Time spent at home poststroke: “home-time” a meaningful and robust outcome measure for stroke trials

<p><b>Background and Purpose:</b> Stroke outcome assessment requires some measure of functional recovery. Several instruments are in common use but all have recognized limitations. We examined duration of stay in the patient’s own home over the first 90 days since stroke—"home-time"—as an alternative outcome likely to show graded response with improved reliability.</p> <p><b>Methods:</b> We examined prospectively collected data from the GAIN International trial using analysis of variance with Bonferroni contrasts of adjacent modified Rankin scale score categories.</p> <p><b>Results:</b> We had full outcome data from 1717 of 1788 patients. Increasing home-time was associated with improved modified Rankin scale scores (P<0.0001). The relationship held across all modified Rankin scale grades except 4 to 5.</p> <p><b>Conclusions:</b> Home-time offers a robust, useful, and easily validated outcome measure for stroke, particularly across better recovery levels.</p&gt

Allopurinol use yields potentially beneficial effects on inflammatory indices in those with recent ischemic stroke: a randomized, double-blind, placebo-controlled trial

<p><b>Background and Purpose</b>: Elevated serum uric acid level is associated with poor outcome and increased risk of recurrent events after stroke. The xanthine oxidase inhibitor allopurinol lowers uric acid but also attenuates expression of inflammatory adhesion molecules in murine models, reduces oxidative stress in the vasculature, and improves endothelial function. We sought to investigate whether allopurinol alters expression of inflammatory markers after acute ischemic stroke.</p> <p><b>Methods</b>: We performed a randomized, double-blind, placebo-controlled trial to investigate the safety, tolerability, and effect of 6 weeks’ treatment with high- (300 mg once a day) or low- (100 mg once a day) dose allopurinol on levels of uric acid and circulating inflammatory markers after ischemic stroke.</p> <p><b>Results</b>: We enrolled 50 patients with acute ischemic stroke (17, 17, and 16 in the high, low, and placebo groups, respectively). Mean (±SD) age was 70 (±13) years. Groups had similar characteristics at baseline. There were no serious adverse events. Uric acid levels were significantly reduced at both 7 days and 6 weeks in the high-dose group (by 0.14 mmol/L at 6 weeks, P=0.002). Intercellular adhesion molecule-1 concentration (ng/mL) rose by 51.2 in the placebo group, rose slightly (by 10.6) in the low-dose allopurinol group, but fell in the high-dose group (by 2.6; difference between groups P=0.012, Kruskal-Wallis test).</p> <p><b>Conclusion</b>: Allopurinol treatment is well tolerated and attenuates the rise in intercellular adhesion molecule-1 levels seen after stroke. Uric acid levels were lowered with high doses. These findings support further evaluation of allopurinol as a preventive measure after stroke.</p&gt

Concrete pavements as a source of heating and cooling

There is great potential to use the large open space of pavement structures, equipped with an embedded pipe network, in conjunction with a heat pump, to provide heating and cooling for adjacent buildings, e.g. airport terminals, shopping centres etc, here termed a Pavement Source Heat Pump (PSHP). Due to the high thermal mass of pavement materials, seasonal temperature fluctuation under the pavement is much less than the temperature fluctuation of ambient air. Therefore, pavements can be utilised as a low grade heat source during winter and as a heat sink during summer. Airports, for example, provide a key potential application as they are very large consumers of energy, typically have very high cooling demands, have a large amount of adjacent pavement area, and are of a similar arrangement throughout the world. In this paper, the temperature distribution into pavements with different thermo-physical properties was modelled in order to evaluate their effects on depth of seasonal temperature fluctuation. The results show that there is a linear relationship between the thermal diffusivity and depth of seasonal temperature fluctuation and it decreases in relation to the thermal diffusivity of the pavement

Deriving modified rankin scores from medical records

<p><b>Background and Purpose:</b> Modified Rankin score (mRS) is traditionally graded using a face-to-face or telephone interview. Certain stroke assessment scales can be derived from a review of a patient’s case-record alone. We hypothesized that mRS could be successfully derived from the narrative within patient case-records.</p> <p><b>Methods:</b> Sequential patients attending our cerebrovascular outpatient clinic were included. Two independent, blinded clinicians, trained in mRS, assessed case-records to derive mRS. They scored “certainty” of their grading on a 5-point Likert scale. Agreement between derived and traditional face-to-face mRS was calculated using attribute agreement analysis.</p> <p><b>Results:</b> Fifty patients with a range of disabilities were included. Case-record appraisers were poor at deriving mRS (k=0.34 against standard). Derived mRS grades showed poor agreement between observers (k=0.33). There was no relationship between certainty of derived mRS and proportion of correct grades (P=0.727).</p> <p><b>Conclusion:</b> Accurate mRS cannot be derived from standard hospital records. Direct mRS interview is still required for clinical trials.</p&gt

Association between disability measures and healthcare costs after initial treatment for acute stroke

