Stroke outcome in clinical trial patients deriving from different countries

<p><b>Background and Purpose:</b> Stroke incidence and outcome vary widely within and across geographical locations. We examined whether differences in index stroke severity, stroke risk factors, mortality, and stroke outcome across geographical locations remain after adjusting for case mix.</p> <p><b>Methods:</b> We analyzed 3284 patients from the Virtual International Stroke Trials Archive (VISTA). We used logistic regression to examine the incidence of mild index stroke, functional, and neurological outcomes after accounting for age, medical history, year of trial recruitment, and initial stroke severity in the functional and neurological outcome analyses. We examined mortality between geographical regions using a Cox proportional hazards model, accounting for age, initial stroke severity, medical history, and year of trial recruitment.</p> <p><b>Results</b> Patients enrolled in the USA and Canada had the most severe index strokes. Those recruited in Austria and Switzerland had the best functional and neurological outcomes at 90 days (P<0.05), whereas those enrolled in Germany had the worst functional outcome at 90 days (P=0.013). Patients enrolled in Austria, Switzerland, Belgium, Netherlands, Finland, Germany, Greece, Israel, Spain, and Portugal had a significantly better survival rate when compared with those enrolled in USA and Canada. Patients enrolled in trials after 1998 had more severe index strokes, with no significant difference in outcome compared with those enrolled before 1998.</p> <p><b>Conclusion:</b> We identified regional variations in index stroke severity, outcome, and mortality for patients enrolled in ischemic stroke clinical trials over the past 13 years that were not fully explained by case mix. Index stroke severity was greater in patients enrolled after 1998, with no significant improvement in outcomes compared to those enrolled before 1998.</p&gt

The Virtual International Stroke Trials Archive

BACKGROUND AND PURPOSE: Stroke has global importance and it causes an increasing amount of human suffering and economic burden, but its management is far from optimal. The unsuccessful outcome of several research programs highlights the need for reliable data on which to plan future clinical trials. The Virtual International Stroke Trials Archive aims to aid the planning of clinical trials by collating and providing access to a rich resource of patient data to perform exploratory analyses. METHODS: Data were contributed by the principal investigators of numerous trials from the past 16 years. These data have been centrally collated and are available for anonymized analysis and hypothesis testing. RESULTS: Currently, the Virtual International Stroke Trials Archive contains 21 trials. There are data on \u3e15,000 patients with both ischemic and hemorrhagic stroke. Ages range between 18 and 103 years, with a mean age of 69+/-12 years. Outcome measures include the Barthel Index, Scandinavian Stroke Scale, National Institutes of Health Stroke Scale, Orgogozo Scale, and modified Rankin Scale. Medical history and onset-to-treatment time are readily available, and computed tomography lesion data are available for selected trials. CONCLUSIONS: This resource has the potential to influence clinical trial design and implementation through data analyses that inform planning

The evolution of language: a comparative review

For many years the evolution of language has been seen as a disreputable topic, mired in fanciful "just so stories" about language origins. However, in the last decade a new synthesis of modern linguistics, cognitive neuroscience and neo-Darwinian evolutionary theory has begun to make important contributions to our understanding of the biology and evolution of language. I review some of this recent progress, focusing on the value of the comparative method, which uses data from animal species to draw inferences about language evolution. Discussing speech first, I show how data concerning a wide variety of species, from monkeys to birds, can increase our understanding of the anatomical and neural mechanisms underlying human spoken language, and how bird and whale song provide insights into the ultimate evolutionary function of language. I discuss the ‘‘descended larynx’ ’ of humans, a peculiar adaptation for speech that has received much attention in the past, which despite earlier claims is not uniquely human. Then I will turn to the neural mechanisms underlying spoken language, pointing out the difficulties animals apparently experience in perceiving hierarchical structure in sounds, and stressing the importance of vocal imitation in the evolution of a spoken language. Turning to ultimate function, I suggest that communication among kin (especially between parents and offspring) played a crucial but neglected role in driving language evolution. Finally, I briefly discuss phylogeny, discussing hypotheses that offer plausible routes to human language from a non-linguistic chimp-like ancestor. I conclude that comparative data from living animals will be key to developing a richer, more interdisciplinary understanding of our most distinctively human trait: language

Water relations and photosynthesis as criteria for adequate irrigation management in 'Tahiti' lime trees

Irrigation scheduling based on soil moisture status is one of the most useful methods because of its practicality and low cost. The effects of available soil water depletion on evapotranspiration (ETc), transpiration (E), leaf water potential at predawn (psiP) and midday (psiM), stomatal conductance (gs) and net CO2 assimilation (A) in lime 'Tahiti' trees (Citrus latifolia) were evaluated to improve irrigation schedule and minimize water use without causing water stress. The trees were spaced 7 <FONT FACE=Symbol>&acute;</FONT> 4 m and drip-irrigated by four drippers with the available soil water content (AWC) depleted by suspension of irrigation (40 days). Leaf water potential was measured on a pressure chamber (psiP and psiM) and leaf gas exchange was measured by infrared gas analyzer (E, gs and A). Evapotranspiration was determined with the aid of weighing lysimeter. Water soil content and potential (psiS) were monitored with TDR probes and tensiometers, respectively, installed at 0.3, 0.6 and 0.9 m depths. Meteorological variables were monitored with an automatic weather station in the experimental area. The threshold AWC level for the onset of ETc decline was 43%, and 60% for gs, A, E and Y P. Also, psiP was more sensitive to AWC than psiM, and is therefore a better tool for irrigation. When AWC was around 60%, values of psiP and psis were -0.62 MPa and -48.8 kPa, respectively

Resolving Underconstrained and Overconstrained Systems of Conjunctive Constraints for Service Requests

Abstract. Given a service request such as scheduling an appointment or purchasing a product, it is possible that the invocation of the service results in too many solutions that all satisfy the constraints of the request or in no solution that satisfies all the constraints. When the invocation results in too many solutions or no solution, a resolution process becomes necessary for agreeing on one of the solutions or finding some agreeable resolution. We address this problem by imposing an ordering over all solutions and over all near solutions. This ordering provides a way to select the best-m with dominated solutions or dominated near solutions eliminated. Further, we provide an expectation-based resolution process that can take the initiative and either elicit additional constraints or suggest which constraints should be relaxed. Experiments with our prototype implementation show that this resolution process correlates substantially with human behavior and thus can be effective in helping users reach an acceptable resolution for their service requests