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Introduction: Although studies have examined emergent CTAs of the head and neck in patients seen by neurologists who are suspected of having a large vessel occlusion, the utility and accuracy of CTA for patients called as a ‘code stroke’ by any healthcare provider has not been evaluated. Methods: At our institution, imaging for all Code Stroke patients includes non-contrast CT of the brain as well as CTA of the neck and brain, regardless of severity. This imaging is often performed prior to detailed neurology evaluation. We queried our radiology department report database for all studies labelled ‘CTA ELVO’, an imaging order code which is specific for Code Stroke. We then cross-referenced this list with our prospectively acquired ischemic stroke registry, which consists of all patients discharged with a diagnosis of acute ischemic stroke. Results: Between January and August 2017, 1265 CTA ELVOs were performed. Average age was 66.3 years, and 52.4% were female. Of all CTA ELVOs, 144 were performed on inpatients (11.3%) and neuroradiologists read 149 studies (11.8%). Critical findings on vessel imaging were present in 165 studies (13%); of these 118 patients were ultimately diagnosed with acute ischemic stroke. Studies with critical findings involved older patients (73.7 years, p Conclusion: The yield of non-invasive vessel imaging in patients called as a code stroke in detecting critical findings is high, revealing abnormalities in approximately one in eight patients. Patients presenting with acute neurologic symptoms should receive vessel imaging as part of the initial workup for suspected stroke.

Walt Whitman. Drum Taps: The Complete Civil War Poems. Introduction by James McPherson. Kennebunkport, ME: Cider Mill Press, 2015. 213 pp.Walt Whitman. Drum-Taps: The Complete 1865 Edition, ed. Lawrence Kramer. New York: New York Review of Books, 2015. xxiv + 170 pp.Two stand-alone editions of Walt Whitman's 1865 Drum-Taps hit bookshelves in 2015 beside a score of books commemorating the sesquicentennial of General Robert E. Lee's surrender and the end of the Civil War-an anniversary coinciding with the birthday of Whitman's war poetry collection. Both editions of Drum-Taps stand apart from the majority of those other books, celebrating one of the few collections of Civil War poetry written by an eye-witness. Cider Mill Press's Drum Taps: The Complete Civil War Poems offers a visceral experience, integrating the poems with full-color and black-and-white historical images of battlefields, hospitals, and veterans. The result is a collage attempting to present Whitman's poetry as documentation-eye-witness testimony to the bravery of soldiers and the savagery of war, with a special emphasis on the "eye." Drum-Taps: The Complete 1865 Edition, published by the press of the New York Review of Books, is a text-only paperback, about one-third smaller in dimensions than Cider Mill's version, with a back cover declaring this edition to be "a revelation, allowing one of Whitman's greatest achievements to appear again in all its troubling glory." The books differ dramatically not only in appearance but, more importantly, in the editorial approaches to the source material.Pulitzer-prize winning and New York Times bestselling author James McPherson, the renowned historian whose books include Battle Cry of Freedom, introduces Cider Mill's Drum Taps (the missing hyphen in the title is the Press's own mistake) as "[making] the war more real to readers of the poems and viewers of the photographs, [offering] a stark portrait of the grim realities of war that confronted Whitman as he made his rounds of hospitals and battlefields" (4). The editors have chosen a fair balance of iconic and lesser known images of the period, including Currier and Ives lithographs, Mathew Brady and Alexander Gardner photographs, and daguerreotypes of enlisted soldiers. A majority of the images are black-and-white or sepia, and are remarkably clear for a book of this size. The color images, mostly artistic representations of the war, are equally stunning in their detail, testifying to the quality of Cider Mill's printing.Any book relying so heavily on illustrations runs the risk of encountering problems in formatting, especially when pulling those images from historical archives and collections. While most of the illustrations are full-page, smaller images require internal framing to fit the 6" x 9.2" book format. Some of these frames-mock-Victorian borders against stock-design backgrounds-contain images no bigger than 2" x 3.5", mostly horizontal images presumably reduced in size to fit the vertical dimensions of the book. Among otherwise full-page spreads, these frames are clunky and often interrupt the continuity of the reading experience. Photo information and credits are located at the back of the book, so, with nearly 200 images to contend with, the reader is forced to constantly flip back and forth between the pages. The presence of the frames might suggest the book's role as a curatorial item, a museum on the page, but the absence of localized, focused captions and the inconsistency of formatting detract from the maneuverability of the work as a whole.Cider Mill internally divides their collection of Whitman's Civil War poetry into two books, the first of which is textually and structurally identical with the Drum-Taps cluster found in the final (1881) arrangement of Leaves of Grass, thus relying on Whitman's later ordering and edits. The two "books" are separated by an "interlude"-two prose pieces detailing the inauguration and death of President Lincoln taken directly from Whitman's Specimen Days, an attribution that does not appear anywhere within the book itself. …

