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Background: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (Pd) might be a useful marker in predicting PAF in patients with acute ischemic stroke.Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared.Results: Maximum P-wave duration (p=0.002), Pd (p<0.001) and left atrium diameter (p=0.04) were significantly higher in patients with PAF when compared to patients without PAF. However, in binary logistic regression analysis Pd was the only independent predictor of PAF. The cut-off value of Pd for the detection of PAF was 57.5 milliseconds (msc). Area under the curve was 0.80 (p<0.001). On a single 12-lead ECG, a value higher than 57.5 msc predicted the presence of PAF with a sensitivity of 80% and a specificity of 73%.Conclusion: Pd on a single 12-lead ECG obtained within 24 hours of an acute ischemic stroke might help to predict PAF and reduce the risk of recurrent strokes.

Large scale quantum computing motivates the invention of two-qubit gate schemes that not only maximize the gate fidelity but also draw minimal resources. In the case of superconducting qubits, the weak anharmonicity of transmons imposes profound constraints on the gate design, leading to increased complexity of devices and control protocols. Here we demonstrate a resource-efficient control over the interaction of strongly-anharmonic fluxonium qubits. Namely, applying an offresonant drive to non-computational transitions in a pair of capacitively-coupled fluxoniums induces a ZZ-interaction due to unequal ac-Stark shifts of the computational levels. With a continuous choice of frequency and amplitude, the drive can either cancel the static ZZ-term or increase it by an order of magnitude to enable a controlled-phase (CP) gate with an arbitrary programmed phase shift. The cross-entropy benchmarking of these non-Clifford operations yields a sub 1% error, limited solely by incoherent processes. Our result demonstrates the advantages of strongly-anharmonic circuits over transmons in designing the next generation of quantum processors.

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Purpose-The aim of this study is to examine the concept of strategic innovation -which includes a strategic approach to innovation -within the framework of its antecedents, the elements forming it and the advantages provided to the company. Methodology-Theoretical analysis: Innovation has been analyzed from a strategic point of view by examining the current literature extensively. Findings-Along with the impact of globalization and the emerging new technologies, companies must manage the change by perceiving it as an opportunity to be able to sustain, grow and compete in a rapidly changing environment and respond to change with innovation. Innovation reflecting the perspective of companies on change creates value through change. In today's business world, there are true opportunities for the ones that can manage the process of change well. At this point, a company desiring to create value and maintain the sustainable competitive advantage should use innovation strategically. Conclusion-A strategic perspective on innovation leads the organization to look at the whole system beyond the product and the process in order to create value. Successful companies in innovation deal with it in a holistic and systematic approach by developing a fully integrated innovation strategy with its mission and objectives and by making organizational culture and organizational systems compatible with the strategy. Strategic innovation is a future-oriented concept that contains a creative discovery. The strategic consideration of innovation involves the use of appropriate strategic management techniques to increase the impact of innovation activities on growth and performance of the company.

We describe the first rescue procedure in a case of total face allotransplantation. The recipient was a 54-year-old man with severe disfigurement of the entire face following an accidental gunshot injury 5 years previously. The large defect included the maxilla, mandible, and mid-face. Full face procurement was performed from a multiorgan cadaveric donor and was allotransplanted to the recipient. The post-transplant induction immunosuppressive regimen included ATG combined with tacrolimus, mycophenolate mofetil, and prednisone, while maintenance was provided by the last three of these. Although the early postoperative period was uneventful, squamous cell carcinoma developed in the upper and lower extremities in the fifth postoperative month, and post-transplant lymphoproliferative disorder (PTLD) occurred in the sixth month postoperatively. Malignancies were treated, involving both surgical and medical approaches. The patient developed opportunistic pulmonary and cerebellar aspergillosis. In order to reduce the adverse affects and metabolic and immunological load, the transplanted face was removed and replaced with a free flap. Although the early postoperative period was promising, with the transferred flap surviving totally and all vital signs and general status appearing to be improving, the patient was eventually lost due to complicated infectious and metabolic events. Although this case was unsuccessful, we suggest that the immunological and metabolic load should be reduced as soon as stable medical conditions are established in case of diagnosis of a situation involving a high rate of mortality, such as PTLD and untreatable opportunistic infections. This should include withdrawal of all immunosuppressive drugs and removal of all allotransplanted tissues.

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