Recanalization and outcome after intra-arterial thrombolysis in middle cerebral artery and internal carotid artery occlusion: does sex matter?

BACKGROUND AND PURPOSE: Recent studies have reported sex differences in recanalization and outcome after intravenous thrombolysis (IVT) in acute ischemic stroke. METHODS: We analyzed sex differences in outcome in consecutive patients with middle cerebral artery (MCA) M1 or M2 and internal carotid artery (ICA) occlusion treated with intra-arterial thrombolysis (IAT). Recanalization immediately after thrombolysis and outcome after 3 months were assessed. RESULTS: Two hundred five patients (111 men) with MCA and 43 (22 men) with ICA occlusion were identified. Baseline variables did not differ between the sexes except for a higher prevalence of smokers among men in the MCA group (31% vs 12%; P=0.001). Partial or complete recanalization (TIMI flow 2 or 3) of the MCA was observed in 71 (75%) women and 80 (72%) men (P=0.488). In the ICA group, 14 (67%) women and 11 men (50%) showed TIMI 2 or 3 recanalization (P=0.425). Favorable outcome (modified Rankin Scale score 0 to 2) was seen in 57 women (61%) and 63 men (57%) with MCA occlusion (P=0.512) and in 6 women (28%) and 4 men (18%) with ICA occlusion (P=0.656). After multiple-regression analyses, there was still no association between sex and outcome (P=0.763 for MCA and P=0.813 for ICA occlusion) or recanalization (P=0.488 for MCA and P=0.104 for ICA occlusion). CONCLUSIONS: There was no association between sex and recanalization or outcome after IAT. These findings are in contrast to previous studies reporting better recanalization and outcome after IVT in women and might have implications in the selection of patients for IAT or IVT.

Echinococcosis presenting as an otogenic brain abscess: an unusual lesion of the middle ear cleft and temporal lobe

This paper presents a case of a 28-year-old male with a seizure episode and a 4-year history of intermittent tinnitus on the left ear. On computed tomography and magnetic resonance imaging, a density with rim enhancement was found at the temporal lobe, associated with mastoid tegmen destruction and middle ear mass, indicating cholesteatoma with complicating brain abscess. Evacuation of the brain abscess was performed with a combined otolaryngologic and neurosurgical procedures (canal wall-down mastoidectomy and temporal craniotomy). The pathology turned out to be infestation with Echinococcus granulosus.

Wolf habitat selection at the territory level : seasonal and interannual variation and influence on reproductive success

Habitat selection has been one of the main research topics in ecology for decades. Nevertheless, many aspects of habitat selection still need to be explored. In particular, previous studies have overlooked the importance of temporal variation in habitat selection and the value of including data on reproductive success in order to describe the best quality habitat for a species. We used data collected from radiocollared wolves in Yellowstone National Park (USA), between 1996 and 2008, to describe wolf habitat selection. In particular, we aimed to identify i) seasonal differences in wolf habitat selection, ii) factors influencing interannual variation in habitat selection, and iii) the effect of habitat selection on wolf reproductive success. We used probability density functions to describe wolf habitat use and habitat coverages to represent the habitat available to wolves. We used regression analysis to connect habitat use with habitat characteristics and habitat selection with reproductive success. Our most relevant result was discovering strong interannual variability in wolf habitat selection. This variability was in part explained by pack identity and differences in litter size and leadership of a pack between two years (summer) and in pack size and precipitation (winter). We also detected some seasonal differences. Wolves selected open habitats, intermediate elevations, intermediate distances from roads, and avoided steep slopes in late winter. They selected areas close to roads and avoided steep slopes in summer. In early winter, wolves selected wetlands, herbaceous and shrub vegetation types, and areas at intermediate elevation and distance from roads. Surprisingly, the habitat characteristics selected by wolves were not useful in predicting reproductive success. We hypothesize that interannual variability in wolf habitat selection may be too strong to detect effects on reproductive success. Moreover, prey availability and competitor pressure may also have an influence on wolf reproductive success, which we did not assess. This project demonstrated how important temporal variation is in shaping patterns of habitat selection. We still believe in the value of running long-term studies, but the effect of temporal variation should always be taken into account.