Background The available information on postictal semiology and behavior in patients with psychogenic nonepileptic seizure (PNES) is limited. In this study, we explore the differences in postictal semiology and behavior between patients with epileptic seizure (ES) and PNES and focus on clinical features that may be helpful in differentiating these two conditions. Methods In this retrospective study, video-electroencephalograph (video-EEG) of 144 seizures from 64 patients with PNES and 66 seizures from 42 patients with ES were reviewed. Three novel postictal behaviors were compared between the two groups: a) abrupt, brief, and rapid blinking or shaking of the head as if regaining sensorium or “coming out” of the ictal event; b) looking around the room with a scanning and uncertain look; c) posing a question of “what happened?” or a similar question to the others present in the room. In addition, differences in several other postictal characteristics were studied. Results At least one of the three specific postictal behaviors was seen in 20.1% of patients with PNES but none of the patients with ES resulting in 100% specificity and 36% sensitivity. While mean ictal duration was significantly longer in patients with PNES (175.3 ± 168 s) compared to ES (105.4 ± 102.9 s), the interval between the end of ictal episode and first correct verbal response (74.5 ± 126.2 s versus 139.4 ± 185.4 s), or first followed command (84.1 ± 133.8 s versus 141.1 ± 192.1 s) were shorter. In the group with PNES, 59.7% of patients demonstrated a whispering or altered voice during the first correct verbal response versus 21.2% of patients in the group with ES. The first followed command was slow or erroneous in 49.3% of the patients with PNES and in 19.7% of the patients with ES. Conclusion In this study, we found significant differences between postictal semiology and behavior of patients with PNES and ES that can be helpful tools in distinguishing between these two conditions. Specifically, three novel postictal behaviors were studied and were found to have a high specificity, but low sensitivity, in distinguishing PNES from ES.

Background: Early neurological deterioration (END) prompting urgent brain imaging occurs in up to 15% of ischemic stroke patients receiving intravenous tissue plasminogen activator (tPA). Most of these are not related to symptomatic intracranial hemorrhage (sICH) but lead to unnecessary interruption of the tPA infusion. We aim to determine predictors of sICH in ischemic stroke patients undergoing emergent brain imaging after tPA. Methods: We queried our prospective stroke database and included all patients who received tPA for ischemic stroke from March 1 st , 2015 until March 1 st , 2017. We then identified patients who underwent emergent brain imaging before the planned 24-hour brain imaging and divided these patients into: sICH+ and sICH- defined by NINDS criteria. We compared baseline clinical factors, pre-admission medications, admission blood pressure, symptoms prompting repeat scan [change in level of consciousness (LOC); worsening or new (W/N) neurological symptoms without change in LOC; headache/nausea/vomiting), thrombectomy, 24-hour NIHSS and 90 day outcome. Results: We identified 511 patients who received tPA (sICH rate 4.1%). Emergent repeat brain CT was performed on 108 (21.1%); 17.5% (19/108) had sICH and 21.3% (23/108) occurred during the tPA infusion with only one being related to sICH. The mean time from tPA infusion to symptoms prompting brain imaging in sICH was 7.3 ± 5.3 hours. In patients who underwent emergent brain imaging, sICH+ patients were older (80.2 ± 15.8 vs. 70.8 ± 15.4, p = 0.026), with higher admission NIHSS (14 vs. 7, p = 0.0016) and 90-day mortality (87.5% vs. 22.4%, p Conclusion: Nearly 95% of patients with ischemic stroke had unnecessary interruption of the tPA infusion for new symptoms shortly after the tPA infusion. A change in LOC was the only predictor of sICH among tPA patients undergoing emergent brain imaging. In this group of patients, the preparation of tPA reversal agents awaiting brain imaging may help reduce tPA reversal times and improve outcomes

