Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study

BACKGROUND: Treatment strategies for acute basilar artery occlusion (BAO) are based on case series and data that have been extrapolated from stroke intervention trials in other cerebrovascular territories, and information on the efficacy of different treatments in unselected patients with BAO is scarce. We therefore assessed outcomes and differences in treatment response after BAO. METHODS: The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO between November 1, 2002, and October 1, 2007. Stroke severity at time of treatment was dichotomised as severe (coma, locked-in state, or tetraplegia) or mild to moderate (any deficit that was less than severe). Outcome was assessed at 1 month. Poor outcome was defined as a modified Rankin scale score of 4 or 5, or death. Patients were divided into three groups according to the treatment they received: antithrombotic treatment only (AT), which comprised antiplatelet drugs or systemic anticoagulation; primary intravenous thrombolysis (IVT), including subsequent intra-arterial thrombolysis; or intra-arterial therapy (IAT), which comprised thrombolysis, mechanical thrombectomy, stenting, or a combination of these approaches. Risk ratios (RR) for treatment effects were adjusted for age, the severity of neurological deficits at the time of treatment, time to treatment, prodromal minor stroke, location of the occlusion, and diabetes. FINDINGS: 619 patients were entered in the registry. 27 patients were excluded from the analyses because they did not receive AT, IVT, or IAT, and all had a poor outcome. Of the 592 patients who were analysed, 183 were treated with only AT, 121 with IVT, and 288 with IAT. Overall, 402 (68%) of the analysed patients had a poor outcome. No statistically significant superiority was found for any treatment strategy. Compared with outcome after AT, patients with a mild-to-moderate deficit (n=245) had about the same risk of poor outcome after IVT (adjusted RR 0.94, 95% CI 0.60-1.45) or after IAT (adjusted RR 1.29, 0.97-1.72) but had a worse outcome after IAT compared with IVT (adjusted RR 1.49, 1.00-2.23). Compared with AT, patients with a severe deficit (n=347) had a lower risk of poor outcome after IVT (adjusted RR 0.88, 0.76-1.01) or IAT (adjusted RR 0.94, 0.86-1.02), whereas outcomes were similar after treatment with IAT or IVT (adjusted RR 1.06, 0.91-1.22). INTERPRETATION: Most patients in the BASICS registry received IAT. Our results do not support unequivocal superiority of IAT over IVT, and the efficacy of IAT versus IVT in patients with an acute BAO needs to be assessed in a randomised controlled trial. FUNDING: Department of Neurology, University Medical Center Utrecht.

Exploiting Runtime Information in the IDE

Developers rely on the mechanisms provided by their IDE to browse and navigate a large software system. These mechanisms are usually based purely on a system's static source code. The static perspective, however, is not enough to understand an object-oriented program's behavior, in particular if implemented in a dynamic language. We propose to enhance IDEs with a program's runtime information (eg. message sends and type information) to support program comprehension through precise navigation and informative browsing. To precisely specify the type and amount of runtime data to gather about a system under development, dynamically and on demand, we adopt a technique known as partial behavioral reflection. We implemented navigation and browsing enhancements to an IDE that exploit this runtime information in a prototype called Hermion. We present preliminary validation of our experimental enhanced IDE by asking developers to assess its usefulness to understand an unfamiliar software system.

Initializing a National Grid Infrastructure: Lessons Learned from the Swiss National Grid Association Seed Project

In addition to multi-national Grid infrastructures, several countries operate their own national Grid infrastructures to support science and industry within national borders. These infrastructures have the benefit of better satisfying the needs of local, regional and national user communities. Although Switzerland has strong research groups in several fields of distributed computing, only recently a national Grid effort was kick-started to integrate a truly heterogeneous set of resource providers, middleware pools, and users. In the following. article we discuss our efforts to start Grid activities at a national scale to combine several scientific communities and geographical domains. We make a strong case for the need of standards that have to be built on top of existing software systems in order to provide support for a heterogeneous Grid infrastruc

Social Support Quality in Internet Based Information and Communication: From "Digital Divide" to "Voice Divide"

