Is clopidogrel better than aspirin following breakthrough strokes while on aspirin? A retrospective cohort study.

ObjectiveThere is insufficient evidence on which to base a recommendation for optimal antiplatelet therapy following a stroke while on aspirin. The objective was to compare clopidogrel initiation vs aspirin reinitiation for vascular risk reduction among patients with ischaemic stroke on aspirin at the time of their index stroke.DesignRetrospective.SettingWe conducted a nationwide cohort study by retrieving all hospitalised patients (≥18 years) with a primary diagnosis of ischaemic stroke between 2003 and 2009 from Taiwan National Health Insurance Research Database.ParticipantsAmong 3862 patients receiving aspirin before the index ischaemic stroke and receiving either aspirin or clopidogrel after index stroke during follow-up period, 1623 were excluded due to a medication possession ratio <80%. Also, 355 were excluded due to history of atrial fibrillation, valvular heart disease or coagulopathy. Therefore, 1884 patients were included in our final analysis.InterventionsPatients were categorised into two groups based on whether clopidogrel or aspirin was prescribed during the follow-up period. Follow-up was from time of the index stroke to admission for recurrent stroke or myocardial infarction, death or the end of 2010.Primary and secondary outcome measuresThe primary end point was hospitalisation due to a new-onset major adverse cardiovascular event (MACE: composite of any stroke or myocardial infarction). The leading secondary end point was any recurrent stroke.ResultsCompared to aspirin, clopidogrel was associated with a lower occurrence of future MACE (HR=0.54, 95% CI 0.43 to 0.68, p<0.001, number needed to treat: 8) and recurrent stroke (HR=0.54, 95% CI 0.42 to 0.69, p<0.001, number needed to treat: 9) after adjustment of relevant covariates.ConclusionsAmong patients with an ischaemic stroke while taking aspirin, clopidogrel initiation was associated with fewer recurrent vascular events than aspirin reinitiation

Clinical significance of erythropoietin receptor expression in oral squamous cell carcinoma

BACKGROUND: Hypoxic tumors are refractory to radiation and chemotherapy. High expression of biomarkers related to hypoxia in head and neck cancer is associated with a poorer prognosis. The present study aimed to evaluate the clinicopathological significance of erythropoietin receptor (EPOR) expression in oral squamous cell carcinoma (OSCC). METHODS: The study included 256 patients who underwent primary surgical resection between October 1996 and August 2005 for treatment of OSCC without previous radiotherapy and/or chemotherapy. Clinicopathological information including gender, age, T classification, N classification, and TNM stage was obtained from clinical records and pathology reports. The mRNA and protein expression levels of EPOR in OSCC specimens were evaluated by Q-RT-PCR, Western blotting and immunohistochemistry assays. RESULTS: We found that EPOR were overexpressed in OSCC tissues. The study included 17 women and 239 men with an average age of 50.9 years (range, 26–87 years). The mean follow-up period was 67 months (range, 2–171 months). High EPOR expression was significantly correlated with advanced T classification (p < 0.001), advanced TNM stage (p < 0.001), and positive N classification (p = 0.001). Furthermore, the univariate analysis revealed that patients with high tumor EPOR expression had a lower 5-year overall survival rate (p = 0.0011) and 5-year disease-specific survival rate (p = 0.0017) than patients who had low tumor levels of EPOR. However, the multivariate analysis using Cox’s regression model revealed that only the T and N classifications were independent prognostic factors for the 5-year overall survival and 5-year disease-specific survival rates. CONCLUSIONS: High EPOR expression in OSCC is associated with an aggressive tumor behavior and poorer prognosis in the univariate analysis among patients with OSCC. Thus, EPOR expression may serve as a treatment target for OSCC in the future

Developing a Listening, Empathy, Presence (LPE) Trait Scale

There are fifteen items under the prototype of a LEP trait scale which could best represent the characteristics of Listening, Empathy, and Present (LEP) traits

Artificial Intelligence and Visual Analytics: A Deep-Learning Approach to Analyze Hotel Reviews & Responses

With a growing number of online reviews, consumers often rely on these reviews to make purchase decisions. However, little is known about managerial responses to online hotel reviews. This paper reports on a framework to integrate visual analytics and machine learning techniques to investigate whether hotel managers respond to positive and negative reviews differently and how to use a deep-learning approach to prioritize responses. In this study, forty 4- and 5-star hotels in London with 91,051 reviews and 70,397 responses were collected and analyzed. Visual analyses and machine learning were conducted. The results indicate most hotels (72.5%) showing no preference to respond to positive and negative reviews. Our proposed deep-learning approach outperformed existing algorithms to prioritize responses

Cyclosporine A Eye Drop-Induced Elongated Eyelashes: A Case Report

Purpose: The most common ocular adverse event following the use of cyclosporine A (CsA) 0.05% ophthalmic emulsion is ocular burning (17%). Other adverse effects that have been reported include conjunctival hyperemia (1–5%), discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging and blurred vision. Here, we report a specific side effect of CsA, namely eye drop-induced eyelash elongation in a patient with refractory giant papillary conjunctivitis. Design: Observational case report. Methods: Case report and review of the literature. Results: A 32-year-old female with giant papillary conjunctivitis on the left eye, who had undergone papillectomy 3 years previously and was refractory to topical steroid therapy, was treated with CsA 0.05% ophthalmic emulsion (Restasis) 4 times a day, preservative-free artificial tears and gentamicin ophthalmic solution in the left eye. After 5 months of topical CsA treatment, elongated eyelashes of her left eye were observed without other adverse effects. Conclusion: Although hypertrichosis and trichomegaly have been documented in the literature as side effects of systemic CsA, topical CsA 0.05% eye drop-induced elongated eyelashes have not been reported, and we believe ophthalmologists should be mindful and inform patients about this specific side effect

