; desiccation timing of common bean did not affect corn grain yield; Brachiaria brizantha should be desiccated 15 days before planting corn to allow maximum grain yield; when millet was used as a cover crop, glyphosate application at planting of corn allowed the highest grain yield.

A simple model for circadian timing by mammals

Circadian timing is structured in such a way as to receive information from the external and internal environments, and its function is the timing organization of the physiological and behavioral processes in a circadian pattern. In mammals, the circadian timing system consists of a group of structures, which includes the suprachiasmatic nucleus (SCN), the intergeniculate leaflet and the pineal gland. Neuron groups working as a biological pacemaker are found in the SCN, forming a biological master clock. We present here a simple model for the circadian timing system of mammals, which is able to reproduce two fundamental characteristics of biological rhythms: the endogenous generation of pulses and synchronization with the light-dark cycle. In this model, the biological pacemaker of the SCN was modeled as a set of 1000 homogeneously distributed coupled oscillators with long-range coupling forming a spherical lattice. The characteristics of the oscillator set were defined taking into account the Kuramoto's oscillator dynamics, but we used a new method for estimating the equilibrium order parameter. Simultaneous activities of the excitatory and inhibitory synapses on the elements of the circadian timing circuit at each instant were modeled by specific equations for synaptic events. All simulation programs were written in Fortran 77, compiled and run on PC DOS computers. Our model exhibited responses in agreement with physiological patterns. The values of output frequency of the oscillator system (maximal value of 3.9 Hz) were of the order of magnitude of the firing frequencies recorded in suprachiasmatic neurons of rodents in vivo and in vitro (from 1.8 to 5.4 Hz).