Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample.

BACKGROUND AND PURPOSE: Sex and race disparities in recombinant tissue plasminogen activator (rt-PA) use have been reported. We sought to explore sex and race differences in the utilization of rt-PA at primary stroke centers (PSCs) compared to non-PSCs across the US. METHODS: Data from the National (Nationwide) Inpatient Sample (NIS) 2004-2010 was utilized to assess sex differences in treatment for ischemic stroke in PSCs compared to non-PSCs. RESULTS: There were 304,152 hospitalizations with a primary diagnosis of ischemic stroke between 2004 and 2010 in the analysis: 75,160 (24.7%) patients were evaluated at a PSC. A little over half of the patients evaluated at PSCs were female (53.8%). A lower proportion of women than men received rt-PA at both PSCs (6.8 vs. 7.5%, p \u3c 0.001) and non-PSCs (2.3 vs. 2.8%, p \u3c 0.001). After adjustment for potential confounders the odds of being treated with rt-PA remained lower for women regardless of presentation to a PSC (OR 0.87, 95% CI 0.81-0.94) or non-PSC (OR 0.88, 95% CI 0.82-0.94). After stratifying by sex and race, the lowest absolute treatment rates were observed in black women (4.4% at PSC, 1.9% at non-PSC). The odds of treatment, relative to white men, was however lowest for white women (PSC OR = 0.85, 95% CI 0.78-0.93; non-PSC OR = 0.80, 95% CI 0.75-0.85). In the multivariable model, sex did not modify the effect of PSC certification on rt-PA utilization (p-value for interaction = 0.58). CONCLUSION: Women are less likely to receive rt-PA than men at both PSCs and non-PSCs. Absolute treatment rates are lowest in black women, although the relative difference in men and women was greatest for white women

Formalism for testing theories of gravity using lensing by compact objects. III: Braneworld gravity

Braneworld gravity is a model that endows physical space with an extra dimension. In the type II Randall-Sundrum braneworld gravity model, the extra dimension modifies the spacetime geometry around black holes, and changes predictions for the formation and survival of primordial black holes. We develop a comprehensive analytical formalism for far-field black hole lensing in this model, using invariant quantities to compute all geometric optics lensing observables. We then make the first analysis of wave optics in braneworld lensing, working in the semi-classical limit. We show that wave optics offers the only realistic way to observe braneworld effects in black hole lensing. We point out that if primordial braneworld black holes exist, have mass M, and contribute a fraction f of the dark matter, then roughly 3e5 x f (M/1e-18 Msun)^(-1) of them lie within our Solar System. These objects, which we call "attolenses," would produce interference fringes in the energy spectra of gamma-ray bursts at energies ~100 (M/1e-18 Msun)^(-1) MeV (which will soon be accessible with the GLAST satellite). Primordial braneworld black holes spread throughout the universe could produce similar interference effects; the probability for "attolensing" may be non-negligible. If interference fringes were observed, the fringe spacing would yield a simple upper limit on M. Detection of a primordial black hole with M <~ 1e-19 Msun would challenge general relativity and favor the braneworld model. Further work on lensing tests of braneworld gravity must proceed into the physical optics regime, which awaits a description of the full spacetime geometry around braneworld black holes.Comment: 13 pages, 3 figures; accepted in PRD; expanded discussion of prospects for observing attolensing with GLAS

Comorbid Medical Conditions as Predictors of Overall Survival in Glioblastoma Patients

