429 research outputs found
Anders lees, sien, praat en glo � �n antwoord op ander se lees van �Om die Bybel anders te lees: �n Etiek van Bybellees�
No full textTo read, see, talk and believe differently � a response to other readers� reading of �Om die Bybel anders te lees: �n Etiek van Bybellees� As any exegesis is necessarily preceded by certain theological convictions, the author of the book Om die Bybel anders te lees: �n Etiek van Bybellees (2007) responds to criticism on the book flowing from a seminar � especially the remarks made by Hans van Deventer and Jurie le Roux. Firstly, the ideas on a changed view of the deity are discussed. This conversation is augmented by a discussion of the criticism levelled at the idea that reading the Bible has consequences for other people, and that a different reading would lead to a different concept of God. Van Deventer�s comments regarding the difficulty of debating theological issues are strengthened by a critical discussion of a debate in Die Kerkblad regarding the grammatical-historical method. His critical remarks regarding the value of a historical consciousness are discussed by way of a question on the relationship between a liberal theology and a conservative political point of view. Le Roux�s struggle with Snyman�s utilisation of apartheid as a rhetorical strategy leads the discussion to a recent example of overcoming racism while using unreflectingly racist imagery. This example indicates how theology effects cosmetic changes, without taking on the real issue. For this reason, the author concludes that a critical reading of the own Western tradition in Africa has become necessary.�--- Abstract translated into Sipedi ---Go bala, go bona, go bolela le go dumela ka go fapana - go arabela go balwa ga 'Om die Bybel anders te lees: �n Etiek van Bybellees' ke babadi ba bangweBjale ka ge go fetleka Bibele go etwa pele ke ditumelo t�a go tiba t�a teologi, mongwadi wa Om die Bybel anders te lees: �n Etiek van Bybellees (2007) o arabela ditsholo t�a puku ye t�eo di tswet�wego ke seminare ye e fetilego - kudu ditshwayotshwayo t�a Hans van Deventer le Jurie le Roux. Sa pele, go ahlaahlwa dikgopolo t�e fetogilego ka Modimo. Poledi�ano ye e tlat�wa ke go ahlaahla tsholo ye e lebanywago le gore go bala Bibele go na le khuet�o ye itsego go batho ba bangwe, le gore go bala ka tsela ya go fapana go tlo tli�a kgopolo ya go fo�agala ka Modimo. Ditshwayotshwayo t�a Van Deventer mabapi le bothata bja go ngangi�ana ka ditaba t�a teologi di loi�wa ke go ahlaahla ka tsholo ka go Die Kerkblad poledi�ano mabapi le mokgwa wa go hlatholla Bibele ka go sekaseka popopolelo(gramatika) le histori ya tlholego ya yona. Ditshwayotshwayo t�a gagwe mabapi le mohola wa boitemogo bja go tli�wa ke histori di ahlaahlwa ka tsela ya pot�i�o tswalanong ya teologi ya tokologo le kgopolo ya sepoloiki ya go gana diphetogo. Bothata bja Le Roux mabapi le kgopolo ya Snyman ya go re kgethollo go ya ka merafe e �omi�wa e le tsela ya go t�hela phori mahlong e i�a poledi�ano ye go mohlala wo e sego wa kgale wa go fenya semorafe ka go �omi�a seswant�hokgopolo sa semorafe sa pepeneng. Mohlala wo o laet�a ka fao teologi e amago diphetogo t�a ka mehla maphelong a batho ntle le go lebanya ditaba t�a paale thwii. Ka lona lebaka leo, mongwadi o ruma ka go re go bala set�o sa batho ba Bodikela mo Afrika ka tshekatsheko le phetleko ya go tiba go tloga go nyakega.--- End of translation ---</p
Heteropsis mimetica Lees and Kremen, sp. nov.