Exigencies for engaging undergraduates in rhetorical problem solving : insights from engineering managers and A3 report analyses

Undergraduate education has a historical tradition of preparing students to meet the problem-solving challenges they will encounter in work, civic, and personal contexts. This thesis research was conducted to study the role of rhetoric in engineering problem solving and decision making and to pose pedagogical strategies for preparing undergraduate students for workplace problem solving. Exploratory interviews with engineering managers as well as the heuristic analyses of engineering A3 project planning reports suggest that Aristotelian rhetorical principles are critical to the engineer's success: Engineers must ascertain the rhetorical situation surrounding engineering problems; apply and adapt invention heuristics to conduct inquiry; draw from their investigation to find innovative solutions; and influence decision making by navigating workplace decision-making systems and audiences using rhetorically constructed discourse. To prepare undergraduates for workplace problem solving, university educators are challenged to help undergraduates understand the exigence and realize the kairotic potential inherent in rhetorical problem solving. This thesis offers pedagogical strategies that focus on mentoring learning communities in problem-posing experiences that are situated in many disciplinary, work, and civic contexts. Undergraduates build a flexible rhetorical technê for problem solving as they navigate the nuances of relevant problem-solving systems through the lens of rhetorical practice.

"Brethren upon the same level" : membership and class in Calumet's Masonic Lodge

The Keweenaw Peninsula of Upper Michigan was a ethnic conglomerate of cultures and ideas, with people attracted to the area by the mineral wealth found along the Copper Range. The center of copper mining from the mid 1860s to 1968 was in the vicinity of Calumet Township, home to the world-famous Calumet and Hecla Mining Company. The township depended on the mines and the company’s president Agassiz’s strove to make the area a “model community,” that included groups such as the Free and Accepted Masons. Men from myriad backgrounds arrived in Calumet from the British Isles, Germany, Finland, Eastern and Southern Europe and the Eastern United States. As in other communities from the time period these men formed common interest groups like Masonic Lodge 271, which received its charter in 1870. Gentlemen joined with merchants and craftsmen. They became “brethren upon the same level,” and were elevated to the status of Master Mason. This symbolic transformation within the Lodge removed the men from the “profane world” outside the sanctity of Masonry, and in the ritualistic transformation of the meeting they were reborn into Masonry’s sacred mysteries. Masonry acted as a means of moral guidance to men and gave them access to a larger social and economic community through a common connection of brotherhood. As the candidates moved through the three Blue Lodge degrees of Entered Apprentice, Fellowcraft, and Master Mason they saw each other as “brethren upon the same level” – all economic classes equal within the Masonic Lodge. To examine equality within Lodge 271, this study sorted workers into classes to allow a comparison of Lodge 271’s membership. Possibly a comparison between other lodges can be drawn from the membership. The Union Building in Calumet, MI will be examined for its role in the ritualistic transformation of Masonry as it housed Masonic activities and transformations. This transformation brought men into the lodge of brothers. While Masonry professed equality between members however, to what extent did the membership of the lodge reflect this between the brethren? To what extent did economic class determine who was made “brethren upon the same level? 1 Arthur Thurner, Calumet Copper and People: History of a Michigan Mining Community, 1864-1970 (Hancock, MI: Book Concern, 1974), 122.

The role of upper-level dynamics and surface processes for the Pakistan flood of July 2010

In July and August 2010 floods of unprecedented impact afflicted Pakistan. The floods resulted from a series of intense multi-day precipitation events in July and early August. At the same time a series of blocking anticyclones dominated the upper-level flow over western Russia and breaking waves i.e. equatorward extrusions of stratospheric high potential vorticity (PV) air formed along the downstream flank of the blocks. Previous studies suggested that these extratropical upper-level breaking waves were crucial for instigating the precipitation events in Pakistan. Here a detailed analysis is provided of the extratropical forcing of the precipitation. Piecewise PV inversion is used to quantify the extratropical upper-level forcing associated with the wave breaking and trajectories are calculated to study the pathways and source regions of the moisture that precipitated over Pakistan. Limited-area model simulations are carried out to complement the Lagrangian analysis. The precipitation events over Pakistan resulted from a combination of favourable boundary conditions with strong extratropical and monsoonal forcing factors. Above-normal sea-surface temperatures in the Indian Ocean led to an elevated lower-tropospheric moisture content. Surface monsoonal depressions ensured the transport of moist air from the ocean towards northeastern Pakistan. Along this pathway the air parcel humidity increased substantially (60–90% of precipitated moisture) via evapotranspiration from the land surface. Extratropical breaking waves influenced the surface wind field substantially by enhancing the wind component directed towards the mountains which reinforced the precipitation.

