Impact of a multidisciplinary group on management of patent foramen ovale in cryptogenic stroke and outcome measures: A retrospective study

Patent foramen ovale (PFO) is a common cardiac abnormality present in roughly 25% of the adult population. Although typically benign, patients with a PFO account for 50% of the population of cryptogenic stroke, an ischemic stroke with an unknown cause. Guidelines suggest closure in patients with a cryptogenic stroke found to have a PFO; however, it is unclear whether medical treatment should be given to all patients, regardless of PFO closure, and data is limited on the treatment outcomes. This retrospective chart analysis of 80 patients with a cryptogenic stroke found to have a PFO will investigate the criteria a multidisciplinary team used to determine whether patients should undergo PFO closure, receive medical therapy, or receive both. Additionally, it will investigate stroke recurrence, the percentage of patients with postprocedural complications, and the percentage of patients where the cause of the stroke was determined later. There is currently limited data on treatment outcomes and stroke recurrence in this cohort of patients, so this study will provide valuable knowledge that will help clinicians make more informed decisions on how to treat patients with cryptogenic stroke found to have a PFO

Measuring chronic stress exposure incorporating the active and healthy ageing (AHA) concept within the cross-sectional Bern cohort study 2014 (BeCS-14).

The aim of the study was to represent chronic stress exposure by a complex generic Active and Healthy (AHA) diagnostic assessment tool incorporating ICF. This is a single-centre, cross-sectional, observational, non-interventional, non-randomized trial in University based women's hospital, division of Gynecological Endocrinology and Reproductive Medicine. All participants followed a standardized, holistic battery of biopsychosocial assessments consisting of bio-functional status (BFS), bio-functional age (BFA) and the questionnaire for chronic stress exposure (TICS). 624 non-pediatric, non-geriatric subjects were recruited in the BeCS-14 cohort. The mean difference between chronological age and BFA was 7.8 ± 8.0 year equivalents. The mean stress level score assessed by SSCS was 13.2 with 45.4% being exposed to above average stress intensity. 22 BFS items (14 objective, 7 subjective) significantly correlated with chronic stress exposure (TICS-SSCS). The constructed sum score composed of SOC_L9 and complaint questionnaire (physical and emotional wellbeing) represented chronic stress exposure best (pearson-correlation value 0.564, p < 0.0001). Higher chronic stress exposure was associated with bio-functional pro-aging (less vitality) in both sexes. In conclusion, chronic stress is accepted as a major risk factor for developing non-communicable diseases (NCD). Our ICF compatible, complex, generic BFS/BFA assessment tool reflects chronic stress exposure and may be applied in various health care settings, e.g., in health promotion and prevention of NCDs

Challenges of a "Toolbox" Approach to Investigative Interviewing:A Critical Analysis of the RCMP's Phased Interview Model

The Royal Canadian Mounted Police implemented the Phased Interview Model in Canada and has argued that it is a novel and productive way to interview suspects. We applaud the Royal Canadian Mounted Police for moving away from a purely accusatorial approach and recognize that Phased Interview Model contains several science-based practices. In this article, however, we evaluate the Phased Interview Model critically. In particular, we present compelling empirical evidence that three fundamental practices (minimizing culpability, mischaracterizing evidence, and asking leading questions) in the Phased Interview Model put the truth-seeking function of police interviews at risk. We also explore the challenges inherent in combining accusatorial and information gathering techniques into a hybrid ‘toolbox’ approach. We conclude that advocating for interview protocols that contain dangerous or untested practices may hinder the Royal Canadian Mounted Police’s ability to achieve their purported goals of obtaining voluntary statements and accurate information

