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BackgroundWe describe the first-in-human experience using the Route 92 Medical Aspiration System to perform thrombectomy in the initial 45 consecutive stroke patients enrolled in the SUMMIT NZ trial. This aspiration system includes a specifically designed delivery catheter which enables delivery of 0.070 inch and 0.088 inch aspiration catheters.MethodsThe SUMMIT NZ trial is a prospective, multicenter, single-arm study with core lab imaging adjudication. Patients presenting with acute ischemic stroke from large vessel occlusion are eligible to enrol. The study has had three phases which transitioned from use of the 0.070 inch to the 0.088 inch catheter.ResultsVessel occlusions were located in the internal carotid artery (27%), M1 (60%) and M2 (13%). Median baseline National Institutes of Health Stroke Scale (NIHSS) was 16 (IQR 10). Across the three phases, the first-pass reperfusion rate of modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b was 62% using the Route 92 Medical system; this rate was 29% in phase 1, 56% in phase 2, and 80% in phase 3. The first-pass reperfusion rate of mTICI ≥2c was 42% overall, 29% in phase 1, 33% in phase 2, and 55% in phase 3. A final reperfusion rate of mTICI ≥2b was achieved in 96% of cases, with 36% of cases using adjunctive devices. Patients had an average improvement of 6.7 points in NIHSS from baseline at 24 hours, and at 90 days 48% were functionally independent (modified Rankin Scale 0–2).ConclusionsIn this early experience, the Route 92 Medical Aspiration System has been effective and safe. The system has design features that improve catheter deliverability and have the potential to increase first-pass reperfusion rates in aspiration thrombectomy.

Purpose To describe interventionalist and workflow characteristics of an acute stroke endovascular thrombectomy (EVT) center without a dedicated interventional neuroradiology service and report clinical and radiologic outcomes. Materials and Methods Retrospective review was performed of all patients receiving EVT at Christchurch Hospital, New Zealand, from June 2014 to the end of December 2019 from a prospective reperfusion registry. During the study period, 5 peripheral vascular interventional radiologists, 2 of whom had experience in other neuroendovascular procedures, performed 210 EVT procedures. Median age of patients was 76 years (interquartile range: 64–83 y), and 107 (51%) were men. Results The most commonly occluded vessel was the M1 middle cerebral artery (n = 114; 54%). Successful reperfusion (Modified Treatment In Cerebral Ischemia score 2b–3) was achieved in 180 (86%) procedures. Favorable 90-day outcome (modified Rankin Scale score 0–2) was achieved in 102 (54%) patients with no disability before stroke. Symptomatic intracranial hemorrhage occurred in 3 (1.4%) patients. Treatment rates in the local catchment area increased from 6 per 100,000 population in 2017 to 15 per 100,000 in 2019. Conclusions The results of this study suggest peripheral vascular interventional radiologists with specific training can successfully perform EVT resulting in a significant increase in EVT provision.

Objective Pseudoaneurysm formation post type A aortic dissection repair is rare. Revision surgical repair is challenging, with a risk of death from haemorrhage. Methods We present a 56-year-old man who presented with a rapidly enlarging distal ascending aortic anastomotic pseudoaneurysm following a recent ascending and hemiarch replacement for acute type A aortic dissection. Results A tight kink in the ascending aortic graft precluded an endovascular repair utilizing two antegrade branches, and so a novel custom-made 3 inner branched aortic endograft was designed, with an antegrade brachiocephalic inner branch and retrograde left common carotid and subclavian artery inner branches. The patient required an angioplasty to dilate the kinked/coarcted surgical graft, but made an uneventful recovery. Conclusion An aortic arch inner branch design with an antegrade brachiocephalic branch but retrograde left common carotid and left subclavian branches was feasible and may prove particularly useful when there is limited space in the ascending aorta.

