Aggressive surgical interventions for severe stroke: Impact on quality of life, caregiver burden and family outcomes

Introduction: Decompressive hemicraniectomy, clot evacuation, and aneurysmal interventions are considered aggressive surgical therapeutic options for treatment of massive cerebral artery infarction (MCA), intracerebral hemorrhage (ICH), and severe subarachnoid hemorrhage (SAH) respectively. Although these procedures are saving lives, little is actually known about the impact on outcomes other than short-term survival and functional status. The purpose of this study was to gain a better understanding of personal and social consequences of surviving these aggressive surgical interventions in order to aid acute care clinicians in helping family members make difficult decisions about undertaking such interventions. Methods: An exploratory mixed method study using a convergent parallel design was conducted to examine functional recovery (NIHSS, mRS & BI), cognitive status (Montreal Cognitive Assessment Scale, MoCA), quality of life (Euroqol 5-D), and caregiver outcomes (Bakas Caregiver Outcome Scale, BCOS) in a cohort of patients and families who had undergone aggressive surgical intervention for severe stroke between the years 2000–2007. Data were analyzed using descriptive statistics, univariate and multivariate analysis of variance, and multivariate logistic regression. Content analysis was used to analyze the qualitative interviews conducted with stroke survivors and family members. Results: Twenty-seven patients and 13 spouses participated in this study. Based on patient MOCA scores, overall cognitive status was 25.18 (range 23.4-26.9); current functional outcomes scores: NIHSS 2.22, mRS 1.74, and BI 88.5. EQ-5D scores revealed no significant differences between patients and caregivers (p=0.585) and caregiver outcomes revealed no significant differences between male/female caregivers or patient diagnostic group (MCA, SAH, ICH; p=""0.103).<"/span><"/span> Discussion: Overall, patients and families were satisfied with quality of life and decisions made at the time of the initial stroke. There was consensus among study participants that formal community-based support (e.g., handibus, caregiving relief, rehabilitation assessments) should be continued for extended periods (e.g., years) post-stroke. Ongoing contact with health care professionals is valuable to help them navigate in the community as needs change over time.

Fire resistance of light gauge steel frame wall systems lined with gypsum plasterboards

Light gauge steel frame (LSF) wall systems are increasingly used in residential and commercial buildings as load bearing and non-load bearing elements. Conventionally, the fire resistance ratings of such building elements are determined using approximate prescriptive methods based on limited standard fire tests. However, recent studies have shown that in some instances real building fire time-temperature curves could be more severe than the standard fire curve, in terms of maximum temperature and rate of temperature rise. This has caused problems for safe evacuation and rescue activities, and in some instances has also lead to the collapse of buildings earlier than the prescribed fire resistance. Therefore a detailed research study into the performance of LSF wall systems under both standard fire and realistic fire conditions was undertaken using full scale fire tests to understand the fire performance of different LSF wall configurations. Both load bearing and non-load bearing full scale fire tests were performed on LSF walls configurations which included single layer, double layer, externally insulated wall panels made up of different steel sections and thicknesses of gypsum plasterboards. The non-load bearing fire test results were utilized to understand the factors affecting the fire resistance of LSF walls, while loading bearing fire test results led to development of simplified methods to predict the fire resistance ratings of load bearing LSF walls exposed to both standard and realistic design fires. This paper presents the results of full scale experimental study and highlights the effects of standard and realistic fire conditions on fire performance of LSF walls.

Dental identification and aspects of medico-legal investigations of the Finnish victims of the Sumatra-Andaman earthquake on 26 December 2004