No full textHeteropsis mimetica Lees and Kremen, sp. nov. LSID: urn:lsid:zoobank.org:act: 365 D 604 C-EAE 3-46 D 4 -AAD 7 -B 715062 FE056 Prior references: “sp. 72 ” (Lees 1997: 56, Fig. 7 G, 7 H). Type material., Deposition BMNH: Holotype: ♂ (Fig. 2 A), Madagascar NE, Anjanaharibe Sud, 14.7502 o S, 49.4998 o E +/- 0.8 km, 95 +/- 5 m, 27 / 11 /1995, 8:00– 16:00, C. Kremen: CK 513, DNA [DNA voucher], BMNH (E) 2008 - 69 [accession number], BMNH (E) 1717105 [QTR barcode]. Paratypes: Deposition BMNH (accession BMNH (E) 2008 - 69): ♂, data as HT but: CK 510, DL 9676 [DNA voucher], BMAD 261 - 15 [DNA barcode voucher], BMNH (E) 1717106 [QTR barcode]; ♂, data as HT but CK 528, BMNH (E) 1717107 [QTR barcode]; ♂, data as HT but CK 511, DNA [DNA voucher], BMNH (E) 1717108 [QTR barcode]; ♂, data as HT but CK 529, DCLW-0136 [wing prep.], 278 DL [genitalia voucher], BMNH (E) 1717109 [QTR barcode]; ♂, data as HT but CK 559, DNA [DNA voucher; whole thorax used], BMNH (E) 1717110 [QTR barcode]; ♂, data as HT but CK 512 b, DL 9678 [DNA voucher, whole thorax and abdomen used], BMNH (E) 1717111 [QTR barcode]; ♂, data as HT but: CK 512 a, DL 9679 [DNA voucher]; BMNH (E) 1717112 [QTR barcode]; ♀ (Fig. 2 B), data as HT but: CK 517, DNA [DNA voucher], BMNH (E) 1717113 [QTR barcode]; ♀, data as HT but CK 518, DL 9677 [DNA voucher], BMNH (E) 1717114 [QTR barcode]; ♀, data as HT but CK519, 1 egg expressed [egg voucher], BMNH (E) 1717115 [QTR barcode]. Deposition MNHN: ♂, data as HT but 25 / 11 /1995, 11:00– 13: 15, C. Kremen: CK 474, IA 309 [isotope voucher]. Deposition summary: BMNH (HT ♂, 7 PT ♂♂, 3 PT ♀♀), MNHN (PT ♂). Type locality. Madagascar NE, Anjanaharibe Sud, 14.7502 o S, 49.4998 o E +/- 0.8 km, 95 m +/- 50 m. Diagnosis. The combination in Ht. mimetica of the space-M 3 as well as space-CuA 1 ocellus expressed on the HWD and a white-translucent ocellus ring (hereafter ‘Orng’) extended close to the base of space M 3 and CuA 1 in the FWD, forming a rectangle, as in some forms of Ht. turbans, is diagnostic for this species for both known populations. In the closely related allospecies Ht. cowani, the Orng is nearly circular for all known populations. This trait is consistent in all Ht. mimetica. Description. Wings. Upperside uniform mid brown, except light brown in the area around the expressed ocelli of HWD where the ventral white area shows through. On FW, space-MI ocellus expressed as conspicuous white spot. Space-CuA 1 ocellus has narrow whitish-orange ring set in a somewhat rectangular white-translucent area whose lower proximad corner extends close to the base of space-CuA 1, as in Ht. sabas (Oberthür, 1923) (Fig. 2 E), rather than Ht. cowani (Fig. 2 C-D Fianarantsoa material). Only two ocelli are conspicuously expressed in HWD, that of space-M 3 and space-CuA 1, both subelliptic and surrounded by a similarly shaped light orange ring. HW margin has two conspicuous mid brown Smls (submarginal lines) following the somewhat crenate margin, slightly more crenate than typical in Ht. cowani. Ocellus expression on ventral surface similar but additional one in HW space-Rs of similar size to those of space-M 3 and space-CuA 1, and in each case surrounded by a pale orange and a wider light brown ring, the three set in a white-translucent and irregularly ‘X’-shaped area extending from the HW costa to mid space-CuA 2, one outer arm of the ‘X’ petering out distad of ocellus space-M 3. Basal area of HW mid brown, irrorated with areas of whitish scaling, and forming a right angle where the basal pattern meets vein M 2. Two bands of light brown and whitish irroration are found in the basal area of the FW together with a large whitish blotch proximad of white spot in space-M 1 and tapering towards the costa from around 2 / 3 along FW costa. Ht. cowani is almost identical in patterning on either surface except for the proximad extension of the whitish part of the Orng, which is fairly circular in Ht. cowani. Variation. Not much variation is evident between individuals of Ht. mimetica and there only one ♂ was dissected. Sexes similar, but ♀ larger, and may have more