Background: The treatment approach of aspiration rather than use of a stent retriever as first-line therapy is increasingly regarded as standard of care for acute ischemic stroke. Continued technological advances include the ongoing development of aspiration embolectomy catheters that are larger in bore, guided by delivery catheters that are more maneuverable through the tortuous neurovasculature. Methods: SUMMIT NZ (ACTRN12619000890134p) was designed as a prospective, single-arm, open label clinical trial at two sites in New Zealand. Eligible participants were patients presenting with acute ischemic stroke from either anterior or posterior circulation large-vessel occlusion within 24 hours of onset, a National Institutes of Health Stroke Scale Score ≥ 6 and a pre-stroke modified Rankin Score of ≤ 2. A novel tapered tip delivery catheter was specifically designed to deliver 0.070” and 0.088” aspiration catheters telescoped through a specialized 8F 90 cm introducer sheath (Route 92 Medical, Inc. San Mateo, CA). The primary effectiveness endpoint was arterial revascularization as measured by a modified Thrombosis in Cerebrovascular Infarction (mTICI) score of 2b or greater at the end of angiography after all endovascular treatments as adjudicated by an independent core laboratory. The primary safety endpoints were device-related peri-procedural complications such as dissection or perforation, symptomatic Intracranial Cerebral Hemorrhage (SICH) at 24 hours and embolization to a previously uninvolved territory. Results: From September 27, 2019 to June 23, 2020, 18 subjects (mean age 69.5, NIHSSS 15.2, time last known well 6.2 hours) were enrolled with a diagnosis of acute ischemic stroke. Acute occlusion was located in the middle cerebral artery (78%, 14/18) and internal carotid artery (22%, 4/18). Successful revascularization was achieved in 94% (17/18) of subjects. No serious adverse device effects have been reported. Conclusions: Preliminary findings suggest that aspiration first mechanical embolectomy using a novel telescoping system including an 0.088” inner diameter aspiration catheter achieves a high rate of arterial revascularization with an acceptable safety profile. A full report on enrollment and results are to be presented.

The Neutrino Experiment with a Xenon TPC (NEXT) searches for the neutrinoless double beta decay of Xe-136 using a high pressure xenon gas time projection chamber. This detector technology has several key advantages, including excellent energy resolution, powerful event classification based on track topology, and favorable mass scalability. It also offers the tantalising possibility of tagging the daughter ion produced in the decay. The current stage of the experiment, NEXT-White, has been been taking data at the Laboratorio Subterraneo de Canfranc (LSC) in Spain since late 2016. In this talk, we will review recent results from NEXT-White after the first year of low-background operations using both xenon depleted in the Xe-136 isotope as a direct measure of background, and enriched xenon data to measure the two neutrino mode. Results form dedicated calibration runs to study detector performance will also be shown. Finally, we will conclude by discussing the experiment’s prospects, starting from the NEXT-100 detector to be commissioned in 2020.

This Guide explores emerging issues on the alignment of learning spaces with the changing curriculum in medical education. As technology and new teaching methods have altered the nature of learning in medical education, it is necessary to re-think how physical learning spaces are aligned with the curriculum. The better alignment of learning spaces with the curriculum depends on more directly engaged leadership from faculty and the community of medical education for briefing the requirements for the design of all kinds of learning spaces. However, there is a lack of precedent and well-established processes as to how new kinds of learning spaces should be programmed. Such programmes are essential aspects of optimizing the intended experience of the curriculum. Faculty and the learning community need better tools and instruments to support their leadership role in briefing and programming. A Guide to critical concepts for exploring the alignment of curriculum and learning spaces is provided. The idea of a networked learning landscape is introduced as a way of assessing and evaluating the alignment of physical spaces to the emerging curriculum. The concept is used to explore how technology has widened the range of spaces and places in which learning happens as well as enabling new styles of learning. The networked learning landscaped is explored through four different scales within which learning is accommodated: the classroom, the building, the campus, and the city. High-level guidance on the process of briefing for the networked learning landscape is provided, to take into account the wider scale of learning spaces and the impact of technology. Key to a successful measurement process is argued to be the involvement of relevant academic stakeholders who can identify the strategic direction and purpose for the design of the learning environments in relation to the emerging demands of the curriculum.