Tsunami waves of the Sumatra-Andaman earthquake on 26 December 2004 claimed approximately 230 000 lives and started the biggest identification operation in Interpol's history. The aim of this study was to resolve methods of the identification and results received. The viewpoint is mainly that of forensic odontology, but also includes other means of identification and results of the medico-legal examination performed in Finland. Of the 5395 victims in Thailand, approximately 2 400 were foreigners from 36 nations including 177 Finnish nationals. Additionally, a Finnish woman perished in Sri Lanka and a severely injured man after the evacuation in a hospital. The final numbers of missing persons and dead bodies registered in the Information Management Centre in Phuket,Thailand, were 3 574 ante-mortem (AM) and 3 681 post-mortem (PM) files. The number of identifications by December 2006 was 3 271 or 89% of the victims registered. Of Finnish victims, 172 have been identified in Thailand and 163 repatriated to Finland. One adult and four children are still missing. For AM data, a list of Finnish missing persons including 178 names was published on 30 December 2004. By February 2005 all useful dental AM data were available. Five persons on the list living in Finland lacked records. Based on the AM database, for the children under age 18 years (n=60) dental identification could be established for 12 (20%). The estimated number for adults (n=112) was 96 (86%). The final identification rate, based on PM examinations in Finland, was 14 (25%) for children (n= 56) and 98 (90%) for adults (n= 109). The number of Finnish victims identified by dental methods, 112 (68%), was high compared to all examined in Thailand (43%). DNA was applied for 26 Finnish children and for 6 adults, fingerprints for 24 and 7, respectively. In 12 cases two methods were applied. Every victim (n=165) underwent in Finland a medico-legal investigation including an autopsy with sampling specimens for DNA, the toxicological and histological investigation. Digital radiographs and computed tomography were taken of the whole body to verify autopsy findings and bring out changes caused by trauma, autolysis, and sampling for DNA in Thailand. Data for identification purposes were also noted. Submersion was the cause of death for 101 of 109 adults (92.7%), and trauma for 8 (7.3%). Injuries were 33 times contributing factors for submersion and 3 times for trauma-based death. Submersion was the cause of death for 51 (92.7%) children and trauma for 4 (7.3%). Injuries were in 3 cases contributing factors in submersion and once in trauma-based death. The success of the dental identification of Finnish victims is mainly based on careful registration of dental records, and on an education program from 1999 in forensic odontology.

Preparation and characterization of Cd(0.75)PS(3)A(0.5)(H2O)(y) [A = Na, K and Cs]

Cd(0.75)PS(3)A(0.5)(H2O)(y) [A = Na, K and Cs], synthesized by the ion-exchange intercalation reaction of the insulating layered CdPS3, exhibits interesting electrical properties. The electrical properties are strongly dependent on the extent of hydration of the alkali ion which resides in the interlamellar space. In the potassium and caesium ion-exchanged compounds, y = I, the lattice expansion is similar to 3 Angstrom and the electric response characteristic of a dielectric. In the as prepared A = Na compound, y = 2, the lattice expansion is 5.6 Angstrom, the compound is conducting with a DC conductance of 3 x 10(-5) S cm(-1) at 300 K. Cd0.75PS3Na0.5(H2O)(y), y = 2, on evacuation or on heating looses water, reversibly, to form a y = 1 phase with electrical properties similar to that of the K and Cs ion exchange intercalation compounds.

Study on the detection efficiency of gaseous photomultipliers

Efficient photon detection in gaseous photomultipliers require maximum photoelectron yield from the photocathode surface and also detection of them. In this work we have investigated the parameters that affect the photoelectron yield from the photocathode surface and methods to improve them thus ensuring high detection efficiency of the gaseous photomultiplier. The parameters studied are the electric field at the photocathode surface, surface properties of photocathode and pressure of gas mixture inside the gaseous photomultiplier. It was observed that optimized electric field at the photocathode ensures high detection efficiency. Lower pressure of filled gas increases the photoelectron yield from the photocathode surface but reduces the focusing probability of electrons inside the electron multiplier. Also evacuation for longer duration before gas filling increases the photoelectron yield.

Influence of target thickness on the generation of high-density ion bunches by ultrashort circularly polarized laser pulses

Ion acceleration by ultrashort circularly polarized laser pulse in a solid-density target is investigated using two-dimensional particle-in-cell simulation. The ions are accelerated and compressed by the continuously extending space-charge field created by the evacuation and compression of the target electrons by the laser light pressure. For a sufficiently thin target, the accelerated and compressed ions can reach and exit from the rear surface as a high-density high-energy ion bunch. The peak ion energy depends on the target thickness and reaches maximum when the compressed ion layer can just reach the rear target surface. The compressed ion layer exhibits lateral striation which can be suppressed by using a sharp-rising laser pulse. (c) 2008 American Institute of Physics.