Street-level bureaucrats and new modes of governance - How conflicting roles affect the implementation of the Swiss Ordinance on Verterinary Drugs

Lipsky’s seminal concept of street-level bureaucrats (SLBs) focuses on their role as public servants. However, in the course of new modes of governance, private actors have gained an additional role as implementation agents. We explore the logic of private SLBs during the implementation of the Swiss Ordinance on Veterinary Medicinal Products (OVMP) where veterinarians are simultaneously implementing agents, policy addressees, and professionals with economic interests. We argue that, because of contradictory reference systems, it is problematic for the output performance if an actor is simultaneously the target group of a policy and its implementing agent.

The Regulatory Framework for Nanomaterials at a Global Level: SAICM and WTO Insights

The regulation of nanomaterials is being discussed at various levels. This article offers a historical description of governmental activities concerning the safety of nanomaterials at the United Nations (UN) level since 2006, with a focus on the UN Strategic Approach to International Chemicals Management (SAICM). The outcomes of the SAICM process were a nanospecific resolution and the addition of new activities on nanotechnologies and manufactured nanomaterials to the SAICM’s Global Plan of Action. The article discusses the implications of these decisions for multilateral environmental agreements. In addition, it studies the consequences of the regulation of nanotechnologies activities on trade governance, in particular the relationship between the SAICM to the legally binding World Trade Organization (WTO) agreements (notably the General Agreement on Tariffs and Trade and the Agreement on Technical Barriers to Trade). The article concludes that the SAICM decisions on manufactured nanomaterials are compatible with WTO law.

Functional Multiparametric Magnetic Resonance Imaging of the Kidneys Using Blood Oxygen Level-Dependent and Diffusion-Weighted Sequences: a Reliable Tool for Monitoring Acute Upper Urinary Tract Obstruction.

PURPOSE Little data is available on noninvasive MRI-based assessment of renal function during upper urinary tract (UUT) obstruction. In this study, we determined whether functional multiparametric kidney MRI is able to monitor treatment response in acute unilateral UUT obstruction. MATERIAL AND METHODS Between 01/2008 and 01/2010, 18 patients with acute unilateral UUT obstruction due to calculi were prospectively enrolled to undergo kidney MRI with conventional, blood oxygen level-dependent (BOLD) and diffusion-weighted (DW) sequences on emergency admission and after release of obstruction. Functional imaging parameters of the obstructed and contralateral unobstructed kidneys derived from BOLD (apparent spin relaxation rate [R2*]) and DW (total apparent diffusion coefficient [ADCT], pure diffusion coefficient [ADCD] and perfusion fraction [FP]) sequences were assessed during acute UUT obstruction and after its release. RESULTS During acute obstruction, R2* and FP values were lower in the cortex (p=0.020 and p=0.031, respectively) and medulla (p=0.012 and p=0.190, respectively) of the obstructed compared to the contralateral unobstructed kidneys. After release of obstruction, R2* and FP values increased both in the cortex (p=0.016 and p=0.004, respectively) and medulla (p=0.071 and p=0.044, respectively) of the formerly obstructed kidneys to values similar to those found in the contralateral kidneys. ADCT and ADCD values did not significantly differ between obstructed and contralateral unobstructed kidneys during or after obstruction. CONCLUSIONS In our patients with acute unilateral UUT obstruction due to calculi, functional kidney MRI using BOLD and DW sequences allowed for the monitoring of pathophysiologic changes of obstructed kidneys during obstruction and after its release.

The Regulatory Framework for Nanomaterials at a Global Level: SAICM and WTO Insights

The regulation of nanomaterials is being discussed at various levels. This article offers a historical description of governmental activities concerning the safety of nanomaterials at the United Nations (UN) level since 2006, with a focus on the UN Strategic Approach to International Chemicals Management (SAICM). The outcomes of the SAICM process were a nanospecific resolution and the addition of new activities on nanotechnologies and manufactured nanomaterials to the SAICM’s Global Plan of Action. The article discusses the implications of these decisions for multilateral environmental agreements. In addition, it studies the consequences of the regulation of nanotechnologies activities on trade governance, in particular the relationship between the SAICM to the legally binding World Trade Organization (WTO) agreements (notably the General Agreement on Tariffs and Trade and the Agreement on Technical Barriers to Trade). The article concludes that the SAICM decisions on manufactured nanomaterials are compatible with WTO law.