Decrease Arrival to CT Time to Improve Stroke Outcomes

Abstract Final The specific goal of the project is to decrease the arrival to t-PA treatment times to \u3c45 minutes in \u3e 50% of the cases. The decreased treatment time will prove to shorten the average length of stay on average by two days (Audebert & Sobesky, 2014). The goal will be accomplished by decreasing the arrival to computerized tomography (CT) scan completion time by at least 20%. The specific population of patients will be all stroke alert arrivals to the process’s microsystem via EMS, an Advanced Primary Stroke Center in Sacramento California. Root Cause Analysis, Strength, Weakness, Opportunity, Threat (SWOT), and Plan, Do, Study, Act (PDSA) are several of the tools used to identify and implement the project. The data six months after process implementation showed a decrease in arrival to CT completion time of 42.9%, well below the target decrease of 20%. The door to needle (DTN) times experienced an overall average decrease of 32.1 % and met the AHA/ASA Target Stroke Phase II goal of 50% of t-PA cases treated \u3c 45 minutes. Finally, patients who received t-PA after process initiation experienced a 2.5 decrease in length of stay when compared to the previous year. This represents a 58.3% decrease in LOS compared to the goal of 50%. These results are very encouraging that the process is having a positive effect on the target patient population. References Audebert, H. J., & Sobesky, J. (2014, October 21st). . ’Time is brain’ after stroke, regardless of age and severity, 10, 675-676. http://dx.doi.org/10.1038.nrnerol.2014.19

Current State of Strain in the Central Cascadia Margin Derived from Changes in Distance between GPS Stations

Using continuously operating Global Positioning Stations in the Pacific Northwest of the United States, over 100 station-station baseline length changes were determined along seven West-East transects, two North-South transects and in three localized areas to determine both the average annual strains over the past several years, and the variation in strain over the central Cascadia convergent margin. The North-South transects (composed of multiple baselines) show shortening. Along West-East transects some baselines show shortening and others extension. The direction of the principle strains calculated for two areas 100 km from the deformation front are close to per-pendicular to the deformation front. The North-South strains are 10?8 a?1, which is an order-of-magnitude less than the West-East strains (10?7 a?1). Along several West-East transects, the magnitude of the strain increases away from the deformation front. All West-East transects showed a change in strain 250 km inland from deformation front

Late Holocene Tsunami Deposits at Salt Creek, Washington, USA

We interpret two thin sand layers in the estuarine marsh at Salt Creek, on the southern shore of the Strait of Juan de Fuca, as the products of tsunamis propagated by earthquakes at the Cascadia subduction zone. The sand layers extend for about 60 m along the left bank of the creek about 800 m from the mouth, and can be traced to the base of a nearby upland area. One layer is exposed in the creek bank about 400 m further upstream, but they are only patchily distributed in the rest of the central area of the marsh. Both layers contain brackish-marine epipsammic diatoms. The lower sand layer marks a sharp contact between intertidal peaty mud and overlying mud, perhaps reflecting modest coseismic subsidence in association with tsunami deposition, but little or no change in the bracketing sediment occurs in association with the upper sand layer. The ages of the sand layers are not closely constrained, but were most likely deposited by tsunamis generated by great earthquakes at the Cascadia subduction zone about 1650 and 1300 years ago. The Cascadia great earthquake of AD1700 may have induced slight subsidence in the marsh, but no tsunami deposit was detected at the inferred contact. The absence of deposits from the marsh immediately inland of the 4 m-high barrier beach indicates that the largest tsunamis in the late Holocene at this site have not overtopped the barrier, which suggests that these tsunamis were likely only 2-3 m high

Method and system for enabling real-time speckle processing using hardware platforms

An accelerator for the speckle atmospheric compensation algorithm may enable real-time speckle processing of video feeds that may enable the speckle algorithm to be applied in numerous real-time applications. The accelerator may be implemented in various forms, including hardware, software, and/or machine-readable media

Characterizing Prenatal Maternal Distress with Unique Prenatal Cortisol Trajectories

Objective: It is widely assumed that glucocorticoids represent a primary mechanism through which exposure to adversity and maternal psychological distress shape prenatal developmental trajectories of both mother and fetus. However, despite repeated investigations and the fact that prenatal cortisol has been reliably linked to developmental outcomes, the empirical evidence supporting an association between prenatal cortisol and maternal distress is scarce. In this study, a novel approach to assessing links between maternal prenatal psychological distress and gestational cortisol profiles, general growth mixture modeling (GGMM), was applied. Method: Measures of pregnancy anxiety, perceived stress, and state anxiety and depressive symptoms as well as plasma samples (for determination of cortisol) were collected from 250 women 4 times during pregnancy. Results: Using GGMM, 3 cortisol trajectory groups were identified, including a typical group (n = 199) that exhibited the expected steady increase in cortisol throughout gestation, a steep group (n = 31) displaying an accelerated increase in cortisol over the course of pregnancy relative to the typical group, and a flat group (n = 20) with relatively higher cortisol levels early in pregnancy that plateaued in midgestation. Women reporting the highest distress scores exhibited trajectories expected to be associated with the least optimal developmental outcomes (flatter trajectories characterized by relatively higher levels early in gestation and lower levels late in gestation). Conclusions: These findings suggest that psychological distress during pregnancy is associated with unique prenatal cortisol profiles and support further examination of this link, to enable continued evaluation of a plausible biological pathway by which maternal psychological distress programs fetal development

Information and communication technology to link criminal justice reentrants to HIV care in the community

The United States has the world’s highest prison population, and an estimated one in seven HIV-positive persons in the USA passes through a correctional facility annually. Given this, it is critical to develop innovative and effective approaches to support HIV treatment and retention in care among HIV-positive individuals involved in the criminal justice (CJ) system. Information and communication technologies (ICTs), including mobile health (mHealth) interventions, may offer one component of a successful strategy for linkage/retention in care. We describe CARE+ Corrections, a randomized controlled trial (RCT) study now underway in Washington, that will evaluate the combined effect of computerized motivational interview counseling and postrelease short message service (SMS) text message reminders to increase antiretroviral therapy (ART) adherence and linkage and retention in care among HIV-infected persons involved in the criminal justice system. In this report, we describe the development of this ICT/mHealth intervention, outline the study procedures used to evaluate this intervention, and summarize the implications for the mHealth knowledge base

Maternal Prenatal Cortisol Programs the Infant Hypothalamic–Pituitary–Adrenal Axis

One of the key proposed agents of fetal programming is exposure to maternal glucocorticoids. Experimental animal studies provide evidence that prenatal exposure to elevated maternal glucocorticoids has consequences for hypothalamic–pituitary–adrenal (HPA) axis functioning in the offspring. There are very few direct tests of maternal glucocorticoids, such as cortisol, during human pregnancy and associations with infant cortisol reactivity. The current study examined the link between maternal prenatal cortisol trajectories and infant cortisol reactivity to the pain of inoculation in a sample of 152 mother-infant (47.4% girls) pairs. The results from the current study provide insight into fetal programming of the infant HPA axis, demonstrating that elevated prenatal maternal cortisol is associated with a larger infant cortisol response to challenge at both 6 and 12 months of age