Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice

Background: The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy.Methods: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics.Results: In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0-79.5%) and a specificity of 84.9% (95%-CI: 82.6-87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4-26.5%); specificity, 100% (95%-CI: 100-100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1-78.0%) and a specificity of 83.5% (95%-CI: 81.0-86.0%).Conclusions: State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.</p

Robust Automatic Steering Control for Look-down Reference Systems with Front and Rear Sensors

This paper describes a robust control design for automatic steering of passenger cars. Previous studies [1--3] showed that reliable automatic driving at highway speed may not be achieved under practical conditions with look-down reference systems which use only one sensor at the front bumper to measure the lateral displacement of the vehicle from the lane reference. An additional lateral displacement sensor is added here at the tail bumper to solve the automatic steering control problem. The control design is performed stepwise: First, an initial controller is determined using the parameter space approach in an invariance plane. This controller is then refined to accommodate practical constraints and finally optimized using the multi-objective optimization program MOPS. The performance and robustness of the final controller was verified experimentally at California Path in a series of test runs. Keywords: Automotive, Robust Control, Automatic Steering I. Introduction Automatic ste..

Robust automatic steering control for look-down reference systems with front and rear sensors

This paper describes a robust control design for automatic steering of passenger cars. Previous studies [l-3] showed that' reliable automatic driving at highway speed may not be achieved under practical conditions with look-down reference systems which use only one sensor at the front bumper to measure the lateral displacement of the vehicle from the lane reference. An additional lateral displacement. sensor is added here at the tail bumper to solve the automatic steering control problem. The control design is performed stepwise: First, an initial controller is determined using the parameter space approach in an invariance plane. This controller is then refined to accommodate practical constraints and finally optimized using the multi-objective optimization program MOPS. The performance and robustness of the final controller was verified experimentally at California PATH in a series of test runs

Robust Control Design For Automatic Steering Based On Feedback Of Front And Tail Lateral Displacement

This paper describes a robust control design for automatic steering of passenger cars. Previous studies [1, 2] showed that reliable automatic driving at highway speed may not be achieved under practical conditions with look-down reference systems which use only one sensor at the front bumper to measure the lateral displacement of the vehicle from the lane reference. An additional lateral displacement sensor is added here at the tail bumper to overcome this problem. The control design is performed stepwise: First, an initial controller is determined using the parameter space approach in an invariance plane. This controller is then refined to accomodate practical constraints. The performance and robustness of the final controller was verified experimentally at California Path. 1 Introduction Automatic steering control is a vital component of highway automation, currently investigated worldwide in several programs, e.g. ITS America (see e.g. [3]) and ITS Japan [4]. Previous approaches ca..

Longitudinal associations between adolescent catch-up sleep, white-matter maturation and internalizing problems

International audienceSleep is an important contributor for neural maturation and emotion regulation during adolescence, with long-term effects on a range of white matter tracts implicated in affective processing in at-risk populations. We investigated the effects of adolescent sleep patterns on longitudinal changes in white matter development and whether this is related to the emergence of emotional (internalizing) problems. Sleep patterns and internalizing problems were assessed using self-report questionnaires in adolescents recruited in the general population followed up from age 14-19 years (N = 111 White matter structure was measured using diffusion tensor imaging (DTI) and estimated using fractional anisotropy (FA). We found that longitudinal increases in time in bed (TIB) on weekends and increases in TIB-variability between weekdays to weekend, were associated with an increase in FA in various interhemispheric and cortico-striatal tracts. Extracted FA values from left superior longitudinal fasciculus mediated the relationship between increases in TIB on weekends and a decrease in internalizing problems. These results imply that while insufficient sleep might have potentially harmful effects on long-term white matter development and internalizing problems, longer sleep duration on weekends (catch-up sleep) might be a natural counteractive and protective strategy

Whole-brain gray matter maturation trajectories associated with autistic traits from adolescence to early adulthood

International audienceAbstract A growing number of evidence supports a continued distribution of autistic traits in the general population. However, brain maturation trajectories of autistic traits as well as the influence of sex on these trajectories remain largely unknown. We investigated the association of autistic traits in the general population, with longitudinal gray matter (GM) maturation trajectories during the critical period of adolescence. We assessed 709 community-based adolescents (54.7% women) at age 14 and 22. After testing the effect of sex, we used whole-brain voxel-based morphometry to measure longitudinal GM volumes changes associated with autistic traits measured by the Social Responsiveness Scale (SRS) total and sub-scores. In women, we observed that the SRS was associated with slower GM volume decrease globally and in the left parahippocampus and middle temporal gyrus. The social communication sub-score correlated with slower GM volume decrease in the left parahippocampal, superior temporal gyrus, and pallidum; and the social cognition sub-score correlated with slower GM volume decrease in the left middle temporal gyrus, the right ventromedial prefrontal and orbitofrontal cortex. No longitudinal association was found in men. Autistic traits in young women were found to be associated with specific brain trajectories in regions of the social brain and the reward circuit known to be involved in Autism Spectrum Disorder. These findings support both the hypothesis of an earlier GM maturation associated with autistic traits in adolescence and of protective mechanisms in women. They advocate for further studies on brain trajectories associated with autistic traits in women

Anxiety onset in adolescents: a machine-learning prediction

International audienceAbstract Recent longitudinal studies in youth have reported MRI correlates of prospective anxiety symptoms during adolescence, a vulnerable period for the onset of anxiety disorders. However, their predictive value has not been established. Individual prediction through machine-learning algorithms might help bridge the gap to clinical relevance. A voting classifier with Random Forest, Support Vector Machine and Logistic Regression algorithms was used to evaluate the predictive pertinence of gray matter volumes of interest and psychometric scores in the detection of prospective clinical anxiety. Participants with clinical anxiety at age 18–23 ( N = 156) were investigated at age 14 along with healthy controls ( N = 424). Shapley values were extracted for in-depth interpretation of feature importance. Prospective prediction of pooled anxiety disorders relied mostly on psychometric features and achieved moderate performance (area under the receiver operating curve = 0.68), while generalized anxiety disorder (GAD) prediction achieved similar performance. MRI regional volumes did not improve the prediction performance of prospective pooled anxiety disorders with respect to psychometric features alone, but they improved the prediction performance of GAD, with the caudate and pallidum volumes being among the most contributing features. To conclude, in non-anxious 14 year old adolescents, future clinical anxiety onset 4–8 years later could be individually predicted. Psychometric features such as neuroticism, hopelessness and emotional symptoms were the main contributors to pooled anxiety disorders prediction. Neuroanatomical data, such as caudate and pallidum volume, proved valuable for GAD and should be included in prospective clinical anxiety prediction in adolescents