Automated Decision-Support System for Prediction of Treatment Responders in Acute Ischemic Stroke

MRI is widely used in the assessment of acute ischemic stroke. In particular, it identifies the mismatch between hypoperfused and the permanently damaged tissue, the PWI-DWI mismatch volume. It is used to help triage patients into active or supportive treatment pathways. COMBAT Stroke is an automated software tool for estimating the mismatch volume and ratio based on MRI. Herein, we validate the decision made by the software with actual clinical decision rendered. Furthermore, we evaluate the association between treatment decisions (both automated and actual) and outcomes. COMBAT Stroke was used to determine PWI-DWI mismatch volume and ratio in 228 patients from two European multi-center stroke databases. We performed confusion matrix analysis to summarize the agreement between the automated selection and the clinical decision. Finally, we evaluated the clinical and imaging outcomes of the patients in the four entries of the confusion matrix (true positive, true negative, false negative, and false positive). About 186 of 228 patients with acute stroke underwent thrombolytic treatment, with the remaining 42 receiving supportive treatment only. Selection based on radiographic criteria using COMBAT Stroke classified 142 patients as potential candidates for thrombolytic treatment and 86 for supportive treatment; 60% sensitivity and 29% specificity. The patients deemed eligible for thrombolytic treatment by COMBAT Stroke demonstrated significantly higher rates of compromised tissue salvage, less neurological deficit, and were more likely to experience thrombus dissolving and reestablishment of normal blood flow at 24 h follow-up compared to those who were treated without substantial PWI-DWI mismatch. These results provide evidence that COMBAT Stroke, in addition to clinical assessment, may offer an optimal framework for a fast, efficient, and standardized clinical support tool to select patients for thrombolysis in acute ischemic stroke

Patient-Reported Barriers and Limitations to Attending Diabetes Group Visits.

PURPOSE: Through this exploratory study, we sought to understand why group visit participation is low among adult patients with type 2 diabetes. METHODS: Eligible study participants included adult patients with type 2 diabetes. After a pilot survey was sent to a random sample of 48 patients, the remaining 187 eligible patients were invited to complete a revised version of the survey. RESULTS: Most frequently cited reasons for not attending group visits included diabetes under control, work and/or other responsibilities, and time barriers. There was variability in the desired time for the visits, though the majority of patients preferred evening visits. While some patients reported copays as a challenge, the likelihood of attending did not decrease for this subgroup. Most patients surveyed (54%) indicated interest in diabetes group visits. CONCLUSION: Implementing strategies to address the patient-identified system barriers (eg, time, transportation, and copays) may increase participation in diabetes group visits

First-year compliance with the Nevada Clean Indoor Air Act

Objectives: We quantitatively evaluated compliance with the Nevada Clean Indoor Air Act (NCIAA) by different types of businesses in Nevada and determined whether compliance affected indoor concentrations of benzene and 3-ethenyl pyridine (3-EP), markers of tobacco smoke. Methods: Managers of 181 businesses in Washoe County, Nevada, were interviewed about business characteristics and practices and policies related to smoking. During unannounced visits, compliance data and air samples (n=66) were collected from interviewed businesses and from an additional sample (n = 56) of businesses without knowledge of the study. Results: Overall compliance, as defined by the NCIAA, was low (28.2%). Benzene concentrations were higher in casino restaurants than in other businesses, although most complied with the requirements of the ban. Neither benzene nor 3-EP concentrations differed significantly between compliant and non-compliant businesses. Conclusions: The finding that casino restaurants had poorer air quality despite their compliance with the NCIAA suggests that compliance alone may not be sufficient to reduce exposure to secondhand smoke, particularly in buildings with both nonsmoking and smoking areas

The Correlation Between Star Formation and 21cm Emission During the Reionization Epoch

Reionization is thought to be dominated by low mass galaxies, while direct observations of resolved galaxies probe only the most massive, rarest objects. The cross-correlation between fluctuations in the surface brightness of the cumulative Ly-alpha emission (which serves as a proxy for the star formation rate) and the redshifted 21cm signal from neutral hydrogen in the intergalactic medium (IGM), will directly probe the causal link between the production of ionizing photons in galaxies and the reionization of the IGM. We discuss the prospects for detecting this cross-correlation for unresolved galaxies. We find that on angular scales <10 arc-minutes, detection will be practical using widefield near-IR imaging from space in combination with the forthcoming Mileura Widefield Array - Low Frequency Demonstrator. When redshifted 21cm observations of the neutral IGM are combined with space-based near-IR imaging of Ly-alpha emission, the detection on angular scales <3 arc-minutes will be limited by the sensitivity of the 21cm signal, even when a small aperture optical telescope (~2m) and a moderate field of view (~10 square degrees) are used. On scales >3 arc-minutes, the measurement of cross-correlation will be limited by the accuracy of the foreground sky subtraction.Comment: 12 pages. 5 figures. Submitted to MNRA