extensive white area near FW ventral apex. Wingspan/fwl: range 38–43.5 (n= 5 ♂♂)/ 20.3–24.3 mm (n= 7 ♂♂); mean= 40.5 +/- 2.2 SD (n= 6 ♂♂)/ 22.6 +/- 1.3 SD mm (n= 8 ♂♂), including referred specimen and HT ♂, 43.5 / 23.5 mm. Range 43–47 / 24.2–25.4 mm (n= 3, ♀♀); mean = 44.7 +/- 2.08 SD/ 24.7 +/- 0.62 mm (n= 3 ♀♀). Androconia: simple mid brown discocellular brush extending only slightly beyond the fork of Rs and M 1, underlying patch light ochreous grey and ‘bullet’-shaped (distally truncate to barely beyond the fork), surrounded by glossy dark scales which extend half way to costa and a similar extent in the other direction, as in Ht. cowani. Palps: from LV, light brown stripe in middle, bordered by two white stripes, and dark brown striped fringes of scales to edges, the edge potentially brushing the interommatidial setae consisting of longer scales. ♂ genitalia: 278 DL, PT (Fig. 5 A, LV, DV). Tegumen with fairly straight dorsal profile from LV, where it is relatively quadrate (slight proximad notch from DV). Gnathos narrow with small rounded projection distad at base arising almost perpendicular to base of uncus in its porrect position and curving strongly towards its forwardprojecting and pointed tips (from DV gnathos bends in and out strongly from its stout base). Vinculum strongly arched proximad with moderate constriction with tegumen. Valves with strongly rounded ‘shoulder’ at base, broad throughout with valve arm not much less broad than valve base, fairly parallel sided and spatulate, tips extending further than maximum extension of uncus, with an area of spinoid setae on inner face of tip (not as extensive as in Ht. cowani and Ht. exocellata; Lees, 1997: 104) and with tip incurved from DV. Saccus fairly long (longer than in Ht. cowani and Ht. exocellata) and inflated towards tip, while juxta is quite broad and down-lipped proximad. Aedeagus narrowly cupped beyond ostium and quite recurved away from body, fairly thin and parallel-sided. Etymology. Refers to the seemingly dual mimetic colour pattern (Fig. 2), on the upperside to Ht. sabas (Fig. 2 E), and on the underside to some forms of Ht. antahala (Ward, 1872) (Fig. 2 F); some Strabena species such as S. consobrina Oberthür 1916 and S. nepos Oberthür 1916 exhibit similar HWV patterns (see e.g. d’Abrera, 1997). In these butterflies, there is a similar configuration on the underside of ocelli set in a mainly white area. Unlike in most of the Ht. strigula group, but as in others of the Ht. exocellata group, and in some other more early diverging clades of Heteropsis, the HW space-M 3 ocellus is expressed. Discussion. This species was first recognized in the field by Claire Kremen at Anjanaharibe Sud in November 1995 (Lees 1997: 65). All specimens including the one referred specimen from Makira show the same wing pattern morphology, with no tendency to variation towards all known specimens of Ht. cowani in BMNH and MNHN from Fianarantsoa (Fig. 2 C-D), Ranomafana, Andrambovato or other collected localities of author or others (Vohiparara/ Sahavondronina, Ambondrombe, Anjozorobe). In Ht. cowani, the shape of the space-CuA 1 ocellus is always with a near-concentric orange ocellus ring. All relevant types were examined. The LT ♂ of Pseudonympha cowani Butler, 1880 is here designated as the specimen (Fig. 2 C) bearing labels “ Lectotype | Type /♂ Pseudonympha cowani Butl. |Male Fianarantsoa Madagascar, Coll. & pres. By W. D. Cowan 8-23.|B.M. TYPE No. Rh 3070 Pseudonympha cowani, Butl. ♂/ Pseudonympha Cowani Butler Type ”; the PLT becomes the ♀ with the same locality data that was photographed by B. d’Abrera 77 / 78 (d’Abrera 1980: 183). The two syntypes of Culapa houlbertiana Oberthür, 1923: 127, pl. 569, figs 4909, 4910 from ‘Fianarantsoa’, were also examined; the ♂ specimen, that is here designated the lectotype (Fig. 2 D), bears the data “ Lectotype | Madagascar Fianarantsoa ex Lamberton, 1922 |A servi de modele a J. Culot, pour le No. 4909 de la Pl. DLXIX Vol. XXI. Etudes de Lepidopterologie comparee|Ex Oberthür Coll. Brit. Mus. 1927 - 3.”