Deformation Dynamics of Nanopores upon Water Imbibition

Capillarity-driven transport in nanoporous solids is ubiquitous in nature and is of increasing importance for the functionality of modern liquid-infused engineering materials. During imbibition, highly curved menisci are driven by negative Laplace pressures of several hundred atmospheres, exerting an enormous contractile load on an increasing portion of the porous matrix. Due to the challenge of simultaneously monitoring imbibition and deformation with high spatial resolution, the resulting coupling of solid elasticity to liquid capillarity has remained largely unexplored. Here, we study water imbibition in mesoporous silica using optical imaging, gravimetry, and high-resolution dilatometry. In contrast to an expected Laplace pressure-induced contraction, we find a square-root-of-time expansion and an additional abrupt length increase when the menisci reach the top surface. The final expansion is absent when we stop the imbibition front inside the porous medium in a dynamic imbibition-evaporation equilibrium, as is typical for water transport and transpiration in plants. These peculiar deformation behaviors are validated by single-nanopore molecular dynamics simulations and described by a continuum model that highlights the importance of expansive surface stresses at the pore walls (Bangham effect) and the buildup or release of contractile Laplace pressures as nanoscale menisci collectively advance, arrest, or disappear. Our model predicts that these observations are valid not only for water imbibition in silica, but for any imbibition process in nanopores, regardless of the liquid/solid combination. This also suggests that simple deformation measurements can be used to quantify surface stresses and Laplace pressures or transport in a wide variety of natural and artificial porous media.Comment: 11 pages, 4 figures. Supplementary information and 3 movies are stored as ancillary file

Nuclear medium effects on the Kˉ∗\bar K^* meson

The $\bar K^*$ meson in dense matter is analyzed by means of a unitary approach in coupled channels based on the local hidden gauge formalism. The $\bar K^*$ self-energy and the corresponding $\bar K^*$ spectral function in the nuclear medium are obtained. We observe that the $\bar K^*$ develops a width in matter up to five times bigger than in free space. We also estimate the transparency ratio of the $\gamma A \to K^+ K^{*-} A^\prime$ reaction. This ratio is an excellent tool to detect experimentally modifications of the $\bar K^*$ meson in dense matter.Comment: 11 pages, 5 figures, contribution based on the invited talk at ECT* Workshop "Strange Hadronic Matter", September 26-30, 201

Archaeological Investigations within San Pedro Springs Park (41BX19), San Antonio, Bexar County, Texas