Purpose: To report the use of the off-the-shelf Zenith t-Branch Thoracoabdominal Endovascular Graft for the treatment of a symptomatic acute type Ia endoleak subsequent to previous infrarenal bifurcated endovascular aneurysm repair. Case Report: A 72-year-old man presented 4 years after implantation of an Anaconda stent-graft with sac expansion and type II endoleak, which was treated over the next 18 months with repeated coil and glue embolization of the leak and sac. Six months after the last attempt, imaging disclosed a new type Ia endoleak. Sac enlargement became symptomatic, and emergent treatment was performed using the off-the-shelf Zenith b-Branch device. The 4 visceral arteries were bridged with Fluency stent-grafts. The Anaconda stent-graft precluded the use of a standard Zenith universal distal body bifurcated device below the t-Branch graft, so a reversed tapered 16×20×82-mm iliac limb was placed to bridge the t-Branch to the larger Anaconda limb; the smaller 12-mm contralateral Anaconda limb was occluded. The procedure was concluded with a femorofemoral bypass. At 10 months after the procedure, the patient is well; the sac diameter has decreased, and there is no endoleak on imaging. Conclusion: The multibranched Zenith t-branch device may be useful in treating proximal endoleaks in bifurcated stent-grafts.

Summary Giant cerebral aneurysms are associated with a poor prognosis, with 2-year survival rates reported as low as 20% (Sundt et al.; Syman et al.). Morbidity is largely associated with haemorrhage, local compressive effects and thrombosis. While endovascular coiling has been acknowledged as a safe treatment in small to medium size aneurysms (Molyneux et al.; Pierot, Spelle & Vitry), the safety of this technique is more questionable in giant aneurysms due to the unknown stability of the coiling mesh and the need for retreatment. Parent vessel remodelling with the use of flow diverters is an evolving technique with promising results (Pierot et al.). However, navigation of microcatheters within the parent artery across giant aneurysms may be challenging due to tortuous anatomy. To improve microcatheter trackability and stability across a giant aneurysm neck, we describe a novel microsnare-assisted support technique.

The syndrome of spontaneous intracranial hypotension is often difficult to treat. Unfortunately, cerebrospinal fluid leaks are often numerous and difficult to detect radiologically. Multiple entries to the spinal epidural space, in an effort to alleviate symptoms, are therefore sometimes necessary. This case report details two patients treated successfully with a single lumbar entry point and the administration of a continuous multi-site epidural blood patch via a mobile catheter and their subsequent follow-up. These procedures are based on that first published by Ohtonari et al. in 2012. It is, to our knowledge, the first undertaken in Australasia.

Introduction Spinal cord ischaemia (SCI) is a rare complication of infrarenal aortic aneurysm repair. Report We present a case of a 68-year-old man with an infrarenal aortic aneurysm treated by fenestrated endovascular aneurysm repair (FEVAR). He developed paraplegia alleviated by cerebrospinal fluid (CSF) drainage and resolved by revascularization of the inadvertently occluded internal iliac artery (IIA). Discussion The incidence and aetiology of SCI following aortic repair are discussed with an emphasis on collateral flow. SCI is rare in FEVAR and does not require routine CSF monitoring but awareness. Prompt restoration of adequate spinal perfusion is curative.

The concept of the learning landscape is used to explore the range of learning environments needed at multiple scales to better align with changes in the medical education curriculum. Four key scales that correspond to important types of learning spaces are identified: the classroom, the building, the campus and the city. "In-between" spaces are identified as growing in importance given changing patterns of learning and the use of information technology. Technology is altering how learning takes place in a wider variety of types of spaces as it is interwoven into every aspect of learning. An approach to planning learning environments which recognizes the need to think of networks of learning spaces connected across multiple scales is proposed. The focus is shifted from singular spaces to networks of inter-connected virtual and digital environments. A schematic model comprising the networked learning landscape, intended as a guide to planning that emphasizes relationships between the changing curriculum and its alignment with learning environments at multiple scales is proposed in this work. The need for higher levels of engagement of faculty, administrators and students in defining the briefs for the design of new kinds of medical education environments is highlighted.