. Automatically PLTs become two ♀♀ bearing labels “ Madagascar Fianarantsoa ex Lamberton, 1922 |Ex Oberthür Coll. Brit. Mus. 1927 - 3.”. The nominal species C. houlbertiana is clearly synonymous with Ht. cowani (Lees, 1997: 60–61; Lees et al., 2003: note 31). Additional information. DNA divergences: COI- 5 P cluster number BOLD:ACW 4993 (BMAD 261 - 15, CK 510) is shared with and 0.052 % divergent to that of Ht. cowani (BMAD 122 - 15, DL 14 Z-050, Anjozorobe), whereas about 10 % divergent to Ht. exocellata (FJ 666704, 549 bp compared). There is limited evidence so far of haplotype fixation. Where in the 434 th and 439 th nucleotide position of the DNA barcode, Ht. cowani has a G and a C (as in Ht. exocellata), Ht. mimetica has an A and a C (n= 2 in both cases). This is then a case of virtual barcode sharing with morphological divergence. More detailed genetic studies are required to investigate further this species pair. Phylogeny/sister species: sister species is Ht. cowani. Ecology and distribution. Habitat: found in Makira in a rather open forest structure dominated by Uapaca Baill. (Phyllanthaceae) growing on quartzite substrate, next to a stream (pers. obs.). Similar habitat on quartzite exists in Anjanaharibe Sud, and it is possible that such forest on poor substrates has an unusually light-penetrating nature. Behaviour: flies low, apparently mimetic of Ht. sabas in flight, as first noted by Claire Kremen (pers. comm.). All individuals were caught low down along or near the path; Ht. mimetica, like Ht. cowani, seems reluctant to come to fruit bait. The key functional aspect of this whitening seems to be translucence, which in sunspots seems to make the space-CuA 1 ocellus stand out in a more (frightening?) way. Translucence may also be an aspect to the wing pattern convergence for the HW, considering the HWV pattern is visible on the upperside. Hostplant: unknown, but presumed to be grasses (rather than bamboos), which are also frequented by Ht. cowani. Early stages: unknown, apart from one expressed egg (not described here). Distribution: replacement species of Ht. cowani endemic to the rainforest of northeast Madagascar and apparently extremely localized, known from only two very localised sites (Fig. 30 A, yellow dots). The species was searched for in its type locality in November 2014, at a similar date to the HT specimen, without success. Conservation: highly range restricted, but the species is currently protected by two parks. Elevational range: 775–950 m (n= 18 incl. observations). Referred specimens. ♂, NE Madagascar, Ankiatomboka-Vohibola, descending to river from O 3, c 760 m, 15.1726 o S, 49.3913 o E +/- 1.5 km, 775 +/- 5 m 10 / 12 /2001, 09: 46, D.C. Lees: DL 01- 175, 267 [= DL 0267, DNA extract number; cytochrome b], BMNH (E) 697383, KA 561 [=KA-P 561, DNA extract number]; ♀, data as HT but 22 / 3 / 1996, H. Raharitsimba: TR 617; ♀, data as HT but CK 520.Published as part of C, Lees David, 2016, Heteropsis (Nymphalidae: Satyrinae: Satyrini: Mycalesina): 19 new species from Madagascar and interim revision, pp. 1-97 in Zootaxa 4118 (1) on pages 11-14, DOI: 10.11646/zootaxa.4118.1.1, http://zenodo.org/record/26459
The efficacy of emamectin benzoate against infestations of Lepeophtheirus salmonis on farmed Atlantic salmon (Salmo salar L) in Scotland, 2002-2006
No full textInfestations of the parasitic copepod Lepeophtheirus salmonis, commonly referred to as sea lice, represent a major challenge to commercial salmon aquaculture. Dependence on a limited number of theraputants to control such infestations has led to concerns of reduced sensitivity in some sea lice populations. This study investigates trends in the efficacy of the in-feed treatment emamectin benzoate in Scotland, the active ingredient most widely used across all salmon producing regions. Study data were drawn from over 50 commercial Atlantic salmon farms on the west coast of Scotland between 2002 and 2006. An epi-informatics approach was adopted whereby available farm records, descriptive epidemiological summaries and statistical linear modelling methods were used to identify factors that significantly