Patent foramen ovale in patients with ischaemic stroke of unknown cause: to close? "pro closure" position

There is ample epidemiological and anecdotal evidence that a PFO increases the risk of stroke both in young and elderly patients, although only in a modest way: PFOs are more prevalent in patients with cryptogenic (unexplained) stroke than in healthy subjects, and are more prevalent in cryptogenic stroke than in strokes of other causes. Furthermore, multiple case series confirm an association of paradoxical embolism across a PFO in patients with deep vein thrombosis and/or pulmonary emboli.2. Is stroke recurrence risk in PFO-patients really not elevated when compared to PFO-free patients, as suggested by traditional observational studies? This finding is an epidemiological artifact called "the paradox of recurrence risk research" (Dahabreh & Kent, JAMA 2011) and is due to one (minor) risk factor, such as PFO, being wiped out by other, stronger risk factors in the control population.3. Having identified PFO as a risk factor for a first stroke and probably also for recurrences, we have to treat it, because treating risk factors always has paid off. No one would nowadays question the aggressive treatment of other risk factors of stroke such as hypertension, atrial fibrillation, smoking, or hyperlipidemia.4. In order to be effective, the preventive treatment has to control the risk factor (i.e. close effectively the PFO), and has to have little or no side effects. Both these conditions are now fulfilled thanks to increasing expertise of cardiologists with technically advanced closure devices and solid back up by multidisciplinary stroke teams.5. Closing a PFO does not dispense us from treating other stroke risk factors aggressively, given that these are cumulative with PFO.6. The most frequent reason why patients have a stroke recurrence after PFO closure is not that closure is ineffective, but that the initial stroke etiology is insufficiently investigated and not PFO related, and that the recurrence is due to another mechanism because of poor risk factor control.7. Similarly, the randomized CLOSURE study was negative because a) patients were included who had a low chance that their initial event was due to the PFO, b) patients were selected with a low chance that a PFO-related recurrence would occur, c) there was an unacceptable high rate of closure-related side effects, and d) the number of randomized patients was too small for a prevention trial.8. It is only a question of time until a sufficiently large randomized clinical trial with true PFO-related stroke patients and a high PFO-related recurrence risk will be performed and show the effectiveness of this closure9. PFO being a rather modest risk factor for stroke does not mean we should prevent our patients from getting the best available prevention by the best physicians in the best stroke centers Therefore, a PFO-closure performed by an excellent cardiologist following the recommendation of an expert neurovascular specialist after a thorough workup in a leading stroke center is one of the most effective stroke prevention treatments available in 2011.

Self-avoiding random walks and Olbers' paradox

In this paper, we prove that a self-avoiding walk of infinite length provides a structure that would resolve Olbers' paradox. That is, if the stars of a universe were distributed like the vertices of an infinite random walk with each segment length of about a parsec, then the night sky could be as dark as actually observed on the Earth. Self-avoiding random walk structure can therefore resolve the Olbers' paradox even in a static universe.

Partial protection and intrathecal invasion of CD8(+) T cells in acute canine distemper virus infection.

Initial non-inflammatory demyelination in canine distemper virus infection (CDV) develops against a background of severe immunosuppression and is therefore, thought to be virus-induced. However, recently we found a marked invasion of T cells throughout the central nervous system (CNS) in dogs with acute distemper despite drastic damage to the immune system. In the present study, this apparent paradox was further investigated by immunophenotyping of lymphocytes, following experimental CDV challenge in vaccinated and non-vaccinated dogs. In contrast to CDV infected, unprotected dogs, vaccinated dogs did not become immunosuppressed and exhibited a strong antiviral immune response following challenge with virulent CDV. In unprotected dogs rapid and drastic lymphopenia was initially due to depletion of T cells. In peripheral blood, CD4(+) T cells were more sensitive and depleted earlier and for a longer time than CD8(+) cells which recovered soon. In the cerebrospinal fluid (CSF) we could observe an increase in the T cell to B cell and CD8(+) to CD4(+) ratios. Thus, partial protection of the CD8(+) cell population could explain why part of the immune function in acute distemper is preserved. As found earlier, T cells invaded the CNS parenchyma in these dogs but also in the protected challenged dogs, which did not develop any CNS disease at all. Since markers of T cell activation were upregulated in both groups of animals, this phenomenon could in part be related to non-specific penetration of activated T cells through the blood brain barrier. However, in diseased animals much larger numbers of T cells were found in the CNS than in the protected dogs, suggesting that massive invasion of T cells in the brain requires CDV expression in the CNS.

