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"Demetrios, Heather"
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Something real
Since the cancellation of her family's reality television show, seventeen-year-old Bonnie Baker, one of twelve siblings, has tried to live a normal life with real friends and a possible boyfriend, until her mother and the show's producers decide to bring \"Baker's Dozen\" back on the air.
Book
Making the Past Relevant (by Diversifying Biographies)
After reading my new biography of World War II spy Virginia Hall, Code Name Badass, a seasoned biographer told me, “I’m... pleasantly surprised you got away with it!” The surprise was justified: it’s not often you see a YA nonfiction work that’ll make your grandma clutch her pearls. Despite the increasing presence of female writers, subjects, and narrative approaches to nonfiction, I’m still not seeing many books that marry the deep research required of a quality biography with bingeable prose. According to Slate, as recently as 2015, roughly three out of every four popular history books were written by men, and of the books that were classified as biographies, 72% were written about men.
Trade Publication Article
Blood passage
\"Nalia and her comrades travel to Morocco to search for Solomon's sigil\"-- Provided by publisher.
Book
I'll meet you there
Skylar Evans, seventeen, yearns to escape Creek View by attending art school, but after her mother's job loss puts her dream at risk, a rekindled friendship with Josh, who joined the Marines to get away then lost a leg in Afghanistan, and her job at the Paradise motel lead her to appreciate her home town.
Book
Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study
AbstractObjectiveTo validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack.DesignProspective cohort study.Setting13 Canadian emergency departments over five years.Participants7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke.Main outcome measuresThe primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit.ResultsOf the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days.ConclusionThe Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.
Journal Article
Bad romance
\"When Grace and Gavin fall in love, Grace is sure it's too good to be true. She has no idea their relationship will become a prison she's unable to escape\"-- Provided by publisher.
Book
Resumption of Cardiac Activity after Withdrawal of Life-Sustaining Measures
After planned withdrawal of life support and determination of death by cardiac criteria, 14% of 480 patients had one or more cycles of a return of blood pressure of more than 5 mm Hg detected by arterial catheter monitoring after a period of pulselessness, all occurring within 5 minutes.
Journal Article
The value of MRI in transient ischemic attack/minor stroke following a negative CT for predicting subsequent stroke
Background
Diffusion weighted magnetic resonance imaging’s (MRI) role in predicting subsequent strokes beyond the validated Canadian TIA Score in in transient ischemic attack (TIA)/minor stroke patients with normal CT scans is unknown. In this study, we assessed the incidence of acute cerebral infarction on MRI in these patients, overall and stratified by the Canadian TIA Score levels and then we assessed subsequent stroke rates at 7, 30 and 90 days based on the presence of acute infarct on MRI.
Methods
This pre-planned substudy of the Canadian TIA risk score cohort was conducted across 13 Canadian emergency departments over an 11-year period. Eligible patients included adult TIA/minor stroke patients with negative CT scans who underwent MRI within 7 days.
Results
Among 11,507 patients, 1048 with negative CT scans had early MRI, which revealed infarction in 330 (31.5%) patients. Acute infarction rates varied by Canadian TIA Score risk group: 130 (15.4%) in low-risk, 754 (30.4%) in medium-risk, and 162 (50.0%) in the high-risk group. At 90 days, the rates of stroke in patients with a positive MRI were 2 (10.0%), 168 (22.3%), and 40 (24.7%) in low-risk, medium-risk, and high-risk groups, respectively. In comparison, in patients with a negative MRI the rate was 1 (0.9%), 7 (1.3%), and 4 (4.9%).
Conclusions
Combining the Canadian TIA Risk Score with follow-up MRI improves stroke risk assessment. MRI enhance the accuracy of diagnosis TIA, especially when CT is negative. The risk score helps prioritize MRI, benefiting medium-risk patients most, while high-risk patients need prompt management regardless of MRI results. Low-risk patients benefit from MRI for determining further investigations.
Journal Article
Derivation of a clinical prediction score for the diagnosis of clinically significant symptomatic carotid artery disease
Objectives
Emergent vascular imaging identifies a subset of patients requiring immediate specialized care (i.e. carotid stenosis > 50%, dissection or free-floating thrombus). However, most TIA patients do not have these findings, so it is inefficient to image all TIA patients in crowded emergency departments (ED). Our objectives were to derive and internally validate a clinical prediction score for clinically significant carotid artery disease in TIA patients.
Methods
This was a planned secondary analysis of a prospective cohort study from 14 Canadian EDs. Among 11555 consecutive adult ED patients with TIA/minor stroke symptoms over 12 years, 9882 had vascular imaging and were included in the analysis. Our main outcome was clinically significant carotid artery disease, defined as extracranial internal carotid stenosis ≥ 50%, dissection, or thrombus in the internal carotid artery, with contralateral symptoms.
Results
Of 9882 patients, 888 (9.0%) had clinically significant carotid artery disease. Logistic regression was used to derive a 13-variable reduced model. We simplified the model into a score (Symcard [Symptomatic carotid artery disease] Score), with suggested cut-points for high, medium, and low-risk stratification. A substantial portion (38%) of patients were classified as low-risk, 33.8% as medium risk, and 28.2% as high risk. At the low-risk cut-point, sensitivity was 92.9%, specificity 41.1%, and diagnostic yield 1.7%.
Conclusions
This simple score can predict carotid artery disease in TIA patients using readily available information. It identifies low-risk patients who can defer vascular imaging to an outpatient or specialty clinic setting. Medium-risk patients may undergo imaging immediately or with slight delay, depending on local resources. High-risk patients should undergo urgent vascular imaging.
Journal Article