affect sea lice abundance following treatment with emamectin benzoate (SLICEH, Schering Plough Animal Health). The results show that although sea lice infestations are reduced following the application of emamectin benzoate, not all treatments are effective. Specifically there is evidence of variation across geographical regions and a reduction in efficacy over time. Reduced sensitivity and potential resistance to currently available medicines are constant threats to maintaining control of sea lice populations on Atlantic salmon farms. There is a need for on-going monitoring of emamectin benzoate treatment efficacy together with reasons for any apparent reduction in performance. In addition, strategic rotation of medicines should be encouraged and empirical evidence for the benefit of such strategies more fully evaluated
Translating cognitive neuroscience to the driver's operational environment: A neuroergonomic approach
No full textNeuroergonomics provides a multidisciplinary translational approach that merges elements of
neuroscience, human factors, cognitive psychology, and ergonomics to study brain structure and
function in everyday environments. Driving safety, particularly that of older drivers with cognitive
impairments, is a fruitful application domain for neuroergonomics. Driving makes demands
on multiple cognitive processes that are often studied in isolation and so presents a useful
challenge in generalizing findings from controlled laboratory tasks to predict safety outcomes.
Neurology and the cognitive sciences help explain the mechanisms of cognitive breakdowns
that undermine driving safety. Ergonomics complements this explanation with the tools for systematically
exploring the various layers of complexity that define the activity of driving. A variety
of tools, such as part task simulators, driving simulators, and instrumented vehicles, provide a
window into cognition in the natural settings needed to assess the generalizability of laboratory
findings and can provide an array of potential interventions to increase driving safety.
Overview of neuroergonomics with respect to driving
Neuroergonomics is the study of brain and behavior
at work (Parasuraman, 2003; Parasuraman & Rizzo,
2007). This multidisciplinary field merges the principles
and practice of neuroscience and ergonomics
to study brain structure and function in everyday
environments. Whereas neuroscience and cognitive
psychology have tended to focus on the neural structures
and mental processes underlying cognition in
controlled laborator
Stroke outcome in clinical trial patients deriving from different countries
No full text<p><b>Background and Purpose:</b> Stroke incidence and outcome vary widely within and across geographical locations. We examined whether differences in index stroke severity, stroke risk factors, mortality, and stroke outcome across geographical locations remain after adjusting for case mix.</p>
<p><b>Methods:</b> We analyzed 3284 patients from the Virtual International Stroke Trials Archive (VISTA). We used logistic regression to examine the incidence of mild index stroke, functional, and neurological outcomes after accounting for age, medical history, year of trial recruitment, and initial stroke severity in the functional and neurological outcome analyses. We examined mortality between geographical regions using a Cox proportional hazards model, accounting for age, initial stroke severity, medical history, and year of trial recruitment.</p>
<p><b>Results</b> Patients enrolled in the USA and Canada had the most severe index strokes. Those recruited in Austria and Switzerland had the best functional and neurological outcomes at 90 days (P<0.05), whereas those enrolled in Germany had the worst functional outcome at 90 days (P=0.013). Patients enrolled in Austria, Switzerland, Belgium, Netherlands, Finland, Germany, Greece, Israel, Spain, and Portugal had a significantly better survival rate when compared with those enrolled in USA and Canada. Patients enrolled in trials after 1998 had more severe index strokes, with no significant difference in outcome compared with those enrolled before 1998.</p>