The role of peptidoglycan in chlamydial cell division: towards resolving the chlamydial anomaly.

Chlamydiales are obligate intracellular bacteria including some important pathogens causing trachoma, genital tract infections and pneumonia, among others. They share an atypical division mechanism, which is independent of an FtsZ homologue. However, they divide by binary fission, in a process inhibited by penicillin derivatives, causing the formation of an aberrant form of the bacteria, which is able to survive in the presence of the antibiotic. The paradox of penicillin sensitivity of chlamydial cells in the absence of detectable peptidoglycan (PG) was dubbed the chlamydial anomaly, since no PG modified by enzymes (Pbps) that are the usual target of penicillin could be detected in Chlamydiales. We review here the recent advances in this field with the first direct and indirect evidences of PG-like material in both Chlamydiaceae and Chlamydia-related bacteria. Moreover, PG biosynthesis is required for proper localization of the newly described septal proteins RodZ and NlpD. Taken together, these new results set the stage for a better understanding of the role of PG and septal proteins in the division mechanism of Chlamydiales and illuminate the long-standing chlamydial anomaly. Moreover, understanding the chlamydial division mechanism is critical for the development of new antibiotics for the treatment of chlamydial chronic infections.

Excess winter deaths caused by cardiovascular diseases are associated with both mild winter temperature and socio-economic inequalities in the U.S.

Mortality from cardiovascular diseases (CVD) exhibits seasonal variation. For example, 30% more deaths occurred in winter compared to summer in a multicountry study [1]. The effect of cold temperature on several CVD risk factors and on seasonal influenza infection may partially underlie this seasonal variation [2] and [3]. However an unexplained paradox has been observed: seasonality in CVD mortality is larger in temperate mid-latitude countries (e.g. Portugal) than in colder northern countries (e.g. Scandinavian countries) [1]. This paradox has also been previously observed in Europe for overall mortality, and it may relate to uneven proportions between countries of people who are unable to adequately protect themselves against cold due to low socio-economic status (SES), e.g. inadequate clothing, housing insulation and heating systems [4] and [5]. We hypothesized that the seasonal variability in CVD mortality is larger in low socio-economic U.S. states experiencing mild winters compared to high socio-economic states experiencing cold winters.

Asset freezing, corporate political resources and the Tullock paradox

In 1967, Gordon Tullock asked why firms do not spend more on campaign contributions, despite the large rents that could be generated from political activities. We suggest in this paper that part of the puzzle could come from the fact that one important type of political activity has been neglected by the literature which focuses on campaign contributions or political connections. We call this neglected activity "asset freezing": situations in which firms delay lay-offs or invest in specific technologies to support local politicians' re-election objectives. In doing so, firms bear a potentially significant cost as they do not use a portion of their economic assets in the most efficient or productive way. The purpose of this paper is to provide a first theoretical exploration of this phenomenon. Building on the literature on corporate political resources, we argue that a firm's economic assets can be evaluated based on their degree of "political freezability," which depends on the flexibility of their use and on their value for policy-makers. We then develop a simple model in which financial contributions and freezing assets are alternative options for a firm willing to lawfully influence public policy-making, and derive some of our initial hypotheses more formally.

L'exploration temporelle comme modalité du voyage imaginaire dans la bande dessinée franco-belge (1930-1980)