ObjectivesEarly neurological deterioration prompting urgent brain imaging occurs in nearly 15% of patients with ischaemic stroke receiving intravenous tissue plasminogen activator (tPA). We aim to determine risk factors associated with symptomatic intracranial haemorrhage (sICH) in patients with ischaemic stroke undergoing emergent brain imaging for early neurological deterioration after receiving tPA.MethodsWe abstracted data from our prospective stroke database and included all patients receiving tPA for ischaemic stroke between 1 March 2015 and 1 March 2017. We then identified patients with neurological deterioration who underwent urgent brain imaging prior to their per-protocol surveillance imaging and divided patients into two groups: those with and without sICH. We compared baseline demographics, clinical variables, in-hospital treatments and functional outcomes at 90 days between the two groups.ResultsWe identified 511 patients who received tPA, of whom 108 (21.1%) had an emergent brain CT. Of these patients, 17.5% (19/108) had sICH; 21.3% (23/108) of emergent scans occurred while tPA was infusing, though only 4.3% of these scans (1/23) revealed sICH. On multivariable analyses, the only predictor of sICH was a change in level of consciousness (OR 6.62, 95% CI 1.64 to 26.70, P=0.008).ConclusionChange in level of consciousness is associated with sICH among patients undergoing emergent brain imaging after receiving tPA. In this group of patients, preparation of tPA reversal agents while awaiting brain imaging may reduce reversal times. Future studies are needed to study the cost-effectiveness of this approach.

Rotary shouldered connections (RSCs) for polycrystalline diamond compact (PDC) drill bits have been unchanged since PDC bits were introduced in the late 1970s. These specifications were carried over from roller cone (RC) bits, which require significantly less torque to fail rock than a PDC bit. Current drilling processes and technologies highlight the need to re-evaluate connection requirements for PDC bits, specifically bits using the 3 1/2 REG connection. The Bakken shale requires extremely long laterals of up to two miles to remain within production zones, which are most economically drilled with a bent housing motor. These long laterals led to significant motor technology improvements for preventing stalls and allowing more weight on bit (WOB), increasing rate of penetration (ROP), and decreasing the number of bottomhole assemblies (BHAs), which reduced drilling costs. These advantages were achieved using a 5-in. motor that has a peak torque output greater than the makeup torque of the 3 1/2 REG connection. Therefore, it is necessary to re-evaluate PDC bit connections. The connection fatigue index (CFI) is used to compare the fatigue life of connections given a set of parameters. It uses the Morrow strain-life equation to predict fatigue life. A unique feature of the equation is that it takes into account both stress and strain in the plastic region, which is crucial because the last engaged thread enters plastic deformation during makeup. The CFI includes Numbered Connections (NC) 35 and NC38 but does not include the 3 1/2 REG connection; therefore, the starting point for evaluation is to perform the calculations for the 3 1/2 REG connection. Fatigue life was evaluated using the CFI for the 3 1/2 REG, 3 1/2 REG with 1-in. stress-relief groove (SRG), NC35, and NC38 connections for a given bending moment. Results from the Morrow strain-life equation predict that the NC35 with a SRG will have the greatest number of cycles to failure of the four connections evaluated. Based on the CFI calculations, the NC35 is predicted to last approximately 800 times longer than the 3 1/2 REG, 40 times longer than the NC38, and 10 times longer than a 3 1/2 REG with 1-in. SRG. The following thread form characteristics account for the exponential increase in life of the NC connections over the 3 1/2 REG: larger pitch diameter, SRG, larger root radius, and reduced taper angle. The NC35 connection was then field tested in a Bakken shale lateral. As well plans are modified for shale drilling and motor technology advances, connection advances are also required. At a minimum, the makeup torque of the connection should be greater than the torsional output of the motor to prevent downhole makeup, mud seal galling, and reduced fatigue life.

