Citations

Background— Stroke, mainly attributable to atherothrombotic disease, represents a leading cause of disability and death in the Western world. Endothelial dysfunction, which is considered a key factor in atherogenesis, is associated with an increased risk of cardiovascular events. However, the magnitude of the association between coronary endothelial dysfunction (CED) and cerebrovascular events is unknown. This study was performed to investigate the association between CED and cerebrovascular events. Methods and Results— We studied 503 patients without obstructive coronary artery disease (CAD) who underwent coronary endothelial function testing by intracoronary acetylcholine infusion. Patients were divided according to the presence (n=305) or absence (n=198) of CED, and medical records were examined for the occurrence of ischemic or hemorrhagic stroke or transient ischemic attack either before (prevalent) or after (incident) coronary endothelial function testing. Among the study population, a total of 25 cerebrovascular events were documented, 22 in patients with CED (15 prevalent) and 3 in patients without (all prevalent) ( P =0.008). Multivariable logistic regression, which included traditional cerebrovascular disease–related risk factors, identified the presence of CED as the single strongest factor associated with cerebrovascular events (OR, 4.32; 95% CI, 1.26 to 14.83). Kaplan-Meier analysis indicated that patients with CED had a significantly higher cumulative cerebrovascular event rate than those without ( P =0.04). Conclusions— Presence of CED in patients without obstructive CAD is independently associated with an increased risk of cerebrovascular events. Thus, detection of this early stage of atherosclerosis may provide important information to identify patients who benefit from aggressive preventive strategies.

The inverse problems in the area of the acoustic scattering often concern the determination of the size, shape, and orientation of an object using the scattered field data. This paper presents a method to retrieve the shape information of an underwater object using illuminated lengths, which can be obtained from the ramp response signatures of the object. An ellipsoidal object submerged in water is considered. Both the low and high backscattered frequency data have been employed to calculate the illuminated lengths. The calculated results show that the illuminated lengths will be more accurate, if only the high-frequency-range data are employed. For ellipsoidal objects, any three illuminated lengths that are not of a same plane can in theory fully determine the shape of the ellipsoid. As the calculated illuminated lengths contain numerical errors, the calculated results of the three semiaxes of the ellipsoid will deteriorate and become unreliable, especially when the three incident directions of the illuminated lengths become close. The reason is that the condition number of the coefficient matrix becomes big in such situations, which leads to an increase of the relative error upper limit in the calculated results. To avoid such errors in close incident wave cases, it is found that the use of more than three incident waves works very well in the shape identification of an underwater object.

In the wake of the September 11, 2001, attacks and the subsequent anthrax scare, there is growing concern about the United States' vulnerability to terrorist use of Weapons of Mass Destruction (WMD). As part of ongoing preparation for this terrible reality, many jurisdictions have been conducting simulated terrorist incidents to provide training for the public safety community, hospitals, and public health departments. As an example of this national effort to improve domestic preparedness for such events, a large scale, multi-jurisdictional chemical weapons drill was conducted in Cincinnati, Ohio, on May 20, 2000. This drill depicted the components of the early warning system for hospitals and public health departments, the prehospital medical response to terrorism. Over the course of the exercise, emergency medical services personnel decontaminated, triaged, treated, and transported eighty-five patients. Several important lessons were learned that day that have widespread applicability to health care delivery systems nationwide, especially in the areas of decontamination, triage, on-scene medical care, and victim transportation. As this training exercise helped Cincinnati to prepare for dealing with future large scale WMD incidents, such drills are invaluable preparation for all communities in a world increasingly at risk from terrorist attacks.