In this paper, I explore the motif of time travel in science fictional French comics until the eighties. Time travel incorporates a fascinating potential for narrative representation, since moving back in time may multiply timelines, according to the well-known paradox of the grandfather. This virtuality has become very popular in novels and in movies, since In his Bootstraps (Heinlein, 1941) and La Jetée (Marker, 1962) until the recent Looper (Johnson, 2012) but it has been rarely represented in French comics before the eighties and the apparition of time paradoxes in series like "Yoko Tsuno" and, mostly, "Valérian agent spatio-temporel". Firstly, many modalities of time travel do not engender time paradoxes, like exploration of prehistoric sanctuaries, imaginary travel, or cryogenic sleep followed by an awakening if a future world with no hope to return in the past. Secondly, time travel has been mostly interpreted as a mere extension of the classic motif of the "extraordinary journey", as exemplified for centuries in fictions by Verne, Mercier, Swift, or Stevenson. Thus, the graphic potential of time travel for the representation of spectacular exotic worlds has predominated in French comic tradition, and this tendency has been encouraged by the dominant mode of publication until the end of the sixties. Indeed, complex scriptwriting involving multiple timelines would not fit the form of a weekly feuilleton addressed to a young audience, because it would be too demanding cognitively speaking. It illustrates also the dominance of graphic concerns over a taste for complex scriptwriting in many comics of this period. Still, the development of time paradoxes in Pierre Christin scriptwriting underlines the potential of the media when it is published in series of albums or in graphic novels. At the same time, Jean-Claude Mézières drawings-featuring spectacular representations of foreign worlds-show that the visual interest of spectacular time travels remains a central issue for this popular graphic medium. Cette étude porte sur le motif du voyage temporel dans la bande dessinée franco-belge de science- fiction jusque dans les années quatre-vingt. Le voyage temporel intègre un potentiel fascinant pour la représentation narrative, étant donné que le retour dans le passé est susceptible d'engendrer des lignes temporelles multiples, selon le paradoxe bien connu du « grand-père ». Cette virtualité est devenue très populaire dans les romans et dans les films, depuis In his Bootstraps (Heinlein, 1941) et La Jetée (Marker, 1962) jusqu'au récent Looper (Johnson, 2012), mais elle a rarement été représentée dans la bande dessinée franco-belge avant les années quatre-vingt et l'apparition de paradoxes temporels dans des séries comme « Yoko Tsuno » et, surtout, « Valérian agent spatio-temporel ». Tout d'abord, de nombreuses modalités du voyage dans le temps n'engendrent aucun paradoxe, par exemple l'exploration de sanctuaires préhistoriques, le voyage illusoire ou le sommeil cryogénique suivi d'un réveil dans le futur, sans espoir de revenir dans le passé. Deuxièmement, le voyage dans le temps a été plus souvent interprété comme une simple extension du motif classique du « voyage extraordinaire », tel qu'on le retrouve, depuis le XVIIIe siècle, les fictions de Verne, Mercier, Swift ou Stevenson. Ainsi, le potentiel graphique du voyage dans le temps pour la représentation de mondes exotiques spectaculaires a prédominé dans la tradition franco-belge et cette tendance a été encouragée par le mode de publication dominant jusqu'à la fin des années soixante. En effet, l'écriture de scénarios complexes impliquant de multiples lignes temporelles ne semble pas adaptée à la forme d'un feuilleton hebdomadaire destiné à un jeune public, parce qu'il aurait été trop exigeant, cognitivement parlant. Cela illustre également la prédominance de préoccupations graphiques sur l'écriture de scénarios complexes dans de nombreuses bandes dessinées de cette période. Pourtant, le développement de paradoxes temporels dans les scénarios de Pierre Christin souligne le potentiel du média quand il est publié en série d'albums ou dans des romans graphiques. Parallèlement, les dessins de Jean-Claude Mézières, qui proposent des représentations spectaculaires de mondes étrangers, montre que l'intérêt visuel du voyage dans le temps demeure une question centrale pour ce média populaire.

Progress in front propagation research

We review the progress in the field of front propagation in recent years. We survey many physical, biophysical and cross-disciplinary applications, including reduced-variable models of combustion flames, Reid's paradox of rapid forest range expansions, the European colonization of North America during the 19th century, the Neolithic transition in Europe from 13 000 to 5000 years ago, the description of subsistence boundaries, the formation of cultural boundaries, the spread of genetic mutations, theory and experiments on virus infections, models of cancer tumors, etc. Recent theoretical advances are unified in a single framework, encompassing very diverse systems such as those with biased random walks, distributed delays, sequential reaction and dispersion, cohabitation models, age structure and systems with several interacting species. Directions for future progress are outlined

The mathematics of McTaggart's paradox

Mc Taggart's celebrated proof of the unreality of time is a chain of implications whose final step asserts that the A-series (i.e. the classification of events as past, present or future) is intrinsically contradictory. This is widely believed to be the heart of the argument, and it is where most attempted refutations have been addressed; yet, it is also the only part of the proof which may be generalised to other contexts, since none of the notions involved in it is specifically temporal. In fact, as I show in the first part of the paper, McTaggart's refutation of the A-series can be easily interpreted in mathematical terms; subsequently, in order to strengthen my claim, I apply the same framework by analogy to the cases of space, modality, and personal identity. Therefore, either McTaggart's proof as a whole may be extended to each of these notions, or it must embed some distinctly temporal element in one of the steps leading up to the contradiction of the A-series. I conclude by suggesting where this element might lay, and by hinting at what I believe to be the true logical fallacy of the proof.

