Clinical prediction of large vessel occlusion in anterior circulation stroke: mission impossible?

Simple clinical scores to predict large vessel occlusion (LVO) in acute ischemic stroke would be helpful to triage patients in the prehospital phase. We assessed the ability of various combinations of National Institutes of Health Stroke Scale (NIHSS) subitems and published stroke scales (i.e., RACE scale, 3I-SS, sNIHSS-8, sNIHSS-5, sNIHSS-1, mNIHSS, a-NIHSS items profiles A-E, CPSS1, CPSS2, and CPSSS) to predict LVO on CT or MR arteriography in 1085 consecutive patients (39.4 % women, mean age 67.7 years) with anterior circulation strokes within 6 h of symptom onset. 657 patients (61 %) had an occlusion of the internal carotid artery or the M1/M2 segment of the middle cerebral artery. Best cut-off value of the total NIHSS score to predict LVO was 7 (PPV 84.2 %, sensitivity 81.0 %, specificity 76.6 %, NPV 72.4 %, ACC 79.3 %). Receiver operating characteristic curves of various combinations of NIHSS subitems and published scores were equally or less predictive to show LVO than the total NIHSS score. At intersection of sensitivity and specificity curves in all scores, at least 1/5 of patients with LVO were missed. Best odds ratios for LVO among NIHSS subitems were best gaze (9.6, 95 %-CI 6.765-13.632), visual fields (7.0, 95 %-CI 3.981-12.370), motor arms (7.6, 95 %-CI 5.589-10.204), and aphasia/neglect (7.1, 95 %-CI 5.352-9.492). There is a significant correlation between clinical scores based on the NIHSS score and LVO on arteriography. However, if clinically relevant thresholds are applied to the scores, a sizable number of LVOs are missed. Therefore, clinical scores cannot replace vessel imaging.

M-AARE - Coupling atmospheric, hydrological, hydrodynamic and damage models in the Aare river basin, Switzerland

The triggering mechanism and the temporal evolution of large flood events, especially of worst-case scenarios, are not yet fully understood. Consequently, the cumulative losses of extreme floods are unknown. To study the link between weather conditions, discharges and flood losses it is necessary to couple atmospheric, hydrological, hydrodynamic and damage models. The objective of the M-AARE project is to test the potentials and opportunities of a model chain that relates atmospheric conditions to flood losses or risks. The M-AARE model chain is a set of coupled models consisting of four main components: the precipitation module, the hydrology module, the hydrodynamic module, and the damage module. The models are coupled in a cascading framework with harmonized time-steps. First exploratory applications show that the one way coupling of the WRF-PREVAH-BASEMENT models has been achieved and provides promising new insights for a better understanding of key aspects in flood risk analysis.

Posterior circulation cerebrovascular syndromes: diagnosis and management.

One in five strokes affects the posterior circulation. Diagnosing posterior circulation stroke can be challenging, as the vascular anatomy can be variable, and because presenting symptoms are often non-specific and fluctuating. Nevertheless, making the correct diagnosis is important, as these strokes have a high chance of recurrence, can be life threatening, and can lead to equally life-threatening complications. Investigation and management largely follow those for stroke in general, although some specific differences exist. These include the preferred use of MRI for diagnosing posterior fossa lesions, the management of basilar artery thrombosis, which may have a longer time window for recanalisation therapy, and the use of endovascular therapies for secondary prevention, which, so far, have not shown any benefit in the treatment of vertebral or basilar artery stenosis. In this review, we summarise the anatomy, aetiology and presentation of posterior circulation stroke, and discuss current approaches to management.

Results of a joint U.S.A./U.S.S.R. hydrodynamic and transport modeling project /

"February 1979."

Evaluation of aeration/circulation as a lake restoration technique /

Mode of access: Internet.

The measurement of liver circulation by means of the colloid disapperance rate.

Unclassified Health and Biology.

Development and verification of a three-dimensional numerical hydrodynamic, salinity, and temperature model of Chesapeake Bay.

Authors: B.H. Johnson, R.E. Heath, B.B. Hsieh, K.W. Kim, H.L. Butler.

User's guide for a three-dimensional numerical hydrodynamic, salinity, and temperature model of Chesapeake Bay /

Authors: Billy H. Johnson, Ronald E. Heath, Bernard B. Hsieh, Keu W. Kim, H. Lee Butler.

Los Angeles and Long Beach Harbors model study : numerical analysis of tidal circulation for the 2020 Master Plan /

"June 1984."

Lower Green Bay hydrodynamic and mass transport : numerical model study /

"December 1987."

Los Angeles and Long Beach harbors model study : Deep-Draft Dry Bulk Export Terminal, alternative no. 6: resonant response and tidal circulation studies /

"July 1985."

Catalogue of books printed for private circulation.

Mode of access: Internet.