National and international studies demonstrate that the number of teenagers using the inter-net increases. But even though they actually do have access from different places to the in-formation and communication pool of the internet, there is evidence that the ways in which teenagers use the net - regarding the scope and frequency in which services are used as well as the preferences for different contents of these services - differ significantly in relation to socio-economic status, education, and gender. The results of the regarding empirical studies may be summarised as such: teenager with low (formal ) education especially use internet services embracing 'entertainment, play and fun' while higher educated teenagers (also) prefer intellectually more demanding and particularly services supplying a greater variety of communicative and informative activities. More generally, pedagogical and sociological studies investigating "digital divide" in a dif-ferentiated and sophisticated way - i.e. not only in terms of differences between those who do have access to the Internet and those who do not - suggest that the internet is no space beyond 'social reality' (e.g. DiMaggio & Hargittai 2001, 2003; Vogelgesang, 2002; Welling, 2003). Different modes of utilisation, that structure the internet as a social space are primarily a specific contextualisation of the latter - and thus, the opportunities and constraints in virtual world of the internet are not less than those in the 'real world' related to unequal distribu-tions of material, social and cultural resources as well as social embeddings of the actors involved. This fact of inequality is also true regarding the outcomes of using the internet. Empirical and theoretical results concerning forms and processes of networking and commu-nity building - i.e. sociability in the internet, as well as the social embeddings of the users which are mediated through the internet - suggest that net based communication and infor-mation processes may entail the resource 'social support'. Thus, with reference to social work and the task of compensating the reproduction of social disadvantages - whether they are medial or not - the ways in which teenagers get access to and utilize net based social sup-port are to be analysed.

Insider Trading in Germany - Do Corporate Insiders Exploit Inside Information?

Our study focuses on the question whether corporate insiders in Germany exploit inside information while trading in their company’s stock. In contrast to prior international studies, which are not able to link insider transactions to a formal definition of inside information, we relate insider transactions to subsequent releases of inside information via ad-hoc news disclosures. We find evidence that corporate insiders as a group seem to trade on inside information. Moreover, members of the supervisory board seem to be most active in exploiting inside information, since they realize exceptionally high profits with their frequent front-running transactions.

Dynamic Optimization of SLA-Based Services Scaling Rules

Current advanced cloud infrastructure management solutions allow scheduling actions for dynamically changing the number of running virtual machines (VMs). This approach, however, does not guarantee that the scheduled number of VMs will properly handle the actual user generated workload, especially if the user utilization patterns will change. We propose using a dynamically generated scaling model for the VMs containing the services of the distributed applications, which is able to react to the variations in the number of application users. We answer the following question: How to dynamically decide how many services of each type are needed in order to handle a larger workload within the same time constraints? We describe a mechanism for dynamically composing the SLAs for controlling the scaling of distributed services by combining data analysis mechanisms with application benchmarking using multiple VM configurations. Based on processing of multiple application benchmarks generated data sets we discover a set of service monitoring metrics able to predict critical Service Level Agreement (SLA) parameters. By combining this set of predictor metrics with a heuristic for selecting the appropriate scaling-out paths for the services of distributed applications, we show how SLA scaling rules can be inferred and then used for controlling the runtime scale-in and scale-out of distributed services. We validate our architecture and models by performing scaling experiments with a distributed application representative for the enterprise class of information systems. We show how dynamically generated SLAs can be successfully used for controlling the management of distributed services scaling.

Information Integration Theory and the Construction of Individually Perceived Group Efficacy

According to Bandura (1997) efficacy beliefs are a primary determinant of motivation. Still, very little is known about the processes through which people integrate situational factors to form efficacy beliefs (Myers & Feltz, 2007). The aim of this study was to gain insight into the cognitive construction of subjective group-efficacy beliefs. Only with a sound understanding of those processes is there a sufficient base to derive psychological interventions aimed at group-efficacy beliefs. According to cognitive theories (e.g., Miller, Galanter, & Pribram, 1973) individual group-efficacy beliefs can be seen as the result of a comparison between the demands of a group task and the resources of the performing group. At the center of this comparison are internally represented structures of the group task and plans to perform it. The empirical plausibility of this notion was tested using functional measurement theory (Anderson, 1981). Twenty-three students (M = 23.30 years; SD = 3.39; 35 % females) of the University of Bern repeatedly judged the efficacy of groups in different group tasks. The groups consisted of the subjects and another one to two fictive group members. The latter were manipulated by their value (low, medium, high) in task-relevant abilities. Data obtained from multiple full factorial designs were structured with individuals as second level units and analyzed using mixed linear models. The task-relevant abilities of group members, specified as fixed factors, all had highly significant effects on subjects’ group-efficacy judgments. The effect sizes of the ability factors showed to be dependent on the respective abilities’ importance in a given task. In additive tasks (Steiner, 1972) group resources were integrated in a linear fashion whereas significant interaction between factors was obtained in interdependent tasks. The results also showed that people take into account other group members’ efficacy beliefs when forming their own group-efficacy beliefs. The results support the notion that personal group-efficacy beliefs are obtained by comparing the demands of a task with the performing groups’ resources. Psychological factors such as other team members’ efficacy beliefs are thereby being considered task relevant resources and affect subjective group-efficacy beliefs. This latter finding underlines the adequacy of multidimensional measures. While the validity of collective efficacy measures is usually estimated by how well they predict performances, the results of this study allow for a somewhat internal validity criterion. It is concluded that Information Integration Theory holds potential to further help understand people’s cognitive functioning in sport relevant situations.