Aurora is a large-scale kinetic art installation that reacts to human presence directly, with sensors triggering outputs, and indirectly, by modifying output behaviour rules. This paper describes a novel method for estimating visitors' fields of interest, their attention to specific parts of the installation, with a future goal of using this measure as a fitness function for output behaviour modification based on genetic algorithms. Due to constraints in Aurora, distributed overhead distance sensors were used as the sensory inputs. A low resolution height graph of the space below the installation is created, and the active sensors are clustered into groups. The height graph and sensor groups are used to produce a probability map of possible visitor locations. Based on these, particle filters are created to estimate the visitors' state, and by extension their fields of interest. Using this overall strategy for tracking and interest prediction, an average prediction accuracy of 92% is found when compared to a set of simulated people moving within a simulated space.

Federal law criminalizes a variety of terrorist activities, including the use of violence or certain weaponry such as chemical or biological weapons. Yet, these laws do not provide prosecutors with the necessary tools to prosecute those terrorists who die in the attacks, evade capture. Nor does it empower law enforcement to go after the supporters of those committing acts of terrorism. Moreover, the nature of law and policy in the post 9/11 world implicates fundamental questions about strategy, tactics, criminal justice, and the ontological nature of the war on terror. Due in part to these challenges, Congress criminalized the act of providing material support to a designated foreign terrorist organization. Resulting laws and regulations have led to restrictions and limits on the freedom of speech. Looking to the First Amendment analysis of various campaign finance law challenges provides a comparable framework for addressing freedom of speech concerns in the context of national security. Moreover, borrowing from campaign finance law provides assistance in addressing obstacles faced by prosecutors, defense attorneys, and practitioners seeking to advise clients on their potential criminal liability.

This paper presents a study on human performance in recognizing affective expressions conveyed through movements of hand-like structures. One movement sequence, closing and opening the hand, was performed by a demonstrator in 3 sets of 5 repeated trials, each set intending to convey a different affective expression. Three different expressions, sadness, happiness and anger, were considered. Expressive movement animations were replicated with a human-like hand model, a stick hand model and with a model resembling a palm frond structure. The structures tested have identical kinematics but different physical appearance. The ability of a human to correctly identify the intended expressive movements performed on these different structures was tested with 66 users viewing videos of the animated structures and reporting via an online questionnaire. Results show that anger is reliably perceived by observers from animated movements on different structures, while the other emotions are easily misperceived. The physical appearance of the structure has some impact on perception performance, but was not found to be statistically significant in this study. Furthermore, analyzing the participants' responses in the context of the valence-arousal model of emotion shows that the subjects were able to recognize the arousal component of the affective hand movements across all structures.

Redox flow batteries have the potential to provide low-cost energy storage to enable renewable energy technologies such as wind and solar to overcome their inherent intermittency and to improve the efficiency of electric grids. Conventional flow batteries are complex electromechanical systems designed to simultaneously control flow of redox active fluids and perform electrochemical functions. With the advent of redox active fluids with high capacity density, i.e., Faradaic capacity significantly exceeding the 1–2 M concentration equivalents typical of aqueous redox flow batteries, new flow battery designs become of interest. Here, we design and demonstrate a proof-of-concept prototype for a “gravity-induced flow cell” (GIFcell), representing one of a family of approaches to simpler, more robust, passively driven, lower-cost flow battery architectures. Such designs are particularly appropriate for semi-solid electrodes comprising suspensions of networked conductors and/or electroactive particles, due to their low energy dissipation during flow. Accordingly, we demonstrate the GIFcell using nonaqueous lithium polysulfide solutions containing a nanoscale carbon network in a half-flow-cell configuration and achieve round trip energy efficiency as high as 91%.