Influence of age on outcome from thrombolysis in acute stroke: a controlled comparison in patients from the Virtual International Stroke Trials Archive (VISTA)

<p><b>Background and Purpose:</b> Thrombolysis for acute ischemic stroke in patients aged >80 years is not approved in some countries due to limited trial data in the very elderly. We compared outcomes between thrombolysed and nonthrombolysed (control) patients from neuroprotection trials to assess any influence of age on response.</p> <p><b>Method:</b>Among patients with ischemic stroke of known age, pretreatment severity (baseline National Institutes of Health Scale Score), and 90-day outcome (modified Rankin Scale score; National Institutes of Health Scale score), we compared the distribution of modified Rankin score in thrombolysed patients with control subjects by Cochran-Mantel-Haenszel test and then logistic regression after adjustment for age and baseline National Institutes of Health Scale score. We examined patients ≤80 and ≥ 81 years separately and then each age decile.</p> <p><b>Results:</b> Rankin data were available for 5817 patients, 1585 thrombolysed and 4232 control subjects; 20.5% were aged >80 years (mean ± SD, 85.1 ± 3.4 years). Baseline severity was higher among thrombolysed than control subjects (median National Institutes of Health Scale score 14 versus 13, P<0.05). The distribution of modified Rankin Scale scores was better among thrombolysed patients (P<0.0001; OR, 1.39; 95% CI, 1.26 to 1.54). The association occurred independently with similar magnitude among young (P<0.0001; OR, 1.42; 95% CI, 1.26 to 1.59) and elderly (P=0.002; OR, 1.34; 95% CI, 1.05 to 1.70) patients. ORs were consistent across all age deciles >30 years; outcomes assessed by National Institutes of Health Scale score gave supporting significant findings, and dichotomized modified Rankin Scale score outcomes were also consistent.</p> <p><b>Conclusions:</b> Outcome after thrombolysis for acute ischemic stroke was significantly better than in control subjects. Despite the expected poorer outcomes among elderly compared with young patients that is independent of any treatment effect, the association between thrombolysis treatment and improved outcome is maintained in the very elderly. Age alone should not be a barrier to treatment.</p&gt

Some Features of the Fort Dodge Gypsum

During the prosecution of field study of the gypsum for the Iowa Geological Survey the writer found immediately beneath the gypsum in several places a basal conglomerate which has not heretofore been described in reports on the region. The locality where this conglomerate is best developed is in a ravine on the west side of Des Moines River opposite Two Mile creek about three miles south of Fort Dodge. The Fort Dodge, Des Moines and Southern railway extends along this ravine and has exposed the conglomerate in some of its cuttings

The Clarinda Oil Prospect

Work has been prosecuted on an oil prospect about six miles south of Clarinda since November of 1928. A part of the record of strata is given in volume XXXIII of the reports of the Iowa Geological Survey. Since the publication of that report the well has been deepened somewhat. A description of the strata penetrated will be given and comparison will be made with the new well at Greenfield to the north and with the oil prospect at Nebraska City to the west

Some Fundamental Concepts of Earth History

We have been accustomed to think, most of us, that in the early days of the world\u27s geologic history Nature manifested herself in forms different from those with which we are familiar; that God, the supreme Power of the universe, employed other types of energy than those by means of which He works today. And these conceptions have been fostered and influenced very largely, consciously or unconsciously, by our religions and theological training

The History of Boyer Valley

One of the largest streams of the Missouri slope in Iowa, and one of much importance in its influence on topography is Boyer River. This streams takes its rise in the Kansan uplands south of Storm Lake, flows a little east of south across Sac county past the town of Wall Lake where it turns abruptly southwest. In this direction it crosses Crawford County, which it divides into practically equal parts. In its course across Crawford county Boyer valley is of the normal mature type but in southern Sac there opens into the valley from the northeast a broad sag which extends southwestward from Wall Lake. Digitate alluvial plains also extend several miles up the valley of the Boyer above the mouth of this sag and up the valleys of two tributaries from the eastern flank of the high ridge east of Odebolt. The flat undrained sag, although it is two or three times as wide as Boyer valley at Herring or Boyer, is nevertheless a direct continuation of it. On the other hand the present course of Boyer River north of the sag is out of line and out of harmony with the valley below

The Pleistocene of Capitol Hill

The Pleistocene exposures on Capitol Hill at Des Moines have become classic through the studies made by McGee and Call which demonstrated the presence of glacial drift overlying loess. The results of these studies were published in the American Journal of Science, Volume 24, 1882, pp. 202-223

Experiences of teaching UML within the information systems curriculum

The Unified Modelling Language (UML) has been a standard modelling language for the development of software intensive systems since 2000. As a consequence, the information systems (IS) curriculum, at the Cavendish School of Computer Science, University of Westminster in London, had UML teaching incorporated two years ago. We have encouraged the introduction to and use of UML in modules that replaced traditional approaches to IS development. In this paper we report on experiences of using UML within the two modules of our undergraduate curriculum, delivered by the IS department. The first module is taught in the second year, i.e. at level 5, and delivers requirements analysis with UML. The second module uses the UML for modelling and designing distributed business applications and is taught in the final year, at level 6. In both modules it is assumed that an introduction to modelling in IS, with the syntax and semantics of a selection of UML modelling elements and diagrams, has been done earlier. We single out some problems and give a rationale for changes in the next academic yea