Mortality After Pediatric Arterial Ischemic Stroke

OBJECTIVES: Cerebrovascular disease is among the top 10 causes of death in US children, but risk factors for mortality are poorly understood. Within an international registry, we identify predictors of in-hospital mortality after pediatric arterial ischemic stroke (AIS). METHODS: Neonates (0-28 days) and children (29 days- < 19 years) with AIS were enrolled from January 2003 to July 2014 in a multinational stroke registry. Death during hospitalization and cause of death were ascertained from medical records. Logistic regression was used to analyze associations between risk factors and in-hospital mortality. RESULTS: Fourteen of 915 neonates (1.5%) and 70 of 2273 children (3.1%) died during hospitalization. Of 48 cases with reported causes of death, 31 (64.6%) were strokerelated, with remaining deaths attributed to medical disease. In multivariable analysis, congenital heart disease (odds ratio [OR]: 3.88; 95% confidence interval [CI] : 1.23-12.29; P = .021), posterior plus anterior circulation stroke (OR: 5.36; 95% CI: 1.70-16.85; P = .004), and stroke presentation without seizures (OR: 3.95; 95% CI: 1.26-12.37; P = .019) were associated with in-hospital mortality for neonates. Hispanic ethnicity (OR: 3.12; 95% CI: 1.56-6.24; P = .001), congenital heart disease (OR: 3.14; 95% CI: 1.75-5.61; P < .001), and posterior plus anterior circulation stroke (OR: 2.71; 95% CI: 1.40-5.25; P = .003) were associated with in-hospital mortality for children. CONCLUSIONS: In-hospital mortality occurred in 2.6% of pediatric AIS cases. Most deaths were attributable to stroke. Risk factors for in-hospital mortality included congenital heart disease and posterior plus anterior circulation stroke. Presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. Awareness and study of risk factors for mortality represent opportunities to increase survival

Modeling the multi-seasonal link between the hydrodynamics of a reservoir and itshydropower plant operation

The hydrodynamics of many hydropower reservoirs are controlled by the operation of their power plant, but the associated water quality impact is often poorly understood. In particular, significant hydropeaking operations by hydropower plants affect not only the downstream ecosystem but also the reservoir water temperature. This paper contributes to understanding that link. For this, we coupled a hydrodynamic model (Estuary, Lake and Coastal Ocean Model, ELCOM) to a grid-wide power system scheduling model. In a case study (Rapel, Chile), we observe the behavior of variables related to the flow regime and water quality (including sub-daily hydrologic alteration, seasonal and sub-daily thermal pollution of the downstream river, and vertical mixing in the reservoir). Additionally, we evaluate how environmental constraints (ECs) can improve the conditions for a wet, normal and dry water-type year. We found that the unconstrained operation produces a strong sub-daily hydrologic alteration as well as an intense thermal pollution of the outflow. We show that these effects can clearly be avoided when implementing ECs. The current (unconstrained) vertical mixing makes the reservoir susceptible to algae blooms. Implementing ECs may intensify the stratification in the reservoir near the dam in some scenarios. The grid-wide economic cost of Rapel's ECs is a modest 0.3%.Chilean Council of Scientific and Technological Research, CONICYT- FONDECYT- 1151438, 1140821 / German Academic Exchange Service (DAAD