<p><b>Conclusion:</b> We identified regional variations in index stroke severity, outcome, and mortality for patients enrolled in ischemic stroke clinical trials over the past 13 years that were not fully explained by case mix. Index stroke severity was greater in patients enrolled after 1998, with no significant improvement in outcomes compared to those enrolled before 1998.</p>
Thrombolysis is associated with consistent functional improvement across baseline stroke severity: a comparison of outcomes in patients from the Virtual International Stroke Trials Archive (VISTA)
No full text<p><b>Background and Purpose:</b> Baseline stroke severity predicts outcomes among thrombolysed patients. The baseline National Institutes of Health Stroke Scale (NIHSS) thresholds are sometimes used to select patients for thrombolysis, clinical trial enrollment, or both. Using data lodged with Virtual International Stroke Trials Archive, we compared adjusted outcomes between thrombolysed and nonthrombolysed patients enrolled in neuroprotection trials (1998-2007) to assess the influence of various levels of baseline NIHSS.</p>
<p><b>Method:</b> We assessed the association of treatment with outcome, measured across the modified Rankin scale score distribution, in patients categorized by baseline NIHSS in increments of 4. We used an age and baseline NIHSS adjusted Cochran-Mantel-Haenszel test followed by proportional odds logistic regression analysis. We report the Cochran-Mantel-Haenszel P values and estimated odds ratios (OR) for improved modified Rankin scale score distribution with treatment for patients within each baseline NIHSS category.</p>
<p><b>Results:</b> Data were available for 5817 patients (1585 thrombolysed and 4232 nonthrombolysed). Baseline severity was greater among thrombolysed than nonthrombolysed (median baseline NIHSS, 14 vs 13; P<0.05). An association of treatment with outcome was seen independently and was of similar magnitude within each of the baseline NIHSS categories 5 to 8 (P=0.04; OR, 1.25; 95% confidence interval [CI], 1.0-1.6; N=278/934 thrombolysed/nonthrombolysed), 9 to 12 (P=0.01; OR, 1.3; 95% CI, 1.1-1.6; N=404/942), 13 to 16 (P<0.05; OR, 1.6; 95% CI, 1.3-2.1; N=342/814), 17 to 20 (P<0.05; OR, 1.7; 95% CI, 1.3-2.1; N=311/736), and 21 to 24 (P<0.05; OR, 1.6; 95% CI, 1.1-2.1; N=178/466). No association was observed within baseline NIHSS categories 1 to 4 (P=0.8; OR, 1.1; 95% CI, 0.3-4.4; N=8/161) or >= 25 (P=0.08; OR, 1.1; 95% CI, 0.7-1.9; N=64/179).</p>
<p><b>Conclusions:</b> In this nonrandomized comparison, outcomes after thrombolysis were significantly better than in untreated comparators across baseline NIHSS 5 to 24. The significant association was lost only at extremes of baseline NIHSS when sample sizes were small and confidence limits were wide.</p>
Dangerous Liaisons: Relationships between design, craft and art
No full textThe introductory essay [co-authored] examines the background and current interconnections between design, craft and the fine arts. This Special Issue was able to expand the debate by showing how attitudes to materials – from 19C sculpture to current fashion – appropriate craftsmanship to reinvigorate notions of handmaking
Translating cognitive neuroscience to the driver’s operational environment: A neuroergonomic approach
No full textA case-control study of physical activity patterns and risk of non-fatal myocardial infarction