Mylonitic deformation at the Kane oceanic core complex : implications for the rheological behavior of oceanic detachment faults

Author Posting. © American Geophysical Union, 2013. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry, Geophysics, Geosystems 14 (2013): 3085–3108, doi:10.1002/ggge.20184.The depth extent, strength, and composition of oceanic detachment faults remain poorly understood because the grade of deformation-related fabrics varies widely among sampled oceanic core complexes (OCCs). We address this issue by analyzing fault rocks collected from the Kane oceanic core complex at 23°30′N on the Mid-Atlantic Ridge. A portion of the sample suite was collected from a younger fault scarp that cuts the detachment surface and exposes the interior of the most prominent dome. The style of deformation was assessed as a function of proximity to the detachment surface, revealing a ∼450 m thick zone of high-temperature mylonitization overprinted by a ∼200 m thick zone of brittle deformation. Geothermometry of deformed gabbros demonstrates that crystal-plastic deformation occurred at temperatures >700°C. Analysis of the morphology of the complex in conjunction with recent thermochronology suggests that deformation initiated at depths of ∼7 km. Thus we suggest the detachment system extended into or below the brittle-plastic transition (BPT). Microstructural evidence suggests that gabbros and peridotites with high-temperature fabrics were dominantly deforming by dislocation-accommodated processes and diffusion creep. Recrystallized grain size piezometry yields differential stresses consistent with those predicted by dry-plagioclase flow laws. The temperature and stress at the BPT determined from laboratory-derived constitutive models agree well with the lowest temperatures and highest stresses estimated from gabbro mylonites. We suggest that the variation in abundance of mylonites among oceanic core complexes can be explained by variation in the depth of the BPT, which depends to a first order on the thermal structure and water content of newly forming oceanic lithosphere.Knorr Cruise 180-2 data and sample acquisition was supported by NSF grant 0118445.2014-02-2

Time-dependent fluorescence in nanoconfined solvents: Linear-response approximations and Gaussian statistics

This is the publisher's version, also available electronically from http://scitation.aip.org/content/aip/journal/jcp/135/8/10.1063/1.3626825.The time-dependent fluorescence of a model dye molecule in a nanoconfined solvent is used to test approximations based on the dynamic and static linear-response theories and the assumption of Gaussian statistics. Specifically, the results of nonequilibrium molecular-dynamics simulations are compared to approximate expressions involving time correlation functions obtained from equilibrium simulations. Solvation dynamics of a model diatomic dye molecule dissolved in acetonitrile confined in a spherical hydrophobic cavity of radius 12, 15, and 20 Å is used as the test case. Both the time-dependent fluorescence energy, expressed as the normalized dynamic Stokes shift, and the time-dependent position of the dye molecule after excitation are examined. While the dynamic linear-response approximation fails to describe key aspects of the solvation dynamics, assuming Gaussian statistics reproduces the full nonequilibrium simulations well. The implications of these results are discussed

Vitamin D-responsive SGPP2 variants associated with lung cell expression and lung function

Background: Vitamin D is associated with lung health in epidemiologic studies, but mechanisms mediating observed associations are poorly understood. This study explores mechanisms for an effect of vitamin D in lung through an in vivo gene expression study, an expression quantitative trait loci (eQTL) analysis in lung tissue, and a population-based cohort study of sequence variants. Methods: Microarray analysis investigated the association of gene expression in small airway epithelial cells with serum 25(OH)D in adult non-smokers. Sequence variants in candidate genes identified by the microarray were investigated in a lung tissue eQTL database, and also in relation to cross-sectional pulmonary function in the Health, Aging, and Body Composition (Health ABC) study, stratified by race, with replication in the Framingham Heart Study (FHS). Results: 13 candidate genes had significant differences in expression by serum 25(OH)D (nominal p < 0.05), and a genome-wide significant eQTL association was detected for SGPP2. In Health ABC, SGPP2 SNPs were associated with FEV1 in both European- and African-Americans, and the gene-level association was replicated in European-American FHS participants. SNPs in 5 additional candidate genes (DAPK1, FSTL1, KAL1, KCNS3, and RSAD2) were associated with FEV1 in Health ABC participants. Conclusions: SGPP2, a sphingosine-1-phosphate phosphatase, is a novel vitamin D-responsive gene associated with lung function. The identified associations will need to be followed up in further studies