How to (dis)solve Nagel's paradox about moral luck and responsibility

Abstract In this paper I defend a solution to the moral luck problem based on what I call "a fair opportunity account of control." I focus on Thomas Nagel's claim that moral luck reveals a paradox, and argue that the apparent paradox emerges only because he assumes that attributions of responsibility require agents to have total control over their actions. I argue that a more modest understanding of what it takes for someone to be a responsible agent-i.e., being capable of doing the right thing for the right reasons-dissolves the paradox and shows that responsibility and luck aren't at odds.

Developing the measurement and management of knowledge: applying the constructive research approach in a knowledge intensive service environment

Intellectual assets have attained continuous attention in the academic field, as they are vital sources of competitive advantage and organizational performance in the contemporary knowledge intensive business environment. Intellectual capital measurement is quite thoroughly addressed in the accounting literature. However, the purpose of the measurement is to support the management of intellectual assets, but the reciprocal relationship between measurement and management has not been comprehensively considered in the literature. The theoretical motivation for this study rose from this paradox, as in order to maximise the effectiveness of knowledge management the two initiatives need to be closely integrated. The research approach of this interventionist case study is constructive. The objective is to develop the case organization’s knowledge management and intellectual capital measurement in a way that they would be closely integrated and the measurement would support the management of intellectual assets. The case analysis provides valuable practical considerations about the integration and related issues as the case company is a knowledge intensive organization in which the know-how of the employees is the central competitive asset and therefore, the management and measurement of knowledge are essential for its future success. The results suggest that the case organization is confronting challenges in managing knowledge. In order to appropriately manage knowledge processes and control the related risks, support from intellectual capital measurement is required. However, challenges in measuring intellectual capital, especially knowledge, could be recognized in the organization. By reflecting the knowledge management situation and the constructed strategy map, a new intellectual measurement system was developed for the case organization. The construction of the system as well as its indicators can be perceived to contribute to the literature, emphasizing of the importance of properly considering the organization’s knowledge situation in developing an intellectual capital measurement system.

Brains and guts in human evolution: The Expensive Tissue Hypothesis

The brain is a very expensive organ in metabolic terms. Each unit of brain tissue requires over 22 times the amount of metabolic energy as an equivalent unit of muscle tissue. There is no correlation across mammals, however, between the relative size of the brain and the relative basal metabolic rate. The Expensive Tissue Hypothesis explains this apparent paradox by looking at the metabolic cost of the brain in the context of the costs of other metabolically expensive organs in the body. The results show that the increase in brain size in humans is balanced by an equivalent reduction in the size of the gastro-intestinal tract. In other words, the increased energetic demands of a relatively large brain are balanced by the reduced energy demands of a relatively small gastro-intestinal tract. This relationship also seems to be true in non-human primates. The size of the gastro-intestinal tract is dependent on both body size and the quality of the diet. It is argued that humans (and other primates) could not have developed a relatively large brain without also adopting a high quality diet that would have permitted a reduction in the relative size of the gastro-intestinal tract. Dietary change is therefore viewed as a 'prime releaser' in brain evolution. It is argued that a high quality diet is necessary for the evolution of a relatively large brain. However, the change to such a high quality diet, which involved an increased proportion of animal based products, need not have been one of the 'prime movers' in brain evolution. In this context, and based on the archaeological and palaeoanthropological record, the factors most probably surrounding the evolution of the human brain are discussed.

Hysteresis Losses in Sintered NdFeB Permanent Magnets in Rotating Electrical Machines

Permanent magnet materials are nowadays widely used in the electrical machine manufacturing industry. Eddy current loss models of permanent magnets used in electrical machines are frequently discussed in research papers. In magnetic steel materials we have, in addition to eddy current losses, hysteresis losses when AC or a rotating flux travels through the material. Should a similar phenomenon also be taken into account in calculating the losses of permanent magnets? Actually, every now and then authors seem to assume that some significant hysteresis losses are present in rotating machine PMs. This paper studies the mechanisms of possible hysteresis losses in PMs and their role in PMs when used in rotating electrical machines.