Giant cerebral aneurysms are associated with a poor prognosis, with 2-year survival rates reported as low as 20% (Sundt et al.; Syman et al.). Morbidity is largely associated with haemorrhage, local compressive effects and thrombosis. While endovascular coiling has been acknowledged as a safe treatment in small to medium size aneurysms (Molyneux et al.; Pierot, SpelleVitry), the safety of this technique is more questionable in giant aneurysms due to the unknown stability of the coiling mesh and the need for retreatment. Parent vessel remodelling with the use of flow diverters is an evolving technique with promising results (Pierot et al.). However, navigation of microcatheters within the parent artery across giant aneurysms may be challenging due to tortuous anatomy. To improve microcatheter trackability and stability across a giant aneurysm neck, we describe a novel microsnare-assisted support technique.

Would anyone dream of trying to run the latest app on an IBM computer from 1980? Most probably not. The reason is quite simple: software development is so much more advanced today than 35 years ago...

The complexity of modern policing requires an accountable police service to operate in a diverse society, where support/trust must be earned by action and deed. The article examines the potential of market orientated strategies in facilitating policing initiatives, such as community policing and enhanced service quality. The work reviews the concept of market orientation and adopts a case study approach to research. Market orientated/customer focused strategies are examined in a range of public, private and international sectors. Findings outline a three‐stage “turnaround” process to enhance service quality and highlight the importance of market orientation in counteracting the concept of “unwilling/reluctant customers”. Draws on case studies from Inland Revenue, Richer Sounds plc and the New York Police Department.

There is a significant re-stenosis rate with percutaneous treatment of stenoses of the infrarenal abdominal aorta with balloon angioplasty. Since 1990 the authors have primarily treated local infrarenal aortic stenoses with metallic endoluminal stents. The authors’ experience with 12 consecutive patients (nine women and three men, aged from 30 to 72 years (mean age = 57 years)) is presented. Follow-up is available in 11 cases over 7–78 months (mean 32 months). The procedure was technically successful in all patients. Of the 11 patients with follow-up available, claudication was cured (n = 7) or significantly improved (n = 4). Those with persisting claudication had concurrent distal arterial dis-ease. Periprocedural complications occurred in five cases, with two significant complications. One case required iliac angioplasty for embolized aortic atherosclerotic plaque, and one case required surgical thrombectomy and vein patch for iliac thrombosis complicating iliac dissection, without long-term sequelae in either case. One patient has had recurrent symptomatic aortic stenosis occurring 6 years after initial stenting, which responded to further stent insertion. Primary patency of 91% and secondary assisted patency of 100% has been achieved. Primary treatment of infrarenal aortic stenosis with endoluminal stenting results in high patency rates, with low morbidity and relatively low complication rates.

This review of Nate Silver’s The Signal and the Noise discusses how Silver’s celebrity statistician status has been achieved and is well-earned. He touches on how the book reinforces, in an understandable fashion, that a conceptual understanding of Big Data is a crucial element of successful professional communication practice. This positive review identifies the strengths of Silver’s book – namely its solid organization and its use of real-world examples. The Signal and the Noise is recommended for professional communicators who want to gain an understanding of data and the many uncertainties inherent to its analysis. ©Journal of Professional Communication, all rights reserved.

Learning and working are increasingly inseparable social processes characterized by a mix of routine and non-routine activities, which are meant to sustain an optimal balance of creative risk taking, idea exploration and development of professional mastery. Learning and working are embedded in broader social institutions such as universities, academic medical centers, professional organizations and business firms. The future of learning and working is witnessing a blurring of these institutional boundaries, and consequently, a spanning of disciplines and professions that have traditionally assimilated and oriented people around knowledge domains. Learning and working practices are increasingly less defined by bureaucratic controls and are, instead, more collaborative, fluid and interdisciplinary. One of the most tangible manifestations of this shift is in the spaces and places where learning and working activities happen and where people interact and organize. This article explores these learning and working paradigm shifts by discussing recent developments in the corporate workplace and exploring how such changes inform the future of interprofessional education.

