Left atrial (LA) spontaneous echo contrast (SEC), or "smoke," is a frequent finding on transesophageal echocardiography (TEE), but it is rarely detected with transthoracic echocardiography. LA SEC is characterized by dynamic smoke-like echoes within the LA cavity or appendage. Most patients with LA SEC have atrial arrhythmias, mitral stenosis, or a mitral valve prosthesis, and they have an enlarged LA, conditions that are associated with LA stasis. Conversely, mitral regurgitation is protective against LA SEC. LA SEC is present in almost all patients with LA thrombus and is associated with previous embolic events in many patient populations. In patients with nonvalvular atrial fibrillation, LA SEC predicts future embolism and death. LA SEC may therefore assist in selecting patients with atrial fibrillation or with mitral stenosis and sinus rhythm who benefit the most from anticoagulation. Hematological studies have shown that LA SEC is a marker of an hypercoagulable state. LA SEC is a manifestation of red cell aggregation, arising from an interaction between red cells and plasma proteins such as fibrinogen, at low shear rates. LA SEC does not require platelets. The detection of LA SEC on ultrasound arises from the increased amplitude of backscatter from red cell aggregates rather than single cells. Patients with LA SEC should be considered for anticoagulant therapy and may require correction of underlying cardiovascular abnormalities. Future directions in LA SEC include further assessment of integrated backscatter for quantification, assessment of its prognostic role in clinically low-risk patients with nonvalvular AF, and novel pharmacological treatment.

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There is a large communication gap between health professional and personal diabetes blogs. Personal blogs do not tend to link to blogs by health professionals. Diabetes patients may be turning to the blogosphere for reasons other than authoritative information. They may be seeking emotional support and exchange of personal stories.

the terms of the Creative CommonsAttribution-Noncommercial-Share Alike License 2.5 Canada (http://creativecommons.org/licenses/by-ncsa/2.5/ca/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly attributed, not used for commercial purposes, and, if transformed, the resulting work is redistributed under the same or similar license to this one. AbstractObjectives -To describe aspects of the 21 st century role of the public library as a physical space by observing the actual use of a selection of public libraries. This study seeks to reveal how patrons are using and experiencing these institutions as spaces and how patrons and staff characterize the role of public libraries in communities.Methods -A multiple case study design was used to examine three urban and three small town public libraries within Nova Scotia, Canada. A triangulated set of methods including patron interviews and questionnaires, staff interviews, and seating sweeps was used to develop answers to the research questions.Results -These public libraries are functioning as successful public places in that they are community spaces used in a multitude of ways and where patrons feel welcome. These libraries play important roles in the lives of respondents and, while respondents were willing to give critical feedback, they generally described the spaces positively. Patron use and experience of these library spaces can be broken into three themes that describe the roles of public libraries in communities. These 5Evidence Based Library and Information Practice 2010, 5.2 6 include the role of provider of books and information, provider of access to technology and provider of a social space where members of the public are welcome.Conclusions -Patron experiences in Nova Scotia public libraries show that libraries are vibrant places that are highly valued by their communities. A number of common themes about the use and perception of these spaces emerged, yet when examined individually each library was also revealed to be a unique place, reflecting the particular qualities of the community and the physical space of the library building itself. It is clear that public libraries are complex institutions which play a variety of valuable roles in the community.

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