Future of earthquake early warning : quantifying uncertainty and making fast automated decisions for applications

Earthquake early warning (EEW) systems have been rapidly developing over the past decade. Japan Meteorological Agency (JMA) has an EEW system that was operating during the 2011 M9 Tohoku earthquake in Japan, and this increased the awareness of EEW systems around the world. While longer-time earthquake prediction still faces many challenges to be practical, the availability of shorter-time EEW opens up a new door for earthquake loss mitigation. After an earthquake fault begins rupturing, an EEW system utilizes the first few seconds of recorded seismic waveform data to quickly predict the hypocenter location, magnitude, origin time and the expected shaking intensity level around the region. This early warning information is broadcast to different sites before the strong shaking arrives. The warning lead time of such a system is short, typically a few seconds to a minute or so, and the information is uncertain. These factors limit human intervention to activate mitigation actions and this must be addressed for engineering applications of EEW. This study applies a Bayesian probabilistic approach along with machine learning techniques and decision theories from economics to improve different aspects of EEW operation, including extending it to engineering applications.

Existing EEW systems are often based on a deterministic approach. Often, they assume that only a single event occurs within a short period of time, which led to many false alarms after the Tohoku earthquake in Japan. This study develops a probability-based EEW algorithm based on an existing deterministic model to extend the EEW system to the case of concurrent events, which are often observed during the aftershock sequence after a large earthquake.

To overcome the challenge of uncertain information and short lead time of EEW, this study also develops an earthquake probability-based automated decision-making (ePAD) framework to make robust decision for EEW mitigation applications. A cost-benefit model that can capture the uncertainties in EEW information and the decision process is used. This approach is called the Performance-Based Earthquake Early Warning, which is based on the PEER Performance-Based Earthquake Engineering method. Use of surrogate models is suggested to improve computational efficiency. Also, new models are proposed to add the influence of lead time into the cost-benefit analysis. For example, a value of information model is used to quantify the potential value of delaying the activation of a mitigation action for a possible reduction of the uncertainty of EEW information in the next update. Two practical examples, evacuation alert and elevator control, are studied to illustrate the ePAD framework. Potential advanced EEW applications, such as the case of multiple-action decisions and the synergy of EEW and structural health monitoring systems, are also discussed.

Feeding ecology of Atlantic bluefin tuna (Thunnus thynnus) in North Carolina: diet, daily ration, and consumption of Atlantic menhaden (Brevoortia tyrannus)

Diet, gastric evacuation rates, daily ration, and population-level prey demand of bluefin tuna (Thunnus thynnus) were estimated in the continental shelf waters off North Carolina. Bluefin tuna stomachs were collected from commercial fishermen during the late fall and winter months of 2003–04, 2004–05, and 2005–06. Diel patterns in mean gut fullness values were used to estimate gastric evacuation rates. Daily ration determined from mean gut fullness values and gastric evacuation rates was used, along with bluefin tuna population size and residency times, to estimate population-level consumption by bluefin tuna on Atlantic menhaden (Brevoortia tyrannus). Bluefin tuna diet (n= 448) was dominated by Atlantic menhaden; other teleosts, portunid crabs, and squid were of mostly minor importance. The time required to empty the stomach after peak gut fullness was estimated to be ~20 hours. Daily ration estimates were approximately 2% of body weight per day. At current western Atlantic population levels, bluefin tuna predation on Atlantic menhaden is minimal compared to predation by other known predators and the numbers taken in commercial harvest. Bluefin tuna appear to occupy coastal waters in North Carolina during winter to prey upon Atlantic menhaden. Thus, changes in the Atlantic menhaden stock status or distribution would alter the winter foraging locations of bluefin

Diet and feeding ecology of two sizes of Barbodes gonionotus (=Puntius gonionotus) and Oreochromis sp. in ricefields in Bangladesh

Fish culture experiments were conducted to compare and evaluate the feeding pattern and strategies, daily ration, gastric evacuation rates, dietary breadth, similarity and overlap of silver barb, Barbodes gonionotus, and tilapia, Oreochromis sp. (natural hybrid of O. mossambicus x O. niloticus) in a rice-fish system. B. gonionotus was found to be a macrophtophagous column feeder while Oreochromis sp. was a detrivorous benthophagic browser. Ontogenic shifts in diet were clearly observed in B. gonionotus while absent in Oreochromis sp. For both species, daily food ration for the small fish was twice as large as that for the large fish. Mean rates of gastric evacuation were 0.18 h super(1) for small and 0.05 h super(1) for large B. gonionotus and 0.09 h super(1) and 0.14h super(1) for small and large Oreochromis sp., respectively. In terms of intraspecific dietary width, the smaller sized individuals of both species had a wider dietary niche than the larger conspecifics. Larger fish increased their specialization and reliance on few food items with increasing size and competitive ability. When both species were reared together, B. gonionotus showed a wider niche width than tilapia. Wider interspecific niche width of B. gonionotus compared to that of tilapia and significant interspecific dietary overlap is likely to result in suppression of the growth of tilapia in mixed culture due to: 1) a high degree of specialization and reliance of tilapia on food of low-nutrient value, and 2) slower gastric evacuation rates as compared to B. gonionotus, which would allow B. gonionotus to outgrow similar sized tilapia.