Within the framework of occupational prestige assessment, a study was carried out to determine the standing of physiotherapy relative to a range of professions, including a number from the medical field. The results indicate that physiotherapy possesses an intermediate status, and one that can be broadly equated with that of osteopathy: in fact, the two professions are virtually indistinguishable on most of the dimensions employed in the study. The results also reveal the position of physiotherapy relative to the nursing profession, and to that of medical practitioners. A feature of the study was the comparative analysis of undergraduate physiotherapy students' perceptions of the various professions. While they attribute a higher standing to their own profession than the public group (design students) involved in the study, their perceptions of the nursing and osteopathy professions are, at times, unexpected. Finally, multidimensional scalogram analysis (MSA) was used to provide typologies of the professi...

The paper examines the communications that occurred between the news media, the general public and the government during the 2009 outbreak of the H1N1 influenza virus from a crisis communications perspective, focusing on events in Ontario, Canada. In crisis communications theory and practice, the analysis borrows from second-level agenda-setting literature, which suggests that an issue’s attributes can affect the perceived level of salience among both the media and the public. The analysis combined a review of government crisis communications planning, a content analysis of radio, television and print news coverage of H1N1, and opinion polling and other data indicating the public’s level of awareness and concern over H1N1. ©Journal of Professional Communication, all rights reserved.

Introduction: Type II endoleaks occur in up to a fifth of endoluminal repairs for abdominal aortic aneurysms and are commonly treated when aortic sac expansion can be demonstrated. Technical failure is common when catheter-guided particulates or coil embolic agents are used. Presented here is a feasibility study using catheter-directed N-butyl-2-cyanoacrylate (Histoacryl, Braun, Tuttlingen, Germany) embolotherapy. Method: A retrospective review of the case notes of patients undergoing embolization procedures for type II endoleaks with expanding sacs was performed from this centre's cohort of endoluminal aortic repair patients under surveillance. Data on patients with type II endoleaks who were treated with either or both cyanoacrylate and coil embolization were extracted. The outcomes were then compared. Results: In total, five cases were identified, and four of these cases had both coil and glue embolization. Technical success was defined as endoleak closure proven on follow-up computed tomographic imaging. Technical success was achieved in all four patients treated with intra-sac cyanoacrylate. One case treated initially with coil embolization was successful. All patients had a computed tomographic scan at 3 months. One minor complication occurred that resolved without treatment. Discussion: Type II endoleaks after EVAR with expanding sacs require treatment. Percutaneous catheter-directed cyanoacrylate embolization offers an alternative to coil or particulate embolization and, in this series, was found to be more likely to result in endoleak closure.

Questions the essential nature of the office building itself in a study, The Responsible Workplace, which criticizes the stereotype found in North America and Northern Europe. Identifies two realities which drive the demand for improvement: more powerful IT and more discriminating users. Lists the changing factors which will influence the design and use of the office buildings of the future: businesses, user expectations, technologies, IT and intelligent buildings, building performance, environmental issues, locations, patterns of office work, and regulatory perspectives. Finally, identifies ten initiatives for innovation which will virtually remake the working environment and invent the cities of the 2000s.

The office as a workplace has reached a critical point in its evolution. The requirement of the conventional office would appear to be holding back the near applications of IT and organisational creativity, which aim to promote a much freer and more dynamic relationship between space and time for the office workplace. Henry Ford′s mass production of the 1920s laid the foundations of the modern office as we know it, but “post‐Fordism” is challenging the rigid patterns then ordained, especially the traditional notions of work time and space. To this end not only must the office be redesigned but also the nature of work itself must be redefined.