The University of Texas at San Antonio Center for Archaeological Research (UTSA-CAR) contracted with Adams Environmental, Inc. to provide archaeological services to Capital Improvement Management (CIMS) of the City of San Antonio (COSA) related to the archaeological investigation of selected areas of San Pedro Springs Park in San Antonio, Bexar County, Texas. The CAR conducted archaeological testing at this National Register Site, 41BX19, from early December 2013 to mid-January of 2014. The goals of archaeological investigations were to identify and investigate any proto-historic and historic archaeological deposits associated with Colonial Period occupants of the area, including evidence of the first acequia and associated dam, and the location of the first presidio and villa. In addition, CAR was tasked with the investigation of any prehistoric cultural deposits encountered. This project was performed by staff archaeologists from the CAR. It was conducted under Texas Antiquities Permit No. 6727, with Dr. Steve Tomka serving as Principal Investigator (PI), and Kristi Nichols and Stephen Smith serving as Project Archaeologists. Dr. Tomka departed from UTSA shortly after the completion of fieldwork. At that time, Dr. Raymond Mauldin of CAR assumed PI responsibilities for the project. One hundred and eleven shovel tests, eleven 1-x-1 m test units, two 50-x-50 cm units, two backhoe trenches, and several auger holes were excavated during this effort. Minimal artifactual evidence of colonial occupants was noted during the archaeological investigations. Several Native American bone tempered sherds that could reflect either Late Prehistoric Leon Plain or Goliad ware were recovered. However, no Spanish Majolicas or lead glazed wares were uncovered, and no gunflints were identified in the lithic assemblage. Due to various utility lines and other obstructions, backhoe trenches to search for the acequia and associated dam could not be excavated. It is likely that areas proposed for investigation of the acequia and associated dam have been disturbed by aforementioned utility lines as well as earlier construction within the park. No evidence of the specific location of the first presidio or villa was located. Shovel testing and test units revealed the presence of historic and prehistoric use of the park, though mixing of historic and prehistoric material, as well as other disturbances (e.g., rodents), was common in the deposits. However, there was an increase in prehistoric material with depth as revealed in shovel testing results. Shovel testing located Feature 1, a burned rock feature that possibly was associated with a sheet midden, as well as several areas with high densities of prehistoric materials. Test excavations, based on these shovel tests, suggest that Feature 1 is a discrete feature that lies below a widespread, low-density distribution of burned rock. Shovel testing also identified a high-density cluster of lithic, bone, and burned rock. The excavation of a 1-x-1 m test unit (TU 4) in this area produced over 4,000 pieces of debitage, with over 50% of this total coming from three levels. Burned rock, a variety of tools, faunal material, and charcoal were present throughout these levels. Temporal placement of deposits relied on artifact typologies (e.g., ceramic types, lithic projectile points, lithic tool types) as well as two charcoal and four bone collagen radiocarbon dates. Artifact typologies suggest occupation as early as the Early Archaic as reflected by a possible Guadalupe tool. A series of Late Archaic Points (Castroville, Frio, Marcos, and Montell) and Late Prehistoric point forms (Edwards, Perdiz, and Scallorn) are present from several areas. In addition, a possible Middle Archaic La Jita point was recovered. The bone tempered Native American wares could date as early as AD 1250, though they could also reflect proto-historic or colonial age materials. Other ceramics primarily suggest a mid-nineteenth- to midtwentieth-century occupation. Using the midpoints of the 1-sigma distribution, calibrated radiocarbon dates show use of San Pedro Park from as early as 100 AD (CAR 345; 1905 +/- 22 Radiocarbon Years Before Present [RCYBP]) to as recently as the early twentieth century. The more recent end of that range is a function of two late dates from two different areas of the park. The first of these is on a bison bone (CAR 344) that returned a date of 158 +/- 23 RCYBP. The second is on a bone consistent with a bison-sized animal (CAR 346) that produced a date of 155 +/- 23 RCYBP. The corrected, calibrated dates for these two samples range from AD 1670 to the early 1940s using the 1-sigma spread. The wide range of these dates is related to the flat calibration curve late in time. However, the most probable date range (ca. 36% probability) for these two dates is between AD 1729 and 1779, with a roughly 48% probability that they date prior to AD 1779. Limited testing suggests that, with a few specific exceptions, the upper 30-40 cm of San Pedro Park is extensively disturbed. However, though some disturbances are present, at least three areas have materials in what appears to be good context. These include material dating to the Late Archaic, Late Prehistoric, and possibly the Proto-historic or Colonial Period. Based on historic maps, previous work, and the current investigation, CAR proposes a series of management areas for San Pedro Park. If work in these management areas follows these suggestions for various limits on subsurface impacts, CAR recommends that. renovation activities within the park be allowed to proceed. The Texas Historical Commission (THC), in a letter dated February 4, 2015, agreed with these recommendations. Finally, CAR provides several recommendations for public education facilities within the park. In accordance with the THC Permit specifications and the Scope of Work for this project, all field notes, analytical notes, photographs, and other project related documents, along with a copy of the final report, will be curated at the CAR. After quantification and completion of analysis, and in consultation with THC and the COSA Office of Historic Preservation, artifacts possessing little scientific value were discarded pursuant to Chapter 26.27(g)(2) of the Antiquities Code of Texas. Artifact classes discarded specific to this project included samples of burned rock and snail shell, all unidentifiable metal, soil samples, and recent (post-1950) material

Screening for brain aneurysm in the Familial Intracranial Aneurysm study: frequency and predictors of lesion detection