No full textAbstract Background The interactive effects of different types of physical activity on cardiovascular disease (CVD) risk have not been fully considered in previous studies. We aimed to identify physical activity patterns that take into account combinations of physical activities and examine the association between derived physical activity patterns and risk of acute myocardial infarction (AMI). Methods We examined the relationship between physical activity patterns, identified by principal component analysis (PCA), and AMI risk in a case-control study of myocardial infarction in Costa Rica (N=4172), 1994-2004. The component scores derived from PCA and total METS were used in natural cubic spline models to assess the association between physical activity and AMI risk. Results Four physical activity patterns were retained from PCA that were characterized as the rest/sleep, agricultural job, light indoor activity, and manual labor job patterns. The light indoor activity and rest/sleep patterns showed an inverse linear relation (P for linearity=0.001) and a U-shaped association (P for non-linearity=0.03) with AMI risk, respectively. There was an inverse association between total activity-related energy expenditure and AMI risk but it reached a plateau at high levels of physical activity (P for non-linearity=0.01). Conclusions These data suggest that a light indoor activity pattern is associated with reduced AMI risk. PCA provides a new approach to investigate the relationship between physical activity and CVD risk.</p
Mismatch-based delayed thrombolysis: a meta-analysis
No full text<p><b>Background and Purpose</b>: Clinical benefit from thrombolysis is reduced as stroke onset to treatment time increases. The use of "mismatch" imaging to identify patients for delayed treatment has face validity and has been used in case series and clinical trials. We undertook a meta-analysis of relevant trials to examine whether present evidence supports delayed thrombolysis among patients selected according to mismatch criteria.</p>
<p><b>Methods</b>: We collated outcome data for patients who were enrolled after 3 hours of stroke onset in thrombolysis trials and had mismatch on pretreatment imaging. We selected the trials on the basis of a systematic search of the Web of Knowledge. We compared favorable outcome, reperfusion and/or recanalization, mortality, and symptomatic intracerebral hemorrhage between the thrombolyzed and nonthrombolyzed groups of patients and the probability of a favorable outcome among patients with successful reperfusion and clinical findings for 3 to 6 versus 6 to 9 hours from poststroke onset. Results are expressed as adjusted odds ratios (a-ORs) with 95% CIs. Heterogeneity was explored by test statistics for clinical heterogeneity, I2 (inconsistency), and L’Abbé plot.</p>
<p><b>Results</b>: We identified articles describing the DIAS, DIAS II, DEDAS, DEFUSE, and EPITHET trials, giving a total of 502 mismatch patients thrombolyzed beyond 3 hours. The combined a-ORs for favorable outcomes were greater for patients who had successful reperfusion (a-OR=5.2; 95% CI, 3 to 9; I2=0%). Favorable clinical outcome was not significantly improved by thrombolysis (a-OR=1.3; 95% CI, 0.8 to 2.0; I2=20.9%). Odds for reperfusion/recanalization were increased among patients who received thrombolytic therapy (a-OR=3.0; 95% CI, 1.6 to 5.8; I2=25.7%). The combined data showed a significant increase in mortality after thrombolysis (a-OR=2.4; 95% CI, 1.2 to 4.9; I2=0%), but this was not confirmed when we excluded data from desmoteplase doses that were abandoned in clinical development (a-OR=1.6; 95% CI, 0.7 to 3.7; I2=0%). Symptomatic intracerebral hemorrhage was significantly increased after thrombolysis (a-OR=6.5; 95% CI, 1.2 to 35.4; I2=0%) but not significant after exclusion of abandoned doses of desmoteplase (a-OR=5.4; 95% CI, 0.9 to 31.8; I2=0%).</p>
<p><b>Conclusions</b>: Delayed thrombolysis amongst patients selected according to mismatch imaging is associated with increased reperfusion/recanalization. Recanalization/reperfusion is associated with improved outcomes. However, delayed thrombolysis in mismatch patients was not confirmed to improve clinical outcome, although a useful clinical benefit remains possible. Thrombolysis carries a significant risk of symptomatic intracerebral hemorrhage and possibly increased mortality. Criteria to diagnose mismatch are still evolving. Validation of the mismatch selection paradigm is required with a phase III trial. Pending these results, delayed treatment, even according to mismatch selection, cannot be recommended as part of routine care.</p>
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