Estimating the food consumption of fishes: one step in linking a species with its ecosystem

Details are given of a new software package MAXIMS which may be used to estimate the daily food consumption of fish. The software estimates the feeding times, the rates of ingestion and evacuation and related parameters. Two applications of the program are described. The first pertains to anchovy (Engraulis ringens ) with one feeding period per day, and the second one to juvenile cod (Gadus morhua ), which feed during dawn and dusk.

Feeding and respiration rates of a planktonic copepod (Calanus sinicus) oversummering in Yellow Sea Cold Bottom Waters

The distribution, feeding and oxygen consumption of Calanus sinicus were studied in August 2001 on a transect across Yellow Sea Cold Bottom Waters (YSCBW) and two additional transects nearby. The distribution of C. sinicus adults and copepodites stage CV appeared to be well correlated with water temperature. They tended to concentrate in the YSCBW (>10,000 ind. m(-2)) to avoid high surface temperature. Gut pigment contents varied from 0.44 to 2.53 ng chlorophyll a equivalents (chl a equiv.) ind.(-1) for adults, and from 0.24 to 2.24 ng chl a equiv. ind.(-1) for CV copepodites. We found no relationship between gut pigment contents and the ambient chl a concentrations. Although the gut evacuation rate constants are consistent with those measured for other copepods, their low gut pigment contents meant an estimated daily herbivorous ingestion of <3% of body carbon in the YSCBW and <10% outside the YSCBW. However, based on estimates of clearance rates, C. sinicus feeds actively whether in the YSCBW or not, so the low ingestion rates probably reflect shortage of food. Oxygen consumption rates of C. sinicus ranged from 0.21 to 0.84 mul O-2 ind.(-1) h(-1), with high rates often associated with high temperature. From the oxygen consumption rates, daily loss of body carbon was estimated to be 4.0-13.7%, which exceeds our estimates of their carbon ingestion rates. C. sinicus was probably not in diapause, either within or outside the YSCBW, but this cold-water layer provides C. sinicus with a refuge to live through the hot, low-food summer.

Summer feeding activities of zooplankton in Prydz Bay, Antarctica

Grazing of dominant zooplankton copepods (Calanoides acutus. and Metridia gerlachei), salps (Salpa thompsoni) and microzooplankton was determined during the austral summer of 1998/1999 at the seasonal ice zone of the Prydz Bay region. The objective was to measure the ingestion rates of zooplankton at the seasonal ice zone, so as to evaluate the importance of different groups of zooplankton in their grazing impact on phytoplankton standing stock and primary production. Grazing by copepods was low, and accounted for less than or equal to 1% of phytoplankton standing stocks and 3.8-12.5% of primary production for both species during this study, even the ingestion rates of individuals were at a high level compared with previous reports. S. thompsoni exhibited a relatively high grazing impact on primary production (72%) in the north of our investigation area. The highest grazing impact on phytoplankton was exerted by microzooplankton during this investigation, and accounted for 10-65% of the standing stock of phytoplankton and 34-100% of potential daily primary production. We concluded that microzooplankton was the dominant phytoplankton consumer in this study area. Salps also played an important role in control of phytoplankton where swarming occurred. The grazing of copepods had a relatively small effect on phytoplankton biomass development.