Glioblastoma (GBM) is an aggressive central nervous system tumor with a poor prognosis. This study was conducted to determine any comorbid medical conditions that are associated with survival in GBM. Data were collected from medical records of all patients who presented to VCU Medical Center with GBM between January 2005 and February 2015. Patients who underwent surgery/biopsy were considered for inclusion. Cox proportional hazards regression modeling was performed to assess the relationship between survival and sex, race, and comorbid medical conditions. 163 patients met inclusion criteria. Comorbidities associated with survival on individual-characteristic analysis included: history of asthma (Hazard Ratio [HR]: 2.63; 95% Confidence Interval [CI]: 1.24–5.58; p = 0.01), hypercholesterolemia (HR: 1.95; 95% CI: 1.09–3.50; p = 0.02), and incontinence (HR: 2.29; 95% CI: 0.95–5.57; p = 0.07). History of asthma (HR: 2.22; 95% CI: 1.02–4.83; p = 0.04) and hypercholesterolemia (HR: 1.99; 95% CI: 1.11–3.56; p = 0.02) were associated with shorter survival on multivariable analysis. Surgical patients with GBM who had a prior history of asthma or hypercholesterolemia had significantly higher relative risk for mortality on individual-characteristic and multivariable analyses

What have we already learned from the CMB?

The COBE satellite, and the DMR experiment in particular, was extraordinarily successful. However, the DMR results were announced about 7 years ago, during which time a great deal more has been learned about anisotropies in the Cosmic Microwave Background (CMB). The CMB experiments currently being designed and built, including long-duration balloons, interferometers, and two space missions, promise to address several fundamental cosmological issues. We present our evaluation of what we already know, what we are beginning to learn now, and what the future may bring.Comment: 20 pages, 3 figures. Changes to match version accepted by PAS

Use of Buffers in Specific Contexts : Highly Trained Female Athletes, Extreme Environments and Combined Buffering Agents - A Narrative Review

This narrative review evaluated the evidence for buffering agents (sodium bicarbonate, sodium citrate and beta-alanine), with specific consideration of three discrete scenarios: female athletes, extreme environments and combined buffering agents. Studies were screened according to exclusion and inclusion criteria and were analysed on three levels: (1) moderating variables (supplement dose and timing, and exercise test duration and intensity), (2) design factors (e.g., use of crossover or matched group study design, familiarisation trials) and (3) athlete-specific factors (recruitment of highly trained participants, buffering capacity and reported performance improvements). Only 19% of the included studies for the three buffering agents reported a performance benefit, and only 10% recruited highly trained athletes. This low transferability of research findings to athletes’ real-world practices may be due to factors including the small number of sodium citrate studies in females (n = 2), no studies controlling for the menstrual cycle (MC) or menstrual status using methods described in recently established frameworks, and the limited number of beta-alanine studies using performance tests replicating real-world performance efforts (n = 3). We recommend further research into buffering agents in highly trained female athletes that control or account for the MC, studies that replicate the demands of athletes’ heat and altitude camps, and investigations of highly trained athletes’ use of combined buffering agents. In a practical context, we recommend developing evidence-based buffering protocols for individual athletes which feature co-supplementation with other evidence-based products, reduce the likelihood of side-effects, and optimise key moderating factors: supplement dose and timing, and exercise duration and intensity

Notes of a Meeting Held in the Diplomatic Reception Room of the Department of State on Monday, March 20, 1911

The document is a carbon transcript of notes from a meeting held in the State Department respecting the necessity of more such meetings, the present organization of the Department, expenditures, and esprit de corps. Present at the meeting were: The Assistant Secretaries, the Solicitor, the Director of the Consular Service, the Chief Clerk and the Chiefs and Assistant Chiefs of the Divisions and Bureaus of the Department.https://digitalcommons.ursinus.edu/fmhw_speeches/1004/thumbnail.jp

Getting shot of elves: healing, witchcraft and fairies in the Scottish witchcraft trials

This paper re-examines the evidence of the Scottish witchcraft trials for beliefs associated by scholars with "elf-shot." Some supposed evidence for elf-shot is dismissed, but other material illuminates the interplay between illness, healing and fairy-lore in early modern Scotland, and the relationship of these beliefs to witchcraft itself

Astrophysical evidence for the existence of black holes

Following a short account of the history of the idea of black holes, we present a review of the current status of the search for observational evidence of their existence aimed at an audience of relativists rather than astronomers or astrophysicists. We focus on two different regimes: that of stellar-mass black holes and that of black holes with the masses of galactic nuclei.Comment: 23 pages, 3 figures, TeX forma