Terahertz generation in multiple laser-induced air plasmas

This is the published version. Copyright 2008 American Institute of PhysicsAn investigation of the terahertz wavegeneration in multiple laser-induced air plasmas is presented. First, it is demonstrated that the intensity of the terahertz wave increases as the number of air plasmas increases. Second, the physical mechanism of this enhancement effect of the terahertz generation is studied by quantitatively measuring the intensity of the generated terahertz wave as a function of phase difference between adjacent air plasmas. It is found out that the superposition is the main mechanism to cause this enhancement. Thus, the results obtained in this paper not only provide a technique to generate stronger terahertz wave but also enable a better understanding of the mechanism of the terahertz generation in air plasma

Energy-efficient electrochemical ammonia production from dilute nitrate solution

Highly efficient electrochemical nitrate reduction could become a key process for sustainable ammonia production overcoming many limitations of the Haber–Bosch process. Current state-of-the-art electrocatalysts have severe drawbacks regarding yield, selectivity and energy efficiency when dealing with dilute nitrate solutions. Herein, we report a layered double hydroxide (LDH)/Cu foam hybrid electrocatalyst that offers a potential solution to this challenge. The [Ni0.75Fe0.25(OH)2](CO3)0.125 (Ni3Fe–CO3 LDH) exhibits an appropriate kinetic energy barrier for the Volmer step generating hydrogen radicals as well as suppressing H–H bond formation by inhibition of the Heyrovsky step. The electrochemically generated hydrogen radicals transfer to a Cu surface enabling NO3− reduction to NH3. The Ni3Fe–CO3 LDH/Cu foam hybrid electrode exhibits an 8.5-fold higher NH3 yield compared to a pristine Cu surface, while exhibiting an NH3 selectivity of 95.8% at 98.5% NO3− conversion. The best half-cell energy efficiency (36.6%) was recorded while achieving 96.8% faradaic efficiency at −0.2 V in 5 mM NO3−(aq)

Mapping infectious disease hospital surge threats to lessons learnt in Singapore: a systems analysis and development of a framework to inform how to DECIDE on planning and response strategies.

BACKGROUND: Hospital usage and service demand during an Infectious Disease (ID) outbreak can tax the health system in different ways. Herein we conceptualize hospital surge elements, and lessons learnt from such events, to help build appropriately matched responses to future ID surge threats. METHODS: We used the Interpretive Descriptive qualitative approach. Interviews (n = 35) were conducted with governance and public health specialists; hospital based staff; and General Practitioners. Key policy literature in tandem with the interview data were used to iteratively generate a Hospital ID Surge framework. We anchored our narrative account within this framework, which is used to structure our analysis. RESULTS: A spectrum of surge threats from combinations of capacity (for crowding) and capability (for treatment complexity) demands were identified. Starting with the Pyramid scenario, or an influx of high screening rates flooding Emergency Departments, alongside fewer and manageable admissions; the Reverse-Pyramid occurs when few cases are screened and admitted but those that are, are complex; during a 'Black' scenario, the system is overburdened by both crowding and complexity. The Singapore hospital system is highly adapted to crowding, functioning remarkably well at constant near-full capacity in Peacetime and resilient to Endemic surges. We catalogue 26 strategies from lessons learnt relating to staffing, space, supplies and systems, crystalizing institutional memory. The DECIDE model advocates linking these strategies to types of surge threats and offers a step-by-step guide for coordinating outbreak planning and response. CONCLUSIONS: Lack of a shared definition and decision making of surge threats had rendered the procedures somewhat duplicative. This burden was paradoxically exacerbated by a health system that highly prizes planning and forward thinking, but worked largely in silo until an ID crisis hit. Many such lessons can be put into play to further strengthen our current hospital governance and adapted to more diverse settings

Analysis of terahertz generation via nanostructure enhanced plasmonic excitations

This is the published version. Copyright © 2009 American Institute of PhysicsIn this paper, we conduct a quantitative study on the physical mechanism of electrons dynamics near the nanostructured metalfilmsurfaces, as well as the efficiency of generated terahertz radiation associated with different types of nanostructures. The simulation results show that although the oscillating motion of emitted electrons outside the metal surface may affect the terahertz generation efficiency to some extent, this efficiency is predominantly determined by the electric field magnitude inside the metalfilm associated with nanostructure enhanced plasmonic excitations. Due to the field enhancement effect of the nanostructure, an appropriately designed nanostructured surface could greatly enhance the strength of generated terahertz signal via the increased nonlinear interactions between the light and the nanostructures

Location-Aware Visual Question Generation with Lightweight Models

This work introduces a novel task, location-aware visual question generation (LocaVQG), which aims to generate engaging questions from data relevant to a particular geographical location. Specifically, we represent such location-aware information with surrounding images and a GPS coordinate. To tackle this task, we present a dataset generation pipeline that leverages GPT-4 to produce diverse and sophisticated questions. Then, we aim to learn a lightweight model that can address the LocaVQG task and fit on an edge device, such as a mobile phone. To this end, we propose a method which can reliably generate engaging questions from location-aware information. Our proposed method outperforms baselines regarding human evaluation (e.g., engagement, grounding, coherence) and automatic evaluation metrics (e.g., BERTScore, ROUGE-2). Moreover, we conduct extensive ablation studies to justify our proposed techniques for both generating the dataset and solving the task.Comment: EMNLP 202