Feeding activities of zooplankton in the Bohai Sea

The Bohai Sea was the site of the Chinese national GLOBEC programme. During the June 1997 cruises of R/V Science No.1, observations and experiments on zooplankton feeding were conducted. At five 48 h time-series stations the following observations and measurements on zooplankton were carried out: (1) diurnal vertical migration, by collecting samples at different layers every 3 h with a closing net; (2) diurnal feeding rhythms, by gut pigment analysis; and (3) ingestion rate, by both gut pigment analysis and the dilution method. A classification by body size was used to deal with the diversity of species and developmental stages of zooplankton assemblages. Samples were separated into three size groups: small (200-500 mu m), medium (500-1000 mu m) and large (> 1000 mu m). The results showed that the copepods (Calanus sinicus, Paracalanus parvus, Acartia bifilosa and Centropages mcmurrichi) performed clear diurnal vertical migrations. However, their behaviour was different at different stations. The variation in gut pigment content over the 24 h cycle showed strong diurnal feeding rhythms, particularly for the large size group. Gut pigment contents reached their daily maximum during the time from dusk to midnight (18:00-24:00). The peak value was about 10 times the minimum observed in the daytime. The in situ daily grazing rate, based on gut pigment contents and evacuation experiments, was 4.00-12.65 ng chla ind(-1) day(-1) for the small size group, 5.99-66.58 ng chla ind(-1) day(-1) for the medium size group and 31.31-237.13 ng chla ind(-1) day(-1) for the large size group. The copepods consumed only a small part (2.90-13.52%) of the phytoplankton biomass hut about 77% of the daily production. The grazing mortality rate of phytoplankton by microzooplankton (<200 mu m) measured by the dilution method ranged from 0.43 to 0.69 day(-1) The calculated daily consumption of phytoplankton biomass was 35-50%, and 85-319% of the potential production.

Shifting Loyalties: World War I and the Conflicted Politics of Patriotism in the British Caribbean

This dissertation examines how the crisis of World War I impacted imperial policy and popular claims-making in the British Caribbean. Between 1915 and 1918, tens of thousands of men from the British Caribbean volunteered to fight in World War I and nearly 16,000 men, hailing from every British colony in the region, served in the newly formed British West Indies Regiment (BWIR). Rousing appeals to imperial patriotism and manly duty during the wartime recruitment campaigns and postwar commemoration movement linked the British Empire, civilization, and Christianity while simultaneously promoting new roles for women vis-à-vis the colonial state. In Jamaica and Trinidad and Tobago, the two colonies that contributed over seventy-five percent of the British Caribbean troops, discussions about the meaning of the war for black, coloured, white, East Indian, and Chinese residents sparked heated debates about the relationship among race, gender, and imperial loyalty.

To explore these debates, this dissertation foregrounds the social, cultural, and political practices of BWIR soldiers, tracing their engagements with colonial authorities, military officials, and West Indian civilians throughout the war years. It begins by reassessing the origins of the BWIR, and then analyzes the regional campaign to recruit West Indian men for military service. Travelling with newly enlisted volunteers across the Atlantic, this study then chronicles soldiers' multi-sited campaign for equal status, pay, and standing in the British imperial armed forces. It closes by offering new perspectives on the dramatic postwar protests by BWIR soldiers in Italy in 1918 and British Honduras and Trinidad in 1919, and reflects on the trajectory of veterans' activism in the postwar era.

This study argues that the racism and discrimination soldiers experienced overseas fueled heightened claims-making in the postwar era. In the aftermath of the war, veterans mobilized collectively to garner financial support and social recognition from colonial officials. Rather than withdrawing their allegiance from the empire, ex-servicemen and civilians invoked notions of mutual obligation to argue that British officials owed a debt to West Indians for their wartime sacrifices. This study reveals the continued salience of imperial patriotism, even as veterans and their civilian allies invoked nested local, regional, and diasporic loyalties as well. In doing so, it contributes to the literature on the origins of patriotism in the colonial Caribbean, while providing a historical case study for contemporary debates about "hegemonic dissolution" and popular mobilization in the region.

This dissertation draws upon a wide range of written and visual sources, including archival materials, war recruitment posters, newspapers, oral histories, photographs, and memoirs. In addition to Colonial Office records and military files, it incorporates previously untapped letters and petitions from the Jamaica Archives, National Archives of Trinidad and Tobago, Barbados Department of Archives, and US National Archives.

The EXODUS evacuation model applied to building evacuation scenarios

The purpose of this paper is to demonstrate the potential of the EXODUS evacuation model in building environments. The latest PC/workstation version of EXODUS is described and is also applied to a large hypothetical supermarket/restaurant complex measuring 50 m x 40 m. A range of scenarios is presented where population characteristics (such as size, individual travel speeds, and individual response times), and enclosure configuration characteristics (such as number of exits, size of exits, and opening times of exits) are varied. The results demonstrate a wide range of occupant behavior including overtaking, queuing, redirection, and conflict avoidance. Evacuation performance is measured by a number of model predicted parameters including individual exit flow rates, overall evacuation flow rates, total evacuation time, average evacuation time per occupant, average travel distance, and average wait time. The simulations highlight the profound impact that variations in individual travel speeds and occupant response times have in determining the overall evacuation performance.