Objectives: Plasma neopterin is a clinical marker of inflammation. Interferon-γ triggers 7,8-dihydroneopterin and its oxidation product, neopterin, to be released from macrophages. 7,8-dihydroneopterin is a potent antioxidant which can protect macrophages from oxidative damage in vitro. This study examined whether 7,8-dihydroneopterin/neopterin levels reach sufficient concentrations in human pus to provide antioxidant activity and be the source of plasma neopterin. Design and methods: Pus was removed by needle aspiration from 19 patients and examined for total neopterin, protein-bound DOPA, dityrosine, α-tocopherol, lipid oxidation and protein carbonyls. Results: Total neopterin was detected between 50 nM and 1.2 μM, with an average concentration of 0.51 μM. Significant quantities of oxidized proteins and lipids were detected. α-Tocopherol concentrations positively correlate with total neopterin levels. Conclusions: Total neopterin levels found in the pus was up to 100 times higher than that reported in plasma, suggesting plasma neopterin originates from inflammatory sites. The concentration of total neopterin suggests that 7,8-dihydroneopterin could act as an antioxidant during inflammation.

Asks what happens to company headquarters when an organisation decides to downsize its operations. Examines new organisational imperatives and the reasons for restructuring and streamlining. Presents the ways that headquarters buildings have responded to the changing business environment. Offers some examples of shrinking headquarters in the United Kingdom. Suggests that it has been possible for some companies to develop, use and manage shrinking headquarters creatively.

Suggests that the trend towards desk sharing is the result of the need to think of the office as a full‐time productive resource. Presents space occupancy survey and several concepts of space sharing. Examines cases where innovative desk sharing solutions have actually been implemented. Considers the contradictory implications of desk sharing and the future of the office in terms of new locations, new technology, new forms of organisation, increasing support space, raising productivity, and finally new forms of facilities management.

Posterior fossa dural arteriovenous fistulae (DAVF) are uncommon lesions. In the past, treatment of these lesions has involved both surgical and endovascular techniques, the latter being favoured in contemporary neurovascular medicine. We describe our experience in the case of a 71-year-old woman with a posterior fossa DAVF who presented with sudden onset headache, collapse and neurological deficit secondary to a subarachnoid haemorrhage. She was treated by means of direct surgical access of the lesion combined with endovascular occlusion resulting in a radiological and clinical cure.

The workplace is changing radically, yet the building designs and environmental systems for conventional offices fail to support the more fluid use of space and time practised by these new kinds of office work. Prepared by the team who wrote The Responsible Workplace in 1992, this book is based on a major research project undertaken by DEGW and the BRE. It identifies the key organizational changes, patterns of work, work settings and types of space layouts and it will help specifiers and users of environmental systems understand what products will be suitable for innovative ways of office working.

This paper advocates for increased news media analysis within the disability studies field. Using a media research project about Canadian news media coverage of disability, this paper explores the shifting nature of recent disability coverage within Canadian newspapers between 2009 and 2010. As a group of researchers in Canada and the USA, who have undertaken numerous content analyses of news media representations of disability, we argue that a paradigm shift is taking place in which some traditional news media representations of people with disabilities are now being framed through a disability rights lens. This paper’s analysis is based on data collected by the Toronto-based Disability Rights Promotion International (DRPI). The project investigates Canadian news coverage of disability issues through Joseph Gusfield’s theory of societal “ownership” of a public problem, which in this case means discrimination against and societal barriers for people with disabilities become identified problems that need to be solved within Canadian society.

The rates of respiration and ammonium excretion of the carnivorous copepod Euchaeta norvegica Boeck decreased by 40 and 70%, respectively, during the first ≈10 h after capture. ETS (electron transport system) activity decreased in parallel with the rate of respiration. Increasing O/N and decreasing N/P atomic ratios during incubation indicated a change from protein to lipid metabolism, suggesting that starvation was the major factor responsible for the depression of the metabolic rates after capture. The adenylate energy charge (EC) ratio was significantly lower during the initial 13 h after capture than subsequently, caused mainly by an elevated AMP level. The total content of adenine nucleotides increased during this period of lowered EC. Starvation could also have been responsible for these changes in the adenine nucleotide levels through degradation of RNA. Our earlier interpretation that the lowered EC values after capture reflected capture stress has not been confirmed. The lactate level of E. norvegica just after capture was low (≈0.1 μ g·mg dry wt −1 ) and thus not indicative of any oxygen debt.