<p><b>Background and Purpose:</b> The distribution of 3-month modified Rankin scale (mRS) scores has been used as an outcome measure in acute stroke trials. We hypothesized that hospitalization and institutional care home stays within the first 90 days after stroke should be closely related to 90-day mRS, that each higher mRS category will reflect incremental cost, and that resource use may be less clearly linked to the National Institutes of Health Stroke Scale (NIHSS) or Barthel index.</p> <p><b>Methods:</b> We examined resource use data from the GAIN International trial comparing 90-day mRS with total length of stay in hospital or other institutions during the first 90 days. We repeated analyses using NIHSS and Barthel index scores. Relationships were examined by analysis of variance (ANOVA) with Bonferroni contrasts of adjacent score categories. Estimated costs were based on published Scottish figures.</p> <p><b>Results:</b> We had full data from 1717 patients. Length of stay was strongly associated with final mRS (P<0.0001). Each mRS increment from 0 to 1–2 to 3–4 was significant (mean length of stay: 17, 25, 44, 58, 79 days; P<0.0005). Ninety-five percent confidence limits for estimated costs (£) rose incrementally: 2493 to 3412, 3369 to 4479, 5784 to 7008, 7300 to 8512, 10 095 to 11 141, 11 772 to 13 560, and 2623 to 3321 for mRS 0 to 5 and dead, respectively. Weaker relationships existed with Barthel and NIHSS.</p> <p><b>Conclusions:</b> Each mRS category reflects different average length of hospital and institutional stay. Associated costs are meaningfully different across the full range of mRS outcomes. Analysis of the full distribution of mRS scores is appropriate for interpretation of treatment effects after acute stroke and more informative than Barthel or NIHSS end points.</p&gt

The environmental context of the Neolithic monuments on the Brodgar Isthmus, Mainland, Orkney

This work was funded in part by Historic Environment Scotland.The World Heritage Sites of Orkney, Scotland contain iconic examples of Neolithic monumentality that have provided significant information about this period of British prehistory. However, currently, a complete understanding of the sites remains to be achieved. This is, in part, because the monuments lack an adequate context within the broader palaeolandscape. Recent investigations (seismic geophysical survey, microfossil analysis and 14C dating) in and around the Brodgar Isthmus, both onshore and offshore, are used to reconstruct the landscapes at a time when sea-level, climate and vegetation were different to that experienced today. Results show that in the early Neolithic the isthmus between the Ring of Brodgar and Stones of Stenness was broader with a smaller loch to the west. Furthermore this landscape contained sandstone outcrops that would have provided a potential source of stone for monument construction. Microfossil analysis and radiocarbon dates demonstrate that the Loch of Stenness was transformed from freshwater to brackish during the early Neolithic, perhaps immediately preceding construction of the major monuments. Finally, the analysis of our data suggests that sediment influx to the loch shows a tenfold increase coincident with widespread vegetation change that straddles the Mesolithic/Neolithic transition at c. 8 ka cal. B.P. These results provide, for the first time, a landscape context for the Neolithic sites on the isthmus.PostprintPeer reviewe

Dense circumnuclear molecular gas in starburst galaxies

We present results from a study of the dense circumnuclear molecular gas of starburst galaxies. The study aims to investigate the interplay between starbursts, active galactic nuclei and molecular gas.We characterize the dense gas traced by HCN, HCO and HNC and examine its kinematics in the circumnuclear regions of nine starburst galaxies observed with the Australia Telescope Compact Array. We detect HCN (1-0) and HCO (1-0) in seven of the nine galaxies and HNC (1-0) in four. Approximately 7 arcsec resolution maps of the circumnuclear molecular gas are presented. The velocity-integrated intensity ratios, HCO (1-0)/HCN (1-0) and HNC (1-0)/HCN (1-0), are calculated. Using these integrated intensity ratios and spatial intensity ratio maps, we identify photon-dominated regions (PDRs) in NGC 1097, NGC 1365 and NGC 1808. We find no galaxy which shows the PDR signature in only one part of the observed nuclear region.We also observe unusually strong HNC emission in NGC 5236, but it is not strong enough to be consistent with X-ray-dominated region chemistry. Rotation curves are derived for five of the galaxies and dynamical mass estimates of the inner regions of three of the galaxies are made. © 2016 The Authors.This project was supported by the Brother Vincent Cotter Award for Physics (UNSW). LVM has been supported by Grant AYA2011-30491-C02-01 co-financed by MICINN and FEDER funds, and the Junta de Andalucia (Spain) grants P08-FQM-4205 and TIC-114. WAB acknowledges the support as a Visiting Professor of the Chinese Academy of Sciences (KJZD-EW-T01). The research leading to these results has received funding from the European Community's Seventh Framework Programme (/FP7/2007-2013/) under grant agreement No 229517.Peer Reviewe

Relativistic nuclear structure effects in quasielastic neutrino scattering

Charged-current cross sections are calculated for quasielastic neutrino and antineutrino scattering using a relativistic meson-nucleon model. We examine how nuclear-structure effects, such as relativistic random-phase-approximation (RPA) corrections and momentum-dependent nucleon self-energies, influence the extraction of the axial form factor of the nucleon. RPA corrections are important only at low-momentum transfers. In contrast, the momentum dependence of the relativistic self-energies changes appreciably the value of the axial-mass parameter, $M_A$, extracted from dipole fits to the axial form factor. Using Brookhaven's experimental neutrino spectrum we estimate the sensitivity of M$_A$ to various relativistic nuclear-structure effects.Comment: 26 pages, revtex, 6 postscript figures (available upon request