Object Approximately 20% of patients with an intracranial saccular aneurysm report a family history of intracranial aneurysm (IA) or subarachnoid hemorrhage. A better understanding of predictors of aneurysm detection in familial IA may allow more targeted aneurysm screening strategies. Methods The Familial Intracranial Aneurysm (FIA) study is a multicenter study, in which the primary objective is to define the susceptibility genes related to the formation of IA. First-degree relatives (FDRs) of those affected with IA are offered screening with magnetic resonance (MR) angiography if they were previously unaffected, are ≥ 30 years of age, and have a history of smoking and/or hypertension. Independent predictors of aneurysm detection on MR angiography were determined using the generalized estimating equation version of logistic regression. Results Among the first 303 patients screened with MR angiography, 58 (19.1%) had at least 1 IA, including 24% of women and 11.7% of men. Ten (17.2%) of 58 affected patients had multiple aneurysms. Independent predictors of aneurysm detection included female sex (odds ratio [OR] 2.46, p = 0.001), pack-years of cigarette smoking (OR 3.24 for 20 pack-years of cigarette smoking compared with never having smoked, p < 0.001), and duration of hypertension (OR 1.26 comparing those with 10 years of hypertension to those with no hypertension, p = 0.006). Conclusions In the FIA study, among the affected patients’ FDRs who are > 30 years of age, those who are women or who have a history of smoking or hypertension are at increased risk of suffering an IA and should be strongly considered for screening

Cost-efficiency assessments of marine monitoring methods lack rigor : a systematic mapping of literature and an end-user view on optimal cost-efficiency analysis

Global deterioration of marine ecosystems, together with increasing pressure to use them, has created a demand for new, more efficient and cost-efficient monitoring tools that enable assessing changes in the status of marine ecosystems. However, demonstrating the cost-efficiency of a monitoring method is not straightforward as there are no generally applicable guidelines. Our study provides a systematic literature mapping of methods and criteria that have been proposed or used since the year 2000 to evaluate the cost-efficiency of marine monitoring methods. We aimed to investigate these methods but discovered that examples of actual cost-efficiency assessments in literature were rare, contradicting the prevalent use of the term “cost-efficiency.” We identified five different ways to compare the cost-efficiency of a marine monitoring method: (1) the cost–benefit ratio, (2) comparative studies based on an experiment, (3) comparative studies based on a literature review, (4) comparisons with other methods based on literature, and (5) subjective comparisons with other methods based on experience or intuition. Because of the observed high frequency of insufficient cost–benefit assessments, we strongly advise that more attention is paid to the coverage of both cost and efficiency parameters when evaluating the actual cost-efficiency of novel methods. Our results emphasize the need to improve the reliability and comparability of cost-efficiency assessments. We provide guidelines for future initiatives to develop a cost-efficiency assessment framework and suggestions for more unified cost-efficiency criteria

Situating dissemination and implementation sciences within and across the translational research spectrum

The efficient and effective movement of research into practice is acknowledged as crucial to improving population health and assuring return on investment in healthcare research. The National Center for Advancing Translational Science which sponsors Clinical and Translational Science Awards (CTSA) recognizes that dissemination and implementation (D&I) sciences have matured over the last 15 years and are central to its goals to shift academic health institutions to better align with this reality. In 2016, the CTSA Collaboration and Engagement Domain Task Force chartered a D&I Science Workgroup to explore the role of D&I sciences across the translational research spectrum. This special communication discusses the conceptual distinctions and purposes of dissemination, implementation, and translational sciences. We propose an integrated framework and provide real-world examples for articulating the role of D&I sciences within and across all of the translational research spectrum. The framework\u27s major proposition is that it situates D&I sciences as targeted sub-sciences of translational science to be used by CTSAs, and others, to identify and investigate coherent strategies for more routinely and proactively accelerating research translation. The framework highlights the importance of D&I thought leaders in extending D&I principles to all research stages